We had a nice discussion about the recent and important British Medical Journal (BMJ) study on screening mammography (Daily Kos link here), but adding to the discussion are some posts from cancer surgeon Orac, first from 2008:
If there’s one thing that lay people (and, indeed, many physicians) don’t understand about screening for cancer is that it is anything but a simple matter. Intuitively, it seems that earlier detection should always be better, and it can be. However, as I explained in two lengthy posts last year, such is not always the case.and now:
The point, obviously, is to find the “sweet spot,” which maximizes the benefit of screening and minimizes the harms due to overdiagnosis and overtreatment. Based on current evidence, of which the CNBSS is just one more part, I’m more and more of the opinion that our mammography screening guidelines need to be tweaked and personalized because the current “one size fits all” regimen is probably too aggressive for most women at average risk for breast cancer. It’s an evolution in my thought that’s been going on for years. In any case, in any statement I’d put something in there about determining what the “sweet spot” is for mammography. It’s also reasonable, for now at least, to stick with existing guidelines, with perhaps more of a personalized approach to screening of women between ages 40 and 49. That’s what I intend to do until new evidence-based guidelines emerge. And emerge they will, likely within a year.To add perspective, this (alas, behind a paywall) BMJ report notes the Swiss approach:
Switzerland debates dismantling its breast cancer screening programme.Overseas, many countries are not enamored of routine mammography, in part because of overdiagnosis. The forthcoming evidence-based guidelines will be very helpful, even if not welcomed.
More politics and policy below the fold.
Hey, don't let controversy be limited to medicine. Let's get CBO in on the fun. From LA Times:
Increasing the federal minimum wage to $10.10 an hour would cause the loss of about 500,000 jobs but would boost earnings for about 16.5 million low-wage workers, according to a report by the Congressional Budget Office.Reuters:
The report, released Tuesday, stoked the long-simmering debate in Congress over hiking the federal minimum wage above its current $7.25 an hour.
Republicans in Congress and allies in the business community have long argued that minimum wage hikes encourage employers to shed workers to help offset higher salaries, and have vowed to fight the move ahead of the congressional elections in November.Matt Yglesias:
They quickly seized on one of the findings in the CBO report: that raising the minimum wage in three annual steps to $10.10 an hour would result in about 500,000 jobs being lost by late 2016.
"With unemployment Americans' top concern, our focus should be creating, not destroying, jobs for those who need them most," said Brendan Buck, a spokesman for House of Representatives Speaker John Boehner, a Republican.
But Democrats also found something to tout in the report, which found that a $10.10 minimum hourly wage would bring 900,000 people above the poverty threshold of $24,100 a year for a family of four. Some 300,000 people would be lifted out of poverty if the minimum wage were raised to $9 an hour in two annual steps, CBO said.
So let me make another point. If the White House genuinely believes that a hike to $10.10 would have zero negative impact on job creation, then the White House is probably proposing too low a number. The outcome that the CBO is forecasting—an outcome where you get a small amount of disemployment that's vastly outweighed by the increase in income among low-wage families writ large—is the outcome that you want. If $10.10 an hour would raise incomes and cost zero jobs, then why not go up to $11 and raise incomes even more at the cost of a little bit of disemployment?Greg Sargent:
Of course politics is politics. And in politics, you always want to say that you have policies where folks can have their cake and eat it too. But logically speaking, the overall goal of economic policy isn't to maximize employment, it's to maximize prosperity. A minimum wage hike with a small but real disemployment impact is the minimum wage hike you want.
Diehard foes of immigration reform like to argue that the American people see securing the border as a far higher priority than doing something about the 11 million undocumented immigrants already here in this country. But now two polls have found that this is no longer true.