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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.

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.

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.

Matt Yglesias:
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?

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.

Greg Sargent:
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.
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Comment Preferences

  •  Ukraine? (8+ / 0-)

    I wonder if that'll inspire any Springs this year?

    OTOH, I worry that it may also inspire some itchy triggered rednecks to try to take their gubmint back....

    "If this Studebaker had anymore Atomic Space-Age Style, you'd have to be an astronaut with a geiger counter!"

    by Stude Dude on Wed Feb 19, 2014 at 04:36:16 AM PST

    •  Venezuela, too. (4+ / 0-)
      Recommended by:
      gffish, Stude Dude, psnyder, thomask

      Reports overnight that a leader of the opposition (to the government) has given himself up and is now in the hands of government forces.  Facing a variety of charges (murder, conspiracy), Leopoldo Lopez gave himself up to authorities yesterday after several days of public protests, government opponents numbering in the thousands in the streets of Caracas, which are ongoing.  Government supporters have also rallied, and tensions between the groups have so far resulted in the deaths of three anti-government protesters and one government supporter.

      Anti-government protesters are demanding better security, an end to scarcities and protected freedom of speech

      "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

      by SueDe on Wed Feb 19, 2014 at 05:53:17 AM PST

      [ Parent ]

  •  Scott Walker email dump? (7+ / 0-)

    There's suppose to be a 27,000 email dump from the Joe Doe 1 probe later today. Anybody know the time? I wonder if there's anything damaging in there?

    "If this Studebaker had anymore Atomic Space-Age Style, you'd have to be an astronaut with a geiger counter!"

    by Stude Dude on Wed Feb 19, 2014 at 04:39:04 AM PST

  •  Famous Last Words...."But the CBO said..."nt (5+ / 0-)
  •  If one is "disemployed" are you "unemployed"? (1+ / 0-)
    Recommended by:

    Yglesias' argument sounds a bit like the argument that if one loses health benefits at work, then it could be good because you are no longer tied to your job for benefits.  In other words, making something that is not good sound good.

    •  Why is it not good that employees (1+ / 0-)
      Recommended by:

      will then be able to acquire insurance through the exchanges and utilize federal subsidies?  These employees aren't losing their jobs.

      "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

      by SueDe on Wed Feb 19, 2014 at 05:56:53 AM PST

      [ Parent ]

    •  If the only reason you are staying in a job (0+ / 0-)

      Is for the health insurance, it IS good that you can get it elsewhere.

      Help us to save free conscience from the paw Of hireling wolves whose gospel is their maw. ~John Donne

      by ohiolibrarian on Wed Feb 19, 2014 at 12:23:23 PM PST

      [ Parent ]

    •  Until NC Republicans actually do something (8+ / 0-)

      all this talk is little but a head fake.

      Real change or just covering their tracks?

      The question that arises with respect to all of these recent statements and actions, of course, is whether they represent a meaningful shift or mere political puffery. Are state leaders actually serious about tempering their policies or are they just trying to blunt criticism?

      The ongoing mess with DHHS (Medicaid and food stamp delays), DENR (in the pocket of Duke Energy) and attacks on public education (eliminating tenure, a half-assed pay plan for teachers, private school vouchers, unlimited & unregulated charter schools) should be an eye opener for NC voters.

      NC is a purple state. The NC GOP has been governing like it's 1950 Alabama.

      Election Day is Nov 4th, 2014 It's time for the Undo button on the 2010 Election.

      by bear83 on Wed Feb 19, 2014 at 05:55:25 AM PST

      [ Parent ]

  •  Interesting on immigration (4+ / 0-)
    Recommended by:
    salmo, Aquarius40, skohayes, tb mare

    that "build the damn fence" has become less important than figuring out what to do with (for?) the undocumented. Wonder how much credit is due to the activists who have been tirelessly humanizing the issue?

  •  Oh the irony. (6+ / 0-)

    When I was young, I got a complete annual physical including mammogram and chest xray [smoker].   Now that I am much older, I get a physical every other or every three years.   I once read somewhere that if you live through your sixties, you are likely to live to the 80s.   At some point in my life, one gets to be old enough to quit saving for their old age and to quit worrying about living to a ripe old age.

    I will not vote for Hillary. What we need is a Democrat in the White House.

    by dkmich on Wed Feb 19, 2014 at 05:00:01 AM PST

    •  dkmich, same for me (4+ / 0-)
      Recommended by:
      skohayes, tb mare, dkmich, wintergreen8694

      Being at very low risk for breast cancer, I've always decried the "mammogram once a year" shtik. I get one every two years. I'm about to leave the sixties, so I'll take it easy too on the other medical stuff too. Haven't been going to the gym because of an acute case of winter, but have been pretty much observing the other guidelines.

      "Religion is what keeps the poor from murdering the rich."--Napoleon

      by Diana in NoVa on Wed Feb 19, 2014 at 05:26:21 AM PST

      [ Parent ]

    •  At a 50 yr old's funeral, someone told me if you (0+ / 0-)

      Make it through your 50's, you'll make it to the 80s.  So, I looked it up. It isn't true :-(

      Dementia, you better treat me good. ~Conor Oberst "Slowly (Oh So Slowly)"

      by NotActingNaive on Wed Feb 19, 2014 at 08:58:56 AM PST

      [ Parent ]

  •  Boosting the minimum wage causes job loss? (9+ / 0-)

    Why do any of those jobs that would be lost exist right now? If they could be cut, they would have already been cut. Surely employers don't hire people they don't need just because they have extra money laying around.

  •  BBC story: California water exported to China (7+ / 0-)

    I haven't seen anything like this in the US media (surprise. . . .) -- California farmers using all-too-scarce water to grow alfalfa hay, which is then shipped to China, while cattle in California are being killed for lack of hay.

  •  how about raising the minimum wage (15+ / 0-)

    to fifteen dollars an hour, and passing a jobs bill to make up the difference?

    and thanks for highlighting the mammography research. it's not easy for a lot of people to accept. neither is the idea that individuals need to be diagnosed and, when necessary, treated as individuals.

    The cold passion for truth hunts in no pack. -Robinson Jeffers

    by Laurence Lewis on Wed Feb 19, 2014 at 05:11:53 AM PST

  •  Oh Good Lord, the Scarborough Stupidity burns. (11+ / 0-)

    In one breath, 'there's no free lunch, raising the minimum wage would only hurt low wage people', in the next, 'I'm fine with raising the minimum wage to offset inflation'.

    Minutes, MINUTES, after they just showed a graphic showing that the 1968 minimum wage (adjusted to modern dollars) was (according to them) 10.60 an hour.

    So the measly raise the Dems are willing to suggest is 0.50 BELOW keeping up with inflation, Joe.  If you're ok with the minimum wage raising it to keep pace with inflation, then it needs to be HIGHER, not lower.  (And that's with 'inflation' measured in the lowball way it is 'officially', which ignores the fact that just about everything has more than doubled in cost since 1968.)

    •  Shhh... (7+ / 0-)

      the Scarborough doesn't like to think about what it says.  Thinking only upsets it.

      "I'm not left wing because i'm ideological, or passionate, or angry. I'm left wing because I'm informed." - Mikesco

      by newfie on Wed Feb 19, 2014 at 05:20:59 AM PST

      [ Parent ]

    •  And Keystone = a jobs bill. nt (2+ / 0-)
      Recommended by:
      Dr Erich Bloodaxe RN, tb mare
    •  I love watching Twitter in the morning (4+ / 0-)

      explode with frustrated liberals who watch Scarborough. His ears must burn like hell every morning.
      That being said, I can't figure out who he's talking about when he says raising the minimum wage would hurt "low wage workers". WHAT?
      Imagine being a waitress making $2.00 (or whatever tipped employees make these days) an hour at the local Denny's and the grocery store next door starts paying $10.10 an hour.
      Either that restaurant owner is going to raise his wages or he's going to be serving food to his customers by himself.
      How is that bad for low wage workers?

      Your beliefs don't make you a better person. Your behavior does.

      by skohayes on Wed Feb 19, 2014 at 06:34:51 AM PST

      [ Parent ]

      •  Any large change in business is going to cause (2+ / 0-)
        Recommended by:
        skohayes, Julia Grey

        some initial chaos, and businesses that weren't doing well and using minimum wage workers might actually go under, destroying some jobs.  And I say 'might'.  It's certainly not guaranteed, especially if they raise prices enough to offset.

        But the new money being pumped down to those low-wage workers is going to create new demand as well, and hopefully cause other jobs to open up, since demand is the true job creator.  As you say, the Denny's might lose an employee, while the grocer gains one.

        Another part of what he hit on is the question of 'Who uses goods made by and services performed by minimum wage workers?'  Joe's contention is that wealthy people like himself and those around his table today do not, and that all of the money will simply be flowing 'from the poor, to the poor'.  Which is an absurd boundary condition scenario.   Even if Joe never directly buys a single thing from a minimum wage employee, somewhere along the line, they were involved with creating the various mass-produced items used by his show, and by the employees of his show.

        Minimum wage raises are the true 'trickle-downs', precisely because not everybody who buys minimum wage produced items are poor.  When some PA runs out to Starbucks to buy the coffees to set on Joe's table, the barista might be a minimum wage worker, or the person who cleans that Starbucks, or even the people who delivered the various lids and cups.

        When you raise the floor, the people at the bottom benefit.  It's the flip side of sales taxes - the people at the bottom are always hit the hardest by regular sales taxes.

  •  The US has a much higher rate of breast cancer (4+ / 0-)

    than the other countries being cited.  If you are screening for a very rare disease, you will rarely find it.

    If, on the other hand, you are screening for breast cancer in a country where one in eight women are at risk for breast cancer (lifetime risk up to age 94), then you are far more likely to find it.

    They are comparing apples to oranges and only see that both are fruit.  

    •  And why is the rate of breast cancer so high in (1+ / 0-)
      Recommended by:

      this country? A high-fat, high-dairy diet?

      "Religion is what keeps the poor from murdering the rich."--Napoleon

      by Diana in NoVa on Wed Feb 19, 2014 at 05:31:52 AM PST

      [ Parent ]

      •  one of the bigger risks appears to be (4+ / 0-)


        The Continuous Update Project Panel judged that for premenopausal breast cancer there was convincing evidence that consuming alcoholic drinks increases the risk of this cancer and lactation protects against it. Adult attained height and greater birth weight are probably causes of this cancer and body fatness probably protects against this cancer.

        The Panel judged that for postmenopausal breast cancer there was convincing evidence that consuming alcoholic drinks, body fatness and adult attained height increase the risk of this cancer and lactation protects against it. Abdominal fatness and adult weight gain are probably causes of this cancer and physical activity probably protects against it.

        Preventability estimates show that about 28% of cases of breast cancer in Brazil can be prevented by not drinking alcohol, being physically active and maintaining a healthy weight.

        "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

        by Greg Dworkin on Wed Feb 19, 2014 at 05:38:00 AM PST

        [ Parent ]

        •  I wonder how it changes from (0+ / 0-)

          continual low drinking vs binge drinking.  I should dig around and see if they've got any studies out from New Zealand, there's a pretty serious binge-drinking culture there among younger adults.

          That's also very interesting that 'body fatness probably protects' premenopausal, but the reverse seems to happen postmenopausal.

          Thanks for the link.

        •  A quick look on teh googles (1+ / 0-)
          Recommended by:

          Suggests that the top 9 or so alcohol consuming countries are European, counting Russia. Australia and south Africa seem to be lead the US too. Different websites give slightly different lists, but if alcohol is one of the bigger risks, the Europeans must be doing something else right that we are not. Stronger regulations on chemical addities and GM foods perhaps? Or something else?

          A homo in a bi-national relationship - at 49, I had to give up my career, leave behind my dying father, my family & friends and move to Europe. And I'm one of the *lucky* ones: Immigration Equality

          by aggieric on Wed Feb 19, 2014 at 06:03:36 AM PST

          [ Parent ]

      •  Eh? (0+ / 0-)

        I haven't looked at breast cancer in detail, are there studies that link fat and dairy consumption to breast cancer rates within a homogeneous population?  

        (Studies between rates in different countries are harder to keep free of extraneous factors that might be affecting your outcomes, which can mislead as to all of the causative agents feeding into differences.)

    •  if it's because we find cancer that would not (3+ / 0-)

      affect you, it's no benefit to find it, and the "at risk" concept is questionable.

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Wed Feb 19, 2014 at 05:33:59 AM PST

      [ Parent ]

    •  btw the US ranks 9th (2+ / 0-)
      Recommended by:
      on the cusp, Methinks They Lie

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Wed Feb 19, 2014 at 05:37:05 AM PST

      [ Parent ]

    •  part of the point (2+ / 0-)
      Recommended by:
      Methinks They Lie, Greg Dworkin

      if one is screening for a rare disease, one will often find it even if it does not exist.

      The latest finding do not really address the rate at which a real disease is found.  The latest findings speak to the benefit of early detection, and the very high rate of detection of false positives.  I have known many people who have had to deal with these false positives, having a biopsy done, all for nothing.

      The question, in the US at least, is should the public pay for a procedure that increasingly has been shown to provide no benefit.  I agree that it may make sense for some risk groups to have a mammogram.  I think a decade worth of data shows that everyone having a mammogram causes much higher loses than the limited benefits would justify.

      And no, this is not an attack on women.  For a time prostate cancer was aggressively screened and treated.  Now in most cases it is simply monitored.  On an unrelated note, I know women who think having to take a pap smear every time on goes in for the stomach flu is an attack on women.

    •  Um, the US Preventative Task Force analyzes (0+ / 0-)

      data on US women, not anyone else, so the evidenced-based guidelines (for which we already have some) are being updated since the last time they convened. So, no, this is not an "apples to oranges" comparison but a run of the mill apples to apples data comparison.

    •  In my family's breast cancer history (0+ / 0-)

      we break all the stereotypes:

      My mother didn't drink or smoke and died of breast cancer at 59 before mammograms were routine (the oncologist figured the breast cancer had been growing for 5 years before she found the lump at age 53).

      Her sister smoke and drank and died of breast cancer at 50 after being diagnosed the year before (again, before the mammograms were routine).

      A cousin died of breast cancer at 37 after being diagnosed at 35.  Mammogram screenings are not normally done for that age range.

      A first cousin once removed died of breast cancer at 72.

      I continue to get mammograms every year because I will never be able to feel complacent about breast cancer.

      You better brace yourselves for a whole lotta ugly comin' at you from a neverending parade of stupid. - Motormouth Maybelle, Hairspray 2007 -

      by FlamingoGrrl on Wed Feb 19, 2014 at 10:12:15 AM PST

      [ Parent ]

      •  Yes, but (2+ / 0-)
        Recommended by:
        Julia Grey, ebohlman

        you are not one of the low-risk women they are talking about. YOU should be getting a mammogram every year, with a baseline at 35. The studies coming out are for women who have a normal history with a usual risk of breast cancer. This is not you, and these recommendations don't apply to you or women with a history of bc in their families.

        These studies DO target women like me--healthy, no symptoms, in their 40s, no history of BC in the family. I dutifully started getting mammograms at 40, and Every.Freaking.Time, I had to go back and do a follow up, not because they believed there was actually something there, but because they couldn't see 100%, or this was blurry, or that spot on this one mammogram isn't in the other one (because the skin got folded over and stuck in the one instance--in short, CYA). When the IOM report came out in 2009, I talked with my excellent Dr. and said I'd like to take the "not until I'm 50" option (which is standard in most developed countries) and she agreed.

        This new report only bolsters the argument that routine mammograms for women between 40-50 aren't much use in saving lives, and their is a very high cost in unnecessary radiation, unwarranted procedures, and frankly needless worry. They may find the cancer earlier, but your survival is dependent on what kind of cancer you have, not when they find it. It's hard for people to swallow because they've been told "the earlier we find it the better" for so long, but the fact is there weren't any long term studies to back that up. Now there are and at least for younger women the evidence is that regular, mass mammogram screening isn't useful.

        Mammograms ARE vitally useful for screening particular women who have known or suspected BCRA mutations or a history of breast or gynecological cancers in their families. These women SHOULD be getting yearly mamograms and being closely monitored. These studies are not meant to apply to those women. Mammography  is also a very useful tool for diagnosis when there is a likely suspicion of cancer from symptoms. But gross mass screening is not effective.

        "No one has the right to spend their life without being offended." Philip Pullman

        by zaynabou on Wed Feb 19, 2014 at 11:28:31 AM PST

        [ Parent ]

        •  folks with BRCA mutations are completely different (0+ / 0-)

          than the 'normal screening' population.

          "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

          by Greg Dworkin on Wed Feb 19, 2014 at 02:00:00 PM PST

          [ Parent ]

          •  That's exactly what I was saying. (1+ / 0-)
            Recommended by:
            Greg Dworkin

            Normal, mass screening is what the U.S. Preventive Services Task Force guidelines are about, and who they are for. Women who have a high risk of breast cancer are not affected by these guidelines.

            "No one has the right to spend their life without being offended." Philip Pullman

            by zaynabou on Wed Feb 19, 2014 at 02:35:47 PM PST

            [ Parent ]

  •  If you have to lay off workers due to a minimum.. (6+ / 0-)

    wage increase, doesn't this imply that you have been employing more labor than is needed to meet existing demand?  If demand is at a certain level and it takes a certain level of labor to answer that demand, even though costs go up due to a wage hike, letting workers go would leave demand unanswered.  At what point would refusing to answer that demand, leaving money on the table, make more sense than shouldering the cost to maintain the ability to answer demand.  Wouldn't employers be putting at risk the quality of service thus risking a loss in customers due to excessive wait times etc. ?  And won't aggregate demand tend to rise when MW workers and MANY others who will get an associated raise have more money to spend in the economy?

  •  Well.... (9+ / 0-)

    "Overseas, many countries are not enamored of routine mammography, in part because of overdiagnosis."

    Here, we don't mind overdiagnosis because of fee for service to treat it. In the United States, cancer is just another commodity.

    Just another day in Oceania.

    by drshatterhand on Wed Feb 19, 2014 at 05:27:32 AM PST

  •  Thanks for today's APR, Greg! (3+ / 0-)
    Recommended by:
    Greg Dworkin, Ohkwai, skohayes

    Enjoying the interesting discussions here.

    "Religion is what keeps the poor from murdering the rich."--Napoleon

    by Diana in NoVa on Wed Feb 19, 2014 at 05:35:24 AM PST

  •  I see a bit of a disconnect here. (1+ / 0-)
    Recommended by:
    The point, obviously, is to find the “sweet spot,” which maximizes the benefit of screening and minimizes the harms due to overdiagnosis and overtreatment.
    'screening' does not equal 'diagnosis' or 'treatment'.

    Screening (mammographies) are merely data.  The problems being listed have nothing to do with the data collected, and far more to do with the way we zealously treat potentially serious issues because doctors are afraid of lawsuits if they 'undertreat', especially with cancers, which can spread quickly.

    Maybe we actually need to move to more screenings AFTER detection, but BEFORE we jump into treatment (unless it's obviously advanced stage).

    •  while that's true in some cases (1+ / 0-)
      Recommended by:

      it isn't true here.

      there is genuine uncertainly about what the right thing to do is, and guidelines up until now, not lawsuits, have point the way that people practice.

      Expert panel guidelines will need to change before practice does.

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Wed Feb 19, 2014 at 05:40:18 AM PST

      [ Parent ]

      •  But again, (0+ / 0-)

        unless you're talking cumulative x-ray damage, there is no 'damage' created by screenings.

        It's what people are doing, and doing too often afterwards.
        It's like saying people are being 'damaged' by knowing their exact credit score, because some of them then turn around and do stupid things while trying to improve it that they wouldn't have done had they not known.

        It's an 'ignorance is bliss' approach to healthcare.

        The real solution is for doctors to actually figure out how to better differentiate between benign and malignant cancers, not to avoid knowing about both.

      •  Except (1+ / 0-)
        Recommended by:

        expert panel guidelines HAVE changed. The IOM did a thorough, well-researched, scientific study and concluded that routine screenings for women with no history or increased risk of BC were of little use before age 50. The problem was, no one wanted to believe it, but the science was sound. This new study only confirms what the earlier one did. The expert panel guidelines are there. People just aren't paying attention.

        I think it's in part because people think they are "doing" something to prevent cancer. It gives an illusory form of control over what is to some extent a random disease process. Plus there is a long history in our culture of belief that sickness is the result of personal choices--if you only did x you wouldn't get sick. Some of it came from religious circles, the idea that suffering is the result of being sinful, etc. Some of it comes from what I call the "Big Pink Machine." Don't get me wrong, I'm all  for cancer awareness and money for research. But a lot of sketchy operators make a lot of money off it too.

        On the part of radiologists, I think it's more complicated than just money. Most of radiology is helping after the fact--the disease or injury is already done by the time you get images. With mammograms, radiologists get to be the good guys--they find the disease, and can say, we saved some lives today. I think that's a hard thing to give up when someone says, well, the evidence says not so much.

        Being in an allied health field, it's hard to see people pushing so hard for evidence-based medicine, then watching them refuse to believe the evidence when it's presented.

        "No one has the right to spend their life without being offended." Philip Pullman

        by zaynabou on Wed Feb 19, 2014 at 11:38:09 AM PST

        [ Parent ]

        •  the last panel I saw was 2009 (0+ / 0-)

          and recommended no routine screening for 40-49. This is different and word is a panel will review and release new guidelines this year.

          CONCLUSIONS: Mammography rates did not decrease among women aged >40 years after publication of the USPSTF recommendations in 2009, suggesting that the vigorous policy debates and coverage in the media and medical literature have had an impact on the adoption of these recommendations

          "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

          by Greg Dworkin on Wed Feb 19, 2014 at 01:58:44 PM PST

          [ Parent ]

          •  Right. It was the USPSTF (0+ / 0-)

            not the IOM. The IOM confirmed the wisdom of having people on expert panels who did not have conflict of interest problems.

            A nice summary of the report is at the USPSTF website and the whole USPSTF report is here.

            From Dr. Handel Reynolds' blog he notes that even though the AMA screamed and yelled, they significantly changed the wording of their own recommendation to say women should be eligible for screening, but that it wasn't saying one should do that.  Dr. Reynolds is a breast radiologist and wrote a great book on the controversy called "The Big Squeeze."

            I think as a matter of policy women should be able to get a mammogram at any age if it is warranted--a woman has symptoms, breast cancer in her family, or is just overly concerned. But I think less women would feel concerned about getting a mammogram if it were made clear that routine screening for low- or normal-risk women is pretty ineffective between 40-49.

            "No one has the right to spend their life without being offended." Philip Pullman

            by zaynabou on Wed Feb 19, 2014 at 02:27:51 PM PST

            [ Parent ]

            •  helpful comments, thanks (0+ / 0-)
              The research is well done and will influence a global conversation. Dr. Richard Wender, chief of cancer control for the American Cancer Society, said an expert panel will factor this research into new guidelines to be released within the year. Until then, current recommendations stand.

              "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

              by Greg Dworkin on Wed Feb 19, 2014 at 02:39:19 PM PST

              [ Parent ]

  •  An interesting discussion (2+ / 0-)
    Recommended by:
    wintergreen8694, Thinking Fella

    over at WaPo today.

    Alan Taylor, a Charlottesville real estate developer, had brought dogs Boo and Hank down to his farm eight miles outside the city. The pups ran the property while he talked to a farming consultant about planting grapevines.

    Then Boo came running back with two bloody wounds in her white fur. Taylor called an emergency veterinarian while his girlfriend chased after Hank, who was in the driveway “just bleeding all over the place,” Taylor said.

    Both dogs were patched up. “Thankfully, just by a miracle, they didn’t die,” Taylor said. But a month later, they’re still wobbly, and the vet bills totaled more than $3,000.

    When he called police, he was shocked to learn that what happened was legal. A man working on the neighboring farm told police that Boo and Hank had gotten into his coop and killed a rooster and that he’d caught them in the coop before and let them go. This time, he shot them, and he was within his rights.

    When I lived in SW Virginia, I worked on a farm where we ran several hundred head of cattle and about 600 sheep.
    Neighbors who had lived in the country all their lives kept their dogs penned at home, while "newbies" thought since they lived in the country, no one would care if their dogs ran all over the country and harassed livestock.
    After one incident where a german shepherd and his crossbred lab friend killed three lambs and wounded two ewes so badly we had to euthanize them, I went to the house where the dogs lived, spoke to the owner, told him the next time I would be gathering up the dogs and taking them to the shelter and filing a lawsuit to recover the costs of the dead lambs and ewes. I would never shoot any dog, but many of my farmer friends have no such compunction when it comes to their animals being attacked and killed (like one friend whose horse was run by dogs into an electric fence and got all cut up).
    Good fences make good neighbors works where ever you live.

    Your beliefs don't make you a better person. Your behavior does.

    by skohayes on Wed Feb 19, 2014 at 06:46:37 AM PST

    •  I'm huge animal lover (2+ / 0-)
      Recommended by:
      skohayes, ebohlman

      and in rescue, but I have zero tolerance for people who let their animals run wild, especially in the country. My mother was very careful when we moved to always introduce our dog to all our neighboring farmers--and she wouldn't hurt a flea--and to keep her on our property at all times.

      People would dump dogs out in our area. They would form packs and go on killing rampages--they took down a neighbor's horse, and went after one of his teenage sons, who luckily had a tractor near by to retreat to. My mom said one day a group of neighbors showed up at her door toting long guns and asking if they could look on our property for the stray dog pack. We didn't allow hunting, but my mom gave them her blessing for that.

      This stuff is serious. People need to get their heads out of their butts and try to be less entitled. The ones of course who end up paying are the poor dogs. It's pretty nearly always true--no bad dogs, just bad owners.

      "No one has the right to spend their life without being offended." Philip Pullman

      by zaynabou on Wed Feb 19, 2014 at 11:43:21 AM PST

      [ Parent ]

      •  We had the same issues (1+ / 0-)
        Recommended by:

        with dogs being dumped on our farm. Over the course of 11 years, I found homes for some, but couldn't keep up with all of them. Many ended up being shot, or just dying of starvation. It was just so sad.

        Your beliefs don't make you a better person. Your behavior does.

        by skohayes on Wed Feb 19, 2014 at 01:24:06 PM PST

        [ Parent ]

  •  the radiologists' response (1+ / 0-)
    Recommended by:
    Greg Dworkin

    We're in the middle of thinking about this.

    My wife got her first mammogram ever, decades after she was 'spoze to, and they told her she should get another one-- nothing wrong, they said, don't worry, it's just since you haven't had it done before, we have nothing to compare certain things to and want a closer look. She really doesn't like being X-rayed, even, and she was already digging in her heels, when this story broke. The hospital asked what the problem was, we sent them a link to the story.

    The radiologist sent us a link to an industry response. Here are some of their points, as I remember them (can't access the actual report from here) minus howls of indignation.

    The original Canadian study was deeply flawed. First, they employed crappy second hand machines. This was back in the 80s, so even good ones were nowhere near as good as the ones we use now.

    They people who evaluated the mammograms were inadequately trained, even by the standards of the day, which were nowhere near as good as today.

    The randomized sorting of patients to the screening group vs the control group was badly flawed. Nurses did preliminary exams before the patients were assigned-- they felt for lumps in the breasts and armpits. There are good reasons to believe that the selection process was not properly double-blind random-- in other words, that the nurses influenced sending people they felt maybe had cancer into the group that got tested rather than letting them go unscreened as part of the control group. Two of these reasons for thinking so:  1) nurses are human beings who want to save lives even more than average human beings 2) over time, the control group had a much higher than average avoidance of cancer death than the general population-- something like 90 percent vs 78 percent, as I recall.



    FIRST OBSERVATION:  Money, wealth, capital, assets, etc. can be created and destroyed
    SECOND OBSERVATION:  Money, wealth, capital, assets, etc. are only useful when it is creating something useful to or for society, the nation or a culture.
    THIRD OBSERVATION:  As wealth is taken out of a society and made unavailable through gambling, speculation or other means social disorder increases.
    FORTH OBSERVATION:  Money, wealth, capital, assets, etc flows upward and if not stirred becomes stagnant.
    FIFTH OBSERVATION:  When consumption increases, employment increases, and visa- versa.
    SIXTH OBSERVATION:  No correlation exists between a low income rate for high income citizens and an increase performance in the national economy.
    SEVENTH OBSERVATION: The invisible hand has a thumb on the scale causing free enterprise and markets to favor the most powerful within any society.
    EIGHTH OBSERVATION: Only government can remove the thumb by using laws, rules and regulations and the strong, sure, even and fair enforcement thereof.
    NINTH OBSERVATION: Investment and consumption are not in competition but enjoy a symbiotic relationship.  Without investment there would be nothing to consume, and without consumption there would be no reason to invest.
    TENTH OBSERVATION: Full employment leads to fuller production and fuller services, and a more equal distribution of wealth, resources, capital and tax revenue.   It does not lead to inflation.
    ELEVENTH OBSERVATION: As the number of mega lending banks decreases, the competition between banks decreases resulting in the credit/bank- ratio-too-GDP increase.  When the credit/bank- ratio-too-GDP approaches 100%, the economic growth of the nation decreases.
    TWELVETH OBSERVATION:   As unemployment increases the nation’s deficit and debt increases.  As unemployment falls so does the deficit and debt, they are directly coupled!  WHY?   Workers pay income taxes.  Taxes produce government revenue thereby reducing the deficit and debt.
    THIRDTEENTH OBSERVATION: Whenever corporations can profit by manipulation of information or cooperative collusion, its workers, customers and consumers are vulnerable to abuse, fraud and malfeasance.

    FOURTEENTH OBSERVATION:  All economic, social and political problems are made worst by stagnation, austerity, sequestionization and lethargy.
    FIFTHTEENTH OBSERVATION:  In a speculative economy which expects its profits NOW! Requires GROWTH!  The Earth’s resources are finite and disappearing.  The real need is for economic/social/political transformative change NOW!
    SIXTEENTH OBSERVATION: CONCERNING CAPITALISM AND INNOVATION:                                                                                                        
    A)    Capitalism asserts they it is more capable at advancing innovation then other economic systems.  Yet, capitalism often choices a lesser technology over a more efficient one to maintain short term profit regardless of the risks to health and safety of workers, citizens and environment.
    B)    The profit motive can become a barrier to progress if the newer advances are either capital intensive or slow to realize an immediate profit; even when the resulting impact and profit may be greater long term.
    D)     Many times it is the Federal government which funds innovations and performs the research of advanced technology and husbands its development and field testing.  Often, once proven successful the new technology is spun off to private industries, but the taxpayers do not receive a gain when a profit is realized.
    E)    Monopolies hinder innovations.

  •  The Canadian BMJ study found tumors of (0+ / 0-)

    about the same size (19mm, 21mm) on average by both methodologies.

    Therefore since the tumors were on average of similar size the outcomes after treatment should have been similar and were.

    The American radiologists in an article said the mammography of the Canadian study didn't seem to meet current American standards.

    The ACR response is here:

    [The content of my post is mine.]

  •  Both the Reuters and the LA Times stories (0+ / 0-)

    on the CBO report said the CBO stated that increasing the minimum wage "would" cost 500,000 jobs. What shoddy journalism. There's a big difference between "would" and "could", which is what the CBO actually said.

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