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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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WHO DOESN’T LOVE A POSITIVE STORY—OR TWO?

“Great journalism really does make a difference in this world: it can even save kids.”

That’s what a civil rights lawyer wrote to Julia Lurie, the day after her major investigation into a psychiatric hospital chain that uses foster children as “cash cows” published, letting her know he was using her findings that same day in a hearing to keep a child out of one of the facilities we investigated.

That’s awesome. As is the fact that Julia, who spent a full year reporting this challenging story, promptly heard from a Senate committee that will use her work in their own investigation of Universal Health Services. There’s no doubt her revelations will continue to have a big impact in the months and years to come.

Like another story about Mother Jones’ real-world impact.

This one, a multiyear investigation, published in 2021, exposed conditions in sugar work camps in the Dominican Republic owned by Central Romana—the conglomerate behind brands like C&H and Domino, whose product ends up in our Hershey bars and other sweets. A year ago, the Biden administration banned sugar imports from Central Romana. And just recently, we learned of a previously undisclosed investigation from the Department of Homeland Security, looking into working conditions at Central Romana. How big of a deal is this?

“This could be the first time a corporation would be held criminally liable for forced labor in their own supply chains,” according to a retired special agent we talked to.

Wow.

And it is only because Mother Jones is funded primarily by donations from readers that we can mount ambitious, yearlong—or more—investigations like these two stories that are making waves.

About that: It’s unfathomably hard in the news business right now, and we came up about $28,000 short during our recent fall fundraising campaign. We simply have to make that up soon to avoid falling further behind than can be made up for, or needing to somehow trim $1 million from our budget, like happened last year.

If you can, please support the reporting you get from Mother Jones—that exists to make a difference, not a profit—with a donation of any amount today. We need more donations than normal to come in from this specific blurb to help close our funding gap before it gets any bigger.

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