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danstr

Published Letters: 274
Editor's Choice: 61

Monday, July 17, 2006 08:42 AM

Nebraska's an odd place, though -

I lived there in Omaha for 11 years, but was always something of an outsider. Nebraskans tend to stay there, or even if they go away, for college or something, they come back, and very few of us outsider types stick around, and even if we do, we never have that much influence. This means it's really culturally isolated, even with mass communications & all. The place is small enough that after a couple of years you can go pretty much anywhere and be certain you'll run into people you know - sometimes you'll know most of the people. This has its advantages, in that I was on first-name basis with my state representative, the mayor, the superintendent of schools, Senator Bob Kerry, and so on. So at least I had a pipeline or two for suggestions from my far-left position.

So that's where I was, up till 2002. Now, during oh, about 1999 or so to 2001, there was this national campaign to pass the Defense of Marriage Act (DOMA). There was sort of a traveling circus that went from state to state promoting this little bit of hatred, and when they arrived in Nebraska, there was a sense of the usual prairie individualism, in that people were saying, "who are these outsiders, to tell us how to conduct our affairs?" But there was also a naive sense of, "Marriage? Sure, that's a good thing to defend." I honestly think there wasn't that much understanding of the underlying bigotry. Nebraskans tend to think, without any real malice, that everyone is pretty much like them. They're often a bit frightened of the blacks in North Omaha, but other than that, the world is a lot like they are. The GL community, for obvious reasons, isn't that big.

So, a number of us started making noise about what a bad idea, how nasty, this DOMA really was. And we really had difficulty being heard. The local media are controlled by conservatives, so our outlets were limited. One thing I participated in was an ecumenical service celebrating the GL community and condemning the DOMA. The leaders, mostly clerics, of the local churches who opposed the DOMA got together and organized this, hoping to get enough coverage that our protests would be heard. I was asked to participate as a Quaker (there was a very small Friends' Meeting in Omaha and another in Lincoln). I think the organizers were a Methodist minister and a liberal Jewish rabbi, but the participants included a broad group, Unitarians and Unity clerics, a Zen Buddhist, even an Islam cleric, and myself. The audience, as expected, was the choir, ie most of the local GL community and friends, but we got TV news coverage, although no newspaper coverage that I saw. The next day, in choir practice (the Omaha Symphonic Chorus, which at that time had a sizable GL membership), I got complimented and thanked for my participation - apparently the news had picked on me - and that was satisfying.

But, here we are - I'm now living in Altadena and working in Pasadena, and Nebraska still has that awful law. But I hope we got some people at least to start thinking outside what they're accustomed to. We shall see. I truly don't think most of them support the DOMA out of malice - they just can't see how it hurts others not like themselves.

Tuesday, July 18, 2006 08:34 AM

Screening.....

this will likely get lost in the sound & fury here, and to some degree it's a secondary issue, but I'd like to point out that part of the problem is the matter of screening for problems with no tolerance for false negatives.

Here's a classic example; bear with me. During the early years of the HIV epidemic, there were suggestions that the old syphilis test formerly required for marriage licenses be replaced by HIV testing. This was firmly and uniformly rejected by the public health community, and the high rate of false positives was the reason.

Here're some numbers to illustrate the point: Screening tests have two main characteristics - Sensitivity is the proportion of diseased people who were correctly identified, while Specificity is the proportion of non-diseased people who were correctly identified. Suppose your HIV test has a specificity of 99.5% and a sensitivity of 99.5%, which sounds great and is pretty close to the actual case.

If you apply this test to a population of a million people where one person in 10,000 is positive, the number of true positives detected (out of a total of 1,000) will be 995. With me so far? However, in with those 995 true positives will be 4,995 false positives, who will be indistinguishable from the true positives by this test. Where did they come from? Well, you've got a million people, of whom 1,000 have the condition - leaving 999,000 who are true negatives. But our test has 99.5% specificity, so .5% of that 999,000 will test false positive, and, presto-chango, you've got 5,990 positive people, of whom only 16.6% are truly positive, while the rest get to hear the news that they've tested positive for HIV.

Now, you can change that all important one person per 10,000 number around and see what happens, but the fact is most of the diseases we screen for, and many of the things we're concerned about in this society, are much rarer than that. SO the rate of true to false postive is even worse - and two real good examples are drigstore employees looking for child pornography in family photo processing, and airport screening. I'm sure readers can come up with many more examples, but all the policies that try to minimize false negatives of rare conditions will sweep huge numbers of false positives into the net, and very rarely are the consequences of that considered or if they are, they're minimized.

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