Nurse Ratched’s Place

26 Responses to “Pink Research: Undercutting Women’s Health”

1. 

   tamara
   November 23rd, 2009 at 3:56 pm

   Are you kidding, I’m still trying to get them to acknowledge that men get breast cancer.
   ANY CLOSE RELATIVES DIAGNOSED?

   brother

   Tech.: WE MEANT BREAST CANCER.

   Self: Yep, lump, inversion, mammogram, radical mascectomy, chemo, and radiation. That counts, right?

   So glad I’m a nurse and can completely respect the medical profession. Sarcasm aside, He had fantastic Doctors who ignored nothing.

   tamara

2. 

   Marjorie
   November 23rd, 2009 at 7:01 pm

   I heard the same announcement on NPR. It doesn’t make much sense. I had my baseline mammogram at age 35 because 3 of my dad’s sisters had breast cancer. The experience was really not that bad in the whole scheme of things. Your breast get smushed for a few seconds and then it’s over. I’d have more anxiety over having to getting any kind of injection (like vaccinations). Yikes!

3. 

   Andrea
   November 23rd, 2009 at 11:43 pm

   Isn’t it funny they wait till November to publish all this? What would have happened had they made this announcement during October, Breast Cancer Awareness Month?

4. 

   Drugmonkey
   November 23rd, 2009 at 11:53 pm

   MJ,

   Your prostate wish is comin’ true. From cancer.org:

   “Interim results from a study done in the United States found that annual screening with PSA and DRE detected more prostate cancers, but it did not lower the death rate from prostate cancer. A European study did find a lower risk of death from prostate cancer with PSA screening (done about once every 4 years), but the researchers estimated that about 1,400 men would need to be screened (and 48 treated) in order to prevent one death from prostate cancer. Neither of these studies has shown that PSA screening helps men live longer (lowered the overall death rate).”

   And as far as the patronization?

   “Neither the PSA test nor the DRE is 100% accurate. Abnormal results of these tests don’t always mean that cancer is present, and normal results don’t always mean that there is no cancer. Uncertain or false test results could cause confusion and anxiety.”

   We’ve come a long way baby…..:)

5. 

   #1 Dinosaur
   November 24th, 2009 at 6:43 am

   Anyone feel like reading the actual guidelines instead of just listening to a well-intentioned but idiotically oversimplified version on NPR before going off like half-cocked idiots?

   Did it occur to anyone that the previous guidelines — recommending routine mammography from age 40 — was overkill based on the data (ie, showing NO mortality benefit, anecdotes ad nauseum aside) and was politically driven by people receiving donations from huge companies like GE who make tons of money from selling, like, MAMMOGRAPHY EQUIPMENT!

   And what about women in their 30′s? Lots of them are getting breast cancer too, but no one seems to be interested in screening them. Many cancers now are rapidly growing tumors that crop up between annual screenings, so perhaps we need to do mammography every six months. No, wait; how about quarterly? What the hell: monthly mammography from age 18. That ought to do it. Oh, wait: wasn’t there a 10-year-old diagnosed? Shucks.

   We could save lots of lives by lowering the speed limit to 45 and raising the driving age to 25. Why can’t people understand the concept of risks and benefits? Read the actual guidelines. They’re finely nuanced, specifically stating that women in their 40′s should discuss screening mammography with their doctors to make decisions based on their values.

   /rant

6. 

   Mother Jones, RN
   November 24th, 2009 at 8:34 am

   Sorry Dino. I still want to know who paid for the study. Don’t believe everything at face value. Question authority. BTW, I’m not the only one who is questioning this study. The American Cancer Society is raising some eyebrows over this one, too.

7. 

   Mother Jones, RN
   November 24th, 2009 at 8:42 am

   Drug Monkey, thanks for bring that study to my attention. Now you don’t have to worry about all those bad test results because we just won’t draw blood anymore. And who likes big bad needles anyway? Now, isn’t that’s better? Good grief!

8. 

   Katie
   November 24th, 2009 at 7:17 pm

   “Question authority” is well and good, but this is a ludicrous oversimplification of the entire issue of screening and preventative health and makes it sound like you’ve been paying no attention whatsoever. We do too much prostate cancer screening, almost unquestionably. The tests aren’t sensitive enough or specific enough, they can miss aggressive and potential lethal cancers and they can detect indolent cancers that would never cause morbidity before the patient’s death of something else. If you want “a group advocating that we do fewer prostate exams” you could start with the CDC. (This took me literally about four seconds of google-fu.)

   And why, you might ask, should we be concerned that screening for prostate cancer may be currently excessive? For basically the same reasons as we should be concerned that screening for breast cancer may be currently excessive. The anxiety of a possible cancer diagnosis from a non-specific test is a real cost. The risk of unnecessary biopsies and possibly unnecessary further interventions is a real cost–economic and human.

   Your reaction to criticism of your argument is “Question authority”. In that context, I find it stunning that you not only apparently refuse to question the original authority that created the original screening recommendations, but are apparently enraged that anyone else questioned it.

9. 

   danielle
   November 24th, 2009 at 7:48 pm

   I have mixed opinion about this. I know other countries have been a bit more conservative than the US and were recommending every other year when US was recommending every year…..it also makes me wonder if the recommendations are because of the Universal Health Care they are trying to get passed and that would be one other way to save money (altho I am sure they will still pay for men’s ED drugs).

10. 

    Mother Jones, RN
    November 24th, 2009 at 10:13 pm

    Katie: The only rage I hear in this conversation is coming from you. Since when did it become a crime to ask blunt questions about research results? Let’s talk about the FDA. Do you remember what happened when they swallowed profit driven research information from the pharmaceutical industry? Things got ugly didn’t it. I ask again, who sponsored the study and what are the motives behind the data?

11. 

    Katie B
    November 25th, 2009 at 9:29 am

    The screening guidelines are an evidence based review by the United States Preventative Services Task Force, an independent advisory panel of doctors, nurses and medical researchers commissioned by the Bush administration to work on an infantile comparative effectiveness research project. They examined the available evidence, and gave their opinions. It was not a new research study. But your suspicions are somewhat correct about the bias of the findings, in that the American College of Radiologists, who have a huge financial stake in lots of people receiving radioactive testing like mammograms, are decrying the recommendations.

    This is evidence-based practice at work. This is telling us that all women, regardless of risk factor, do not need a yearly mammogram beginning at age 40, because there is insufficient evidence to support that. If you are at high-risk, or there is a suspicious finding by you or a provider, then a mammogram is necessary. That’s what they’re saying. It’s what, to them, the evidence shows.

    We need to come to grips to accept that evidence based practice is not going to be always as easy and black and white as we want it to be. It’s also going to be important to use this publicity problem with the USPSTF to teach us that more robust comparative effectiveness research – those that compare treatments, testing, and delivery models – to find what are the most cost effective and high quality health care services.

12. 

    Aftercancer
    November 25th, 2009 at 10:52 am

    I am 42 years old and a 3 1/2 year breast cancer survivor. I had no “family history” but I would up with mastectomy, chemo (x12) radiation and now Femara. Let me tell you something. The day we have women dying from anxiety I’ll agree with this crap but in the meantime ladies do your self exams and advocate for your own health.

    I found it fascinating that the physicians involved in the guidelines were SHOCKED by the negative response and never intended for this information to do anything other than “open the communication between women and their doctors”. One of the reasons that the response to this was a huge and vocal as it was is that more than 20 percent of the breast cancer diagnoses in the U.S. are in women under age 49.

    If I have to choose between anxiety and cancer, I’ll always choose anxiety.

13. 

    Lady Patient
    November 29th, 2009 at 2:26 am

    Here’s the site that lists who the task force members are. 2 are affiliated with the health insurance industry.

    http://www.ahrq.gov/clinic/USpstfab.htm#Members

    This quote speaks volumes:

    “Most of the member companies of American Health Insurance Plans, an association of more than 1,300 health insurance providers, look to the task force as the standard, said Susan Pisano, spokesperson for the insurance group.”

14. 

    Steve
    November 29th, 2009 at 12:49 pm

    All this stuff about NOT testing vs real world results is just a smokescreen. What’s the real issue here?
    The issue is somebody wants to ration your healthcare. Somebody doesn’t want to have all of the “preventative” tests done because it COSTS money. Whether its obama or the “evil” health insurance companies; somebody is watching out for their bottome line.
    I personally would like my wife and daughter get the test done. And I sure as heck would like a PSA done. Now if the tests came back negative, then shazam!, we would go on living. If the tests are positive, WE would like to stratagize with OUR doctor.
    These studies are preconditioning you to accept less then expert/quality care.

    Steve

15. 

    Caroline
    November 30th, 2009 at 4:10 pm

    I work on a non-profit project called SpeakHealth.org, and we had a guest blogger Dr. Margret Chesney (NIH, Uni of MD Center for Integrative Health) write about the mammogram kafuffel. I was right with you until I read her post.

    The USPSTF report was totally misconstrued by the media, but the actual report itself is pro-womens health: “The real-world effect of this is the removal a one-size-fits-all recommendation in favor of one determined by a woman and her physician.”

    Here is the whole thing: http://speakhealth.org/lets-talk-about-the-recent-mammogram-recomendation/

    Does it ring true? Let us know. I’m of the opinion that the science people should have known where the media was going to take that report, and they really could not have chosen a worse time to try to raise the very important issue of dr.-pt relationship and patient-centered care. I mean, in this atmosphere of health care reform, a more PR savvy approach was called for.

    ~c

16. 

    Mother Jones, RN
    November 30th, 2009 at 6:24 pm

    I take a very jaded view of these findings because of my experiences as a nurse in our profit driven health care system. My experience is not unique and I think that’s part of the reason for the media backlash. Health care providers are speaking out and the press is listening.

    I don’t doubt Dr. Chesney’s sincerity when she talks about the study. She has stellar credentials, but I wonder what data she is reading and who put it together.

17. 

    #1 Dinosaur
    November 30th, 2009 at 7:21 pm

    Whoa!! What the hell does your “experiences as a nurse in our profit driven health care system” have to do with understanding reams of complex statistical epidemiological analysis? Not much. It’s like patients refusing to do what you, the nurse, tell them to do, because “I know my body.” Yeah, they do; but they don’t know anatomy, physiology, or why it’s important to get their ass up out of bed, or ambulate, or cooperate with all your other nursing interventions. Likewise, you don’t know dick about the epidemiology involved; not even as much as Maggie Mahar, and her degree isn’t even medical.

    Granted the timing of these recommendations was problematic, but posts like this are much more part of the problem than the solution.

18. 

    Mother Jones, RN
    November 30th, 2009 at 7:45 pm

    Tsk, tsk, Dino. Watch your tone. Your hubris is overwhelming. I know that I’m “just a nurse,” Doctor, but I’ve seen facts turn into fallacy too many times for the sake of money. If you enjoy reading studies, which apparently you do, pick one about bad research projects. Truly, research can be all about the money.

19. 

    #1 Dinosaur
    November 30th, 2009 at 9:16 pm

    You mistake my meaning. I have a tremendous respect for what nurses do, but analyzing statistics is not it. Clinical nursing practice (and clinical primary care, for that matter) has surprisingly little to do with academic analysis of epidemiology. There’s little to no overlap in the skill sets. Read the Health Beat post linked above to understand why the hype you’re buying into is flawed.

20. 

    Kim
    December 1st, 2009 at 9:25 am

    Huh, this practicing clinical nurse actually spent last semester being educated on the basics of critically examining research studies. Will come in handy when I begin my career in research, I suspect.

    Have the guidelines here, and as soon as life slows down will read them (and comment).

    I guess we women should just bow to the floor and say “thank you” for all the “useless” anxiety we will now be spared.

    Oh, and I need to check the guidelines (like I mentioned), but I think someone should tell my thirty-something friend who waited a couple of years after her last normal pelvic exam that she was spared two years of anxiety BEFORE her ovarian cancer was detected (I believe the word “cantelope” was used to describe the size of the tumor.)

    Something isn’t right here, and I’m not sure what it is.

    But I’ll read those guidelines and let you know.

21. 

    storytellerdoc
    December 3rd, 2009 at 4:15 pm

    Great site. I think now we are seeing those recommendations challenges like none other. Thank God. And about the prostate…ouch! LOL There are as many men probably outrages over this as well, since we all have women we love in our lives.

    I’ll be following. Well done.

22. 

    DayOwl
    December 10th, 2009 at 4:12 pm

    Here’s what the NPSTF study said:

    -Increased the frequency of mammograms does not increase survival rates for breast cancer.

    -Starting mammograms at an earlier age does not increase survival rates for breast cancer.

    -In fact, the current number of mammograms considered advisable might be doing more harm than good.

    Hysterical response: OH MY GOD RATIONING!

    Use Your Brain Response:
    You mean they’ve been subjecting me to these things all these years, promising that it would save my life, making lots of money, and it wasn’t actually helping me at all?

    In an open letter published in the Times of London, twenty doctors addressed the misleading nature of mammogram campaigns:

    http://www.timesonline.co.uk/tol/comment/letters/article5761650.ece Take the time to read it.

    “[I]f 2,000 women are screened regularly for ten years, one will benefit from the screening, as she will avoid dying from breast cancer. At the same time, TEN healthy women will, as a consequence, become “cancer patients” and will be TREATED UNNECESSARILY.” (Emphasis mine.)

    —as in mutilated, poisoned, and radiated, to no good end. Is it right to do devastating harm to so many women so that one may survive?

    My own take on the pink ribbons is that they represent a massive, hideous exploitation of women by the medical-industrial complex. And yes, I know the statistics regarding breast cancer deaths in the US. They run a distant second to heart disease (for women). I also know that a lot of the “information” about BC in the media is grossly overstated and misleading.

    Instead of fussing that the government is sentencing you to die of breast cancer, use this opportunity to get some actual facts about the effectiveness of screening protocols and other “preventive” medical services. They do not live up to their promises. Not by a long shot.

    And consider this: Maybe mammograms are a form of rationing. They serve to divert us from the very real health care access problems being experienced by patients today. They can pretend to be taking care of you when they’re actually doing nothing.

    Maybe the insane pressure women receive to “make sure you get your mammogram!” is the real problem and the real harm. Maybe that’s where we’ve all been had.

23. 

    Change of Shift – Volume Four, No. 11 // Emergiblog
    December 11th, 2009 at 1:08 pm

    [...] Things are a bit rambunctious over at Nurse Ratched’s Place! Mother Jones has a few issues with the new mammogram guidelines and a few readers take umbrage in Pink Research: Undercutting Women’s Health. [...]

24. 

    Steve
    December 15th, 2009 at 10:16 pm

    I remember when my wife heard that announcement. She had a total shit-fit.

    Does anybody here remember when Kaiser Permanente got LIT UP several years ago because they put a gag order on their member MD’s that they could not discuss alternate breast cancer treatments with their patients. It seems to me that a very good number of these women who got raked over the coals by Kaiser Permanente were under 50 when they died of their breast cancer.

    So women under 50 don’t need breast cancer screenings? Try telling that to a family who has lost their wife, sister, daughter or mom to breast cancer.

25. 

    Steve
    December 15th, 2009 at 10:17 pm

    PS-Kaiser Permanente paid out millions to victims families after the lawsuit, but last time I looked, it didn’t bring any of these women back from the grave.

26. 

    emmy
    December 16th, 2009 at 11:59 am

    The first time that I heard the media’s take on these studies I went ballistic. If I’d followed them I’d be dead now. But when I heard the actual recommendations I had to agree because it fit my experience exactly. The study claims that most women who are diagnosed with breast cancer find a lump either as a result of having a breast exam done by a practicioner or by and accident. Before the age of 50 few breast cancers are discovered as a result of monthly breast exam done at home or by a routine screening mammogram. The report recommends that women younger than 50 discuss their need for a mammogram with their physician and that rather than the ritualized monthly breast exam, that women become familiar with the size, shape and feel of their own breast, a “touch your boobies” type of approach. In my case, even though I’d had a clean mammogram six months prior to finding my cancer, I found my lump while I was drying off after a shower. As for me, I will continue to receive my diagnostic mammograms and ultrasound tests every year even if I have to pay for it out of my own pocket. And I hope that my daughter has a doctor that requests a mammogram for her before the age of 40 and every year afterward.