Tuesday, November 17, 2009

Good Morning, Everyone. Another gloomy day predicted. But looking outside I have some hope that we might get a bit of sun. At least we aren't (I hope) going to get what Kansas has had--plenty of snow. Yeah, THAT four letter word in in use again. I would know it is getting colder even if I didn't have to go outside. One of the cats who hasn't wanted to curl up in bed with me did so last night. He hasn't done that since last spring. And all of them want much more lap time after about six months of being very happy to stay on the sofa. And they get very upset when we have to insist that they stay off our laps.

It looks like the announcement that women should not start getting mammograms before age 50 and then only every two years has created a fire storm. The teaser for Good Morning America, which I have no intention of seeing, announced they had assembled a panel of experts to thrash out what women should do in light of the new information. Like every other bit of advice, this is being presented as though the 'one size fits all.' No one wants to use any more brain power than absolutely necessary to consider whether any advice, old or new, fits their circumstances. And, of course, the news media seems more interested in a lively debate that throws out a lot of heat and very little light. I notice they aren't suggesting that women carefully consider their individual circumstances, and ask themselves and their doctors serious questions on this matter.

Given the state of today's economy, I wonder if the situation described at Adapting In Place will become 'the new normal.'


As you can tell I didn't finish this last night. So, I guess I will continue now. It is soggy and gray today. The hoped-for sun never materialized yesterday.

I have been thinking about the comments I made about the new guidelines concerning mammogram screening as more and more 'experts' and 'women-on-the-street' weigh in on the subject. This whole topic (as is most in medicine now-a-days). There are several threads that are buried in the discussions that few are acknowledging. First, especially in the interviews with ordinary women who may or may not be cancer survivors or beneficiaries of mammograms, is fear. Actually, several fears. One fear is that, for those who have insurance that covers mammograms as currently recommended, those insurance companies will implement the new recommendations to boost their bottom lines. They will charge their customers the same or slightly more for half the service. Another fear is of the cancer itself the treatment of which is costly and potentially disfiguring. If you have insurance, you may have to fight the insurance company to get the benefits you paid for, or you may find yourself cut off for any number of reasons before your treatment is completed, or you may find yourself uninsurable in the future. Coupled along with that fear is one that comes out of the push over the years for 'early' detection. We have been told that early detection means a better outcome and the earlier the better.

But my perverse little mind asks some other questions. How many women can afford (on their own) a mammogram every year? How many are in a situation where they insurance only covers mammograms every other year now? What data might there be on the prevalence of false positives, or the cumulative effects of exposure to the radiation involved, or on the growth rates of different breast cancers, on spontaneous remission? Does anyone remember the news of a while back that aggressive treatment of prostate cancer was often unnecessary? I said above that there is no 'one size fits all' medicine. We are all individuals and our own physical characteristics and psychological make up affects our treatments. Do we have a strong family history of breast cancer? Have we ourselves been diagnosed with breast cancer? These may be indications that we should have yearly mammograms starting even before age 40. The furor has created a lot of heat and very little light, like so much that hits the mainstream media fan. I think I will remain what I have been to date--a medical minimalist with a high quota of skepticism.

Kevin Sachs blog at the New York Times reveals the depths of Republican hypocrisy. At the same time they block any movement on a health care reform bill they claim that the new mammography guidelines are 'rationing.' The question I asked above is very relevant here: how many women (or their families) can afford either the mammograms (on what ever time scale) or the treatments (if the tests reveal cancer) out of their own pockets? Why is rationing by insurance company bureaucrats better than rationing by government bureaucrats? Oh, I forgot. Lobbyists from paid by the insurance company bureaucrats are funding legislators' campaigns. It is very obvious who is paying the piper and who is calling the tune.

John Rosevear at The Motley Fool has a good post on the economy this morning: 'Recovery? On What Planet?' It reflects much of what I have been thinking and seeing from my 'worm's eye' perspective. We hear that the economy grew last quarter which sounds good until we start dissecting the numbers and see that most of the growth was really not growth at all. We hear that consumer confidence is up but wonder why because another of our friends or family has either been laid off, had their hours cut, or can't make their bills. There was a wonderful, if very short, piece on the news this morning announcing that Goldman Sachs apologized for its role in precipitating the financial mess and is going to make a seemingly large sum of money available for lending to small businesses. What was wonderful about the report was the counterbalancing statements that the sum represented a little over 2% of the bonuses Goldman expects to pay this year and that the big banks have cut their small business loan business by several times that amount.

Oftwominds has a good blog this morning detailing another reason why we are not going to see much of a recovery any time soon--or rather not much of a recovery towards what we once thought of as normal prosperity. I have said often over the last few years that we have become a nation of people hired to sell goods made elsewhere to other people hired to sell goods made elsewhere to people hired .... . Exporting our way out of this mess is a fantasy. But then there was another story on the morning news that reflects the problem. Another trade show that has had a long history of being hosted in Chicago has decided to go elsewhere citing the costs involved in holding their conventions and shows in Chicago. A legion of other cities are very eager to cut huge breaks to reduce those costs and thereby attract new convention business. This is another race to the bottom. Those cities gain some but Chicago looses a lot. The two (the loss and the gain) will meet somewhere well south of the middle.

Nouriel Roubini also has a post which underlies a fact that I have noticed before: we are really two economies. And it is the smaller one that is showing some weak signs of recovery. The larger economy, the one most of us inhabit, shows few signs of recovery.

I will leave you with those notions and go have breakfast now. See you later.


Looking to the Stars said...

Our weather has been sunny last couple of days. The dogs are in heaven :)

I do not like having my boob crushed so I don't have any tests done. I do it the old fashion way and exmine myself and when I find a lump (I have found three) I put arnica on it. They have always gone away. Can you tell I don't like going to the doctor :)

Kay Dennison said...

No surprises here! And yeah, all this you-know-what grates on my last nerve (which is hanging on by the proverbial thread).

My mother is a breast cancer survivor and is because it was detected early. She is 83 and has been declared cancer free. The docs want me to have a mammogram yearly because of her history. Adapting in place? It seems like all I've been doing my life is adapting to something or someone. I'm getting too damned old to adapt which is why I'm exploring all the "aging in place" info I can find. Fortunately we have programs for it in Ohio.

I'm just glad I'm past the recommended age so it's one less thing to fight about.

I just hope that white stuff stays away!