Sunday, February 26, 2012

Latinos and health care in Kansas City, Kansas

Kansas City, Kansas, where I live, makes up the bulk of Wyandotte County. It is the poorest county in Kansas, with a large number of low-income residents of all ethnicities, and stands in many ways in stark contrast to Johnson County to its south, Kansas’ richest county. It is not as poor or depressed as Camden, NJ (see February 18, 2012 blog, Camden and you: the cost of health care to communities); while it has lost many blue-collar industrial jobs, a large number still remain in its Fairfax industrial district (including a GM plant) and along the two enormous trainyards in town. Many of the workers in those plants no longer live in KCK (as the city is known to distinguish it from KCMO). It is seen as a regional “success story” because of the development in the western part of the county around the NASCAR track (and now including a huge mall with Cabela’s, Nebraska Furniture Mart, and a new professional soccer stadium). However, all occurred with tax abatements from the county, so people’s property tax assessments are very high because the value of the real estate is low.

KCK was incorporated early in the 20th century, combining a number of independent towns, most based around a primary industry, and sometimes even named for it (Argentine, home of a silver smelter, and Armourdale, where there was a meat-packing plant). Much of its history – and present – is determined by its border with Missouri; even today, living in this metropolitan area is greatly affected by being in two states. The Missouri River divides Missouri and Kansas south to Kansas City, where it turns east toward St. Louis, and most of the border between the two states is a two lane street. Quindaro, in the northeast part of the city, is on the Missouri River; it was settled by African-American slaves who crossed the river from Parkville, MO, and, after being dragged south by the current, coming out in the free state of Kansas. Quindaro was a major underground railroad center, and the ruins of the original settlement are now an archeological site, with a statue of John Brown on what was the campus of Western University. The current Quindaro neighborhood is overwhelmingly Black and poor.

Latinos, mostly from Mexico, arrived in 3 waves. The first came to help build the railroads that have been so central to KCK, the second to work in the silver smelter, and the most recent, as in so many US cities over the last 10-20 years, looking for any kind of jobs. 70% of the population increase in Kansas from 2000 to 2010 was Latino; while there are other concentrations, especially in southwest Kansas where there are meatpacking plants and the first majority-minority counties in the state, KCK is definitely a center for Mexican-Americans. The new Latino population is overflowing the boundaries of the traditional Hispanic community, the Argentine (a little confusing, as it is named for silver, not the country of origin of its Spanish-speaking majority), to cover much of the city. A huge mural portrays the history of Argentine, including the migrations of blacks and Latinos and the “clash of cultures” seen in the segment reproduced here.
The Latino community of KCK, like others, suffers the health problems associated with poverty, with young families, and with chronic diseases. The youth of this population means that pregnancy and childbirth, and well-child care, are a dominant health need. Diabetes is very common in the community. And many people do not have good health care access. Most of the industries in town are small, and do not offer health insurance, or offer it with very high premiums, copayments and deductibles. At a time when the National Business Group for Health, representing mostly Fortune 500 companies whose employees have the best health insurance, is predicting big increases in employee premiums, copayments, and deductibles, workers at small companies will be harder hit. And, of course, a large portion of Latino workers are undocumented, and thus ineligible for insurance, although most pay taxes. Even their children, who should be eligible for Medicaid or SCHIP, often do not have coverage because their parents are afraid to enroll them. This is not an idle worry in a state whose legislature is trying to deny in-state tuition at its public universities to students who are legal citizens and residents, often born here, but whose parents are undocumented.

As the poorest county in Kansas, Wyandotte County also has the poorest health status in rankings of Kansas’ 105 counties by the Kansas Health Institute in 2009. In national health rankings by the Robert Wood Johnson Foundation in 2011, Wyandotte County came in at 95 – because there was no data for 10 of the state’s smaller counties. As recently as February, 2012, the Community Dashboard published by Kansas Health Matters, continues, unsurprisingly, to show major health challenges. These go far beyond access to medical care to include the entire gamut of the social determinants of health. Access to preventive care and to early diagnosis and treatment of disease is important, but so is having a place to live. And enough heat in the winter. And enough food to eat. And a safe neighborhood, and safe housing. Often providers decry patients missing their appointments; a recent home visit by a health worker found the steps to be so rotten in front of the house of one such patient that it was lucky they didn’t try to come in – they likely would have fallen and broken their hip.

But access to medical care is an important component of health, and it is limited for residents of KCK. Being in Kansas, there are no publicly funded hospitals (there is one across the state line in Kansas City, MO); there are no publicly funded clinics (as there are in San Antonio, TX, where I used to live). There is no state, county, or municipal funding to provide health care to the uninsured and underserved, not in Wyandotte County or even in the very wealthy (but still with a large number of poor, including Latino poor, residents) Johnson County.  The Affordable Care Act (ACA) promises to increase the number of Americans with insurance, and will make a large difference for many, but will be far from a solution to the issues confronting Latinos in KCK.

First, of course, undocumented people will still not be covered. Then, much of the increase in coverage for the poor will be in the form of expanded Medicaid eligibility, largely funded by the federal government, in 2014. Of course, this depends on finding providers who will accept Medicaid rates.  Many of the Latino and other workers in KCK work for companies too small to be required to provide coverage. People who are not Medicaid eligible or undocumented may be offered the opportunity to purchase insurance, or required to if the “individual mandate” is ruled legal by the Supreme Court, but are not likely to be able to afford quality coverage. We read a lot about “quality of care”, but “quality of coverage” is also important – not all insurance is the same. There are often high premiums, co-payments, and deductibles and also low maximal coverage limits. ACA will help to some degree, but many of our people will be left out in the cold.

KCK has a number of “safety net” clinics, if no publicly funded ones. There are a couple of branches of a Missouri-based Federally-Qualified Health Center (FQHC), but these depend on the higher reimbursement they receive from Medicare and Medicaid; recently the one in the Quindaro moved several miles further west, to a neighborhood with more of these government-insured patients. This was better for their business plan than staying in a neighborhood full of uninsured people, but it left Northeast KCK with no doctors. Luckily, another safety-net, which doesn’t get increased Medicare/Medicaid reimbursement and depends on both grants and paying everyone (including the doctors) $14/h, opened a branch in the community. So, at least, there are community organizations, like these clinics, and the student-run free clinic, and Latino community service agencies, to help. But the need is far greater.

And, of course, like elsewhere, there are not enough primary care providers, especially with the new people to be covered under ACA. This is documented in a recent Washington Post piece “Success of health reform hinges on hiring 30,000 primary care doctors by 2015”. Of course, to “hire” them, they have to exist. Which means training them. Which means paying them enough, compared to other specialists, that medical students choose to enter them.

The health problems faced by Latinos in Kansas City, KS, are not unique. But they are serious. And they demand serious solutions, to be confronted by the city, county and state as well as the federal government and insurance companies. And that is yet to happen.

Saturday, February 18, 2012

Camden and you: the cost of health care to communities

Dr. Jeffrey Brenner, Executive Director of the Camden (NJ) Coalition of Healthcare Providers, spoke at the recent Society of Teachers of Family Medicine (STFM) Medical Student Education conference, on “Bending the Cost Curve and Improving Quality in One of America’s Poorest Cities (powerpoint available at the Family Medicine Digital Resource Library, His work first came to major national attention about a year ago with the publication of the New Yorker article “The Hot Spotters” by Dr. Atul Gawande (January 24, 2011). This article discussed how Dr. Brenner and colleagues had used mapping techniques to identify where the largest number, and highest cost, utilizers of health care services in Camden lived, and developed programs to try to address their needs. These programs both improved their health and lowered the cost of care. This is not magic or simple; it requires hard work and results can be slow, but they do make a difference. 

Dr. Brenner’s talk had two major sections. The first dealt with both the high cost of care in the US and the bizarre way that the money spent on care is allocated. One component is the huge regional disparity in the cost of care that is not explained by the overall cost of living. This topic is the subject of an earlier Gawande New Yorker piece, “The Cost Conundrum” (June 1, 2009), which focuses on the enormous difference in per capita Medicare expenditures in two similar Texas communities on the Mexican border: McAllen (one of the highest cost) and El Paso (one of the lowest). Brenner and Camden are in New Jersey, the state with the highest per capita expenditure in the nation, especially in the last 2 years of life (see his slide #5). Beyond the regional variation in health costs is the enormous disparity in what kinds of care Medicare, Medicaid, and other insurers pay for. They pay for procedures, but not for preventive care. Hospital emergency care is paid for, primary care is not. Early diagnosis and intervention that can make a difference both to people, in terms of the quality of their lives, and to the system, in terms of preventing future high costs are not paid for. Those later high-cost interventions, which former head of the Center for Medicare and Medicaid Services (CMS), Donald Berwick, MD, refers to as “rescue care” (see interview in the film “Money-driven medicine: the real reason health care costs so much”, also discussed by Bill Moyers August 28, 2009), of course are. That is, the US health system excels, rather than in primary and preventive care. This model is also illustrated in cartoon form by Camara Phyllis Jones, MD, of the Centers for Disease Control, in “Social Determinants of Health and Equity, the Impacts of Racism on Health”, which I have previous cited (Social Determinants, Personal Responsibility, and Health System Outcomes, September 12, 2010).

 Jeff Brenner had a solo practice in Camden (slide #2), but despite being willing to work for very little, cuts to Medicaid reimbursement made it impossible for him to continue to run the business and stay In practice. But, while reimbursement to primary care providers like him are cut, the cost of late-stage care is driving our national debt, with expenditures on health care rising as Social Security and other obligations are relatively static (see graphic).

The other part of Dr. Brenner’s talk dealt with conditions in Camden, a destitute, end-of-the-road, best-days-are-far-behind, city of just under 80,000 across the Delaware River from Philadelphia, and the programs that have been developed to begin to help the people who live there. Brenner and his colleagues were able to pinpoint two buildings where the highest utilization of services, and thus cost, was located. Gawande states “…that between January of 2002 and June of 2008 some nine hundred people in the two buildings accounted for more than four thousand hospital visits and about two hundred million dollars in health-care bills. One patient had three hundred and twenty-four admissions in five years. The most expensive patient cost insurers $3.5 million.” But Dr. Brenner’s main point is that these patients did not see value for this cost. When he later helped to organize the residents of one of these two sites, the Northgate II apartment complex (slide #13), the residents could not believe that this much money had been spent on them. They felt that they were not even able to see a doctor when they were sick, not to mention get preventive care and management of their health conditions. For a tiny fraction of this money, Brenner and his colleagues were able to start a small clinic in the building, staffed by a nurse practitioner, to deliver primary care to its residents. They set up a broad-based coalition, staring with area churches, to help develop a systematic response (slides 15-20). They even managed to get legislation in New Jersey to establish a demonstration project for Medicaid accountable care (slide 21).

The work done by Dr. Brenner and others is beginning to be replicated in other cities in New Jersey (Atlantic City, also discussed by Gawande, and more recently Newark) and across the country. The Camden collaborative is part of a national coalition of community groups, predominantly faith-based, called
PICO that is working in cities across the country to address many of the same needs that people have wherever they live. They are beginning to recognize that the way money is spent in the US health care system is perverse and backward, rewarding providers for high-cost interventions rather than for keeping people as health as possible. Just as the residents of Northgate II could not believe that tens of millions of dollars had been spent on their healthcare when it felt to them as if they had such limited access, people around the nation are realizing the same thing.

People live in communities where there are no jobs for those who are capable of work, and where the rest of society puts its (literally) most toxic contamination further adding to their health stressors (portrayed by Brenner in slides not on line). They live in communities that are often “food deserts” without access to healthful nutrition. Their neighborhoods are not safe, both in terms of crime and in terms of toxic waste. Their homes are often inadequate, and they may not have heat in the winter. When they do develop chronic disease, there is no primary care in their community (see what happened to Dr. Brenner’s practice) and sometimes they cannot even get downstairs because the elevator is broken and their untreated chronic conditions make it impossible to walk down stairs. Their basic social structure is often disrupted to non-existent. They do not have to core survival needs of life met, and they do not have reasonable access to basic health care, but when they do make it to the emergency room, millions of dollars of medical care is provided. The fact is that we patch holes in people’s lives and communities with dollars spent on medical care. Think of the irony here: to us, to our country, and most painfully to these people.

And things are not as bad for the economically better off, for the working and middle class, for folks who do not live in Camden or similar communities, it is still not so good. We are all part of a health care system in which providers game the system to do the services that make the most money by delivering them to the best insured. We are part of a health care system that emphasizes expensive “rescue care” rather than primary care; that emphasizes medical care rather than the basic social needs people have that will move them farther from the “edge of the cliff” (as depicted by the CDC’s Dr. Camara Phyllis Jones in Social Determinants of Health and Equity, the Impacts of Racism on Health, discussed in my blog Social Determinants, Personal Responsibility, and Health System Outcomes, September 12, 2010).

Of course, while Jeff Brenner and others are mostly concerned with improving the lives and health of people, the amazing thing is that this can be done by lowering costs. Of course, costs to one part of the system are profits to another, so those profiting from the current arrangement are predictably resisting change. But this opportunity, to spend less overall to improve health, is one we cannot afford – in financial or human terms – to pass up.

Sunday, February 12, 2012

The high cost of drugs: treating cancer and cholesterol while building profit

The cost of drugs can be enormous, as anyone who is on many of them, or even one expensive one, can tell you. For most people with good health insurance, the amount that they pay is only a portion of the cost (as with much of health care); still, the co-payments for some drugs, particularly non-generics, can be high enough to be significant for even upper-middle-class people. Lower income people may have to choose between medication and other frivolities – like food. For very high cost drugs, like many of those made artificially by “recombinant DNA” that are used for conditions including cancers, autoimmune diseases like rheumatoid arthritis, neurologic conditions like multiple sclerosis, and inflammatory bowel disease like Crohn’s, the cost is enormous.

The high cost of cancer drugs, in particular, is the foundation of several industries. The most obvious, of course, are the drug companies who manufacture them, and make great profits. The markup price that health insurers (including Medicare) pay for the administration of these drugs, however, is a major source of revenue for hospitals and the doctors who supervise their administration. The staggering growth of “cancer centers” in almost every hospital that can put one together is testimony to this. Most hospitals pursue certain “product lines” (sorry if it offends you to be a widget in a product line) that they see as the most profitable. Yes, medical need is one component; there has to be demand. Clearly cancer, and heart disease are very common and very serious for the people who have them, as well as being high-profit product lines. If less common, diseases that can be treated by neurosurgery are also serious. Indeed, even some neurological conditions that have not been historically treated by surgery, such as stroke, are becoming profit centers when procedural intervention (by, “interventional radiologists”) can be used to treat them. But there are lots of conditions which are also common and serious and are not among the “product lines” hospitals often develop because they are not “profit lines”; obstetrics and psychiatry and pediatrics come to mind (although neonatal intensive care and pediatric cancer treatment, as well as certain types of high-intervention obstetrics, are exceptions).

It is that cancer-drug markup that makes treating cancer profitable. Anecdote: a relatively high-income colleague received the bill for her first set of breast cancer chemotherapy. $30,000. Her husband hid it for several months. (“That’s not so bad,” she was told by a staff member, “we recently had an uninsured woman get a bill for $45,000.” Didn’t make her feel a lot better.) After that initial event, her copayments for treatment were on the order of $600 a month. Because she had good insurance. And she could afford it. Not without some pain, you understand, but much more than someone in one of the lower income groups. Or who is uninsured. Sure, she is happy her cancer could be treated. The point is that hospitals invest in – and advertise their expertise in -- treatment for this kind of disease, and not that kind of disease based on the profitability of it, not the seriousness of the disease.

In addition to the hospitals and the pharmaceutical manufacturers, scientists and the universities that they often work for depend on deals with drug manufacturers to bring their discoveries to market. This can be very lucrative for the universities who employ these scientists, as well as (often) the scientists themselves. It is big business. Bad? Not necessarily. Only a small percentage of the compounds being researched lead to profitable drugs, which is one of the main arguments that pharmaceutical companies use for their high prices and profits (they are consistently, and by far, the most profitable industries in the world if we include only those industries that produce something; the financial industry is something else). Of course, by the way, most of the initial research that produces these new drugs is supported by the National Institutes of Health (NIH) -- which would be you, the taxpayer. So most of those compounds are developed and studied at public expense; then only the most promising are bought by drug companies. Yes, many of these don’t become marketable, not to mention blockbuster profit centers, but the yield is much greater than it was before all the publicly-funded research culled them out. Oh, by the way, even though you funded that research, you don’t get a discount on the drugs that finally come to market. Sorry.

Sometimes, of course, there are drugs that are “blockbusters”, and they are not always the most expensive cancer drugs. They are big because they treat (or sometimes are thought to treat) conditions that are very common, so that there are millions of users. These are not as likely to support the development of new hospital product lines (where the profit-per-user has to be very high) but make a lot of money for the manufacturers. In the past these have included anti-anxiety drugs of the benzodiazepine class (eg., Valium ®, Librium ®), non-steroidal anti-inflammatory drugs (NSAIDs) for arthritis pain (including a few taken off the market for major side effects like Vioxx ®), and most recently “statin” drugs that reduce cholesterol. These drugs not only work for that purpose, they seem to have other beneficial effects in prevention of heart disease, the reasons for which are not entirely understood, so they are very popular. While selling such heavily-used drugs is always profitable, the greatest profit comes in the first decade (or so) when it is under patent and there are no generic competitors.

In a recent Perspective, “Generic atorvastatin and health care costs”,  in the New England Journal of Medicine, Jackevicius and colleagues look at the impact of the costs of statin drugs on health care costs by examining the projected savings on atorvastatin, initially sold as Lipitor®, which became generic this last November.[1] They used the data on the gradual price reduction that followed simvastatin (Zocor®) becoming generic in 2006. There are some differences; atorvastatin is more potent than simvastatin and less likely to cause muscle pain (myopathy), so it may be preferable to many. When neither was generic, Lipitor® had by far the biggest share of the market, but when simvastatin became generic in 2006, it became the biggest seller, with Lipitor® dropping precipitously and brand name Zocor® almost disappearing. Because of its two advantages (greater potency, less myopathy) generic atorvastatin should become the number one statin in the near future. The savings are projected to be enormous: “The overall cost savings from the availability of generic atorvastatin are projected to reach $4.5 billion annually by 2014, equivalent to 23% of total expenditures on statins in that year.”

That’s a lot of money. It is good to be saving it. However, that “saving” means that we have been spending it for the last decade or more. Yes, drug companies deserve to make a profit. Yes, there are investments made that need to be recouped. But this – like, if perhaps not quite so egregious as what we have seen lately in the financial sector – seems to be excessive.

We should not use drugs that harm us or are unnecessary. The question is can we, as individuals or a society, afford to pay so much for the drugs we need in order for their profits to be so high?

[1] Jackevicius CA, Chou MM, Ross JS, Shah ND, Krumholz HM, “Generic atorvastatin and health care costs”, NEJM 19Jan2012;366(3):201-3.

Friday, February 3, 2012

Komen and Planned Parenthood: The politics of abortion meet the politics of breast cancer

As of this posting it appears that Komen has restored its funding for Planned Parenthood. I thought I would run this post anyway. I think it makes some important points.

As reported in the New York Times on February 1, 2012, “Cancer group halts financing to Planned Parenthood”, the Susan G. Komen Foundation will abruptly end a program that gave about $700,000 to 19 Planned Parenthood (PP) affiliates to fund breast mammograms and ultrasounds for women who cannot afford them. Just to be clear, the Komen Foundation, the world’s largest breast cancer foundation which is famous for its pink ribbons and “Run for the Cure” races, has not changed its position on screening for breast cancer. It just doesn’t want to fund this screeining through Planned Parenthood, which will present a problem for the three-quarters of a million women who have had their mammograms through that organization.

Why? There has been a very long standing relationship between these two organizations committed to women’s health, and this decision seems to be very sudden. According to the Times, “A spokeswoman for the Komen foundation, Leslie Aun, told The Associated Press that the main factor in the decision was a new rule adopted by Komen that prohibits grants to organizations being investigated by local, state or federal authorities. Ms. Aun told The A.P. that Planned Parenthood was therefore disqualified from financing because of an inquiry being conducted by Representative Cliff Stearns, Republican of Florida, who is looking at how Planned Parenthood spends and reports its money.”

On the face of it, this is absurd; any state legislator can do an investigation into any organization for any reason, and they do. Unlike investigations by law enforcement bodies, in which presumably there is at least a reasonable suspicion of illegal activity. It can only be inferred that this “new rule” was specifically instituted to remove funding for PP. And Komen didn’t have to wait for Rep. Stearns; my state of Kansas has been regularly investigating our Planned Parenthood, starting under former Attorney General Phill Kline, who illegally kept subpoenaed records after he left office. When it finally went to trial after several years, the case was decided by a jury in less than 30 minutes, for PP. More recently, the current administration (also, coincidentally, Republican) has tried promulgating new health department rules regulating abortion providers that were absurdly picky, such as the size of janitorial closets. This has also been discarded.

Wait, Planned Parenthood does abortions? Could that be part of the reason? Why yes. Some, but not all, PP affiliates perform abortions. PP provides comprehensive women’s health services, including contraception and education, as well as breast cancer screening. The Times article notes that many have suggested that it is pressure from right-wing anti-abortion groups that has caused this action. For example, “…in December, LifeWay Christian Resources, which is owned by the Southern Baptist Convention, said it was recalling a pink Bible it was selling at Walmart and other stores because a dollar per copy was going to the Komen foundation and the foundation supported Planned Parenthood.” Of course, this is not really a different reason; the reason that Rep. Stearns and AG Kline and others have for investigating PP is because they do abortions.

In further “explanation” (since the original one was so nonsensical), the Komen “…foundation issued a statement saying it was seeking to ‘strengthen our grants program’ and had ‘implemented more stringent eligibility and performance criteria….While it is regrettable when changes in priorities and policies affect any of our grantees, such as a longstanding partner like Planned Parenthood, we must continue to evolve to best meet the needs of the women we serve and most fully advance our mission.” I had to include this last sentence so that I can recommend that you copy it and save it for a time when you need a piece of corporate double-speak jargon that says nothing except “We’re lying here.”

Planned Parenthood affiliates who do offer abortion services see them as part of the continuum of women’s health care. They offer sex education and contraception, but sometimes this fails – or hasn’t been used -- and women seek an abortion, which may be their first contact with PP. And they may then avail themselves of PP’s other services so they do not have another unwanted pregnancy.  Of course, there are many people who are opposed to abortion who support these other missions (contraception and sex education, as well as breast cancer screening). Therefore, PP usually segregates its funds so that only donations that are unrestricted or specifically intended to support abortion services are used for that purpose. However, there are many others, particularly organized “right-to-life” groups, who are not only opposed to abortion, but to the other missions as well.

A rational, data-driven approach would note that the only things that have ever been shown to reduce the abortion rate are comprehensive sex education and easy availability of contraception. This is why the abortion rate in many countries where abortion is legal is lower than in others where it is not – because those same countries provide sex education and contraception. And, of course, they also provide safe abortions so that the women who receive them are much less likely to develop infections, become sterile, or die.

The only way to understand the opposition to contraception and sex education is to recognize that it is really about being opposed to sex. If you hold the view that sex should only occur in marriage, and then only for the purpose of procreation (thus, only heterosexual marriage), and should not be for fun (and maybe should not ever be fun) this starts to make sense. In a bizarre way. Of course, this excepts the many religious and anti-abortion leaders who are involved in active and extramarital sex. They seem to have no problem telling women what to do with their lives, while living their own lives in total hypocrisy. Of course, but these are mostly men, so what do you expect? They don’t get pregnant.

In another big news item in the same issue of the Times, we are informed that rates of second surgery after lumpectomy for breast cancer vary widely by surgeon, from 0% - 70%. (Breast Cancer Surgery Rules Are Called Unclear by Denise Grady reports on Variability in Reexcision Following Breast Conservation Surgery by Lawrence McCahill and colleagues, published in JAMA, February 1, 2012. In doing lumpectomy for breast cancer, there is a cosmetic reason for taking only the least amount of tissue necessary to remove all the cancer. After all, this is the reason that lumpectomy was developed to replace mastectomy. Sometimes, on pathological examination, the “margins” are not “clear”; that is, cancer cells are found microscopically up to or past the border of the excision, and an additional surgery is required to get the rest. The question is whether there are surgeons who regularly seem to do this more often, that is take too little tissue, rather than random variation; the answer seems to be “yes”.

However, the study shows that there seem to be many more surgeons who often do a second surgery even though the margins are clear than there are surgeons who regularly take too little and need to repeat the surgery. This also means that many surgeons who have the former practice may often take too much tissue the first time to avoid the repeat surgery. This is because they believe that there need to be larger margins of normal tissue, of 2-5mm, between the cancer the edge of the excision. Comments by McCahill and other expert breast surgeons indicate that there is no data showing the larger margins provide any lower rate of recurrence than smaller ones.

What is clear, however, is that cancers found earlier and smaller are more likely to require less invasive surgery and have a greater chance of recovery. While the age of starting and the frequency of screening may be controversial (see my perspective on October 30, 2010, Breast cancer screening: conflicting evidence? what are the important questions for health?), it is hard to argue that having making it more difficult to obtain that screening for 750,000 women who use Planned Parenthood is good policy if your goal is to identify and treat breast cancer as early as possible.

Which, of course, is supposed to be the Komen Foundation’s mission.

 The “Lede” story on the Komen Foundation’s reversal, Cancer Group Backs Down on Cutting Off Planned Parenthood quotes Komen’s Twitter post (@komenforthecure): “We want to apologize for recent decisions that cast doubt upon our commitment to our mission of saving women’s lives.”

And for thinking that they could just do this and not ignite a firestorm of protest. Good to see some life in the reproductive rights movement! The anti-abortion-people-who-talk-only-to-themselves-so-much-they-think-everyone-agrees-with-them were unsuccessful in this attempt. Hopefully the women’s health and pro-choice community can remember that these rights are not guaranteed by anything but the willingness of the people to fight for them.

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