Monthly Archives: May 2013

Mastectomies, Movie Stars, Media and Medicine

How ironic that Angelina Jolie chose National Women’s Health Week – and the week after Barbara Brenner, executive director of Breast Cancer Action and a feisty advocate for women with the disease died (from Lou Gehrig’s Disease) – to share with the world that she had elected to have a double mastectomy in an effort to avoid breast cancer.

The press lit up with the news. Breast cancer “experts” and media moguls leapt at the chance to say Jolie had been “brave,” and “courageous,” and indeed she had: Choosing to have your healthy breasts amputated at the age of 37 takes guts and must have been a heart wrenching decision to make. In her case, it is understandable. Having an estimated 87 percent chance of contracting a potentially fatal disease is enough to make any woman think twice about whether prophylactic mastectomy is warranted. (I still wonder how that precise percentage was derived.)

Still, a chill ran down my spine when I heard the news and I wondered what Barbara Brenner, an outspoken breast cancer educator who had had breast cancer herself, would have said. Here’s why.

Only about one percent of American women carry the BRCA1 or BRCA2 mutation that Jolie’s doctors identified. Therefore, as H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice pointed out in a CNN commentary, her story “is not relevant to more than 99 percent of women [here].” Although it’s a terrible thing to carry the gene, it affects relatively few women. Yet, now that Jolie has gone public, even more women will be seeking mastectomies, adding to an alarming increase in demands for the surgery ever since Sherly Crow, Marlee Matlin, and Miss America contestant Allyn Rose made the same choice or heartily endorsed it.

Mastectomy and all that it entails is not something to be taken lightly. As with other major surgeries, it can result in serious complications, along with persistent pain and limited mobility. Repeat surgeries may be necessary, especially if a woman chooses to have breast implants. If tissue is transplanted from other parts of the body to reconstruct the breasts, more incisions will be needed, and if muscle is removed for this purpose, long-term weakness can result. As one advocate put it, “it is not a breeze” and not a cure-all.

It is also an expensive proposition, as is the testing for BRCA 1 and 2. It costs about $3,000 dollars to be tested and many thousands of dollars to have elective surgery. Some insurance companies cover some of the costs, but many don’t. That’s okay if you’re a movie star, but ordinary women, including many women of color, will never be able to afford treatment close to what Angelina Jolie has just experienced. And even she still has a chance, reduced though it may be, to getting breast cancer.

In The New York Times op ed. revealing her surgery, Jolie said “cancer is still a word that strikes fear into people’s hearts.” How many women’s decisions around prophylactic mastectomy are based on fear-mongering rather than evidence-based decision-making? Was it responsible for Jolie to remind readers that “breast cancer alone kills some 458,000 people each year,” without also providing the stats on the gene she carries?

Many women are choosing mastectomy – even for healthy breasts – when advances in early detection and subsequent treatment, including lumpectomy, offer viable alternatives. Joan Walsh of Salon.com made this case, based on her own personal experience. “I chose a course of rigorous medical follow-up,” she posted, “[including] an annual screening mammography and twice-yearly breast exams by a surgeon.” Walsh elected not to be tested for the BRCA gene, instead giving emergency attention to the slightest anomaly. “I’m so glad I didn’t listen to the doctor who wanted to treat my breasts like ‘ticking time bombs,’” she says. As respected breast surgeon Dr. Susan Love noted in The New York Times, “When you have to cut off normal body parts to prevent a disease, that’s really pretty barbaric when you think about it.”

The risks and benefits of any breast surgery, and especially mastectomy, vary from woman to woman. As Dr. Isabelle Bedrosian, a surgical oncologist at M.D. Anderson Cancer Center in Houston put it in a New York Times report, “There is an upside to [Jolie’s] story and that is that women will hopefully be more curious about their family history. [But] we need to be careful that one message doesn’t apply to all. Angelina’s situation is very unique. People should not be quick to say ‘I should do like she did,’ because you may not be like her.”

Fortunately, few of us are. That should be the starting point if we are ever faced with a decision about breast cancer treatment options, even if that decision proves to be as difficult as the one Angelina Jolie made

Lessons from Abroad: Ten Tips in Ten Days

Having recently returned from travel in Europe, I realize we have much to learn from “the old country.” Lessons range from how to better enjoy life to more serious issues of conservation and infrastructure.

For one thing, Americans need to get a (café) life. Unlike Europeans, we don’t have a true café culture. While we may enjoy outdoor drinking or dining, we don’t take time to simply sip coffee in the morning or wine at night, people-watching for the sheer fun of it. Such activity seems to Type-A Americans as wasting time. In Europe it’s essential in the course of a day. My bet is café sitting is as healthy a thing to do as exercising regularly.

Along with that pleasure comes “savoring the sauce.” In other words, Europeans cherish their regional and national cuisine. They take time to prepare food, to feast on a meal as if it were their last, and to enjoy it with family and friends. Dining, no matter the setting, is a communal celebration of life. Here, more often than not, we eat to live. There, they live to eat. It is part of a delicious café-based, culinary culture!

Europeans have also mastered some instructive aspects of travel and transport. For example, they get Ring-Around-the-Rotary. For some reason, we don’t use rotaries sufficiently, despite their proven advantage in keeping traffic flowing. No matter the size of the circle, they move cars in an orderly, safe fashion and often eliminate the need for traffic lights. Europeans also have some of the most sophisticated, inviting mass transit systems in the world. Whether rapid trains like France’s TGV or electric trolleys in urban areas, we have much to learn about how to move people quickly, efficiently, and in energy-saving ways. And bikes are big in Europe. Whether in cities or rural settings cycling is still prevalent. Many cities have bikes that can be rented for a small fee at one location and returned to another, as if taking a shopping cart from one supermarket and leaving it at one closer to home. Some American cities have been slow to pick up this idea. More need to consider it.

Bikes galore

Speaking of grocery carts, what about the park-it-or-pay-for- it system that many European supermarkets use? Similar to airport carts, patrons pay to remove a cart from the kiosk where they are kept. In order to get their money back, they must return the cart, attaching it to other carts in the queue in order to get a refund.

Ah, kiosks. It’s lovely to pick up a newspaper at one, but sad to see the rampant commercialism that seems to have overtaken every piazza and park in Europe. For anyone who first experienced, say, Venice’s magnificent San Marco Square in the 1960s or 70s, the shock of schlock there now is heartbreaking. And the rampant development in places like Tuscany’s hill towns or the French ski resort of Chamonix is enough to make older travelers weep. The lesson here? Resist commercialism and overdevelopment. It’s okay, for example, to set limits on tour buses or to have walking areas with no vehicles permitted except for handicapped transport. If we must build something new, make sure it blends with the old. And if increasing tourism needs must be met, be respectful of the past and tasteful for the future.

But back to the positive lessons from Europe: Satellite those cells! Pitch the plastic! Have two-speed flushes!

Everywhere I travel, cell phone reception is clear and available, and that goes for the beaches in Phuket, the high mountains of Peru and the countryside near Paris. So why won’t my “mobile” work here? The answer is that they use satellite technology while we rely on towers.

Restaurants all over Europe are now prohibited from serving water in plastic bottles. Want Perrier or Evian? It will come to your table in reusable glass carafes. True, stores can still sell spring water in plastic, but just limiting them in restaurants makes a huge difference. So does eliminating plastic bags. Increasingly, shops are providing cloth carriers for those who haven’t brought their own “carry bags.” And kudos to airlines like Lufthansa that have eliminate plastic eating utensils in economy class!

As for toilets with two flush buttons – not all flushes require as much water – bravo to that technology. And to the windmills that grace the landscapes of Europe, dancing their unsynchronized ballets in the breeze.

European countries are not perfect. (Italy could use a lesson in road signage, not to mention driver etiquette.) But they are older than America and like wise grandparents they have things to teach us. We shouldn’t, as adolescents are prone to do, turn our backs thinking we know better.

When traveling abroad, we need to look, listen, and learn. What better place to contemplate those lessons than in a sidewalk café, sipping café au lait or a glass of chilled pinot before a superb meal in the local tradition?

Paying Attention to Climate Change Before It’s Too Late

Once more the pictures say it all: Oil-covered wildlife struggle to survive. Sludge doesn’t just clog the waterways, now it slinks like a threatening snake down suburban streets. People wonder if they will recover and worry that their homes may not be livable.

The potential for disaster should a pipeline be allowed to run from Canada to the Gulf of Mexico was made clear by the recent oil spill in Arkansas. It also, as Sen. Bernie Sanders (I-Vt.) said, “raises the broader question of “whether we continue to be a carbon-based economy or whether we finally recognize that if we don’t get a handle on greenhouse gas emissions that this planet is going to be facing some disastrous problems in years to come.”

Sen. Sanders told an MSNBC audience last month that according to scientists who have testified at Energy and Environment Committees, the damage coming from global warming is worse than previously thought. “What they’re now saying is if we don’t get our act together and start cutting in a very significant way greenhouse gas emissions, we’re talking about this planet heating up by eight degrees Fahrenheit by the end of the century. That is calamitous for this planet.”

Mr. Sanders isn’t the only source of alarm. Climatepath, an organization comprised of environmental and climate scientists, lists several facts on its website that should worry us. Based on their report “Climate Change 2007: The Physical Science Basis: Contribution of Working Group I to the 4th Assessment Report of the Intergovernmental Panel on Climate Change (IPPC),” a group of scientists has concluded that “we have not yet seen the more dramatic changes resulting from warming, which has led many to complacency. Like a tsunami, we may not recognize the threat until it is on top of us. The truth is out there.”

Among the conclusions in the report submitted to the IPCC, the leading body for assessment of climate change established by the United Nations and the World Meteorological Organization, are these: Fossil fuel and agriculture have drastically increased greenhouse gases, the radiant forces of increasing these gases is warming the planet, the warming will continue and accelerate if no action is taken, and it will have severe consequences.

“The current warming trend is of particular significance because most of it is very likely human-induced and proceeding at a rate that is unprecedented in the past 1,300 years,” the report says.

Evidence for rapid climate change is compelling. For example, global sea levels rose about 6.7 inches over the past century. The rate in the last decade is nearly double that. Global temperatures are also rising. The twenty warmest years have occurred since 1981 and all ten of the warmest years have occurred in the past twelve years.

According to an article published in The New York Times in January this year, 2012 – a year in which we saw a March heat wave, severe drought in the Corn Belt, and a huge storm that brought utter devastation to the Middle Atlantic States – was the hottest year ever recorded in the contiguous U.S.

More than 34,000 daily high records were set at weather stations across the country last year with only 6,664 record lows recorded. That ratio is seriously “out of whack,” one scientist said. “The heat was remarkable, according to another scientist with the National Climatic Data Center. “It was prolonged [and the fact] that we beat the record by [a full) degree is quite a big deal.” It certainly was a big deal for a third of the nation’s population which suffered through ten or more days of summer temperatures exceeding 100 degrees.

Last year was not only the country’s warmest year. It was also the second-worst on the Climate Extremes Index, which measures climate-linked disasters. At least eleven disasters including several severe tornadoes, Hurricanes Isaac and Sandy, and fast-moving thunder storms that killed over twenty people occurred in 2012. The estimated damage surpasses $1 billion.

The consensus seems to be that last year is a taste of things to come. The government simply must see climate change for what it is – a looming disaster requiring immediate, serious, sufficiently funded attention. Given the disbelievers on the far right, and the inability of Congress to get anything done these days, the words of famous nature photographer Ansel Adams are sobering: “It is horrifying that we have to fight our own government to save the environment.”

Horrifying,yes. But never more urgent for all of us.

This Memorial Day, Let’s Remember Women in War

Now that qualified women can enter combat officially, it’s a good time to remember the many roles women have played during wartime, whether military or civilian.

Writer Frank Moore dubbed classical women during the Civil War “Angels of Mercy” as they rolled bandages and patriotically waited for their men to come home. But he also understood that “the story of war will never be fully or fairly written if the achievements of women in it are untold.@ He knew that there were women soldiers in the Civil War, honored in DeAnne Blanton and Lauren Cook’s book They Fought Like Demons. The stories of hundreds of women who assumed male aliases, wore men=s uniforms, and charged into battle as both Union and Confederate soldiers are compelling. Mary Ann Pittman and Loretta Valesques, for example, both raised a company of soldiers and later became spies.

More than a hundred years later, Marge Piercy=s 1980s epic novel Gone to Soldiers offered an important portrait of women=s experiences during WWII. Writing about women who ferried airplanes for the Air Force, served as intelligence officers in Europe, worked in factories to produce war goods and more, she put a female face on the reality of war.

Later, when Vietnam nurses lobbied for recognition, a new realization of women=s contributions and trials on the front lines emerged.

Still, many a wartime heroine has gone unnoticed or been forgotten. Claire Chevrillon was one of them. An English teacher in Paris in 1942, she served in the French Resistance for three years. In 1943 she was arrested and imprisoned. AWhat I remember about arriving,@ she recalled, Awere the dark, subterranean, endless corridors through which I walked followed by a guard, as if in a nightmare.” Chevrillon survived and wrote a 1985 memoir. AThe instinct of one nation or race to dominate another doesn=t die,” she said. “It grows insidiously, feeding on private and public concern, until suddenly it=s too late to prevent disaster.@

Minnie Vautrin was an American missionary in China during the 1937 ARape of Nanking.@ Called the Goddess of Mercy for trying to save as many girls and women as possible, she repeatedly faced down threats and bayonets to provide asylum for refugees at the college she headed. A 1938 diary entry reveals her despair: AHow long will this terrible situation last? How can we bear it?@ In the end, Vautrin could not bear it. After helping women locate their husbands and sons at war’s end and teaching destitute widows how to survive, she returned to the U.S., committing suicide in 1941.

Ninety-nine Army and Navy nurses later known as the Angels of Bataan and Corregidor were captured in the Pacific by the Japanese during WWII. The first to be sent into the middle of battle, they became the only group of American women captured and imprisoned by an enemy. Before their incarceration, they helped build and staff hospitals in the middle of a malaria-infested jungle, pioneering triage nursing. Among them were women like Eleanor Garen, whose diary entry on a bad day read: AGaren, This is to yourself. Remember, life is not a bed of roses.@

An estimated eight to twelve thousand women served in the Vietnam War. Most of them were nurses; all had volunteered. Few were recognized as true veterans when they came home. One of them, Lily Jean Adams, was twenty-two years old when she worked as an intensive care nurse. She remembered what it was like comforting a dying soldier. ASometimes they would say >don=t leave me!= And I wouldn=t. I had an inner sense that this was just as important as taking care of the living.@

Women war journalists have been equally brave. Traditionally a male arena, war reporting obscured the trauma experienced by women and other civilians living in attacked areas. These noncombatants survive by fleeing to the hell of refugee camps, where sexual assault and other trauma is common. Today approximately a third of frontline journalists are female and they have a measurable influence on the content of war coverage. They follow models like Anna Benjamin, the first female photojournalist who covered the Spanish-American War, Mary Boyle O=Reilly, who was at the front in World War I, and Peggy Hull, who covered both World Wars and was the first accredited female American war correspondent.

Today women make up approximately 16% of American military forces and about 6% of veterans. Although women were not officially recognized as members of the Armed Forces until 1901, and then only as nurses, women have served in every major war in U.S. history. In WWI women who weren’t nurses could finally join the military; over 30,000 of them enlisted. During WWII women=s roles expanded and over 400 women of the 400,000 who served lost their lives. Desert Storm marked the largest deployment of women to a combat theater in U.S. history until the second Iraq war, with more than 40,000 women serving. Today women are graduating in ever larger numbers from U.S. military academies, often at the top of their class.

Frank Moore was right. The story of war will never be fully written or understood if the achievements and contributions of women are unrecognized. From soldiers to spies, nurses to Navy personnel, journalists to junior officers, veterans to wounded warrior wives, the stories of women in wartime must be told. The women at the center of those stories need to be honored, for they are women of courage, strength and resilience, not only now but as they have always been during wartime.