Towards more effective online information support for mammography screening decisions.

We sought to determine the extent to which web-based patient-directed resources of U.S. public health agencies and professional groups offer consistent and relevant information on the benefits and harms of mammography screening. Between August 2016-February 2017, we identified, collected and analyzed information about mammography screening from the websites of 14 well-known governmental public health agencies and professional groups. We recorded and compared the qualitative and quantitative information the sites offered on (1) breast cancer mortality; (2) false-positive results; (3) unnecessary biopsy; and (4) overdetection. Our results show considerable variation on which benefits and harms are mentioned, whether they are discussed in qualitative and/or quantitative terms, and how this information is delivered and framed. We argue that it is ethically problematic that benefit and harm information is presented in inconsistent and incomplete ways, and we suggest that organizations work towards the adoption of uniform categories to genuinely support preference-sensitive decision making.

Examining the use of 'natural' in breastfeeding promotion: ethical and practical concerns.

References to the 'natural' are common in public health messaging about breastfeeding. For example, the WHO writes that 'Breast milk is the natural first food for babies' and the U.S. Department of Health and Human Services has a breastfeeding promotion campaign called 'It's only natural', which champions breastfeeding as the natural way to feed a baby. This paper critically examines the use of 'natural' language in breastfeeding promotion by public health and medical bodies. A pragmatic concern with selling breastfeeding as 'natural' is that this may reinforce the already widespread perspective that natural options are presumptively healthier, safer and better, a view that works at cross-purposes to public health and medicine in other contexts. An additional concern is that given the history of breastfeeding in the USA, 'natural' evokes specific and controversial conceptions of gender and motherhood.

Religion, Medicine, and Politics: Catholic Physicians' Guilds in America,1909-32.

In 1909 the first Catholic physicians' guild formed in New York City. By 1911 guilds could be found in Philadelphia and Boston. They acted as professional organizations as well as brotherhoods built on a set of shared religious and moral convictions. They brought moral perspectives from Catholic doctrine into critical conversation with their medical work. By 1931, enough enthusiasm existed to form the National Federation of Catholic Physicians' Guilds (NFCPG). The creation of NFCPG marked a clear effort to insert Catholic values into America's health care debates. Focusing on the Philadelphia and Boston guilds, and with the use of archival collections at the Boston and Philadelphia archdioceses, this article examines the origins of the guild movement. Over the first several decades of their existence the guilds became an increasingly politically savvy force in American health care as they worked to influence local, state, and federal health policies surrounding women's health care.

Maternal expectations: new mothers, nurses, and breastfeeding.

By the middle of the 20th century, breastfeeding rates had fallen to less than 20% in some areas of the United States. Despite these grim statistics, many mothers continued to seek information, advice, and the experience of breastfeeding their infants. This article explores the role that nurses played in these women's struggles to breastfeed in the years between the end of World War II and the 1970s. The role of the nurse in shaping the meaning and experience of breastfeeding in America has been an important, albeit often overlooked, part of the history of infant feeding. In addition to exploring the ways in which hospital policies and structures shaped nurses' relationships with breastfeeding mothers, this article looks at how different maternal ideologies influenced the nature of these (mostly) same-sex interactions. This article argues that the ideas about, and experiences with, motherhood had important implications for how nurses and mothers approached the practice of breastfeeding in the hospital.

An Examination of the Ethical and Legal Limits in Implementing "Traceback Testing" for Deceased Patients.

This paper examines the legal and ethical aspects of traceback testing, a process in which patients who have been previously diagnosed with ovarian cancer are identified and offered genetic testing so that their family members can be informed of their genetic risk and can also choose to undergo testing. Specifically, this analysis examines the ethical and legal limits in implementing traceback testing in cases when the patient is deceased and can no longer consent to genetic testing.

Feasibility of a Traceback Approach for Using Pathology Specimens to Facilitate Genetic Testing in the Genetic Risk Analysis in Ovarian Cancer (GRACE) Study Protocol.

Guidelines currently state that genetic testing is clinically indicated for all individuals diagnosed with ovarian cancer. Individuals with a prior diagnosis of ovarian cancer who have not received genetic testing represent missed opportunities to identify individuals with inherited high-risk cancer variants. For deceased individuals, post-mortem genetic testing of pathology specimens allows surviving family members to receive important genetic risk information. The Genetic Risk Assessment in Ovarian Cancer (GRACE) study aims to address this significant healthcare gap using a "traceback testing" approach to identify individuals with a prior diagnosis of ovarian cancer and offer genetic risk information to them and their family members. This study will assess the potential ethical and privacy concerns related to an ovarian cancer traceback testing approach in the context of patients who are deceased, followed by implementation and evaluation of the feasibility of an ovarian cancer traceback testing approach using tumor registries and archived pathology tissue. Descriptive and statistical analyses will assess health system and patient characteristics associated with the availability of pathology tissue and compare the ability to contact and uptake of genetic testing between patients who are living and deceased. The results of this study will inform the implementation of future traceback programs.

Negotiating exclusion: MSM, identity, and blood policy in the age of AIDS.

In the US, blood donors face a variety of restrictions that leave many people excluded entirely from the donor pool. This paper explores the specific circumstances and meanings surrounding the donor ban on Men-who-have-Sex-with-Men (MSM). The ban on MSM is one of the few existing donor guidelines to receive considerable criticism on grounds that it effectively prohibits any sexually active gay man from donating blood and thus discriminates against gays. Due in part to these questions of fairness, the Blood Products Advisory Committee (BPAC) of the Food and Drug Administration (FDA) met to reconsider the decades-old policy, first in 1997 and again in 2000. The FDA asked its advisory committee to address the efficacy and utility of the MSM ban in light of technological developments in blood-banking, epidemiological data on the spread of HIV, and mounting pressures from gay rights and blood-banking organizations to update the policy. Through a detailed reading of meeting and conference transcripts that took place between 1997 and 2000, I argue that 'MSM' became a contested definitional category during the FDA's reappraisal of the policy. During and between the Committee's discussions, presenters and experts debated the differences between sexual behavior and sexual identity in relation to HIV and, eventually, HHV-8, a virus known to cause Kaposi's sarcoma in immunosuppressed individuals. I argue that the underlying flexibility in the meanings behind the term 'MSM' allowed Committee members, in the end, to retract their more nuanced discussions of human behavior and HIV and to uphold the contested policy. Finally, I suggest how the debates surrounding the MSM donor ban can help us to better understand the place of sexuality in discussions and claims of biopolitical citizenship in early 21st-century America.

Beyond the Nature/Medicine Divide in Maternity Care.

Much has been made of distinguishing natural from medical in childbirth in both popular and professional contexts. But what do we really mean by natural childbirth? This essay examines the history behind the natural childbirth movement and suggests that distinguishing natural from medical childbirth is no longer productive in ongoing efforts to improve maternal health care.

The Life and Legacy of Niles Polk Rumely Newton: Breastfeeding Researcher, Advocate, and Mother, 1923-1993.

In the 1950s, researchers devoted very little time to understanding breastfeeding, physicians and nurses learned almost nothing about it in their training, and even those mothers who showed an interest in breastfeeding often found the lack of information and support for doing so to be overwhelming. In this period, Niles R. Newton stands out for a number of reasons. Born in 1923, Niles went on to marry, have four children (all of whom she breastfed), earn a master's degree and a PhD, and carry on a successful research career as a specialist in the psychology of childbirth, breastfeeding, and childrearing. Her unique work in the psychology and physiology of breastfeeding shed precious light on many of the most common problems that mothers faced when they set out to breastfeed their infants. Her research quickly became the cornerstone of the back-to-the-breast movement and was snapped up by breastfeeding advocates, mothers, and La Leche League, in particular, who helped popularize and disseminate Newton's ideas to an eager audience. This article examines Newton's life and works in more detail and argues for the central place she holds in the history of modern breastfeeding.