Overdignosed— a brief review and commentary

OverdiagLike many people in the USA, I am concerned about the state of our health care. Don’t get me wrong, I’m grateful to live in a country that has lots of great medical facilities and practitioners. But, I’ve watched people go through some pretty difficult situations, too, so I read Over-diagnosed: Making People Sick in the Pursuit of Healthcare in hopes that I’d learn more about what sometimes goes wrong with our healthcare system. This book offers some first hand insights from three physician authors, and I learned a great deal from it.

Many of the chapters have a “case study” to frame the discussion. One of the most memorable is the story of an older gentleman with a borderline diagnosis of diabetes. In the interest of keeping those blood sugar numbers in the optimal range, the principal author (Dr. H. Gilbert Welch) prescribed medication. Unfortunately, the gentleman’s blood sugar dropped, causing him to lose control of his car, resulting in an accident that broke his neck. The gentleman survived, but he had to wear a halo brace for many weeks while his neck healed. When it was all over, the doctor and patient agreed that the best practice in his case would be to forgo the diabetes medication. This anecdote is a great way to illustrate how over diagnosis can make people sick!

Each chapter explains how modern testing, coupled with ever changing standards for “normal,” have resulted in more and more people being diagnosed with something. The approach is cautionary, explaining that many times a diagnosis might be correct, but if the condition is unlikely to cause the patient any reduction in quality of life, or end the patient’s life early, then it is far better to not treat the disease. However, once diagnosed, both the patient and most physicians will be reluctant to “watchfully wait.” Indeed, the principal author states in the introduction that he does not have routine checkups, even though he works in healthcare and could easily do so. Instead, he waits for something to go wrong. As the old saying goes, “If it ain’t broke, don’t fix it.”

The mammogram is probably the first test that my doctor wants me to have done, but our author states that for most women, they do more harm (due to radiation) than good. Aggressive cancers can develop in the one to two year interval between tests, but slow growing cancers can result in over-reaction by doctors and patients. Also, many women go through the “false positive” situation, which might mean more testing, including a breast biopsy. I’ve known several women who had that done, only to find out that the mammogram was incorrect (or incorrectly interpreted.)

Another interesting story is a conversation between the author and a pharmaceutical rep. The latter was touting the benefits of a drug for women with bone density issues. After a friendly discussion, the drug company rep admitted that the greatest risk for these women is mostly hip fractures, which can lead to all sorts of problems, including premature death. The author states that helping women prevent falls, though physical therapy and other practical measures, would be much more useful. And the testing phase of the drug was eventually discontinued due to subjects developing bone cancer.

The author is firm in his stance that patients are often over-tested and over-diagnosed. He believes that many doctors do this out of an interest in finding answers for their patients, and not merely in making more money. He is also firm that the threat of a law suit can be a driver for hyper testing and the end result of over-diagnosis. I’m all for people having the right to seek redress in the case of gross malpractice, but doctors who have been the defendant in a case, win or lose, will often err on the side of caution and order tests that probably aren’t needed and will refer cases that are only marginal. The costs of this mind set are not negligible, as tests can costs hundreds or even thousands, and that doesn’t include the costs of treating a condition that might not need any treatment. Nor does it address the mental stress of having a chronic “condition.”

Common sense is sorely lacking these days. Certainly many aspects of modern America are getting totally weird, so I guess it is not unusual that medicine is affected. I am grateful to Dr. Welch and his fellow authors for this very cogent discussion of the problem of over diagnosis. I am seriously contemplating what to say at my next doctor visit, when I will face that computerized list of items that modern medicine says I need, but just might result in me joining the long list of those who are “over-diagnosed.”

Flag draped caskets

Recently, hubby and I attended the funeral of a contractor who worked for us several times over a couple of decades, a craftsman who was also so personable that we viewed him as a family friend. In addition to being a darned good carpenter, he always visited a bit with us. Mike collected license plates from cars, and he asked for an old plate off my car. (I drive a Honda Odyssey, so my personalized plate says “HOMERS”, thus I drive around in Homer’s Odyssey. A lot of people don’t understand the tag, but Mike was one those who got the joke and thought it funny.) So, after he finished doing a re-roof and soffit repair, I gave him one my old plate, which he put into “a place of honor” in his shop. Since I love to read, he would bring me his old Time magazines. When he gave me a stack, he usually apologized for taking so long, and recommended the articles he had enjoyed the most. I am going to miss those visits.

The first person who eulogized him was his daughter. Although we knew him well, she was able to relay some interesting tidbits of his life, so we were able to know him even better in death than we had in his life. The minister who delivered the message also knew him well, and told some stories of Mike’s service to the church as well as the community.

I didn’t know that Mike had served in the National Guard until the funeral, but his casket was draped with a flag, honoring his service.


When I listened to the funeral of President George H.W. Bush, I was very much reminded of the accomplishments of the forty-first president. His presidency only lasted four years, but he was a hero during our nation’s greatest war, a congressman, an ambassador, and he was commander in chief during the first Gulf War, a crucial time in our country’s history. The remarks by former Canadian Prime Minister Brian Mulroney were particularly enlightening, as they blended the public accomplishments with the private persona of the former president. The remarks by his son, former President George W. Bush, a eulogy that was primarily about Bush as a father, also helped the nation know this man a bit better.

Most Americans know that Bush (41) was a warrior, and the military aspect of his funeral was a affirmation that some of the greatest Americans served the country well, and that flag draped coffin is a sign of honor which signals that another of our nation’s heroes has gone on to a greater reward.

Our friend Mike left his fingerprints all over the community, as he worked for many people in our area. President Bush left his fingerprints on the nation, because he was involved in government service at the highest levels. Regardless of the scope, to serve well is to live well.

Anxious for Nothing— brief review and commentary

A friend told me how much she is enjoying her study of Max Lucado’s book, Anxious for Nothing, so I bought an eBook version. Quite frankly, her comments were so positive that I did not want to wait to pick up the physical book. I’ve read several of Lucado’s Christian living texts, and they have all been easy to read and helpful, and this book fits that mold.

The title says quite a lot. Modern people have too much information coming at them, much of it negative, so being anxious is almost a modern plague. This plays out in all sorts of ways: addiction, suicide, failed relationships, etc. Lucado discusses the whys, and then gives some very good solutions to our problem thinking. One of my favorite passages says this: “There is a reason the windshield is bigger than the rearview mirror. Your future matters more than your past.”From my own experience, over thinking the past— the coulda, woulda, shoulda— is very damaging. When I counsel students, who almost always want me to allow them to “make up work” or “try again” I tell them to do better going forward. I even use the windshield analogy. But I like Lucado’s take on it.

Okay, his writing lacks sophistication; but not substance. Anxious for Nothing can be a quick read, but there is sufficient food for thought for study, too.

Count the flags!

FlagWe had an interesting discussion about celebrating America’s Independence Day, and the  ways to celebrate are as diverse as the country itself. Most of the towns around here offer some sort of fireworks, usually preceded by live music, and people bring lawn chairs and visit for a while. When our kids were kids, we usually visited the one in the town where we lived. Currently, we live out in the country, so we don’t usually bother.

Hubby wants to watch a movie, preferably Independence Day Resurgence. We loved the original ID4 movie, but somehow we missed seeing the sequel. Despite its mediocre reviews, I imagine that we’ll be looking for that one in a couple of days.

In my work as an adjunct instructor, I work with students from lots of differing situations, but some of the most interesting are immigrants to our country. Many of them are just so appreciative for the opportunities that Americans have. I remember one gentleman, originally from Romania, who came over a couple of decades back, beginning with nothing but some work ethic. At first he made his living doing odd jobs. He worked his way into owning his own construction business, and he and his wife raised their family through hard work and savvy real estate deals. At our college, he was working on his HVAC (that’s heating and air-conditioning) certification, as he wanted to open an HVAC business so he could scale back doing difficult construction work as he aged. Being a very smart business man, he said that in the south making money on repairing air conditioning was a sure thing! One day at the end of our class, he spend probably half an hour, telling all of us about what a wonderful country we were living in, because he could never do all that he was doing in the economically and socially constricted country of his birth. It was quite refreshing. Sometimes, caught up in the polarized morass of modern media, Americans forget just how wonderful our country is, and how it differs from others.

When I mentioned that it can be difficult teaching young children about our country, one  mother of youngsters mentioned that when they are driving in the car, her kids count flags. Regardless of the destination, they look for the red, white, and blue symbol of our great country. That, too, is a great way to begin celebrating the good ol’ US of A.

Happy American Independence Day, y’all.

Hollar— and great customer service

hollar-pic.jpeg
Mostly, I intend to write about writing, but real life does get in the way of that, and this post is about the fabulous customer service I got from an online “dollar store” known as Hollar.com. When I ordered from them for the first time, I got several items to try, and a puzzle to share with my family, who are (just like mom) big fans of Star Wars. Let me be perfectly honest— the price for the 100 piece puzzle was $1. But, when the group effort was finished, one piece was missing. Hubby laughed at me and had some disparaging remarks about my being cheap enough to order a $1 puzzle. He is right about me being cheap, however.

Slightly annoyed, I whipped out my iPad, took a picture of the 99 piece puzzle, posted it as a comment on the Hollar Facebook page. Within a few minutes, I had a couple of responses from concerned folks at Hollar. They asked for the order number, and when I replied via FB messenger with it, they assured me that I would get a new puzzle. I was expecting (maybe) a credit on my next order, but they said the item was in stock and would soon be on its way. Kudos, right?

A few days later, I got the box, which was bigger than expected and heavier, too. Curious, I opened the box and there was another boxed Star Wars puzzle. Below it, heavily cushioned, was a very nicely framed Star Wars puzzle, with a missing piece, along with a personal note explaining that they, too, didn’t like missing pieces. Hubby, who had brought the box from the post office couldn’t stop laughing, and I was so pleased with the item that I immediately hung it.

Nowadays, people love to say that almost all companies have “customer no service” rather than treating people right. Obviously, Hollar.com has a different philosophy, as well as a great sense of humor. Needless to say, I will be visiting the site again, because such great customer service deserves a second chance.

Go check out Hollar.com. Really!

“Current Events Day”

coachWhen my kids were kids, I often assisted with homework, but I made a tactical error and told them I’d actually do any thing we determined to be “busy work.” (At the time, I still believed in the integrity of most educators.) My daughter had a couple of coach/ social studies teachers in high school who would set aside one day a week for “current events” which basically meant the students were to bring in a news story and read it to the class. There were absolutely no criteria assigned, nor was there any grade. Since the teacher was just using this instead of doing any work himself, this qualified as a mom task, and I decided to use the weirdest items I could find.

As it is has been a while since my kids were in school, I no longer read so much weird news, but sometimes a headline just grabs my attention. So, I just read a news story which would have made the cut for current events day at JHS. What do y’all think of this one? Call 911!

Star Wars: The Force Awakens

Since Star Wars The Force Awakens has broken lots of records for attendance, there are no doubt too many audience reviews for mine to matter. There are several elements that make this a film worth watching, and fans are mostly happy with it, at least in part due to the items (in my own order of excellence) enumerated here:

#1 The Score! John Williams’ score was instrumental in turning the original Star Wars from a mere comic book B movie into a box office bonanza. For the other films his compositions have kept the audience entertained, and Williams’ music is just as important here ever. For those not into classical music, the technique he uses is called leitmotif, wherein each character or plot device has it’s own musical theme, all interwoven into the whole. This is an operatic technique that helps the audience be even more emotionally involved the happenings on screen. It’s very cool, and it works beautifully in Episode VII.

#2 The respectful treatment of the aging stars of the original series. Although there is considerable exposition prior to the appearance of the famous trio, each character is given his (or her) moment on screen. The audience has a chance to see what’s happened during the passage of time, and the situation of each is organic in regards to their characters and situation way back when the Jedi returned in Episode VI.

#3 The new characters are interesting. Writing is hard work, and creating characters that readers (and/or viewers) care about can be difficult. In Poe Dameron, Rey, and Finn, the writers have given us a new generation of action characters. Hey, there’s even a cool new droid, BB-8. Compared to the characters in Episodes I, II, and III, these new guys are…oh, let’s be real. There is no comparison with those films. The new kids seem to be worthy successors, however. The actors do an excellent job of bringing them to life, too.

#4 Real “special effects” rather than CGI. Don’t get me wrong, computer generated effects have their place. But when Yoda ceased to be a puppet and became a glowing figure out of a computer game, his personality shifted from cute and quirky to something less interesting. This Star Wars has the look and feel of the original, but with more money. No doubt the prop masters were kept very busy during filming, but there is a difference when the actor is doing lots of stuff against a green screen vs. real props and sets.

#5 Good vs. Evil is central to the story line. For audiences to care, the good guys have to be mostly good, but have enough flaws for us to identify with them. The bad guys should be so bad that even Oprah wouldn’t try to understand them, instead she’d just shoot ’em.

The links are present for those who want to know more about certain aspects of the film, but that’s my take on the new Star Wars movie, which I recently saw with hubby and our young adult son.

American Sniper— the book

American Sniper by Chris Kyle coverOkay, I admit, I have a tendency to do certain things backwards. Hubby laughs at this one: whenever I pick up a magazine, I thumb through and begin reading somewhere near the back. I sometimes do that with catalogues, too. Why? Because the snazzy pictures are in the front, and the words are in the back. I like words.

American Sniper, the movie, is in theaters in my area of the country as I write this, which means it is the perfect time for Pam to read the book! Chris Kyle’s exploits are apparently quite controversial, based on the reaction to the film, but I did not find it so much controversial as conversational. After I finished, I felt like I has spent a while talking with this Texas cowboy turned Navy Seal, who loved guns and his country enough to go back into a war zone, over and over.

Why is Kyle’s career a controversy? There are those who feel that Americans were invaders in Iraq. Okay, I see that. A little bit, anyway. Any war on foreign soil will have that aspect. And there are those who feel that being a sniper, hiding behind a big rifle with a bigger scope, is a cowardly way to fight. That I don’t get, at all. Guerilla warfare is not new. And, in the war in Iraq, with insurgents attacking government installations and convoys, having a sniper on every tall rooftop made a lot of sense. As he often puts it in the book, Iraq was a “target rich” environment. His recorded number of “kills” is far above any other sniper, and he is matter of fact in explaining that his accomplishment was in part due to being in the thick of things for four deployments.

Kyle’s story, which begins during his childhood in Texas, is entertaining and quintessentially American. When he discusses the war, it is the voice of a military man, explaining what happened from his point of view. Also of interest are brief interludes where his wife, Taya, discusses what was happening from her perspective. This gives the story more depth because modern warfare can happen so far away that the combatant’s home country is isolated from the realities of war. The price paid by the family is made quite real through her observations.

If you haven’t read Kyle’s autobiography, you might want to give it a try. Although it becomes a bit repetitive, because what he did on a day-to-day basis didn’t change all that much, his voice is strong throughout the book, and Chris Kyle was a man’s man in a country that has, by and large, gone soft.

Middle School Mentality

Since the video of bus monitor Karen Klein was posted on YouTube, there has been much written about the incident, but not much written about the mentality of the students who tormented her. If you haven’t seen the video or read any of the news stories associated with it, a brief summary of the incident is in order. In a video shot by a fellow student, a group of boys are heard calling an older female bus monitor fat, discussing what it would be like to stab her, and saying that her family would want to commit suicide because of their association with her. Klein does dissolve into tears, but never strikes back at her juvenile tormenters.

As a former teacher, and one who spent years working with students in the middle grades, I sadly state that this video is not so shocking to me. First, I will state that although I was sometimes the target of some taunts, my position as a teacher gave me more authority, and so I never dealt with anything so horrible. But, that said, parents and the public must understand the “middle school mentality” does include more than a bit of viciousness. More than once, I have described middle school students as being similar to a pack of rabid dogs. Individually, they are usually okay, but when grouped together, it is not uncommon to get some really bad chemistry. If there is an age where homeschooling is more appropriate, I believe it is the middle grades. When kids lose their need to impress adults, but before they become accountable, there is a danger zone, and grades 5-9 tend to be the rough ones, for the students as well as for the teacher and staff members.

My own children suffered bullying at that age; in fact, I was blessed to have a husband with a high enough position in the community that he could literally call up the superintendent of schools and ask him to personally intervene in a bad situation that was causing our daughter to go through emotional turmoil.

I have little doubt that the parents of those students in the video do not have to endure constant profanity and threats at home. Actually, I would imagine that the parents were probably shocked at the video of Klein being tormented. While the parents are partially responsible, the students are of an age to take responsibility for their actions. However, putting such students with so little control together, and giving those in authority no real power to keep the students in line, is the real problem.

If these students were in a homeschool, being responsible to one or two adults, and entrusted with assisting younger students, they simply would not get into a situation where they would have nothing better to do than torment others. Anyone who had read Lord of the Flies knows that it is not a new problem.

I’m sorry for Karen Klein, but not shocked. She has stated that if she had retaliated, she would have been fired. If any aspect of this incident is shocking, it is that society doesn’t realize what goes on when middle school mentality is allowed to run amok.

If It Bleeds, It Leads

One of my sisters is a journalism major, and when discussing television news, she often laughs and says, “Oh, if it bleeds, it leads!”

Television is such a visual medium that, by its very nature, can’t objectively report news. As a journalism major, who has dabbled in the field but seldom actually made a living in it, my sister once told me that she records the evening local news, two hours per day, each week, and reviews it in an hour or two on Saturday morning. She’s right, of course, the stories and film clips are recycled so often that there are only enough actual new items to fill a two-hour per week broadcast. My sister’s method makes for much more balanced coverage of the “news” since she is not bombarded by the same stories over and over. Just like viewing a commercial for a candy bar three times an hour can lead to a trip to the store for chocolate, seeing the same news clip once an hour for three days can make a natural disaster into Armageddon.

Worse, there are many news stories which ought to lead, but recently, the most visual (and loud, of course) stories were the “lead” items.

Charlie Sheen, with broken teeth and loud expressions of ego-centric rage, was the lead story for a few days. Important? Too those with only a few portions of gray matter still functioning, perhaps.

The New York City bus crash? A human tragedy, to be sure, but it was leading because it was bleeding. No doubt the driver was tired and dozed off. It probably happens every day, somewhere, but because there were many folks on the bus, it was visually stunning, so it became a lead story.

Japan’s earthquake aftermath should be a “lead” story. But, the constant emphasis on the “nuclear” disaster is a bit misleading, if you’ll pardon the pun. There is not going to be a Chernobyl situation in Japan, because the nuclear reactors there were built to withstand most problems, and the containment devices are working fairly well, given the trying circumstances of the earthquake and tsunami. If Japan had used coal or oil to generate electricity, there would have been problems with that as well. The microscope of television news is making the problem(s) associated with radiation appear much, much worse than they actually are. Right now, the Japanese need clean water, food, and shelter; and hopefully, Americans will do what they usually do, and provide aid to a nation in need.

There is much good going on in the world, but it doesn’t bleed, therefore it does not lead. For example, legislatures across this country are attempting to deal with illegal immigration by enacting laws which attempt to verify citizenship (and therefore harass non-citizens) and those actions are misguided. Most of us “Americans” came from somewhere else and became Americans. On my way to work, I pass by a church which has a huge sign out front, touting “Free Classes in English and Citizenship.” That church, with its parking lot filled with cars of those who want to become citizens, is doing more to help the immigration problem by helping assimilate immigrants than all of the legislatures combined. But the efforts of these kind Christians won’t make the news, because doing good is not a lead story.

By Pamela/Pilar Posted in news