Jama January 13th 2010

About half of the total pages in this episode of the Journal of the American Medical Association is taken up with discussions about the most recent screening mammogram recommendations from the US Preventive Task Force and the media and political controversy that followed.  

It's refreshing to see that JAMA is attempting to cut through the political drama and misinformation, commonly referred to as "spin", and get down to the actual risks and benefits of screening for breast cancer with mammography.  They actually point out that the real harms from screening mammography don't come from the false positives but from all the unnecessary diagnosis.  In one article they have a tiny table of the benefits of this screening test followed by the harms.   

If you can get your hands on this Jama edition,  take a look.  If you want to borrow mine,  drop me an email doctorcrafts@yahoo.com

They even mention the senate getting involved much like they did in 1997 but this time instead of passing a non-binding resolution supporting screening mammography,  they passed an amendment to the so called health care reform bill forcing insurance companies to pay for screening tests.  This reportedly includes testing for ovarian and lung cancer which are even more fraught with harms of unnecessary diagnosis, surgery chemo etc.  

All this press coverage and medical journal coverage will at the very least prompt more thorough discussions in exam rooms all over the country as women again decide whether it is in their best interest to under this screening test this year.  At the same time large institutions and hospitals are budgeting for an increase in revenue from their mammography centers.  It is easy to see how this seemingly routine decision affects the health care industry's bottom line.  This effect is magnified during a recession.  

Is more information helpful or harmful to the bottom line of these institutions?  

Do the interests of the average patient overlap with the financial interests of these institutions who respond to these so called controversies with more advertising?  

With the swine flu mirage and with screening mammography we can clearly see the political apparatus align itself with the medical industrial giants.  Based on the number of patients who chose not to accept the swine flu vaccine,   it is obvious that credibility is slipping. 

It will be interesting to see the rates of screening mammography for 2010 to judge whether the best efforts of industry and government will continue to prop up a harmful, expensive practices.  

Never a dull moment.  

Local Swine Flu News

The numbers nationwide have dropped to next to nothing. Yet the CDC announces the death toll increased 10 fold based on new ways of estimating. The vaccine hasn't been used widely in this area because of the shortages, and the protective effects take 2-4 weeks to materialize. The reason the numbers are dropping is because EVERYONE had the infection. Ok not everyone; but close enough to make it very difficult for the swine flu to spread. But the bottom line message repeated in most of the news casts still is "the most important thing you can do is get vaccinated". Get vaccinated even though one third or more of the population has already been infected? Get vaccinated even though there's no evidence that it prevents infection much less saves lives? Get vaccinated with an accepted risk of adverse reactions on the order of 1 per 100,000 doses?

Why wouldn't the people creating the news ask these experts with the CDC "why did your numbers shift so wildly?" or "why are we seeing decreases in disease rates despite the vaccine not being available?"

"why do 30%-50% of medical professionals still refuse the vaccination?"

Don't they like drama? Doesn't controversy cause ratings to spike?





http://www.kimatv.com/news/local/79595382.html


YAKIMA COUNTY --- Flu numbers are already going down. But experts still warn you; be cautious.

In Yakima County, the number of flu cases dropped from 31% in September and October to only 4% in the first week in December. The numbers count both H1N1 and the Seasonal Flu. While the Yakima Health District calls the numbers promising, they still urge caution. Jessica Brown is with the Yakima Health District.

"Both with H1N1 and the seasonal flu, we encourage people to get vaccinated as soon as they can. With the seasonal flu, we yearly don't see it peak until at least January, sometimes into February or even March."

The Health District thinks vaccines and hand washing have played a big role in bringing the flu numbers down.

Swine Flu Peaks?

http://www.msnbc.msn.com/id/34066494/ns/health-cold_and_flu/


But somehow it's STILL important to get your vaccine and take Tamiflu. I want a big scoreboard of the 200 million doses the government ordered for the US that ticks down as the vaccines are actually delivered to clinics and pharmacies. So we can see how many are left over and ask for our money back.

Even better let's see a running total of vaccines actually administered to people.

Great use of health care resources "leaders".

While I'm at it wishing for stuff, I also want to see a total of the profits generated from the sales of Tamiflu and vaccinations.

OK go ahead and include the money wasted on advertising the "pandemic".

Notice how the mutations in H1N1 variety of flu virus occur so consistently with Tamiflu? Yeah H1N1 is really good at mutating into a Tamiflu resistant form. So when the worry was "if swine flu mutates it could be more deadly" why would we promote the use of Tamiflu so widely? So widely that the company ramped up production so high that they surpassed their total production adding up the past 9 years? Yeah the company that makes Tamiflu is making more Tamiflu this year than they have in all of Tamifu history.

A drug without proven benefit other than decreasing the natural course of some flu strains a day.

Well at least the swine flu is decreasing before seasonal flu hits but you wait when seasonal flu hits. We'll hear something like "we can't tell if this is yet another wave of more severe swine flu!"

Who writes this stuff?

Creative Piggy Flu Profits

http://abcnews.go.com/m/screen?id=9115918


Talks about pharmacies jacking up prices on Tamiflu for children. Mentions that there are 2.2 million children without health insurance. I wonder how many families had to sacrifice some other purchase to cover the cost of this worthless medicine.

The Associated Press on the new recommendations re screening mammograms

http://news.yahoo.com/s/ap/20091116/ap_on_he_me/us_med_mammogram_advice

It's interesting how the potential harms listed talk about unnecessary biopsies and other false alarms but in my mind it would be much more harmful to be diagnosed with breast cancer unnecessarily.  As stated earlier in this blog,  the best estimate we have state that for every one woman saved by a screening mammogram 10 women are diagnosed with a cancer they didn't need to know was there.   

What exactly do we mean by an "unnecessary diagnosis":

A cancer that would resolve on its own or a "pre-cancer" called DCIS that would resolve on its own or a cancer that was so slow growing that it would never grow large enough to affect the person's life or health or even become clinically apparent.  

So for every woman who has her life saved from screening mammography,  there are 10 women walking around who think of themselves as breast cancer survivors.  They spend the rest of their lives following strict follow up with oncologists and surgeons and getting yearly mammograms waiting for the cancer to "come back".   Most of them underwent surgery, radiation and sometimes chemo to treat their "early cancer".  

The magnitude of harm done over 30 years by screening mammograms will have to be admitted at some point in these disclosures and discussions.  

Interesting also how the title of the article is "new advice".  And throughout the article there's this impression that women between the ages of 40 and 50 are somehow not worth all those resources mammograms represent.  What they don't say is screening mammograms HARM HEALTHY WOMEN.  

The radiology organizations fought successfully to reverse a report by the national cancer institute in 1997 when the NCI's expert panel suggested that there was no proof mammograms between the age of 40 and 50 did more good than harm.  

We'll see if there's a similar backlash this time.  

the US Preventive Task Force Changes Mammogram Recommendations!

http://www.nytimes.com/2009/11/17/health/17cancer.html

The new recommendations reverse longstanding guidelines and are aimed at reducing harm from overtreatment, the group says. It also says women age 50 to 74 should have mammogramsless frequently — every two years, rather than every year. And it said doctors should stop teaching women to examine their breasts on a regular basis.

Just seven years ago, the same group, the United States Preventive Services Task Force, with different members, recommended that women have mammograms every one to two years starting at age 40. It found too little evidence to take a stand on breast self-examinations.

While many women do not think a screening test can be harmful, medical experts say the risks are real. They include unnecessary tests, like biopsies that can create extreme anxiety. And mammograms can find cancers that are better off not found. Some cancers grow so slowly that they never would be noticed in a woman’s lifetime. When they are found, women end up being treated unnecessarily.

This is huge!   The US Preventative Task Force has a lot of impact on what screening tests get done and what doesn't.  After nearly 30 years of recommending a test that does more harm than good,  it's starting to look like there's going to be some recognition and improvement.  This will result in an immediate drop in the number of women needlessly diagnosed with breast cancers that posed no risk to their health.  It will cut the needless anxiety from a false alarm dramatically as well.  

All you hospitals out there that budgeted to make more money on screening mammograms next year compared to this year,  you might want to redo the budget. 

Just sayin'

Thanksgiving

FYI

I'm going to be out of town for the week of Thanksgiving

Will still be checking emails but probably not as often 

Won't be around for house calls,  so no one get sick that week.