Skip mammograms, quit breast self-exams, and maybe lighten up on 'defensive medicine' while we're at it

All those mammograms, self-exams and dutiful attention to catching breast cancer at the very first sign? Forget it. Might even do more harm than good.

As summarized by Associated Press writers Stephanie Nano and Marilynn Machione late Monday,
Most women don’t need a mammogram in their 40s and should get one every two years starting at 50, a government task forcesaid Monday. It’s a major reversal that conflicts with the American Cancer Society‘s long-standing position.

Also, the task force said breast self-exams do no good and women shouldn’t be taught to do them.

For most of the past two decades, the cancer society has been recommending annual mammograms beginning at 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women’s odds of survival.

“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chair of the panel.

The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies.

But Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group, said insurance coverage isn’t likely to change because of the new guidelines. No changes are planned in Medicare coverage either, said Dori Salcido, spokeswoman for the Health and Human Services department.

Maybe, just maybe, a clearer look at breast cancer screening could be accompanied by a good look at a little of the other possibly unnecessary and extraordinarily pricey “defensive medicine” going on around the country. What a fine way that would be to hold down costs and save a lot of time and angst. In another recent article (November 5) published in the San Francisco Chronicle, Associated Press reporter Steve LeBlanc wrote of how the costs of “defensive medicine,” along with malpractice insurance and lawsuit awards, are adding significantly to the soaring costs of health care.

LeBlanc illustrates the issue with a story that rings sadly true:

Dr. James Wang says he tries to tell his patients when medical procedures aren’t necessary. If they insist, though, he will do it – not so much to protect their health as his own practice.

After being sued for allegedly failing to diagnose a case of appendicitis, Wang says he turned to what’s known as “defensive medicine,” ordering extra tests, scans, consultations and even hospitalization to protect against malpractice suits.

“You are thinking about what can I do to prevent this from happening again,” he said, adding that he did nothing wrong but agreed to a minor settlement to avoid a trial.

We have, LeBlanc explains, doctors battling malpractice premiums and lawyers saying malpractice suits discourage bad medicine — meanwhile, the costs of it all add up to some ten percent of health care expenditures.

We the public, healthy and sickly alike, are caught in the middle. Could we not somehow declare a truce? We’ll quit rushing to sue, lawyers back off from chasing ambulances, doctors go about the business of practicing medicine according to patient need rather than fear of consequences. Seems like a good idea to me, but I’m not holding my breath.

I’m also not having any more mammograms any time soon.

New advice: Skip mammograms in 40s, start at 50 – Yahoo! News.

Identity Theft: Crime without Punishment

Caitlin Kelly posted a raw but fascinating essay earlier today, My Con Man Wasn’t Madoff, but Just as Ruthless and Deceptive, that took me back to another cautionary tale worth sharing.

My son, who flies for a major U.S. airline, came home from a trip a few years back, got off the plane and called his then-fiancee (she married him soon, happily for all concerned.) “I’m at the park with a picnic,” she said; “come on out.” It was a beautiful summer afternoon. Changing into casual clothes, he drove straight to the park and found her at the designated spot, where they shared a lovely, leisurely time.

Things were not lovely when he returned to his car. It had been broken into, in broad daylight on a well-traveled street. The thief had made off with his pilot’s uniform and airline ID, his daybook, checkbook, wallet, computer, ID — his life. Plus the financial life of a family he’d been advising with a church group, also on his computer hard drive.

After reporting the crime to the police, my son began the arduous task of rebuilding his life: canceling credit cards, changing passwords, you may know the drill. Within a very short time he discovered that the thief — who had to look somewhat like his white, male, 30-something target since he was using photo ID all over the place — had left a paper trail any incompetent novice detective could follow. Problem is, nobody wanted to bother.

Why? Banks were unconcerned with those few several-hundred-dollar checks; they covered the losses. Retailers said insurance would cover the illicit purchases; they cared not one whit about losses that ran into the thousands. The police had other fish to fry, and explained with a galling indifference that even if they hauled the guy into court he’d probably get off, or quickly out of jail.

The thief eventually quit cashing checks with my son’s name inexpertly forged, and the credit cards soon lost their usefulness — so presumably he went on to another victim. But who picks up the tab for all this? You and I, Mr. and Ms. John Q. Public, thanks to those losses being passed directly along through jacked-up prices and hidden or not-so-hidden fees.

It is hard, when you’re the victim and know you could easily find the victimizer, to accept the fact that justice will not be done. Especially when a huge chunk of your life has gone to replacing and rebuilding that life. But just as Caitlin found with her con man, crimes that loom large to many of us simply go unpunished. So we swallow hard, lock our doors and learn not to leave everything in the car.

We are enjoying seeing Bernie Madoff’s stuff auctioned off while he sits in prison; he’s paying for a few of the fish that were too little to fry. But it doesn’t seem quite enough.

Doctors oppose abortion cuts in health bill

The San Francisco Medical Society has come out in opposition to removal of abortion coverage in the health reform bill, pointing out the potential danger to women’s lives if they are denied access to such care. Charles Wibbelsman, MD, President of SFMS, writes in today’s San Francisco Chronicle that the board of directors will urge congressional representatives to find a compromise.

It is a shame that such a complex issue as health care reform has been hijacked in the form of the Stupak amendment, which would ban all public funding for abortion (“Amendment to House bill reignites abortion debate,” Nov. 10).

Experience has shown that denying coverage of abortion does not stop or even curtail it, but rather shifts the costs elsewhere, and threatens to delay a woman in seeking and obtaining this medical procedure, thus potentially endangering her.

The San Francisco Medical Society’s board of directors has voted to urge our elected officials, particularly Sens. Dianne Feinstein and Barbara Boxer, to find a compromise that will not ban such funding and keep women with unwanted pregnancies safe.

Women’s lives should not be held hostage to politics.

At last, a ray of sanity from the medical community. I, for one, am proud of SFMS for standing up for the uncounted thousands of women, most of them poor and disadvantaged, who will suffer harm from denial of access to care should the conservatives and the U.S. Conference of Catholic Bishops win the day on this matter.

via Stupak amendment hijacks health care reform.

Thinking about the Bush think tank

Why am I not encouraged by reports of the official launch of the George W. Bush Institute on the campus of Southern Methodist University? According to Dallas Morning News reporter Lori Stahl,

Former President George W. Bush will make his first scheduled Dallas appearance at SMU today when he and wife Laura unveil plans for the Bush Institute before an audience of 1,500 people at McFarlin Auditorium.

The Institute has been described by foundation officials as a scholarly forum that will conduct research and promote dialogue on four core principles identified by the Bushes.

These core principles, reports the San Francisco Chronicle, include education, global health, human freedom and economic growth. Hmm.

My father Earl Moreland, who grew up to be, among other things, president of Randolph-Macon College in Ashland, VA for 28 years, died in 1987 without voting for either of his fellow Texans. He was in the first class ever to enter what would become SMU, and one of my fond memories is of accompanying him to Dallas for his 60th reunion.  I believe it is safe to say he would not be proud to have a Bush think tank on the campus of his alma mater.

For my part, I am just stumbling over those “core principles,” and their connection to our former president. Education? Global health? Embodied by someone who condemned millions throughout Africa and beyond to sickness and death through his ill-advised policies? Economic growth? Hello? Times are surely tough today, ten months into Barack Obama’s presidency, but did he create this mess or inherit it?

Some of my favorite people voted for George W. Bush. All of them are, in my humble opinion, smarter than he is. One of them did graduate work at SMU years ago, but does not support placement of the Institute on campus.

During our trip to Dallas for his reunion (the school opened in 1915, you can do the math) my father remarked that he would come back for his 65th if there were anyone around to reune with. Turned out he never made that return visit. If he were here today I’m not sure he would be making plans for his 100th.

My father had a favorite response to all things he considered outrageous (often applied to his daughters) which sounded like “Poosharisha!” It was from his second language (which I sadly never learned), adopted during a 12-year period in Brazil at the Instituto Porto Alegre. Long after he died I learned it was a Portugese expression that  translates, roughly, “That is beyond anything within the natural order of the universe.”

Somewhere in the ethernet I hear my father contemplating the coming of the George W. Bush think tank, and clearly also hear his voice. Poosharisha.


George W. Bush to unveil Bush Institute programs today at SMU | News for Dallas, Texas | Dallas Morning News | Latest News.

Fear (and the high cost) of falling

My husband was face down on the floor of the breakfast room, stretched below the table with one hand resting beside a chair he had pushed into the corner. As I came up from the garage, returning from a long opera just before midnight, he called out, hoping to spare me from alarm or a heart attack of my own. This is the sort of scene that tends to cause alarm at any age. According to an article in last Sunday’s New York Times, a similar scene occurs with alarming frequency: more than one-third of people ages 65 or older fall each year, writes Steve Lohr in an “Unboxed” feature, “Watch the Walk and Prevent a Fall.”

In our recent case, all was soon well. My husband had lost his balance while setting dinner on our not-too-sturdy table, and more or less slid to the floor. Still recovering from spinal fusion surgery 8 months earlier, he had done everything possible not to break anything — old bones or new rods and bolts that is; he wasn’t worried about the china — as he went down. But once down, getting back up was not an easy assingment. You know those awful “I’ve fallen, and I can’t get up” ads? Believe them. He tried shoving a chair into the corner to gain traction, but soon realized there was not enough strength in his lower legs to do the job, and decided just to wait. (Some people do carry cell phones… but that’s another story.) At 6’3″ and over 200 pounds, Bud outweighs me approximately two to one, so my getting him up was, we already knew, not an option. Happily we have a neighbor who seldom goes to bed early. Once he came over and the three of us strategized a while we were able to set my husband upright again. More specifically, John and Bud accomplished the deed; I supervised. Bud was tired and hungry, but otherwise fine.

Most of the falling elderly are not so lucky. About one fall in 10 results in serious injury such as a hip fracture, according to the Times story. Some 20 percent of older adult victims of hip fractures die within a year. If that weren’t enough to get one’s attention, reporter Lohr writes that “the estimated economic cost of falls ranges widely, up to $75 billion a year in the United States, if fall-related home care and assisted living costs are added to medical expenses.”

The last time I fractured my ankle, which I tend to do with dismaying frequency, I grumbled to a friend about “that dumb accident.” There are no smart accidents, she replied. (I was running late, and carrying a very large empty computer box down the stairs.) And this is a good thing to keep in mind. Somewhere not far past the age of 50 (I throw that in for all those weekend soccer-playing dads) bone breakage gets easier and healing begins to take longer. Somewhere a little farther along in the aging process, falling takes over from dumb accidents as #1 cause.

“Watch the Walk and Prevent a Fall” focuses on early research, backed by the National Institute on Aging, into the relationship between activity patterns and falls. “Fall prevention also promises to be part of an emerging — and potentially large — worldwide industry  of helping older people live independently in their homes longer,” Lohr writes. New technologies such as sensors that track behavioral and activity patterns will play growing roles in fall prevention, along with customized exercise programs and close attention to the role of medications.

Considering the risks and the cost, fall prevention may fast claim serious attention. But for now, especially if you’re over 65: get up slowly, watch your balance, and be careful setting your dinner plate down on a wobbly table.

Housing, homelessness & other inequities

Today’s Sonoma County (CA) Press Democrat features a front page story about Joe Montana’s digs near Calistoga, available for $49 er–million. It is right above a photo of homeless vet Jack Saltzman reading in his hatchback, the juxtaposition of photos hard not to notice.

Others vets don’t have hatchbacks. Press Democrat feature writer Jeremy Hay reports that according to the Department of Veterans Affairs, approximately 400, or 12%, of Sonoma’s 35,000 vets are homeless, which fellow homeless vet Don Bridges says is “just the tip of it.” Some 131,000 of the nation’s 24 million veterans are homeless on any given day.

Hay details some of the measures being undertaken to alleviate the problem, including $3.2 billion recently pledged by the V.A. to be spent over the next five years toward getting veterans off the street and keeping them from falling into homelessness. But returning vets have been part of another world most of us only see in the extreme abstract and can’t possibly comprehend; fitting right back into mainstream America can be harder than anywhere they have served, where at least, another vet explains, “you’ve been part of your tribe.” More vets will return, and more will wind up on the streets.

None of this is the Montanas fault.

Another Press Democrat front page story, a New York Times article by Andrew Martin and Lowell Bergman, mentions a 91-year-old Florida woman who got a letter from Citibank last month advising her that her new credit card interest rate was 29.99 percent, up 10 points from the previous rate. Haven’t we been reading about Citibank lately?

These bits of information are being digested by those of us who elected Mr. Obama and now feel sad and frustrated because our expectations were, perhaps, too high. Some of us are wondering why he ever wanted the job in the first place.

We don’t have an answer to homelessness. We may not make an offer on the Montana estate — even though, with a Tuscan-style mansion, equestrian center, full-sized basketball court, gym, pool, etc, etc it is probably worth that matching 49er price — because with 20% down and a 30-year 6% fixed rate mortgage the monthly payments of $235,023 would be a stretch. And we are not planning any credit revolt, despite the fact that it is the responsible credit users who are being penalized by the likes of Citibank. What we are doing is just trying to comprehend the surreal nature of today’s news as covered on one front page.

And keep the faith.

Abortion, health reform and me: who is making our choices?

Am I the only person around who is squirming — make that fuming a little — over the concessions made to the anti-choice guys before the House passed its health reform bill? Does no one else find it offensive to turn from reading on page one of today’s New York Times about this sad state of events to page 14 for a large photo of President Obama shaking hands with Cardinal Sean O’Malley? They were meeting at the funeral for Senator Ted Kennedy in August, where reportedly the good clergyman told the president that the Congress of Catholic Bishops really wanted to support health reform ——– oh, but only if everybody caved to their wishes that abortion remain unavailable.

It is not as if we weren’t forewarned. I posted a brief note in this space a few days ago (see Abortion Foes Winning Health Concessions, 11/4, below) and tried to resume a position of calm.

It is hard to remain calm. Somewhere the lines about separation of church and state have to fuzz themselves back into reality. I believe in the right of the U.S. Congress of Catholic Bishops to tell Catholics how to behave (despite the fact that of my many Catholic friends I know almost none who pay any attention in matters of personal choice.) I even believe in the right of the Pope to tell the Bishops to tell their parishioners how to behave. I even believe in the responsibility of all individuals, including my Presbyterian self, to behave according to their conscience and their faith. I just hate being governed by someone else’s faith.

This is not a small distinction. My own church, admittedly starting with a small group here in woo-woo San Francisco, passed a fairly strong national resolution denouncing our country’s torturing folks and seeking justice. As far as I know, no one threatened the president about withholding support for these occasionally immoral wars we keep fighting unless the instigators of torture-in-our-name were sent to jail. However strongly I would like to see the latter happen, I believe there are limits to what faith communities should do.

I had personal experience with back-alley abortion, in the dark days pre-Roe v Wade. It was not pleasant. Is there any way a celibate Catholic bishop could even remotely understand the horrors to which he is condemning poor, desperate pregnant women with the relentless push to make abortion totally unavailable? No. I wish there were.

We still have got to have health reform. But what prices we are paying.

Abortion foes winning health concessions

Anti-abortion forces, sensing victory in the health bill, are happily using their clout. They will undoubtedly win big. David M. Herszenhorn and David D. Kirkpatrick report in the New York Times that staunch anti-abortion Representative Brad Ellsworth (D-IN) is likely to get what he wants, which means other leading opponents of a woman’s right to choose, including a few elected representatives and the U.S. Congress of Catholic Bishops, will also get what they want.

Struggling to finish their big health care legislation, House Democratic leaders signaled Tuesday that they were prepared to make several changes to the bill to satisfy abortion opponents, including many Democrats, who had threatened to block it.

The opponents are insisting that tax dollars not pay for health insurance that would cover abortion. That is a tricky proposition given that the health care bill would provide hundreds of billions in federal subsidies to help moderate-income Americans buy health insurance, mostly from private carriers.

But Democratic leaders have little choice but to make some concessions. As many as 40 Democrats have said they might oppose the health care bill without tighter restrictions on abortion – a potentially decisive number.

So okay. We desperately need health reform, and such concessions apparently have to be made.

I just wonder if any of these guys know anything about what it was like in the days before Roe v Wade, which is the scenario to which they wish to see us return.

And I find it interesting that they, who seek to exercise so much control over what a woman may do with her body, are mostly men.

Democrats Near Deal on Abortion Coverage – Prescriptions Blog – NYTimes.com.

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