For many women, getting a Pap test, which screens for cervical cancer, is an annual ritual.

Perhaps no longer. According to new guidelines issued today by the American College of Obstetricians and Gynecologists (ACOG),

• Women between the ages of 21 and 30 should have a Pap test every two years

• Women aged 30 and older who have had three consecutive negative Pap tests may be screened every three years; and

• Women aged 65 and older can stop getting a Pap test if they’ve had three negative tests in a row and no abnormal tests results for 10 years.

Furthermore, the ACOG recommendations suggest that women receive their first screening at age 21. Previous recommendations had called for young women to be screened within three years of becoming sexually active or at age 21, whichever came first.

Cervical cancer is caused by a very common sexually transmitted virus known as the human papillomavirus (HPV). The American Cancer Society reports that about 11,000 new cases of cervical cancer will be diagnosed this year, and about 4,000 women will die from it.

First, do no harm

According to ACOG, the purpose of the new guidelines, which were published in the December issue of Obstetrics & Gynecology, is to reduce unnecessary testing — and to prevent the potential harm and anxiety that many women experience from unnecessary treatments.

In a press release, Alan G. Waxman, MD, the University of New Mexico physician who led the ACOG committee that revamped the guidelines, made the following statement: "The tradition of doing a Pap test every year has not been supported by recent scientific evidence. A review of the evidence to date shows that screening at less frequent intervals prevents cervical cancer just as well, has decreased costs, and avoids unnecessary interventions that could be harmful."

The potential harm from over-testing is particularly high for young women.They’re more likely to develop cervical abnormalities that look precancerous, but that frequently go away on their own. Yet, if these abnormalities are found on a Pap test, physicians are likely to recommend that they be removed — a process that may damage the cervix and cause problems later when the woman becomes pregnant, including an increased risk of premature birth.

A coincidence?

Yes, it may seem strange that these recommendations came out during the same week as the U.S. Preventive Services Task Force’s (USPSTF) highly controversial recommendations for breast cancer screening.

But, no, there was no conspiracy. And these recommendations have nothing to do with any hidden agenda to ration healthcare. Reports the New York Times:

Furthermore, ACOG strongly rejected the USPSTF's mammography recommendations of earlier this week.

Curiouser and curiouser

I suspect that these new Pap guidelines will cause very little controversy, particularly as many physicians have been informally following them for several years.

Yet I also find it curious that the same evidence-based arguments being used to support these guidelines — “new medical information,” “unnecessary testing,” "harmful unnecessary interventions” — are being accepted for cervical screening but not for breast cancer screening.

In fact, for those people so concerned about health-care rationing, ACOG clearly states that the cost of Pap testing was a factor in its recommendations. Cost was not a consideration in the USPSTF's mammography recommendations.

In a very curious interview this morning on CBS TV, Dr. Bernadine Healy, now health editor for U.S. News and World Report, claims the ACOG guidelines are “prudent and sensible” while the USPSTF ones on mammography are “an assault on patient-doctor choice.”

Furthermore, she made the even stranger statement that a woman’s Pap decision “needs to be a choice between a woman and her doctor. That [decision] should not come from the White House.”

Healy doesn’t explain why she believes the Pap guidelines would not get between patient and doctor while the mammography recommendations would. Both guidelines are issued as recommendations, not policy.

And, as I’ve pointed out before, USPSTF is not a government agency. It’s a panel of independent experts — just like the ACOG panel.

Both groups looked at the scientific evidence and came to their best-judgment conclusion. Women can now use that information to decide how they want to individually proceed with cancer screening.

Yet the political posturing and fear-mongering regarding the proposed changes in mammography screening continues.

I expected some controversy and debate about the U.S. Preventive Services Task Force’s new recommendations about breast cancer screening, but nothing as virulent as what has occurred over the past few days.

Nor did I anticipate the rampant, breathless fear-mongering rhetoric that has framed much of the media’s response to the recommendations.

Press reports around the country, especially TV ones, seem to have focused primarily on individual women and doctors who are “outraged” about the recommendations (which essentially say that women who are not at high risk for breast cancer can wait until age 50 to begin screening mammograms, and that even then, getting a mammogram only every other year is fine).

On ABC’s daytime talk show “The View,” co-host Elisabeth Hasselbeck made the stunning claim that the recommendations were “gender genocide.”

Gender genocide? Really? (More about that in a minute).

Politics, alas, rears its head
People opposed to national health-care reform quickly jumped on the recommendations as “the first step toward that business of rationing care based on cost” (Rep. Phil Gingrey, R-Ga.).

Rep. Sue Myrick (R-N.C.), a breast-cancer survivor, is quoted in the New York Times as saying she didn’t think a government commission “should be engaged in decisions like this between a woman and a doctor.”

“My concern,” she added, “is that we’re basically sending a message that you don’t have to take care of yourself when we’re trying very hard to do prevention in this country.”

Cost wasn't a factor
Let’s clear up some things. First, the U.S. Preventive Services Task Force is an independent group of physicians and academic experts, not a government agency that makes policy. And, indeed, as Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, said in a written statement issued Wednesday, “The Task Force has presented some new evidence for consideration but our policies remain unchanged.”

Sebelius suggested that women “keep doing what you’ve been doing for years — talk to your doctor about your individual history, ask questions, and make the decision that is right for you.”

Second, the task force recommendations state quite clearly that the decision about screening mammography before age 50 “should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms.”

Oh, and for the record: The task force specifically did not factor the cost of screening into their recommendations. The recommendations are based on the latest scientific studies. That's all.

Don’t worry your little head?
A lot of the fear-mongering about these new recommendations has centered on the idea that somehow they’ll “confuse” women — that we women won’t understand what to do with this news and therefore might, heaven forbid, make the “wrong” decisions. (Listen carefully to the doctors on this Wednesday segment of ABC’s “Good Morning America” show and you’ll hear that patronizing message under much of the discussion.)

Give me a break. I want as much information as I can get — no matter how “confusing” or scientifically complicated and nuanced it is — when I make decisions about my personal health.

Remember the non-nuanced advice women got for decades about menopausal hormone replacement therapy? I’d rather weigh the information myself, thank you very much.

And then there’s the narrative — perhaps most pointedly made by Hasselbeck’s “gender genocide” comment — that somehow these recommendations are evidence of forces in the medical community (and in the government) that are willing to sacrifice women’s health to save a few bucks.

Again, give me a break. First, there’s nothing new about this mammography debate. And among the people who have been raising questions about this issue the longest are some of the greatest advocates for women’s health — groups like the National Women’s Health Network (NWHN), which first raised doubts about the value of mammography screening in women under age 50 back in 1993.

Here’s what Cynthia Pearson, long-time executive director of the NWHN, wrote on the organization’s website Tuesday:

Too bad that her outrage isn’t getting heard in the media.

Before you finish reading this article, you’ll probably yawn.

That is, if you haven’t already done so, just from reading the headline.

As we all know, yawning is very contagious — so much so, that even thinking or reading about yawning can trigger the reflex.

What you may not know, however, is that yawning is also contagious among chimpanzees. Or that yawning can be contagious across species: Your yawning may cause your dog to do the same. (Skeptical? Here's a video.)

We humans tend to yawn (on our own) when we’re tired, bored or hungry. But, as biologist Steve Jones asks in a recent article in the British newspaper the Telegraph, “Why?”

That’s the question that continues to stump scientists.

Several theories
“Dogs do it, lions do it, even babies in the womb do it — but nobody really knows why,” writes Jones. “Theories abound. ... Some have suggested that a sudden drop in blood oxygen, or a surge of carbon dioxide pumped out by a tired body, sparks it off — but no, breathing air rich in that gas, or with extra oxygen, makes no difference.”

Other theories:

• Yawning helps cool the brain.True, notes Jones, we do tend to yawn more on hot days than on cold ones. But we yawn less often when we have a fever.

• Yawning signals an impending change of state — a “general preparation for some new mental experience,” says Jones. Parachutists, he points out, often yawn before they jump.

• Yawning is a form of erotic posturing and, thus, linked to sex. A paper presented at a recent scientific meeting on sexual medicine, Jones reports, described how women with depression who were given a particular (unnamed) mood-altering drug “immediately went into uncontrollable bouts of yawning, accompanied by repeated orgasms over many hours.”

Hmmm ...

A sign of empathy?
There's a growing scientific concensus around the idea that yawning’s contagiousness is a signal of empathy, the “ability to understand and to react to someone else’s state of mind,” Jones says. Research suggests that people with autism, who often have impaired empathy, are less likely to “catch” a yawn from someone else, he points out. And some research suggests that how quickly a person responds to someone else’s yawn may be an objective measurement of how empathic he or she is.

Although chimps “catch” yawns (even in reaction to a yawning computer avatar), they tend to do so as a “statement of dominance rather than sympathy (with a strong hint of sexual aggression built in),” says Jones.

The fact, then, that we humans tend to discreetly and politely cover up our yawns with our hands, may be “a deep insight into what it means to be human,” says Jones, “a sign of an ancient shift from a quarrelsome and sexually violent mental universe to a generally cooperative and agreeable one."

In case you missed it during last night’s newscasts or this morning's talk shows, the U.S. Preventive Services Task Force has made a huge about-face with its breast cancer screening recommendations.

Based on the latest string of studies (which I’ve posted about frequently, for example, here), this independent panel of prevention and primary-care experts now recommends the following:

• Women should start having screening mammograms at age 50 rather than at age 40.
• Women between the ages of 50 and 74 should have mammograms every two years rather than once a year. (The task force says current evidence is insufficient to determine whether the benefits of screening mammography outweigh the potential harms for women aged 75 and older.)
•  Doctors should stop instructing women to conduct regular breast self-exams. (The task force said that there’s insufficient evidence to know whether clinical breast exams — those done by doctors — were beneficial.)

(These recommendations are not, however, for high-risk women — those with a strong family history of the disease, for example.)

Writes the New York Times:

Dr. Petitti also told the Times that although she knew the new guidelines would be a shock for many women, “we have to say what we see based on the science and the data.”

According to the Times, the National Cancer Institute is now considering revising its breast-cancer screening guidelines as well. But the American Cancer Society, the American College of Radiology, and (according to Bloomberg News), the American College of Obstetricians and Gynecologists have announced their intention to continue to recommend annual mammograms starting at age 40.

UPDATE: On Tuesday, the Mayo Clinic in Rochester announced that it will not be changing its screening recommendations, but will be sticking with its current ones, which encourage women to get annual mammograms starting at age 40. Mayo also intends to continue to promote both breast self exams and annual clinical exams.

Right now, it’s unclear how these new guidelines will affect insurance reimbursements for mammograms. Some people (I heard it being discussed on MSNBC this morning) are already charging that this change in recommendations is being done more to control health care costs than to improve health.

Those people, I politely suggest, haven’t really examined the research. Nor, I think, have they considered that all the money spent on unnecessary mammograms (and the often resulting unnecessary biopsies and treatment) could be much better allocated. As the women’s health advocate (and long-time believer in a more evidence-based approach to mammography) Dr. Susan Love blogged yesterday: “We need to help women understand what mammography can and cannot do, and focus on finding the cause of breast cancer and preventing it altogether.”

The new guidelines were published in the Annals of Internal Medicine, which you can read in full here.

The manufacturers of bisphenol-A (BPA), the controversial compound found in literally thousands of consumer products (including many food containers), took a big PR blow last week with the publication of a new study linking BPA with male sexual dysfunction.

The study, funded by the U.S. government and published in the journal Human Reproduction, is the first to investigate the impact of BPA on the human reproductive system. Previous studies had uncovered disturbing adverse health effects on laboratory animals, including damage to the brain and nervous system and cellular changes associated with breast and testicular cancer.

For the current study, researchers followed 634 male factory workers in China over five years. The men who were exposed to high workplace levels of BPA reported significantly more sexual dysfunction than their peers who worked in factories where BPA wasn’t present.

Specifically, the BPA-exposed workers were four times more likely to experience erectile dysfunction and reduced sexual desire and seven times more likely to have difficulty with ejaculation.

And the sexual problems developed within only months of taking a job with high BPA exposure.

True, the levels of BPA exposure experienced by the Chinese workers were 50 times those faced by the average American man. Yet this study raises the troubling question of whether lesser levels of the chemical could also affect sexual function.

An interesting perspective

Blogging for U.S. News and World Report, physician-journalist Ford Vox, MD, brings up an important point about the just-published study: The factory workers in this study inhaled the BPA particles at their workplace. In the U.S., BPA typically enters the body through the digestive system. Could that make a difference? Writes Vox:

The study’s authors, Vox reports, are already diving into the data to see if different levels of BPA in the control population correlate with different levels of sexual complaints. “That study will mean much more to American men,” says Vox.

Vox also points out that BPA may be among men’s “least likely excuses for sexual misfires.” He writes:

Reducing your exposure

Limiting exposure to BPA is not easy, however. In its December issue, Consumer Reports published a study that found BPA leaching into the food of almost all the metal food cans it tested — including those labeled “BPA-free” or “organic.”

The highest levels of BPA were found in canned green beans and canned soup.

“A 165-pound adult eating one serving of canned green beans from our sample, which averaged 123.5 ppb, could ingest about 0.2 micrograms of BPA per kilogram of body weight per day, about 80 times higher than our experts' recommended daily upper limit,” notes Consumer Reports. “And children eating multiple servings per day of canned foods with BPA levels comparable to the ones we found in some tested products could get a dose of BPA approaching levels that have caused adverse effects in several animal studies.”

Consumer Union, which publishes Consumer Reports, has called for Congress and food manufacturers to eliminate BPA from all materials that come in contact with food. (The Food and Drug Administration is currently reassessing the safety of the chemical.)  In the meantime, it recommends that you take the following three easy steps to reduce your exposure to BPA:

• Choose fresh food whenever possible.
• Consider alternatives to canned food, beverages, juices and infant formula.
• Use glass containers when heating food in microwave ovens.

Believe it or not, a handful of studies have actually investigated this issue. After all, superstitious beliefs can affect behavior, and behavior definitely affects health.

But let me quickly reassure those of you who might be slightly paraskevidekatriaphobic (irrationally fearful of Friday the 13th): Although few and small, the studies on this topic strongly suggest that you’re not at increased risk of having an accident  today — well, unless your fear and anxiety about today gets the better of you.

A gender dispute
I’ll start with the completely good-news study: In 2008, statisticians working for a Dutch insurance company reported that people in the Netherlands experienced fewer accidents (and fires and thefts) on Fridays that fell on the 13th of the month than on Fridays that fell on other dates  (7,500 versus 7,800 reports, on average).

On the other hand, a 2002 Finnish study came up with a more worrisome finding. It reported that on Friday the 13th, the risk of dying in a traffic accident for women (not men) increased by 63 percent. The study’s author suggested that the increased risk might be caused by women’s “twice-as-high prevalence of neurotic disorders and anxiety symptoms,” which makes them “more susceptible to superstition and worsening of driving performance.”

Needless to say, that finding didn’t go down well, particularly when all sorts of methodological problems were found with the study. A couple of years later, two other Finnish researchers reported that their investigation revealed no increase in traffic accidents — among women or men — on Friday the 13th.

“However,” they concluded, a bit ominously, “this does not imply a non-existent effect of superstition related anxiety on accident risk as no exposure-to-risk data are available. People who are anxious of ‘Black Friday’ may stay home, or at least avoid driving a car.”

Will the boss agree?
By far, though, my favorite study on this topic (for its readability alone) remains a 1993 one published in the British Medical Journal. It made the slightly startling finding that although fewer British people drove on Friday the 13th, compared with other Fridays, driving-related accidents increased by as much as 52 percent on that day.

The authors’ must-be-tongue-in-cheek conclusion: “Staying at home is recommended.”

Here’s what they say:

Now, how to convince the boss?

Whether you call it an epidemic or not (epidemic is a term that gets tossed around a bit too casually these days), there’s no denying the fact that the rates at which people are being diagnosed with nearsightedness (myopia) is truly astounding.

Particularly in Asia. In some Pacific-rim countries (Hong Kong, Taiwan, Singapore), about 80 percent of young adults are now myopic.

In Western countries, the rates of myopia seem to currently fall between 30 and 50 percent — and are rising, by some accounts.  The U.S. rate is at the lower end of that scale.

An article published recently in New Scientist explores the various theories about why myopia may be on the rise. Without a doubt, genetics plays some role. (Twin studies have confirmed this.) But, as reporter Nora Schultz points out, “genetics alone can’t explain the condition.”

Reading out, exercise in?
Because nearsightedness seems to be more common among highly educated people, some scientists have proposed that it's somehow linked to reading, computer use and other “near work.”

Here’s the theory: When young children are, say, reading "Green Eggs and Ham," the lenses in their eyes develop a new elongated curvature that enables them to focus on the book’s small print. This helps the children with the visual task of reading, but the new curvature makes their eyes less able to see things at a distance.

Sounds reasonable. Research, however, has failed to support that theory.

Then, a couple of years ago, a study reported that 8-year-olds who spent more time engaged in outdoor sports and activities (12 versus 8 hours a week) were less likely to become nearsighted three years later, at age 11. Further research suggested that it was the time spent outside, not the physical activity per se, that offered the protection. (Kids who played indoors sports didn’t experience any benefits to their eyesight.)

A team of researchers decided to see if this theory could explain the incredibly high rate of myopia in Asia. Writes Schultz:

Why would the outdoors have such an effect? Some research suggests, says Schultz, that sunlight slows down myopia-associated growth of the eyeball, perhaps by causing the retina to produce high levels of dopamine, a brain chemical known to inhibit eye growth.

(Of course, too much sun can also damage the eyes in ways that can lead to cataracts and other serious vision problems later in life. Schultz doesn’t address this issue in her article.)

Other possibilities
Researchers are also exploring the possibility, reports Schultz, that myopia may be more related to what’s going on in our peripheral vision than in our central vision (which may explain why cornea refractive therapy — the wearing of hard contact lenses overnight to temporarily reshape the cornea — has been found to slow the progression of myopia by about 50 percent).

And then there’s the highly controversial theory that the rising rates of myopia are linked to high blood-sugar levels caused by the world’s increasing consumption of refined carbohydrates.

Whatever scientists eventually identify as the main cause behind the current skyrocketing incidence of myopia around the world, I'm thinking that, at least in the near future, investing in the stocks of a few eyeglass manufacturers might not be a bad way of tip-toeing back into the stock market.

The good news: Despite how challenging, annoying and frustrating (hey, we’ve all been there) a weight-loss diet can seem at the beginning, if you stick with it, you’re likely to feel happier within a few weeks.

The bad news: If you’ve chosen a low-carb weight-loss plan (like the Atkins diet), that improved mood may fade away. After a year, you’re likely to feel the same as before you began to shed pounds.

Your mood won’t be any worse, but it won’t be any better, either.

That’s the central finding from an Australian study published this week in the Archives of Internal Medicine. The researchers enlisted 106 overweight and obese volunteers, who were randomized to either a low-carb, high-fat diet (like Atkins) or a high-carb, low-fat diet (like the “Mediterranean” diet).

At the end of a year, both groups had lost about the same amount of weight (on average, about 30 pounds each), and both also scored about the same on tests that measured their short-term memory and speed-of-processing thinking skills. (The memory skills, by the way, improved for both groups.)

But, the people on the low-fat diet were more likely to enjoy a sustained boost in mood. Specifically, at the end of the year they scored better on tests that measured anger-hostility, confusion-bewilderment and depression-dejection.

Harder to follow?
Why would a low-fat diet be better at enhancing mood over the long run?

The researchers aren’t sure, but they speculate that it might be tougher to adopt a low-carb diet in our Western culture, which tends to favor carbohydrates like bread, pasta, rice and fruit. Or low-carb diets may just be harder for individuals to follow. Both factors could dampen a low-carb adherent's mood.

Or, it may be that low-carb diets produce less serotonin, the brain chemical associated with feelings of happiness and well-being.

It’s important to note, however, that the mood states of both groups fell well within the normal range for healthy adults throughout the study. So we’re not talking about any major emotional problems here.

Nor is this study the final word on this topic.

Still, it would be nice to feel somewhat happier after losing 30 pounds, wouldn’t it?

Pharmaceutical companies fight tooth and nail to keep physicians (and patients) from switching to generic versions of their brand-name drugs after the patents for their drugs expire.

After all, billions of dollars are at stake.

One way the pharmaceutical companies wage this battle is to persuade physicians that the generic drug (whose bioavailability must be 80 percent to 125 percent of that of the original drug) is not only inferior, but potentially harmful.

The strategy works beautifully, even when the data behind the brand-name-drugs-are-superior claims are, at best, very weak — and can be traced to, um, not exactly neutral, nonbiased sources.

A case in point: generic antiepileptic drugs. 

Two articles (extracts here and here) in the November issue of the Archives of Neurology debate whether brand-name antiepileptic drugs offer enough of an advantage to outweigh their huge additional cost — particularly since that cost causes some people (those for whom the drugs aren’t covered by health insurance — where have we heard this story before?) to stop taking them, or to take them only intermittently.

In a rather pointed editorial that accompanies the articles, pediatric neurologist Steve Roach, MD, charges physicians with being gullible.

“When the price of eggs rose to unprecedented levels in 1966, President Lyndon B. Johnson ordered his surgeon general to decrease demand by warning his fellow Americans of the health hazards of egg consumption,” Roach writes. “The evidence against the lowly egg was at best shaky, and recent studies suggest that the health risks from eggs, if any, were greatly exaggerated. Nevertheless, millions of health-conscious Americans dutifully altered their diets, secure in their belief that eggs must be bad for one’s health. Are we physicians so gullible and easily manipulated that we could possibly fall for such an arrogant ploy? Evidently, because most physicians of the day accepted the marginal idea that eggs are worse than other foods with the same lack of skepticism that many neurologists today display toward the notion that generic antiepileptic drugs (AEDs) pose a frequent patient risk.”

“The data supporting an increased seizure risk after conversion to generic AEDs are weak,” he continues. “Carefully designed comparison studies of the caliber required by the FDA to initially establish a drug’s safety and efficacy do not exist.”

Why, then, do physicians continue to believe that the generic anti-epileptics are inferior?

“It is important to recognize potential sources of bias and conflict of interest when analyzing the suitability of generic drugs,” writes Roach. “The cost of developing and marketing a new drug is huge, so it is easy to understand the desire to continue selling an expensive brand-name drug after its patent has expired. The fact that many of the articles promoting brand-name AEDs over generic drugs have been written by individuals who are employed by AED manufacturers or those receiving personal financial and research support from these companies does little to promote confidence. What is difficult to explain, however, is how usually questioning physicians could accept such weak arguments without even a trace of skepticism or a demand for more evidence.”

One more reason medical costs have gone through the roof.

In the first volume of his autobiographical novel "In Search of Lost Time" (or, if you prefer, "Remembrances of Things Past"), Marcel Proust famously wrote about how the odor (and taste) of a small French cake (petite madeleine) dipped in tea evoked highly emotional memories of his childhood.

In recent years, scientific studies have confirmed a strong link between odor and memory. Last week, a team of Israeli researchers reported in the journal Current Biology that the reason we associate particular odors with childhood may be because something unique goes on in our brain during our first, but not our subsequent, encounters with a smell — something that may leave a lasting impression, for better or for worse.

Researchers at the Weizmann Institute of Science in Israel presented adult volunteers with images of 60 objects. During each presentation, a machine called an olfactometer emitted either a pleasant or an unpleasant odor. The volunteers were then asked to look at the images a second time and to try to recall which odor was associated with which image. During this part of the experiment, the volunteers underwent fMRI imaging, which measures neural activity in various areas of the brain. Finally, the entire process was repeated — with the same images, but with different odors for each.

A week later, the volunteers were brought back to the lab to have their brains scanned again while reviewing the images and trying to recall the odors that had been emitted when they saw them before.

Unique brain-activity pattern created
The researchers found that people remembered the earlier of the two image-odor associations best if it had been unpleasant. But — and this was the really interesting part — they also found that the first image-odor association created a unique pattern of brain activity, even if both odors were equally remembered. This "signature" activity appeared in two brain structures: the hippocampus (key to memory formation) and the amygdala (crucial to the processing of emotions).

So strong was the brain activity pattern that the researchers could accurately predict from the fMRI readings taken on the first day of the experiment which associations a person would remember the following week.

The researchers repeated the study using sounds, but found that auditory experiences had no similar imprint on the brain.

Proust was on to something. Our first associations with an odor may be the ones we carry with us all our lives.

(On a completely non-health-related — but definitely Proustian-related — topic, I recommend Germaine Greer’s curmudgeonly article, “Why Do People Gush over Proust? I’d Rather Visit a Demented Relative,” in last weekend's Guardian newspaper.)