The XX Factor

From a healthcare perspective, Angelina’s Jolie’s case is pretty clearcut, even if her personal decisions were fraught and complex. Her insurance presumably paid for her breast-cancer gene tests because her mother died of ovarian cancer.* When women like Jolie appear to be at higher than usual risk for breast cancer, their risk factors are punched into a mathematical model and out comes a magic number that helps us make health care decisions. A first-degree relative with breast cancer is pretty much a slam-dunk, and most insurance companies will pony up the cost for Myriad’s monopoly-priced diagnostic panel.

For the rest of us, figuring out risk is trickier. The standard breast-cancer model, the Gail model, tends to underestimate risk, and doesn’t take into account all sorts of well established risk factors such as obesity, alcohol consumption, exposure to radiation, use of hormone replacement therapy and family history of breast cancer in relatives more distantly related than a sister or mother. As a baseline, the average risk of U.S. women is 12.2 percent, or the risk of one in eight women getting breast cancer if they live through old age.

When my doctor used the Gail model, my risk was slightly higher than average, about 14 percent, but neither of us found that reassuring. That’s because I have two grandmothers and a great-grandmother who died of breast cancer or ovarian cancer, which is genetically related to breast cancer.  My doctor referred me me to a genetic counselor, who ran a more sophisticated risk model called the Tyrer-Cruzick that upped my estimated risk to 19.8 percent. That’s two-tenths of a percent lower than the risk that triggers the use of “high-risk” detection tools like regular MRIs in addition to mammograms. Welcome to the gray zone of risk assessment. Both my counselor and I thought I should get tested for the BRCA genes, but my insurance carrier firmly disagreed. At over $3,000, Myriad’s test is too expensive for me and most other women to get, regardless of what they and their doctors may think.

So why didn’t I just cough up the money? Isn’t my health and life worth it? A couple of reasons. For one thing, I learned that our fear of breast cancer is clouded by misconceptions. We tend to think of breast cancer as a heritable disease, but in the vast majority of cases, it’s not. Straight hereditary factors only account for about 10 percent of all breast cancers. And while the BRCA genes are the well-known poster children of risk,  they get more credit than they deserve. In families with histories of breast and ovarian cancer, about half do not have BRCA mutations at all. 

Given my family history, I could have a genetic flaw like the one that originated on a BRCA2 gene in 16^th century Iceland. Or my grandmothers could have inherited one of the 700 other distinct “founder effect” mutations on BRCA genes discovered in Dutch, German and Pakistani populations, among others. But it’s just as likely they had totally different genetic variants that can cause breast cancer, including TP53, PTEN, STK11/LKB1, CDH1, CHEK2, ATM, MLH1, and MSH2, or ones that are as yet undiscovered.

I decided to opt for a much cheaper panel that tested for several known genetic mutations, the dominant BRCA ones excluded thanks to Myriad’s DNA-grabbing patent. When that panel came back negative, I was relieved. Many companies offer these tests, including 23andMe, which does it for $99.

Using the models, tests and screens made me feel like I was doing something, but ultimately, they’re not terribly meaningful. It’s not even very helpful to know your magic risk number for breast cancer. Most women with lots of risk factors will never get breast cancer, and many without the big risk factors will get it nonetheless. In other words, many of the standard risk factors (early puberty, late menopause, obesity, older maternal age, obesity, smoking) are fairly useless. The reason is that we still don’t know really know what causes breast cancer. But at least most of us don’t have Jolie’s BRCA gene (it occurs in 1 in 500 people), and for that, we should be thankful.

Correction, May 14, 2013: This post originally stated that Angelina Jolie's mother died of breast cancer. She died of ovarian cancer.

It’s that time of year, folks. Winter coats are being stored away, blossoms are dappling the trees, and before long, the annual summer parade of skinterns will begin.

Skintern is a term I first heard from a male colleague who disapproved of the yearly ritual of scantily-clad young women showing up to do summer internships at our company. (This was before I started working at Slate.) Every June there would be a new batch, just as clueless about appropriate office attire as those from the year before. Think dresses so clingy they leave nothing to the imagination, tops worn without a bra and tied together with string, daisy dukes, sheer harem pants, and cleavage straight out of a men’s magazine.

But don’t worry, ladies. I’m not here to judge. I’m here to help.

I spent most of my early 20s is a state of panicked confusion about what was appropriate professional attire. And I get that when it comes to office wear, summer is the worst of all: It’s hot outside, you want to look good, and often there’s no clear company dress code. But fear not! Follow the tips below, and I promise you won’t get fired—or the intern equivalent—for your sartorial artlessness. (No luck if you’re terrible at your job, though. The perfect A-line skirt can only do so much.)  

Nothing see-through. No sheer shirts, dresses, or pants. If you are wearing anything that doesn’t block light, you should wear something that fully covers you underneath, like a full slip or cotton tank top.

Your bra and underwear are your business only. When it comes to thongs, lace, and patterns, to each her own. You rock whatever garments make you feel great. However, no one at the office should know anything about your preferences.

Save your skin. Mini-dresses, mini-skirts, short-shorts, halter-tops, and half-shirts should not be worn in a professional setting. (When in doubt, if the article of clothing has a hyphen in it, it is probably off-limits.) More than a hint of cleavage should be avoided—and no bare backs. Showing skin in the office does not make you look sophisticated, it makes you look naked.

Shoe choice matters. I’m less bothered by sneakers and flip flops than laceup, over-the-knee boots and sexy four-inch heels. You may have picked a wonderfully appropriate skirt or dress, so continue the winning streak by saving the glittery platform sandals for another occasion, like pole dancing class.

The shorts conundrum. I am unable to offer you a hard and fast rule about shorts. I wear (appropriate-length) shorts to work. My boss does too, because “What else are you supposed to wear when it’s 90 degrees outside?” Slate’s HR manager, however, says shorts are a no-no—though she would not stage a shorts intervention unless the offending culottes were “distracting.” Since opinions vary, this brings me to my next point.

When in doubt, ask. I hire and manage some interns during the summer, and exactly one intern has asked me what was appropriate to wear to the office—and I respected her for asking. A friendly HR manager, internship coordinator, or person you report to should be happy to give you a few guidelines specific to your office, especially if it means she won’t be getting an eyeful en route to the coffee machine.  

Now that you are armed with this essential knowledge, go forth into the workplace and impress everyone you meet with your hard work and keen intellect. Ladies, I will see you on the other side of the glass ceiling.

When Media Matters counted all the guests to appear on 13 cable evening news shows on CNN, MSNBC and Fox in April 2013, their mission was to chronicle what the face of an “expert” looks like. It turns out it looks disproportionately white and male: Caucasian men made up 58 percent of cable news guests, although they are only 31 percent of the population. This problem persisted across the networks. CNN had the biggest diversity issue—62 percent of its guests were white men—but MSNBC did only slightly better, inviting white, male guests 54 percent of the time. 

The researchers broke down the results by show. On all 13 programs, male guests outnumbered women. On 12 of the 13 shows, white people were overrepresented. All In with Chris Hayes was the only exception. According to the Census, non-Hispanic whites make up 63 percent of the population, and they were 59 percent of Hayes' guests. Hayes did better than his competitors and colleagues on gender diversity as well, with 41 percent of his guests being women. (On that front, Rachel Maddow was his closest competitor, bringing in 37 percent female guests.) God only knows how much worse it would be if reproductive rights weren’t constantly demanding media attention.  

The white maleness of the cable news circuit creates a self-perpetuating cycle. When most of the “expert” faces we see are white and male, white maleness gets associated with the concept of expertise. This, in turn, makes it harder for the producers of the shows to strive for diversity. Consciously or unconsciously, the people who book guests may worry that if they don’t deliver enough white male faces, audiences won’t perceive their shows as expert-heavy. So they bring on more white men, continuing the process by which white maleness and expertise are strongly, and wrongly, associated. 

One way for producers to throw a wrench into this cycle is to set diversity as a deliberate goal. It also helps to cover more stories that hold special significance for women and people of color. But the real trick to it may just be thinking of women and people of color as potential experts on all sorts of issues—on tax rates, congressional budgets and foreign policy, for instance, as well as on poverty, racism, and reproductive rights. If cable news leads the way, the imagined link between white maleness and expertise can be broken. 

Today, Angelina Jolie published a piece in the New York Times about her decision to undergo a preventive double mastectomy last month. As a carrier of a gene mutation called BRCA1, Jolie cut her chances of contracting breast cancer from 87 percent to under 5 percent by undergoing the procedure. I felt so honored to read Jolie’s detailed first-person account of her experience, as well as her advocacy for all the women around the world to gain access to the too-expensive tests and procedures that have empowered her to fight for her own life. Those warm feelings were soon deflated by some of the unexpectedly nasty commentary that pooled around her story. Commenters snarked that Jolie had received a “boob job.” Some suggested that her medical emergency was just a tabloid ruse to cover up elective breast implants. Others morbidly asked after the whereabouts of the breast tissue removed from her body. “RIP Angelina’s boobs” was a typical ignorant comment. Said one commenter on a Jezebel post about the op-ed, “How many guys stopped reading as soon as they realized Angelina Jolie has no breasts—she's dead to me!"

I’d like to dismiss these commenters as trolls, but their attitudes are unfortunately pervasive in our culture, and they don’t just represent a personal affront to Angelina Jolie, a veteran of such inappropriate body commentary. These comments affect every woman who has undergone a similar procedure—every woman who has overcome the pain, the fear, and the constant and casual reminders that her breasts are more valuable than her life. Really, these comments affect all women who have seen their bodies reduced to mere objects for others to consume. As scholar of the stars Anne Helen Petersen says, “Remember: What we talk about when we talk about celebrities is, as ever, ourselves.” Some of us are not speaking very highly of the women in our lives today.

Jolie, for her part, addressed aesthetic concerns straightforwardly in her op-ed. (She also made a worrisome reference to "wonderful holistic doctors working on alternatives to surgery," which I can only hope won't steer readers away from the valid medical treatment they may need). “There have been many advances in this procedure in the last few years, and the results can be beautiful,” Jolie wrote. “On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.” It’s powerful to hear Jolie own this choice as beautiful. But I’d go further to say that, regardless of the aesthetic aftermath of breast cancer surgeries—and the individual choices every woman makes in how to deal with them—the results of these procedures are necessarily and breathtakingly beautiful. Not only does this procedure not diminish a woman’s femininity in any way—it highlights her humanity. As Jolie put it, “Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries. We managed to find moments to laugh together. We knew this was the right thing to do for our family and that it would bring us closer. And it has.”

And yet, perversely, some fans feel as if a part of Jolie has been stolen from them. One well-meaning but misguided commenter told me on Twitter yesterday: “Happy to hear she's giving herself much better odds. As a guy, I will miss her lovely curves though.” (The reconstructive surgery she described presumably restored her curves.) I can tell you from experience that when a person you love makes it through that surgery, they have never looked more lovely. I don’t mean that in a strictly emotional sense—it registers physically, too. The way that they look at you when they wake up. The breaths they take. Their smile. The way they move through space. You don’t miss anything: You are reminded of all of the wonderful things that you are not missing. It's gorgeous.

Kermit Gosnell has been found guilty of murder for the deaths of three babies who were born, and then killed, in his hellhole of a Pennsylania abortion clinic.  From Fox:

“Prosecution experts said one was nearly 30 weeks along when it was aborted and it was so big that Gosnell allegedly joked it could ‘walk to the bus.’ A second fetus was said to be alive for some 20 minues before a clinic worker snipped its neck. A third was born in a toilet and was moving after another clinic employee grabbed it and severed its spinal cord, according to testimony.”

That’s all you need to know to welcome this verdict. There is nothing controversial about finding a man guilty who killed live babies. Gosnell was also found guilty of involuntary manslaughter for the death of a patient who died of an overdose in his care. Her death is a reflection of the abusive, repulsive scene of his clinic, a place of unspeakable conditions. The grand jury report that laid out the charges against Gosnell is excruciating to read, a document of horrors visited on poor and desperate women and innocent newborns. So are the accounts of the Pennsylvania agencies that dropped the ball on investigating and catching this man.

We can debate whether Gosnell’s trial got enough press coverage—whether the mainstream media shied away from putting it on the front page for fear of putting abortion in a bad light. But Gosnell’s misdeeds aren’t about legal abortion. They’re about killing babies after viability—after they could live outside their mothers’ wombs. In Pennsylvania, abortions after 24 weeks are illegal. It’s important to remember why women were driven to Gosnell’s clinic. But you can fully support a legal right to abortion—and greater access to it—and simultaneously applaud this guilty verdict. The women and babies of Pennsylvania are safer with Gosnell facing many years in prison or the death penalty. That is front page news.

Elspeth Reeve at the Atlantic Wire has some fun dismantling Joel Stein's "get off my lawn" Time article, in which Stein denounces the millennial generation as a bunch of self-satisfied narcissists. (It's behind a paywall, so this famously broke generation is unlikely to find out what mean things Stein is saying about it.) Reeve objects to Stein's evidence, but the real meat of her post chronicles the long history of articles like Stein's—essays in which a member of the older generation dismisses the youngsters as self-involved. The WWII generation did it to the Boomers, the Boomers to Generation X, and now Generation X to the Millennials. 

What becomes apparent in all these articles, which go back at least to 1907, is the egotism not of the accused generation, but of the writer. The writers invariably fancy themselves part of a generation that, unlike the youth of today, has deep thoughts and knows the value of hard work. Stein even starts off his piece by saying, "I am about to do what old people have done throughout history: call those younger than me lazy, entitled, selfish and shallow." But even though he knows it's unlikely that every generation is less awesome than the one before it, he's going to plow right ahead and say it anyway.

If one bothers to step outside of the cycle of whining, the more honest conclusion is that today’s kids are pretty great people, especially compared to the rest of us screw-ups. Millennials are more liberal than the generations before, suggesting a shift away from the politics of resentment and toward a politics of generosity and social support. They're pretty responsible, too. They're the ones who managed to cut the teenage pregnancy rate by 42 percent since 1990, and even though there are as many of them as there are Baby Boomers, they managed to come of age without creating the same massive spike in the crime rate. Even though they're starting out their adult lives in an period of economic crisis, they're an optimistic crew. Frankly, as someone from the tail end of Generation X, my main problem with this generous, optimistic, tolerant generation is that all their goody-two-shoes stuff is insufferable. I'll just be sitting in the corner with my punk records and inability to say anything that's not drenched with irony, secretly glad that such good people are taking over the world. 

Last summer Mayor Bloomberg said he was going to tell hospitals to keep infant formula locked up in cabinets to encourage new mothers to breast-feed. He might want to reconsider: A new study shows that limited early formula supplementation might actually help some moms breast-feed longer. Doctors took 40 babies who were between 1 and 2 days old, exclusively breast-feeding, and had lost between 5 and 10 percent of their birth weight. Twenty of those babies were given only breast milk. The other 20 were given a small dose of formula via a syringe (to avoid nipple confusion) after they breast-fed—not enough to make them full and possibly reject breast milk at their next feeding. These formula moms only supplemented their breast milk until their mature milk came in.

The results were that moms who had supplemented their breast milk in the first days were less likely to use formula down the road than the mothers who were exclusively breast-feeding during those difficult early hours. At three months, 95 percent of the babies who had received formula in those first few days were still getting some breast milk, compared with only 69 percent of the babies that had received no formula. And as an added benefit, the babies who were given formula lost slightly less weight in the short run.

It’s difficult to know exactly why that tiny bit of formula in the early days made the difference, but one speculation is that it eased anxiety about the babies gaining weight. Since many moms stop breast-feeding because they’re concerned that their children aren’t getting enough food, getting that limited boost from formula in the early days gave them the assurance to keep going with breastfeeding, the study’s authors hypothesized. They had a potential escape valve of formula, so could relax.

Forty women is a small sample, and as the authors point out, their sample size was mostly white and Asian, and more educated than the general population. And it doesn’t answer all the questions about early use of formula–say, whether it is associated with more allergies. But this is at least a rare infant study that was able to use a randomized sample. And even with these measured caveats, the takeaway here seems to be that we can open our minds to the possibility that a little flexibility in feeding can lead to more confident moms and better outcomes for babies.

I think we can all agree that no one had a worse week in the Game of Thrones than Theon Greyjoy, who lost his manbits as part of a mysterious man's campaign to totally destroy him. But this was an episode full of continuing shifts in the power rankings for the ladies, from Talisa's pregnancy to Brienne's fight with an actual bear. From top to bottom, here are the women winning—and losing—the Game of Thrones:

1. Daenerys Targaryen: Dany may have been advised to blood her Unsullied early, but the Breaker of Chains and Mother of Dragons is clearly feeling a little feisty herself. “You will release every slave in Yunkai," she tells the Yunkish emissary, who is trying to buy her off. "Every man, woman, and child shall be given as much food, clothing and property as they can carry as payment for their years of servitude.” When he refuses, her dragons get excitable. “You swore me safe conduct," the man tells her, panicked. “But my dragons made no promises. And you threatened their mother," Dany shoots back. A whole bunch of gold and the potential conquest of a new city is one heck of a Mother's Day gift.

2. Margaery Tyrell: Okay, so her plans to marry her brother off to Sansa Stark may have failed. But Margaery has good advice to offer to the younger woman—and her plotting is far from over. “My son will be king," Margaery tells Sansa. "Sons learn from their mothers. I plan to teach mine a great deal.” In the Game of Thrones, patience, and the ability to recover from setbacks, are some of the greatest virtues.

3. Melisandre: “My mother’s a tavern wench,” Gendry tells the woman who bought him from the Brotherhood Without Banners as they sail through the wreckage of Stannis Baratheon's fleet. “Mine was a slave," Melisandre counters, reminding him that he should never count himself out. "So was I. Bought and sold, scourged and branded, until the Lord of Light lifted me up." And she warns Gendry, "There is power in a king's blood." It's not clear what Melisandre has planned. But given the way she's talking to Gendry, maybe he isn't the one who should worried about what happens when she gets her work underway.

4. Talisa: Robb Stark's wife hasn't been much of a player since she married the King in the North. But everything changes after she reveals she’s pregnant. Now, Talisa's the woman who will give the Starks an heir, a position that makes her, if nothing else, an extraordinarily powerful pawn.

5. Brienne of Tarth: Normally, getting tossed in a pit with a bear with only a wooden sword to defend yourself makes for a terrible day in Westeros, a country with a lot of bad days to choose from. But this day, and this torment, happen to make Jaime Lannister discover that he cares rather a lot for Brienne. They've bonded on their road trip. Now that they’re back together and on the same page, they'll make a fearsome pairing.

6. Ygritte: One moment you're smooching your boyfriend on top of a giant ice wall and teasing him about his country's style of fighting. The next, Orrell, who is the archetype of a creepy Westerosi Nice Guy, is trying to get between the two of you. He tells Ygritte, of Jon, "You like his pretty hair and his pretty eyes? You think pretty’s going to make you happy? You won’t love him so much when you find out what he really is.” And the thing is, he may be right.

7. Sansa Stark: All season long, all I've wanted is for Sansa Stark to wake up and recognize what's happening around her. Now she has, bitterly castigating herself for her childhood dreams. “They seemed so nice in their painted armor," Sansa says of her romance with King's Landing. “All those candles burning in all those windows. I’m stupid. Stupid little girl, with stupid dreams, who never learns.” She may be terrified by the prospect of marriage to—and sex with—Tyrion Lannister. But with Margaery there to comfort her, and a clear-eyed assessment of her life, Sansa might just begin to find her way.

8. Shae: Sansa isn't the only one to get a dose of misfortune out of her betrothal. Tyrion's engagement leaves Shae to give her lover some real talk about their relationship. “I am a Lannister of Casterly Rock,” Tyrion says. “And I'm Shae, the funny whore," she rebuts. And when he offers her a home and children, Shae's assessment of this fairy story is withering in the extreme. “Children? You think I want children who can never see their father? Who would be killed in their sleep if their grandfather found out about them?” "You'll always be my lady," Tyrion tells her, trying to substitute sentiment for logistics. "I'm your whore," Shae tells him. Let's hope the energy from that anger helps her find a way out of her predicament.

9. Arya Stark: I love the younger Stark girl, but tonight, Arya finds out that spunkiness is not always her friend. After telling Thors of Myr that her god is Death, Arya makes a run for it, only to end up in the custody of Sandor Clegane, aka the Hound. "Kick all you like, Wolf Girl," he tells her. "It won't make a difference." We just got a setup for a buddy comedy even blacker than the one Brienne and Jaime lived through.

10. Osha: Poor Osha. Bran's blowing her off. The Reeds are forcing her to go North. And in this episode, we find out just how much she lost. "I had a man once, a good man. Bruni his name was," Osha explains to her charges. "He came in through the back of the hut. Only it wasn’t Bruni, not really. His skin was pale, like a dead man’s. His eyes bluer than clear sky. He came at me, grabbed me by the neck and squeezed so hard I could feel the life slipping out of me. I don’t know how I got the knife. But when I did I stuck it deep into his heart. And he hardly seemed to notice. I had to burn our hut down with him inside." All those Westerosi women complaining about their arranged marriages have no idea what pain can follow when you get to choose the person you're with, especially when winter is coming.

I’m looking forward to reminding my mom how much I love her this weekend—as Hallmarky as Mother’s Day is, there aren’t enough minutes in the year to express my appreciation of my mom. But my enthusiasm is tempered by the increasingly ridiculous mom-themed marketing pushes that have been hitting my inbox in preparation for the holiday. I teared up watching Google’s Mother’s Day ad featuring Google Plus—I am not made of stone—and yet I remain unconvinced that I should honor my mother by inviting her to the most irrelevant social network on the Internet. Then there is the press release factory that keeps trying to sell me on an interview with a marketing executive about “the many ways in which Mom has transformed—her responsibilities, her values, even her personality.” It’s almost as if mothers aren’t real people—they’re just monolithic “mom” now, something marketers create to sell products

I suppose it could be worse: I also heard from a porn company that’s celebrating the holiday by “giving away free rentals of three of the studio’s most popular MILF scenes."

Of course, Americans have been raising the alarm about the commercialization of Mother’s Day since the 1920s, when Anna Jarvis—a pioneer of the holiday—promoted the holiday as one of “sentiment, not profit” and dismissed greeting cards as “a poor excuse for the letter you are too lazy to write.” But even before Jarvis coined “Mother’s Day,” her own mom, Anna Reed Jarvis, organized something more radical: Her “Mothers' Work Days” in the 1850s were meant to organize women around social justice issues in their communities. As Stefanie Coontz wrote in her terrific 1992 history of the holiday, the apostrophe initially fell at the end of “mothers,” and that was a significant choice: Mothers’ Day was organized under a collective spirit, and “celebrated the extension of women's moral concerns beyond the home.” It was only when Mother’s Day moved to celebrate the individual mom by focusing on “sentimentalism and private family relations,” Coontz writes, that it became “so vulnerable to commercial exploitation.”

Today’s moms are facing down a new permutation of that commercial exploitation: An incessant stream of click-bait trend stories that focus on the private family choices of mothers, group them into factions based on a few scant identifiers (Formula Feeders! Feminist Housewives! Pregnant CEOs!), then politicize their every move as another shot fired in the Mommy Wars. These narratives simultaneously fail to treat mothers as complex individuals and fall short of any real collective consciousness. It is all in-fighting: Click, click! Only when Mother’s Day rolls around are we instructed to treat all mothers on the same happy-go-lucky terms: Here. We bought you all the same flower arrangement.

So this Mother’s Day, while I’m tempted to tell my mom how much she’s meant to me as her daughter, I also want to remember to celebrate her as a wonderful person—one whose tireless social activism extends far beyond my own existence. That’s not the most compelling trend story I’ve ever pitched, but I think it would sound nice in a letter.

Allie Brosh is back! She’s the genius behind the blog and web comic Hyperbole and a Half, and we’ve missed her since October 2011, when she disappeared from the Internet to battle depression.

It is a truth universally acknowledged that depression sucks. In his memoir Killing the Black Dog, the poet Les Murray describes his fragmentary thoughts, filtered through the disorder, as “kelp marinated in pure pain.” But out of that darkness Brosh has given us a searingly smart and precise account of what it’s like to not “feel anything about anything,” to be stuck in a “boring, lonely, meaningless void.” And she ends on a note—not of hope, exactly, but of the precondition for hope, which is a sense that nothing is definitively known or fixed. We love her post, and we hope you do too.