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Cancer Medicine

If you’re going to cite me, at least read and understand what I wrote

Bloggers love it when other bloggers cite them to support their arguments. I’m no different, as even a blinking Plexiglass box of lights likes to have its arguments appreciated. I particularly love it when a skeptical blogger uses some small thing I’ve written to refute particularly egregious nonsense. Unfortunately, there’s the flip side to this. There are times when I’d prefer I wasn’t cited. No, I’m not talking about anti-vaccinationists like J.B. Handley launching broadsides against me when I hit a particular nerve, various quacks or boosters of quackery going after me when, well, I hit a particular nerve, or pseudoscientists of all stripes attacking me because, well, I scored points against them. To me those are examples that validate what I’m doing; they mean I’m being effective.

What I don’t like is being cited to support a viewpoint that I most assuredly do not support and that, in fact, the post being makes it clear that I don’t support. In other words I hate it when I’m cited in such a way that makes it clear that the blogger doing the citing either didn’t read what I wrote and/or didn’t understand it. I’ve found just such an example citing my post from last week about the USPSTF’s new recommendations regarding mammography. A blogger named Susie Madrak completely missed the boat citing my work:

So I’m reading all these stories and saying, “Where’s the data about the risk from radiation?”

I finally found this important (and missing) piece of the puzzle in the San Francisco Chronicle:

Radiation causes 1 death for every 2,000 women screened annually starting at age 40, according to a study published in 2005 in the British Journal of Cancer. Another study shows that each mammogram increases the risk of breast cancer by 2 percent. Mammography also saves women’s lives, so that’s why it’s a trade-off.

Here’s some more info from Respectful Insolence, a medical research blog.

Got that? Statistically, some women have approximately as much chance of getting breast cancer from a mammogram as they have of it saving their lives. That’s why it’s considered a policy wash.

Yes, you might be one of those rare women saved by early detection. But you might also be someone who develops breast cancer from the yearly radiation exposure.

No, no, no, no. I said nothing of the sort. In fact, in the post cited, I didn’t even mention risks of secondary malignancy Interestingly, this same blogger has a different version of the same post that doesn’t cite me and has an even more overblown message:

Got that? Statistically, you have as much chance of getting breast cancer from a mammogram as you have of it saving your life. That’s why it’s considered a policy wash.

Yes, you might be one of those rare women saved by early detection. You ‘re just as likely to also might be someone who gets breast cancer from the yearly radiation exposure.

Where Ms. Madrak got the idea that my post said anything that supports her viewpoint, I have no idea. Although I like being cited as much as the next blogger, I don’t like it when my posts are used for a purpose opposite to my purpose and at odds with what I wrote. Even my more recent post, which explicitly addressed the issue of screening mammography and the risk of breast cancer from low dose radiation exposure wouldn’t give aid and comfort to Ms. Madrak’s misunderstanding of the issue.

As far as the San Francisco Chronicle referenced, the BJC article cited does indeed estimate 1 breast cancer death for every 2000 women screened modeling based on an excess relative risk model, which means that the risk of radiation-induced breast cancer was calculated relative to the estimated “underlying” incidence of breast cancer in the UK population. Moreover, the study also found that beginning mammographic screening of women between the ages of 40-49 may reduce the risk of dying of breast cancer by as much as 20%. Basically, the study concluded that if the reduction of the death rate due to breast cancer in a population that begins screening at age 40 is 20%, then the benefits in early diagnosis clearly outweigh the risks of a radiation-induced cancer from mammography, but if mammographic screening only reduces the risk by 10% then it’s close to a wash, with small or possibly no benefit.

As for the article referenced claiming that there is a 2% increase in the risk of cancer for each mammogram, I couldn’t find it. Moreover, another study suggest that the risk is 8 deaths from radiation-induced cancers for 100,000 women screened beginning at age 40. Meanwhile another study suggests that, for high risk BRCA carriers, weighing the relative risk of cancer from mammography, there would be “no net benefit from annual mammographic screening of BRCA mutation carriers at age 25-29 years; the net benefit would be zero or small at age 30-34 years, but there should be some net benefit at age 35 or older.” And these latter two are studies of young women, which, as I discussed the other day, are at higher risk from radiation-induced tumors to begin with.

Finally, another problem with a lot of these studies is that, because they have to span many years, they are looking at mammography as it was done 10, 20, or even 30 or more years ago. Back in those days, the radiation doses from mammography were much higher now, particularly compared to modern digital mammograms. These days, the dose of a standard screening mammogram is on the order of 0.7 mSv. (For comparison, typical radiation exposure from normal background radiation is around 2.5 mSv/year.)

So, to Ms. Madrak, I say, thanks but no thanks for your citation and incoming link. Next time, please read what I wrote and make sure you understand it before citing it in support of your ill-informed viewpoint.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

41 replies on “If you’re going to cite me, at least read and understand what I wrote”

What I used to love about the blogosphere was that when someone had a problem with something you wrote, they simply engaged in a dialogue via the comments section with the helpful intent of correcting or clarifying your position – because after all, we can’t all be experts about everything, and the strength of the blogosphere has always been shared and amplified knowledge.

Now, when people have more information than you, they simply rip off a shot without even the courtesy of a conversation. (I suppose this is “progress.”) Nice that your method of engagement was to mail me this link using a fake email address, too.

I’m not a trained scientist, and you’re right, I’m ill-informed on this topic. (Although it’s difficult to know exactly how credible you are since, unlike me, you post both your work and your attack on me as an anonymous coward.)

While you may have a more comprehensive understanding about the science behind this policy (again, difficult to say, since you don’t post your c.v. and we have only your word for it), I do know one thing: This was a rather cowardly way to bring it to my attention.

And by the way? You spelled my name wrong.

How can anyone be that dense as to do something like that in this day and age, where looking up a blog post takes about 10 dynes more energy than looking out the window ?

@Susie Madrak;
Who Orac is, isn’t really important. If you doubt the content of the post, just look up the links.

shorter Madrak: “whine blah whine you’re mean for not taking this up in the comments of MY blog where I can censor you! you anonymous person!”

Me:
If Orac’s anonymity is all that much a problem, why did you try to use his ‘nym and reputation to begin with ?
Not like it’s all that hard to figure out who it is behind the plastic box with lights.

Now, when people have more information than you, they simply rip off a shot without even the courtesy of a conversation. (I suppose this is “progress.”) Nice that your method of engagement was to mail me this link using a fake email address, too.

I’m not a trained scientist, and you’re right, I’m ill-informed on this topic. (Although it’s difficult to know exactly how credible you are since, unlike me, you post both your work and your attack on me as an anonymous coward.)

A few things:

1. I did not to my knowledge ever send you a link to anything from my blog. If someone sent you a link to this, it wasn’t me, as far as I can recall. Or are you misinterpreting e-mail notifications of TrackBacks for my having actually sent you an e-mail?

2. Re: “Anonymous coward.” Give me a freakin’ break. My identity is one of the most poorly kept secrets in the blogosphere. I’m part of a group blog where I posted a slightly different version of the post you cited under my real name, and if you had linked to that I would have responded on that blog. Also, you do realize, don’t you, that the “anonymous coward” attack is one of the lamest ones there is in the blogosphere.

3. Regarding e-mail versus blogging about it. Give me a freakin’ break again. When someone publicly cites me in a way that proves that they either didn’t read my post or clearly didn’t understand it, I will probably react on my blog by calling her out about it. Besides, I could just as well have asked you to have e-mailed me about my post before using it if you didn’t understand it.

4. Susie, Suzie, sorry I spelled your first name in a different way than you choose to. I fixed it. Now that that distraction is over…

Now address the substantive criticism or go away.

My guess is that someone e-mailed the post to you representing it as saying something it didn’t, and you just used it without reading it. Go back and read the two posts I cited. You might learn something. Or not. Given your attitude, I’m not sure I care.

“I said nothing of the sort. In fact, in the post cited, I didn’t even mention risks of secondary malignancy.” Ok, now I’m confused. I thought your post was about whether, or to what extent, young women with BRCA mutations have an increase in BC risk from radiation associated with screening mammograms. Isn’t that secondary malignancy?

I don’t recall your addressing the question of BC risk from screening mammograms in women at average risk. So I would agree that the link to your post is, at a minimum, taken out of context.

As the “anonymous” person who sent only the link to this post to Susie Madrak from her contact page at http://susiemadrak.com/contact/ , my only intention was to bring this blog post to her attention.

Also as a regular reader of crooksandliars.com I’m surprised to see someone who blogs there react to criticism with this sort of attitude.

In a previous post, I believe that you described the new mammography guidelines as: “a recipe for confusion and controversy”. Ok, here we are.

Beneath several layers of unnecessary comments on the part of #1 above is a genuine need. She is admitting that she is not an expert, nor fully informed. Women are questioning these guidelines and they need a short, easily comprehended analysis that can provide guidance as to when to schedule the next mammogram appointment. Frequently they turn to friends, acquaintances or even bloggers for answers.

So help her out. What she needs is a paragraph or two of distilled information that helps women know what to ask their own doctors about scheduling mammograms. Many of the rest of us would also find this useful when answering questions posed by our own friends.

We need to reach the middle ground, those who might be influenced by the rabid forces of anti-science but are still approachable. I believe that we should care whether or not bloggers such as this on read the two posts carefully and understand their contents. Given that that did not happen, it again points to the need for a distilled version. And I agree with #1 that this issue should be also addressed at her blog. Because getting her readership a science based viewpoint is important.

“I said nothing of the sort. In fact, in the post cited, I didn’t even mention risks of secondary malignancy.” Ok, now I’m confused. I thought your post was about whether, or to what extent, young women with BRCA mutations have an increase in BC risk from radiation associated with screening mammograms. Isn’t that secondary malignancy?

While discussing radiation, Madrak cited my post about the USPSTF guidelines as backup. I didn’t even mention radiation exposure in that post.

@Susie Madrak,

…we can’t all be experts about everything, and the strength of the blogosphere has always been shared and amplified knowledge.

You’re right, bloggers can’t be experts on everything but the strength of the blogosphere has always been the exchange of information and getting that information to the experts who can give a qualified opinion on it. Or at the very least, people who can provide an informed take on the situation. Blogs have always fought and knocked on each other so let’s not share a utopia that never was here. And when people had a big audience, they posted their issues with your work on their blogs as well. Always had.

Science is a damned hard topic to write about and one has to take great care in doing it because you will have no shortage of experts tearing into you when you make a mistake. This is what they do. This is what their grad school is often like. Same thing for engineering professions.

I’m not a trained scientist, and you’re right, I’m ill-informed on this topic.

Then why would you possibly write about it? What kind of an excuse is that? Don’t snarl at me because I totally misrepresented your professional advice and compromised the perception of your blog’s scientific accuracy to those who may not have heard of it and now think it’s filled with questionable bunk, but it’s ok because I didn’t know what I was talking about?

I’m not a trained scientist either. I’m a trained analyst who’s skills are in research and development projects. But I ask experts, read carefully and research the hell out of every topic I write because I know that in the science blogosphere, if you write something out of left field, you may as well pack up your blog and call it quits. And you know what I do when someone alerts me to a mistake I made? I fix it and thank the expert for pointing it out to me.

…it’s difficult to know exactly how credible you are since, unlike me, you post both your work and your attack on me as an anonymous coward.

Everyone who spent a few minutes on Google knows who Orac is, his name, and his credentials. He also blogs on Science Based Medicine under his full name. You can tell by the same exact posts and references to this blog as his “other blog.” But then again, people will often address my user name on my blog instead of clicking on the about page where my name is stated loud and clear. It seems that before tackling the bloggers who irritate them, people won’t look up who they’re addressing, even if they’re given every chance to do so.

So all your indignation about Orac’s pseudonym and a shot at his qualifications really shows is that you don’t do your research. But that’s ok even when writing posts which give out medical advice because you’re not a trained scientist and can’t be expected to live up to their standards in providing accurate information on the topic, right? Because that’s the vibe I’m getting from your comment here…

So help her out. What she needs is a paragraph or two of distilled information that helps women know what to ask their own doctors about scheduling mammograms.

Uhh…. You must be new here. Orac doesn’t really do short.

Further, this isn’t really a topic amenable to distillation. In order to really understand the motivation behind the recommendations, you need to know a bit about everything from statistics to surgery to cancer to game theory. Orac’s covered the medical side of things at length, and Mark Chu-Carrol has a post about the mathematical motivation over here. I’m sure you can find other blogs that cover it from different perspectives if you look.

What I don’t understand is people who expect understanding to come easily. It’s not always possible to distill knowledge without losing accuracy.

Susie, regarding this:

What I used to love about the blogosphere was that when someone had a problem with something you wrote, they simply engaged in a dialogue via the comments section with the helpful intent of correcting or clarifying your position – because after all, we can’t all be experts about everything, and the strength of the blogosphere has always been shared and amplified knowledge.

I find it pretty astonishing that you wrote that, because as you may remember, that’s exactly what I tried to do!

I posted the very first comment in that thread on your blog, and informed you that you were making unsubstantiated claims. I linked to a relevant study, and directed you and my fellow readers to Orac’s post about the guidelines, since I’m not an expert.

You responded by posting 3 links to studies, without any elaboration, of which 2 linked to the same study hosted on different websites! You didn’t actually respond to my criticism at all, and when I pointed out that the studies you linked to didn’t support your point, and were insulting because you clearly didn’t respect me enough as a reader to make sure that they did, you got huffy and dismissive. You just changed your post in a very minor way and didn’t remove or correct the irresponsibly wrong statements.

It boggles my mind that after all that, when Orac called you out, you whined about not being alerted more discreetly in your comments. Unbelievable.

DLC:

Not like it’s all that hard to figure out who it is behind the plastic box with lights.

Greg Fish:

Everyone who spent a few minutes on Google knows who Orac is, his name, and his credentials. He also blogs on Science Based Medicine under his full name. You can tell by the same exact posts and references to this blog as his “other blog.”

I just checked her blog entry that is under discussion, in the 7th comment someone linked to the “other blog.” She has no excuse for not knowing Orac’s identity.

Susie Madrak: Philly’s contribution to Crooks and Liars. For every decent post she writes there’s about five that veer into tin foil hat territory.

It’s kind of a shame, because she is very passionate about health care. The posts about her own trials with the health care system can be heart breaking. Unfortunately, IMO, her emotions short-circuit her critical thinking skills in a nanosecond.

@11 and 12, you are right of course, it is always more complicated than that. I have read many of the reports you mentioned. I don’t think that everyone will read at this depth, or even that they are capable of doing so.

My concern is that we are not addressing the target audience, the people in the middle. A rational argument can be made. It is not at the extremes of “radiation is bad, might kill you, and should be avoided at all costs” or “these guidelines demonstrate that when the government takes over medicine, treatments will just be denied and you will die”.

If the public in general does not get an opportunity to see at least the framework of a sensible strategy regarding their own decision making spelled out, in wording that they can comprehend, in a location where they are likely to be looking, the forces of reason cannot prevail.

This is Orac’s blog, and of course, he is free to accept, reject, or ignore my advice.

Oh, Tacroy, you said a mouthful.

Distilling information into a digestible state for the many is made all the harder when the issue is being used as a political football. And, as an absolute newcomer, I don’t think I might necessarily take away the relevant points under discussion here, but then, I’m not writing an article for a high-traffic blog about it.

Ms. Madrak, though, has a go-to argument she employs when all else fails, and that is to slam the pseudononymous, as if blogging under a nym weren’t a completely time-honored and understood practice. And I’ve had personal experience with the impossibility of having an honest discussion with her on her own, heavily-censored blog.

Interesting. I had never heard of Ms. Madrak before this incident. I wonder if my posting about what she wrote has lead to commenters trying to take her to task over there. I might have to wonder over and see…

Best of luck, Orac. After she tired of deleting me (and my comments were not abusive, merely annoyingly not in lockstep), she cutely made some sort of cyber-arrangement whereby not only was I blocked from commenting, but I couldn’t access her blog at all, nor could anybody from rumproast who’d taken part in that morning’s discussion; we landed instead on a dailykos page, as she decided that’s where we belonged.

What I don’t understand is people who expect understanding to come easily. It’s not always possible to distill knowledge without losing accuracy.

It’s not only losing accuracy, it is losing everything. I run into this with my work all the time. Someone (non-scientist) asks, “Can you explain your research in a manner that I can understand?” When that person has only taken general chemistry and doesn’t even remember that, how am I supposed to explain our thermochemical studies of electron-coupling in polyradicals using mass spectrometry? They barely know what an electron is.

So, let me see if I can understand Susie’s mind. At first, she is happy to cite Orac in her article as a legit source for additional information then when Orac calls her on misrepresenting what he wrote she questions Orac’s credentials and expertise.
So to recap: Orac’s writings and credentials are good enough to cite as ‘a medical research blog’ when it suits her uninformed viewpoint but when she gets called out on it only then does she question Orac’s expertise.
Susie, if you really do question Orac’s knowledge and honesty in this matter then why did you cite him in the first place?

@22 “losing everything” in my opinion, is likely to come about if the public loses its respect of and support for science and scientists.

Maybe, in your example, you can’t get much beyond conveying that you do something exciting and important that involves those little understood electrons. Understanding doesn’t have to come easily, nor does it have to be at the greatest depth possible, but one can, I believe, at least convey enough to make your work seem credible (and make your work and/or work like yours possibly worthy of taxpayer support).

Referring back to this blog post, women need enough information to process why the change in mammography recommendations has occurred and still feel that their medical providers remain a credible source of decision making data and recommendations.

If scientists do not take the time to explain science to the public, then the public is very likely to fall prey to those purveyors of what Orac likes to call “woo”.

When asked for a simple explanation of his work in quantum electrodynamics, Richard Feynman said, “If I could explain it to the average person, I wouldn’t have been worth the Nobel Prize.”

On the topic of general physics, Richard Feynman was undoubtedly one of the greatest “explainers” of all time. And someone who did quite a bit to build respect of, and support for, science.

The issue at hand is not quantum electrodynamics, or even the inner workings of an x-ray machine. It is decision making regarding getting a mammogram.

I think that all of the above posts are excellent. Or at least highly likely to be excellent, I’m not sure I have read all of them. They are examples of why I read your blog.

If you read the comments from Susie’s readers on her blog, I think you’d agree that if some of them followed the link here, they might not absorb much. Somehow, I think that these people need to be reached.

Thank you, Orac, for your many lucid explanations of science for non-scientists on this blog. (I found your article on the Orange Man particularly helpful at one point). I never took either college biology or chemistry, but I find that I can usually understand even your “peer-reviewed” discussions, which is a testimony to your ability to explain complicated scientific issues for the layperson.

Look hard enough at Susie Madrak’s blog, and you see a lot of woo friendliness and a vague sense that she might be anti-vaccine, even though I’m sure she insists that she isn’t. At the very least, she’s happy to throw vaccines under the bus because they’re produced by evil drug companies.

http://susiemadrak.com/2009/06/05/09/57/why-should-we-believe-merck/

http://susiemadrak.com/2006/05/08/22/06/looking-out-for-big-pharma/

So I’m not surprised that she not only misinterpreted your post, Orac, but that she got ultra-defensive when you called her out on it. That’s very much an altie, anti-pharma m.o.

@ #28 #30

“….Somehow, I think that these people need to be reached.”

“Look hard enough at Susie Madrak’s blog, and you see a lot of woo friendliness…”

Looks like Madrak’s Crooks share a lineage with the Huffington Hordes. I don’t think they can be “reached out” in any meaningful way.

I don’t think they can be “reached out” in any meaningful way.

If that sounds flippant or cynical, let me clarify:

If you read the comments from Susie’s readers on her blog, I think you’d agree that if some of them followed the link here, they might not absorb much. Somehow, I think that these people need to be reached. #28

If Orac make succinct one paragraph statements about decision-making on mammography screening for a laywoman, and if that doesn’t support Madrak’s views, she would never link him on her blog, and neither would she not attack and possibly censor any such links in the comment section (“hey, is that what they call medical research these days?!”, “anonymous coward, he is pharma shill!”, you get the point.)

Looks like Madrak’s Crooks share a lineage with the Huffington Hordes. I don’t think they can be “reached out” in any meaningful way.

Ugh. Tell me about it. I read Crooks and Liars and Raw Story on a regular basis. Your irony meter must have extra-heavy shielding if you stop there. The writers and commenters will howl with outrage (rightfully) at Beck’s or Hannity’s latest truth mangling, and then angrily defend their own 9/11 or vaccination conspiracy theories.

Pointing out this inconsistency usually results in being told how you’re blind and being used by The Man (TM). At the very least, it’s a useful proving ground for spotting logical fallacies.

You’re in good company, Orac. There’s a whole discipline of science which regularly has its peer-reviewed published articles misquoted and used to support a position the exact opposite of what the articles really say. Some of the authors have written to correct these misconceptions and posted them in public places so others can link to them.

And still, they are misquoted. Once a misquote is out there it is like the mythical Hydra–cut off one head and two more grow in its place.

Or even worse, someone sees your explanation and then proceeds to tell you why you are wrong about your own study, your own data, your own interpretations and do all that without the benefit of any relevant background at all

E.g. A certain former tv personality who had a high school diploma tried to tell an expert who had decades of experience and education regarding the subject why his (former tv guy) interpretation of the paper was right and the expert’s interpretation of his own paper was wrong—jaw-dropping, mind-boggling, stunningly arrogant. If Kruger and Dunning had this guy in their study he would have skewed the data right out of the graph where it would have fallen to the fall in scattered messy pieces.

@ Daniel J. Andrews:I have a nickname for some of our favorite woo-meisters(and *maitresses*) and their political equivalents(like Sarah Palin):”Dunning-Kruger personified”. Be that as it may,I have real worries about this trend.If we consider the general decline of education in science/social science (especially in medicine, psychology,economics) combined with the loss of newspapers/magazines,the rise of politically-fueled, inflammatory reportage in the media(e.g. Murdock’s empire), and the meteoric growth of dependence on the internet for information. I often hear/see astonishingly strident anti-elitism: in the wake of last autumn’s/spring’s economic fiasci,in response to the health care bill,by anti-vaccinationists,at some of the pseudo-scientific websites proliferating like wildfire.100 years ago, Collier’s Magazine exposed patent medicine, leading to governmental regulation and the FDA.I think that *this* time the reform has started *here*.

@23: Well said, kelly. That didn’t even occur to me until I read your comment, but it’s an excellent point.

OK, I realize this is not at all on-point. and agree with what you’ve said here in general, but it’s a pet peeve:

Susie, Suzie, sorry I spelled your first name in a different way than you choose to.

The way someone chooses to spell or pronounce her name is the way it’s spelled or pronounced. Her post says “By Susie…” It’s a matter of basic respect to make sure we spell/pronounce people’s names the way they wish rather than as we might be lazily inclined.

That said…Susie, you’re a pinhead.

“If you’re going to cite me, at least read and understand what I wrote”

Wow, you mean he actually believes in the Principle of Charity? What a shift in thinking.

Unfortunately, this topic isn’t even close to being simple.

True enough, though think that if basic statistics were a high school requirement — it’s frankly much more important (and interesting) to modern life than solving quadratic equations or congruent triangles — people would be much better equipped to understand.

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