Health Care Iconoclast Fights On
Just because Dr. Susan Love retired from surgery doesn’t mean she’s retired.
More than three years after setting down her scalpel, and two years after publishing her controversial tome on menopause, the former director of the Revlon/UCLA Breast Center is launching her own Web site; developing what she hopes will be a “Pap smear” for breast cancer; working on a third edition of “Dr. Susan Love’s Breast Book” (Addison-Wesley, 1990), which has come to be known informally as the breast cancer bible; and pondering the possibilities of a women’s health think tank.
In her spare time, she’s completed a master’s in business administration and developed a deeper comprehension--and, yes, appreciation--of the principles of managed care.
“I turned 50,” she says dryly of her MBA adventure. “I wanted to prove my brain was still working.”
Irreverent as ever, Love persists in tweaking the purveyors of conventional wisdom and in casting herself as the truth-teller whose duty is to point out that the emperor’s not wearing a stitch.
“There is a place for people who want to say, ‘Wait a minute’--as an iconoclast--’Let’s look at the data here.’ That’s not a comfortable place to be, but . . . oh, well.”
Love has made a name for herself not just as a doctor with a devoted patient following, but as an advocate for research that, she hopes, will help women sort through a muddle of medical options. Should one get a mastectomy or a lumpectomy? Bother with the monthly breast exam or not? Take hormones or not?
Her position on the hormone issue has raised the most ruckus of late.
It’s not that she is against hormone therapy, Love explains, though she does resist calling it hormone “replacement” therapy. As she sees it, that term implies some medical deficiency in menopausal women.
“What I am against is the knee-jerk tendency of most doctors to hand you a prescription for hormones as soon as you seem to be menopausal, rather than taking a close look at your individual needs, risks and lifestyle,” she writes in “Dr. Susan Love’s Hormone Book” (Random House, 1997), co-authored by Karen Lindsey.
Love contends that long-term hormone ingestion carries risks, including breast cancer, which are not necessarily offset by widely proclaimed benefits such as protection against heart disease or osteoporosis.
“We know other ways to prevent heart disease that are less dangerous,” she says, although she does not quibble with short-term use--two or three years--of hormones to ease menopausal symptoms.
Though Love has been portrayed as extreme by some critics, her outspokenness has been a boon to the consumer movement in health care, says Dr. Laura Esserman, a surgeon at UC San Francisco.
“It’s good to be controversial,” Esserman said. “Anything that causes women to ask questions [of their doctors] is a good thing.”
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Love’s most consistent theme over the years has been that women themselves are well qualified to weigh the evidence--however incomplete--and make their own choices. Medicine, she likes to say, is “a work in progress,” with lots of questions that have no clear answers.
“We can only do the best we can at any given time,” she said.
To that end, Love hopes her Web site, https://www.SusanLoveMD.com, will provide women with the most complete information to date on breast cancer and menopause. It is scheduled to be up later this month.
“The current information is quite shallow,” Love said of online data on these issues. “It doesn’t go into depth.” Love plans to provide layers of information, even describing--for those who can stand the nitty gritty details--what breast surgery feels like to a patient.
Love says she is conscious of accusations that some health Web sites have not made a clear distinction between paid advertisements and medical information.
“If we do have advertising, we’ll have it in a separate area” of the site, she said. “We’ll be explicit [about] what is getting paid for and what is not.”
Love says she has learned to understand and appreciate medicine as a business. She still decries pharmaceutical firms’ sway over doctors’ prescription practices, but she sees some potential pluses in managed care. Chief among them, she says, is accountability--forcing doctors to justify their practices based on recognized standards.
Love’s own new business venture--a medical device intended to detect breast cancer by drawing fluid from the nipple--is still in clinical trials, so she won’t say much about it.
Whatever the outcome of those trials, Love, who is famous for describing breast cancer treatment as “slash, poison and burn,” is hopeful that the fight will rely much more heavily in the future on “prediction and prevention.”
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Love is a keynote speaker Saturday at 11 a.m. at The Times’ Festival of Health at USC.
