Getting paid to be screened?

Cécile Bour, MD, February 13, 2021

That is the question asked in the JIM[1] of February 13 by a citizen, a participant in the INCA[2] citizen consultation organized to ” put an end to cancers”.

This woman gives here her opinion on an item proposed by the INCa which seemed to her to be particularly unethical.
She is an agri-food engineer with a PhD in Life and Health Sciences. 
She speaks jointly with two other scientists, Dr. Theodore Bartholomew, a physician at the Royal Surrey County Public Hospital in Great Britain and holder of a Master’s degree in Bioethics, and Dr. Harald Schmidt, Assistant Professor at the Department of Medical Ethics and Health Policy and Research Associate at the Center for Health Incentives and Behavioral Economics, at the University of Pennsylvania, in the United States.

We have already expressed our concern about this citizen consultation supposed to support the next ten-year cancer plan, through two articles [3] [4] published at the time of its launch where we denounced the collusion with pharmaceutical industry and very low citizen participation despite the dithyrambic presentation of the INCa communicators.

Not only citizens have been able to vote just for fallaciously formulated items (see our articles), without prior information on the ins and outs of certain proposed measures, but the participation rate is in no way representative of the French population (2478 effective participants for 3. 8 million people affected by cancer in France, and 47 million French citizens registered on the electoral rolls…), thus denying the “adequacy” that would exist between “the objectives and measures presented and the expectations of our fellow citizens” proclaimed by the INCa communicators.

And we were already astonished by this item[5] in particular, which also retained attention of the three authors in the JIM :

Experimenting with material incentives to facilitate people’s participation in screening :

Incentive mechanisms such as financial motivation or payment of expenses (transportation, childcare, work), which have been very little used to date, will be experimented with in order to evaluate their contribution to the development of participation in the program.

Adherence to screening programs or procedures also requires the mobilization of professionals, whether in the carrying out of the act or in the informing and raising awareness on screening, otherwise by incentivizing.

This is not without recalling similar measures already in place in the United States, where many private health insurance companies incentivize women to perform screening mammograms by offering compensation in various forms.

What do the authors denounce in the article?

This French citizen and the two co-authors denounce together the cynicism of this financial incentive measure proposed by the INCa, which ignores the demands of the true citizen consultation [6] dedicated to breast cancer screening and organized in 2016, that called, in addition to the cessation of this screening, for better information given to women on the benefit-risk balance of this breast cancer screening (“Taking into consideration the controversy in the information provided to women and in the information and training of professionals”).

This is the point made by the three authors, who recall that the issue at stake is to inform women about the risk-benefit balance of screening, in particular the risks of overdiagnosis, in order to enable them to make a better choice, one that is optimal for each of them: “The risk of these incentives is that the decision-making process is short-circuited, that women make decisions they will regret and that they would not have made in the absence of incentives”.

The authors point out the unethical nature of this item: “… the choice of screening should be made by properly informed women and not by their physicians, nor by health insurers, public health policy makers or other actors. This initiative should not be promoted, but rather ensuring that women have access to truly useful information on the advantages and disadvantages of screening. Rather, we advocate encouraging active and informed choice by encouraging women to use evidence-based decision support tools”.

At the beginning of the article, the authors recall the Cochrane Collaboration review[7] and the risk of overdiagnosis inherent in this screening, which should be known by each woman before engaging in screening. And they ask a very logical question:  “Instead of trying at all costs to strengthen screening as foreseen in the new ten-year cancer plan, why not mobilise more resources for equal access for all women to informative materials and documents on the risk-benefit balance of this screening, to enable them to make a conscious decision on whether or not to participate in mammography screening”?

 Citizen’s demands heard? Is informing the population a concern of the new plan?

No, not at all.

The proposed measure on financial incentives for women to increase their participation is further proof that the National Cancer Institute is doing just what it wants to do, promoting the pursuit of its obsolete objectives, formulating the items in such a way that citizens can only approve due to lack of explanation, and burying the demands of the citizens of 2016 in anti-democratic brutality.

We also noticed that in the small group of 24 people who concocted these items of the consultation, we find the representative of the drug companies (LEEM) Mr. Eric Baseilhac, director of economic affairs.

The sad consequence of all this is formulated in the new European cancer plan, published shortly after this “citizens’ consultation” supposedly based on citizens’ opinions but in advance elaborated a long time ago, and which proclaims the intensification of screening:

« …ensuring that 90% of the EU population who qualify for breast, cervical and colorectal cancer screenings are offered screening by 2025. To support achieving this, a new EU-supported Cancer Screening Scheme will be put forward ».

The pharmaceutical and medical imaging industry can rub their hands :

« In addition, to support new technologies, research and innovation, a new Knowledge Centre on Cancer will be launched to help coordinate scientific and technical cancer-related initiatives at EU level. A European Cancer Imaging Initiative will be set up to support the development of new computer-aided tools to improve personalised medicine and innovative solutions »

Everything continues as planned, all is going well in the best of all worlds.









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