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Americans Wildly Overestimate the Impact of Routine Mammographies

| Thu Apr. 17, 2014 9:46 AM PDT

Aaron Carroll passes along the following stunning chart about the actual efficacy of routine breast cancer screening on 50-year-old women:

Obviously, there are circumstances where routine screening is a good idea—perhaps if you have a family history of breast cancer or other specific risk factors. But the best recent evidence suggests that routine screening for all women has a negligible effect. At best, it's very slightly positive. At worst it's literally zero because false positives lead to interventions that themselves carry a risk of death.

The problem is that people don't believe this. They think that routine screening has a far greater impact than it really does. The perception of 50-year-old women is that routine screening saves the lives of about 80 women out of a thousand:

Therein lies the problem. If you think that breast cancer is going to kill 16% of all 50-year-old women in the next 10 years and that mammography makes a huge difference in the mortality rate, then you’re going to demand a universal screening program. Hell, I’d demand it if that were the case. Until we can change the perception of the public to more closely match reality, and make them realize that the harms may outweigh the benefits, we’re going to get nowhere in trying to make changes.

We're all complicit in the level of overdiagnosis in American health care. Over the past few weeks, I've probably gotten something like $20,000 worth of tests and other care—with more to come—in an effort to try and figure out why my breathing suddenly went south. I didn't push back on any of it, and the reason is obvious: when a doctor tells you that your problem might be an embolism or a bad heart or interstitial lung damage, then you damn well want to find out if it is. (It's not. We still don't know what's going on.)

Obviously an acute problem like mine is not the same as routine testing. But I do that too. I've resisted the routine colonoscopy so far because my risk profile is low, but I do get a biannual echocardiogram. Why? Because I have high blood pressure, high cholesterol, and a family history of cardio problems. Routine heart monitoring makes sense in my case.

Routine mammographies make sense too—for some women. But for all of them? The best evidence says it doesn't.

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"House of Cards" Veteran Wants To Make a Reality TV Show Starring Capitol Hill Staffers

| Thu Apr. 17, 2014 9:21 AM PDT

Oh, boy.

On Thursday, the Washington Examiner's Betsy Woodruff reported that a veteran of the Netflix political drama House of Cards is working to produce a reality TV show based in Washington, DC. The show would star local "up-and-comers," including Capitol Hill staffers ("the best and brightest on the hill") between the ages of 19 and 29.

A casting session is set to be held on April 26. One source told the Examiner that the first round of casting has already occurred. (It's unclear how many Hill staffers would actually be up for this, since most Senate and House offices probably wouldn't allow employees to take part in a potentially revealing reality series.)

Mother Jones obtained the casting call, which is dated April 14. Check it out:

House of Cards reality tv show casting call

Sharon "Rocky" Roggio, who's apparently behind the project, was the assistant property master on this year's season of House of Cards and worked on A Very Harold & Kumar 3D Christmas and the Red Dawn remake. Jena Serbu served as a production designer on Amish Mafia and Breaking Amish: LA.

Other attempts at reality TV in Washington include MTV's The Real World: D.C. and Bravo's The Real Housewives of DC. In 2011, Doron Ofir Casting (the company behind such reality-TV hits as Jersey Shore) put out a casting call for "young hot politicos who care about America [and] follow the heated debates, rallies, protests and scandals!" Last month, the Washington Post reported that Leftfield Pictures, the Manhattan production company behind Bravo's hit show, Blood, Sweat and Heels, is considering launching a DC version of the series. TV dramas and comedies set in Washington, DC, include Scandal, Veep, The Americans, and the attempted sitcom H Street.

Latest Gallup Result: 9-10 Million Newly Insured Under Obamacare

| Thu Apr. 17, 2014 8:38 AM PDT

Speaking of the uninsured, I inexplicably failed to blog about the latest Gallup results yesterday. Based on polling that goes through mid-April, Gallup now estimates that about 9-10 million people have gained insurance since Obamacare rolled out last year. If you assume that perhaps a million people lost insurance, that's a net increase of 8-9 million. Of this, about half gained insurance through the exchanges. The rest gained it through Medicaid and increased participation in employer plans.

I'm not going to try to analyze this number any further. It basically represents good news, since it's a higher estimate than we've seen before, and it also jibes with the recent Rand numbers suggesting a large rise in people covered by employer plans. Apparently the individual mandate is having a bigger impact on this than anybody predicted. However, it's one data point in a noisy series, and I suspect we still have to wait another month to get a reliable set of numbers from all the polling outfits. By the end of May, unless the various polls are in wild disagreement, I imagine we'll have a fairly good idea of just how big the impact of Obamacare has been so far.

UPDATE: Sorry, everyone else has been leading with a number of 12 million, so that's what I used. But the Gallup poll estimates that 4 percent of US adults are newly insured, not 4 percent of the entire country. That's in the range of 9-10 million. I've corrected the text.

Note, however, that this ignores children who are newly insured, either via exchanges or Medicaid. So the real number is probably a bit higher. Maybe in the 10-11 million range? It's hard to say. There are a lot of different surveys that are all measuring slightly different things, and they're all working on data that's still incomplete. That's why it's probably wise to wait another month or two before we get too confident in any of these numbers.

Rand Paul Really Doesn't Want to Talk About His McConnell Endorsement

| Thu Apr. 17, 2014 8:31 AM PDT
Sen. Rand Paul (R-Ky.)

A tea party revolutionary four years ago, Sen. Rand Paul (R-Ky.) has bucked many of his old supporters by backing Mitch McConnell, the Senate minority leader, in McConnell's primary against Matt Bevin, a hedge fund executive backed by the Senate Conservatives Fund. Why would Paul do such a thing? He has been cagey, to say the least. "He asked me when there was nobody else in the race, and I said yes," the junior senator told Glenn Beck in February. Evidently even that was too verbose. Per the Glasgow (Ky.) Daily Times, Paul has now taken his answer off the record:

After addressing about 30 people who turned out to hear him, the senator opened the floor for questions.

One constituent asked him why he came out in support of Sen. Mitch McConnell, R-Louisville.

Paul declined to answer the question publicly, saying he would speak with her in private and explain his reason for supporting the senior senator.

Paul family political guru Jesse Benton, who is now managing McConnell's re-election campaign, told a tea party activist in a secretly-recorded conversation last year that, "between you and me, I'm sort of holdin' my nose for two years because what we're doing here is going to be a big benefit to Rand in '16, so that's my long vision."

One reason Paul might decide to keep his explanation private: His answer sounds a lot like Benton's.

Daffy Duck, Glorious Archetype of Selfishness, Is 77. Here Is His First Cartoon.

| Thu Apr. 17, 2014 8:16 AM PDT


Daffy Duck, one of America's preeminent ducks, is 77 today.

If Bugs Bunny is the brightest star in the Looney Tunes sky, surely Daffy Duck is second. But it wasn't always that way! Before either of them, a pig named Porky occupied the top spot and on April 17, 1937 the sensational swine starred in "Porky's Duck Hunt." The Warner Brothers short featured the curly-tailed stutterer loading up his shotgun and setting out to hunt his way into America's heart, like you do. But then things don't go as planned—they can't, you see; Aristotle said so—and Porky comes upon a duck who isn't like the others. This duck's got a white ring around his neck and he doesn't conform, man. He won't go gently into that good night. He does what he wants. He's wacky. He flies around the frame in a very un-medicated way. Watch it. (The colorized version is embedded above. Here's the original black & white.) It's pretty funny!

Daffy is nameless in this first appearance, but a rose by any other name—or no name at all, a nameless rose—is still a rose. And this duck is still Daffy. Aside from his trademark white ring and lisp—voiced as he would be for 52 years by Mel Blanc—what makes him so essentially Daffy is that he's, well, nuts. This was his defining characteristic in the beginning. Created by Tex Avery, Daffy was a minor lunatic the established characters could play the foil to.

Over the course of the next decade, however, Daffy grew from being just some prop prey in hunting sketches to a full-blown star. As he became more prominent, his character became more complex. Still wacky, Daffy matured into his most famous role, as Bugs Bunny's arch-nemesis. (Bugs, the Betty to Daffy's Veronica, the White Swan to his Black, had been introduced in 1940.) Daffy became the crafty, scheming, plotting back-stabber who, motivated by unrestrained selfishness, will do anything to get what he wants, but in the end always comes up short. His every attempt is foiled, most often by the more moral Bugs, because in Looney Tunes' moral universe, unrestrained selfishness is a killer.

"I learned very little about social morality but a great deal about survival, and this, after all, is what Daffy Duck is all about."

Part of us empathizes with Daffy because though his defining characteristic is selfishness, his fatal flaw is recklessness. Everyone is a little bit selfish. Selfishness is very banal and very human, and at some age most everyone learns to rein it in. At 77, Daffy still hasn't reined it in.

Chuck Jones, who created Bugs, drew Daffy from 1951 to 1964 and was responsible for some of his most famous films. In his memoir, Chuck Amuck: The Life and Times of an Animated Cartoonist, Jones describes the first time he encountered within himself the voice he would one day associate with Daffy. The moment came at his sixth birthday party. After Chuck blew out the candles on his cake, his father handed him a knife and told him to cut as large a piece for himself as he wanted.

At this point Daffy Duck must have had, for me, his earliest beginnings, because I found to my surprise and pleasure that I had no desire to share my cake with anyone. I courteously returned the knife to my mother. I had no need for it, I explained; I would simplify the whole matter by taking the entire cake for myself. Not knowing she had an incipient duck on her hands, she laughed gently and tried to return the knife to my reluctant grasp. I again explained that the knife was superfluous. It was impossible, I pointed out with incontrovertible logic, to cut a cake and still leave it entire for its rightful owner. I had no need and no desire to share. 

My father thereupon mounted the hustings (he was nine feet tall and looked like a moose without antlers) and escorted me to my room to contemplate in cakeless solitude the meaning of a word new to me: "selfish." To me then, and to Daffy Duck now, "selfish" means "honest but antisocial"; "unselfish" means "socially acceptable but often dishonest." We all want the whole cake, but, unlike Daffy and at least one six-year-old boy, the coward in the rest of us keeps the Daffy Duck, the small boy in us, under control.

"You may cut as large a piece as you want" is a dangerous euphemism. There is a prescribed wedge on every birthday cake that is completely and exactly surrounded by corporal punishment. Exceeding these limits by even a thousandth of an inch brands one as "selfish." From my seventh birthday on, I learned to approach with judgment sharper than a razor's edge this line, without cutting the "un" from "unselfish" to "selfish." I learned very little about social morality but a great deal about survival, and this, after all, is what Daffy Duck is all about.

So, happy birthday, Daffy, America's most famous animated cautionary tale of avarice!

Is the Census Recount of the Uninsured a Legitimate Scandal?

| Thu Apr. 17, 2014 8:14 AM PDT

A friend of mine thinks the decision by the Census Bureau to change the way it counts the uninsured—which will make it more difficult to make pre and post-Obamacare comparisons—is sleazier than I give it credit for:

To me this is all about 2016. I think Democrats really want to be able to show a sharp contrast that will demonstrate the dramatic impact of an attempted repeal of the ACA, and stronger numbers on the uninsured would only help the ads that much more. The administration knows that a Republican president will be under terrific pressure to undercut and thwart the law regardless of its popularity (even if with as few fingerprints as possible) and that they will use whatever tools they have to do so. So 2016 is extremely important.

The reason I lost it is because even with independent agencies, there is a certain measure of influence. No, the executive doesn't have a large measure of direct control over independent agencies, but they damn sure know what they are doing — or at least somebody does. They don't operate in a vacuum. (Except, perhaps, some of the security services.) So, this is either:

  1. Something started years ago with a drop date of Spring 2014 that (a) no one picked up on until now and no one can derail the train; or (b) the executive saw coming and was willing to let it happen to help put the best read on the numbers in advance of 2016.
  2. Something that has been out there (sure, everything is "out there") but languishing, which the executive decided to speed up and put in place well before 2016. The goal was to get the most positive read on the numbers, so they indirectly applied pressure to the Census to put it in place — and since the Census wants it anyway there's really no stick here.

Of these, (1)(a) seems most implausible (even if certainly possible) and (2) seems most likely if 2016 is the primary issue. Thus, I am assuming that this is going forward with the executive's blessing on the timing, and a calculation has been made that the blowback — if any — will be among the right's base and they are already energized so this won't change the dynamic much.

And if my assumption is correct, I still think it's a cheap / too-cute-by-half tactic that I would be calling out if the roles were flipped.

I have a hard time buying this for several reasons. First, it is too cute by half. Obama's political shop is not the runaway train that, say, Chris Christie's apparently is. It's implausible to me that anyone there would give this more than a moment's thought before dismissing it. It's just too stupid.

Second, it's not at all clear that the change made by the Census will make Obamacare look better. We're still going to have a clean 2013-14 comparison, after all, just not a longer-term one. Besides, surely any number is better than one with such a big cloud around it that it's open to merciless attack. Especially when it's one that the boffins at the Census Bureau won't defend.

Third, there are loads of other numbers about the uninsured—Gallup, Rand, HRMS, etc. Playing games with the Census numbers won't change any of that.

Bottom line: I continue to think this is most likely something dreamed up by technocrats in the Census Bureau who were oblivious to the political implications. I'll acknowledge that the political implications are obvious enough that this is a little hard to believe, but that's where Occam's Razor takes me. In any case, Darrell Issa is sure to open hearings on this, so I imagine we'll hear from Census officials soon enough.

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Putin: Eastern Ukraine is Really "Novorossiya"

| Thu Apr. 17, 2014 7:36 AM PDT

The Guardian reports that Vladimir Putin held a long, "meticulously stagecrafted" press conference today:

Accusing the Kiev authorities of pulling the country into an "abyss", he called on Ukraine to pull back its heavy artillery from the east of the country, asking: "Who are you going to use it against? Have you completely lost your marbles?"

....Putin referred to the region in question by its tsarist name "Novorossiya", or "New Russia", as it was referred to in the 19th century under tsarist rule, and suggested it was a historical mistake to hand it over to Ukraine.

"It's new Russia," he told millions of watchers "Kharkiv, Lugansk, Donetsk, Odessa were not part of Ukraine in Czarist times, they were transferred in 1920. Why? God knows. Then for various reasons these areas were gone, and the people stayed there — we need to encourage them to find a solution."

That does not sound very promising, does it?

We're Still at War: Photo of the Day for April 17, 2014

Thu Apr. 17, 2014 3:00 AM PDT

Marines put out a controlled fire on a mobile aircraft fire training device at Marine Corps Air Station Futenma April 7 during a visit from Girl Scouts. The firefighting display showed how the Marines respond to an emergency situation. The mission of Girl Scouts of America is to build the courage, confidence and character of girls, who can then make the world a better place, according to their website. The Marines are aircraft rescue and firefighting specialists with ARFF, Headquarters and Headquarters Squadron, MCAS Futenma, Marine Corps Installations Pacific. (U.S. Marine Corps photo by Lance Cpl. David N. Hersey/Released)

Film Review: "Burt's Buzz"

| Thu Apr. 17, 2014 3:00 AM PDT

Burt's Buzz

EVERYDAY PICTURES/FILMBUFF

Jody Shapiro's documentary profiles Burt Shavitz, the thick-bearded, staunchly frugal, middle-aged Maine beekeeper who cofounded Burt's Bees, following his rise from hip 1960s photographer to the unlikely brand ambassador for a multimillion-dollar skin and body care empire. As a portrait of the compelling curmudgeon, Burt's Buzz isn't quite as penetrating as one might hope for. But it's an oddly charming peek into the world of corporate celebrity through the lens of a guy who apparently wants nothing to do with it. "No one has ever accused me of being ambitious," Shavitz says. And, of his intrusive fans: "I'd like to point the shotgun at them and tell them to be good or be gone."

Invading Crimea May Have Cost Russia $200 Billion So Far

| Wed Apr. 16, 2014 9:07 PM PDT

Russia's military actions are costing it dearly:

Russia's annexation of Ukraine's Crimea region last month and the instability it created in Russian financial markets were cited by government officials for record capital flight and sharply downgraded growth forecasts for the country. Finance Minister Anton Siluanov said that instead of projected 2.5% growth this year, Russia's economy might show no growth at all.

....U.S. and European sanctions to punish Russia for occupying and annexing Crimea have so far targeted only a few dozen officials and businessmen. But the prospect of broader penalties, such as a Western boycott of Russian oil and gas, have scared investors into cashing out their ruble-denominated assets for hard currency and taking their money abroad. Russia's foreign exchange reserves were drained of a record $63 billion in the first quarter of the year, Economic Development Minister Alexei Ulyukayev said Wednesday in an address to the lower house of the parliament.

....Russian stocks fell 10% last month, wiping out further billions in capital. The ruble has lost 9% of its value since the start of the year, boosting prices for the imported food and manufactured goods on which the Russian consumer market is heavily dependent. "The acute international situation of the past two months" was the cause, Ulyukayev said, referring to the Ukraine unrest.

That's a helluva big drop in economic growth. Just by itself, it represents a cost of $50 billion. Add in the flight of cash and the stock market decline, and you're somewhere in the neighborhood of $200 billion.

Is that enough to make Russia blink? Maybe not. But it hurts, and the prospect of losing even more has got to be enough to give even Vladimir Putin a few second thoughts.