I got a call from Kaiser Permanente several days ago informing me that I was due for my yearly mammogram.  That call came the day before I saw the headline in the NY Times telling me that having a test every other year is now the recommendation from the U.S. Preventive Services Task Force for a woman my age.  Besides, they say, nevermind the breast self-exam, or even the exam by my primary care physician.  None of this is going to save my life.  Statistically, anyway.  And besides, more frequent exams may lead me to extreme anxiety when a lump is found that turns out to be benign (which has happened 2 or 3 times already), and I may be subjected to unnecessary treatment for an early-stage cancer which might have gone away on its own–unnecessary treatment being more tests, and perhaps radiation and/or chemotherapy, and even surgery.  Whoa!  What should a woman do?

Robert Aronowitz gives a fascinating history of the treatment of breast cancer in his article “Addicted to Mammograms” (NY Times, 11/20/09).  Aronowitz tells us that in the 19th century, doctors had cottoned onto the germ theory, conquering diseases like cholera, but were frustrated in their attempts to cure cancer.  Cancer had been considered a systemic illness, running throughout the body, and so why operate on a specific tumor. 

In the 1870′s doctors began to believe that cancer begins locally and remains local for some time before spreading (what we now call metastasis).  Concurrently, anesthesia was being developed, and so doctors were encouraged to operate–in the case of breast cancer, to remove the breast of the patient.  By the turn of the century, William Halsted of Johns Hopkins was promoting an approach that included the removal of the breast as well as the lymph nodes in the armpit and the muscles attached to the breast and chest wall.  This approach soon became medical dogma–even though Halsted’s own clinical observations indicated that the operation did not save lives: he became aware that patients died of metastatic cancer.

Early in the second decade of the 20th century, doctors began advising women to see their doctors “without delay” if they discovered a breast lump.  The message was that if you discovered the cancer in time, surgery could provide a cure.  This claim was, unfortunately, based on wishful thinking and not hard scientific evidence–and resulted in the creation of what Aronowitz calls “a culture of fear” around breast cancer, as women understandably tried to gain more and more control over cancer, believing that surveillance and early detection and treatment would save lives.  During the 1930′s and ’40′s more and more cancer was being diagnosed and treated, much of it in the early stages, and cancer survival rates seemed to support the early detection theory.

However, by the 1950′s some researchers were pointing out that despite the seeming progress, mortality rates for breast cancer had hardly improved.  And they continued in the same vein from 1950 to 1990, with about 28 cancer deaths per 100,000 people.  In 1971, evidence showed that mammograms were of little value to women under 50–but this news collided with the prevailing practice, and so it was ignored.

As with all medical decisions, there are trade-offs–some are clearer than others.  To prevent one death from breast cancer, you have to screen 1,900 women in their 40′s for 10 years.  During the screening you will find more than 1,000 false-positives, and these women will have to endure all the resulting overtreatment. 

Not to mention the financial piece–and to be sure, cost will be considered by the government and by insurers.  Medical diagnosis and treatment is limited in every country and every culture–because resources are finite.  Every society has to decide where to best place those resources.  Some citizens are afraid that medical care will be “rationed” under the new health care plan Congress is now considering.  It is being rationed already, in favor of those who have money.  It should be rationed on a more logical and scientific and just basis. 

But this begs the question: so should I have my mammogram?  I’ll probably discuss this with my doctor, who is a wise man.  My mother died of breast cancer, and her sister died of cancer, too.  In fact, all my 6 aunts and uncles on my father’s side died of cancer, too.  Does this make me “high risk”?  Like all women, I’ve been socialized to be frightened of my body–it’s too fat, it’s not the right shape, it’s sure to become “diseased” if I don’t worry about it every moment.  What’s the balance between prudence and pathological concern?  Like many women, I just don’t know.

What if you had a friend with a number of serious problems, what would you say to him?  And when I say “serious problems,” I’m referring to problems of character–spiritual problems, as it were–for the spiritual dimension is the ground that we come from, for all of our living, is it not?  Let’s say that your friend behaves in the following way:

–He begins to use most any means at all, to justify the ends he was going for.

–He manipulates others by playing on their deepest fears and insecurities.

–He tells lies and encourages others to lie, in service of their goals.

–He discounts science and tries to discredit reputable scientists.

–He shows little compassion for the poor, the sick, the weak.

–He believes that “freedom” means that the strong should take all they can get.

–He says he is a Christian and he has serious doubts about those who are not.

I have a friend like this.  But I am saddened by what has become of him.  Although historically he has had values that differed from mine in significant ways, I could understand and respect his values–values like like preserving tradition, taking personal responsiblity, and loving one’s country.  But I no longer respect him or his values.

You may have guessed his name by now: he is called Grand O. Party.  But the moniker of “grand” surely no longer applies, and the “party” lacks all integrity and therefore all cohesion and all power to influence our country in positive ways.

Can my friend be redeemed?  Of course.  We all go down the wrong path at times.  We are led astray by false leaders and promises of wealth and glory.  My friend needs to give up his ways of lying and manipulating, to get his way.  He needs to stop worshiping shallow and vain leaders, more given to ego than to genuine caring about the country.  He needs to learn to respect and co-operate with those who may differ from him, whether in race or class or religion or sexual orientation.  He needs to understand that we are a country, and we must face our demons together as a people, or we are lost.

Will my friend change?  Is he like most of us–that is, he has to fall hard, has to lose everything before he will change his ways?  I hope not.  In the not-too-distant past, my friend has added substantially to the national conversation.  I would hope that someday, some way, that might happen again.

I’m glad I’m not in politics, because then I can sit here at my computer and come up with sensible solutions to funding our nation’s health care needs–without having to answer to the hordes of well-funded lobbyists from pharmaceutical companies and insurance companies.

So here are a few places where I would go first, to find money:

–The easiest and most obvious one is to change the tax structure.  Forget going after the top CEO salaries–yes, they’re obscene, but if we reduced them all to zero, we wouldn’t even begin to raise the sums we need.  We need to substantially raise the taxes of very wealthy people.  Obama is going there now, but I wish he could go further, and faster.

–Then I would let a whole lot of people out of prison–or never put them in there, in the first place.  There are surely violent, anti-social people who need to be locked up.  But there are too many people populating our prisons who could pay their debt to society in some other way than doing jail time.  Many might even conceivable be rehabilitated, if we actually tried to do that, which we don’t.  The U.S. incarcerates people at nearly 5 times the world average, as Nicholas Kristof recently pointed out (NY Times, 8/20/09), And California spends $216,000 annually on each inmate in the juvenile justice system, but spends only $8,000 on each child in the Oakland public school system.  What is wrong with this picture? 

–And third, there’s the obesity factor.  Our kids (nevermind the adults who can’t fit into airplane seats or into caskets) are getting to be real fatties, which is a major health issue.  And soft drinks are the biggest culprit of all, I’m given to understand.  So why are we selling soft drinks so cheaply?  We should add a fat tax on every soft drink sold and use all that money for health care.

In fact, if we made all these changes, we’d probably take care of the health care crisis and have enough money left over to solve global warming.  We wouldn’t even have to stop spending billions of dollars on foreign wars–which, in truth, would be my very first choice of a smart cost-cutting measure.  But, hey, I’m trying not to dream too big. 

Yesterday I took part in a panel discussion at Lewis and Clark College’s current conference on “Reimagining the Good Life.”  Our panel’s subject was the relationship between economics and religion, in attaining “the good life.”  I opened with the following three-minute statement, which I’m sharing with readers as my “Reflection” for this week:

I remember the first time I began to understand that our economic system could be questioned, that it was not just a given, but actually the product of human choice.  I was a social work student, back in the ’70′s, and I heard a speech by David Gil, a professor from Brandeis.  “Who owns the air?” he said.  “Who owns the water?”

A word about the ancient god of the free market system, Adam Smith.  When Smith is quoted regarding the “invisible hand” of the market, what is conveniently forgotten is his assumptions about the conditions necessary to make free markets work.  Smith assumed that we would operate on a small scale and so would know the character of the people we trade with.  He assumed that our financial dealings would exist in the context of our values.  Instead, Smith’s writing is used to justify the mad pursuit of shareholder profit, which is held to be holy and untouchable.

If we consider ourselves religious or spiritual, we know that we must see and enter the suffering of the world, else our own spiritual wounds will never heal.  The question comes, though, how do we enter the suffering of the world?  Churches are most comfortable with deeds of charity alone.  I recall the words of Archbishop Camara of Brazil: “When I give food to the poor, they call me a saint; when I ask why the poor have no food, they call me a Communist.”  There’s nothing wrong with giving soup to hungry people–but the more difficult and dangerous way is systemic change, to get at the system that causes the suffering.

Wendell Berry looked at the derivation of “economics” in his book Home Economics.  Originally the word meant “activity involved in caring for the home.”  Now it is a sophisticated discipline, supposedly a science, grounded in mathematical equations instead of human values.

Do I, a minister, know enough to speak about economics?  Am I a citizen?  We cannot leave this crucial area to the “experts,” who have overlooked the poor among us, saying “that’s just the price we have to pay for prosperity”; who have called the bleeding of the earth an “externality”; who have been enamored of formulas in books and have not been concerned that children are hungry.  No, we can’t leave economics to the experts, because economics is all about how we divvy up resources and therefore it is fundamentally a moral issue.

We wonder that we can do in the face of forces which seem immovable.  Well, these forces are in fact subject to change.  Human beings have made choices, and different choices can be made.  We can say no, and no, and no.  We can say no, until they hear us.  And we can say yes, here is a new way.  It’s time now.  Let’s move there together.

According to the NY Times (10/23, B1-5), I am a member of a small and shrinking minority known at the “cell refuseniks”–those people who refuse to own a cell phone.

Now most of the people who do not have cell phones (a mere 15% of the population) do so because they “are older” or “less educated” or “unable to afford phones.”  These reasons are not mine.  (Well, I am “older,” but not so old that I cannot punch buttons.)  So I am among the refuseniks–the 5% of the 15% (that would be, let me see my calculator) less than 1% of the population–exactly .75%!  I have never felt so lonely.  Others all around me–walking down the street, riding bicycles, waiting for prescriptions to be filled or movies to start, in church, in business meetings, on trains, in restaurants, during serious conversations about death or breaking up with your boyfriend, and of course in automobiles everywhere–all these others are chatting away to their friends and business acquaintances, while I walk through the world alone. 

And, yes, I have made this choice.  Why, you may say, why?

Because I want to be present in this world.  It’s that simple.  I want to be with the people I’m with.  I want to see the fall leaves.  I want to notice the bicyclists when I drive (I worry so about them).  And another thing.  I am grossly offended–please note this, cell phone users–grossly offended when I am engaged with someone in what I consider a significant conversation, exchanging words carefully and respectfully, and that person interrupts our intercourse by answering a cell phone ring (often an offensive sound in its own right) and then begins another conversation in my presence.  And I am similarly offended when forced to hear one end of someone else’s conversation, which may be intimate or loud or boring or all three.

There are reasons for people to own a cell phone.  I understand that.  Single moms who need to know where their teenagers are.  People who take emergency calls of one kind or another.  Women (or men) who drive alone at night on deserted roads in undependable cars. That’s about it.  But wait!  What about business calls?  Business calls are not human emergencies. 

Someone asked me once, “What if a genie appeared to you and told you that you could make 3 inventions disappear from the earth–what would they be?”  Well, of course, you’d have to go for the weapons, wouldn’t you–the intercontinental ballistic weapons systems, the land mines, the nuclear bombs of all kinds, etc., etc.  But given that the weapons were gone, I know what my next two would be: cars and cell phones.  The planet might survive.  And I could tell my friend about my . . . well, about my life, without being interrupted.