H. Gilbert Welch on cancer screening In early October, the United States Preventive Services Task Force recommended that healthy men no longer undergo prostate cancer screenings. It was also the beginning of Breast Cancer Awareness month and calls for regular mammogram screening among women. "It's a stark juxtaposition: screening is good for women and bad for men. But just how different are these two cancer screening tests?" asks H. Gilbert Welch author of Overdiagnosed: Making People Sick in the Pursuit of Health, writing in The New York Times. "The answer is: not very." Both screenings present difficult choices. "Screening is like gambling: there are winners and there are losers. And while the few winners win big, there are a lot more losers." Doctors have a lot of incentive not to miss cancer, which results in a lot of false positives and over-diagnoses. Unnecessary treatment of those wrongly diagnosed can have harsh side-effects. Breast surgery "can be disfiguring" and prostate surgery can cause bladder and sexual problems in men. The winners of screening are those who catch a lethal cancer before it advances far. These people are rare, " on the order of less than 1 breast or prostate cancer death averted per 1,000 people screened over 10 years," Welch says. "Overall, in breast cancer screening, for every big winner whose life is saved, there are about 5 to 15 losers who are overdiagnosed. In prostate cancer screening, for every big winner there are about 30 to 100 losers." To some those numbers make it a worthwhile chance while others will avoid screening. The numbers are worse for men than women, and the side-effects of surgery also might be worse for men. "When it comes to breast and prostate cancer screening, there are no right answers, just trade-offs," he concludes.
Harry Reid on Senate rule changes Critics of a Senate rule change passed by Democrats last week have called it the "nuclear option," an attempt to forever limit the ability of the minority to challenge a bill. In fact, the change was "a return to order," writes Senate Majority Leader Harry Reid in The Washington Post. Thursday the Senate was attempting to pass legislation to punish Chinese currency manipulation with a tariff. To prevent the vote, the Republicans forced the chamber to vote on an endless series of amendments that had nothing to do with the legislation. "Finally, we offered votes on seven amendments," he writes. "They came back with a demand for nine votes that required suspending the Senate's rules." The Senate rules honor the minority's right to debate, but on the assumption that the chamber's goal is to compromise and move forward. In recent years, minorities have abused their ability to delay movement. At the start of this Congress, Reid agreed not to change Senate rules if Republicans agreed not to abuse parliamentary procedures. "Since then, Republicans have failed to abide by that agreement." Their move on Thursday "was an attempt to make cloture meaningless -- to say that the road to passage must include a vote-a-rama of unrelated, purely political votes." Democrats are seeking to end debate when a 60 vote majority votes to end it. By changing the rules "we restored the balance between individual rights and comity in the rules of the Senate," Reid says.
William McGurn on 'the cult of anti-Mormonism' When on Friday a Dallas pastor who introduced Texas Gov. Rick Perry at an event subsequently called Mormonism a cult, he unleashed a wave of media scrutiny over the beliefs of other Republican candidates. Each of them should refer to the Constitution's requirement that "no religious Test shall ever be required as a Qualification to any Office or public Trust under the United States," writes William McGurn in The Wall Street Journal. Mormonism was a sensitive issue for Romney in 2008, and this shows that it remains one now. This is in part because "34 percent of white evangelicals," a big voting bloc in primaries, "report themselves 'less likely' to vote for a Mormon for president." That same Pew survey, McGurn points out, also reveals that more Democrats than Republicans are actually hostile to a Mormon candidacy. "More alarming" than these attitudes, McGurn writes, were the public backlashes against Mormons who backed the church's support of Proposition 8, a California ballot measure that outlawed gay marriage there. "LDS temples in Los Angeles and Salt Lake City received envelopes filled with white powder, provoking an anthrax scare. A Book of Mormon was burned outside an LDS chapel in Denver." Prominent Prop 8 supporters with jobs in the arts, in particular, were forced to resign their jobs. McGurn worries we've come to a point where public retribution is limiting people's willingness to participate in political debate. Thus, our pressuring of Republicans to step back from anti-Mormon rhetoric is healthy. "Even more encouraging would be a press willing to give attention to very real concern among politically active Mormons" -- whether Mormon's would stay quiet during a Romney campaign for fear of a public retribution campaign similar to the one they witnessed in 2008.
Frank Bruni on caricatures in the Massachusetts Senate campaign "I have my doubts that Elizabeth Warren is elitist and I'm not convinced Scott Brown is sexist, but I'm sure of this: we just got our first glimpse of how sadly petty and predictably reductive the 2012 U.S. Senate campaign in Massachusetts is bound to be," writes Frank Bruni in The New York Times. During a Democratic debate last week, Warren made a jab at Brown for posing naked during his modeling days as a college student. Brown retaliated saying "thank God" Warren never posed nude. Pundits were able to accuse Warren of elitism for making fun of Brown's efforts to fund his own college education, and they accused Brown of sexism for being a Republican "pretty-boy" opposing a "brainy Democratic woman" with jabs at her appearance. This Senate campaign will be fierce because Democrats want to win back Ted Kennedy's old seat. "Both parties' candidates will be shoehorned into the election cycle's abiding cliches and conceits, whether they fit or not. Warren and Brown don't, at least not neatly." Warren has spent 20 years at Harvard so conservatives will call her elitist and out of touch, but she grew up in Oklahoma to working class parents, married and had children early, and went to the University of Houston undergrad and Rutgers for law school. Her support for consumer protections gives her a solidarity with the middle class. Brown, meanwhile, went to Tufts and Boston College, making his "elitist" accusations silly, but also undercutting liberal attempts to paint him as "intellectually challenged." He'll be cast as a Wall Street candidate, though he broke ranks to vote for Dodd-Frank. He also broke them to vote for DADT's repeal. "None of that conforms to the troglodyte image summoned by opponents who were offended (justly) by his seeming put-down of Warren's looks." Campaigns will turn these two complex candidates into "caricatures," Bruni warns, so we should keep in mind the ways they differ from their cliches.
Larry Sabato on the ever-earlier election calendar "With 13 months still to go before the end of another presidential cycle that began the day after the last one finished, it's worth asking: Does it have to be this way?" writes Larry J. Sabato in The Wall Street Journal. The First Amendment guarantees politicians the right to campaign for president as early as they like, and long-plotted campaigns have existed since Thomas Jefferson. "What is novel, though, is the growing length of the overt public campaign for party nominations. For that we can largely thank Jimmy Carter," Sabato writes. Before Carter, candidates usually waited for the calendar year of the election to begin a campaign, but Carter "practically became a resident of Iowa," in 1975. Because candidates increasingly need huge sums of money to launch a competitive primary campaign, and states now compete to move their primaries earlier and earlier, campaigns are moving earlier as well. In 1972, Florida tried to move their primary ahead of New Hampshire's to attract the money and media attention. New Hampshire countered, setting off a "leap-frogging" process. "In 1968, only New Hampshire held a March primary. By 1988 there were 20 March primaries." Republicans have tried to limit this by delaying nominations until February 6, and incentivizing later primaries with more delegates to the convention. Most "saw the wisdom in this" but once again Florida tried to move back their primary even in the face of the repercussions. Florida's political clout in the general election means the party probably won't actually enforce its punishments. "A statute or constitutional amendment establishing a system of March-to-June regional primaries -- with rotating order so that every state gets to be part of the first group every fourth election -- would help," Sabato says, though he acknowledges this is hugely unlikely, so we will probably undergo this crazy campaign structure for awhile yet.