Emily B, I agree with you that it’s really unfortunate that the conclusion that we don’t need to routinely do mammograms until 50, instead of aparking a national, rational discussion about the advisability of “screening and prevention,” has become the harbinger that we’re all going to live under British health care rationing. The debate over whether we benefit from searching for early cancers is not new, and no wonder the public is so confused. This is like the “no fat” to “no carbs” pendulum swings on official diet recommendation. First we’re told looking early for breast cancer is the way to save lives; now we’re told look too early and often and we mostly finds lumps that are benign. Barack Obama has said that improved detection and prevention under his health care plan will lead to Americans being healthier, but this government task force on mammograms raises questions about what that means and whether it works. And now the administration, when confronted by evidence that we should do less, realizes it can’t take that political hit. As Steve Pearlstein writes, this is not good news for our ability to contain costs.

There’s no way to take the politics out of health care. But instead of seeing this debate as something sinister, we all would benefit from constant reexamination by the medical profession of its recommendations about how we should be examined. A few years ago, CT scans were supposed to revolutionize lung cancer treatment. Finally, we had a technology that would discover these tumors before they became deadly. But it turned out the screening didn’t save lives, it picked up tumors that wouldn’t have progressed. So this wasn’t a matter of “anxiety,” as in the false-positive mammogram. This meant people were being treated for a cancer that would have just sat there had it not been found.

In the mammogram debate, we are mostly hearing from the women who are angry and fearful that their annual mammogram will be taken away. But I wish that in my 40s my doctor hadn’t lectured me every year that I was overdue for a mammogram, and instead we’d been able to discuss when it made sense to start and how often I should have one.

Photograph of mammogram by John Foxx/Stockbyte/Getty Creative Images.

Tags: breast cancer, health care reform, mammograms

I've been trying to understand the flap this week over the recommendations from the U.S. Preventive Task Force—a group ill-prepared to handle the controversy—to delay routine mammograms to age 50 for most women. And now, in a truly terrible coincidence of timing, we have a second round of commotion over the advice of the American College of Obstetricians and Gynecologists to push pap smears to screen for cervical cancer back to age 21.

The politics are irresponsible but obvious: Tie the recommendations to the boogeyman of rationing, if you oppose the White House on health care. Never mind that neither set of recommendations binds insurers or anyone else. ACOG's pap smear advice will be "set in stone," Sen. Tom Coburn said, and adopted without regard to differences among patients. Sarah Palin naturally piled on, suggesting that the new advice is really all about "bureaucratic pressure to control costs."

Why do many women seem susceptible to the fear-mongering? Why is it hard to see that the costs of overscreening can outweigh the benefits of early detection?

Kevin Sack does a good job of beginning to answer these questions in the NYT this morning. The evidence about the danger of overscreening asks us to upend how we've long thought about risk. After years of dutiful breast self-exams and teenage pap smears, there's a new playbook. That's a lot to get used to, I suppose.

Also, I think, these evidence-based recommendations ask us to give up a couple of myths we hold dear. The first is that saving one life is worth any amount of trouble or money. "One life out of 1,904 to be saved,” Sen. Kay Bailey Hutchison said of the stats about getting mammograms in your 40s. Right, and the point should be, that's not much bang for the buck. But what if it's your life, your bang? We seem frozen on that question, unable to have the deeper discussion that should follow from it.

The second myth we've grown attached to is that more tests and screenings equal more control. If you get regular mammograms and pap smears, then you're protecting yourself. It's a kind of talisman: You won't get cancer, or at least you won't die of it. Cut it out early and fast! Now we have to absorb the idea that some slow-growing cancers are better left alone. We have to let go of the illusion that testing guarantees wellness and confront the far less reassuring reality that false positives lead to unnecessary interventions that can hurt us—biopsies and radiation treatment and removal of relatively harmless growths. Remember the adage that the cure can be worse than the disease? It's unsettling. But also true.

Tags: breast cancer, cervical cancer, mammogram, pap smear, us. preventive task force

DoubleX is starting a new partnership with the Washington Post Magazine. Each week our contributors will argue over a certain question, and we invite you to join in. This week: Thanksgiving togetherness—love it or dread it?

Hanna Rosin: I know what they say, that holidays are occasions to revisit family stress. Many a great novel and movie has been built on this premise. And in general, I would say it's true. The Jewish holidays are all about starving and yelling. Vacations involve too much childcare. But for me, Thanksgiving is the blissful exception. Maybe it's because I really like my in-laws. Maybe it's because turkey has a soporific effect. Or maybe it's because my mother-in-law bakes dozens of pies, at a ratio that works out to be about one per person. Who could complain about that?

June Thomas: I look forward to Thanksgiving because it gives me a chance to drop in on other people's lives. I'm an immigrant and an only child, so I don't bring any of my own traditions to the table, but thanks to friends, I've gotten to spend many Thanksgivings as an honorary family-member. I've eaten buffet-style with my girlfriend's 10 siblings, where we ate a wild turkey from "down the hill," and I got to test my memory by trying to match kids to parents. I've sat at the table of generous pals who round up all their single and foreign friends to make sure they're not home alone with the Macy's parade and a TV dinner. I've also done the ex-pat thing, where people gathered after an ordinary European workday and tried to fool themselves that strawberry jam is an acceptable substitute for cranberry sauce. And best of all, I've always left with a parcel of food, because nothing says family like leftovers.

Dahlia Lithwick: I'm with Hanna and June. As an immigrant, I think Thanksgiving is the sweetest thing since pecan pie. A four-hour dinner just isn't enough time for all the ancient childhood resentments and festering sibling rivalries to flare up under the civilized surface. Even if you add in the football and the inevitable politics, I always think everyone behaves much better than the novels and movies would suggest. What's not to love? The only thing bubbling away under the surface at Thanksgiving dinner is hot brown sugar. Mmmmmmmmmmm.

KJ Dell'Antonia: Oh, come on. Won't someone speak up for the awful family traditions, the kitchen rivalries, the relative who follows your 3-year-old around with a dustpan and broom? The pointed saying of a grace that prays that some unnamed family member will do exactly the thing he or she is most opposed to doing? The comments on what you choose to eat, or not eat, and its effect—positive or negative—on your waistline and general health? The real reason movies are such a popular destination on Thanksgiving afternoon? Put the sweetness and light back in the can with the pumpkin, people.

Lauren Bans: I wish I could enjoy Thanksgiving more. Unfortunately our dinners usually turn into spats. Past debate topics have included Kobe Bryant: Rapist or Not? and Why Won't You Just Go to Law School? And then there's my dad's particular favorite, Palestinians: I Mean, What Is Wrong With Them!? We get loud and argumentative and the shouting makes me overindulge on soothing serotonin-packed carbs that show up on my waistline later. There's also my pimp of a Grandma. As she's grown older, she's become more and more insistent upon Jewish boyfriends, to the point where last year she invited the grandson of her synagogue friend over for dessert and proceeded to show him my baby pictures. (He was nearly 40. I'm 27.) It could not have been more Bridget Jones-ian. That said, the weekend after Thanksgiving is great. We usually go to museums, the Mall of America, and a play. As long as we're not at one long table together, we seem to do just fine.

Lenora Babb: My Thanksgiving:

Everyone meets up, personal questions get asked, boyfriends stand awkwardly in the corner or get quizzed by grandpa (who can't hear their responses anyway, but just blusters various questions out and glares disapprovingly). My sister finds creative ways to cover her many tattoos and looks uncomfortable all night, having had to flip her nose-ring up where it rests hidden inside her nostrils.

Anyone who doesn't want a drink is asked, "What's-a-matter? You got religion?"

The cousins in law school give updates on their progress, and the lawyer aunts and uncles counsel them. I am asked about my plans for law school—when am I taking the LSAT? And am I studying? And what exactly is that master's program I'm in? Liberal Studies. Huh. "Well, not a lot of jobs there!"

My mother may get grumpy because my dad has disappeared at the critical moment—putting the turkey in the oven. Once everyone gets a little tipsy, the stories begin—perhaps embarrassing tales from the aunts' and uncles' youth (there are five of them, my mom the youngest). Someone will probably get upset at this point, or a heated argument will flare up. If not family stories then the talk will turn to politics. Whoever is the loudest wins.

Amanda Marcotte: My family holidays and how fun they are sadly depends on how many relatives of my generation can make it—cousins, siblings, my aunt and uncle who are my age. If we're outnumbered by the older generations, then political fights appear to be inevitable. Endless hours of talk radio and Fox News have encouraged conservatives to enjoy annoying liberals, and so when liberal family members like myself show up without our generational reinforcements, they see us an vulnerable and attack. Having more young adults around works, even if those younger adults still see themselves as Republicans. They still feel generational sympathy for us and close ranks, usually in the form of a poker game. Unfortunately, we're typical Americans and have a familial diaspora from one coast to the other, and so getting everyone in one place at one time is nearly impossible.

Rachael Larimore: I am pleading the Fifth on Thanksgiving with the family ...

But I can assure you, having lived in Seattle for eight years, that liberals enjoy annoying conservatives just as much as the vice versa. I believe my husband and I are responsible for multiple incidents of fractures resulting from jaws hitting the floor, which is what happens when you are at a social event in Seattle and you tell people you are a Republican.

Jessica Grose: Since my family is not religious and we don't celebrate Christmas, Thanksgiving was always the major holiday in our clan. The far-flung California branch would come back east and every year my Austrian grandmother would cook a major feast singlehandedly. Like Dahlia and June, she wholly embraced this American holiday, and her charm and spirit always set the tone for the day. She cooked the entire meal by herself—the turkey and at least five sides AND dessert—until she was 89. What's more, my parents' wedding anniversary and my mom's birthday always fall on or around Thanksgiving Day. With so much to celebrate combined with the delicious, narcotizing turkey, past grievances and political differences are always put aside with very little fuss.

Dayo Olopade: I guess I am at the stage in life where I'm realizing that I don't actually live anywhere near any of my family members. So Thanksgiving, a massive reunion chez Olopade, is totally awesome for me.

Probably the best thing about Thanksgiving at my house is that it's a glorious sham. No seasonal root vegetables, no green bean casserole, no pumpkin pie. Sometimes there is a can of cranberry sauce that no one eats. But it's optional. Basically my mom cooks a bunch of (delicious) Nigerian food—efo, pepper soup, jollof rice, plantains—plus a turkey to cover up our minor fraud. And as marriage and reproduction has expanded the gathering to more than 50 strong, we've taken to preparing two turkeys—one for the dinner, and one for after my excellent mother gives away every last drumstick to the stray international student or lonely colleague she's invited into the belly of the Nigerian beast.

Jessica Lambertson: My boyfriend and I have to share holidays, and this year he gets Thanksgiving.

It's especially awkward for me because his parents are immigrants from Taiwan. Not only do they not really celebrate Thanksgiving, they don't like turkey. It's a mixture of interest and devastation for me. You mean you don't pass around corn kernels and count your blessing on them? There won't be the required yams and green-bean casserole? I don't have to lead the family in a song-prayer?

Instead, we go out to dinner and get hot pot (probably the most wonderful crossover from Chinese cuisine). I have to explain that I'm getting a graduate degree I will probably never use, and he has to explain why he hasn't gone back to school.

Dinner usually goes pretty well but then there's the required family fight afterward. With the little Mandarin I know, I can pick up some choice words, but it's usually resolved by bed time.

I won't have my kooky German grandpa and my mother's frantic desire to make a pie for each person at the table, but I will have a more relaxed weekend.

Tags: family, holidays, Thanksgiving

Time magazine's "Can These Parents Be Saved?" story offers a glorious rundown of the rampant possibilities for overparenting that have become available in recent years. From kid leashes ("Kinderkords") to fears about kindergarden "pencil-holding-deficiency," the opportunities for parental self-congratulation are plentiful—almost anyone can think "I may have hovered once in a while, but I was never that bad."

But Time suggests that the recession forced the beginning of an end to all that. With extracurricular activities cut from the budget and protective gadgets eliminated from the shopping list, parents found new reservoirs of time available to their suddenly unleashed young, and found that everyone seemed to like it that way. The article reports, too, that new ways to organize, monetize, and movement-ize "free-range parenting" are springing up. Parents gather in a "Slow Family Living" class and attend (and presumably pay for) seminars on reducing the contents of their playrooms.

We may be ready to stand over our kids a little less, but plenty of us are still anxious enough to want the experts to continue hovering overhead. Insecure parents make easy targets—for books, for products, for new trends in under-and over-parenting. The message pendulum swings constantly (note the links to related articles in the Time piece alone: iPhone apps for parents, gadgets for college, parenting classes to "teach parents to stay engaged." I thought we were supposed to disengage, but apparently not too much.) Gain a little confidence in your parental decision-making, and the culture, as much as the media, can undercut you.

My 8-year-old son plays hockey. He is, frankly, on the most laid-back, we-play-for-fun team possible (which could also be interpreted as the B team) and already, two months into the season, has had multiple games in one weekend involving three- and four-hour long drives. This weekend's tournament involves a two-night hotel stay—and don't think that's because it's some sort of special grand finale. It's just a run-of-the-mill thing, and there will be many more to come this year alone. We said no, but if we say no too many more times, guess who won't even be playing on the B team? That physical activity we're supposed to encourage doesn't come easily anymore. Playing in the yard is great, but shouldn't a kid be able to choose to do more without requiring one parent's full allotment of "leisure" time?

Overparenting goes beyond those kid leashes and pencil-holding tutors. It's burned deep into our culture. If everyone else's parents help their kid to produce a picture-perfect volcano for the first-grade science project, it's a rare teacher who'll recognize that the sad little lopsided Lego version taped to construction paper looks that way because the child's parents chose not to hover, and the even rarer teacher who'll reward what looks like less work with words of praise and encouragement. I hope Time magazine has spotted a trend, but it's going to take a long time to get all the helicopters down out of the sky.

Tags: helicopter parenting

Yoga is a meditative practice sometimes thought to help liberate the soul from all worldly suffering. The Olympics are a tribalistic sporting event in which nation states battle to produce impressive feats of human athleticism. Bikram Choudhury—a man who teaches yoga in a speedo and a diamond-studded Rolex, guards his trademarked pose sequences like a Rottweiler on meth, and likes to compare his balls to “atom bombs”—says its high time to combine the two. “This,” Bikram’s wife tells the New York Times, “is our dream.”

There’s always a story in your local yoga instructor’s reaction to Bikram’s hyper-competitive corporate orientation (the man is proud of the term “McYoga”), so the New York Times asks some very centered people whether yoga ought to be a competitive sport. A tournament “seems fairly antithetical to what yoga is all about,” says a typical respondent, “I don’t really understand how you would compete to be the happiest, most balanced person.”

Competitive yoga certainly sounds like a crazy American way to ruin a spiritual Indian practice, but competition is neither new to yoga nor a particularly American adaptation. The Choudhurys were yoga champs in India long before they made it overseas and got rich selling an especially intense version of the traditional practice. Bikram has been so successful in mainstreaming yoga that the Calcutta-born yogi now gets to endure lectures from Americans on what “yoga is all about.” Happily, no one actually gets to decide what yoga is, who ought to participate, and whether the most successful yogi is the one who gets the gold.

Tags: Bikram yoga, olympics, yoga

Oprah Winfrey is going to announce today that she will be leaving her eponymous talk show in 2011. The New York Times believes Winfrey is resigning from network TV in order to focus on the cable network she's working on, called OWN, which will feature shows from all of her favorite cronies, like Dr. Oz, Rachael Ray, and Dr. Phil. While this might be the case, I think another reason Oprah is hanging up the mic is because she has destroyed the core of what made her so popular in the first place: She's no longer relatable.

Last year I profiled a blogger for the Times who was living her life based on all Oprah's advice for a year. The blogger, Robyn Okrant, has a forthcoming book based on her experience, and one of the major points she makes is that Oprah is now more famous than almost anyone she interviews. This wouldn't necessarily be a problem, except that Oprah gathered her fan base because of the fact that she was just like them. What pop-culturally conscious woman who was alive in the mid-'80s does not remember when Oprah dropped 67 pounds on the crash diet Optifast and wheeled out a giant tub of fat on her show to signify that weight loss? And who doesn't remember when she gained it all back? The average Jane could easily commisserate with this kind of vulnerability and outward struggle. Of course, Oprah still struggles with her weight, but she does it with the help of a vegan chef, a physical trainer, and a team of assistants.

Many women without personal chefs still watch Lady O, but her ratings have been declining substantially. During the July 2009 rerun season, Oprah had her lowest ratings since the show debuted in 1985. Oprah's minions still have enough of the common touch to appeal to the audience that she seeks to move over to her cable network. Or at least that's what she's hoping.

Photograph of Oprah Winfrey by C.J. LaFrance/Getty Images.

Tags: dr. oz, Dr. Phil, living oprah, Oprah, rachael ray, robyn okrant