Hypothermia and Carbon Monoxide Poisoning Cases Soar in New York After Hurricane Sandy

The number of cold-exposure cases in New York City tripled in the weeks after Hurricane Sandy struck compared with the same period in previous years, the health department reported in an alert to thousands of doctors and other health care providers on Wednesday.

And even though power and heat have been restored to most of the city, there are still thousands of people living in the cold, the department said.

The department warned health care providers that residents living in unheated homes faced “a significant risk of serious illness and death from multiple causes.”

The number of cases of carbon monoxide exposure, which can be fatal, was more than 10 times as high as expected the week of the storm and 6 times as high the next week, reflected in greater numbers of emergency department visits. Calls to the city’s poison center also increased, health officials said.

And as temperatures dip, health officials said the cold could lead to other health problems, including a worsening of heart and lung diseases and an increase in anxiety and depression.

“My bigger concern is what happens in the future as we get closer to winter in the next four weeks,” Dr. Thomas A. Farley, the city’s health commissioner, said in an interview. “There are probably about 12,000 people living in unheated apartments right now.”

Between Nov. 3 and 21, more than three times as many people visited emergency rooms for cold exposure as appeared during the same time periods from 2008 to 2011, the health department said. The storm hit on Oct. 29.

It took days before many elderly and disabled residents, trapped in cold, dark apartments without working elevators or phones, were visited by emergency responders and health workers. Some went to emergency rooms.

Dr. Farley said prolonged exposure to cold even slightly below room temperature could be deadly, and he urged residents of unheated apartments to consider relocating. He said they could find help by calling 311.

The alert said residents in cold apartments should wear layers of dry, loosefitting clothing. They should not use ovens or portable gas heaters because of the risks of fire and carbon monoxide.

The statistics were collected through a system that gathers major complaints daily from most of the city’s hospital emergency departments. The number of hypothermia cases reported to the system since the storm is 65, but that is considered an undercount.

Health department officials said the figure also did not reflect the much larger number of people whose underlying heart and lung problems had worsened in cold environments. An increase in asthma attacks, heart attacks and stroke would be more difficult to detect immediately. Officials said both the very young and older people, as well as people with chronic diseases, mental illness and substance use, were most at risk.

Dr. Farley said the increase in hypothermia cases was greatest immediately after the hurricane and during the cold period around the northeaster on Nov. 7.

Some people exposed to cold were treated at Staten Island University Hospital. “Our initial cases were people immersed in water, most in the process of being rescued,” said Dr. Brahim Ardolic, chairman of the hospital’s department of emergency medicine.

Makeshift efforts to keep warm also caused health problems. Many city residents without heat used stoves and, in some cases, generators indoors or in garages, leading to exposure to carbon monoxide, a colorless, odorless gas.

“It’s a really scary exposure because you usually don’t realize what happened,” Dr. Ardolic said. “It can be insidious enough that you can go to sleep and wake up, if you’re lucky, with a severe headache. If you’re unlucky, you just won’t wake up.”

One post-storm patient was Hazel Mintz, 90, who lives on the 12th floor of an apartment building in Far Rockaway, Queens, that lost heat. She was taken to the emergency room after the storm because of chest pain. Days later, after neighbors heard a carbon monoxide alarm and smelled something burning in Ms. Mintz’s empty apartment, a caregiver opened the door to find a blackened kettle atop a burner with a gas flame. “I put on the gas to warm up,” Ms. Mintz, who has recovered, said.

At St. John’s Episcopal Hospital in Far Rockaway, one of the areas hardest hit by the storm, 13 people have been treated for carbon monoxide exposure since the storm, including a family of three burning charcoal indoors to keep warm, said Dr. Rajiv Prasad, the emergency department director.

Read More..

Hypothermia and Carbon Monoxide Poisoning Cases Soar in New York After Hurricane Sandy

The number of cold-exposure cases in New York City tripled in the weeks after Hurricane Sandy struck compared with the same period in previous years, the health department reported in an alert to thousands of doctors and other health care providers on Wednesday.

And even though power and heat have been restored to most of the city, there are still thousands of people living in the cold, the department said.

The department warned health care providers that residents living in unheated homes faced “a significant risk of serious illness and death from multiple causes.”

The number of cases of carbon monoxide exposure, which can be fatal, was more than 10 times as high as expected the week of the storm and 6 times as high the next week, reflected in greater numbers of emergency department visits. Calls to the city’s poison center also increased, health officials said.

And as temperatures dip, health officials said the cold could lead to other health problems, including a worsening of heart and lung diseases and an increase in anxiety and depression.

“My bigger concern is what happens in the future as we get closer to winter in the next four weeks,” Dr. Thomas A. Farley, the city’s health commissioner, said in an interview. “There are probably about 12,000 people living in unheated apartments right now.”

Between Nov. 3 and 21, more than three times as many people visited emergency rooms for cold exposure as appeared during the same time periods from 2008 to 2011, the health department said. The storm hit on Oct. 29.

It took days before many elderly and disabled residents, trapped in cold, dark apartments without working elevators or phones, were visited by emergency responders and health workers. Some went to emergency rooms.

Dr. Farley said prolonged exposure to cold even slightly below room temperature could be deadly, and he urged residents of unheated apartments to consider relocating. He said they could find help by calling 311.

The alert said residents in cold apartments should wear layers of dry, loosefitting clothing. They should not use ovens or portable gas heaters because of the risks of fire and carbon monoxide.

The statistics were collected through a system that gathers major complaints daily from most of the city’s hospital emergency departments. The number of hypothermia cases reported to the system since the storm is 65, but that is considered an undercount.

Health department officials said the figure also did not reflect the much larger number of people whose underlying heart and lung problems had worsened in cold environments. An increase in asthma attacks, heart attacks and stroke would be more difficult to detect immediately. Officials said both the very young and older people, as well as people with chronic diseases, mental illness and substance use, were most at risk.

Dr. Farley said the increase in hypothermia cases was greatest immediately after the hurricane and during the cold period around the northeaster on Nov. 7.

Some people exposed to cold were treated at Staten Island University Hospital. “Our initial cases were people immersed in water, most in the process of being rescued,” said Dr. Brahim Ardolic, chairman of the hospital’s department of emergency medicine.

Makeshift efforts to keep warm also caused health problems. Many city residents without heat used stoves and, in some cases, generators indoors or in garages, leading to exposure to carbon monoxide, a colorless, odorless gas.

“It’s a really scary exposure because you usually don’t realize what happened,” Dr. Ardolic said. “It can be insidious enough that you can go to sleep and wake up, if you’re lucky, with a severe headache. If you’re unlucky, you just won’t wake up.”

One post-storm patient was Hazel Mintz, 90, who lives on the 12th floor of an apartment building in Far Rockaway, Queens, that lost heat. She was taken to the emergency room after the storm because of chest pain. Days later, after neighbors heard a carbon monoxide alarm and smelled something burning in Ms. Mintz’s empty apartment, a caregiver opened the door to find a blackened kettle atop a burner with a gas flame. “I put on the gas to warm up,” Ms. Mintz, who has recovered, said.

At St. John’s Episcopal Hospital in Far Rockaway, one of the areas hardest hit by the storm, 13 people have been treated for carbon monoxide exposure since the storm, including a family of three burning charcoal indoors to keep warm, said Dr. Rajiv Prasad, the emergency department director.

Read More..

U.S. Growth Revised Up, but Year-End Slowdown Is Feared

Even as the government said that the United States economy grew faster than first estimated in the third quarter, economists warned that the rate of expansion could slow sharply before the end of the year as worries mount about the fiscal impasse in Washington.

Nam Y. Huh/Associated Press

An employee on the assembly line this month at Generac Power Systems in Whitewater, Wis., a maker of residential generators.

The Commerce Department said Thursday that gross domestic product expanded at an annual rate of 2.7 percent in the three months ended Sept. 30, well above the 2 percent estimate it initially made in late October. But the revision was driven by increased inventory accumulation and a jump in federal spending — factors unlikely to be repeated in the current fourth quarter, economists said.

What’s more, the revised figures show spending by businesses on equipment and software declined by 2.7 percent in the third quarter, the first decrease since the end of the recession in mid-2009 and a sign of just how cautious many companies have become amid the uncertainty in Washington and slowing growth in Asia and Europe.

“It’s a nice headline number,” said Nigel Gault, chief U.S. economist at IHS Global Insight, of the 2.7 percent rate, “but it exaggerates the underlying momentum in the economy. Sustainable improvements in growth are not driven by inventories.”

The two biggest growth areas in the third quarter — inventory growth and federal spending — “are likely to be minuses in the fourth quarter,” he said. Mr. Gault expects the annual rate to sink to 1 percent this quarter, hurt by a fiscal stalemate in Washington as well as the aftereffects of Hurricane Sandy.

To be sure, there were signs of optimism in Thursday’s data. Residential fixed investment rose 14.2 percent, a sign that the housing recovery is gaining steam. Indeed, a separate report Thursday from the National Association of Realtors showed pending home sales rose to a two-and-a-half-year high.

And not all economists took a pessimistic view. “The economy certainly hasn’t taken off, but it’s nowhere close to a stall,” said David Kelly, chief global strategist for JPMorgan Funds. “The economy is still underperforming its full potential, but once we get past the ‘fiscal cliff’ uncertainty, we could see stronger growth next year.”

The new estimate of growth represents a substantial increase in the level of the second quarter, when the economy grew at a rate of just 1.3 percent. It also marks the fastest rate of expansion since the fourth quarter of 2011, when the economy grew at a 4.1 percent annual pace.

This was the second of the government’s three estimates of quarterly growth. The final figure is scheduled for Dec. 20.

“Over all, it was a disappointing report,” said Michelle Meyer, senior United States economist with Bank of America Merrill Lynch.  The accumulation of inventories went from subtracting 0.1 percentage points from the initial estimate to adding 0.8 percentage points, she said.

    “A lot of that inventory build was unintentional, which suggests a downside risk for the fourth quarter,” she said.  “Businesses had expected stronger sales and consumer spending and were caught off guard."

    Ms. Meyer said she expected the economy to grow by 1 percent in the fourth quarter and 1 percent in the first quarter of 2013, well below the level needed to bring down the unemployment rate, which stood at 7.9 percent in October.

    On Thursday, the government also reported that first-time unemployment claims dropped by 23,000 to 393,000 last week. But Ms. Meyer cautioned that these figures were much more volatile than usual because of the Thanksgiving holiday as well as Hurricane Sandy.

Read More..

As Opposition Meets in Cairo, More Violence Mars Syria

The Syrian opposition pushed ahead on military and political fronts on Wednesday, as rebels shot down a government warplane in the north of Syria and a newly formed coalition started talks in Cairo on how to pick a transitional government to replace that of President Bashar al-Assad.

The coalition, whose official name is the National Coalition of Syrian Revolutionary and Opposition Forces, was formed at a meeting in Qatar earlier this month, and has already been anointed with official recognition from Britain, France, Turkey and the members of the Gulf Cooperation Council. But in order to encourage further recognition internationally, it must tackle the broader problem of uniting multiple groups in exile and rebels on the ground in Syria.

That challenge was apparent on the first day of what are expected to be two days of talks in Egypt. Disagreements emerged over the composition of the coalition when the Syrian National Council, one of its members, tried to increase the number of its representatives.

“Nothing will proceed until we work this out,” said one council member at the talks, who spoke to Reuters on condition of anonymity.

The talks took place against the backdrop of a 20-month civil war in which about 40,000 people have been killed so far in clashes between armed rebels and jihadist forces on one side and Mr. Assad’s military on the other. The conflict has flared at various times along Syria’s borders with Lebanon, Israel, Turkey and Jordan and in most of the country’s cities, including deadly car bombings on Wednesday near Damascus, the capital.

In Turkey, once an ally of the Assad government, a team of NATO inspectors visited sites on Wednesday where the alliance might install batteries of Patriot antiaircraft missiles that Turkey, a member, has requested to prevent any incursions by the Syrian air force, which has become the Assad government’s main weapon against the rebels. Patriot missiles have also been discussed as a way of enforcing a no-fly zone over rebel-held areas of Syria near the Turkish border if one is imposed.

Meanwhile, opposition politicians gathered in a Cairo hotel to shape an alternative government. Ahmad Ramadan, a member of the national council, said in an interview with Radio Sawa, an Arabic-language broadcaster sponsored by the United States government, that the talks were more likely to decide on the selection process than to choose actual candidates.

Khaled Khoja, a coalition member attending the talks, said: “I don’t think we’ll be discussing the election of a transitional government during the meeting today. We’re still discussing whether to have a government or to have committees instead.”

State media said on Wednesday that at least 34 people, and possibly many more, died in the two car bombings in Jaramana, a suburb of Damascus that is populated by minorities.

The official SANA news agency said the explosions struck at about 7 a.m. and were the work of “terrorists,” the word used by the authorities to denote rebel forces seeking the overthrow of President Assad.

The agency said the bombings were in the main square of Jaramana, which news reports said is largely populated by members of the Christian and Druse minorities. Residents said the neighborhood was home to many families who have fled other parts of Syria because of the conflict and to some Palestinian families. The blasts caused “huge material damage to the residential buildings and shops,” SANA said.

The death toll was not immediately confirmed. An activist group, the British-based Syrian Observatory for Human Rights, initially said that 29 people had died but revised the figure later to 47, of whom 38 had been identified. Of the 120 injured, the rebel group said, 23 people were in serious condition, meaning that the tally could climb higher.

There were also reports from witnesses in Turkey and antigovernment activists in Syria that for the second successive day insurgents had shot down a government aircraft in the north of the country, offering further evidence that the rebels are seeking a major shift by challenging the government’s dominance of the skies. It was not immediately clear how the aircraft, apparently a plane, had been brought down.

Video posted on the Internet by rebels showed wreckage with fires still burning around it. The aircraft appeared to show a tail assembly clearly visible jutting out of the debris. Such videos are difficult to verify, particularly in light of the restrictions facing reporters in Syria. However, the episode on Wednesday seemed to be confirmed by other witnesses.

“We watched a Syrian plane being shot down as it was flying low to drop bombs,” said Ugur Cuneydioglu, who said he observed the incident from a Turkish border village in southern Hatay Province. “It slowly went down in flames before it hit the ground. It was quite a scene,” Mr. Cuneydioglu said.

Video posted by insurgents on the Internet showed a man in aviator coveralls being carried away. It was not clear if the man was alive but the video said he had been treated in a makeshift hospital. A voice off-camera says, “This is the pilot who was shelling residents’ houses.”

The aircraft was said to have been brought down while it was attacking the town of Daret Azzeh, 20 miles west of Aleppo and close to the Turkish border. The town was the scene of a mass killing last June, when the government and the rebels blamed each other for the deaths and mutilation of 25 people. The video posted online said the plane had been brought down by “the free men of Daret Azzeh soldiers of God brigade.”

On Tuesday, Syrian rebels said they shot down a military helicopter with a surface-to-air missile outside Aleppo and they uploaded video that appeared to confirm that rebels have put their growing stock of heat-seeking missiles to effective use.

In recent months, rebels have used mainly machine guns to shoot down several Syrian Air Force helicopters and fixed-wing attack jets. In Tuesday’s case, the thick smoke trailing the projectile, combined with the elevation of the aircraft, strongly suggested that the helicopter was hit by a missile.

Rebels hailed the event as the culmination of their long pursuit of effective antiaircraft weapons, though it was not clear if the downing on Tuesday was an isolated tactical success or heralded a new phase in the war that would present a meaningful challenge to the Syrian government’s air supremacy.

Hala Droubi reported from Dubai, United Arab Emirates. Alan Cowell contributed reporting from Paris; Sebnem Arsu contributed reporting from Istanbul, and Hania Mourtada from Beirut, Lebanon.

Read More..

Dark Warnings About Future of Internet Access

PARIS — A commercial and ideological clash is set for next week, when representatives of more than 190 governments, along with telecommunications companies and Internet groups, gather in Dubai for a once-in-a-generation meeting.

The subject: Control of the Internet, politically and commercially.

The stated purpose of the World Conference on International Telecommunications is to update a global treaty on technical standards needed to, say, connect a telephone call from Tokyo to Timbuktu. The previous conference took place in 1988, when the Internet was in its infancy and telecommunications remained a highly regulated, mostly analog-technology business.

Now the Internet is the backbone for worldwide communications and commerce. Critics of the International Telecommunication Union, the agency of the United Nations that is organizing the meeting, see a dark agenda in the meeting. The blogosphere has been raging over supposed plans led by Russia to snatch control of the Internet and hand it to the U.N. agency.

That seems unlikely. Any such move would require an international consensus, and opposition is widespread.

Terry D. Kramer, the former Vodafone executive who is the United States ambassador to the conference, has vowed to veto any change in how the Internet is overseen.

Analysts say the real business of the conference is business. “The far bigger issue — largely obscured by this discussion — are proposals that are more likely to succeed that envision changing the way we pay for Internet services,” Michael Geist, an Internet law professor at the University of Ottawa, said by e-mail.

Hamadoun Touré, secretary general of the I.T.U., has repeatedly said that the U.N. group has no desire to take over the Internet or to stifle its growth. On the contrary, he says, one of the main objectives of the conference is to spread Internet access to more of the four and a half billion people around the world who still do not use it.

And yet, groups as diverse as Google, the Internet Society, the International Trade Union Confederation and Greenpeace warn that the discussions could set a bad precedent, encouraging governments to step up censorship or take other actions that would threaten the integrity of the Internet.

“This is a very important moment in the history of the Internet, because this conference may introduce practices that are inimical to its continued growth and openness,” Vinton G. Cerf, vice president and chief Internet evangelist at Google, said in a conference call.

Google set up a Web site last week, “Take Action,” encouraging visitors to sign a petition for a “free and open Internet.” The campaign is modeled on the successful drive last winter to defeat legislative proposals to crack down on Internet piracy in the United States.

More energy is expected to be spent on how companies make money off the Internet. In one submission to the conference, the European Telecommunications Network Operators’ Association, a lobbying group based in Brussels that represents companies like France Télécom, Deutsche Telekom and Telecom Italia, proposed that network operators be permitted to assess charges for content providers like Internet video companies that use a lot of bandwidth.

Analysts say the proposal is an acknowledgment by European telecommunications companies that they cannot hope to provide digital content. “The telecoms realize that they have lost the battle,” said Paul Budde, an independent telecommunications analyst in Australia. “They are saying, ‘We can’t beat the Googles and the Facebooks, so let’s try to charge them.’ ”

The European lobbying group says that without the new fees, there will be no money to invest in network upgrades needed to deal with a surge in traffic. Regulators have required European telecommunications operators to open their networks to rivals, and the market for broadband is fiercely competitive, with rock-bottom prices.

In the United States, by contrast, most telecommunications companies have been permitted to maintain local monopolies — or duopolies, with cable companies — in broadband, keeping prices higher. And American regulators have ordered broadband providers to give equal priority to all Internet traffic. Such “network neutrality” is incompatible with charging content providers for moving their bits of data.

Analysts say this may explain why American telecommunications companies have not joined the European call for a new business model. “Models that try to force payment terms between nations and telecom operators run a huge risk of cutting off traffic,” Mr. Kramer said in an interview. “Liberalized markets are the only way to expand the success of the Internet.”

People who have been briefed on the conference submissions say that not a single European government delegation has endorsed the telecommunications operators’ proposal, and the European Parliament has passed a resolution denouncing it. Only governments, not private groups or companies, can put items on the meeting agenda.

While many documents prepared for the conference remain secret, several people who have seen submissions say there is broad support for Internet connection fees in French-speaking Africa and among Arab nations — countries in which many telecommunications companies are still owned or heavily regulated by governments.

Much of the attention before the 12-day conference has focused on a proposal from Russia that would effectively remove control of the Internet’s infrastructure from a collection of decentralized and apolitical organizations, mostly based in the United States. “Member states,” Russia proposed, “shall have equal rights to manage the Internet, including in regard to the allotment, assignment and reclamation of Internet numbering, naming, addressing and identification resources.”

Those functions are performed by the Internet Corporation for Assigned Names and Numbers, a private organization with an international board that operates under contract with the United States government.

The Russian proposal was widely interpreted as a call to legitimize domestic censorship of the Internet. Yet analysts note that governments inclined to filter the Web, like China and Iran, have not waited for consensus in an international meeting to do so.

Read More..

Well: Ignoring the Science on Mammograms

Last week The New England Journal of Medicine published a study with the potential to change both medical practice and public consciousness about mammograms.

Published on Thanksgiving Day, the research examined more than 30 years of United States health statistics to determine, through observation, if screening mammography has reduced breast cancer deaths. The researchers found that, as expected, the introduction of mammogram screening led to an increase in the number of breast cancers detected at an early stage.

But importantly, the number of cancers diagnosed at the advanced stage was essentially unchanged. If mammograms were really finding deadly cancers sooner (as suggested by the rise in early detection), then cases of advanced cancer should have been reduced in kind. But that didn’t happen. In other words, the researchers concluded, mammograms didn’t work.

This is a bold claim for an observational study. There are countless reasons why conclusions from such studies are commonly fraught with error. What if, for instance, the lion’s share of advanced cancers occurred among women without access to screening mammograms—a fact often not available in health statistics? Or what if mammography successfully prevented a major increase in advanced cancers, leaving the health statistics unchanged?

Hippocrates, the father of medicine, called experience “delusive.” He recognized that uncontrolled observations may lead to faulty conclusions. For centuries the flawed logic of observational data seemed to validate bloodletting, an unhelpful and often harmful therapy. But most who were bled eventually improved—no thanks to the bloodletting—an observation that led medical authorities to believe in the practice.

Fortunately, we have learned something about bad logic. Today we seek studies designed to neutralize illusions. By enrolling people in a study and assigning them randomly to treatments, for instance, groups tend to be evenly balanced in every way except one: the treatment. Controlled studies led to the discovery that bloodletting is harmful rather than helpful, and randomized trials of screening mammography would therefore be a worthy gold standard to answer once and for all the question of whether the test saves lives.

It may be surprising, therefore, to learn that numerous trials of mammography have indeed randomly assigned nearly 600,000 women to undergo either regular mammography screening or no screening. The results of more than a decade of follow-up on such studies, published more than 10 years ago, show that women in the mammogram group were just as likely to die as women in the no-mammogram group. The women having mammograms were, however, more likely to be treated for cancer and have surgeries like a mastectomy. (Some of the studies include trials from Norway, the Netherlands, Sweden, and this major review of the data.)

In other words, mammograms increased diagnoses and surgeries, but didn’t save lives—exactly what the researchers behind last week’s observational study concluded.

It is affirming to see this newest study. But it raises an awkward question: why would a major medical journal publish an observational study about the effects of screening mammography years after randomized trials have answered the question? Perhaps it is because many doctors and patients continue to ignore the science on mammograms.

For years now, doctors like myself have known that screening mammography doesn’t save lives, or else saves so few that the harms far outweigh the benefits. Neither I nor my colleagues have a crystal ball, and we are not smarter than others who have looked at this issue. We simply read the results of the many mammography trials that have been conducted over the years. But the trial results were unpopular and did not fit with a broadly accepted ideology—early detection—which has, ironically, failed (ovarian, prostate cancer) as often as it has succeeded (cervical cancer, perhaps colon cancer).

More bluntly, the trial results threatened a mammogram economy, a marketplace sustained by invasive therapies to vanquish microscopic clumps of questionable threat, and by an endless parade of procedures and pictures to investigate the falsely positive results that more than half of women endure. And inexplicably, since the publication of these trial results challenging the value of screening mammograms, hundreds of millions of public dollars have been dedicated to ensuring mammogram access, and the test has become a war cry for cancer advocacy. Why? Because experience deludes: radiologists diagnose, surgeons cut, pathologists examine, oncologists treat, and women survive.

Medical authorities, physician and patient groups, and ‘experts’ everywhere ignore science, and instead repeat history. Wishful conviction over scientific rigor; delusion over truth; form over substance.

It is normally troubling to see an observational study posing questions asked and answered by higher science. But in this case the research may help society to emerge from a fog that has clouded not just the approach to data on screening mammography, but also the approach to health care in the United States. In a system drowning in costs, and at enormous expense, we have systematically ignored virtually identical data challenging the effectiveness of cardiac stents, robot surgeries, prostate cancer screening, back operations, countless prescription medicines, and more.

When Thomas Jefferson described his vision for the institution that would become the University of Virginia, he said:

This place will be based on the illimitable freedom of the human mind. For here we are not afraid to follow truth, wherever it may lead.

As we begin down the arduous path of health care reform, requisite to economic success, the question for policymakers and health care authorities is this: Are we ready to stop ignoring science? If so, the road may be smoother than we imagined for there is, and has been, much truth to follow.

---

Dr. David Newman is an emergency room physician in New York City and author of the book, “Hippocrates Shadow: Secrets from the House of Medicine.“

Read More..

Well: Ignoring the Science on Mammograms

Last week The New England Journal of Medicine published a study with the potential to change both medical practice and public consciousness about mammograms.

Published on Thanksgiving Day, the research examined more than 30 years of United States health statistics to determine, through observation, if screening mammography has reduced breast cancer deaths. The researchers found that, as expected, the introduction of mammogram screening led to an increase in the number of breast cancers detected at an early stage.

But importantly, the number of cancers diagnosed at the advanced stage was essentially unchanged. If mammograms were really finding deadly cancers sooner (as suggested by the rise in early detection), then cases of advanced cancer should have been reduced in kind. But that didn’t happen. In other words, the researchers concluded, mammograms didn’t work.

This is a bold claim for an observational study. There are countless reasons why conclusions from such studies are commonly fraught with error. What if, for instance, the lion’s share of advanced cancers occurred among women without access to screening mammograms—a fact often not available in health statistics? Or what if mammography successfully prevented a major increase in advanced cancers, leaving the health statistics unchanged?

Hippocrates, the father of medicine, called experience “delusive.” He recognized that uncontrolled observations may lead to faulty conclusions. For centuries the flawed logic of observational data seemed to validate bloodletting, an unhelpful and often harmful therapy. But most who were bled eventually improved—no thanks to the bloodletting—an observation that led medical authorities to believe in the practice.

Fortunately, we have learned something about bad logic. Today we seek studies designed to neutralize illusions. By enrolling people in a study and assigning them randomly to treatments, for instance, groups tend to be evenly balanced in every way except one: the treatment. Controlled studies led to the discovery that bloodletting is harmful rather than helpful, and randomized trials of screening mammography would therefore be a worthy gold standard to answer once and for all the question of whether the test saves lives.

It may be surprising, therefore, to learn that numerous trials of mammography have indeed randomly assigned nearly 600,000 women to undergo either regular mammography screening or no screening. The results of more than a decade of follow-up on such studies, published more than 10 years ago, show that women in the mammogram group were just as likely to die as women in the no-mammogram group. The women having mammograms were, however, more likely to be treated for cancer and have surgeries like a mastectomy. (Some of the studies include trials from Norway, the Netherlands, Sweden, and this major review of the data.)

In other words, mammograms increased diagnoses and surgeries, but didn’t save lives—exactly what the researchers behind last week’s observational study concluded.

It is affirming to see this newest study. But it raises an awkward question: why would a major medical journal publish an observational study about the effects of screening mammography years after randomized trials have answered the question? Perhaps it is because many doctors and patients continue to ignore the science on mammograms.

For years now, doctors like myself have known that screening mammography doesn’t save lives, or else saves so few that the harms far outweigh the benefits. Neither I nor my colleagues have a crystal ball, and we are not smarter than others who have looked at this issue. We simply read the results of the many mammography trials that have been conducted over the years. But the trial results were unpopular and did not fit with a broadly accepted ideology—early detection—which has, ironically, failed (ovarian, prostate cancer) as often as it has succeeded (cervical cancer, perhaps colon cancer).

More bluntly, the trial results threatened a mammogram economy, a marketplace sustained by invasive therapies to vanquish microscopic clumps of questionable threat, and by an endless parade of procedures and pictures to investigate the falsely positive results that more than half of women endure. And inexplicably, since the publication of these trial results challenging the value of screening mammograms, hundreds of millions of public dollars have been dedicated to ensuring mammogram access, and the test has become a war cry for cancer advocacy. Why? Because experience deludes: radiologists diagnose, surgeons cut, pathologists examine, oncologists treat, and women survive.

Medical authorities, physician and patient groups, and ‘experts’ everywhere ignore science, and instead repeat history. Wishful conviction over scientific rigor; delusion over truth; form over substance.

It is normally troubling to see an observational study posing questions asked and answered by higher science. But in this case the research may help society to emerge from a fog that has clouded not just the approach to data on screening mammography, but also the approach to health care in the United States. In a system drowning in costs, and at enormous expense, we have systematically ignored virtually identical data challenging the effectiveness of cardiac stents, robot surgeries, prostate cancer screening, back operations, countless prescription medicines, and more.

When Thomas Jefferson described his vision for the institution that would become the University of Virginia, he said:

This place will be based on the illimitable freedom of the human mind. For here we are not afraid to follow truth, wherever it may lead.

As we begin down the arduous path of health care reform, requisite to economic success, the question for policymakers and health care authorities is this: Are we ready to stop ignoring science? If so, the road may be smoother than we imagined for there is, and has been, much truth to follow.

---

Dr. David Newman is an emergency room physician in New York City and author of the book, “Hippocrates Shadow: Secrets from the House of Medicine.“

Read More..

President Obama Asks Congress to Keep Tax Cuts for Middle Class

Doug Mills/The New York Times

President Obama spoke on Wednesday at an event at the White House with people who would see their taxes go up next year if Congress does not extend tax cuts for the middle class.

WASHINGTON — President Obama called again on Congress on Wednesday to extend Bush-era tax cuts for all income under $250,000 and leave a broader restructuring of the tax code to next year, as he pressures Republicans to let tax rates rise for the wealthiest Americans.

Surrounding himself by supporters he presented as typical middle-class taxpayers, Mr. Obama said he hoped to resolve the tax and spending issues now confronting Washington by an end-of-the-year deadline. But he said lawmakers should not wait for such an agreement to pass legislation preserving current tax rates for 98 percent of Americans.

“My hope is to get this done before Christmas,” he said of an agreement to avert deep spending cuts and tax increases scheduled to take place automatically with the new year. “But the place where we already have in theory at least complete agreement right now is on middle-class taxes.”

He said such an approach “would give us more time next year to work together on a comprehensive plan to bring down our deficits” and “streamline our tax system.”

The administration planned to send a high-level delegation to Capitol Hill to talk through the situation. Treasury Secretary Timothy F. Geithner and Rob Nabors, the White House legislative affairs director, will visit, separately, the top leaders of both parties in both houses, an administration official said.

Republicans in Congress have resisted letting the Bush tax cuts expire for anyone, including the wealthy. But Representative Tom Cole, an Oklahoma lawmaker and a highly regarded party political strategist, broke with his party leadership on Tuesday by calling for a quick deal with Mr. Obama on extending the tax cuts just for the middle class.

Mr. Obama seemed to refer to that during his event in the office building adjacent to the White House. “I’m glad to see if you’ve been reading the papers lately that more and more Republicans in Congress seem to be agreeing with this idea that we should have a balanced approach,” he said.

But a prominent figure in the fiscal discussions expressed pessimism that the two sides would be able to reach an agreement to avert what is being called a fiscal cliff.

“I believe the probability is that we are going over the cliff, and I think that we will be horrible,” Erskine B. Bowles, a former White House chief of staff who served as co-chairman of Mr. Obama’s deficit reduction commission, told reporters at a breakfast hosted by The Christian Science Monitor. “It will be devastating to the economy.”

The president’s appearance with taxpayers was part of a week of campaign-style events staged by the White House to rally public support for its side in the fiscal fight. He planned to meet with 14 chief executives of corporations at the White House later in the day and travel to the Philadelphia suburbs to tour a factory on Friday.

Republicans have said Mr. Obama seems more interested in perpetuating his campaign than in sitting down to hash out the difficult issues. They also note that they have expressed a willingness to raise tax revenue by closing loopholes and limiting deductions, but they have complained that Mr. Obama has not focused as much on the spending side of the equation, particularly entitlement programs like Medicare and Medicaid.

“We have not seen any good-faith effort on the part of this administration to talk about the real problem that we’re trying to fix,” Representative Eric Cantor of Virginia, the House Republican majority leader, told reporters on Wednesday. “This has to be a part of this agreement, or else we just continue to dig the hole deeper, asking folks to allow us to kick the can down the road further. And that we don’t want to do.”

Speaker John A. Boehner of Ohio echoed that argument but expressed hope that he could reach an agreement with Mr. Obama. “It’s time for the president and Democrats to get serious about the spending problem that our country has,” he said at a news conference. “But I’m optimistic that we can continue to work together to avert this crisis, and sooner rather than later.”

But some Republicans were beginning to make the argument that extending the Bush tax cuts for 98 percent of Americans would still be a victory for their party and a validation of the former president.

Senator Patty Murray of Washington, the Democratic chairwoman of the Budget Committee, said the talk was encouraging. “This has never been about partisanship or political point-scoring,” she said. “It’s been about protecting the middle class from paying more in taxes and calling on the wealthy to pay their fair share.”

Read More..

Tibetan Protesters Injured in Crackdown; Self-Immolations Continue

BEIJING — At least five Tibetans have set fire to themselves in recent days to protest Chinese rule in Tibetan regions, while at least 5 Tibetan students were in critical condition and 15 others were being treated for injuries after security forces cracked down on a large protest in western China on Monday, according to reports by Radio Free Asia and Free Tibet, an advocacy group.

The protest took place in an area of Qinghai Province that the Chinese call Hainan Autonomous Prefecture, and that Tibetans call Tsolho. More than 1,000 Tibetans, mostly students and teachers, took to the streets to demand equal rights for ethnic minorities and the freedom to study and use the Tibetan language. Several reports said the protest began after local officials distributed a booklet that condemned Tibetans who had self-immolated and belittled the Tibetan language.

With the five recent self-immolations, at least 22 Tibetans have set fire to themselves this month alone, and 86 since 2009, according to Radio Free Asia. The first case was a monk from Kirti Monastery, which became the heart of the self-immolations last year and earlier this year, though the acts have since become more widespread and now constitute one of the largest such phenomena anywhere in the world in recent memory. The latest four cases were reported Sunday and Monday in the western China provinces of Gansu, Sichuan and Qinghai, which all have significant Tibetan populations.

The students who protested Monday were from the Chabcha Sorig Lobling School, according to Free Tibet. They gathered at 5:40 a.m. and marched peacefully into the town of Chabcha. Chinese security forces began a violent crackdown at 9 a.m., the report said. “It’s still unclear what happened next, but many young students were so badly injured they were taken straight to hospital,” Free Tibet said. Security forces locked down the town, the group added. Radio Free Tibet reported that security forces fired tear gas and beat students with rifle butts, arresting four.

The events could not be independently confirmed; Chinese officials have barred foreign journalists from traveling to the sites of protests or self-immolations by Tibetans. Phone calls made on Tuesday to offices of the prefecture government and party committee went unanswered. A woman answering a call on the prefecture emergency hot line said she had not heard of any protests.

Radio Free Asia, which is financed by the United States government, said the school in Chabcha, known as Gonghe in Chinese, trained students in medicine. The offending booklet that inspired the protests was called “Ten Real Views of Tsolho Area,” and the medical students burned all the copies given to them and “called for equality among nationalities and freedom to study the Tibetan language,” according to a person who was quoted anonymously by Radio Free Asia.

Moves by officials in Qinghai to restrict the use of the Tibetan language, particularly in classrooms, have resulted in protests by students before. The northeast Tibetan region that Qinghai encompasses, generally called Amdo, is historically an area known for Tibetan scholarship and the production of cultural works. Even today, poets, writers and singers in Qinghai create works in the Tibetan language that are distributed widely across the Tibetan world.

Mia Li contributed research.

Read More..

Bits Blog: Study Finds Rise in Texting Even as Revenue Drops

A new report finds that certain activities that people do on a cellphone, like taking a picture and shooting video, have increased significantly in the last few years. Texting, in particular, has grown considerably — but not texting in the traditional sense.

The Pew Research Center published a study over the weekend that showed that the number of cellphone owners who text on their phones has grown to 80 percent from 58 percent in 2007.

As I reported this month, traditional text messaging — the kind where you pay to send messages over the phone network — recently declined for the first time in the United States, following a trend in countries around the world, like the Philippines and Finland, according to Chetan Sharma, an independent mobile analyst. As a result, the money that carriers earn from text messaging has been dropping, too.

So how could texting be on the rise? Instead of sending traditional text messages, cellphone owners are shifting toward Internet-based messaging services, like Apple’s iMessage, Facebook messaging and WhatsApp, Mr. Sharma says. These services are popular because they don’t charge per text; they are gradually redefining what we think of as text messaging.

The Pew study also found that the number of cellphone owners who use phones to send e-mail has jumped to 50 percent from 19 percent in 2007, and the number of cellphone owners using phones to shoot video has risen to 44 percent from 18 percent five years ago. The number of cellphone owners who use their phones to download apps is 43 percent, up from 22 percent in 2009. All these factors are directly correlated with the rise of the smartphone — more than 50 percent of American cellphone owners own one, according to Nielsen.

“Cell users now treat their gadget as a body appendage,” said Lee Rainie, director of the Pew Research Center, in a statement. “There is striking growth in the number of people who are taking advantage of the growing number of functions that these phones can perform, and there isn’t much evidence yet that the pace of change is slowing down.”

Read More..