Skip to content

Category: Culture

The best that has been thought and written and why these ideals are difficult to meet.

November 19, 2009 | 8 Comments

Mammogram wrap-up

We’re all tired of this topic, and unless I hear something especially goofy from the peanut gallery, this will be my last word on this subject (for the time being, anyway).

We guessed it. Both sides of the Great Political Divide went crazy and blamed either “big government rationing” or “big insurance profits” as the reason for the new paper’s recommendations. Both sides were at pains to say how much they were “for” women (I am too!). Both sides suspected a deeper conspiracy because of the timing of the paper. Nobody stopped to consider that both conspiracies can’t be true simultaneously, and that maybe—just maybe—the people who wrote the article believed what they were saying. Or, even stronger, that its findings might be correct.

Absolutely nobody I heard even made even so much as an attempt at a hint to explain “Why 40?” It’s as if beginning screening at 40 was handed down by sacred tradition, and thou shalt not question it.

Like I said, 40 might even be right for some women, but you can’t know that by any arguments you heard from the press, physicians, government bodies, and medical societies over the past three days. All we got were non sequiturs, illogical emotional probes, distractions, irrelevancies, and on and on. The closest anybody came to justifying the age was “40 saves lives,” which I hope you can agree is no sort of argument at all, merely an appeal, loosely, to authority.

We also heard, in the parade, from a handful of people who said, “The mammogram saved my life.” We did not hear from the larger group of women who never had a mammogram and never had cancer, either. Nor were there any voices from the immensely larger false positive crowd.

So I’ll tell this story again. An otherwise healthy women went for a routine screening and was told “the mammogram found something.” She went back and had another dose of radiation and still there was “something.” Days, weeks passed until the ultrasound. “Will you still love me if I have my breast cut off?” Worry, stress, tears. The ultrasound also showed something, suspiciously not in the same exact spot. Finally, a needle biopsy. Relief! It was nothing! The woman was very grateful, too. She said, “I would not have known I didn’t have cancer had I not gone through all that.” My argument that she could have saved herself all that grief had she just assumed, as was rational, that she did not have cancer; after all, she had no risk factors. She got angry with me for suggesting this. She wanted to know.

Since I have a cruel streak, I told her that she could still have cancer after all, because even biopsies are not perfect, and besides, the entire breast wasn’t sampled, just one spot. So she couldn’t actually know, she still had to rely on probability and statistics. Plus, that biopsy and all those x-rays have actually increased her risk of future cancers and other infections.

This was an email exchange and after my last comment, I never heard back from the woman.

Update Another oft-heard argument is that if we change the screening age to 50, we will miss a lot of women, from 40-50, who have cancer that could have been detected had they had a mammogram. This is true, but irrelevant; for, by the same logic, we can justify screening to start at age 15. Why? Because, of course, if we don’t start at 15, we will miss a lot of women, from 15-40, who have cancer that could have been detected had they had a mammogram.

But to say “start at 15” sounds absurd, doesn’t it? It is. And the reason it is, is the very same reason, or reasoning process, that went into the new recommendation of 50. You have to balance the costs—the actual high and very real costs—of false positives, the costs of false negatives, treatment capacities, and the important (but infrequently mentioned) base rate of the disease (per risk groups, usually; those with a family history vs. those without, etc.). This is a perfectly quantifiable calculation, and the paper’s authors came to conclusion that 50 strikes that balance. Maybe this is wrong, but they went about it the right way, and kept politics out of it.

Update I made a point to listen to Charles Krauthammer tonight. He was spot on, as his many columns usually are.

November 18, 2009 | 9 Comments

More on mammograms

Emotions, as they say, run high, especially about “health.” There is a great deal of superfluous, extraneous, and irrelevant discussion taking place with regard to the new mammogram guidelines. Yesterday, many organizations rushed to the microphone to say, “Don’t worry! We still recommend every women gets mammograms as frequently as possible.” They were worried lest women think they did not care. Let’s examine this phenomenon.

There is a range in how much people care about their own physical being, from hypochondria to indifference. I’ll use the term hypochondriac to mean not just those who suffer from the mental disease of ridiculous concern, but also for those who worry disproportionately to the actual risk of any malady. Antibacterial-goo-carrying hand washers are in this category, as are mothers who fearfully drag their tot to doc every time it sneezes. The indifferent eat and drink whatever the hell they want and say, “A short life, but a merry one.”

The reactions of those at either caring extreme to those at the opposite end is not symmetric. That is, hypochondriacs regard the indifferent in a manner that is wildly different than how the indifferent think about hypochondriacs.

The indifferent think hypochondriacs are nuts, and that they’d be better off if they just wouldn’t worry so much. But the indifferent are inclined to think that if the hypochondriacs want to run to the doctor for every perceived symptom, let them; as long as they leave us alone.

Hypochondriacs—and their close cousins the worrywarts, hand-wringers, and fretters—think the indifferent are nuts, too. But in general the hypochondriacs cannot abide the indifferent and want to change their behavior. Misery loves company, and the misery caused by constant concern should be enforced, even mandated, for all. Hypochondriacs rally under the banner, “Something might be wrong with you!”, which is a true statement, but an empty one, because it contains no information beyond the fact that some people get sick and some don’t. It doesn’t tell you the odds.

Very well. Hypochondriac females desire, as early as they are allowed, to have a mammogram, and have them often, “so that they know.” The indifferent look at these females and say, “Go ahead, but I don’t want to take the chance of a false positive.” But the hypos can’t stomach this, don’t care at all about false positives—they might as well not even exist—and so they browbeat the indifferent until they agree, at least verbally, with the hypos’ concerns.

But there is middle ground.

All the new mammogram recommendations did was to seek a balance between the admitted inaccuracies of mammograms—and they are very inaccurate—with the chance of developing breast cancer (which is small), all while attempting to account for the average person’s feelings about false positives and false negatives. The average person is not a hypochondriac nor is she indifferent. Further, there are many more in the middle than at the extremes.

The study—and my own work—highlighted four things which were previously unemphasized, and which every woman thinking about a mammogram should consider.

  1. False positives exist and are common. And they have serious consequences. The costs involved with the mammogram’s mistakes should, and almost never are, considered before deciding to have the test. Women should be better advised.
  2. The doctor’s costs are not the same as the woman’s. Obviously, the doctor doesn’t suffer at all if the mammogram gives a false positive. In fact, his billing increases as he calls the woman back for further tests. It’s not his breast being squeezed under glass, nor his breast being cut open to extract a possible unnecessary biopsy, nor his breast being exposed to additional radition.
  3. The age at which to begin mammograms is not set in stone. To those who condemn the new guidelines, I ask—seriously—why not recommend mammograms at 13 or 14? Why not get them twice yearly, or even once every quarter? The answer you give cannot be “Don’t be silly.” You must base your response on quantitative data. That is what the study (and my work) tries to do.
  4. Not all cancers are equal. Some breast disease can be lived with and won’t kill, and some of these, sometimes, are better left alone. Read the original paper (linked here) for a more thorough discussion.

That last point need emphasis. It might not be that 50 is the right age for healthy, otherwise not-at-risk women (at risk women include those with family histories of cancer, etc.) to commence screening, it might be that it is 52 or 48. It also might not be best for tests to be annual or semi-annual. What is best and how do we tell? To explain that requires the math I pointed to yesterday. The point to take away is that this is a question that can be answered empirically and quantitatively—and not politically. The correct age and timing will be different for each woman—and there are tools to help her decide what these numbers are.

One more thing: I heard some docs say, “The data used in the study were not all current. Treatment methods have changed.” This is true, but largely irrelevant. Breast cancer treatment is not at issue: the accuracy and usefulness of mammograms is, and these fallible instruments have not improved much through time.

November 14, 2009 | 30 Comments

Can you do these math problems? If not, you can still go to college

Here are four problems, published by the New York Daily News, that high school graduates attempted as they entered the City University of New York (CUNY) system. The percents are those who answered correctly.

  • 64%: 5 + 3 (4+6)
  • 44%: How much is 0.2 divided by 5?
  • 34%: Write 3/8 as a decimal
  • 10%: Solve the equation x2 = 9

Note again that these are the results from fresh high school graduates entering college. These are not older people coming back to school after many years, nor are they the folks who eschewed college. These are people who should know these answers.

I can just see—maybe—that knowing the answer to the fourth question should not be a requirement for a university education. But one-third could not accomplish a simple addition/multiplication problem.

As I’ve argued before, that’s about the percentage of people who do not belong in university. For an interesting debate of this subject, head over to Our pal Charles Murray is there.

I’ve told this story many times, but when was an undergrad I was in an intensive mathematical program. Five days a week, tons of homework every night, oral quizzes—-oral quizzes! A lot of people washed out after the first year, even more the second. One first-year washout was a female who we can call Jenny. I met Jenny again in our senior year and asked what was her new major. “I’m going to be a math teacher,” she said. Those who can’t do…

Here is an article from City Journal on math education. Perhaps I’ll give away the punchline when I tell you that “educators” spoken of in the article invented the phrase “deep conceptual understanding.”

Try not to read this article with any sharp objects in hand or within reach. You have been warned!

Some schools acknowledge that a large proportion of kids will do poorly on math, and will hence have lower GPAs. Solution? Have them donate to the school. 20 points for each $20 on the final exam. Full story here; sent in by long-time reader Ari.

November 9, 2009 | 8 Comments

Vacuous Verisimilitude; Or, V has arrived

How did this show get past the ABC censors? How did the folks in Hollywood—good Progressives, all—let this program sneak onto the air? Were movie studio heads so distracted by attending yet another Washington fund raiser that a genuine alternate viewpoint was allowed to air?

We may never know, but we can be grateful for the remake of V. Because it turns upside down every well known Left Coast trope.

A Catholic priest (Joel Gretsch) has doubts. No, not those kinds. He distrusts the milky language of the Visitors and says so in his sermons. A Monsegnior insists the Vs are part of Heaven’s plan. The priest answers, “Rattlesnakes are God’s creatures, too. Doesn’t mean they’re good for us.” The Monsegnior counters that the people are grateful for the Vs appearance. Reply: “Their world’s in bad shape, father. Who wouldn’t welcome a savior right now?…[And] under the right conditions and with enough time, gratitude can morph into worship. Or worse. Devotion.”


He admonishes his credulous flock, “We’re all so quick to jump on the bandwagon…but let us at least examine it and make sure it’s something we want to get on.” The strangest thing of all is that the priest is portrayed sympathetically! There’s not a choir boy in sight.

The evil leader lizard woman Anna (played by Morena Baccarin) is subdued and quiet, like a snake lazing in the sun. She blinks like a reptile. And she speaks with a forked tongue (no, silly; I’m being metaphorical).

Thrill-up-his-leg journalist (Scott Wolf) rhetorically asks, “Should the press be so tough on the Vs?” He readily sacrifices his integrity for unrestricted access to The One—oops, I mean Anna. She threatens to walk off the set of her first broadcast interview unless he agrees to lie for the greater good. “We can’t be seen in a negative light,” she says. Naturally, once the camera rolls, Anna tells the world, “Please feel free to ask me anything and everything. I’m here to discuss all topics without reserve.” She then announces the creation of the Visitor-imposed “universal health care”.

Our reporter feels a slight tinge of guilt over what he’s done. A V assuages him with, “Compromising one’s principles for the greater good is not a shameful act. It’s a noble one.”

There’s a slick scene where a doctor notches some ‘V’s onto the mastoid processes of some Underground members to reveal bone, and, hence humanness. Geeks will be happy to see Alan Tudyk, who plays a resurrectable alien. (I note parenthetically that he ought to keep away from sharp metal objects. Right, Serenity fans?)

Morris Chestnut—Morris Chestnut! that’s his real name, I swear—plays a renegade lizard. They had them in the original series, too. Patriots who rebelled against their autocratic one-party government.

The 1983 version alluded to Nazis, using a story line seen through the eyes of an aged Holocaust survivor. It was that survivor who taught kids who were defacing Alien posters to do so in the shape of a “V for victory” and so give the show its name.

In this updated version, the kids “tag” for the Vs. That is, they vandalize property in the name of Progress. One kid’s mom (Elizabeth Mitchell), who is an FBI agent and the heroine who will learn that the Vs long ago planted sleeper cells on Earth, catches her son misbehaving. He proclaims duty and says, “The Vs. They call it spreading hope.”

Eventually, our young hopeful (Logan Huffman) joins the V’s “Peace Ambassador program” This NGO is a pro-V grassroots neighborhood organizer organization. Initiates get brown shirts! No, just kidding. They’re gun-metal blue. They toast their pact with, “To the dawn of a new day!” Change has come!

In the original, the Vs were softening us up for Alien Chow. Now it looks like they just want to clear us out to make way for Progress, and perhaps slavery.

A beautiful plot point has the Vs lamely announce, “We came to borrow some water”. Now, any species that can build and power ships that can traverse the vastness of interstellar space can trivially make water. Anna even admits that her planet is “ocean filled.” But the will to believe is strong so that nobody bothers to question this transparently idiotic plea for cooperation—-strike that, for dialog. Anna gushes, “We are honored by your friendship. We will cherish it. Nurture it. And never abandon it. We are of Peace. Always”

After a setback and Awakening, our FBI lady shivers with the priest on a rooftop and echoes his thoughts about the gullibility of the People: “The [V’s have] armed themselves with the most powerful weapon out there. Devotion.”

Anna leaves us with these prescient words: “[E]mbracing change is never easy. But the reward for doing so can be far greater than you can ever imagine.”


V is on Tuesday’s at 8 pm on ABC. It’s also available on Hulu and later in the week.

Update: Reporter asks White House Press Secretary Gibbs about Obama’s resemblance to Anna.