There’s a caveat, however: Those gains have been reaped mostly by the well-off. While racial disparities have begun to narrow, the impact of limited access to treatment for the poorest Americans has increased wealth-based inequality, according to the American Cancer Society’s annual update on trends and statistics.
Metal cutlery was only available to the wealthy in the middle ages. At some point they became widely available for everyone.
Such is the way with most technological advances, where the high price initially payed by the rich is turned into more productivity and lower production costs, resulting in greater availability.
So you’re comparing, in absolute terms, the availability of cutlery in a “trickle down” sense to the availability of decent healthcare for every American?
Are you ashamed to live on this earth with most of Europe which waited nearly 10 years to buy into proton radiation therapy after the US adopted it? For nearly a decade there were more therapy machines in my tiny low population poor state than all of the UK.
With a much less healthy population the US sees significant cancer and heart disease treatment successes over most of Europe. The US may pay quite a bit more for these successes, but it's not exactly black and white on which is better. There's a reason the top five cancer centers in the world are in the US.
Edit: Just realized my mistake. You are fine with trickle down healthcare in Europe, but are not fine with it in the US. There was absolutely nothing to be gained by engaging with someone so openly biased. My bad.
It varies by state/city. In my state, basic care is ok: ER pretty much works, same weekend appointments for general practitioners, maybe more for specialists. I don't have direct experience whith surgery, but I had family members on cancer treatment, and the public health system was better in some cases than the private one.
I agree that some perspective is required here, but it is pretty amazing how terrible it is.
Like, we've been to the moon, have stuff like google to search through tons of information without leaving the bathroom, and people are trying to convince me we'll soon have useful quantum computers and autonomous vehicles, but it still takes me 3 hours to book a checkup with a doctor, and the soonest they can see me is 3 months from now. Then there's the billing system, which seems to have been devised to fill the maximum number of people's rice bowls. To say nothing of what happens to the uninsured. It's nuts.
Would you please stop taking HN threads into ideological flamewar? The comment upthread shouldn't have been so provocative, but that's no reason to take the bait and do worse.
Also, we've asked you this before, and continuing to violate the guidelines in this way eventually gets you banned here.
Why is my comment ideological flamewar? I have linked to a page that cites an academic article about the fake statistics from Cuba. How is that doing worse? Worse than what?
I also find it interesting that of all comments in this thread you chose mine to reply and threaten me with banning, given the absurdities that have been said above.
This speaks volumes about the moderation here. You are clearly fine with "ideological flamewar" as long as it's your ideology.
The flamey part wasn't the link, but the use of snark to make a shallow political point.
We can't read all the comments on HN, or even in any large thread, so that logic doesn't work. If you take the time to check, you'll see that we've often moderated comments that cross the line in the opposite ideological direction. Ideological rage is destructive here regardless of which charge it carries.
Except this hasn't been true since about 1980. Gains from economic growth have not been passed on to everyone. Health care is not available for everyone, especially. This isn't just a matter of technology.
The "cost" of production of medical technologies has very little to do with their price, in the US anyway.
There's a grain of truth in here, and it's true that things available to the wealthy/elite tend to become available gradually to all over time.
But that doesn't necessarily mean that things become _equal_ over time; it's rare to find wealthy people who will purchase the same kind of cutlery as the common person, to continue your analogy - for various reasons (fear of feeling inferior, ego, or just plain being oversold on it by marketing/salespeople).
The point that the article appears to be making is that healthcare advances are applying for the wealthy - but in fact _reversing_ in some cases for the poor. That's not fair or desirable.
More likely it's due to the fact that men are more likely to work in fields that force them into contact with carcinogens. Road workers, oil rig workers, construction workers, etc.
Sweden has significant reduced the number of smokers, and it is the only country where more women then men smoke. Alcohol usage has also significant dropped, and the difference in usage between women and men is within a couple of percentiles: 32.1% (Women) vs 34.6% (Men).
The disparity in male vs female mortality is only slightly reduced. 3.3 years (Sweden) vs 4.5 years (USA). There was a sociology study from 2008 that even claimed that the disparity is artificial small in Sweden because women smoke more then men. They said that it should be much higher (in favor of women) if we removed smoking as a factor. In context smoking is also estimated to lower mortality by 14 years.
For most of us males, prostate cancer is something we will eventually get, but is unlikely to kill us. Breast cancer seems a lot more dangerous. I of course worry about it, but it doesn't seem nearly as dangerous as breast cancer.
You also have to factor in the age at which people die from the different cancers. Deaths from breast cancer tend to skew a lot younger (dying from prostate cancer before you're 50 for example is less common than dying from breast cancer before you're 30). So if you instead look at 'lost' life years due to cancer (compared to the life expectancy), the picture changes dramatically. The number of women who die before 60 from breast cancer is roughly 10 times that of men who die before 60 from prostate cancer (UK numbers).
That is one way to look at it, through I will say there is more context. Treatment increases the short time risk of death, but reduces mortality in the long run. Prostate cancer screening is not done for men below the age of 50 because the risk of over treatment is deemed to be too costly, which in comparison to breast cancer means that prostate cancer is allowed to grow unchecked for longer compared to breast cancer. When I see researchers mentioning the decision to not do prostate cancer screening they often acknowledge that this pushes up the age group where the disease kills the patient.
But to go back a bit, the issue that was brought up was the disparity in male vs female cancer incidence and mortality. Prostate cancer has higher incident rate in Sweden compared to breast cancer, and higher mortality rate. Because of the higher incidence rate and years that patients will suffering from it we can also see it has having higher debilitating effect. While there is some validity in counting "lost life years" I do not think it validates the claim that it dictate which disease is more dangerous.
Breast cancer has higher "lost life years".
Prostate cancer has higher rate of incidents, mortality, and "life debilitating years".
On a positive note, I was surprised to see prostate cancer research getting bit of a push here in Sweden. A couple of years ago there were a initiative to get farmers to use pink plastic hay bags that both contributed to breast cancer research funding and natural awareness advertisement which people can see from the car when driving by. People voiced that they should also do it for prostate cancer, and this year they did. Not sure it has the same effect as the color they picked is not as eye catching and recognizable, but it is something.
I am currently reading the book "The Hundred-Year Lie: How to Protect Yourself from the Chemicals That Are Destroying Your Life" by Randall Fitzgerald. It details the crazy amount of synthetic or toxic chemicals in our daily lives, pesticides on our food, and a list of other pollutants to the body. Just from reading that this article it doesn't surprise me, and I would be surprised if this trend doesn't continue and accelerate. The poorest Americans are deceived into a false sense of wealth by being able to purchase cheap, synthetic, and toxic alternatives to quality products that only the well off can likely afford. Everything from natural furniture, organic foods, natural material clothing, cosmetics and care products, and medicine are much more costly than their toxic, cheap alternatives. This will also increase the divide between the wealth and the poor since the brain is affected by the chemicals that we are exposed to resulting in lack of concentration, poor memory, irritability, impulsiveness, and even the resulting gut bacteria affects the brain through the vagus nerve. The poorest Americans also have jobs, and live in areas which expose them to more pollutants than the wealthy, and the bigger issue is that a lot of these people don't even realize that this is an issue. Trust in institutions like the FDA, aggressive marketing by corporations like deceitful labeling of foods to try and make them "sound" healthy, and general lack of education make them super vulnerable and at the whims of the highly education, profit-obsessed, shareholder-serving, psychology-understanding, resource-rich, lobbying elite
There are certainly issues of this sort. I've seen references to "environmental racism" where poor neighborhoods like Altgeld Gardens in Chicago are built on top of reclaimed landfills, and the water pipes are all made of lead. And Camden, New Jersey had very similar problems being a site of major industrial pollution.
On the other hand, the upper middle class obsession with purity and organic stuff verges on neuroticism and New Age mysticism. Much of the panic over chemicals involves only trace amounts. Like how formaldehyde in vaccines is extremely tiny compared to formaldehyde in pears, yet it is used as a reason not to vaccinate. Or how sea salt has been replacing iodized salt, even though rates of iodine deficiency in the West are rising, and this is a major problem for cognitive development.
One of the arguments in the book I mentioned was that yes the trace amounts are "safe", but in some cases the body cannot detox certain synthetic chemicals, so they build up in the body until they reach a level that begins to cause health issues
Broadly, this corresponds to the use "threshold model" and "linear no-threshold model" in toxicology, which describe whether the risk/harm from a substance has a safe 'cliff' or declines smoothly down to 0 dose.
It's well understood that carcinogens are LNT hazards. The old quip that "even breathing causes cancer" is literally true, so there's no such thing as a safe dose of a carcinogen, just an acceptable dose. (Interestingly, effectively-safe doses decline as lifespans - and therefore cumulative risk - rise.) Increasingly, we seem to be finding that non-carcinogenic risks which have been filed under 'threshold' are actually LNT threats for which the low-end risk gets lost in other noise.
I'm not particularly sold on the 'synthetic' framing here, though. Lead exposure is almost certainly LNT at least in childhood. Copper and zinc are linked to Alzheimer's in some uncertain-but-suspicious way. While endocrine disruptors like BPA are synthetic, they're acting on the same pathways as 'natural' disruptors like phytoestrogens. 2.5nm particulate pollution now appears to be not only carcinogenic but also development-inhibiting; the primary sources are man-made but the primary agents (NOx, SO2) are naturally occurring at much lower doses.
Very broadly, I do expect many thing we're exposed to today will eventually be viewed as horrible errors like leaded gasoline (if hopefully less severe). But I'm not sure 'synthetic' is a meaningful metric, and I'm not sure bioaccumulation of the compound is actually a very common pathway relative to accumulative damage.
There is no data (or even a link to a study) in this article that gives the the reader any sense of what the mortality gap between the wealthy and poor is, or even how "wealthy" and "poor" are defined. I come away from this article with a better idea of the male/female mortality gap than the wealthy/poor gap (one of the article's two headline claims).
I've noticed that politicized headlines in non-editorials that aren't suppprted by any facts or data are an increasing media trend in the past few years. I saw this in another article I commented on a few days ago.
I ended up on this soapbox after a recent study showing academic-performance harm from fine particulate matter in the air. The article had no numbers, so the HN thread was full of (weirdly politicized) speculation about American intelligence. Meanwhile, the underlying study showed modest effects in parts of China where daily particulate levels average 10x higher than the very worst "stay indoors" days in America. It was an interesting study, but the headlines it produced were actively making people less informed.
It's a particularly damning problem in this article because there are so many different ways to read this result. It could be that rich people get better or more intensive care after diagnosis. Or that they're more likely to get regular checkups and so are on average treated at an earlier stage. Or that with HPV vaccine not on the scheduled list, many insurers won't cover it and so the rich face less cervical cancer. Or simply that rich people are less likely to smoke and live with smokers. Or, especially since the long-term data here comes from a small set of disproportionately-urban regions, wealth is acting as a strong proxy for environmental exposure.
And even lay readers can discern those things! If rich people have lower incidence, that's different than lower mortality per incidence. Major risk factors like smoking can be adjusted for. We're told that wealth used to correlate with cancer, but the only summary of the change is the vague "in part to changes in diet and smoking as well as screening and treatment rates". This article needed, at minimum, a graph of incidence and mortality by income.
>"Population‐based cancer incidence data in the United States have been collected by the National Cancer Institute's (NCI's) Surveillance, Epidemiology, and End Results (SEER) Program since 1973 and by the Centers for Disease Control and Prevention's (CDC's) National Program of Cancer Registries (NPCR) since 1995. The SEER program is the only source for historic population‐based incidence data. Long‐term (1975–2015) incidence and survival trends were based on data from the 9 oldest SEER areas (Connecticut, Hawaii, Iowa, New Mexico, Utah, and the metropolitan areas of Atlanta, Detroit, San Francisco–Oakland, and Seattle–Puget Sound), representing approximately 9% of the US population."https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21551
So, looks like the headline chart[1] is only using data from the 9 original SEER regions (Connecticut, Hawaii, Iowa, New Mexico, Utah, and the metropolitan areas of Atlanta, Detroit, San Francisco–Oakland, and Seattle–Puget Sound). Also, some new data source was added in 1995, which is about when we see that peak in incidence/mortality. So we have some room for systematically biasing the data here, especially when we consider the various pitfalls of "age-adjustment".
They also say much of the mid-1990s spike in incidence for males was due to detection of asymptomatic prostate cancer:
>"Cancer incidence patterns reflect trends in behaviors associated with cancer risk and changes in medical practice, such as the use of cancer screening tests. The volatility in incidence for males reflects rapid changes in prostate cancer incidence rates, which spiked in the late 1980s and early 1990s (Fig. 3) due to a surge in the detection of asymptomatic disease as a result of widespread prostate‐specific antigen (PSA) testing among previously unscreened men"
And statistically speaking, the poor are overwhelmingly very obese, whereas the wealthy are fit/thin. Fitness is a new class indicator.
Over 80% of Americans are obese or overweight, largely due to lifestyle choice, food addiction, and food abuse. Obesity and related disease are by far the leading cause of death and illness in the USA, it's an extraordinarily costly epidemic that nobody wants to acknowledge.
The numbers I can find are closer to 70 than 80%, but still. The really scary number is that the obesity rate is closing in on 40%. So the majority of people who are overweight or obese are in fact obese!
The War on Cancer has been an absolute bust and it has gobbled up trillions in taxpayers' money with NOTHING to show for it. This money would have been better spent on improving the food supply, the social safety net, and quality of life for the average American.
Big Media is one giant lying machine. As much as I do not agree with Trump on many of his policies, he is spot on on the "fake news" phenomenon and it happens across all the entire political spectrum. CNN is just as guilty as Fox News.
60 comments
[ 3.1 ms ] story [ 84.0 ms ] threadThere’s a caveat, however: Those gains have been reaped mostly by the well-off. While racial disparities have begun to narrow, the impact of limited access to treatment for the poorest Americans has increased wealth-based inequality, according to the American Cancer Society’s annual update on trends and statistics.
Such is the way with most technological advances, where the high price initially payed by the rich is turned into more productivity and lower production costs, resulting in greater availability.
I’m ashamed to live on this earth with you.
As for you being ashamed: cry me a river.
Edit: Just realized my mistake. You are fine with trickle down healthcare in Europe, but are not fine with it in the US. There was absolutely nothing to be gained by engaging with someone so openly biased. My bad.
Does it? What's your source please.
Please review https://news.ycombinator.com/newsguidelines.html and post civilly and substantively, or not at all.
What is this bubble you live in?
Have you been to a third-world country? Have you been to a communist country?
Like, we've been to the moon, have stuff like google to search through tons of information without leaving the bathroom, and people are trying to convince me we'll soon have useful quantum computers and autonomous vehicles, but it still takes me 3 hours to book a checkup with a doctor, and the soonest they can see me is 3 months from now. Then there's the billing system, which seems to have been devised to fill the maximum number of people's rice bowls. To say nothing of what happens to the uninsured. It's nuts.
https://mises.org/power-market/dont-trust-cuban-health-care-...
Also, we've asked you this before, and continuing to violate the guidelines in this way eventually gets you banned here.
https://news.ycombinator.com/newsguidelines.html
I also find it interesting that of all comments in this thread you chose mine to reply and threaten me with banning, given the absurdities that have been said above.
This speaks volumes about the moderation here. You are clearly fine with "ideological flamewar" as long as it's your ideology.
We can't read all the comments on HN, or even in any large thread, so that logic doesn't work. If you take the time to check, you'll see that we've often moderated comments that cross the line in the opposite ideological direction. Ideological rage is destructive here regardless of which charge it carries.
The "cost" of production of medical technologies has very little to do with their price, in the US anyway.
We shouldn't discard a system because it's not perfect. The alternative could be much worse.
But that doesn't necessarily mean that things become _equal_ over time; it's rare to find wealthy people who will purchase the same kind of cutlery as the common person, to continue your analogy - for various reasons (fear of feeling inferior, ego, or just plain being oversold on it by marketing/salespeople).
The point that the article appears to be making is that healthcare advances are applying for the wealthy - but in fact _reversing_ in some cases for the poor. That's not fair or desirable.
The disparity in male vs female mortality is only slightly reduced. 3.3 years (Sweden) vs 4.5 years (USA). There was a sociology study from 2008 that even claimed that the disparity is artificial small in Sweden because women smoke more then men. They said that it should be much higher (in favor of women) if we removed smoking as a factor. In context smoking is also estimated to lower mortality by 14 years.
(note: I've never once seen a bumper sticker for prostate cancer ...)
Male deaths from prostate cancer was 88 per 100,000 men.
Female deaths from Breast cancer was 47 per 100,000 women.
When you say that breast cancer seems a lot more dangerous, could you elaborate that a bit?
But to go back a bit, the issue that was brought up was the disparity in male vs female cancer incidence and mortality. Prostate cancer has higher incident rate in Sweden compared to breast cancer, and higher mortality rate. Because of the higher incidence rate and years that patients will suffering from it we can also see it has having higher debilitating effect. While there is some validity in counting "lost life years" I do not think it validates the claim that it dictate which disease is more dangerous.
Breast cancer has higher "lost life years".
Prostate cancer has higher rate of incidents, mortality, and "life debilitating years".
No, but it does imply unknown.
The big misconception IMO is that people think "natural" implies safe or known.
Could be beneficial, could be harmful.
On the other hand, the upper middle class obsession with purity and organic stuff verges on neuroticism and New Age mysticism. Much of the panic over chemicals involves only trace amounts. Like how formaldehyde in vaccines is extremely tiny compared to formaldehyde in pears, yet it is used as a reason not to vaccinate. Or how sea salt has been replacing iodized salt, even though rates of iodine deficiency in the West are rising, and this is a major problem for cognitive development.
It's well understood that carcinogens are LNT hazards. The old quip that "even breathing causes cancer" is literally true, so there's no such thing as a safe dose of a carcinogen, just an acceptable dose. (Interestingly, effectively-safe doses decline as lifespans - and therefore cumulative risk - rise.) Increasingly, we seem to be finding that non-carcinogenic risks which have been filed under 'threshold' are actually LNT threats for which the low-end risk gets lost in other noise.
I'm not particularly sold on the 'synthetic' framing here, though. Lead exposure is almost certainly LNT at least in childhood. Copper and zinc are linked to Alzheimer's in some uncertain-but-suspicious way. While endocrine disruptors like BPA are synthetic, they're acting on the same pathways as 'natural' disruptors like phytoestrogens. 2.5nm particulate pollution now appears to be not only carcinogenic but also development-inhibiting; the primary sources are man-made but the primary agents (NOx, SO2) are naturally occurring at much lower doses.
Very broadly, I do expect many thing we're exposed to today will eventually be viewed as horrible errors like leaded gasoline (if hopefully less severe). But I'm not sure 'synthetic' is a meaningful metric, and I'm not sure bioaccumulation of the compound is actually a very common pathway relative to accumulative damage.
I've noticed that politicized headlines in non-editorials that aren't suppprted by any facts or data are an increasing media trend in the past few years. I saw this in another article I commented on a few days ago.
https://news.ycombinator.com/item?id=18794757
If it's a real problem (which I believe it probably is), journalists shouldn't ignore "show, don't tell" in their writing.
I ended up on this soapbox after a recent study showing academic-performance harm from fine particulate matter in the air. The article had no numbers, so the HN thread was full of (weirdly politicized) speculation about American intelligence. Meanwhile, the underlying study showed modest effects in parts of China where daily particulate levels average 10x higher than the very worst "stay indoors" days in America. It was an interesting study, but the headlines it produced were actively making people less informed.
It's a particularly damning problem in this article because there are so many different ways to read this result. It could be that rich people get better or more intensive care after diagnosis. Or that they're more likely to get regular checkups and so are on average treated at an earlier stage. Or that with HPV vaccine not on the scheduled list, many insurers won't cover it and so the rich face less cervical cancer. Or simply that rich people are less likely to smoke and live with smokers. Or, especially since the long-term data here comes from a small set of disproportionately-urban regions, wealth is acting as a strong proxy for environmental exposure.
And even lay readers can discern those things! If rich people have lower incidence, that's different than lower mortality per incidence. Major risk factors like smoking can be adjusted for. We're told that wealth used to correlate with cancer, but the only summary of the change is the vague "in part to changes in diet and smoking as well as screening and treatment rates". This article needed, at minimum, a graph of incidence and mortality by income.
>"Population‐based cancer incidence data in the United States have been collected by the National Cancer Institute's (NCI's) Surveillance, Epidemiology, and End Results (SEER) Program since 1973 and by the Centers for Disease Control and Prevention's (CDC's) National Program of Cancer Registries (NPCR) since 1995. The SEER program is the only source for historic population‐based incidence data. Long‐term (1975–2015) incidence and survival trends were based on data from the 9 oldest SEER areas (Connecticut, Hawaii, Iowa, New Mexico, Utah, and the metropolitan areas of Atlanta, Detroit, San Francisco–Oakland, and Seattle–Puget Sound), representing approximately 9% of the US population." https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21551
So, looks like the headline chart[1] is only using data from the 9 original SEER regions (Connecticut, Hawaii, Iowa, New Mexico, Utah, and the metropolitan areas of Atlanta, Detroit, San Francisco–Oakland, and Seattle–Puget Sound). Also, some new data source was added in 1995, which is about when we see that peak in incidence/mortality. So we have some room for systematically biasing the data here, especially when we consider the various pitfalls of "age-adjustment".
They also say much of the mid-1990s spike in incidence for males was due to detection of asymptomatic prostate cancer:
>"Cancer incidence patterns reflect trends in behaviors associated with cancer risk and changes in medical practice, such as the use of cancer screening tests. The volatility in incidence for males reflects rapid changes in prostate cancer incidence rates, which spiked in the late 1980s and early 1990s (Fig. 3) due to a surge in the detection of asymptomatic disease as a result of widespread prostate‐specific antigen (PSA) testing among previously unscreened men"
[1] https://wol-prod-cdn.literatumonline.com/cms/attachment/4799...
Over 80% of Americans are obese or overweight, largely due to lifestyle choice, food addiction, and food abuse. Obesity and related disease are by far the leading cause of death and illness in the USA, it's an extraordinarily costly epidemic that nobody wants to acknowledge.
https://www.niddk.nih.gov/health-information/health-statisti...
https://www.cdc.gov/nchs/data/databriefs/db288.pdf
The War on Cancer has been an absolute bust and it has gobbled up trillions in taxpayers' money with NOTHING to show for it. This money would have been better spent on improving the food supply, the social safety net, and quality of life for the average American. Big Media is one giant lying machine. As much as I do not agree with Trump on many of his policies, he is spot on on the "fake news" phenomenon and it happens across all the entire political spectrum. CNN is just as guilty as Fox News.