Tag Archives: susan g. komen for the cure

The Trauma of Politics in Medicine

It’s been a quick reversal for the Susan G. Komen for the Cure Foundation, reinstating funding some 72 hours after cutting off Planned Parenthood because of new criteria barring grants to organizations under investigation, prompted in this case, by a Republican congressman.

“We will amend the criteria to make clear that disqualifying investigations must be criminal and conclusive in nature and not political,” Komen CEO and founder Nancy Brinker said in a statement issued Friday.

The uproar brought more than $3 million in donations to Planned Parenthood in just three days, but also highlights the volatile mixture of politics and medicine.

Dr. Richard Carmona recently observed that one of the most popular presentations he made during his tenure as the 17th Surgeon General of the United States did not address emerging infections, physical trauma, or national diasters, but rather the plague of politics in medicine.

“This traumatic plague of politics is more insidious and virulent than emerging infections; has potentially more morbidity and mortality than hemorrhagic shock or blunt or penetrating trauma; has virtually no diagnostic criteria; and is resistant to all therapy, especially voices of reason, substantive discussion or positions of compromise,” he said during a memorial lecture at the recent meeting of the Eastern Association for the Surgery of Trauma.

Dr. Richard Carmona Patrice Wendling/Elsevier Global Medical News

Dr. Carmona didn’t have far to look for examples to flesh out his diagnosis.

More than a century ago, public health officials’ efforts to control the bubonic plague outbreak of 1900 in San Francisco were nearly derailed by politicians who claimed that quarantine procedures, including closing the city’s harbor to incoming ships, were an over-reaction that would impede commerce and tourism, and result in the collapse of San Francisco, and possibly California. The Surgeon General who intervened based on the scientific evidence was labeled a heretic and asked to resign.

In the 1980s, similar calls were made after former Surgeon General Dr. C. Everett Koop refused to back down from statements that HIV could be prevented. At the time, Dr. Carmona reminded the audience, senior elected officials were telling the American public that HIV was God’s way of punishing homosexuals.

In the 1990s, the tenure of Surgeon General Dr. Joycelyn Elders  was cut short after controversy erupted over a 1994 speech at the United Nations World AIDS Day that included remarks that masturbation was a normal part of sexuality and that abstinence-only education was “child abuse.”

During his own term under President George W. Bush, Dr. Carmona said, abstinence-only became the mantra of the administration, “based solely on ideological and theological concepts, and not science.

“Science had really demonstrated that abstinence alone was a failed proposition,” Dr. Carmona said. “Ironic, that an administration that was repeatedly caught up in the issue of abortion did not see the connection that comprehensive sex education was the best method to prevent STDs, unwanted pregnancies, and therefore abortions. As Surgeon General, this is a science-based position I have always held.”

Dr. Carmona, the only Surgeon General to be unanimously confirmed to the position in over 200 years, said the trauma of politics and its preventable deleterious outcomes are owned equally by politicians on both sides of the aisle.

He pointed out that over-the-counter sales of Plan B stalled under the Bush administration before gaining limited approval in December 2006, but fared no better seven years later under the more liberal Obama administration. In December 2011, HSS Secretary and Democrat Kathleen Sebelius overruled the FDA’s decision to make the emergency contraceptive available, without prescription, to girls of all childbearing ages. While Sebelius cited a lack of conclusive data, Dr. Carmona said it was the administration’s desire to avoid a political battle in the face of an upcoming election.

“The immunization for preventing the continued viralness of political trauma is transparency, full disclosure, accountability for elected officials, a citizenry that is informed and participatory, coupled with civil discourse of complex issues,” he said.

–Patrice Wendling

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Filed under Family Medicine, Health Policy, health reform, IMNG, Obstetrics and Gynecology

Step Aside, Pink

Courtesy Wikimedia Commons/Jason Meredith/Creative Commons

Raise your hand if you’ve never seen a pink ribbon or don’t know what it means.

No one?

The tremendous success of the pink ribbon breast cancer awareness campaign is a great fundraising and awareness lesson for any charitable organization.  There are no clear numbers on research funds raised by pink ribbons, in part because there are so many sources for pink ribbon items. Still, those ribbons and the public awareness they’ve raised have made a huge difference in breast cancer research and survival. For example, the 5-year breast cancer relative survival rate in 1975-1977 was 75%. In the most recent data from the American Cancer Society’s Cancer Statistics 2011 (table 12), the 5-year breast cancer relative survival rate in 1999-2006 was 90%.

According to the NCI Snapshot of Breast Cancer: “In the United States, breast cancer is the most common non-skin cancer and the second-leading cause of cancer-related death in women. Each year, a small number of men are also diagnosed with or die from breast cancer. Although the rate of diagnosis of breast cancer increased in the 1990s, it has decreased since 2000, and the overall breast cancer death rate has dropped steadily.” In 2008, the incidence rate for breast cancer in white women and African American women is just a tad less than 130 breast cancers per 100,000 women in each group.

The point is this: we’re had incredible success in raising money, awareness and survival for breast cancer. Maybe it’s time to put the same effort into defeating other cancers.

For example, the 5-year relative survival rate for lung/bronchus cancer — represented by a white ribbon, by the way — in 1975-1977 was 13%; in 1999-2006 that rate had increased only to 16%.  Worse still: the 5-year relative survival rate for pancreatic cancer (purple ribbon)  in 1975-1977 was 3%; in 1999-2006 that rate was 6%.

According to the NCI Snapshot of Lung Cancer, lung cancer is the second most common cancer and is the primary cause of cancer-related death in both men and women in the United States. The overall mortality rate for lung and bronchus cancers rose steadily through the 1980s and peaked around 1993. Mortality rates are highest among African-American males, followed by white males.

The button I wear to support my dad's battle against lung cancer. Kerri Wachter/Elsevier Global Medical News

In 2008, the incidence rate of lung cancer among African American men was roughly 100 per 100,000 men; for white men the rate was about 70 per 100,000 men.  Remember though that the 5-year relative lung cancer survival rate in 2006 was estimated at 16%.  That’s a lot of people dying…and that’s just lung cancer. By the way November is the awareness month for lung cancer and stomach cancer (periwinkle ribbon).

The point is, maybe it’s time that the White Ribbon (or purple or gray or … ) became the new Pink Ribbon.
Kerri Wachter

Special thanks to David Sampson, director of medical & scientific communications for the American Cancer Society, for his help with data.

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Filed under Family Medicine, Hematology, IMNG, Internal Medicine, Obstetrics and Gynecology, Oncology, Primary care, Pulmonary Diseases and Sleep Medicine

Seeing Red: Heart Disease and Women

The Red Dress Campaign has caught women’s attention regarding the very real dangers of cardiovascular disease, but a new study shows they may not be taking the message to heart.

Photo courtesy of The Heart Truth®, NHLBI, NIH

The study, presented at the recent American College of Cardiology meeting, found that the overall incidence of acute MI decreased among 315,246 patients admitted to New Jersey hospitals 1986-2007. The decrease was significant among both men and women, but was more prominent among men.

The incidence of acute MI fell from 598 to 311 per 100,000 men and from 321 to 197 per 100,000 women, according to cardiologist Dr. Liliana Cohen and her colleagues at the Robert Wood Johnson Medical School in New Brunswick, N.J. They also identified a growing gap in the rates of left heart catheterization and percutaneous coronary intervention between men and women.

The rates of catheterization increased fivefold in women and threefold in men over the 22-year study period, but the likelihood of catheterization remained lower for women. Moreover, the difference among male and female cath patients going on to receive PCI increased from 2.2% in 1986 to 9.4% in 2007.

Finally, both in-hospital and 1-year mortality remained higher among women, and failed to show a significant decrease after 2002 – the year the National Heart Lung and Blood Institute launched the Red Dress campaign.

“Although awareness of cardiovascular disease in women has increased in the general population, there has been much less translation of this into clinical practice,” Dr. Cohen told me.

This may be due to women presenting later because they doubt an MI can happen to them or that physicians still are not treating women as aggressively as they treat men, she said. It also may relate to the fact that women have more difficult cardiac anatomy, so that once they receive cardiac cath, PCI remains difficult.

Photo courtesy of The Heart Truth®, NHLBI, NIH

Dr. Cohen suggests that in its next phase, the campaign needs to continue to focus on public health awareness, but also on research into how to translate public awareness into clinical practice by focusing on physicians and into newer techniques of PCI for the smaller blood vessels in women.

Quibble if you will about the generalizability of data from a single state or the potential impact of a single PR campaign, but it’s hard to ignore these disappointing outcomes.

I once heard a bold and blistering guest lecture at a cancer meeting by Nancy Goodman Brinker, founder and CEO of Susan G. Komen for the Cure, who told several thousand — mostly male — oncologists that a survival rate topping 90% for early stage breast cancer simply wasn’t good enough.  Truer words were never spoken.

— Patrice Wendling

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Filed under Cardiovascular Medicine, IMNG, Internal Medicine, Surgery, Thoracic Surgery