HeatlhBeat readers may remember that, in the past, I questioned whether Dr. Sanjay Gupta should become Surgeon General.
Today, after I read Naomi’s thoughtful post on Mammography Guidelines (see below), I heard Dr. Gupta on CNN, grilling a nurse who is part of the Task Force that has raised questions about the benefit of mammograms for many women.
“So you’re saying that some lives just aren’t worth it?” Dr. Gupta demanded. He went on to suggest that he could not imagine how a health professional could be so lacking in compassion. It wasn’t just that the spot was too short to address a complicated issue. Gupta’s idea of exploring the topic was a classic example of “attack TV.”
At least he’s not Surgeon General.
I believe that the whole news release and subsequent brew-ha-ha yesterday had everything to do with sabataging the bill for the Reform of Health Care that is at the Senate right now.
The group proposing (not enacting) the change in mammography recommendations needed to clarify that it was not for at risk women, and they had no authority to do what they said!
It was a way to expose the public’s knee-jerk response to their frustration with other government activities, and had nothing to do with health care.
I believe that Reform of Health Care is desperately needed, that no initial bill will represent the end product, and that representatives need to hbeed their consituents more than the dollars generated.
To say that Breast Self Examination is unnecessary negates the fact that some women needed permission to do that (and some instruction). When they did it, thousands of women saved their own lives finding their own breast lumps (as I did – twice in the ’70s).
The flap over the USPSTF breast cancer screening guidelines is a sad microcosm of the health reform debate and the near impossibility of reducing costs. An independent expert panel, using the latest available data, makes recommendations that vary somewhat from the conventional wisdom. Immediately, the guidelines are excoriated by providers, interest groups, and patients. Opponents of health reform and comparative effectiveness research start in with “I told you so.” HHS backpedals furiously, reassuring everybody that Medicare coverage policy won’t change.
The logical extension of all these objections, of course, is to test everybody for everything. Women in their 30s get breast cancer, maybe they should be tested. How about women in their 20s? Why not men? We’re not immune from breast cancer.
Emotion almost always trumps science in politics. And if my wife was one of those who was diagnosed with a mammogram at age 45, I’d probably be emotional too. We don’t like to draw lines.
But until we can have an intellectually honest, dispassionate discussion of the costs/benefits of health care practices and procedures, how can we ever hope to “bend the curve?”
While I like Dr. Sanjay, I think Dr. Sanjay likes Dr. Sanjay and his role as a celebrity doc a little too much.
would he have a larger — or smaller — audience if he left CNN to serve as surgeon general?
Sheldon is right on the money…we speak of informed choice and participatory medicine, all of which is laudable, but this kind of kerfluffle undermines the entire effort. As my daughters’ headmaster used to say “Well, it’s a slooooww process!”
It’s not an example of “attack TV” it is an example of a horrible interview and a bad spokesman. She should have had more hard data to back up the recommendations. If they were partially done because of the risks of overtesting she should have stated that. Gupta’s first question is a legitimate one. He wanted to know what now happens when the rubber meets the road in the exam room. Not a talking point like “start the conversation”. What would that conversation be that doesn’t include mammograms or self examinations? Many recommendations are made by people that haven’t practiced direct patient care for years and I seriously doubt if a practicing oncologist is even on the board.
Doctor or not Maggie, he is now in the business of making himself attractive to his bosses, any advertisers who might pay him, and the public who might buy a book or pay to hear him speak.
Gupta = Talking head, subtype: self serving.
I am glad to see that none of that surprised you Maggie. You’re getting wise to the world!
This entire issue also shows that PR and how recommendations are rolled out matter, greatly. I guarantee the average American with little medical knowledge watches that and the results are not good. They are downright pitiful. She had plenty of time to articulate the Task Force’s policy, stating that there was a “small benefit”, left the door wide open. I do agree questioning her compassion was wrong, but either the risks outweighed the benefits or they did not. He was voicing what will happen to the average physician that has 40 year old requesting a mammogram. Unfortunately, the conversation will be this “not on my license or malpractice insurance.” Try multiplying that a thousand fold with comparative effectiveness guidelines, that is what you face. But if you provide safeharbor to physicians for following these, the incentives align and the rollout is vastly improved.
Both CNN’s Sanjay Gupta and MSNBC’s Nancy Synderman need to go. They are both hopelessly linked to all that is wrong with status quo American Medicine
I like Dean Ornish,Andy Weil and Mehmet Oz as my media Docs
And few Doctors writes as well as Atul Gawande, Nortin Hadler and Larry Dossey.
Dr. Rick Lippin
Southampton,Pa
Maggie,
You have identified the wrong villian in this set piece. Admittedly, the nurse was a bad spokesperson and presented an incoherent argument.
But how did you really expect the interview – featuring a breast cancer survivor, with no risk factors, whose tumor was discovered in her 40s only by SCREENING mammography to go? She is the living counter example to the revised mammogram policy.
If CNN had wanted to come out in favor of the proposed changes they could have found any one of a large number of women who have been subjected to multiple follow-ups, multiple biopsies and lots of anxiety over benign findings.
And Dr. Gupta’s question was a good one – one that pointed out the problem of the revised policy as it affects women like the one on the show.
The villian here (or hero viewed from a different perspective) is CNN and the setup they made – not Dr. Gupta.
Lois, Sheldon, Shasta, Jim, drburr47, Ed, Jenga, Dr. Rick and Legacy
Lois,
Thanks for your comment.
I totally agree that some who led the protest about what the Task Service report said are trying to use it to undermine reform.
I would add that what the Task Service had to say was not news timed to promote health reform–or “rationing”.
They are trying to protect women against unnecssary biospsies, lumpectomies and matectomies.
This research has been around for some time. –see Naomi’s excellent earlier posts. (You’ll find links to those earlier posts in her post today.)
I also agree that self-examination does little harm–and it can be useful.
For instance, self-examination can reassure women who are at-risk (because mothers or sisters had breast cancer) and in between mammograms, reassure them that they are okay.
Or, they may discover a lump. (One of the reasons that mammograms have not proved as useful as many of us once hoped, is that many younger women who die of breast cancer are the victims of very agressive cancers that grow very quickly–in between annual mammograms. So the mammograms don’t save them. )
Also, self-examination doesn’t usually lead to discovery of those very small leisons that would go away or cause no harm.
But I have to disagree with you on just one point. The Task Force–and the research they are referring to—DOES differentiate between at-risk women and other women.
It’s just that most of the media doesn’t bother to report on exactly what the researchers said.
Sheldon–
I agree with everything you say.
But I also believe that the very fact that some in the mainstream media were willing to report the Task Force’s recommendations without simply dismissing them, means that we, as a society, are beginning to accept the idea that “more” tests, treatments, etc. does not necessarily mean better care. As you know, “more care” can lead to worse outcomes.
But it will take some time for the American public to absorb this idea. See the last post here on HeatlhBeat on this point (scroll down to the mammogram post by Naomi Freundlich)
I think she’s entirely right. For several decades the experts have been telling women that they Must have mammorgrams–or die of breast cancer. You can’t expect women to suddenly reverse course.
And of course much of the media will simply play on their fears.
But the story is beginning to get out there. And not just on HealthBeat or in the blogosphere. Some in the mainstream press reported the story in a fairly even-handed way.
This is a beginning. And it dovetails with what many health care reformers are telling us.
Shasta:
You wrote: “While I like Dr. Sanjay, I think Dr. Sanjay likes Dr. Sanjay and his role as a celebrity doc a little too much.”
Very well put!
Jim:
If Gupta were Surgeon General, he would have far more clout.
Do you remember when the Surgeon General came out to tell us that tobacco was dangerous to our health?
That was huge. People trusted the Surgeon General, and it began to change the public’s view of smoking.
Breast cancer– and whether or not women need mammograms–is exactly the type of issue where a Surgeon General’s pronoucements would have an enormous impact.
And today, Gupta showed us how he would weigh in. Without facts, without medical evidence . . .
drburr47
Your daughter’s headmaster was quite right.
But just as children do, eventually, mature (if adults are making a true effort to help them), so a society does, eventually, change its views.
At one time, many said that this country could not exist without slavery. The economy, at least in part of the nation, depended on it.
We learned that wasn’t true.
Then there was the theory that if we gave women the women the vote, education and equal rights, the country would go to hell in a hand basket.. . .
Over time this country has made progress. Uusally , progress has been made three steps forward, two steps back (In recent years, we’ve been immersed in the two steps backward).
But I have to say, if you look back in history, to say, 1850, we have made progress.
And I think we’ve recently entered a period where three large steps forward is a real possibility.
Ed–
Yes, Gupta is a talking head, self-serving, and focused on holding onto his job in a business that values ratings more than truth.
Jenga–
I think you are very wrong to fault the nurse who was interviewed by Dr.Gupta.
I would urge you (and everyone ) to lick on the link in this post to the Gupta interview.
If you look at it, you will realize that the nurse he chose to interivw has little television experience.
Perhpas CNN picked her as easy prey for Gupta. Perhaps health care professionals on the Task Force who are more media savvy refused to appear on CNN with Gupta.
I don’t know.
But I do know this nurse was set-up. She wasn’t prepared for the interivew.
I don’t think this means she doesn’t know the facts.
I’ve done enough televisons (maybe 40 appearnaces over the last 15 years) to know how intimidating it can be to appear on camera.
It takes many appearnces to begin to feel comfortable enough to be able to say what you want in say in 3 or 4 minutes.
Sometimes I can do it, sometimes I can’t.
Rick–
I agree.
Please tell us where the three TV docs you like appear.
Legacy–
Please see my reply to Jenga.
CNN picked the nurse –it was a set-up. (or no one else from the Task Force was willing to be interivewed by Gupta._
But I’ve been involved with enough TV over the past 10 years (appearing as a guest,and not a natural at it) to know that
a very popular anchor or interviewer like Gupta picks the guests.
The nurse who appeared was not TV savvy–which doesn’t mean that she is not a very intelligent, accomplsihed and caring health care professional.
It does mean that she’s not super-telegenic and smooth on TV–i.e. she’s not Sarah Palin. As a human being, this is to her credit.
One retired medical oncologist noted that many years ago, the NCI tried to convince everyone not to screen women younger than 50 but were given such a tongue lashing by Congress that they went home, licking their wounds and withdrew their recommendation.
Likewise, the ACS avoids looking clearly at the data and continues to recommend screening for women under fifty. The ACS doesn’t want to enrage its donor base and Congress didn’t want to upset constituents.
It is important to note that companies like General Electric and DuPont, both which manufacture mammography equipment, are large donors to organizations that are against any change in the recommendations.
We can’t look at how early we can detect cancers, but whether this screening saves lives. There is little proof mammography in women under 50 saved very many lives.
Reducing the death rate would save one life with a huge number of women screened (and lots of money to be made by numerous medical professionals, says the least General Electric and DuPont).
From the USPSTF report, “mammography screening at any age is a tradeoff of a continuum of benefits and harms. The ages at which this tradeoff becomes acceptable to individuals and society are not clearly resolved by the available evidence.
Instead of promoting their celebrity doctors, the networks and cable news should use their time to educate people on the evidence behind the USPSTF recommendations.
In another TV segment, Dr. Gupta, addressing the Task Force’s assertion that 1900 women would have to be screened 10 years to save one life, said it would cost $190,000. Not only did he use the low figure of $100 for a mammogram, he neglected to multiply by 10, and didn’t factor in the cost of biopsies and other procedures.
cRose, Gregory,
Thanks for your comments.
cRose–Thanks much for the comment (Not surprised Gupta forgets to multiply by 10 .Too busy being Telegenic.)
Gregory–
Very interesting about the NCI and Congress. Could you give me a source, or a link? I would like to read the story.
The ACS is focused on collecting contributions. This has been a problem for some time.But on PSA test for prostate cancer, they have done the responsible thing and no longer recommend routine testing for average-risk men–and deserve credit for that.
Finally, you write: “the networks should use their time to educate . . ”
You are, of course, right.
But unfortuately, in this country, television executives have decided that Americans are not interested in learning anything.
Those who run television in many other countries have a much higher opinion of the population they serve.
They fact that, for many years, so many people
have been willing to pay relatively large sums for access to HBO’s often excellent dramatic programming (The Wire, The Sopranos, Six Feed Under, etc) tells us that many Americans are looking for thoughtful, imaginative programming.
ANC also has some excellent and dramatic programing. .
When it comes ot issues and politics, shows like Bill Moyers on PBS still have a strong following. Rachel Maddow has become very successful.
I wish I could name an excellent conservative news show.
Of an excellent show taking a moderate perspective.
At one time, William Buckley offered a highly articulate case for the conservative perspective. (I’m not a huge Buckley fan, but he was clearly an intelligent man of real integrity, interested in engaging the issues).
But recently, conservative programming has descended into “Shout TV”–and “Attack TV”–very, very far from the Buckley standard.
And most of PBS’ political and news programming disappoints by being boring and bland.
(This was a case of government intervention dumbing down television.)
“Unnatural Causes”– a brilliant, prize-winning documentary about povert and heatlhcare that appeared on PBS last year and again this fall (but at odd times on the PBS schedule) is an example of what PBS should be showing. (IF you can find it on PBS, look for the DVD. Full disclsoure: the producer, California Newsreel, is distributing the film based on my book. But I’m not making penny on the film, and as regular readers know, I wouldn’t give a film such high praise unless I meant it.)
According to the Atlantic, John Crewdson, the only American reporter at the Stockholm news conference in 2002, on The Lancet publication of the Swedish meta-analysis, analyzing and updating the half-dozen Swedish mammography studies that told us nearly all of what we knew about the value of mammography, last month, Dr. Otis Brawley, the cancer society’s chief medical officer, was quoted in the New York Times admitting “that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.” Crewdson wasn’t surprised by Brawley’s statement, since he had expressed the same view to him when they met at a cancer symposium in Milan in 2003.
Following the task force report’s release, however, Brawley appeared to change direction, telling The Times that the cancer society had concluded that the benefits of annual mammograms beginning at 40 “outweighed the risks” and that the ACS was sticking by its earlier advice. One of Brawley’s colleagues said, “He’s trying to save his job. He was broiled at home for the interview in which he said that the medical establishment was ‘overselling’ screening.”
Dr. Donald Berry, head of biostatistics at the M.D. Anderson Cancer Center, points out that if the Swedish update is read carefully, the benefit for women 40-50 is really only 9 percent, which is not statistically significant, meaning it could represent the play of chance and not a real advantage. What Brawley failed to mention is that the numbers the news media are flinging around are the relative benefit. Utterly obscured is the number that really matters, the absolute benefit.
http://www.theatlantic.com/doc/200911u/mammograms
I guess it is “Shout TV” or “Attack TV” only if you disagree with them. You don’t have to look very far to see virulent opinion shows on the left, which you fail to mention. Keith Olbermann’s spittle-filled tirades are as hateful as anything on current TV. Same goes for the “Ed Show”. I can’t recall a conservative show ever telling a sitting president or someone on another program to “Go to Hell”. That is the epitome of “shout or attack TV”. I think the glory days of opinion TV was Crossfire with Bob Novak and Bill Press. Maybe we have hope with John King’s new show.
Thanks Maggie
Oz has his own TV show now I believe after being on Oprah regularly
Ornish and Weil write for Huff Post
Rick Lippin
Jegna–
Here’s an easy rule of thumb.
It’s “shout
TV” if people are shouting throughout 70% of the show.
It’s “attack TV” if people are launching personal attacks on others during 70% of the show.
(These percentages are approxmiations.)
You will note that I didn’t list Olberman as one the highest behchmark for televison. Moyers or Maddow he’s not.
He does shout from time to time. I’m not enthusiastic about the ending sequence.
But he spends much of the show, talking in a rational voice, about ideas,.
In the past, conservatives did that too.
Many years ago, when I was teaching English Lit, I used conservative George Will’s Newsweek columns as examples of how to make an argument
He is not as good as he once was. Embittered, somewhat vitriolic, throws him off his game. (This also happens to aging liberals)
In my post, I pointed to William Buckley as as example of an
intelligent, articulate conservative.
As today’s super-conservative, Karl Rove version of the Republican party shrinks (or implodes) I expect that new blood will create a new, more rational, and more persuasive Republican party (or a new conservative party will emerge.)
Talking about shout TV and Bill Moyer’s specifically, I recently watched the Moyer’s Journal piece about the Johnson administration wrangling over Vietnam. The parallels with Afghanistan are scary. Hopefully Obama can learn from this nation-building fiasco parallel, which is Moyer’s point!
http://www.pbs.org/moyers/journal/blog/2009/11/a_tale_of_two_quagmires.html
NG–
I watched that too.
An excellent show. And very true.
Those of us who remember the Vietnam War couldn’t help but see the parallels when President Bush began pushing to go into Iraq.
It was pretty clear that this war would be Iraq redux. A guerilla war designed to save the country for Democracy, when in fact many in the country didn’t want us there. And the longer we stayed, the less welcome we would be.
All of military technology is not very helpful when fighting a guerilla war–whether in a jungle, or door to door.
This is why it was inevitable the war would drag on and on, with more and more U.S. military killed, while destroying the country we had come to save.
Perhaps if we insisted that all high school and college students study history, in depth, throughout high school and for at least three terms in college, the country as a whole might be in a better position to stop repeating the same mistakes.