That a group of researchers has come out with new recommendations for disease screening is not surprising. It's what researchers do. The unfortunate result, however, has been the transformation of the recommendations into a political tool.

Controversy erupted within a couple of days after the U.S. Preventive Services Task Force suggested that routine mammograms are not necessary in women older than 40 but can be safely delayed until after age 50. It's the beginning of health care rationing, screamed opponents of the health care reform bills now in Congress.

There are two parts to this debate, one disturbing and one legitimate.

The disturbing part is the fear-mongering about rationing as if the alternative were unlimited care. Treatments are already limited. Medicare, Medicaid, insurance companies or family budgets all impose restrictions on how much can be done with the resources at hand. What is unfortunate about this debate is that it is pulling the doctor-patient conversation into the political arena where it does not belong.

All the yelling on Capitol Hill failed to capture the nuances of the task force recommendations. While recommending biennial mammograms for women ages 50 to 74, recommending against teaching breast self-examinations, and recommending against mammograms for those 40 to 49, the task force also said the mammogram decision for this latter group should be made individually and should include consideration of the patient's values and feelings about benefits and harms.

What was captured in news stories was the disagreement among various expert groups. The task force is part of the federal Agency for Healthcare Research and Quality, which assembles standards for evidence-based medicine, and it consists of 16 people. There are three people with doctorates in nursing or public health, and the rest are physicians with interests in areas such as pediatrics, family medicine and health policy. Both the American Cancer Society and the American College of Obstetrician and Gynecologists continue to recommend mammograms for women in their 40s. All this is as it should be. Anyone who watches biomedical research knows that recommendations see-saw as the available evidence changes.

The legitimate point for public discussion is cost, and not a phony choice between rationing or paying for everything, which would be fiscally irresponsible as well as unrealistic. The idea of mammography is that it's simple and relatively cheap so that it can be widely used to catch disease in its early stages. Yet money is never unlimited so there must be a limit somewhere, and it's up to expert groups to figure out where that limit should be. We don't, for example, screen every woman for breast cancer after age 20 even though we would catch a rare case of the disease.

Our discussion, therefore, should not focus on stoking fears about rationing, but on how much rationing we should have and where it should be. Catching problems when they're small is easier on patients, and in the long run is cheaper. It would be better if Congress devoted its time to discussing how to balance the system of health care payments to emphasize preventive care.