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What should women do about the new pelvic exam recommendation?

First-year medical student Michelle Gentile assists her classmate Abbie Harts as she performs a pelvic exam on a volunteer at Northwestern University.

Joshua Lott/Reuters /Landov

First-year medical student Michelle Gentile assists her classmate Abbie Harts as she performs a pelvic exam on a volunteer at Northwestern University.

Calling all women: What is your reaction to the new recommendation against pelvic exams for healthy women who are not pregnant and show no signs of disease?

Are you thrilled? 

Are you a little confused?

If so, Impatient is here for you. I felt those mixed emotions, too, especially as I began to read more about the American College of Physicians' recommendation, and responses to it.

Below, I'll break down for you the reasons for the recommendation, and what obstetricians and gynecologists are saying. Then, I want to hear about what you'll do, next time you get your annual well-woman exam.

The recommendation

A group of doctors wrote in the Annals of Internal Medicine:

"The current evidence shows that harms outweigh any demonstrated benefits associated with the screening pelvic examination."

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In LA, one mammogram is $60, another is $694. Why?

Mammography detects cancer, but debate rages over when and how often women should get screened.

/iStockphoto.com

Why is there a big variation in the price of mammograms in Los Angeles? Is the more expensive mammogram “better” than the cheaper one?

Last week, we asked our audience a question: What did your mammogram cost?

As part of Price Check – our collaboration with KQED in San Francisco and ClearHealthCosts.com – we’re collecting this data for the next month. The goal is to bring transparency to health costs in California, and help inform the policy debate over how to hold down these costs.

If you need a little more incentive to add your information to our database, consider this:

Before we launched this project, staff from ClearHealthCosts.com surveyed California medical centers. They found that in the Los Angeles area, the self-pay (or cash) price for a mammogram could range from $60 at H. Claude Hudson Comprehensive Health Center, to $254 at Westchester Imaging Medical Center.

Meanwhile, an audience member shared her costs: She said her Kaiser Permanente insurance paid $694 for a mammogram.

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3rd California baby dies of whooping cough as epidemic surges

Whooping Cough Vaccinations Administered In Los Angeles

Kevork Djansezian/Getty Images

Health officials say the whooping cough vaccine is the best protection against the disease. But its immunity wanes over time, and getting the disease doesn't confer immunity.

The whooping cough epidemic continues to surge in California, and it has claimed the life of a third baby, state Department of Public Health officials said Friday.

The details

In just the past two weeks, 1,100 new cases of the disease, also known as pertussis, were reported to the health department. That brings the total number of cases so far this year to more than 4,500.

State officials said the third baby who died was a Sacramento child who contracted whooping cough last year at three weeks of age and was hospitalized for over a year.

Two other infants --  one in Riverside County and one in Placer County -- who like the Sacramento baby contracted the disease when they were too young to be vaccinated -- have also died this year of whooping cough.

Children can get their first dose of the DTaP vaccine, which protects against diptheria, tetanus, and pertussis, at around six to eight weeks. They are not considered fully protected until they've received at least three of the five recommended doses - usually by the time they are six months old.

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He switched Anthem Blue Cross plans; his Cymbalta went up $488

prescription pills medicine money

Photo by Chris Potter via Flickr Creative Commons

David Garden's employer-sponsored Anthem Blue Cross plan covered Cymbalta, which he takes for the chronic neuropathic pain associated with muscular dystrophy; his new Anthem plan does not.

What would you do if your new insurance plan wouldn't cover the medication you depend on?

One drug, two costs

David Garden - a Santa Monica slow growth advocate and self-professed rabble-rouser - has a form of muscular dystrophy. For the past two years, he's taken Cymbalta, which is commonly prescribed for depression, but also alleviates the chronic neuropathic pain associated with his disease.

Garden, who worked as a camera technician, had employer-sponsored Anthem Blue Cross insurance through the Motion Picture Industry Pension and Health Plans. When he retired at age 45, in part due to his condition, he continued this coverage through COBRA for 18 months.

Throughout that time, a 90-day supply of the medication cost him a cool $25 co-pay.

When his COBRA ran out, Garden decided to buy insurance on the Covered California exchange. He stuck with Anthem Blue Cross. He'd already bought the plan when he learned that neither Cymbalta, nor its generic version, were covered on the drug formulary for Anthem’s Covered California plans.

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Doctors don't like talking about death, either

Dr. Martha Twaddle talks to a patient and strokes her hair during a visit at the Midwest Palliative and Hospice CareCenter in Skokie, Ill., in 2012.

Antonia Perez/MCT /Landov

A doctor visits a patient in hospice care. A new set of end-of-life guidelines is designed to help physicians talk to their patients about dying.

It turns out that doctors have trouble talking about death, too.

As part of her report today, KPCC health correspondent Stephanie O’Neill spoke with Dr. Glenn Braunstein, vice president for clinical innovations at Cedars-Sinai Medical Center.  He's among the leaders of what's believed to be the first effort in a major American city to set end-of-life guidelines for doctors.

In a moment of candor, he said that even he has trouble having end-of-life conversations with his patients:

"I find them to be draining; they're emotionally draining. You know, not only am I thinking about the patient before me, but I'm thinking about my parents, my in-laws, I'm thinking about other people that I know who have died."

"And when I see the family members react, you know, at times I let my own emotions show. It can be difficult, but it's also a very human type of interaction."

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