CHANCE News 1.09
              (7 Nov to 13 Nov 1992)

Prepared by Laurie Snell

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>>>>>==========>> Mostly medical news this week. I couldn't even find out if the LA Rams continued their 12 game coin tossing streak. Your money matter. Wall Street Journal Nov 10 John R. Dorfman An account of the next round choices in the continuing contest between the Dartboard portfolio and professional investors. "Professional investors outperformed a randomly selected dartboard portfolio in the contest that ended Oct. 30 -- redeeming the honor of the pros, who had lost out to the darts in the previous four outings. Professional stock pickers now lead the forces of chance 16-13 after a series of 29 overlapping six-month contests" <<<========<<

>>>>>==========>> An old article but one that came up in discussion of this weeks news on breast cancer studies. Better Odds; Faulty Math Heightens Fears of Breast Cancer. The New York Times, 15 May 1992, Sec 4 Page 2 This article discusses some problems with American Cancer Society often quoted statement that the odds of getting breast cancer are 1 in 9. It turns out that this means that the probability of getting breast cancer sometime between birth and 85 is 1/9. (The more recent 1 in 8 comes from increasing the 85 to an even larger number.) The article argues for taking age into account since this cancer is most common in older women. Obviously, family history is also relevant. <<<========<<

>>>>>==========>> Mammogram benefits questioned in study. Los Angeles Times; Nov 14, 1992; Part A page 27 Report of a study to appear in the Canadian Medical Assn. Journal on the effect of mammogram screening for breast cancer. This study looked at two groups of women with no history of breast cancer: more than 50,000 ages 40 to 49 and almost 40,000 in the 50-59 age range. Both age groups were randomly divided, with half of each group receiving annual mammograms plus physical breast examination and the remainder given physical exams only. All were encouraged to perform monthly breast self-examinations. In the younger group more women from the mammogram group had died of cancer after seven years -- 38 compared to 28 but the difference was not considered significant. For women ages 50 to 59, the addition of mammography more than doubled the number of breast cancers detected compared to physical exam alone but at seven years, the total number of deaths from breast cancer was virtually the same -- 38 among women who had received regular mammograms and 39 among those who did not have the X-rays. <<<========<<

>>>>>==========>> Study finds many heterosexuals are ignoring serious risk of AIDS. The New York Times; 13 Nov 1992 A16 An account in this weeks Science of a survey carried out by Joseph Catania of more then 10,000 Americans questioned by phone about their sexual practices. The study found that heterosexuals do not behave as if they consider themselves to be at risk for AIDS and Catania warns that the United States could develop an AIDS picture similar to that of Africa, where 75 percent of all AIDS patients are heterosexual. <<<========<<

>>>>>==========>> Study sees excess in x-rays of heart. The New York Times, 11 Nov 1992, A16 Lawrence K. Altman Report of a study reported this week in the Journal of the American Medical Association which concludes that about half the special x-ray procedures (coronary angiograms) to examine the heart are unnecessary or could be safely put off for long periods. The study followed the history of 171 patients who were referred for a second opinion as to whether they needed an angiogram. Not a very big study. <<<========<<

>>>>>==========>> Edge of the Chasm -- AIDS comes to Asia. The New York Times, 8 Nov 1992, Sec 1 page 1 Philip Shenon A long and depressing account of the rapid spread of AIDS in Asia. "Conservative estimates suggest that by the end of the decade, the H.I.V virus will infect more than one million Asians each year, more than in the rest of the world combined." The World Health Organization reports that more than three quarters of all H.I.V. infections now develop from heterosexual encounters. Even though it is estimated that over a million people in India alone are now infected with H.I.V. virus the death toll in Asia so far is thought to be less than 15,000 making the disease an invisible threat. <<<========<<

>>>>>==========>> The viewpoint section of the 7 Nov. 1992 Lancet features two opposing views of the current national clinical trials study to see if Tomixifen can prevent breast cancer. Socioeconomic status and risk for substandard medical care. H. Burstin, S. Lipsitz, and T. A. Brennan Journal of American Medical Association 4 Nov 1992, Vol 268. No. 17. This article and another similar article in the same journal seemed to have been timed to come out on election day. Rates of medical injury and substandard care by gender, race, income, and payer status were developed from reviews of 30,195 medical records in New York in 1984. In a univariable analyses Black patients or patients with low income seemed to be at a higher risk for substandard care but a multivariable analyses revealed that these were not independently associated with risk and differences can be accounted for by level of insurance -- the uninsured are at risk for substandard care. !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! CHANCE News 1.09 (7 Nov to 13 Nov 1992) !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Please send suggestions to: jlsnell@dartmouth.edu