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Culture War Roundup for the week of October 2, 2023

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Cancer screening doesn't generally have the advertised benefits when we look at all-cause mortality rather than cancer-specific mortality. Here's a fairly recent review of evidence on mammograms specifically. At this point, I'm against government funding of mammograms until someone can demonstrate that it actually improves health outcomes.

Hydro asked if it was mostly "gay stuff and contraceptives," and the answer is no.

I understand that you're in favor of general slashes to most forms of government aid. But I doubt that the opposition to Planned Parenthood stems from principled minarchism.

The linked report is interesting, though. It's a plausible thesis, and the provided meta-analyses don't suggest much of an effect from mammography.

Since then, overdiagnosis has become apparent in two studies of mammography trials based on at least 15 years of follow-up data, which imply overdiagnosis rates of 5 to 55 percent depending on the subgroup and base rate (1, 2).

#1 concludes with a 10% overdiagnosis in women 55-69. #2 says 30% in women age 40-49 and 20% in women age 50-59. They're certainly suggestive of a correlation with age. Let's use the conservative figure. For every 7 women who needed the diagnosis, then, 3 didn't. That...doesn't feel terribly wrong to me? And I'd certainly feel comfortable with a 9-to-1 rate.

Anyway, back to the main thrust: all-cause mortality. Much like the trend lines, the author oscillates between emphasizing the lack of statistical significance and the weirdness of seeing a trend line at all. How could the interventions actively kill people sooner? Is there a confounder, where the people who actually get screenings are the ones who are a little unhealthier to start?

So...interesting results. Probably a good reason not to screen under 50 or 55. This is a little more strict than what various governments already suggest.

Though I would hesitate to use this as evidence against cancer screening in general. The paper cites colorectal and cervical cancer as examples where the outcomes really are much better with earlier detection!