Monday, December 18, 2006
14,000 Women
BY NANCY BERLINGER

If you follow breast cancer as a nonclinician, you quickly learn that the San Antonio Breast Cancer Symposium is the meeting to watch: advocacy groups send correspondents, file reports, and hold post-meeting web conferences to discuss the latest research findings and clinical advances. But the big news out of this year's meeting, which opened December 14, has already hit the headlines: In 2003, the rate of new cases of breast cancer in the United States fell by 7 percent. To put this another way, 14,000 women were not diagnosed with breast cancer in that year. The single-year drop – described in news reports as “startling” and “huge”– was uncovered through an analysis of federal cancer-registry statistics. Almost more startling is the leading theory for the reason for the drop. In 2002, a “safe” drug – hormone replacement therapy – was found to increase the risk of breast cancer. In the months that followed the announcement, millions of post-menopausal women decided to stop taking this drug.  Researchers theorize that some of these women would have been diagnosed with hormone-receptive positive cancers in 2003 – had the supply lines to nascent cancer cells not been cut off in 2002.

The news out of San Antonio reminded me that one of the ways patient safety experts drive home the extent of medical error as a health care problem is to compare to breast cancer: in the United States, mistakes kill more patients than breast cancer does. Because medications are the leading cause of medical injury, these experts urge clinicians not to restrict their safety efforts to preventing known types of errors, such as ordering the wrong drug or delivering the wrong dose. To prevent harm, clinicians must also be wary of the very concept of a “safe drug.” They must investigate “typical complications” to determine if these are in fact harms caused by allergies, side effects, or interactions. Once they know or suspect a drug is harmful, they have an obligation to protect patients from that harm. The startling possibility that 14,000 women were not diagnosed with breast cancer in 2003 because they stopped taking their hormone replacement pills in 2002 is a Power Point-ready lesson in the danger of holding any drug harmless.

 – Nancy Berlinger

Comment on this essay.

Comments are sent to the forum moderator. Select responses may be posted.

A Phony 'War on Science'
Michael Gerson, Washington Post
“In their talk of a Republican war on science, liberals may be blinding themselves to a very different kind of modern war in which their own ideals are deeply implicated: a war on equality.”

It’s Not Immoral to Want to be Immortal
Arthur Caplan, MSNBC
“Despite a lot of hand-wringing and finger-pointing, it is not obvious that wanting to live a lot longer is evil or immoral.”

Science Is Leading Us to More Answers, but It's Also Misleading Us
David A. Shaywitz, Washington Post
“Consumers of scientific information must balance the hope we place in global biology with the skepticism this field has surely earned.”

Taking the Scary out of Breast Cancer Stats
Carol Tavris and Avrum Bluming, LA Times
“The media understand how deeply women fear breast cancer, and the result is that every study that seems to find a link between some new risk factor and the disease makes headlines everywhere.”

Dollars to Doughnuts Diagnosis
Albert Fuchs, LA Times
“Insurance doesn't make routine care affordable; it makes it more expensive by adding a middleman.”

Tainted Medicine
Jerome P. Kassirer, LA Times
“Disclosure of financial ties may give a scientist or researcher a clean conscience, but that doesn't erase the possibility of a conflict.”

Children's health can't be left to faith alone
Arthur Caplan, MSNBC
“Parents do not have the right to watch a child wither away while they pray.”

Transplant List Numbers Raise Doubts
Arthur Caplan, MSNBC
“The American people have a right to expect absolute honesty about the number of people waiting for a transplant at any time.”

An Epidemic No One Wants to Talk About
Robert E. Fullilove et al., Washington Post
“Simply put, we will never rid the United States of HIV and other STDs if our only weapon is medical treatment.”

Making Cells Like Computers
Erik Parens, Boston Globe
“Conceivably, we are on the verge of installing synthetic genomes in bacterial cells to create products we want. But we are still a long, long way from doing what most people mean by ‘synthesizing life.’”

Miracle Workers?
David Rieff, New York Times Magazine
“Even today, the oldest of all relations between patient and physician — that of supplicant to shaman — continues to exert its authority.”

Overselling Overmedication
Judith Warner, NYTimes.com
“Most of the critics decrying the over-medicalization of the American mind rest their arguments upon the bedrock assumption that people who have nothing wrong with them are being medicated for largely fictitious concerns.”

Ads Spur Urge for Drugs
David Lazarus, LA Times
“DTC advertising has turned prescription drugs into just another gotta-have-it consumer product.”

Food Politics, Half-Baked
James E. McWilliams, New York Times
“Lost in this rhetorical battle was a quiet middle ground where the benefits and drawbacks of genetically engineered crops were responsibly considered.”

Perpetrating the Autism Myth
Benjamin Kruskal and Carole Allen, Boston Globe
“The scientific evidence is clear: neither the MMR vaccine nor thimerosal (mercury) in vaccines has any relationship to autism.”

Closing the Barn Door After the Cows Have Gotten Out
Verlyn Klinkenborg, New York Times
“The real beneficiaries are the nation’s large meatpacking companies — the kind that would like it best if chickens grew in the shape of nuggets.”

Human Embryos Cloned: What Does It Mean?
Art Caplan, MSNBC
“Let's not be frightened by scare tactics into not funding research that may be the key to curing what is currently incurable.”

Don’t Ask, Don’t Tell Is Bad Policy for Cloned Food
Art Caplan, MSNBC
“All of this fear-mongering about clones has made Americans forget that cloning is nothing more than artificially creating twins.”