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This is the second part of my conversation with Dr. John Dombrowski, a Washington D.C. anesthesiologist and pain management specialist who sits on the American Society of Anesthesiology's administrative affairs committee.

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As Congress goes into recession, the debate over healthcare hits home. But what's really happening on the reform front? Will it meet the needs of the American public? In a 5-hour special series over five days, we'll hear from doctors, hospital administrators, insurance companies, economists and average people about what's driving up healthcare costs, what it will take to make real changes, and what trade-offs people are willing to make to see meaningful reform through.

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Robin Lowe went to the Sano Medical Clinic in Costa Mesa one June with what appeared to be an obvious and urgent problem. She had felt a lump in her left breast.

At 29, she was young to develop breast cancer. Making matters worse, she was pregnant.

Dr. James Stirbl, the doctor who ran the clinic, examined Lowe but did not recommend she undergo a mammogram or a biopsy, according to the Medical Board of California.

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When a major insurance company goes under in California's strained healthcare system, the reverberations run deep.

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Six of the world's biggest drug companies are about to be winnowed down to three. If all the mergers go through, we will have Pfizer-Wyeth, Merck-Schering-Plough and Roche-Genentech controlling more than $100 billion in drug sales every year - amounting to one seventh of all revenues for drug companies worldwide. (I wrote a story about this a couple weeks ago for the Los Angeles Times.)

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This story, pegged to new research on dual mastectomy rates, examines why some breast cancer patients choose to have both breasts removed even if it may not improve their survival.

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The therapeutic use of cannabis (marijuana) is a hot topic in some parts of the United States. The National Institutes of Health do not recommend its use for treatment of any illness, though some physicians prescribe it for pain, glaucoma, nausea and anorexia associated with chemotherapy, and, less commonly, for epilepsy, multiple sclerosis, migraine, and asthma. Laws on medical usage vary by state, with 13 states, as of July 2009, permitting medical usage under certain conditions. The majority of Web sites on medical marijuana have a bias one way or another.

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Dr. Laurene Mascola is chief of the Acute Communicable Disease Control (ACD) unit for the Los Angeles County Department of Health's Public Health Programs & Services, which performs disease surveillance and epidemic control activities for more than 60 diseases. Mascola oversees the County's programs for immunization, food and water safety epidemiology, vectorborne (insect) disease, hospital outbreaks and bloodborne diseases. Mascola has extensive experience in epidemiology and disease prevention, publishing more than 100 articles and abstracts in numerous medical and public health journals.

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In 2002, health care costs, particularly for cancer treatments, were soaring for seniors in some Medicare HMOs. After negative publicity about one HMO's drastic increase in chemotherapy copayments, the HMO agreed to reduce the cost to make it more affordable for patients.

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