Nikki Stern's Open Salon Blog

Evidence-Based Science and the 44-Year Old Cancer Patient

Fri, 20 Nov 2009 12:11:31 -0500

My 44-year old friend Natalie looks great. She is half way through her radiation treatment for a malignant tumor found so far back in her breast no self-exam would have found it. Hopefully she'll be able to avoid chemotherapy. She had no family history of cancer, no genetic or behavioral markers. It's true there is no way of knowing whether this particular tumor would have killed her; some cancers are so slow-growing as to be almost non-threatening. Mammograms detect more thoroughly than ever any anomoly but even when something is found to be malignant, it's not always possible to know whether it's potentially fatal. Natalie doesn't care and neither do her friends, frankly. At this level, the anxiety is more than worth it.

I understand the concept of "evidence-based science" as well as the next person. Reason demands evidence, at least when it comes to issuing absolutes. Too many people are inclined to make presumptive declarations -- that is, declarations that presume knowledge. So yes, show me the evidence.

I also understand that our bodies are highly complex organisms with any number of uncertainties built right into them. There may be tumors and aneurysms, clogged veins and weakened livers, and even degenerative disks, none of which are necessarily going to harm us or even slow us down. Why find out if you're caring a potentially threatening gene, some argue, the operative word being potentially? Life is about uncertainty; some things we can't know; others we don't need to.

But even though I get all that, even though I believe that we must all learn to live with uncertainty, even though I realize living involves risk and many kinds of cancer aren't life-threatening, I cannot wrap my mind around what not being tested might have meant for my friend Natalie.

My difficulty with the recommendations has nothing to do with the politicizing of the findings, which are, after all, reissues of earlier recommendations. Trying to tie these recommendations to the "threat" of managed care is another deliberate attempt at fear-mongering. But I find the "small risk" argument to be an unpersuasive one: except for chemo, most women will tell you mammograms, sonograms, biopsies, anxiety, and even radiation are worth undergoing. Yes, evidence shows that only one in more than 1900 women's lives were saved by early testing. But that one may have been my friend Natalie.

Going (Not So Very) Rogue, part 2

Tue, 17 Nov 2009 12:11:30 -0500

As promised, here is my take on both the Oprah and the Barbara Walters interviews. There are or will be differences of opinions or perhaps just various shadings. Read everything you can. An informed public is, well, informed, even if, at this juncture, we're all just throwing out our opinions. That's what makes horse races, as my dad used to say.

I watched both interviews and was not in the least surprised. That some of my fellow progressives are surprised has startled me immensely, to say the least. But I'll get to that in a minute.

The main themes of both interviews and apparently the book (which I promise to read and review separately) revolve around Palin's use and misuse by the McCain campaign and her life as a regular person. The questions asked by Oprah and Walters were similarly predictable. What made me wince with the first interview was how uncomfortable Oprah seemed. Generally an open and warm interviewer or, on occasion, a righteous scold, she is usually right there, up close and personal in facial expression and body language. Here, she seemed for a time glued to the back of her share and her face looked so stiff I thought I was watching Barbara Walters for a minute. It was as if she were walking a tightrope over a pit filled with viscious snakes. Say what you will about Oprah's being untouchable but not only was she confronting a potential rival (there are rumors that Palin may be looking at hosting a talk show; inquiries about that from Oprah produced a canny response from Palin that was at once fawning and designed to make Oprah look as if she's on her way out); she was also mindful that her audience may be much bigger fans of Palin's than she is. Oprah addressed her endorsement of Obama up front, along with an explanation as to why no candidates, including Palin, were invited onto the show. The rest of the questions were vintage Oprah, who managed to "catch" Palin a couple of times (as when Palin inadvertantly referred to Katie Couric as "Miss Perky"), only to step back into safer territory.

Barbara Walter's interview, shown in part on "Good Morning America" was as taped and scripted as you might expect and yielded no new surprises. Palin again insisted that the announcement of Bristol's pregnancy by the McCain campaign missed an opportunity Palin wanted to take to warn of the dangers of unprotected pregnancy -- an interesting nuance, in that she didn't seem opposed to birth control, nor did she seem of the view that teens can be trusted to practice abstinence. Even her candid admission to feeling, for a second, some understanding as to why a woman faced with a pregnancy involving a Downs syndrom baby might consider abortion.

What hit me was not how engaging Sarah Palin is or that her claims of being mismanaged by the McCain campaign seemed quite likely. She's not a monster and might be fun to meet or hang around with on some level. But what continues to astound me is the way in which her confidence in her ability to do absolutely anything is uncoupled from any apparent interest in the preparation that might be required to do certain things, such as become the President of the United States. Not only does she not seem particularly versed or interested in policy details or even big-picture concepts beyond canned platitudes about the economy or our national security; she doesn't seem to think she'd really need that kind of information in order to represent Joe or Jane Six-Pack. I'm all for the can-do attitude but I'd like it attached to a "probably might want to learn how to." People might have thought that electing funnyman Al Franken to the Senate was pretty silly but reports are the guy studied his you-know-what off.

At the end of the day -- progressives take note -- hating Sarah Palin is kind of dumb. She sells book, she ignites passion, she inspires fascination: she represents all the trials and tribulations and desires and contradictions that make up celebrity in this decade. She's not evil or mean. She's certainly ambitious and apparently feels she is as deserving, as qualified and as prepared as anyone anywhere to take over as Commander-in-Chief. The only danger is if a majority of Americans thinks she is too.

My Heart Belongs to Bruuuuuuuce!!!

Wed, 18 Nov 2009 10:11:43 -0500

The first time I saw Bruce Springsteen live was in 2002. I'd already lived in New Jersey for eleven years at that point. I knew he was the boss. I owned several CDs. I'd met a couple of his sidemen years before when I was eking out a living in New York as a songwriter and occasional session singer. But I'd never seen the man perform live.

I was less than a year past losing my husband and one month into the Great Inappropriate Affair that would restore my passion and nearly destroy the rest of me. I was roiled, embroiled, crazed, needy, and very much alive. A couple of us were invited to go to a Springsteen concert in Continental Arena stadium. We did the whole thing: tailgate party, T-shirts proclaiming our love for the Boss, excellent seats close up. I knew Bruce was quite the performer. I was aware that the crowds filling up the arena were ready to embark on a Bruce lovefest, and I knew someone was bound to spill beer on me while screaming out the lyrics to "Born in the USA."

But nothing - and I mean nothing - prepared me for the man's artestry, his delivery, his magneticism, his kinetic energy, his profoundly personal relationship with his fans, or his fantastic-looking ass. When he slid across the stage on a puddle of water, I honestly thought I was going to faint. I screamed something - maybe it was "marry me" How embarrassing for his wife and sideman Patty but she took it in stride.

Now I'd never turn Mark Harmon away. Or George Clooney. I suspect Harrison Ford might project some appeal. If I was going cougar (more like grey panther), I'd certainly throw open my door for Daniel Craig, Johnny Depp, or even Will Smith (although he's almost TOO cute).

But Bruce is the man these days. He combines story and song, soul and sex, lust and love, longing and lament and he makes it look at once familiar and graceful. In Bruce's hands, sixty is SO the new sexy.

Sarah Palin Goes Rogue in New Book: Part 1

Mon, 16 Nov 2009 10:11:21 -0500

Sarah Palin's new book hits the bookstores tomorrow, just after her much anticipated appearance on "Oprah" and her slightly less promoted appearance on "Good Morning American" with Barbara Walters. Can NPR be far behind?

Since I'm an average Jane, just like former Governor Palin, I will have to tune into "Oprah" this afternoon at four and (yawn) watch "GMA" in its entirety to catch tomorrow's interview, after which I'll wait in line with the rest of the Princeton area elites to pick up a book, which, according to both the New York Times and the Wall Street Journal excoriates the McCain campaign to the nth degree. So there, you wimpy, mainline Republican party regulars.

For those of you who can't wait with breathless anticipation for my reviews tomorrow (it's hard to go a day without breathing), I have some advanced thoughts which I'd be happy to share with you.

First, as everyone knows or soon will, the phrase "going rogue" was apparently attributed to a McCain advisor, one of many who accused Palin of going off-message. Both the Times and the WSJ, whose reviews reflect their vastly different editorial perspectives, note the book's sustained criticism of the McCain campaign. Says the WSJ review: "One of the biggest mistakes of the failed McCain campaign—and there was no shortage of them—was its handling of Mrs. Palin," although it also gently suggests Ms. Palin might have been a touch more self-critical. Oh really?

The Times, as might be expected, observes that the author castigates a campaign that took an unknown Alaska governor from near-obscurity to becoming "one of the most talked about women on the planet" and someone who could pull a $5 million advance. In other words, this is ingratitude at its worst.

The first half of the book is more of a personal memoir and, never having been a moose-gutting, rifle-toting mother of five, I think I might find it interesting. The reality of having a Downs Syndrome baby is apparently addressed in a straightforward manner, as is Ms. Palin's unquestioned and unshakeable faith in a God who pretty much informs her every decision.

The big question mark -- Palin's readiness to be in the White House -- is obliquely addressed in the WSJ, which says that Palin's supporters "won't find much new ammunition with which to counter those who say that Mrs. Palin isn't ready for the rigors of the White House." The Times reviewer takes an entirely different path by pointing out, mid-review, that McCain's decision to select someone with so little experience and knowledge of the world "underscores just how alarmingly expertise is is discounted -- or equated with elitism -- in our increasingly democratized era, and just how thoroughly colorful personal narratives overshadow policy arguments and actual knowledge." Ms. Palin had argued during the campaign (and apparently does in the book) that she and her husband Todd were qualified to represent the Joe Six-Packs because they understood tight budgets, public schools, teenage misbehavior, and other everyday concerns.

The idea that being like someone -- or rather, that being average -- qualifies you to lead is part of a larger discussion about the way in which we've interpreted democracy to cover entitlement, so that everyone believes his or her opinion or recommendation or analysis is equal to anyone else's and deserves airing, consideration, or more. That discussion is one I will happily begin on OS another day. As for whether Palin plans to make a run in 2012, expect the caginess you might get from any prepped, prepared and thoroughly rehearsed politician.

Cliff Notes Op-Eds (aka My Two Cents)

Tue, 10 Nov 2009 13:11:49 -0500

I've been sick with a head cold which a massive dose of "Emergen-C" has probably prevented from turning worse. I'm still tired, stressed, and more than a little cranky. I'm also behind the curve in terms of current events commentary, so I'd thought I'd play catch-up by offering my unsolicited opinion on a range of news topics, albeit at a deeply discounted price, given the economy, my general mood, and the fact that the stuff is unsolicited (which makes me just like the other 80 million bloggers across the globe). Anyway:

Army doctor at Fort Hood kills twelve: The shooter was commissioned, a loner, a psychiatrist (!) and a Muslim, in no particular order -- or maybe the order matters. The location was a military base in Texas. The hero was a local policewoman. So many stories, so much analysis, so few new angles. Once again, mainstream media is obsessing.

Health care legislation may not solve problem of rising costs: I admit that while championing a solution that would provide health care for the uninsured, I foolishly believed Congress and the White House might also be able to craft legislation that addressed the runaway cost of health care. Was I wrong? Tell me I was wrong. Otherwise, what the hell are we doing?

Republican candidates win gubernatorial races in Virginia, New Jersey: First of all, these victories do not represent an indictment of Obama; rather, the Democratic candidates represented an indictment of incompetancy. Second, New Jersey is exceptional; that is, exceptionally corrupt. If the virus is spreading, however, I have to rethink this whole third party thing.

Joe Jackson petitions son Michael's estate for an allowance: I have no idea what kind of a father Jackson was, except probably a typically show-biz type -- all swagger and gaga over the cash cow he produced. Still, he's now eighty and he's asking for approximately $180,000 a year, which is probably less than some of the Goldman-Sachs bonuses this year. Give it to him.

Andrea Agassi has "written" a book: This autobiography apparently contains shocking revelations about drug use (gasp), fake hairpieces (no) his antipathy for his first wife, Brookes Shields (oh dear) and his apparent dislike of tennis (oh please). Mostly, it's noticeable for pull quotes, serialization potential, and the overtly earthly presence of its "ghost" writer. It's sure to be a best-seller.

Now hand me the Kleenex and turn off the light on your way out.