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
1 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
Thursday, May 28, 2009
Doctors discuss the consequences of misleading medical news
Doctors have to spend a lot of time correcting patients' misimpressions of medical research based on mainstream media reporting, readers told ACP Internist in a survey.
Mainstream media coverage of medical news overstate results and include too few details, according to ACP Internist's poll, "Your Thoughts Exactly: Media reporting of medical research."
According to the poll results, all respondents voted that mainstream media reports of medical studies were exaggerated "extremely," "very much" or "moderately." There were no responses of "somewhat" or "not at all."
When asked to rate the level of detail of medical stories in the mainstream media, all but one respondent thought there was "somewhat" or "way too little" detail in coverage.
The poll is based on a study in Annals of Internal Medicine that concluded the public relations departments of academic medical centers overstate results or don't include important caveats when pitching study results to the media. Authors questioned if this was being passed through to mainstream media reports, which patients then carry into their visits with physicians.
In the daily grind of medical practice, doctors reported a "time drain" of calming patients who'd seen a news report, or deflecting false hopes and over-expectations from others.
One poll respondent summed it up perfectly: "Medical news is almost always distorted, and leads to false hopes and expectations from patients. However, it's part of my daily job to provide patients with accurate and useful information about their medical conditions."
Also, another respondent chastised the media for the lack of distinction made between test tube studies and phase 3 clinical trials, and also the lack of explanation that discoveries about the mechanisms of diseases do not immediately translate into treatments that can be made available.
"Dramatic results are not often carefully noted to be preliminary and unreproduced," another respondent said. "This leads patients to believe findings are ... established. This often requires time to properly balance the whole of the existing (or non-existing) data. Patients don't get the language of 'may be' that is usually reported in the media."
"Fortunately, patients trust their doctor more than the media," one concluded.
Perhaps the best way to overcome poor medical reporting is to do it yourself. One doctor successfully reports medical knowledge to his patients by appearing on TV as a medical commentator.
Labels: patient communication, patient education, patient information
posted by Ryan DuBosar at
11:36 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
Friday, August 22, 2008
A juicy dilemma
It's a classic image for the AARP set: The glass of OJ and the pile of pills next to one's plate at the breakfast table.
But this week, researchers presented a study that suggests orange, apple and grapefruit juice can reduce the absorption of some very important drugs, the New York Times and several hundred other news outlets reported.
Fexofenadine, ciprofloxacin, levofloxacin, itraconazole, atenolol, celiprolol, talinolol, cyclosporine, etoposide-- all are on the list of drugs affected by the three juices. And the study researchers from the University of Western Ontario suspect more will be added to the list, the Times article said.
Given that the jury is still out on how many drugs are affected by juice, what will/should physicians do in terms of educating patients about their prescriptions? Should they tell them to take all pills with water, to be on the safe side? Should they tell them why, or is that too much information to go into?
Should they tell certain patients to avoid drinking juice altogether (as has been done for years for patients who take drugs that interact with grapefruit juice), until more is known about how long the interaction effect lasts? What about eating an orange or an apple around the time one takes his or her pills-- should doctors address that, as well?
In other words, what should doctors do with information like this, while they wait for more clarifying research to emerge? It seems like a tough spot to be in.
Labels: juice, medication, patient education
posted by Jessica Berthold at
11:39 AM
0 Comments
Monday, August 4, 2008
More free patient info
The NIDDK has been busy. Here are more online patient resources for various conditions.
"What I need to know about Interstitial Cystitis/Painful Bladder Syndrome" booklet.
"Prostatitis: Disorders of the Prostate" fact sheet.
"IgA Nephropathy" fact sheet .
"Home Hemodialysis" fact sheet .
You can also go here to order a free print copy of a booklet or fact sheet, or call 1-800-891-5390 to order copies. Packets of 25 copies of booklets and fact sheets cost $10 and $5, respectively, to cover shipping and handling.
Labels: patient education, patient information
posted by Jessica Berthold at
3:26 PM
0 Comments
Booklet for pregnant patients with diabetes
On the heels of a study that found pre-pregnancy diabetes increases the risk for birth defects, the NIDDK is giving away a patient guide: "For Women with Diabetes: Your Guide to Pregnancy".
It's a 44-page booklet with info about checking and controlling blood glucose, maintaining a healthy diet, staying active and taking tests and diabetes medications during pregnancy. It also includes logs for recording daily blood glucose and ketone levels, food intake and physical activity.
The new booklet is available online in English, with a Spanish version coming soon.
You can also order a print copy via this site or by calling 1-800-860-8747.
Labels: Diabetes, patient education, pregnancy
posted by Jessica Berthold at
3:10 PM
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.
Contact ACP Internist
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Previous Posts
- QD: News Every Day--Santa's take on H1N1 influenza...
- Rethink pink: breast cancer screening evidence met...
- QD: News Every Day--Santa's take on H1N1 influenza...
- QD: News Every Day--when evidence and politics col...
- Ghostwriting haunts Congress' hallowed halls
- QD: News Every Day--payment fix inches forward (fo...
- QD: News Every Day--not the intended effect
- Medical news of the obvious
- QD: News Every Day--flu's growing tally
- QD: News Every Day--no holidays for Congress
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