Just wanted to clarify something, this sentence is correct.
I heard a few times in “The Office” and “30 Rock” that people is suppose to say “bravo” to men and “brava” to women, that is incorrect.
Brave translates as Bravo for male gender and Brava for female (or valiente for both).
But “Bravo” as an expression is like “I applause for you” whatever gender.
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That is only partly correct. “Bravo” comes in this case from Italian and its use in opera and theatre, not from Spanish, so technically one could say “Brava” for women (as it is the case in Italian). Also, the translation is not at all “brave”, but more like “good” or, more specifically, “talented”.
It is true though that internationally, only “bravo” is used, in English and in many other languages, so ultimately using “brava” for a woman is highly unusual and possibly wrong.
A doctor? Multiple doctors? A technician administering a patented genetic test with huge potential to generate $$$ for the patent holder? We don’t know the details, and it matters.
Obviously. But you have some brains and can think for yourself. There are a lot of people who don’t and can’t or won’t, and some of them are going to be exploited by a cynical industry ruled by pharmaceutical multinationals, insurance companies, and mercenary doctors (before anyone jumps on me for that, 99% of them are, I’m sure, outstanding individuals whose shoes I’m not fit to polish. 1% of them are scumbags who are in it for the money).
Anyway, my point was simply that neither the medical community nor the general public have a strong grasp of probability. Probability theory and statistics is not taught in schools - you’ll only meet it as an undergraduate, and then only in certain subjects. I’d like to see a rigorous scientific justification of that “84%” figure, because from where I’m standing it looks like bullshit.
I know two women who have had late abortions (~4 months) based on the say-so of their doctors, which I’m sure must be a level of trauma on par with having your boobs lopped off, perhaps worse. In both instances, they’d had a prenatal test for Down’s syndrome. Both aborted babies (they weren’t ‘fetuses’ at this point) were quite obviously normal. Now, this from the most recent followup study of a supposedly accurate test:
[i]"The population were 46,193 pregnancies in 14 London hospitals over five years, in which the quadruple test was applied to serum samples between 14-22 weeks of pregnancy. A test was deemed positive if the computed risk of an affected foetus was 1 in 300 or greater (where greater risk means lower numerical values, 1 in 200, 1 in 100 etc). Gestational age was determined by ultrasound in 4 of 5 women.
There were 88 affected pregnancies, giving an overall risk in this population of 1 in 525, not taking age into account. With the quadruple test there were 3,271 positive tests that detected 71 affected foetuses. Just under 98% of all positive tests were false positives. Sensitivity, specificity and likelihood ratios are shown in Table 1. The chance of an affected foetus following a positive test was 1 in 46, and with a negative test was 1 in 2525."[/i]
A lot of medical tests are of this order of reliability, but doctors present them as infallible - sometimes because they themselves don’t understand concepts like ‘specificity’ (which describes how good a test is at correctly identifying patients without problems). Of course tests are valuable. I’m an engineer, I devise and use tests all the time. But people need to understand the nature of the tools being used before they make life-changing decisions.
I don’t think I would. I’d prefer to meet the guy in the black cloak intact, so I can wave it around while doing the Ka Mate in his face.
I concur, excellent post.
I believe what they recommend to do is a high sensitivity test and then follow it with a high specificity test. DS testing is a bit tricky as the gold standard does/did require amnio teating which has a real risk of miscarriage. There is a new test that can detect fetal RNA from a maternal blood sample now.
Many docs probably barely understand these concepts , are too busy or too lazy to look into the actual stats backing up these tests or are afraid of liability issues such as amnio testing above.
In spite of having failed Statistics twice, and barely passed the third time, I do understand specificity and other concepts that make my stomach churn and turn. I am also fully aware of the “false positive” aspect in the Down syndrome test -which any responsible doctor wil explain in terms of its relation to other risk factors. That said, if I received a similar result from this genetic test, I would probably still come to the same conclusion -replacing the dangerous bits with silicone- if I have to weight in other factors that added to the genetics put me at risk of not seeing my kids grow up. I am a vgery distrustful person in terms of medical advice and do not take a pill without Googling it to oblivion and possibly consulting with my kid brother the family doctor. I would put the same level of ditrust in pharmaceutical companies which, as you say, already have my stink eye for copyrighting human genomes. But at the end of the day, I do not think any mother, or for that matter, any woman, would see such results coldly and gamble on her health. It is true many people would be easily scared and that due to our love/hate relationship with our breasts this is a rather difficult decision. But at the end of the day, many people have limbs or parts of their body taken away because of cancer. And they still lose the battle, some of them. Some overcome it. Considering then that the possibility of getting cancer falls under this “lose a bit to try to gain all” is a private question, a personal matter.
In summary, if you have the information available, it is up to you to decide, statistics or not, gut feeling, whatever. But anyone would rather see 3 doctors and test 6 time sbefore taking this leap. II do not think insurance comapnies would allow you to go on just one word, one test. But at the end, it is a choice.
The other issue is that insurance companies are being given the opportunity to deny coverage based on this 84% figure. Is it real? I think it is grand standing to the detriment of the majority.
1 in 6 men will get prostate cancer; for breast cancer, it is 1 in 8 women (and some men). I would never be genetically tested for predisposition to prostate cancer because it would ruin your chances of getting adequate insurance. Cancer is something best spread over the whole community as a cost than lobed on to individuals. If you go farther than that then you enter the world of genomics.
There’s nothing wrong with testing, but the insurance companies need to be regulated AND protected at the same time. Otherwise move towards a national unified health system such as Taiwan’s.
Sure … but again, the fact that you understand it doesn’t negate the fact that a lot of other people won’t. The termination rate after a Down’s syndrome diagnosis is reliably in the >90% range. So if doctors are explaining the test properly, there are a lot of people who either (a) don’t understand or (b) are prepared to abort their unborn child on the flimsiest of evidence, even though Down’s (in the grand scheme of things) is not a particularly awful disease. I’m more inclined to believe it’s (a) … or, perhaps, that doctors just don’t bother with the explanation.
Having said that, I do agree that Jolie’s case is not really comparable. The circumstances and (possible) outcomes are different.
I hated statistics too (especially since, for some ridiculous reason, lectures were at 8:30am). I assume I passed the exam, although I don’t remember doing so. Books: well, don’t buy the textbooks we used. You’ll be asleep by page 2 (I was). I recommend “Bad Science”, by Ben Goldacre. It’s actually an extended (and amusing) rant against the misuse of scientific jargon in public discourse, but it’s well supported with good explanations of various statistical methods and hard numbers, without dumbing things down.
That’s the difficult bit, isn’t it? Once you’re given this information, and assuming you know how to interpret it, you’re still left to decide “well, what now?”. I would hate to have to make that decision. I certainly can’t criticize Jolie’s personal choice. I’m only bothered by the idea of her making it public (very public).
As for being “at risk” of not seeing one’s kids grow up: any one of us could be run over by a bus tomorrow. Doubly so in Taipei. We’re all at risk of lots of things, some controllable, some not. Everyone must make a personal choice about their own level of “acceptable” risk. A lot of Taiwanese people have a different risk threshold compared to “westerners” - they regularly expose themselves to risks that we believe are avoidable. Their reasoning might be faulty, but they’ve basically accepted a tradeoff (risk of death) in return for some benefit (saving three seconds and a few NT$ by not wearing a crashhelmet). To them, this makes sense.
My personal line is drawn at genetic testing. I don’t want to know if my cellular machinery is off-kilter. I’ll just try to make sure that when I go, I’ve done what I wanted to do with my life, and have as few regrets as possible. 100 years ago, a lot of people didn’t see their kids grow up, either because their kids died, or because they (the parents) died. They dealt with this, I assume, by making the most of every day that they and their kids were alive and together.
People are criticising a woman for being pro-active in protecting her health and increasing her chances of being around for her children and grandchildren? My gob is well and truly smacked.
That is the way we see it and it is good. But then there are those who Finley warns about, the ones who smack their lips at this marketing opportunity, the masses who jump on the next health train fad without thinking, etc. There lies the danger. But knowledge is the best vaccine against that.
As to this case, I’d say: AJ, thanks for sharing, thanks for being open, thanks for pushing a bit further away the stereotypes and fears and myths that surround breasts and women health in general. At the very least, it gets people talking. It is her choice, she explained her reasons. If it saves a life or two, good. Hope no one misuses the knowledge, though.
That is the way we see it and it is good. But then there are those who Finley warns about, the ones who smack their lips at this marketing opportunity, the masses who jump on the next health train fad without thinking, etc. There lies the danger. But knowledge is the best vaccine against that.
As to this case, I’d say: AJ, thanks for sharing, thanks for being open, thanks for pushing a bit further away the stereotypes and fears and myths that surround breasts and women health in general. At the very least, it gets people talking. It is her choice, she explained her reasons. If it saves a life or two, good. Hope no one misuses the knowledge, though.[/quote]
You could say the same about any celebrity talking about their health issues, though. Generally, it encourages people to be more realistic about their own health when they see that even the rich and famous have bodies that break, too. And it does a huge amount for acceptance of stigmatised conditions. The US health care system is an exploitative piece of crap, but that isn’t AJ’s fault or problem.
Having been pregnant in Taiwan, I can assure you that my own doctor did not explain anything at all about the test. He just told me that we’d be doing it at the next visit. I told him that I didn’t want the test. He told me I HAD to have it and asked why I didn’t want it. When I told him I didn’t want the test because I would not abort my pregnancy regardless, he looked at me like I was a crazy hippy, and conceded in a scolding voice that if it didn’t matter to me what kind of baby I might have then there was no point in testing. And we didn’t.
So there you have a double kind of fault, I guess. Doctors in Taiwan that are thought of/think of themselves as gods, and people who are blind faith, lemming like followers of these gods to the point that the life growing inside them is less viable to them than what the doctor tells them/doesn’t tell them. Culturally, they can’t and won’t ask.
And I can see what you mean in this context, when you worry that women will start hacking themselves up because of poor understanding of an expensive new test.
As far as the insurance bit goes, I had no idea people could get insurance against breast cancer in the first place. But there are laws here that state that an insurer cannot ask a new hire information about his/her health and must insure the person under the company plan. However, if you fail to join at the appointed non-disclosure window, you’ll be asked and can be refused because of hypertension, high cholesterol, or many other common American ailments. So I guess an expensive test result that returned a high risk of cancer might make you un-insurable as well. In my own case, years ago now, I refused to be diagnosed with hypertension, and refused to treat it, because I was afraid I’d not be able to get insurance anywhere else if I ever left my job. For the same reason, I’d likely not have the test Angelina had. And also because I don’t like to have to try to solve problems I don’t yet have. But if I did have the test, and I did have results like hers, I might do the same. Maybe. Thank God I don’t have to know for sure!
Another large issue that is overlooked in the media is the fact that cancers are usually genes that are activated by something (unknown cause usually). You may have a genetic predisposition for something, but nothing ever happens unless the gene is activated. Many new studies show that healthy eating and moderate exercise and limiting stress tends to highly reduce the risk of cancer in many cases.
Having her breasts removed won’t stop any type of cancer, especially if a gene is flipped on. She will simply get it somewhere else. Cancer knows no boundaries.
Indeed. My family is genetically predisposed to live long lives, I mean centenarians. But if I start driving a scooter in Taipei I think my genetic background will be moot!
I hope that Myriad Genetics doesn’t get a free ride off this publicity, because, as I said and I think most people are not aware of this, there is an extremely important test case going through the US Supreme Court right now on ownership of the human genome. This affects all of us because the US IP system is the most influential worldwide. It really pisses me off that something that we inherited from our ancestors can be patented. If I want to analyse my DNA or do something with my DNA what business is it of other people?
So you can see, you are not allowed to develop another way of testing for these individual mutations in these genes, your OWN genes. Even if you develop an alternative method to detect such mutations, you would have to pay Myriad Genetics the royalty, but they would also have to agree to license to you first. It’s a monopoly and IP grab on our bodies.
When Jolie goes off with her 87% figure (which is directly from the Myriad website) she is doing free marketing for this company.
If someone has mentioned this already I apologize. The test is for women with Jewish ancestry or Eastern European.
I worked at a Genetic and IVF clinic in US once. The founder’s (a physician) wife was tested positive for the mutation. She was at her late thirties and without children. She had the elective mastectomy and had her ovaries removed.
Ovarian cancer is worse than breast cancer. By the time symptoms showed up, it is too late.
I will give the woman that made this type decisions the benefit of the doubt. It is a horrendous decision to make, let alone going through the surgery. Even with reconstructive surgery, the tissue damage are massive. Removable of ovaries mean medical menopause. No women in her right mind will go along with this without serious consultations and considerations. Give us women some credit.
Doesn’t breast feeding severely reduce the breast cancer chances?? With 7 kids don’t her chances go down? I know some of them are adopted but some of them must be hers too no? Oh google I will.
Yes, this was part of my gripe, too. I did briefly wonder whether money was involved, but it seems rather unlikely (she just doesn’t come across as the sort of person who is “into” money). The patenting thing is weird - I googled it after you mentioned it. There’s no way such a patent can be valid: patenting a technique is one thing (such as the specific algorithm for calculating the risk) but patenting the discovery of the genes is bullshit. You can’t patent discoveries of natural phenomena, only invented things or methods. The law is crystal clear, and I’m baffled as to how these companies work around it.
Doesn’t surprise me in the least. There was a rumour going around a few years back that certain doctors were using the test as an excuse to abort half-caste babies; I guess what was actually happening is that perfectly healthy babies were being terminated because of the massive false-positive rate, and foreigners (who IMO would make a lot more fuss about such things than locals) started asking questions.
Anyways … to get back OT, I agree with jcmd that this situation is a bit different, and you really can’t argue with her decision. But this sums it up for me:
[quote=“tommy525”]Well if I was told id have a 85 pct chance of dying if i kept my dong, id get rid of the dong (and I don’t mean spend it in Vietnam).
But id get a second and third and fourth opinion first.[/quote]
Tommy, sorry to tell you that you have a greater than 85% chance of dying if you keep your dong.
Before you get out the pruning sheers, however, please recognize that your chances of dying remain high even without your dong. Same goes for the rest of you.
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