Square One

Scott W. Wright writes in this week’s JAMA about his breast cancer, the feminization of the breast and why men should reclaim the breasts in order to combat the the stigma of male breast cancer. Here is an excerpt:

So I pose the question: Would we be better off if we returned to an age when men had breasts? Would that help men and physicians get beyond the stigma? In the time of Samson and Moses, when great men—heroic men—turned to beseech God, did they beat their chests? Did they flex their pecs? Of course not. To beg for mercy or wisdom or might, men of old beat their breasts. Home to a man’s heart. The bulwark to a man’s soul.

In Judaism, the Hoshen breastplate was a sacred garment reserved for the High Priest. For the fiercest warriors of the Roman Empire, the breastplate was the piece of armor that best symbolized a man’s willingness to march into mortal combat. Consider literature, when men would put pen to paper and seek to evoke the most compelling image of our gender’s strength and raw courage. What was it that Tarzan did to show that he was dominant over all other men and beasts? He beat his breasts. Far from being ashamed that he had breasts, Tarzan used them as calling cards to declare himself King of the Jungle. And, incidentally, he got the girl.

So there was a time—an age—when it was not only OK for men to have breasts, it was from within men’s breasts that great ideas and ideals sprang forth.

But over time something happened. The concept of a man having breasts gave way to a different sense of self. A changed view of what is masculine. We men at some point seem to have lost our breasts. They gave way to chests. Breasts became sexualized: Objects exclusive to the domain of women and girls. A real, modern man proves who he is by flexing the muscle in that manly chest of his. When things get a little rough, a man’s man no longer pulls inspiration from deep within his breast. The sources of valor and self-worth have apparently been moved to lower parts of the anatomy. A man must show he has guts. And make damn sure he’s never open to being accused of lacking, well, “testicular fortitude.”

The full article is here.

In spite of my several competing interests, and its relatively low impact factor compared to its supposed peer general medical journals, the club of the big five including The Lancet, JAMA, New England Journal of Medicine and Annals of Internal Medicine, I still think the BMJ is perhaps the best medical journal for a young clinical/medical/health scientist. While other journals go out of their way to be interractive, it seems to me to be in the nature of the BMJ to be engaging and interractive. It is not unusual, in fact it is rather the rule than an exception, to learn more from the BMJ’s rapid responses to an article on bmj.com than from the main article itself.

Reading through BMJ’s triumphal announcement of their decision to go all the way with publishing only untraedited versions of research articles (BMJ pico) in print, about two months ago, I chanced upon a 2003 BMJ article by Gerd Gigerenzer and Adrian Edwards working at the Centre for Adaptive Behaviour and Cognition, Max Planck Institute for Human Development, which they started out by saying:

“The science fiction writer H G Wells predicted that in modern technological societies statistical thinking will one day be as necessary for efficient citizenship as the ability to read and write. How far have we got, a hundred or so years later? A glance at the literature shows a shocking lack of statistical understanding of the outcomes of modern technologies, from standard screening tests for HIV infection to DNA evidence.”

They dispel the notion that this is due to some inherent innumeracy of mankind, and place the charge at the feet of scientists for not representing data clearly enough. In an example, they explore the difference between expressing information as conditional probabilities and as natural frequency:

Conditional probabilities
The probability that a woman has breast cancer is 0.8%. If she has breast cancer, the probability that a mammogram will show a positive result is 90%. If a woman does not have breast cancer the probability of a positive result is 7%. Take, for example, a woman who has a positive result. What is the probability that she actually has breast cancer?

Natural frequencies
Eight out of every 1000 women have breast cancer. Of these eight women with breast cancer seven will have a positive result on mammography. Of the 992 women who do not have breast cancer some 70 will still have a positive mammogram. Take, for example, a sample of women who have positive mammograms. How many of these women actually have breast cancer?

They found that most doctors could not answer the question correctly when framed in conditional probabilities , but could when presented as natural frequencies.

The BMJ version of the article is here, and if you don’t have access to the BMJ, then there is a free pdf version of the same article here.

There is a also a more recent and comprehensive discussion by Gigerenzer and four others about framing statistical information, which is targetted at a much wider readership here and it is free. Although much longer than the BMJ article, reading it is well worth the time and effort.

You may then want to try out this question from this week’s BMJ quiz.