Workers who cut countertops are dying of silicosis
news.yahoo.com
news.yahoo.com
People working in there weren't wearing any sort of hearing protection and became deaf within months. And after introducing pressured air driven equipment, they were all dying in a few years from silicosis. Until someone added water spraying to precipitate the dust into mud (wherein their issue became to fiddle caked in mud all day long in the dark, which I guess is an improvement over certain death). Which happened years later.
Thinking about the kind of life they had terrorizes me. I don't get how, for the longest time, people were fine with that. I mean no judgement on the workers, they probably didn't have a choice - but the people sending them in probably saw them as kettle.
Makes you think about the sort of progress in worker protection that was made since then. But also this kind of story reveals how people are still ready to profiteer from such deadly practices, if given the opportunity.
In the century between the 1850s and 1950s we went from not even having radio communications or the germ theory of disease to building nuclear submarines and fiber optic data networks.
Once we had penicillin and cities stopped dumping raw sewage into the water supply, people started to have better options and these kinds of businesses had to improve safety to attract workers.
If you had to choose between the job you have now and the ones they had then, how much more would they have to pay you to get you to choose the latter? More than it costs for the safety equipment, right? So they started installing it.
Then governments passed laws requiring it because politicians are adept at taking credit for good things that were about to happen regardless.
If the government isn't enforcing the law, what good is a new law for them to not enforce?
There's a stronger record of laws preventing a government from acting against workers and ones permitting workers to take matters into their own hands.
Striking workers were usually on the wrong side of the law though because they were using coercion and force to make every worker to participate in strikes (they could hardly work any other way without laws restricting “right to work”)
Well sure they could. The workers who agree with the strike go on strike and if that's enough of them to put pressure on the employers to meet their demands, their demands get met.
If it isn't, you've failed to convince your fellow workers that the light is worth the candle and if you don't want to work under the terms that they do, you can go work for someone else.
This is mainly a problem when there is no other someone else to work for, but now you're back to anti-trust rather than labor laws.
Or your employers can hire some thugs to disperse you and the other strikers. When you resist the governor will just use that as a justification to send in the national guard to “maintain law and order”. At least that’s how it often worked in the good old days..
> Well sure they could.
In an imaginary world maybe. In a society with no safety nets and and where any meaningful accumulation of savings is infeasible? Not so much.
> you can go work for someone else.
Under the same conditions. Labor has an inherently weaker bargaining position (due to certain pretty obvious factors) compared to business owners. Unless you have some external regulation or societal pressure and employers are behaving fully rationally (i.e. maximizing profits) that will always be the case for the majority of the workforce.
Now we're back to "everyone agrees that violence should be illegal."
> In a society with no safety nets and and where any meaningful accumulation of savings is infeasible? Not so much.
But then what difference does it make if you go on strike with 75% of the other workers or 100%? Either way the boss just waits two weeks until you all need to buy food.
Which still assumes that the employer is a monopoly. Otherwise you go on strike by taking some gig work in the meantime, which maybe sucks, maybe even sucks more than your current job, but it lets you make rent for as long as it takes for the employer to feel the need to meet your terms.
> Labor has an inherently weaker bargaining position (due to certain pretty obvious factors) compared to business owners. Unless you have some external regulation or societal pressure and employers are behaving fully rationally (i.e. maximizing profits) that will always be the case for the majority of the workforce.
There is no law requiring employers to pay anyone more than minimum wage and yet >98% of people make more than minimum wage. What explains this other than that employers have to compete with each other for labor?
There's nothing better for workers than a competitive market. What's the boss going to do when the workers have the option to quit and get a better job somewhere else?
The only reason you need to strike is if there isn't any other employer offering better terms that you can go work for instead. Otherwise you can just threaten to quit unless they meet your terms and actually do it if they don't.
Conspiracies only work if the market is concentrated enough; if there are ten thousand employers and it's easy to start a new one then you're not going to be able to hold together a secret illegal cartel.
None of those actually work in a competitive market.
The government tends to default to supporting strikebreaking(and still generally does in any era, including this one) because industrialists, financiers and politicians share lines of mutual support: legal ownership of intangibles like a corporation acts as an alternative to feudal fiefdoms and warlords, in that it's less destructive and lets complex processes evolve.
Corporations are very effective at putting taxable assets on the books, which allows a more complex state bureaucracy, so politicians end up wanting the support of business for government power and expenditures. Financiers want their thumb on the scale, for the winners they picked to continue winning, rather than to run off and form a competitor. And the industrialists themselves, though they are often at the forefront of the most dramatic reorganizations, tend to get stuck in equilibriums where either they're the evil monopolist, or someone else is. Once you arrive at the equilibrium, the elite players lose their dynamism and are pressured to stay within the existing trends or lose their place.
Thus when the Pinkertons or their modern counterparts come in, the officials shrug and say "business as usual, business as usual". The system convulses when it becomes a riot and property is destroyed because that weakens the whole premise: less capital to deploy, fewer assets to tax, failure to return on investment. And people out of a job, but if they were rioting it may have been a crummy job. It creates a shock that can break the equilibrium and enable a different deployment of labor and capital in a new technological environment. That's essentially why the industrial era has so many short, distinct periods and upheavals within it; the sausage is being made, though it's ugly to witness.
What you're getting at is that market competition can be destroyed through regulatory capture. But now you're making the case for regulatory form and anti-trust rather than some kind of labor laws, which was kind of what I was getting at to begin with.
Trying to regulate an artificial monopoly is a fool's errand, not least because if they have the political influence to capture regulators and retain their monopoly then they can also interfere with the passage or enforcement of anything that benefits workers at their expense. So all efforts should be directed to breaking them into tiny, tiny pieces none of which have enough power to capture the government.
With no external control businesses tend to form cartels and/or adopt practices and regulations that are more hostile towards both consumers and workers than what governments can come up to.
On average anyway. Of course there markets and goods which are somewhat immune to this and exceptionally incompetent governments which can do significantly more harm than good.
Cartels are generally a result of government regulation, because they require something to be creating a barrier to entry that prevents new entrants from breaking the cartel.
You can also have cartels enforced by e.g. acts of violence or vandalizing competitors who won't join the cartel, but who claims that non-consensual violence or property damage shouldn't be illegal?
If you encounter an uncompetitive market in practice then you clearly have some kind of a regulatory failure, but the answer in these cases is not to pass more laws to mitigate the consequences of insufficient competition, it's to address whatever is causing the market to be uncompetitive.
They are often the result of companies bribing or otherwise coopting the government to enact those regulations.
> You can also have cartels enforced by e.g. acts of violence or vandalizing competitors
Or you could just abuse your dominant position by preventing your suppliers or retailers from doing business with your competitors, outright buying them, running them out of business by temporarily dumping your prices etc. these are all both more effective and more realistic options than outright violence.
> but the answer in these cases is not to pass more laws to mitigate the consequences of insufficient competition,
Having corrupt and incompetent governments leads to bad outcomes. That’s not particularly insightful nor does it automatically discredit any form of regulation.
> it's to address whatever is causing the market to be uncompetitive.
You’re certainly right. Sometimes this can be accomplished by reducing restrictions and sometimes by introducing additional laws. We should also take into account that unregulated markets are hardly ever competitive.
Which is the thing that does this:
> automatically discredit any form of regulation.
The default assumption is that a proposed regulation benefits powerful interests, because powerful interests are the ones who can have regulations enacted.
That doesn't mean it's a violation of the laws of physics for a regulation to do something good, but if you open the US Code to a random page it's not what you'd expect to find, and if someone proposes a new rule they should be viewed with skepticism.
> Or you could just abuse your dominant position by preventing your suppliers or retailers from doing business with your competitors, outright buying them, running them out of business by temporarily dumping your prices etc. these are all both more effective and more realistic options than outright violence.
These also require the market to already be uncompetitive. If there are a thousand suppliers and retailers, you have to be able to strongarm them all or your competitor can just use any that you can't. If there aren't regulations creating a market barrier to entry then new competitors can form and you have to buy them out for more than they make in the market which in turn is more than their entry cost, but if you do this then it's profitable to keep creating new competitors to make you buy until you run out of money. You can sell at a loss but with low barriers to entry now customers or retailers can go into competition with you just to force you to keep doing that forever and lower their own costs.
Also notably such things have been anti-trust violations for a hundred years or so without requiring any new legislation (and this is still a useful check when some other regulations have caused a market to already be uncompetitive or have high barriers to entry).
> Sometimes this can be accomplished by reducing restrictions and sometimes by introducing additional laws.
But many of the laws proposed to address problems caused by a lack of competition are not even attempts to restore competition. They're commonly attempts to mitigate the damage caused by the lack of it. And these laws typically make it harder rather than easier to actually restore competition, because regulatory overhead favors large conglomerates with legal departments, reduces the flexibility that could allow new challengers to find a niche or is just literally drafted by the incumbents to create a regulatory moat.
> We should also take into account that unregulated markets are hardly ever competitive.
There is no such thing as unregulated markets. Governments at a minimum enforce contracts and property rights, and then must do so in a way that doesn't enable market consolidation, e.g. by not enforcing contracts for the formation of a cartel or allowing one entity to buy all of the land in a city.
But regulations should be directed to pricing major externalities and promoting competition rather than trying to micromanage a society made rotten by other rules that make markets uncompetitive.
That really not true. Nobody forced them to adopt anything (in a literal way). It’s just that automated factories could produce more faster while paying their workers much less since they didn’t require skilled craftsmen.
Also artisans generally used a guild/cartel model which artificially constricted supply which inflated their incomes.
> out to make the Luddites look foolish and technological progress the hero of the story.
I thought it was pretty obvious to everyone that they were breaking machines because they eliminated demand for high skilled/high pay labour?
With this attitude we’d still be driving with leaded gas, living in lead painting rooms with asbestos roofs and spraying ozone layer destroying aerosols amongst a bunch of other things. The mechanism you described only really works with short term safety issues. If it takes years or decades for health problems to develop neither workers nor their employers tend to be particularly bothered about solving them.
The mechanism I described works for employment issues, because employees can choose not to take a job and more dangerous jobs carry a risk premium that both employers and employees have the incentive to reduce when reasonable safety measures are available.
With leaded gasoline and CFCs the victims have no option to refuse, and it's completely legitimate to prohibit harms and risks imposed on other people without their consent.
For some reason you’re making the assumption that most employees are as capable of estimating this premium as well as their employers and/or that it’s even possible to estimate this risk in advance?
This view also assumes that skills are perfectly replaceable, that there's no cost for requalifying for another profession, and that this is instantaneous or that people have some magical way to offset the opportunity costs of requalification while they train for another job.
The problem nowadays (and this is not exclusive to HN, although it is especially salient here) is that people like to fall between two ideological extremes: Either that the government is a inherently neutral and benign all powerful institution 100% of the time, or that free markets always exist, and are always pareto-efficient and that governments action is always some sort of rent-seeking parasite.
In the real world things are a lot more complicated. Not every thing can be solved with the heavy hand of government, neither the market itself is always able to reach the most humane solution. Politics is still needed, and we haven't reached the end of History.
It does not assume any of these things. The cost of switching jobs is not required to be zero. What it does is provide a ceiling for what the existing employer can get away with.
They may be able to get away with paying you 5% below market or subjecting you to an inflexible schedule and it isn't worth changing jobs to one that doesn't do that, but if they try to make you use equipment that will kill you then you just walk right out the door.
Moreover, this is why a competitive market is important -- if you're qualified to be a steel worker but the steel industry is a monopoly, you can always learn to be an aircraft mechanic, but that takes time. Whereas if the steel industry has 10,000 companies in it, you go and work for one of the others using your existing skill set. Which reduces what employers can get away with.
It’s not just people “profiteering” though? The story mentions workers standing at Home Depot. These are ordinary homeowners hiring these shops to custom cut countertops for them. It’s not some mega-corp mass-manufacturing counter tops.
And now half the people who should be trying to put a stop to it are instead talking about how we need low skill, low education foreign workers that can easily be exploited to keep consumer prices low.
A non-trivial number of these mine workers were arrested on trumped up charges like "vagrancy" for not having a job or "trespassing" for walking along a railroad. They would often be sold to companies as convict lease (cheap) labor. Essentially slave labor long after the Civil War since the 13th Amendment has the slavery loophole where it's allowed as long as you're convicted of a crime.
This disproportionately affected freed slaves in the South but was an issue for everyone everywhere since it introduced a profit motive to manufactured charges and inflated sentences. The extent that it predominantly affected Black folks and poor white folks had a lot to do with public sentiment not doing anything about it for a very long time.
To a not-small-enough extent, the same conditions exist today where labor can be coerced for little to no pay among the prison population, many of whom have been threatened with obscenely long sentences being shortened by accepting plea deals even when innocent or with extenuating circumstances. For-profit prisons often make the situation worse by further incentivizing incarceration on a larger scale.
Metzger argued that the kind of sophisticated and costly measures that would be needed to reliably protect workers cutting engineered stone are not economically plausible in an industry where immigrant workers typically labor in small shops and are often paid in cash. Engineered stone "is too dangerous to be used safely," he said. "If there’s any industrial product that should be banned, this is the product.""
All this thanks to synthetic stone - important note for countertops owners, if you want to make sure you don't support the product
This is not a technology problem, this is an 1880s "Safety devices are too expensive problem" along with paid under the table workers problem. All kinds of other industries manufacture 'dangerous' products with regulations that protect the workers. Housing and agriculture are both industries that do not and fight ever further for anti-regulations to protect the workers even less.
The bulk of the dust hanging in the air could be removed with adequate ventilation fans, which seems pretty basic.
What kind of countertops should be avoided? Would have been nice if the article suggested some solutions as well
We typically order water to drink in restaurants and when it gets to the table, the servers almost always toss some straws on the table. If we say we don’t want them or if we mention when ordering that we don’t want straws, we get looks like we must be some weirdos. Why automatically push straws for everyone?
I find it quite strange for adults to drink with straws. It is a child thing in my world.
If anything, straws make some stuff TOO easy, like drinking loads of soda while driving, and this is not good for you.
I think that a lot of problems could be solved by people just consuming less of some stuffs, instead of trying to find a technical solution to the present problems of consuming some of that stuff.
Also having a lot of ice complicates things especially if it starts floating near the top.
Just because there's more silica doesn't mean that it's suddenly unsafe whereas cutting granite is safe. Even drywall or cutting concrete you're supposed to wear PPE.
Yeah, but it doesn’t kill you within a few years if you don’t, right?
Demolition, sanding drywall compound all is bad without PPE and Hepa filters.
You can buy a cheap yet very comfortable 5000 or 7000 series respirator from 3M for about $20 and the "pink pancake" P100 filters are another $12. If you're a hobbyist those ought to last you a year, maybe even 5 depending on what you're cutting. I do metalwork as a hobby and I can definitely feel it in my lungs (and taste it) the next day if the garage door is shut and I forgot to wear the respirator.
Effects depend on the particle geometry.
But as a general rule of thumb: if it's biologically inert and tough enough to stick around for awhile... it'll just stay in your lungs. E.g. fiberglass, cement, rock, paint.
I wear a respirator a LOT more these days than I did when I was younger.
Regulation is the only way to prevent labor from being treated as disposable by these businesses, regardless of the status of these workers.
Pretty much any aerosolized mineral is going to wreak havoc on your lungs.
How can I avoid buying these products or reduce exposure to these more dangerous materials if I'm a worker? Is porcelain "engineered stone"?
They should have ppe for any cutting, regardless, I agree.
So whether it is engineered or natural stone the problem is that stone cutting has dust that needs to be dealt with. But the emerging issue is that with the rising popularity of engineered stone, a higher percentage of countertops overall are hazardous to cut.
It seems that the US either lacks suitable health and safety legislation or fails to enforce it.
Even more surprising to me was Sunstein and his wife Samantha Power attending Henry Kissinger's birthday party after Power previously published a book basically pinning 150,000 deaths in Cambodia directly on him. They knew this guy is basically a war criminal and still went to celebrate his birthday.
In the old slashdot times, such a comment would probably have +5 insightful badge attached, here in HN in 2023, it is downvoted to hell.
I think this is poe’s law in action :) I did not read the reply as earnest.
Cass Sunstein was the administer of the White House Office of Information and Regulatory Affairs. The OIRA is given the remit to review drafted rules (ie regulations) that various federal agencies want to enact. The OIRA is supposed to perform an external cost-benefit analysis of the proposed regulations. OIRA is suppose to turn around rulings in 90 days.
While Cass Sunstein was administrator (2009 to 2012), various pieces of regulation were submitted for review, and ended up being reviewed for ~3+ years. Examples include:
* Requiring rear-view cameras (submitted for review in 2011, regulation finally passed in 2014 with a 2018 deadline for compliance)
* The silicosis workplace safety regulations (as mentioned - submitted in 2011, finally passed review in 2013)
* Coal ash handling regulations (from the EPA) delayed from 2009 to 2014
For the specific case of silicosis specifically, it doesn't appear that the OIRA ended up blocking the regulation, though it certainly slowed it down.
Some news articles:
* https://www.ucsusa.org/resources/attacks-on-science/white-ho...
* https://www.reuters.com/investigates/special-report/usa-regu...
* https://www.theregreview.org/2013/11/26/26-verchick-silica/
It is worth noting that these delays continued after Sunstein left office, and there's certainly evidence of OIRA significantly delaying review processes prior to Suntein's term as administrator.
Since the article is referring to "83 cases among countertop workers identified across the state [of California] since 2019", it's almost certain helmets would save more lives than anything you do about engineered stone. So what's the excuse there?
I'm not saying that we need more delays. I'm also not saying that there isn't room for more regulation here, but just slapping any poorly considered regulation down may not solve the problem.
It’d be interesting to see a cost-benefit analysis of OIRA’s cost-benefit analysis. All the delays aren’t free.
I’m pretty sure none of them wore masks when doing this. I honestly didn’t think to wear a mask either (since they weren’t and never really even warned us how bad it would be), but fortunately we were behind closed doors most of the time the particles were in the air.
Fortunately it was a granite countertop and not quartz. But I still can’t imagine that stuff is good to breathe on a recurring basis, and it still amazes me that they were fairly casual about the whole thing.
My guess is the industry just isn’t educating workers about the risks.
My guess is that the companies that did were undercut by the ones that didn't.
A relative of mine died of silicosis after having worked for years in the granite industry. Granite is probably as bad without adequate protection.
This article [1] indicates quartz contains about 2x silica vs. granite.
[1] https://blogs.cdc.gov/niosh-science-blog/2019/10/29/silicosi...
Granites are primarily composed of feldspar and quartz, which are both primarily composed of silica. Silica is the thing that causes silicosis, and when that granite was cut it was clouds of silica dust that covered your home.
You were no more safe in that granite dust than you would have been in quartz dust.
[1] https://www.osha.gov/sites/default/files/publications/OSHA37...
This isn’t the same as something like a virus, where it’s more binary.
To be clear, I’m not arguing to prove I’m right (because I’m certainly not an expert and am open to being wrong), I’m trying to understand more about how particle inhalation can have varying risks (or not) based on density.
I’m mostly just curious about the science, and whether/why it is more binary than I’m understanding, vs. just taking some random HN strangers’ words.
I quick search on Amazon for "Stone Cutting Dust Cover" gave plenty of cheap looking clear plastics covers with a hole for a vacuum cleaner. I bet there are pro variants available of those.
The problem is not lack of education but lack of enforcement of regulations.
People have an attitude (somewhat helpful) that you can always get will yourself to recovery or "what doesn't kill you makes you stronger" and all that, but severe damage to your lungs really has no treatment. Essentially your body just adapts to the reduced function by being more efficient or by changes in behavior (like walking slower). That lung capacity is lost for good.
There is tons of decisions about factory equipment where there is a trade off between safety and the environment. Factory managers often joke about how various scrubbing equipment has OSHA on one side, and the EPA on the other. It is critical that the culture prioritizes safety above all else.
Wasn’t great but the rent was cheap, until it wasn’t
I wish I ONLY had to clean the surfaces once a week.
In my country and city unfortunately -- even though I dont live near a major road or construction site -- dust is everywhere. Within 24 hours or less of wiping clean, you can see a visible layer of dust on any horizontal surface in home.
dust is everywhere ..haven't learnt to classify it into types :)
I suspect the problem is that welding related disease/problems show up quite quickly in most cases, and welding tends to be a higher paid industry. More room for margin on PPE and workers have higher demands.
The “safety squint” is still a thing.
I just am astounded, horrified. The answer to abusive management is simply rebalance power. The answer to abusive markets is pay more (Edit: better supply chain ledgers)
Just horrified
re supply chains - the simple way to stop sales of any product is a shelf market like this: "The product X was manufactured by the small child who last month was mutilates by a factory accident. Nice picture. our product has the following verified supply chain. but it's more expensive. your choice of course"
https://www.dir.ca.gov/dosh/dosh_publications/Engineered-sto...
In New Jersey which also has lots of stone cutting, doesn’t allow dry cutting and has entirely different advice.
https://www.nj.gov/health/workplacehealthandsafety/documents...
> New Jersey law (N.J.S.A. 34:5-182) requires that employers provide workers with full-face air-purifying respirators when engineering controls cannot be used. Use of respirators should be part of a complete respiratory protection program.
While the CA page says
Respirators should only be used:
• As a last resort for
protection when local
exhaust ventilation or
water controls are not
feasible or do not
adequately control
employee airborne
exposures.
• Where exposures
exceed the permissible
exposure limit (50 μg/m3,
8-hour TWA) while installing or implementing feasible
engineering and work practice controls.
• When the employee is in a regulated area.
Actually, it is possible to transplant lung, but sure, this is not solution of real problem, people for some reason cannot fulfill safety considerations.
In reality, what I seen myself, in such cases, all adequate people work with respirator or gas mask, they are now extremely affordable.
And yes, I many times hear, they feel discomfort, it is usually really hot in coal mine, so people frequently take off mask, and for short moment of slight comfort, sacrifice their health.
Unfortunately, after covid I understand them. Yes, psychology don't like wear mask, even when it is not really limiting breath.
I few times have to just sit in mask for 2-4 hours, this was extremely hard.
More fun stuff: https://www.youtube.com/watch?v=9I0IAwOIwXo
If workers refuse to wear masks, then whose fault is this?! If employers do not provide the PPE necessary of this job, then they should be sued and put in jail! My friend was buying 3M N95 masks before COVID-19 at extremely low prices in small quantities - somewhere between $.50 and $.70 a piece. So, everybody can calculate the "savings" those cruel employers do - a lot less than $50/mo/employee!
There are so many Latino workers in Southern California who do not wear PPE for a variety of reasons. For example, all those leaf blowers not only breathe in gas for hours, but they also inhale dust and mold! And nobody seems to care about them! My city of Irvine for years was pretending they want to enforce the switch to electrical leaf blowers as based on numerous studies, 2-stroke engines pollute the air of California a lot more than all cars together, but have done nothing! If I don't run and close all my windows, my house gets filled with gas for literally minutes and then it's really hard to get rid of those toxic fumes! This madness should stop!
The same applies to many other workers! There's the law, but nobody seems to care to enforce it!
It doesn't matter whose fault it is; it remains the employers responsibility to ensure that it does not happen, if necessary by dismissing the worker concerned.
Anyway, do you expect their employer to watch them all the time when they work? If they have passed instruction and cannot be supervised all the time, then it's employees fault.
American Standard has a large factory in my homeland Bulgaria and people from my hometown commute more than an hour and such commute in Bulgaria is rare, but they do it for the good salary. Although the factory passes EU regulations, which I honestly doubt due to the huge level of corruption and widespread respiratory health issues of workers.
So, everybody knows that they will get sick if they work there long enough, yet, they do it, because of the money and job security!
So, sometimes, even when people know the risks, they still harm themselves for money!
> So, sometimes, even when people know the risks, they still harm themselves for money!
In many places this is not really a free choice because alternatives that do not harm one's health do not exist or demand qualifications that the prospective employee does not have. Requiring the employer to police this raises the standard everywhere and the employees would no longer have to make that trade off.
“All this thanks to synthetic stone - important note for countertops owners, if you want to make sure you don't support the product”
The difference is not in the danger of the materials.
The difference is supplying safety equipment and having a culture that demands the use of it.
Regulations work.
When enforced.
Does OSHA not require masks in these cases?
Management on the other hand should enforce masks as a means to avoid liability.
In cases like these you have to ban the dangerous material, or essentially kill the market for the products that use it.
BTW, I'm not sure how solid granite, soapstone, marble, etc. would be any better. Maybe my 30 year old totally fake Corian is back in style. But for the microplastics from scrubbing it?
There's a OSHA/NIOSH pamphlet linked through the original article (https://www.osha.gov/sites/default/files/publications/OSHA37...) with table and additional details.
The pamphlet said that in one study, a marble shop performing dry grinding (no wetting, nor other engineering controls) had airborne silica levels of 39-45 ug/m3, while a granite shop which also did not use engineering controls say 89-460ug/m3.
Contrast that with recent efforts to hire nearly one hundred thousand IRS agents to get a sense of the priorities of your leadership.
[0]https://www.fisherphillips.com/en/news-insights/workplace-sa...
Ukraine is a life or death situation you say?
Solicosis isn't?
How many tax men do we need before we get the government to do the bare minimum here?
That money is used to pay for things that the government does. What exactly is your beef here?
If you need to wear a respirator all day i'm told the most comfortable is an air supply and dragging a hose behind you.
The only problem is that a 6800-series costs $200, plus probably $30 a month in P100 cartridges given the level of particulates in the air, and that's more than these companies think their workers' lives are worth.
Try spending an hour in your shop constantly lugging heavy tools and wood around wearing that respirator on a humid 80 degree day, then you can be smug and waggle your finger at laborers for not protecting themselves.
I'm just one datapoint, but my assumption would be that if it's truly too much of a burden, their employer should be buying better respirators and/or filters.
Yes, I'm extremely fortunate that I can pay for help when needed, but I do quite a lot of my own work. So, if you're going to invent a guy to be mad at, maybe you should pick a softer target.
The respirator was actually not an issue.
They're a little pricey up front, but I figured it was cheap overall compared to the long-term costs of using something less effective. Having eye protection integrated as well is ideal, since it never fogs up.
Maybe you are meaning for medical staff? Yeah there's a fully unfiltered exhaust stream blowing downwards.
What's your solution for the full face with glasses? The spectacle kit looks like it's a frame that you need to get custom lenses put into. The few times I've worn mine (FF-400) I've just suffered the extra ear pressure, but it's not great. It's also a size too small because it was what was in stock at the start of Covid when nobody knew wtf was going to happen, but I don't see that increasing one size would change much. I plan to eventually trying to form a custom thing to hold a regular pair of glasses.
And have you really found the P100 cartridges need to be discarded every few weeks? The only things I've found say that particulate filters only need to be discarded when they become difficult to breathe through, and I've never actually reached that point.
And I'm assuming that a lot of silica particles will go through a P100 a lot faster than the stuff I do. ;)
However, all three organizations have been subject to decades of budgetary cuts/freezes/criticism by republican lawmakers and thus have a fraction of the inspectors they should.
https://blogs.luc.edu/compliance/?p=4470
https://www.kqed.org/news/11875988/minimal-to-non-existent-s...
https://peer.org/lack-of-scientists-dooms-epa-chemical-revie...
https://www.baltimoresun.com/news/environment/bs-md-drinking...
The Senate also is allergic to appointing a permanent leader of the ATF: https://www.pbs.org/newshour/show/why-the-atf-is-often-leade...
The way republicans have functioned for a few decades (after realizing that legislatively trying to kill the ATF, EPA, OSHA, etc is unpopular) is to hamstring the budget for those departments, tie up leadership appointments as much as possible, and then in hearings shout about how ineffective the agencies are.
It's like starving someone and then criticizing them for being lazy and inactive.
The same technique is used to attack social services. WIC, a food stamp program for mothers with infants and children, requires yearly "certification" which involves in-person interviews at offices that few and far between, often not public transit accessible, and so on. How is a mother who is so poor she needs WIC (and thus may not even have a car) supposed to afford to take a day off from work and travel to an office so someone can verify that her child still exists?
Compare that to other government programs that benefit the wealthy and corporations. Do people writing off luxury cars, entire homes, and bizjets have to show up at a regional IRS office (annually) to have their records audited, proving that the luxury property is actually being used for business purposes and they're entitled to a writeoff (or being given use of said property without paying taxes on it)?
Asbestos is apparently worse because of the sharp edges of the particles, but if I put any angle grinder dust under the microscope I see plenty of sharp bits too.
I think the actually harmful thing is that the dust is 'fresh' rather than being the result of years of chemical weathering which tends to smooth off the sharpest pointiest bits at nanometer scale.
https://en.wikipedia.org/wiki/Mesothelioma
the workers in the article are young and are dying from the effects of "plainer" silicosis (which is similar to asbestosis).
Poking around on the CDC site, it seems like the most recent data they have up is from 2014.
Safety regulations need to be put in place with the cheapest being a good quality respirator.
The next time you're driving around and you see someone getting work done on their roof, take note if the roofers are using anchors/ropes/harnesses. IME it's about 50-50.
Complacency. When you have done something a hundred times and nothing has hit you in the eye (some things might have gotten close) then the statistics go to favor 'I won't get hit in the eye this time'. What is usually not factored in 'if I continue to do this constantly I will get hit in the eye eventually'.
This is the nature of complacency and is kind of a flip of the gambler's fallacy.
Firing skilled laborers harms both the employer and the employee.
> Workers must wear it or be let go.
Firing skilled laborers harms both the employer and the employee.
> This is not hard.
It seems very hard.
Yes, and it's mandatory to drive the speed limit. And yet, here we are.
No, I'm saying fine the company out of business for not enforcing the wearing of PPE and then actually do it.
Its not. From a most basic level you (whatever position you're in, I've been the laborer myself, later the foreman and more recently the superintendent, now the field engineer) must keep an eye out and do your part to first, instill the safety culture, secondly to enforce it and hit any lapses as soon as they happen (sit someone out, send them home, write them up) and third, show everyone that you fucking mean it and its not a bunch of empty words, typically, by pushing back against higher management when they're trying to push schedules and work loads down onto the field crews that aren't realistic.
Whether you're using emotional appeals with your field crews, pointing out that no one comes to work not to go home at the end of the day, and how harrowing it is to watch a friend get hurt or killed, how it'll effect their partners and families; or a hard nosed impersonal business logic to explain to schedulers that pushing the team won't make them any more productive, or to accountants that cutting the budget for cheaper PPE will only instill a bad taste, I can't deny it takes work. But again it isn't hard, in the end no one wants to get hurt. You have to get past that teenaged sense of invulnerability and get it into their heads that it can and will happen to them unless they're careful.
> Firing skilled laborers harms both the employer and the employee.
Crews come and go, grow and shrink. Firing a troublesome employee brings a lot less harm to both parties than someone getting hurt or killed.
"what if I bend incorrectly whilst picking up this gum wrapper that blew into my yard?!?!".
technically they're not saying anything that's untrue, and yet...
and yes, I get it, a full on back support belt to pick up a gum wrapper is probably overkill, but walking around a construction site without steel toed boots sure as shit isn't. You may disagree with exactly where that line sits, but there is a line, and when it's crossed "it aint hard".
People can destroy their health for all I care, but the society should care a lot about enforcing certain things on employers because I don't really believe that those employers are voluntarily paying the medical bills of their victims.
But in this case I believe things should be easier since IMO a violation of this level of safety standard should risk bankrupting your company.
So your choice become to keep employing someone who can't follow basic regulation to save his life and risk the job of everyone else or just fire him (not as hard no ?). And I might be a bit optimistic but in this scenario I would expect that the union might not support him as much.
And I made only a quick search but the scenario where union would protect safety violation appear to be less probable. Since at least regarding OSHA violations : https://blog.dol.gov/2022/05/11/the-connection-between-union...
> based on publicly reported OSHA data found that union worksites are 19% less likely to have an OSHA violation and had 34% fewer violations per OSHA inspection than non-union worksites.
People make their own decisions how to behave and need to own them. Allowing important things to slide like health and safety matters is unacceptable.
> What about when the employees are unionized, and the union takes the side of the non-compliant laborers?
Start a new company and wind down the old one, transferring over existing customers.
Use a mask and cut it using water for dust management
If people were getting shocked while working with electricity we'd be calling the ridiculousness of it. This is basically the same thing, over a longer timeframe
https://en.wikipedia.org/wiki/Silicosis#Regulation_in_the_US
TL;DR: it's already regulated (by OSHA). Total number of deaths annually by silicosis in the US is low (~15/year). The workers need to file an OSHA complaint if they haven't already.
the OSHA page (https://www.osha.gov/laws-regs/regulations/standardnumber/19...) mention "the employer shall fully and properly implement the engineering controls, work practices, and respiratory protection specified for the task on Table 1" which one could read as more than just need to provide but I have idea if it's true.
As for the death tool which seem low it's not so good when take into account the number of worker (from the article):
> In California, workplace safety regulators have estimated that out of roughly 4,000 workers in the industry across the state, silicosis will afflict between 485 and 848 — and that as many as 161 could ultimately die
As a musician, it especially kills me to watch people destroy their ears. These workers are often too young to appreciate good health.
I think it's more than what you've described. I think it's that a lot of folks actually prefer dangerously loud volumes, and this contributes to a positive feedback loop of expectations for loud concerts. I wish most concerts were quieter, but I may be in a minority.
Anyway, the solution for "it's quiet at the back" isn't "turn it up at the front". It's line arrays, distributed speakers etc.
I support everyone's right to destroy themselves if they choose to do so.
If we don't have the right to destroy ourselves, how can we also have rights to build and better ourselves? How can we be said to own ourselves at all if we can't choose to destroy ourselves?
The idea that we can't be allowed to choose to harm or destroy ourselves is the most fundamental violation of the most basic of human rights.
"I used to, but the acid kept dissolving them."
A modern example: I've seen gravestone engravers completely covered in stone dust while wearing only a thin handkerchief; no hearing, eye, or proper lung protection. Sure they should know the risks but you can't force people to not smoke tobacco or use proper PPE.
If that means steel-toed shoes, a jock cup, thick gloves, shooting glasses, amplifying mickey mouse muffs, sunscreen, bottled water, and a P100 respirator, so be it.
Safety regs are written in blood. And it only takes an instant or a culture of disregard to lead to later cancer, permanent disfigurement, or death. There are no old bold pilots or construction workers.
1) The ancient Greeks and Romans knew about the hazards of breathing dust, and knew that stone workers were particularly at risk.
2) The name Silicosis was coined in 1870 by Achille Visconti who was studying lung disease in hard-rock miners. https://en.wikipedia.org/wiki/Silicosis
3) Silicosis can be entirely avoided by cutting stone (and silicon bearing ceramic materials) with a "wet cut"... literally just add water!
So, this danger has been known to stone workers for 2 millennia, protection is cheap, effective and readily available, and yet people are still falling prey to it.
I have personally witnessed professional counter top installers working in obviously unsafe ways, who have actively & energetically refused face masks, water dust collection, and vacuum dust collection (which is far less effective).
This is an article about human frailty, not about some new threat.
It is an important point that human callousness towards the well being of others seems to be self emergent. Clearly the people at the top of the stone cutting industry in LA are not investing in training their new young workers in proper technique.
How can this be addressed? I don't know. It seems Adam Smith and Karl Marx have both failed to leave us useful guidance on the subject.
PPI is VERY important, and so many people ignore it.
Edit: changed wording to agree with you.
Not the same disease per se as there are slight differences but coal workers pneumoconiosis and silicosis are very similar given that they have a very similar inhalational dust profile.
We have quartz composite worktops in Europe too. I'm pretty sure that people aren't getting silicosis from them here. You can buy them in IKEA https://www.ikea.com/no/no/p/kasker-spesialtilpasset-benkepl...
Engineered stone is created, it's not like natural stone, we don't have to cut it. They also have the choice to cast it, net shape.
They just need to redo their whole schema, they need to reconfigure their process to customize the engineered stone before its solidified, not after.
That's not viable. They are cut only after the actual physical space has been built (carpentry mainly) because measurements have to be taken then since nothing is perfectly true/plumb/square. Today the turnaround is about a week for the material to be cut and then installed. Sending it off to the manufacturer to create to spec would not only add several weeks to the process but significant expense.
Stone (both natural and engineered) can be cut safely. These shops just haven't been. Proper respirators, ventilation, and wetting will create a safe space to work in.
I think that's the problem, we're unwilling collectively as a society to pay the cost.
https://www.latimes.com/california/story/2023-09-24/silicosi...
Yahoo news is something I avoid like the plague.
The solutions exist, the problem is making people invest in them and stick to it.
In the ideological camp with me are the "degrowthers", who seem to be more common in Europe than in the US, but they all seem to be pitching borderless, stateless surveillance communism that relies on the same ultra high-speed high-tech plastic-based international-shipping constructs we have now, except with "green" energy instead of regular energy.
You're right that it's more common in Europe. When I go back to the US life feels so insanely gluttonous. Driving a studio apartment three miles to get a coffee is lunacy
It sure is. I have a cheap drip coffee maker that I drink from all day, at a cost of a few cents a cup. Dirt cheap.
That'll last for a couple weeks, at 12 cups (actual cups) a day.
Coffee is my cheapest vices. I love coffee. When the pandemic hit, I stocked up on coffee.
Unfortunately, nuclear deterrence only works against rational actors, by rational actors. It doesn't prevent irrational human behavior or accidents. So a heavily nuclear armed world would probably see a downturn in violence between states until one fateful year when an accident or miscalculation escalates to kill more people than every war of the past 200 years combined.
[1] Terms and conditions apply: only valid for countries with population greater than 20 million.
What you can do is live the life you want. Many people talk like you, but never make changes in their own life. A few do make such choices, and many after 10 years realize they didn't actually want the things they did and return to modern life.
Because we have a public health care system, funded by taxes, having a large number of young men out of the work force (not paying taxes) and using the health care system effectively means my taxes, everyone's taxes, are higher.
There's incentives for our government to protect workers from risks that will cost a fortune to fix.
In America, there's only the "because it's the right thing to do" reason, which is never enough for anyone to actually do anything.
Yeah one heck of a perverse incentive.
Someone taken out of the workforce may qualify for that if they don’t already qualify for disability insurance or similar payments (although I’m not 100% clear if those are funded via private disability insurance or public programs)
First, Medicare pays a lot more to healthcare providers than Medicaid. Medicare pays more for more medications than Medicaid, and has fewer prior authorization requirements for those medicines. Fewer providers will accept Medicaid, and people using Medicaid will receive less or worse healthcare than those in Medicare.
Second, Medicaid is administered by each state, and there is a lot of variability on how easy the state makes it so people can actually get healthcare. Lots of states straight up refuse money simply to punish people of a certain socioeconomic class because it happens to win votes.
Bottom line, Medicaid is so leaders can claim they are helping poor people get healthcare AND keep taxes low. Medicare is for actually delivering healthcare to people because that contingent makes up a huge proportion of votes.
And yes, even Medicare is not delivering all healthcare, as it has multiple tiers to deliver differing amounts of healthcare to different socioeconomic classes.
I love how there is even an Additional Medicare Tax. The political lines in the US are very much old v young, but some of the young, especially politically active ones, vote with the old since they are among the wealthy young, and the rest do not participate enough, or do not have sufficient knowledge about how resources are being meted out and how they will be affected now and in the future.
Like I could just book a one way flight to LA and become a US citizen because reasons ?
https://www.uscis.gov/about-us/our-history/overview-of-ins-h...
That said, overstaying tourist visas (aka just hopping on a plane and then not going back) is a very popular form of illegal immigration into the US.
I'm all for helping people but you cannot import the world's misery and expect it to be smooth, first because it doesn't solve anything, second because it just doesn't work from a simple demographic point of view.
The taxes part is the same; only the healthcare half is different.
Maybe subsidies for selling fresh fruit and veg also.
I guess you could tax their victims instead though... they don't have a lobby so theyre probably easier to take advantage of.
Nobody is the victim of choosing to eat a cake.
Coming any second now, right behind robotaxis, with the only difference being that robotaxis will probably actually happen within the lifetimes of the current “laptop class”.
High caloric density is what you want if you need to be able to feed your country in war, so we subsidize these foods.
No one wants to eat just plain corn though, so companies process it into other foods that are then sold cheaply because they are receiving these large subsidies.
People end up consuming large quantities of these foods because they are cheap, and our brain reward centers a pre-wired to love lots of cheap easy calories.
Knowing all of this, it makes perfect sense to tax the living crap out of highly processed foods that are made from subsidized ingredients. You're just taking back the subsidy you put there in the first place, and shaping consumer behavior for the greater good (which is a common use case for taxation).
The consequence of this would be that the subsidized food gets exported to a country that doesn't tax it, at which point you're subsidizing some other country's food.
The US is also a large net exporter of food, implying there is more than enough domestic production for wartime needs. Also, the US hasn't been in that kind of a war in almost a hundred years and MAD makes it unlikely that it ever would be again. The obvious conclusion is to eliminate the subsidies.
If theyre smart they won't take this shit either.
Nice of you to let Americans sacrifice their health on $othercountry's behalf though.
What do you suppose the chances are of 100% of other countries imposing a similar tax on this type of food?
> Nice of you to let Americans sacrifice their health on $othercountry's behalf though.
Stop subsidizing it and you don't have to tax the subsidy back out.
Quite high. Agricultural dumping is typically frowned upon even more than regular dumping. Half of the reason for the WTO's existence was to get countries to stop being so trigger happy about doing this.
At least for removing the subsidies you only have to fight the businesses.
I will never be punished for being over- or underweight since I am good. The universe would have to be broken for me to be taxed.
Sugar tax, coal tax, corn syrup tax, worked-your-employees-90h/week tax? Sure.
And what about physical activity ?
The best public investment to promote physical activity is designing cities to enable "the gym of life"!
This is not exactly the best use case for arguing about Canada versus US healthcare policies.
Edit: Actually over a quarter.
Look at Germany. Look at France. Look at what's happen to Japan because such an option isn't as viable.
It's simply not politically feasable to say, "Without immigrants, our economy is f'ed."
And yet, that's what politicians in Germany are saying: "Denn Deutschland braucht sie dringend: Durch die seit Jahrzehnten sinkende Geburtenrate gibt es auch weniger Arbeitskräfte. Diese Lücke konnte lange über Zuwanderung aus dem EU-Ausland gefüllt werden. Doch inzwischen reicht das nicht mehr aus." (https://www.spdfraktion.de/themen/neustart-migrationspolitik, the social-democrat representatives in Parliament)
"Because Germany needs them urgently: Due to the declining birth rate for decades, there are also fewer workers. For a long time, this gap could be filled by immigration from other EU countries. But this is no longer enough."
To the detriment of their origin countries who suffer from losing their best and brightest. How "Northern countries exploit the South again" is a (rather quiet) talking point that I believe will become louder in the future.
> While there are no accurate figures representing the number or composition of undocumented migrant population in Canada, estimates range between 20,000 and 500,000 persons
> Research suggests most undocumented individuals live in large urban centres and typically work in seasonal and informal sectors, such as construction, agriculture, caregiving and housekeeping.
> Undocumented migrants are a vulnerable group due to their lack of immigration status, as was seen during the COVID-19 pandemic. They have limited access to health care, social services or employment protections.
Source: https://www.canada.ca/en/immigration-refugees-citizenship/co...
Until this year, asylum-seekers could transit through the United States into Canada under the Safe Third Country Agreement, by crossing the border at an irregular crossing like Roxham Road.
Sources: https://www.cbc.ca/news/politics/deal-roxham-road-migrants-b...
https://www.cbc.ca/news/canada/canada-asylum-seeker-increase...
https://web.archive.org/web/20230601135133/https://www.nytim...
https://www.pewresearch.org/short-reads/2021/04/13/key-facts...
https://www.indexmundi.com/factbook/compare/canada.united-st...
So seems like Canada has many fewer immigrants of this type than the US.
They also allow international students at diploma mills to work 40 hrs a week, above the table.
It's a sham.
Is there any evidence of this? That the Canadian Gov cares more about workers than the US Gov?
>Because we have a public health care system, funded by taxes, having a large number of young men out of the work force (not paying taxes) and using the health care system effectively means my taxes, everyone's taxes, are higher.
What evidence do you have that this is the case?
>In America, there's only the "because it's the right thing to do" reason, which is never enough for anyone to actually do anything.
Is this your opinion or is this the reality. I don't know if you have ever walked by a construction site in Toronto to see guys cutting cement or stone. None of them have masks. Sometimes they will have a wet saw when cutting cement on the street but that is to reduce dust for traffic and pedestrians and not so much for their health. The Canadian Postal Union fought the Federal Gov for years to provide an environment where paper dust was considered a health hazard and workers need to be protected. Many postal workers suffered from COPD because paper dust was too fine for the Lungs to filter. What about farmers and dust? I'm sure they suffer just as much as American farmers.
I've come to realize Canadians suffer from an inferiority complex and have to constantly try and make comparisons to make themselves feel better, it's a strange phenomena.
- Expat....
From a cost perspective it’s best that people die suddenly. If I live a fairly healthy life into my 80s and die of a heart attack, I might not necessarily have cost my insurer that much, as opposed to if I suffer from a chronic illness for 10, 20, 30 years.
Cancer is now usually not a sudden death sentence - treatment is good enough now that most cancers caught early can be treated and patients often go through multiple remissions before it or a complication from treatment finally gets them.
Insurers very much do not want their customers getting cancer, because it is invariable an extraordinarily expensive condition to treat and treatment can go on for years.
Small clarification - early detection is most often curative and cheap.
The really expensive part is that several advanced stage cancers (even IV with widely disseminated metastatic disease) now survive for many years on treatments costing low to mid 6 figures/year.
It actually provides a pretty good incentive for insurers to cover screening and early detection beyond what is mandated by law.
> It actually provides a pretty good incentive for insurers to cover screening and early detection beyond what is mandated by law.
The evidence in favor of mass screening programs in the hope of early detection is actually weak to non-existent [1].
> In total, 2 111 958 individuals enrolled in randomized clinical trials comparing screening with no screening using 6 different tests were eligible. Median follow-up was 10 years for computed tomography, prostate-specific antigen testing, and colonoscopy; 13 years for mammography; and 15 years for sigmoidoscopy and FOBT. The only screening test with a significant lifetime gain was sigmoidoscopy (110 days; 95% CI, 0-274 days). There was no significant difference following mammography (0 days: 95% CI, −190 to 237 days), prostate cancer screening (37 days; 95% CI, −37 to 73 days), colonoscopy (37 days; 95% CI, −146 to 146 days), FOBT screening every year or every other year (0 days; 95% CI, −70.7 to 70.7 days), and lung cancer screening (107 days; 95% CI, −286 days to 430 days).
There are large institutions, both nonprofit and commercial, which stand to gain by convincing people that mass screening is useful and important. The available scientific evidence does not support their position.
[1] https://jamanetwork.com/journals/jamainternalmedicine/fullar...
What you want to do is look at stage at presentation, treatment costs by stage, and screening costs. These were done for nearly every recommended screening program.
The available evidence behind currently recommended screening programs unequivocally shows improved cancer-specific survival and earlier stage at diagnosis.
> What you want to do is
No, what I want to do is assess whether broad screening programs actually make people live longer. Overall survival is the correct metric. Evidence in favor of the claim is lacking.
> none of the studies are sufficiently powered for OS.
"Sufficiently powered" is relative to what size of effect you want to detect--which you haven't specified, so I'm not sure how you can make the assertion that none of the studies are sufficiently powered.
> The available evidence behind currently recommended screening programs unequivocally shows improved cancer-specific survival and earlier stage at diagnosis.
These outcomes ignore negative effects of screening on people who don't have cancer, which is why I'm not interested in them. And yes, there are negative effects, and no, they are not negligible.
Correct according to whom? If you want to choose only one metric quality adjusted life years is likely the best one.
While OS may be your goal that's not the primary endpoint of screening programs.
Some examples of why OS is limited: breast lumpectomy vs mastectomy and systemic therapy or polypectomy vs neoadjuvant therapy and colonic resection are both associated with very high morbidity that is very important to patients. The vast majority of patients care about quality of life.
> "Sufficiently powered" is relative to what size of effect you want to detect--which you haven't specified, so I'm not sure how you can make the assertion that none of the studies are sufficiently powered.
We do not expect any one screening program to have a large change on overall survival because there are many ways to die, very few studies are powered to detect the small differences expected. The reference below does some modeling and discusses cancer-specific vs all-cause mortality for your perusal.
https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.2476
> These outcomes ignore negative effects of screening on people who don't have cancer, which is why I'm not interested in them.
See morbidity discussion around delayed diagnosis above.
> And yes, there are negative effects, and no, they are not negligible.
As you're choosing to limit the discussion to overall survival, do you have any data to support the claim that screening has more than a negligible negative effect?
There is a better argument to be made for other harms of screening like cost and stress but if we want to discuss these negative effects of screening we also have to step back from overall survival and discuss morbidity benefits.
ETA:
> 2) that I'm misinterpreting something, given that I didn't really offer any interpretation at all.
This is your interpretation, and is an incorrect one:
> The evidence in favor of mass screening programs in the hope of early detection is actually weak to non-existent [1].
The evidence you cite says nothing about early detection and treatment paradigms.
By all means, if you have studies showing that broad screening programs are beneficial in terms of overall (not cancer-case only) QALY then please share them. I'm guessing you don't.
> As you're choosing to limit the discussion to overall survival, do you have any data to support the claim that screening has more than a negligible negative effect?
Do you have any data to support the claim that screening has more than a negligible positive effect on overall survival? (No).
Stop trying to put the burden of proving a negative on me. If you want to advocate for spending ten of billions of dollars annually (not to mention time and stress) on broad screening programs you bear the burden of demonstrating that's useful.
If we can afford to spend the money on screening everyone certainly we can afford to spend less money to run a large randomized trial screening only some people, but advocates of the screening programs won't stand for it because they are convinced of their own righteousness and refuse to admit uncertainty about whether the screening programs are actually doing more good than harm.
I gave you one.
> Stop trying to put the burden of proving a negative on me.
You're making the claim there's more than a negligible negative effect not me.
> Do you have any data to support the claim that screening has more than a negligible positive effect on overall survival? (No).
Did I say there is a sizable positive effect on overall survival? I said it's irrelevant.
No you didn't, you gave me a simulation study that discussed what kind of sample size might be necessary to find statistically significant effects in all-cause mortality. There's not a single mention of QALY in there. Please stop misrepresenting things.
> You're making the claim there's more than a negligible negative effect not me.
The cost itself is a nonnegligible negative effect.
> Did I say there is a sizable positive effect on overall survival? I said it's irrelevant.
You're wrong.
It's borderline fraud, in my humble opinion, to go around suggesting that massive interventions should be evaluated based on their effects only on the people who benefit most, ignoring the negative effects on the other 98% of the population. Which is exactly what you did in your first reply to me:
> What you want to do is look at stage at presentation, treatment costs by stage, and screening costs. These were done for nearly every recommended screening program.
> The available evidence behind currently recommended screening programs unequivocally shows improved cancer-specific survival and earlier stage at diagnosis.
This approach to evaluating an intervention is intellectually dishonest and emotionally manipulative. Any evaluation that does not take into account the other 98% of the population--through overall survival or QALY or some other metric--is giving an extremely biased picture of what the intervention is actually doing to the population as a whole.
Several screening programs like breast have been rigorously evaluated from costs, benefits and harms. I know very well what the negative effects are, do you? You haven't mentioned anything specific or provided estimates of harms yet you're the one making the assertion.
> You're wrong.
So if we're all wrong, what's the argument and where's the evidence without resorting to no OS benefit ignoring that this is again not the point of screening.
> It's borderline fraud, in my humble opinion
Your humble opinion disagrees with the entire medical community, including the study you initially cited. So we're all fraudulently screening for what purpose? You know that physicians don't collect billings or work fee for service in academic medicine correct?
> Which is exactly what you did in your first reply to me:
Did I say that was the only reason to screen and ignore the harms? I used that as an example of why overall survival is not useful as an isolated statistic.
You're the one who wanted to limit the discussion to one measure, I was pointing out the flaws.
In any case, anything that makes people die young, or more generally reduces people’s capacity to work (like many diseases of affluence) is incredibly expensive to society once you factor in indirect and opportunity costs.
The US is pretty much the only country to successfully reduce it, near as I can tell (perhaps Canada has had success too?).
https://uwaterloo.ca/tobacco-use-canada/adult-tobacco-use/sm...
[1] https://www150.statcan.gc.ca/n1/pub/82-624-x/2012001/article...
[2] https://www150.statcan.gc.ca/n1/pub/82-625-x/2020001/article...
[3] https://www.macrotrends.net/countries/JPN/japan/smoking-rate...
[4] https://ourworldindata.org/grapher/sales-of-cigarettes-per-a...
Traveling outside the US to Europe or Asia (eastern/southern Europe or China in particular) it’s very visible, where in the US outside of a few locations it’s almost invisible now and notably uncommon.
Especially for educated or higher income folks, too.
I'm pretty sure the figures will look somewhat similar in most western countries.
The US healthcare system uses private insurance, implying that more use of the healthcare system raises everyone's premiums. And people without insurance then go to emergency rooms which are in turn still passing the cost onto private insurers. So voters already have the same incentive in order to avoid their premiums going up.
On top of that, insurance is optional. There is no guarantee a person will get affordable care. That's the entire point of the system! If there were a guarantee, it would be indistinguishable from Canada (and practically every other country's) single payer healthcare system.
How does that affect issues like this where an increase in overall costs would reasonably be expected to apply to all insurers?
> On top of that, insurance is optional.
More than 90% of the population has health insurance, which is well over the majority required to bring about legislation.
> If there were a guarantee, it would be indistinguishable from Canada (and practically every other country's) single payer healthcare system.
That certainly isn't true. Serious problems with the US healthcare system include AMA lobbying to maintain a doctor shortage, various patent laws and FDA rules that limit competition and increase costs and a malicious lack of cost transparency. None of that would be improved merely by routing the premiums through the government.
A more plausible conclusion from observing the results of an entity's involvement in something is that if it is incompetent with the thing you gave it to do, don't give it more stuff to do.
When my code doesn't work, I don't sunset the code, I fix it. Why would the best course of action be to stop trying instead of fixing the root of the problem?
About 90% of that scale requires sunsetting at least some of your code and doing something differently.
https://onlinelibrary.wiley.com/doi/full/10.1111/resp.14242
> There’s incentives for our government to protect workers from risks that will cost a fortune to fix.
There are many examples where this is inaccurate but let’s keep it simple and delve a little deeper into the silicosis problem presented in this specific study.
From the JAMA article:
Although a substantial number of the patients, including some of those who were uninsured or with restricted-scope Medi-Cal, likely had an undocumented immigration status, we did not directly collect information about whether individuals were undocumented immigrants.
Note that public health system in Canada is not “free”. Legal immigrants, documented workers, citizens and refugees have access to provincial or federal health insurance which pays for care.
Undocumented or illegal immigrants have neither (and also would not get WSIB which would be the payer for most silicosis cases) and actually have better coverage in California.
Additionally:
Ten patients (19%) were uninsured, 20 (38%) had restricted-scope Medi-Cal, 7 (13%) had Medi-Cal, 8 (15%) had private insurance, and 7 (13%) had workers’ compensation.
So 34/52 had some form of government provided or mandated insurance.
As an aside while restricted-scope Medi-Cal and uninsured rates are the surrogates for undocumented immigrants in this study, those over the age of 50 (or 19-25) are also eligible for full scope Medi-Cal but were not identified in this study. Medi-Cal will also be expanding in January 2024 to cover undocumented immigrants aged 26-49.
Even if we assume Canada’s silicosis incidence is lower, all of the above strongly suggests your public health system cost-savings incentive hypothesis is incorrect.
Sure, no axe to grind here. Do tell us your impartial take.
I also provided a reference that is open access but here is the relevant section for you:
In Canada, there are no national data on the incidence or prevalence of silicosis. In the province of Alberta, where silicosis is a notifiable disease, health insurance data revealed 861 cases with at least one reported diagnosis of ‘silicosis’ during a period of 10 years from 2000. These results were based on raw data and not a secondary review of primary imaging and clinical information. Data from 2000 through 2009 showed that only 29 workers' compensation claims were accepted for silicosis in Alberta. Data from Quebec's compensation system revealed 351 compensated cases of silicosis between 1988 and 1998. Of note, workers who participated in regular surveillance had milder disease at the time of compensation.
The JAMA study is from 2019-2022. Data that is 20-30 years old is relatively poor quality.
Changes in medicine, workplace safety rules and occupational trends makes it hard to compare to silicosis rates in Canada to the US in order to assess the claims of the comment I replied to therefore I think the relative incidence described in this review article (from 2022) is inaccurate.
If you want to disregard my quality assessment, the discussion ends with the review article showing silicosis rates are 3x higher in Canada.
Can you elaborate on how any of this shows I have an axe to grind or that I’m biased?
Canadian data is poor quality. On any issue you might care to pick, the topic is better studied in the United States. I run into this all the time. For example, we make allocation decisions at a charity I volunteer at with, about what health problems unemployed LGBT people tend to have. We use data for American urban populations. The data doesn't exist for Canada, AFAIK. It's a smaller country! There's simply less research and statistic-taking done! It's a reasonable statement.
Besides -- commenting on the lack of good data usually implies the exact opposite of what you seem to think -- it is an admission by the poster that their argument is based on weak evidence.
Which is exactly why I limited my reply to a discussion about the California study and healthcare systems rather than reiterating the claims in the 2022 article I referenced which states silicosis incidence is 3x higher in Canada, based on 20-30 year old data.
Although I live in the US now I’m a dual citizen and practiced medicine in both countries, the only axe I have to grind with Canada is the harsh winters which are incompatible with my fragile desert descent body.
I'm enough of a pedant to annoy the fuck out of most anybody who knows me, but really? Look, there is no "free" health care anywhere, but it's a term that has (perhaps unfortunately) become widely used as a synonym for, depending on your sensibilities "no charge at the point of service" and/or "socialized health insurance and health care coverage".
And Canada is certainly one or both of those.
The metric "well, they don't provide it for undocumented persons" is a weird one, as is the use of California as a counter-example.
The comment I replied to asserts that the government incentive to reduce healthcare expenditures improves workplace safety, and consequently in the context of this article would have prevented silicosis/PMF in these patients.
I highly doubt most HN commenters are aware of whether undocumented migrants are covered in the Canadian system as they are in California, certainly the person I replied to was not, so I explain differences in coverage.
Consequently, the argument doesn’t hold water as the financial incentive for the government is stronger in California than in Canada as it relates to this study population.
> The metric "well, they don't provide it for undocumented persons" is a weird one, as is the use of California as a counter-example.
I'm not providing any counter examples, undocumented workers in California are the subjects in the article we are commenting on. Where in fact there happens to be socialized healthcare that you seem to think I'm arguing against.
You yourself seem to not understand this distinction with your comment: "no charge at the point of service".
There is always a charge at the point of service and a bill is generated. The difference with the US is that the Canadian healthcare system, which also functions mostly privatized, uses a single payer model so the government is the only one legally permitted to pay for insured services. In other words, each province runs a large insurance company and there is a law that states that no one is allowed to charge any person or company other than the government insurance plan for anything the government has deemed reimbursable for any person covered by the plan.
(So you don't misinterpret my statements again: while government run hospitals, but not the physicians working in them, do get capitation payments they also bill for some services. What is billed vs paid through capitation varies by province. Services rendered to uninsured patients are never from capitation funds and are always charged directly to the patient).
If the services rendered or you are uninsured, like the patients in the article study, it functions the same as the US and you will personally receive a bill in the mail with similarly obscene rates much higher than what the government insurance company would have paid.
This distinction has everything to do with the article and GP's point which asserts that the Canadian government will bear some cost for the care of the patients in the California study which is flatly incorrect. If there was no charge at the point of service none of this would matter.
I was thinking more broadly than just the US or Canada. In Scotland, for example, there is literally no charge at the point of service.
The discussion, and the part of my comment you quoted, is specifically about Canada and the US. So I'm not sure what you're even arguing or why.
Dad knew but he was stuck in the past of "It had to be done" mentality. And really as a high school drop out he really may not have understood the danger. For years he and my grandfather had a painting business with the paint at that time containing lead.
That is true with or without publicly funded healthcare.
https://news.ycombinator.com/newsguidelines.html
Edit: we've had to ask you not to do this on HN more than once before. Please avoid it in the future.
I can see how what I said would be construed that way.
Flamebait in a comment has to do with the most inflammatory thing it contains, not the most interesting thing. When a house is on fire, people don't admire the décor.
The point, at least as I interpreted it, was that society is very good at building callous machines that throw away human lives for no reason and then the same society turns and pats itself on the back for the incredible virtue it has in allowing those people to "heroically" destroy themselves.
These countertops might not even outlive the people they're killing at a young age. In the past 15 years, I've talked to people who have gone from needing granite counter tops, to quartz, to the next trendy fashion. If a countertop killed me, then I would hope that it would last a century, but the truth is that it might not last a decade simply due to being unfashionable. And somehow I doubt its replacement is going to be any safer to cut.
To those who didn't read it - it is a rather short novel, uncannily funny, scary, and most of all - revealing of how human societies actually work. This is one of the earlier Pelevin's works, so the style is still illustrious. Some jokes might not be immediately transparent as they are contextualized in the late USSR.
Correction: it is scary in the cthonic/transcendent sense, not that it is spooky (it's not at all).
No matter if the countertop last forever you still died just for someone greed or utter apathy and negligence ...
First, you're striping agency from those workers blaming abstract society instead. There is no such thing as "collective guilt". Those particular workers are free to leave such an unsafe industry at any moment, probably even more free than, say, smokers who choose death from respiratory complications. I have exactly zero empathy for either. True that sometimes workers are not exactly free to leave the job and coerced into insane working conditions, e.g. the curse of russian monotowns: https://www.youtube.com/watch?v=HwzP-zr0S0c . That is definitely not the case for california though.
Second, your interpretation of the book is not right. Works of Pelevin, just as many other great writers, are not exactly fiction, but a compilation of a real life contemporary trends distorted by weird observation angle and grotesque style. The core theme of Omon Ra is very basic: government brainwashes people to be literal disposable cogs. AFAIR the book does not reference "society" in any way. I've read the book over 20 years ago though. One great thing about Pelevin is that he definitely had access to people of highest power at some point (early 00's at least) and translated their completely crazy worldviews into his books.
So the choice is between different shops, not about homelesness.
"The line separating good and evil passes not through states, nor between classes, nor between political parties either -- but right through every human heart -- and through all human hearts. ..."
this is like the Shein of counters. wealthy people probably use natural stone.
Quartz is also strictly a better material: it's not as porous as granite, much much harder than marble (marble can be scratched so easily), and can be made into almost any color or pattern.
Super rich folks may prefer natural stone, but not because it's a better material... it may be preferred because it's a worse material in many cases. The cost and fragility is part of the allure by itself.
Average granite is 72% quartz:
> It finds that each year homeowners remodel upwards of 10.2 million kitchens — roughly one in 10 of all households — and 14.2 million bathrooms, two of the most important rooms in a home. Further, annual new home construction adds roughly 1 million kitchens and 2.3 million bathrooms to the marketplace
National Kitchen + Bath Association (NKBA)
I've taught him well.
I was the safety representative at a previous job. Management care a lot about safety and provided everything required, and high quality gear as well. Still people would cut corners and not use the equipment because it was faster not to. These where people paid by the hour, they have zero incentive to work faster. If people work on contact however, it's easy to create an environment where speed is priorities over safety.
Then they get written up, and eventually fired. Companies need to be stomped on(and are where I live), if they don't do this.
Of course they made so because otherwise it would be convenient to the company provide the safety equipment and not enforce their usage, this way getting work done faster (and thus have more profit).
There are plenty of people to blame, and there is plenty that can be done. This dumb ass "No regulations needed, free market will take care of itself" is how the rich put the poor or ignorant into early, terrible graves.
There's some small margin of workers who have access to protective gear but don't wear it, but in reality for most workers it's the job of the company to provide it and train workers to use it.
You know the when these stores even supply this protective gear, they get the cheapest option that’s still legal.
Weirdly enough, that doesn't apply to car mechanics which seem to be dead set on bringing their own tools to work.
Not saying it's good or right, but there are incentives that push towards it.
I am a nerd and my glasses were falling off from the sweat. I think I was wearing a pair of work boots which may be required. But the guy giving me orders on-site was not my employer. These clients are well-aware that day laborers may not be back tomorrow. So why give us durable safety equipment that costs money? The day labor office is my employer, but they may not be accurately informed about the safety requirements of the client and the site. They may require us to purchase safety equipment at own expense, but if we don't know what the site requires, or how long we will be there, that's an up-front expense we are unwilling to part with.
Day laborers are one step up from the guys hanging out in Home Depot parking lots, whereby they are legal to work in these United States, but can't get a job anywhere else.
So it's a 3-way tug-of-war of vagueness and parsimony, and it always just ends up being nod-nod, wink-wink, do the best you can.
Objectively, it has a very high utility per dollar. Heat resistant, water resistant, knife resistant, stain resistant, etc.
Well, it depends on the situation.
If I, a factory owner, offer optional safety equipment that slows workers down a bit, but I also demand such high productivity that corners have to be cut - whose fault is it when the inevitable happens?
What if I, a factory owner, provide optional basic safety equipment costing $30 per person, but the mask makes the goggles steam up and the boots aren't comfortable? There's better safety equipment available for $300 per person - is it my fault for not buying it?
What if I, a factory owner, happened to start my factory by hiring macho tough guys who don't like wearing a mask, and subsequent hires learn that behaviour from them?
Generally I to listen to the craftspeople I employ on issues of safety because keeping them safe is the whole point of safety. But they and I have a shared responsibility to make sure, if they say the machine is actually safer without the guard, that they're right about that.
I actually worked in such a factory, so this is based on direct experience, and what I saw was people cut corners mostly because they were tired after long shifts, though lack of comfort was also a factor due to the heat.
The employer did try to make everyone wear the gear and had inspections and most people wore most of the stuff most of the time, we even won a safety award at one point for going so long without any OSHA-recordable injury. But we weren't perfect and one day I helped bandage a guy who was airlifted after slicing his arm open in a really bad way, something the kevlar wrist protectors should have stopped.
So I would say that employers do try, to the limit they can, but all accidents happen during gaps. And the employees tend to have their own interests in comfort or cutting corners that sometimes conflict with their safety. More limited shifts and attention to comfort might help, but it's not always clear how to provide that.
You can still have things like the guy who got crushed by his forklift after rushing to dump a hopper of trash by doing something really dangerous while unloading it because he wanted to hurry and finish so he could go to his family for Christmas vacation. And it's not easy to stop that kind of thing, even if you do a lot of warnings and inspections to yell at people who don't do things right and pay attention to close calls.
Go on…
After all, if you get a minor injury and you know getting treatment will cost your colleagues a $200 bonus, you might keep quiet about it and tough it out to the end of your shift.
To achieve a good culture of safety, you need to make the rewards for safety strong enough to resist the rewards for cutting corners - but you also need to make sure a guy can get a band-aid from the first aid kit or tell his boss about a trip hazard with no disincentives.
If anything I'd worry more about the temperature of the floor or the number of hours worked, but it's hard when some people had second jobs or what have you.
With that mentality we'd still have 1800s lifespans