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Public health, groupthink, and my son's jacket

Statistical analysis, anyone?

Yet another example of how people don’t understand how public health decisions are made

“I guess I am the 0.7 woman whose life would be considered expendable under the U.S. Preventive Services Task Force’s new recommendations on mammography screening,” writes a reader to the SF Chronicle. She points out that her potentially life-threatening case of breast cancer was caught by a mammogram.

The first article I read in the Chron yesterday quoted two women who were against the decision, both of them survivors of breast cancer detected through self-examination. It seems that no one is able to find or perhaps wants to find all the women who were probably hurt by overly aggressive testing recommendations: the women who went through painful biopsies unnecessarily, the women who were treated for cancers that probably would never have made them sick, and the higher risk of breast cancer in healthy women who get their soft tissues blasted with radiation once a year.

Once again: Public health decisions are not made as a value judgment of individuals. The woman quoted above says that the recommendations are made to define her as “expendable.” Quite the opposite is true: People whose life work is trying to keep us healthier have the tough job of saying, “Look, if something results in more people getting sick, and a few people getting cured, then it makes more sense as a public policy to avoid making the larger group sick.”

I once read a piece by a women with cystic fibrosis who pointed out that there are some benefits to her disease. But does that mean we should all strive to get cystic fibrosis? The fact that some women’s cancers are caught by mammogram during their forties doesn’t bear on the overall decision: what is the best decision for an entire population?

Forget teaching kids algebra: I think we need to introduce statistical analysis starting in kindergarten!


I’m reading a really interesting article in the New Yorker about how people’s opinions are swayed by their social groups. When people with moderately left or right views are put in a group with others of similar views, their entire group as a whole gets more radical in that direction. So a left-leaning person put into a group thinking that perhaps we shouldn’t have a public option in healthcare would be likely to come out thinking that we should have a public option.

I find this really interesting — my mother (a medical researcher) and I have been discussing lately how most people seem to be comfortable moving their views to fit their social group’s views, no matter whether they actually agree with them or not. It’s similar to what people who study traffic patterns see from the air: a highway that’s moderately full will show groups of cars bunched together, with a smaller number of independent-minded drivers moving between the groups.

Isn’t that a bit like life?

Healthy again, sorta:

Our son went off to school again today, apparently healed from his flu and ready to go. He was so well that he left his jacket lying on the floor. It was forty degrees out, and he’d just gotten over the flu. In a ten-year-old, lapses in memory are apparently part of the healthy organism!

Posted in Parenting.

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