Saturday, October 29, 2011

The Sound and the Fury

I couldn’t resist posting this Adobe Photoshop picture from one of the Occupy Wall Street protests (h/t

James Taranto devotes his latest Best of the Web Today column to the protesters.

Is anyone reminded of William Faulkner? Maybe a review of Macbeth’s soliloquy in Act 5, Scene 5 is appropriate.

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Thursday, October 27, 2011


This week I’ve been doing prep work for our state election being held on Tuesday, November 1 in Colorado. Most counties in Colorado (all but four) are holding a “mail ballot only” election. Ballots were mailed out just over two weeks ago, and have to be received at the county no later than 7:00PM on election day. If you are a Colorado voter and would like to check whether or not your ballot was received, go to this site and enter your voter information.  (Scroll halfway down the page to the “Mail-in Ballot Stage Information” area.) It’s a good way to ensure the United States Postal Service did its job!

I work as an “Election Judge.” That’s a lofty way of saying I help process incoming ballots. It’s not glamorous work, but needs to be done. I like to think I’m helping make sure our elections are fair and accurate.

The specific work I’m doing this time around could be characterized as “sanitizing” the ballots. Ballots come in with a signature that is verified against the legal documents the county has on file for the voter. I’m with a team whose job is to remove the ballot from its signed envelope and ensure the secrecy of that ballot.

We check for anything that might soil the ballot or make it ambiguous to the scanning equipment. We also look for any identifying marks that would allow the ballot to be traced back to a specific voter. If the voter writes something on the ballot that might identify him or her in some way, we flag the ballot so that it gets a duplicate made that does not have any identifying marks.

As you might imagine, we have a “dual control” process at work, where members of both the Democratic and Republican parties are engaged in this activity so that voter intent is preserved. We take an oath to protect the privacy of the election results and the information of our voters. On my team, I am the designated Republican, along with two Democrats.

In the interest of keeping “peace in the family,” each team is cautioned to refrain from engaging in any political discussions. However, since the days are long and the work is tedious, that rule sometimes is violated. For whatever reason, my team was quite interested in determining my political beliefs. It was as if I had been released from captivity, and my credentials needed to be checked.

My other team members were older women, one a retired teacher and the other a housewife who sells artwork on the side. I’ll refer to them as “RT” and “HW.” At one point, the conversation became quite feisty:

“So what kind of a Republican are you?” asked HW. “Are you one of those TeaBaggers?

“I guess I would identify with the Tea Party in many ways,” I replied. “I’m for limited government.”

“How about voting for President?” inquired RT. “Which of the Republican primary candidates are you for?”

I like Sarah Palin, actually,” I said. “She celebrates the Constitution. I like that.”

“Well, she quit. You would waste your vote,” said HW.

“I guess I’d vote for Herman Cain, then. He seems to be the one who would be less of a conventional politician.”

“I don’t know about that,” said HW. “Herman Cain is financed by the Koch brothers.”

“I think that might be inaccurate,” I countered, trying to be charitable.

“Well, we certainly need to do something,” said HW. “All the bankers should be in jail. And the oil companies, all they want to do is pollute our water with their fracking!”

“And the rich don’t want to pay their fair share.” said RT. “We’ve got to tax the rich.”

I tried to explain that taxing the rich wouldn’t offset the spending of the federal government. We’d have to increase the income taxes of “the rich” by 50%, and that just wouldn’t be possible.

But my words fell on deaf ears. I had underestimated the raw power of the Democratic Party in getting its message out. These were not fringe elements of the party. They were dedicated, conscientious people who held a committed point of view. The star power of our president was on display, as well as the segmentation of our populace into those who were well-intended versus those who were mean-spirited. It was eye-opening.
I bring up this incident to point out the difficulty of the “Paul Revere” effect. People who are trying to warn our culture of impending problems are largely ignored. Thankfully, we have the ability to pull back from cataclysm just in the nick of time.

The other bit of good news is that the explanations of our reality are getting better. Here is an NPR interview of New York University law professor Richard Epstein on PBS:

And here, just for fun, is a Herman Cain advertisement. How can you not like this guy?

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Saturday, October 15, 2011

Weaponizing Healthcare

With apologies to Maureen Dowd, the style of this post is going to be a bit snarky.

House Minority Leader Nancy Pelosi was in the news this past week for her characterization of Republicans as killers.  The quote that is getting all the attention is her reaction to the Protect Life Act:

"Under this bill, when Republicans vote for this bill today, they will be voting to say that women can die on the floor, and health care providers do not have to intervene if this bill is passed."

The idea that Republicans want to see young women in a pool of blood on the floors of hospitals is extreme. However, some of our political leaders are clearly comfortable in expressing this sentiment. They believe that I, as a Republican, have murderous intent in my heart, directed particularly at young women.


Contrast that rhetoric with the quiet efforts of the U.S. Preventive Services Task Force (USPSTF). I noted its current work in my previous post. The USPSTF is recommending against use of the PSA test for early detection of prostate cancer.

Here is what Medscape says on its Web site about USPSTF actions from a few years ago (my emphasis):

Despite the apparent survival advantage of early diagnosis conferred by PSA screening, a 2008 US Preventive Services Task Force statement recommends against screening for prostate cancer in men aged 75 years or older. The statement also concludes that the current balance of benefits versus drawbacks of prostate cancer screening in men younger than age 75 years cannot be assessed because of insufficient evidence.

That was the USPSTF in 2008. This year, the USPSTF wants to do away with the test completely. Here are three facts we know:

1) The PSA test is useful in early detection of asymptomatic prostate cancer.

2) Early diagnosis of prostate cancer increases life expectancy.

3) The USPSTF wants our universal healthcare system to exclude the PSA test.

Here is what I find troubling: Our current healthcare legislation makes exceptions to its provisions for political favorites. That means people affiliated with Democratic Party organizations might very well have unrestricted access to PSA tests, while Republicans will face barriers.

What’s the big deal? If I want a PSA test, I can still get it. I just might have to jump through extra hoops and pay additional money. The only ones who would be negatively impacted would be those “stupid Republicans;” the ones who “cling to guns or religion.”

The “dirty little secret” is that the public policy effects will only show up years later. A study done 20 years from now will find that mortality rates for American males are higher in the universal healthcare system than in private systems. The results will be characterized by our media as “unexpected.”

And what if the study finds a political component? So it turns out a disproportionate number of Republican males are experiencing the early deaths. Males affiliated with the Democratic Party and not in the universal healthcare system have significantly longer life expectancies.

Would that be a scandal?


A scandal is when Republicans are “outed” by Minority Leader Pelosi when she exposes them as harboring murderous intent. The fact that male Republican voters will be quietly killed off by a Voodoo Healthcare System is simply “right and natural.”

Behold our anti-Republican culture.

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Tuesday, October 11, 2011

PSA Politics

“Wait until your Dad sees this.  He will go nuts!”

That was the comment to a family member in reaction to a New York Times article over this past weekend.  I was the “Dad” in question, and the article reported the latest government assessment of the Prostate-Specific Antigen (PSA) test.

As part of a physical exam, Americans typically get blood drawn to check for levels of cholesterol, glucose, etc.  Our culture considers these tests routine.  However, if you are a male over the age of 50, you might consider getting a PSA test.  It requires no additional effort on your part, and can tell whether or not your prostate is operating in a “normal” fashion.

Unfortunately, the PSA test has become controversial.  The U. S. Preventive Services Task Force (USPSTF) recommends against it. A draft statement issued today (available for comment until 11/8/2011) makes this contention: “There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”

Richard J. Ablin, a research professor who discovered this cancer screening tool, characterizes his discovery as a “public health disaster.”

I don’t agree.  Let me offer some personal perspective.

In 1997, I was 50 years old and had a PSA test done with my annual physical.  My level came back at 1.4.  Normal is between 0.0 and 4.0 ng/mL, so it was no problem.  Eleven years later, in October of 2008, the test showed my PSA level at 2.8, still within normal range.  In January of 2010, my level came back at 4.0.  My Primary Care Physician (PCP) counseled, “Get thee to a specialist!”

While my PSA level was still within normal range, I had experienced a dramatic rise within the space of 15 months.  That is a danger signal, and my PCP sensed that something was not right.

The urology clinic where I ended up did an “ultrasensitive” PSA test.  The level came back at 3.91, validating the earlier results.  I scheduled a biopsy for February 11, 2010.

A little background on biopsy of the prostate:  It is more involved than it sounds.  Twelve (or more) needles are sequentially injected into the prostate to retrieve tissue samples from the left, right, top, bottom and middle of the prostate.  The idea is to try to map where cancer might be located within the prostate capsule.  It could be on just the left side, or maybe just at the base.  The extent of the cancer then gets graded and staged so that you have an expectation of whether aggressive treatment is needed.

On February 16, 2010 I received the news:  I had prostatic adenocarcinoma in five of the twelve samples from the biopsy.

The problem with prostate cancer is that it is asymptomatic.  You feel fine.  The only thing that is “wrong” is that you have some abnormal readings in your blood test.  It is deceptive in this way. People don’t die from prostate cancer.  They die from adenocarcinoma that originates in the prostate, is untreated, and ends up moving to the skeletal structure or some other organ in the body that is critical to sustaining life.  It is there that you experience the symptoms.  When that organ succumbs, the disease is fatal.

I had some time to think about all of this.  The initial determination was that I had Stage II cancer.  The tumors were still contained within the prostate. The cancer was too advanced to simply cut it away from the prostate, but if I could kill the prostate, the cancer would be killed as well.

How to kill the prostate?  The choices were to remove it or radiate it.  I chose to have it removed, simply for emotional reasons.  I wanted the cancerous prostate out of my body, sitting in a Petri dish somewhere.  There it could do no harm.

On 3/17/2010, I had my prostatectomy, done through a robotic procedure that removed the prostate and seminal vesicles.  The subsequent pathology indicated that the surgical margins were clean, with no evidence of malignancy.  That was the good news.  The bad news was that when the prostate was closely examined, the diagnosis was upgraded to Stage III adenocarcinoma, based on the tumor extending slightly beyond the prostate capsule.

There was a slight chance that metastasis had begun, but even that had a bright side.  When I now get a PSA test, the reading comes back at <.01 ng/mL.  That means the removal of the prostate got rid of the primary source of the cancer.  If a subsequent PSA reading comes back at a higher level, I will know that it is due to adenocarcinoma being located somewhere else in my body.  The PSA test thus becomes a tumor marker.

I’m relating my experience to give you an idea of the advances that have been made in this area of oncology in the last thirty years, and how a PSA test is used.  Prostate cancer in men is like breast cancer in women.  It is an affliction that is best treated upon early detection.  The absence of an abnormal PSA is like the absence of a lump in the breast.  It is reaffirming.

So what does all of this have to do with politics?  Healthcare and politics are becoming inescapably entwined in our culture.  The USPSTF makes its negative recommendation and suddenly PSA tests face the prospect of not being a covered healthcare benefit.  The benefit of early detection ends up being associated with political favoritism.

It is almost criminal that we pass a healthcare law where people with strong affiliations to the Democratic Party are granted exemptions from the law.  Those of us in the non-Democrat rank and file must be medically sophisticated and have the resources to choose an early detection tool and pay for it without government support.  The benefits of the past thirty years of research in prostate cancer accrue to those with a Democratic Party allegiance while the rest of us are instructed to wait until we experience full-blown symptoms and our only treatment choices might be palliative care or hospice.

Is it possible the political calculus is that non-Democrat males will end up dying sooner?  Could this be a hidden motive behind universal health coverage?  Those of us on the universal plan end up receiving “Voodoo Healthcare” where advances in medicine are withheld by government fiat under the rubric of protecting us from our perceived medical anxieties.

This is pure speculation, but if our culture adopted a healthcare system where Republicans were given special exemptions, there would be immediate outrage.  “Occupy Wall Street” is our current political spectacle, but imagine how protests against Voodoo Healthcare would appear.  “Voodoo Denver” or “Voodoo San Diego” would feature protesters at major hospitals staging “die-ins” to highlight the attenuation of human life that would be part and parcel of universal healthcare.  It wouldn’t be pretty.

I’ve got to ask this final question: Is it possible Sarah was right?
UPDATE 10/12/2011:
Here is a good follow-up article in The New York Times by Tara Parker-Pope.  The comments indicate this is an area of medicine where patient choice should figure prominently in the treatment.  It makes it even harder to understand why a governmental organization feels compelled to side with a particular point of view.  Aren't there more important things that should occupy the time of the USPSTF?

UPDATE 10/15/2011:
A blog post at Ricochet by "Western Chauvinist" continues to stir the pot.  Note the comments by "Dr. Bean" (Albert Fuchs, MD of Beverly Hills, California).  Dr. Fuchs deceptively explains why facing early death is preferable to managing non-life threatening discomforts.  He also stipulates that results of a PSA test can be "false-positive PSAs, meaning abnormal PSAs but no cancer."  The implication is not that another PSA test will be performed to verify the results, but that a biopsy must follow.

While that might very well occur, I think most people will be like me and get another confirming test before undergoing the biopsy.  When pathology of the samples from the biopsy either confirms the existence of cancer or not, that is not a "false-positive" problem with the PSA test.  Rather, it is a result from further testing.  To characterize the PSA test as suffering from a "false-positive" problem is like saying a five-day weather forcast is a "false-positive" because subsequent observations refine that forecast and provide additional detail.

UPDATE 5/22/2012:
The U.S. Preventive Services Task Force has reached its final decision:

"The Task Force concludes that many men are harmed as a result of prostate cancer screening and few, if any, benefit.  The USPSTF recommends against the service."

UPDATE 6/17/2012:
Diane Carmen has a thoughtful analysis of the issue in The Denver Post this weekend.  Dr. Richard Augspurger had a companion piece that features this quote:

The U.S. Preventive Services Task Force recently recommended against routine use of the prostate specific antigen (PSA) blood test to diagnose prostate cancer.  This recommendation was given despite significant opposition from urologists, oncologists, patients and advocacy groups.  No urologists or medical oncologists who regularly treat prostate cancer participated in the recommendation.

Why would it be important for the USPSTF to exclude urologists and oncologists?

UPDATE 11/19/2015:
The New York Times notes that early detection of prostate cancer is declining in the United States:

Fewer men are being screened for prostate cancer, and fewer early-stage cases are being detected, according to two studies published Tuesday in The Journal of the American Medical Association. The number of cases has dropped not because the disease is becoming less common but because there is less effort to find it, the researchers said. The declines in both screening and incidence “could have significant public health implications,” the authors of one of the studies wrote, but they added that it was too soon to tell whether the changes would affect death rates from the disease.

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Monday, October 3, 2011

Are Republicans Islamophobic?

Waiting for a doctor’s appointment last week, I was looking for a magazine to read and came across an issue of TIME from last year. The cover hits us with the question, “Is America Islamophobic?” 

That might have been an interesting analysis to pursue, but the story in the magazine was even more direct. It didn’t investigate if America might be islamophobic, but that “Islamophobia has become the accepted form of racism in America.” It questions, “Why has Islamophobia suddenly intensified?”

TIME wants to know, “What is the matter with you guys?”

The article is worth reading as an example of how a major publication pivots from its role of reporting and shedding light on contemporary issues, to embarking on a mission of instilling guilt and shame.  It gives us an interesting focus on American culture.

You might want to keep in mind that the writers for TIME are anti-Republican in their viewpoint.  While not every TIME writer fits this generalization, studies over the last few years put the ratio at something greater than 90% within every American news organization.  You can rest assured that the writers of TIME do not see themselves as those within America who are stricken with Islamophobia.  They are above that type of emotion.

What is TIME trying to accomplish?  It’s a classic distraction.  They are asking us to confine our perceptions to a specific construct.  We are to become guilt-ridden and anxious because of our cautious feelings.  Those feelings are to be classified as religious hatred.

Culture, religion, and science are aspects of human endeavor.  We group ourselves by perception and outlook, and our ideologies often classify us.  The problem comes when our ideologies take on the mantle of a political movement.  That’s when things go awry.  A political movement might take root in a culture or in a religion or in an area of scientific inquiry.  Once in place, political movements create all sorts of havoc.

Let’s take Islam as an example.  It begins with a body of faith and philosophy and is rightly classified as a religion.  However, at some point, "the religion” becomes secondary to “the movement.”  Secular objectives become paramount:

--Make the power of the leaders the goal.

--Employ deception to advance the movement.

--Use censure and violence to force adherence.

The tools of deception and censure are clear signs of an ideology becoming a movement.  TIME references them within Islam but does not connect the dots.  Instead, it uses description from a Duke University associate professor: “Oh, my God, these people are totally against my religion.”

The problem is not that people are against the religion.  People are against the political movement and its consequences.  They are against suicide bombings.  They are against the execution of aid workers.  They are against the use of hospitals and mosques as military garrisons.  These activities are not signposts of a religion.  They are indicators of a religion that has been hijacked by a political movement.

Our culture has a perceptual set of “blinders” in this area.  In the science of climate change, we see the same circumstance.  A scientific inquiry is taken over by a political movement and people who challenge the direction of that movement are labeled as “anti-science.”

An anti-discrimination effort becomes a Black Power movement and concerned citizens are “racists.”  A pacifistic ideology becomes an anti-war movement and non-followers are “war mongers.”  In each case, we see the predictable concentration of power, the deception in principles, and then censure and violence.

The next time you see a “phobia” attached to an ideology or group of people, consider whether the emotions are directed at a people or at a political movement.

Keep in mind that you’ll have to do the analysis for yourself.  Our culture is not inclined to help your understanding.

UPDATE 9/27/2012:
Pat Condell has some thoughts on the religion of peace after the killing of our Libyan ambassador  (h/t Roger Kimball).

UPDATE 1/10/2013:
Jonathan Schanzer reviews the book "The Islamophobia Industry" in today's Wall Street Journal.  Mr. Schanzer understands that Islam is part of a political-religious movement, and makes this distinction:
In reality, Islamophobia is simply a pejorative neologism designed to warn people away from criticizing any aspect of Islam. Those who deploy it see no difference between Islamism—political Islam and its extremist offshoots—and the religion encompassing some 1.6 billion believers world-wide. Thanks to this feat of conflation, Islamophobia transforms religious doctrines and political ideologies into something akin to race; to be an "Islamophobe" is in some circles today tantamount to being a racist.
What's surprising is that Americans don't see anything extraordinary about the words "racist" and "islamophobe" only being used to characterize Republicans.  Our culture makes that possible.