Thursday, February 11, 2010

It's a record 4 posts in one day

Couldn't resist sharing another article by Dr. Lisa Schwartz

The authors believe relationships between drug companies and journalists might result in more favorable news stories, in a similar fashion to how industry funding of medical research is associated with more favorable research outcomes.


The authors were surprised by the widespread business of pharmaceutical and other healthcare businesses offering cash prizes and travel benefits to journalists. They state, "... we believe journalists accepting these prizes are clearly creating conflicts-of-interest for themselves" and calls for journalists to stop accepting these sponsored awards.

Schwartz says that the practice of medical journalism has evolved to blur the lines between traditional news reporting and producing advertising materials that mimic reporting. News corporations, which depend on advertising, need to be especially vigilant in maintaining a separation between their editorial mission and their advertising sales.

And here's another one from 2002:

Most commonly noted harms were false positive, false negative; few stories mentioned over-diagnosis

So an article from 2002 pointing out the media not mentioning over-diagnosis. And talking about we seem to be much more cautious about taking a pill compared to getting a test.

And another one from 2004 about the public's perception of screening tests:

"Some clinicians will see our results as welcome evidence of the success of public health campaigns for widely recommended cancer screening tests," the researchers write. "OthersÉwill see disturbing evidence that these same campaigns have communicated a misleadingly simple and one-sided message Ð a message that discourages meaningful discussions about the use of these tests in settings when the recommendations are less clear (e.g., screening at younger ages, at advanced age, or for individuals with multiple comorbidities [illnesses]." The public is primed to believe that there is value in having any test that is marketed as being able to find early cancer, suggest the authors. They conclude, "The challenge now is to balance messages and reduce the public's risk for overtesting and overtreatment."

The findings are limited, the researchers caution, because they do not know whether the public's enthusiasm for early detection would change if the potential benefits and harms of screening were fully communicated and understood.

One about over-diagnosing melanoma:

The incidence of melanoma of the skin is rising faster than any other major cancer in the United States. In 2002—the most recent year of data—the incidence was about six times that in 1950, but some dermatologists suspect that this rise may reflect more skin biopsies, not more disease. Welch and colleagues noted that death rates from melanoma have remained stable since 1986; what has increased during that time, they report, is the rate of skin biopsies.

Also in the news today

Noticed this is tomorrow's edition of Science News just now (don't ask me how I have it a day early, science is awesome?)

Just another good review of the information and a little bit of the politics surrounding screening mammograms.

3 posts in 1 day? Raise your hand if you're sick of reading.

Mammograms do catch cancers. But the task force found high rates of false-positive mammograms and treatment for “overdiagnosed” cancer, questioning the benefits of routine mammography for 40-somethings. Your thoughts?

Women need to be clear about their chance of developing breast cancer, how much mammography reduces that chance and what are its associated harms. Imagine 10,000 women age 40. Over the next 10 years, without mammogram screening, about 35 will die of breast cancer. With screening, 30 will die — five fewer. But of 10,000 getting screened, 600 to 2,000 will have at least one false positive leading to a biopsy, and 10 to 50 will be overdiagnosed. They will be told they have cancer, and they will undergo surgery, chemotherapy or radiation, which can only hurt them since their cancer was never destined to cause symptoms or death.

Overdiagnosis is the most important harm of screening. People sometimes find it hard to believe that overdiagnosis is possible. These cancers look the same under the microscope but don’t behave like cancer. Because we can’t tell which cancers constitute an overdiagnosis, everybody who has cancer is treated.

In the news Health Care Reform

Sassi told Sebelius that insurance costs also continue to rise because medical prices are increasing faster than inflation, and people are using more health care. That use increase is driven by an aging population, new treatments and "more intensive diagnostic testing," he wrote.

More reasons to scrutinize the diagnostic tests and new treatments. The insurance companies say that's driving up rates. They also say:

Brian Sassi, the head of WellPoint's consumer business unit, said in his letter to Sebelius that the weak economy is leading individual insurance buyers who don't have access to group plans to drop coverage or buy cheaper plans. That reduces the premium revenue available to cover claims from sicker customers who are keeping their coverage.

So let me get this straight, people drop insurance because insurance is too expensive and insurance companies raise the rates on everyone left to make up for it?

No insurance companies, you go bankrupt. The remaining people aren't made of money and many just needed one more push to drop your plan and 39% will probably do it.

They aren't so stupid that they'd price gouge during a recession?

And all DC can talk about it how they'll force the insurance companies to take people with preexisting conditions and make them compete with each other with the plans they offer.

WellPoint is the largest publicly traded health insurer based on membership and is a dominant player in the individual insurance market in California. Based in Indianapolis, the company runs Blue Cross and Blue Shield plans in 14 states and Unicare plans in several others.

So we're going to break up this giant and have a bunch of smaller corporations compete for people to insure? Will those costs be cheaper? Oh right the plan is to inject 30,000,000 customers by mandating insurance coverage.

And as time has gone by, we have recruited every health person we can to screen and test and diagnose with new chronic conditions treatable only by a newer medication sold by the company that helped characterize the "disease" in the first place.

Who writes this stuff?

Evidence Based Medicine

We like to give lip service to the term evidence based medicine as physicians. It's a hallmark of cutting-edge scientific, modern medicine. Not shooting in the dark with our recommendations, not rigidly following the dogma of the expert's experience, not hoping our theories work out but insisting on PROOF that we're doing more good than harm.

But it goes beyond that.

Evidence based medicine is a way of turning the age old recommendation and paternalistic guidance of the physician into teaching, empowerment. It's rather ironic that as medicine has grown more complicated, we're expecting more and more understanding from our patients. Now patients make decisions after weighing the ups and downs of a medication or test; before patients were compliant with instructions.

And we should praise evidence based medicine; look at what it has saved us from already:

Screening stress treadmill tests which caused more harm from evaluating all the false alarms with heart cath tests (the plastic tube through the groin artery test) than saved lives through early detection

Screening Chest Xrays for catching lung cancer early in smokers (found spots that didn't need to be found AND added radiation which is cancer causing to the smokey mixture in the lung tissue)

Screening CT scans for kidney cancers (found more spots that were never going to spread in the lifetime of the individual than caught and cured genuine deadly cancers)

Screening CT scans for lung cancer (found just as many "cancers" in nonsmokers as smokers, the overwhelming majority never to cause a single symptom)

We learn from our mistakes and abandon harmful practices all the time. But when it comes to screening mammograms, medicine as a culture holds on stubbornly no matter how high the pile of damning evidence grows.

And it's no wonder. To admit that we've done more harm than good with screening mammograms would be admitting that most of the women we labeled as breast cancer survivors were victims of unnecessary treatment. It would also be admitting that the benefits and harms were unclear at the onset of large scale screening in the 80s. Which is an admission that our collective experience with screening mammography has been a large failed experiment.

We live in a society that equates being wrong with failure; we practice medicine with the constant judgment of the "Standard of Care" hovering an inevitable lawsuit away and we devote our lives to curing , relieving suffering and advocating. We have a score card in our head and the evidence tells us that most of the cures, most of the victories were actually harms.

And eventually, admitting screening mammography was a failed experiment without proper consented draws out the conflicts of interest within the wealthy so called advocacy groups such as the American Cancer Society.

Which leads to organizations like DuPont and General Electric (the largest corporation on earth according to Forbes 2009). Companies who have either funded, created and or benefited from the positions and marketing prowess of the ACS.

But more importantly, rejection of screening mammography is a rejection of powerful forces who are hopelessly budgeted to the continuation and expansion of harmful, expensive procedures while minimizing true prevention and treatment.

The health of the largest corporation on earth hinges on screening for breast cancer?

Crazy world.

In other words, I have been wrong and for a decade participated in the promotion of harmful medical practices while gaining financially. I regret my negligence and will strive to prevent the same error from ever happening again as I openly explore what led to my errors.