Post cartoon sums up resistance to health reform

Check out this Tom Toles cartoon.

Breast cancer screening - more politics

Contrast the conciliatory tone of this editorial co-authored by Eric Winer, MD, Medical Director of the Susan G. Komen Breast Cancer Foundation with the gloom and doom expressed by Komen's president Nancy Brinker, as quoted in this op ed piece by Washington Post writer Dana Milbank.

Per Winer:

Fourth, we must be careful not to send a message that screening and early detection are of no value: there is no doubt that early detection of breast cancer can save lives. We are particularly concerned about the perceptions of women who are members of disadvantaged minority groups and those who lack education and health insurance. It would be lamentable if progress made in breast-cancer awareness were reversed as a result of this debate. Efforts to educate the public about breast cancer must be maintained and, in some areas, increased.

and Brinker:

The recommendations "have taken a tremendous toll, and I believe they set us back," Brinker told reporters at the National Press Club on Monday afternoon. "The women I have heard from, thousands and thousands and thousands, are justifiably outraged and worried and angry."

Oh, and here's a quote from a statement by Winer on Komen's website:

Susan G. Komen for the Cure wants to eliminate any impediments to regular mammography screening for women age 40 and older. While there is no question that mammograms save lives for women over 50 and women 40–49, there is enough uncertainty about the age at which mammography should begin and the frequency of screening that we would not want to see a change in policy for screening mammography at this time.

What do you think? Are the substance of what Winer and Brinker said similar enough that Winer will keep his job? (Note that Milbank himself is probably just as angry as Brinker, yet he claims he has no problem with the science, just in the way the recommendations were rolled out.) Does Winer's official Komen statement waffly enough to accommodate both his view of the uncertainty of the science and Komen's aggressive pro-screening stance? And will women reading the recommendations - or more importantly the docs who are recommending screening - really take home the message that mammography screening is useless?

I'd love to hear the behind-the-scenes discussions at Komen as they proceed.

Another new evidence blog...

this one from Michael Power, one of my colleagues from a great evidence-based-medicine listserv out of Oxford University.

New evidence blog

David Rind, an academic physician in Boston, has started a blog called Evidence in Medicine. Rind has a clear, persuasive, honest yet non-sanctimonious writing style. Here's hoping he doesn't get bored or overwhelmed too quickly with the task of keeping up a blog! So far he's covered vitamins, the perils of Pharma, and mammography.

And more recommendations for less screening...

This time from the American College of Obstetrics and Gynecology (ACOG), for later and less frequent cervical screening among young women. A number of people interviewed by the NYTimes once again don't seem to acknowledge that there might be harms from screening; in fact, one of the ACOG guideline authors points out quite a few harms, that she claims makes the case for limiting Pap smears more compelling than that for limiting mammography.

cervical cancer
screening
guidelines

New mammography recommendations from USPSTF

By now you've heard that the US Preventive Services Task Force has updated their recommendations on mammography this week. In fact, the recommendation for women 50-74 is the same as before (B recommendation). The Task Force now recommends against routine screening for women 40-49, and states that the evidence is insufficient either way for women 75 and over.

Gary Schwitzer's Health News Blog analyzes coverage by the three major network news outlets and found that it was light on evidence. And while waiting for a plane, I caught a glimpse of Florida Congresswoman Deborah Wasserman-Schulz commenting on CNN about the guidelines. The congresswoman earlier this year sponsored legislation, known as the EARLY act, to promote intensive screening and breast self exam training for young women. This legislation has been criticized by cancer experts. Wassermann-Schulz apparently doesn't see any possible downside to screening. In addition, in saying that the guidelines are "patronizing" and that women need more information not less, she apparently ignores the Task Force's statement that

The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.

breast cancer
screening
guidelines

Clear prescription drug labels that present risks and benefits

Hi folks, me again; no, I'm not dead yet!

Anyway, lest it get lost, this NYT Prescriptions blog describes an effort - now in Congress - to introduce charts (drug fact boxes) to drug labeling that present clinical benefit and side effects, side by side, in the form of understandable absolute risks. Seems so simple, but this information usually gets buried in drug-approval applications and doesn't make it into the labeling at all. And all you hear or read in direct-to=consumer drug advertising is rapid-fire or small-print, nonquantitative laundry lists of symptoms that have reported in drug studies, with no indication of whether such symptoms even differed between test and control groups, and they generally carry a legalistic, "FDA made us say this" tone. Sen. Barbara Mikulski (D-Maryland) drafted the legislation.

prescription drugs
drug labeling
FDA