New Mammogram Recommendations Miss the Real Fear

Image courtesy of NIH

My 40th birthday comes in less than a month and, right on schedule, my ob.gyn handed me the paperwork last week to get my first screening mammogram.  Yesterday, the U.S. Preventive Services Task Force issued new recommendations that will now have women younger than 50 years skipping screening mammograms completely.  Will I still be getting my screening mammogram? You bet, I’ll get it done before the year is out–so that my insurance company will still pay for it.

Why?  Because cancer is a truly terrifying word for most of us.  Yes, it’s an irrational fear that I might develop breast cancer before age 50.  Given my family history, it’s far more likely that I will develop heart disease. Still, like many women, I’m far more scared of developing breast cancer and the fact that it’s an irrational fear doesn’t make it any less real to me.

In the new recommendations, the USPSTF says that the small chance of detecting breast cancer on a screening mammogram in women younger than 50 years is outweighed by “the psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results.” 

I think the task force misses the real fear for most women. I went through a series of imaging tests and consultations last year for what turned out to be benign thickening of tissue. It was a harrowing experience and several months of nonstop anxiety and I’d gladly go through it all over again to know that another mass was benign or to catch a tumor early.  The real fear is not detecting breast cancer early, even if  the risk of developing the disease is statistically very small.

So, I’ll get that screening mammogram this year but what about next year and the year after that?  Will my insurance company stop covering screening mammograms for women younger than 50 and will I end up having to spend my own money to feel reassured?

—Kerri Wachter, @knwachter on Twitter

No Pause In The Debate: The Policy & Practice Podcast

From press conferences, interviews, and more around Washington, D.C.

Congress took a holiday last week to honor America’s military heroes both past and present, but the veterans of the health reform debate did not pause.

Photo by Flickr user US Army Africa

A breakaway group of physician organizations mounted a challenge to the American Medical Association’s backing of the House-passed reform bill.  Activists on both sides of the abortion issue took up their positions, hoping to persuade the Senate to either dump or keep the House amendment barring abortion coverage in the public insurance exchange.

And all hoped to have some last-minute influence over the Senate, which was expected to unveil its final bill by Tuesday, Nov. 17.

Take a listen.

– Alicia Ault (on Twitter @aliciaault)

All’s Fair in Love and Influenza?

Image courtesy of Flickr user Lu_Lu (cc)

I’m a healthy 39-year-old with no chronic health conditions that put me into one of the H1N1 vaccine priority groups.  Still, when I found out yesterday at a routine visit that my ob.gyn was offering the vaccine to all patients, I couldn’t roll up my sleeve fast enough.  I felt a little guilty given shortage problems with the H1N1 vaccine in recent weeks…but not guilty enough to forego the shot.  I rationalized getting the vaccine by thinking that the public health is better off with everyone who wants the H1N1 vaccine getting it.  Why turn away those who want it?

What do you think?  Let us know by casting your vote in our poll.

—Kerri Wachter, @knwachter on Twitter

Coalitions Splinter: The Policy & Practice Podcast

Photo courtesy Flickr Creative Commons user Mccready

The House approves a health care reform bill, but Democrats splinter over an abortion provision. The bill receives support from the American Medical Association, but some surgeons’ groups beg to differ. And physicians of all specialties await a Congressional fix to the Medicare SGR formula.

It’s all in this week’s Policy & Practice podcast. Take a listen and let us know what you think.

–Joyce Frieden (Twitter @joycefr)

Barriers to Accurate Reporting

From the annual meeting of the American Academy of Child and Adolescent Psychiatry, Honolulu

“Speakers and Attendees: Please check with the Press Office in Sea Pearl 4 before accepting a media interview.”

This message appeared prominently on page 11 of the program for the AACAP meeting, which I just finished covering.

My next hint that reporters at the meeting were in for a difficult time was a warning that was read by session moderators and also appeared in a black-box on page 7 of the program:

“This presentation and the accompanying materials are protected by copyright and may not be reproduced or summarized, in whole or in part, for any commercial purpose without prior written authorization from the copyright holders.”

Now I’m no lawyer, but I do know that no one can copyright an idea, only a particular expression of an idea. Any summary that a reporter writes in his or her own words cannot on its face constitute a copyright violation. In addition, the Fair Use provisions of copyright law permit anyone to quote brief word-for-word excerpts.

So what gives?

I spoke with Rob Grant, AACAP’s new communications manager, to register my objections to this policy. He said these standards were established about 2 years ago after members of an anti-psychiatry organization gained entry to the meeting by posing as reporters. Rob wouldn’t discuss details, and said the AACAP did not intend to prevent attendees from talking to legitimate members of the press. He gave me his mobile phone number and said to please phone him directly or give the number to any attendees who balked at talking to me.

Fortunately, none of the speakers and attendees who I interviewed insisted on talking first to Rob or being lugged up to the Press Office for preapproval.

Yet another proviso, a ban on taking pictures, and the unavailability of PowerPoint slides for the press, certainly got in the way of confirming that the numbers and other details in my articles are accurate.

As an alternative to setting up roadblocks, perhaps the American Academy of Child and Adolescent Psychiatry could adopt procedures for credentialling reporters. The American Society of Clinical Oncology, for example, requires online registration for reporters and asks them to submit recent examples of their reporting, preferably about cancer topics.

It’s not a foolproof solution, but it would seem preferable to threats and limitations.

—Bob Finn (@bobfinn on Twitter)

Pulling Back The Curtain on the FDA

From the FDA’s Public Meeting on Transparency at the National Transportation Safety Board Conference Center, Washington, DC

Outside of the C.I.A., the Food and Drug Administration (FDA) has been one of the most enigmatic federal agencies, inscrutable to the industries it regulates, a mystery to the public, and feared by executives at small publicly traded companies whose stock can take wild swings in response to the slightest whisper from the Emerald City, that is, White Oak, Md.

Courtesy Flickr Creative Commons User dbking

But like Dorothy and her raggedy band of cohorts, FDA Commissioner Margaret Hamburg and her deputy Joshua Sharfstein are determined to pull back the curtain and expose the inner workings of Oz.

As a start, they’ve organized a “transparency” initiative (details are here). On Tuesday, Dr. Sharfstein led discussions with a panel of agency colleagues, industry, physicians, and consumers on hypothetical situations where the agency would be called on to say, communicate to the public about a foodborne disease outbreak, or let manufacturers know how and why it had made a decision about a new drug approval.

The agency plans to eventually make all its decision-making processes more accessible to everyone – and soon, said Dr. Sharfstein.  First, it will create an “FDA 101” area on its website, envisioned as an interactive area for consumers to learn all about the agency’s mission and inner workings.

The second phase will be finding a way to explain to the public how the agency makes its decisions; last, it will become more accountable to industry.

With almost-daily and ever-larger outbreaks of foodborne illnesses, growing pharmaceutical and device recalls, and sporadic epidemics like H1N1 influenza, the discussions are not just academic. Being able to communicate – and quickly communicate — fact-based public health information is crucial, especially when misinformation proliferates so quickly these days.

The Centers for Disease Control and Prevention has long cultivated its reputation as a credible source of information in times of crisis and has also developed strong relationships with the partners it needs to rely on – physicians and scientists – during those crises.

The FDA, which has just as big a stake, has operated in some kind of alternate universe.  But, a whirlwind election blew in the force of change.

Will Dorothy, that is, Dr. Hamburg, be able to bring the agency back to reality?

–Alicia Ault (on Twitter @aliciaault)

Not Your Usual After-Lunch Speech

From the annual meeting of the American Academy of Psychiatry and the Law in Baltimore, MD:

Photo of Patrick Kennedy courtesy U.S. House of Representatives

It’s not every day when you hear a luncheon speaker discuss how his mom used to greet visitors at the front door while she was less than fully clothed. Especially when the speaker is a member of Congress.

But Rep. Patrick Kennedy (D-R.I.) spoke with no holds barred when he discussed his family’s addiction battles. “My mom had the worst case of alcoholism that you could possibly imagine,” he said to the assembled group of psychiatrists. “And we kept it a big secret — or so we thought. Until one of my friends would come over, and their mom would come over to pick them up, and my mom would answer the door completely naked. And they’d be like, ‘What’s going on in this house?’”

Rep. Kennedy continued, “And you can’t begin to imagine the amount of denial. My mom would be driving us to school … and be sideswiping cars all the way to elementary school. It was the most well-known, least-hidden secret from the world, and yet nobody said a word about ‘Maybe this is not safe.’ … For many famlies, that still happens, and it’s still going on in most of America, and that’s really scary.” He noted that even though addiction is “a physical illness, a genetic illness, yet we do nothing to treat it as such because we’re so mired in an old-fashioned view of this thing as a reflection of someone’s moral turpitude that they’re insufficient in their ability to control their behavior.”

He also discussed his own ongoing addiction battle. “‘When I went back to treatment this last year after having 2 1/2 years of sobriety, I was in treatment with three members of the Special Forces — two Navy SEALs and one Green Beret. Now I’m telling you, if this is about control of your behavior, these are probably the most powerful, self-disciplined, powerful individuals our society could produce … So it just brings home the fact that this isn’t about self-control, because if it were, how could people that could pass every other test in the world in terms of self-discipline lose the one that comes about as a result of controlling themselves with respect to a disease called addiction?”

Members of the audience seemed to like what they heard; they gave him a standing ovation when he finished.

–Joyce Frieden (Twitter @joycefr)

High Stakes for Physicians: The Policy & Practice Podcast

Photo by Mary Ellen Schneider.

From press conferences, interviews, and more around Washington, D.C.

Physicians have a lot riding on what happens in Congress this year. After months of wrangling over health reform, House Speaker Nancy Pelosi (D., Calif.) will try to get her version of the health overhaul bill through the chamber. The bill includes a public plan whose rates would be negotiated with physicians.

But that’s not the only legislative priority of great importance to doctors this year. Unless Congress steps in, doctors will face a 21% Medicare pay cut in 2010 and more cuts in the years to come. A bill that would have scrapped the widely criticized Medicare pay formula failed to gain traction in the Senate, but House Democrats are trying to keep the fix alive with their own bill.

Get all the details in the latest installment of the Policy & Practice podcast.

— Mary Ellen Schneider (@MaryEllenNY on Twitter)

There’s More Than One Answer to These Questions

Image courtesy of Flickr user Jim Linwood

from the Kennedy Krieger Institute’s annual autism conference

That’s a line from an Indigo Girls’ songs.  While I think their questions were probably aimed at Life, the Universe, and Everything, they could just as easily have been talking about autism.  I’ve covered this meeting twice now and both times I’ve been struck by  how many possible autism factors are under investigation.  There seems to be evidence of a role for genetics, brain abnormalities, and autoimmunity as causes of autism.  Today I listened to research on epilepsy and autism spectrum disorders (ASD) and GI symptoms and ASD.  This wide range of research made clear to me what a tragic mistake it would be to pin all of our hopes for identifying the cause of autism on just one factor.

The evidence is clear that vaccines do not cause autism but even if there were evidence–and I repeat, there is none–it would be exceptionally harmful to those with autism and their loved ones to limit research to just vaccines.  If the true object is to identify the causes of autism in order to develop effective treatments, the most productive strategy is to look at as many possible factors.  Everyone affected by or working with those affected by autism should be relieved to know that a great deal of this research is getting done–albeit out of the limelight.

—Kerri Wachter, @knwachter on Twitter

Throwing Down the (Green) Gauntlet

The ACG blue bag. Photo by Sherry Boschert.

From the American College of Gastroenterology annual meeting, San Diego

I was pleasantly surprised to see the American College of Gastroenterology promoting its eco-friendly iniatives at its annual meeting. So much so, in fact, that I think the ACG has thrown down a green gauntlet. Will other medical societies take up the challenge? Anyone know of other large medical conferences that can top the following?

A sign at the ACG meeting. Photo by Sherry Boschert.

- Forget the generic black shoulder bag made from unidentified petroleum products that you get at registration. The ACG’s blue bag is made from recycled content.

- Printing only session and abstract titles — but not the abstracts — reduced the program book by 300 pages, down to 172 pages. Multiply 300 by 4,000 attendees, and that’s 1.2 million paper pages saved. Abstracts were available online and on compact disk. On the other hand, the abstracts did fill the pages of a print supplement of The American Journal of Gastroenterology. The program book, meeting newspaper, and other materials did not seem to be on recycled paper.

Better than trash. Photo by Sherry Boschert.

- Bins collected name badges and program books for recycling.

- Meeting hotels were chosen within walking distance of the convention center to avoid using shuttle buses.

- The decorator of the conference and exhibit hall, a company called Freeman, donates the signs afterward to schools to use the foam cores for arts and crafts. Aisle carpets get recycled into a second life as drainage pipe for septic systems. Fancier booth carpeting gets re-used in affordable housing facilities or in “pet-related products.” (Huh?) Recycled aluminum forms the frames of most booths.

- The San Diego Convention Center itself provides ubiquitous recycling bins, uses low-flow sinks and toilets, has drought-tolerant landscaping with efficient drip-system irrigation, donates excess food from meeting events to local charities, uses recycled content in all paper products (copy paper, toilet paper, towels, etc.), and plans to install solar panels on the building within the year.

Exhibits = exercise??? Photo by Sherry Boschert.

But let me offer a friendly caution to meeting organizers — don’t get carried away trying to flaunt the whole good, green lifestyle thing. It’s fine to encourage attendees to exercise (especially in beautiful, warm Southern California), but to suggest that they exercise in 1/4-mile or 1/2-mile routes in the exhibit hall? That’s a stretch.

Sherry Boschert (@sherryboschert on Twitter)