(2013), won the Distinguished Book Award from the Sex and Gender section of the American Sociological Association in 2016. She is also the co-editor, with Anne Marie Champagne, of Interpreting the Body: Between Meaning and Matter (2023).
Friedman applied the “Page 99 Test” to her new book, Mammography Wars: Analyzing Attention in Cultural and Medical Disputes, and reported the following:
From page 99:Learn more about Mammography Wars at the Rutgers University Press website.Many interventionists focus their criticisms of the USPSTF on the point that there were no specialists in breast cancer on the panel charged with debating the merits of mammography, with the result that their recommendation was based “only” on computer modeling and “the subjective opinion of the panel members, none of whom had any expertise in caring for women with cancer” (Dr. Adams, radiologist). Dr. Cashman, also a radiologist, similarly argues that the panel did not include any “experts in the field”:In several ways, page 99 is a good representation of the book: One gets a sense of some of the empirical data (interviews with doctors and scientists), and it is roughly representative of my analytical approach, which often proceeds by juxtaposing narratives to reveal contrasting patterns of attention. That said, it includes only one form of empirical data (out of three included in the book). The discussion is also narrowly focused on different understandings of the United States Preventive Services Task Force’s (USPSTF) mammography guidelines, which decontextualized does not convey the book’s broader aims. These aims include generating empirical insights into debates over mammography as well as theoretical/conceptual contributions to the sociology of attention, which I develop in chapters focused around general themes such as attentional diversity, attentional battles, and attentional weighing.There is a lot of things wrong with their, um, analysis and their conclusions. The first thing that is wrong is that there are sixteen members of this Task Force: about twelve physicians and the rest were, uh, nurses, or nurse practitioners or other researchers. And of the twelve physicians, seven of them were either internal medicine doctors or family practice doctors. None were radiologists that do what I do, that screen and diagnose breast cancer. None were surgeons and do breast surgery, and none were oncologists or other specialists that take care of breast cancer patients. And so they had no experts in the field on this panel.In terms of attention, interventionists thus stress that in evaluating which guideline to follow, what is relevant to attend is how many organizations support the guideline, and whether those organizations represent the opinions of specialists in breast cancer.
Rather than the number of organizations, skeptics emphasize the quality of scientific evidence supporting each recommendation. They also argue for attending to international comparisons to assess the USPSTF recommendation. For example, skeptics point out that the USPSTF issues guidelines only after a careful scientific process of evaluating the state of the research, whereas other organizations (even if more numerous) are not held to as stringent a scientific standard. As Dr. Price, a clinical oncologist with additional training in public health, puts it: “The Task Force uses a different process, you know, a more formal process of systematic evidence review.” Dr. Jackson, a family medicine doctor and academic researcher in public health, similarly contrasts the “evidence-based” process of the USPSTF with what he disparagingly refers to as a “consensus-based” process used by some other organizations: “a lot of organizations out there including medical organizations that do not do evidence-based guidelines and they basically just do, you know, what’s called consensus-based guidelines, so basically just a bunch of guys sitting around a table saying what they personally think.” In addition to using a more strictly scientific process of evidence review, skeptics pointed to the differing standards or criteria by which various
The context for the discussion on page 99 is that experts disagree over how best to define and measure the benefits and harms of mammography, and even over the validity of the very idea of early detection—thus the title, Mammography Wars. This is not because of a lack of data. No medical screening has been more scrutinized than the mammogram. Rather, as my research suggests, the two sides interpret the existing data through different frameworks of meaning.
My analysis is based on three types of empirical data—interviews with doctors and scientists, interviews with women age forty to fifty, and newspaper coverage of mammography—through which I identify two dominant patterns of thought that define disputes over mammography: interventionism and skepticism.
Briefly, interventionists firmly believe in the benefits of early detection and minimize any possible harms of screening. They are accordingly critical of any effort to delay the age recommendation for mammograms or reduce the frequency of screening. Skeptics are less confident in mammography’s effectiveness and give more weight to the harms of screening, which they also define more broadly than interventionists. They therefore generally advocate delaying the initiation and slowing the frequency of mammography to limit these risks.
On page 99, I am analyzing how interventionists and skeptics each assess the USPSTF mammography guidelines. Specifically, I highlight the way they apply different frameworks of relevance: interventionists emphasize that the USPSTF did not include enough experts in breast cancer and screening, while skeptics point out that the USPSTF’s recommendations are in line with international norms and based on a systematic scientific review of the evidence.
--Marshal Zeringue
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