Sweeping new U.S. breast cancer guidelines released on Monday recommend against routine mammograms for women in their 40s, and suggest women 50 to 74 only get a mammogram every other year.

The new guidelines by the U.S. Preventive Services Task Force, an influential panel of independent experts, would sharply curtail the number of breast mammograms done in the United States, sparing women the worry of false alarms and the cost and trouble of extra tests.

But U.S. cancer experts say the altered schedule may mean more women will die from breast cancer.

Should you and your loved ones get mammograms? What are the implications for health care reform, with members of Congress looking for ways to cut costs?

Join us for a live online on breast cancer screening and mammograms on Tuesday, Nov. 17, at 12pm ET. The event will be moderated by Reuters Health Executive Editor Ivan Oransky and joined by Reuters’ editor in charge of health and science, Maggie Fox.

Our confirmed participants:

Heidi Nelson, research professor of medical informatics and clinical epidemiology and medicine at the Oregon Health Sciences University, who has led systematic evidence reviews for the U.S. Preventive Services Task Force.
Daniel B. Kopans, professor of radiology at Harvard Medical School and director of breast imaging at the Massachusetts General Hospital.

You’ll be able to follow the discussion by listening in on the conference call line below or via the live blog here (it’s also embedded lower on this page.) If you have any questions for the participants, please leave them in the comments below. We’ll ask a selection on your behalf.

Update: Thanks to everyone who participated. You can hear a recording of the call here

Increasingly vocal calls for taxes on sugary drinks and junk food are fueling a behind- the-scenes battle that public health officials say is reminiscent of America's war on cigarettes.

Fueling the debate are revenue-hungry federal, state and local governments officials who are eying a potential $50 billion windfall from taxes on over 10 years.

Take a look at the New York City Department of Health's ad discouraging people from drinking sugary sodas, and let us know whether you think a junk food tax would be good public policy, or an intrusive step too far by the nanny state.

Peter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA associate commissioner. The views expressed are his own.

In SiCKO, Michael Moore portrayed the British National Health Service and the Canadian health system as particular exemplars of excellence. He backed it up with a lot of statistics, but statistics, as the saying goes, are like a bathing suit. What they show you is interesting, but what they conceal is essential.

And what SiCKO concealed was that systems such as those in the United Kingdom and Canada are cost-based rather than patient-centric models. Facts, no matter how inconvenient to one’s argument, must not be ignored.

Citizens of countries with government-run health care systems experience long wait times, a lack of access to certain treatments and, in many instances, substandard medical care. For example:

• The five-year survival rate for early diagnosed breast cancer patients in England is just 78 percent, compared to 98 percent in the U.S.

• A typical Canadian seeking surgical or other therapeutic treatment had to wait 18.3 weeks in 2007, an all-time high, according to The Fraser Institute.

• The average wait time for bypass surgery in New York is 17 days compared to 72 days in the Netherlands and 59 days in Sweden.

• More than half of Canadian adults (56 percent) sought routine or ongoing care in 2005. Of these, one in six said they have trouble getting routine care.

• Eighty-five percent of doctors in Canada agree private insurance for health services already covered under Medicare would result in shorter wait times.

• Approximately 875,000 Canadians are on waiting lists for medical treatment.

“Congress has an important role to play in healthcare reform” said United States Representative John Shadegg, (R-Arizona), who has introduced healthcare legislation in support of free-market competition. “We can help patient in this country, not by setting up a massive new government bureaucracy, but by empowering individuals to make the best choices for themselves and their families.”

If we’re going to look to other healthcare models for solutions, we must uncover and study their problems. Health care is too important to allow reform by sound bite. “Drugs from Canada” is as much a false promise as “free” healthcare.

Last autumn, my organization the Center for Medicine in the Public Interest interviewed people on the streets of New York City and asked them if they’d prefer “government” healthcare or “universal” healthcare. They overwhelmingly chose “universal” healthcare. But when we asked them to explain the difference between the two, they generally just shrugged their shoulders.

And when we asked them how much more in taxes they’d be willing to pay to support universal healthcare, they shook their heads and said, “No, we want it to be free, like in Europe and Canada.” Such are the fallacies that political rhetoric hath wrought.

Equally as prevalent is the notion of “free” or “low cost” drugs “like in Canada and Europe.” And here too we need to be honest and examine the other side of the coin — that of cost-savings for the payer (often in the guise of healthcare technology assessment programs such as Britain’s National Institute for Health and Clinical Excellence) versus care denied for the patient. What is overlooked is that price controls equals choice controls.

Our national conversation about health care has to go beyond vague concepts of reform and convenient political rhetoric. We must all be part of the solution and suspicious about false choices.

- Shelley Ross is secretary general of the Medical Women's International Association, a non-governmental organisation representing women doctors from all continents. The opinions expressed are her own. -

The Medical Women's International Association was created in 1919, not long after the first International Women's Day in 1911. MWIA's founder was an American by the name of Dr. Esther Pohl Lovejoy, who served as its first president. She was an obstetrician by training but an activist and humanitarian by action. Not only did she establish MWIA but she also founded the American Women's Hospital Service during the First World War.

The motto of the Medical Women's International Association, Matris Animo Curant, comes from Latin and translates to read, "She Heals with the Spirit of a Mother."

From the time of Hygeia in ancient Greece to present day, women have had a significance influence on the practice of medicine.

To name three of its objectives, MWIA (1) works to overcome gender-related differences in health and healthcare between women and men throughout the world, (2) works to overcome gender related inequalities in the medical profession and (3) works to promote health for all through the world with particular interest in women, health and development.

International Women's Day on March 8, gives us an opportunity to reflect on how we are doing with accomplishing these objectives.

Regarding gender-related differences in health and healthcare, a past Director-General of the World Health Organization Dr. Gro Harlem Brundtland, once said that no country treats their women the same as they treat their men. This is often more readily apparent in the developing countries, where family resources dictate that boys will receive medical care and girls will not. Reproductive health is another example of gender related differences in health care.

In 2009, women are still being denied skilled care during pregnancy, labour and delivery because they cannot access appropriate medical care. In sub-Saharan Africa, the cause is often lack of transportation to the medical facility whereas in the U.S., it is the lack of medical insurance.

Regarding gender-related inequalities in the medical profession, the biggest change has been in the number of women in medical school. In the developed world, female medical students equal if not surpass the number of male medical students. This has already changed the way medicine is practiced, as women have demanded a better work-life balance.

With this improvement in working conditions comes the danger of the profession becoming a Pink Collar profession, where the female predominance equates to lack of influence. One of MWIA's jobs is to ensure that there are enough women in leadership roles to ensure that medicine continues to have the ability to influence policy makers and advocate for those in need of health care.

The number of women in medical school does not equate with the number of women in higher academic positions, such as deans of medical schools or heads of departments. For those women who wish to climb the academic ladder, there are many obstacles along the way, including the lack of female mentors. On the other hand, many women doctors feel that there is no discrimination, as they are busy balancing home and work and are quite happy to keep their head above water with their required day to day activities.

MWIA has had some successes when it comes to promoting health for all. MWIA has written a manual on how to make sure health care has a gender perspective and a manual on adolescent sexuality. MWIA was very involved in promoting immunization against Human Papillomavirus (HPV), which is the leading cause of cancer of the cervix. Thanks to MWIA's work, there are many programs in schools that are immunizing girls and in some countries, boys, against this infection.

MWIA has spoken out for years against female genital mutilation (FGM). Dr. Koso Thomas of Sierra Leone wrote a book thirty years ago to help eradicate FGM, and recently starred in a Danish film, called "The Secret Pain," that looks at FGM in her home country. MWIA has recently spoken out about osteoporosis, to help improve women's awareness of the condition that predisposes them to major life changes. It is well known that once you have a hip fracture, your chance of leading an independent life ever again is less than 50 percent. MWIA holds international conferences that allow discussion on topics of timely interest. The next congress will be in Munster, Germany, in 2010. Visit the MWIA website at www.mwia.net for more information.

So, on International Women's Day, the question is whether things are as good as they are going to get for women and the answer is no. MWIA will continue to work to improve the lot of both women in medicine and the health of all women.

– Dana Radcliffe is a Day Family senior lecturer of business ethics at the Johnson School at Cornell University. The views expressed are his own. —

Are a CEO’s health problems a private matter? Or does he or she have an obligation to disclose them to investors and other stakeholders?

These are questions Apple and its iconic co-founder and chief executive Steve Jobs have had to face ever since he was diagnosed with a rare form of pancreatic cancer in 2003.  Happily, the disease proved to be treatable with surgery, which Jobs underwent in 2004.  But shareholders didn’t learn that Apple’s chief had been ill until he sent out an email to employees, announcing that he had had cancer but was now “cured.”

The issue of what, if anything, the company should disclose about its CEO’s health concerns resurfaced last summer, when Jobs spoke at Apple’s annual developers conference.  There he appeared, as the New York Times put it, “unusually thin and haggard.”  Reacting to the inevitable rumors that Jobs was ill again, the firm’s public relations department reported that he was suffering from “a common bug.”

A PRIVATE MATTER

However, according to the Times’ John Markoff, Jobs told some associates that he was experiencing “nutritional problems.”  Moreover, people close to Jobs told Markoff that in early 2008 he had a surgical procedure to treat a problem related to his weight loss.  Yet, in July, in a conference call after the release of Apple’s quarterly earnings statement, a senior officer deflected an analyst’s question about Jobs’s health, calling it “a private matter.”

Not surprisingly, investor uncertainty about whether Jobs would be able to continue as CEO was reflected in sharp fluctuations in the price of Apple’s stock.  In December, the worries intensified when the company said that Jobs would not give his much-anticipated annual keynote address at Apple’s Macworld conference.  At first, the reason offered by a spokesman was that the firm would not take part in the event after 2009.  That “explanation” only fueled the rumors.

So, last week, Jobs responded by issuing a statement.  About his weight loss, he said doctors had finally determined that it was due to a “hormone imbalance”—a “nutritional problem” whose remedy “is relatively simple and straightforward.”  This announcement seemed to calm investors, with Apple’s stock price rising by 4 percent.

Then, this week, Jobs emailed Apple employees that he had just learned that “my health-related issues are more complex than I originally thought.”  Consequently, he said, he is taking a six-month medical leave of absence, although he will “remain involved in strategic decisions while I am out.”  The news alarmed investors, as shares dropped 7 percent in late trading.

Clearly, Apple and its chief executive have not been diligent in keeping investors, employees, and other stakeholders informed about the state of Jobs’s health.  Should they have been?

LEGAL VS ETHICAL POINT OF VIEW

From a legal point of view, the company has a duty to disclose information that is “material”—i.e., facts a reasonable investor would need to know in order to make an informed decision about whether to buy or sell the company’s stock.  Materiality can be difficult to establish, and if litigation ensues, lawyers will argue at length over exactly what Apple should have revealed and when.

But, from an ethical point of view, the answer seems less arguable.  To be sure, Steve Jobs, like anyone else, has a right to keep details about his health problems private.  But an individual’s right to privacy is not absolute.  In this case, it has to be balanced against obligations Jobs and his board of directors have to Apple’s stakeholders, especially its shareholders, employees, and customers.

Since Steve Jobs returned to Apple in 1997, its breath-taking success has been due in no small part to his visionary and aggressive leadership.  Many investors worry (rightly or wrongly) that Apple would not be as innovative and market-savvy without Jobs’s famously tight control over its direction and operations.  Apple well knows all this—indeed, the company has shrewdly leveraged the immense admiration and popularity Jobs enjoys, encouraging the identification of Jobs with the Apple brand.  So, by design, investor confidence in Apple has been based to a considerable degree on confidence in Jobs’ leadership.

In general, the company has an ethical obligation to alert investors—and other stakeholders—to serious risks to the company’s health.  Because Apple and its CEO have actively encouraged “the Apple community” to associate the company’s success with his leadership, they have an obligation as well to keep stakeholders apprised of serious risks to Jobs’s health.