Mortality Due to Cancer


I’m going to open with the journey that led to this post. It started with this post by John Horgan questioning the U. S. Prevention Services’s updated guidelines on early breast cancer screening. Basically, his conclusion is that the new guidance may actually lead to more deaths which appears to be the inference derived from the service’s own data. That led to this post of his on cancer mortality which in turn led to the graph at the top of the page from Our World in Data.

I wish the graph had been updated to the present day. Twelve years can be an eternity. I also wish the graph had been adjusted for age. As a pathologist buddy of mine observes everybody dies of something. If heart disease doesn’t get you cancer will.

Several things jumped out at me from the graph and I wanted to reflect on those. The most obvious is that less smoking has resulted in an enormous difference in the mortality due to lung cancer. It probably has reduced mortality due to other forms as well. But that isn’t the only thing.

Note that death rates for several forms of cancer (pancreas, leukemia) were increasing until the mid-1960s and have plateaued since then. I would speculate that the adoption of Medicare/Medicaid resulted in a decline in cancer deaths.

Several cancers (breast cancer in women, prostate cancer in men, colo-rectal cancer) show sharp declines in mortality in the 1990s. In the cast of prostate cancer I can only speculate the approval of the PSA test was instrumental. There may be a similar factor in breast cancer in women. Routine colonoscopies may be related to the declines in mortality from that cause. All of those would seem to contradict Mr. Horgan’s observations.

Mortality due to liver cancer, stomach cancer, and uterine cancer has been decreasing for a long time—over the last century. Mortality due to liver cancer in men, bucking the trends, has actually increased since 1980. I have no explanation for that. I would suspect it is behavioral or environmental.

5 comments

Behaving Erratically

I wanted to call your attention to what I think is a very good piece by Sean McMeekin at Compact on what he refers to as our “erratic Russia policy”. Here’s a snippet:

The lack of historical or material ties between America and Ukraine notwithstanding, defending Ukraine’s territorial integrity is now, judging by countless pronouncements by official Washington, a cardinal principle of US foreign policy, even as Russia’s most essential interest, judging by countless pronouncements by Vladimir Putin and other Russian officials, now requires waging war against Ukrainians because they are American-supported.

Does any of this make sense?

I wanted to make two points. The first is that I don’t think you can explain our policy with respect to Russia without understanding how little it is affected by national interests and how much affected by personal interests. For the last 30 years and in all likelihood substantially longer our posture has been heavily influenced by people making money based on our relations with Ukraine, Georgia, etc. or by people who are otherwise interested—Polish-Americans, Ukrainian-Americans—or both financially and otherwise interested.

The second observation is that over the last 30 years there have been several of what you might think of as “inflection points”. The first of these inflection points was our engagement in Yugoslavia. That marked the end of NATO’s existence as a defensive alliance and its transmogrification into, well, something else. To this day the Chinese consider our bombing of their embassy in Belgrade during that engagement as deliberate.

We can’t plead opposition to genocide. If that were the case we would be attacking China, Myanmar, and many other countries in which genocides are still taking place.

The second is our invasion of Iraq. We removed Saddam Hussein, largely on the pretext of his possession of weapons of mass destruction, basically because we could. He wasn’t a threat to us; he wasn’t supporting our enemies. Iran is a considerably greater threat to us and we haven’t invaded Iran. Ultimately, our invasion of Iraq enabled a genocide which almost wiped out the Yazidis in northeastern Iraq.

The third is our involvement in the removal of Moammar Qaddafi in Libya. Although, unlike the previous two examples, there was a Security Council resolution which authorized our protecting civilians there, reasonable observers conclude our degradation of the Libyan military which enabled his overthrow to have gone substantially beyond our mandate there. Interest didn’t justify it; neither did international law. What did was the hypothetical and bloodthirsty “responsibility to protect”.

There are many other examples but those are the most blatant.

What we need to understand about these actions of ours is that the United States is that guy yelling and behaving erratically doing Michael Jordan impressions in the subway car. What prevents somebody from wrestling us to the ground is that we’re too big and strong.

1 comment

Failed By City Government

The editors of the Wall Street Journal remark on a story I touched on yesterday:

Every subway rider in New York City knows the experience. You get on a train, and a passenger nearby is shouting to himself or at others. He may ask for money or harass a passenger. You move away as far as you can, perhaps wondering if you should intervene to calm him down or stop the harassment. Should you take the risk? Most of us walk away and get on another subway car.

What they describe “most of us” is doing is the right course of action. They go on to praise the man who killed Jordan Neely as a “samaritan”:

Daniel Penny, a Marine veteran, took that risk on May 1 and intervened to subdue Jordan Neely, a homeless man who was acting erratically, shouting and claiming he had little to live for. Mr. Penny subdued Neely, put him in a chokehold, and Neely died. On Friday the Manhattan district attorney charged Mr. Penny with second-degree manslaughter for which he could serve up to 15 years in prison.

At this point and with respect to whatever transpired in that subway car, the justice system is working as it should. If the case goes to trial a jury will decide whether Mr. Penny was justified, if he went too far, and, if found guilty, what the punishment should be. They will consider his state of mind and the outcome. Mr. Penny may be acquitted, he may be convicted of a lesser offense, or he may be found guilty.

However, we shouldn’t lose track of the fact that the city failed Mr. Neely. The editors touch on that:

Neely’s death is a tragedy, but the charges against Mr. Penny raise troubling questions about the decline of public order and the way the mentally ill have been left to fend for themselves on our streets and public spaces.

I don’t think they’re pointed enough. Mr. Neely should never have been in that subway car. He had already been determined to have been a danger to himself or others. To my mind that means that treatment for his mental condition should have been mandatory and compulsory and he shouldn’t have been roaming loose. The inability of the subway system to function both as a transportation system and a means of housing the homeless is a completely separate topic.

Whatever a jury decides about Mr. Penny’s actions, that shouldn’t let city authorities off the hook.

3 comments

What the Numbers Say

The youth unemployment rate is 9.57%. The real annual earnings for individuals with high school diplomas or less have been flat or declining for decades, see here and here.

If there were a high demand for entry level/low skill workers, we would see something different. The youth unemployment rate would be roughly the same as the general unemployment rate and wages for those workers would be rising.

An ever-increasing supply of workers willing to work for very low wages has several effects. First, it lowers the wages of entry level/low skill workers. It increases income inequality. It also distorts the economy by causing more to be invested in activities that exploit that unending supply of entry level/low skill workers. That includes things like hospitality (fast food), construction, agriculture, etc.

That is what we’re seeing. It’s not good for us as a society.

1 comment

The Slippery Slope

Let’s talk about the death of Jordan Neely. If you’re not familiar with the story, he was a mentally ill homeless man behaving erratically on the New York subway. Daniel Penny, characterized as a “24 year old ex-Marine”, put Mr. Neely in a headlock which he held for three minutes. He was assisted by several other of the car’s passengers. Mr. Neely was taken to a hospital where he was pronounced dead. The death has resulted in demonstrations, complaints of racism and anti-homeless bigotry, and an endless torrent of columns and op-eds.

I suspect I’m the only person here who has taught self-defense. As practically anyone who teaches self-defense will advise, the first rule of self-defense is avoidance. The second is defusing the situation. You don’t resort to force unless there is no other alternative.

Mr. Neely was not harmless. He had assaulted an elderly woman a couple of years ago.

I think there is a slippery slope here. The slope goes from avoidance to “stand your ground” to force when you feel threatened to shoot first and ask questions later. Not only is that not effective self-defense it’s no way to organize a workable society.

13 comments

Farewell to All That

This letter, posted at RealClearPolitics, from longtime Cook County prosecutor Jason Poje makes for depressing reading. He’s not the first prosecutor to resign and I doubt he will be the last. Here’s a snippet:

The simple fact is that this State and County have set themselves on a course to disaster. And the worst part is that the agency for whom I work has backed literally every policy change that had the predictable, and predicted, outcome of more crime and more people getting hurt.

Bond reform designed to make sure no one stays in jail while their cases are pending with no safety net to handle more criminals on the streets, shorter parole periods, lower sentences for repeat offenders, the malicious and unnecessary prosecution of law enforcement officers, overuse of diversion programs, intentionally not pursuing prosecutions for crimes lawfully on the books after being passed by our legislature and signed by a governor, all of these so-called reforms have had a direct negative impact, with consequences that will last for a generation.

Read the whole thing. One point that he makes is worth repeating. Our legal system is adversarial. In it defense attorneys defend and prosecutors prosecute. When defense attorneys defend and prosecutors defend, the system can’t work.

2 comments

Undermining Support for Immigration


The editors of the Wall Street Journal who have long supported increased immigration lament:

All of this is depressing enough for its human and other costs, but also for those who believe the U.S. needs more legal immigration. Even pro-immigration Republicans aren’t going to support more legal visas until the border is all but closed. A deal to legalize the Dreamers brought here illegally as children looks to be more distant than ever.

The only way to stop the migrant deluge now is to radically change the incentives to come. Send the message that if you are caught arriving illegally at the border, you will be deported and put on a banned list for legal entry. No exceptions. Once the flow subsides, it might then be possible to rebuild enough public trust for a bipartisan immigration compromise.

The tragedy is that Joe Biden has done more to undermine public support for immigration than Trump adviser Stephen Miller ever imagined he could.

I have include the graph at the top of this page for context. As you can see, since Joe Biden became president the percentage of people who think we should have more immigration or about the same amount of immigration has declined while the percentage of those who think it needs to decrease has risen. In fairness the trend began before he became president; he just hasn’t helped.

My own view is that the number of immigrants should remain about the same but the mix of immigrants should be different than at present. That can’t be accomplished without controlling the number crossing our southern border.

I have a neighbor who just retired from a lengthy job working for the federal government processing asylum requests. She’s depressed about the situation. I may try to solicit a guest post from her.

10 comments

Family Ties

I won’t expand on the Wall Street Journal’s editorial about the Biden family business:

House Republicans on Wednesday released their latest report on the Biden family’s business ties, and one conclusion is that it’s good to be related to Joseph Robinette Biden. Hunter Biden and his relatives traded profitably off the Biden name with transactions that suggest the main family business is influence peddling.

other than to observe that that Michael Kinsley was right: the scandal is what’s legal. Influence-peddling is not illegal in the United States. Being an unregistered foreign agent is.

Also, I don’t care about George Marcos. It sounds to me like he’s a pathological liar. You can fool all of the people some of the time, etc.

5 comments

It Was Fun While It Lasted

There are contradicting opinion pieces on the debt limit in the Wall Street Journal today. William Galston says that the House should relent:

F. Scott Fitzgerald once wrote that “the test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function.” The challenge for Congress and the president is to meet this test. On one hand, the likely consequences of default are unacceptable. On the other, our long-term fiscal trajectory isn’t sustainable. Our political leaders must find a way of reconciling these truths to reach a practical result.

Like many observers, I believe that the disagreements between the parties are too deep to resolve between now and June. I hope that party leaders can agree to suspend (not increase) the debt ceiling until Sept. 30, allowing discussions of the debt ceiling and the budget to proceed simultaneously. Mr. Biden has said that he is willing to discuss fiscal policy as part of the budget negotiations, but only separately from debt-ceiling talks. Republicans should care more about the substance of budget cuts than about the legislative context in which they occur.

Long-term budget talks need a goal that is both feasible and meaningful. A balanced budget would require spending cuts and tax increases that neither Congress nor the American people would accept. A more practical target is to reduce the annual deficit enough so that U.S. debt grows no faster than the U.S. economy.

while James Freeman says that’s absurd:

Those not accustomed to studying the absurdities of Washington may wonder why Biden administration staff are discussing increasingly kooky ways to evade federal law rather than simply accepting the constitutional reality that Congress has a say in federal spending and debt decisions. Perhaps due to Mr. Biden’s career as a political posturer, he doesn’t even appear to be embarrassed as he pretends that he’s standing on principle in rejecting negotiation to secure more borrowing authority. Naturally our posturer-in-chief had the opposite position as a senator and as vice president, when he served as a negotiator.

Now, apparently disappointed that he didn’t cut a better deal on behalf of President Obama in 2011, Mr. Biden suddenly pretends that negotiation is unnecessary and the White House can simply order Congress to pass a higher debt limit.

Yet much of the press portrays Mr. Biden as someone who is trying to solve a problem. “Biden meets with congressional leaders in urgent bid to avoid default,” claims a Washington Post headline. But his bid is obviously not urgent if he’s still unwilling to negotiate on the subject.

Tyler Pager and Jeff Stein report for the Post:

The White House in recent days has emphasized that Biden is willing to discuss spending cuts as long as they are not tied to the debt ceiling increase, a message he is expected to repeat at Tuesday’s meeting.

So he’s conceded that a president must negotiate such things with Congress, except at the moment when negotiations are most needed? This is absurd. But it won’t be funny if the government can’t pay its bills.

As a matter of policy I’m more predisposed to agree with Mr. Galston’s view but for one detail: President Biden poisoned the well when he reneged on his commitments to Sen. Manchin in the Inflation Reduction Act. At this point it is not unreasonable to conclude that President Biden will honor no commitments on spending cuts unless forced on him.

Thirty years ago as the Cold War ended and people were talking about the “peace dividend” I observed that it would be fun while it lasted but it wouldn’t last. The same was true of the COVID-19 spending spree.

There is obviously a desperate need for us to align federal spending with the growth of the economy. Everything that we know tells us that the higher the debt overhang the greater the impediment to economic growth. China is experiencing that as well.

The question is how to accomplish it. It won’t be easy with one party that believes every dollar spent by the federal government stimulates the economy while the other party believes that every dollar by which taxes are reduced does the same. Two one-trick ponies together do not make for a competent team.

26 comments

No Twinge of Regret

The reaction of the editors of the Wall Street Journal to President Trump’s loss in the civil suit about which I commented yesterday resembles mine:

Does it matter politically now that a jury has found Donald Trump liable for battery and defamation against a woman who said he assaulted her sometime in the 1990s? In a better world it would matter, but in the debased and polarized American politics of 2023, it may not.

[&#133l

Yet it’s no small matter that the jury sorted the testimony and found against Mr. Trump on the preponderance of evidence standard that applies in civil litigation. (The criminal statute of limitations that requires proof beyond a reasonable doubt has long expired.) The jury rejected Ms. Carroll’s claim that Mr. Trump raped her. But they found it more likely than not that he sexually assaulted her and lied about it. The jury awarded her a more than token civil penalty of $5 million.

They go on to observe that Mr. Trump’s deposition did him little good:

A modicum of restraint, or twinge of regret about the accusation against him, might have put some doubt in the jury’s mind. Yet even when it’s in his legal interest, Mr. Trump can’t stop from justifying his crude behavior. This is the Donald Trump whose words and actions so often subverted his own Presidency.

Here’s the crux of the editorial:

Yet if most Republicans dismiss the verdict as one more political assault, Mr. Trump’s opponents and the press have themselves to blame. They also show no restraint. This lawsuit, like the two impeachments and the recent Alvin Bragg indictment that stretches the law, seems less an attempt to get at the truth than to find some way, any way, to disqualify him from ever becoming President again. Voters don’t like being told that a man they elected should be disqualified by members of the opposite party or the press.

Character matters in a President, however, and Republicans will want their presidential nominee to win in 2024 and then to govern successfully. The Carroll lawsuit, compounded by the liability judgment, is the kind of tempest that is Mr. Trump’s constant companion.

From what I’m seeing at this point it makes little difference.

1 comment