Opinion

The Great Debate

You don’t need that annual pelvic exam. So why is your doctor giving you one?

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In June, the American College of Physicians (ACP) reported what many doctors have known for years: There is little justification for the widespread practice of the annual pelvic exam. In its clinical guidelines, the physicians group recommended against performing the exams for non-pregnant women who don’t have pelvic pain or other symptoms that suggest a gynecologic problem. These guidelines do not apply to Pap smears for cervical cancer screening, for which there is strong evidence for their continued use. They apply to the pelvic exam, where the clinician first uses a speculum to perform an internal exam, and then with his or her hands, feels for pelvic organs.

The guidelines are based on an extensive review of nearly 70 years’ worth of studies looking at the benefits and harms of the annual pelvic exam. After decades of research, the studies don’t show any benefits to performing this annual exam. When surveyed, many doctors said that they do the pelvic exam to screen for ovarian cancer, yet the review found that the pelvic exam could not effectively detect ovarian cancer, nor reduce deaths from it. Nor did the exams reduce deaths from non-ovarian and non-cervical cancers.

The review did find, however, that more than a third of women who received pelvic exams reported pain or discomfort and a similar percentage of women reported fear, embarrassment or anxiety. Not surprisingly, women who had experienced sexual abuse were more likely to experience these harms. This finding is particularly troubling because doctors don’t always know about their patients’ histories of sexual abuse.

Additionally, when low-risk patients are examined, the vast majority of abnormal exams end up being false alarms. The findings turn out to be false, however, only after additional workup is done. This workup may include ultrasounds or CT scans, specialty referrals, and even biopsies or surgeries. These procedures and evaluations may expose patients to radiation, put them at risk for complications such as bleeding or infection, and add costs. One study showed that pelvic exams resulted in a 1.5 percent increase in unnecessary surgeries. Even normal results from a pelvic exam may be problematic, because a pelvic exam’s ability to detect ovarian cancer is so poor that a normal result may be a false reassurance.

To match feature DOCTORS-DUMMIES/Despite these findings, an alarming number of physicians continue to conduct annual pelvic exams. That’s partly because of a position taken by the organization that establishes guidelines for gynecologists, the doctors who conduct the majority of pelvic exams in the United States. After the publication of the recent ACP guidelines, the American College of Obstetricians and Gynecologists (ACOG) reported that it “firmly believes in the clinical value” of the annual pelvic exam, even though it acknowledges that its recommendations were “not evidence based.”

Why the contestants on ‘Dating Naked’ are (kind of) just like us

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If naked horseback riding strikes you as a bad idea, then Dating Naked is not the reality show for you.

The show, which debuted last month, is filmed on a Caribbean island, and it’s much like any other reality dating show, except that contestants show up for their dates — which involve island-y activities like spearfishing, zip lining, paddle boarding, and yes, horseback riding — totally naked, and stay that way for the duration of the date. Suffice it to say, the folks responsible for pixelating the footage for this show have their hands full.

Dating Naked is one of several reality shows in which nudity is part of the central premise. Recently, we’ve also seen the debut of Buying Naked (TLC), about a real estate agent who caters to a nudist clientele; Naked and Afraid (Discovery Channel), in which strangers are left naked in a deserted location and must fend for themselves in the wilderness, is currently in its third season. If you hold to the journalism adage that three makes a trend, then naked reality shows are officially a hot new trend (or, in the case of the Naked and Afraid contestants who spent three weeks in the Yungas cloud forest of Argentina, a cold one).

Africa’s about more than Ebola, it’s about optimism, too

The seat of the representative from Guinea remains empty at the U.S.-Africa Leaders Summit in Washington

The conversations at the U.S-Africa Leaders Summit in Washington this week, Secretary of State John Kerry said on the first day, are very different from discussions about Africa 15, or even 10, years ago.

He’s right — and he should know.

In the early 2000s, then-Senator Kerry (D-Mass.) was one of the leaders in the bipartisan effort to scale up U.S. funding for the HIV/AIDS pandemic through the President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria — just as both programs were gaining their footing in Africa. As recently as 2000, The Economist had featured a notorious cover story calling Africa “the hopeless continent,” and debating its future of war, disease and endless poverty.

Kerry takes his seat with Kikwete and Mahama as they arrive for a civil society forum during the U.S.-Africa Leaders Summit in WashingtonThe representatives from some 50 African nations who arrived in Washington this weekend, by contrast, brought with them a ringing sense of optimism and hope — to say nothing of style and flair.  In this miserable political year, the city could do with all those attributes.

from Stories I’d like to see:

What we don’t know about Qatar and what we don’t know about key Senate races

U.S. Secretary of State John Kerry walks with Qatari Crown Prince Tamim bin Hamad Al Thani in Doha

1. Inside Qatar:  the terrorists’ benefactor and America’s friend

As the war in Gaza continues, we keep hearing that one pipeline for negotiations with Hamas goes through Qatar, the tiny, oil-rich kingdom in the Gulf that has friendly relations with Hamas. In fact, Qatar hosts the leaders of Hamas and provides financial support.

According to the online Times of Israel, “Qatar continues to fund the movement’s terror apparatus abroad, enabling tunnel digging and rocket launching.”

The United States, like Israel, has branded Hamas a terrorist group and, over the weekend, stepped up its criticism of the Qataris’ support of Hamas. Yet Washington maintains friendly relations with Qatar. The bond is so tight that the largest U.S. military base in the region is there.

from Nicholas Wapshott:

The analogue titans’ last gasp against the digital giants

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Amazon’s bullying of the book publisher Hachette and the uninvited bid by Rupert Murdoch’s 21st Century Fox to swallow rival TimeWarner has caused some economists and commentators to ask, why are such aggressive moves not attracting the attention of the Justice Department’s trust-busters? Both moves are textbook examples of how monopoly power can abuse -- or so they would have seemed not long ago.

At stake are the benefits that consumers and employees alike enjoy from the proliferation of competing companies operating in a free market. For markets to work freely and fairly, there must be enough companies competing; when the critical mass of businesses sinks below a certain number, monopolies occur, which is bad for consumers. When that happens, governments in mature societies intervene to prevent over-consolidation and protect people from exploitation.

This isn’t socialism; it is how the free market is meant to work. It is the ordered way of doing business advocated by free-market gurus like Friedrich Hayek, who believed the integrity of free enterprise was paramount to ensure that prices are arrived at fairly.

The best way to treat Ebola patients who reach America

 Members of the media wait in front of Emory University Hospital after an ambulance carrying American doctor Kent Brantly, who has the Ebola virus, arrived via Dobbins Air Reserve Base in Atlanta, Georgia

Dr. Kent Brantly, an American physician stricken with Ebola, was evacuated this weekend from Liberia to Emory University Hospital in Atlanta, where he will receive treatment for the deadly virus. His colleague Nancy Writebol, also infected with the Ebola virus, returned to the United States on Tuesday. But many Americans have expressed outrage over transport of these Ebola patients into the United States.

This reaction is unjustified — and callous. In the United States, much more can be done for a critically ill Ebola patient than if he or she were on the ground in West Africa. We have intensive care units that allow for careful, continuous monitoring of blood pressure, oxygenation and organ function. Blood pressure may be supported with intravenous fluids and “pressor” medications like norepinephrine, which increase blood pressure. If organs begin to fail when blood pressures are low, we can use ventilators to support breathing or dialysis if kidneys aren’t working. Ebola patients have weakened immune systems and can acquire secondary infections, for which we have a much broader array of antimicrobials at our disposal in the United States.

Medical staff working with Medecins sans Frontieres prepare to bring food to patients kept in an isolation area at the MSF Ebola treatment centre in KailahunThe likelihood that other Americans could get Ebola from Brantly or Writebol is extremely small. Ebola is not airborne. It is spread through direct contact with a sick patient or infectious bodily fluids. Brantly and Writebol are being treated in a specialized unit, separate from other patients at Emory University Hospital. The healthcare workers staffing this unit will be working in shifts and have access to personal protective equipment. Hospital staff will follow the Center for Disease Control and Prevention’s infection control guidelines for management of contaminated fluids, materials, equipment and surfaces. This is in contrast to working conditions in Guinea, Liberia and Sierra Leone, where the disease has been spreading.

Who really owns your friendly neighborhood McDonald’s?

Demonstrators take part in a protest to demand higher wages for fast-food workers outside McDonald's in Los Angeles

I work at a McDonald’s franchise, but the corporation is my boss.

McDonald’s may say it’s not — and argue this point before the National Labor Relations Board. But the corporation sure acts like one. It sets the rules and controls just about every aspect of our franchise.

On Tuesday, the board’s general counsel determined that McDonald’s is a joint employer in its restaurants. McDonald’s has said it will fight this. But under the ruling, McDonald’s can’t say I work only for the franchise, and the corporation has to respond to my co-workers and I when we demand $15 an hour and the right to form a union directly.

It’s about time. To anyone who works for the company — as I have for 25 years — it’s clear who’s in charge.

Forcing the CIA to admit some ugly truths

CIA Director John Brennan participates in a Council on Foreign Relations forum in Washington

George Tenet, who presided over the CIA when terrorist suspects were waterboarded and subjected to other forms of brutal “enhanced interrogation,” has set himself a near-impossible task.  He is leading an effort to discredit an impending Senate committee report expected to lay out a case that the intelligence agency tortured suspects and then misled Congress, the White House and the public about its detention and interrogation program.

Tenet, working with other senior officials who ran the CIA in the years after September 11, is said to be trying to develop a “strategy” to counter the findings of the Senate Select Committee on Intelligence’s 6,300-page report that was five years in the making.

But how do you strate-PHOTO TAKEN 24FEB04- CIA Director George Tenet [has resigned for personal reasons, President George..gize against the truth?

It is now well-established that the CIA ran several “black sites” in Eastern Europe and Southeast Asia where al Qaeda suspects were subjected to forms of harsh interrogation that were banned as “torture” by President Barack Obama after he took office in 2009.

Think everything on a dollar menu costs a dollar? Think again.

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How expensive are those everyday low prices? How much do things really cost on that fast-food restaurant’s dollar menu? The answer is more than you think, but maybe not for the reason you think.

The Supplemental Nutritional Assistance Program (SNAP, the current name for food stamps) is often thought of as something for the unemployed, though nothing could be further from the truth. Actually, 73 percent of those enrolled in the country’s major public benefits programs are from working families, just stuck in jobs whose paychecks don’t cover life’s basic necessities.

The United States now has the highest proportion of low-wage workers in the developed world, most of whom receive only the minimum wage (the federal standard is $7.25 an hour) and typically are capped by their employers well below 40 hours a week, so they won’t qualify for benefits. Hard work doesn’t always pay off. The math: even full-time work at $7.25 an hour only adds up to $290 a week. How do you live on that?

To keep grads solvent, take the middleman out of student loans

Occupy Wall Street demonstrators participating in a street-theater production wear signs around their neck representing their student debt during a protest against the rising national student debt in Union Square, in New York

The mounting student debt crisis could cause serious economic damage to the United States. Rising college costs and declining financial aid at both state and federal levels have significantly contributed to the problem. A good deal of responsibility, however, belongs to the financial institutions that service federal student loans, according to a new report.

Millions of students use loans underwritten by the Treasury Department and granted by the Department of Education to help make college a reality. Once the loan is approved, however, borrowers usually deal with third-party servicers — and that’s where the trouble often begins.

In 2010, the Education Department expanded its Direct Loan Program and contracted many for-profit financial institutions to service and administer the loans. Complaints to the department’s Office of Federal Student Aid jumped significantly.

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