Thursday, November 19, 2009
Rethink pink: breast cancer screening evidence met politics and lost
The controversy started at exactly 5 p.m. Monday, when the Annals of Internal Medicine lifted its embargo on new breast cancer screening recommendations and the rest of the medical community simultaneously released opposing positions. With lines drawn and positions taken, a furor began ultimately pitted evidence-based medicine against political machinations. So far, medicine has lost. 
The recommendations, issued by the U.S. Preventive Services Task Force, suggest that asymptomatic individuals with no family history or other risk factors could wait before starting mammograms and undergo screening every two years instead of annually. They balanced the benefits of less frequent screening against the harms of more frequent screening by reviewing the evidence and creating models.
The recommendations have since been on the pages of every newspaper in America, from the smallest locals to the biggest dailies. The American College of Physicians is tracking "impressions," as they're called, in the millions.
There's always a downside to new knowledge, and it's playing out in week following the announcement. It will take time for physicians to digest the new recommendations. It will take time to explain them to patients. In the meantime, public discourse has been messy.
Experts have told women to talk to their doctors about how evidence-based recommendations apply to individual circumstances. But other medical societies are sticking to their guns on annual screenings at earlier ages, and it's unsettling for patients to see doctors disagree and even more unsettling when shouting matches erupt on television.
But neither the government nor insurers are rushing out to make dramatic changes to existing practice of medicine. To calm fears, HHS Secretary Kathleen Sebelius clarified that the doctors who drafted the recommendations, the U.S. Preventive Services Task Force, comprise an independent body of experts who review evidence but don't set policy. To calm fears, she stated that women should still go to their doctors to discuss their individual needs. Insurers aren't going to change their policies, either.
In short, the recommendations inform the talks between doctors and patients. They give physicians something to consider during the informed consent process. Consider the words of family physician David Baron, MD, who said, "I respect [USPSTF] a great deal. They've got no horse in the race. They are independent experts." Take it from practicing physician Jan Gurley, MD, who summarized in plain language how recommendations should impact encounters between physicians and patients.
This is in contrast to internist and TV commentator Elizabeth Lee Vliet, MD, who went on the attack about a "distant and impersonal 'review of data' from published studies." In an op-ed shopped around to media outlets, she further ranted that, "I am profoundly concerned that government 'experts,' far removed from the daily care of patients, are sitting 'on high' to proclaim that women don't need to start mammograms at age 40."
And of course, Dr. Vliet decried it as a cost cutting measure and as the start of "government-mandated, guideline-based rationing of health care." Those are her poorly chosen words. But she's not alone.
U.S. Rep. Marsha Blackburn of Tennessee bemoaned that, "This is where you start getting a bureaucrat between you and your physician." Rep. Michele Bachmann of Minnesota joined the misinformation brigade, starting her press conference on the task force recommendations by blaming President Obama and Speaker of the House Nancy Pelosi. Watch for yourself.
Hijacking evidence-based recommendations to further partisan debate is a semantic trick. And it's a disgrace.
Labels: cancer, evidence-based medicine, guidelines, health care reform, health policy, patient communication, patient education, women's health
posted by Ryan DuBosar at
12:15 PM
2 Comments
Tuesday, September 15, 2009
Everything is out to get you.
It seems to be one of those days when the health media is focused on all the ways everyday life can kill you. Hope you're reading this blog from a hypoallergenic bunker. Just a quick survey reveals: Chlorinated pools can give your kids allergies or asthma. Air pollution raises blood pressure. And your showerhead may be harboring dangerous bacteria.
But don't get depressed about all this, or that could hasten your death from cancer. There is some positive news in the other direction, however. A new study found that metformin, a diabetes drug that thousands of Americans are already taking, can lower the risk of cancer. At least if you're a mouse.
Labels: cancer, Medical news
posted by Stacey Butterfield at
10:00 AM
0 Comments
Friday, August 7, 2009
Violent video game aids teens with cancer
Plenty of video games reward players with extra lives for good performance. This one rewards good performance with extra life.
A violent video game is being congratulated for helping teens with cancer. It replaces the traditional shooter with a robot and aliens and bad guys with cancer cells. The robot destroys the cells, simulating how cancer treatments affect the body and also explaining medical terms.
The game can be downloaded for free. The best part is its name: Re-Mission.
Labels: cancer, patient education
posted by Ryan DuBosar at
3:20 PM
1 Comments
Friday, June 12, 2009
Good news (which we still don't believe)
There is still no convincing evidence that mobile phones cause brain cancer, according to a new review published in Emerging Health Threats Journal. But the authors won't absolutely rule out risks from long-term exposure.
The review finds that most studies of mobile phone use show no significant link to brain cancer or other health effects. However the authors point out that less is known about long-term effects, for example, children who would use mobile phones their entire lives.
A feature article about the good news is here. Still convinced cell phones will main or kill you? You're 100% right. Click here and here for proof.
Labels: cancer, environment
posted by Ryan DuBosar at
3:16 PM
0 Comments
Monday, April 6, 2009
Cancer study bullish on broccoli
New research shows that if you want to prevent stomach cancer it really helps to like broccoli. While scientists have known for a while about the green vegetable's potential cancer-protective effects, there isn't much hard evidence on whether it prevents bacterial infections in humans. But a small study in the April issue of Cancer Prevention Research reports that eating 70 grams of fresh broccoli stems a day for eight weeks significantly lowered Helicobacter pylori levels in 48 infected Japanese men and women.
Researchers assessed the severity of H. pylori in participants at enrollment and again at four and eight weeks using standard breath, serum and stool tests, according to an American Association for Cancer Research news release. Reducing H. pylori levels presumably will lead to a lower risk of developing stomach cancer, said researchers, noting the well-established link between the two.
It's food for thought, and many may deem broccoli the lesser of two evils considering the alternative: alfalfa sprouts. The study randomly assigned participants to an equivalent daily amount of the sprouts, which had no effect.
Labels: cancer, Nutrition, research
posted by Janet Colwell at
8:00 AM
0 Comments
Wednesday, February 25, 2009
What's your poison?
While there has been evidence galore that alcohol in moderation may be good for your heart (see this, this and this for a few examples), a new study has raised a serious counterpoint. The study from the Feb. 24 online Journal of the National Cancer Institute found that women who drank even small amounts of alcohol were at higher risk of cancer than those who drank nothing.
To wit, for every extra drink per day, the increase in incidence per 1000 women was 11 for breast cancer, 1 for cancers of the oral cavity and pharynx, 1 for cancer of the rectum, and 0.7 each for cancers of the esophagus, larynx and liver. That adds up to 15 cancers per 1000 women, the journal said. Put another way, the authors estimated that about 13% of cancers of the breast, aerodigestive tract, liver, and rectum could be attributed to alcohol, an editorial noted.
The editorial goes on to say: "From a standpoint of cancer risk, the message of this report could not be clearer. There is no level of alcohol consumption that can be considered safe."
Has it come to this: Hesitating at the wine or beer aisle, as you contemplate whether you'd rather have cancer or heart disease? That's being melodramatic, of course, but what should a PCP tell a patient who asks whether she should be drinking a glass of wine a day "for her heart"?
Labels: alcohol, cancer, cardiology
posted by Jessica Berthold at
9:32 AM
0 Comments
Thursday, February 5, 2009
Helping patients manage high cost of cancer care
More cancer patients are surviving their disease but finding that recovery, too, exacts a high price. According to research presented this week at the American Association for Cancer Research conference, many survivors--even those with health insurance--forgo needed medical care due to cost, Reuters reported. According to National Cancer Institute researchers, the prevalence of neglecting care for financial reasons was 7.8% for general medical care, 9.9% for prescription medication, 11.3% for dental care, and 2.7% for mental health care.
In light of those findings, it's fitting that American Society of Clinical Oncology has come out with practical financial guidance for cancer patients. The group's Cancer.Net Web site now has a section about managing the cost of cancer care, including suggested questions to ask your doctor and other professionals. Beyond the strictly medical treatment and medication-related questions, the site lists issues to consider surrounding transportation, living expenses, long-term care and employment issues, for example, as well as a list of organizations that offer financial support to cancer patients.
It's a nice resource for physicians to recommend to patients burdened by financial worries related to their illness.
Labels: cancer, patient education
posted by Janet Colwell at
9:55 AM
0 Comments
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
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Previous Posts
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- Ghostwriting haunts Congress' hallowed halls
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- QD: News Every Day--not the intended effect
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