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Mammography screening just doesn’t work very well in women before menopause, as the U.S. Preventive Services Task Force has now recognized. Everyone hoped that it would. But in 1993, it became clear from well-done studies that our hopes hadn’t panned out, and screening just didn’t work well for women in their 40s (or at all, for even younger women). The fact that most women didn’t know this, and instead received a falsely optimistic message about the life-saving benefits of once-a-year mammography screening, was incredibly frustrating. More background here.
At the National Women’s Health Network, we’re glad that the federally appointed task force has told the truth about what studies have found. Now women have a better chance of getting an honest assessment about the value of a heavily promoted technology. Information is always a good thing.
But I’m not at all happy today. Not even to be proven right about things that I took a lot of criticism for saying. Rather, I’m outraged. We’ve known for 16 years that mammography screening doesn’t work well for women before menopause, and not at all for women under 40. And at the same time, we’ve known that a significant number of breast-cancer cases occur in women under 50. So once we knew mammography wasn’t good enough, the next step was obvious—we needed to find something better.
Women need the equivalent of a pap smear for breast cancer screening. Pap smears are far from perfect, but the technology works equally well in 18-year-olds and 68-year-olds. How far have we gotten on a pap smear equivalent for breast cancer? Not very far at all. And that’s why I’m outraged. A huge amount of money has been spent on breast-cancer research in the last 16 years, but far too little has gone for research into truly new forms of screening. Who suffers as a result? All young women, of course, but African-American women suffer more than everyone else. For some reason that’s not yet fully clear, African-American women are more likely to develop breast cancer before age 40 than are white women. So if we fail to develop a screening that works at all ages, it’s African-American women who get hurt most. Let’s get moving.
Another version of this post appears here.
Photograph of pink ribbon by Photodisc/Getty Creative Images.
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We keep hearing from proponents of health care reform that government rationing of health care is a “canard.” We don’t have health care reform yet, but with the new recommendations from the U.S. Preventive Services Task Force that women shouldn’t get mammograms until the age of 50, and then only every two years, it feels like we’re getting the rationing.
The Los Angeles Times writes that “[i]nsurance companies and Medicare administrators … said they they would continue to pay for the procedure -- although it is not clear how long they can resist the panel's influence.” The LAT adds that the panel’s recommendations are “generally followed” by insurers and Medicare. (The NYT does say that Congress requires Medicare to pay for annual mammograms, which provides some measure of comfort.) The panel is made up of “health care experts” but no oncologists, and not surprisingly, oncologists and organizations like the American Cancer Society are unhappy about the new guidelines.
There are legitimate concerns to be addressed regarding mammograms. Mammograms expose women to radiation, and a false positive on a mammogram can lead to an unnecessary biopsy. But in my eyes, those concerns pale in comparison to the fact that breast cancer in younger women can be more aggressive and more resistant to treatment. What boggles my mind is that the panel worries about “anxiety” resulting from false positives and complications from a minor procedure like a biopsy, but describes as “modest” the 15 percent reduction in the death rate that has resulted from mammograms. I doubt any women who have survived breast cancer because of early detection would consider that to be a “modest” benefit.
The panel’s recommendations aren’t that different from the NHS guidelines in Great Britain, where women over age 50 are “invited” to have a mammogram every three years. That should raise a red flag: Women in the United States are more likely than their British counterparts to be diagnosed with breast cancer, but they are also more likely to survive. If the cancer is caught early, the survival rate in the United States is 97 percent, compared with 78 percent in Britain. That sounds like an argument for maintaining our current standards, not reducing them.
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It was a lethal combination of insomnia and an unusually steady wireless Internet signal that led me to rewatch the entirety of My So-Called Life (now on Hulu!) a few nights ago. In 1994, Jordan Catalano, the soulful, musician-type bad boy who woos Angela under the staircase was everything I wanted in a television heartthrob. Namely, because their union so easily played into the delightful romantic trope of the late '80s and early '90s, wherein members of different social cliques intermingled for matters of the heart. The bad boy fell for the cheerleader, the working class redhead scored the trust-fundy Ivy League-bound chick (Some Kind of Wonderful), or the jock found himself falling for a dandruff-prone kleptomaniac (Breakfast Club). In My So-Called Life, Jordan took the bookish, painfully shy (albeit hot) Angela Chase to the school basement at least once an episode to touch her lips and utter sweet nothings like, “Your cuticles look like little moons.” It was wish-fulfillment for every nerdy, under-kissed girl watching. (Ahem, me.)
But rewatching their courtship at the older, wiser age of 27 completely destroyed all the residual fondness I had been lugging around for Jordan Catalano when I simply remembered him as that mysterious puppy dog-eyed Jared Leto character. To begin with: “Your cuticles look like little moons” is stupid. And even the best imploring puppy-dog eyes don’t make up for illiteracy. In fact, Catalano was not particularly gifted in anything, even wooing. He made Angela keep their trysts under wraps and sang in a ridiculously bad and unfortunately-named band, Frozen Embryos. (How did I manage to forget about the song “Red,” which, as it turned out, was not for Angela, but his red car?) I only realize now his character was less teenage heartthrob and more a cautionary tale of emo-caddery. Close to a decade of dating has taught me that characteristics like “mysterious” and “damaged” are code for “functionally retarded: STAY AWAY.” What’s most incredible about the show is that Angela realizes that she’s over Jordan in Episode 17 (apparently long before I did) and his larger-than-life persona is almost instantly deflated. How often does a nerdy teenage girl get to do that to the popular boy on television?
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Politico.com reports that days after husband Mark Sanford admitted to having an affair, Jenny Sanford filed an application to trademark her name for use in "product merchandising to be sold at online retail store featuring clothing, mugs and other household items; stickers, decals, notepads.’” Herein, a few ideas that should sell out fast.
OK, we get that this kind of thing is probably exactly what Jenny Sanford is trying to prevent. But here are a few items we'd like to see in our scorned-wife-fantasy-revenge-scenario of the still- (but presumably soon-to-be-former) Mrs. Sanford's store (that would be VindictiveBitch.com):
The "My husband went to Argentina and all I got was this damn divorce?" mug.
"I'm not with stupid?" T-shirts
A "While You Were Out Hiking" notepad.
Weekend Dad parking decals.
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Emily, I agree with you that Sarah Palin just needs to go away. But I think that it's oversimplifying the case to say her womanhood explains the fascination with her, though that is part of it. Palin's political career is almost surely over, but that doesn't mean she's going away or that she's been neutered. I don't think Palin intends to fill a political hole in the Republican party. This book and book tour incline me to think she instead wants to challenge the Rush Limbaughs and Glenn Becks of the world as America's Next Top Crazy Right-Wing Nut Pundit. And that will make her way more dangerous than she'd be impotently running for office.
Sarah Palin isn't a smart person, or a curious person, or a kind person, but she is a master at channeling the hatred and resentment of the folks I like to call the "25 percent-ers"—cranky white people who live in a perpetual state of paranoia, feeling hemmed in by hippies, women's libbers, and immigrants. And yes, they're still fighting the culture wars of the '60s, an era that Palin herself barely remembers.
Palin plays these fools like a fiddle. She makes them feel superior to people they don't care to understand, coddles them with sentimental nonsense, flatters their desire to believe that willful ignorance is a virtue, and distracts them from sticky policy questions while feeding their belief that all politics is culture wars. Last year during the election, a neighbor of mine put out an aggressively stupid yard display in support of McCain/Palin, complete with Confederate flags and signs with misspellings like "Mavrik" and "Socialest," and while taking that picture, I asked the man who put up the display about his support for McCain. He announced that McCain was all right, but it was Palin for whom he really wanted to vote. It was then that I realized how dangerous this woman really is, and we wave that off at our own peril.
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Emily Y., Emily B., Hanna, and Jessica: You’re all so on point with your observations of Sarah Palin. Like Emily Y., I would like to see her go away, but not before I add my voice to the chorus of why I believe she is a fraud.
I watched Palin on Oprah yesterday afternoon. I wanted to hear what she had to say, since I have no intention of reading, let alone buying, her book. There are enough published excerpts of Going Rogue that I’ve already gotten my fill.
Although there were no major new revelations, the Oprah interview was interesting because it showcased Palin’s depth of intellectual dishonesty. When Oprah brought up Palin's embarrassing, cringe-worthy interview with Katie Couric and asked Palin why she simply didn’t cite a few of the many newspapers and magazines that she claimed to read regularly, Palin said she could have but didn’t because she was “annoyed” with Couric’s badgering line of questioning.
She said Couric approached the interview as if she was talking about “a nomadic tribe” of out-of-touch Alaskans who didn’t read. “I’m a lover of books,” Palin insisted.
Palin also said that Couric had a political agenda and treated Joe Biden with kid gloves when she interviewed him. “Joe Biden made mistakes,” but Couric didn’t bore in on him or ask him the same questions repeatedly, Palin said. “She moved on to substantial issues.” Palin neglected to add that these same substantial issues tripped her up and revealed her to be seriously uninformed, reinforcing public perceptions that she was unqualified to be vice president.
“Do you think that was a seminal, defining moment for you, that interview?" Winfrey asked.
"I did not," Palin responded. "And neither did the campaign ... .The campaign said, right on. Good. You're showing your independence."
"No sentient person would look at that and say that," one former senior McCain campaign official told the Washington Post. (Check out this fact-check of things Palin said in her book: Lies, lies and more lies.)
I love that Palin also offers up some armchair psychoanalysis in her book and diagnoses Couric as suffering from low self-esteem. That’s priceless, given that Palin could just as easily be accused of suffering from delusions of grandeur.
And Rachael, while you may find Palin’s “energy and ambition” admirable, and have every right to, a lot of folks find her ambition shameless and self-serving. From the first day she appeared on the national stage, it was not about serving the country, it was about serving Sarah Palin and turning herself into a bankable brand. And that “thick-as-hell-skin” you speak of sure seems to be absent in the I-am-a-victim-of the-meanie-members-of-the-media-who-dared-to-ask-me-tough-questions narrative displayed in the published excerpts of the book. And when she’s not blaming the media, she’s blaming the McCain camp for every mistake she made, which is curious because she paints herself as a helpless puppet whose strings were pulled by McCain operatives yet at the same time wants us to believe she is a smart, strong, independent thinker who would make a fine vice president, maybe even president.
If “the sneering condescension she encounters from liberals” drives you right into Palin’s arms, what do you say of the Republicans and conservatives—David Brooks, Peggy Noonan, Kathleen Parker, just to name a few—who have also justly criticized her? And what do you say of the 44 percent of Republicans who don’t support her and don’t find her as infinitely admirable as you do? Are they sneering haters too?
You write:
It's as if people can't disagree with her on the issues and yet acknowledge that she made an incredible journey from “hockey mom” to small-town mayor to vice-presidential nominee. At least not without mocking her kids' names or the clothes she wore before the infamous convention makeover.
Come on. The criticisms of Palin were not that overly simplistic. People also objected to her hyprocritical stance on sex education, her cluelessness about foreign and domestic policy, her inability to articulate her stand on the issues in one-on-one interviews? That's what made her journey from hockey mom to vice-presidential nominee so incredible. And let’s not forget how she fired up those angry crowds during the presidential campaign and worked them up into a lather by using racial code words. Remember her more recent comments about death panels? So very responsible.
So I agree, Rachael, that your support of Palin does not “project cool-headed logic.” It suggests selective memory and a bit of Palin-like revisionism.
Richard Cohen rightly calls Palin an irresponsible “demagogue” in his colum today. “The Palin Movement is fueled by high-octane bile, and it is worth watching and studying for these reasons alone,” he says.
Unfortunately, he's right. The very thing that makes Palin so repellent to people like me is what drives the public's fascination with her and guarantees that she will not be exiting the stage she loves any time soon.
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Two years after yet another industry pledge to eliminate junk-food advertising to kids under 12, researchers at Cal-Davis have found that kids' television programming is still disproportionately supported by advertising for foods high in fat, sugar, and calories, and low in any real nutritional value. In response, Senators Jim Moran (Va.) and Bill Pascrell (N.J.) have introduced the Healthy Kids Act, which proposes "specifying categories of foods and beverages for or about which any advertisement, promotion, or marketing directed at children and youth shall be an abusive, unfair, or deceptive act" and limiting advertising for certain other foods and beverages—presumably the slightly less objectionable ones—to two minutes an hour on weekends, three on weekdays. The FCC would do the limiting, the FTC the defining, and yet another agency—the Health and Human Services Department—might set additional guidelines based on the "emotional vulnerability" of kids and their limited skill at distinguishing ad content.
The bill is bound to be popular among voters—one in three of whom believes that all junk food advertising, not just ads targeting kids, should be regulated in some way. It's just as likely to be unpopular in the industry, which is already citing free-speech concerns and promising to do better next time. But if we truly want kids to consume less junk, then regulating its advertising is good policy. Fourof the top 10 advertising spenders on television are public companies that sell (among other things) junk food of one kind or another, with a duty to their shareholders to sell as much of that food as they possibly can. Accepting limits on advertising to kids might, perversely, be good business. Junk-food producers would be freed to push their wares within certain constraints, leaving the hypocrisy to those more skilled at not letting the left hand know what the right is doing.
Because while these three federal agencies work to limit the promotion of junk food, a fourth agency—the Department of Agriculture—will continue to work tirelessly to make the junk food itself both cheap and plentiful. In September, Michael Pollan noted in an editorial in the NYT that, with the proposed health care bill, the federal government is "putting itself in the uncomfortable position of subsidizing both the costs of treating Type 2 diabetes and the consumption of high-fructose corn syrup." The Healthy Kids Act would have that same government encouraging the production of foods and beverages containing high-fructose corn syrup, but discouraging their consumption. It seems cynical to call that progress, but I guess we'll have to take what we can get.
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