Let Us Ponder the Various Meanings of the Word “Boobs”

by Tedra Osell on February 1, 2012

someecards.com - Thank you for cutting off funding to cancer screening programs in order to prove that you are pro-life.
In case you hadn’t heard, the latest you-must-be-shitting-me news in re. lady parts is that the massive fund-raising organization responsible for all those pink mixers and spatulas at Target, the Susan G. Komen Foundation, has decided that preventing breast cancer is less important than Taking a Stand for The Babies. Because while we all love the boobies, those … other lady parts are Embarrassing and Controversial. Sure, PP provides breast cancer screening to over a quarter of a million women but they also sometimes help other women—or even the same women!—evade their proper role as incubators. And if you’re not gonna have babies, you don’t need those boobies anyway, and if you die well, that’s just the price we have to pay for making sure that the babies will live. Nothing says “pro-life” like defunding cancer screening! Or something.

I’m now doubly grateful to all of you who stepped up and donated to PP. Because unlike Komen, they’re actually in the business of providing health care to women, rather than to just our most uncontroversial and marketable body parts.

(If you feel the need, you can tell Komen to fuck off here.)

{ 69 comments }

1

Andreas Moser 02.01.12 at 6:17 pm

Boobs can be quite helpful in political protests as the Ukrainian group FEMEN demonstrates: http://andreasmoser.wordpress.com/2012/01/28/ukrainian-girls-show-us-how-to-protest/

2

Steve LaBonne 02.01.12 at 6:31 pm

This was in the cards the moment they hired Karen Handel- who campaigned in Georgia on a promise to defund Planned parenthood- as their VP for Public Policy. I would be totally unsurprised to learn that the Republican congressional investigation witchhunt that triggered this idiocy was pre-arranged with her.

3

bay of arizona 02.01.12 at 6:47 pm

This just confirms the shittiness of the Komen foundation. The President of the org helped Bush to water down the patient’s bill of rights, and in return Bush appointed her Ambassador to Hungary. Most of what they do seem to be ‘pinkwashing’ – letting people pretend that they are good-hearted for wearing something pink.

October is both domestic violence and breast cancer awareness month, and the NFL wears pink everything.Nothing is said about violence, even though it is a perfect opportunity to let the young males watching that violence against women is bad, because that would be ‘controversial’ or something.

And then there’s that save the tatas crap.

4

christian_h 02.01.12 at 6:55 pm

Thanks Tedra. Indeed despicable behaviour by the Komen foundation. The harder question is what to do about it, beyond giving to PP and complaining to Komen. Picket a “race for the cure”? Or would that be too controversial, aggressive?

5

dsquared 02.01.12 at 7:18 pm

It is only partly on topic, but the current state of evidence-based medicine is that young women without specific risk factors should not, in fact, be encouraged to carry out regular self-examinations of their breasts[1] (let alone have regular, painful and largely counterproductive mammograms), and therefore people should also probably be aware that an awful lot of currently operating breast cancer charities are a massive waste of money.

[1] What? no? really? Yes. Breast self-examination has no effect on mortality. In general, it is no longer true for the majority of breast cancers that early detection makes much of a difference to treatment outcomes, and in large samples, any small effect is outweighed by the tendency of mammograms and self-examinations to lead to biopsies, which occasionally cause formerly benign tumours to turn malignant. This really, really is the current state of science.

6

Steve LaBonne 02.01.12 at 7:27 pm

dsquared @5 makes an excellent point (and I would add that SGKF lobbied hard against the new evidence-based recommendations, for clearly self-serving reasons), and that kind of thing is a good reason to be suspicious of “disease of the month” organizations in general.

7

Ben Alpers 02.01.12 at 7:28 pm

@christian-h: Despite marketing themselves very effectively, Komen is hardly the only organization working on issues related to breast cancer. They do seem to have a very visible presence at many workplaces and corporations. I think we should keep an eye out for such efforts to raise money for Komen and, when possible, suggest that some other recipient might be a better idea.

8

Scott Martens 02.01.12 at 8:00 pm

Komen has come under some criticism from other sources in the past. Samantha King wrote a particularly critical book (Pink Ribbons, Inc.) suggesting, inter alia, that the foundation’s corporate connections are the reason it places no emphasis at all on reducing the environmental causes of breast cancer and focus purely on early detection and what is, most likely, an unrealistic “search for a cure”. It does seem to be a convenient charity for a lot of companies, especially the kinds of large companies people love to hate. Even the NFL is a Komen sponsor.

On the other hand, this does not mean the funds they are getting aren’t going to good research or to needed preventive medicine. But… I bet its diverse corporate ties and (according to Forbes) not terribly reliable donors make it easy to pressure. The things PP people are saying suggest this was caving into pressure rather than Komen intending to take a stance. That makes it rather cowardly but perhaps less vile.

As for their CEO’s links to the Bush administration, the chairwoman of Komen has almost exactly the opposite connections. I’m not inclined to read too much into that.

9

Steve LaBonne 02.01.12 at 8:07 pm

Scott @8, this is along the same lines as a comment that somehow got into moderation hell, but: Google Karen Handel (their VP for Public Policy) and you may be less inclined to give them the benefit of the doubt.

10

Scott Martens 02.01.12 at 8:11 pm

Steve @8: Ugh. That does incline me to think this decision was made by a rank-and-file right wing apparachik. Sarah Palin endorsed her – that should tell you everything you need to know.

11

zrichellez 02.01.12 at 8:13 pm

Sending a Komen an emissive may be briefly satisfying but for longer lasting impact on their organization perhaps consider following the Canadian example and engage in a little forensic accounting to thank them for their political decision to harm women they were supposed to be championing. From the Globe and Mail reporting on the Canadian Cancer Society (who I have never seen buy a full page ad in InStyle):

“The CBC analyzed the charity’s financial reports and found “that each year, as the society raised more dollars, the proportion of money it spent on research dropped dramatically — from 40.3 per cent in 2000 to under 22 per cent in 2011.”
The pink-ribbon backlash
While the amount of money channelled toward research has increased slightly, as part of the charity’s overall increasing budget, spending on fundraising and administration has been on the steady rise, according to the CBC.

One Ontario cancer researcher said this should be a concern for those in the field:

“Most scientists don’t realize that the budget has been going up and up, and donations have been growing, but the budget for research has been shrinking,” Brian Lichty, a researcher at McMaster University who is looking into treating cancer with viruses that kill tumours, told the CBC”

Maybe its all fine here. Maybe not.
I have supported the Komen foundation through sponsorships and purchases. Too many friends have been impacted to ignore the cause. But Komens despicable decision will encourage me to find other ways to support research.

12

zrichellez 02.01.12 at 8:13 pm

13

Scott Martens 02.01.12 at 8:16 pm

According to Ezra Klein: “Komen said it could not continue to fund Planned Parenthood because it has adopted new guidelines that bar it from funding organizations under congressional investigation. The House oversight and investigations subcommittee announced in the fall an investigation into Planned Parenthood’s funding. “

This policy, innocuous as it sounds, seems to have been chosen particularly to justify defunding PP without even having to say it was about abortion. And “adopting new guidelines” is exactly the VP of Public Policy’s job.

14

Don A in Pennsyltucky 02.01.12 at 8:19 pm

As far as I can tell, the main thing that the Komen foundation promotes is the athletic apparel industry. It’s not like Komen is buying all those pink uniforms for professional and college sports teams.

15

Salient 02.01.12 at 8:47 pm

the current state of evidence-based medicine is that young women without specific risk factors should not, in fact, be encouraged to carry out regular self-examinations of their breasts (let alone have regular, painful and largely counterproductive mammograms)

OT banking off OT, we really do need to get harping on the American Cancer Society about this; their recommendations are a decade behind the times now, and there are a hell of a lot of U.S. organizations (Planned Parenthood among them) who organize their whole cancer prevention service suite entirely around bad ACS recommendations.

And it’s worth mentioning it’s not just ACS dragging its heels due to caution and a desire for ‘more research’ or whatever. The relative ineffectuality of early-life mammograms was known by 2002 and was very well-reviewed by 2009, when the USPSTF announced its recommendation statement. (Seems worth noting this happened shortly after Obama took office.)

In fact, the ACS has been surprisingly pissy about reacting to this research and the corresponding USPSTF recommendation statements. Their line is political bullshit; I rememberthere was a news story (Associated Press or something) about the ACS’ refusal to adopt the 2009 USPSTF recommendations; the spokesperson quote was something like “they’re telling women that mammography saves lives, just not enough of them.” Which struck me at the time as a very bullshit way of representing the research, and strikes me now as utterly unconscionable.

16

bigfatmike 02.01.12 at 8:48 pm

Does anybody have some statistics to make a rough estimate of how many lives will be lost if 250k women don’t get exams? For one year? If the loss of funding is permanent?

17

christian_h 02.01.12 at 8:55 pm

On the OT OT topic: I did my national service in a leading German gynecological hospital. At the time we were part of a study that was supposed to prove that yearly (!) mammograms should be had by women over 40. The people involved were quite clearly either consciously massaging the data, or lacked knowledge of statistics and subconsciously steered towards the result they desired (more mammograms).

18

Sebastian 02.01.12 at 9:00 pm

Gack, so does this mean that cutting off PP isn’t actually likely to cost any lives?

19

bexley 02.01.12 at 9:11 pm

Sebastian – IIRC the evidence points towards screening over 50s around once every one or two years. To the extent that cutting off funding for PP affects screening for that group of women then it’s likely to cost lives.

20

js. 02.01.12 at 9:18 pm

Steve @8,

Wow. Maybe I shouldn’t be surprised, but it’s shocking to me that an organization concerned with women’s health–or at least officially so–would make this person a VP of anything.

Also, Barbara Ehrenreich wrote an article several years ago that I think was highly critical of Komen–re. both the excessive testing and all the pink. Can’t find it now, but it was excellent (as you’d expect).

21

rageahol 02.01.12 at 9:29 pm

Komen always rubbed me the wrong way because of how much money they spent on marketing and “awareness” and how little they spent on research or treatment. or that was my perception, anyway.

22

Ben A/baa 02.01.12 at 10:07 pm

biopsies, which occasionally cause formerly benign tumours to turn malignant

I do not believe this is accurate. Do you have a citation or reference?

23

Meredith 02.01.12 at 10:15 pm

I like TBogg’s suggestion:

but you can make a donation to Planned Parenthood and request a thank you card be sent to

Karen Handel
Senior VP of Fail
c/o Susan G. Komen Foundation
P.O. Box 650309
Dallas, TX 75265-0309

24

rageahol 02.01.12 at 10:25 pm

I don’t think it’s that the biopsies turn benign tumors malignant, but that the cost in terms of both pure dollars (testing, potential lump-ectomy, follow-up) and more opportunity cost type things (freakout stress, and one of the worst things you can do if you think you might have cancer is flood the body with immune-suppressing stress hormones, since there are transient tumors that we think get handled through normal immune surveillance) means that it can be actively harmful to screen women who arent above a certain threshold risk. if you’re going to get a malignant tumor before 50, it’s much more likely to be a fast-growing one that could very well escape surveillance anyway, and those are also much more likely to be fatal.

but read the actual recommendations:
http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm

25

JW Mason 02.01.12 at 10:46 pm

biopsies, which occasionally cause formerly benign tumours to turn malignant. This really, really is the current state of science.

Really? Says nothing about that in the linked article. What’s the source?

26

Henri Vieuxtemps 02.01.12 at 10:48 pm

Would any of this stuff (Komen, Planned Parenthood) be necessary if this country had a normal, publicly financed medical care system, like the UK, France? Does anything like that exist in those countries? The sleep of reason produces monsters.

27

David 02.01.12 at 10:55 pm

As a local art critic put it, she rejects the idea that her breasts are innocent and her vagina guilty. May the wrath of the Internet descend upon this cowardly and brain dead organization.

28

leederick 02.01.12 at 11:08 pm

(1) I don’t really understand the breast examination point, I can’t see why the recommendation should be ‘don’t examine – as a clueless doc may then give you a unnecessary biopsy’ rather than ‘don’t perform unnecessary biopsies, clueless docs’. It’s a bit like seeing cyclists getting run over, and concluding the problem is people cycling.

(2) I can’t see what the problem with huge administration and fundraising costs is. Surely charities should fund raise up until the point where one marginal dollar raised equals one marginal dollar extra fundraising and admin costs.

(3) I also think there’s something a bit odd about charities giving money to other charities. Presumably if Komen donors had wanted PP to have the money they’d have donated to PP rather than Komen.

29

Saul 02.02.12 at 12:41 am

leederick;

(1) Screening activities, like self-examination or mammography, are population health exercises rather than treatment of individuals. The pros and cons are worked out not just on the personal but systemic costs. The obvious risk to the system is to be drowned in low yield biopsies. The risks to the individual are less obvious but still substantial. Once a procedure like a biosy is sufficiently low-yield the small risks (infection, anaesthetic risks) become relatively high. Also, pathology can be wrong, not necessarily through anyone’s error, leading to unnecessary operations.

If the recommendation of self-exam does not work in practice, it should not be made. Having said that, the evidence or self-exam was always weak. It has mainly been pushed, as far as I can tell, to make sure breast cancer awareness was started early and compliance with (high-yield) mammography was raised. Publicity, basically.

Interestingly, with the introduction of Gardasil (the HPV vaccine) the yield of Pap smears is dropping so that the screening recommendations are being revised there as well.

(2) I think the implication is that the charity is becoming less focused on it’s core work and more a self sustaining corporate entity, managed for the benefit of the senior staff. This may or may not be true but decisions like this do suggest it.

(3) No comment. I have never lived in the land of the free so must admit I find such questions…odd.

30

MPAVictoria 02.02.12 at 12:46 am

“Would any of this stuff (Komen, Planned Parenthood) be necessary if this country had a normal, publicly financed medical care system, like the UK, France? Does anything like that exist in those countries? The sleep of reason produces monsters.”

Possibly. Planned Parenthood also operates in Canada.

31

faustusnotes 02.02.12 at 12:54 am

I think dsquared and Steve Labonne are only partly right. A Swedish scientist has just released a book on the breast screening controversy and I think his opinion is that all screening should be stopped, and that self-examination is sufficient. There’s a big controversy brewing internationally over breastscreening.

Certainly, though, current guidelines shouldn’t be recommending screening for women under 50 and if the US is doing that then that’s just another example of stupid and counter-productive over-treatment. As far as I know the guideline is for women between 40 and 50 to seek screening if they have a family history (mother or Aunt, I think) of breast cancer before 50.

OT OT OT, in my opinion NICE exaggerates the threat of false negatives, and is too conservative in its screening strategies, possibly for cost-cutting reasons. The British cervical screening recommendations are imo too weak.

Not so OT, this is another example of the sucky-ness of not having universal health care. In Australia and the UK breastscreening is provided free by the govt to people who fit into the categories (over 50, or over 40 + doctor’s recommendation). We don’t rely on stupid charities to fund essential health services, and decisions about the appropriateness of the program are made on the basis of evidence and clear guidelines that are set by a democractically elected (well, not in the UK) govt.

32

Tedra Osell 02.02.12 at 2:02 am

Re. d2 @5: At my last mammogram (two years ago, I think? I’m 44) I asked the technician about precisely that and she was Absolutely Adamant that mammograms save lives, why just last week she’d done a mammogram for a woman younger than me and they’d discovered, etc. (But yes, I am pleased to know that Science is on the side of Sloth, and as I said, I haven’t had a mammogram in at least two years, so.)

33

faustusnotes 02.02.12 at 2:19 am

In Japan and the USA there is a tendency to overprescribe these screening procedures because the doctor/hospital gets paid for it. While in Australia and the UK the incentive is not to screen if possible (since the screening is arranged separately to any GP service and is done for free).

This is one of the reasons for the USA’s ballooning medical care costs. In Australia, you would only be recommended a mammogram at 42 if you had a strong family history of early breast cancer, but here in Japan it’s a pretty routine part of medical checks (I know a woman in her 30s who is subjected to a mammogram at her annual workplace health check!)

There’s been a long debate about the effectiveness and cost-effectiveness of breast screening. In the 90s and early ‘noughties the evidence tended to fall on the side of screening, but it was always borderline, and the new evidence coming out appears to be against screening. Especially because most breast cancers are slow-growing and modern treatments are improving, the chance that early detection will make any difference to outcomes is declining. This pushes up the number-needed-to-treat, and thus makes the screening less and less worthwhile. The book I linked to seems to include evidence that there is a lot of political pushback going on, but that in the next few years we’re going to see radical changes to the breast screening programs of several nations.

34

Jonathan Lundell 02.02.12 at 2:26 am

Three words: Breast Cancer Action .

35

Pamela 02.02.12 at 5:53 am

As long as sexual health is seen as a moral issue and not purely a health issue, we will continue to be having these conversations.

36

Roxeanne de Luca 02.02.12 at 6:16 am

Planned Parenthood doesn’t to mammograms, ultrasounds, or breast MRIs; all it does is the doctor version of the self-exam. It’s better than nothing, but is hardly in need of a grant (any halfway competent physician’s assistant can do it). De-funding PP won’t result in hundreds of thousands of women not getting their screenings; it will channel funds to groups who are able to comprehensively help women at risk for breast cancer by providing screening beyond feeling for lumps by hand, as well as groups that deal with women more at risk. (Your average 16-year-old who walks into Planned Parenthood is hardly a risk for breast cancer; she can still get it, but it’s unlikely and not the best use of funds.)

37

daelm 02.02.12 at 7:43 am

ehrenreich article:

http://www.guardian.co.uk/lifeandstyle/2010/jan/02/cancer-positive-thinking-barbara-ehrenreich

there was also a presentation online somewhere where she elaborated on this for some foundation – can;t remember the names, but i remember being pretty impressed by her.

d

38

daelm 02.02.12 at 7:46 am

39

Scott Martens 02.02.12 at 12:59 pm

MPAVictoria @30: I don’t think PP does abortions in Canada, just referrals. But yeah, I imagine that young women might not want to see their GP (who also treats their mother) for stuff like STD tests, pregnancy tests, birth control, and sexual and reproductive health.

40

MPAVictoria 02.02.12 at 2:42 pm

“I don’t think PP does abortions in Canada, just referrals. But yeah, I imagine that young women might not want to see their GP (who also treats their mother) for stuff like STD tests, pregnancy tests, birth control, and sexual and reproductive health.”

Scott I talked this over with my partner, who is a long time supporter of PP in Canada, and it appears you are correct. Thanks!

41

Just some guy 02.02.12 at 3:54 pm

This is not only a political decision, it is a marketing/development one as well. My wife is a breast cancer survivor, and we were supporters of our local Komen until yesterday. Many, many small donors will quit giving to Komen, but the counter-backlash will occur when a handful of wealthy, conservative women decide to “make-up” the missing small donations. There’s no doubt in my mind the Komen board has already weighed these factors in making their decision. They are, like many “mainstream” charities calculating that the future lies with fewer, wealthier donors rather than a broader base of smaller donors. They are counting on the economic trends of the past 30 years remaining the same.

42

Murray Reiss 02.02.12 at 5:03 pm

There’s also a great NFB (National Film Board) film, “Pink Ribbons, Inc.” that “shows how the devastating reality of breast cancer, which marketing experts have labeled a dream cause, has been hijacked by a shiny, pink story of success.” http://www.nfb.ca/playlist/pink_ribbons_inc/ Both Barbara Ehrenreich and Samantha King are interviewed in it.

43

Salient 02.02.12 at 5:29 pm

Gack, so does this mean that cutting off PP isn’t actually likely to cost any lives?

It’ll cost lives, and possibly ameliorate a lot of agony spent over false positives. But then, if men were likewise encouraged to get an annual colonoscopy and perform self-exam prostate exams, that would save lives, at the expense of a lot of agony. And if all adults were encouraged to submit themselves to an annual MRI and EEG, who knows what could be detected and nipped in the bud, but it’s not sensible to recommend that even if it strictly speaking would save lives.

One important point is that breast self-exams can be, potentially, awfully counterproductive. Swollen lymph nodes happen all the time and can occasionally manifest basically as a lump. The ‘breast cancer awareness’ SBK movement has, perhaps with good intentions, introduced a huge amount of anxiety over something that (a) happens to a huge number of women and (b) is nothing to worry about because (c) it’s only very rarely indicative of a serious cause for concern, and the serious causes for concern are indistinguishable from the nothing-to-worry-about in self-examination. This is one of the times where I pretend to be utilitarian long enough to agree with the USPSTF conclusion that a lot of 20th-century breast cancer screening procedures are ‘not worth it’ in terms of utility.

OTOH it should be emphasized, mammograms *are* recommended for women 50+, and there’s quite a span between that and Medicare eligibility for Planned Parenthood to fill. I haven’t ever heard before that benign tumors can turn malignant when biopsied, so I set that claim aside, but having an unnecessary mammogram sucks and having an unnecessary biopsy sucks. I didn’t mean to suggest we should be anything less than pissed at SBK, which has just abandoned the main thing that kept it from being an utterly awful charity, or anything less than concerned about Planned Parenthood’s future, which has just been provably compromised by the bullshit Congressional investigation.

44

Tedra Osell 02.02.12 at 8:30 pm

Personally I don’t find mammograms to be a really big deal; they’re less of a hassle and less painful than pap smears. But I did once have some godawful procedure that involved threading some kind of probe thing into a nipple duct, which made me faint in the examining room.

45

MPAVictoria 02.02.12 at 8:59 pm

“some kind of probe thing into a nipple duct”

If your goal today was to make me wince at my desk mission accomplished. That sounds just awful. My sympathies.

46

Bill Benzon 02.02.12 at 9:05 pm

FWIW, the super-rich mayor of New York City, Michael Bloomberg, has decided to give $250,000 to Planned Parenthood. That’s roughly 1/3 of the amount the Komen Foundation gave:

http://cityroom.blogs.nytimes.com/2012/02/02/bloomberg-to-give-250000-to-planned-parenthood/?hp

47

faustusnotes 02.03.12 at 12:14 am

Was the probe thing a consequence of an uncertain mammography or breast exam? (or for that matter, any other kind of screening activity?)

Years ago I knew a woman whose job was teaching doctors to administer pap smears in a way that didn’t hurt. Apparently, with pap smears the pain is largely a function of poor technique.

48

faustusnotes 02.03.12 at 12:14 am

But, thanks to modern (Australian!) science, maybe 30 years from now pap smears will be irrelevant …

49

Tedra Osell 02.03.12 at 4:23 am

The probe thing was b/c of bleeding, which turned out to be merely a cyst with some kind of unimportant problem that went away on its own. For the record, it wasn’t actually painful; I fainted because like MPAVictoria I found it TOO FREAKY TO DEAL WITH.

It was interesting, though, to find out that even though I was young and knew full well (and my doctors confirmed this) that it was highly unlikely that the bleeding was the big C, I was immensely relieved when the results came back. I suddenly realized that I’d been way more worried than I’d allowed myself to realize.

50

Tim Wilkinson 02.03.12 at 12:34 pm

dsquared @5: biopsies…occasionally cause formerly benign tumours to turn malignant. This really, really is the current state of science.

In response to which:

Ben A/baa @22: I do not believe this is accurate. Do you have a citation or reference?
and
rageahol @24: I don’t think it’s that the biopsies turn benign tumors malignant
and
JWMason @25 Really? Says nothing about that in the linked article. What’s the source?

I’m pretty sure that it’s untrue. I don’t think dsquared will acknowledge that, though.

(I may have interfered in the normal course of events with that prediction of course. But we can always look at other recent examples such as “the view that it was possible to establish the truth of religion by intellectual argument has been heresy [sic] for most of the history of Christianity” and “there is very little involvement from bankers in the Greek situation”. It’s a bit depressing – and almost paradoxical – that refusing to admit error can be quite effective as part of a reputation management programme.)

51

faustusnotes 02.03.12 at 1:25 pm

well then there are no lessons about screening to be learnt from your unfortunate nipple experience. zannen! As you were!

52

Bill Benzon 02.03.12 at 4:49 pm

Looks like the Komen foundation has decided to restore the grants:

http://www.nytimes.com/reuters/2012/02/03/us/politics/03reuters-usa-healthcare-komen.html?hp

53

Steve LaBonne 02.03.12 at 4:57 pm

They can’t unshit the bed with a bit of insincere damage control. A lot of executive heads- starting with Brinker and Handel- will need to roll for them to recover even a portion of their former standing. And their even bigger problem is that they’ve been a particularly sucky charity for years in terms of serving their corporate interest vs. serving the cause they claim to support (and in terms of being a Republican front group basically all along), but few dared to question their bona fides. That immunity is over for good.

54

Tedra Osell 02.03.12 at 7:24 pm

Tim@50: I’m pretty sure that d2 will acknowledge when he’s wrong as a general rule; he’s intellectually upright like that. I’m also pretty sure that he popped in to comment and isn’t following the thread, so I don’t think he’ll “acknowledge” anything because I doubt he’s still reading.

Bill @52: Thanks, I was just going to post a similar link. Steve @53: Agree totally.

55

Merp 02.04.12 at 12:20 am

@17

The people involved [in the mammogram study] were quite clearly either consciously massaging the data . . .

Hi-yooooooooo!

56

Jon H 02.04.12 at 6:24 am

Bill Benzon: “Looks like the Komen foundation has decided to restore the grants:”

Not so much, I don’t think. Current grants will run to completion – which is exactly how it was going to be yesterday. PP will be eligible to apply for grants in the future, but of course Komen can deny them. End result would be roughly the same.

I think there may be something in the new announcement of local decision making by Komen organizations on whether to support PP. If so, I expect in Bible belt states where women already have it rough Komen will be quick to defund local Planned Parenthood programs, and elsewhere the right wing will make a concerted effort to take control and then defund local PP programs.

57

Jon H 02.04.12 at 6:34 am

I don’t really know about the whole self-exam/screening issue for young women, but I do know that of the three women I know to have been through breast cancer treatment, one was in her 20s and had (I believe) a double mastectomy; one was in her 30s and had a double mastectomy; one is in her early 40s, and I believe is going with radiation and a lumpectomy.

I don’t know if the two younger women went through it due to genetic testing, or because a lump was found in an examination.

Statistics may well suggest that self-exam and screenings for young women are useless, but that isn’t very persuasive when you’re more concerned about keeping particular individuals healthy.

I mean, we’re not talking about biopsies to screen for Kreutzfeld-Jakob or annual invasive tests of 30-somethings to check for early-onset Alzheimers. Breast cancer strikes young people pretty often.

58

faustusnotes 02.04.12 at 7:00 am

Jon H, decisions about screening aren’t about whether it will save individual A but about whether it is more likely to save individual A than leaving their disease to become symptomatic. If a woman goes to screening and has cancer identified, that doesn’t mean it was the best thing for her. If, for example, it doesn’t improve her survival but leads to a double mastectomy a year earlier, it means she spends an extra year of her life without breasts, and that is all the effect it has had.

For screening to be recommended for a non-contagious disease we require several conditions:
- disease must have an asymptomatic stage (this can be weakened if the symptoms are general)
- an acceptable and ethical treatment must exist
- the screening test must have acceptable sensitivity and specficity
- the effect of the disease must be significant enough to warrant early intervention
- detection of asymptomatic disease improves treatment outcome

The last one is the kicker, and is what all the debate about breast screening focuses on. There is no point in identifying someone with asymptomatic (non-communicable) disease if it doesn’t benefit them: all you’ve done is make them feel sick earlier than they would otherwise have been, and subject them to potentially fatal interventions (in the case of e.g. prostate biopsy or mastectomy) that would have been just as effective if they had been delayed until onset of symptoms.

Note that as treatments for cancer improve, the benefits of early detection will decline, because the treatments are more likely to work at the symptomatic stage.

A good example of this is HIV: it has a 10 year asymptomatic stage, but in the 1980s we had no treatments that would benefit people with HIV during this period. Thus if we screened them and identified them, all we’ve achieved is to shorten their healthy life by 10 years (because telling someone they are sick changes their quality of life). Obviously with HIV there are community benefits to doing this (because it’s infectious and a person who knows their status can change their behavior); but if it were non-communicable, screening would have been a waste of time.

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Bostoniangirl 02.04.12 at 12:34 pm

The “early” breast cancer screening story I heard which saved a life was about something that happened in the late 50′s/ early 60′s from a woman now in her 90′s. A local hospital had found a tumor and said to watch it for a while. (My guess is that it wasn’t that small by modern standards). One of the people at her job was the son of an HMS professor in gynecology or something who told him to “tell that woman to get herself down to the Brigham hospital”. They were working on an early-detection program, since breast cancer was mostly a death sentence then by the time it was caught. I think that if she’d waited the six months to a year the first doctor recommended she probably would have died. I think she got it in her other breast a decade later and had to have a mastectomy. As I said above, I don’t know whether the first tumor would have been seen as an early detection by today’s standards.

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dsquared 02.04.12 at 12:40 pm

I am apparently wrong about biopsies turning benign tumours malignant – I had just assumed that when NICE referred to them as “harmful”, that’s what they meant.

Tim Wilkinson – you are pre-emptively banned from commenting on any of my threads, for being a prick.

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Barry 02.04.12 at 1:41 pm

BTW, I’ve heard that one of the problems with a biopsy on a possibly malignant tumor is that the very act will spread tumor cells around.

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Tim Wilkinson 02.05.12 at 2:29 pm

Tedra @54: he’s intellectually upright like that.

Not entering into a correspondence with Tedra here, but just for the record, I disagree. I consider dsquared to be guilty of deterrent banning of critics qua critics, and of constant recourse to (what I regard as) meretricious playground tactics like retreat to ambiguous irony and the old classic, diversionary mock-umbrage, as here. My own opinion, furthermore, is that his use of putdowns and insults have a bully-boy aspect to them, particularly deployed as they are from a position of high status. I do not consider any of that intellectually upright.

dsquared – Yes, that’s hardly unexpected, but I must warn you that this will not help your case when next your ban comes up for review.

As a response I’d have thought it’s also pretty embarrassing (objectively speaking, of course).

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Tim Wilkinson 02.05.12 at 2:44 pm

I should perhaps explain to anyone reading this that I bear no personal animus against Mr squared, have enjojyed variuos of his contributions, share a number of opinions and interests with him, etc.

But he recently nailed his colours to the mast and started defending a variety of things which we’ll designate by the term ‘bankers’, thgus joining a bloc which includes the Chipping Norton set, Goldman Sachs etc, and which I consider enemies to me, my family, the NHS and pretty much all I hold dear.

Since then, not only have his bad habits got worse, but even if they hadn’t they are now harmful and not to be tolerated, where previously there was little reason to spoil jokes and get into scraps by challenging them. If people can be encouraged to be considerably more critical of, and less deferential toward, this increasingly pernicious output, that’s a good thing.

Also – far be it from me to take the P out of PPE, but I can’t resist a quick namecheck for Thomas “St Thomas” Aquinas. ‘Heresy’, in those so very ex cathedra italics, snigger.

Note also the use of the term ‘pre-emption’ where ‘disproportionate retaliation’ would probably be more appropriate.

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James Wimberley 02.05.12 at 10:35 pm

Henri in #26″Would any of this stuff (Komen, Planned Parenthood) be necessary if this country had a normal, publicly financed medical care system, like the UK, France?”
The main French cancer charity ARC had a huge scandal some years back (1991-1996). It was only spending 28% of funds raised on research, the rest went on bloated admin costs and a sybaritic lifestyle for the boss.
SFIK the British equivalents are clean. But they are responsible for a surprising proportion of research and even care (Macmillan nurses).

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dsquared 02.08.12 at 1:10 pm

But he recently nailed his colours to the mast and started defending a variety of things which we’ll designate by the term ‘bankers’, thgus joining a bloc which includes the Chipping Norton set, Goldman Sachs etc, and which I consider enemies to me, my family, the NHS and pretty much all I hold dear.

Tim, do you not see how if you are going to accuse me of vile intellectual dishonesty for making small errors on matters of theology (and then, villainy upon villainy, not monitoring every thread I comment on and so not noticing that someone had corrected me! Infamy!), then it kind of reduces your own credibility to post something like the italicised passage above? It’s kind of … well, intellectually dishonest.

Anyway, yes, banned from my threads. It’s perfectly clear that you don’t want to have a polite or good-faith debate on these issues with me, so you shouldn’t be surprised that you aren’t going to get one.

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Alex 02.08.12 at 1:47 pm

Harmful in the sense that a biopsy is a surgical procedure, and like all surgical procedures, it involves cutting into people, which you want to avoid unless it’s unequivocally necessary.

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Tim Wilkinson 02.08.12 at 1:47 pm

No, basically, I think you have quite a bit of influence and get a bit of an easy ride, partly as a consequence of making use of a battery of techniques for defecting criticism, which includes allowing the witty and amusing presentation to obscure flaws in the underlying argument – which when you’re openly trolling about Bud or something is one thing, but when it’s something more serious, not so. One of those techniques – apart from banning people, e.g. JWMason/’Lemuel Pitkin’, and being shall we say pretty robust in meeting critics (not by trading floor standards, but) – is that ex cathedra kind of tone. It hustles people – who already tend to treat you as the golden boy, deservedly in mnay ways – into accepting what you’re saying. So examples where it’s been used to present false propositions are pretty germane.

That’s all really. Except to point out that you’re providing a tu quoque rather than very susbtantive argument even here, with It’s kind of … well, intellectually dishonest. The point is that I’d perviously been h9olding my tongue because it’s difficult, troublesome, ban-inviting and (previously) unnecessary to start trying – rather quixotically – to right a subtly skewed balance, as I see it.

It’s perfectly clear that you don’t want to have a polite or good-faith debate on these issues with me, so you shouldn’t be surprised that you aren’t going to get one.

But you’ve probably seen enough of my contributions here and elsewhere to realise that I’m not especially unreasonable and in fact generally pretty earnest about topics of any seriousness. This line is almost exactly the same one I’ve already pointed to. And I actually took issue with the description of you as ‘intellectually upright’ where that clearly meant not to be suspected of ever failing to volunteer self-corrections or use similar very slightly dubious techniques’. You are not going to deny you have a fair bit of ego – you wouldn’t, as they say, be where you are now. And everyone has a tendecny to get protective of their rep, treat things as a sparring match rather than pure disinterested pursuit of truth, etc. My pesky little contribution – which I did quite honestly explain – was to try and counteract yours.

I dunno, whatever. You’ll be OK I reckon.

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Tim Wilkinson 02.08.12 at 1:55 pm

Apologies to Tedra for threadjacking – I don’t think I’ve yet posted an on-topic comment on any of her threads. (3rd person because I very much doubt she wants to get involved in this little contretemps).

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JW Mason 02.08.12 at 4:20 pm

I am apparently wrong about biopsies turning benign tumours malignant – I had just assumed that when NICE referred to them as “harmful”, that’s what they meant.

Good to have that cleared up. Thanks.

It’s good to forthrightly admit mistakes, and that should be encouraged. At the same time, tho, most people would not write that it “really, really is the current state of science” that biopsies cause tumors to become malignant, if what they actually meant was that they’d read that biopsies might be a bad idea and were wildly guessing that might be the reason. So that’s something to file for future reference.

(DSquared, if you’re reading this: You’ve already preemptively banned me, so you needn’t again. You are welcome to comment on my blog any time tho, if you want.)

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