K. Dettwyler wrote: “As with all of my writings and presentations, on
LactNet, and elsewhere, my
goal is to provide women with full and accurate information, so that they
can make whatever choices they want/need to, based on their clear
understanding of the consequences of those choices. That applies to
breastfeeding vs. bottle-feeding, and duration of breastfeeding. It also
applies to decisions women make about how to deal with suspicious breast
lumps.

I don't believe in keeping information from people (in this case, that
breast surgery is a risk for later breast cancer) because of what some women
might, theoretically, do with that information (avoid a needed biopsy or
lumpectomy).

It is clear in the breast cancer literature that the techniques for early
detection are not risk-free (just as formula is not risk-free). Mammograms
involve x-raying the breast. X-rays are known to cause cancer. Biopsies
and lumpectomies involve cutting into breast tissue. Cutting into tissue is
correlated with higher rates of cancer. Some women will get breast cancer
from mammography screening. Some women will get breast cancer from having
had a biopsy or lumpectomy. A recent study suggested no benefit to monthly
breast self-exams, at the population level.

This doesn't mean that people shouldn't do breast self-exams, or shouldn't
have mammograms, or shouldn't have biopsies or lumpectomies of suspicious
lumps. It means that people need to know what the risk/benefit ratio is of
each option, and add that to their own personal feelings and comfort levels,
because we all worry about different things. But I cannot condone
withholding information from people so that they don't really know what they
are choosing.”  (Pardon the long quote.  All of it is very important in my
opinion.)

I couldn’t agree more.  Anything less than a full disclosure to the patient
of risks v. benefits is a disservice to the patient.

Another thread regarding SSRI’s (selective serotonin reuptake inhibitors)
has begun, leading to their comparison with cocaine (which Mary J.
inadvertently confirmed, that both inhibit reuptake of serotonin at nerve
terminals, although cocaine acts on catecholamines as well, giving it a
wider range of action and more toxicity.) Cocaine has “medium” serotonergic
potential, while fluoxetine (Prozac) and sertraline (Zoloft) have “high”
serotonergic potential.  Cocaine also increases the release of presynaptic
serotonin as well as blocking its uptake. Also, many serotonin uptake
inhibitors have been associated with extrapyramidal syndromes, such as
dystonia, akathisia, and parkinsonism  (Serotonin syndrome. A clinical
update. Mills KC - Crit Care Clin - 1997 Oct; 13(4): 763-)  These drugs are
not so innocent as some believe.   Prozac (fluoxetine) is excreted in
breast milk. Drug therapy in the nursing mother.
Dillon AE - Obstet Gynecol Clin North Am - 1997 Sep; 24(3): 675-96
Knockout mice born without dopamine transporters self-administer cocaine,
challenging the current belief that the interaction between cocaine and the
dopamine transporter is the most important part of the addictive properties
of cocaine. [39] These [and previous] studies have raised some intriguing
questions about the roles of serotonin and dopamine in cocaine addiction.
[28] Serotonin re-uptake is inhibited by cocaine, and serotonin neurons
connect with mesolimbic dopamine systems. Serotonin is involved in the
regulation of sleep, appetite, aggression, learning, pain perception,
libido, and mood. Low serotonin levels are associated with depression,
alcoholism, and risk-taking or impulsive behavior. Neurobiology of tobacco
smoking and other addictive disorders.
Gamberino WC - Psychiatr Clin North Am - 1999 Jun; 22(2): 301-12.  I could
cite articles ad nauseum regarding the various subtopics raised.  There are
many studies on this topic.

Even cocaine has its uses: as a local anesthetic, particularly for mucous
membranes, as well as being a South American folk remedy for altitude
sickness.  As my pharmacology professors often reminded us, every
substance, even water, is toxic beyond a certain dose.  Perhaps poisons may
be defined as much by their quantity as their quality.

Also, Elaine wrote:
Do you really think a Dr. would just hand someone a
bottle of Prozac and never see them again? Most Drs. are thorough and
wouldn't leave a patient to just "see how it works out".
Unfortunately, I have seen the elderly in a certain anonymous big city
nursing home to be unwitting SSRI guinea pigs, left on the stuff for years,
even those patients who can no longer verbalize their symptoms.

Patients are no better served by sugar-coated euphemisms than they are by
scare tactics.  I think that most of us would agree that neither extreme of
emotional appeals serves the patient so well as knowing the truth regarding
their therapy.  Nursing moms especially need the accurate data regarding
risk v. benefit, because there is another very vulnerable person involved.
Let’s not hold back anything which would be an important factor in a
patient’s health care decisions.

With good will toward all, even toward those who may vehemently disagree,
Colleen

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