Longread #205 -- Ignoring the Science on Mammograms -- 11/30/12

Yesterday's longread looked at new approaches to improve the efficiency of medical care in the U.S. It focused largely on proposals to improve patient-doctor communication in ways that increase the use of palliative care in lieu of expensive, ineffective, and aggressive cancer treatments near the end of life. As explained in that article, reforming the system was at odds with the financial incentives for oncologists, many of whom garner their largest percentage of income through drug prescriptions.

Today's longread looks at a similar issue but at the opposite end of the cancer continuum: early detection. A central theory that has guided many years of cancer research and clinical practice is the idea that earlier detection of cancer means better outcomes for patients. While this is true on a general level (an earlier stage cancer almost always has a better prognosis), the challenge lies in finding tests that work effectively for early detection. Mammograms, which have become a staple of preventive medicine for women over age 40, are imperfect in this regard. While the research results are more complicated than this article implies, much of the opposition to changes to mammogram screening guidelines (such as those two years ago that suggested a starting age of 50 instead of 40) is based on what the author calls the "mammogram economy." This isn't to say that we should do away with screening mammography altogether, but we should do our best to let science guide us toward standards that both reduce costs and improve the well-being of patients.

For anyone interested in the research that has been done on mammograpy as a screening tool for breast cancer, here are some useful links:

• National Cancer Institute breast cacner screening summary: http://www.cancer.gov/cancertopics/pdq/screening/breast/Patient/page1/AllPages
• NCI breast cancer screening summary for health professionals (this is much more technical but goes through the studies one-by-one): http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional/page1/AllPages
• US Preventive Services Task Force (USPSTF) recommendations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

"Ignoring the Science on Mammograms" by David H. Newman, M.D.
Published in the New York Times, November 28, 2012
http://well.blogs.nytimes.com/2012/11/28/ignoring-the-science-on-mammograms/

Eric

Longread #204 -- Against the Odds -- 11/29/12

The rising costs of medical care in the U.S. are one of the biggest challenges to our country's long-term financial picture. For years, health care costs have been rising although with limited demonstrated benefits to the overall health of Americans. Virtually everyone agrees that the system is broken, but of course, there is tremendous disagreement about how to fix it. This longread looks at one initiative being conducted at Stanford to identify key areas where costs can be reduced without negatively affecting the quality of care. The most frustrating aspect of this story is how bottom lines become prioritized over the health of patients and the long-term health of the medical care system. Nevertheless, the concept behind this initiative is important and may likely help lead us toward positive solutions to the looming health care crisis.

"Against the Odds" by Kris Newby
Published in the Stanford Medicine Magazine, Fall 2012
http://stanmed.stanford.edu/2012fall/article3.html?src=longreads

Eric

Longread #203 -- The Plot Against Occupy -- 11/28/12

Criticisms of U.S. counter-terrorism policies are certainly not new. Especially since the start of the "War on Terrorism," analysts have exposed ways in which the efforts of U.S. agencies were ineffectual, racist, and threatening to fundamental civil liberties. This article extends these critiques of the FBI and the broader practices of U.S. counter-terrorism. First, the article points out that the reaches of these agencies has expanded to include targeting virtually any groups with strong dissenting voices such as the Occupy movement. Second, the tactics used to foil supposed terrorist plots reek of entrapment. The end result is counter-terrorism missions that not only chill free expression but that also spur on the terrorist acts that are supposedly being prevented. These policies may create positive headlines for law enforcement, but an informed analysis reveals they are probably doing nothing to make us safer.

"The Plot Against Occupy" by Sabrina Rubin Erdely
Published in Rolling Stone, September 17, 2012
http://www.rollingstone.com/culture/news/the-plot-against-occupy-20120926?print=true&src=longreads

Eric

Longread #202 -- Cuba's New Now -- 11/27/12

Even though the Cold War has been over for more than two decades, Cuba remains a pariah in the eyes of the U.S. During this time, though, Cuba has undergone significant changes as a result of the resignation of Fidel Castro and the changing dynamics of international politics and economics. This article looks at the complex challenges facing Cuba as a country as well as everyday Cubans who struggle with the day-to-day challenges of a country in an ambiguous state of change.

"Cuba's New Now" by Cynthia Gorney
Published in National Geographic, November 2012
http://ngm.nationalgeographic.com/2012/11/new-cuba/gorney-text?src=longreads

Eric

Longread #201 -- Rethinking the Computer -- 11/26/12

With our society's growing reliance on technology, the issues of computer and network security have become increasingly important. It seems that every few months there is another major security flaw that is exploited to expose the confidential information of governments, corporations, or individuals. This longread looks at a computer scientist who is rethinking the entire paradigm of the computer to try to identify long-term solutions to ensure cyber-security.

"Killing the Computer to Save It" by John Markoff
Published in the New York Times, October 29, 2012
http://www.nytimes.com/2012/10/30/science/rethinking-the-computer-at-80.html?src=dayp&pagewanted=all&_r=0

Eric

Longread #200 -- A Soldier of Kindness -- 11/21/12

Today's longread is one of the more moving pieces that I have read recently. As we approach tomorrow's Thanksgiving holiday, stories of people like Army Lt. Col. David Cabrera remind me of how important it is to be thankful and to turn that gratitude into meaningful and positive interactions with other people.

Happy Thanksgiving!

"As first military social work officer killed in action, Army Lt. Col. David Cabrera was a ‘soldier of kindness’" by Jim Sheeler

Published in the Washington Post, November 8, 2012

http://www.washingtonpost.com/lifestyle/magazine/as-first-military-social-work-officer-killed-in-action-army-lt-col-david-cabrera-was-a-soldier-of-kindess/2012/11/02/0dce8cf4-e1a6-11e1-98e7-89d659f9c106_print.html

Eric

Longread #199 -- The GOP & Demographics -- 11/20/12

Now that a few weeks have passed since the elections, analysts have had more time to break down what happened and predict how national politics may evolve over the coming years. One of the biggest issues that has been discussed is the need for the GOP to reach out to minority voters with a specific emphasis placed on Latino voters. In this longread, Nate Cohn, a former debater at my alma mater of Whitman College, breaks down why a focus on reaching out to Latino voters won't be enough to overcome the challenges facing the Republican Party.

"The GOP’s Challenge Extends Beyond Hispanics and Immigration Reform" by Nate Cohn
Published by the New Republic, November 15, 2012
http://www.tnr.com/blog/electionate/110159/the-gops-challenge-extends-beyond-hispanics-and-immigration-reform#

Eric