Mammograms Only Occasionally Save Lives, Analysis Finds

AppId is over the quota
AppId is over the quota

Some doctors and public-health experts have stirred controversy in recent years by arguing that aggressive breast-cancer screening does more harm than good. Many health professionals disagree, but perhaps the most compelling critics of the less-is-more philosophy are the many breast cancer survivors who claim that a routine mammogram saved their lives.

These survivor anecdotes — which often turn up in the media — may be causing the public to overestimate the true value of mammograms, a new study suggests. In an analysis published this week in the Archives of Internal Medicine, researchers at Dartmouth estimate that only about 1 in 8 women whose breast cancer was identified during a routine mammogram actually owe their lives to the screening.

This estimate doesn't mean that women shouldn't bother to get mammograms, but it does suggest that overly frequent screening can result in overtreatment, the authors say. Many tumors identified during routine mammograms would have grown very slowly (if at all) and would never have threatened a woman's life, says Dr. H. Gilbert Welch, one of the coauthors of the analysis.

"A certain fraction of women are being treated for a disease that was never going to bother them," says Dr. Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, in Hanover, N.H.

LIST: 25 Breast Cancer Myths Busted

The U.S. Preventive Services Task Force (USPSTF), a government advisory panel that issues guidelines on cancer screening, recommends that women start having mammograms every other year when they turn 50, while women who have risk factors for breast cancer should talk with their doctor about starting screening earlier. (Prior to 2009, the panel recommended annual mammograms for all women beginning at age 40.) A large study published last week found that biennial screening resulted in fewer false alarms and unnecessary biopsies than annual screening.

The results of the new analysis should reassure women with average breast-cancer risk that it's safe to wait until age 50 — or later — to begin mammograms, Dr. Welch says. However, he adds, women who would prefer to undergo screening earlier or more frequently should do so if it will make them more comfortable. "It's generally a really close call, and how patients feel really matters," he says.

To investigate the value of mammography in terms of lives saved, Dr. Welch and his colleague, Brittney Frankel, used breast-cancer data from the National Cancer Institute and the Centers for Disease Control and Prevention to calculate a woman's likelihood of developing breast cancer over a 10-year period, the likelihood that the cancer would have been detected by mammography, and a woman's risk of dying from breast cancer over a 20-year period.

LIST: Simple Things That Could Cut Your Breast Cancer Risk

Using the relevant data for a hypothetical 50-year-old woman who received a breast cancer diagnosis following a routine mammogram, the researchers estimate that the probability that the mammogram will be responsible for saving her life is about 13%. And even that estimate may be high, they say: mammograms prevent fewer deaths today than they did 20 or 30 years ago (thanks to better treatment that has made early detection less crucial), so the actual probability could be as low as 3%.

"Women need to understand their trade-offs here," Dr. Welch says. "The reason to be screened isn't because you've heard a lot of survivor stories. Some of those women have not benefited [from screening]."

Dr. Timothy Wilt, a researcher at the Minneapolis Veterans Affairs Center who specializes in chronic disease outcomes, says that breast-cancer diagnosis and treatment can even be harmful in some cases. Radiation treatment, for instance, can cause disfigurement, accelerate blockage of arteries in the heart, and increase the risk of secondary cancers, he says.

LIST: How to Help a Loved One Cope With Breast Cancer

"Looking harder and treating more doesn't always help people live longer and live better," says Dr. Wilt, who coauthored an editorial accompanying the study and is a member of the USPSTF. The push toward less screening "is not about rationing care," he adds. "It's about making good health care decisions to help patients live better and live longer."

Dr. Laura Esserman, the director of the breast care center at the University of California, San Francisco, says that doctors and women should shift their focus away from breast-cancer screening and toward prevention. For instance, Esserman says, women can reduce their risk of breast cancer by maintaining a healthy weight, exercising regularly, and minimizing their alcohol consumption.

"Mammography has some value," she says, "but I think it's pretty clear that the public has overvalued it and a lot of people who push it have overvalued it."

News

Debt Financing

Read More

Analysis: The debate over closing child heart surgery units

AppId is over the quota
AppId is over the quota
27 September 2011 Last updated at 11:17 GMT By Jane Hughes Health correspondent, BBC News Nicolas Tompkins had surgery at 2.5 weeks Nicolas Tompkins' parents believe he wouldn't be with them if it wasn't for the doctors and nurses at the Royal Brompton Hospital in central London.

At just four weeks old, he's recovering from a 15-hour operation to correct a complicated and rare defect in his heart.

Surgeons effectively had to re-wire it, after discovering that his lungs weren't properly connected, and he wasn't getting enough oxygen.

He was lucky to be treated by a world expert in his condition.

His parents are incredulous at the thought that the team which saved his life could be about to be broken up.

"Everybody we meet here, every doctor, every nurse, is clearly at the top of their game," said his father, Andrew Tompkins. "There's nowhere like this in the world. How could they want to close it?"

Continue reading the main story

If we get centres of excellence, we can save money and still get better care”

End Quote Mike Farrar NHS Confederation Chief Executive The reason is that children's heart surgery across England is being reorganised. And, as one of three hospitals in London carrying out this kind of specialised paediatric treatment, the Royal Brompton was told it would have to scale down its children's heart unit and stop doing all operations.

Other units in Leeds, Southampton, Newcastle and Leicester are still waiting for a decision as to whether they will also stop doing operations. Ultimately, at least four will close across England.

The review does not affect patients in Scotland, who are all treated in Glasgow. Welsh patients are treated in England, while patients in Northern Ireland travel to Dublin for treatment.

Bristol scandal

The review of children's heart surgery came about as a result of the inquiry into the Bristol heart babies scandal in the 1990s, when a number of babies died needlessly during operations by surgeons with insufficient experience. It concluded that children would get better, safer care if there were fewer, larger, more specialised units.

"We know the best results can only be achieved by surgeons and units treating a lot of patients," said Professor Norman Williams, President of the Royal College of Surgeons. "And we also know that patients benefit from units with enough surgeons to give a round-the-clock service."

Yet, as the Royal Brompton's experience shows, reorganising services is not straightforward.

Without cardiac patients, it says its paediatric intensive care unit would no longer be viable. And without intensive care, it would no longer be able to offer its specialist children's lung services - treating children with cystic fibrosis and other conditions. It says its respiratory unit is second to none in the country, and many, many patients will lose out.

And so one part of the NHS is going head-to-head against another in the High Court. Watching around the country are not just the other units under threat, but NHS hospital trusts which know they must reorganise other hospital services to remain viable and provide the best possible patient care.

Tough challenge

The NHS Confederation has said the reconfiguration process will become increasingly necessary; not just because of a tougher financial climate, but also to improve care.

"At the moment, we're not getting the best outcomes we can because some services are distributed across too many sites," said NHS Confederation Chief Executive, Mike Farrar. "If we get centres of excellence, we can save money and still get better care."

Reorganising services is one of the hardest things the health service has to do, said Chris Ham, head of the health thinktank, the Kings Fund.

"But it is absolutely necessary at the present time," he said. "Not first and foremost because of the financial pressures but because we will only deliver world class standards of care if we grasp this nettle and take decisions that are long overdue by concentrating some of those services in fewer hospitals."

The fight over the future of the Royal Brompton may well be one of many more to come.

View the original article here

Peliculas Online

Read More

Analysis: States lobby against Medicaid cuts in Congress

AppId is over the quota
AppId is over the quota
By David Morgan

WASHINGTON | Thu Sep 29, 2011 5:18am EDT

WASHINGTON (Reuters) - With billions of dollars in Medicaid spending at risk in Congress, states are forming a loose confederacy to oppose any federal cuts that could damage state budgets already awash in red ink.

The "red" and "blue" states that mark America's political divide between conservative and liberal sympathies are often far apart on issues involving healthcare, including Medicaid, the $420 billion-a-year program for the poor.

But lobbyists say governors, legislators and other state officials, Republican and Democrat alike, have found common ground in a push to convince a special congressional deficit panel that White House-backed Medicaid cuts totaling $41 billion will only weaken a system that already struggles to deliver care to 60 million beneficiaries.

The 12-member bipartisan panel, dubbed the "super committee" because of its powers, is tasked with finding $1.2 trillion in savings to cut huge U.S. deficits. The full Congress is due to vote on their recommendations by late December.

State officials appear most unified on an alternative cost-cutting strategy, which they say could save more than $100 billion by changing the healthcare delivery system for the poorest, sickest and most costly patients. Known as "dual-eligibles," they qualify for both Medicaid and Medicare, the government-run program for the elderly.

There are about 9 million dual-eligibles and state officials see billions of dollars in savings from shifting them into managed care plans better able to eliminate unnecessary doctor's visits, tests and hospital admissions.

"Support for that proposition is very broad," Maryland Governor Martin O'Malley, who chairs the Democratic Governors Association, told Reuters.

States also hope the super committee will adopt proposals to control Medicaid prescription drug costs, combat waste and fraud, and relax federal restrictions on benefits and eligibility, lobbyists said.

HEAD IN THE SAND

The current lobbying effort is expected to reach critical mass in October, when Democratic and Republican governors are due in Washington for separate initiatives that include private meetings with super committee members.

Medicaid and Medicare are central to the deficit debate between Republicans in Congress and President Barack Obama, who has vowed to veto any bill that would require sacrifices from the old and frail while allowing the wealthy to avoid taxes.

Medicaid is also key to the success of the 2010 U.S. health reform law, the centerpiece of Obama's domestic policy agenda, which calls for coverage to be extended to 16 million uninsured Americans who currently do not qualify as beneficiaries.

States, healthcare providers and beneficiaries lobbied successfully last summer to spare Medicaid from automatic cuts that would be imposed if the super committee failed to reach agreement by November 23.

This time, states may be less unified on larger questions about the future of Medicaid because of partisan differences including a Republican push to repeal Obama's health reforms and convert Medicaid into a block grant program with few federal rules, both of which Democrats oppose.

But they are not only pushing back against potential cuts.

"That's a head-in-the-sand approach. But there are ways to look at Medicaid changes -- some of which would be helpful and some of which would make the problem worse," said Matt Salo of the National Association of Medicaid Directors.

States are out of step with healthcare industry and consumer groups who hope the super committee will deadlock. A deadlock would trigger spending cuts that would spare Medicaid and impose only modest reductions on Medicare.

States oppose the triggers because they would cut up to $35 billion from discretionary federal grants for education, public health and other programs, according to Federal Funds Information for States, a Washington research group sponsored by governors and state legislatures.

FISCAL ALBATROSS

The sprawling Medicaid program, funded jointly by federal and state governments, is a fiscal albatross for many states still struggling with recession-induced deficits. Persistent joblessness is swelling the ranks of the needy and tax increases remain politically unfeasible.

U.S. states ended their last fiscal year on June 30 with an aggregate deficit of about $100 billion, with Medicaid accounting for nearly one-quarter of their spending, according to the Center for Budget Policy and Priorities, a Washington think tank.

State officials complain Medicaid is a problem because federal mandates make it hard for governors and lawmakers to address costs by adjusting benefits and eligibility.

At issue in Congress are two proposals that Obama forwarded to the super committee last week. One would force a $15 billion reduction in federal Medicaid contributions to states by altering the formula used to set Washington's matching rate.

The second would curtail states' ability to raise money through taxes on Medicaid providers, a key source of revenue for state contributions. That measure would cost states $26 billion, and has already drawn criticism.

Healthcare lobbyists believe Republicans on the panel have a strong political incentive to embrace the proposals because they call for reductions in entitlement spending and carry a Democratic president's endorsement.

"Every state is in agreement that if all the federal government does to reduce its deficit is push costs and mandates onto the states ... it's really a nonstarter," said Tony Keck, director of Health and Human Services in South Carolina, a state at the forefront of opposition to Obama's health policies.

Advocacy groups that represent Medicaid beneficiaries also oppose federal funding cuts. But with many states already cutting back on Medicaid, they warn that managed care plans for dual-eligibles and added flexibility for state governments could endanger the quality and breadth of care on which some of America's most vulnerable citizens depend.

(Editing by Todd Eastham)

View the original article here

Peliculas Online

Read More

Analysis: Bachmann vaccine comments toxic, doctors say

AppId is over the quota
AppId is over the quota

Rep. Michele Bachmann participates in the CNN/Tea Party Republican presidential candidates debate in Tampa, Florida, September 12, 2011.

Credit: Reuters/Scott Audette

By Julie Steenhuysen

CHICAGO | Thu Sep 15, 2011 5:38pm EDT

CHICAGO (Reuters) - No matter how much the U.S. medical community repudiates the suggestion by presidential candidate Michele Bachmann that a vaccine for human papillomavirus (HPV) is dangerous, doctors fear the damage has already been done.

Physicians are bracing for more parents to refuse the HPV vaccine, which protects against the most common cause of cervical cancer, for their daughters.

They say the comments by the Republican candidate will only stoke growing and unfounded fears about a whole class of common immunizations needed to fight disease.

"There are people out there who, because of this kind of misinformation, aren't going to get their daughter immunized," said Dr. Kenneth Alexander, a pediatric infectious disease expert at the University of Chicago Medical Center.

"As a result, there will be more people who die from cervical cancer," Alexander said in a telephone interview.

Dr. Mary Anne Jackson, an infectious disease expert at Children's Mercy Hospital & Clinics in Kansas City, Missouri, said doctors are already struggling to convince parents to immunize girls against HPV, a sexually transmitted virus.

"There will be repercussions of this comment that will directly impact every provider who takes care of adolescents and young women," Jackson said in a telephone interview.

Bachmann first raised the issue during a Republican presidential debate on Monday as a swipe at Republican rival and Texas Governor Rick Perry, who issued an executive order in 2007 mandating girls get the HPV vaccine as part of a school immunization requirement. The order was later overturned.

In that forum, she questioned the state's authority to force "innocent little 12-year-old girls" to have a "government injection" that was "potentially dangerous."

The following day, she told NBC's "Today" show the story of a woman from Tampa, Florida, who approached her after the debate and said her daughter became "mentally retarded" after getting the Gardasil vaccine made by Merck.

Physician groups including the American Academy of Pediatrics (AAP) rushed out statements defending the safety of Merck's vaccine and Cervarix made by GlaxoSmithKline, whose most common side effects include a sore arm, a rash and fever.

As a measure of their incredulity over Bachmann's comments, two bioethicists are offering rewards, one of more than $10,000, if she can bring forward the child who suffered irreparable damage.

'THE INTERNET, AND INNUENDO'

The AAP says there is absolutely no scientific validity to Bachmann's statement that the HPV vaccine is potentially dangerous.

"Since the vaccine has been introduced (in 2006), more than 35 million doses have been administered, and it has an excellent safety record," Dr. O. Marion Burton, president of the American Academy of Pediatrics, said in a statement.

But no amount of proof will suffice for some families, who fear that even a small percentage of children may be harmed.

"I recently had a mother who had cervical cancer who refused the HPV vaccine for her child," Jackson said. "I asked her where she got her information and she said, 'the Internet, and innuendo.'"

That may help explain the slow uptake of the HPV vaccine. According to the Centers for Disease Control and Prevention, only 32 percent of adolescent girls last year had gotten all three shots of the HPV vaccine.

"We've got 12,000 women a year in this country getting cervical cancer. The vaccine could prevent about 70 percent of that," Alexander said.

Vaccine fears have already fueled recent outbreaks of measles, mumps and whooping cough, according to the CDC.

Much of the fear stemmed from a study by Dr. Andrew Wakefield, the now-disgraced British doctor who researchers believe falsified data for a 1998 study which convinced thousands of parents that vaccines are dangerous.

Concerns that vaccines might cause autism have not only caused parents to skip vaccinating their children, but also forced costly reformulations of many vaccines.

Bachmann's suggestion that the HPV vaccine may be linked with "mental retardation" only feeds into those fears.

"What is especially disturbing is you've got organizations like the American Academy of Pediatrics, the Advisory Committee on Immunization Practices, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists -- every learned medical organization in the country and indeed around the world -- in favor of immunization," Alexander of the University of Chicago said.

Jackson said when presented with information about the HPV vaccine, about 85 percent of families decide to have their child vaccinated, about 12 percent are hesitant, and the rest are "flat-out refusers."

It's the families in that 12 percent she is worried about.

"It's not going to impact the flat-out refusers. I worry it is going to impact this group of vaccine-hesitant families."

(Editing by Michele Gershberg and Xavier Briand)

View the original article here

Peliculas Online

Read More

HEALTH MANAGEMENT. Analysis: Forecast bad for UN chronic disease meeting

LONDON (Reuters) - ten years to commit to the fight against AIDS, the United Nations takes on an even bigger pile of Mörder--common chronic ailments-in what design is up for a bruising battle between big business, Western Governments and the world's poor.
Tobacco, food and drink companies are in the firing line for peddling products, accused in connection with cancer, diabetes and heart disease while politicians in the rich world, in the absence of a fixed goals or means the appropriate against provide.
"This is an opportunity generation." Rebecca Perl the World Lung Foundation (WLF) we have millions of life here, and it said is a disgraceful and immoral could save that industry lobbying short-term profits to a public health disaster has put, "told of Reuters." WLF participates in irritable preliminary talks for several months.
The fear is that the large company has successfully lobbying rich Governments only half-heartedly in non-communicable diseases or NCDs, fight despite predictions that they paralyze the health systems of developing countries could be.
A bit a short-term financial requires such as climate change, prevention and treatment of non-communicable diseases affluent Nations and multinational companies hours to prevent that overwhelmed poor countries in the future.
Fears grow in these strict times already, that a high-level UN Conference in New York on September 19-20-only the second in the Centre of the disease after an AIDS in the year 2001-could be a flop.
The collection includes scores of delegates of the UN Member States, including about 20 head of Government as well as representatives of the public health groups, non-governmental organizations, the private sector and science.
After a draft of political declaration, that are the foundation of the United Nations think many platitudes but few concrete commitments on NCDs contains close to the negotiations.
Ann Keeling, Chairman of the NCD Alliance, which groups of 2,000 health organizations from which all over the world, said "There is no strong and temporally fixed commitments there," the news agency of Reuters. "It's a big disappointment from this point of view."
NOT ROCKET SCIENCE
The extent of the problem is immense. Some 36 million people die each year from NCDs--about 80% of them in poor countries where prevention programmes are virtually non-existent, and access to diagnosis and treatment is extremely limited.
As a result, death of NCDs are almost twice as high in poor countries as in the industrialized world.
Prevent that outrun this Todesfälle-- or at least a good part - is not rocket. A simple improvement enables proven measures such as the reduction of smoking, diet, drugs available and promote the use could tap a huge hole in this number.
"It is a common history, the cancer, cardiovascular, diabetes and respiratory medicine to tobacco, alcohol, diet and General-links and that's where we have the most cost-effective impact", says David Kerr, President of the European society for medical oncology.
The key points are money, goals and control.
Complete a billion people from lighting, or to prevent every day cheap medications such as aspirin and Statins, heart attacks and strokes may be less expensive, but the repayment does not quickly and it is unlikely that many votes to win.
"The time horizon for return on investment is very long and many political horizon." So it is difficult to require people to this kind of resources, ", says Gordon Tomaselli, President of the American Heart Association."
The NCD Alliance says spending $9 billion a year on tobacco control, food risks would advice and treatment for people with heart avert millions of premature deaths in this decade.
That's a lot? Compared to care for HIV patients in developing countries already costs by 13 billion per year.
In contrast to combat AIDS, which UN focus was ten years ago, the price of drugs of less is a problem here, as many as cheap generic drugs are available, although there are disputes about the costs for some more products expensive such as insulin.
STUBBING FROM TOBACCO
The sharpest concentrated themselves this time on fatty foods, sugary drinks and--in allem-- the tobacco industry, the World Health Organization Director General Margaret Chan was described as "an industry that has lots of money and no scruples, for use in the insidious as possible."
With tobacco, if the development however, that public health lobby says nothing else does the UN session, it should be predicted to kill more than one billion people of this century at least a smoke-free world of one of its central objectives.
Smoke alone causes one of three cases of pulmonary diseases, one of four cases of cancer and in 10 cases of heart disease, says Perl. "So what a bang, get for your money there, to look for."
Conflicts Governments find it hard. Japan tobacco is of, for example, 50 percent owned by the Japanese Government, and the massive profits U.S. cigarette to strengthen the US economy manufacturers.
China, the world's male smokers, the combination of taxes and sale of China national tobacco houses a third-all State Office-account for about 9 percent of annual tax revenue of the Government.
This is one reason more, according to Paul Lincoln of UK National Heart Forum and Jaakko Tuomilehto, an epidemiologist at the University of Helsinki, hiking tobacco taxes, advertising to put the brakes and insist on health warnings graphic.
"There are no excuses," Lincoln said. "We have the know-how." "The challenge for public health as ever and ever is to overcome the ideological and vested interests."
Tuomilehto is more stump: "it is a crazy thing to have a product in the shops, the every second consumer-it kills is madness."

Read More