Month: August 2009

by Chris Bodenner

This post by Dr. Lundberg – arguing for the curtailing of mammograms for women under 50 as one way to save billions of dollars – irked some for its alleged concern for cost over care. Lundberg wrote that such testing "seems to lead to at least as much harm as good," but failed to elaborate. A reader writes:

I'm a medical imaging physicist. Some women under 50 will have their breast cancer detected by mammograms. But some women will have breast cancer induced by the radiation used to make the mammograms. Mammography (and any imaging procedure involving ionizing radiation) is only advisable if the chance of saving a life exceeds the chance of causing cancer.

Mammography is unique because its a screening modality, one of a handful of routine uses of ionizing radiation on healthy patients. The older you are, the more sense it makes to have a mammogram for two reasons: the more likely you are to have breast cancer and the more likely you'll die from other causes before the radiation damage can cause a future cancer. For women in their 20s, the medical risks of mammograms outweigh their benefits. For women in their 70s, the benefits outweigh the risks. For women in their 40's, the risks and benefits are roughly balanced. Neither the risks nor the benefits are particularly precisely known, so its difficult to say at what age the risks outweigh the benefits. Its possible that for women in their 50s, the net benefits of screening mammography are small (only a few women in this group will be saved by mammography, perhaps not many more than the few who would develop fatal cancer due to their mammography) and raising the age might save society some money.

Similar arguments can be applied to other uses of radiation as a screening tool. There has been a push to have Cardiac CT screening scans of healthy patients, especially by cardiologists who own CT scans and profit from each scan. Not only are these scans expensive, but they also pose a (small) risk to the patients who may subsequently develop cancer as a result of their scans. These small risks can outweigh the small benefits of the scans to healthy patients.

WebMD explores the issue further. And here is a most recent article.

by Patrick Appel

Richard Sexon checks in on the election underway:

With violence rising and intimidation rife, you can never be certain the outcome of such an election. Both internationals and nationals have been targeted in the widely expected rise in attacks. Violent, state-skeptical elements, led by Taliban, have promised to disrupt the elections as much as possible. However, unless something radically changes, we can expect a relatively narrow Karzai bloc victory, as compared to his past resounding success. With the arrival of additional US forces, and a new Afghan government, we will see over the next five years if either change is afoot or stagnation is setting in.

by Patrick Appel

Fallows takes on Betsy McCaughey.

by Patrick Appel

Matt Steinglass explains to Conor Friedersdorf why you can't pass health care reform in small chunks:

[T]he reason one often can’t pass individual planks of the reform in isolation is that taken individually, each plank generates perverse consequences that will lead to strong opposition from a particular constituency.

Exactly. If you sliced the House bill into pieces and passed each piece individually only the politically popular bits would get through. The cuts to medicare advantage would never make it on their own, but you can't fund the bill without them. Simple, small bills sound nice, but there are a lot of sections in complicated bills that would make the status quo worse if enacted in isolation. I've my concerns about the health care bill, but its page-count is not one of them. Conor also addressed his grandmother's fear of sweeping, disruptive reforms, but many of the conservative solutions to the health care mess, some of which I'd be willing to try were they politically feasible, would be equally disruptive, if not more so. Take the Wyden-Bennett bill, which has largely been labeled the bipartisan health care bill. Here is Ramesh Ponnuru on the politics of the bill:

Is there any reason to expect the public to be more enthusiastic about a plan that gets rid of the tax break for employer-provided coverage altogether? The disruption of existing arrangements has, as I noted earlier today, been the most important political disadvantage of Obamacare. It's a bigger one for Wyden-Bennett. As for its vaunted low costs, they are achieved by more than doubling the percentage of Americans in HMOs. That should sell well.

Timothy Noah described a few days ago why health care lite is hard. His take on Wyden-Bennett:

Eliminating the tax exclusion for health insurance would quickly and a bit too obviously chase employers out of the health care business—a result much to be desired but one that could turn the town hall crazies into a lynch mob.

And here's Alex Knapp arguing in favor of the bill:

Conor, like any good conservative, doesn't like the idea of sweeping changes, a viewpoint I have sympathy for and often share. But a lengthier bill does not necessarily mean it is more radical. Wyden-Bennett is 168 pages long. The House bill is 1017 pages. The 1935 Social Security bill was 64 pages. Their size doesn't tell you much about their nature.

by Patrick Appel

Raising taxes won't fix the budget gap.

by Patrick Appel

P.J. Tobia posts a video of a journalist getting beat by Kabul cops:

[If] a local journo writes a story that burns a big-shot in government or the drug trade, the reporter will be looking over his or her shoulder (to say nothing of their family’s) for years to come. I don’t know any reporters who carry a gun in the US. Here, I know more than a few reporters who won’t leave the newsroom unless fully strapped.

by Patrick Appel

The health care debate gets nuttier.

by Patrick Appel

It looks like end of life counseling is being dropped from the Senate Finance Committee's version of the health care bill. Marc's reaction:

[F]or those Democrats and liberals who'll be angry about this: the response to Palin's remarks about "death panels" as well as to Sen. Chuck Grassley's repetition of the idea was swift and fairly unequivocal: it's not as if the pro-reform side didn't quickly rebut the issue with better facts. My sense is that fear-based emotional appeals set in more quickly than reason-based emotional appeals — always have.

by Robert Wright

Did Muhammad really say 'Kill the infidels wherever you find them'?

by Robert Wright

Good news. China has dropped plans to require “anti-pornography” (read “anti-political-freedom”) software on personal computers. The bad news is that these filters will still be required in internet cafes, where many lower income Chinese get their net access. (Kind of inverts the meaning of “dictatorship of the proletariat”.) Still, given the rate at which the cost of computers is dropping and China’s economy is growing, computer ownership will no doubt expand, so keeping homes free of authoritarian software will have trickle-down benefits. 

Among the pressures that got the government to abandon this plan was an American threat to use international trade law against it. This is the second time this week that trade law has intersected with information flow in China. Yesterday the WTO ruled that Chinese restrictions on the import of American books, movies, and music are illegal. This ruling wasn’t so much about freedom of expression; the main question was whether Chinese would buy bootlegged copies of Hollywood movies or official copies. Still, I’m wondering: If America complained that Saudi Arabia, a WTO member, was banning the import of Brokeback Mountain, could the WTO rule against Saudi Arabia? If there are any trade lawyers out there with the answer, please email us.