Earlier this week the U.S. Preventive Services Task Force shocked legions of women when it recommended waiting until 50 for a first mammogram, despite previous recommendations that women begin mammograms at 40. Then today, the American College of Obstetricians and Gynecologists released new guidelines for Pap smears. Previously, all sexually active women were encouraged to get the test—which examines cells in the cervix to determine whether there are any abnormalities that could lead to cancer—every year. Now, the recommendations state that women begin the Pap test at 21, retest every other year, and then, once women hit their 30s, schedule a test every three years.

While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.

Overall, the report says, the modest benefit of mammograms — reducing the breast cancer death rate by 15 percent — must be weighed against the harms. And those harms loom larger for women in their 40s, who are 60 percent more likely to experience them than women 50 and older but are less likely to have breast cancer, skewing the risk-benefit equation. The task force concluded that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women age 50 to 74, and one death for every 377 women age 60 to 69.

It's hard to draw too many conclusions right now, but we do know this: Thursday night, authorities shot and then apprehended the lone suspect, Maj. Nidal Malik Hasan. A psychiatrist who was set to deploy to Iraq at the end of the month, Hasan reportedly opened fire around the Fort Hood Readiness Center, where troops are prepared for deployments to Iraq and Afghanistan. And though this scene is a most extreme and tragic outlier, it comes at a time when the stress of combat has affected so many soldiers individually that it makes it increasingly difficult for the military as a whole to deploy for wars abroad. In an abrupt news conference, Lt. Gen. Robert Cone, the top commander at Fort Hood, said in response to the shooting that authorities would "increase the security presence" on the military base. On the surface, it seemed like a logical enough plan. But it makes one wonder how much any kind of lockdown will either get at the root causes of soldier stresses or better prepare them for more battle.

The H1N1 vaccine shortage isn’t just frustrating. It’s unleashing an ethical and emotionally-charged debate about people’s shot-worthiness. Back in August, the CDC announced recommendations on who should be first in line for vaccination. The list: pregnant women, caregivers for babies under 6 months, health-care workers, anybody 6 months to 25 years old, and people with health conditions like asthma and diabetes. But we all know that vaccine distribution hasn’t gone perfectly—lines have been long, supplies have run out, and, yes, some Americans have gotten the shot when they shouldn’t have.

All of this blew up into a vitriolic exchange on a local moms bulletin board in Washington, D.C., after a mother said she’d gotten vaccinated at a Virginia clinic even though she didn’t qualify. And she urged other moms to do the same to protect their kids. Hello swine-flu mommy wars. One woman called her selfish. (And there were choicer words, too.) Another warned there would be a “day of reckoning” for people like her. And this: “To the people who have gotten the H1N1 vaccine and are not in the CDC priority groups—WHAT YOU DID IS DISGUSTING. YOU ARE DISGUSTING.”

The calmer posts said she wasn’t at fault: at least some health-care workers at the clinic, they reported, were encouraging people to get the vaccine while they could—even if they weren’t in one of the priority groups. But that’s not supposed to happen, at least not until more ample supplies of vaccine are available. Moms aren’t the only ones at war. A report that Goldman Sachs and other big New York companies have received vaccine has some people up in arms, even though Goldman says it’ll provide it only to high-risk groups. And then there’s the news that Gitmo detainees will get vaccines, too. House Republican John Boehner isn’t too happy about that—and neither are a lot of other people.

Now, CDC Director Dr. Thomas Frieden is pulling out his megaphone and trying to bring some order. In a letter sent to state and local health officers and released by the CDC today, Frieden said, “It is more important than ever to focus on ensuring equitable access to the vaccine for the priority groups.” He went on to ask local health officials to review their plans immediately and “work to ensure that the maximum number of doses is delivered to those at greatest risk as rapidly as possible.”

Frieden does a good job walking the line between thanking public health officials for their hard work—they are, after all, on the receiving end of vaccine frustration—and making it clear that they need to abide by the recommendations. Now it’s up to the vaccinators to listen.

Read the entire letter after the jump.

Should health-care reform require insurers to cover chiropractors? Acupuncturists? Yoga? Spiritual healers? These are the questions raised by a recently noticed health-care amendment requiring insurers to consider covering "religious and spiritual health care."

The amendment, covered in this Los Angeles Times article, comes with backing from Senate heavyweights like Orrin Hatch, John Kerry, and the late Ted Kennedy. And while it does not mention Christian Science by name, it's been widely interpreted as a protection of the church's prayer treatments, which it encourages as an alternative to medical help. Others have understood the provision as even more far-reaching as to include any health provider acting within the scope of their license.The Freedom From Religion Foundation has criticized the amendment as an unconstitutional violation of church and state.

Even with its powerful supporters, the amendment seems unlikely to make the final bill; Pelosi already dropped it from the House version. But just the suggestion of covering religious health care highlights a difficult question for reformers: how, exactly, does prayer fit into the president's support for evidence-based medicine? Or, more broadly, is there a place for any sort of unproven, alternative medicine, religious or otherwise, in health-care reform?

Michael Goldsmith, the baseball fan who penned the NEWSWEEK My Turn column that became a game-changer for major league baseball, died this week at the age of 58.

Goldsmith suffered from and finally succumbed to amyotrophic lateral sclerosis, or ALS. Also known as Lou Gehrig's disease, the degenerative condition robbed the Hall of Famer of his life and robs 30,000 Americans at any given time of their ability to walk, speak, and eventually breathe. It's a rare disease—striking two out of 10,000—but a brutal one, agonizing for those who suffer from the disease and those who love them.

Gehrig is the most famous face of ALS, but it was Goldsmith who suggested, in a NEWSWEEK My Turn column that ran on Nov. 1, 2008, that baseball join the fight in a more public and organized way:

Major League Baseball has never taken comprehensive action against ALS. Defeating ALS will require the same type of determination, dedication and drive that Gehrig and Cal Ripken demonstrated when they set superhuman records for consecutive games played. With this in mind, why not make July 4, 2009, ALS-Lou Gehrig Day? Dedicate this grim anniversary to funding research for a cure; every major- and minor-league stadium might project the video of Gehrig's farewell, and teams, players and fans could contribute to this cause.

The column soon caught the attention of  The New York Times and MLB Commissioner Bud Selig, and the plan Goldsmith envisioned was put into action. On July 4  this season, the 70th anniversary of  Lou Gehrig's "Luckiest Man" speech, players wore commemorative patches. ALS groups sold awareness buttons, and ballparks played video of Gehrig's noble farewell on the JumboTrons. Goldsmith was honored at Yankee Stadium that day, throwing out the ceremonial first pitch. His family later recalled how much he savored that experience—despite his being an Orioles fan.

Selig issued a statement about Goldsmith's passing, saying he was "deeply saddened" and offering his condolences. Game 5 of the World Series, played last night in Philadelphia, was dedicated to Goldsmith's memory.  Throughout the game, fans were encouraged to donate to ALS charities by visiting the MLB blog 4ALS Awareness. According to the George Vecsey, who wrote about Goldsmith's NEWSWEEK column in the Times, "Commissioner Bud Selig said Goldsmith believed in the power of one person to make an impact, and he promised that Goldsmith’s aspirations would continue to be honored."

It would be a tribute to both Gehrig and Goldsmith and a testament to the enduring power of sports, teamwork, and camaraderie if baseball took that "comprehensive action" Goldsmith suggested. It's worth noting that the Philadelphia Phillies, who are currently trying to battle their way out of a 3-2 deficit against the Yankees in the World Series, have raised more than $11 million in the past 25 years through their charity work with The Greater Philadelphia ALS Society. A baseball-wide campaign to actively fight ALS and support those who suffer from it would go a long way to aid the cause and to bring back some lost dignity to America's pastime.

Aside from being a baseball fan, Goldsmith was the Woodruff J. Deem professor of law at Brigham Young, and a husband, father, son, and brother. We at NEWSWEEK offer his friends and family our deepest sympathies.

A group of Harvard scientists and students were poisoned in August after drinking from coffee contaminated with a chemical preservative known as sodium azide, according to an internal memorandum leaked to the Boston Herald yesterday. Seconds after sipping the coffee, all six victims felt dizzy and were rushed to a nearby hospital. The lab workers were released, but the jury’s still out on how the odorless white solid, which can be deadly, got in the single-serve coffee machine near the victims’ pathology lab. NEWSWEEK’s Johannah Cornblatt talked to Dr. Michael Greenberg, the president of the American Academy of Clinical Toxicology, about the dangers of sodium azide, as well as the chemical’s atypical use as a poison. Although Greenberg considers sodium azide a strange choice for a poisoning agent, he remains “very suspicious” that the chemical ended up in the Harvard coffeemaker by accident.

How is sodium azide typically used?
It’s usually used as a preservative. It used to be used in automobile airbags. It was used in farming. It’s also used as a pest control.

What happens if sodium azide comes in contact with your skin?
It can cause burns. They’re usually not terribly bad, but it depends on how much you get on your skin, where you get it on your skin, and how long it stays on.

What about if you inhale or ingest it?
If you breathe in sodium azide or you ingest it, it can be a serious problem. If you ingest it, it will form a gas. If the person is vomiting, that gas could come out of the vomit and harm the people around them. So people in the emergency department need to be careful dealing with the body waste and vomit of anyone poisoned by sodium azide. It can cause seizures, coma, death.

How likely is death? 
It depends on the duration and the concentration. It can be a lethal chemical if you drink it. If you drink enough of it, it can kill you for sure.

What are the long-term side effects if you do survive?
It depends on how sick you become. If you have low blood pressure because of it—which can happen—you can have various other problems related to low blood pressure, like cardiac injury or brain injury.

How often is sodium azide used as a poison?
We don’t commonly come across sodium azide as a poison. Usually when we see exposures, they’re accidental instead of homicidal. I don’t think I’ve seen a homicidal use of sodium azide in my career.

Is it possible that the sodium azide ended up in that coffee maker by accident?
I suppose if it was being stored improperly in a container that looked like another container. But it’s probably not something that’s going to naturally turn up in a coffeemaker.


 

It’s the book every medical writer in the country wants to ignore. Suzanne Somers’s latest “health” tome hit the bookstores this week, and this time she's offering her advice on how to cure and prevent cancer. As if people with cancer don’t have enough problems. When the review copy arrived, we decided to give it a once-over—so you don’t have to.

The gist of Somers’s argument is that conventional cancer treatments—surgery, radiation, chemotherapy—take a destructive approach and that chemo, in particular, is overused. Long an advocate of alternative therapies, Somers argues that it makes more sense to build up the body to fight cancer than it does to tear it down through radiation and chemicals. She is particularly enamored of nutritional “cures.”

Of course, Somers has had no formal medical or scientific training, but considers herself an authority—in part because she’s survived breast cancer after choosing not to have chemotherapy, and because she’s a regular on the alternative-medicine circuit.  This book, like her others, consists mainly of transcripts of her conversations with various alternative-medicine doctors, as well as lots of details about her own experiences and prevention regimen, which she has spelled out many times before, most notably on Oprah  earlier this year. It’s noteworthy that her promotion of the book began by publicly blaming Patrick Swayze’s recent death on chemotherapy, rather than his pancreatic cancer. (She has since apologized to his family.)      

Cancer is a highly emotional topic, particularly since the war on cancer isn’t going particularly well. As my colleague Sharon Begley recently put it, “Cancer is on track to kill 565,650 people in the United States this year—more than 1,500 a day, equivalent to three jumbo jets crashing and killing everyone aboard 365 days a year.”  The fact is that  modern medicine is far from understanding everything we need to know about cancer, and the most effective treatments available often come with nasty side effects. We all wish there were more effective and less toxic options, and we need to stay open-minded about new discoveries and alternatives. Maybe some of the doctors Somers interviewed in her book will eventually prove to be on to something.

But there is a big difference between staying open-minded and tossing aside treatments that have been proven effective after rigorous testing in favor of new “natural” therapies that have undergone much flimsier scrutiny. If you’re someone who needs answers now, and want to make health decisions based on solid scientific findings rather than wishful thinking, there’s not much in Somers’s latest book to help you. The basic problem with the book, says Dr. Otis Brawley, the American Cancer Society’s chief medical officer, “is that it’s really inaccurate” when it describes the science behind current treatments  and lacks a basic understanding of the scientific method. Not all research findings are equally authoritative. Just because something sounds good doesn’t mean it works. “Some people confuse what they believe with what they know," Brawley said. 

Even if some patients are cancer-free after following a certain treatment plan, that doesn’t prove that it was the treatment that cured them, especially if no control group was used for comparison. “We’re finding that about 25 to 30 percent of some cancers stop growing at some point,” Brawley says. ”That can make some treatments look good that aren’t doing anything.” Until doctors figure out how to identify which patients have cancers that won’t progress, he said, the only option is to treat everyone.   

Somers relies heavily on patient testimonials, but any scientist knows that  talking only to those who benefited from a treatment can give less than objective results. A case in point: she lavishes praise on the research of Dr. Nicholas Gonzalez, who uses a combination of enzymes, massive amounts of nutritional supplements (130 to 175 a day—yes, you read that right), a strict diet, and daily coffee enemas, which he says can cure pancreatic cancer. However, just about two months before Somers’s book was published, the Journal of Clinical Oncology  published the results of a controlled observational trial of Gonzalez’s protocol vs. chemotherapy for patients with inoperable pancreatic cancer. The study was funded by the National Cancer Institute and enrolled 55 patients who met strict clinical criteria. A year into the study, 56 percent of those using chemotherapy were still alive, compared with only 16 percent of those who chose the enzyme therapy. In other words,  those who picked chemo over the alternative treatment lived three times as long. Interestingly, the study was concluded in 2005, yet Somers doesn’t mention this in the book.

Somers also shines the spotlight on  Dr. Stanislaw Burzynski of Houston, whose controversial cancer treatments have resulted in years of battles with the FDA and the courts. Over the past 30 years, despite government investment, he has failed to provide compelling data that his expensive treatments work. More recently he expanded his research efforts into anti-wrinkle creams. (Side note: it is more than a little ironic that Somers is touting the work of Burzynski, who synthesizes peptides from human urine to create what he says is a cancer cure. In the books she’s written about hormones, Somers has expressed nothing but disdain for FDA-approved hormones synthesized from horse urine.)

Another treatment that gets the sign of approval from Somers is mistletoe extract, which is a popular treatment in Germany, and which she credits with keeping her cancer-free for years. There are some intriguing studies, but good science requires looking at all the studies, not just the ones that support your opinion. When German scientists published a review of the data on mistletoe as a cancer treatment in 2008, they found that the evidence was “weak.” Other reviews have concluded that there were quality problems with many of the studies and that more research is necessary.

Not all the recommendations Somers makes in the book raise eyebrows. She says eating healthy and exercising, reducing stress, and getting a good night's sleep may reduce the risk of cancer. That's true, but it's not news. She’s right that not every woman with stage I breast cancer needs chemo. Few doctors would argue. In fact, they have the technology to calculate the size of the likely benefit, and agree that sometimes it’s quite small.  Most doctors offer it as a choice to women who want to do everything possible to prevent cancer’s return.

“And she’s right when she says that only some leukemias, lymphomas, and testicular cancers can be cured with chemotherapy,” Brawley says. “We admit that many conventional treatments are not as beneficial as we would like. But that doesn’t dismiss evidence that screenings have reduced the death rates of breast and colon cancer, or that the lives of other patients with cancer can be saved with early treatment or that chemo prolongs lives. Even in cases of stage IV breast cancer, or lung or prostate or colon cancer, when the cancer has spread throughout the body and particularly into the bone, we can’t cure people with chemotherapy, but we can prolong life and increase their quality of life. In her book, Somers completely rejects the idea that chemotherapy has any of these benefits.”

When I interviewed Somers earlier this year, she said that she gets irritated when the media identify her as the former ditsy blonde from the TV sitcom Three’s Company. She would rather be identified as an author; after all, she’s written 18 books, most on the topics of weight loss (even though she’s admitted to Larry King that she’s used liposuction) and hormones (she recommends treatments most hormone specialists and oncologists describe as potentially risky.)

For her next book, we’d like to suggest a topic she knows very well: media manipulation. You have to love the fact that the only blurb on the back of the book (“Ms. Somers writes with the passion of the prophet”—Wall Street Journal) comes from a review trashing an earlier book. Somers’s real specialty is understanding that when a celebrity writes a controversial book, it doesn’t matter how much mainstream doctors and serious researchers attack it, or whether people’s health is put at risk. Attacks bring publicity, and publicity sells books. Here’s hoping that this time the public proves her wrong.

Wingert is a NEWSWEEK correspondent and  the coauthor of  The Menopause Book.