{P}rescription - #1 - 20 September 2023
🔵 Cancer screening tests don’t deliver their promise 🔵 Extending longevity by hibernating 🔵 How to win an argument without losing a friend 🔵 Want new ideas? Take a walk |
CONTENTS
| Cancer screening tests don’t deliver their promise || Extending longevity by hibernating || How to win an argument without losing a friend || Want new ideas? Take a walk |
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LEAD ARTICLE
The early bird … gets the crab. Heart disease and cancer top the list of causes of death after the fifth decade. Early diagnosis, while cancer is in its limited stage, is the key, we are told, to survival after treatment. This is tricky because most common cancers reside in the body for a relatively long period of time—months and years—before they are large enough to cause symptoms. Are there strategies for detection in the "pre-symptomatic" period?
"I’ll take half a dozen." For a long time now, six tests have been pushed as being of value in early diagnosis of the most common cancers.
Stool examination for occult blood suggesting malignant processes in the bowel.
Sigmoidoscopy (endoscopic examination of the interior of the last foot or two of the lower bowel) for colon cancer.
Colonoscopy (endoscopic examination of the interior of the entire large bowel) for colon cancer.
Prostate-specific antigen (PSA), a blood test for prostate cancer in men.
Mammography for breast cancer in women.
Chest CT for lung cancer, especially in high-risk groups like smokers.
There is heated debate on when and how often these tests need to be offered, but we won't go there today.
Failed promises. For decades, no one has seriously questioned the scientific validity of this panel. It sounded like a "good thing to do" and has been taken as an article of faith. But does this effort and expense deliver on its promise? A recent report in the prestigious journal JAMA is highly sceptical of the value of this recommendation. According to the study consisting of 2,111,958 individuals, only one of the six screening tests, sigmoidoscopy, increases life expectancy, that too by just 110 days.
The downside. For one, the monetary cost — the huge amounts of money spent pursuing false promises. More importantly, the emotional cost of errors from testing can be quite profound. False-positive tests (indicating a problem when there is none) occur regularly. The individual has to go through another round of investigations, often more invasive and expensive, to rule out the existence of cancer. The anxiety generated during this trial-by-ordeal is intense. False-negative tests are equally problematic. The false reassurance of an "all clear" could lead to complacency and delay in subsequent diagnosis.
Eating without proof of the pudding. The testing industry is huge and highly profitable. Technology keeps improving the capability of investigative tools. As Arthur Clarke, the famous sci-fi writer said, “Any sufficiently advanced technology is indistinguishable from magic.” Medical technology today is truly magical in its ability to look into the farthest corners of the body. We are mesmerised by their sophistication and grant them immunity from hard testimony in support of their claims.
"Win-win" trumps the truth. Many clinical guidelines, including the half dozen we are looking at, are the product of "consensus panels" of experts. Their main ambition is a "win-win" outcome, not necessarily the truth. Say the panel is debating two issues: "2 + 2 = 4" versus "2 + 2 = 6"; they will quite often end up recommending the midway position that "2 + 2 = 5!"
Experts are seldom right. In 1987, Philip Tetlock started a study where he began to collect forecasts from almost 300 experts, eventually accumulating 27,500 predictions. After 18 years of painstaking follow-up, he published his results in 2005, showing that experts were terrible forecasters. Panels of experts often put out a "consensus of the ill-informed."
"The plural of anecdote is not data." There are always reports and stories of someone or another getting a scan that showed an early stage of cancer which saved their life. A collection of such stories is just that, not science. Historically and unfortunately, stories fascinate us, while data puts us to sleep.
Devil's (or maybe, angel's) advocate. It is possible that this report may also be invalid. Huh? It's a meta-analysis, an examination of many studies on the subject, cumulated and scrutinised with rigid rules. It’s a popular study technique where the authors attempt to aggregate many small truths to establish a big truth. Lots of very knowledgeable, intelligent people dismiss meta-analysis as a dubious truth-seeking tool.
MORE HERE
▶️ Estimated lifetime gained with cancer screening tests. Quick Bite || Full article
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💬 “The one undeniable talent that talking heads have is their skill at telling a compelling story with conviction ... Consumers [should] stop being gulled by pundits with good stories and start asking ...how their past predictions fared—and reject answers that consist of nothing but anecdotes and credentials.” Philip Tetlock
💬“When did the future switch from being a promise to being a threat?” ― Chuck Palahniuk
Make mine a double. Human lifespans have doubled in most places in the world within the last century. From a meagre 30 or so years, it is now in excess of 60 years on average and well into the 80s for wealthy societies. This is easily one of mankind's greatest achievements. We shall not get into the question of how this happened; there is much debate on this topic.
Longevity pills? While there is universal advocacy for lifestyle modifications, there is also work afoot in research labs for identifying chemicals or compounds which can enhance longevity.
Laboratory studies on a compound called SNC80 show promise for inducing a state similar to hibernation (biostasis) with minimal effects on organ systems.
Apoptosis or programmed cell death is a mechanism that is hard coded into our genes. It is set at different points for different organisms, but all living cells must die. Ben Franklin's centuries-old observation on death and taxation still holds good.
Immortality - bad idea. Some Silicon Valley billionaires are even talking about living forever—an utterly horrible idea. The possibility of immortality or even extending life spans by large numbers is not in the best interest of the earth as a living ecosystem. Our already dangerously overcrowded and exploited planet cannot handle the burden of universally prolonged life spans. Plus, imagine the amount of emotional baggage that will build up. We will wish we were dead.
Dolce vita - good idea. On the subject, I would strongly recommend Dan Buettner's documentary series on Netflix, "Blue Zones." He examines in depth the factors that underlie why there are clusters of populations where people live into their 90s and 100s with nothing other than a remarkably simple and nurturing lifestyle. Must watch.
MORE HERE
▶️ Can we stop time in the body? Quick Bite || Full article
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💬 “[longevity] is not about the mere extension of life along a horizontal plane, but about the deepening of life along a vertical plane. Mere longevity cannot render life meaningful any more than brevity has the power to make it meaningless.” ― Peter Rollins
You never really win an argument. Even if you are right and the facts are in your favour, the opposing party ends up disliking you because people hate to be shown up as wrong. In many cultures, losing face is intolerable. It’s better to dissemble than speak the truth and disrespect your opponent.
Imitate hostage negotiators. Talking down hostage takers is easily the most challenging of situations where skilful argument and pacification is of utmost importance. Hostage negotiators are highly skilled professionals who know the inner working of those they deal with. There are many ideas and tactics that we could learn from them and use so that both sides come out satisfied.
The flip side — how to disagree. While on the subject, it's worthwhile looking at the obverse side. In 2008, Paul Graham wrote an essay, "How to disagree". He outlines a 6-part hierarchy of disagreement which "will help people to evaluate what they read. In particular, it will help them to see through intellectually dishonest arguments."
MORE HERE
▶️ Don't steamroll, and go easy on the stats: how to win an argument - without making things worse. Quick Bite || Full article
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💬 “You see, a conflict always begins with an issue - a difference of opinion, an argument. But by the time it turns into a war, the issue doesn't matter anymore, because now it's about one thing and one thing only: how much each side hates the other.” ― Neal Shusterman
💬 "It is equally important to avoid terrible arguments or expressions of outrage. You should steer clear of emotionally damaging behavior. People forgive, but it is best not to stir things up to the point at which forgiveness is required.” ― Andrew Solomon
Eureka moments. Archimedes, the tub, "Eureka", running naked through the streets of Atherns: we are all familiar with the story. The tub is only a metaphor for getting away from your place of work. A stimulating walk will do just as nicely and is far less likely to get you arrested for indecent public behaviour.
Quite often, we hit a wall when looking for fresh ideas. The harder you try, the worse it gets. At times like these, the best option is to stop and do something totally different: take a nap, take a shower, listen to music. Let your mind work unsupervised and it will quite often come up with a solution.
Stories are legion about writers, in particular, using short walks to generate new material. The Lake District and William Wordsworth's poetry is a famous example of creativity stimulated by walks in nature.
Multi-sensory inputs. Perhaps, the reason for this effect might be that walking in the outdoors stimulates all senses at once: sight, sound, smell, touch and position. You could argue that there are many other activities that provide the same background. True, if they are slow and gentle enough to allow you to "walk and chew gum at the same time." Gardening, yoga, Tai-chi could all work.
The Japanese paradox. It's well known that the Japanese have the world's greatest longevity. But there isn't much of a workout culture in Japan. In a survey of 1,000 Japanese people ages 20 to 60, about half of those asked said they didn't exercise much, about once a month or not at all. BUT:
Japanese adults walk an average of 6,500 steps a day. Men in their 20s to 50s walk nearly 8000 steps a day on average, and women in their 20s to 50s walk about 7000.
Not many households in Japan have cars. Since this is the case, most people walk to work. People walk when they go grocery shopping. People walk when they are going out to dinner. It's something that people of all ages do every day. Walking is as natural as breathing. Perhaps the kind of exercise we need is the kind that fits into our daily lives.
MORE HERE
▶️ Why walking helps us think. Quick Bite || Full article
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💬 “All truly great thoughts are conceived while walking.” ― Friedrich Nietzsche
Why the change? Why Substack?
It’s designed for writers and people who like good writing.
Its newsletter utility is simple and seamless.
It’s much easier to maintain and use than blogging platforms like Wordpress.
The Substack community is intelligent, thoughtful, and most of all, courteous, nice people.
There are no trolls and trouble makers on it, at least as far as my experience of it goes.
I can keep my contributions free for as long as I chose.
It’s the best “social media” tool that I have come across in many years.
Fascinating , educative , thought provoking as always . Thank you for the lead to the Netflix Documentary "Blue Zones". The article on BIostsatis was, for me, the piece de Resistance!
Hi Arjun: Loved this issue, especially the articles on cancer screening and negotiating