Mammograms, less often?

Changes in recommendations for breast cancer screening, mammograms specifically, came out today.  I think this change is premature and based on normative interpretations of data on the costs and benefits of cancer screening. In other words, the data aren’t clear and leave too much to interpretation, which is exactly what the panel making the changes has done.  No Good!!! The stakes are just too high.

Women *who don’t have any risk factors* should now wait until they are 50 to have yearly mammograms, not when they are 40 per previous recommendations. The US Preventative Services Taskforce, linked to the Dept of Health and Human Services, is an independent panel of “experts” who makes these recommendations and made this change.  But also keep in mind recommendations are issued independently by the American Cancer Society and a host of other groups with a vested interest.  Not so long ago this panel recommended starting mammograms at 40. What changed? Data, they say. Data on the benefits versus risks of screening, a question that has come under scrutiny as of late for other diseases such as prostate cancer.

Data suggest that early cancer screening results in, what the panels thinks, too many false positives.  Unnecessary and stressful biopsies and removal of ‘harmless’ cancerous tumors that are not life threatening are some of the cited costs of early screening at starting at 40.  The benefits are clear, catching cancer early enough for removal and survival. But they also include increasing odds of saving the breast, less invasive surgery as a result, and overall better outcomes for those who had invasive cancers caught early.  Of course, these benefits only apply if cancer was found during early screening.  The costs are paid by those with ‘harmless’ tumors or who are cancer-free.

An important normative question that the panel ignores, or rather neglects to mention, is this: are the costs of early screening (undue stress, unneccesary biopsies, removal of ‘harmless’ tumors) worth it if the benefit is that 1 woman saves her life from early detection of breast cancer?  There is no clear-cut answer to this important question and further complicating the issue is the fact that medical researchers cannot yet distinguish between a ‘harmless’ cancerous tumor and one that will be life threatening at some point in the future. So we really don’t know what the costs of removing ‘harmless’ tumors are, the panel can only guess.  My answer, and I think that of many otehrs, is yes, yes those costs are worth it if screening at 40 saves a few lives.

So if a doctor can’t tell if a tumor detected early from mammogram or other screening tools will be life threatening, should it even be included as a cost of early detection?  I see it as a benefit, however that is exactly what this panel is suggesting by pushing screening recommendations towards a higher age based on recent data about costs and benefits of early screening.  Until doctors and researchers can identify harmless tumors from fatal tumors, I want to be screened early and am willing to undergo biopsies if necessary.  In fact, I already had a needle aspiration.  It was negative.  The stress and $200 cost of that biopsy was well worth the potential benefit of early screening and I plan to continue asking for screening.  But I do fall under the category of having risk factors, so I am not included in the population for whom the changes were made.  But many others are.  And high risk factors for breast cancer are being female and getting older.  Only 15-20% of causes are related to other factors.

I also met many women at the Breast Cancer 3-Day event I walked in this October (and raised $2,555 for) who had mothers, aunts, sisters, daughters, and friends who died at young ages from breast cancer who were not in a high risk category.  Again, are these lives worth the “costs” of early screening?  I should say so.  I wouldn’t want to tell any of those remarkable people I met that weekend “no”.

I worry that insurance companies now have an incentive to deny screening coverage to women under 50, and their doctors, who ask for it.  I had to fight to get my own early screening covered by insurance until a biopsy was needed.  I will keep doing it and hope that women listen to all recommendations, including those from the American Cancer Society and American College of Radiology who are sticking with the mammograms at 40 guideline. Go with your instinct about your own body, and feel those boobies every month.  That’s really the best screening tool.

“Capitalism: A Love Story”

Saw this last night with the husband.  Our reaction was a 60 minute discussion of the major points of the film followed by frantic rethinking of our plan for a big purchase (new car).  No resolution on the big purchase yet, but it’s a purchase of necessity.  Really, it is.  Though this smacks of hypocrisy when I consider that similar claims (read: twisted justifications) have been made in regards to new tvs, playstations, jewelry, designer duds, and a smattering of other ‘essential’ purchases like a $600,000 home on a $45,000 salary.  Sigh.

Official Website for Film.

Finer points from Moore and my reactions:

1) Capitalism has only been successful in practice for a given country (the U.S.)  if there is no competition.  Well, ok.  Historically this is sort of true (for post-WWII US) but this idea is too simplistic and drawn from a very low sample, 1.  This is problematic. But there is a deeper point here and that speaks to the principle of competition in a capitalist system, whether or not it’s necessary for it to function well or if too much competition can have negative effects.  Ha-Joon Chang’s book, Kicking Away the Ladder speaks to this debate better than I but his point is that unfettered capitalism (high levels of competition) doesn’t necessarily lead towards greater welfare.  Drawing from historical evidence, he finds that protection from competition has in fact been a critical component in the growth of most industries and economies.  So Moore is on to something, but the nuances of this point are lost in the film.

2) There is a revolving door between the financial industry and elite policymakers (Senate and Executive branch) akin to the one associated with the Military-industrial complex, first warned about by Eisenhower.  Carter (as President) warned us of growing consumerism and materialism, linked to this financial industry/government revolving door.

3) Regulation is required for capitalism to work. No kidding and no further comment. Human nature is not strictly benevolent nor generous and capitalism makes it more difficult to resist crushing your neighbor, especially if you never see them.

4) Higher education is funneled to the financial industry.  I was once a finance major in undergrad and found the experience deeply at odds with the experience in my political theory classes.  Ever since then I have been critical of unfettered neoliberal economic policies inherent in an unregulated capitalist system.  I missed my opportunity to sell out and wasn’t even conscious of it at the time.  Does that make me a better person?  No.   Just lucky.

5) The haves are afraid of the power of the political power of the have-nots, but the have-nots can be easily bought off using the myth of the American dream.  Yes!  With this I wholeheartedly agree.   But the power of the American myth is so deeply engrained in our psyche:  ‘We can do it!’  ‘You too can pull yourself up from your bootstraps’ and ‘be rich, be happy’.  I call bullshit.  But it’s hard to vote against the American dream and essentially that’s what we would be doing in electing officials who would enact more redistributive policies.  It would be admitting that we can’t be as rich and succesful as the top 1%, or even 15%, and the rich need to subsidize the less wealthy to make up a gap that will never disappear.  Europeans seem comfortable with this proposition.  I am as well.  But those higher on the ladder of success have a very hard time admitting that they are also beholden to the extremely wealthy.  Essentially the are the upper middle class that have been bought off by the elites to perpetuate the myth of the American Dream.  This is similar to what happens in a country that transitions from elite to popular rule- in order to kep elites happy, they are bought off by the very top to perpetuate the system that guarantees their security.  But the kick is, the top elite know damn well it’s a myth, that the American dream won’t come true for the majority of the people.  In fact, it is quite literally impossible for most.

The bottom line is this film makes you think, but only if you have the tools to sort through and expand Moore’s overly simplistic ideas.  And it’s scattered all over the place, hitting on political and economic points that are related, though somewhat loosely.  And Moore’s main point presented dramatically at the end of the film is plain weird- “we need to replace capitalism with democracy”???  Hmmm….  Read Hamilton and Madison for more on how this plan is a bad idea.  Not to mention it ignores the basic fact that a financial system is separate from a political system (see Japan, South Korea, China, etc).

Image courtesy of official film website.

Public Health Option

Bring it, please.  Gregory Mankiw blogged about it today and posted links to the opinions of other economists: Paul Krugman is whom I agree with on most counts.  It just makes sense.  It’s not a perfect plan or a magic bullet by any means, but it’s a good policy change that will at least put some market pressure on private insurers.  Change is never easy…

Chocolate, a love affair

My love affair with chocolate began with a slow start.  I, dubious of my taste buds’ ability to discern between a Hershey’s bar and anything else, stood in my own way for years until I hit my late twenties and decided that maybe it was time to grow up, in a gastronomical sense.  And it was then I started exploring the world of fine chocolates.  Like wine, I tell you, it’s like wine without the swirling and legs.  But there is sniffing involved.  That first whiff of fine chocolate is unmistakable.  Nutty, rich, and filled with tones from the ingredients used to infuse that particular piece of chocolate.  Maybe lime, maybe chile, maybe praline… And the first bite is always a little bitter (if it’s over 60% cocoa content) but once it dissolves in your mouth you taste the rich flavor distinct of only the best.

My personal favorite flavors include peanut butter discs, lemon truffle, key lime truffle (See’s Candy does this one the best), and classic dark chocolate truffles.

So who has the best chocolate?  Depends on where you live… I scope out the chocolatiers in new cities, sampling their wares as I walk along city streets, and seek out my favorite local spots for bars, truffles, and bits.

1) Toronto: Belgian chocolatiers who favor nutty flavors and textures, reflecting their love affair with praline (hazelnut).  The Belgians seems to recognize the value of a tart lime flavor as well, a flavor often missing from their American counterparts.  More to the point, a flavor often included but rarely done well.

2) San Francisco: the land of variety, though the better chocolate is found in places like Recchiuti Confections rather than the usual suspects Ghirardelli or Scharffen Berger.  Recchiuti has the best peanut butter discs and an assortment of other lovely flavors.  I remember being enchanted by the Bergamot as well.  And what could be better than chocolate and sour dough? Not much.

3) NYC: known for truffles and really, everything else too.  It’s hard to beat the variety of chocolatiers in NYC, ranging from Max Brenner (not my cup of tea) to Teuscher and La Maison du Chocolat (Tuescher has good milk and white chocolate from Switzerland and La Maison has truffles to die for).  Also known for the annual NYC Chocolate Show, which I hope to attend this year on Nov 1st.

4) Philadelphia: Naked Chocolate.  Specifically the European style hot drinking chocolate.  I order the Aztec, you can choose the classic or Hawaiian.  And, yes, Hershey’s.  Though I haven’t been to Hershey yet….

My current favorite bar is the Dagoba Lavender and Blueberry bar, a small sweet and dark little lovely filled with teh aroma of lavender and the unique tart/sweet taste of blueberry bits.  In the words of Carrie, hello lover!  Other favorites include Chocolove (I gave away the full size milk chocolate bar to everyone at my wedding).

Stay tuned for more chocolate love…

The NSF, Senator Coburn, Political Science, and Ostrom

Seething, that’s my reaction to Senator Coburn’s speech in support of his sponsored amendment No. 2631 to H.R. 2847 to cut ALL Political Science funding from the NSF.  View his speech HERE, starting at minute 131:00 (and lasting approx. 11 minutes, though he drones on for many more minutes in a general diatribe against govt. spending).  His speech starts out in reaction to the outrage of political scientists over the past several days after introducing the amendment, the fervor coming from the American Political Science Association and political scientists on their own blogs, twitter accounts, facebook, and calls and petitions to Congress.  Even Paul Krugman thought the amendment was a silly idea and Charli Carpenter and Daniel Drezner offer good reasons why.

The part that irks me the most is his remarks about political science not being a “real science”, implying that it does little to nothing to advance the people of this country.  Really?  REALLY?  Personally, I have used data from data projects partially funded from the NSF on armed conflicts and autocracy/democracy.  For what?  Maybe not to save the little girl Coburn dangles in front of Congress, but the data have been used in studies that analyze the impact of US foreign policy on war.  Or the relationship between trade and war.  Or whether democracies really are more peaceful (hello, US, remember those covert invasions of fellow democracies?).  Now we’re talking.  This shit is important!  Coburn knows very little about political science, as evidenced by his speech.  It’s just so damn hard not to get riled up at his ignorance.

In related news, Elinor Ostrom, a *gasp* political scientist at Indiana University won the Nobel Prize in Economics for her work regarding collective action in areas commonly thought by economists to necessitate government, or other, intervention.  This includes fisheries and pastures, often thought according to economic theory to be subject to the tragedy of the commons. According to her research evidence suggests they can be managed successfully by users of the common good, without intervention.

I repeat, a POLITICAL SCIENTIST, won the Nobel Prize.  And she certainly benefited from NSF funding over her career, not to mention battling serious gender inequities along the way.

“Whip It”, whip it good…

Drew Barrymore’s latest film, “Whip It”, combines the authenticity of a good indie film (thanks largely to the acting of rising indie queen Ellen Page) while promoting good ole fashion crack em’ up roller derby.  I had forgotten what “whip it” meant, not counting Devo’s catchy 1980s tune and the terrible red hats they don in the video, but was soon reminded as I was mesmerized by the roller girls being whipped around the track in order to pass their opponents and score points.  Ah, I remembered roller skating parties in the 80s where girls used to whip each other around the track, but we never thought of it as sport.  A subset of women did, however, and have been involved in this underground sport for years.  Roller Derby girls, as portrayed I think quite accurately by this film, are a diverse bunch of women ranging from the stereotypical, muscled up, masculine meanies to the subdued but slick girlie-girls.

Part of what roller derby does is equalize women on the track, like football or rugby.  Regardless of who you are on the streets, it comes down to how you play on the field (or track in this case).  But what roller derby offers that many traditional sports do not is a chance to flaunt your femininity and use it as a tool for sport.  This, I applaud.  Now maybe figure skating achieves this too, but something about roller derby speaks to an authentic version femininity whereas figure skating (for me) requires and displays a particular vision of femininity which I don’t identify with on a daily basis.  But perhaps the figure skaters would say the same thing about derby girls.  I guess I just self-identified.

Roller derby is a cross between rugby and burlesque where women can leave their daytime personas at the door and morph into an exaggerated character of themselves, be it feminine in the traditional sense or not.  I suppose whether you think it’s feminine is shaped by your perspective of women in general, but also of women in sport.  Personally, I can’t think of anything more feminine than roller derby, fishnets or not.  If you’re a girlie girl, then wear all pink and a full face of makeup.  If you’re tough, show off that ink and rip a hole in them stockings, that’s ok too.  Choice of identity, that’s what roller derby gives women, and that’s what is missing in other ‘more feminine’ sports (or those that require makeup and costume).

Will I throw on a pair of skates, slick on red lipstick, and hit the track?  Maybe, but not until I’ve completed a few centuries on my bike, tragically without lipstick or fishnets.  Now there’s an idea…

Image courtesy of www.drewbarrymore.com

The Swell Season (from “Once”)

The duo behind the gem of a film, “Once“, will release their new album “Strict Joy” on Oct 27th and are touring the US this fall.  You can find a recording of their Tiny Desk Concert on NPR.

“Once” is a musical film, unlike anything I have ever watched or heard.  As a fan of musicals when I was, oh, 13 years old I was unsure of what to expect when told by a friend it was a musical.  But this is an indie musical more for hipsters than for loud audacious singers looking for the next chance to belt out a tune of a favorite story.  I say ‘hipsters’ with a sense of qualm as this conjures up images of too cool for school Gen Xers and clueless but angst ridden Gen Yers (wearing a variation of the ubiquitous American Apparel/skinny jean/scarf/colored tights uniform) swarming around Brooklyn and other NYC borough neighborhoods.  But hey, call it like it is, right?

Along the same vein of “(500) Days of Summer”, “Once” a story about love, but not a love story.  The two main characters’ lives weave together for a short period of time but inevitably take separate paths by the end of the film.  In this case, the partnership lives on through their music.  So what if the story behind the film is fiction?  It’s a brilliant merge of fictional story with the backdrop of a beautifully authentic musical partnership.  I, for one, am a fan and can’t wait to get tickets for an upcoming east coast show.