The Prudent Use of Medical Screening Tests by Denise Zito

Everyone has probably heard the story of the 1950’s x-ray machines used by stores to measure your shoe size. I wasn’t there but I heard you could stand on these and see your foot bones as well as learn your shoe size. They were especially used to measure children’s feet and were considered technology at its best. Eventually, someone pointed out that maybe it wasn’t healthy to use an x-ray machine to measure your foot-- there were safer ways to figure out what size Striderite your toddler needed.

The latest outcry over healthcare reform involves the revised guidelines for mammography. The U.S. Preventive Services Task Force, made up of independent experts in primary care and prevention, systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. This group is a branch of the Agency for Healthcare Quality, a highly respected advisory group. If you look at their website, you’ll see a long list of recommendations in favor of some screening procedures and recommending against others. For example, the agency recommends against routine chest x-rays to detect lung cancer because there is no evidence that we would save more lives by doing this. However, they do recommend screening for prostate cancer in elderly men.
This Task force has reviewed breast cancer data and is now recommending that women in their 40s not undergo routine mammograms, and instead individually discuss with their doctors whether to have the exams. It recommends that routine mammograms begin at age 50.
Critics are saying that the revision of the guidelines is a form of rationing.
In fact the reason for the change is well-founded in fact and science. Though the task force is emphasizing the number of false positive mammograms, what many people seem to forget is that a mammogram is an x-ray and an x-ray carries its own set of risks and should be used prudently. Every x-ray or mammogram received carries a small risk of inducing cancer. And no one knows which woman is sensitive to the radiation and can actually be damaged by the x-ray, instead of benefiting from it by detecting an early cancer.

The U.S. has for years been encouraging women to begin yearly mammogram screening at age 40, while Europe begins at age 50 and screens every other year. The Task Force has looked at the data and determined that it’s not worth the associated risk and unproductive follow-up procedures, and the unnecessary exposure to radiation for the benefit of a few more early breast cancer detections. And, we’re not certain that early detection of all cancers leads to a better outcome.

If you’re a woman whose cancer was detected by early mammogram, you’ve got a right to be upset by this recommendation. But the rest of us should stop and ask ourselves—‘what if I’m a woman who is sensitive to radiation and might actually be increasing my risk of cancer by having a yearly extra x-ray.’ We worry a lot about the former and forget about the latter situation.

Now I’m not suggesting that a mammogram is as dangerous as the shoe-fitting x-ray machine, I’m only saying that prudence and hard science should dictate health policy and that revising guidelines to give women less radiation exposure over their lifetime, is probably a very good thing.

Maggie and the Blue Butterfly by Kathryn Pigg

It was a major hurricane. As it swept inland it broke trees, eroded the land under homes, caused long power outages, and major episodes of cabin fever. I checked in with my friend Maggie to see if she wanted to go for a meal at a restaurant some 30 miles inland, one with power restored. She was eager to go. We had a good visit, catching up on her latest artist projects and on mine.

It wasn’t until her fifties that Maggie had followed her dreams and gifts. Her children grown and out on their own, she’d gotten her art degree and begun finding her way in that competitive world. Her work had sold well. She’d been able to find jobs that were part time and so still allowed her time to paint. These were not jobs with benefits.

Over lunch, that day after the storm we laughed at life and the wind and valued our survival, and we returned to her house with renewed energy. As we drove up behind her car in the driveway, we both abruptly stopped talking. On the back bumper of her aging car, on the bare metal, was a beautiful blue butterfly, very still, although it did not appear to be injured. We wondered out loud why and how it held on to the metal. Then we understood that somehow it had been stunned by the storm like so many of us. Carefully we got out of the car, and one of us gently moved the butterfly to one of Maggie's thriving plants. Slowly rhythmically that blue butterfly began to move its wings and drink from the moisture on the plant. In five minutes or so it flew away.

Maggie flew away too. Looking back now over the years that have passed, I realize that when she was in her early 60s, I began to worry each time I saw her that she seemed to have less energy. I did not say, "have you seen a doctor." I knew she had no access to a doctor. She did not qualify for Medicaid.  

What neither of us knew was that Maggie had developed heart disease. Her daughters became concerned and they were able to find some help they could afford. There was eventually a diagnosis, but what good is a diagnosis if there is no access to adequate medication or hospital intervention One of her daughters still regrets that she did not try harder to find help. Yet, how many of us have the needed resources to care for a desperately ill loved one who is living without medical insurance.

Maggie died at home shortly after seeing a doctor, early one morning, her beloved cat curled up beside her. A cousin who had come for a visit and to check on how she was feeling, discovered her already gone. The autopsy confirmed the doctor's diagnosis.

Some are not blessed by the care Maggie and I gave that day to a blue butterfly stunned by a storm. The destructive storm of our health insurance system took Maggie's life. Too quickly. We miss her.

                                   --Kathryn Pigg is a retired Methodist minister. She lives in Bridgewater.

Thoughts on America's Moral Underpinnings and Health Care Reform by Owen Norment

I’m a member and currently co-chair, along with a retired pediatrician, of a Charlottesville-area group called Clergy and Laity United for Justice and Peace. We try to do some things—sponsor occasional events, write some letters, make some public statements in support of public policy initiatives that we take to be vital to the common good. Recently we’ve been much engaged with the issue of health care reform.

          

Good health is a basic necessity that ought to be sustained by enlightened public policy. Yet availability of adequate health care is badly in disarray in the United States, with millions of our citizens having only minimal access to needed medical treatment. Complex though the details of reform may be—and they are complex, and acknowledging that there are many practical and political hurdles to overcome, it is essential that we consider such reform in the broader context of the foundational values of our society

Just and equal access to health care is an essential human right. We have therefore a moral obligation to correct injustices in our current system. The core values of our society, values that define who we are, underwrite this obligation. Values inherent in the Hebrew and Christian Scriptures stand at the headwaters of the American moral tradition. These ancient texts envision values rooted in a good order of creation and in the social bonding of an inclusive community, wherein love for neighbor is a corollary of love for God, and wherein therefore we are mutually obligated to extend human care to the dispossessed and marginalized neighbors among us. Such humane values are broadly shared among other spiritual and moral traditions as well.

Biblical faith is not merely individualistic and otherworldly, but has implications for real-world social justice, here and now, as well. The Hebrew prophets cry out urgently and repeatedly for this. Likewise Jesus speaks often of God’s reigning compassion not just beyond us but already among us.

This basic moral mandate of love for neighbor must be made effective through practical structures of justice. We must not be distracted from the urgency of this deep-rooted mandate by misunderstandings of what is really at stake or by the hard work of ironing out legislative complexity. Therefore I and others in the group I represent endorse the efforts of President Obama and the Congress to enact comprehensive health care reform legislation, including a viable public option.

        --Owen Norment is a retired Presbyterian minister and Professor Emeritus of Religion at Hampden-Sydney College. He now lives in Charlottesville.

Pirates, Music Sales and the Recording Industry of America by Ted Ghaffarian

Pirates. That term has been used pejoratively by the Recording Industry of America—the RIAA—for some time. Now if I called someone a pirate, I’d mean they were merciless, scruffy anarchists who plunder and disrupt all notions of decency and peace (either that or Captain Jack Sparrow drinking rum and hitting on my girlfriend).

Many file sharers have a strong distaste for this term. But I actually do think it fits when we extend this metaphor even further to the World Wide Web. If file sharers are pirates, then the internet is a vast sea, teeming with mediocre and irrelevant information. Law abiding consumers are tiny boats, with limited resources to find islands of products. In a digital sea, our consumer senses are limited to viewing images of far off products that are potentially islands away. I can’t go to an online clothing outlet and put on a pair of pants to make sure they fit, or feel the material. There is very little tangibility to consuming online products, which may be why many turn to piracy before purchasing online media.

Since the advent of digital media, the RIAA has assumed that their yearly losses stem primarily from file sharing and duplication. The Guardian, an English newspaper, published a story, based on research done by the   BI Norwegian School of Management, which found that consumers of  legal and illegal digital media between the ages of 15 to 20 are ten times more likely to purchase music. That means pirates the RIAA callously names them —at least for that important demographic of consumers —are a vital source of digital sales for the music industry.
Artists have begun to capitalize on this information already. In 2007, Radiohead, an internationally popular rock band, released their seventh studio album without record label backing and distribution. Instead, they released the album on their own website, claiming that it was up to the consumer to pay whatever he deemed fit in return for downloading the album. That means one could even download the album without paying anything.

As a financially dependent college kid, that was my first choice. However, I listened to the album in its entirely, and donated as much as I could afford to the band's cause, because I thought the album was incredible. Contrary to what many in the recording industry would think, most downloaded the album and then made a possitive financial contribution to the artist. Not only was this a wildly successful experiement, but it made Radiohead a fortune because they didn't have a record label netting all or most of the profit.

If the RIAA cannot see the enormous opportunities that file sharing--the loosing of all those pirates--offers the music business, then it will ultimately end up sinking its own ship.