Passionate Minorities

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Ezra Klein on the new recommendations suggesting women should start getting mammograms at age 50, not age 40:

You could hardly imagine a better example of why cost control is so hard: This was a recommendation from an institution with no actual power that was based entirely on accepted medical evidence. Cost was not a component in the analysis. This is simply the data on whether mammograms make sense for most women between 40 and 50, not whether they’re “worth” doing as opposed to other expenditures.

And the political outcry has been deafening.

Beyond the purely scientific aspect of the debate, one of the notable things about the reaction to the new mammography guidelines is the way it highlights how passionate minorities drive so many public debates.  The USPSTF recommendation is based on large-scale costs vs. large-scale benefits, but the conversation that followed has been based mostly on personal stories.  And you’ll never hear any personal stories about the costs.  Only the benefits.  Virtually all of the personal testimony over the past few days has been from women who either contracted breast cancer in their 40s and were saved by a mammogram, or who have unusual conditions that require unusual monitoring.  Obviously, if you fall into one of these categories you’re going to feel very, very strongly about the benefits of early mammography.

And the millions of women who (if the USPSTF is to be believed) got mammograms in their 40s and suffered ill effects of one kind of another?  For the most part those effects were relatively minor, so nobody feels motivated to write op-eds about them.  But they’re surprisingly widespread: the report suggests that the cumulative risk of a false positive result is over 50% for women who get annual mammograms between 40-49.  That’s a lot of false positives, a lot of extra biopsies, and a lot of unnecessary panic.

It’s a close call, and annual testing may still be worth it.  (The USPSTF continues to recommend it for women with a family history, genetic prediliction, or environmental risks.)  That’s a largely personal choice.  But as with most political arguments, the public debate on this is being driven mostly not by dispassionate science, but by a passionate minority.  That’s democracy for you.

UPDATE: Via comments, it turns out that women who get false positives are occasionally motivated to write op-eds about the experience after all.  Here’s one from Andrea Stone.

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Reclaiming power from those who abuse it often starts with telling the truth. And in "This Is How Authoritarians Get Defeated," MoJo's Monika Bauerlein unpacks six truths to remember during the homestretch of an election where democracy, truth, and decency are on the line.

Truth #1: The chaos is the point.

Truth #2: Team Reality is bigger than it seems.

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SIX TRUTHS

Reclaiming power from those who abuse it often starts with telling the truth. And in "This Is How Authoritarians Get Defeated," MoJo's Monika Bauerlein unpacks six truths to remember during the homestretch of an election where democracy, truth, and decency are on the line.

Truth #1: The chaos is the point.

Truth #2: Team Reality is bigger than it seems.

Truth #3: Facebook owns this.

Truth #4: When we go to work, we're in the fight.

Truth #5: It's about minority rule.

Truth #6: The only thing that can save us is…us.

Please take a moment to see how all these truths add up, because what happens in the weeks and months ahead will reverberate for at least a generation and we better be prepared.

And if you think journalism like Mother Jones'—that calls it like it is, that will never acquiesce to power, that looks where others don't—can help guide us through this historic, high-stakes moment, and you're able to right now, please help us reach our $350,000 goal by October 31 with a donation today. It's all hands on deck for democracy.

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