March 21st, 2011 by Michael Kirsch, M.D. in News, Opinion
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Recently, every newspaper in the country reported on a landmark development in breast cancer treatment. It is now clear that certain breast cancer women do not need to undergo removal of lymph nodes from the armpit as part of their treatment. This would spare them from the risk and discomfort of an unnecessary procedure. It is welcome news, particularly for those of us who argue that in medicine, less is more. This is an example of the benefit of comparative effectiveness research, a tool that can separate what patients truly need from what the medical profession believes they must have.
Let’s hope that breast cancer breakthrough metastasizes across the medical profession. Here’s what it accomplished.
- It spares women from unnecessary surgery.
- It saves money.
- It demonstrates that physicians and medical professionals can serve the public interest.
- It gives hope that all medical specialties will critically evaluate and justify the tests and treatments that we recommend to our patients.
Ironically, when the U.S Preventive Services Task Force (USPSTF) published their mammography guidelines last year, also arguing that less is more, they were assailed as medical traitors against women.
When it comes to breasts
There’s a tug of war
Some want less
And some want more.
Every practicing physician, medical educator and researcher should examine their own practices and medical advice. On what basis do we recommend our treatments? Do we do so because we were taught these practices in our training years ago? Is it from habit or adhering to the community standard? Is it because patients have such a high expectation of a medical intervention that we feel obligated to act?
Can anyone argue that patients are subjected to too much/many
- Chemotherapy
- Antibiotics
- Colonoscopies
- Cardiac stents
- CAT scans and their imaging cousins Read more »
*This blog post was originally published at MD Whistleblower*
March 2nd, 2011 by GarySchwitzer in Better Health Network, Opinion
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Dr. Barron Lerner has written a book about breast cancer: “The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America.” And he’s written a book about celebrity patients: “When Illness Goes Public: Celebrity Patients and How We Look at Medicine.” He wed the two topics in a blog post on the New York Times health blog entitled “Suzanne Somers, Cancer Expert.” Excerpts:
“Earlier this week, NBC’s “Dateline” devoted an entire hour on Sunday evening to allow the actress Suzanne Somers to express her rather unconventional beliefs about cancer.
It is not the first time a major media outlet has given air time to Ms. Somers, whose journey into the medical realm has been featured on a variety of news programs, talk shows and entertainment channels. A few years ago, Oprah Winfrey invited Ms. Somers on her show to share the secrets behind her youthful appearance — a complex regimen of unregulated hormone creams and some 60 vitamins and supplements.
But is it entirely outrageous that respected media organizations continue to give the “Three’s Company” sitcom star a platform to dispense medical advice? Not really, in a world in which celebrities have become among the most recognizable spokespeople — and sometimes experts — about various diseases.
…
…patients — especially those who want to explore every possible avenue — have the right to know that there are unorthodox cancer therapies that some people believe are helpful.
But not without several caveats, and that is where Ms. Somers, and many of those in the media who discuss her books and views, have failed. Ms. Somers says she is promoting hope, but false hope benefits no one.
Many people with end-stage cancer are, understandably, desperate, and thus potentially vulnerable to a sales pitch — even an expensive one. But here is a case when an informed patient may truly be a wiser patient. Perhaps if doctors were more willing to address the fact that these nontraditional treatments exist, and share what we do and don’t know about their effectiveness, an actress like Ms. Somers would have less influence, and science would override celebrity.”
There’s been quite an online response to Dr. Lerner’s blog post. One reader wrote, succinctly:
“From Thigh Master to Snake Oil.”
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
January 28th, 2011 by Elaine Schattner, M.D. in News, Opinion
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The FDA [has] issued an alert about a possible link between breast implants — saline or silicone — and a rare form of lymphoma called anaplastic large cell lymphoma (ALCL). These lymphoma cases are exceedingly rare, but the association appears to be significant.
The FDA identified a total of approximately 60 ALCL cases in association with implants, worldwide. Of these, 34 were identified by review of published medical literature from 1997 to May, 2010; the others were reported by implant manufacturers and other sources. The agency estimates the number of women worldwide with breast implants is between five and 10 million. These numbers translate to between six and 12 ALCL cases in the breast, per million women with breast implants, assessed over 13 years or so.
In women who don’t have implants, ALCL is an infrequent tumor, affecting approximately one in 500,000 women is the U.S. per year. This form of lymphoma — a malignancy of lymphocytes, a kind of white blood cell — can arise almost anywhere in the body. But ALCL cases arising in the breast are unusual. The FDA reports that roughly three in 100,000,000 women are diagnosed with ALCL in the breast per year in the U.S.
These are very small numbers. Still, the finding of ALCL tumors by the implant capsules is highly suggestive. Almost all of the implant-associated ALCL cases were T-cell type, whereas most breast lymphomas are of B-cell type. The lymphomas arose in women with both silicone and saline-type implants, and in women with implants placed for purposes or augmentation and for reconstruction after mastectomy. Read more »
*This blog post was originally published at Medical Lessons*
January 27th, 2011 by John Di Saia, M.D. in News, Opinion
1 Comment »
From the Food and Drug Administration (FDA) safety alert yesterday:
ISSUE: The FDA announced a possible association between saline and silicone gel-filled breast implants and anaplastic large cell lymphoma (ALCL), a very rare type of cancer. Data reviewed by the FDA suggest that patients with breast implants may have a very small but significant risk of ALCL in the scar capsule adjacent to the implant.
BACKGROUND: In total, the agency is aware of about 60 cases of ALCL in women with breast implants worldwide. This number is difficult to verify because not all cases were published in the scientific literature and some may be duplicate reports. An estimated 5 million to 10 million women worldwide have breast implants. According to the National Cancer Institute, ALCL appears in different parts of the body including the lymph nodes and skin. Each year ALCL is diagnosed in about 1 out of 500,000 women in the United States. ALCL located in breast tissue is found in only about 3 out of every 100 million women nationwide without breast implants.
While the FDA’s new report is interesting, as it stands it’s of little consequence. A mere 60 cases of a unusual breast cancer worldwide is a tiny number compared to the huge number who develop the much more common ductal breast cancers (about one in seven women in the U.S.) Breast implants have not been found to affect this more common cancer incidence. I do expect this statistic to be misquoted by the anti-breast implant factions online.
As an aside, I do remember a case in a fellow plastic surgeon’s mother of a lymphoma near a breast implant capsule when I was a resident. This is the only breast cancer of this type I have ever seen, however, in 14 years of practice. While I don’t doubt the association, I do focus on the significance of this report to the average breast implant patient, which is very little at this point.
– John Di Saia, M.D.
*This blog post was originally published at Truth in Cosmetic Surgery*
January 12th, 2011 by GarySchwitzer in Health Policy, Video
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Comedian Stephen Colbert, who says he is “a huge supporter of the Susan G. Komen for the Cure foundation,” nonetheless took a sarcastic swing at the organization this week “for spending almost a million dollars a year in donor funds to sue…other groups” for using the phrase “for the Cure” in their promotions.
We blogged, “Who owns pink ideas or cure slogans? Welcome to the Charity Brawl” back in August after the Wall Street Journal (to our knowledge) first reported the story.
Then in December, the Huffington Post reported that “Komen has identified and filed legal trademark oppositions against more than a hundred of these Mom and Pop charities, including Kites for a Cure, Par for The Cure, Surfing for a Cure and Cupcakes for a Cure — and many of the organizations are too small and underfunded to hold their ground.”
Colbert said: “If they don’t own the phrase ‘for the Cure,’ then people might donate money thinking it’s going to an organization dedicated to curing cancer, when instead it’s wasted on organizations dedicated to curing cancer.”
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
Recently, every newspaper in the country reported on a landmark development in breast cancer treatment. It is now clear that certain breast cancer women do not need to undergo removal of lymph nodes from the armpit as part of their treatment. This would spare them from the risk and discomfort of an unnecessary procedure. It is welcome news, particularly for those of us who argue that in medicine, less is more. This is an example of the benefit of comparative effectiveness research, a tool that can separate what patients truly need from what the medical profession believes they must have.
