Weekend reading: Overweight doctors; ADHD diagnosis wars; States cut treatment for mentally ill; The war on breast cancer

May 3 2013

Every week reporter Ankita Rao selects interesting reading from around the Web.

The New York Times Magazine: Our Feel-Good War On Breast Cancer
Recently, a survey of three decades of screening published in November in The New England Journal of Medicine found that mammography's impact is decidedly mixed: it does reduce, by a small percentage, the number of women who are told they have late-stage cancer, but it is far more likely to result in overdiagnosis and unnecessary treatment, including surgery, weeks of radiation and potentially toxic drugs. And yet, mammography remains an unquestioned pillar of the pink-ribbon awareness movement. Just about everywhere I go -; the supermarket, the dry cleaner, the gym, the gas pump, the movie theater, the airport, the florist, the bank, the mall -; I see posters proclaiming that "early detection is the best protection" and "mammograms save lives." But how many lives, exactly, are being "saved," under what circumstances and at what cost? Raising the public profile of breast cancer, a disease once spoken of only in whispers, was at one time critically important, as was emphasizing the benefits of screening. But there are unintended consequences to ever-greater "awareness" -; and they, too, affect women's health (Peggy Orenstein, 4/25).

Mother Jones: MAP: Which States Have Cut Treatment For The Mentally Ill The Most
Between 2009 and 2012, states cut a total of $4.35 billion in public mental-health spending from their budgets. According to a report by the National Alliance on Mental Illness, significant cuts to general fund appropriations for state mental health agencies have translated into a severe shortage of services, including housing, community-based treatment and access to psychiatric medications. "Increasingly, emergency rooms, homeless shelters and jails are struggling with the effects of people falling through the cracks," the report says, "due to lack of needed mental health services and supports" (Deanna Pan, 4/29).

Scientific American/Salon: Is ADHD Actually Undertreated?
A German children's book from 1845 by Heinrich Hoffman featured "Fidgety Philip," a boy who was so restless he would writhe and tilt wildly in his chair at the dinner table. Once, using the tablecloth as an anchor, he dragged all the dishes onto the floor. Yet it was not until 1902 that a British pediatrician, George Frederic Still, described what we now recognize as attention-deficit hyperactivity disorder (ADHD). ... Despite this lengthy history, the diagnosis and treatment of ADHD in today's children could hardly be more controversial. ... Yet although data point to at least some overdiagnosis, at least in boys, the extent of this problem is unclear. In fact, the evidence, with notable exceptions, appears to be stronger for the undertreatment than overtreatment of ADHD (Scott Lilienfield and Hal Arkowitz, 5/1).

The New York Times: When The Doctor Is Overweight
Dr. George Fielding, a pioneer of weight loss surgery in Australia, remembers how patients treated him in the late 1990s, when his weight reached 330 pounds on his six-foot frame. He would meet new patients, dressed in Armani suits and feeling on top of the world, and then be abruptly upended. ... Despite being an internationally recognized expert on lap band and gastric bypass surgeries, Dr. Fielding knew that his appearance was dissuading some patients from using his services. ... So Dr. Fielding wasn't at all surprised by the results of a recent study in the International Journal of Obesity showing that patients secretly -; or not so secretly -; look with disdain on doctors who are overweight or obese (Jan Hoffman, 5/1).

The Atlantic: The Decline Of Emergency Care
Last Monday, two bombs built to take lives exploded in a city that's built to save them. Five Boston hospitals are Level I trauma centers. Three specialize in pediatrics. Each one is ready to treat all aspects of injury. At all times, they have the full roster of emergency services available: the entire spectrum of surgical specialists; respiratory therapists; laboratory services; nurses; and radiologists. They can land helicopters. They can treat burns. And they're ready to support patients through rehabilitation. If you're severely hurt, this is where you want to be. The CDC has found that trauma centers reduce the risk of death by 25 percent. ... But across the country, more and more trauma centers and emergency departments are closing. And they're closing in communities that need them the most (Jason Silverstein, 4/26).