June 17, 2023

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.

WaPo: "Could cancer become a chronic, treatable disease? For many, it already is."

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 — [Note: 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.

Lung and female breast cancer mortality in the United States, 1999–2020.

Deaths from breast and lung cancer per 100,000 people from 1999 to 2020, decreased from around 27 to 19 for female breast cancer, and from around 56 to 32 for lung.

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.

Lung and female breast cancer incidence in the United States, 1999–2020.

Newly diagnosed breast and lung cancer per 100,000 people from 1999 to 2020, flat for breast cancer, decreasing for lung cancer.

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.

June 16, 2023

The Style of Board Orders and Chairman's Letters (and, one should add, E-mails)

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)

June 13, 2023

🏀 ESPN: How the Nuggets cultivated the NBA's most dynamic duo

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.

June 12, 2023

🍿 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).

June 9, 2023

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).

June 7, 2023

🍿 The Ring (2002), held up rather well, though with more jump scares than I remembered. It’s the lack of gratuitous gore that makes it scarier than some other attempts. Gloomy Washington state standing in for gloomy Japan was an inspired choice.

June 6, 2023

🍿 Evil Dead, the 2013 version, had nothing of the qualities that made the original trilogy enjoyable. “Thank you”, CGI, for turning a campy gross-out horror comedy featuring plastic puppets squirting purple slime into yet another festival of gore.

Let the record show that I am bullish on Vision Pro, in part because of the glowing reviews from the likes of Ben Thompson and Matthew Panzarino, but mostly because of the misguided negative comments which are delightfully reminiscent of 2007. It has potential!

June 5, 2023

The people against the United States Congress

Reginald Booker and Sammie Abbott are second only to Pierre L’Enfant in their influence on Washington D.C.’s urban development, and they were neither architects nor civil engineers. I would happily watch an HBO/Apple TV+ miniseries about their fight with the congressmen who wanted to pave over the capital with miles and miles of highway. I mean, just look at them:

Exhibit A: Sammie Abbott (left) and Reginald Booker testifying against the freeways in 1969 (photo from the Evening Star).

Black and white photo of a bespectacled elderly Arab man and a younger African American man wearing sunglasses and a denim jacket sitting behind a desk. The older man is talking emphatically with his right arm raised while the younger is looking down at their desk. There is an audience and a row of security guards in the background.

The Man they were fighting against was Rep. William Houston Natcher (D), chair of an Appropriations subcommittee which wanted to flood the District with money in a cash for concrete program. And again, a picture here is worth more than a thousand words:

Exhibit B: William H. Natcher (right) at the Great American Villains' Convention, circa 1971.

Black and white photo of an elderly white man standing next to a smiling Richard Nixon

Thanks to Booker and Abbott’s good work, DC now has a semi-functional metro under an agglomeration of vibrant, interconnected, walkable neighborhoods, instead of a completely dysfunctional and congested freeway system criss-crossing a checkerboard of destroyed city blocks, à la Baltimore. The Washington Post wrote about the pair a couple of decades ago, and the story is engrossing as ever. Someone, anyone, please forward it to David Simon.