In 1990, the NIH said that for women with early-stage disease, a mastectomy (removing the entire breast) was basically equivalent to removing a lump from the breast combined with radiation therapy. That prompted mastectomy rates to fall for several years.

A study released yesterday found that the rate has started rising again, at least at the Mayo Clinic. Between 2003 and 2006, the percentage of women choosing mastectomy rose to 43% from 30%.

Rates were higher among women who had an MRI before surgery, perhaps because MRIs tend to detect possible lesions that might persuade women to remove the entire breast. Because the percentage of women who had MRIs doubled during this period (from 11% to 22%), MRI use probably drove up the overall mastectomy rate.

But, in a puzzling finding, the mastectomy rate also increased during the period among women who didn’t have an MRI before surgery, to 41% in 2006 from 28% in 2003. Matthew Goetz, the author of the study, said on a conference call yesterday that this rise is something of a mystery.

But he suggested a few possible reasons for the increase. New options for reconstructive surgery may be one factor; increased use of genetic tests for breast-cancer risk may be another.

Image: AP

“We’ve tried everything to drum up support” for organ donation, Carney told the Sydney Morning Herald, but “people just don’t seem willing to give their organs away for free.”

Plus, let’s be realistic, the advocates of the new approach argue. There already is a market for organs; it just happens to be a shady one. Some Australians, unable to get kidneys at home, travel to Pakistan and India to buy organs on the black market. Forget about ethics or even good clinical practices in that sort of transaction.

Sally Satel, an American psychiatrist and the recipient of a kidney from a friend, thinks Carney’s on the right track, she writes on the opinion pages of the WSJ. She points to World Health Organization estimates that 5% to 10% of transplants performed each year occur in “clinical netherworlds” in China, Colombia, Egypt Pakistan and the Philippines. “The way to stop illicit transactions – and the depredations of underground markets – is to sanction legal exchanges,” she argues.

There are worries, of course, that monetary incentives for organs in Australia or America would simply shift exploitation of the desperately poor onshore from less developed countries. To minimize that risk, Satel and Carney suggest careful screening of donors and longer-term rewards rather than lump sums for donations. Those might include a down payment on a house, money for a retirement fund, or even lifetime health insurance.

How much money would it take? A couple of years ago, economists Gary Becker and Julio Elias of put the “going price” at about $15,000 for kidneys and about $35,000 for livers, though they acknowledged the data for those figures were limited. Even if those guesstimates were too low, payment for organs wouldn’t dramatically affect the total cost of transplants, which run about $100,0000 for kidneys and $175,000 for livers.

Kidney via Wikimedia Commons

Insurers in the state have been taking some heat in recent months for canceling policies of individuals who had inaccuracies on their applications. But in a deal yesterday, two big insurers in the state agreed to restore coverage for nearly 1,200 people who had their policies canceled after incurring big medical costs, the Los Angeles Times reports.

The industry says canceling policies when people misrepresent themselves is a key way to prevent fraud and keep prices down. But critics say there are cases where insurers use honest mistakes as an excuse to cancel policies of people who become sick and run-up high health bills.

Kaiser Permanente and Health Net agreed yesterday to let people whose policies have been rescinded since 2004 buy health insurance again, regardless of their current health status. Health Net recently lost a $9 million case against a woman who had to stop chemotherapy when the company canceled her insurance, the LAT notes.

The state’s department of managed care brokered the deal, and is working with PacifiCare (part of UnitedHealth), Anthem Blue Cross and Blue Shield to cut similar deals involving some 4,000 people, the article says.

Image via Wikimedia Commons

The details will be presented at a meeting of the American Society of Clinical Oncology later this month, but you can sift through the data snapshots here.

ASCO held back a few gems. The group still hasn’t released the most hotly anticipated studies — for those, we’ll have to wait for the conference. But last night’s data dump does have some drug studies people are talking about this morning. Here are a few that caught our eye:

Eli Lilly’s Alimta (generic name: pemetrexed) slowed the spread of non-small cell lung cancer in patients with advanced disease. It’s already approved for use in patients who have failed chemotherapy; this study suggests it may be added to treatment earlier in the course of disease. Read the abstract.

Which is better, Genentech’s Herceptin (trastuzumab) or GlaxoSmithKline’s Tykerb (lapatinib)? Maybe the two together. In women with advanced Her-2 positive breast cancer who received both drugs, disease progressed more slowly than in women who received Tykerb alone. (Abstract here.)

Jim Reddoch at FBR Capital Markets makes Celgene his “top pick” going into the conference. The company’s drug Revlimid is used to treat myeloma. Reddoch cites a few studies, including this one, that suggest the drug may become more widely used to treat the disease.

Photo: iStockphoto

Today, the House Energy and Commerce subcommittee on oversight and investigations took its first swing at the target, with a hearing that focused on problems with regulation and full disclosure of ownership. Subcommittee Chairman Rep. Bart Stupak of Michigan, the ex-cop who’s been going after direct-to-consumer ads and the FDA, said he plans other hearings as well.

The testimony featured some horror stories, such as the tale of a woman whose Alzheimer’s-afflicted husband was allowed to wander from his nursing home and found at the bottom of an embankment. The nursing home ended up paying a $1 fine, she testified.

Some law-enforcement types — Connecticut Attorney General Richard Blumenthal and Lewis Morris, an official with the Health and Human Services Office of the Inspector General – also backed the idea that there needs to be more ownership disclosure. For his part, Kerry Weems, acting administrator of the Centers for Medicare and Medicaid, said the regulator is already working toward more consistent oversight and gathering ownership data.

The subcommittee also released a report commissioned by the Centers for Medicare and Medicaid that suggested that the regulatory enforcement system for nursing homes has a lot of problems. Though it’s dated March 22, 2007, CMS apparently hadn’t gotten around to making it public, Rep. Stupak noted. Mr. Weems, in his testimony, said the agency had been developing an action plan to respond to the report, and wanted to release them together. If you can’t wait, click on the PDF icon on the right.

On the Senate side, Sens. Charles Grassley, the Iowa Republican, and Herb Kohl, the Wisconsin Democrat, released a report from the Government Accountability Office that flagged a lot of the same concerns – which the GAO has been hammering on for a decade now. Click here for the full report.

In the end, it’s the Senate that bears watching this year. Sen. Grassley is trying to get provisions from nursing-home disclosure legislation sponsored by him and Sen. Kohl into a Medicare-related bill that’s expected to pass Congress by July 1. That’s likely the only vehicle for nursing-home changes that’s moving anytime soon.

The finding — part of a growing body of evidence that connects vitamin D to several types of cancer — was just published, ahead of the upcoming American Society of Clinical Oncology conference. It was based on a University of Toronto study of 512 women diagnosed with breast cancer between 1989 and 1995. Researchers kept track of the women’s health through 2006.

Vitamin D levels were broken into three categories: “deficient” (192 of the women were in this group) “insufficient” (197 women) and “sufficient” (124 women). (Even among healthy women, high rates of vitamin D deficiency are common.)

Those with deficient levels were 73% more likely to die than those with sufficient levels. Cancer was also significantly more likely to spread to other parts of the body in women with vitamin D deficiency, the researchers found.

Previous studies have connected low vitamin D levels with higher risk of colon, prostate and breast cancer, as well as higher mortality from the cancers, according to this NEJM article.

The link is still poorly understood, but vitamin D may bind with cancer cells and slow the growth of cells or cause them to die.

Sunlight is an important source of vitamin D. Some foods, such oily fish, are also sources, as are dietary supplements. For more on vitamin D in foods and supplements, along with info on recommended daily intake by age and gender, see this page from the NIH.

Turns out it’s not going so well for J&J. A judge today threw out most of what was left of the case, the Associated Press reports.

J&J brought the suit to stop the Red Cross from licensing the logo to companies that sell products such as first aid kits and sanitizers.

“We know the American Red Cross gave (the licensees) the right to use the cross, but we don’t think the right is theirs to give,” a J&J lawyer told the Health Blog last summer, when the suit was filed.

But U.S. District Judge Jed Rakoff disagreed.

J&J’s interpretation of the law “would criminalize not only the licensing agreements that… ARC has been entering into for more than a century, but also a host of other familiar and traditional ARC activities,” the judge wrote.

But Rakoff also dismissed a Red Cross counterclaim that argued J&J was misusing the red cross logo. Sounds like the “I know you are but what am I” school of litigation to us.

A J&J spokesman told the AP the company was disappointed that the judge rejected its legal argument, but pleased that J&J could continue using the red cross as its trademark. The Red Cross was jubilant, saying in a statement that the “ruling represents a complete vindication of the right of the Red Cross charity to use its emblem or authorize others’ use of its emblem in the sale of products related to its mission.”

The only part of the suit still pending is J&J’s allegation that the Red Cross purposefully interfered with J&J’s relationships with two companies, Water-Jel Technologies Inc. and First Aid Only.

If you live around New York and maybe even if you don’t, it’s pretty hard to avoid the former New Jersey governor Jim McGreevey’s fall from grace. In the latest chapter–his divorce trial–McGreevey painted a pretty bleak picture of his personal finances.

Admittedly, we don’t write much about marriages torn asunder or gubernatorial meltdowns. But, believe it or not, a few health tibdits emerged from McGreevey’s time on the witness stand.

McGreevey told the court that he is broke and deep into debt, according to the Star-Ledger of Newark, N.J. How broke? He owes $200,000 to his live-in lover, more than $150,000 to his lawyers, more than $6,000 to credit-card companies and, Health Angle No. 1: $2,000 to his dentist. We have always admired his dentition.

Meanwhile, among his assets are a $14,710 life insurance policy, $4,000 of furniture and, Health Angle No. 2: $80 of Merck stock.

The drugmaker’s shares are trading today at just about $40. So we figure this means McGreevey owns a couple of shares. Perhaps he’ll keep one and give the other to his estranged wife?

Merck hasn’t lent McGreevey’s finances much of a hand lately. The company’s shares are down about 31% since the beginning of the year, meaning his $80 used to be $116, assuming he owned the same number at the end of 2007.

Then you can click through to see words other people associate with the brand. In standard tag-cloud form, the more popular a word or phrase is, the larger it shows up on the page.

When our colleagues over at the Buzzwatch blog wrote about the site earlier this week, it had attracted 180,000 responses from 30,000 readers in a few days since going live.

We, of course, wanted to see how health-care companies played. While the site is longer on media and tech companies than on health outfits, we did find a couple of Health Blog regulars there: Pfizer and Johnson & Johnson.

The two biggest tags on the Pfizer page: “drugs” and “viagra.” Also pretty big is “medicine,” as is “evil.” A few off-color terms, apparently related to Viagra, are also popular.

J&J may be a behemoth involved in everything from anemia drugs to high-tech stents, but to Americans the company still comes off as the Norman Rockwell of the drug store. The biggest tags on the J&J page are for “babies,” “baby oil,” “baby powder” and “shampoo.”

Photos: Associated Press

Kings County Hospital Center (Photo: NYHHC)

“It’s not rocket science,” Alan Aviles, the hospital system’s CEO, told Health Blog. “It is really four or five or six relatively simple practices that need to be followed every time.”

One kind of hospital-acquired infection — ventilator-associated pneumonia — plummeted by 78% between 2005 and 2007 at the New York City Health and Hospitals Corp., the organization said. Another, central-line infections, fell 55%. Surgical-site infections fell as well, but not as dramatically.

Another way to look at it: The country’s biggest public hospital chain — with 11 facilities and 30% of its patients uninsured — has averaged 5.2 months without a central-line infection, and 5.8 months without a case of ventilator-associated pneumonia.