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Posted on: 06.29.2015

Mammography’s Shadows, VII: Legacies

by Sylvia Kraemer
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Posted in Healthcare, Uncategorized

Crab ImageGood science gives the same answer to questions posed by both male and female investigators.  But good science normally only answers questions as they are posed.  In the case of breast cancer, ordinarily only females experience the disease, with its attendant costs to themselves—and opportunities for others.  The same is true for current breast cancer detection practices, which rely primarily on screening x-rays (mammography).

This reality is illustrated in the commentary published in the British Medical Journal on the 2014 article summarizing the 25 year follow-up of the Canadian National Breast Cancer study.  The comments—all from men—focused, with one exception,[1] on the methodological and numerical minutiae of various randomized control trials and population-based investigations of the relationship of mammography screening and mortality from breast cancer.  As for risks–overdiagnosis and radiation-induced cancer in later years–virtually nothing was said.

By assessing methods of breast cancer detection or treatment solely within the limited epistemic confines of quantitative measures of breast cancer detection and mortality, we neglect the single most compelling constant of all:  the irradiation of women’s breasts and mid-sections for screening, diagnosis, and treatment.

The American Cancer Society (ACS) assures screening participants that mammography’s radiation dose is 0.4 millisieverts for “the typical mammogram with 2 views of each breast.” It adds that Food and Drug Administration regulations ensure that  the “radiation dose is required to be very low.”[2]  [See Baconspromise.org post IV, “Hunting Cancer with X-Rays.”]  The society also compares a woman’s x-ray exposure from a mammogram to “about the same amount of radiation she would average from her natural surroundings over about 7 weeks.”  This comparison obscures the fact that at any given time mammography exposures represent net increments to exposures from a woman’s natural surroundings.

When the ACS and the American College of Radiology further assure women that, despite its “risks,” screening mammography has been shown to have “benefit,” most women will infer that the “benefit” being referred to is a reduced risk of death from breast cancer.  After all, “mammography saves lives.”  Alas, it is not so simple.

For regulatory purposes the Food and Drug Administration defines mammography’s “benefit”as “the quality of the resulting radiograph[s].”[3]  Meanwhile, since x-ray  image quality is directly proportional to the radiation dose, improvement in mammography “benefit” has occurred along with a gradual increase in mean glandular dose per image to over four times the amount of exposure claimed by the American Cancer Society.[4]

The FDA’s own surveys of trends in mammography dose and image quality have found that the typical four image mammogram entails a mean x-radiation exposure of over 7 milligrays, or almost 18 times the amount advertised by the ACS.  (This does not take into account repeated images that may be taken during the same mammography session for the benefit of the radiologist attempting the most accurate reading.) Meanwhile, the FDA’s regulatory upper dosage limit for standard mammography equipment is 3.0 milligrays per exposure, or a total of 12 milligrays for the four exposures of the typical screening mammogram.[6]

Radiology technicians naturally make every effort to minimize radiation exposures.  But they must also make every effort to ensure the best possible image for the waiting radiologist, and the reality is that standard FDA-compliant equipment is able to direct much more radiation during a mammography than the limits the ACS suggests.

These higher levels of radiation are delivered with repeat or diagnostic mammograms, which are involved in breast biopsies performed whenever a woman’s screening mammogram produces “suspicious” results.  According to one recent estimate, such biopsies are done “about 1.6 million” times a year.[7]

A recent analysis of the insurance records of 700,000 women between the ages of 40 and 59 found that all had had routine screening mammographies, 11% of which were regarded as “suspicious” and thus resulted in repeat mammograms, ultrasounds and needle biopsies.  Except for the ultrasounds, the additional testing resulted in considerable additional x-radiation exposure.  Less than 2% of these follow-on procedures confirmed cancer.[8]  Repeat screening mammography, often within days of the initial exposures, has reportedly increased with the transition to digital mammography.[9]

Precise numbers for the frequency with which women are brought back for repeat mammograms are probably unobtainable.   Combing through proprietary records of radiology departments and insurance claims would be a daunting task.  That being so, assurances that the x-radiation exposure from mammography is too small to worry about—or “worth the risk”—are meaningless.

Perhaps the most insidious consequence of efforts to assure women that the radiation risk from mammography is “low,” is that such statements, and any comparative numbers offered to support them, invite women to infer that there is a safe threshold for x-radiation exposure, and that “low” is meaningful with reference to that threshold.  But there is no such thing as a safe threshold.

In 1955 the National Academy of Sciences created a committee on the biological effects of atomic radiation to review what had been learned from laboratory science and the findings of the Atomic Bomb Casualty Commission, formed in late 1945 to assess the radiation consequences of the bombings of Nagasaki and Hiroshima.

The committee issued an initial assessment in 1956, which was updated for its 1960 report.[10] The sub-group examining genetic effects confirmed that irradiation of female mice produced genetic damage. (That x-rays damage chromosomes, and are thus capable of producing tumors, had been shown by Theofore Heinrich Boveri before World War I.) It also confirmed genetic consequences for the “children of survivors of the atomic bombings at Hiroshima and Nagasaki,” as well as “children elsewhere whose parents received radiation for medical or other reasons.”[11]  However, cautioned the report,

. . . most of the man-made radiation to which the population of the United States is exposed involves dose rates not yet adequately investigated experimentally. For example, we do not know whether the effects of low doses given at high dose rates, as in medical exposures, will be more like the response from acute irradiation or more like that from chronic irradiation.”

Pathologies such as skin cancer and leukemia may result from “relatively low level” exposure “from time to time over a period of years. . . .” and it is “characteristic” of radiation that its “effects may manifest themselves not only immediately, but perhaps only after a long period of intermittent . . .exposure.”[12]

Delayed manifestation of biological effects results from the fact that . . .all types of induced and spontaneous tumors appear not to arise at once . . . . There is much evidence indicating that malignant change ordinarily develops only after a series of ‘precancerous’ changes or a state of tissue disorder has taken place.                  

The committee cautioned against predicting “human tumor incidences from small radiation doses based on extrapolation from the observed incidences following high dosage,” such as those recorded after the atomic bombings of Japan.  Furthermore, prediction—        

  . . .requires evaluation of the possibility that there is a threshold dose below which there is no probability of inducing leukemia, a concept which implies a factor of safety that would be most reassuring to those who are exposed to radiation in excess of the natural background . . . . However, no member of the Subcommittee feels that he can estimate the size of the threshold or, for that matter, even prove its existence. . . . The detailed information available . . . argues Strongly against a DNA repair-mediated low-dose threshold for cancer initiation. [13]   

Subsequent reports from the National Academy of Sciences’ Committee to Assess Health Risks from Exposure to Low Level Ionizing Radiation have affirmed this conclusion, viz. “it is prudent to assume that there is no threshold.”[14]

It is a truism that we usually get answers only to the questions we ask.  So let us enlarge the limited frame of reference for most randomized control trials or population-based studies of screening mammography’s merits, in three ways:

First, begin a population based inquiry in 1950, prior to the adoption of screening mammography [See Table 3], to detect larger “before” and “after” patterns requiring explanation.  This, as we have seen, the National Cancer Institute has already begun to do in order to examine whether the earlier diagnosis of breast cancer has, in fact, made a difference in the overall rate of breast cancer incidence. (See Blog Post VI, “The National Cancer Institute Weighs In.”)

Secondly, if we are serious about learning the risks of mammography screening, we will examine data reflecting changes in the incidence of conditions that are known to be susceptible to x-radiation, for example, (a) other forms of cancer, especially originating in the chest area, such as the thyroid glands, trachea, bronchus and lungs, and (2) heart and cardiovascular disease.

Thirdly, we can focus on those ages in which mortality from cancer and heart disease are most pertinent, viz., over the age 45.  Nature has provided us with a perfect comparison group for women confronted with these diseases:  men.

The National Center for Health Statistics collects and maintains the largest and most comprehensive data on health in the United States, data which goes as far back as 1950.  And it does so using analogous definitions, collection procedures, and statistical methods across all measures of health and disease.

If one compares deaths from malignant neoplasms of the trachea, bronchus and lungs for both men and women 45 years and older, over the six decades between 1950 and 2010, one cannot but be struck by the continued increase of female mortality from those diseases beginning in 1980, and especially after 1990, when corresponding male deaths began to decline precipitously. [See Table 1 ] (The same dramatic disparity is evident between men and women after the age of 65.)  This disparity cannot be blamed on smoking. [See Table 2]

Meanwhile, the incidence of thyroid cancer has increased more than twice the rate in women than in men since 1991, with increases being larger among white women, who are more likely to have received screening mammograms.  In the early 1970s, rates of thyroid cancer among women had begun to hold steady (black women) or decline (white women).  An increase in the rates for both white and black women becomes evident in the 1980s and 1990s and does not reverse before 2011, year of the most recent SEER data.[15]

Then there is cardiovascular disease.  During the three decades after 1950 the death rate from heart disease (or cardiovascular disease, CVD) in the United States for women 65 years and older remained the same, at about 300 per 100,000.  Substantially more men 65 and older died from heart disease during that period, though their death rate improved significantly (from 425 to 377 per 100,000) in 1977.  At the end of the 1970s appreciably fewer women of all ages were dying from cardiovascular disease than men.

By 1980 something changed.  Deaths from cardiovascular diseases among women began to approach CVD deaths among men, surpassing the rate for men in four years.  Indeed the numbers of men dying from cardiovascular disease began to decline after 1980, while the death rate for women continued to increase.

For a brief period (1990-1995) the CVD death rate for both men and women of comparable ages increased slightly, but in 1995 the rate resumed its decline for men.  Women’s CVD death rate not only increased more sharply during 1990-1995, but continued to increase until 2000.  Then their CVD death rate also began to decline, even more sharply than the rate for men.  By 2010 the disparity in CVD death rates for men and women was the smallest since 1985.[16] [See Chart – CVD Mortality Trends]

Nearly half (47%) of the decrease in age-adjusted mortality from cardiovascular disease among men and women by 2000 has been attributed  to improved treatments, with the remaining improvement attributable to reductions in risk factors, such as smoking and physical inactivity.[17]  Nonetheless, in spite of improvements in the treatment of both cardiovascular disease (CVD) and cancer, in 2010 a woman over the age of 45 was twelve times as likely to die from CVD as from breast cancer.[18]

Common explanations for the post-1980 disparity in CVD mortality between men and women are that “women have smaller hearts and smaller arteries,” their hearts beat faster and 300 million more times in a lifetime than men’s hearts, while women’s heart rate dynamics are more variable and complex. What’s more, tobacco use is supposedly more dangerous in women.[19] However, such reasoning does not explain why fewer women than men died from heart failure for the three decades between 1950 and 1984.

Finally, let’s return to the possibility that some breast cancers that occurred, recurred, or metastasized  among women in their 50s through 70s did so as a result of cumulative x-ray exposures from diagnostic or therapeutic mammography.  A rereading of the National Cancer Institute’s attempt to quantify “overdiagnosis” in its 2015 guidance for physicians inadvertently raises this question.

For any given number of women over the age of 40, a certain number of breast cancers is likely to occur. Thus increases in early detection should be accompanied by corresponding decreases in breast cancer detection in later years. [20]  Accordingly, the NCI examined “several observational population-based studies” that compared “breast cancer incidence before and after adoption of screening.”

If mammography screening were as effective as its proponents promise,

. . . there would be a rise in incidence followed by a decrease to below the prescreening level and the cumulative incidence would be similar.  Such results have not been observed.  Breast cancer incidence rates increase at the initiation of screening without a compensatory drop in later years. . . .  A population-based study showed increases in invasive breast cancer incidence of 54% in Norway and 45% in Sweden in women aged 50 to 69 years, following the introduction of nationwide screening programs.  No corresponding decline in incidence in women older than 69 years was ever seen.  Similar findings . . . have been reported from the United Kingdom and the United States.

The NCI attributes these findings to “overdiagnosis.”  But they could also reflect the induction of breast cancer by the cumulative exposure of women’s breasts to x-radiation.  We cannot know how many of those later incidences of breast cancer are radiation-induced, but the fact that they do occur is a serious and troubling outcome, especially for older women.

*   *   *

šIf numbers provide an inadequate foundation for establishing medical protocols, it is because statistical correlation is too readily confused with causation, and because those aspects of biological phenomena that can be captured by quantities do not replicate biological processes over time—which carcinogenesis certainly is.

For some the “gold standard” of evidence in medicine is the randomized control trial.  For others, scientific proof entails not only quantification, but replicability.  But numbers cannot replicate biological processes, nor can we completely replicate in the laboratory the etiology of disease in a given group of persons.  Still, numbers—especially in epidemiology—do have the power to capture evidence of trends, and thus to pose questions that might not otherwise be raised as a result of cultural bias, or economic interest.

So it is that we must question the ethics of continuing to subject the upper torsos of women asymptomatic and at low-to moderate risk to breast cancer to cumulative and repeated exposure of even low-levels of ionizing radiation without compelling and justifying reasons, applicable and acceptable to each individual patient.  Compounded by the continuing and larger radiation exposures involved in over-diagnosis and over-treatment, the ethics of policies that promote widespread screening mammography beg to be challenged.

Screening mammography remains an experiment.  We are learning the amount and costs of over-diagnosis and over-treatment.  Given the complexity of possible additional health risks from the practice, the likelihood of providing sufficient reliable information to obtain genuinely informed consent to mammography is remote. Therefore, before continuing to consider routine screening mammography as appropriate for all women of any age we must also eliminate it as a contributor to disparate disease trends among adult men and women, as well as a source of recurring or new breast cancers.

(This is the concluding post in a seven part series on the unknowns of routine screening mammography for asymptomatic and low-to moderate risk women. As a result, screening mammography remains a medical experiment. The complexity of the unresolved questions mean that genuinely informed consent to the procedure is highly unlikely. Posted June 29, 2015.)

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[1] Donald J. Benjamin, “Comment re. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: Randomised screening trial,” British Medical Journal (11 February 2014), http://www.bmj.com/content/348/bmj.g366, Downloaded March 2, 2015.

[2] American Cancer Society, “Radiation exposure from mammography,” http://www.cancer.org/treatment/understandingyourdiagnosis/ examsandtestdescriptions/mammogramsandotherbreastimagingprocedures/ mammograms-and-other-breast-imaging-procedures-mamm-radiation. Downloaded March 3, 2015.  The sievert is a derived unit in the International System of Units which, when applied to human radiation exposure, incorporates an estimate of the probability of cancer induction or genetic damage. 1 milligray is conventionally considered equivalent to 1 millisievert.

[3] David C. Spelic, “Dose and Image Quality in Mammography: Trends during the First Decade of MQSA,” http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/ FacilityScorecard/ucm113606.htm.  Downloaded March 3, 2015.

[4]  The specific FDA amounts are 1.5 milligrays in 1995 and 1.76 milligrays  in 2003. The milligray is the metric measurement unit of absorbed radiation dose of ionizing radiation, e.g., x-rays.  For FDA findings, see David C. Spelic, “Dose and Image Quality in Mammography: Trends during the First Decade of MQSA,”http://www.fda.gov/RadiationEmittingProducts/Mammography QualityStandardsActandProgram/FacilityScorecard/ucm113606.htm.  Downloaded March 3, 2015.

[5] 1990 Recommendations of the International Commission on Radiological Protection (ICRP Publication 60). (Oxford: Pergamon Press, 1991).

[6] Food and Drug Administration, Mammography Quality and Standards Act Regulations, (67 FR 5446), Subpart B, Section 900.11 (e)(5)(iv)-(x), http://www.fda.gov/Radiation-EmittingProducts/ MammographyQualityStandardsActandProgram/ Regulations/ucm110906.htm.  Downloaded March 3, 2015.

[7] Joann G. Elmore, et al., “Diagnostic Concordance Among Pathologists Interpreting Breast Biopsy Specimens,” Journal of the American Medical Association, Vol. 313, No. 11 (March 17, 2015), pp.1122-1132.

[8] Mei-Sing Ong and Kenneth D. Mandl, “National Expenditure for False-Positive Mammograms and Breast Cancer Overdiagnoses Estimated at $4 Billion A Year,” Health Affairs, Vol. 34, No. 4 (April 2015), pp. 576-583.

[9] Denise Grady, “In Shift to Digital, More Repeat Mammograms,” The New York Times (April 20, 2008).

[10] National Academy of Sciences-National Research Council, The Biological Effects of Radiation:  Summary Reports (Washington, DC: 1960).

[11] National Academy of Sciences-National Research Council, The Biological Effects of Radiation:  Summary Reports (Washington, DC: 1960), p. 3.

[12] National Academy of Sciences-National Research Council, The Biological Effects of Radiation:  Summary Reports (Washington, DC: 1960), pp. 27-29.

[13] National Academy of Sciences-National Research Council, The Biological Effects of Radiation:  Summary Reports (Washington, DC: 1960), pp. 32-35.

[14] For example, “at the level of cancer-associated gene or chromosomal mutation, the presence of a true dose threshold demands totally error-free DNA damage response and repair.” National Academy of Sciences, Biological Effects of Ionizing Radiation, V (National Research Council, 1990),  National Academy of Sciences, Biological Effects of Ionizing Radiation, VII, Phase 2 (National Research Council,  2006), p.245.

[15] National Cancer Institute, “A Snapshot of Thyroid Cancer.” http://www.cancer.gov/researchandfunding/progress/snapshots/thyroid;  National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER) Program, FastStats, Table 26.3.  Downloaded April 14, 2015.

[16] Alan S. Go, MD, et al., “AHA Statistical Update: Heart Disease and Stroke Statistics—2014 Update: A Report From the American Heart Association,” Circulation, Journal of the American Heart Association (December 18, 2013); Source: National Center for Health Statistics:  “Health, United States, 2012,” Hyattsvile, MD (2013); National Center for Health Statistics, “Health, United States, 2010, With Special Feature on Death and Dying” (Hyattsville, MD., 2010).

[17] Earl S. Ford, MD., et al., “Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980-2000,” New England Journal of Medicine, Vol. 356 (June 7, 2007), pp. 2388-2398.

[18] National Center for Health Statistics:  “Health, United States, 2012,” Hyattsvile, MD (2013); National Center for Health Statistics, “Health, United States, 2010, With Special Feature on Death and Dying” (Hyattsville, MD., 2010).

[19] See, for example, Hope Ricciotti, MD, “Heart Disease – Differences Between Men and Women,” Beth Israel Deaconess Medical Center. http://www.bidmc.org/Centers-and-Departments/Departments/Medicine/ Divisions/Cardiovascular-Medicine/For-Patients/Your-Heart-Health/Tips-for-Heart-Health/Heart-Disease—Differences-Between-Men-and-Women.aspx. Downloaded March 17, 2017, and Mike Zimmerman, “Heart Disease: Lifesaving News,” AARP: The Magazine (April-May, 2014).

[20] National Cancer Institute, “Breast Cancer Screening (PDQ®): Harms of Screening Mammography: Overdiagnosis,” Update: February 6, 2015. http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional/page8. Downloaded February 25, 2015.

 

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Posted on: 06.18.2015

Mammography’s Shadows, VI: The National Cancer Institute Weighs In

by Sylvia Kraemer
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Posted in Uncategorized

Crab Image

Like all federal agencies the National Cancer Institute is subject to indirect political pressure through congressional and executive branch control of agency budgets.  Such pressure can and does influence programmatic decisions. That had been the case with the Breast Cancer Demonstration Project of the 1970s (see this blog’s post for May 25, 2015, “Mammography’s Shadows: The Campaign,”).

But thanks to federal commercialization policy, which prohibits government agencies from competing in the market for commercially available products and services, neither the institutional survival of federal mission or regulatory agencies, nor their employees’ job security, depends on revenue streams from medical procedures, equipment, and pharmaceuticals. Moreover, the science intensive agencies, such as the National Institutes of Health, supplement their internal scientific capabilities with advisory groups and consensus conferences of outside researchers, while those agencies reserve to themselves the duty of final arbiter of disputed research findings.

Thus it should not be surprising that the National Cancer Institute’s own positions on the benefits and risks of screening mammography might vary from those taken by the American Cancer Society and Memorial Sloan Kettering Cancer Center.  When reporting on screening mammography in the framework of its parent agency’s (National Institutes of Health) goals for its “Healthy People Program”[1], a programmatic document,  the NCI cautiously endorsed widespread screening mammography.

But it did so with subtle differences, noted here in italics: In 2012 the institute wrote  biennial “mammography screening allows for the early detection of breast cancer, which may help reduce mortality from breast cancer, especially among women aged 50 to 69 years.”  For these women “there is solid evidence that screening may lower this risk by up to 30 percent.  For women in their 40s, the [mortality] risk may be reduced by about 17 percent.  For women aged 70 and older, mammography may be helpful, although firm evidence is lacking.”[2]

In the NCI’s subsequent breast cancer screening guidance for health professionals, however, the federal cancer agency explicitly relied on the comprehensive ‘physicians data query (PDQ®)’ research database.  This evidence-based foundation, in contrast to the policy goals of the NIH, supported a much different construction. Well over half of the 38 research reports referenced in the guidance were published after 2000, none was published prior to 1990, and missing are citations to the “large randomized trials conducted a generation or more ago” upon which Memorial Sloan Kettering claimed it based its own mammography screening guidance.

Noticeable by its repeated appearance among the published research reports referenced by the NCI is the work of H. Gilbert Welch, Professor of Medicine at Dartmouth’s Geisel School of Medicine, and Peter C. Gøtzsche of the Nordic Cochrane Center, and their co-investigators.  Since the early 1990s Welch in particular has been calling attention to screening mammography’s hazards of over-diagnoses and over-treatment.[3]

Peter C. Gøtzsche, meanwhile, has been a thorn in the side of routine mammography screening advocates, because the Cochrane group’s rigorous meta-analyses of randomized controlled trials in medicine have failed to support the claim that screening mammography reduces breast cancer mortality, while also suggesting it results in significant over-diagnoses and over-treatment.[4]  In a debate about the health of women’s bodies dominated overwhelmingly by men, it’s noteworthy that two laudatory forwards to Gøtzsche’s 2013 book were written by women, the President of the National Breast Cancer Coalition (Fran Vesco) and President of the Royal College of General  Practitioners (Iona Heath).

The NCI evaluated screening mammography research studies on the basis of both their internal validity (reliability of cause-effect relationship, elimination of confounding variables) and external validity (generalizability beyond populations studied).[5]  In the February 2015 update to its December 2014 health professionals’ review of breast cancer screening, the NCI analyzed research findings as they would apply to 10,000 women who undergo annual screening mammography (a) for women in their 40s, 50s and 60s, and (b) extending over two time periods, 10 years and 15 years.  Given cancer latency which can reach beyond 10 years, the longer time periods are important.

The institute’s research analysts found that the best estimates of cancer deaths averted over the next 15 years for women in their 40s attributable to screening mammography did not exceed .16% (or 16 out of 10,000).  That percentage increased slightly for women in their 50s (at most .32% or 32 out of 10,000) and again for women in their 60’s (at most .49% or 42 out of 10,000).  At no time did the estimates approach 1%.

At the same time, the best estimates of the false-positive results during a ten year period reached minimums of 59% (5,940 out of 10,000) for women in their 40s, 58% for women in their 50s, and 48% for women in their 60s.[6]  False-negative results occur as well, and no doubt the fear of that result accounts for what the NCI concluded was the “biggest risk factor for having a false positive mammogram,” namely “the individual radiologist’s tendency to read mammograms as abnormal.”[7]

Especially valuable was the NCI’s effort to wrestle with the question of over-diagnosis, or the diagnosis and treatment of cancers over the 10 year period that would never have become clinically significant.  Since “cancers that will cause illness and/or death cannot be confidently distinguished from those that will remain occult . . . all cancers are treated.”  But an effort to assess the extent and circumstances of over-treatment is critically important to those women suffering through treatment unnecessarily, albeit generating revenue for those furnishing it.

The NCI approached this question by examining studies comparing breast cancer incidence before the introduction of screening mammography, and afterwards.  If mammography screening has an appreciable effect, the incidence of cancer detected in a population should increase during the early years of screening, but then the incidence should decline in later years.  This would result from cancers having been found earlier that would have been palpable only in later years.

What the NCI analysis of population-based screening data from studies in Norway, Sweden, the United Kingdom, and the United States found was that “breast cancer incidence rates increase at the initiation of screening without a compensatory drop in later years.”

One study in 11 rural Swedish counties showed a persistent increase in breast cancer incidence following the advent of screening.  A population-based study showed increases in invasive breast cancer incidence of 54% in Norway and 45% in Sweden in women aged 50 to 69 years, following the advent of screening.  No corresponding decline in incidence in women older than 69 years was ever seen.[8]

While couched in terms of evidence of possible over-diagnosis, the NCI’s analysis of trends in breast cancer incidence before and after the introduction of screening mammography is an important step toward liberating the debate over mammography screening from the very narrow epistemic and conceptual confines within which it has been conducted over the past half-century.

First, measuring the value of screening mammography entirely in terms of “early treatment saves lives,”  limits the question to mortality data, which seems certain and definite.  But the reporting of deaths and determination of their causes is not an exact or detached science, especially when applied to older persons.[9]  Secondly, while male physicians naturally incline to the heroic aspiration to preserve life (postpone death), those female patients who must suffer through ultimately unsuccessful breast cancer treatment may prefer quality of life over its duration.  But those patients are unlikely to know at the onset how long their treatment must be endured and whether it will succeed.

Secondly, the mantra “early detection saves lives” assumes that we know enough about the causes and optimal treatments for various breast cancers to fulfill the promise of “early detection.”  This assumption becomes critical to the validity of all statistically based arguments for screening mammography:  it requires that breast cancer treatment for all women is a constant and thus neutral factor, when it In fact is a critical and unstable variable.

One of the few comments responding to the Canadian National Breast Cancer Study published in the British Medical Journal (2014) that did not get ensnared in numbers generated by randomized control trials came from Donald L. Benjamin, a researcher at Australia’s Cancer & Support Society.  Benjamin’s own research into the efficacy of surgery for breast, bowel, lung, prostate and ovarian cancer (research also based on randomized controlled trials) led him to conclude that breast cancer is a systemic disease, and its tumors are symptoms rather than its causes.[10]  While this is not a new insight, its truth confounds efforts to reduce standard modes of breast cancer detection and mortality to simple comparative numbers.

The appreciation of breast cancer’s systemic character has had a substantial effect not only on determining risk (e.g., the presence of biomarkers such as mutations of the BRCA1 and BRCA2 genes in families experiencing unusual levels of breast and ovarian cancers[11]).   Our increased understanding of the role of estrogen receptors (ER) in breast cancer has led to successful endocrine therapies using tamoxifen, an ER suppressor, and aromatase inhibitors that block the enzymes that convert androgens into estrogens.[12]  How effective these therapies are, and their side-effects, continue to be examined, as they should be.

In short, understanding how breast cancer works is an ongoing process, and breast cancer therapies are not fixed in time, nor are their results for all women constant or uniform. Thus the most important variable in efforts to link screening mammography and breast cancer mortality is the etiology of breast cancer in individual women.  Treating breast cancer morbidity as a neutral constant, as one attempts to establish a linear relationship between tumor phase at detection and breast cancer mortality, is the most serious weakness in all quantitative justifications for screening mammography.

Thirdly, by assessing methods of breast cancer detection or treatment solely within the limited epistemic and conceptual confines of breast cancer itself, we neglect the single most compelling constant of all:  the irradiation of women’s breasts, with inevitable x-ray scatter to the torso during mammography screening, diagnostic mammography, and radiation treatment.

This has turned out to be a very high risk to take, all in order to spare women of any age from breast cancer deaths at the rate of less than on-half of one percent per 10,000.

(Published June 18, 2015.  Our next and final post in the “Mammography’s Shadows” series looks at the now apparent consequences for untold women of their cumulative annual exposures to breast x-rays.  It also notes that it was women, not only because of the nature of their disease but because of cultural attitudes, who were persuaded to participate in this long-term and hazardous medical experiment.)

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[1] See: http://www.healthypeople.gov/2020/about/History-and-Development-of-Healthy-People.

[2] The federal Healthy People 2010, 2020 target is biennial mammography screening for 70% of all women over 40, a target that was met only briefly in 2003. National Cancer Institute, “Cancer Trends Progress Report-2011-2012 Update: Breast Cancer Screening.” http://progressreport.cancer.gov/ doc_detail.asp?pid=1&did=2011&chid=102&coid=1016&mid=. Downloaded March 9, 2015.

[3] See, for example, H. Gilbert Welch, Should I be Tested for Cancer?: Maybe Not, and Here’s Why (University of California Press, 2006), and H. Gilbert Welch, “Breast Cancer Screenings: What We Still Don’t Know,” The New York Times (Dece,ber 29, 2013).

[4] See Donald G. McNeil, Jr., “Confronting Cancer: Scientist at Work — Peter Gotzsche: A Career That Bristles With Against-the-Grain Conclusions,” The New York Times (April 9, 2002), and Gøtzsche, Peter C. Mammography Screening: Truth, Lies and Controversy. (Radcliffe Publishing Ltd., 2012).

[5] National Cancer Institute, “Breast Cancer Screening (PDQ ®): Health Professional Version,” (December 5, 2014). http://www.cancer.gov/ cancertopics/pdq/screeningbreast/healthprofesional/.Downloaded December 20, 2014).

[6] National Cancer Institute, “Breast Cancer Screening (PDQ®): Harms of Screening Mammography,” Update: February 6, 2015. http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional/page8. Downloaded February 25, 2015.

[7] National Cancer Institute, “Breast Cancer Screening (PDQ®): Harms of Screening Mammography,” Update: February 6, 2015. http://www.cancer.gov/ cancertopics/pdq/screening/breast/healthprofessional/page8. Downloaded February 25, 2015.

[8] National Cancer Institute, “Breast Cancer Screening (PDQ®): Harms of Screening Mammography: Overdiagnosis,” Update: February 6, 2015. http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional/page8. Downloaded February 25, 2015.

[9] See for example, Kathryn Schulz, “Final Forms:  What Death Certificates Tell us, and What They Don’t,” The New Yorker (April 7, 2014), pp. 32-37.

[10] Donald L. Benjamin, “Comment re. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: Randomised screening trial,” British Medical Journal (11 February 2014), http://www.bmj.com/content/348/bmj.g366, Downloaded March 2, 2015; DonaldJ. Benjamin, “The Efficacy of Surgical Treatment of Cancer-20 Years Later,” Medical Hypotheses Vol. 82 (2014), pp. 412-420.

[11] BRAC1 and BRCA2 are human genes and their proteins that participate in the repair of damage to the chromosomes and DNA, and the destruction of cells with damaged DNA.

[12] Monica Morrow, MD, “50 Years in Breast Cancer: Dramatic Progress in Treatment Based On an Improved Understanding of Biology,”  Annual Meeting of the American Society of Clinical Oncology, 2014. http://am.asco.org/50-years-breast-cancer-dramatic-progress-treatment-based-improved-understanding-biology. Downloaded  January 3, 2015.

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Posted on: 08.18.2014

That ‘Vision Thing’

by Sylvia Kraemer
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Not the least of Maine’s glories is her coastline, thousands of miles of it, with countless harbors offering respite or refuge for her many sailors.  And experienced sailors know that, while they can find a harbor on a nautical chart, the likelihood of their arriving there depends upon a well-weighted keel and their crews’ ability to tack to ever changing winds.

Thus this Mainer was struck by Hillary Rodham Clinton’s Janus-faced complaint that the president who enabled her to become Secretary of State lacked a foreign policy with “vision,” or an “organizing principle.”  Former President George H. W. Bush could sympathize with President Obama; he, too, was blamed for lacking “the vision thing.”[1]

One of the most powerful “organizing principles” of the last two centuries has been that of the unified nation state as the driving force of history.  As a monument of German political theory in the 19th century, the idea’s most enduring consequences lay amid the carnage of two world wars.

But the ideal of the unified nation state has had a powerful influence here, too.  The preservation of the union was Abraham Lincoln’s vision when he decided to resupply Fort Sumter in Charleston Harbor (April 15, 1861).[2] By contrast, the Emancipation Proclamation of January 1, 1863, was a smart tactical measure–but of no less historic consequence.

The Civil War also produced this country’s only original formal philosophy—pragmatism: Sanity, in public as in private life, belongs not to the hedgehog, with its one big idea, but to the foxes, who know many things.[3] Nothing, then, could be more American than President Obama’s notion that, above all else, we should not do something stupid.

Weary of the 1970s, this country may have been comforted to hear Ronald Reagan’s invocation of the United States as “a city on a hill.”  But John Winthrop’s Puritan vision for the tiny, homogeneous Massachusetts Bay Colony no longer befits a large, heterogeneous, diverse, and generally bumptious land like ours.  To much of the rest of the world, a city on a hill bears a strong resemblance to an empire upon which the sun never sets.

“Strategic vision,” an ill-fitting combination of military theory and romantic idealism, has surely become one of the most widely hawked nostrums of modern management in both private and public sectors.  Were public administration (a.k.a. “government bureaucracy”) less a subject of general opprobrium, more of us would know of Charles E. Lindblom’s now classic essay, “The Science of ‘Muddling Through’” (1959).[4]

In it Lindblom argues convincingly that the inherently messy business of democratic politics is not such a bad thing, because “muddling through” would “assure a more comprehensive regard for the values of the whole society than any attempt at intellectual comprehensiveness.”

Which brings us to the University of Southern Maine’s costly—in consultant fees, faculty time, student distraction, and administrative overhead—groping for the single “organizing framework” or “vision” to lead itself out of its budgetary doldrums.  A university should require no management consultants and community meetings to help it identify its guiding vision for the future.  The idea of a university is the vision:  a place of cosmopolitan learning and liberation from dogmas past and present.  Attaching its fortunes to any local community is to risk its future on local values. The idea of a university is the boat’s well-weighted keel.  A nimble faculty crew, and a captain who can read the water as well as the sails, will maintain the boat on its proper voyage.

But not all of us in Maine are sailors.  For those who aren’t, there is wisdom from John Irving’s “The Cider House Rules,” set in Maine.  It comes from Arthur, head of the seasonal apple-picking crew: “know what your business is.”

 

[1] Time magazine (January 26, 1987).

[2] Sylvia Fries (Kraemer), “Abraham Lincoln and the Language of Sectional Crisis,” Lincoln Herald (1977).

[3] “The fox knows many things, but the hedgehog knows one big thing” -Archilochus

[4] Public Administration Review, Vol. 19 (1959), 79-88.

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Posted on: 07.14.2014

The New Enclosure (Part II)

by Sylvia Kraemer
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Posted in Environmental Policy, Intellectual Property, Open Systems, Science and Engineering in the Law, Science and Policy, Technology in US Politics, Uncategorized

The notion that the things we create belong to us is not new; it dates back at least to 560, when Ireland’s King Diarrmait ruled against the monk Colmcille, who had secretly copied his mentor Finnian’s psalter.  (Legend records Diarmait’s judgment as “To every cow belongs her calf, therefore to every book belongs its copy.”)

But that is not how President Andrew Jackson’s appointee to the U.S. Supreme Court Justice John McLean applied the principle in his majority opinion in Wheaton v. Peters (1834).  Scholars can debate whether ownership of one’s own original works is in fact a natural or common law right, as King Diarmait supposed, or whether it is a privilege granted by the sovereign.[i] But Justice McLean could find in the United States no common law right to the exclusive use of one’s creations.

At issue was whether Henry Wheaton enjoyed a common law copyright in the annotated  reports, with opinions, of the Supreme Court that he had prepared and published, a copyright that Richard Peters had violated when he published cheaper, abridged editions of  Wheaton’s reports.

Two lower courts had held, as McLean would affirm, that:

“It is clear there can be no common law of the United States. The federal    government is composed of twenty-four sovereign and independent states, each of which may have its local usages, customs, and common law. There is no principle which pervades the union and has the authority of law that is not embodied in the Constitution or laws of the union.”[ii]

Only the Congress, by virtue of section eight of the first article of the Constitution, has the power “to promote the progress of science and useful arts, by securing for limited times, to authors and inventors, the exclusive right to their respective writings and discoveries.”  “Congress,” wrote McLean, “by the act of 1790, instead of sanctioning an existing perpetual right in an author in his works, created the right, secured for a limited time, by the provisions of that law.”[iii]

And then, at the end of his majority opinion, McLean added:

“It may be proper to remark that the Court is unanimously of opinion that no reporter has or can have any copyright in the written opinions delivered by this Court, and that the judges thereof cannot confer on any reporter any such right.”

Thus it was that the U.S. Supreme Court established, almost as an afterthought, that the information generated by those in whom the “People of the United States” have vested their  legislative, executive, and judicial powers, belongs to the people of the United States, and that any proprietary right in that information can be granted only by the Congress, as provided in Article I, Section 8.

In the modern world intellectual capital is the purest coin of any realm.  No less than the metallic coin of economics, its greatest social benefits accrue from widespread accumulation and circulation.  Before World War II the largest accumulation of intellectual capital owned by the federal government took the form of census data, information gathered by regulatory agencies, and scientific and technical information collected by the departments of Agriculture, Interior, the US navy, army, and coast guard.  Of comparable value for the continuation of democracy was the growing body of  interrelated reports prepared by the legislative, judicial, and executive branches of government and their administrative agencies.

World War II and the Cold War resulted in the unprecedented expansion of publicly directed and funded research. Federal investments in research and development (R&D) increased at over twice the rate of the total federal budget between 1940 and 1980.  This research produced new ideas and knowledge—information necessary for effective understanding and action—of inestimable value.

Most of those federal dollars—which grew from $186 million in 1940 to over $72 billion in 2000—flowed as contracts and grants  through the procurement offices of the departments of defense and energy, the National Institutes of Health, and the National Aeronautics and Space Administration.   Those dollars then began to substantially support the budgets of an expanding aerospace and healthcare industry, as well as research universities. The accumulated skills of these private sector institutions at obtaining federal grants and contracts, and their lobbying to sustain the federal research and development programs that produced them, ensured that they would receive the lion’s share of the public’s R&D investment for decades to come.

At the start of the 21st century three fourths or more of the R&D budgets at each of the principal federal research and development agencies[iv] went to a relatively small group of corporations that included such familiar heavy-hitters as Lockheed-Martin, Boeing (which absorbed McDonnell Douglas in 1997), Raytheon, Bechtel, TRW, and Science Applications International.  Beneficiaries among academic institutions included the universities of California, Michigan and Washington, Columbia, Stanford, and the Johns Hopkins University.

Before the 1980s, once a sponsoring agency obtained information from a recipient of one of its research grants or contracts,  members of the public could, in turn, request that information under the federal Freedom of Information Act or FOIA (subject to the usual privacy or national security exemptions).  Most agencies, however, settled for research reports, accepting their contractors’ or grantees’ claims that data must be withheld from the public in order to protect the identity of human research subjects, sequester data prior to its publication in peer-reviewed research journals, or to protect the data’s potential proprietary value.

Waiving delivery of research data as a matter of policy received the imprimatur of the U.S. Supreme Court in 1980, when it ruled (in Forsham v. Harris) that if a federal agency did not actually create or obtain research data itself, such data could not be considered federal records and subject to the FOIA.  Forsham was a boon to academic research institutions that had wandered from their ideological moorings of disinterested science into the sporty waters of high-technology business, a process well-captured in Daniel S. Greenberg’s Science for Sale: The Perils, Rewards, and Delusions of Campus Capitalism (2007).

Then, critics of the national air quality standards released by the Environmental Protection Agency in 1997 during the Clinton administration, led by Senator Richard Shelby (R-AL), complained that not only would the standards burden industry with ruinously high compliance costs, but several studies of toxic effects of air and water pollutants had later proven faulty.  Thus, given their serious policy consequences, data collected by the EPA for setting its standards should be available for public inspection.  Shelby attached to the Omnibus Appropriations Act for fiscal year (FY) 1999 an amendment requiring federal agencies to disclose “all data produced under a [federally funded research] award.”  The scientific community arose in alarm.[v]

Led by the National Academy of Sciences, the scientific establishment persuaded the White House’s Office of Management and Budget (OMB, which oversees the writing of regulatory language implementing federal statutes) to define research data subject to public disclosure in a way that would serve its expanding proprietary interests.  The OMB ultimately excluded from research data subject to FOIA disclosure any data supporting regulations having an impact of less than $100 million, and “materials necessary to be held confidential by a researcher until they are published, or similar information which is protected under law” (e.g., intellectual property.)  The Shelby amendment, once it emerged from OMB’s process, had a lethal weakness: What constituted research “data” under OMB’s ‘clarifying’ definitions could be determined only by those who held it, viz., the same research scientists wanting to retain the data for their own uses.[vi]

Just how important public access to the results of its own investment in intellectual capital had become was evident with the completion in 2000 of the joint U.S. and British Human Genome Project.  Prime Minister Tony Blair’s and President Bill Clinton’s joint statement that “the genome should be made freely available to scientists everywhere” sent bio-technology stocks plummeting.  Investors had concluded that the federal government would oppose patenting human genomic data.  In a hasty effort at damage control, the White House urged the securities markets to read the leaders’ joint statement more carefully, where they would find: “Intellectual property protection for gene-based inventions will also play an important role in stimulating the development of important new health care products.”[vii] (To continue reading about the proprietary capture of public intellectual capital, see The New Enclosure-Part III).

 

[i] Adam Mossoff, “Who Cares What Thomas Jefferson Thought about Patents?  Reevaluating the Patent ‘Privilege’ in Historical Context,”  Cornell Law Review, Vol. 92, No. 953 (2007).

[ii] U.S. Supreme Court, Wheaton v. Peters, 33 U.S. (8 Pet.) 591 (1834).

[iii] U.S. Supreme Court, Wheaton v. Peters, 33 U.S. (8 Pet.) 591 (1834).

[iv] Departments of Defense and Energy, the National Science Foundation, National Institutes of Health, and the National Aeronautics and Space Administration.

[v] National Research Council, Bits of Power: Issues in Global Access to Scientific Data (Washington, DC: National Research Council, 1997).

[vi] Sylvia Kraemer, Science and Technology Policy in the United States: Open Systems in Action (Rutgers Univesity Press, 2006, pp. 102-108.

[vii] White House Office of Science and Technology Policy, “Joint Statement by President Clinton and Prime Minister Tony Blair of the U.K.,” March 14, 2000.  Alex Berenson and Nicholas Wade, “The Markets: Stocks & Bonds; A Call for Sharing of Research Causes Gene Stocks to Plunge,” The New York Times (March 15, 2000).

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Posted on: 01.23.2014

Why The Liberal Arts?

by Sylvia Kraemer
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Posted in Art and Culture, Colleges and Universities, Education, History of Ideas, Uncategorized

 

It’s difficult to hear a discussion of education in the United States without being reminded of the urgency of increasing students’ proficiency in ‘STEM’ (science, technology, engineering and math) disciplines.  This, we learn, is necessary to secure their competitiveness in a technology-driven job market.  What is too rarely pointed out is that a primary purpose of technological innovation is to reduce labor costs, i.e., reduce jobs.  “New” technologies do not necessarily do an adequate job of replacing the jobs lost from obsolete industries.

We have been here before.  During the 1950s and 1960s, besting the Soviet Union in the “space race” required thousands of well-trained engineers.  That we had such individuals was a result not of STEM education campaigns, but GI-bill education benefits designed to soften the impact on unemployment by demobilized service men and women.

The National Defense Education Act of 1958 boosted college attendance from 15% to 40% in all disciplines, with results that are as interesting to social historians as to presidents of colleges and universities who have struggled to sustain the rapid campus expansions of the 1960s and 1970s.

Then, in the early 1980s, we were once again consumed by fears of national decline when faced with growing industrial powerhouses in formerly ‘foreign’ places, e.g., Japan—a fear well documented by David Halberstam’s The Reckoning (1986).  The Reagan administration, only a few months into its first term, appointed a National Commission on Excellence in Education which, in August of 1981, released “A Nation at Risk: The Imperative for Educational Reform.”

The report begins: “Our Nation is at risk. Our once unchallenged preeminence in commerce, industry, science, and technological innovation is being overtaken by competitors throughout the world.”  Less well remembered is the report’s emphasis on disciplines other than STEM, disciplines that lie at the heart of a liberal arts education:

“Our concern, however, goes well beyond matters such as industry and commerce. . . .  For our country to function, citizens must be able to reach some common understandings on complex issues, often on short notice and on the basis of conflicting or incomplete evidence. . . .  Indicators of the risk [include] . . . About 13 percent of all 17-year-olds in the United States can be considered functionally illiterate [while] nearly 40 percent cannot draw inferences from written material;  only one-fifth can write a persuasive essay.”

And now we have the results of a study, conducted by the American Association of Colleges and Universities and National Center for Higher Education Management Systems, released this week, of the education and occupation of 3 million US residents between the ages of 21 and 65.  Comparing the “earnings trajectories and career pathways” of majors in the liberal arts with those from STEM and professional or pre-professional fields, the study found that not only does a college degree matter, but that “at peak earnings ages (56-60)” liberal arts majors earn on average more than those who majored in the other fields.  What’s more, unemployment is lower among mature workers who were liberal arts majors.

This study, based on 2010-2011 census data, confirms what many of us have learned from experience: ordinary social skills and technical preparation may get a young adult through the gate, but they will not equip him or her to stay the course.  That is because a lifetime of work and living is full of change—personal and historical.  Success in living and working requires a well-furnished imagination; empathy for the many different ‘others’ with whom we will need to cooperate;  a grasp of the power of aesthetic pleasure of all kinds;  and a full command of at least one language enabling us to be articulate in a complete and accurate way.

These attributes come primarily from immersion in the liberal arts, a microcosm of a universe where syntax and a rich vocabulary matter not because of “correct form,” but because they build meaning, and meaning matters.  A few years out of a lifetime spent in the study of good writing, be it fiction or expository prose;  of social and political philosophies and systems;  of aesthetics made manifest in the arts; and, most of all, of the rich storehouse of human experience captured in our history, has been demonstrated, once again, to be time well spent.

###

 

 

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Posted on: 02.16.2013

National Public Wi-Fi: Why it Matters to You

by Sylvia Kraemer
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Posted in History of Ideas, Open Systems, Politics, Science and Engineering in the Law, Technology in US Politics, Uncategorized

 

A recent proposal by Federal Communications Commission (FCC) chairman, Julius Genachowski, would recover some of the country’s little used radio and TV broadcast radio spectrum in order to create a national public wireless (WiFi) network.  Telecommunications companies, which make money selling data plans to enable smart phone and Wi-Fi computer users to access the Internet, are lobbying against the proposal.

Such a network would, of course, be a boon for countless small businesses and Internet-linked technology developers, not to mention the rest of us.  But Chairman Gnachowski’s  proposal also rests on sound historical and policy precedents.

By international law the federal government is responsible for the private as well as public use within the U.S. of the global radio spectrum—which does not “belong” to anyone any more than the sky or the oceans belong to anyone, not even to “job creators” in the telecom industry.

The digital electronic impulses that bring text and images to the screens of our smart phones and Wi-Fi enabled computers are similar to the analog electromagnetic impulses that Samuel Morse tapped out to send the first telegraph in 1844.  Today those digital electronic information “packets” can travel beyond the wires and cables around and above us, carried into remote places by the invisible radio wave spectrum that encircles our globe.

The need for public regulation of the use of radio waves first became obvious in 1912, when radio communications following the Titanic’s distress signals on the night of April 14 were confused, if not unintelligible, thanks to the swarm of amateur radio operators busily working the airwaves.   Within a year the Congress had established (with the Radio Act of 1912) that the federal government would regulate both wire-line and wire-less communications, a principle which has stood firm for over a century of statutory action and judicial decision-making.

Those of us who do not yet use the Internet with mobile devices may be tempted to dismiss these increasingly ubiquitous gadgets as fads, high-end toys for grown-ups and over-indulged children.  But there is little that we do today that does not at some point involve the use of devices relying on the radio spectrum, from automatic garage door openers to cell phones to the remote controls for our television sets.

More importantly, radio waves provide the essential ‘highways’ to every location for the transmission of news, information, electronic libraries, educational programming, remote medical and research data, and only lastly entertainment.  Once upon a time radio waves sent the news to listeners gathered around brown bakelite boxes.  Millions more now receive over the air the electronic data that produce text and graphics on their touch screens.  And as the technology gets cheaper millions more will join the touch screen world.  The telecommunications industry—AT&T, Verizon, T-Mobile, and others—knows this.

But so does the FCC.  The Internet was built with public funds, for the use of all Americans.  Unless all Americans are able to use it, the open public forum that has served democracy by offering a platform and audience for free speech will become enclosed by proprietary technological and monetary barriers.

The Internet is not intellectually inert.  Each webpage contains information and images selected for it by its website ‘builders,’ people who also decide which links to further—and possibly contrary or controversial—information will be included, or not.  Our best assurance of an Internet that disseminates a continual conversation of new as well as old voices, rather than an ongoing chorus of the like-minded, is a genuinely publicly accessible Wi-Fi network.

Like the operators of all public utilities, Wi-Fi operators will need to receive reasonable compensation as incentives for efficiency and innovation.  But you and I, not industry CEOs, should decide what is reasonable.

The big telecommunications companies will be spending bundles of money to persuade us—and lawmakers—that Wi-Fi is a commercial service coupled to their commercial products, access to which should be priced in the marketplace.  And they will be wrong.

 

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Posted on: 01.07.2013

Lessons From Our Table

by Sylvia Kraemer
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Posted in Art and Culture, Uncategorized

One of the blessings of the past holiday for this Maine parent was the return of adult children home for Christmas.  Humorists console some of us with tales of dysfunctional families to help dispel the mixed emotions conjured up by the holidays.  A largely functional family is also a blessing.

Ours has slogged its way through rough patches, and survived with humor and love intact, and more intelligence than when we started.   My three ’30-something’ children appear happy, have graduated from good universities, and are well on their way in their chosen professions—which might help to pay a few jaw-dropping student loans.

For their travels they were rewarded with a white Christmas (and New Year’s), not to mention the Portland Stage’s splendid performance of Dickens’ ‘A Christmas Carol.’  ‘Wow!’ said one of the three at the end, as he replaced the tissue furtively dug from a pocket to vanish the tear that no one noticed but his Mother.

The greatest pleasures were the conversations while dining with family and friends, and this year conversation often returned to those things that combine to form an education.   What transpires in Maine’s many varied K-12 schools will occasion a good bit of heat in 2013 (as it does every year) and, often more heat than light.  So, here is what attentive guests at our holiday meals might have taken away from our chatter:

‘Schooling’ is useful, but over-rated, whether one is schooling at home, or in a classroom.  Basic literacy and numeracy are essential, of course, but let us not fool ourselves into thinking that when the little ones traipse off to school—or we put away the breakfast dishes and haul out the ‘do it yourself’ teaching materials—that we are educating our children in the fullest sense of the term.

We learn less by instruction or persuasion, than by example.  Children regularly exposed to curiosity and wisdom in the adults who surround them will learn to recognize curiosity and wisdom not only in others, but as something to emulate in themselves.

With the possible exception of the ‘STEM’ subjects [science, technology, engineering and math], which by their nature require extensive systematic preparation to master, there are other vital qualities we invoke when we talk about education—qualities which, like the Christmas ghosts who escorted Mr. Scrooge on his painful journey—cannot be conjured up  from lesson plans.

“Critical thinking skills” and “creativity” —these important concepts have become the overused and under-examined bromides of our education debates, offered in contrast to the rigid accountability of standardized testing.  But neither critical thinking nor enduring creativity can emerge from vaporous language or vacuous minds.

The minds of children and the young need furnishing.  Woe to the child whose mind is furnished by the gargantuan marketing machine we call the ‘entertainment industry.’  The best furnishing comes through direct experience—broadened, deepened, and examined through reading.

It will be said that many children do not come from families where books and reading are a fact of daily life.   That may be so; but it is not insurmountable.  One of my children’s favorite memories is of Mrs. Zuidama, a warm and wise woman at their day-care center, who set aside an hour every day for story time.

Even earlier, as soon as the youngest could sit up in a stroller, we went several times a week to the children’s corner of the Bangor Public Library to paw through the shelves for our ‘take home’ books.  We rarely missed a weekly morning story time led by one of the librarians.

Read to children until they insist on reading for themselves.  What to read?  Ask your school or public librarian—who will appreciate the question.  Browse through the books yourself.   At our dinner table, the titles tumbled out, beginning with “Pat the Bunny” and “Goodnight, Moon.”  We have our favorites, but children are entitled to discover theirs.

E-readers and tablets?  They are no substitute for a child’s beloved jam-encrusted, page torn, spine frayed, and bed cover-buried book.  When the e-reader has run out of battery and we can’t find the dang charger, Charlotte will still be spinning her web.

 

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Posted on: 12.04.2012

Senator Rubio’s Mistake

by Sylvia Kraemer
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Posted in Art and Culture, Current History, History of Ideas, Politics, Science and Policy, Uncategorized

An astronomer writing in Slate recently takes Senator Marco Rubio (R-Fla.) to task for being unable (or unwilling?) to give the astronomers’ answer to a reporter’s question, posed during a press interview, about the age of the Earth.  After noting that the question has nothing to do with the proper subject of the interview, Rubio responds that the Earth’s age is a “mystery,” and that some believe the Biblical account of the Earth’s creation.

Not only is the hapless Senator a member of the Senate’s Commerce, Science and Technology Committee (and therefore he should have basic scientific facts on the tip of his tongue), but as a member of Congress he should know the age of the Earth because “all of our industry, all of our technology, everything that keeps our country functioning at all can be traced back to scientific research and a scientific understanding of the universe.”

Set aside the question of whether the astronomer has, on the tip of his tongue, the number identifying the next Congress (which will also be of great import to the nation, and the number is 113-1).  His argument is such a caricature of the rhetoric the science establishment trots out to appeal for funding increases that he does the cause of public support for scientific research a disservice.

Being able to remember a number (especially out of context) is hardly a sign of intelligence, character, wisdom or civic virtue, as Albert Einstein was not the first to remind us.  What’s more, beyond such accumulated physical facts as the contents of the periodic table or the boiling point of water, any scientific knowledge that cannot be replicated under laboratory conditions is dependent on the circumstances of its discovery.

Historians and philosophers of science, at least since Karl Popper, have convincingly demonstrated the contingency of most scientific “truths.”  Nor has the total reliance  of the economy and technological growth on scientific research been substantiated by decades of research in economic growth and business history.  Indeed, there have been instances when scientific research depended upon technological innovation, as in the cases of optics and computational machinery.  The relationship between science and technology is iterative, while much of technological innovation is due as much to economic “pull” as to scientific “push.”

While I am no fan of Sen. Rubio, the notion that science is the only form of “intelligence” worth our pursuit or admiration represents an appalling poverty of learning.   Those who believe that the Bible contains a literally true history of our world lack the gift of metaphor, and for that they are to be pitied more than ridiculed.

A starry sky on a clear winter Maine night is a wondrous thing to behold; so also is an infant’s first true smile.  If forced to choose, we should chose the smile.

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Posted on: 10.27.2012

Ten Tips for the 53%

by Sylvia Kraemer
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Posted in Current History, Politics, Science and Policy, Technology in US Politics, Uncategorized

In a recent letter to the editor of the local newspaper a reader supports Mr. Romney’s assertion that 47% of the American public depends on federal benefits, and therefore undeserving of the presidential candidate’s concern.  The letter writer then shares with us his pride at being part of the other 53%,

Without mentioning national defense or Medicare, here are ten tips to help those who agree with Mr. Romney to earn and keep their membership in his 53%, the self-reliant and stalwart individuals who think they don’t depend upon federal benefits:

1) Put away the car keys.  Not only were Maine’s I-95, I-195, I-295, and I-395 built with federal dollars,  but the fuel mileage of your vehicle would be much worse without the periodically updated CAFE* fuel efficiency standards Uncle Sam has been setting for the auto industry since 1975.  The gas is heavily subsidized by taxpayers with oil company leases (often royalty free) on public land, as well as preferential tax treatment such as oil depletion allowances). (*Corporate Average Fuel Economy)

2) Oil up that bicycle in the garage.  Oops!  No can do.  The commercial lubricant you’d use has been manufactured to viscosity standards set by the federally funded National Institute of Standards and Technology.

3) Instead, put on those sturdy Maine-made hiking shoes and head out for a nice nature walk.  But be careful that you don’t walk on a trail blazed with the aid of topographical maps based on the federally funded geodetic surveys.

4) Surely the hardworking 53% can look forward to a boat trip along Maine’s glorious coast.  But take along plenty of your own rescue gear, so you won’t need to compromise your principles by calling on the U.S. Coast Guard if you capsize.  Also prepare for foul weather, since you won’t depend on the federally developed and funded  satellites that bring you the weather news.  Be sure to leave behind those nautical charts based on coastal surveys paid for by the federal government.

5) Get on a plane and go visit the folks?  No high-in-the sky for you.  The aircraft you’d fly in was built to designs drawn from federally funded aeronautical research.  The air routes and navigation aids were also provided by the federal government.

6)  Ah, home, sweet home!  But lock up your firearms.  Much of the research and development that make those firearms effective was paid for by the Uncle Sam.  Colt and Remington would have never gotten off the ground without war department contracts and research done at federal armories such as Springfield and Harper’s Ferry armories, in Massachusetts and  West Virginia.

7) Better lock up that medicine cabinet containing those prescription drugs.  The majority of them were developed from federally funded research overseen by the National Institutes of Health.

8)  Hide the TV remote under the sofa cushions.  TV relies on swathes of global radio spectrum obtained on your behalf by the Federal Communications Commission, which assures that every American citizen has access to radio and television broadcasts, as well as wireless data transmission.  And that includes the Internet, developed with federal dollars.  Now’s a good time to donate that cell phone to a soldier or veteran.

9) At least you can be sure of your membership in Mr. Romney’s 53 percent because you earn all your own income yourself.  Or do you?  Are you sure that your job is not supported indirectly by a federal grant or contract?  To find out, go to the public library, wait for a free Internet computer terminal, and do a search of www.fpds.gov (the federal procurement data system).

10)  Stuff that hard earned money into your mattress, since you won’t want to depend on Uncle Sam’s $250,000 insurance per depositor account.  But if you have that much money, you’ll be happy that Social Security is privatized, so you can entrust your savings to the tender mercies of a deregulated Wall Street.

But be sure your dollars are not invested in companies benefiting from corporate federal welfare!   Corporate welfare takes many forms, among them:  Oil depletion allowances; reduced taxes on income from capital gains; private sector gold, silver, and uranium extracted from royalty-free leases on public land; federal payments to farmers; and import and tariff rate quotas protecting U.S. produced watch parts, anchovies, brooms, ethyl alcohol, milk and cream products, olives, tuna, upland cotton, wheat gluten, wire rod and line pipe, and sugar–to name a few.

As the late night comedian quipped:  “Bro’, we’re all in this together.”

~~~

 

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Posted on: 10.17.2012

Maine: The Costs of “Political Speech”

by Sylvia Kraemer
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Posted in Current History, Open Systems, Politics, Uncategorized

In its article on forced ‘disappearance’ to eliminate political opposition, Wikipedia lists no less than 22 countries where ruling parties have resorted to this practice.  Among the better known are Argentina and Chile, under the regimes of Jorge Rafael Videla (1976-1981) and Augusto Pinochet (1976-1981), respectively.

As a means of eliminating unwelcome political speech, ‘disappearing’ has the advantage of denying the opposition a locus of protest. One day, someone or some thing is simply no longer there.  Who was it? What was it?  No longer noticing, how long before we forget?

We in Maine have also had a small exposure to the (mercifully bloodless) ‘disappearing’ of political speech.  U.S. District Court Chief Justice John A. Woodcock ruled in Newton v. LePage (March 23, 2012) that a mural in the Maine Department of Labor building depicting the history of Maine’s working people, and summarily ‘disappeared’ by Governor Paul LePage, is political (or government) speech:

“…the parties agree and the Court takes as a given that the labor mural projects a message and that that message is speech.” [p. 65] Thus the resolution of the issue of the governor’s removal  of the mural  “rests not in a court of law but in the court of public opinion.”

If our governor’s political speech were merely “blunt,” as he maintains, we might do no more than roll our eyes and move on.  But the most notorious of his one-liners are striking for their tacit violence.  What’s more, the resort to violence to end–rather than resolve–disputes appears normal among some of his supporters.

According to a manager in a Route 1 convenience store, “we like him because he says what we really think.”  Another supporter writing to the Press Herald advises that a columnist critical of LePage would have been “seen … as a smart aleck twit and I think he’d have frequently gotten beat up at school.  And he’d have deserved it.” [Charles Todorich, PPH, July 21, 2012].

The true cost of our governor’s preferred political speech is not the heartburn it surely gives to the Prius and Birkenstock set.  It is that it peremptorily forecloses meaningful and creative efforts to resolve policy disputes with the largest number of our citizens possible.

In business school they call it negotiating a “win-win” solution to a conflict of interests.  In public administration they call it getting “buy-in from as many stakeholders as possible.”  The most important reason to work for consensus is not so we can all feel good about ourselves.  It is so that whatever resolution is ultimately achieved will endure.  Otherwise enough people able to undermine a policy will always be waiting for the chance to do so.  Achieving a “win-win” solution is ‘realpolitik’ at its finest.

For example, Maine has before it two important opportunities to improve and modernize its infrastructure, opportunities critical to our long-term economic vitality.  These are an east-west highway across the state, and universal access to broadband Internet, now possible thanks to the completion of Maine’s first high-speed fiber-optic telecommunications network.

The weight of historical evidence shows that robust transportation and communications networks have been essential to this country’s economic prosperity and political cohesion.  A map of railroad routes built across the U.S. in the 1860’s, routes which headed west, rather than south, reveals a chief reason the southern states failed to benefit from an emerging vigorous national economy and evolved an insular culture and politics that persist in its rural areas to this day.

An east-west highway across Maine would do much to relieve the rural isolation–attractive to some, impoverishing to many–of its northern and western counties.  Some creative mediation by a responsible state government would ensure that the right questions are asked and answered, and the legitimate concerns of the opposition accommodated.

Similarly, Press Herald columnist Charles Lawton has recently written of the challenge facing those who support the extension of broadband throughout Maine.  Too few Mainers appreciate what a computer and broadband Internet access can contribute to their lives (for example, telemedicine), and too few Maine businesses recognize the need today for an active on-line presence to survive–much less grow.  The failure of Maine’s businesses to exploit this essential component of our commercial infrastructure begs for constructive state government involvement, including financial incentives.

But these opportunities–and others of comparable importance–are likely to be lost with this governor, fallen prey to the unfortunate tenor of his political speech.

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