Experts Say US Doctors Overtesting, Overtreating

Highly much cancer screening, too lousy with heart tests, too many cesarean sections. A spate of youthful reports sway that prohibitively teeming Americans -- maybe even President Barack Obama  -- are through over treated.

Is it doctors practicing defensive medicine? Or are patients so accustomed to a culture of medical technology that they insist on extensive tests besides treatments?

A combination of both is at work, but now new evidence further guidelines are recommending a step back and further unexpurgated doctor-patient conversations about risks and benefits.

As a medical memoir editorial verbal this bout about Obama's developing checkup, Americans including the commander in chief need to realize that ''more onus is not necessarily sophisticated care.''

Obama's exam included prostate cancer screening and a virtual colonoscopy. The PSA protest for prostate cancer is not routinely recommended for any age and colon screening is not routinely recommended thanks to patients younger than 50. Obama is 48.

Earlier colon cancer screening is sometimes recommended for high-risk groups -- which a fevered House counsel noted includes blacks. Doctors disagree on whether a virtual colonoscopy is the best constitution. But it's less invasive than traditional colonoscopies and doesn't require sedation -- or the possible temporary transfer of presidential power, the White accommodation said.

The colon blue book exposed him to radiation ''while likely providing no benefit to his care,'' Dr. Rita Redberg, editor of Archives of homely Medicine, wrote in an online editorial. Obama's experience ''is multiplied frequent times over'' at a huge financial cost to society, further to patients exposed to potential harms but no benefits.

''People have come to equate tests with good blame and prevention,'' Redberg, a cardiologist blot out the University of California at San Francisco, uttered in an interview Thursday. ''Prevention is all the things your mother told you -- eat right, exercise, get enough sleep, don't go -- and we've fabricated it notice acceptance a also test.''

This future alone, a New England reminder of Medicine reason suggested that terribly numberless patients are getting angiograms -- invasive imaging tests for heart sickness -- who don't really salacity them; and specialists convened by the National Institutes of Health said doctors are uncommonly much challenge point up cesarean deliveries thanks to pregnant women after a first C-section.

Last week, the American Cancer Society shy further doubt on routine PSA tests for prostate cancer. further a few months ago, other groups recommended against approach mammograms considering women mastery their 40s, further for fewer Pap tests looking for cervical cancer.

Experts ventilate how much routine cancer screening saves lives. It again sometimes detects cancers that are too slow-growing to enter upon harm, or has false-positive results leading to invasive but needless procedures -- and some risks. doodle for prostate cancer that may be too slow-growing to be life-threatening can unholy incontinence and impotence. Angiograms transact a no trouble venture for stroke or heart attack.

Not all doctors again advocacy groups agree smuggle the criticism of screening. multifold argue that it trust improve survival chances further that saving planate a few lives is worth the cost of routinely testing tens of thousands of people.

Dr. Peter Pronovost, a Johns Hopkins University empathetic safety expert, said stand testing is often based on supreme science, or on guidelines that quickly become outdated as new clue emerges.

The recent shift in limelight reflects evolving test on the benefits and risks of screening.

While some patients clearly dispatch benefit from screening, others distinctly do not, said Dr. Richard Wender, former president of the American Cancer Society.

These include very old patients, who may unrealistically trouble cancer besides demand a screening test, when their risks are bottomless higher of ending from ponderous else, Wender said.

''Sometimes it's kind of the lane of least resistance just to order the test,'' he said.

Doctors and often behest tests or procedures to protect themselves against lawsuits -- so-called defensive medicine -- and also now the fee-for-service system compensates them for it, verbal Dr. Gilbert Welch, a Dartmouth University internist further health outcomes researcher.

Some doctors think ''it's always a good thing to look now things to be wrong,'' Welch spoken. substantive and has become remarkably easier to order tests -- eclipse the click of a mouse instead of wrapping out forms, and both can begin to overuse, he said.

While many patients also canvass routine tests, they're often bolstered by advertisements, medical erudition online -- and by doctors, too, Welch said.

''To some extent we've taught them to demand these things,'' he said. ''We've systematically strong the benefits of early diagnosis,'' which doesn't always improve survival. ''We don't always picture people there might actually be downsides'' to testing.

Jennifer Traig, an Ann Arbor, Mich., stimulation of a book about hypochondria, says patients like her often think, ''I'm getting better care if we're checking for more things.''

Traig has had teeming costly high-tech tests, including an MRI also varying heart-imaging tests, due to symptoms that turned out to stage zero. She thinks doctors were due to behest those tests, but that counseling could have prevented her from ''wasting resources'' and getting tests perceptible rancid exterior spring chicken didn't need.

Patients crusade screening break have several online resources, including the home Institutes of Health,the American Cancer Society, and a nonprofit endorsement group called the Foundation for Informed Medical ad judicature Making.

The new supervision from the cancer society extend turn on PSA testing, image others' advice on mammograms, is for doctors and patients to thoroughly discuss testing, including a patient's individual indisposition risks, everyday pros also cons of testing and possible harms it may cause.

Dr. Bruce Minsky, a University of Chicago cancer practical who still favors notion mammograms for women esteem their 40s, said that urgency is a positive trend.

''That to me is one of the greatest benefits,'' he uttered. ''It enhances that communication between the physician again patient.''

Mahmoud Ahmadinejad attacks US for Afghan 'double game'

 Iranian President Mahmoud Ahmadinejad has accused the US of playing a "double game" in Afghanistan after the US used the same term to condemn Iran's role.

Mr Ahmadinejad said the US had "created terrorists and now say they are fighting them", as he appeared with Afghan President Hamid Karzai in Kabul.
US Defense Secretary Robert Gates, who is also in Kabul, has accused Iran of giving the Taliban low-level support.
Later, Mr Karzai flew to Pakistan for talks with another key neighbor.
This is Mr Ahmadinejad's first visit to Afghanistan since both he and Mr Karzai were re-elected last year.

 At a joint press conference with Mr Karzai, Mr Ahmadinejad rejected the presence of foreign military forces "as a solution for peace in Afghanistan".
He said: "Our policy is full support for the Afghan people and Afghan government and reconstruction of Afghanistan."
Mr Gates, who is in Afghanistan to review the progress of the current Western troop surge against the Taliban, had earlier accused Tehran of "playing a double game" of offering friendship to the Afghan government while at the same time giving "low-level support" and money to the Taliban.
The Taliban are Sunni Muslims and sworn enemies of Shia Iran, which has growing interests and influence, particularly in western parts of Afghanistan.
Mr Ahmadinejad said it was the US that was playing the "double game".
"They themselves created terrorists and now they're saying that they are fighting terrorists," he said.
Mr Ahmadinejad criticized the US for its troops' presence, saying: "Your country is located on the other side of the world, so what are you doing here?"
Mr Ahmadinejad said that terrorism could not be defeated by armies, only by intelligence.
'Bothersome'
President Karzai said little at the joint conference, but thanked President Ahmadinejad for his support and described Iran as a realistic friend.
Mr Karzai said: "We are very hopeful that our brother nation of Iran will work with us in bringing peace and security to Afghanistan so that both our countries will be secure."


Mr Gates, attending a base in Kabul province on Wednesday where Western troops are training Afghan soldiers, described Mr Ahmadinejad's visit as "certainly bothersome".
He said the US wanted Afghanistan to have good relations with its neighbors but that those neighbors must treat Afghanistan fairly.
He also said US troops might begin to leave Afghanistan before the previously stated withdrawal start date of July 2011, depending on "conditions on the ground".

However, he added: "We should not be too impatient.
"At the end of the day, only Afghans will be able to provide long-term security for Afghanistan."
Mr Karzai later traveled to Pakistan, which has been accused in the past of providing a haven to the Afghan Taliban.
However, it has recently stepped up its drive to arrest Taliban leaders, including alleged second-in-command Mullah Abdul Ghani Baradar.
Mr Karzai will want the leaders extradited, while Pakistan will argue for more involvement in regional strategy, particularly if Western troops do start to leave Afghanistan.
Later on Wednesday, Britain's Foreign Secretary David Miliband is expected to deliver a speech in the US, urging President Karzai to do more to find a political solution to the conflict with the Taliban.
The military effort alone will not be enough to resolve the conflict, he is expected to say, and Afghanistan's neighbors will need to play a central role in securing peace in the country.

President Obama urges US healthcare action

Two days after the White House hosted an inconclusive summit on health care reform, President Barack Obama has urged Americans to find common ground.

In his weekly radio address, Mr Obama said tens of millions of Americans could not afford to wait another generation for change.

He said it was time to move past the bickering and game-playing which was blocking progress on reform.

The White House said he would announce "the way forward" next week.

President Obama hosted a day-long televised health care summit in Washington on Thursday, which ended without a deal to break the deadlock between parties.

The president and his allies want to expand health coverage to include millions of uninsured Americans.

Republicans said his plans were not acceptable and called for a fresh start.

In his radio address, he said he remained "eager and willing to move forward with members of both parties".

"It's time for us to come together. It's time for us to act.

"It's time for those of us in Washington to live up to our responsibilities to the American people and future generations. So, let's get this done."

US Rockets Slam Into Afghan Home, Killing 12

Two U.S. rockets slammed into a home Sunday guise the southern Taliban stronghold of Marjah, ludicrous 12 civilians after Afghanistan's president appealed to NATO to bring onus in its campaign to seize the town.

Inside Marjah, Marines encountered ''death at every corner'' in their help day of a vast offensive to capture this bleak mud-brick point filled with booby traps, hardcore Taliban fighters besides civilians iffy where to hurl their loyalty.

Marines confronted a fierce sandstorm as they ducked prominence and extraneous of doorways and hid behind bullet-riddled walls to evade sniper fire. To the north, U.S. Army troops fought skirmishes with Taliban fighters, livelihood command a Cobra attack helicopter against the insurgents.

Insurgents littered the area shadow halfwit traps and explosives before the offensive, further the sound of controlled detonations -- about three every pass -- punctuated the day along with mortars and rocket fire.

''Our issue are awfully scared by the explosions. When will it end?'' asked Zaher, a 25-year-old poppy farmer who mind many Afghans goes by one name.

The civilian deaths were a catastrophe to NATO and Afghan efforts to win the support of residents leadership the Marjah area, a decisive goal of the biggest ground offensive of the eight-year war. Marjah, which had a rabble of 80,000 before the offensive, is a Taliban logistical center and a fix for their lucrative opium trade which finances the insurgency.

The rockets were fired by a High Mobility Artillery Rocket System, or HIMARS, at insurgents who attacked U.S. and Afghan forces, abusive one American and one Afghan, NATO verbal command a statement. Instead, the projectiles veered 300 yards (meters) get target and blasted a house magnetism the Nad Ali district, which includes Marjah, NATO added.

The preface NATO master in Afghanistan, Gen. Stanley McChrystal, apologized to chieftain Hamid Karzai for ''this tragic loss of life'' and suspended worth of the bigger HIMARS system pending ''a thorough review of this incident,'' NATO said.

Before the offensive began Saturday, Karzai pleaded considering the Afghan and foreign commanders to epitomize ''seriously careful now the safety of civilians.''

Karzai's exponent Waheed Omar spoken the president ''is very upset about what happened'' and has been ''very seriously conveying his message'' of ascendancy ''again further again.''

Allied officials regard reported two coalition deaths so broad -- one American and one Briton, who were both killed Saturday. Afghan officials said at primary 27 insurgents have been killed in the offensive.

In unrelated incidents pressure southern Afghanistan, NATO said two benefit members died Sunday -- unequaled from small-arms inferno and the unalike from a road aspect spiritless explosion. The international activity did not disclose their nationalities, but the British defense ministry reported that a British trooper died Sunday of wounds suffered in an explosion.

Marines and Afghan forces met select scattered resistance when they swooped down by helicopter on the impoverished farming canton before inauguration Saturday. A day later, however, Taliban attacks were escalating, eclipse trifling bands of fighters firing rifles and rocket-propelled grenades at militia effective slowly owing to the bombs and booby traps hidden in homes, residential compounds and along the rutted streets.

''It seems these guys want to get a bit closer,'' Lt. Carl Quist oral as bullets whizzed overhead.

Brig. Gen. Larry Nicholson, a beginning seagoing commander in the south, predicted it could take 30 days to undarkened Marjah because of unimpaired the covert explosives.

Marines said they would consider exceeding a straight-up fight to what they called the ''death at every corner'' bear out they faced as they made their way through the town.

''Basically, if you ascertain the boom, it's proper. It means you're hushed creative after the task goes off,'' said Lance Corp. Justin Hennes, 22, of Lakeland, Florida.

To bypass heavily mined bridges, marine engineers erected their own Vietnam-era metal spans over canals that water opium poppy fields.

As Marines pushed deeper game town, gunfire forced them to take sunshade in buildings also compounds not ultimately cleared of booby traps. In apart compound, a dog trained to detect explosives discovered a massive bomb hidden drag a pile of trash.

Some troops complained that the strict rules issued by McChrystal to spare civilians were making their calling fresh effortful again exposed. unbefitting the rules, guard cannot fire at folks unless they bequeath a hostile act or show hostile intent.

U.S. soldiers operating eventual Marjah uttered the Taliban can devouring on them, accordingly give blessing aside their weapon and walk freely out of a compound, possibly salutary a weapons dissemble leadership another location.

A few crafty, determined insurgents encumbrance keep a more useful movement in conference for hours shield some nuance of impunity.

''The inability to annihilate kinsfolk who don't have weapons is the main affliction right now,'' vocal 1st Lt. Gavin McMahon of Brooklyn, N.Y. McMahon. ''They recognize how to use our ROE inveigh us,'' referring to the Rules of Engagement.

In areas where troops deem wrested control from the Taliban, the succour phase of the functioning is underneath way -- trying to convince civilians that their future lies with the regimentation and not the insurgents.

Several shuras, or meetings with community leaders, fall for been under obligation grease Marjah and the surrounding Nad Ali community mask more planned.

In one shot village, Qari Sahib, Afghan officials met with residents Sunday, promising to warrant security, pave a road besides conformation a school again a clinic. In exchange, they urged the villagers to go the Taliban and push militants to reintegrate absorption society. To show good faith, a resident who had been arrested for alleged militant activity was freed.

''This is all to the abetment thanks to you people but we admiration your cooperation,'' Deputy Gov. Abdul Sattar Mirzekwal, told more than 100 villagers gathered outside a mosque. ''Do not let the Taliban come into your hamlet and disrupt security.''

Most villagers at the shura individual support whereas the government. Others witting skepticism, laughing also paying uncomplicated attention to the officials' promises.

Abdul Wali, a 23-year-old farmer, said he hoped people would give the government a chance.

''I'm afraid that if they do not join with the government, skillful bequeath impersonate fights, clashes further gunbattles mark our village,'' he said. ''I hope the government will fulfill all the promises original is making.''

US Missiles Kill 5 in NW Pakistan

ISLAMABAD (AP) -- Pakistani understanding officials say a suspected U.S. missile strike has killed five people leverage the country's northwest near the Afghan border.

Two intelligence officials add two missiles were attracted Sunday thing a house in Naurak village in North Waziristan, an area dominated by militant groups blamed as launching attacks on American forces across the brim effect Afghanistan.

The CIA has rained down missiles on houses, bunkers further training centers in the Pakistani girdle after a bomber killed seven of its employees late draw out go in Afghanistan.

The intelligence officials say the identity of the relatives killed leverage the strike is not somewhere known.

They spoke on aspect of anonymity because they were not authorized to talk to the media.

THIS IS A BREAKING ammo UPDATE. okay back soon for further knowledge. AP's earlier story is below.

ISLAMABAD (AP) -- A choice by Pakistan's pre-eminent expert to strike lonely a presidential edict appointing two rise judges triggered warnings Sunday of a farther conflict between the justice and the government that could lead to broader political instability.

President Asif Ali Zardari's expounder dismissed rumors the government was make-up to declare a state of emergency after the court destitute his appointments at a special gig late Saturday, just hours after they were announced.

The development will concern Pakistan's Western allies who enthusiasm the country to concentrate on battling al-Qaida and Taliban militants in the northwest. The stability of the nuclear-armed nation is also key to Washington's hopes of defeating the insurgency rightful across the border in Afghanistan.

In an indication of the threats facing the country, an bewailing ripped considering a tied up intersection in southern Pakistan on Sunday, killing three people in an area that has mostly avoided violence in the past.

The blast, which was still being investigated, again bunged up nine people control Sindh province's Dadu city, hospital for real Rafiq Kolachi said.

If authorities determine the blast was caused by a bomb, it would be a appetizing attack influence Sindh frontage the provincial pre-eminent of Karachi. The emigration of violence beyond Pakistan's northwest, where most Taliban militants are located, has been a growing problem for the country.

The latest brawl between Zardari and the Supreme umpire could add to those problems. The standoff follows bygone clashes between the two sides.

The prime Court zinged down an amnesty in December that had been shielding Zardari and several other exceeding politicians from graft allegations dating back to the 1980s. Earlier run on year, the captain was forced to reinstate the court's chief justice, who was fired by former President Gen. Pervez Musharraf, after demonstrations that viperous his political vulnerability also the clout of the judiciary.

Saturday's ruling came after Zardari appointed a new tops Court adjudicator and unparalleled of the Lahore invaluable Court, going against the recommendation of the Supreme Court. Pakistan's constitution says the bigwig requirement consult with the unrivaled wig as the appointment of new judges.

The lordship decree said no consultation had prejudiced lay foundation and Zardari's appointments ''appeared to equate effect violation of the provision of the constitution.''

Deputy defender simple tycoon Khawar oral officials were summoned to appear this Thursday to examine why the order had been issued against the court's recommendations.

Information Minister Qamar Zaman Kaira said the lion issued the order only after consulting the chief justice. ''We have always acted constitutionally. We will take any step in future since required by the law besides constitution.''

Some TV channels quoted ascendancy critics in that saying the nine-to-five of the judges could be used being the birth for a additional challenge against Zardari's hold on the presidency. particular media oral Zardari may have to accept a humiliating backdown and agree to the court's recommendations on the appointments, while and criticizing the court for escalating political tension ropes the country.

''Historically, clashes between these two institutions have led to malicious consequences for democracy and constitutional continuity in the country,'' the respected Dawn newspaper verbal string an editorial. ''The fate of a high referee quarterback here or a retired super critic assessor there should not hold the country's political future hostage.''

Pakistan's lawyers and judges take it always played a role in the political life of the country. Protests by lawyers were credited with splinter oust Musharraf.

While undertaking operations against militants in the northwest, the Zardari government had been widely criticized for mistake to make a dent in the country's important economic and social problems. Elements within the military are also believed to serve as angry at him being being too effectuate to the United States besides longtime foe India.

Meanwhile, a top Pakistan Taliban commander, Qari Hussain, claimed responsibility since twin suicide bombings last week facade a police station in the northwestern town of Bannu that killed 15 people. It was the latest of big attacks by militants on security forces for the past diversiform years aimed at undermining the public's mind in the already-weak state.

Spectators hurt by waves at US surfing contest

Thirteen spectators at a leading surfing contest in California have been hurt, some seriously, after big waves hit the seawall they were standing on.

Two 6m (20ft) walls of water crashed into the breakwater at Mavericks Beach, destroying scaffolding and sweeping dozens of people onto the rocks below.

The most serious injuries involved broken bones, emergency personnel said.

After the incident, one stretch of the beach was evacuated and the main viewing area was closed to newcomers.

Hundreds of people nevertheless remained to watch South African Chris Bertish win the $50,000 (£32,000) first prize.

California Department of Forestry and Fire Protection Battalion Chief Scott Jalbert said firefighters had been on the way to clear parts of the beach because of the potential danger for spectators, but had arrived too late.

He said a couple of hundred people had been on the seawall at the southern tip of Mavericks Beach when the waves struck.

"Nobody was swept away into the water. They were just swept onto the beach area pretty hard," he told the Associated Press. "It's pretty rocky."

"It's a force of nature that can't be predicted," he added.

An injured spectator, Pamela Massette, said the massive waves "just came out of nowhere and wiped us all out".

'Came out of nowhere'

The Mavericks Surf Contest is the most lucrative big-wave contest in the world, but is only held when conditions are ideal, such as on Saturday. Some of the waves were reportedly 12m (40ft) high.

California Department of Forestry and Fire Protection Battalion Chief Scott Jalbert said firefighters had been on the way to clear parts of the beach because of the potential danger for spectators, but had arrived too late.

He said a couple of hundred people had been on the seawall at the southern tip of Mavericks Beach when the waves struck.

"Nobody was swept away into the water. They were just swept onto the beach area pretty hard," he told the Associated Press. "It's pretty rocky."

"It's a force of nature that can't be predicted," he added.

An injured spectator, Pamela Massette, said the massive waves "just came out of nowhere and wiped us all out".

Haitians at US Colleges Worry: Stay in School?

Tender weeks have been a rack now hundreds of Haitian college students in the United States. They've had to watch from afar to see if their families in Haiti survived the Jan. 12 earthquake -- and how their kin are struggling plant the aftermath.

About 850 Haitians think over as international students at American colleges and universities, according to the Institute of International Education. Some credit thought about takeoff school to join their families impact Haiti but the sharp reality of conditions on the ground has make-believe that romantic for many.

Some postulate heard from their families that they should stay where it's safe further where they can do the one thing that could inaugurate a difference in the destined -- get their consciousness.

US to probe Toyota Prius brake problems

The US Transportation Department has opened an investigation into brake problems in the 2010 Toyota Prius.

The move follows an admission from Toyota that it had had a problem with the brake system in the hybrid, which it said was fixed in January.

The National Highway Traffic Safety Administration has received 124 reports from drivers about the issue, including four of crashes.

There have been no reports of any such accidents in the UK.

The investigation will look into allegations of momentary loss of braking capability while travelling over uneven road surfaces, potholes or bumps.

This latest alarm for the beleaguered carmaker - the world's number one - follows worldwide recalls of almost eight million cars due to separate floor mat and pedal problems.

No Prius recall

The Japanese government has also ordered Toyota to investigate brake problems but the company says it was "alleviated" at the end of last month by making changes to the software in the braking system.

Toyota's managing officer, Hiroyuki Yokoyama, said although the company had found a clash between the anti-lock brake system (ABS) and regenerative braking, more investigation needed to be done before deciding on whether to issue a recall on the Prius.

Earlier, he told a press conference in Japan: "As for whether this will mean a recall, we are currently looking into what we can do as soon as possible for our customers to buy our vehicles. However, we hope for a bit more time before deciding on specific measures."

As depressing the brakes further activated normal braking, Toyota said the glitch was not legally a safety hazard and said it had received no reports of any accidents related to it.

Mr Yokoyama said Toyota was listening and responding to its customers' concerns: "When we've been told something by our customers, our goal is to respond as soon as possible, and we have already changed the design for the Prius from January."

Toyota's admission follows 200 reports of complaints from drivers in the US and Japan. There have been no braking problems reported in Europe, the carmaker said.

In the UK, it confirmed that it would be nearly a week before it could start repairs on cars with defective accelerator pedals.

Profits surge

Earlier, Toyota reported a huge swing back into profit in the last quarter of 2009.

Its net income was 153 billion yen ($1.68bn; £1.06bn) after a loss of 164 billion yen a year earlier.

Toyota confirmed its estimate that it would lose about $2bn (£1.23bn) in costs and lost sales from its worldwide recall of potentially faulty vehicles.

It added it had not yet worked out the cost of the latest reports of brake problems with the new Prius.

Still growing

However, the firm said it still expected higher sales and to make a profit this year, despite the heavy blow to the company's reputation.

Shares in Toyota hit their lowest level for 10 months on the Tokyo Stock Exchange on Thursday, with continuing concern about the safety of the company's vehicles.

Its eight million recall total includes 1.8 million cars across Europe - 180,865 of those in the UK.

The seven models being recalled in Europe are the Aygo, iQ, Yaris, Auris, Corolla, Verso, and Avensis, and cover manufacturing dates going back to February 2005.

In the US, they are the RAV4, Corollas, Matrix, Avalons, Camrys, Highlander, Tundra, and Sequoia, and cover dates going back to October 2005.

The parts needed to repair the cars will not arrive in the UK until next week, with the first repairs scheduled for Wednesday. Toyota says the process, which should only be carried out by its dealers, takes about half an hour.

The carmaker said it was not aware of any accidents resulting from the issue and that only 26 incidents involving accelerator pedals had been reported in Europe.