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.
Tuesday, April 8, 2008
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.
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?
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.
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?
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.
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.
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