Saturday, December 26, 2009

Tremdous Find May Mean Future Cure

Troubleshooters that block cancer
Scientists have shown how a family of "limpet-like" proteins play a crucial role in repairing the DNA damage which can lead to cancer. 
They hope the finding could pave the way for a new type of drug which could help kill cancer cells, and promote production of healthy replacements.
The proteins seem to have a remarkable ability to zero in on damaged areas.
The breakthrough, uncovered independently by two teams, appears in the journal Nature.
The family of Small Ubiquitin-like Modifier (SUMO) proteins track down sites in the body where DNA damage has occurred.

They attach themselves to normal proteins, and guide them in to fix the genetic faults.
Using this method, the proteins are even able to repair double strand DNA breaks - the most severe type of DNA damage.
When their work is done, the proteins detach themselves and move on.

Breast cancer gene
One of the study teams was able to follow this process of repair taking place on the BRCA1 gene, which, if damaged, is associated with a very high risk of breast cancer.
SUMO was shown to attach to the damaged gene, and switch it back on - helping prevent breast cancer forming.

Researcher Dr Jo Morris, from King's College London, said: "This new insight is the first step towards developing drugs which may protect normal cells from the side effects of chemotherapy, or improve the effectiveness of current breast cancer treatments."

Dr Lesley Walker, of Cancer Research UK, which part-funded the study, said: "DNA damage, particularly double strand DNA breaks, are a fundamental cause of cancer and we know that people who have mutations in the BRCA1 gene have a higher risk of developing some kinds of cancer.
"Discovering that these limpet-like proteins play such an important role in repair may provide new opportunities to stop cancer from growing."
But she added: "This is an extremely complex and intricate biological process so it may be many years before we can use this knowledge to safely intervene and help treat cancer patients."

Story from BBC NEWS:

Monday, December 14, 2009

Get the Latest Reports From San Antonio

The San Antonio Breast Cancer Symposium has wrapped up with some exciting findings...
You may find them HERE.

Some topics include:
New Breakthroughs in TNBC treatment
Effective Drug Combo's for Metastatic Disease
Preventing Hair Loss with non-anthracycline chemotherapy
The Use of Testosterone to treat AI induced joint pain, vaginal dryness
Is Topical Estrogen Safe for women on AIs?
Lymph Node Transplantation: hope for women with Lymphedema
Male Breast Cancer
How your weight affects hot flash severity
Weight and Blood Pressure and risk of recurrance
Curcumin to the Rescue
Stabilizing Bone Mets
Treatment for Osteonecrosis of the Jaw

and much more!

Tuesday, December 8, 2009

Sad fact, but true...

 Very sad fact. They say women are the "weaker" sex, yet if a woman is seriously ill, in a study of 500 patients, 105 men ended the marriage because they couldn't handle it. And only 15 women left their ill husbands. If you are wondering what happened to your marriage, read on..
October 15, 2009

Until her sickness do us part: why men leave ill partners

Men are seven times more likely than women to leave a seriously ill partner, a study has found. So why are males less able to cope?

Cancer was, says Lesley Forrester, far easier to deal with than her husband’s reaction to her diagnosis. “We had been together for ten years and I thought he was quite sensitive and caring, but he stunned me by becoming totally repelled by my body once I told him,” says the 41-year-old from Bedfordshire.
“It was as if he thought he’d catch something if he came near me. He couldn’t understand why I was so upset at either the illness or at his behaviour. He cooled so much towards me that our relationship became silent and lonely. Six months after I first found the lump he ran back into the arms of an ex-girlfriend and I have barely seen him since. He broke my heart.”

Abandonment would have been difficult at any time, Forrester says, but in her time of greatest need it dealt the harshest of blows. Yet was her husband’s behaviour as uncommon as might be supposed?
According to the Office for National Statistics, there were 144,220 divorces in the UK in 2006-07 (the latest figures available) and, of those, about 18 per cent (25,959) were due to “family strain”, a term that includes serious illness. In the US, a survey by the National Centre for Health Statistics found that 75 per cent of first marriages end in divorce if one of the partners develops a terminal or chronic illness.

Although it is not stated in these divorces which partner was ill, a study published last month in the journal Cancer found that a man is seven times more likely to leave than his wife if the other becomes seriously ill.

In the research, Dr Marc Chamberlain, a neuro-oncologist at the Fred Hutchinson Cancer Research Centre in Seattle, looked at 500 marriages where one of the partners had an illness such as multiple sclerosis or cancer. Of those, 105 ended because the wife was ill, but only 15 couples divorced when the husband was sick. Of the 23 divorces among multiple sclerosis patients, 22 occurred when it was the woman who had fallen ill, and only one where the man was the patient. And out of 23 divorces involving brain tumour sufferers, 18 of the patients were women. In 13 of the 14 failed marriages where other cancers had been diagnosed, women, too, were the patients.

What’s more, Chamberlain says, the findings “were not altogether unexpected”. For years, researchers probing the emotional impact of diseases such as cancer looked only at the effect it had on the patient. More recently, a growing realisation that a couple is affected emotionally by serious illness has led to a spate of investigations into each partner’s behaviour.

In 2001, Dr Michael Glantz, a neurooncologist at the University of Utah School of Medicine and a colleague of Chamberlain’s on the recent study, looked at the effects of brain cancer on 193 couples. He found that 13 husbands walked out on their wives after diagnosis but only one woman left her husband. “At that time I was disappointed. Stunned, really,” Glantz says. “Since then other studies have suggested that men are less able to commit to the burdens of having a sick spouse than women.” In another study, he found that 17 out of 183 married female brain cancer patients endured a divorce or separation within a year of their diagnosis.

In a book published this year, Elizabeth Edwards, whose husband John was an American presidential candidate in 2004 and 2008, relives the pain and sense of betrayal she felt when he was forced by a tabloid newspaper to admit that, while she was being treated for breast cancer, he had been unfaithful. Last summer, he confessed that he had lied repeatedly during his 2008 presidential campaign about his relationship with videographer Rielle Hunter. Edwards’ betrayal of his wife at her most vulnerable moment, compounded by rumours that he is the father of Hunter’s child, left him condemned by many to the moral (and political) scrapheap.

What causes this apparent chasm in emotional coping mechanisms between the sexes is intriguing experts, and the theories are plentiful. There is, of course, the straightforward, if unappealing, interpretation that husbands are programmed to bail out on sick wives while women are socially or genetically predisposed to stand by their man. But the reasons for this kind of behaviour are complex. Sometimes, the well partner feels more distress and despair than the sick one, says Paula Hall, a counsellor for Relate, who has worked with many couples affected by cancer.

Indeed, a study in the Journal of Oncology last year reported that spouses were lonelier than their ill partners and had lower levels of wellbeing and marital satisfaction. “There is an immediate shift in a relationship when an illness is diagnosed,” she says. “You stop being partners as you knew it and move to being patient and carer. That can lead to feelings of fear, not just about the disease, but about the relationship and the well partner’s ability to cope. Feelings of anger and resentment about life and the situation can quickly arise.”

A few researchers have suggested that men are more likely to walk out on a wife whose condition is newly diagnosed because the illness is more than they bargained for when they married. Depression, anxiety and medication can take their toll on the person who is being treated to the extent that socialising and keeping up friendships become difficult. “That can be a terrific strain on any relationship,” says Tara Beaumont, a clinical nurse specialist for the charity Breast Cancer Care. “The person who is well may find themselves asking why their life has changed so drastically and yearning for what they had before.”

Sickness can also interfere with or eliminate sex and intimacy from a relationship. “That is something many men struggle to accept when their partners are ill,” says Hall. “But there is so much that can be done to help the physical side of a relationship to stay strong. Sex may not be on the cards for a while, but affection shouldn’t be neglected. You need to find new ways to be a couple in every sense of the word.”

Some men blame a fear of being alone for their infidelity. Alison O’Flagan, 48, from Birmingham, discovered her partner was being unfaithful six months after she was told she had breast cancer. “He had withdrawn all affection and I felt increasingly isolated,” she says.

“His behaviour was more difficult to cope with than my illness. In the end I became suspicious and checked his phone and e-mails and found he was seeing two other women. I confronted him and he said he wasn’t going to break off either of the relationships because if something happened to me he didn’t want to be alone. We split up and the irony is that he is the one who is on his own, not me. I have a huge circle of family and friends who have helped me through everything.”

There are suggestions, too, that traditional roles shift more significantly when a woman becomes ill. Mark Litwin, a professor of urology at the University of California’s Jonsson Cancer Centre, found that for men with prostate cancer, having a partner, regardless of whether the relationship was good beforehand, improved their survival and quality of life. But Professor Laurel Northouse, of the University of Michigan Cancer Centre, who studies the needs of families with cancer, has found that when women get cancer the strength of a relationship probably matters more because of challenges to conventional caretaking and gender roles. Both partners may have to adapt when a woman gets cancer, Northouse says. Men may still be working full time, but may have to cope with additional tasks such as ferrying their wife to appointments, arranging childcare, cleaning and doing household duties. “It can mean even the most devoted husbands become exhausted,” Northouse says.

What a women wants most of all when she is ill is not so much for her husband to take charge, but for him to listen to her feelings and to express his own more often. Marc Silver, who wrote a survival guide for men, Breast Cancer Husband, after his wife’s condition was diagnosed, says many men are uncomfortable listeners. “Men have an urge to ‘fix’ things. They want to get in there and make it better when what they really need to do is shut up and listen,” Silver says. “Even if you have heard it one hundred times before, your wife needs you to respond by saying that whatever happens, you are there for her.”

Of course, not all relationships fail to weather the storm of something like cancer. Professor Jill Taylor Brown, a researcher at the University of Manitoba in Canada, examined data on marital dissatisfaction among a group of women who had breast cancer and another who did not. Illness appeared to have little influence as 10 per cent of women in each of the groups claimed to be unhappy in their marriages. For some people, illness proves a positive factor in bringing a couple closer together. One recent study at the University of Quebec found that 42 per cent of couples thought that the experience of breast cancer had strengthened their partnership. “Accepting the changes that take place is a process that takes time and effort,” says Paula Hall. “But many people do find their love grows stronger as a result.”

Even if divorce does follow a woman’s diagnosis of serious illness, it is not always because her partner has walked out. In studies of women with breast cancer, Northouse found that only 3 to 4 per cent of marriages ended in divorce within the first 12 months and that, in some cases, it was the wife who decided she no longer wanted to invest emotionally in a man she did not love. “To outsiders it might look as if the husband is leaving her,” Northouse says. “But she may be saying ‘That’s it. I’ve had enough’.” Cancer brings a new perspective to life that jolts some women into realising their partner is not the man they thought he was.

Karen Tyler, 42, says her diagnosis of bowel cancer helped to sharpen her focus about her eight-year marriage, which recently ended in divorce. During her debilitating treatment, she went to relationship therapy with her husband. “We didn’t communicate well before I was ill and that didn’t improve during or after my treatment,” she says. “I was prepared to try to improve matters until I just woke up one day and realised I was fighting for my life alone, and that being part of this couple wasn’t helping me at all. I could devote more effort to the battle without him. Divorce was easy once I accepted that.”

Friday, December 4, 2009

If you are local, please help

Young's Farm is a beautiful, family owned farm that has been in our area since 1893. I grew up shopping for our vegetables there. I go at least twice a week and it is a wonderful resource for organic vegetables, home made pies and jellies and unique farm-style gifts.

The owner is a fellow survivor, we were in treatment together, she and I share the same oncologist. She has kept the farm true to its roots because she is a member of the Young's family and has worked there her whole life.

Next to the farm is Villa Banfi, the winery. They have vineyards in Italy and here on Long Island. They bought up a good portion of the Young's Farm property to keep the space open and to help continue the legacy of the open space that is beloved by all who live here. On the weekends, you can see people from all over the area there. It is a destination because it is a step back in time, to a simpler, lovelier way of life.

Long Island has changed since I was a girl. Open spaces have been turned into housing developments. The Banfi Fields/Young's Farm is one of the last open spaces in the county.

The new owners of the Villa Banfi property want to turn Young's Farm into a House Farm of McMansions. The county and the Nassau Land Alliance has made an offer to purchase the property to keep it open and farmed.

The Legislature will hold a vote on Monday, December 7th. If there are enough signatures on the petition voting YES, Young's Farm will be saved, along with all the jobs of the wonderful people who work there.

Please sign this petition. It takes only a moment.
Go to this link:

THIS is what you will be saving...

Wednesday, December 2, 2009

Another Bit of Misinformation.....

A new report has been released today to tell us all that breast ultrasounds pick up tumors 100% of the time in women under 40.


My tumor, which was found when I was in my 30s, was picked up on mammogram and when the docs did a follow-up ultrasound it was not there. The radiologist said that since it was not picked up on both, I should "watch and wait" for six months.... Fortunately I have a gyn who hates cancer as much as I do and he insisted on an immediate biopsy. That resulted in finding a grade 3, highly aggressive Triple Negative Breast Cancer next to my chest wall.  If I had followed the three most dangerous words in the English language, "watch and wait" my TN tumor would have made a nice, comfy home for itself in the chest wall and the vascular and lymphatic system. Would I still be here? I don't know- Ferne isn't... and she was told to wait.

Here is the article- tell your friends to not take this as gospel because it could be deadly. The TRUTH IS: Women under 40 need better screening. It is NOT just replacing mammography with ultrasounds. If they really gave a damn about us they would find a way to get EVERYONE Breast MRIs which can find tumors as small as 7mms. But who is going to pay for that? We have research into erectile dysfunction to fund.... the Space Shuttle to launch to change the spark plugs on the International Space Station.... Think about it.

CHICAGO (Reuters) - Breast ultrasounds found 100 percent of suspicious cancers in women under 40 who found lumps or other suspicious areas of the breast, offering a cheaper, less-invasive alternative to surgery or biopsies, U.S. researchers said on Wednesday.

They said targeted ultrasound -- which examines just the area of the breast where a lump is identified -- should become the standard of care for women under 40.

The findings may address some of the concerns raised by a federal advisory panel about breast exams done by women or doctors to investigate lumps or hot spots in the breast, which most often turn out to be harmless.

In a controversial set of recommendations issued last month, the U.S. Preventive Services Task Force recommended that women not be taught to perform self breast exams because they often result in worry and expense for tests, biopsies and unnecessary surgery.

"That concerns us because while breast cancer in young women is rare, it absolutely does occur. Often, those cancers are only diagnosed because the woman noticed the lump in her breast or her doctor noticed a lump in her breast," said Dr. Constance Lehman of the University of Washington and director of imaging at the Seattle Cancer Care Alliance, who presented her findings at the Radiological Society of America meeting in Chicago.

"There are harms that follow after a woman does a self breast exam -- unnecessary surgeries, unnecessary biopsies. To that point, what we're saying is if you use imaging appropriately you can avoid those harms," Lehman said in a telephone interview.

Lehman did two studies testing the effectiveness of ultrasound to distinguish between potentially cancerous lumps and harmless masses in younger women.

In one, they studied more than 1,100 ultrasound exams of women under age 30. In the second, they studied 1,500 exams in women aged 30 to 39.

In both studies, ultrasound correctly identified the cancers and all of the benign breast changes. The only cancer not found was in a region of the breast that was not identified as an area of concern. Instead, it was identified by a full breast mammogram.

"Less than 3 percent of the patients that presented in this way had cancer. But it's important for us to find those patients that did have cancer," Lehman said.

"We had 26 women whose cancers were diagnosed because they brought the lump to the attention of their doctor, or their doctor brought the lump to the attention of the breast imaging specialist," she said.

Lehman said in the United States there is no standard way of treating women under age 40 who find a lump in their breast.

"Some of them go to the operating room to have the lump removed. Others have it followed. Others have a needle biopsy and we wanted to bring some clarity to this treatment," she said.

She said ultrasound is a quick and easy test that uses sound waves to create an image of the breast. It typically costs $100 to $200 per exam.

Lehman said using ultrasound could help balance some of the harms of overtreatment with the benefits of self breast exams in women under age 40, who are too young for routine mammogram screening even under the American Cancer Society guidelines.

The task force also recommended against routine mammogram screening for women in their 40s for many of the same reasons, a change the American Cancer Society and many other breast cancer experts reject.

Tuesday, November 24, 2009

How YOU can help fight the new breast cancer guidelines

As we all know, the new mammography and BSE guidelines will be deadly for women. How on earth they could be considered is nothing short of murder.

Months ago, the No Surrender Breast Cancer Foundation started the Before Forty Initiative.
You can read about it HERE.

Little did we know that such an irresponsible report would surface and actually be considered. Here were are fighting for EARLIER screening and a government board tells women to wait until it is too late to find their cancer.

Chase Community giving is  donating to registered, 501 c3 not for profit foundations that need money.  WE NEED MONEY

What do we need it for?
 We need to hire a computer person/web editor.

We need a comprehensive publicity campaign.
We need to print our BEFORE FORTY INFORMATION PAMPHLETS so we can start NOW and get the word out so women will IGNORE those deadly guidelines and save their own lives.

We all know that without early detection, winning the battle against breast cancer is very difficult. Particularly if it is found BEFORE FORTY, the cancer is more aggressive. And in many cases, it is Triple Negative. This is especially true for African American women because TNBC strikes them more frequency, BEFORE FORTY.

So, how can you help us fight this?

We know it is hard after treatment for a survivor to donate her own money. So Chase Community Giving is helping solve that for us. 

All you have to do is Click on THIS LINK. This will bring you to the Chase Community Giving page. Once there, you then select "BECOME A FAN of CHASE"
After you become a Fan you can then VOTE FOR NO SURRENDER at this link or enter "No Surrender Breast Cancer Foundation" in the Charity Search box.

The more votes we get, the greater our chance of winning funding for BEFORE FORTY, publicity and the web editor.

Won't you please help us out?

Our Constantine has spelled out better instructions, I copied them from our forum here:

The No Surrender Community:

As you may know already, Chase and Facebook have teamed to launch a unique corporate philanthropy program called Chase Community Giving: You Decide What Matters, a grassroots campaign that allows you to choose from more than 500,000 small and local charities to decide which community organizations you want to receive donations totaling millions. The eligible charity receiving the most votes will be awarded $1 million, the top five runners-up will receive $100,000 each and the 100 finalists will be awarded $25,000 each.

The No Surrender Breast Cancer Foundation (NSBCF) that Gina has founded and operates is the non-profit organization that as you know runs the exceptional content-rich No Surrender family of breast cancer support sites (including the No Surrender Breast Cancer Support Message Forum most of us are heavily engaged in) and NSBCF is one of the non-profit organizations competing in this program. Since it is inevitably substantial in cost (personal) for Gina to administer and operate NSBCF, a grant can help assure that NSBCF survives and prospers to continue its outreach Good Works. For me, given its exceptional value and professional content, and the wonderful community of users who continue to populate and enrich it, I post there almost exclusively and now serve as a one of NSBCF's medical advisors (and everyone - advisors and the administrator (Gina) - serves without compensation).

Voting for NSBCF is relatively easy and worth the effort:

  1. Proceed to the Chase Community Giving page
  2. Search for "No Surrender Breast Cancer Foundation". 
    1. If you are not yet a Facebook user, you can sign up (you'll receive an email with a confirmatory link to click).
    2. Then before you can actually vote, you must become a "Fan" of the Chase Community Giving program, a quick and straightforward process. 
    3. If you need it there is a nice Chase Community Giving FAQ page, which even includes a brief video illustrating the process of signing up and voting.
  1. After you vote look to see that the page acknowledges "Thanks for Voting!" and off to the  left side, shows a count of "19 Votes Left" (a count of 20 indicates that the vote didn't properly  register).
  2. Optionally you can, after voting, add a comment as an encouragement to others.

Let's help to make sure that No Surrender is around to continue helping so many with breast cancer, and to improve to better serve its community.

Constantine Kaniklidis
Breast Cancer Watch

(Please note: if you vote and it registers correctly the page will say "You have 19 votes left." If it says "You have 20 votes left." your vote did not go through.

These are hard times for non-profits. Especially young ones like ours that are just starting to grow. But grow we must so we can make sure no woman is ever alone through her cancer again.... so she knows to be her own best advocate and to fight for screening BEFORE FORTY.... to learn about her cancer.... to benefit from our breaking research news.... to know that 24/7 they will find other survivors on our message forum to share with.

This money will help us more than I can convey. Please, take a moment, and vote. That is all we ask.
Thank you.

Wednesday, November 18, 2009

The White House Weighs In & No Surrender Responds

And now the White House weighs in. No Surrender takes them on, point by point. Put me on an enemy list. I've done chemo - twice, you don't scare me.  Bring it on.

The White House Blog

Reality Check: Beware What “Critics Say” on Reform and Mammograms

One of the hallmark tactics from opponents of health insurance reform has been to grab onto any convenient piece of information and twist it into some misguided attack on reform, no matter how unrelated it may actually be.  The hope appears to be that some media outlet will give them unchecked airtime under the banner of covering the “controversy.”  Today they’re going back to that playbook again, and Fox News obliges them with the headline “Critics See Health Care Rationing Behind New Mammography Recommendations.”   The story refers to new recommendations from the independent U.S. Preventive Services Task Force: 

"Some lawmakers on Capitol Hill are blasting new guidelines from a government task force that recommends against routine mammographies for women under 50,  questioning whether they are tantamount to health care ‘rationing’ in the fight against the No. 2 cancer killer in U.S. women."
There’s only one problem: the recommendations of this task force would actually be used to provide access to effective preventive services for free or at low-cost. The USPTF would have no power to deny insurance coverage in any way.   The line of attack is actually somewhat ironic, because one of the guiding principles of reform from the very beginning in March has been to invest in significantly increased  effective preventive care, something these “critics” never seemed to care much about over the past 8 months. 

Just so there’s no ambiguity, here are the answers to about every question you (or “critics”) might have on the U.S. Preventive Services Task Force: 

Will Medicare now stop paying for breast cancer mammography for women because of this recommendation?
Women who are currently getting mammograms under Medicare will continue to be able to get them. There are no plans to change that. The law states that in order to change Medicare coverage of mammograms a formal rule making process must be undertaken and that is not happening.

Isn’t this the first step toward denying coverage for mammograms?

No. The Task force is an independent panel of experts in prevention and primary care that evaluates available evidence and makes recommendations about effective clinical preventive services based on scientific information. Under the health insurance reform legislation, the USPTF would have no power to deny insurance coverage in any way. Their recommendations would be used in health reform to identify effective clinical preventive services. 

How will this recommendation affect private health insurance coverage?
The Task Force does not address insurance coverage and payment issues; it focuses on the science of the clinical services it evaluates.   Each insurance company is different and makes its own coverage decisions.  The Task Force recognizes that clinical and policy decisions involve more consideration that this body of evidence alone.  Clinicians and policymakers should understand the evidence but individualize decision making to the specific patient or situation.

Tommy Thompson said the Task Force recommendations were the official position of the U.S. Government. Is that your position?
We have tremendous respect for the Task Force and the work they have done.  They are an independent scientific body that makes recommendations based on scientific evidence; however they do not set official policy for the federal government. Under health reform, their recommendations would be used to identify preventive services that must be provided for little or no cost.

Won’t the USPSTF be used to ration care under health reform?
Absolutely not.  The USPSTF, an independent task force made up of some of the nation’s top doctors and scientists provides science-based recommendations regarding the most effective preventive, treatment and screening services. The Task Force’s recommendations would be used to help determine the types of services that must be provided for at little or no cost and the Task Force would have no power to deny insurance coverage in any way..

What do these recommendations mean for the current health reform bills?
While the bills are still being drafted and debated in Congress, health insurance reform legislation generally calls for the Task Force’s recommendations to help determine the types of preventive services that must be provided for little or no cost. The recommendations alone cannot be used to deny treatment.


WH says: "One of the hallmark tactics from opponents of health insurance reform has been to grab onto any convenient piece of information and twist it into some misguided attack on reform, no matter how unrelated it may actually be."

NO SURRENDER RESPONDS: There is not one piece of information that can be twisted to look any other way than it already appears: The Task Force has decided to murder thousands of women a year with these recommendations. 

WH says: Fox News is guiding critics. "the recommendations of this task force would actually be used to provide access to effective preventive services for free or at low-cost. The USPTF would have no power to deny insurance coverage in any way.   The line of attack is actually somewhat ironic, because one of the guiding principles of reform from the very beginning in March has been to invest in significantly increased  effective preventive care, something these “critics” never seemed to care much about over the past 8 months. "

NO SURRENDER RESPONDS: Fox News doesn't have to tell us anything. We are breast cancer survivors. We have heard the words that changed our lives forever. We are alive today because our cancers were found early enough to let us live for a few years. The USPTF will have a direct impact on insurance companies denying us coverage. It is giving fuel to any cost saving measures they can find. We already have to fight like hell to get a breast MRI or PET scans. To say that you are working to significantly increase preventative care then you obviously don't care about preventative care for anyone under the age of 50.

The WH Says: Women who are currently getting mammograms under Medicare will continue to be able to get them. There are no plans to change that. The law states that in order to change Medicare coverage of mammograms a formal rule making process must be undertaken and that is not happening.

NO SURRENDER RESPONDS: Of course women under Medicare will still get their mammograms... they are all over the age of 62 and fall into the screening guidelines. What about those of us who are under fifty with the most aggressive tumors? 

The WH Says: Under the health insurance reform legislation, the USPTF would have no power to deny insurance coverage in any way. Their recommendations would be used in health reform to identify effective clinical preventive services. 

NO SURRENDER RESPONDS: Do you think we can't read? Their recommendation is that women should stop baseline self exams, stop mammograms, and only start bi-annual screening after the age of fifty. If their recommendations "would be used in health reform" then you will be denying coverage to women under the age of 50. 

The WH Says: The Task Force does not address insurance coverage and payment issues; it focuses on the science of the clinical services it evaluates.   Each insurance company is different and makes its own coverage decisions.  

NO SURRENDER RESPONDS: Under Health Reform, private insurance will be regulated by the government. They will also be competing with their own regulators. If their regulators are not covering mammograms for women under 50, so, too, will they follow. 

The WH says: Under health reform, the task force's recommendations would be used to identify preventive services that must be provided for little or no cost.

 NO SURRENDER RESPONDS: There is nothing "preventative" in denying screening to all women under the age of fifty. All you are focusing on is the cost saving of not having to pay for millions of mammograms any longer. The task force and their guidelines will be followed to the letter by insurance companies and their "regulators" also known as the Federal Government.

The WH Says: The USPSTF, an independent task force made up of some of the nation’s top doctors and scientists provides science-based recommendations regarding the most effective preventive, treatment and screening services. The Task Force’s recommendations would be used to help determine the types of services that must be provided for at little or no cost  

There is nothing "preventative" in these recommendations. The task force does not have a single oncologist on it. You admit you will be using these recommendations. You will be responsible for the murder of millions of women whose cancers are missed until they are found too late.

No Surrender Concludes:

With all due respect, you have no idea what in hell you are talking about. EARLY DETECTION IS OUR ONLY DEFENSE. Denying mammography to women until they are fifty will kill women. They won't die right away, they will suffer horribly first. Then they will die. If you want to represent the "hope and change" you promised, get insurance companies to start paying for mammograms BEFORE THE AGE OF FORTY. We are losing a generation of women. Women who were diagnosed with breast cancer before the age of forty. African American women will be effected the most by this murderous legislation since they develop a more aggressive form of breast cancer BEFORE FORTY. Without early detection, it cannot be controlled and it spreads rapidly and they die.

We may not be doctors... but we are warriors who have all fought on the front lines of breast cancer. We will not give up this fight. We will not let you murder our sisters.  You have no idea what you are up against.  To quote a truly great leader, we leave you with how we feel about this task force and the possibility it passes into legislation:

"We shall go on to the end, we shall fight on the seas and oceans, we shall fight
with growing confidence and growing strength in the air, we shall defend our [sisters], whatever the cost may be, we shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; We shall never surrender." (Sir Winston Churchill)

Tuesday, November 17, 2009

The Before Forty Initiative Needs you NOW more than ever

The Before Forty Initiative

Women are told that they should get their first mammogram at the age of forty. For the woman whose cancer is present before the age of forty, this recommendation could have deadly consequences. Young women have more aggressive cancers that grow at a rapid rate and can spread beyond the breast before they are detected. This is particularly true for African American women who have a higher rate of developing a type of breast cancer known as “triple negative.”

Triple Negative breast cancer does not respond the hormones estrogen and progesterone, and is not fueled by the HER2/nue protein. It also is a more rapidly growing disease. There are certain subtypes of TNBC that are “basal,” or “luminal A,” which are so deadly, they have the same survival rate as pancreatic cancer. These subtypes are most often found in the African American community and in women who carry the gene variant BRCA1 and BRCA2. Women of Ashkenazi heritage are carriers of this gene variant.

These cancers are very difficult to control. The only defense a woman has is by finding it before it grows and spreads. A woman does not have that chance if she waits until the age of forty to get her first mammogram. It will be too late. What could have been a rescue mission turns into a recovery mission, offering only palliative care.

This does not have to be. The founder of the No Surrender Breast Cancer Foundation was given baseline mammograms starting at the age of 35. At age 39, a triple negative tumor was found in a follow-up mammogram. An abnormality had been detected because there was a change from her earlier mammograms. Had this been her first mammogram, it would have been considered normal tissue. Because her tumor was found early, she was able to have it removed, do a six month course of chemotherapy followed by radiation, and has been free of triple negative disease for eight years.

Since the inception of the website, many women, members of the NSBCF Support Forum, have died because their tumors were found too late. One woman was Ferne Dixon. She was a young, vibrant African American woman who never had a baseline mammogram. She was told she was too young to worry about the lump she had found. When the lump was larger, she finally went for a mammogram and her triple negative cancer was found. It was too late. Even though she endured months of chemotherapy and radiation, her disease spread and took her life. She said that if she had not had the lump she would not have gone for the mammogram, even though she knew that it was recommended. She was 41 when she was diagnosed. She discovered that many African American women have a false sense of security because most breast cancer is found in Caucasian women. This statistic is true, however, most of the deadly, triple negative breast cancers are found in young, African American women and women who carry the BRCA1 gene variant.

The No Surrender Breast Cancer Foundation's Before Forty Initiative is dedicated to promoting the importance of early, baseline screening for all young women, before the age of forty. If a woman is African American or in a high risk group, we will become the leading advocate for comprehensive screening before the age of 35.

Simple mammography is often not enough. Young women have dense breasts and many doctors tell them it is too difficult to accurately read a mammogram. Young women need more than mammograms. They may need a breast ultra-sound and, if necessary, breast MRIs. This is particularly true if there is an abnormality detected. The NSBCF seeks to change the standard of care so that these types of screening techniques are not only offered, but covered by insurance.

The second phase of this standard of care is to put an end to the “Watch and Wait” practice of medicine. Most young women are told, when an abnormality is found, that they have dense breasts and they should “watch and wait” and reevaluate the lump in six months. During this time, a triple negative tumor can triple in size and spread to the lymph nodes and distant organs. Watching and waiting for cancer to become deadly must stop. Making women aware of the danger of this practice will save lives. The NSBCF is making this a major part of the Before Forty Initiative.

The Before Forty Initiative:

Increase awareness to young women about the risk of breast cancer. Inform them of the better prognosis and treatment options if their cancer is found early.

Make the age of 35 be the standard for baseline mammogram. Make the age of 30 the standard for high risk groups.

Get insurance companies to cover baseline mammograms and subsequent follow-up diagnostic tests if warranted, including ultra-sound and breast MRI.

Increase awareness for African American women about Triple Negative Breast Cancer. Educate young women that African American women are at a higher risk of TNBC and have a poorer prognosis. The only way they can beat the disease, should they get it, is if it is found early.

         • Never “Watch and Wait.” Teach women the deadly consequences of waiting for a cancer to grow in six months.

We have lost too many young women before the age of forty to let this continue any further. We seek to save lives. We will not stop until the standard of care is Before Forty.

To all readers of this blog:
Many of you are writing me and asking how you can help...
This is premeditated murder.  Women who are diagnosed BEFORE FORTY have the worst tumors... the ones that are the hardest to treat.

African American women are in that category! They are predominantly diagnosed with TNBC YOUNG- in their later years, their risk of breast cancer is much lower than Caucasian women.

You asked me what you can do to help?

Please help us.

We are trying to raise publicity for Before Forty. 

To everyone who has donated to our foundation- you have already helped get this off the ground and I thank you so much.

Look- I am like you. I am broke too. I know how hard it is donate money. But you can tell people to check out Before Forty when they ask what they can do.

Why? Because we are ALREADY DOING IT!
We need people. People all over the country talking about our initiative because we are taking it to DC to lobby the government. We are going to then attack the insurance companies. Then tell every doctor to never say, "you are too young."


We are waiting to get some money in from the grants submitted, we will then be able to support the public service announcements... which I hope will star, not doctors or actresses, but YOU- REAL WOMEN who have had breast cancer!

We really need you guys to help. Spread the word. If you know someone rich, ask them to donate so we can start putting real money behind this.


We are not going to take this sitting down- what part of No Surrender do they not understand??????

Monday, November 16, 2009


 To save money, to reduce insurance costs and to reduce "Anxiety" a panel that guides the ACS has declared that women should skip mammograms until the age of 50, and then only have them every other year or so... because they don't do any good.... they cause too much anxiety....they cost too much.

Not having screening and having your cancer found too late costs a lot of money, too. It causes anxiety that is beyond all compare. And they can't do any good because your cancer is already spreading.

This blog post is dedicated to the women we have lost, only very few had the genetic cancer link that is exempt from this murderous recommendation. Most of these women were diagnosed before the age of 40 or in their early 40s.  None of them are alive today.
Kari Lynn
Mary Ellen

In Reversal, Panel Urges Mammograms at 50, Not 40

Most women should start regular breast cancer screening at age 50, not 40, according to new guidelines released Monday by an influential group that provides guidance to doctors, insurance companies and policy makers.
The new recommendations, which do not apply to a small group of women with unusual risk factors for breast cancer, reverse longstanding guidelines and are aimed at reducing harm from overtreatment, the group says. It also says women age 50 to 74 should have mammograms less frequently — every two years, rather than every year. And it said doctors should stop teaching women to examine their breasts on a regular basis.
Just seven years ago, the same group, the United States Preventive Services Task Force, with different members, recommended that women have mammograms every one to two years starting at age 40. It found too little evidence to take a stand on breast self-examinations.
The task force is an independent panel of experts in prevention and primary care appointed by the federal Department of Health and Human Services.
Its new guidelines, which are different from those of some professional and advocacy organizations, are published online in The Annals of Internal Medicine They are likely to touch off yet another round of controversy over the benefits of screening for breast cancer.
Dr. Diana Petitti, vice chairwoman of the task force and a professor of biomedical informatics at Arizona State University, said the guidelines were based on new data and analyses and were aimed at reducing the potential harm from overscreening.
While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.
Over all, the report says, the modest benefit of mammograms — reducing the breast cancer death rate by 15 percent — must be weighed against the harms. And those harms loom larger for women in their 40s, who are 60 percent more likely to experience them than women 50 and older but are less likely to have breast cancer, skewing the risk-benefit equation. The task force concluded that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women age 50 to 74, and one death for every 377 women age 60 to 69.
The guidelines are not meant for women at increased risk for breast cancer because they have a gene mutation that makes the cancer more likely or because they had extensive chest radiation. The task force said there was not enough information to know whether those women would be helped by more frequent mammograms or by having the test in their 40s. Other experts said women with close relatives with breast cancer were also at high risk.
Dr. Petitti said she knew the new guidelines would be a shock for many women, but, she said, “we have to say what we see based on the science and the data.”
The National Cancer Institute said Monday that it was re-evaluating its guidelines in light of the task force’s report.
But the American Cancer Society and the American College of Radiology both said they were staying with their guidelines advising annual mammograms starting at age 40.
The cancer society, in a statement by Dr. Otis W. Brawley, its chief medical officer, agreed that mammography had risks as well as benefits but, he said, the society’s experts had looked at “virtually all” the task force and additional data and concluded that the benefits of annual mammograms starting at age 40 outweighed the risks.
Other advocacy groups, like the National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network, welcomed the new guidelines.
“This is our opportunity to look beyond emotions,” said Fran Visco, president of the National Breast Cancer Coalition. The task force “is an independent body of experts that took an objective look at the data,” Ms. Visco said. “These are the people we should be listening to when it comes to public health messages.”
Some women, though, were not pleased. “I know so many people who had breast cancer and survived, and what saved their lives was early detection,” Janet Doughty, 44, of San Clemente, Calif., said in a telephone interview. She said she had had an annual mammograms since her late 30s and would not stop now.
The guidelines are not expected to have an immediate effect on insurance coverage but should make health plans less likely to aggressively prompt women in their 40s to have mammograms and older women to have the test annually.
Congress requires Medicare to pay for annual mammograms. Medicare can change its rules to pay for less frequent tests if federal officials direct it to.
Private insurers are required by law in every state except Utah to pay for mammograms for women in their 40s.
But the new guidelines are expected to alter the grading system for health plans, which are used as a marketing tool. Grades are issued by the National Committee for Quality Assurance, a private nonprofit organization, and one measure is the percentage of patients getting mammograms every one to two years starting at age 40.
That will change, said Margaret E. O’Kane, the group’s president, who said it would start grading plans on the number of women over 50 getting mammograms every two years.
The message for most women, said Dr. Karla Kerlikowske, a professor in the department of medicine, epidemiology and biostatistics at the University of California, San Francisco, is to forgo routine mammograms if they are in their 40s.
Starting at age 50, Dr. Kerlikowske said, “the message is to get 10 mammograms in a lifetime, one every two years.” That way they get the most benefit and the least harm from the test. If women are healthy, she added, they might consider having mammograms every two years until age 74.
Nearly two-thirds of all women in their 40s had mammograms within the last two years, as did 72 percent of women age 50 to 65, according to an editorial by Dr. Kerlikowske that accompanies the report.
In order to formulate its guidelines, the task force used new data from mammography studies in England and Sweden and also commissioned six groups to make statistical models to analyze the aggregate data. The models were the only way to answer questions like how much extra benefit do women get if they are screened every year, said Donald A. Berry, a statistician at the University of Texas M. D. Anderson Cancer Center and head of one of the modeling groups.
“We said, essentially with one voice, very little,” Dr. Berry said. “So little as to make the harms of additional screening come screaming to the top.”
The harms are nearly cut in half when women have mammograms every other year instead of every year. But the benefits are almost unchanged.
The last time the task force issued guidelines for mammograms, in 2002, the reportwas announced by Tommy G. Thompson, the secretary of health and human services. When the group recommended mammograms for women in their 40s, some charged the report was politically motivated. But Dr. Alfred Berg of the University of Washington, who was the task force chairman at the time, said “there was absolutely zero political influence on what the task force did.”
It was still a tough call to make, Dr. Berg said, adding that “we pointed out that the benefit will be quite small.” In fact, he added, even though mammograms are of greater benefit to older women, they still prevent only a small fraction of breast cancer deaths.
Different women will weigh the harms and benefits differently, Dr. Berg noted, but added that even for women 50 and older, “it would be perfectly rational for a woman to decide she didn’t want to do it.”
Researchers worry the new report will be interpreted as a political effort by the Obama administration to save money on health care costs.
Of course, Dr. Berry noted, if the new guidelines are followed, billions of dollars will be saved.
“But the money was buying something of net negative value,” he said. “This decision is a no-brainer. The economy benefits, but women are the major beneficiaries.”

Sunday, November 8, 2009

Point-Counter Point: HR 3962 Healthcare Bill

News from Capitol Hill:

WASHINGTON (AP) - In a victory for President Barack Obama, the Democratic-controlled House narrowly passed landmark health care legislation Saturday night to expand coverage to tens of millions who lack it and place tough new restrictions on the insurance industry. Republican opposition was nearly unanimous.

The 220-215 vote cleared the way for the Senate to begin debate on the issue that has come to overshadow all others in Congress.

A triumphant Speaker Nancy Pelosi likened the legislation to the passage of Social Security in 1935 and Medicare 30 years later.

"It provides coverage for 96 percent of Americans. It offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it," said Rep. John Dingell, the 83-year-old Michigan lawmaker who has introduced national health insurance in every Congress since succeeding his father in 1955.

In the run-up to a final vote, conservatives from the two political parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups. They prevailed on a roll call of 240-194.

Ironically, that only solidified support for the legislation, clearing the way for conservative Democrats to vote for it.

The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.

Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging and market allocation.

A cheer went up from the Democratic side of the House when the bill gained 218 votes, a majority. Moments later, Democrats counted down the final seconds of the voting period in unison, and and let loose an even louder roar when Pelosi grabbed the gavel and declared, "the bill is passed.'

From the Senate, Majority Leader Harry Reid of Nevada issued a statement saying, "We realize the strong will for reform that exists, and we are energized that we stand closer than ever to reforming our broken health insurance system."

The bill drew the votes of 219 Democrats and Rep. Joseph Cao, a first-term Republican who holds an overwhelmingly Democratic seat in New Orleans. Opposed were 176 Republicans and 39 Democrats.

Nearly unanimous in their opposition, minority Republicans cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.

United in opposition, minority Republicans cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.

"We are going to have a complete government takeover of our health care system faster than you can say, 'this is making me sick,'" jabbed Rep. Candice Miller, R-Mich., adding that Democrats were intent on passing "a jobs-killing, tax-hiking, deficit-exploding" bill.

But with little doubt about the outcome, the rhetoric lacked the fire of last summer's town hall meetings, when some critics accused Democrats of plotting "death panels" to hasten the demise of senior citizens.

The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.

Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging and market allocation.

At its core, the measure would create a federally regulated marketplace where consumers could shop for coverage. In the bill's most controversial provision, the government would sell insurance, although the Congressional Budget Office forecasts that premiums for it would be more expensive than for policies sold by private firms.

The bill is projected to expand coverage to 36 million uninsured, resulting in 96 percent of the nation's eligible population having insurance.

To pay for the expansion of coverage, the bill cuts Medicare's projected spending by more than $400 billion over a decade. It also imposes a tax surcharge of 5.4 percent on income over $500,000 in the case of individuals and $1 million for families.

The bill was estimated to reduce federal deficits by about $104 billion over a decade, although it lacked two of the key cost-cutting provisions under consideration in the Senate, and its longer-term impact on government red ink was far from clear.

Democrats lined up a range of outside groups behind their legislation, none more important than the AARP, whose support promises political cover against the cuts to Medicare in next year's congressional elections.

The nation's drug companies generally support health care overhaul. And while the powerful insurance industry opposed the legislation, it did so quietly, and the result was that Republicans could not count on the type of advertising campaign that might have peeled away skittish Democrats in swing districts.

Over all, the bill envisioned the most sweeping set of changes to the health care system in more than a generation, and Democrats said it marked the culmination of a campaign that Harry Truman began when he sat in the White House 60 years ago.

Debate on the House floor had already begun when Obama strode into a closed-door meeting of the Democratic rank and file across the street from the Capitol to make a final personal appeal to them to pass his top domestic priority.

Later, in an appearance at the White House, he said he had told lawmakers, "to rise to this moment. Answer the call of history, and vote yes for health insurance reform for America."

Participants also said Obama had referred to this week's shooting rampage at Fort Hood, Texas, in which 13 people were killed. His remarks put in perspective that the hardships soldiers endure for the country are "what sacrifice really is," as opposed to "casting a vote that might lose an election for you," said Rep. Robert Andrews, D-N.J.

It appeared that a compromise brokered Friday night on the volatile issue of abortion had finally secured the votes needed to pass the legislation.

As drafted, the measure denied the use of federal subsidies to purchase abortion coverage in policies sold by private insurers in the new insurance exchange, except in cases of incest, rape or when the life of the mother was in danger.

But abortion foes won far stronger restrictions that would rule out abortion coverage except in those three categories in any government-sold plan. It would also ban abortion coverage in any private plan purchased by consumers receiving federal subsidies.

Disappointed Democratic abortion rights supporters grumbled about the turn of events, but pulled back quickly from any thought of opposing the health care bill in protest.

One, Rep. Jan Schakowsky, D-Ill., detailed numerous other benefits for women in the bill, including free medical preventive services and better prescription drug coverage under Medicare. "Women need health care reform," she concluded in remarks on the House floor.

A Republican alternative was rejected on a near party line vote of 258-176.

It relied heavily on loosening regulations on private insurers to reduce costs for those who currently have insurance, in some cases by as much as 10 percent. But congressional budget analysts said the plan would make no dent in the ranks of the uninsured, an assessment that highlighted the difference in priorities between the two political parties.

It was a theme of Obama's remarks to Democrats at midmorning.

The president said Democrats have a 70-year history of creating and defending programs like Social Security and Medicare, Andrews said afterward, adding Obama had said the day's vote "is going to define the difference between the Republican and Democratic parties for decades."

Associated Press writers Phil Elliott, Alan Fram and Erica Werner contributed to this report.


What the Pelosi Health-Care Bill Really Says

Here are some important passages in the 2,000 page legislation

The health bill that House Speaker Nancy Pelosi is bringing to a vote (H.R. 3962) is 1,990 pages. Here are some of the details you need to know.

What the government will require you to do:

• Sec. 202 (p. 91-92) of the bill requires you to enroll in a "qualified plan." If you get your insurance at work, your employer will have a "grace period" to switch you to a "qualified plan," meaning a plan designed by the Secretary of Health and Human Services. If you buy your own insurance, there's no grace period. You'll have to enroll in a qualified plan as soon as any term in your contract changes, such as the co-pay, deductible or benefit.

• Sec. 224 (p. 118) provides that 18 months after the bill becomes law, the Secretary of Health and Human Services will decide what a "qualified plan" covers and how much you'll be legally required to pay for it. That's like a banker telling you to sign the loan agreement now, then filling in the interest rate and repayment terms 18 months later.

On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income. A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income. Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.

• Sec. 303 (pp. 167-168) makes it clear that, although the "qualified plan" is not yet designed, it will be of the "one size fits all" variety. The bill claims to offer choice—basic, enhanced and premium levels—but the benefits are the same. Only the co-pays and deductibles differ. You will have to enroll in the same plan, whether the government is paying for it or you and your employer are footing the bill.

• Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement.

• Sec. 412 (p. 272) says that employers must provide a "qualified plan" for their employees and pay 72.5% of the cost, and a smaller share of family coverage, or incur an 8% payroll tax. Small businesses, with payrolls from $500,000 to $750,000, are fined less.

Eviscerating Medicare:

In addition to reducing future Medicare funding by an estimated $500 billion, the bill fundamentally changes how Medicare pays doctors and hospitals, permitting the government to dictate treatment decisions.

• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what's called a "medical home."

The medical home is this decade's version of HMO-restrictions on care. A primary-care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary-care provider. Medical homes begin with demonstration projects, but the HHS secretary is authorized to "disseminate this approach rapidly on a national basis."

A December 2008 Congressional Budget Office report noted that "medical homes" were likely to resemble the unpopular gatekeepers of 20 years ago if cost control was a priority.

• Sec. 1114 (pp. 391-393) replaces physicians with physician assistants in overseeing care for hospice patients.

• Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country. This will reduce payments for care (and by implication the standard of care) for hospital patients in higher cost areas such as New York and Florida.

• Sec. 1161 (pp. 520-545) cuts payments to Medicare Advantage plans (used by 20% of seniors). Advantage plans have warned this will result in reductions in optional benefits such as vision and dental care.

• Sec. 1402 (p. 756) says that the results of comparative effectiveness research conducted by the government will be delivered to doctors electronically to guide their use of "medical items and services."

Questionable Priorities:

While the bill will slash Medicare funding, it will also direct billions of dollars to numerous inner-city social work and diversity programs with vague standards of accountability.

• Sec. 399V (p. 1422) provides for grants to community "entities" with no required qualifications except having "documented community activity and experience with community healthcare workers" to "educate, guide, and provide experiential learning opportunities" aimed at drug abuse, poor nutrition, smoking and obesity. "Each community health worker program receiving funds under the grant will provide services in the cultural context most appropriate for the individual served by the program."

These programs will "enhance the capacity of individuals to utilize health services and health related social services under Federal, State and local programs by assisting individuals in establishing eligibility . . . and in receiving services and other benefits" including transportation and translation services.

• Sec. 222 (p. 617) provides reimbursement for culturally and linguistically appropriate services. This program will train health-care workers to inform Medicare beneficiaries of their "right" to have an interpreter at all times and with no co-pays for language services.

• Secs. 2521 and 2533 (pp. 1379 and 1437) establishes racial and ethnic preferences in awarding grants for training nurses and creating secondary-school health science programs. For example, grants for nursing schools should "give preference to programs that provide for improving the diversity of new nurse graduates to reflect changes in the demographics of the patient population." And secondary-school grants should go to schools "graduating students from disadvantaged backgrounds including racial and ethnic minorities."

• Sec. 305 (p. 189) Provides for automatic Medicaid enrollment of newborns who do not otherwise have insurance.

For the text of the bill with page numbers, see

Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former Lt. Governor of New York state.