Monday, November 30, 2009

Serena Williams’ verdict is finally in - after almost 3 months!

The top ranked woman on the WTA tour has been fined $82,500 for her outlandish behavior during the 2009 U.S. Open semi-final loss to Kim Clijsters of Belgium. According to Liz Clarke of the Washington Post, Ms. Williams fine amounts to 8.25% of the $1 million she could have been fined under the event’s Code of Conduct.
One of my favorite tennis commentators, Mary Carillo, said it best when she called the verdict a “cockamamie decision”. "Serena Williams physically threatened and verbally assaulted an official during one of the most watched tennis matches of 2009, and after three months of thoughtful, considered cogitation, the Grand Slam Committee came up with 'Grand Slam Probation' and a 'suspended ban'?" Carillo wrote. "And half of what was deemed to be her fine? Boy, that ought to show everyone." 
Ms. Carillo was referring to the probation that Ms. Williams is subject to through 2011. If Ms. Williams does not commit another “Major Offense” in any of the Grand Slam events through 2011, then she will not be suspended from the U.S. Open for one year and subject to an additional fine of $82,500. By the way, Ms. Williams earned $6.5 million this year. Her fine must really hurt!
What do you think about this verdict? I would be interested in hearing opinions from others, even those that disagree with my critical assessment of the final outcome. For those that did not see the U.S. Open “performance” by Ms. Williams, the following YouTube video is attached.


Friday, November 27, 2009

What You Need To Know About Breast Cancer Screening

My sister, Cyndi, was first diagnosed with breast cancer on December 31, 1998. What a great New Year’s gift! The diagnosis was based upon a biopsy of the breast, following a mammogram that did not reveal any problems. Now, my sister is pretty smart, so she asked for a copy of her pathology report and was loaned a copy of the “Breast Bible” from her doctor. In addition, it helps that Cyndi has several friends that are doctors and she likes to ask a lot of questions. Needless to say, Cyndi was very disturbed that the mammography process did not work to capture her breast cancer.
In February 1999, Cyndi had a lumpectomy with reconstructive surgery the following month. Unfortunately, the lumpectomy did not have clean margins. About a year later, Cyndi began to notice an orange peel look in her remaining breast and voiced concern to her doctor. So, she had another mammogram, and guess what – it also was clean! Cyndi felt like she was at the end of her rope and decided it was time to change doctors in August 2004.
Then, on September 1, 2004, Cyndi was diagnosed the second time with breast cancer. Once again, the mammogram of her remaining breast was clean and so was the ultrasound. The difference this time was that she had found a technician as concerned about the process of diagnosing breast cancer as she was. The technician just happened to have a friend that had recently undergone a mastectomy and was currently going through chemotherapy.  The technician’s friend coincidentally also had voiced her concerns about confidence in her recent mammogram and ultrasound. Cyndi pleaded with the ultrasound technician during the procedure to biopsy anything that looked remotely suspicious. Sure enough, during the procedure, he commented to Cyndi, “well there is a spot with a little shading”. Immediately, Cyndi responded with “please do the biopsy”!
The biopsy revealed that Cyndi had a tiny spot with cancer in her remaining breast, but less than 1 cm. The mammogram once again was clean. The Seattle Cancer Care Alliance ordered an MRI, which showed that she had a 7.5 cm tumor hiding. She thought that she must not have heard the information correctly. She knew that 1 cm is bad and at 7.5 cm, she thought her life was over. That was over 4 years ago.

On November 16, 2009, the U.S. Preventative Services Task Force (USPSTF) released its “Screening for Breast Cancer” recommendations that increased the standard age for women to undergo the mammography procedure from 40 years of age to 50.

The public has not taken this information in stride. The controversy over the new recommended guidelines has been the focus of several prime time newscasts. The emotional reaction from various individuals and organizations has followed a logical pattern. Women have responded with complete outrage, that some “obscure” group was trying to govern their bodies, and that proposed health care legislation would impose new rationing on their ability to get this “critical” procedure in the future.
Organizations such as Susan K. Komen For the Cure and the American Cancer Society publically denounced the new recommendations. Ambassador Nancy G. Brinker, founder of Susan K. Komen For the Cure (SKK) responded passionately to the USPSTF recommendations on Meet the Press with “This is a nightmare”. The full Susan K. Komen response to the new USPSTF recommendations can be found on their web site.

The American Cancer Society (ACS) is also continuing to recommend mammograms for women beginning in their 40’s after evaluating the same information as the USPSTF. Their full response can also be found at their web site.

And representing the scientific community, Nancy Snyderman, Chief Medical Editor for NBC News, responded on Meet the Press with “we are on the brink of becoming a scientific illiterate country”. Her particular concern is that we are relying too much on the anecdotal evidence and not enough on the science, which she feels supports the USPSTF recommendations.
Now let’s assume that all individuals and groups are right in their reaction to the new proposed mammography guidelines. Where does that leave us?
It is obvious that the mammography failed my sister, badly, and on multiple occasions. The ultrasound did not fair much better. The USPSTF has concluded that there is an unacceptable level of false-positives and associated anxiety with the mammography procedure. Fine, we know what does not work, but how about a plan to replace this outdated procedure? Why is everyone so focused on this unreliable technology?
For example, Dr. Nancy Snyderman’s concurrence, that mammogram’s provide little benefit to those under 50 years of age, would be much more tolerable if she also presented a legitimate alternative to this outdated procedure. Ambassador Nancy G. Brinker and the SKK and the ACS should admit that their investment of billions of our private donations has produced little, if any, advances in the prevention of breast cancer. By opposing the USPSTF guidelines, at least they are showing us that they are doing something with “our” war chest of charitable donations. Both the SKK and ACS should be much more proactive and aggressive in helping to advance breast cancer screening solutions beyond what was first developed in 1960 for the first patient screenings in 1969. Enduring forty years of the same unreliable technology while billions are being donated to charities that claim to be committed to improving breast cancer diagnosis is unacceptable.

Cyndi provides good advice for women trying to decide on their individual plan for breast cancer prevention. “Mammograms are good for women if they don't have dense breasts. If they do have dense breasts, they need an MRI. Neither time that I had breast cancer did the cancer show up on a mammogram or an ultrasound. In fact, they gave up on doing mammograms on me. The Seattle Cancer Center Alliance has started doing more MRI's. I think its something a woman needs to discuss with their doctor. If a woman does not feel comfortable with the decision that their doctor has made, they should get a second opinion. The only reason I'm here today is because I finally took charge. And I changed doctors and facility for care. Even when going through treatments, we need to make sure we get what we need.”

Cyndi is not looking for sympathy from anyone. In fact, her optimistic approach to living life continues to be an inspiration to me. She has also inspired others as well. One of my best friend’s wife, recently had a double mastectomy, and he mentioned that Cyndi’s experience was helpful to them as they were faced with very difficult decisions. And, the good news for the readers of Fritz’s Word is that she has agreed to become a resource for Breast Cancer survivors. Cyndi has completed the initial certification, and is in the process of becoming a peer counselor for the Breast Cancer Network of Strength, a 24hour hotline for women going through breast cancer, as well as for the husbands.

Please feel free to forward this article to family, friends, co-workers, or anyone else that you think might benefit from the information.


Thursday, November 26, 2009

Happy Thanksgiving!

This Holiday Season, we would like say “thank you” to all of our loving and caring family, friends, and colleagues. Thank you for being there – always!

We empathize with the significant economic challenges that are afflicting so many as a result of the global financial crisis. As challenging as it might be, there is a silver lining in this crisis – we are witnessing a renewed focus on developing, nurturing, and renewing important relationships. Recently, I spent over three hours at a coffee shop with one of my best friends. We enjoyed discussing the events going on in each of our lives and what we were each doing to become a better husband, father, friend, employer, and community member. Long after our coffee was gone, we both left the coffee shop fully energized and feeling as though our time together was cut short. To me, life does not get much better than this!

Happy Thanksgiving everyone!


Monday, November 9, 2009

Beyond Pink Ribbons

Imagine this disturbing scene. The young 17 year-old girl hustles over to the local health club after school, gets out of her 1998 Toyota Camry with a bright pink athletic bag, strolls up to the check-in counter, and the front desk attendant cheerfully hands her a shiny silver Smith and Wesson revolver with one bullet resting in the chamber.  What is going on here?

Indoor tanning is like playing a game of Russian roulette and even with the compelling evidence about its dangers; the health clubs choose to ignore the facts in favor of large profits. To make matters worse, the clientele is usually our young adult population; the same group that we go to great lengths to make sure that they drive a safe vehicle, and to educate them on the dangers of using drugs and smoking cigarettes. Physician specialists and the World Health Organization have taken notice and have been working hard to educate the public about these dangers.

I managed one of our area’s largest health clubs more than 23 years ago and we considered tanning beds as one of our “value-added” services. Safety information about tanning beds was still in its infancy and we believed that the beds were safe. I even remember my wife and I using the tanning beds in preparation for a trip to Hawaii with the misguided belief that developing a base tan was the healthy thing to do. Little did we know at the time how dangerous these machines were and that the potential health impact from tanning might not show up until much later in life.

A link between smoking and lung cancer by German scientists in the late 1920’s lead to the first anti-smoking campaign, but it took many more years to gain any significant traction. We all know how difficult, dangerous, and costly it has been to try to fight the cigarette industry. The tanning industry has their $5 billion in estimated annual revenue to help fuel their campaigns. Unfortunately, there is not much of an economic incentive to protect the public from the dangers of tanning beds.

The American Academy of Dermatology (AAD) reports that each day in the United States, over 1 million people tan in tanning salons and nearly 70% of these patrons are females between the ages of 16 to 29 years. This year, the World Health Organization announced that it has moved UV tanning beds to its highest cancer risk category – “carcinogenic to humans”.

The dangers of indoor tanning have also caught the attention of well-respected physicians like Theresa Devere, M.D., a dermatologist at Oregon Health and Sciences University in Portland, Oregon. Dr. Devere has written peer reviewed articles and book chapters and presented at dermatologic meetings. Dr. Devere specializes in all aspects of general dermatology, with special interests in pediatric dermatology, Hansen's disease and pigmented lesions. I asked Dr. Devere about the tanning industry’s claims regarding the safety of using tanning beds.
"My response to the tanning bed propaganda is that there is no such thing as a healthy tan. A tan is essentially damage to the skin. Every time the skin tans it induces damage at the level of the DNA, which requires repair. Most of the time the repair is done correctly and there is no problem. However, if the repair is done incorrectly, a mutation occurs in the DNA. This mutation is the first step in the development of skin cancer, which can show up years later. 
The WHO recently released a report that tanning beds increase the risk of melanoma. I have seen this myself in young patients with melanomas in areas that are unexpected (breast, buttock, and other areas that are exposed by tanning bed rays but not sun). I strongly advocate more regulation of the tanning bed industry, especially for minors. "

This means that the young girl is taking the risk that her skin will not repair itself properly and mutation may occur in her DNA – the first step in the development of skin cancer. Unfortunately for the young girl, should she later develop skin cancer, it has been nearly impossible to legally connect the club as the root cause of her cancer. That is until now. Fitness Management published an article titled “Tanning Beds: Lawsuit in Waiting?” The article’s lead statement is telling – “as evidence continues to accumulate regarding the potential danger of tanning beds, one wonders how long it will be before lawsuits begin to be filed against fitness centers offering access to the beds”. The full article can be found at:

The AAD noted that, “A review of seven studies found a 75% increase in the risk of melanoma in those who had been exposed to UV radiation from indoor tanning before the age of 35”. The American Academy of Dermatology Association position is clear. “The ADA opposes indoor tanning and supports a ban on the production and sale of indoor tanning equipment for non-medical purposes.”

My wife and I are melanoma skin cancer survivors. Our intimate experience with this deadly disease helps us ask the right questions and more importantly, who to ask. If your daughter’s life depended upon the answer of the question, “who do you trust, the tanning bed industry or a physician like Dr. Devere”, how would you answer the question? What is your risk if you are wrong? By default, the health clubs and tanning parlors are answering the question for you. The stakes are high – 8650 people are expected to die of Melanoma skin cancer in 2009. We believe that this number is too high and we hope to do our part in the prevention of melanoma skin cancer.

We need your help to persuade health clubs to follow the ADA position and remove their tanning beds. I have posted the letter that I sent to two local health clubs recently and am still awaiting their response. I will keep my readers posted of developments as they occur. In the mean time, please encourage others to register to follow my blog and to send the letter to health clubs in your local area. Please keep me informed of the responses you receive from the health clubs. The ADA has developed a great video for young adults about the dangers of tanning beds. You can see this video at Check it out and then please help our young friends and family by acting as their much needed voice. Thank you!


Letter to Local Health Clubs

Dear [name],

I am contacting [club name] to respectfully request the removal of all tanning beds from the Club. Both [my wife] and I are Melanoma cancer survivors and are involved in advocacy to help prevent the same occurrence in others through avoidance of high-risk exposures, early detection, and advocacy. It is the category of high-risk exposures that motivates our request of the Club.

As part of an article that I am writing for my blog on the dangers of tanning beds in health clubs, I requested Dr. Devere of the Oregon Health and Sciences University's Department of Dermatology to respond to tanning industry propaganda and she replied to me today with the following:

"My response to the tanning bed propaganda is that there is no such thing as a healthy tan. A tan is essentially damage to the skin. Every time the skin tans it induces damage at the level of the DNA, which requires repair. Most of the time the repair is done correctly and there is no problem. However, if the repair is done incorrectly, a mutation occurs in the DNA. This mutation is the first step in the development of skin cancer, which can show up years later. It is not only burning that causes mutations at a cellular level. 
A base tan does help prevent burning to some degree, but at a cost as described above. The other cost is premature skin aging. A better way to prevent burning is to wear adequate sun protection in the form of sunscreen of at least 30 SPF with UVB and UVA protection. Also, wearing protection clothing, hats and sunglasses. 
The WHO recently released a report that tanning beds increase the risk of melanoma. I have seen this myself in young patients with melanomas in areas that are unexpected (breast, buttock, and other areas that are exposed by tanning bed rays but not sun). I strongly advocate more regulation of the tanning bed industry, especially for minors. "

In addition, I went to the WebMD site and the following was the announcement by the WHO in late July 2009:

"The World Health Organization’s International Agency for Research on Cancer (IARC) announced today that it has moved UV tanning beds to its highest cancer risk category – carcinogenic to humans”.

Based upon the research and the fact that [club name] is a "health" club; the dangers, or potential risk of danger, associated with tanning beds should lead all health clubs to remove this potential danger as soon as possible.

I appreciate your consideration and look forward to your reply. I also welcome personal dialogue with you regarding this topic.

Thank you,