Risk/Benefit Ratio of Mammograms Being Questioned

In an article from the NYTimes titled "Benefits of Mammograms Under Debate in Britain" the author discusses the controversy raging over information pamphlets handed out to patients on the benefits of mammograms in the UK. (http://www.nytimes.com/2009/03/31/health/31mamm.html?ref=health&pagewanted=print) A group of advocates and experts complain that the pamphlets are not truthful and exaggerate the benefits of mammograms and understate the risks.
"What women are not told... is that for every woman whose life is saved by breast cancer screening, up to 10 healthy women are given diagnoses — and, often, surgery — for a cancer that is so slow-growing it would never have threatened a woman’s life...."

Mammograms have been accepted as such a basic tenet of preventative care for women over the age of 40 in the U.S. , that questioning the benefit is startling to many here. I touched on this topic when discussing the newly questioned benefit of PSA testing. (http://ksparrowmd.blogspot.com/2009/03/prostate-screening-test-psa-may-not.html)

I've personally refused mammograms over the years and have encountered only astonishment and disbelief that I would avoid such a life saving exam. From reading I had done, I wasn't convinced that for a person like myself, with zero risk factors, the benefit would outweigh the risk, and now the data seem to support that stance. Indeed, Dr. Peter C. Gotzsche the author of the Cochrane analysis study states, "It may be reasonable to attend breast cancer screening with mammography, but it may also be reasonable not to attend.” And Dr. Lisa Schwartz from Dartmouth says “You’re not crazy if you don’t get screened, and you’re not crazy if you do get screened”...People can make their own decision, and we don’t need to coerce people into doing this (mammography.)"

I will be fascinated to watch the reaction to this issue by HMO's like Kaiser. Will they change their policies?
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When "Oversight" means "Overlook"

In yet another depressing instance of profit motive undermining patient well-being we are presented with the story of a private company, "Coast Independent Review Board", charged with overseeing the safety of new drugs and medical devices (An Overseer of Trials in Medicine Draws Fire Published: March 26, 2009 NYtimes.) "Coast,"located firmly inland in Colorado Springs, was snared by undercover federal agents when it approved a make-believe surgical device rejected by two of Coast's competitors.
"Where was the due diligence of your company?" demanded Congressman Stupak at a Congressional hearing on Thursday March 26th. In retort, remaining as combative and self-righteous as any thug worth his salt, the CEO Drueber griped that he could not imagine why anyone would design a fake trial. (You mean besides catching frauds?) "I cannot believe that my government did this to me and my company. It is unconscionable.”
What is "unconscionable" is a company that is willing to sign off on potentially dangerous drugs or devices for a fee. There have been recent hearings on patient deaths from unsafe devices which were allowed because of fraudulent data submitted to the FDA. The charges against Coast are not trivial. In recent years, review of new medical devices and drugs has shifted from academic medical institutions to private review companies that are paid by the company that develops the new device. This setup can lead to corruption of the process as seems to have happened at Coast.
Following the money we find out from the article that "over a five-year period, Coast reviewed 356 study proposals and rejected only one, according to data presented at the hearing. Meanwhile, since 2004 the company’s revenue has more than doubled, to $9.3 million in 2008."
It cuts down on outlays if you don't actually do the work of reviewing and increases profits if drug companies seek you out because you're known to overlook rather than oversee.
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Tension Neck Syndrome Improved with Acupuncture and Physiotherapy

A patient with neck problems alerted me to this study. He has been working with a trainer but sees a marked improvement with acupuncture treatments. This study compares physiotherapy alone, acupuncture alone, to combination treatment. Unsurprisingly, the combined therapy works the best.
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Tension neck syndrome treated by acupuncture combined with physiotherapy: a comparative clinical trial (pilot study).
França DL, Senna-Fernandes V, Cortez CM, Jackson MN, Bernardo-Filho M, Guimarães MA.
Complement Ther Med. 2008 Oct;16(5):268-77
Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Ciências Médicas, Brazil.
"After 6 months of follow-up, the improvements of all groups were maintained (p < style="font-weight: bold;">The data suggested that acupuncture effect may facilitate and/or enhance physiotherapy performance in musculoskeletal rehabilitation for tension neck syndrome."

Animal Studies Corroborrate My HRV Studies

This blog entry is hardly of broad interest, but it pertains to the studies that I've done.
My own research has looked at the effect of acupuncture on the autonomic nervous system, or stress response. ( Analysis of Heart Rate Variability in Acupuncture Practice: Can It Improve Outcomes?MEDICAL ACUPUNCTUREVolume 19, Number 1, 2007Kristen Sparrow, MD) What I found is that in patients who responded (i.e. got better) from acupuncture, had a decrease in their stress response during treatment. This was corroborated in an article published last year by Baecker.(Acupuncture in Migraine :Investigation of Autonomic Effects Clin J Pain Volume 24, Number 2, February 2008)

I am quite interested in this recent article because it was performed on rats and showed that electroacupuncture applied at Stomach 36 but not Bladder 21 resulted in a decrease in the stress response in restrained rats.

There are so many variables in the clinic setting that it is difficult to have confidence in the results at times. This animal study confirms my findings and that just might be meaningful.
Excerpts of the study follow.
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Electroacupuncture Improves Imbalance of Autonomic Function under Restraint Stress in Conscious Rats.
Am J Chin Med. 2009;37(1):45-55
Imai K, Ariga H, Takahashi T.
Department of Surgery, Duke University, Durham, North Carolina 27710, USA
Acupuncture may modulate the imbalance of the autonomic nervous system. It is well known that restraint stress delays gastric emptying via inhibiting parasympathetic activity and/or stimulating sympathetic activity in rats.
EA at ST-36 significantly reduced the elevated heart rate and LF, compared to that of control group. EA at ST-36 also significantly increased HF component after finishing the stress loading. In contrast, EA at BL-21 had no significant effect on the heart rate, LF and HF. It is suggested that EA at ST-36 stimulates parasympathetic activity and inhibits sympathetic activity under the restraint stress in rats.

Prostate Screening Test PSA may not save lives

This particular article is worth reading in its entirety for those interested in the relative value of mass screenings for common diseases. For those of us who don't always trust the common medical orthodoxy, the conclusion of this article doesn't come as a huge surprise. I recently attended a symposium offered at UCSF on Issues in Women's Health. Even I was stunned when one of the presenters was making a case that perhaps even self breast exams over diagnosed breast cancer and exposed the patients to too much medical care which could adversely affect their health. (No snark intended.) Breast cancer has a radically different risk/benefit ratio in terms of screening than PSA, but it is still worthwhile to take a clear-eyed look at the actual numbers of lives saved. Again, it seems that Europe is more likely to lead the way in actually challenging the value of these popular tests and procedures.
(I have not activated the links in my quotations following. If you would like to link to the references, please go to the original article.)
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Prostate Test Found to Save Few Lives
By GINA KOLATA
Published: March 18, 2009

"The PSA blood test, used to screen for prostate cancer, saves few lives and leads to risky and unnecessary treatments for large numbers of men, two large studies have found."...

The studies — one in Europe and the other in the United States — are “some of the most important studies in the history of men’s health,” said Dr. Otis Brawley, the chief medical officer of the American Cancer Society.

In the European study, 48 men were told they had prostate cancer and needlessly treated for it for every man whose death was prevented within a decade after having had a PSA test.

Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center, says one way to think of the data is to suppose he has a PSA test today. It leads to a biopsy that reveals he has prostate cancer, and he is treated for it. There is a one in 50 chance that, in 2019 or later, he will be spared death from a cancer that would otherwise have killed him. And there is a 49 in 50 chance that he will have been treated unnecessarily for a cancer that was never a threat to his life.

Prostate cancer treatment can result in impotence and incontinence when surgery is used to destroy the prostate, and, at times, painful defecation or chronic diarrhea when the treatment is radiation. ...

Vis a vis breast cancer and mammograms:

If the European study is correct, mammography has about the same benefit as the PSA test, said Dr. Michael B. Barry, a prostate cancer researcher at Massachusetts General Hospital who wrote an editorial accompanying the papers. But prostate cancers often are less dangerous than breast cancers, so screening and subsequent therapy can result in more harm... With mammography, about 10 women receive a diagnosis and needless treatment for breast cancer to prevent one death. With both cancers, researchers say they badly need a way to distinguish tumors that would be deadly without treatment from those that would not...

The benefits of prostate cancer screening, he said, are “modest at best and with a greater downside than any other cancer we screen for.”