It's a silly question. Of course, no matter what one is screening for — breast cancer, diabetes, prostate cancer, hyperlipidemia, whatever — the screening does not save lives. It may, at best, present an opportunity to save, or extend, or improve the quality of, a life.

Screening provides information. It's what we do with the information that matters, and that's where any debate should be centered. To argue against screening is to argue in favor of ignorance, which runs against the tide of human history. And against good sense.

So the question should be, what do we do when breast cancer is detected, whether by mammogram or self-examination or some other screening technique? When cancer is detected, do we have an array of effective therapies at our disposal and a discriminating health care system prepared to put them to use for the benefit of the patient?

Fred's argument isn't really against mammograms, which, as many commenters pointed out, are inexpensive. Fred's argument seems to be that we're wasting money on breast cancer therapies that are expensive and, he claims, ineffective (at least statistically). He's saying that if we avoided early detection of breast cancer, we'd also avoid wasting money on costly remedies that may or may not work.

So the question is this. Do current, state-of-the-art, breast cancer therapies work? Are the effective? Do they save, extend, or improve the quality of, lives? That's where the debate should be. But not really a debate, either. Let's say, that's where the research should be. And that, in fact, is where the research is.

The greatest controversy is about what to do when early-stage breast cancer is detected. Stage 0 or Stage 1. DCIS, for example, or DCIS with some localized invasive cells but nothing showing in the lymph nodes. If we find it, what do we do?

The standard of care today might include lumpectomy, with or without sentinel node biopsy, depending upon the path report, followed by 3 to 6 weeks of external radiation of the breast and 5 years of oral hormone blocking therapy, Tamoxifen or one of the aromatase inhibitors. Plus followup mammography every 6 months for 5 years.

Can we say that this current mainstream standard of care produces good results? One wishes there were an overwhelmingly clear cut answer. But here we run up against the limitations of science, and the primary injunction that differentiates physicians from scientists: primum non nocere. First do no harm.

The large, double-blind study is the gold standard of medical research. So can we have 20,000 volunteers, please? Women who will sign up for the research program, not ever to know whether they are receiving real or bogus radiation therapy, aromatase inhibitors or sugar pills. Women who will remain in the program for five years and be content to live or die without ever knowing whether they were in the group that received treatment or in the control group. Let's follow them for five years, ten years, twenty years, and see how they fare. Then we'll write a report with statistical analyses that will help us to developed evidence-based guidelines for the treatment of early stage breast cancer.

It won't happen, because, thankfully, we will not be content to stand idly by and watch women die when we think we have good ways to treat their condition. So, it's true that medicine is not a perfect science, Instead, medical research must find indirect, and often painfully slow and inefficient, approaches to scientific truth, approaches which leave us to deal with some level of ambiguity in the interim.

It's also true that there is an incredible amount of human variability in terms of individual response to disease and to medical treatments.

Fred seems to be looking for some mathematical certainty that finding and treating early stage breast cancer will save more lives than not finding and not treating it. Then he will know whether to spend the money or not. The problem for most of us is that, while we are waiting for such certainty, real people whom we know and love are suffering, and we want, and expect, the health care system to do the best it can for them, given the current state of knowledge.

Today, the current state of knowledge is expressed in standards of care that recommend regular mammograms to detect cancer, and surgery, radiation, hormone blockers and other therapies to treat the cancer when it is found. And the current state of knowledge suggests that women are better served by early diagnosis and treatment, than by ignorance.

(say that three times as fast as you can)

Over here on the left, we are arguing about whether to blame Republicans or Democrats for the concatenating train wreck that is America today. Let me say clearly, before I say more, it is the Republicans. The Republicans, about whom I can do nothing.

It's true. Nothing I do or say will ever change the mind of a Republican. Therefore, it would pretty much be a total waste of time to spend time attempting to influence Republicans.

But for Democrats I still hold out some hope. And Democrats must change. They really must.

That's why you see so much criticism of Democrats, including Barack Obama, on this Web site. Because there are "fellow travelers" (to borrow a phrase from the 50s) among Democrats. Democrats who walk the same path as Republicans, drink at the same Wall Street watering holes, eat from the same corporate feeding troughs as Republicans.

It is Democrats whom we can hope to change. Must change.

Must have been pretty strung out, you know, lolling in the living room, tweaking, spinning LPs backwards to make funky sounds.

In all the hype about electric cars, I've seen it critically discussed approximately nowhere.

Thanks for raising the question.

It is class warfare.

Should the economic policy of a country be designed to increase profits, even if that negatively impacts citizens? Or should the economic policy be designed to improve the well-being of citizens, even if that negatively impacts profits?

Government plays an indispensible role in maintaining a balance, which isn't easy. Lately, the balance has shifted excessively toward profits.

Yup.

Reagan seized a moment in history to turn the country in his direction. Like FDR did before him.

Obama missed the opportunity to do the same. Maybe it's because, as you say in the second paragraph, he doesnt' stand for anything. I don't know. Maybe its because he isn't the man for the moment.

He's clearly better than McCain would have been, better than any Republican I know of who might have been a candidate. Maybe no Democrat could have done better.

Whatever, for us, in the end, it's a great opportunity lost. And it is the loss of opportunity that we complain about.