Decades of Data Fail to Resolve Debate on Treating Tiny Breast Lesions
By GINA KOLATA
More than 30 years after the widespread use of mammograms set off a surge in the detection of tiny lesions in milk ducts, there is still debate about how — or even whether — to treat them. In an era when there has been so much study of how to treat more advanced cancer, it might seem odd that there is so much uncertainty about these minute sprinklings of abnormal cells, often called Stage 0 cancer, which some say are not cancers at all.
The latest round of controversy was set off by a paper published Thursday in JAMA Oncology that analyzed 20 years of data on 100,000 women who had the condition, which is also known as ductal carcinoma in situ, or D.C.I.S. The majority had lumpectomies (with or without radiation) and most of the others had mastectomies. The death rate from breast cancer of these patients, regardless of their choice of treatment, over the next 20 years was about the same as the lifetime risk in the general population of women, 3.3 percent.
The study’s authors and other leading researchers in the field said the data indicates that treatment has not made much of a difference, if any, for the tens of thousands women a year who are told they have this condition. (Last year about 60,000 in the United States got a D.C.I.S. diagnosis.) One piece of evidence is that the women who had mastectomies had their entire breast cut off and so if D.C.I.S. was, as many had thought, a precursor to cancer or an early cancer, their death rate should have been lower than it was for women who had lumpectomies that could have left D.C.I.S. cells behind.
Another major clue is that though tens of thousands of cases of D.C.I.S. were being diagnosed and aggressively treated each year, there seemed to be no substantial impact on the incidence of invasive breast cancers found annually in the general population. About 240,000 were diagnosed with it last year. If treating D.C.I.S. was supposed to fend off invasive breast cancer, the incidence of invasive breast cancer should have plummeted once D.C.I.S. was being found and treated, the experts said.
That has intensified questions about what D.C.I.S. really is — cancer, precancer, a risk factor for cancer?
Six ways to make Maine more senior-friendly
BDN Editorial
Policymakers, advocates for the state’s seniors, and seniors themselves have focused attention in recent years on helping seniors age at home where they can remain active and connected to their communities. While government grants and workshops are helpful in moving this work forward, many solutions aren’t complex or costly. That means they can be implemented locally and quickly.
The Bangor Daily News has spent six months researching and reporting on how to improve the quality of life of older Mainers. While we aren’t experts, we conducted an informal survey, and the results highlighted six common-sense changes that don’t require immense bureaucratic struggles to implement.
The most popular potential solution is to ensure that communities are organized in ways that support seniors. An extensive example of this thinking and planning is a program called At Home Downeast on the Blue Hill Peninsula. Under the 3-year-old program, area residents pay an annual fee for services including rides to medical appointments, grocery shopping or delivery, and small changes to their homes to make them safer. The interaction with volunteers can be as important as the services provided.
“It’s a lifesaver for people my age. … I feel I can talk to them and feel at home,” Margaret Staples of Brooklin told the BDN earlier this year. “Now I don’t feel alone.”
Locally developed solutions don’t have to be as extensive as this one. Weekly suppers organized by churches or community groups provide sustenance and companionship. Volunteer transportation networks, which are vital in a rural state such as Maine, provide links to stores, health care providers and friends.
In addition, those who participated in the survey supported more check-ins on seniors. Police departments and medical practices can do these on a formalized basis, but again, community members can help. Check-ins improve safety — sometimes even helping police anticipate emergencies — and provide social connections to seniors who may spend most of their time alone at home.
Steroid Shots No Better for Back Pain Than Placebo
By NICHOLAS BAKALAR
Steroid Shots No Better for Back Pain Than Placebo
Steroid shots are commonly used for back pain, but evidence that they work no better than placebos is mounting.
In a review published Monday in Annals of Internal Medicine, researchers combined data from 30 placebo-controlled studies of epidural steroid injections for radiculopathy (back pain that radiates to the legs) and eight studies of spinal stenosis (back or neck pain caused by narrowing of the spinal canal).
The study showed that for radiculopathy, injections provided some short-term pain relief, but over time were no more likely to be helpful than placebos, and they did not reduce the need for later surgery.
The pooled data showed similar results with injections for spinal stenosis — some moderate temporary pain relief, but no differences between treatment and placebo in pain intensity or functional ability lasting six weeks or longer after the shot.
The authors acknowledge that most of the trials had methodological shortcomings, and that some analyses were based on small numbers of patients.
Dr. Roger Chou, the lead author and a professor of medicine at Oregon Health & Science University, said there was probably some financial motivation for continuing to use the procedure despite the lack of evidence for its effectiveness. “The professional societies are concerned because they worry about the implications for insurance coverage,” he said. “We don’t say anything about that in the study.”
The Case for Teaching Ignorance
By JAMIE HOLMES
IN the mid-1980s, a University of Arizona surgery professor, Marlys H. Witte, proposed teaching a class entitled “Introduction to Medical and Other Ignorance.” Her idea was not well received; at one foundation, an official told her he would rather resign than support a class on ignorance.
Dr. Witte was urged to alter the name of the course, but she wouldn’t budge. Far too often, she believed, teachers fail to emphasize how much about a given topic is unknown. “Textbooks spend 8 to 10 pages on pancreatic cancer,” she said some years later, “without ever telling the student that we just don’t know very much about it.” She wanted her students to recognize the limits of knowledge and to appreciate that questions often deserve as much attention as answers. Eventually, the American Medical Association funded the class, which students would fondly remember as “Ignorance 101.”
Classes like hers remain rare, but in recent years scholars have made a convincing case that focusing on uncertainty can foster latent curiosity, while emphasizing clarity can convey a warped understanding of knowledge.
In 2006, a Columbia University neuroscientist, Stuart J. Firestein, began teaching a course on scientific ignorance after realizing, to his horror, that many of his students might have believed that we understand nearly everything about the brain. (He suspected that a 1,414-page textbook may have been culpable.)
As he argued in his 2012 book “Ignorance: How It Drives Science,” many scientific facts simply aren’t solid and immutable, but are instead destined to be vigorously challenged and revised by successive generations. Discovery is not the neat and linear process many students imagine, but usually involves, in Dr. Firestein’s phrasing, “feeling around in dark rooms, bumping into unidentifiable things, looking for barely perceptible phantoms.” By inviting scientists of various specialties to teach his students about what truly excited them — not cold hard facts but intriguing ambiguities — Dr. Firestein sought to rebalance the scales.
By JAMIE HOLMES
IN the mid-1980s, a University of Arizona surgery professor, Marlys H. Witte, proposed teaching a class entitled “Introduction to Medical and Other Ignorance.” Her idea was not well received; at one foundation, an official told her he would rather resign than support a class on ignorance.
Dr. Witte was urged to alter the name of the course, but she wouldn’t budge. Far too often, she believed, teachers fail to emphasize how much about a given topic is unknown. “Textbooks spend 8 to 10 pages on pancreatic cancer,” she said some years later, “without ever telling the student that we just don’t know very much about it.” She wanted her students to recognize the limits of knowledge and to appreciate that questions often deserve as much attention as answers. Eventually, the American Medical Association funded the class, which students would fondly remember as “Ignorance 101.”
Classes like hers remain rare, but in recent years scholars have made a convincing case that focusing on uncertainty can foster latent curiosity, while emphasizing clarity can convey a warped understanding of knowledge.
In 2006, a Columbia University neuroscientist, Stuart J. Firestein, began teaching a course on scientific ignorance after realizing, to his horror, that many of his students might have believed that we understand nearly everything about the brain. (He suspected that a 1,414-page textbook may have been culpable.)
As he argued in his 2012 book “Ignorance: How It Drives Science,” many scientific facts simply aren’t solid and immutable, but are instead destined to be vigorously challenged and revised by successive generations. Discovery is not the neat and linear process many students imagine, but usually involves, in Dr. Firestein’s phrasing, “feeling around in dark rooms, bumping into unidentifiable things, looking for barely perceptible phantoms.” By inviting scientists of various specialties to teach his students about what truly excited them — not cold hard facts but intriguing ambiguities — Dr. Firestein sought to rebalance the scales.
With Mergers, Concerns Grow About Private Medicare
By REED ABELSON
As some of the nation’s largest health insurers plan to merge, a new report raises fresh concern over the lack of competition in the private Medicare market. The analysis, released on Tuesday, concludes “there is little competition anywhere in the nation.”
The report from the Commonwealth Fund, a research group, looked at the market share of insurance companies offering private Medicare Advantage plans in 2012. The authors found that 97 percent of markets in United States counties were “highly concentrated,” in which a small number of insurers dominated. The lack of competition was worse in rural markets.
Only one county, Riverside, Calif., qualified as a competitive market, according to the report.
For decades, insurers have offered private plans as an alternative to traditional Medicare, the government-run program that provides coverage to about two-thirds of beneficiaries.
UnitedHealth Group, Humana and Aetna are all major players in the private Medicare Advantage market. While UnitedHealth remains independent, Humana and Aetna announced this year that they planned to combine forces.
Proponents of these plans say competition from private insurers benefits consumers by reducing Medicare costs and improving the quality of their coverage.
“Seniors are overwhelmingly satisfied with Medicare Advantage because of the wide range of coverage options available and the overall value these plans provide,” Clare Krusing, a spokeswoman for America’s Health Insurance Plans, a Washington trade association, said in an email. “This market remains competitive, particularly with Medicare Advantage plans demonstrating improved care delivery for beneficiaries compared to traditional Medicare.”
But the study’s findings come at a point when the proposed mergers of Aetna and Humana, as well as that of Anthem and Cigna, could allow the nation’s largest insurers to gain even more leverage in a market. Consumer advocates and others have raised concernsover whether individuals will benefit from the mergers, which reduce the number of the five largest for-profit companies to three.
By REED ABELSON
As some of the nation’s largest health insurers plan to merge, a new report raises fresh concern over the lack of competition in the private Medicare market. The analysis, released on Tuesday, concludes “there is little competition anywhere in the nation.”
The report from the Commonwealth Fund, a research group, looked at the market share of insurance companies offering private Medicare Advantage plans in 2012. The authors found that 97 percent of markets in United States counties were “highly concentrated,” in which a small number of insurers dominated. The lack of competition was worse in rural markets.
Only one county, Riverside, Calif., qualified as a competitive market, according to the report.
For decades, insurers have offered private plans as an alternative to traditional Medicare, the government-run program that provides coverage to about two-thirds of beneficiaries.
UnitedHealth Group, Humana and Aetna are all major players in the private Medicare Advantage market. While UnitedHealth remains independent, Humana and Aetna announced this year that they planned to combine forces.
Proponents of these plans say competition from private insurers benefits consumers by reducing Medicare costs and improving the quality of their coverage.
“Seniors are overwhelmingly satisfied with Medicare Advantage because of the wide range of coverage options available and the overall value these plans provide,” Clare Krusing, a spokeswoman for America’s Health Insurance Plans, a Washington trade association, said in an email. “This market remains competitive, particularly with Medicare Advantage plans demonstrating improved care delivery for beneficiaries compared to traditional Medicare.”
But the study’s findings come at a point when the proposed mergers of Aetna and Humana, as well as that of Anthem and Cigna, could allow the nation’s largest insurers to gain even more leverage in a market. Consumer advocates and others have raised concernsover whether individuals will benefit from the mergers, which reduce the number of the five largest for-profit companies to three.
Why the GOP presidential candidates can’t reform health care
In the last few days, Scott Walker and Marco Rubioreleased health care plans, and other Republican candidates are sure to follow soon. Most will probably be pretty similar, even if some are more fully fleshed out than others.
But they’ll all share one feature, the thing that tells you that they aren’t even remotely serious about this issue: they will take as their starting point that the entire Affordable Care Act should be repealed.
I say that that shows they aren’t serious not because I think the ACA has done a great deal of good, though I do think that. I say it because it shows that they’re completely unwilling to grapple with both the health care system as it exists today, and how incredibly disruptive the wholesale changes they’re proposing would be. Walker’s plan even says, “unlike the disruption caused by ObamaCare, my plan would allow for a smooth, easy transition into a better health care system.” This is the health care equivalent of thinking the Iraq War would be a cakewalk.
The reality is that repealing the ACA now that it has been implemented would mean a complete and utter transformation of American health care. Republicans have often lamented that the law was so terribly long and included many different rules and regulations — yet now they act as though the law amounts to just a couple of rules here and there that can therefore be tossed out without too much trouble. But they were right the first time: the law is indeed complex, and has brought hundreds of changes big and small to American health care, not just in how people get insurance but in how Medicare and Medicaid work, how doctors and hospitals are paid, and in all sorts of other areas.
The ACA established health care exchanges. It brought millions of people into Medicaid, it closed the Medicare prescription drug “doughnut hole.” It gave subsidies to small businesses. It funded pilot projects to explore new means of providing and paying for care, it imposed new regulations on insurance companies. It created new wellness and preventive care programs, it provided new funding for community health centers. It did all that, and much more. You can argue that each one of these was a good or a bad idea, but you can’t pretend that unwinding them all would be anything resembling a “smooth, easy transition.”
In the last few days, Scott Walker and Marco Rubioreleased health care plans, and other Republican candidates are sure to follow soon. Most will probably be pretty similar, even if some are more fully fleshed out than others.
But they’ll all share one feature, the thing that tells you that they aren’t even remotely serious about this issue: they will take as their starting point that the entire Affordable Care Act should be repealed.
I say that that shows they aren’t serious not because I think the ACA has done a great deal of good, though I do think that. I say it because it shows that they’re completely unwilling to grapple with both the health care system as it exists today, and how incredibly disruptive the wholesale changes they’re proposing would be. Walker’s plan even says, “unlike the disruption caused by ObamaCare, my plan would allow for a smooth, easy transition into a better health care system.” This is the health care equivalent of thinking the Iraq War would be a cakewalk.
The reality is that repealing the ACA now that it has been implemented would mean a complete and utter transformation of American health care. Republicans have often lamented that the law was so terribly long and included many different rules and regulations — yet now they act as though the law amounts to just a couple of rules here and there that can therefore be tossed out without too much trouble. But they were right the first time: the law is indeed complex, and has brought hundreds of changes big and small to American health care, not just in how people get insurance but in how Medicare and Medicaid work, how doctors and hospitals are paid, and in all sorts of other areas.
The ACA established health care exchanges. It brought millions of people into Medicaid, it closed the Medicare prescription drug “doughnut hole.” It gave subsidies to small businesses. It funded pilot projects to explore new means of providing and paying for care, it imposed new regulations on insurance companies. It created new wellness and preventive care programs, it provided new funding for community health centers. It did all that, and much more. You can argue that each one of these was a good or a bad idea, but you can’t pretend that unwinding them all would be anything resembling a “smooth, easy transition.”
Financial transaction tax a progressive way to pay for Medicare and Social Security expansion
August 21, 2015
by Diane Archer
One way to pay for a Medicare or Social Security expansion without affecting low or middle-income populations is through a financial transaction tax. A financial transaction tax could easily raise $130 billion a year in additional federal revenue through a miniscule sales tax on stocks and other financial assets every time they are traded.
Here are three key things to know about a financial transaction tax from Dean Baker at the Center for Economic and Policy Research:
- The United States could raise more than $130 billion a year or $1.5 trillion over ten years in new revenue through a 0.1 percent tax on stock and a 0.01 percent tax on derivatives (as 11 countries in the European Union are now considering). Of note, the U.S. imposed a 0.04 percent tax on stock trades until the mid-60s. And, China, the United Kingdom, India and Switzerland impose a financial transaction tax today.
- The financial transaction tax has virtually no effect on the overwhelming majority of Americans. It generates a tiny sum of money unless you are regularly buying and selling substantial amounts of stock. It principally affects Wall Street and day traders, people who flip stocks worth a lot of money a lot of the time. A 0.1 percent tax on stock trades means that people would pay .10 cents if they bought $100 worth of stock and $1.00 if they flipped $1000 worth of stock.
- The financial transaction tax would likely lead to a smaller financial industry, which would mean a more efficient financial industry. Data suggests that investors would make fewer short-term stock trades if there were a financial transaction tax; that would reduce the size of the financial sector, potentially leading people to engage in other work that helped to speed growth.
Bernie Sanders is supporting a financial transaction tax to cover the cost of making public colleges tuition-free. The Obama Administration has been unwilling to support such a tax. Representative Keith Ellison of Minnesota has a bill in Congress that would impose a financial transaction tax. Senator Tom Harkin and Representative Peter DeFazio co-sponsored a bill that imposed a financial transaction tax of 0.03 percent.
August 21, 2015
by Diane Archer
One way to pay for a Medicare or Social Security expansion without affecting low or middle-income populations is through a financial transaction tax. A financial transaction tax could easily raise $130 billion a year in additional federal revenue through a miniscule sales tax on stocks and other financial assets every time they are traded.
Here are three key things to know about a financial transaction tax from Dean Baker at the Center for Economic and Policy Research:
- The United States could raise more than $130 billion a year or $1.5 trillion over ten years in new revenue through a 0.1 percent tax on stock and a 0.01 percent tax on derivatives (as 11 countries in the European Union are now considering). Of note, the U.S. imposed a 0.04 percent tax on stock trades until the mid-60s. And, China, the United Kingdom, India and Switzerland impose a financial transaction tax today.
- The financial transaction tax has virtually no effect on the overwhelming majority of Americans. It generates a tiny sum of money unless you are regularly buying and selling substantial amounts of stock. It principally affects Wall Street and day traders, people who flip stocks worth a lot of money a lot of the time. A 0.1 percent tax on stock trades means that people would pay .10 cents if they bought $100 worth of stock and $1.00 if they flipped $1000 worth of stock.
- The financial transaction tax would likely lead to a smaller financial industry, which would mean a more efficient financial industry. Data suggests that investors would make fewer short-term stock trades if there were a financial transaction tax; that would reduce the size of the financial sector, potentially leading people to engage in other work that helped to speed growth.
Bernie Sanders is supporting a financial transaction tax to cover the cost of making public colleges tuition-free. The Obama Administration has been unwilling to support such a tax. Representative Keith Ellison of Minnesota has a bill in Congress that would impose a financial transaction tax. Senator Tom Harkin and Representative Peter DeFazio co-sponsored a bill that imposed a financial transaction tax of 0.03 percent.
No comments:
Post a Comment