Wednesday, December 2, 2009

Not So Pretty in Pink

(Extra! Extra!)

The upshot of Obama's Afghanistan "I'm so sorry but we gotta keep killing them" speech? Paul Craig Roberts whispers to us here. (And aren't you just dead surprised?)

Obama also found out that he cannot change anything else either, if he ever intended to do so.

The military/security lobby has war and a domestic police state on its agenda, and a mere American president can’t do anything about it.

President Obama can order the Guantanamo torture chamber closed and kidnapping and rendition and torture to be halted, but no one carries out the order.

Essentially, Obama is irrelevant.

President Obama can promise that he is going to bring the troops home, and the military lobby says, “No, you are going to send them to Afghanistan, and in the meantime start a war in Pakistan and maneuver Iran into a position that will provide an excuse for a war there, too. Wars are too profitable for us to let you stop them.” And the mere president has to say, “Yes, Sir!”

Obama can promise health care to 50 million uninsured Americans, but he can’t override the veto of the war lobby and the insurance lobby. The war lobby says its war profits are more important than health care and that the country can’t afford both the “war on terror” and “socialized medicine.”

From the unequaled Tomgram, we are treated to Barbara Ehrenreich's latest illumination of women's health issues which clarifies a few of the latest developments for us. If I didn't think it really important to get this conversation started, I wouldn't run the whole essay. But I do (emphasis marks added - Ed.). (And don't forget about reading her latest book, Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America. It's the book of the year IMHO as it tells almost everything you need to know about how we got to this unpretty pass.)

Welcome to the Women's Movement 2.0

Not So Pretty in Pink

The Uproar Over New Breast Cancer Screening Guidelines

By Barbara Ehrenreich

Has feminism been replaced by the pink-ribbon breast cancer cult? When the House of Representatives passed the Stupak amendment, which would take abortion rights away even from women who have private insurance, the female response ranged from muted to inaudible.

A few weeks later, when the United States Preventive Services Task Force recommended that regular screening mammography not start until age 50, all hell broke loose. Sheryl Crow, Whoopi Goldberg, and Olivia Newton-John raised their voices in protest; a few dozen non-boldface women picketed the Department of Health and Human Services. If you didn’t look too closely, it almost seemed as if the women’s health movement of the 1970s and 1980s had returned in full force.

Never mind that Dr. Susan Love, author of what the New York Times dubbed “the bible for women with breast cancer,” endorses the new guidelines along with leading women’s health groups like Breast Cancer Action, the National Breast Cancer Coalition, and the National Women’s Health Network (NWHN). For years, these groups have been warning about the excessive use of screening mammography in the U.S., which carries its own dangers and leads to no detectible lowering of breast cancer mortality relative to less mammogram-happy nations.

Nonetheless, on CNN last week, we had the unsettling spectacle of NWHN director and noted women’s health advocate Cindy Pearson speaking out for the new guidelines, while ordinary women lined up to attribute their survival from the disease to mammography. Once upon a time, grassroots women challenged the establishment by figuratively burning their bras. Now, in some masochistic perversion of feminism, they are raising their voices to yell, “Squeeze our tits!”

When the Stupak anti-choice amendment passed, and so entered the health reform bill, no congressional representative stood up on the floor of the House to recount how access to abortion had saved her life or her family’s well-being. And where were the tea-baggers when we needed them? If anything represents the true danger of “government involvement” in health care, it’s a health reform bill that – if the Senate enacts something similar - will snatch away all but the wealthiest women’s right to choose.

It’s not just that abortion is deemed a morally trickier issue than mammography. To some extent, pink-ribbon culture has replaced feminism as a focus of female identity and solidarity. When a corporation wants to signal that it’s “woman friendly,” what does it do? It stamps a pink ribbon on its widget and proclaims that some miniscule portion of the profits will go to breast cancer research. I’ve even seen a bottle of Shiraz called “Hope” with a pink ribbon on its label, but no information, alas, on how much you have to drink to achieve the promised effect. When Laura Bush traveled to Saudi Arabia in 2007, what grave issue did she take up with the locals? Not women’s rights (to drive, to go outside without a man, etc.), but “breast cancer awareness.” In the post-feminist United States, issues like rape, domestic violence, and unwanted pregnancy seem to be too edgy for much public discussion, but breast cancer is all apple pie.

So welcome to the Women’s Movement 2.0: Instead of the proud female symbol - a circle on top of a cross - we have a droopy ribbon. Instead of embracing the full spectrum of human colors - black, brown, red, yellow, and white - we stick to princess pink. While we used to march in protest against sexist laws and practices, now we race or walk “for the cure.” And while we once sought full “consciousness” of all that oppresses us, now we’re content to achieve “awareness,” which has come to mean one thing - dutifully baring our breasts for the annual mammogram.

Look, the issue here isn’t health-care costs. If the current levels of screening mammography demonstrably saved lives, I would say go for it, and damn the expense. But the numbers are increasingly insistent: Routine mammographic screening of women under 50 does not reduce breast cancer mortality in that group, nor do older women necessarily need an annual mammogram. In fact, the whole dogma about “early detection” is shaky, as Susan Love reminds us: the idea has been to catch cancers early, when they’re still small, but some tiny cancers are viciously aggressive, and some large ones aren’t going anywhere.

One response to the new guidelines has been that numbers don’t matter - only individuals do - and if just one life is saved, that’s good enough. So OK, let me cite my own individual experience. In 2000, at the age of 59, I was diagnosed with Stage II breast cancer on the basis of one dubious mammogram followed by a really bad one, followed by a biopsy. Maybe I should be grateful that the cancer was detected in time, but the truth is, I’m not sure whether these mammograms detected the tumor or, along with many earlier ones, contributed to it: One known environmental cause of breast cancer is radiation, in amounts easily accumulated through regular mammography.

And why was I bothering with this mammogram in the first place? I had long ago made the decision not to spend my golden years undergoing cancer surveillance, but I wanted to get my Hormone Replacement Therapy (HRT) prescription renewed, and the nurse practitioner wouldn’t do that without a fresh mammogram.

As for the HRT, I was taking it because I had been convinced, by the prevailing medical propaganda, that HRT helps prevent heart disease and Alzheimer’s. In 2002, we found out that HRT is itself a risk factor for breast cancer (as well as being ineffective at warding off heart disease and Alzheimer’s), but we didn’t know that in 2000. So did I get breast cancer because of the HRT - and possibly because of the mammograms themselves - or did HRT lead to the detection of a cancer I would have gotten anyway?

I don’t know, but I do know that that biopsy was followed by the worst six months of my life, spent bald and barfing my way through chemotherapy. This is what’s at stake here: Not only the possibility that some women may die because their cancers go undetected, but that many others will lose months or years of their lives to debilitating and possibly unnecessary treatments.

You don’t have to be suffering from “chemobrain” (chemotherapy-induced cognitive decline) to discern evil, iatrogenic, profit-driven forces at work here. In a recent column on the new guidelines, patient-advocate Naomi Freundlich raises the possibility that “entrenched interests - in screening, surgery, chemotherapy and other treatments associated with diagnosing more and more cancers - are impeding scientific evidence.” I am particularly suspicious of the oncologists, who saw their incomes soar starting in the late 80s when they began administering and selling chemotherapy drugs themselves in their ghastly, pink-themed, “chemotherapy suites.” Mammograms recruit women into chemotherapy, and of course, the pink-ribbon cult recruits women into mammography.

What we really need is a new women’s health movement, one that’s sharp and skeptical enough to ask all the hard questions: What are the environmental (or possibly life-style) causes of the breast cancer epidemic? Why are existing treatments like chemotherapy so toxic and heavy-handed? And, if the old narrative of cancer’s progression from “early” to “late” stages no longer holds, what is the course of this disease (or diseases)? What we don’t need, no matter how pretty and pink, is a ladies’ auxiliary to the cancer-industrial complex.

Barbara Ehrenreich is the author of 17 books, including the bestsellers Nickel and Dimed and Bait and Switch. A frequent contributor to Harper's and the Nation, she has also been a columnist at the New York Times and Time magazine. Her seventeenth book, Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America (Metropolitan Books), has just been published.

Read it. Suzan _______________________

10 comments:

Batocchio said...

Tomgram does great stuff. When The Atlantic was good, it used to offer long feature stories on important issues. Some were crap, but many were pretty good and informative. I've particularly appreciated their stuff on Iraq and Afghanistan.

Suzan said...

I used to take The Atlantic before it lost its way down Conservaftard Road.

For 25 years.

It's just another loss.

S

BadTux said...

I've looked at the breast cancer mortality rates. The one and only predicative factor of the breast cancer mortality rate of a nation is its demographic makeup. That's it. The USA actually has a *higher* breast cancer mortality rate than most of the world (and higher than Canada and Britain, the two nations the conservatards love to hate) despite the "cult of the mammogram", but not because of mammograms, or despite them, but, rather, because the U.S. has a significant African-American population and for some reason people of African descent are more prone to breast cancer. If we break it down demographically to compare Americans of European descent to Britons and Canadians of European descent, the difference in breast cancer mortality rate is effectively... none.

The same goes for prostate cancer, BTW. I was astounded to find that the mortality rate for prostate cancer (deaths per 100,000 in each specific age group) in Britain was exactly identical to the mortality rate for prostate cancer amongst white men in the USA, despite all the propaganda about the "horrible" British PHS. The "survival rate" differs, but that's because the USA finds (and treats) more early-stage prostate cancer, the majority of which would never have killed the person (in autopsies of 50 year old men, approximately 40% of them have early stage prostate cancer, but an extremely small percentage of 50 year old men will go on to die of prostate cancer, generally in their late 70's or early 80's. Most men die of something else long before their prostate cancer does anything interesting.

In short, the screening fetish isn't making a significant difference in mortality rate for either prostate OR breast cancer. Astounding, given all the emphasis on screening that's pervaded our society for so long now...

- Badtux the Healthcare Penguin

Lisa G. said...

Badtux,
I am thinking hard about your comment; my only thought on that is that African Americans have a larger tendency to be poor and therefore not have annual physicals and preventive care that most Euro white people do. They also have higher rates of obesity and high blood pressure than whites do; again I think due to the same reasons. All I know is that my mother had breast cancer at 42 and recurrences at 67 and 69. Without that screening at 40, she may well be dead by now. I had my first mammo at 23 (right after she was diagnosed) and had them every 3 years until 40; now I have them every year. Mine is only a matter of time; I'm fighting with the insurance company for a bi-lateral mastectomy with a reduction. Mine's not a case of if, but when. We'll see if they come through for me or not. If not, I'll pay out of pocket for it. I've never liked the damned things to begin with (I breast fed both my sons) and now they could kill me. Time for them to go!

BadTux said...

Nope, the same statistic applies in European nations where people of African descent get the same (universal) healthcare as white people, their rate of breast cancer is *still* higher there despite the fact that their black population is relatively affluent (being primarily professionals who are there for work or governmental purposes, not menial laborers). Nobody knows why. But it seems true everywhere, something to do with their genetics perhaps but nobody is sure what.

Incidentally, East Asians have the lowest mortality rate from breast cancer... even East Asians from poor countries like Vietnam. Again, doesn't seem tied to income, screening rate, or anything other than genetics, but nobody has identified what, exactly, gives them their seeming resistance to getting breast cancer.

Short and long of it is that screening or not screening doesn't seem to make any difference in the overall mortality rate. Which doesn't make sense, because it *should*, but I guess what happens is that screening adds its own complexities to the situation (e.g., the radiation exposure from mammograms) and furthermore that many of the cancers detected would never "take off" and cause mortality if simply left alone. Sort of the prostate cancer situation, where for some reason screening doesn't make a difference in overall mortality... something which can be confirmed not only by the above experiment but also by looking at the U.S. mortality statistics for white males vs. the European mortality statistics (where prostate screening is much rarer). They're statistically identical.

- Badtux the Medical Penguin

Suzan said...

So, DNA rules?

And the East Asian diet is totally a non-starter? I thought it was the magical whole-grained rice effect.

And how about the outlier data for people like Lisa who know that they have an increased probability for it?

I haven't read the study yet, only Barbara's take, BT, but you have whetted my appetite for diving in.

Thanks sweetie.

It's a pleasure to read your lucid prose.

S

BadTux said...

Yes, the East Asian diet seems to be a non-starter. Even 2nd generation Americans of East Asian descent who eat a mostly-American diet seem to get those particular cancers less often than people of European or African descent. DNA does seem to be a big factor, but nobody knows quite how or why that would be so. To tell you the truth I was quite surprised by what I found when I started looking at all this data, it in no way supports a lot of the health care rhetoric coming down the pike from either side of the bench (left or right), Canadian and British health care had roughly the same results as U.S. health care once you controlled for race and income seemed to have absolutely nothing to do with it (even middle class and wealthy black women with access to good health care die of breast cancer more often than white women), and preventative care seemed to make no (zero) difference in overall mortality rate for breast and prostate cancers. What to make of it, I don't know.

The other surprising thing I found was that preventative care doesn't lower health care costs overall, because while unhealthy people use more healthcare, they also die sooner and thus quit using healthcare sooner. So preventative care is a good idea because it results in a healthier person, but people talking about how preventative care will save money on health care... well, just not backed by the data.

None of this fits well into talking points though, so that kind of orderly look at the data in an attempt to make sense of it rarely seems to happen. Sigh. I do so wish that 50% of Americans weren't below average (where average isn't all that smart to begin with)...

- Badtux the Data Penguin

Suzan said...

It's the same with doctors (and scientists!) too.

50% graduated at the bottom of their class - although, of course, somebody had to. You just hope it's not your doctor, don't you?

(I graduated at the top - heh heh - meh.)

S

Lisa G. said...

Badtux,
Well they do say that diet has some correlation to breast cancer, but you pointing out that Asian women who eat American food still have no statistically greater risk. That leaves genetic and environmental. I fortunately have tested negative for BRCA1 and 2, although that would have made the insurance cover my mastectomy. It's a double edged sword but you have made some excellent points.

Suzan said...

Lisa,

Did you see Nick Kristof's piece in The New York Times today?

I sent it to Bad Tux and will look it up for you if you want me to.

He's sure the causes are poisons in the environment.

Okay. Almost.

(Aren't we all?)

S