Small Press Bookwatch

The Health/Medicine Shelf

The Death Of Mammography
Rene Jackson & Alberto Righi
Caveat Press
PO Box 3400, Ashland, OR 97520
0974524530 $19.95 www.rjacksonrn.com

Co-authored by Rene Jackson (Special Procedures Nurse in Medical Imaging at Charlotte Regional Medical Center, Punta Gorda, Florida) and Alberto Righi (Medical Director of a radiology group in Florida), The Death Of Mammography: How Our Best Defence Against Breast Cancer Is Being Driven To Extinction is an in-depth and thought-provoking study of the beneficial diagnostic tool of mammography and the legal and economic challenges this procedure is encountering. Comprehensively analyzing the positive use of the use of the mammogram, The Death Of Mammography provides readers with a clear description of breast cancer and treatment options, explains mammography technology, reveals how legislative and legal issues are restricting breast-cancer screening, and realistic solutions and reforms. The Death Of Mammography is very strongly recommended for non-specialist general readers and health activists involved with the issue of breast cancer and mammography.

Volume 6, No. 2 www.floridawriters.net Spring 2006 

The Florida Palm accepts only FWA member books for review. Books must be published within the past year, or scheduled for future publication to be considered.
Book Review

by Kathleen O’Connor

The Death of
Mammography
by Rene' Jackson, RN BSN MS
and Alberto Righi, MD
ISBN: 0974524530
Publisher: Caveat Press
(March 20, 2006)
Paperback: 245 pages

The Death of Mammography belongs on the reference shelf of every woman and healthcare provider. This well-researched book, co-authored by Rene Jackson, RN BSN MS and Alberto Righi, MD, provides a thorough overview of the history and treatment options for breast cancer and gives a compelling account of why we may be losing our most effective screening procedure for providing early diagnosis. Mammography is a woman’s best chance for early detection of breast cancer and early screening does save lives. But the tool has its limitations and can fail to detect up to 30% of cancers for a variety of reasons. According to the authors, over-optimistic news reports and well-meaning but misinformed groups have led some women to have unreasonable expectations of mammography. The results are increased litigation and skyrocketing costs for malpractice insurance for radiologists. Because of this, fewer radiology students are specializing in mammography and over 700 mammography centers have closed their doors. This leads to longer wait times and decreased access to the screening tool. This book is very readable and is clearly divided into sections. The early chapters provide a thorough and current explanation of the biology, prevention and treatment of breast cancer. The authors then make an eloquent case for explaining that we have no infallible screening tool for breast cancer but that what we do have helps many women.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Book Reviewer Kathleen O’Connor is the
author of three novels: No Accident (Port Town
Publishing), The Way it Happens in Novels
(Ballantine Books) and No Doubt (Whiskey
Creek Press, May 2006).

The Death of Mammography

1/24/2006

The Death of Mammography by René Jackson and Alberto Righi
Caveat Press, Ashland, OR, 2006, $19.95

The current medical liability crisis endangers not just mammography, but every aspect of clinical care. The Death of Mammography by Rene Jackson and Alberto Righi provides an explanation of the nature of this litigation crisis in the U.S. and its detrimental effect on access to care.

The authors describe the pathology, diagnosis, and treatment of breast cancer in language that allows non-medical experts to understand the concepts. The rationale and controversies of breast cancer screening, and the biases associated with screening, are visited, but with the emphatic conclusion that screening does indeed save lives.

The authors go to some length to explain the fallibility of mammography, the errors of perception, the important concept of hindsight bias, and the economic cost of defensive medicine. The authors are quick to point out, however, that despite its limitations, mammography remains the single best test for the early detection of breast cancer.

Every chapter begins with a narrative that follows a real-life court case. The increasingly familiarly scenario involves a radiologist being sued for not following an area of asymmetry in a patient's mammogram, with the woman later developing breast cancer. As the story unfolds, the suspense builds up to the jury’s verdict. The reader cannot help but feel sympathetic for the defendant radiologist whose professional confidence and belief in the special doctor-patient relationship is severely eroded.

The authors make a candid assertion that the malpractice crisis is economically driven. This cycle is perpetuated by trial lawyers' associations that donate money to politicians who oppose tort reforms, according to Jackson and Righi. The ethics and integrity of the plaintiffs' expert witnesses is also questioned. However, there is no commentary in the book from expert witnesses in which they address accusations of inaccurate testimonies because of financial motivation. This makes the authors' arguments one-sided.

Overall, The Death of Mammography is eminently readable with an appropriate balance of fact and opinions. The radiologist is certain to be humbled by the imperfection of imaging and find him or herself feeling empathetic to a colleague that has been involved in a medical lawsuit.

By Saurabh Jha
AuntMinnie.com contributing writer
January 24, 2006

Dr. Jha is a fourth year resident in diagnostic radiology at the Hospital of the University of Pennsylvania in Philadelphia. Upon completing residency in June 2006, Jha will pursue a fellowship in cardiovascular imaging.

The opinions expressed in this review are those of the author, and do not necessarily reflect the views of AuntMinnie.com.

Copyright © 2006 AuntMinnie.com

"The Death of Mammography" by René Jackson, RN, BSN, and Alberto Righi, MD

Review by Leonard Berlin, M.D., F.A.C.R.

Few subjects are characterized by as much discordance between public perception and reality as is breast cancer. Surveys disclose that the public’s perception is that women have a 40% chance of dying from breast cancer, yet the reality is that their chance of dying from this disease is 4%. The public’s perception is that if women develop breast cancer, mammography is virtually 100% accurate in finding the cancer in its earliest stage, thus assuring that women will be cured. The reality is that mammography may miss up to 30% — perhaps even more — of breast cancers, and furthermore, even if the cancer is detected in its earliest stage, some women will die of the disease anyway.

There is one aspect of breast cancer in which perception and reality are not discordant, however, but rather in accord: the perception that if a woman undergoes mammography and the radiologist who interprets the mammogram fails to detect a cancer, some semblance of which can later, in retrospect, be seen, the woman clearly has been harmed, the radiologist certainly has been negligent, and thus women should sue the radiologist for medical malpractice. The reality bears out the perception: medical malpractice litigation alleging delay in diagnosis of breast cancer is the most prevalent condition for which malpractice lawsuits are filed against all physicians, and, in fact, radiologists are the specialists most frequently sued in such cases.

Against this backdrop of the myriad perceptions, misperceptions, and realities surrounding breast cancer, mammography, and medical malpractice, there has emerged “The Death Of Mammography,” a book quite unique in that it is in essence a combination of two books: one, an encyclopedia of knowledge regarding breast cancer and mammography; the other, a treatise on malpractice litigation and its impact on the practice of medicine in general, along with a first-hand account of a malpractice lawsuit focusing on a radiologist’s alleged missing of a tiny cancer on a mammogram.

René Jackson, a nurse and freelance health writer, and Alberto Righi, a radiologist, present in easily understandable language, facts, figures, and discussions of virtually every conceivable aspect of breast cancer, ranging from the history of the disease to its growth patterns, biology, and histologic types; from its diagnosis and treatment to its risk factors and prevention; from its political and legislative clout to its impact on the psyche of women and their families whom it afflicts. The authors’ voluminous material on breast cancer is extensively researched, scientifically accurate, and authoritatively written. The data the authors have produced pertaining to, and their observations regarding, the medical malpractice litigation system as it exists in American courtrooms today and the widespread defensive medicine such litigation engenders, are plentiful and impressive, albeit thought provoking.

Dramatically interwoven as a prologue to each of the book’s thirteen chapters is a passionate and finely-detailed description of a medical malpractice lawsuit, beginning with a woman’s first being told by her physician that she has breast cancer, notwithstanding the fact that her previous mammogram had been interpreted by a radiologist as normal, and culminating with a jury verdict that left the radiologist dejected and despairing that he as well as many other radiologist-mammographers have been and continue to be, treated unfairly by the American civil justice system.

Rene Jackson and Alberto Righi have produced a spellbinding 256-page volume that digs far beneath the surface of the “glossy veneer” typical of many books dealing with, and news media coverage of, breast cancer, mammography, and what the authors call the medical malpractice “lottery.” This book is sure to pique the interest of women of all ages and their families, the doctors who may one day render medical care to them, the attorneys who may one day represent — or oppose — them in a courtroom, and the judges or potential jurors who may one day judge them. This book is sure to be welcomed warmly by some and criticized severely by others. This book is sure to call into question, if not cast doubt on, the “I’ll get a mammogram — my breast cancer will be diagnosed early and I’ll be cured — and if not, I’ll sue the radiologist” mentality. And this book is sure to cause all its readers to ponder whether mammography as a diagnostic test can survive the morass of malpractice litigation in which the nation presently finds itself mired, or whether mammography is truly on an uncontrollable downward spiral that will eventually lead to its death.

Leonard Berlin, M.D., F.A.C.R.
Chairman, Department of Radiology
Rush North Shore Medical Center
9600 Gross Point Road
Skokie, IL 60076
Phone: 847-933-6111
Fax: 847-933-6113
E-mail: lberlin@rsh.net

Review by John Thomas, President, Chief Development Officer, Cirrus Health

"The Death of Mammography" by Rene Jackson, RN BSN and Alberto Righi, M.D. addresses Breast Cancer, the most devastating medical diagnosis facing women today in the U.S., and the threat placed by our "litigation society" on access to diagnostic and treatment for this disease. The authors combine an outstanding expose on the history of medicine applicable to breast cancer and radiology, with an acute understanding of the legal process, describing in accurate and granular detail the legal process involved in medical liability jurisprudence. Ironically, it is a book I would recommend to any woman who has been diagnosed with or wants to understand more about breast cancer, even though it is a sharp critique of the failures of our medical liability system in the U.S.

At first blush, one might think it inappropriate to use such an emotional subject and diagnosis to expose the dangers of our flawed and out of control legal system, but I reach a different conclusion. Unless the American Society comes to understand the imperfections of "medical science" and the "humanity" of our medical professionals, this society will continue to expect and demand perfect outcomes, no matter the situation. Likewise, it is imperative, that patients understand how personal injury lawyers and the system relies on those imperfections in a way that benefits no one, but the legal system, much to the destruction of the U.S. health care system, and specifically access to diagnostic tools and care. If we, as a society, continue to ignore these truths, articulated so well in this book, then we deserve the logical outcome this legal system is taking us---total government control and provision of all health care, with only the rich getting timely access to the best care available.

In the mean time, physicians, diagnostic providers and others will continue to reduce access to limit their liability (unlimited in many states) and those that continue to provide the care will only do so at a cost to the consumer to cover this high cost. As the private sector reduces access, public and other government sponsored health care is crumbling under the weight of long delays in diagnosis and treatment, worsening outcomes, all at a horrific emotional and financial cost to our society, not to mention the destruction of thousands of families. "The Death of Mammography," more than any other book I've read on the U.S. litigation crisis and failures, captures the essence of the problem in a highly charged emotional situation. An enjoyable read, but one with dark and troubling implications, every mother should read, and every man with a mother, wife or daughter should read and heed the warning bells rung loudly and clearly by Ms. Jackson and Dr. Righi.

John Thomas
President, Chief Development Officer
Cirrus Health
2800 State Highway 114 East, Suite 300.
Trophy Club, Texas 76262