Peggy Orenstein has written the article Mad Dog would like to have written, but thought it was too politically incorrect.
For readers of Mad Dog Democrat, the idea anything is too politically incorrect for Mad Dog may come as a surprise, but this topic is so incendiary and requires such tact, Mad Dog knew it was simply beyond his talents.
The problem here is: Is anyone rooting for breast cancer? Does anyone not wish to see an end to breast cancer? So any time you question or undermine the efforts of a group which is trying to end breast cancer deaths, you have to tread lightly, something Mad Dog has not mastered.
Ms. Orenstein writes an article which embraces the complexities and the successes and the lack of successes in a very adroit way.
The problems with the Susan Komen organization and others like it is they are focused on raising awareness of breast cancer, on the psychological impact, on making breast cancer socially acceptable to talk about, to acknowledge you've had, but at some point we all really have to accept, okay, mission accomplished when it comes to marketing and name recognition and attitude change: What we really need now is some good, effective science and technology.
Breast cancer, as she points out is not even one disease. There are different types of breast cancer (estrogen receptor positive, estrogen receptor negative, Herc positive, triple negative--the list expands as molecular genetics identifies new types.) There is even a pre-breast cancer which may or may not ever develop into breast cancer, DCIS.
As Ms. Orenstein points out, delicately, women almost never die of breast cancer which is confined to the breast; what they die from is metastatic breast cancer, i.e. breast cancer which escapes the breasts and implants in liver, brain, bone, lung and elswhere, seedlings in the wind, taking root, becoming the ultimate invasive species.
The big problem is this process may occur before there are enough breast cancer cells to see on mammography, so even if you remove the breast cancer you find by imaging, by mammogram, ultrasound, MRI, you may still be dealing with a mortal illness--you just won't know it for some years.
When Mad Dog was an intern at Memorial Sloan Kettering, he admitted dozens of patients every week who told the same story: "They told me they got it in time. It was so small. I was cured." But here they were, 10 or 15 years later with breast cancer growing in vertebrae, femurs, ribs, lungs, liver, brain and all stops in between. Dying of a disease the doctors thought they had cured.
It was this realization, that microscopic, invisible tumor cells escape early and may be growing in distant sites which moved the researchers in Milan, Italy to try chemotherapy to flow in the blood and kill the invisible metastases at the time of the original breast surgery and that study was done in the early 1970's. American doctors came later to accept this concept and now protocols include chemotherapy to get those sleeper cells.
But chemotherapy does not kill every cell in every patient and patients are still dying from widely metastatic disease despite all the protocols, years later.
And mammography may not have made much of a dent in this process.
But when various scientific groups, recognizing the futility of screening mammography for various groups of patients--e.g. women less than 40--have recommended mammography start later and not be used annually all hell breaks lose because breast cancer organizations--who have a stake, financially, professionally and emotionally--oppose these recommendations, not because the science is flawed but because they have other motivations.
Consider this example, which Orenstein quotes: Suppose you have 100 women who have a mammograms at age 67, are found to have breast cancer and treated but they all die 3 years later at age 70. The 5 year survival in that group is 0%. Suppose now, you have 100 64 year old women who have a mammograms and gets treated but the treatment doesn't work and they all die 6 years later at age 70 The 5 year survival for these women is 100%. Looks like a great victory for mammography: You've improved 5 year survival by 100%! But what have you really done? You've made the women in the first group aware they have cancer three years earlier and they've had to live with that knowledge but they have not lived a day longer for it.
The fact is, funding for research is competitive: If the National Institutes of Health funds breast cancer at $100 billion dollars there is not going to be $100 billion for melanoma. And with diseases acquiring advocacy groups, AIDS, prostate CA, testicular CA, decisions may rise or fall based on who has the best paid lobbyists in Washington, rather than who has the best scientific arguments in Bethesda (where the NIH is.)
And what happens to testicular CA if it's major poster boy falls from grace for doping while he was winning the Tour de France?
Is this any way to run a railroad?
Ms. Orenstein has written a very important public policy, public health article. It is one every citizen ought to read, in the quiet of his or her own home, preferably after a Valium or a good glass of wine.
On Jefferson Davis Avenue, in New Orleans, stands a statue of the man, "Profound scholar of the constitution, In judgment sound, in morality firm, in resolve steadfast" or words to that effect, but most of all, "Patriot."
In Cabin John, Maryland, stands the Union Arch Bridge, which, legend has it, was dedicated by Abraham Lincoln in 1860. In 1861, Lincoln sent a detachment of calvary to remove a plaque from this bridge because the plaque listed various officials who had part in the construction of the bridge: Montgomery Meigs, of the Army Corps of Engineers and Jefferson Davis, Secretary of War.
Apparently, Mr. Lincoln disagreed with the idea Mr. Jeff Davis was a patriot.
There must be a difference between traitor and patriot.
Some would say it's all in your point of view.
Others would say it's in where you stand now.
Far as Mad Dog can see, there are parallels and then, there are parallels.
In the case of the "War" on "Terror" both war and terrorists have bullets and bombs and there are deaths and innocents (non combatants) are killed and maimed.
Of course, in the case of the war on terror, there are no armies, no capitals, no flags, no actual battles--and as Carver once said of the "War on Drugs" in The Wire , this isn't even a war. Why not? "Because wars end," Carver replied.
This is a subtlety lost on Senator Graham, of course. Many things are lost on Mr. Graham. Mr. Graham does not approve of people who hail from places which are in rebellion against a power which they feel has been imposing its will over them, not respecting their local traditions and values, a place like Chechnya, for example, or say, South Carolina.
Of course, you cannot compare the Chechnya rebels to the rebels of South Carolina. They were both rebelling against a stronger neighbor from the north which insisted a separatist movement would not be tolerated, but the Confederacy had an army with uniforms and canon and they fought out in the open and they were Christians, praying to a Christian God. In fact, these rebels were so upright and upstanding Mr. Graham's fellow South Carolinians fly the Confederate flag over their state house to this day, just to show the guerrilla spirit is still alive and well in South Carolina.
Chechnya knows all about guerrilla spirit. Apparently bombs go off every week there, and no police station is safe.
The Confederates in South Carolina might just admire that, if those Chechnyans were Christians and wore nice gray uniforms.
But now we have the Confederates back in positions of power and when they are United States Senators they invoke hell fire and brimstone against the unholy, unwashed terrorists from foreign places, and Heaven Knows, we don't like foreigners and we ought o re examine our immigration policies which allow undesirables like Russians or Chechnyans or people who don't speak English at home from unloading their baggage here in the United States.
In fact, when the Russians point out a potential trouble maker and the FBI investigates and that trouble maker subsequently makes trouble, well the FBI has dropped the ball on the one yard line. Fumbled, I tell you! The FBI ought to be able to predict human behavior. What have we been spending all those hard earned tax dollars down at FBI headquarters in Quantico, Virginia if not to be able to read minds and predict future behavior by nasty, ill meaning violent revolutionists?
Mad Dog can see where Mr. Graham is coming from. Same place he is always coming from. South Carolina.
A friend who worked for the U.S. government in an agency which oversaw international trade once remarked, with a Cheshire smile, "We worry a lot about whether or not we are racist in this country; we don't hold a candle to the Europeans."
He spent a lot of time in England, Switzerland, Germany and Scandinavia, so I thought he probably knew of what he spoke.
Today's New York Times carries a stunning article by Jonas Hassen Khemri, the first generation son of an immigrant to Sweden.
He details what is was like growing up dark skinned in Sweden: being stopped on the street, questioned, asked for government ID, thrown into the back of a police van, then told only , "You may go now." Listening to government ministers defending racial profiling blandly by saying, "Oh, well, they are the guilty ones." Watching his father sweating out interrogations by Swedish officials, who looked at his government ID dubiously--this guy says he's Swedish, well he doesn't look Swedish. Hearing of friends beaten up in police vans. Followed about in stores by security guards with walkie talkies, who assumed if you are dark skinned, theft must be afoot.
It all sounds like stuff we have put behind us in the United States, having faced our own different modes of racism forthrightly. Of course, until now we haven't succumbed to that special terror of government power--the National ID--which some of us remember from the old movies in which the Gestapo stops Lauren Bacall or some other heroine and says, "Unt now, I vould like to zee your papers." Red staters rage about the indignity of background checks for gun purchases, but they have no reservations about the indignity and huge leap in government control embodied in a national ID card. You want to see real terror and oppression: Just vote for a national ID card.
We've gotten by that sort of thing here in the USA. Well, mostly.
Of course, not all of us. When the Boston bombers turned out to have been born in Russia, and, damn it, one was dabbling in Islam, well, Lindsey Graham is right there with the "Suspend the Constitution!" cry. Hey, why should we give this ungrateful foreigner any rights? Let's just hang him now without a trial (a South Carolina specialty) or put him away for life.
Well, there's precedent for life imprisonment, no trial--Gitmo.
And also Stop and Frisk in New York City, the city of Michael Bloomberg a semi liberal mayor, who apparently is not disturbed by racial profiling, if it happens in zip codes where people don't have much money or power. Mayor Bloomberg worries about allowing people to drink gargantuan soda pop but he does not worry about people thrown up against a wall by his own police.
Mad Dog would like to humbly suggest: The reason we go through the dance of doing things within the Constitution is not out of respect for heinous criminals; it is for ourselves. We do not take the pains and expense of trials for the sake of the accused, any more than we do funerals for the sake of the dead. We do funerals for the sake of the living and we do trials for the sake of the citizens who do not stand accused, that we may all demonstrate our respect for a little mentioned and oft ignored idea: The Law.
We are better than the guys who set off bombs and blow legs off people because we think hard and long before we do harm to anyone.
Having cared for wounded accused in emergency rooms and on the wards, Mad Dog was struck by how surprised they were by the kindness, or at least by the absence of hostility they saw in the nurses and doctors rendering care. In some cases, Mad Dog had the impression these men had never experienced human kindness and it was disturbing to them. They were suspicious at first, then tentatively responsive, but often they withdrew again, as if they knew responding to kindness would make them vulnerable, so they retreated into indifference. Some of them could not help themselves, however and they were the ones most often psychologically damaged--by all the respect and fairness. So Mad Dog doesn't buy the approach of the Lindsey Grahams of the world. Just beat those miscreants like dogs. No, if you really want to make them suffer, treat them with respect and they begin to feel a connection to humanity. That's the greatest pain.
You want to really inflict pain on the surviving Boston bomber? Once you have him reasonably stable and comfortable, once you have shown him care and concern and made him feel well again, bring around one of those girls who knew him in high school, or from college, one of those girls who called him a "sweetheart" who thought of him as a kind, funny, caring person, and simply allow them to visit; allow him to return to that person he once was. As Mephistopheles says in Faustus, the greatest hell is remembering happier times. The greatest hell for this 19 year old will be remembering the person he was before he was transformed.
So, with our system of laws, of treating the accused as innocent until proven guilty, we honor not the accused, but ourselves. We worship at the alter of "justice."
Well, mostly--unless you are a villager blown up by a mistaken drone attack.
But, at least, most of the time, outside of Gitmo, and drone attacks and Stop and Frisk, we try.
Nobody's perfect.
One way to feel better about yourself today: Consider Lindsey Graham. Consider his whole ridiculous state. If you have done something lately you think was pretty stupid or ill considered, just think of Lindsey Graham. Compared to him, compared to the several million people who voted for him and live their smug little lives in South Carolina, you are a tower of intelligence, discretion and moral fortitude.
"I did know Jahar. In the 4 years of high school I spent with him, he
was nothing but a kind, unassuming, gentle person. He was funny, had
lots of friends, and was very athletic. I haven't spoken with him since
high school (we graduated in the same class from Cambridge Rindge &
Latin)."
Another acquaintance said she knew Dzhokhar from the University of
Massachusetts-Dartmouth. She said he had a group of "maybe four or five"
Russian-speaking friends whom he was never without. "All I really knew
of them was that they smoked weed and liked to party, just like regular
kids. Jahar was such a sweetheart."
--From the Internet
So how does a kid who enjoyed his friends, seemed engaged, had success in school wind up fashioning a bomb which blows the legs off people, robbing a 7 Eleven, shooting a policeman to death, throwing bombs at police?
Of course, Mad Dog wondered whether or not the police could have been wrong about the role these two brothers played in the bombing. Showing them walking down the street carrying backpacks hardly proves they had bombs in those back packs. But if they really did throw bombs at police, were caught on surveillance robbing a 7 Eleven, were identified by the man whose car they hijacked, sounds like a case which might get an indictment out of a grand jury.
Assuming for the moment the police got the right guys, Mad Dog asks: How do you go from being a kid who is embraced by his friends to a maniac who is alienated enough to kill wantonly?
They interviewed a man in Watertown who said he was happy the kid had been captured alive because he wants to hear him answer a lot of questions.
Mad Dog is not sure the answers will actually provide much insight. But if he were dead, there would be zero chance for answers.
It is hard to work up much sympathy for the person who blew legs off people, but the image of this 19 year old crawling off to die in the backyard boat of some Watertown citizen does strike even the cold black heart of Mad Dog as sad. A wounded animal is always pretty pathetic. Once they are defanged, no longer a threat and just dragging themselves off to find a hole, it is not the same.
Mad Dog knows the obvious question is coming: Would you have felt that way if there were footage of Hitler dragging a leg behind him, off to his bunker? And the answer is: No. Mad Dog would be unmoved.
But a 19 year old kid, who not long ago was a "sweetheart." Makes you wonder.
Hanah Arendt, commenting on Adolph Eichmann on trial in Israel, reflected on the banality of evil. The people who carried out Hitler's final solution, for the most part, were not foaming at the mouth fanatics, but ordinary people who simply bought into the Third Reich's notion that killing Jewish babies and Roma was a good thing.
Looking at the images of the two young men suspected of participating in the Boston bombing, a red headed woman on the street was shaken by their ordinariness: "They could be anyone," she said with a shudder. "They look so unremarkable."
Most people seemed to harbor a working hypothesis about their motivations. Mad Dog assumed they were avenging drone strikes in Afghanistan/Pakistan which have killed innocent villagers. Others have suggested it was some libertarian anti tax group. Each person seems to have a favorite villain, depending on that person's most cherished group to hate.
But what will we do with the information, if it ultimately does come out? If it turns out to be an Afghan out for revenge? Or if it is a latter day Columbine alienated teen ager group? Or if it is a white supremacist group? Mad Dog supposes we'll use the information to support our own biases: See, that's where that type of thinking leads to-- the killing of innocent people.
In the end, the result may be a surprise: Some years ago a sniper shot people in the Washington, DC area in what appeared to be a totally random way. Police were looking for a white guy in a white van. It turned out to be a black man and a black boy firing from the trunk of a dark sedan. The man was out to kill his ex wife, and the other shootings were a ruse. If he had shot only his wife, he would have been the prime suspect, but if he shot her as part of a random shooting spree, she's just another random victim.
Or, we may never know, just as we never knew who sent those Anthrax ladened letters. Now we have letters to President Obama laced with Ricin. An echo from the past.
Oddly, just days after Boston, a fertilizer plant leveled much of a Texas town. Timothy McVeigh used a fertilizer bomb to level the federal building in Oklahoma City. Echos from the past.
Has Rush Limbaugh had time to say, "Nobody's talking about background checks for people who buy fertilizer" yet?
We are fortunate to have someone in the Presidency who can rise to these occasions. After eight years of cringing, what a relief to hear from a man who can soar rhetorically, and who can rally our spirits.
The news from Boston was pretty bleak, made bleaker by the efforts of careerist reporters, who were thrown on television and radio with no news to report, but with hope in their hearts this could be their own big moment. So they interviewed each other and repeated the words de jour : "Chaos" and "Heart wrenching" and "Like a war zone" and "panic."
Which is to say, the news people had no news to report beyond the first three minutes: Two explosions ripped through crowds around the finish line of the Boston marathon after the first wave of (fastest) runners had finished, and at a time when the spectators lining the street had diminished in number. Had the bombs gone off earlier, casualties would have been higher. Police are in the early stages of painstaking investigation and really will have nothing to say until they gather evidence and reconstruct and think out what the evidence means, which means we will all just have to wait to learn what happened.
There was alarm and there was surprise, but there was not "chaos,"as far as Mad Dog could see: Doctors who were in attendance in significant numbers ran straight toward the victims lying across from them, despite the obvious danger, and police reacted with calm and deliberation and the hospitals swung into their well rehearsed "disaster" drills, as they have been trained to do, and patients were transported to the waiting teams at Mass General, Tufts and Boston Medical center and operating room teams awaited them and treated them, and intensive care units received them, even at Childrens' Hospital, and while many questions remain about who did this, why, and how, what was never in question was the proficiency, efficiency and efficacy of the medical community, one of the nation's best--in Boston--and the calm deliberate and speedy response of the "first responders" the police, fire and rescue.
As far as Mad Dog can bring to mind, this is the first attack which actually took a toll of civilians since 9/11/2001. There have been thwarted attempts--the shoe bomber, the underwear bomber and the Times Square bomber, but this is the first that went off and killed people since New York, 2001.
Speculation immediately was centered on Middle Eastern terrorists, as it was immediately after the Towers came down in 2001. In the case of the Towers, that speculation was basically on target. Not so clear here, yet.
It must be remembered, Timothy McVeigh fit nobody's profile of a Middle East terrorist.
As any fan of The Wire knows, there is much that can be learned from a patient, thorough, unhurried examination of the crime scene, done without bias or preconceived notions, just methodical, meticulous and clean. When emotions run high, sometimes the in charge cop has to order everyone out of the area, just to allow those with specific tasks to do their jobs.
Eventually, we will learn more of value, but watching the yammering nabobs on TV Monday, we saw the worst of the commercial news making machine. They did not serve the nation well.
