Page C10 Wyoming Tribune Eagle Sunday, November 3, 2019

By Liz SzaboKaiser Health News

When Dr. Worta Mc-Caskill-Stevens made an ap-pointment for a mammogram last year, she expected a sim-ple breast cancer screening – not a heavy-handed sales pitch.

A receptionist asked if she wanted a free upgrade to a “3D mammogram,” or tomosynthesis.

“She said there’s a new ap-proach and it’s much better, and it finds all cancer,” said McCaskill-Stevens, who de-

clined the offer.A short time later, a techni-

cian asked again: Was the pa-tient sure she didn’t want 3D?

Upselling customers on high-tech breast cancer screenings is just one way the 3D mammography industry promotes its product.

A KHN investigation found that manufacturers, hospitals, doctors and some patient advocates have put their marketing muscle – and millions of dollars – behind 3D mammograms. The jug-gernaut has left many women feeling pressured to

undergo screenings, which, according to the U.S. Preven-tive Services Task Force, haven’t been shown to be more effec-tive than tra-ditional mammo-grams.

“There’s a lot of money to be made,” said Dr. Ste-ven Wo-loshin, direc-tor of the Center for Medicine and Media at The Dartmouth Institute for Health Policy and Clinical Practice, who published a study in January showing that the health care industry spends $30 billion a year on marketing.

KHN’s investigation shows industry money has shaped policy, public opinion and pa-tient care around 3D by:

� Paying influential doc-tors. In the past six years, 3D equipment manufacturers – including Hologic, GE Healthcare, Siemens Medi-

cal Solutions USA and Fujif-ilm Medical Systems USA – have paid doctors and teach-ing hospitals more than $240

million, in-cluding more than $9.2 mil-lion related to 3D mam-mograms, according to a KHN analy-sis of the Medicare Open Pay-

ments database. Just more than half of that money was related to research; other payments covered speaking fees, consulting, travel, meals or drinks. The data-base shows that influential journal articles – those cited hundreds of times by other researchers – were written by doctors with financial ties to the 3D industry.

� Marketing directly to consumers. Manufacturers have urged women to de-mand “the better mammo-gram,” using celebrity

spokeswomen such as breast cancer survivor Sheryl Crow. Manufacturers spent $14 mil-lion to market 3D screening over the past four years, not including spending on social media, according to Kantar Media, which tracks the ad-vertising industry.

� Lobbying state lawmak-ers. Private insurers in 16 states are now legally re-quired to cover 3D screen-ings, along with Medicaid programs in 36 states and Washington, D.C. Officials at Hologic, the leading manu-facturer, told KHN that about 95% of insured women have coverage for tomosynthesis.

� Funding experts and ad-vocates. Hologic has given educational grants to the American Society of Breast Surgeons, a medical associa-tion that recently recom-mended 3D mammograms as its preferred screening meth-od, according to the group’s website. Hologic declined to reveal amounts. Hologic also has funded patient advocates

such as the Black Women’s Health Imperative, which lobbies for access to 3D mammograms.

Enthusiasm for 3D has sparked a medical technolo-gy arms race, with hospitals and radiology practices com-peting to offer the newest equipment. Patients have caught the fever, too. When rural hospitals can’t afford 3D machines, foundations often pitch in to raise money. More than 63% of mammog-raphy facilities offer 3D screenings, first approved for sale in 2011.

Taxpayers write the check for many 3D screenings, which add about $50 to the cost of a typical mammo-gram. Medicare, which began paying for 3D exams in 2015, spent an additional $230 mil-lion on breast cancer screen-ings within the first three years of coverage. By 2017, nearly half the mammograms paid for by the federal pro-gram were 3D, according to a KHN analysis of federal data.

Teacups & TwigsChristmas Show

Nov. 24, 25, 29, 30Dec. 1, 2, 6-9, 13-16, 20-23

Regular Store Hours: Wed.-Fri. 12-6pm, Sat. 10am-5pm11241 Coonrod rd • Cheyenne, wy • 307-637-7282

Take I-25 N. to Horse Creek Rd. Go East to stop sign (Yellowstone Rd.) Go left to Coonrod Rd., then turn right.Go until you see a red brick ranch style house with a gray roof on the left side of the road.

There is a barn wood sign that says “Teacups & Twigs”. Major Credit Cards Accepted

—Refreshments & Door Prizes —

Nov 6-9, 13-16, 20-23, 27 (Closed 28), 29-30Dec 4-7, 11-14, 18-21

2019 Teacups & TwigsPrairie Christmas

Take I-25 N. to Horse Creek Rd. Go East to stop sign (Yellowstone Rd.) Go left to Coonrod Rd., then turn right.Go until you see a gray brick ranch style house with a black roof on the left side of the road.

There is a barn wood sign that says “Teacups & Twigs”. Major Credit Cards Accepted

Thank you To allof Noah’s friends and co-workers whosent cards and attended his funeral.

We will all try to live by his motto“Don’T PanIC”.

FromA loving family

hallberg’s,kelly’s, ryan’s,Jensen’s, rogers,and Frey’s

Love is strongerthan death DO YOU SUFFER WITH NEUROPATHY?

A SAFE, NEW, ADVANCED, LASER TREATMENT FOR NEUROPATHY!

Spine CorreCtion Centerof the Rockies

CALL TODAY for a free consultation

• Neuropathy• DiabeticNeuropathy

• Numbness &Tingling

• Pins & Needles• Painful Hands& Feet

ACCEPTING MOST MAJOR INSURANCES AND MEDICARE

2244 E Harmony Rd. Suite 110 | Fort Collins970-226-1117 | www.spinecorrectioncenter.com

ScienceS U N D A Y SHIGH-TECH RIVALS POSE A THREAT TO OLD-FASHIONED STETHOSCOPES

CHICAGO (AP) – Two centuries after its invention, the stethoscope – the very symbol of the medical profession – is facing an uncertain prognosis.

It is threatened by hand-held devices that are also pressed against the chest but rely on ultrasound technol-ogy, artificial intelligence and smartphone apps instead of doctors’ ears to help detect leaks, murmurs, abnormal rhythms and other problems in the heart, lungs and else-where. Some of these instruments can yield images of the beating heart or create electrocardiogram graphs.

Dr. Eric Topol, a world-renowned cardiologist, con-siders the stethoscope obsolete, nothing more than a pair of “rubber tubes.”

It “was OK for 200 years,” Topol said. But “we need to go beyond that. We can do better.”

In a longstanding tradition, nearly every U.S. medical school presents incoming students with a white coat and stethoscope to launch their careers. It’s more than sym-bolic – stethoscope skills are still taught, and proficiency is required for doctors to get their licenses.

Over the past decade, though, the tech industry has downsized ultrasound scanners into devices resembling TV remotes. It has also created digital stethoscopes that can be paired with smartphones to create moving pic-tures and readouts. Proponents say these devices are nearly as easy to use as stethoscopes and allow doctors to watch the body in motion and actually see things such as leaky valves. “There’s no reason you would listen to sounds when you can see everything,” Topol said.

At many medical schools, it’s the newer devices that really get students’ hearts pumping.

“Wow!” ‘’Whoa!” ‘’This is awesome,” Indiana Universi-ty medical students exclaimed in a recent class as they learned how to use a hand-held ultrasound device on a

classmate, watching images of his lub-dubbing heart on a tablet screen.

The Butterfly iQ device, made by Guilford, Connecti-

cut-based Butterfly Net-work Inc., went on the

market last year. An update will in-

clude artificial intelligence to help users po-

sition the probe and interpret the

images.

By Richard ReadTribune News Service

ANATONE, Wash. – Some-where near this tiny farming town in September, a Wash-ington Department of Fish & Wildlife hunter conducted what officials call a lethal re-moval, killing a gray wolf, a member of a species that the state considers endangered.

Most likely the agency em-ployee or contractor fired a shotgun from a helicopter after following signals from a radio collar on a member of the Grouse Flats pack. Citing “safety reasons,” officials won’t say how or where the wolf – which they believe to have been a breeding female – was exterminated Sept. 25.

A century after gray wolves were all but eradicated from Washington, the state is try-ing to encourage the return of the iconic predators, which normally hunt deer, elk and smaller wild animals. The state’s gray wolf population has gradually recovered to at least 126 since 2008, when the first two packs since the 1930s established dens.

Wildlife officials ordered the Grouse Flats extermina-tion after determining that the pack roaming grasslands in the state’s farthest south-east corner had killed four farm animals in two months. That’s the minimum number of deaths or injuries required within 10 months for them to begin killing wolves until the livestock attacks cease.

Five days after the mother wolf was killed, Washington Democratic Gov. Jay Inslee wrote to the director of the Fish & Wildlife department, an agency accused by animal advocates of bowing to the in-terests of ranchers hostile to

wolves. Inslee cited public outrage over the elimination of packs near the Canadian border, and asked Kelly Susewind to find ways “to sig-nificantly reduce the need for lethal removal of this spe-cies.” He gave the director until Dec. 1 to report back.

The ultimatum from Inslee, who’s seeking a third term as governor after dropping out of the Democratic presiden-tial campaign, irked rural res-idents who often feel margin-alized by politicians from Washington’s more populous west side. The political divide between red and blue runs roughly north-south along the Cascade Range, with Seattle and Olympia, the capital, holding sway over the state’s eastern range country.

Jay Holzmiller, 62, is a hunter and cattle rancher in the Anatone area, the Grouse Flats pack’s home territory. He pulled himself recently into the driver’s seat of a tall crew-cab pickup in his tidy

farmyard and gestured to-ward a neighboring ranch, one of two next to his wood-lots and pastures where cat-tle were lost last summer to the pack.

Holzmiller, whose ranch-house walls are festooned with mounted heads of wild animals he’s shot, is troubled by declines in elk and deer herds preyed on by wolves, bears and cougars. He said that Inslee’s directive dis-rupts painstaking compro-mises reached through years of negotiations between wild-animal advocates, farmers and hunters.

Inslee nominated Holzmill-er in 2013 to a six-year term on a commission that over-sees the wildlife department, and then opted not to renew his appointment. The rancher feels that the commission’s membership favored envi-ronmental interests.

“We’re fighting for a way of life,” Holzmiller said. “There’s a huge concern

whether our hunting culture is going to come to an end, and there’s lots of us rednecks that love to do it.”

Wolves began roaming into Washington during the early 2000s, after being reintro-duced during the previous decade in Yellowstone Na-tional Park and central Idaho. Scientists said that adding “apex predators” would pro-duce ecological benefits, for example culling large herds of elk whose grazing had killed trees in Washington’s Olympic National Park, caus-ing riverbanks to erode and diminish salmon habitat.

As wolves moved in as well from British Columbia, Washington developed rules designed to protect them while minimizing attacks on livestock. By 2011, polls showed that 75% of state resi-dents supported wolf popula-tion recovery plans.

Now, gray wolves howl in the night across broad swaths of eastern Washington, thrill-ing naturalists and spooking ranchers. The population has grown by an average of 28% a year since 2008, said Staci Lehman, a Fish & Wildlife Department spokeswoman in Spokane.

“We are still trying to fig-ure out how to strike that bal-ance between wolves, people and livestock,” Lehman said.

Under the rules, ranchers are encouraged to take steps to keep wolves away from cat-tle, such as putting up flags and lights and dispatching range riders on horseback. When those tactics fail, offi-cials can order lethal remov-als, 28 of which have occurred since 2012 in northeastern Washington’s Colville Na-tional Forest, the area of chief concern to Inslee.

Wolves are protected in Wash.SO WHY DOES THE STATE KEEP KILLING THEM?

A gray wolf wearing a tracking collar walks north of the central Washington town of Cle Elum in June. The state Department of Fish & Wildlife has exterminated entire packs after attacks on cattle, relieving ranchers and infuriating animal rights advocates. Washington Department of Fish & Wildlife/courtesy

Marketing juggernaut pushes 3D mammograms

“There’s a lot of money to be made.”

Dr. Steven WoloshinDirector of the Center for

Medicine and Media at The Dartmouth Institute for Health

Policy and Clinical Practice