Figleaf's Real Adult Sex

Matthew Yglesias notes a really big problem with the common narrative about Congressman Bart Stupak’s anti-abortion “principles.”

One of the real oddities of Bart Stupak’s refusal to get back on board the health reform train is that virtually everyone who looks at the current language thinks it’s close to Stupak’s own language, and basically achieves what Stupak says is his goal—avoiding taxpayer subsidies of abortion. The people who agree with Stupak are overwhelmingly conservative reform opponents, who are casting about for things to object to. People who want to see health coverage expanded, including anti-abortion Catholics, generally don’t see things Stupak’s way.

Read the quote in context here.

He’s done enough damage. At this point, like his similarly intractable colleague Dennis Kucinich on the left, or his erstwhile colleague Eric Massa, Stupak’s grandstanded himself into post-irrelevancy. They all are, or were, steadfast “no” votes on HCR. It’s past time to ignore them.

Summary: An example of the political, law-enforcement, and practical problems of detecting vs. dealing with potential terrorists supports Echidne’s analysis of the problem with breast-cancer detection recommendations.

Matthew Yglesias discusses the difference between “common sense” anecdotal evidence and statistical evidence.

Suppose I invent a magical device that can be pointed at a Muslim and say with 90% accuracy whether or not he’s an al-Qaeda operative. Well, if I start waving it around and it starts beeping on one guy, what should we conclude about him? A terrifyingly large number of people are going to say “there’s a ninety percent chance he’s with al-Qaeda! Let’s panic!” In fact, that’s not the case. There are a billion Muslims in the world. A test with 90 percent accuracy is going to mistakenly classify about 100 million of them as al-Qaeda operatives. And al-Qaeda actually has fewer than 10,000 people working for it. I’m going to get something like 10,000 false positives for every actual terrorist I find.

Meanwhile, applying the test to people is going to have severe consequences. The public doesn’t understand this correctly and is going to be put into a wholly unwarranted state of panic about the prevalence of terrorists. People will, of course, demand that those flagged by my machine be subjected to extra-heightened scrutiny. It’s easy to imagine lots of innocent people being mistakenly killed or subjected to discrimination or shunning. And that sense of beseigement and unfair treatment would ultimately heighten tensions between the world’s Muslims and the West, while wasting massive quantities of law enforcement resources chasing basically worthless leads.

Read the quote in context here.

It seems odd to call a discussion of terrorism and racial profiling “non-controversial,” and perhaps even more odd for me to quote so extensively about something seemingly so remote from anything having to do with my main topics of relationships, sex, and gender.

Yet I bring it up to support a post by Echidne of the Snakes defending the statistics and methodology behind the new mammogram restrictions.

It was seriously principled, and courageous, for her to go out on a limb like that. Like a lot of problems in mitigation it’s easy to point to someone who benefitted from the status quo, but harder to identify those who suffered from it.

I think Yglesias’ post explaining the cost of more testing at certain ages (even if the tests were very accurate — which they aren’t in either Yglesias’ nor Echidne’s cases) would tend to overwhelm the system, and individuals, with false positives on the one hand, and still-treatable cases on the other.

Without intending any gender equivalencies, at all, it’s instructive to note that a similar situation arose in prostate cancer detection 10 or 15 years ago: PSA tests brought the price of detection down and the early detection way, way up. But, as you note, detection isn’t the same thing as treatment. At all. In fact detection isn’t even the same thing as understanding the disease!

For better or worse, because the imbalance between detection on the one hand and both understanding and treatment on the other hand was so lopsided it became a big problem for medical ethics: first, it turns out overwhelming numbers of men over 50 or so have detectable early prostate cancer. But for most it’s so slow to grow they die of old age before they can die of the cancer. For most but not all. Enough die, and die fairly horribly, to make treatment a consideration. But the treatments (burning off, cutting off, or poisoning) are generally so debilitating and expensive they shouldn’t be undertaken unless you’re sure it’s the bad kind. Which makes it a shame that researchers then, and now, still can’t tell whether an early cancer will go bad.

The line between the risks and benefits of breast-cancer testing are much harder to draw than prostate-cancer testing was. And so we’re stuck (or I should say “stuck”) with statistical analysis. Which is why it’s really nice to have a committed, ethical, and highly-interested statistician explain these particular findings for us. And with breast cancer the benefits are close enough to the costs (barring further progress in the development of treatment anyway) that it’s really hard to say what the right thing to do might be. And so we’re likely to run into really big shifts in the conclusions.

On a final note I especially appreciated Echidne’s explanation of not only the cost vs. benefit of testing, but how the cost incurred for marginally-valuable testing might be diverting funding from research into treatment or prevention. (emphasis mine.)

Screening is not treatment. To do it at all is based on the hope that early detection raises the odds of survival. This has been shown to be true for cervical cancer and the pap test and also for colon cancer screenings. But the most recent evidence suggests that breast cancer screening is less effective than previously thought. As I mentioned in an earlier post, researchers now suspect that mammograms capture a lot of tumors which might either disappear on their own or never grow much, while missing the very aggressive tumors which develop very rapidly. It is the latter types which are reflected in the mortality statistics

...

The choice to pay for screening (by both individuals and the society) is ultimately a value judgment. But resources are not infinite. If money is spent (by both individuals and the society) in one type of screening, it is not available for other types of screening or for other types of prevention or treatment.

It’s hard when answers aren’t cut and dried, and even harder when the ranges are so close you can get these big shifts in recommendations. And when it’s a controversial subject it’s even harder. Cool that she was willing to dig into it.

Update: See also Amanda Marcotte’s take, with another allusion to prostate cancer (it’s being downscaled too) and more backup links.

Jill, formerly Twisty, of I Blame The Patriarchy, herself a double-mastectomy survivor, reflects on an intrinsic bias towards treatment over prevention for many types of illness — breast cancer in her case.

Specifically Jill was responding to the lack of online information, particularly photographic information, about mastectomy and aftercare compared to, say, enough images of pink ribbons and pink soda-bottle packaging to repave Los Angeles.

As Samantha King writes in the enlightening Pink Ribbons, Inc.:

[Women] are discouraged from questioning the underlying structures and guiding assumptions of the cancer-industrial complex. The culture of breast cancer survivorship does not, in other words, embrace patient-empowerment as a way to mobilize critical engagement with biomedical research, anger at governmental inactionk or resistance to social discrimination and inequality, even if its history is bound up with attempts to do just this.”

People can’t find out how really fucking gross treatment is, because if they did they might start thinking, hey, maybe preventing breast cancer — as opposed to waiting for women to get sick and then slamming them with a series of debilitating, barbaric procedures — is a good idea.

She said it here.

One needn’t agree that there’s a purposeful conspiracy to get the point that there’s not as much emphasis placed on finding ways to prevent common illnesses like breast cancer as there is for “the cure” after they’re diagnosed. Nor does one need to think the emphasis on treatment boils down to profit motive to agree more emphasis could be put on prevention.

Part of the problem, of course, at least in America, is that we’re great optimists and (Katrina notwithstanding) pretty good at responding to immediate catastrophe. And so we have a hard time in general with anticipation: “you won’t get cancer if you…” when you don’t have it (yet) is just way harder to gear up for compared to how we’re able to marshall ourselves in the face of “you have cancer…” (What’s that line “nothing so concentrates the mind as the prospect of being hanged in the morning?)

But I digress. I just want to echo Jill’s point that when one is facing a crisis like prospective surgery and chemotherapy (of any sort) it would be awfully nice if there was as much information available about what to expect before and during the process as well as there is for after.

Oh, one last thing: this, I think, is one of those areas where blogging really shines. It’s sometimes heartwrenching to read someone’s personal experience with surgery, recovery, chemo, remission, reoccurrence. But it’s very good to know. Just as its good to know what to expect before our first kiss, our first orgasm, our first time driving, our first child, or job, and so on, it’s good to know what to expect when we fall ill. Again, that’s where people who blog have shined.

This is a brief departure from sex blogging, true, but it’s too good to pass up and the original poster should get wider notice.

Women’s history scholar Sungold of Kittywampus says

Stop scrambling German history.

It was [Otto von Bismarck, not Hitler, who introduced universal health care in Germany. Bismarck established public, non-profit insurance agencies funded by worker and employer contributions. He didn’t do it because he was a bleeding-heart liberal; his intent was to co-opt an issue that drew support to socialism.

Please get your mustaches straight.

She said it here.

It’s a great point you know. Confusing the current proposal for health-care reform, as illustrated in the accompanying chart…

Chart found at Think Progress, Yglesias division

...with socialized medicine, or, for that matter, confusing President Obama’s governing style with Hitlers is kind of dumb. Not as dumb as thinking the original Bible was written in English. Not as dumb as not knowing whether the Old Testament was written before the New Testament. Not as dumb as not realizing Stephen Hawkings is, in fact, British. Or, (and this is a new one) that Barack Obama was born in Hawaii but that Hawaii isn’t part of the United States! But still dumb.

To be precise, according to Wikipedia…

Bismarck’s program centered squarely on insurance programs designed to increase productivity, and focus the political attentions of German workers on supporting the Junker’s government. The program included Health Insurance; Accident Insurance (Workman’s Compensation); Disability Insurance; and an Old-age Retirement Pension, none of which were then currently in existence to any great degree.

Also note: Bismark introduced universal healthcare in Germany in 1883. Adolph Hitler didn’t come to power until 1933, fifty years later.

Nor was Bismarck exactly a political liberal…

In the year of his marriage, 1847, at age 32, Bismarck was chosen as a representative to the newly created Prussian legislature, the Vereinigter Landtag. There, he gained a reputation as a royalist and reactionary politician with a gift for stinging rhetoric; he openly advocated the idea that the monarch had a divine right to rule. His election was arranged by the Gerlach brothers, who were also Pietist Lutherans and whose ultra-conservative faction was known as the “Kreuzzeitung” after their newspaper, which featured an Iron Cross on its cover.

... in other words he more of a protege of the Fox News, National Review, or Washington Times of his day.

Sungold illustrates her post with a picture of Bismarck’s giant handlebar mustache. I’m illustrating mine with an entirely different, and even more appropriate mustache.

Photo by Flickr user blunderer. Used under a Creative Commons license.

Bottom line: if you’re into not just “worker” productivity but actual workforce productivity Otto von Bismarck and Barack Obama can be found on the right side of the divide, while Adolph Hitler and the post-Reagan ‘wingers can not.