New cancer test isn’t ready for prime time

(CNN)A simple blood test to detect cancer early. How great is that?

A widely reported study in the journal Science described a liquid biopsy test — CancerSEEK — which combined measuring eight tumor biomarkers with testing for pieces of DNA with cancer associated mutations in 16 genes.
It’s not one test; it’s a battery of tests. And while collecting the blood may be simple, the subsequent analysis is extraordinarily complex.
    The task at hand is particularly challenging. We all have pieces of DNA in our blood. Distinguishing the tumor DNA from the background DNA requires finding the mutations specifically associated with cancer.
    Adding to the complexity, healthy individuals can have mutations. To avoid labeling innocuous mutations as cancerous requires a bunch of statistical fine-tuning.
    In other words, there are a lot of steps in a liquid biopsy and much potential for things to go awry.
    To their credit, the CancerSEEK investigators were very forthright that the study conditions were ideal for the test to accurately detect cancer. The liquid biopsy simply had to discriminate between patients with known cancer (the majority of whom had symptoms) and healthy individuals. And the statistical fine-tuning was tailored to the study participants — with the knowledge of who had, and who did not have, cancer.
    Although the test was able to detect most of the late-stage cancers, it detected less than half of the stage 1 cancers.
    But doctors don’t screen to find advanced cancer, we screen to find early cancer. And we don’t screen people with symptoms of cancer, we screen people who don’t have symptoms of cancer.
    There’s no doubt that there would be more detection errors in the less controlled environment of the real world.
    Just how often was made clear in a recent JAMA-Oncology study. Forty patients with metastatic prostate cancer received liquid biopsies to tailor therapy in real time to the genetics of their spreading tumors. That’s the vision for precision medicine.
    But the investigators added a little twist. They wanted to know whether it mattered which lab the liquid biopsies were sent to. So they sent each patient’s blood for two different commercial liquid biopsies: Guardant360 and PlasmaSELECT. Both tests were designed to detect mutations in the same genes.
    Yet in over half of the 40 patients, the tests gave different answers about which mutations were present. Different liquid biopsy tests give different answers in a majority of patients? That’s not precision, that’s awful.
    Sure, the analyses of liquid biopsies will improve. But if this much confusion exists about what mutations are present in the blood of patients with metastatic cancer (who have a lot of tumor DNA), imagine the uncertainty that will exist for asymptomatic individuals not known to have cancer — the very people who would be screened.
    And then there is the question of what to do with a positive result. This is very different than detecting a concerning lung nodule on a screening chest CT scan or a concerning breast mass on a screening mammogram. In these cases, it’s clear what to do to get a definitive answer: surgically biopsy the nodule or the mass. But with a liquid biopsy, the anatomic location of a cancer can be a mystery. It may not even be clear what organ the cancer is in.
    Imagine what this might mean for a patient: A doctor says, “It looks like you have cancer, but we are not sure where.”
    Even if there is certainty that the cancer is in, say, the liver, doctors may not know where in the organ. What to do then? Randomly biopsy different parts of the liver?
    This is doubly concerning when screening average-risk individuals, because most positive results are expected to be false alarms. We typically learn that a screening test is falsely positive because a surgical biopsy is normal. But absent the knowledge of where to biopsy, how can we ever be sure a positive liquid biopsy is wrong?
    Doctors won’t know where to look, but we will keep looking. Liquid biopsies are a recipe for more health anxiety, more procedures, more complications and more overdiagnoses. Not to mention, more out-of-pocket costs for our patients.
    Of course, we should continue to study liquid biopsies. The detection of circulating tumor DNA may ultimately prove useful in selected settings, such as tailoring therapy for aggressive cancers that are rapidly mutating. But the real enthusiasm is for screening average-risk individuals.

    Join us on Twitter and Facebook

    One reason is obvious: there is a lot of money to be made. A Goldman Sachs video estimated the potential liquid biopsy market to be $14 billion annually, adding “and we’re just at the beginning.” That kind of money doesn’t come from testing the few patients with aggressive cancer, that comes from screening millions of people.
    And there is a less obvious reason: it is easier for a new test to pass regulatory muster than it is for a new drug. While the FDA has a longstanding mandate to protect us from snake oil treatments, this often doesn’t extend to snake oil testing.
    The enthusiasm for finding things that might benefit people in the future ignores the fact that doing so can cause people to have problems now. In short, a bad test can do as much damage as a bad drug. Worrisome liquid biopsies will start a cascade of subsequent, not-so-simple tests and procedures. People will be hurt in the process.

    Read more:

    A seismic shift in government is coming, and here’s who will drive it

    (CNN)On January 3, Tina Smith will be sworn in to replace Al Franken as the junior US senator from Minnesota. The resignation of a male senator confessing to sexual misconduct, and his almost immediate replacement by a woman, is symbolic of an extraordinary period in American history. It also likely foreshadows a massive shift: the titanic infusion of women into leadership at all levels of government.

    Current numbers from Rutgers University’s Center for American Women and Politics show that women’s representation at lower levels is equally dismal: only 24% of statewide elected officials, 25% of state legislators and 22% of major-city mayors are women. And the statistics are even more abysmal for women of color, about 18% of the US population, who make up only 7.1% of Congress, 2.2% of statewide elected executives, 6% of state legislators and 9% of major-city mayors.
    In DC-speak, our government is pale, male and stale. There simply aren’t enough women in power to join their male allies who are holding perpetrators accountable. We cheer when we see a room with more than a modicum of female officials trying to make sure women’s experiences inform policy-making. Less cheery are the many long tables with dozens of chairs that ought to be filled by women leaning forward over stale coffee, pen in hand.
      Of course, we’re not talking about one particular woman or one particular man. But as a group, men and women take strikingly different approaches to crafting legislative agendas. A mound of research — including a 2016 study by political scientists Craig Volden, Alan E. Wiseman and Dana E. Wittmer — shows that female legislators are more likely to introduce bills of importance to families. They are much stronger advocates for women’s health concerns, such as affordable contraception, breast cancer research and domestic violence laws.
      The difference women make in politics isn’t limited to the Democratic Party. There are many energetic, wise, considerate, smart women in Republican ranks, although at only 9% of their party’s congressional caucus, they have a particularly rough row to hoe.
      We may disagree with many fundamentals of their strategies, but there certainly are times our goals interlock. Compared with Republican congressmen, GOP women sponsor many more bills across the aisle. And in both parties, congresswomen, more than their male colleagues, champion family-friendly policies, including increasing the minimum wage, closing the wage gap, fighting for paid leave, expanding childcare options and improving education. Their unique experience as women, and often as mothers, is invaluable to the democratic process.
      What more perfect time to make a dramatic shift toward gender parity in American government? The last time we significantly increased our numbers in Congress — 1992’s “Year of the Woman” — came on the heels of accusations of sexual misconduct during Anita Hill’s testimony in front of an all-male Senate Judiciary Committee.
      Women across the country had had it. There was something deeply wrong with Professor Hill’s not being considered credible when she described with shocking and heartbreaking detail then-Supreme Court nominee Clarence Thomas (at that time her boss) allegedly trying to come on to her numerous times. Thomas denied it and was confirmed, but Hill’s ignored testimony incited scores of women across America to run for office. The number of senators tripled from two to six and a record 24 women were elected to the House of Representatives.
      Similarly, women are galvanized after last year’s election of Donald Trump — with more than a dozen accusations of sexual harassment, plus his own bragging of sexual assault (all of which he denies). On the world’s largest stage, Hillary Clinton won the popular vote by a margin of almost 3 million votes, leaving over 65 million voters feeling disenfranchised by her electoral defeat. Then Trump’s inauguration was upstaged by the gargantuan Women’s March, a watershed day that drew millions of people worldwide.

      Join us on Twitter and Facebook

      Now, at the grassroots, more numbers bode dramatic change. Emerge America, which offers training to female Democratic candidates, has seen an 87% increase in applicants to their candidate training programs. She Should Run, an advocacy group supporting female candidates, reports that more than 15,000 women have contacted them since the election. And, in contrast to about 900 calls in 2016, EMILY’s List has received 25,000 from women exploring running for office.
      This is a political seismic shift. We’ll be feeling the Trump afterquake long past the 2018 elections. We stand staring over a brink, into a world where men who prey on women are replaced by women. Given the President’s guffaw at global warming, a metaphorical twist is ironic. The climate has forever changed. Hallelujah.

      Read more:

      2017 was Trumpism’s last gasp

      (CNN)As the year comes to a close, the job of making sense of it begins.

      Will it be the participants in the Women’s Marches all over the world or the neo-Nazis who marched in Charlottesville? Will political polarization worsen or will bipartisanship return? Will the mass shooting in Vegas stand as the worst in modern US history, or be tragically outdone next year? Will America continue to be punked and manipulated by Russia, or will we start to protect our elections like we do our borders?
      Will we remember the brave voices of the #MeToo movement and the ousting of alleged serial abusers like Roger Ailes, Bill O’Reilly (who denies it), and Matt Lauer (who apologized), or will we remember that Bill Cosby had more than 50 women accuse him of sexual assault and he still wasn’t convicted?
        Time magazine offered the perfect metaphor for 2017’s rally of contradictions. It named “The Silence Breakers” — the voices against sexual harassment — as the defining “person” of the year. Its runner-up, however, was President Donald Trump who admitted sexual assault on tape and faces many serious and credible sexual harassment accusations (he denies them all), and still has his job.

          Omarosa: White House lacks diversity

        While the year saw the rise of Trump, this is not the beginning of his term, it is the end. As painful as it has been to watch him and his supporters rally, theirs is merely a last gasp of a dying world view.
        Ten years ago, when my father-in-law was dying of esophageal cancer, we called hospice in. I’ll never forget what they told us: that just before death, we might see a surprising surge of energy in him, something that doctors refer to as “terminal lucidity.”
        They cautioned us that this would not be a sign of strength, but rather that death was near. Sure enough, a few weeks before his death, he was out of bed and had a surprising amount of energy. It was a last gasp at life. He died shortly after that.
        That’s what 2017 represents for me: a last gasp by Trump and the bigoted, sexist, nationalist and greedy forces that propelled him to power.
        Trump has demonized the free press, world leaders, Muslims, immigrants, women and the NFL. He has bullied, barked and insulted his way through the year. There are too many affronts to list here. But every tweet has pushed us one inch closer to his alternate view of the world — to normalizing this un-American behavior. The fact is, Trump and his dying world view can rally for a little while, but his alternate reality can’t win — and here are just a few signs of why:

          Trump council member will quit if DACA ends

        In reality, America is more diverse than ever. It is easy to see that Trump’s world is white. Just look at who he has appointed — more white male judges than any president in three decades. His nominees for 24 Cabinet and cabinet-level posts included only six women and nonwhites. That’s more white male representation than any of the past five presidents. Here is an interesting breakdown of the White House intern cohort this year. I will let you judge with your own eyes how well it reflects America. This whitewash rally? A last gasp.
        In reality, the majority of Americans are women. It is easy to see that Trump’s world is by men for men. His administration is attacking women’s reproductive rights at every turn. Trump has pushed repeatedly — in failed attempts to repeal Obamacare — to end the Medicaid expansion. The reality is the majority of Medicaid enrollees are women, and more than half of all US births are covered by Medicaid.
        In April, behind a closed door, he signed a law that allows states to withhold federal funding from Planned Parenthood and other clinics that provide family planning services, like contraception, breast cancer screening and fertility counseling — if they also provide abortion services. According to the Guttmacher Institute, “Planned Parenthood health centers serve two million (32%) of the 6.2 million women who obtain contraceptive care from some type of safety-net family planning center.”
        And two months ago, his Department of Health and Human Services issued new rules that would allow employers to opt out of covering birth control under the Affordable Care Act for “moral” reasons.
        This attack on women’s rights? A last gasp.
        Trump’s world does not. His lawyers just told the Supreme Court that businesses should have the right to hang signs in their windows stating that gays will not be served. When Trump tried to ban transgender citizens from serving in the military, our armed forces ignored him. His anti-LBGT opinions? Extremely offensive … and a last gasp.

          Trump on transgender ban: Doing military a favor

        In reality, the vast majority of Americans — including Republicans — support net neutrality.
        Trump just traded your open Internet for corporate greed when his Federal Communications Commission voted to repeal net neutrality rules. Companies can now feel free to block websites or charge internet users — that means all of us; you and me — for higher-quality service or specific content that has long been accessible to all. It was a 3-2 vote. Care to guess how the three men and two women voted?
        Out here in reality — in real America, not the world Trump envisions — many wonder “if it’s really happening.”
        I’m here to tell you — despite his twitter temper tantrums — Trump’s rally and world view is dying.
        This is the beginning of the end of Trump and his “idea” of America. The turning point was when Trump endorsed Roy Moore, who is accused of sexually abusing teenage girls, in his failed Senate bid. Moore was the one who said the last time America was great was when “families were united … even though we had slavery,” letting America know that the ex-judge, who held the full support of the America’s President, did not see black families.
        There is a desperation in the air. There always is when someone is dying — you can smell it.
        From the macho threats of nuclear war to the disgraceful ending of a health care program that serves 9 million poor children in America, to taking away tax exemptions on student debt; from building walls and ending DACA to keep out new Americans, to loosening regulations to allow polluting industries to resume polluting, to muzzling science and clamping down on speech. It’s all a last gasp.
        Trump’s maniacal obsession with undoing of Obama’s legacy- – the last gasp.
        His refusal to denounce white supremacists in Charlottesville — the last gasp.
        His demonization of Black Lives Matter and the Women’s March — the last gasp.
        The term “fake news” and the attacks on the free press — the last gasp.

          Trump rewrites history on Charlottesville

        Trump’s support isn’t growing, it’s shrinking. Ignore his blustering. He’s got the lowest approval ratings of any sitting president.
        That’s the reality.
        Millennials are leaving the Republican Party in record numbers, with nearly a quarter of them defecting from Trump’s party.
        That’s the reality.
        Oh, and then there’s Robert Mueller’s expanding investigation.
        That’s the reality.
        2017 is the last gasp. Trump’s world will come to an end. In fact, just remove Trump and much of this madness disappears. And he will be removed. He’ll cross too many lines. Hell, he might even be removed from office. There will be another president. The damage will get reversed — and Americans, proud of who we really are, will be the ones left standing.
        The best thing for us to do, as he seems to lose his grip on reality, is to hold tight to ours. Continue to show up to the polls, ask questions, demand answers, speak up and step up, run for office.
        Just ask the black (women!) voters in Alabama who turned out in record numbers to elect Alabama’s first Democrat in three decades and the record number of women and minority candidates who are running for office in 2018.
        America, in reality, hasn’t gone anywhere.

        Read more:

        The Senate bill that puts the public at risk

        (CNN)As early as this summer, the US Senate could take up a bill that would dramatically tilt the scale from public interest to corporate interest on common sense safeguards for consumers, workers, safety, health and the environment.

        The bill, a version of which passed in the House earlier this year, was introduced by Sen. Rob Portman, R-OH., and is cynically named the Regulatory Accountability Act. What it would do is put people at needless risk.
        The Senate should vote it down.
          Proponents of the bill claim it would make federal regulations more transparent to promote public input. But, in reality, it would do the opposite — empower the small, political Office of Information and Regulatory Affairs in the White House to wield authority over our health, safety and welfare, operating far from public view.
          The bill was crafted to provide Wall Street, fossil fuel companies, industrial polluters and others with new tools to grind the wheels of public protections to a halt, making it harder for individuals to hold corporations to account.
          By reviving a system of administrative tribunals, the legislation would, in some cases, enable corporate attorneys to badger agency officials with endless proceedings and trial-like hearings that would ultimately hold up pending protections.
          We’ve tried that before — as federal efforts to set standards for peanut butter were bogged down for a decade by the processed food industry — and wisely abandoned the practice decades ago because it drove taxpayer costs through the roof, delayed needed action and produced little tangible benefit.
          Portman’s bill, by design, would paralyze our ability to keep up with changing times and respond to emerging threats like financial scams and toxic chemicals that harm consumers, or industrial practices that endanger workers. It would also make it easier for corporations to overturn existing protections in court and diminish the worth of the legal, scientific and economic expertise in the federal agencies we depend on to know their subjects best, by imposing subjective rulemaking standards that invite litigation.
          At immediate risk are pending protections like those to modernize the prevention of the spread of disease through meat and poultry, rules regarding aircraft and airports, and guidelines to strengthen protections against lead-contaminated tap water.
          The bill would also jeopardize urgently needed safeguards like those that address emerging risks in self-driving cars, standards for breast cancer detection protocols, terrorist threats to chemical facilities and nuclear power plants and corporate pollution.
          The Regulatory Accountability Act isn’t a stand-alone initiative. It’s the legislative centerpiece of a larger effort by the Trump administration and congressional Republicans to overthrow the entire system of rules-based safeguards we have a right to expect from our government.
          This flawed approach ignores the purpose of the rules and the manifest benefits they provide. But this is nothing new — there were similar industry pushbacks when efforts were made to improve auto safety through the implementation of seat belts and air bags, remove lead from gasoline and warn consumers of the health hazards of smoking.
          Overall, federal regulations have been estimated to provide from $269 billion to $872 billion in annual public benefits, at a cost of between $74 billion and $110 billion. That works out to as much as $11.78 in benefits for every dollar invested by business and government to comply. That’s what the White House Office of Management and Budget concluded in December, based on expert analysis of regulations reviewed between 2005-2015, with amounts adjusted for inflation.
          That’s why public safeguards are put in place — to benefit the public. Critics sweep those benefits under the floor with language meant to distract us from what’s really at stake.
          Trump and his enablers on Capitol Hill, for example, speak of “midnight regulations” rushed through behind closed doors, “regulatory overreach” from “unelected bureaucrats” or what White House chief strategist Steve Bannon calls “the administrative state,” the idea that somehow government has no role in protecting our safety, health, environment and financial security.
          Every federal safeguard, rule or standard that protects us – in our homes, on the job or anywhere else — serves a purpose and must be grounded in law, sound science, and the public interest. Each must have a basis in the federal statutes Congress passes and be openly shared with the public, which can express opinions long before the legislation is made final.

          Join us on Twitter and Facebook

          What Trump and congressional Republicans are really trying to do is to stack the deck against us by granting corporations new powers to bog down the process through which responsible public oversight protects the people.
          Nobody wants over-regulation, but these essential protections are fundamental to keeping people safe and our businesses prosperous. Unless the Senate stands up for the American people and says no to the Regulatory Accountability Act that safety and prosperity may be taken away.

          Read more:

          Obamacare vote is the diagnosis — now let’s cure Congress

          (CNN)When I was diagnosed with breast cancer on December 1, 2011, I didn’t know what would come next, but I knew it wasn’t going to be easy. I feel the same way now, the morning after Republicans in the House of Representatives conspired with our President to destroy critical health care protections that are my lifeline, and that of millions of my fellow Americans.

          Some of them didn’t even read the bill for which they voted. Such was their inhuman detachment from the reality of its likely consequences.
          Perhaps some of what I learned about surviving cancer will help those of you now afraid of losing your access to lifesaving treatment. Spoiler: I lived.
            When news broke that the American Health Care Act had passed the House by less than five votes, it aired with footage of that bizarre Rose Garden party at which lawmakers and President Donald Trump, pretty much all older white men, gathered with cases of Bud Light to party. Some reports have them pre-gaming before the vote, getting pumped up by listening to “Takin’ Care of Business” and the theme from “Rocky.”
            Seriously, who does those things before or after stealing health care from 24 million people?
            Like so much of these past 100 days of the new presidency, had it been fiction, a sharp editor would’ve sent it back for rewrite — too grotesque, too over-the-top weird.
            The frat party footage rolled. “Hold my beer,” you can imagine one of those lawmakers in the Rose Garden saying, as Twitter and Facebook and Snapchat and our phone texts exploded with loved ones realizing they, their moms and dads, their babies and grandparents, may suddenly be in mortal danger.
            But even in that White House garden where all those men stood, the soil yields diverse colors of flowers, crawling vines and shrubs, and even the random weed that manages to sprout. Even there, with the beer, we are reminded that the diversity of genes makes living organisms strong. The diversity of America makes us strong.
            During my treatment, I learned that people like to speak of cancer as a battle. It is not. It is a disease of cellular biology, a progressive one, that strikes without warning and seemingly without logic. My National Institutes of Health-trained oncologist helped me understand that this wasn’t a foreign terrorist enemy, so to speak, but my own native cells gone haywire. Like Congress. That shared body of representatives has one common job, to represent the well-being of our human American lives. How could they take an action that is so clearly against the most basic human interest, of remaining alive? I felt that same sense of betrayal about my body’s own rogue cells. I needed chemotherapy, surgery, and radiation. In my opinion, those heartless congressmen need tough medicine, too. And they need to start looking for new jobs.
            The idea of being thrown back into a world where people can be denied coverage because of pre-existing conditions strikes a terror inside me that is not abstract. I lived that fear and I know those determinations can have life-threatening consequences.
            I was first diagnosed before Obamacare, and I had only purchased my policy a few months beforehand. Insurance was expensive, my income limited, and I didn’t consider myself at risk. I was a yoga-doing, bicycling vegan health nut who neither drank nor smoked, meditated regularly and did all the perfect things I’d learned to do to prevent cancer. I didn’t understand that you don’t get cancer because you’ve been bad — it’s just a lightning strike.
            But when I began chemo, my insurance company opened a fraud investigation because it thought I might’ve hidden my cancer as a pre-existing condition. I know, it sounds pretty nutty. Had the company’s investigation found me guilty (I wasn’t and it didn’t), my treatment would’ve ended immediately.
            In those years, women with pre-existing conditions were routinely denied lifesaving breast cancer treatment unless they could come up with the impossible amount of money it took to pay directly. Until 2012, much of the dark humor in our waiting rooms was about how only rich people in America could afford to get cancer.
            Before Obamacare, some of the cancer medications I had to take were hundreds of dollars a pill. All of that changed in the middle of my initial treatment course when the Affordable Care Act went into effect. Now my prescription refills were $20 instead of $800. Mercifully lifted was the familiar and ever-present fear that my access to what keeps me alive would be taken away right when I needed it most, and I would die.
            For me, cancer was never a battle. But surviving the dehumanizing labyrinth of medical care before Obamacare was.
            And what we have before us now, yes, this is a battle, too. A fight for the body and soul of America — my own, and yours, everyone you love. This is not health care. This is life care.
            We don’t get to choose the body we are born into, and the cells that exist within us. Some may be cancerous, others healthy. We don’t get to choose the country we are born into, and even though many of us voted, I didn’t choose this president. None of that matters. We now have a diagnosis. We all share it.
            And the cure is an inclusive process to create a truly functional and representative system of universal health care for all human beings in America.
            Bring in the doctors, the nurses, the patients, the insurers, the scientists, the women with metastatic cancer, the researchers whose funding has been cut and whose innovations we desperately need to find a cure. Let every voice be heard. Let it be in the sunlight. Let the work be checked — and read by all the legislators who have power over us.
            We need a no-BS approach to health care that honors the words of our forefathers. Every American is entitled to life, liberty and the pursuit of happiness. You can’t get to liberty or happiness without your life.

            Join us on Twitter and Facebook

            Folks like to tell us cancer patients a lot about how prayer and positive thinking can cure cancer. I prayed. God answered my prayers. He told me to get my ass to the hospital and keep showing up and doing what my doctors told me. It all hurts, still, five years later. The financial wreckage is still real, and I’m still cleaning it up. But I’m alive and grateful.
            This is the version of positive thinking cancer taught me. Reality matters. You are either telling the whole truth or you are lying. I either have an accurate diagnosis and a careful, well-planned course of treatment, backed by science and concern, or I will die painfully.
            The chemotherapy destroyed my veins so thoroughly that we must now take all draws from the back of my writing hand. The hole in that hand is now a scar. The pain in that hand informs my writing. I’m so grateful to be alive, and to be one of the many millions of cancer patients in America who still have a living story to tell. Please listen to us. We have gone where you do not want to go. We survived life before Obamacare. You should not have to. In cancer, and in this political moment, time is of the essence, America.

            Read more:

            Red, white or pink? Women’s rights don’t come color-coded

            (CNN)The color was red for International Women’s Day, although red used to signify concern for women’s heart health and before that, well — The Reds! Pussy hats were pink at the big women’s marches in January, but pink signifies breast cancer awareness, or did. Does it still?

            While I support every person out there protesting and admit to a knee-jerk aversion to describing women in terms of what they are wearing, turning political activism into a color war does have its limits. I understand that visual symbols of solidarity are important, but when meanings are ascribed to these colors, as they are, we run into peculiar and often misleading interpretations of history.


            But the long ago images are also misleading. They purport to represent “the suffrage movement,” which was not a monolith, but a decades- long sprawl, a tangle of people and ideas, often in conflict with each other, leading, by 1920, to passage of the amendment giving women the right to vote. The 19th-century pioneer generation — Elizabeth Cady Stanton, Susan B. Anthony and their allies — gave not a hoot for the color of their clothes nor for marching around in public. Public spectacle came in with the next generation, who “took it to the streets,” with street corner soapbox speakers and parades, which appalled more conservative members of the movement.
            Early marches were fueled by white working class women fighting the exploitations of industrial capitalism. Believing that winning the vote would help that fight, they carried signs demanding equal pay for equal work and an end to sweatshops. By 1912, socialists carrying red or purple placards marched, singing “La Marseillaise,” along with suffragists who were not always so pleased to have them there. No African American women were present, partly because they were not wanted in public demonstrations and partly because their activism had taken a different, less visible turn.
            As the movement grew larger and more popular, public support for granting voting rights to educated white women became strong. But the majority of the American public and opponents of woman suffrage did not believe “other” women — immigrants and workers, Chinese women in California, Jewish radicals in New York and African-American women everywhere — deserved the vote. Leaders of mainstream suffrage organizations kept these “others” out of sight for, they would say, “tactical” reasons.
            The result is those suffrage tableaus that keep popping up in the media today. Everyone dresses alike, to display solidarity. Absolute order and discipline in the line of march are paramount. Class ideas are enshrined — women on horseback actually own those horses. All is respectable, non-threatening and, to some, beautiful. As the country drifted toward entering World War I by 1916, suffrage leaders offered themselves to that effort, and the whiteness took on the extra added patina of patriotism.

            Join us on Twitter and Facebook

            These lovely images that purport to embody the suffrage movement, then, are sanitized pictures of a particular time and particular people. Although we could not have gotten to today without that movement, I say that if we’re nodding to anything, we should nod at the mirror, because out there agitating for women’s rights right now is something that looks like America.

            Read more:

            Donald Trump and the psychology of blame

            (CNN)In eighth grade, I ran for student council president. The candidates all had to speak in the auditorium to the entire student body. An opponent went first, and promised to have soda come out of the water fountains throughout the school. The audience applauded wildly. When I spoke, I argued that his plan would not work — that the school administration would certainly oppose it.

            It didn’t matter. He won.
            I learned: Politics is not mostly about logic or reality, but appearance and desire — telling an emotionally appealing story, offering hope and making promises, even if you can’t keep them.
              Since the election, pundits have pondered why Donald Trump won, Hillary Clinton lost, and where the Trump presidency is headed. They have traced his win to Russian hacking, the Electoral College system, the media, James Comey, Bernie Sanders, and Clinton taking Midwestern blue collar voters for granted — all of which clearly played roles. And they have repeatedly tried to understand and assess what Trump may now do.
              Yet several additional critical issues have been ignored and deserve attention — concerning the psychology of blame.
              In a complex world, we look for causes and effects, and whom to blame. Most voters want simple answers. But the world is messy, defying easy solutions. Nonetheless, countless social media sites and messages seem to give answers, telling viewers who is at fault — shaping attitudes and votes.
              But while recent exposs have examined the mechanics of how particular fake news stories have gone viral, it is crucial to understand, too, why such stories prove so appealing — how they assign blame.

              ‘Fast thinking’

              The Nobel laureate Daniel Kahneman found that when confronting too much complex numerical information, people use mental shortcuts to process it — so-called “fast” rather than “slow” thinking. Yet people also rely on “fast thinking” to process not only numbers, as he describes, but social and political problems and information as well.
              We draw on prior beliefs, biases, and scripts — familiar stories. These shortcuts generally involve narratives of blame — helping us decide who or what caused the problem, and thus how we should solve it. People seek to fault others for problems because to hold ourselves accountable is too painful.
              Conventional political wisdom might say, “Don’t waste time refuting your opponent — let the press do it.” But we no longer live in conventional political times; the press failed to do it sufficiently. She could instead have said, “Bipartisan politics is complicated. Many of us have tried to compromise. But not all elected officials have done so. In fact, Trump’s party got us into the Iraq War, and helped create The Great Recession.”
              To assign, limit or escape blame, individuals employ various rhetorical strategies — denying that certain events ever happened (“I didn’t say that”), or giving justifications or excuses. But, to blame others and deny responsibility generally entails stretching the truth and minimizing accountability.
              In the world of information overload, short attention spans, tweets and unvetted online “news,” countless people lose track and become uncertain. The realities are far more complicated, but overly simplistic narratives stick — partly because they mobilize rage.
              Occasionally, we reevaluate and change our understanding — when confronted by facts from trusted sources or when another storyline, based on this new information, feels more compelling, especially if the new explanation gives a sense of control.

              More nuanced reality

              Still, altering such perspectives can be hard. Some of the women with breast cancer whom I interviewed shifted their views of their disease, though doing so was not always easy. “I’m such a big environmentalist,” one woman told me, “that it’s hard for me to believe that genes also played a role in my cancer.” She wrestled with the ambiguity of multiple factors contributing to her disease. Gradually, she came to appreciate this more nuanced reality, though it was less emotionally satisfying.

              Join us on Twitter and Facebook

              Yet social science can help us determine how to successfully develop and disseminate accurate messages — both the form and content — articulating and galvanizing anger against the status quo. Historically, certain messages have conveyed liberty and justice instead of hate — as in the Arab Spring.
              Importantly, we need to pay more attention to how the psychology of blame operates — how humans inherently seek to assign fault, how that quest can be misused by Trump or other politicians, and how much is at stake — the pursuit of truth that is crucial for our democracy.
              Otherwise, we will all be waiting for soda to flow from the water fountains.

              Read more:

              Obamacare saved my life. What now?

              (CNN)I was lying in bed with my dog, recovering from my most recent surgery, when a news alert went off on my iPhone after midnight.

              “Breaking news: The Senate has just taken a major step toward repealing the Affordable Care Act,” the headline read.
                Fear. That’s what I and millions of my fellow Americans felt reading that headline, because this ACA debate is real for me. It’s not health care. It’s life support.
                I am a breast cancer survivor because the Affordable Care Act, politicized by the GOP as “Obamacare,” ensures that for-profit insurance companies can’t deny me coverage because I had the audacity to be diagnosed with cancer.


                I’d dragged myself that morning to the cancer clinic, bracing for harsh medicine that would maybe save my life, if I was lucky. Medicine that brought me to my knees vomiting for hours, medication that caused total hair loss across my entire body.
                The insurance company wanted to shut that down for fraud.
                Believe me: Before my diagnosis, cancer was the furthest thing from my mind.
                I was a yoga-junkie vegetarian non-smoker and nondrinker. It never occurred to me that people like me could get cancer. To now be told that I was suspected of crime, insurance fraud, was a new shock.
                Eventually, the fraud investigation was cleared. I got my treatment. By the grace of God and science, I lived. I continue to receive treatment so that I may continue to live, one day at a time.
                Countless Americans before me experienced the same kind of shocks before ACA. “Pre-existing condition” was a very scary term. And it is poised to become so once again, if the ACA is repealed.
                This is not a joke. If we don’t protect Americans like me, Americans like me will die.

                Join us on Twitter and Facebook

                As I write this, there is no evidence of disease in my body. Thank you, God. This is as close to cured as I get, until and unless we find a cure.
                I am missing a breast, a uterus, 19 lymph nodes, a latissimus dorsi, a whole lotta money, and a chunk of my sanity. But I’m alive, and I will dedicate every bonus day of my life to fighting for the right all Americans have to receive life support, like me, when they need it most.
                Like many of the challenges before us as a nation today, the fight over ACA is no longer about left or right, conservative or liberal. This is about whether we want to be a just, honest, compassionate and humane society, or a country that watches its own die while the rest of the civilized world recoils in horror.
                My story is not unique. Please listen to the many of us who have fought hard to live long enough to tell our stories. All we are is America itself, fighting for its life.

                Read more:

                Get ready for the risks of genetic testing

                Would you want to know your future if science could tell it to you?

                Some forms of commercial genetic testing promise something like this kind of future-telling. But you need to think long and hard about peeking into your own genes to see what they hold in store for your health. It may not be so easy to cope with the bad news that could result. And it is likely that other people could know your genetic future even if you do not consent to tell them.
                  Let’s say you send your spit (yes, spit is the source of DNA for this kind of testing) off to one of the many companies advertising direct-to-consumer genetic testing and the results showed you had a huge risk of a fatal disease.
                  Would that freak you out? Would you want to get this news in a letter sent by overnight mail? Wouldn’t you prefer to have someone available to counsel you about what negative findings mean and what to do about them?


                  There are people who say they don’t need help dealing with whatever the genetic tests reveal. And a new study sponsored by one of the genetic testing companies, 23andMe, backs them up — sort of. The study suggests most people can get bad news about their risk of getting or transmitting breast cancer to a new generation without going all to pieces emotionally.
                  I think the study is weak. It involved only a few hundred people who already likely knew they were in a high risk group for breast cancer. It is likely that such people who seek testing will take bad news with greater calm than would you or I if we had no expectations.

                  Stay up to date on the latest opinion, analysis and conversations through social media. Join us at Facebook/CNNOpinion and follow us @CNNOpinion on Twitter. We welcome your ideas and comments.

                  At most, the study suggests that people in high risk groups who know they are likely to get a genetic disease can handle negative health information. But it doesn’t tell us much about how the average person will cope in such a situation.
                  Remember that genetic testing is still in its infancy.
                  While some commercial companies promise to tell you what is the optimal diet for you to eat or whether your kid will be a star athlete, the reality is that genetic testing is nowhere near capable of doing any such thing. The accuracy of testing depends on the disease.
                  Some genes when present mean 100% certainty that you will get a disease, but some raise your risk only 5%. And test predictions are based on studies of small, mainly white, American populations. Testing quality depends on the lab and that is all over the place right now. So much genetic testing is not exceedingly reliable and not always trustworthy in terms of what it means for you.
                  Nonetheless, finding out about health risks hidden in your genes still seems to me the kind of news that at least requires you make available a trained genetic counselor to help you deal with it.
                  Remember genetic testing is about risk and probabilities — and the future is shaped by your genes and your lifestyle — facts that counselors can help make clear. It is cheaper for companies not to have to offer counseling. But cheaper is not necessarily better if the test comes up snake eyes for high risk for Alzheimer’s, Huntington’s, diabetes, cancer, depression or blindness for you or your children.
                  Even if you think you have what it takes to absorb unexpectedly distressing results about your health without the help of a counselor or doctor, there is another reason to be wary of sending off your spit to a company touting affordable genetic testing on the Internet.
                  In January, a team of American and Israeli scientists showed they could reconstruct the identity of people from supposedly anonymous genetic samples using readily available databases on the Internet. Genetic hackers who get a sample of your DNA could use public databases to figure out whose genetic sample they have and then they would know all about the future written in your genes too.
                  Maybe people are more resilient than worrywarts like me when it comes to facing potentially upsetting revelation about their genes. Still, it does not take a lot of people actually breaking down and crying to think that competent personal counseling always ought to be an option before finding out about your genetic destiny. And given the problems inherent in guaranteeing personal privacy when it comes to cracking your genetic code, you need to be very careful where and to whom you send your DNA.
                  Genetic testing is a very useful new tool for helping us stay healthy. But doctors, counselors and even legislators need to get involved so that genetic knowledge can be properly understood and kept private.
                  Join us at Facebook/CNNOpinion.

                  Read more:

                  What this week showed me about women

                  (CNN)“More than a few times, I’ve had to pick myself up and get back in the game.” It was a single line from Hillary Clinton’s speech to the Democratic National Convention on Thursday night. But it was one of the most authentic and relatable parts of that speech. That line, and the reality of how hard women have to fight just to be who and what they want to be, resonated deeply with me as I remembered the experiences of the most important people in my life.

                  The way I see it, the Democrats have seized the whole “who is a real American?” narrative from the GOP. The party has decided it will present itself as the real keepers of patriotism. They decided to be the party that says it’s OK to be proud of our country, understanding that America is both great and that we need to work to make it even better. The party to say that addressing America’s shortcomings is more patriotic than a blind defense of the status quo.
                    How did they do this? With women leading the way.


                    But, I also see your strength. I see your resilience. I see you dust off your shoulders and put on a smile when you’d rather punch someone in the face. I see you fall and think that you will never recover. But then, I see you rise. I see you get up, get out there and do it all over again with a simple “OK, where are my heels?”
                    I see my grandma, who came to this country from Puerto Rico at only 16 years old, alone, and worked for decades in New York City factories. She passed this year. She was my Santa Claus.
                    I see my mom, who is a breast cancer survivor, and who worked as a social worker helping New York’s poorest families and then as a childcare provider. She had a brain aneurysm this year — and, two days after surgery, was driving herself to the store.
                    I see my wife, who despite her humble upbringing in the Dominican Republic and Harlem was able to become a news reporter for the largest media company in the Americas — in an industry that is very male-dominated and in a position frequently held by social elites.
                    I see my daughters, who remind me of the different world they are growing up in — and who continually check me on my own privilege. Like the time my eldest told me she was going to buy a big house, and I absentmindedly asked her if she was planning to marry rich, to which she responded, “No, Daddy, I’m going to be the rich one, and if I marry, he will be taking my name.”
                    I see you, and I know that I can never have the kind of strength required to do the things you’ve done, the things you have to do, with what you must deal with day in and day out simply because you are a woman. How can half the world have endured so much for so long, and be so good at what they do?
                    But this week is the week that the DNC reshaped the narrative and adopted one that reflects all of us. The party has chosen its first female presidential candidate — a woman who has kept on going, who has proven her abilities despite countless challenges, criticisms and obstacles for just doing her job. Every woman who has ever been challenged in their journey can surely relate to her struggle. So I understand why this is a momentous occasion not just for women, but for this entire country. This is history. This is HERstory.
                    I know there is still work to do, and while momentous, we cannot forget the intersectionality of race, class, gender and sexuality. A movement toward true equality cannot celebrate progress of some and ignore the lack of progress of others. But I am confident that together, there will be more equality and justice for all. And I am here as your friend and ally, even if you are your own champion.
                    I see all of you, all the women in my life, and all the women out there, and I am watching you change our world for the better.
                    Fight on!!!
                    With all my admiration and love,

                    Read more: