It is time to abolish Kindergarten graduations. What exactly are we celebrating here, and how low are we setting the bar for future festivities?

For my non-American audience: yes, this is a thing, with toddlers all dressed up and ready to receive their diploma. Pure madness!

Tyler Cowen had a “fireside chat” about Effective Altruism. Every trade conference I go to has “fireside chats” with “industry leaders”.

The fireside chats were a series of evening radio addresses given by Franklin D. Roosevelt, the 32nd President of the United States, between 1933 and 1944. […] On radio, he quelled rumors, countered conservative-dominated newspapers, and explained his policies directly to the American people. His tone and demeanor communicated self-assurance during times of despair and uncertainty.

Gotcha.

Finished reading: In Defense of Civilization by Michael RJ Bonner 📚

Michael Bonner is the anti-Harari: the history he writes about is narrower in scope and more precise, the present more grounded in reality, the future less bright — unless we work hard for it. He will not be speaking at Davos.

Washington Post’s Katherine Ellison on the striking decrease in mortality from lung and breast cancer in the US:

There are many and varied explanations for the progress, says Memorial Sloan Kettering oncologist Larry Norton, including “better early diagnosis, better imaging, better blood tests, better preventive measures and better treatments, including precision medicine with gene-profiling of patients’ tumors.”

The rest of the article focuses on treatments — immunotherapy in particular — ⊕ And yes, of course dostarlimab was mentioned. Once a darling, always a darling. and cancer survivorship, but in discussing decreasing deaths from lung and breast cancer the article missed an opportunity for some education in cancer epidemiology.

The two sources chosen to present these data, ASCO’s cancer.net for lung and Breastcancer.org for breast are lacking in two ways: they are an impenetrable wall of text without much context, and they both have an agenda. Now, it happens that I agree with ASCO’s agenda — I am a dues-paying member — and don’t know enough Breastcancer.org to form an opinion, but neutral parties they are not. If only there was a tax-funded, publicly available database which could help us visualize trends in cancer statistics.

Now it so happens that the CDC maintains such a database, with its very on visualization tools, and it is exactly what we need. It will even make your PowerPoint slides for you! And yes, deaths from both lung and breast cancer have been steadily decreasing for the past two decades.

But is it because of better prevention, early diagnosis, more effective treatments, or all three? Looking at cancer incidence — the number of newly diagnosed cases per year — may help some. Better prevention would lead to decreased incidence, early detection would lead to an increase, a combination of the two may cancel each other out leading to a flat line, and any change in treatments would not affect it at all.

A slight initial dip in female breast cancer incidence followed by an even slighter increase make me think that early detection — all those mammograms — is superimposed on better prevention. The case is less ambiguous for lung cancer: the incidence is plummeting. In both cases, “prevention” was initiated by the 1964 Surgeon General’s report on tobacco smoke which led to massive anti-smoking campaigns from the 1970s onwards. The results weren’t immediately obvious — not having to air out all your clothes after a night out notwithstanding — but cancer rates started dropping after 20 years, and 50 years later we are reaping the full benefits.

Note that in lung cancer the mortality slope is steeper than the incidence slope. And while this may be explained by early detection and better treatments, it is possible that at least some of the improvement over newly diagnosed lung cancers is due to non-smoking associated lung cancer being generally less aggressive and occurring in younger and healthier people than tobacco-associated cancers. What could help unravel these different components — and highlight the increasing importance of cancer survivor healthcare — would be a prevalence curve: how many people in the United States are currently living with a particular cancer. Alas, those data are not available.

If you thought interpreting those four curves was interesting, do go back to the CDC database and check out the incidence and mortality curves for thyroid cancer — that poster child of over-diagnosis — and prostate cancer, the incidence of which fluctuates ever which way with changing screening recommendations but with mortality marching downwards for the last 20 years.

A memo written in 1977 has more useful advice on writing e-mails than a whole business class’ worth of courses. Number 8 in particular:

My last imposition on you for today is the excessive use of “appropriate” or “inappropriate,” when what the writer really means is either “legal” or “illegal,” “proper” or “improper,” “desirable” or “undesirable,” “fitting” or “not fitting,” or simply “this is what I want (or do not want) to do.”

Another duo to be expunged: comfortable/uncomfortable.

(h/t Josh Withers)

You won’t see me link to ESPN too many times, so enjoy (emphasis mine):

“If you want to be a success, you need a couple years,” Jokic said after Monday’s title game. "You need to be bad, then you need to be good, then when you’re good you need to fail, and then when you fail, you’re going to figure it out.

“There is a process – there are steps that you need to fill – and there are no shortcuts. It’s a journey, and I’m glad that I’m part of the journey.”

This is, of course, true in absolutely every field of human endeavor, but in too many of those fields any failure, let alone failing repeatedly, is just not an option. And we are all worse for it.

🍿 The Godfather (1972): even better than I remembered it. Somehow, the best of the late 1960s and early 1970s has aged much better than the 1980s’ top of the crop (with all due respect to Back to the Future).

After seeing a friend and collaborator yet again plant foot firmly in mouth, I begin to see a pattern. A course on ergodicity should be a requirement for a public health degree, since the masters of public health keep getting it wrong (see also: the screening colonoscopy debate).