Published May 3, 2004; Category: SOUNDINGS
Should I Be Tested for Cancer? Maybe Not and Here's Why
By H. Gilbert Welch, Professor of Medicine and of Community and Family Medicine
University of California Press
Reviewed by Noah Tsika '05
H. Gilbert Welch outlines the pros and cons of early cancer detection. The most basic approach to cancer prevention typically involves the promotion of a healthy lifestyle coupled with the highly touted cancer screener, which seeks not to cure the disease but to catch it in its earliest stages. However, these screeners - everything from CAT scans to lung biopsies - often do more harm than good. For instance, Welch acknowledges that the annual number of colon cancer deaths in the United States is well over 50,000 - making it third on the list of cancer killers - but he also explicates the risks involved in colon screening tests. The increasingly common colonoscopy, which is an examination of the entire colon using a fiber-optic scope, is the best way to determine colon fitness - in most cases, it is the final word in lower-digestive tract health. But a colon biopsy, however decisive, still poses a rare threat: the fiber-optic scope is often trailed by another pliant scope used to take a bite out of the intestinal tissue. While this biopsy - which yields tissue a pathologist examines under a microscope - is often the only way to confirm or deny the presence of cancer, the scope can poke a hole in the colon wall, which then requires immediate surgery. Welch, however, does not restrict himself to tales of screener disasters, but recognizes that in any consideration of health, there is always some give and take. He emphasizes that cancer screening does not reduce overall mortality, and that deaths from "interval cancers" - those cancers that show up in the period between screening tests - are on the rise, and are the deadliest of all. Ultimately, Welch is interested in educating consumers, as in this excerpt:
You might think I am trying to persuade you not to have a mammogram or not to undergo fecal occult blood testing. I'm not. Again, these two tests probably help people. Buried in the statistics are a few people who benefited greatly, people who beat cancer and wouldn't have otherwise. But I object to the emerging mindset that patients should be persuaded, frightened, and coerced into undergoing these tests. There is today a certain "medical correctness" about screening - making patients feel guilty if they choose not to pursue testing. This is wrong.
Robert Desnos, Surrealism, and the Marvelous in Everyday Life
By Katharine Conley, Associate Professor of French
University of Nebraska Press
Reviewed by Noah Tsika '05
First came The Incoherents, a group of artists, writers, and poets who in the latter half of the 19th century rose to prominence in the art world. Through their valuing of spontaneous artistic expression, The Incoherents gave a voice and a vision to personal forms of nihilism, such as the belief that all life is composed of nightmares, animal hybrids, flashes of light, hallucinations of matter-images that would later be termed Felliniesque. It is this love of phantasmagoria that partly paved the way for the 20th century poet Robert Desnos, a surrealist working in Paris and the subject of Katharine Conley's new book Robert Desnos, Surrealism, and the Marvelous in Everyday Life. From Paris to the provinces, Desnos, one of the leaders of the original surrealist group and largely considered by historians of the movement to have been its leading light, etched out his doctrine: the liberation of the unconscious mind. He favored the grotesque-incongruous displays, like the male artist Marcel Duchamp's famous incarnation as the bosomy, pearl-necklace-wearing Rrose SŽlavy-claiming, as the first and principle tenet of surrealism, that the subconscious originates all such bizarre models. Composing and reciting surrealist poems for French radio broadcasts, Desnos was arrested by the Gestapo because he was Jewish in February 1944, just before the Germans lost the war. For Desnos, surrealism operated until the very end: deported near the close of World War II, Desnos was held at the camp of Terezin in Czechoslovakia. The incongruity of this historical moment, what makes it surrealist, is the fact that Terezin was, at the time of the poet's arrival, newly liberated: Desnos, the father of surrealism, died of typhoid fever in a "free" prison. Conley summons up the power of Desnos the public figure, who before his arrest composed a poem titled "The Voice," in which the reader (or listener) is asked to pay strict attention to a distant but audible voice calling for an end to earthly suffering:
The voice is not the voice of the poet known for his voice in person and on the radio but that of France itself. The distance traveled by the voice is one of time transmuted into space. France is humanized by the fact that her voice beats, the way a heart does, like a "muffled" drum. The rhythm must be muffled because, within the perspective of the poem, France is alive only clandestinely. The "clear" sound of the voice and of its heartbeat rhythm, which, like a drumbeat, is capable of stirring the hearts of those willing to tune into its message, is available only to those who choose to listen. A choice must be made to hear a drumbeat different from the one that predominated in France at the time: the sound of PŽtain's National Revolution and of his voice on the radio, which preached a future in which France would be subsumed into the "new order" of a greater Europe controlled by Adolf Hitler's Germany.
Final Solutions: Mass Killing and Genocide in the 20th Century
By Benjamin A. Valentino, Assistant Professor of Government
Cornell University Press
Reviewed by Noah Tsika '05
By breaking down the concept of mass killings into three categories - communist mass killings, ethnic genocides, and "counter-guerilla" campaigns - Benjamin Valentino gets at the ways in which leadership breeds bloodlust. He examines popular theories of mass killing - those that overstate the role of social variables (like historical anti-Semitism) while understating the significance of small groups in the implementation of the modern massacre. Communist mass killings, for example, have been executed by radical leaders - Stalin, Mao, Pol Pot - interested in the formation of a future utopia; they have led, the author argues, to the deadliest periods of slaughter known to the 20th century. Ethnic genocides are distinguished by the racially prejudiced views of the perpetrators: they are marked by a view of a future in which an entire ethnicity is absent - thus the crude popular term "ethnic cleansing." The third category, counter-guerilla mass killings, is a form of genocide in which the defeat of political insurgents overrides all else - including civilian life. By categorizing types of mass murder, Valentino endeavors to formulate the best approach to the prevention of genocide:
It is possible to prevent or limit mass killing and genocide if we are willing to pay a price for our convictions. In some cases, that price will be modest in comparison with the number of lives we will save. In others, the costs may be prohibitive. The United States alone cannot prevent this kind of violence everywhere it occurs. Yet, the lesson of the Holocaust, perhaps the defining episode of violence in a century marked by bloodshed, is not that preventing mass killing and genocide is easy. The pledge "never again," issued in the wake of that tragedy, did not include the qualification "so long as there is virtually no risk of casualties." Deciding where and how to intervene to avert such violence in the future will require hard choices about the potential costs and benefits of action. By failing to face the causes of mass killing, we have avoided facing these hard choices for too long.
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