The Hartford Courant, Hartford, Conn., Friday, Nov. 20, 2009:
New guidelines on mammograms are causing anxiety and confusion. This doesn't bode well for the future of health care reforms, which are bound to challenge conventional wisdom about scary diseases and the comforting routines people have adopted for preventing them.
One way to stop the explosion in health care costs, however, is to listen to medical experts like the U.S. Preventive Services Task Force on limiting needless tests. The United States spends more on health care than other industrialized nations, but with some of the worse outcomes.
For years, many experts have recommended annual mammograms for women 40 and older to check for breast cancer. But the Preventive Services Task Force has now concluded that women in their 40s without risk factors need not be screened, and women 50 to 74 should be tested every other year rather than annually. The task force also said there is no proven value in self-examination.
Regular testing of women in their 40s prevents one death for each 1,904 women tested. The downside is that mammograms often produce false positives — suggesting breast cancer where none exists. In these cases, patients are subjected to expensive biopsies, useless treatments and needless worry. The new recommendations do not apply to women with a family history of breast cancer.
Understandably, women worry about a disease that kills 40,000 of them annually. There is considerable relief when the yearly screening comes back negative. Balanced against that, however, is the slightly elevated danger that yearly radiation exposure poses.
Researchers have also concluded that some slow-growing tumors are best left alone because the risks of treatment outweigh the benefits. Some cancers grow so slowly that they would never be noticed in a lifetime. Doctors have reached similar conclusions about excessive testing and treatment for prostate cancer in men.
It may seem cold — especially to breast cancer victims and their loved ones — to apply a cost-benefit analysis to such a frightening and pervasive disease. But it is legitimate to ask whether annual mammograms provide enough benefit to justify the cost and added anxiety. Nearly 40 million women undergo mammograms each year at a cost of several billion dollars.
Major health insurers in Connecticut said they will continue to pay for annual mammograms — which is the right response. No one is suggesting that doctors be barred from authorizing annual screenings. The new guidelines are just that, guidelines. Such an important decision must be made by a woman in consultation with her doctor.
Now, however, the decision is no longer obvious.
Connecticut Post, Bridgeport, Conn., Monday, Nov. 16, 2009:
In a country where private property is sacred, the government's right to seize land for its own devices will always be contentious.
Done in the service of building a school or a hospital, it can be defensible. Taking people's homes for the nebulous "public good" of economic development is deplorable.
In a case that went all the way to the U.S. Supreme Court, the residents of New London fought back against such folly. When the drug company Pfizer announced in 2001 it was opening a new research center in that city, officials began the process of acquiring nearby land for an accompanying development project. Homeowners who were to be forced out said "no."
The residents lost that case, as the Supreme Court four years later ruled the government had the right to take their homes and turn the land over to a private developer, all because the plan was supposed to, someday, bring jobs and tax dollars to the struggling community. It was a bad decision then and only looks worse in retrospect.
The news now is that Pfizer is leaving New London, closing its facility and moving its work up the street to Groton. All the grand development plans, which weren't progressing in any event, have now been shelved for good. Where people's homes once stood, only weeds grow.
The situation bears some similarities with Bridgeport's own Steel Point. What was once a neighborhood of homes and businesses, taxpayers all, has for a decade and more stood vacant, as one grand proposal after another faded from the scene.
There's a new plan now, one city leaders swear will finally bear fruit. And maybe it will.
The lesson, though, is clear. Eminent domain must be an absolute last resort, not merely one option on the table. It can only be used for concrete plans, with stable financing. And it should be strictly limited to works that serve an unambiguous public good.
Anything else is an abuse of power.