Prof. Devi Sridhar in The Guardian about the epidemic of missed cancer cases:

Early [cancer] diagnosis is important because it improves survival outcomes. In England, more than 90% of people survive bowel, breast and ovarian cancer for at least five years if diagnosed at the earliest stage. This allows treatment to start earlier, before the cancer has spread through the body. Yet even with a cancer diagnosis, the NHS is struggling to provide treatment within the current 62-day target time: 36% of patients waited longer than 62 days in England, 21% in Scotland and 43% in Wales. The main bottleneck is staff shortages, which the Covid-19 pandemic has made more acute. Again, this points to the need for investment in the NHS – in not just infrastructure, but also the workforce.

Prof. Sridhar is chair of global public health at the University of Edinburgh so I was surprised to see her make a basic error in epidemiological reasoning. “Early cancer diagnosis is important because it improves survival outcomes”, the paragraph begins, citing not original research but a comment in The Lancet which, yes, is a prestigious journal, Impact factor 202.731, which is ridiculously high. but calling on comments to back your claims without primary literature are level 0 data.

The Lancet article ⊕ There is a story here about going down rabbit holes due to poor citation practices — I once spent two days hunting for the primary reference to a single sentence for a letter in a journal nobody reads — that deservs a post of its one. One day., “Earlier diagnosis: the importance of cancer symptoms” does refer to a 2015 systematic review of 209 studies in the British Journal of Cancer — not as prestigious, you’ll notice Impact factor 9. — whose main conclusion was that the studies were of such varying quality that “Heterogeneity precluded definitive findings”.

The authors did speculate in the conclusion that they “believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers”. Which, fair enough, but: number one, that’s just like, your opinion, man; and number two: there is already a plethora of data about lead time bias fooling you into thinking your early detection prolongs survival when in fact all it did was make the person aware they had cancer for longer without making an iota of difference on when and of what they would die. ⊕ I base this claim purely on personal anecdote, where people “cured” of their lymphoma were reluctant to get a mammogram — a possible side effect of chest radiation — so they wouldn’t have the aura of cancer hang above them once again. Since this is a situation for which we know that when the cancer does occur, a so-called “secondary malignancy”, it is more aggressive than usual, they ended up doing it, and good for the patient! Yes, there are people who would rather know, but a good proportion — as this is a blog post and not a commentary in The Lancet I am going to allow myself some speculation here — possible more than half would rather not!

So what is going on here? Surely the chair of global public health at a well-known university knows about the lead time bias? The last three years made me question jumping to that conclusion right away, but let’s give some benefit of doubt. The key word here, I’m worried, is public health, a blunt-force instrument which does away with nuance in favor of broad if not deep messages and interventions. Sometimes these are terrifyingly successful: witness the eradication or near-eradication of infectious diseases, or my favorite — plummeting smoking rates in the United States after a public campaign and a flurry of lawsuits that saved more lives than all statins and chemotherapeutics put together. But the dangers of oversimplification are real, like the crusade to ban saturated fats in favor of simple processed sugars backfiring spectacularly. Caveat audiens.

So anyway, that’s why I don’t read newspaper coverage of medical matters, opinion pieces, or The Guardian.

After a 10-month hiatus I am reactivating my linkblog account on Radio3, one of Dave Winers' many great projects. It has cross-posting to Micro.blog which Just Works™️. Happy days.

It is remarkable how quickly the new Verge homepage became my go-to for tech information. Nilay Patel’s introductory article from two months ago was prescient.

An interesting task popped up on my to-do list this morning. ⊕ Not important for the story, but some may recognize that this is OmniFocus. I’ve been using it with great success for more than a decade and cannot recommend it highly enough for anyone who has to juggle between work, family, and — and this is what tipped me to using it but probably won’t apply to you — the massive amounts of paperwork needed for US immigration.

It was one year ago yesterday, then, that during a buisiness trip to California, over drinks and appetizers, I was subjected to an hour-long tirade about the evils of fiat currency and the brilliance of digital gold that is bitcoin, and why would I want to miss out on the future of finance?

This was from two friends, both half a decade or so younger than me, who hadn’t previously met but quickly found common ground in their love of decentralized finance and Tesla stock.

I held my ground and tried to explain — as well as I could after a few beers — that I wasn’t much of a gambler, and that even if I was I would rather have gambled somewhere that has free drinks and livelier entertainment. I told them to read the Incerto. One of them had the books but hadn’t gotten around to reading them, and disliked Taleb on principle. We agreed to disagree, and parted ways with this task dictated on my phone.

And here we are today.

They are both fine, or so I’ve been told, because they sold everything at just the right time. My task is therefore complete, although I didn’t have to wait a full year to check it off. The value then, after all, was the same as it is now, which is to say exactly zero.

Today is Election Day in America. By law, this is the first Tuesday after the first Monday in November.

Why pick such an impractical day for voting, when people need to take time off work and kids have to miss school?

Because Americans used to be a bunch of farmers. Of course.

Angela Lansbury (1925-2022). The original production of Sweeney Todd is my favorite work of hers, and The Worst Pies in London one of my favorite parts. I hear she’s known for other things as well.

Rem Koolhaas:

Junkspace is what remains after modernization has run its course, or, more precisely, what coagulates while modernization is in progress, its fallout. Modernization had a rational program: to share the blessings of science, universally. Junkspace is its apotheosis, or meltdown…

This article will be 20 years old next month, and I am only hearing about it now. Hard to think of a better descriptor for the post-WW2 detritus we inhabit.

This FT lunch interview with Piers Morgan was written for someone more clued in to British media than I am, but he seems to be an insufferable oaf, and proud of it! Even if just a facade — though one that pays off handsomely — is that how you want people to see you?

Charlie Warzel puts out a brilliant newsletter every week, and today’s is no different. “Business dude lorem ipsum” indeed.

An old one but good one from Scott Aaronson:

A blankface is anyone who enjoys wielding the power entrusted in them to make others miserable by acting like a cog in a broken machine, rather than like a human being with courage, judgment, and responsibility for their actions.

Dealing with some government bureaucracy today and boy does this word fit for some — not all! — of the people involved.