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Are We Scaring Ourselves to Death?

How Pessimism, Paranoia, and a Misguided Media are Leading us Toward Disaster

St. Martin's Press

TO YOUR HEALTH!

HEALTHY, WEALTHY, AND WISE (?)

Tylenol poisonings. AIDS. Rare killer viruses with no cures. Hamburgers that kill children and old people. Beef that makes you mad. Salmonellacontaminated chicken in the local grocery store. Pesticides on fruits and vegetables. Toxic shellfish. Milk pumped up with bovine growth hormones. Mexican food, Italian food, Chinese food, movie theater popcorn. According to media stories over the past few years, all of these are "harmful to your health"!

To add to the confusion, sometimes one piece of health news is followed within weeks by another that directly contradicts the first.

• In February 1995, the Centers for Disease Control told us that any kind of exercise improved life expectancy, even sporadic modest exercise. Then, two months later, a Harvard University study announced that only people who exercised strenuously and regularly enjoyed longer lives.

• A Danish study, published in the 6 May 1995 issue of the British Medical Journal, encourages the drinking of wine. According to the ten-year study, people who drink three to five glasses of wine a day live longer. However, other studies point out that the benefits of alcohol might not outweigh the risks.

• One study finds that eating fish doesn't prevent heart disease, as it is widely believed to do. Another study reports that reducing dietary fat to 30 percent of calorie intake doesn't help reduce the risk of heart disease — in spite of dozens of news stories to the contrary.

It's difficult to know what to embrace and what to fear. Questions cloud our attempts to apply the results of scientific research to our lives. We learn that food irradiation can kill potentially harmful bacteria, such as E. coli in beef and pork, and salmonella in chicken. But does irradiation carry unforeseen cancer risks?

Another example is caffeine. Eighty percent of Americans consume caffeine daily. However, a Johns Hopkins University report published in the Journal of the American Medical Association in October 1994 found that caffeine causes birth defects and is an addictive drug with classical psychoactive dependence. Other studies tell us that caffeine magnifies the risk of heart attacks and the effects of stress. Conversely, different researchers and food professionals assert that caffeine can protect against colon and rectal cancer, increase alertness and productivity, reduce suicidal tendencies, and increase sexual activity in the elderly. So what do we do, have that second cup of coffee or not?

And what is the difference between saturated fat, unsaturated fat, and polyunsaturated fat? Does fluoride help our teeth, or hurt our kidneys?

Help! We're continually bombarded with advice on health issues. A recent New York Times headline (10 May 1995) read, "Amid Inconclusive Health Studies, Some Experts Advise Less Advice"!

The overabundance of health advice can, itself, be harmful to our health. Dr. Donald Louria, chairman of preventive medicine and community health at the New Jersey Medical School in Newark, told the New York Times (10 May 1995) that "the danger of [overselling health advice to the public] is that they will not believe the stuff we have that's documented." In other words, the bona fide, scientifically sound health advice gets lost in the crowd. Another physician, Dr. Walter Willett of the Harvard School of Public Health, worries about the "lack of distinction between wishful thinking and solid facts in health advice. When a new study contradicts conventional wisdom, people throw up their hands and decide not to believe anything scientists say" (New York Times, 10 May 1995).

The good news is that our health has never been better in the history of mankind! According to the National Center for Health Statistics, as recently as 1890 the average life expectancy for Americans was just over 31 years old. By 1930, the average life lasted just under 60 years — almost doubling in only forty years. By 1990, the average life expectancy had reached 75.4, the highest in history. Infant deaths have dropped by half over the past twenty years, to just over 9 babies in every 100,000 born today (Los Angeles Times, 11 September 1994).

In addition, the death rate from heart disease (the No. 1 killer) has dropped 27 percent since 1970. Deaths from stroke (the No. 3 killer) are down 44 percent. Smallpox is gone, and polio is almost gone. We can cure leprosy. Cancer deaths (the No. 2 killer) have increased, but this rise is mostly due to smoking and to the fact that we're living longer; other diseases don't get us first.

Nevertheless, in spite of this overwhelmingly good news, 78 percent of Americans still think that they face more risk than their parents did twenty years ago, according to researchers Marsh and McLennan in the Los Angeles Times (11 September 1994). Only 6 percent think that we face less risk. Why is this? It seems that we're scaring ourselves to death. The following information can help us sort through some of the many "scare stories" and the conflicting advice about our health.

BREAST CANCER SCARE

U.S. News and World Report describes "a breast-cancer epidemic": "Every three minutes, a woman is diagnosed, and every 11 minutes, a woman dies from the disease. It strikes one in eight women and kills 46,000 a year" (23 November 1992).

The National Breast Cancer Coalition sends a fundraising letter to millions of Americans. The letter reads, "We are at war. And our enemy is breast cancer. It attacks women brutally and indiscriminately. It has reached epidemic proportions in America.... And if you think you're safe because breast cancer doesn't run in your family, think again. Three-quarters of new cases are diagnosed in women who have no family history of the disease."

The concerns about breast cancer being reported in the media are important. This dreaded disease is deadly, disfiguring, and physically and emotionally painful even if "cured." It's true that breast cancer is on the rise. At the same time, women can't walk around in terror of breast cancer. In fact, many studies have shown that anxiety predisposes people to diseases such as heart disease and even cancer.

Let's try to sort through the rhetoric on breast cancer to identify the real risks and arrive at an intelligent approach for women to prevent the disease.

Outlook (6 May 1995) reports on how the Women's Health Letter breaks down that famous "one in eight women" statistic. Those 1-in-8 odds refer only to women who live to be ninety-five. Three-quarters of diagnosed breast cancers occur in women over fifty. Breast cancer is primarily a disease of elderly women. Thanks to medical advances, we have more elderly people alive today in our society than ever before in history. If we have more cases of breast cancer, it's because we have more older women. That's the "epidemic."

It's true that there are more cases of breast cancer in young women than there were sixty years ago, because there are more younger women today, especially the baby boomers. Our population has increased. The number of cases has grown, but the rate of cases — the percentage of people in that group who get breast cancer — has not changed. The actual risk itself hasn't increased.

The Women's Health Letter (6 May 1995) stated that the 1-in-8 statistic doesn't describe a woman's immediate risk. Rather, women have different risks at different ages, with the risk increasing as a woman ages. Specifically, according to a chart developed by the National Cancer Institute, "A 20-year-old woman has a 1-in-2,500 chance of developing breast cancer. At age 30, it's 1 in 233. At age 40, it's 1 in 63. At age 50, it's 1 in 41. At age 60, it's 1 in 28. At age 70, it's 1 in 24. At age 80, it's 1 in 16. And at age 95, it's 1 in 8."

Another reason why we might seem to be having a breast cancer epidemic is related to the sophistication of our medical technology. A specialist in breast cancer at the University of Southern California, Dr. Malcolm Pike, told the Los Angeles Times (13 September 1994) that "there's been an enormous increase in screening, in early detection, an enormous increase in the number of mammographic machines around." Dr. Pike believes that most of the increase in breast cancer cases is due to the increase in detection. We can't name something and turn it into a statistic if we don't know it's there. Sixty years ago, if a woman died of breast cancer, we might not have known what caused her death. Now we know.

This same medical technology that increases the statistics on cases of breast cancer also decreases the statistics on deaths from breast cancer. The National Cancer Institute (Los Angeles Times, 1 1 January 1995) reports that breast cancer deaths dropped 6 percent from 1989 to 1992 (only three years) because more women were screened and treated. Women whose breast cancer is detected early have up to a 93 percent chance of survival.

One of the problems in coping with the fear of breast cancer has been mixed messages from the experts. Just as a woman is about to rush out to get a mammogram to assure herself that she doesn't have breast cancer, she hears that mammograms might increase the risk of cancer because of the radiation in the X ray. In fact, the National Cancer Institute argues against women under fifty having mammograms. The woman rushes back home, only to read in the newspaper the next day that the American Medical Association and the American Cancer Society say that women in their forties should have mammograms.

Why so much media attention and so many mixed messages about breast cancer? Consider who is reporting the news. Four out of 10 newsroom workers are women, and many women feel (perhaps correctly) that women's health issues haven't received a fair shake from the media and thus from government funding. Breast cancer has become more than a health issue that reflects the actual incidence of the disease. It is a political issue. For that reason it gets more coverage than it otherwise would.

Breast cancer is also what journalists call a "sexy" issue — one that grabs attention. For example, a movie about a woman fighting breast cancer would receive more attention from the general public than a movie about a woman fighting heart problems, even though heart disease kills more women each year than breast cancer. Breasts are sexual; they have deep reproductive significance; they are central to a woman's own sense of her attractiveness; they flounce through men's fantasies. In American culture (unlike many others) women cover their breasts, implicitly making them even more special, not to be revealed to just anyone. Breasts are special to us; breast cancer, therefore, is also special (and especially frightening).

How about the allegation from environmentalists that pesticides have contributed to the so-called breast cancer epidemic? Research answers with a resounding no. The largest study ever on breast cancer was conducted by the Mayo Clinic in 1994. This study found no evidence that pesticides in our food cause breast cancer. Still, the proposition that pesticides cause breast cancer is another of the many scares put forth by environmentalists.

In fact, we might argue that indirectly, at least, pesticides help prevent breast cancer. Pesticides help farmers produce low-cost and plentiful fruits and vegetables. Many studies have shown that eating vegetables and fruit protects people from cancer. The Los Angeles Times (19 January 1995) reported on a recent Greek study that found that eating vegetables reduced a woman's risk of breast cancer by 12 percent. Fruits help prevent breast cancer by 8 percent. If a woman avoids fruits and vegetables because of the media's reports linking pesticides and cancer, she may be truly "scaring herself to death."

Let's get back to the quandary faced by the forty-year-old woman considering a mammogram. Should women under fifty have regular mammograms? Breast cancer might not be an epidemic, but it's still a risk, right? That's true — a risk that varies in seriousness for different women. If a younger woman has a family history (i.e., "high risk") of breast cancer, she should have mammograms. If she doesn't have this history and is under fifty, experts argue that she can probably go either way, depending on how "safe" she wants to feel and how much money she wants to spend. Mammograms cost money. Generally speaking, mammograms for low-risk women under forty don't make economic sense because mammography for women in this age group has not been shown to save any lives, according to a recent study by RAND, the think tank based in Santa Monica, California. Also, the composition of younger women's breasts makes it harder to see tiny tumors.

Women should not avoid mammograms because of fear of the radiation in X rays. The risk of the X ray pales in comparison to the benefit of the mammogram, even for women under forty. So if the X ray is the only thing coming between you and a mammogram that you should have, you're hurting not helping yourself.

For young women who are afraid to do breast self-examinations in the shower and in front of the mirror, take courage: you're very unlikely to find a tumor. But you will become more familiar with your breasts so that you won't panic one morning when you snap on your bra and think you feel a little knot that, in reality, has been there all the time. You'll also know what your breasts are like so that as you age, entering into higher risk groups, you can (quite literally) save yourself from invasive breast cancer.

AMPLE ENDOWMENT: THE PUMPED-UP HYSTERIA OVER BREAST IMPLANTS

The largest product-liability settlement in American history — $4.25 billion — was reached in September 1994. Over ninety thousand women have filed claims to receive compensation awards ranging from $105,000 to $1.4 million, depending on their medical condition and their age when their symptoms first appeared. While the final disposition of this case is still uncertain — plaintiffs, claims administrators, and lawyers are still haggling over many parts of it — it is clear at this point that the companies involved in making breast implants will be shelling out at least the $4.25 billion already agreed to in the settlement.

Why are these women being awarded such ample endowments? Because, they claim, their health has been placed at severe risk by the breast implants they received. They claim that their implants cause cancer, rheumatoid arthritis, short-term memory disorders, lupus, other immune disorders, and fevers, aches, and chills. They assert that the main manufacturer of breast implants, Dow Corning, hid scientific evidence for twenty years that silicone, the most important ingredient in implants, suppresses the immune system.

It would seem that a settlement of $4.25 billion implies an admission of guilt by Dow Corning. But this isn't the case. Dow Corning (and other manufacturers of breast implants and their components) agreed to the settlement to avoid the legal costs of individual lawsuits, but they do not admit that breast implants cause harm. On the contrary. The companies insist that breast implants don't cause cancer, immune system disorders, or any of the other diseases claimed by the women.

The implant manufacturers aren't simply trying to deny guilt. There is strong medical evidence that implants don't cause the symptoms claimed by the women. This should come as good news to the two million women who have implants, and who have been unnecessarily terrified by the hype against implants.

Doctors have also contributed to the hype. Many of them have their own agendas behind either banning or promoting implants. For example, The Los Angeles Times (9 September 1994) ran an op-ed piece by Dr. Samuel Epstein, a public health professor at the University of Illinois at Chicago and chairman of the Cancer Prevention Coalition. Dr. Epstein claims that breast implants, particularly polyurethane-wrapped implants, are horribly dangerous and that Dow Corning is a first-class villain. As Dr. Epstein put it, "Polyurethane-wrapped implants are ... carcinogenic sponges." That's a highly politicized way of discussing risks, even if it were true.

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Excerpted from Are We Scaring Ourselves to Death? by H. Aaron Cohl. Copyright © 1997 Affinity Communications Corp.. Excerpted by permission of St. Martin's Press.
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