Tuesday, April 29, 2008

on pomeranians

In between conference sessions on Friday my sister and I drove out to the Oromocto SPCA to walk mutts. That SPCA looks like the dregs of a very desperate trailer park, and although it’s not so bad once you’re inside, I kindly beg you to go adopt some big beast if you’re at all interested. There was a little Pomeranian with a dopey expression, as big as my big hand. Poor fellow had been hammered by an asshole and left for brain dead, but he was walking and smiling, and adopted. Even though a feisty little pom pom bit my thumb near off at a dinner party in our town’s swanky waterside neighbourhood last week, I still would have taken this little vegetable home.

As a consequence of giving up all food and bringing it back at an uncharacteristically lethargic pace, I now do really appreciate the eating of meat, despite regrettable environmental consequences, slaughterhouse nastiness and all. Rare steak righteousness eventually overtook my bleeding heart. But dogs are another matter entirely. I am one of those freaky spinsters who relinquishes her best furnishings as dog beds and dresses her canines in secondary fur coats. Dogs do not get hit on the head with a hammer.

Yet I have a friend, name withheld, who is a brainiac and a few degrees ago (academic, not Celsius) ran cardiac tests on dogs. She was testing how their hearts stopped. Meaning, of course, she had to stop them.

The dogs were specially bred for research purposes. I imagine that means bred for boredom, captivity, homogeneity, quiet. I don’t really know and I don’t think I asked. Dogs died and she’s a cardiac brainiac now. She’ll keep you alive. And yes, you matter more than a dog.

Which brings me to PETA, and Pam Andersen, this week off to the White house to call of outdated animal testing. I don’t know the details, maybe the tests she’s twisted-knickered about are really unnecessary. Maybe they are old fangled. Point is Pam is just another of PETA’s innumerable bunnies-for-bunnies. But besides anoretic eating extremes, what do women’s bodies have to do with the treatment of animals? Must such a straight electric-fence link be made between chattel treatment of women and chattel treatment of, uh, chattel?

Thursday, April 24, 2008

update on blood

Picard weighs in on the arbitrariness of banning men who have sex with men from blood donation:
http://www.theglobeandmail.com/servlet/story/RTGAM.20080424.wlpicard24/BNStory/specialScienceandHealth/home

on the oven

Personal pet peeves include: dearth of public garbage cans for dog shit; whipped cream; cheapskates; flat gin and tonics; jack johnson; men who can’t salsa but ask you to dance with them anyway; the Chrysler 300; any and every comment about defecation; confusion between RU 486 and Plan B; cooled coffee; crookedly hung art; crowds and queues; children made to pose in photos like mini adults; bullshit; people who don’t print double-sided; and

How women in office buildings won’t shut the fuck up about competitive calorie counting.

Oh my god it is a pain in the ass to come to work come spring, and not because it’s so damn beautiful out that I’m drooling at my view of the sunny Scotia Bank. Apparently women who work in office buildings did not take science 000 and exclaim with evangelic fervour that SODIUM HAS NO CALORIES!

All day long all people have to talk about is which brand of yogurt wins for calorie-per-125 ml- serving, whether or not glucose is a type of transfat, and that you can probably burn juice calories faster than milk calories because juice is thinner.

These people are employed through your tax dollars.

And, lest I forget, I am also repulsed by women baking for staff meetings. I am revolted by women with candy saucers out on their desks. I literally have to keep a six foot distance. Have you ever, ever, ever heard of a man baking a goddamn muffin to call a nine o’clock in the board room? Does my CEO have scotch mints below his doctorate? Why on earth would you escape to an office space if your environment was no different than the foyer of a desperate housewife?

Glass ceiling looking a tiny bit like the uncleaned roof of a General Electric oven.

Tuesday, April 22, 2008

on the inappropriately clothed

It is obviously spring now. There are teenagers in flipflops smoking on parkbenches outside my office window. But nobody is falling in love or anything, in fact there are a number of cases lately of falling out of it. Still, I hang my hopes on the inappropriately clothed. I love the inappropriately clothed. If I didn’t work in what counts as an office tower in this diminutive city, I’d be inappropriately clothed and smoking on a park bench.

When I was stuck in suburban Quebec City, extremely sad and extremely lonely, I coped by disappearing underwater at the Laval pool everyday (Olympic sized. Simply incredible) and counting laps, breaths, anything. This is exactly how I coped with being extremely sad and extremely lonely since I was twelve years old. That summer though I was out one morning at 5am walking off sad lonely steam in the neighbourhood when I found not one but two immaculate rusted over 1975 bronze CCM commuters. A hers-his pair of ‘em. I gripped each handlebar stem in a fist and shoved those beauties up the hill. I scavenged rags and cleaners out from under my then-boyfriend’s-parents’ sink and set to work. By 8 the household was awake and scandalized that I had dumpster-dived in what turned out to be the bf’s uncle’s driveway. I was beaming. I had my ticket out of suburbia.

When you don’t know how to drive, and I didn’t then, a bicycle is the power of a room of your own (something else I didn’t have then) times about a billion. Somebody pissing you off? LEAVE!!! Get on your vehicle and get the hell out of there. Shove a pump in your handbag. That’s it.

I learned how to drive about two weeks later. And driving is wonderful. You can, most importantly, cart crap around with you when you drive, like poodles and cases of wine. Even still though, I do not own a car and there are so many bikes in my house right now it's Brest at the beginning of the Tour.

Spring comes and the last dark crusts of snow melt into the gutter and yet all that can cure the sad loneliness of winter is a good long bike ride. Everyday 'till the November blizzards. Even though cycling is as pleasurable as sex while driving a convertible in Europe, it is not that popular among women. I have never understood this. Women need to take over roadie culture. It’s physiologically obvious. Drawbacks include hard breasts and enormous legs, but whatever. Swimming causes hard breasts and giant shoulders.

Dr S reminds me that side effects are sometimes entirely necessary, even partly curative, depending on what you are trying to treat.

Wednesday, April 16, 2008

on the man

All my (American) femmy blog favourites have had some coverage on the (Canadian) Walrus blog by Edward Keen, “Act Like A Man”. Although not put in so many words, Eddie is basically wondering why it is such a big deal to expect men to take pride in being responsible, capable human beings. He uses UFC and facial hair to colour his pallid analyses, but it comes down to questioning why males resist employment and moving out of their parents’ homes, and what the hell happened to courage and integrity and plain old talent. It’s cute enough, overdue to say the least. We’ve been in a static wait for the self-aggrandized GI-Joe-playing Bush to Act Like A Man and apologize for a hysterically manic spending spree of the entire American economy and hundreds of thousands of lives on a losing war. Our own childish and slovenly national leader is no better in The Man department, greedily hoarding power in areas he has no talent for or jurisdiction over. Hillier, now stepping down in a rare state of sustained honour, was one of few who had the cajones to stick up to our rolly-polly creepy-eyed PM, and that was in the unfortunate context of amplifying our military might. We recall when Linda Keen flared her testicles in the fight of nuclear safety, she was promptly canned. That doesn’t mean I didn’t join a cheerleading squad with her initials stitched across my breasts.

Which brings me back to the other Keen’s blog, and Acting Like A Man, a critical response thus far to his blogging. To which I say, "Of course you don’t have to actually be chromosonely masculine to take action against impotence!" And I am not likely to worry about “Acting Like A Man” being unnecessarily gender-loaded vernacular for Grow Up. It’s the dude’s blog, he can call it what he wants and I’ll take the same liberty. I hope it catches on, though, this responsibility and integrity thing.

Tuesday, April 15, 2008

on troublemakers

Barbara Seaman, author of The Doctors' Case Against the Pill and a longtime women's health shit-disturber, has died.

http://www.cmaj.ca/cgi/content/full/178/8/988

Friday, April 11, 2008

on not working at a strip joint

i promise not to turn this into a work blog, but i can't quit smiling this afternoon, it's Friday, oui, and this is what a visiting surgeon, whilst sipping a weak cup of tea, said to me today:

do you have callouses on your bum from getting grabbed so much?

(honestly, is that funny or is that funny? he didn't even say ASS. loves it).

Thursday, April 10, 2008

on plastic

In Newfoundland and here at home, pathologists are getting the slit-eyed once-over by a suddenly skeptical public. How do we know if these folks in their lab coats can really tell if we have cancer?

A series of public inquiries will have to be left to handle that. What we do know is that cosmetic surgery ain’t no specialty, there is no accreditation and therefore no way to be bitch-slapped for doing a bad job. This gross regulatory oversight got a bit of exposure back in the fall, when a pretty and young TO professional lost her life to liposuction under a general practitioner’s knife.

A Toronto-based friend of mine, now in medical litigation, did some academic work on just what is the legal framework buttressing cosmetic surgery and found, well, NOTHING. A GP can go for a three hour CME workshop on breast implants and then hang a sign outside her practice saying “Cosmetic surgery, Breast augmentation, Get it here!” Really.

Were I a plastic surgeon who actually studied the art and science of body reconstruction and perfection for about 5 years post med school, I’d be ticked off that the unqualified competition were calling themselves surgeons, taking away my customers (say what you want about “health-care-for-hire”), potentially doing physical harm to said patients that I will have to clean up later, potentially disfiguring the public understanding of plastic surgery, and wasting GP time that could be used for chronic disease management, reproductive care and all the other general problems GPs are trained to care for.

The plastic surgeons DID get pissed, and today the College of Physicians and Surgeons (the body responsible for the professional standards and training for specialists; which is not their union nor the body that presides over the affairs of general practice) meet to approve (or I suppose, not) additions to the vacuum of cosmetic surgery regulation. These will include that GPs not call themselves surgeons nor advertise to provide services for which they are not trained.

Say what you want about an individual’s decision to get liposuction, but any way you slice it (erg, sorry about that), he should be reasonably informed about what he’s getting himself into. My GP can do my pap test…but my boob job? No thanks.

Wednesday, April 9, 2008

On prison, redux

Surprise surprise, Darcie Clarke moved to quiet Merritt, BC specifically to get away from the man who is suspected of killing her three children. Surprise surprise, she didn’t think leaving was enough, so she had a peace bond between them. And surprise surprise Allan Shoenborn violated it. And paid a whole $200 in fines! And the next time he was in jail, they let him out on bail because the court neglected to take note of all of these screeching sirens and neon flashing red flags! They forgot about how he’s a drunken wife abuser!

I kind of wish my tax dollars could stop going to inquiry after analysis after assessment all proving once again that the most dangerous thing a woman can do in a violent intimate partnership is leave the man. Actually I don’t know what is more depressing, that we keep finding the same thing and are seemingly powerless to change the dependent variable, or what this damn dependent variable turns out to be. I actually was commissioned in ’06 to do one of these reviews, reporting on years of domestic homicides and suicides in New Brunswick from the bowels of our province’s coroner’s office. I found what everyone finds: combine separation, alcohol, mental illness, a history of violence, useless peace bonds, and someone ends up dead. If there are children, it’s often the children.

BC has a Child Death Review Unit., and particularly in high-population jurisdictions like BC, these coroner outfits are valuable for tracking trends in accidental deaths (the BC CDRU’s latest report is on unsafe infant sleep practices). It can also trace how fatal child abuse might be found at the intersection of miscommunicating health, community, and education services. (NB, too, has a child death review board). But the Shoenborn children’s deaths are not about their being children, vulnerable to accidents and the excessive force of unfit parents. (Not that I am saying Mr Shoenborn was a fit parent; he clearly was not). The Shoenborn children died because the father was out to injure their mother.

You leave me, I’ll leave you with nothing.

The frequency of child death involvement in domestic disputes and the articulation of separations is disgustingly high. In the NB review I completed, almost as many children died as women. And more men died than women, because of so-called “love triangle” killings of women’s new partners, suicides, and murders of sons. The separation of Child Death Review and Intimate femicide-focused domestic violence death review hides the deadly extent of intimate partner violence, and also frankly results in double counting.

More to the point, all this counting doesn’t seem to be stopping anything. One would think that if decades of research in this area showed the stark clarity of the explanatory factors listed above, it would be pretty immediate- banally status-quo- to check if a separated man was an abuser, an alcoholic, mentally ill, and had a peace bond against him before releasing him from prison. Have these facts all stapled together in a file, and make a sensible call to keep him a spell. In my secondary research, I read that men who have a history of incarceration for domestic violence are less likely to reoffend lethally. Initially I was surprised- obviously these men are violent, and violence escalates, that’s the thing about violence. But in prison, the men sobered up. They got psychiatric help. Frankly, they learned that their pathetic behaviour made them each an excuse for a man. So they changed.

Tuesday, April 8, 2008

on eating fish

This morning i forwarded a pretty depressing news item about the closure of the wild california salmon fishery to a friend of mine in conservation ecology. We're both pretty involved in "local activism" as it were, me marching around for reproductive freedom, him marching around for wetlands and woodlots. Our causes admittedly do not overlap much..It's hard to fit everything in in a day.

His reply to the news of a collapse of the fish stocks:

"Thanks... pretty disturbing news - To put it in your terms it would be like vaginas falling off the face of the earth; but I guess in my terms that would be pretty disturbing as well, ha."

Yes indeed.

Monday, April 7, 2008

on dear

On Saturday I had to drive to Moncton by myself and very dangerously tired, for a meeting, about cancer. It turned out to be unequivocably worth it- one of those rare meetings that left me squeezed of a bit of cynicism in each of the ten topics I am most cynical about, including cancer advocacy and provincial language politics.

There were seven deer on the median, near the exit to Sussex. On either side of the divided highway the deer fence continues for nearly a hundred kilometers. And there were seven of them stuck in the middle.

This morning a big game biologist was telling the host of CBC Information Morning that there have been 1000 deer roadkills in New Brunswick. Which is astounding and gruesome. Except that is the count since March 20, the start of spring. I spat my coffee across the kitchen floor. A THOUSAND?

Personally, I’ve never killed an animal on the road. But I only got my license about two years ago (part of a frantic, overdue response to a summer of isolation in suburban Quebec), so I wager my luck is near to running out. I’ve never even been in a car that killed anything. Except, notoriously, the two times my father, with our entire family in the Jeep, hit a moose. But neither time did the moose die (nor, improbably but somewhat obviously to those who know me, did any of my family).

But seeing the deer I didn’t think of those accidents. I thought of a story I hadn’t read since the fall of 2000, “the Doe”, by Molly Gloss. Kate, a woman with a family, goes off for an annual weekend of alone time. On the drive back, she hits a deer. It’s raining and dark, and Kate touches the deer’s wet khaki rump. And feels the fetal heartbeat.

She sets out flares and locks herself inside her car. A vehicle stops, a boy in late adolescence gets out and comes to Kate’s window. His girlfriend stays in the car. Kate explains to the boy what has happened, that she wants to call a vet. The boy asks if she has a gun, says something will have to be done. Kate says nothing, implying she cannot be expected “do something”. This silence goes on uncomfortably long. Then she persuades the boy to drive to the next town to get help. He thinks it will take too long, the deer will suffer too much, but he agrees.

He drives off, and Kate leaves her car and finds a huge slab of rock, and brings it down on the pregnant doe.

on tea

For the record, Dr S hauled me out of my misanthropic curled-lip antisocial state, and had me eat a steak and drink some freaking wine. I was a generous honeypot within minutes. Tannins & hemoglobin, the bitch elixir.

Friday, April 4, 2008

on hulahoops

I admit I am not in a good mood. I wish I was- it’s above zero in this country, there is no precipitation, it’s a Friday, and somebody brought their toddler grandson to our office today. I should bust out a hulahoop. But I’m grumpy.

My dear sweet (okay, sometimes she makes me crave toothpaste she’s so sugar) friend and I had tea this afternoon, outdoors, next to some geekchic teens playing chess so quickly they’d constantly be twitching multiple plastic pieces in each snarled hand. A woman wheeled her infant by and I said “hi baby”. And the woman said instructively to her baby, “On dit ‘Bonjour’”. And I said very ironically, “Oh, un petit bébé Francophone!”, and his mother said, completely without irony, “Bien non, un bébé Français. De Paris”.

Gawd I’m a sucker for French snobbery.

So there we are, drinking tea, which I hate, but I am trying to drink less this week on account of the soggy excess of travels to TO, so tea it is. And my friend tells me about her friend whose boyfriend won’t let her visit her old penpal female friend blah blah blah. Then she tells me about her other friend who dumped his girlfriend when she got pregnant, and promptly brought a new one home, blah blah blah. The she tells me about this more-than-a-friend who keeps her skychecked but can’t get over his baggage, blah blah blah. And I have to abruptly (erg, rudely) stop her and we start talking about our mothers. I know- amazingly a more sumptuously satisfying gossip item.

Until I am out of this unfortunate mental fog please mercifully do not talk to me about men unless it is to exclaim at their dashing heroism or gray-templed wisdom weakening your knees, ok?

Thursday, April 3, 2008

on skateboard injury

So novelist Meg Wolitzer has a new book out she’s titled “The Ten-Year Nap”. Well if that doesn’t sell itself I don’t know what would- “The Nanny Diaries, part XX”?

Honestly what title could possibly invoke more ennui? WHO BUYS THIS SHIT?

And why bother reviewing it? A tale of overachieving, upper middle class women who succumb to the cutesy gurgling of the newborn only to find themselves a decade later, still fashionable, fit and hopelessly vapid as unemployed housewives on the Upper East Side. Wow, how inventive. How controversial. Entering the Mommy Wars indeed.

Give me a break. And a national day care program. And “The Feminine Mystique”, the 45th anniversary edition.

Writers like Wolitzer, and her narcissistic memoirist peer Rebecca Eckler, the self-styled Mommyblogger and litigiously-insistent originator of Apatow’s “Knocked” Up plotline, cause me to daydream wistfully of tube-tying ceremonies in bleach-perfumed boardrooms on the 188th floor.

Of course I like babies. In fact I really, really like babies. I think they are so damn fat and adorable. But you have to be kidding me if it is (publishable) news to someone that her career will go into cardiac failure if she takes ten years “to nap”. Ten years ago we barely even had the internet!!!!!!

Ten years ago we didn’t have adequately available daycare and we still don’t. If you are brilliant and a New Yorker corporate lawyer and not getting enough flexibility to take care of your kid when he’s sick, how about demanding better treatment by your employer? Like, instead of taking ten years off and then demanding to be let back into the labour force, pouting over your displaced pension and permanently-eroded earning potential. Maybe if the wealthy and powerful among us weren’t the first and the most graceful to cave into the inevitably-self-destructive anti-reproductive norms of the workplace, things wouldn’t be so excruciating for the moms who balance three lousy minimum wage jobs AND twins on either hip.

In the movie “Little Children” (which I loved, not just because of Winslet in the red one-piece, because I also read the book, yo), Brad Adamson is a stay-at-home dad who’s wife is disappointed in him because he can’t muster up the wherewithal to write and pass his bar ads. He feels like a loser. He frankly is a big loser, but at least he stays in shape. His kid is a regular that-kid-from-Jerry McGuire-type cutiepie. It’s not the kid’s fault. It’s Brad’s lack of adult contact, the monotony, the isolation. He gets depressed. He finds a woman in a similar (but more patriarchally familiar) ten-year-nap, and cheating on his wife with her is the natural equivalent to a strong dose of Percocet. At the end of the story, he regresses not from just constant hanging out with kids but to being one, and hits his head attempting a skateboard stunt. He wakes up from his concussion (nap), and asks for his wife. And I believe we are supposed to think that after this crisis, things are going to change.

Leslie Bennett’s wrote an a 21st century take on Betty Friedan’s wake-up call, “The Feminine Mistake”. I thought that was a pretty cheeky title. It didn’t come in pastel with Kinsella curlicue font, let me tell you. She wrote damning of the wasted investment and shocking naivete of professional women vacating corner offices, diplomas and diaper bags in hand. Wolitzer concedes, in an interview with Salon’s Rebecca Traister, “There is something inherently appalling about really intelligent people, in any context, not using their minds.”

And it’s not just the democratic tragedy- that so much talent is concentrated on 1.2 kids who spend seven hours a day in elementary school anyway. It’s that it makes the stay-at-homers crazy. Woolf’s house-bound housewife Clarissa Dalloway’s experience parallels Septimus Smith’s PTSD. They are confined; they are confused by memories of past freedom, joy. Septimus jumps out of the window. Brad falls off a half-pipe. Friedan’s generation take Valium with gin.

The women in Wolitzer’s novel make greeting cards.

She exclaims that “You're not thinking about the young woman who can't have the things that you are so cavalierly tossing aside. This story isn't clean”. The story doesn’t sound any good, either. But the market responds to it. And day care staff gets $8/hour.

Wednesday, April 2, 2008

on grad school

January 2002 I made the socially punishing mistake of starting grad school mid-session, mid-team, mid-winter. Only one classmate would talk to me. Her name is E. We remain close. Her early relocation to Ottawa, recruited by the feds, facilitated our friendship- I was in the capital often enough for academic conferences to follow her emotional and professional process as faithfully as true friends typically do. At some point I met her sister, who I do not know if I would count as a friend, I admire her a bit too much for that to be possible. She’s older than us but delicate. She is serious but not brittle. She is, of course, an academic. In corduroy from Queen West’s Preloved and wearing woolen tights and insulated wellies, she joined E and me for a coffee one sunny frigid morning at Bridgehead. She’s been a doctoral student for at least as long as they flirtatiously claim it’ll take when you first start, beaming authoritatively at you and drafting a supervisory schedule in such hieroglyphic script you believe it might actually mean something.

E recently put in a Phd app. I recently ran off from a program. E’s sister is staying the course. She has other pursuits to break up the long self-analyzing moments between chapters. She has a peculiar layered fringe over her forehead, a small face, child-like eyes that dwarf her other features. Letting her latte cool and breaking apart a pastry, she explained:

The popularity of grad school among young women- and at least half of the faculties are at least half full with women- is attributable to the “post-feminist” threat of their otherwise entrance into the workforce. To keep these ceiling-hungry, entitled and intelligent (and often gorgeous) women out of power, credentialism and academic elitism has shifted into a feminized overdrive. Grad school is a perfect pressure cooker: an average of ten years of social disassociation, from both productive and reproductive labour, alienates women when they finally defend an otherwise unread thesis and enter either realm…an alienation that can push them right back into the ivory tower.

Did I mention I want to go back to school?

Tuesday, April 1, 2008

on subsidies

From the curios of immaculate conception to the perversities of public health in Ontario…

The day I arrived in slippery gray (but so succexy) Toronto, the province announced a $150-million dollar package intended to cover all screening tests for men, the media brouhaha resting on prostate cancer screening in particular. It used to be that unless you were a high-risk candidate, a PSA-level blood test cost you roughly $30 out-of-pocket; under the new scheme it will be OHIP-covered, always. As luck would have it, I was actually in town for a conference about screening. For the first time in my new position, I was attending sessions dominated by well-groomed men in suits, orated by overconfident American experts, and consensus-bound by the most unlikely sentiment: criticism of the screen-happy status quo.

Needless to say there wasn’t a single urologist sitting cabaret-style among us. And it wasn’t open to special interest groups or industry reps.

Here is the deal with prostate screening: First off, that digital rectal exam that gets the butt end (ergh) of about half of all men’s health joking out there is, actually, almost useless in the detection of PC. There are other uses for DRE, but as prostate cancer detection it has low specificity and low sensitivity- so lots of men who have it are told they don’t, and lots who don’t are told they do. The PSA is better at finding what it intends to find, but then there is the often-neglected question with screening: what are you going to do with what you find? Screening is not done for the sake of screening, but to lead to interventions and, hopefully, reduced morbidity and mortality.

Mortality from prostate cancer has stuck at 3% since they started tracking, while incidence trends have mimicked the popularity of the PSA test….rising when there are encouraging population health measures like the Ontario announcement last week, and falling when the debunking message reaches a receptive clinical or policy audience. In short, detection has done nothing to improve mortality. When PC is detected, men can “watch and wait”, or have surgery. One percent of patients die in these surgeries. Morbidity is high and horrific: at least 30% of patients end up with incontinence (urinary and/or rectal…ew), and another third with impotency. Since PC has such a long lead time, these men may be very young when they go under the knife, and have to live with the dual devils of incontinence and impotence for a very, very long time. Which arguably would be okay if the sacrifice was saving their lives, but it isn’t. Mortality simply has not changed.

About 30-40% of men are found to have prostate cancer when they die. In the vast majority of cases, the PC didn’t kill them. Any number of other diseases, infections or injuries did.

It is not harmless generousity to push PSA testing by way of economic incentives like McGuinty’s subsidies. As far as I can tell this financing package is yet another distraction from the failure of the cancer industry (including public-administered health care provision) to do much of anything to reduce cancer mortality since the disease blimped out of social hiding some decades ago. While I gather many physicians have seen the evidence of the bigger trials (PLCO and ERSPC), PC remains misunderstood by most men and frankly most policymakers. Clinicians continue to offer it because patients ask because they hear the hype, hype that comes from groups that respond perversely to the risks of testing by promoting its availability. This phenomenon is apparently called the “popularity paradox”. The campaigning is the loudest for tests that are the most likely to cause harm…as if the patient groups behind these campaigns are responding with evangelism to their cured existence, even if campaign masters’ own cancers were not discovered through screening.

I asked Dr. Gilbert Welch, who wrote the controversial “Should I Get Tested for Cancer?” if somewhere in his book I’d find an economic analysis. He scoffed. Even if population screening wasn’t extremely costly and wasn’t eating up time in pathology labs and primary care visits, it would be harmful because it leads to physical harm. Men get hurt by these unnecessary surgeries. To Welch, an economic analysis was irrelevant, because there would be absolutely nothing to file in the benefits side of an equation, and the harms are overwhelming.

So, what can a man do in the face of one of the top three cancers among men? Pay attention to his body and talk to a physician when something changes. Some would argue that incredibly detailed discussions of all the risks of PSA testing and seeking informed consent is the way to go; I am cynically proposing “informed decision-making” is not economically or ethically worth the time: if it’s a bad test, don’t offer it, period. PC is one of those cancers that is either never going to progress to causing symptoms, let alone death; or be curable once symptoms arrive; or be incurable no matter when you detect it (including through presymptomatic screening programs). Only very very rarely will presymptomatic diagnosis be necessary for cure…certainly not often enough to justify the harms of general screening.

I realize this post isn’t terribly Alice B. But then my Alice would be incredibly cranky if her man had unnecessary physiological impotence for the last thirty years of his life.