Showing papers by "Michael J. Baum published in 2000"

Is clinical breast examination an acceptable alternative to mammographic screening

Abstract: Breast cancer screening and mammography have almost become synonymous in the public perception, yet this should not necessarily be the case. Ideally, a screening tool for breast cancer would reduce mortality from breast cancer while having a low false alarm rate and being relatively cheap. Screening should not be at the expense of the symptomatic services nor inappropriately divert scarce resources away from equally deserving areas of the NHS that are less politically sensitive.1 An ideal screening test would be simple, inexpensive, and effective. Of the three modalities of breast cancer screening—breast self examination, clinical breast examination, and mammography—breast self examination fulfils the first two criteria, but early results of two randomised trials conducted in Russia and China suggest that it would not be effective in reducing mortality from breast cancer. 2 3 Clinical breast examination is also relatively simple and inexpensive, but its effectiveness in reducing mortality from breast cancer has not been directly tested in a randomised trial. Mammography is complex, expensive, and only partially effective. We believe that there is sufficient circumstantial evidence to suggest that clinical breast examination is as effective as mammography in reducing mortality from breast cancer and that the time has come to compare these two screening methods directly in a randomised trial. #### Summary points The goal of breast screening is to prevent death and not simply to detect cancers by mammography Mammography does detect some cancers “early,” but many of these are not potentially lethal and their detection causes needless anxiety Clinical breast examination is more likely to detect cancers that are potentially lethal Results of the second Canadian national breast screening study suggest that mammographic detection of cancers that are not palpable does not affect mortality New GMC guidelines on informed consent state that women in the NHS breast screening programme should …

For and against

Abstract: # Declaration of Helsinki should be strengthened {#article-title-2} The World Medical Association is now debating the next revision of the Declaration of Helsinki. Kenneth Rothman and Karin Michels argue that critics of the declaration, notably the US Food and Drug Administration, are trying to give scientists greater latitude than the declaration allows. In particular, Rothman and Michels dispute the morality of performing placebo controlled trials when there is an existing accepted treatment, and they offer other suggestions to strengthen the protection of patients who participate in medical experiments. Michael Baum argues against their absolutism on this issue and against what he considers their anti-science stance # For {#article-title-3} Actions that penalise some for the good of others are defended under the utilitarian banner of doing the greatest good for the greatest number. For this reason we justify imposing quarantine to prevent the spread of infectious illness. In the same spirit some scientists and regulators would ask patients who participate in medical research to make sacrifices for the greater good. Their position puts them at odds with the Declaration of Helsinki, which does not mince words in choosing between the greatest good for the greatest number and the rights of the individual patient: “In research on man, the interest of science and society should never take precedence over considerations related to the well being of the subject.”1 This ethical choice of the patient's rights over the good of society in general is now up for re-examination as the World Medical Association deliberates the next revision of the declaration. Why would the World Medical Association consider stepping back from its strong support for the rights of the patient? It is under pressure to do so from several critics, 2 3 notably the United States Food and Drug Administration. The Food and Drug Administration mandates many human experiments as part of the approval …

Steroidal modulation of scent investigation and marking behaviors in male and female ferrets (Mustela putorius furo).

Abstract: Gonadectomized male and female ferrets (Mustela putorius furo) given either testosterone propionate (TP) or oil vehicle preferred to investigate the side of a test cage previously soiled by a breeding male or female as opposed to a clean side. Male and female ferrets receiving TP showed more urogenital wiping than oil-treated animals in either side of the test cage. In a 2nd experiment, ferrets treated sequentially with TP, oil, and estradiol benzoate (EB) were given simultaneous access to sides of a test cage previously soiled by either a breeding female or male. Either EB or TP treatment of females and TP treatment of males facilitated the investigation of odors of opposite-sex ferrets. Females given TP and males given either TP or EB showed increased urogenital wiping in both sides of the test cage. Sex steroids modulate scent investigation and marking in adult ferrets in a sexually differentiated fashion.

Survival and reduction in mortality from breast cancer. Impact of mammographic screening is not clear.

Abstract: Editor—We should all rejoice that there has been an improvement in survival and reduction in mortality for carcinoma of the breast, but Richards et al in their paper perpetuate the myth that this is related to the breast screening programme.1 The periods for comparison were 1981-5 and 1986-90. The Forrest report on mammographic screening was published in 1986,2 the first screening centres were established in 1988, and the country was not covered by the programme until 1990. Even the greatest zealots for mammographic screening would not expect an impact on mortality until 1997. The fall in mortality could therefore be attributed only to improvements in treatment, and it is relevant to note that the first overview of the trials of adjuvant systemic treatment were published in 1985.3 The only support for the assertion that the reduction in mortality can be attributed to the breast screening programme was a personal communication from S M Moss. Many people are of the opinion that mammographic screening is saving thousands of lives, but opinion alone does not provide sufficient data to support a publication in a prestigious journal such as the BMJ.

Effect of gonadal steroids on pituitary LH secretion and mediobasal hypothalamic GnRH mRNA in ferrets.

Abstract: In vitro release and content of GnRH in mediobasal hypothalamic slices are reduced by ovariectomy of female ferrets but are not affected by castration of male ferrets in breeding condition. The aim of the present study was to determine whether this sex difference reflects a sexually dimorphic effect of gonadal steroids on mediobasal hypothalamic GnRH mRNA content of male and female ferrets killed 4 weeks after gonadectomy, either with or without steroid hormone replacement. This time interval exceeds the 6‐10 days needed for increments in plasma LH concentrations to stabilize after gonadectomy of ferrets of both sexes. In situ hybridization using an 35 S-labelled oligoprobe complementary to the human GnRH coding region showed that the number of mediobasal hypothalamic neurones and the cellular content of GnRH mRNA did not differ significantly among groups of male and female ferrets that were either in breeding condition or that had been gonadectomized and treated with sex steroids or oil vehicle. These results indicate that gonadal hormones regulate mediobasal hypothalamic GnRH biosynthesis and release in both sexes via post-transcriptional events that may include GnRH mRNA translation or the conversion of pre-pro GnRH precursor into mature GnRH.

Music to be born to, music to die to

Abstract: People say that birth and death are lonely events as you are the only one experiencing them at that very moment. But music can be a birth or death companion. We asked a range of contributors which music they would choose at either end of life. Some believe that birth and death are life defining moments. Presumably, therefore, they deserve a soundtrack to match. The reality in our family has been more prosaic. My daughter, Zoe, now aged 9, arrived after a long labour. Discarded tapes of Vivaldi's Four Seasons littered the delivery suite. Unfortunately Zoe's parents were less well organised. The scramble to the hospital allowed time only for a rummage in the glove compartment of our car, which provided a battered copy of Twenty Golden Country Greats as the sole musical accompaniment to the birth. On a good day my wife acknowledges a sneaking regard for Tammy (“five husbands and 15 abdominal operations, honey”) Wynette. So it could have been worse. The lyrics seemed appropriate (“sometimes it's hard to be a woman”), but the chorus left something to be desired (“stand by your man”). At least we didn't hit “D.I.V.O.R.C.E” until mother and daughter were well into recovery. It seems inevitable that my passing will be marked in similarly tasteful fashion—perhaps the immortal Peter Sellers' song, “They're Digging up Grandpa's Grave to Build a Sewer”? When I was a boy, my aunt, then a radio announcer, declined my request to play this tune on air. But that's another story…. To be born to? Handel's Water Music , which is full of tunes that would accompany the breaking of the waters. To die to? “Etz chaim hi lamahazikim bah,” the beautiful melody sung by the cantor as the Torah scrolls are returned to the ark on the Sabbath. The …

New developments in the arts and health

Abstract: Will expand the scope of medical studies