Overdiagnosis: An epidemic or minor concern?

An editorial by two oncologists in the New Year’s issue of Annals of Internal Medicine discusses overdiagnosis, a controversial health problem that some have called “a modern epidemic” but others, including the editorialists, feel is a minor concern. Although many chronic conditions are overdiagnosed, cancer is the most thoroughly studied, as well as the most emotionally charged.

I am a generally healthy man with no family history of significant health problems. Yet increasing numbers of men like me who are approaching middle age may be shadowed by a sniper on a rooftop, each armed with a highly accurate loaded rifle pointed directly at our heads. By age 70, nearly half of all men will be shadowed by a sniper, though in only 3 percent of us will he actually take the fatal shot. A 1 in 30 chance of being assassinated without warning still seems too high, and therefore health authorities concerned about the problem of snipers on rooftops recommend that all men after age 50 (or perhaps 40) be offered routine surveillance to determine if there’s a sniper up there. If there is, perhaps he can be safely disarmed.

The  trouble is, the disarmament team is successful at best, 21 percent of the time (reducing a man’s chance of being shot from 3 percent to a barely more reassuring 2.4 percent), and at worst, hardly ever. In addition, attempts to subdue snipers by force often lead to unwanted consequences: stray shots fired in the scuffle that cause non-lethal but persistent injuries to the bladder and reproductive system. In about 1 in 300 men, the attempt to disarm the sniper goes terribly wrong, causing the gunshot to miss the head but deliver an equally fatal round through the heart.

Oncologists and others whose careers primarily consist of treating cancer argue that the true problem is not one of overdiagnosis but overtreatment, and that a more conservative approach to management (rather than less diagnosing) of indolent cancers will solve the problem. Let’s not rush in to disarm all of the snipers, they say – instead, let’s watch them for signs of aggressiveness and act later if necessary (termed “watchful waiting” or “active surveillance”). Men who choose this option live the rest of their lives with the anxiety-provoking knowledge that guns are pointed at their heads, however small the possibility of a shot. They and their physicians may become so obsessed with the sniper, constantly scanning the tops of tall buildings, that they forget to look both ways when crossing the street and succumb to some other preventable cause of death.

A reasonable objection to my analogy of the sniper on the rooftop is that unlike a bullet to the head, death from cancer is neither quick nor painless. By measuring deaths averted as a primary outcome, the argument continues, one minimizes the benefit of sparing patients the symptoms and treatment of metastatic disease (in other words, “there is more to life than death.”) This argument only holds in cases when cancer was destined to progress enough to cause symptoms (not overdiagnosed). I don’t discount it, having witnessed firsthand the suffering that metastatic prostate cancer inflicts on patients, but cancer is hardly unique in this regard. There is, unfortunately, a great deal of suffering involved in slow deaths from non-cancerous causes such as congestive heart failure, chronic obstructive pulmonary disease, multi-infarct or Alzheimer’s dementia. To be worth the price of overdiagnosis, cancer screening should do more than replace one cause of death for another.

Back to the Annals editorial about overdiagnosis in breast cancer. The authors write:

We believe that the term “overdiagnosis” in the context of breast cancer places this problem in an inappropriate light, suggesting that these patients do not have cancer. The question is not whether we should find early, more easily treatable cases of breast cancer but rather how to treat early-stage cancer found on mammography. … For the individual patient, the question is not whether to have a mammogram that might “overdiagnose” breast cancer but how to treat the early-diagnosed non-invasive or invasive breast cancer once we have found it.

Essentially, this boils down to: overdiagnosis be damned, let’s find all of the cancers we can, and then worry about what to do about them later. (Let’s find every single one of those snipers on the rooftops and then decide if and when they should be disarmed!) On the contrary, I believe that individual women (and men, in the case of prostate cancer) should be presented statistical information about overdiagnosis along with potential benefits and then offered a choice, rather than a default option. Some – perhaps most – women will choose to be screened, despite evidence that more than 3 in 10 breast cancers are overdiagnosed. Others will not. The latter should have their choices respected, rather than be harangued or fired.

Finally, I apologize to any of you who were offended by my explicit comparison of overdiagnosis to gun violence, given the recent tragedy that has drawn belated attention to the latter as a public health problem. Although not as immediately devastating or newsworthy, overdiagnosis is a formidable public health problem in its own right, an epidemic that has affected millions of men and women over the past few decades in cancer alone. It deserves attention, not dismissal, in the pages of major medical journals.Overdiagnosis: An epidemic or minor concern?

Kenneth Lin is a family physician who blogs at Common Sense Family Doctor.

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  • Homeless

    The probability that you will be fatally shot given that you are being shadowed is 0.5*0.03 = 1.5% which is about 1 in 67 for all men.

  • SBornfeld

    You wrote:
    ” By measuring deaths averted as a primary outcome, the argument
    continues, one minimizes the benefit of sparing patients the symptoms
    and treatment of metastatic disease (in other words, “there is more to life than death.”) This argument only holds in cases when cancer was destined to progress enough to cause symptoms (not overdiagnosed).”

    Bingo. By considering treatment-related morbidity against cause-specific death, the USPSTF only APPEARS to make a balanced cost/benefit analysis of PSA screening.
    But considering the current membership is studded with pediatricians, epidemiologists and public health specialists, they cannot really be expected to be familiar with the suffering incurred by victims of the second largest cancer killer among men.

    • Homeless

      I would guess you are an oncologist, urologist or someone who profits from over-treatment of cancer.

      • SBornfeld

        You would guess wrong. I’m just an informed reader of the literature with 2 first-degree relatives who have or have had prostate cancer.

    • http://www.facebook.com/jewel.markess.3 Jewel Markess

      Epidemiologists are people who actually know statistics and are trained specifically to design and evaluate studies. Whereas those who are as you say familiar with the suffering have a lot of anecdotal information, ZERO data, and because of their emotions aren’t able to make a decision based on facts. Oncologists have a lot of anecdotal information, but epidemiologists are those who can collect and evaluate data in a scientific manner.

      Just because a disease is terrible doesn’t mean one needs to force people to have a test that is more likely to harm then to help them.

      • SBornfeld

        The USPSTF has demonstrated abundantly that they can cherry-pick data with the best of them.

        • meyati

          Cherry pick is the word of the day. It’s not just picking patients with a probable positive outcome, but picking wealthy patients, or healthy patients with a rare cancer for research. My father was a boxer, army sgt. hunter, etc. He had a rare stomach cancer. He started out and even ended up without high blood pressure, no problems from smoking, no liver problems until the cancer settled in it. No kidney problems- he was agreeable to be experimented on for several reasons. The main cancer hospital-which is also a research center wanted to put me on a plane and get me there. I’m not as amiable as my father. They learned that some patients say-NO-

  • http://www.dpsinfo.com LaurieMann

    My 82-year old mother was found to have a small breast cancer and she had a lumpectomy. She’s believed to be cancer free now, so she avoided chemo and radiation. Would the cancer have grown and metastized, or would it have just stopped growing? Until we have better tumor/DNA analysis, we have no way of knowing, so I’m glad she had the surgery. Hopefully, within a few years, we’ll have better analytical tools to know what cancers can be “waitfully watched” and which ones need the whole medical arsenal.

  • http://twitter.com/LymphomaJourney Andrew Griffith

    Interesting analogy that makes the point.

  • http://www.facebook.com/shirie.leng Shirie Leng

    My understanding is that the problem with screening tests is that no one knows what do do with the results, because we can’t tell an aggressive tumor from a non-aggressive one most of the time. We have some markers that can help guide treatment, but we don’t always know whether those cells need to come out or not. Because of this, screening should be an individual decision. Some people can’t live with not knowing, others would rather live a longer period in the dark.

    • meyati

      The trick is in somehow forcing a dermatologist to do that biopsy. I tried waving money in front of them-so now I have an incurable cancer. They don’t want to remove anything that’s not-recognizable as a cancer. They seem to lack curiosity which is why you have your complaint-nobody seems to know what to do with the results.

      • querywoman

        Meyati, please share how you finally got the biopsy of the cancerous lesion, which I assume was the one below your nose.

        • meyati

          The surgeon wanted me to go to day surgery, but I wanted it done in her office. My son is an emotional fragile disabled vet, and it tore him up when I had a colonoscopy and he had to wait for me to come out of the anesthesia. I knew that he’d do much better if I walked out, made my appointments for stitch removal and the 3 week follow up.
          The second one, she gave me about a half of a dozen lidocaine shots, even several in my lip, and both sides of my nostril, and way up inside my nose. This time I didn’t go completely numb, When she stuck needles in the affected field, in some places it felt like a feather was brushing. I did flinch on one shot. of course she sterilized me before the shots and again before she began slicing. I had the right side of my face draped so I wouldn’t flinch from any movement around my eye. Curiously, these injections hurt less than the first one. Those curled my toes-I really had my toes curled inside my shoes to control the pain. Both times, tears ran down my face from the right eye, but I flinched only that one time. She took out the new cancers-they go in the blood to hair folicles and pop up like bubbles from the pore, then eat or drill their way down to the bone-through the bone. She talked to herself-which really helped me to understand what happened. She removed the tumors and bagged them. Then she began cutting and cutting. Sometimes it was like a little touch- I just felt pressure. I don’t know if it was scraping bone or cutting through cartilage, but sometimes it sounded like somebody whittling on a piece of hard wood. Because she talked to herself, I knew that she couldn’t get a clear cut, The more flesh she removed, the more cancers she saw. She took out about a quarter to half of an inch from inside my nose, part of the flare of my nostril, part of the cheek on down to removing part of the lip. Now I have a little nose and mouth. She did a beautiful job, but it was ghastly for the first month. My nose on the right side was turned sideways. I had catgut all over it, and my whole upper lip swelled up like I had about a thousand too many botox injections. I immediately called my GP, told them that I was just diagnosed with cancer, and I needed to see my GP ASAP to get referrals. He saw me like that-and I just don’t have any problems with him backing me up. It’s left me problems with my ear, the sinuses on the right side don’t drain well, then radiation also does the same thing. My GP wanted me to go to an ENT, and it will probably take months to get in, but I wanted to wait until radiation was finished-so we’d know exactly what my problems and symptoms are. Then last week I had to take Thurs and Fri. off. because the corner of my mouth is pulled so tight, I was developing a bad ulcer there-burning too much, I began having trouble eating, and an ulcer was developing on my top lip and inside. It didn’t hurt as bad as after the surgery. For weeks my whole top lip was covered with a scab- it would drop off and then about 3 days later reform. I was ghastly looking. I look much better than many people that have been in accidents or fires., but this isn’t about vanity. It’s how I was treated differently from men, and I might die a horrible death because they wouldn’t touch a stage one cancer-they lacked complete curiosity and lacked any type of feeling for me.

  • querywoman

    Though this article uses the term “overdiagnosis,” the real problem is substituting profitable preventive magazine for the treatment of sick patients with real symptoms. I have repeatedly been to doctors complaining of illnesses with symptoms, which they ignored while preferring to play around with the blood pressure cuff, do cholesterol screenings, Pap smears, and mammograms.

    I always had to pay and pay and persevere until I found doctors who would treat illnesses with symptoms!

    I do believe that currently the number one selling prescription drug in the US is an anti-cholesterol drug, for a supposed condition that has no symptoms. A family doctor told me about one year ago that only diet has really been proven to lower cholesterol.

    Generations have lived and died on this earth without the blood pressure cuff! The average American doctor is powerless without a blood pressure cuff!
    The ACOG stopped recommending annual Pap smears several years ago! I never understood why, as a woman, it is assumed that I will willingly submit to this rite of passage.

    I am 56 and have repeatedly refused a mammogram, which is my legal right. I have never seen real evidence that 1 in 9 women will get breast cancer. I have asked official sources, including the government, for the official study with that determination and it has never been provided!

    What kind of researchers don’t ask for studies to back up what’s claimed? I have a serious problem with my government funds being used to promote this statistic.

    If 1 in 9 women got breast cancer, I’d know a lot more women who have it .Approximately 50,000 women die in the US each year of breast cancer. The large suburban city in which I live has approximately 1 million people, What a blaring discrepancy for a misguided public health campaign!

    Heart disease is the main killer of women, and often not dx’d quickly enough for women. I knew a female medical doctor, also married to a male medical doctor, who complained that her mother’s early signs of heart disease were dismissed as emotional stress!

    Lung cancer kills more women than breast cancer!

    I prefer not to use gynecologists. I would rather get a complete physical from a family doctor or internist, who will also look into my ears, eyes, nose, and throat!

    • http://www.dpsinfo.com LaurieMann

      Given the fact that one grandmother died of a stroke (and they did use the BP cuff in the ’60s & ’70s so she knew she had high BP), I’m happy to monitor my BP and take Benicar and Lipitor. I took 9 months off of Lipitor, watched my diet (not too well, but I did a little better) and walked about 500 miles. My blood test came back with my LDL at a record high. I’m back on Lipitor to get it back in a marginally normal range.

      • querywoman

        I take 3 blood pressure meds every day and 1 cholesterol med. I have my reasons for agreeing to take them, mostly related to my diabetes. That does not mean that I totally agree that they are necessary.
        It’s hard to get to the truth about blood pressure. I just read an article on the net that stated blood pressure meds will only prevent a stroke in 1 out of 200 patients.
        Blood pressure meds have risks like any other medicine. Furthermore, a doctor who ignores an illness with symptoms and starts in on a blood pressure rant, as has happened to me, is being counterproductive.
        Patient compliance goes up when all of a patient’s needs are addressed.

    • meyati

      I won’t go to a gyn, especiallly GYN nurse practicioners. Don’t get me wrong, I’ve had wonderful one GYNs, but never a nurse. Like many women my age, part of my urinary tract is prolapsed. For some stupid reason they say that I’m in denial about peeing my panties, and we argue a lot. I’ve been doing the Kegel exercises since I was 20 years old, and I lift light weights. Then the nurse gyns want me to wear a weight belt. I basically use 3 lb dumbbells. Sometimes I work up to 30 -40 lb barbells. I do a lot of crunches, stretches, etc. Why do I need a weight belt for a 3 lb dumbbell? I tell them that I’m not in any competition, I’m not trying to press 500 lbs-leave me alone. Seriously do they think that I’d want to ruin my weight bench by peeing on it or embarrass myself in a gym? Really, if I pee my panties, but I come in clean smelling and nobody complains- who should care?

      • querywoman

        So Meyati, you are not lazy? I am not physically strong,but I am determined, stubborn, and perseverant. Gynecology exists to get a woman into surgery!
        I’m struggling with the issue of a “sleep study.” I recently had pneumonia. The pulmonologist at my first post-hospitalization wanted a sleep study so badly.
        My mother, who used to be a heavy smoker, had sleep apnea but wouldn’t use her CPAP much.
        I told this guy that I slept too much, and usually fell asleep easily. The test was negative for apnea! I’m feeling that it was a total waste of Medicare dollars!
        My home health nurse says another patient of hers, who also had pneumonia, was furious when a pulmonologist tried to get her to do a sleep study. He asked her if she fell asleep watching TV, and she thought her was nuts. She refused the sleep study, but did other tests. My nurse says the woman still gets mad about and claims it was just a way to make money.

      • f. lusu

        i had talked about that same problem and my gyn said he could do transvaginal mesh surgery to take care it. he didn’t suggest it, but i guess it’s sometimes easier for drs to say yes instead of saying no to people who want the latest thing they have seen on TV. i asked what % of women, who had the surgery done, had a normal functioning life after having that procedure. he told me 15%. i have to give him a lot of credit for not lying to me. i feel a little sick when i think about the emotional and physical damage that might have happened to me. i once had a gyn that told me “every day is a good day for surgery”!

        • meyati

          The Marines used a mesh on my brother’s hernias. They took them out a few months ago because they were causing him infections, pain, etc. My grandson was talking about my oncology radiologist. Levi was saying that the doctor is so different. He’s human. He actually cares. I told Levi that he’s like many doctors were until about 1975. Of course my doctor is very tech oriented-he’s a radiologist-but he keeps jigsaw puzzles out for patients and escorts to work on-I found out that he picks the puzzles out himself-he keeps a fridge with chocolate malt and milk shake fixings for frail patients, those losing too much weight, those that seem to poor to eat decently, or have indifferent care takers.. The ACS said that radiation patients can’t have chocolate. I asked the nurse why, and she told me about the fridge-the clinic has lots of chocolate syrup, because the frailest patient-that can’t taste anything anymore will try to get a chocolate milk shake down.
          We’re being treated by fad medicine-the new in things, whether they work or not.

    • f. lusu

      i’m sure at least one of the incompetent dr.s you went to thought that you were totally exaggerating all your symptoms. i had one dr that looked at me like i was a hypochondriac and said, ‘and how many drs have you seen?’

      • querywoman

        In ,my experience, most doctors think an illness with symptoms is a psychiatric disorder, which they ignore or trivialize, and then switch into a sales pitch for some profitable preventive procedure.

  • meyati

    I have incurable cancer. I spent about 25 years trying to get a ‘zit’ removed from just under my nose. I was told that I was vain. I even volunteered to do full-body exams with dermatology students. I did this for several years, but when I asked about the zit-I was told that everybody has a blemish, and I shouldn’t be worried about it. One group was told, with a wink, that they had to be careful to distinguish vanity from a potential skin problem. I offered money up front for the lab. I was told that it was too small to remove, if anything was wrong, the insurance would be mad-and it would make trouble for the book keeper and me. At this point I can’t be mad at any doctor-female doctors wouldn’t do a biopsy either. Just don’t go to a dermatologist trained at UNMH-they learned all of the wrong things.

    • querywoman

      Luckily, I do not have cancer, but your experience in getting a
      “minor” blemish investigated was the same as mine in getting layer after
      layer of eczema tissue investigated. It took me over two years to get a
      skin biopsy. I won’t go into all the details of that here.

      I used to think I had the controversial Morgellons Disease, but I no
      longer believe that. I have a serious bizarre case of atopic eczema that
      is white and mixes into my fair German-English skin. The dermatologist
      I use now agrees. His nonlicensed staff members who have worked for
      skin doctors for years tell me they have seen my rash before.

      It’s almost impossible to get a wart, mole, or suspicious skin lesion
      removed. Yet, it’s very little work to get to a skin lesion. Most
      doctors will gladly cut into a woman’s breast or vagina to get to a
      lesion!

      I don’t know that the biopsy I had was that productive with my illness, but it certainly didn’t hurt. The biopsy was done at a large public hospital. Now I see the director or dermatology at another very large hospital in my city.

      I’d been told I was delusional, whereas you were told you were vain.
      My skin disease story includes a lifetime of neglect, including having my chronic itching being laughed at and ignored while some clown doctor tried to bully me into preventive measures that I already ranted about!

      You said women doctors wouldn’t help either. I’m not surprised! I’ve been to some real nutwhack power-mad women docs!

      • meyati

        Dear Query, my maternal family is German and my father’s is Irish. I sent in a short article about this to Dr.Kev. He wouldn’t print it. I don’t think that he believed it. You wouldn’t believe what happened in oncology. The surgeon that removed part of my nose and lip said that the bones were intact-I just needed to have my nose and flesh removed. Oncology wanted to remove my right eye, nose, and cutting out the bones. I think that they saw a person without heart, kidney, etc problems and physically active that they could experiment on. I had to take my 26 year-old grandson to get some basic questions answered. The oncologist wouldn’t tell me how long it would take to get a prosthetic face, he had to admit that it might take many surgeries- and nobody has told me yet- How was I supposed to live and care for a wound like that for about a year. I felt like I met a Nazi doctor and I was a Jew. I had to do my own research, do my own appointments, choose my own treatment. They didn’t do any lab work-I was able to convince my GP to order lab work. How can a tumor board even think of such surgery without knowing if I had clotting problems, had anemia, hepatitis, etc. I got rid of the team leader who proposed this barbarous treatment. I got rid of the twit nurse navigator that was supposed to speak up to the doctors for me. I have a head doctor that said-if he had this, he’d go for radiation too. No wonder the editors here can’t believe this. I have 10 more radiation treatments-then a few months for the radiation to finish it’s work-a CAT scan, lab work, and an appt. with my new team leader.

        • f. lusu

          thank god for the internet. we are able to do our own research on a disease or disorder, just in case. i actually know more about new research of my disease than he does. i have been able to have more options because of it. i trust him and leave the treatment to him, but at least i know the right questions to ask, even the ones that have been uncomfortable for him to talk about.

          • meyati

            Because mine was rare, I had a horrible problem in getting any information. Everything kept linking me to basal cell carcinoma-a very harmless type of skin cancer that doesn’t do anything. The doctor that wanted to remove right side of the face kept asking me about nasal drip and my lungs. When I got home I entered -lungs atypical BCC- and it opened up the links and reality of this cancer. Then I got on blogs and talked to other victims. There’s one man that has hundreds on his back, and his 10 year-old son has it too. If it gets in my lungs, my estimated time is 8 months-otherwise this stuff is so flakey that I could be here sitting comfortably and complaining to you 10-15 years from now. Nobody really knows.

          • f. lusu

            sometimes it’s being victims of the disease or victims of the drs.- i know they don’t want to hear it, but maybe they will think about what everyone has written here. the blogs and support groups are invaluable.

          • meyati

            There are key words that cause us to lose our senses-make us sort of crazy: Cancer, heart attack, vagina, breasts. I know that I was born and like everyone else, I will die. I certainly don’t want to spend months suffocating to death, and I fear the pain. American doctors are caviler about pain, and the DEA is on a rampage against doctors and patients. It seems so unfair that the government and doctors are so interested in our sex lives-they say it’s for quality of life, but some of these cures and preventive care is worse than the disease-where’s the quality of life in that? Right now I can walk my hounds, eat and laugh with my family. i have only 8 treatments left. I’ve done 7 weeks. People ask me how I can be happy-it’s easy-I think of what I’d be like 7 weeks after having my nose, bones, eye-upper sinus cavity removed. This might work for very long, but the same could be said of the surgery. I went out and cleaned dog poop from the back yard, and I was happy to be out and smell the cold wind coming down from the mountains.

          • f. lusu

            it’s unbelievable that family docs can’t give pain medication to their established patients, or call in medication to the pharmacy for breakthrough pain on weekends and nights. people are taking up space in the ER for breakthrough pain. why let pain management dr.s make big bucks doing ‘procedures’ on people who are basically held hostage for their medication. so many dr.s tend to be so clueless about pain in any situation. i wish they could experience a day of horrible pain. they won’t be so dismissive and arrogant. what’s going to happen if there are more DEA restrictions?

          • querywoman

            Aahhhh, pain! My hardest symptom to get treated in the late 1980s was pain, including serious neck spasms, while docs diddled around with the blood pressure cuff and recommended cancer screenings!
            My neck pain was dismissed as “stress,” but hypertension was not just “stress” and just had to have strong chemicals. My neck spasms needed regular nonsteroidal inflammatory meds not narcotics, ice packs not moist heat, and yoga. I figured out myself that it was related to overwork on computers.
            We used to be told not to go to emergency rooms with minor illnesses. I recently had flu complications that went into pneumonia. A doctor told me to go to the ER. The paramedics who picked me up said that’s what the docs always say now, go to the ER.
            I spent 8 days in the hospital, but I contend most family docs (I hate the term PCP) don’t want to be bothered by weekend/eve phone calls and would rather you do the ER!

        • querywoman

          Meyeti, doesn’t seem like the doctors on this blog are responding to us yet! Your experience and mine prove that the idea that doctors do excess tests because of defensive medicine is bogus!
          They weren’t motivated to biopsy our skin, a very simple and inexpensive procedure, out of fear we would sue them later.
          To biopsy the “zit’ under your nose was just out of the question!
          At a public hospital, I wanted a biopsy of lesions on my ears. The derm-in-training told me she could only biopsy something like a running sore! I argued with a nurse in charge of regulatory that the test wouldn’t have bankrupted them!

          Doctors only do defensive medicine when an expensive test is available as a defense!
          I have been seeing a competent derm for over 4 years, who has not cured all my eczema, but it is slowly flaking off. For the past few days, I have been in a special agony due to painful lesions flaking on my my hands.
          It doesn’t last forever, though. It peels and then I am in less pain for a while till more stuff comes off.
          If I went to a brand-new doc right now, I’d only hear that picking at it caused it, without any regard for the layers that have already peeled off.
          I have pictures of it in process now.

          I’m hoping that I can win some of the battle before I die!

          • meyati

            They are in denial-they don’t want to say anything that would validate this situation. I finally have a good team leader—my oncology radiologist is Asian Indian, my new team leader is West African. I’m sort of tired of the good old boy WASP doctors. My dentist is Sicilian-I’ve had him for 20 years

        • querywoman

          Meyati, you also have a problem with overtreatment! I don’t know if it’s right or wrong, but the oncologists seem to be gung-ho on aggressive treatment, without any regard for disfigurement and your comfort.
          I had an abnormal Pap smear when I was younger. Perhaps I should thank that knife-happy gyn, because he left me perpetually leering of cancer screening.
          So they wanted you to have all this stuff without knowing if you had clotting problems, anemia, etc? That was one of the big problems with the knife-happy gyn – he was not interested in any other condition, and there were several, that were sapping my energy.
          I am totally opposed to any medical treatment that centers around a woman’s body as a potential cancer battlefield.
          I am a whole person!

  • Dyck Dewid

    The lack of ‘dealing’ with personal mortality, my state of impermanence, death, seems an obvious omission in this argument. Good starter. But, more dialogue, please!

    Although psychologically uncomfortable or even painful to ‘know’ that one will come to an end, it is nonetheless a fact, and better dealt with sooner than later. Denial is epidemic, no? And yet, to accept this fact mentally or philosophically is not adequate. Nor is it adequate to deal with statistics or when it could happen. Death must be dealt with experientially and in the present moment, repeatedly.

    I consider it a sacred gift, regardless of how rendered, to ‘know’ that “I will return from whence I came… to no longer existing.” If you wish to see some vital ways this ‘knowing’ changes and improves ones life, just ask.

  • f. lusu

    you used the words Texas and social services in one sentence! ha! it always seems to be near the bottom of the states.

    • querywoman

      Yes, Texas is at the bottom of social services in the states. I was a welfare worker in Texas for over 9 years. However, there are plenty of resources, even in Texas, for everything except adult dental.
      Governor Perry just decimated Planned Parenthood in Texas, which I know was doing prenatal screening around El Paso.

    • f. lusu

      i’ve had a couple people ask me how to access free mental health counseling in the houston area. is ‘free’ even possible if they don’t have severe mental illness? i know there is a big medical center there so would that indicate more mental health resources in that city? what organization should they contact for help?

      • querywoman

        I’ll check out Harris County Mental Health and Retardation and get back on here. You could try googling Texas Department of Health for behavioral health services in Harris County. In North Texas, the Dallas area and east of Dallas, the public mental health services are now called Northstar Behavioral Health.

        • querywoman

          MH-MRA of Harris County is the public mental health system there. I won’t post a web link, because I don’t think this site likes us posting web links. Northstar Behavioral Health has very generous income guidelines, and allows use of certain external providers.

        • f. lusu

          thanks for the information. i found a phone number for them on the web site of MHMRA of Harris county. i think it’s a good place for them to start.

  • f. lusu

    and after they finish med school they work 80 hours a week. it works out to be a minimum wage job with only 1 day off a week! they need that day off to catch up on shopping laundry,etc. they must be running on fumes! if they were given 1 more day of downtime they wouldn’t make so many mistakes. the hospitals don’t want to pay for extra drs to be in the ED,so the interns are called in to do a shift! they do need the long hours of training to master the skills they need, but lack of sleep is unhealthy for both patients and dr.s . it might not be a good idea to have elective surgery, in a teaching hospital, in the month of july; because of the ‘july effect’-everyone has brand new responsibilities. med students graduate in july and become new interns, interns become the residents,residents become the attendings. lol,i think drs can only develop the god complex after they start their own practice and get enough sleep.