Cancer in America Is Way Down, for the Wealthy Anyway
bloomberg.com
bloomberg.com
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.
>"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...
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.
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.
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...
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.
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.
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.