Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Should You Get A Mammogram?

A recent mammogram study in the New England Journal of Medicine was so controversial that the authors (Drs. Welch and Bleyer) decided to make a YouTube video to defend and explain their conclusions. Now that’s a first, isn’t it? Well kudos to the study authors for their creative approach to getting ahead of a controversy. However, their video (created for the “general public”) is still a bit too technical in my opinion. I’d like to take a crack at distilling it further.

A question on most women’s minds (as they turn 40 and beyond) is whether or not they should get a screening mammogram (x-ray of the breasts). If you have found a lump in your breast or you have a family history of breast cancer the answer is yes. No need to read any further. However, for the majority of us lumpless, family-history-free women, a screening mammogram is far more likely to expose us to unnecessary follow up testing than it is to catch a tumor early.  Dr. Welch explains that screening mammograms aren’t very good at identifying aggressive breast cancer early enough to make a difference in whether one lives or dies anyway. That’s very disappointing news.

Dr. Welch goes on to explain that most of the gains we’ve made in breast cancer survival have been because of improved breast cancer treatments, not because of early detection with mammograms. He estimates that every year in the U.S. 1.3 million women are “over-diagnosed” with breast cancer because of screening mammograms, subjecting women to unnecessary biopsies, surgical procedures, and further follow up studies. In the video, Dr. Welch doesn’t explain exactly what these “over diagnosed” cancers end up being exactly (Cysts? Benign calcifications? Early non-aggressive cancers that the immune system kills on its own?) But suffice it to say that they don’t contribute to the cancer death rates.

So, given the fact that you are more likely to suffer through a false alarm than to discover a cancer early (and even if you do find it early, if it’s the “bad” kind you may not survive) are you willing to undergo a screening mammogram? That’s a personal question that we each have to answer for ourselves. As time goes on, however, I suspect that the answer will be made for us since health insurance companies (whether public or private) will begin to balk at paying for tests that do more harm than good overall. I think this issue is really at the heart of the controversy (the perception of rolling back a health benefit that women currently “enjoy”). Eventually screening mammograms may become an out-of-pocket expense for women who simply prefer the peace of mind that a normal test can give – even at the risk of going through a false alarm.

That being said, it sure would be great if we could find a screening test that identifies breast cancer early – especially the aggressive kind. Perhaps a blood test will do the trick one day? At least it is comforting to know that we have made great strides on the treatment side, so that fewer women than ever before die of breast cancer. More research is needed on both the screening and treatment sides of course.

As for me, I do regular breast self exams – though because I have no family history of breast cancer I’ve opted out of screening mammograms because I feel the cost/benefit ratio is not in my favor. I certainly hope that a better screening test is developed before I face a potential diagnosis. I respect that other women will disagree with me – and I think they have the right to be screened with the only option we currently have: the mammogram. I’m not sure how long it will continue to be covered by insurance, but at a price point of about $100, most of us could still afford to pay for it out-of-pocket if desired.

The bottom line of this controversial research study is that screening mammograms don’t actually catch death-causing breast cancers early enough to alter their course. Even though it makes intuitive sense to be screened, long term observations confirm that overall, mammograms do more harm than good. So now we wait for a better test – while some of us continue with the old one (as the National Cancer Institute recommends), and others (like me) don’t bother.

***

Thanks to ePatient Dave and Susannah Fox who brought the issue to my attention on Facebook. Isn’t social media grand?

Research Regarding Infant Deaths Linked To Japan’s Fukushima Meets Controversy

nuclear radiation, reporting on health, fukushima, vicente navarro, michael moyerLast week, I wrote about controversial research linking fallout from Japan’s earthquake-damaged Fukushima nuclear plant to infant deaths in the United States.

The research, which was harshly criticized by Scientific American’s Michael Moyer and others, was published in the peer-reviewed Journal of International Health Services, and I had asked the journal’s editor-in-chief Vicente Navarro for his response to the criticisms.

Navarro, professor of health policy at Johns Hopkins University’s Bloomberg School of Public Health, emailed me this comment today: Read more »

*This blog post was originally published at Reporting on Health - Barbara Feder Ostrov's Health Journalism Blog*

The Importance Of Promoting Good Science And Medicine In Journalism

Sheril Kirshenbaum, research associate at the University of Texas Austin’s Center for International Energy & Environmental Policy, blogged this week under the headline, “Battle Hymn of the Science Journalist.” Excerpt:

There are many excellent science journalists who inhabit the blogosphere and those mainstream news outlets that still feature science sections. These talented individuals want to share your story, your research, and they appreciate and value what you do.

However, there are also a lot of horrible journalists making the rest of us look bad.. Writers who care less about getting it right, and more about trumping up controversy. Journalists whose headlines are notoriously misleading or false. Some Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Cutting Healthcare Costs In Spain: Evidence-Based Disinvestment

In an economic downturn, two classic cost-reducing solutions come to mind in the healthcare services industry: reduce offerings (give fewer services)  or control demand (limit access to healthcare or increase copayments). There are many more but these two are the most frequently used. Actually, budget cuts in the Spanish region of Catalonia fit in the first type: they will need fewer resources (both human and material) because their services offered will shrink.

It’s always controversial to cut healthcare services in Spain. Even talking about it leads to accusations of promoting total privatization, attacking the Welfare State and so on. But there is another way to cut services, drugs or technologies. It’s what Dr. Iñaki Gutierrez-Ibarluzea called ‘Evidenced-based disinvestment’ in an op-ed for Spain’s ‘Primary Care Journal’ (‘Revista de Atención Primaria’). It’s easy: just find out which services, technological means or drugs offer little or no benefit for patients’ health. In other words, stop financial support for anything inefficient. Read more »

*This blog post was originally published at Diario Medico*

Reflections On Nursing Education

The discussion regarding the entry level for nursing has been ongoing for decades. I have articles written in the 1940s extolling the virtues of the BSN long before the first ADN program opened in 1952.

Every now and then, someone broaches the topic of making the BSN the entry level and BAM! the flames that ensue make the health care reform debate look like Mr. Roger’s Neighborhood.

Why the rancor?

Well, if one states that the BSN should be the entry level for a registered nurse, then it follows there must be a reason why an ADN should not.

That does not sit well with ADN graduates. Read more »

*This blog post was originally published at Emergiblog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles