Former NIH Director, Bernadine Healy, rejects new mammo guidelines
Nov 23rd, 2009 | 35 responses
I’ve been waiting, not so patiently, since the U.S. Preventative Services Task Force released new recommendations for breast cancer screening, to know what Bernadine Healy thinks. Now we know: she says we should ignore them.
[CHRIS WALLACE]: What would you tell a woman patient with no particular history of breast cancer what she should do about getting mammograms?
DR. BERNADINE HEALY, FORMER HEAD OF THE NATIONAL INSTITUTES OF HEALTH: I think she should stick with the existing guidelines that come out of the medical professional organizations and have been in place for a long time, which is start your screening at age 40; if you are concerned about a risk, maybe a baseline of 35; and then — and then have it done every year in your 40s. You might go to every other year in your 50s.
And you and your doctor will decide for how much longer it should go.
WALLACE: So basically you’re saying ignore the [U.S. Preventative Services Task Force] recommendations this week.
HEALY: Oh, I’m saying very powerfully ignore them, because unequivocally — and they agreed with this — this will increase the number of women dying of breast cancer. Women in their 40s have a very aggressive kind of breast cancer. They tend to progress fast. And to not screen women in that age group is astounding to me, and it goes against the bulk of individuals who are actually caring for patients. You may save some money, Chris, but you’re not going to save lives.
Her opinion on the role/goal/composition of the Task Force:
This particular task force has been in existence for about 25 years and its focus is on public health, modeling of health policy and economics.
It does not have people who are experts in hands-on patient care, for the most part, and on oncology or even in breast cancer or cervical cancer. It gets information from those groups, but it ultimately comes up with models.
You know, Chris, there’s really been no new information here. It is a different way of looking at the same problem. Their perspective is if you can cut in half the money we’re spending on screening for breast cancer and lose only, you know, maybe 10 percent, 20 percent of the benefit, that’s a good tradeoff.
A doctor who is responsible ethically for their individual patient would not make that tradeoff.
…
This is not the voice that medicine has used that focuses on the individual patient rather than the good of society. And even if they included the other groups, like the obstetricians and gynecologists, and the oncologists, and the cancer society, that would be fine, but they didn’t.
The issue here is that we are listening to one voice. And unlike what the secretary said and Senator Stabenow just said, this is not just a recommendation. This is codified in law that this is the group that will be providing information.
The bolded sentences highlight precisely what I’ve been saying in discussions about this topic – and why I think the tradeoff supported by the guidelines are completely unacceptable.
I appreciate that overall, she did not allow Wallace to drag her into a politicized conversation about the topic.
35 Responses to “Former NIH Director, Bernadine Healy, rejects new mammo guidelines”
Jill — there's always reduction to absurdity if anyone motives you later to be especially theatrical.
Any public (or private “insurer”) health care service's cost can be reduced to a minimum by greatly reducting it, and to zero by terminating it. But that isn't necessarily the “solution” to a cost problem, or allocation problem, anyone is seeking.
“if you can cut in half the money we’re spending on screening for breast cancer and lose only, you know, maybe 10 percent, 20 percent of the benefit, that’s a good tradeoff”
Don't be surprised to see this become more commonplace in the future, especially 10-20+ years from now.
Well – I think the bigger danger – which health care reform opponents lobby in all the time – is to suggest that that has not been going on for decades and it's something brand new and different & just introduced into our gov't and society since 1/09.
Jill,
1. As a critic of the repellent mischief we've seen this year (which is at the heart of current foundering and recovery efforts by the Dems), I've been subjected to all kinds of nonsense here, as have critics all over the USA this year, by stating the obvious, that concerns about rationing and denial of care, and “experts'” decisions ruling our health (in addition to additional political historical concerns) for having the temerity to report the obvious truth, that cost concerns, cost-benefit analysis, cost-effectiveness criteria, appropriateness criteria, and allocation issues and ethics (and politics) have been with us for more than 40-50 years. It's hardly new (and denial of it now, or “shock and awe” about it with this mammogram issue, is unmerited, to say the least).
2. Side issue: With other women's issues, such as incidence of birth defects and first pregnancies that may be problematic (and other things completely, such as ageism in society or in the workplace, or the departure of professional athletes from the elite ranks, for example),
“if you are concerned about a risk, maybe a baseline of 35″
Middle age starts at 35.
That's true, even though older age, disability, and the correct modern retirement age is in the seventies.
(Another unrealistic thing long known as the reverse of reality is the Sixties-ish political view that the age of retirement, and government retirement entitlement initiation, should be at decreasing, not increasing, from the decades-obsolete traditional age of 65.)
I'm sorry, but this entirely makes me question Dr. Healy's opinion here. One of the reasons these recommendations came out was become some of the practices did not save women's lives. Period. It had nothing to do with money. Moreover, there is actual risk with certain procedures, such as radiation risk. Dr. Healy doesn't even mention it. I have not read her full interview, only what you present here, but she does not come across as objectively considering the evidence. She comes across as a doctor who wants to say things to make people happy. We all want to think there is some step we can take that will prevent or catch such a horrible disease, and she's willing to go along telling us all that we can — when in fact we can't.
Proof of this are the “Obama” (sic) Mammogram Recommendations themselves. The 'fact' of the matter is the panel responsible for the report began their work in 2006 and they sent their conclusions out for 'review' in 2007.
Behind Cancer Guidelines, Quest for Data
PRI 's Here and Now discussed this story with the author on the program today. (audio of interview available after 2pm EST)
“One of the reasons these recommendations came out was become some of the practices did not save women's lives. Period. It had nothing to do with money.”
It was a generalist, epidemological, analytical revisitation of previous screening criteria. Yes, it was an appropriateness review or an effectiveness, or a risk-benefit (“trade-off”) rather than cost-benefit analysis.
And it not only avoided money issues (cost-benefit analysis, etc.) but didn't compare the effectiveness (and inherent cost-benefit inferences) of these screenings versus other kinds of screenings, screenings for other diseases, etc..
Jill — Thanks for this article. I've had such a hard time swallowing these new recommendations both for mammograms and annual pelvic exams for women, for some quite personal reasons. My mom was diagnosed with stage 1 but very aggressive cancer in her mid 40s. Because she had been diligent about getting her mammograms, it was caught at stage 1, and she's now been cancer free for almost 10 years. If she had been getting every-other-year mammograms, the doctors estimate she would have been at stage 3, which is much more deadly. I know that there are a lot of false positives, especially for younger women, but to me that says that we need to improve detection tecniques, not cut back on testing.
As for pelvic exams — it's my understanding that they're now saying that young women should wait until they're 21, and then only get them every other year. This is probably a totally fine recommendation if all you're worried about is cervical cancer. Quite frankly, this is not why most women go get their first paps very soon after becoming sexually active, and it's not why they continue to get them each year. The reasons young women go to the OBGYN are (1) birth control prescriptions, and (2) STD checks. Those early exams were also where I learned about things like safe sex practices, how to accurately take a pregnancy test, about Plan B, about the sympoms to watch out for as far as different STDs, and how to protect myself from pregnancy and STDs. Not everyone wants to have a heart-to-heart with mom about what herpes looks like, and frankly, sex ed in schools leaves a lot to be desired. I knew the statistics — only 1 in maybe a million HPV-positive women end up with cervical cancer, and I probably wasn't going to be one of those — but that's not why I went to the doctor, and it's not why I go now.
OK – just gonna say it flat out: I'm not exactly sure what you're getting at!
That we agree that this is not new re: the fact that we do say yes to some and no to others, right – you're saying that, yes? I agree. I haven't been reading here at TMV since probably mid summer due to my election campaign but you know my writing well enough – it wouldn't matter if others were saying there are five lights when I know there are four. 
Capitalism always ensures that there is rationing of all and pretty much any resource and service. People are conflating economic structures with government organizational structures – I've written about that before.
Anyone who says otherwise doesn't know what they're talking about.
Pacatrue, you wrote, “One of the reasons these recommendations came out was become some of the practices did not save women's lives. Period.”
Actually – no – that's not one of the reasons these recs came out, but if you can link to where you read that, I would like to see it.
The reasons these recs came out was that the task force determined that the harms being caused by mammos and self-breast exams (enumerated by them as “extreme anxiety,” too many biopsies and false positives) outweighed the 15% decline in deaths that performing mammos and SBE for women ages 40-49 provides. They've acknowledged that balance repeatedly and that is how Healy's opinion makes sense.
You wrote, “”Obama (sic) Mammogram Recommendations” themselves.” I don't know to what you're referring – to what are you referring? Thanks.
roro80, I could not agree with you more. As I wrote in a comment above and have put in other posts on this topic, the fact is that performing mammos and self exams between ages 40-49 results in a 15% decline in deaths. The Task Force has not challenged that. And it is that fact that is making Healy and others irate and take the positions that they have. You and I are not alone in feeling that these recommendations are wrong-headed for any one of a number of reasons.
Thank you for sharing what you did.
About the PAPs, that is a harder one but I agree with you there about the value and the bigger picture concern of “what are we teaching” when it comes to watching our health. We talk so much about people taking care not to smoke, to eat right, to exercise – but now we're going to start fostering more of a wait and see and a you don't need to know until we tell you atmostphere?
I don't think so.
I wanted to tackle this again. First up, I want to compare Jill's post a few days ago with the comments quoted here from Dr. Healy. Jill's post (and roro's comments here) struck me as well-reasoned thoughts and doubts about the recommendations. Dr. Healy's, to be honest, not so much. It doesn't help that Dr. Healy appears on Fox News seeming to provide the exact talking points that some Republicans are trying to use to political advantage: People are trying to take medical care away from Americans to save money. That's essentially what she says. She suggests that the people doing the work aren't even qualified to do it and that they will happily let thousands of women die to find some savings.
Next up, the actual recommendation. I misspoke earlier. Yes, more screenings can save lives. According to the stat in this piece, it's 1 in every 1900 could be helped. That's a seemingly tiny rate, but multiply it by millions of women and it thousands of people. But here's the problem.
Theoretically, we could save even more lives if we started mammograms at age 20 and did them once a month. We'd potentially help tens of thousands more women. But most people think that's horrible overkill. Enormous inconvenience to women, enormous costs, multiplied risks from radiation exposure, complications from biopsies, and the false positives. Of course, a “false positive” in these cases means that women are being told they have cancer. They are being told they might die; they might have to get mastectomies; etc.
The upside of our extreme screening is that we are maximally good at finding cancers immediately; the downside is that we could be actually killing women from the screenings, and if we avoid that, there's emotional and financial costs. Screening every month from 20 until 80 would mean essentially that every woman in the nation would be told at some point that they have breast cancer due to false positives.
I'd like to stick with the false positives for just a moment. The primary problem we are dealing with is the issue of “base rate”. I happened to write a post about the base rate fallacy a few days ago on my own blog, using breast cancer as an example, though that was largely coincidence. Here's that post. Roro mentioned improving detection techniques. Of course, I agree in general, but there's only so far you can go with that to prevent false positives. Let's say the current biopsies are correct 99.9% of the time. Only 0.1% of women who have a biopsy done will be told they have cancer when they do not. Sounds terrific. But let's multiply that 0.1% time 100 million women. That's 100,000 women who will falsely be told they have cancer when they do not. If they get mammograms every year from 40 to 50, plus every other year from 50 to 70 (Dr. Healy's recommendations), that's 20 mammograms per woman for 20*100,000 or 2 million women being told they have cancer who do not. And that's WITH a diagnostic that's already correct 99.9% of the time.
OK, so clearly we have to find the right balance. Once ever month starting at 20 is clearly not it. But where is it? I don't know. The panel went through a series of studies and thinks the age of 50 is the right balance. That may not be quite right. The point of my monthly screening example is to make the strong point that saving lives is not the only thing we should care about in preventative care.
The panel is making a recommendation for the entire group of all women, and that will not cover everyone equally well. Roro has family history and so would probably be better served starting earlier. (Please note that I am not a doctor.) I just read that there's some evidence that rates of breast cancer in women 40-50 are slightly higher in African-American women than in white women, and so perhaps they should start earlier as well when trying to find the balance. Ultimately what we need is not to find the magic screening number but figure out why some women are more at risk than other women. (This actually matches Roro's diagnostic comment when I think about it.) If a doctor can profile an individual woman and say, for you Ms. Jones a unique individual, you should start screening at 42, but you, Ms. Smith, should probably start at 54, then we will be getting somewhere. Until then we are left with mass group recommendations.
In the end, though we are always playing the odds. Dr. Healy mentions starting at 35. Why not 30? She must not care about women age 30-35!!! Here come death panels. She's a bean counter who will sacrifice women for money.
But, no, Dr. Healy is playing the odds like everyone knowing that the rates of breast cancer between 30 and 35 are quite low, and the costs (the same costs she disregards as irrelevant in the Panel's considerations) are not worth it. Even though some women, some amazing women who are our mothers and daughters and co-workers and friends, will get breast cancer at 32, before the screenings started.
Jill, I'm agreeing with you that there are some trying to turn the new “mammogram guidelines” into something political and that Obama did it. The study was undertaken and their conclusions were reached several years before Obama was elected.
As the mammogram recommendations are not Obama's (or the Democrats) I added a sic after Obamas name.
Got it – thank you! I don't always read as two and three dimensionally as I should online and can get myopic in how I'm thinking about something during online exchanges.
Well – I really wouldn't parse quite the way you do, but I follow how you have done so.
I believe inclusion of women in the 40-49 range is appropriate for a number of reasons but not the least of which include: this is a primetime that women are caretakers of both children and aging parents. The human toll of illness, detected or undetected, is enormous at this phase. The decline in deaths is 15% – that is huge when applied to the general population who will be diagnosed in the 40-49 range. Consider the collateral damage that would be allowed to occur if a full 15% of women who will die between the ages of 40-49 were allowed to die because of no screening coverage or recommendations.
I agree 100% that WOC will be seriously, negatively impacted if the recommendations are adopted in any wholesale way. It would be an absolute dereliction of humanity.
The whole what's is gonna cost thing – you know, let's talk Viagra. And insurance coverage for it because erectile dysfunction is considered a disability. But if we're only having sex to procreate and we're talking about men who've already had kids and are still with the same women, then why do they get to have Viagra covered? Isn't that a subsidy I'm paying?
We could go on and on and on like that – when what is called for is an examination of the human impact. This stuff about extreme anxiety and overbiopsying and the false positives? Sorry – I will NEVER buy that those harms outweigh saving the lives of 15% of the women who otherwise would be diagnosed with breast cancer in the 40-49 range if the guidelines remained as is.
Hey pacatrue — Your statistical analysis is very interesting; I've done my own. Here's my statistical info on breast cancer by age: http://www.imaginis.com/breasthealth/statistics…
There were a couple of numbers for false positives for mammograms, between 3.5% – 8%, so I split the difference and used 6%. I also used a method where those whose mammograms indicate cancer go on to get a biopsy (much more expensive and invasive, and generally the next step you take after an irregular mammogram). False positive for this I used 1%. I used a false negative rate of zero, for simplicity, which is not exactly accurate, but it doesn't change the results much. Here's what I come up with:
A woman who gets a mammogram between ages 20-30 and is diagnosed has a less than 1% chance of actually having the disease; 30-40 has a 7% chance, 40-50 has a 20% chance, and 50-60 has a 32% chance. This is after the initial mammogram.
However, this seriously narrows the full range of people who should be tested by biopsy. Among those left in the test group (who were diagnosed via mammogram), a woman who tests positive on the biopsy who is 20-30 years old now still only has a 45% chance of actually having breast cancer; 30-40 years old has an 88% chance, 40-50 has a 96% chance, and 50-60 has a 98% chance of having the disease after the two positive tests.
It's an interesting problem, because even in the 50-60 age range, false positives outstrip the real positives. It should also be noted that younger women tend to get more aggressive forms of cancer which develop from stages 0 or 1 to higher, more deadly stages more quickly. So that needs to be weighed as well, although I'm not sure how to statistically analyze that one.
“I'm not exactly sure what you're getting at!
”
This event (“mammo guideline” revision) (re)introduces numerous issues and ironies.
(Naive or unrealistic activists had better be careful about what they want.)
Well – I'm not sure which activists you're talking about – health care reform? people who want to keep the guidelines as they've been? the ones who want to cut back?
The fact is, breast cancer screening hasn't improved and the medicine practice around the screening remains unable to agree because they simply don't know.
For me, there's just no justification that can be given with adequately persuasive information – data or anecdotal at this time that tells me dropping a guideline that if kept will save the lives of 15%of the women diagnosed between ages 40-49 should be dropped (sorry – definitely writing as I think!).
Jill –
Don't worry about “thinking out loud” (and putting it onto this site in real-time).
> I'm not sure which activists you're talking about – health care reform? people who want to keep the
> guidelines as they've been? the ones who want to cut back?
No! There is no activism in these two groups that amounts to anything at all. Activists want ever more treatment, and for government to provide it (or for “insurers” to be required to provide it, which is in effect the same time, but indirectly). These people also (because they're defensive in that learned people don't ignorantly believe the “more, more, more” oft-unfounded or dishonestly-driven mantra) deny that any kind of rational approach to health care “reform” and the related major issues of appropriateness, effectiveness, cost, allocation of therapies and of money and effort on this versus that, will lead to any kind of (or more) rationing, denial of care, or any kind of negative or unpleasant or disappointing outcome.
Here (once again), they are proven right, and ironically, given this event's timing and applicability (not only with “appropriateness,” and pertinent issues about overhyped preventive care and risks as well as benefits of all kinds of care, including preventive or prophylactic care, and screening, but with the health care “reform” effort and associated emotionalism and impatience and current frustration at lack of “progress”). It provides quite a bit of delicious irony.
It's not the a final determination of everything (these were “I statements” and less than level A recommendations, in fact, which make the overreaction to it additionally noteworthy and amusing), but it does throw some rational, real-world cold water on those expecting findings to follow the (politically) “correct” trend of supporting current levels of intervention or advocating additional treatment, and the heavy politicization of women's health issues (like real and fake pollution and “climate change”).
[chuckle] Thou cannot serve two mistresses. Thou shalt not worship both Goddess and Mammo.
“there's just no justification that can be given with adequately persuasive information”
Well, we do have to separate the politics from the science (even more so with “climate change” and the puritanical PC fundamentalism and quasi-Insquisitionist elements and related behaviors there, but also with health care — which has been so corrupted not only with women's health issues, for example, but which has seen at least one article in the [oft-politically-slanted] New England Journal of Medicine that parrots the BS about systematic discrimination of the medical system against minorities, and the actual suggestion that minorities on the transplant organ waiting lists have their progress in the queues moved up with awards of “race-conscious points, for example). (There's more PC brownshirt-ism and puritanical fundamentalism in PC-politicized science than any caricature that can be made up about “purists” in the Dem and GOP political parties.)
A lot of people are overreacting to what was done, and the irony of this event is amusing and delicious.
“dropping a guideline that if kept will save the lives of 15% of the women diagnosed between ages 40-49 should be [rejected as a policy decision]“
Well, certainly the potential consequences are devastating (which is why we want to seek, not reject, for example, defenses against ballistic missiles and other deliveries of nuclear weapons, and try for the best defense possible, as any “leakage” is devastating, to use a better example and illustration). But also, “it depends.” On what? On how effective the screening really is; on the risks of testing as well as the benefits of disease and death forestalled; on, yes, the costs versus the benefits, and this is especially pertinent when comparing this screening routine for this disease against the needs and desires to spend time and money fighting and reducing other diseases and deaths as well. We can't magically do everything at zero cost or effort. Think “allocation” as well as cost and effectiveness (still the key from an intellectual and clinical viewpiont, in a fiscal and other-subject vacuum). Sooner or later, we need to do triage. With this event, it was simply a revision of current thought (“consensus” should be used right away if we want to treat this as well as, or better than another political subject, “climate change”) and a finding (which isn't necessarily surprising, given the reality we know about preventive care, which is no miracle or panacea) that some screening is less merited on the latest known facts than it was before.
(I'll look for any replies in about three hours. I'm in Terre Haute on the road west to St. Louis and beyond Will try to check again in St. Louis briefly.)
PS: I apologize for the last line in the first posting I made today, Jill. It should have begun with “Thou canst not…” [grin]
OK, no reply spotted now that I'm in St. Louis.
(God, I miss this place, and the neighborhood where I used to live, among the finest in the eastern USA — I'm not in a hurry this afternoon to get back on the highway; that says something…)
Jill, the recent mammo findings are not the last word, and certainly more federal R&D is merited (including making tests more sensive and able to detect cancer earlier — ahem — as well as reducing false positives, for example). Also, at least this subject, highly politicized as it is, isn't as corrupt as climate “science” (lefty PC “psyience”) has long been known to be, and about which the current scandal about leaked e-mails about PC corruption and suppression of dissent from catechism is no surprise, only interesting insofar as the extent of it was revealed (and kept silent by lefties, including on this site).
Hmm – well – if people knew what to do to encourage researching screening until we get an acceptable tool, then I'd be for activists. I'm not sure I agree with your definition of activist though – I think we're all activists in one way or another:
http://neohiofamily.com/articles/index.php?view…
I appreciate all your comments, esp. given your being in transit on and off. That we need better screening tools is accepted by most so yes, more R&D. But I think what is so tragically ignored in the original release from the task force is the human toll represented by dismissing the 15% of women ages 40-49 whose lives are saved by the current guidelines. We're talking employment, spouses, mothers for one thing. How that cost isn't the same as or higher than the “extreme anxiety” and overbiopsying that the task force shows a preference for reducing is beyond me.
But I also think they did a lousy job of trying to make their case.
Yes – I'm sure, this will not go away.
“I appreciate all your comments, esp. given your being in transit on and off.”
Thanks. Greetings from Joplin. For some “strange” reason, I was delayed leaving St. Louis…
I was thinking of you earlier, as I was in a used book store (i.e., a gold mine) and spotted a book, Big Coal, and thought of you and a slogan attributable to you, given your stance on coal as an energy source. (See below)
“what is so tragically ignored in the original release from the task force is the human toll represented by dismissing the 15% of women ages 40-49 whose lives are saved by the current guidelines”
Yep. This is not strict usage of the nomenclature, but consider it a sinister “opportunity cost” of making a cost-benefit analysis or appropriateness decision in favor of rejection of screening those who we know a fraction will have cancer that would have been detected if we were looking.
“this will not go away”
Oh, no, not at all. This issue (breast cancer screening and early detection methods) will probably get more R&D (not merely lip service as lightweight balm in the next few weeks or months). On a more general note, consider not only breast cancer, but other cancers and other conditions that someday might be able to be reliably predicted based on genetic as well as other inherent “markers.” We would probably all agree this is a good thing. But — once these pieces of information and the methods for revealing them are known, the insurers legitimately will have a right to use them, which means more pre-existing condition identification (much more, probably), and what I have long figured would be the end of the insurance model and an even-more-likely-than-now (which is close to “already”) insistence by the public overall of government intervention in health care (more than now, beginning at least with regulation and prohibition of uses of these more advanced future detection methods, which is counterintuitive and counterproductive in general, and which leads to a bigger push for government intervention in more ways, possibly including provision of health care eventually).
Jill's New Slogan (for what's it worth — the price paid is zero)
“It's Cheap. It's Filthy. It's Coal!”
(I like “filthy” rather than “dirty”)
DLS – what are you referring to here:
“I was thinking of you earlier, as I was in a used book store (i.e., a gold mine) and spotted a book, Big Coal, and thought of you and a slogan attributable to you, given your stance on coal as an energy source. (See below)”
I was one of the first and only bloggers writing about the TVA disaster that occurred just about a year ago now – I'm strongly against mountaintop removal and strip mining.
You lost me.
“I'm in Terre Haute on the road west to St. Louis”
Off-topic: How long are you staying in Missouri? I used to live there, near Jefferson City, many years ago. I miss driving, as in using my steering wheel for something besides a hand rest, along the back roads. I'm in Terre Haute right now, with my wife's relatives.
“You lost me.”
??? Well, you had actually addressed something. Not only was I aware that you're anti-coal, but that you specifically have exhibited this position in the past on the thread you created that you yourself just described, above,
” the TVA disaster that occurred just about a year ago now – I'm strongly against mountaintop removal and strip mining”
which of course I was reminded of (all of it) when I saw that book yesterday.
“How long are you staying in Missouri?”
NOT LONG ENOUGH! I had to leave yesterday, the same day I arrived, as I needed to get farther west as soon as possible. Not truly imperative, but I was on a tight budget and schedule and needed to get out to where I should spend the most time and money, where I'm set to start a new job on Monday.
I wish I had been able to stay longer (at least overnight, to revisit my favorite restaurant in the neighborhood where I used to live). As it was, I did manage to get “stuck” there from 12:30 until after six PM (just drove until early the next morning to get to Joplin, my next stop rather than Oklahoma City). I went by my old neighborhood (shopping district and former street where home used to be), then headed to a site to check on e-mail (sent from there), then took my time getting out of town. I miss it already.
“I miss driving, as in using my steering wheel for something besides a hand rest, along the back roads”
Driving along the Missouri River (including through the best-known wine country) was always fun, as was threading through the Ozarks (beginning in Eureka and Pacific!). The road north from Herrmann (which included a good, old-fashioned truss bridge across the river) snaked north through the hills on the north side of the river, then emerged abruptly onto open prairie. Welcome to Siberian America! North of Jeff City, the Arctic Ocean is approximately 2,000 miles onward, more or less(!).
I lived a little further up river in the rolling metropolis of Jamestown, MO (pop. 243). I lived in the suburbs
. We had a view of the bluffs from there, ten acres of woods, and a pond on the property. The country is beautiful, at least from the top of a hill. Good luck on your travels.
[out of order]
“Good luck on your travels.”
Thanks. I've been doing it in earnest for many, many years and want to keep doing it while I still can. (Health problem is eventually going to severely constrain travel.)
“The country is beautiful, at least from the top of a hill.”
You bet! This is an added benefit of visiting the oldest, most famous Missouri wineries — not limited to the especially-famous view from Montelle, either.
http://www.squidoo.com/missouri-wine-country
http://www.southernliving.com/travel/south-west…
NOTE: While I understand it joins other old truss bridges in being replaced with what technically is better, while I like some newer bridge designs (though many cable-stayed bridges are ugly, and multiple beam bridges are boring), I have a fondness for old truss bridges (which are often narrow, which emphasizes their length as well as height). I'm sad about the losses with the passage of time, and frequent progress.
http://www.modot.mo.gov/northeast/projects/even…
http://bridgehunter.com/mo/gasconade/hermann/
(Other trusses were lost at Alton and farther from St. Louis, at Cape Girardeau, earlier. At least I got to drive on the old Cape Girardeau bridge before it was removed. Also worth mentioning is that the old 66 Chain of Rocks Bridge is open to recreational non-motorized users in St Louis metro.)
http://www.trailnet.org/p_ocorb.php
http://www.theroadwanderer.net/66Illinois/chain…
Oddly enough, I have a brother who's building a large truss bridge in Iowa, to replace an older one, using trusses of the type where the rust protects the rest of the metal. When they're finished, it will look about 50 years old.
Did you ever cross the Booneville bridge when it made your car sway along way?
“the type where the rust protects the rest of the metal”
Cor-Ten steel? Similar to what was done at New River Gorge (West Virginia)?
“Did you ever cross the Booneville bridge”
Nope. I've gotten to cross a number of old truss bridges, but not that one.
Speaking of places to go and other bridges: my most noteworthy may be the Baring Bridge in western Washington state, just off US 2 on the way from Seattle metro to Stevens Pass and the Cascade Tunnels of 1900 and 1929). The Baring Bridge is Model A stuff. (I crossed it often in an RX-7.)
http://www.bridgemeister.com/pic.php?pid=44
http://www.abarim.com/Bridge%20at%20Baring.htm
I used to go to Stevens Pass and Scenic, west and beneath the pass, to watch trains at the portal of the Cascade Tunnel as well as visit the two old Cascade Tunnel portals. There has been other interest in the area after I left Seattle in the 1990s. The following is a map of the area around Stevens Pass and the tunnels as well as the old railway route. (Suitable for recreational trail use; I don't know if the old Cascade Tunnel will ever be used as a rec trail; when I was still in the Seattle area, the Snoqualmie Tunnel, 2 miles long, was opened to recreational users. I loved taking a flashlight and walking through it, from eastern to western Washington and back, two different worlds — others rode quickly through the tunnel on bicycles.)
Stevens Pass
http://people.msoe.edu/~westr/stevens.htm
Snoqualmie Tunnel
http://www.theslowlane.com/paths/iron.html
http://www.piap.com/photos/20050820/pictures/ds…
http://www.pnwhikes.com/hike.asp?hid=48#pictures
http://www.the4cs.com/~cathy/Photos/Tunnel2008/…
(I wish more tunnels were opened to the public for recreational use.)