"A statement of fact cannot be insolent." The miscellaneous ramblings of a surgeon/scientist on medicine, quackery, science, pseudoscience, history, and pseudohistory (and anything else that interests him)
Orac is the nom de blog of a (not so) humble pseudonymous surgeon/scientist with an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his miscellaneous verbal meanderings, but just barely small enough to admit to himself that few will. (Continued here, along with a DISCLAIMER that you should read before reading any medical discussions here.)
Before I try to leave this topic for a while (which, like so may topics in the past, has temporarily taken over the blog for the last few days), one of the comments I've kept hearing since I started blogging about the new USPSTF mammography guidelines is something along the lines of, "Well, if the government runs health care, naturally politics will impact any attempts at science-based guidelines. That may be true, but in fact excessive politicization has always been a problem in that area, particularly for breast cancer. There's a good interview with to Dr. Barron Lerner, associate professor of medicine at Columbia University College of Physicians & Surgeons and author of The Breast Cancer Wars: Hope, Fear and the Pursuit of a Cure in Twentieth-Century America. The whole interview is worth reading, but here's one point that I've discussed before:
Next up, two weeks hence, on December 3, will be TechSkeptic at Effort Sisyphus. His instructions for submitting your work are here. General instructions for what we look for in a Skeptics' Circle entry are here. So, by the way, is the schedule. If you're interested in hosting one of these puppies yourself (and what skeptical blogger wouldn't like to try his or her hand at this at some point?), check out these instructions for hosting and drop me a line.
A lesson that's worth learning. Of course, I only wish people ignored vaccine denialists; unfortunately, enough people don't that vaccines are a frequent blog topic for me:
As I discussed in detail when I analyzed them, the new USPSTF recommendations for screening mammography for breast cancer have sparked a debate that has degenerated from a scientific and public policy debate into pure emotional rhetoric. When last I visited this topic, yesterday, I had intended it to be my last post for a while, perhaps ever. However, the amount of idiocy that I was dealing with became so overwhelming and the post grew to even huger than Orac-ian proportions. So I decided to split the post into two parts, because the particular argument I'm about to discuss deserves its very own takedown. It also cleverly allowed me to post a big "TO BE CONTINUED..." and thereby nefariously manipulate my audience to be curious over whom the target of today's Insolence would be and thus more likely to pay me a return visit. Or not. Who knows? Either way, it let me make two long posts out of one gargantuan post. How cool is that?
For those just joining the debate, I concluded yesterday's post by describing the claim that the USPSTF's recommendations were the equivalent of "death panels" and an example of the horrors that will come if the health insurance plan being debated in the Senate right now were to become law as the undead beast continuing to lumber on, using one of my favorite analogies, the brain-eating zombie, to describe how the whole "death panels" thing destroys any intelligent argument and renders its adherents stupid and/or ignorant, much the way certain varieties of brain-eating zombies do when they feast upon grey matter. In fact, as I said yesterday, the brain-eating death panel zombie even shows up in places where you wouldn't necessarily expect it. In this case, it appears to have eaten can eat the brains of bloggers that I used to consider fairly reasonable, creating new zombies. However, unlike the drooling "Hot Air"-type death panel zombie, though, the new "death panel" zombies are more like the speedy, running zombies in 28 Days Later, not the shambling, dripping, drooling zombies of Night of the Living Dead. They're the new, improved, cleverer zombie, like the ones in The Return of the Living Dead who, after feasting on the brains of paramedics, picked up the radio from their ambulance and asked the dispatcher to send more paramedics. But at the heart, the zombie lie continues on, eating brains and reducing the level of debate from the merits of the recommendations as a matter of science and public to raw emotions manipulated by fear of government.
Most disturbing to me all was that a blogger who really should know better than to use such brain-chomped terms to describe a complex issue, Dr. Rich, has fallen victim to the zombie, likening the USPSTF's recommendations to "soft death panels":
I knew when I first heard about them that the new United States Preventative Services Task Force (USPSTF) recommendations on breast cancer screening would be controversial. I tried to discuss these guidelines and the issues involved in a calm and rational way, relatively devoid of Insolence, Respectful or not-so-Respectful, yesterday, pointing out that screening guidelines were clearly due for revision but also recognizing the problems with the USPSTF recommendations and valid criticisms of them. In the end, I concluded that, among the critics, the ASCO discussion of the proposed guidelines was the most reasonable At the same time, this being Orac and all, I couldn't resist snarkily dissing at least one overblown and unjustified criticism of the guidelines, coming from, embarrassingly, a professional organization to which I belong.
One day later, I realize that the example of a brain dead and hyperbolic attack of the new guidelines was nothing compared with what was to come and, I suspect, still is to come. Although some attacks are just misguided and based on erroneous information, a lot of them are truly nothing more than appeals to emotion and logical fallacies. Indeed, the stupid is flaming fast and furious, flowing down the sides of the volcanoes of stupid spewing forth lots of heat, until the lava of stupid is finally lapping at the last walls defending rational discourse over what is a very difficult issue, both in terms of science, medicine, and policy. In fact, some of the attacks on the new guidelines carry distinct echoes of the same rhetorical techniques of Mike Adams and Joe Mercola. They have been truly painful to read, so full of neuron-necrosing nonsense that I wonder if those conspiracy theorists in tin foil hats might have a point, even though I realize that mere tinfoil will not stop such powerful waves of stupid. Worse, a lot of the press coverage has given free rein to the very same sorts of flaws that so irritate me in the coverage of alternative medicine.
Let me just say right now that I am more forgiving of the press coverage that emphasizes anecdotes over data, stories like this one, which follows a pattern that I've seen emerging in the coverage of this story, namely the highlighting of an anecdote of a woman under 50 (or even under 40) who had a breast cancer that was detected either by screening mammography or by self breast examination. Another example is this story. This is lazy journalism at best, where finding the "human interest" angle trumps a science-based discussion of the pros and cons of the new recommendations, what they mean to women, and how they might be applied. It's the triumph of pure emotion over science. Meanwhile, Congress is getting involved, specifically Rep. Debbie Wasserman Schultz (D-FL), who is threatening to hold Congressional hearings on the matter. (Now there's something that'll shed a lot of light on the science!) Wasserman is a breast cancer survivor; so I can understand her emotional investment in the issue. I can understand the emotional involvement of anyone who's life has been touched by cancer. Unfortunately, she's just plain misguided to try to meddle in the development of science-based medical guidelines this way. Her activities are far more likely to interfere with the scientific debate that must occur now regarding screening than they are to facilitate a new scientific consensus based on the strongest data available.
I've made my position clear on the new guidelines. They are imperfect and most definitely do not mean that women under 50 should not be screened. Rather, they will most likely serve as reasonable, albeit flawed, starting point for a debate that has been brewing for the last several years as more and more studies have questioned how beneficial screening mammography is for younger women relative to its risks and documented the problems of overdiagnosis and overtreatment. I've also pointed out how I know that women will be confused by this change. In fact, if anything failure to communicate such a monumental change in recommendations in a manner that would mitigate some of this controversy is clearly the USPSTF's biggest failing in the matter. The task force did an absolutely execrable job of laying the groundwork for its announcement, so that it didn't appear to come out of nowhere. Even so, as I said before, an update of our screening guidelines was expected, and there is much to discuss. However, there is a relentless drumbeat of attack that is not based on science and strikes me as knee jerk. Some of it is downright idiotic; there's just no other way to put it. I feel obligated to address it because, as a skeptic, I find such bad arguments and misinformation an offense to my intelligence.
Overall, the idiocy falls into three general categories:
Remember how I started a post a year and a half ago saying just this? I did it because that is the default assumption and has been so for quite a while. It's an eminently reasonable-sounding concept that just makes sense. As I pointed out a year and a half ago, though, the question of the benefits of the early detection of cancer is more complicated than you think. Indeed, I've written several posts since then on the topic of mammography and breast cancer, the most recent of which I posted just last week. As studies have been released and my thinking on screening for breast cancer has evolved, regular readers have had a front row seat. Through it all, I hope I've managed to convey some of the issues involved in screening for cancer and just how difficult they are.
This week, all I can say is, "Here we go again."
On Monday evening, the United States Preventative Services Task Force (USPSTF) released new recommendations for screening mammography, which it published in the Annals of Internal Medicine, that have, let me tell you, shaken my specialty to the core. I must admit I was surprised at the recommendations. No, I wasn't surprised that recommendations to scale back mammographic screening were released. I saw it coming, based on a series of studies, some of which I've discussed right here on this very blog. What surprised me is how much of a departure from current mammography guidelines the USPSTF recommendations were and, even more so, that they were released this year. I hadn't expected recommendations like this this soon. But I have to deal with them, and so I might as well try to help my readers understand them too.
If you want a dose of science and rationality about the H1N1 flu pandemic, and you need it now, check out The Skeptics' Guide to the Universe. Led by Steve Novella, the discussion involves more than one friend of the blog, if you know what I mean and can be downloaded here.
Just when I thought I was out, they pull me back in again.
Yes, I know I've used this clip before at least twice and the line in it several more times over the last couple of years. However, sometimes it's just so completely appropriate to how I'm feeling about a topic I'm about to write about that I just don't care and have to use it again. This is one of those times. The 2009 recipient of the Richard Dawkins Award bestowed upon him by the Atheist Alliance International (a.k.a. Bill Maher, anti-vaccine comedian and host of Real Time With Bill Maher, has decided, after an all too brief absence, to lay down a swath of burning stupid about vaccines again. When last we left Maher, he was busily embarrassing himself on the last two episodes of his television show, first by getting slapped down hard by Bill Frist, of all people (and, after his antics during the Terry Schiavo controversy, Bill Frist comes across as the voice of reason compared to Maher, Maher's got a serious problem) and next having his arguments dismembered unceremoniously on the season finale of his show, concluding with his having his head handed to him (nay punted right back at him like a smug, smirking football) by Chris Matthews, who compared him to a celebrity Scientologist like Tom Cruise attacking psychiatry.
The horrified look on Maher's face was priceless. Direct, hit Chris, right below the waterline. I only wish you had had time to finish the job while the woo ship Maher was listing and taking on water.
If you had, I might not have had to see this assault on reason by Maher published on Sunday on--where else?--that bastion of anti-vaccine quackery, The Huffington Post, in the form of a post entitled Vaccination: A Conversation Worth Having, a post that he also crossposted on his own blog here. All I can say is this: If you had any doubts that Bill Maher is an unreconstructed anti-vaccine loon, this post provides conclusive evidence, all topped off with a heapin' helpin' of arrogance of ignorance and that special brand of vacuous self-absorption that few aside from celebrities are capable of. Oh, the pain to read this.
In case you've forgotten, it's only two days until that festival of critical thinking, that feast of reason, The Skeptics' Circle to land over at Beyond the Short Coat. Instructions to submit can be found here.
The New York Times has been periodically running a series about the "40 years' war" on cancer, with most articles by Gina Kolata. I've touched on this series before, liking some parts of it, while others not so much. In particular, I criticized an article one article that I thought to be so misguided about how the NIH grant system leads researchers to "play it safe" and how we could cure cancer if we could just fund "riskier" research that I had to write an extended screed about the misconceptions in the article. The latest installment, Medicines to Deter Some Cancers Are Not Taken, also by Kolata, is much better in that it discusses a problem at the heart of cancer, namely that we have developed drugs that can decrease the risk of specific cancers but they are not as widely used as they could be.
The first part of the article contrasts a seeming incongruity:
Many Americans do not think twice about taking medicines to prevent heart disease and stroke. But cancer is different. Much of what Americans do in the name of warding off cancer has not been shown to matter, and some things are actually harmful. Yet the few medicines proved to deter cancer are widely ignored.
Take prostate cancer, the second-most commonly diagnosed cancer in the United States, surpassed only by easily treated skin cancers. More than 192,000 cases of it will be diagnosed this year, and more than 27,000 men will die from it.
And, it turns out, there is a way to prevent many cases of prostate cancer. A large and rigorous study found that a generic drug, finasteride, costing about $2 a day, could prevent as many as 50,000 cases each year. Another study found that finasteride's close cousin, dutasteride, about $3.50 a day, has the same effect.
This is indeed a contrast. Think about it. Millions of Americans take statins, for instance, to lower their cholesterol and thereby try to prevent the complications of elevated cholesterol, such as heart disease, vascular disease, and strokes. Yet, for at least two common cancers, there are proven effective drugs that will lower the risk of cancer considerably with a side effect profile at least as favorable as that of statins.
Orac is the nom de blog of a (not so) humble pseudonymous surgeon/scientist with an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his miscellaneous verbal meanderings, but just barely small enough to admit to himself that few will. (Continued 
