Photo of the day

This photo and some amusing photoshopped versions (my favorite featured the Stay-puft marshmallow man) went totally viral in the Raleigh area today.   A lot of people wonder if this photo of our snow and icemageddon was photoshopped, but it was actually real.  Just a stranded driver with her Iphone on a major Raleigh artery.  Very glad I stayed home yesterday (barring a trip out for pizza lunch nearby just as the snow began):

'Oh my gosh!' Raleigh woman's snow photo goes viral

We had an inch of snow per hour which we are simply not equipped for here.  That was followed by hours of sleet and freezing rain.  Fortunately, not quite enough freezing rain for major power outages.  We lost ours, but only for four hours during the middle of the night.  Not the days-long nightmare I feared.

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Why do some ethnic groups succeed?

I don’t think I’ve written about the Asian Tiger Mother controversy before, but I can say I’ve always found it plenty rich that a Yale professor married to another Yale professor attributes her awesome, crazy-rigorous, parenting for her child’s success.  Anyway, turns out that Amy Chua and her husband have a book out claiming to explain cultural success (some cultures have the right values, e.g., impulse control, and others don’t).  Great takedown of their premise from law professor Daria Roithmayr in Slate:

Here is the book’s thesis: Some groups (Cubans, Nigerians, Mormons, Jews, some Asian groups, south Asian Indians, and Iranians) have experienced upward mobility in the U.S. at higher rates because they possess three cultural qualities: impulse control, feelings of superiority, and feelings of inferiority. By impulse control, they mean the ability to resist temptation (to quit, for example); superiority and inferiority appear to be a simultaneous belief in your group’s specialness (e.g., God’s chosen people) and deep-seated anxiety about inadequacy, the kind that a Chinese mother might instill in her daughter by calling her garbage.

These cultural traits are the ticket to success. Being Latino is no impediment, Chua and Rubenfeld argue, since Cubans can make it. Nor is being black, if Nigerians can do well (though the authors disclaim these comparisons on talk shows). The Triple Package is available to everyone.

The problem with the thesis is that in setting out their claim, the authors ignore the more obvious explanation for differences in group success: history. To be specific, in their quest to make it all about culture, the authors either ignore or strongly discount the particular circumstances of a group’s first arrival, and the advantages enjoyed by that first wave…

The Triple Package’s minimizing of history is a bit curious, given that many of the authors’ own sources favor this explanation. Here are some of the early-wave stories that the authors could have told but didn’t:

  • It isn’t just that Chinese-Americans have developed a “‘how dare they look down on me’ mentality and an iron will to succeed.” It’s more that the second wave of Chinese immigrants—those who have formed the foundation of current Chinese communities—were professionals (nurses, doctors, and engineers) who brought wealth and education with them. (Most of the first-wave Chinese, who were poor railroad workers and miners, died or were sent back.)
  • Why do south Asian Indians earn higher wages? As Triple Packageacknowledges, immigration law has done a great deal of prescreening for a very select cross section of south Asian Indians. A majority of them come on employment-based visas, with higher educations and English skills, to work in high-tech jobs in California, New York, and Chicago. The Indian median incomes come from this group and not the poorer subsequent waves that theTriple Package profiles.

Uhh, yeah.  History.  Just a minor detail.  Does culture matter?  Sure.  But it makes a hell of a lot more sense to look at it this way:

Serious sociologists like Harvard’s William Julius Wilson and Yale’s Elijah Andersonbelieve that culture plays a role in economic success, but that history, economic forces, and first-wave wealth explain far more than culture. Put differently, history and structure drive the bus, and culture might be a passenger along for the ride. But the cultural arguments in the book aren’t serious, more entertaining anecdote and “status anxiety as social theory” than well-supported science.

It just amazes me that they could present this as serious scholarship and so ignore history and path dependence.  Not to mention, even if we are to claim particular cultures have superior values, rather than building off superior starting advantages, it seems quite likely that these superior starting advantages may very well have led to the superior values that help these cultures succeed.  It’s all Guns, Germs, and Steel.  

Too many mammograms?

I’ve written plenty about our excess of prostate cancer screening, but I find the issue of mammograms even more fascinating (and I’ve written about a few times, too).  Sadly, because unlike prostate cancer, which is rarely lethal, breast cancer sadly does strike down thousands of relatively young women in the prime of their lives every year.  But, does increased mammogram screening actually do anything to prevent this?  Best answer says no.  Nice summary by Jon Cohn of a really important study new study:

On Wednesday, the British Medical Journal published one of the largest, most rigorous studies of mammography to date. If that study is right, the experts on USPSTF deserve some kind of apology.

The study followed almost 90,000 women (that’s a lot of people) over the course of 25 years (that’s a long time). And it was as close to a perfectly scientific study as you’ll find in this field. Researchers assigned women into two groups randomly. Women in one group got regular mammograms starting at 40. Women in the other group got only physical exams. Mammograms can pick up growths before it’s possible to feel them, so it was a good test of whether detecting those small growths translates to significantly more women surviving breast cancer…

The answer, according to the researchers, is a pretty definitive “no.” In fact, the researchers found, the primary consequence of such widespread screening was over-diagnosis, which led to procedures and treatments that were uncomfortable and costly and, occasionally, harmful. 

Cohn than quotes from this Austin Carroll post on the topic:

Of the 44,925 women in the mammogram group, 500 died of breast cancer. Of the 44,910 in the no mammogram group, 505 died of breast cancer. This was not a significant difference. There wasn’t a significant difference if you looked at only older women (50-59) or younger women (40-49). There wasn’t a difference if you lengthened the screening period to seven years.

Mammograms did not affect mortality at all.

However, they did affect diagnosis. During the screening period, 666 cases of cancer were diagnosed in the mammography group versus 524 in the no mammography group. This meant an excess of 143 breast cancers were diagnosed with screening. Fifteen years later, the excess settled in at 106 cases of cancer.

More than 20% of the cancers detected by mammography were over-diagnosed. This means that mammography over-diagnosed one case of breast cancer for every 424 women screened with mammography. Do you know how many women we screen a year here?

This study is going to make a whole lot of people upset. It’s a large, well designed randomized control trial with a really long follow-up period. The people in the mammogram groups actually complied with screening in surprisingly high numbers. It’s hard to find fault with much of this. The data make a really good case that universal screening with mammograms does almost no good, and likely does harm.  [emphasis mine]

Well, this should settle things– right?  As if.  Back to Cohn:

As Ezekiel Emanuel, the oncologist and former Obama Administration advisor, explained to the New Republic, studies like this are a “Rorschach test” for researchers. While people who tend to be skeptical of medical intervention will see evidence that we screen too much, people who tend err on the side of early, aggressive action will find flaws with the study. Among other things, they will point out, the study is based on screenings that took place 25 years ago—when the technology itself was less sophisticated.

“There will never be a truly definitive mammogram study,” says Emanuel, who was longtime head of the National Institutes of Health Bioethics Department and is now a vice provost at the University of Pennsylvania. “You’re in this circle where you will never resolve the issue. You need a long timeline to get the best results, but in that time span the technology always improves—and people will always say, well, this is based on old technology so it’s not so relevant anymore.”

This may be a Rorschach test but this study truly makes it hard to argue that there’s evidence for mammograms providing a net benefit.  Unlike the studies that find in their favor, this was a randomized, controlled trial– the gold standard.  Of course, doctors being doctors, I don’t actually expect anything to change any time soon, but I’m definitely not encouraging my wife to get a mammogram (though, of course that’s her call).  That said, it’s also important to note that the non-mammogram group had annual breast exams.  That’s important and should not be ignored.  It’s just the the results suggest there’s no mammogram benefit above and beyond the breast exam.  

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