tag:blogger.com,1999:blog-1812431336777691886.post5144406279897626103..comments2024-02-29T03:57:00.088-05:00Comments on The Mermaid's Tale: Cancer moonshot and slow-learnersAnne Buchananhttp://www.blogger.com/profile/09212151396672651221noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-1812431336777691886.post-78914431407146045322016-06-17T08:18:14.306-04:002016-06-17T08:18:14.306-04:00Well, there is no need to continue this discussion...Well, there is no need to continue this discussion of things we partly agree on, but that avoid some of our main points. Hopefully, you'll have a long, happy life!Ken Weisshttps://www.blogger.com/profile/02049713123559138421noreply@blogger.comtag:blogger.com,1999:blog-1812431336777691886.post-86121641599896333462016-06-16T22:24:12.879-04:002016-06-16T22:24:12.879-04:00" If you are spared the early coronary you..." If you are spared the early coronary you're at risk for a later disease that may be worse (or not, of course)."<br /><br />That later disease may look worse to observers, but ask the patient, and the patient always prefers the later disease. Really. You get decades of quality life by ducking that coronary. You always prefer a chance of getting at 80 than dying of a coronary at 55. Of course, you hope that medical researchers will be working on those in the meantime. (This is why smokers irritate me no end: the work spent on fixing smoke-induced cancers is work not spent on the diseases I'm likely to get.)<br /><br />"Many early onset disorders are quick and less lingering"<br /><br />That's certainly not true for cancer. Younger patients have better overall health and are better able to withstand aggressive treatment. Earlier detection means much longer times lived with the disease. (My reading is that if you subtract out the effects of less smoking, overall cancer death rates haven't been declining all that much. Of course, earlier detection means more early false positives and more people being treated for non-life-threatening cancers. Ouch.)<br /><br />"the number of expected person-years of misery"<br /><br />As you might guess, I don't buy this concept. At all. I'll take misery at 80 in exchange for those decades of guitar playing.<br /><br />"but our point was that there's no free lunch for a population"<br /><br />And I disagree. If your "population based science" is coughing up conclusions that are wrong for every individual, you are doing something wrong. Fixing a major cause of early death is a complete win for the patients concerned, and certainly doesn't make anything worse for the rest of the population. That sounds like a free lunch to me.<br /><br />At the back of my head in all this is a lovely review article I read in Science one week. By some bloke who had just turned 100. His obituary appeared a few weeks later. My conclusion here is, of course, that he'd have had more useful things to contribute had he managed to make it to, say, 104.<br /><br />Really. The bell does toll for thee. Every. Single. Time.<br /><br /><br />David J. Littleboynoreply@blogger.comtag:blogger.com,1999:blog-1812431336777691886.post-66212759261621266632016-06-16T10:35:00.137-04:002016-06-16T10:35:00.137-04:00Thanks for these long comments. How and when one ...Thanks for these long comments. How and when one dies and how one thinks about that is very personal, of course, and of course I'm glad I've lived to my current age rather than dying of the plague decades ago! But if lots of people now die earlier of coronaries, they are not dying later of cancer or dementia-related disorders. If you are spared the early coronary you're at risk for a later disease that may be worse (or not, of course). The effort to prevent early onset disease is a good one, but many late-onset traits are not at all pleasant, and the reason for the hospice movement etc. is that so many are lingering in very poor states.<br /><br />In a sense, if rates of cancer at age 80 are known, curing earlier heart disease doesn't increase the later 'rate', though the number will increase, a point I think was your main first one. Many early onset disorders are quick and less lingering so the number of expected person-years of misery may increase if earlier causes are eliminated. That's not an argument for letting us all go of plague at early ages, but our point was that there's no free lunch for a population, yet politicians seem eager to give the opposite impression. Preachers have always done something similar, except the immortal bliss they're selling isn't here on earth.Ken Weisshttps://www.blogger.com/profile/02049713123559138421noreply@blogger.comtag:blogger.com,1999:blog-1812431336777691886.post-76559787946574936092016-06-12T12:23:16.366-04:002016-06-12T12:23:16.366-04:00Hi again. I'm on your case because I respect y...Hi again. I'm on your case because I respect you. But.<br /><br />You wrote: "anything that reduces early onset diseases increases the number of late onset diseases."<br /><br />I disagree with this idea. Strongly. First, you don't measure diseases by deaths, you measure them by deaths per unit population. Really. That's how we think about diseases.<br /><br />Consider the following groups. (Different sizes since in real life they're different sizes.)<br /><br />Group A: 10,000 people who died of early onset disease prior to 65.<br />Group B: 100,000 people who didn't acquire early onset disease prior to 65.<br />Group C: 10,000 people who didn't die of early onset disease prior to 65 because it was cured.<br /><br />The RATE (yes, I'm shouting) of late onset disease in in each of groups B, group C, and group B + C is going to be identical.<br /><br />You haven't "increased late-onset disease" by curing earlier onset disease, you've increased the SIZE of the group**. You have to divide by population size to understand what a disease is doing to you.<br /><br />So the idea that curing early-onset disease increases the burden of late onset disease is wrong: it just increases the size of the population subject to the disease.<br /><br />Second, everyone in group C is way happier to be in group C than in group A. It is a complete win for everyone in group C not to have died of bubonic plague. No one thinks that it's anything other than great news that we've cured bubonic plague (we have, haven't we?). No one in group C thinks they'd rather be in group A.<br /><br />Third, if you want to argue that the folks under 65 are going to have to pay for treatment of late-onset diseases, ask how many of them are willing to volunteer to die of early onset disease*. That number is, of course, zero. To argue that curing early-onset diseases is anything other than a complete win for everyone involved is, sorry, completely dizzy.<br /><br />*: And, FOURTH, it's worse than that. The major costs of treatment occur in the last months of life, and those costs are just as enormous, e.g., for early cancers as well as later ones (maybe more so, since people (both themselves and their families) are more bent out of shape at dying young). So normal taxation of earnings of folks who were saved from early-onset disease may make their deaths cheaper overall. Really. Four strikes is way beyond being out.<br /><br />**: Quibble here. I probably need to look at not total population when counting deaths but "population over age X, where X is one standard dev. below average onset" or something like that. But, this is going to be a second-order effect, since in real life Group B is much larger than Group A. We have cured most early-onset fatal diseases, and aren't increasing the population much by saving people under 65. Which is why I changed the sizes of groups A, B, and C while writing this.<br /><br />Fifth. Not all deaths are long and lingering. Other than Alzheimer's, most people are intellectually functional up to the end. And if you've been intellectually active, you're less like to get Alzheimer's. (Hey! There's a reason for my spending the time to argue with you.) (Oops, this doesn't really affect this argument; it's just supports my intuition that pretty much all human deaths are pure tragedy. Heck, I even cry for Justice Scalia; he seemed to be having so much fun throwing his racist, sexist, hate-the-poor/love-the-rich recalcitrant monkey wrench in the liberal project that I thought he'd live forever. It's sad to see someone having that much fun die.)<br /><br />Well, actually it does have to do with this meme, since the feeling is that the dementias are a really vile way to go. But, really. Getting dementia at, say, 80 is better than dying of cancer at 55. By a lot.<br /><br />Whatever. Keep up the good work thinking/arguing about these issues, and don't let the computer nerds in the peanut gallery get to you.David J. Littleboynoreply@blogger.com