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The (non)ergodicity of cancer screening

My fellow NCI-trained oncologist, friend, and occasional co-author Vinay Prasad had another appearance on my favorite podcast, and I’m happy to say that the result is a contender for the best EconTalk episode of 2023. It is all about cancer screening, but also about decisions, paternalism, and regret. No mention of Covid — thankfully — and Russ Roberts mostly listens but then asks the most poignant questions that result in some spirited conversation.

The word not mentioned — a surprise since Russ likes to pull in Talebisms whenever there is a good opportunity — was ergodicity. Or rather, the non-ergodicity of medical interventions: there may only be a 0.01% chance of death with a procedure, but if it happens to you, you are 100%, not 0.01% dead. People I don’t do well with negative definitions and it would be nice if there were a separate word for non-ergodic processes, like there is for antifragility.

Another missed opportunity is to discuss efficacy — the outcome of a procedure in ideal settings — versus effectivness, which is how procedures behave when you let humans do their human things en masse. Even with that, it is a great episode, do listen, and maybe take some notes along the way.

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