There have been massive improvements in treatments in the last 5 years. Sure, cancer is far from being "cured" - but survival today is far better than 5 years ago for many forms.
Among many others:
- CAR T therapy going from lab to oncology suite (first launch 2017, but use rapidly growing)
- Liquid biopsy going from lab to PCP's office - starting with Grail Galleri and moving from there (yes, the NIH results were weak, but the idea of a liquid biopsy at all would be laughed off 10 years ago)
- Move of Atezolizumab and Tecentriq from infusion (hour) to injection (minutes) to increase availability
- Lower dose CT scanning for lung cancer, including for non-smokers
And a long line of immunotherapies that are making the leap from lab to chair right now.
The last 5 years have probably been the most exciting in cancer research since the launch of the monoclonal antibodies in the early 2010s. There is still incredibly far to go, but the trend is in the right direction: https://employercoverage.substack.com/p/decline-in-cancer-mo...
Long answer, it's a variable you need to consider when doing data analysis, and it depends on what exactly you're talking about, but it's absolutely not true for improvements in cancer survival general. One alternative method is to look at per-capita death rates, for example:
Reduction in global age-standardized cancer death rate since 2000
(Scroll down to second graph. Since the population is getting older, age-standardization makes a fairer comparison)
https://ourworldindata.org/grapher/cancer-death-rates
2000 is an arbitrary year I picked for clear visual changes without needing to haggle over statistics. If you want to feel optimistic, switch the childhood cancer death graph to 1960-now.
This method has different possible failure points. It could be that less people are getting cancer, or that people who would get cancer are dying of other causes, or reporting of cause of death has changed, though this is very unlikely for some figures, such as leukemia death rates for children in the US. Statistics is hard. Overall though, the evidence is very good that cancer survival has improved a lot due to better treatments since 2000.
If you have a more specific claim you're dubious about, I'd be willing to look into it for you. I'm very enthusiastic about this topic.
Combined with your data, that implies that whatever wins we got from decreased cancer rates (e.g., less smoking) or improved treatment have been squandered elsewhere (probably obesity / heart disease).
If life expectancy had dropped over that time, then I guess it could be that cancer was as deadly as ever.
I wonder what the deal is with Greenland in your dataset. Lots of smoking? Lots of radiation?
I'm not exactly dubious about anything really, it was just something plausible I had heard a while ago and, while I don't recall where I heard it, I must have given it some credence for it to stick with me.
IIRC survival improvement has happened across all staging categories, including the worst one (IV, distant metastases found), so the answer would be "no".
A friend of mine, aged 50, has worked in pediatric oncology her entire (nursing) career. The ratio of surviving kids has flipped from 30/70 to 70/30 during her tenure.
Cool question. What form would an answer take? We need some detection benchmark data thats invariant over the period of interest. I hope the data exists but I would be surprised.
Another way to come at it would be mortality data. But that has a bunch of its own problems.
Everything is changing at once, it makes this kind of science so hard.
mRNA cancer vaccines are the most exciting new treatment about to hit the clinic. Moderna's Phase 2b intismeran autogene randomized trial found a 49% (!!!) reduction in the risk recurrence or death for patients with high risk melanoma already on standard treatment. Several Phase 3 trials are underway. mRNA vaccines have the potential to work for a wide variety of tumors.
(95% confidence interval is 0.294-0.887, wide but not too wide, n=157, to be expected for phase 2).
How they work is also completely fucking insane. Intismeran autogene is personalized for every patient via sequencing their tumor DNA. That's sci-fi shit. If you're not impressed by that, you should be. Fast and scalable DNA sequencing, neoantigen identification, RNA synthesis, none of this is easy and all of it relies on recent innovations across multiple fields.
The first proofs of concept for personalized vaccines like this date back to 2017[1] or 2015[2]. The process for designing the vaccines requires a machine learning algorithm first published in 2020[3]. Details of the algorithm aren't available, but it validated against data published in 2019[4], and there have been many recent advancements in algorithms and datasets for biotech ML that it likely relied on. As you might already know, mRNA vaccines were first tested in humans around the 2010s[5].
Radar is ineffective underwater because the radio waves are absorbed by the water. That is why there's no radar in use on submarines.
Sonar is not a valid solution here because it annoys the whales. Or at least high-power sonar, as used by the military, does. It would defeat the point.
Sonar is the solution; passive sonar using numerous hydrophones to chart the bearing of the whale. How that bearing changes over time allows you to deduce if you're on a collision course. This is tech developed by the military.
No jets use or have ever used leaded products. Jets run on Jet-A, which is a close relative of kerosene. It has never been leaded. The purpose of lead was to prevent cylinders from prematurely detonating ("knocking") in internal combustion engines. Jets do not have any cylinders to knock; the fuel burns continually in an open combustion chamber.
You may have been thinking of 100LL (100 Low Lead) fuel for piston engined planes. Many airports stopped selling 100LL in January of 2022. The FAA has approved a lead-free replacement in fuels like UL94 that are steadily replacing 100LL.
At last! I live in France and it is still 100LL everywhere, except for ultralights which mostly use automotive gas (mogas) or sometimes UL91.
But do they actually sell it everywhere? My experience with aviation is that change happens incredibly slowly. The simple fact that they still use that abomination that is 100LL is telling. Poisoning thousands of people for decades just because of paperwork essentially. As an amateur pilot, I understand the idea of using only tried and tested solutions, you really want things to be reliable up there, but our representatives can at least make the necessary efforts to make our already environmentally questionable hobby not needlessly poison people.
> Many airports stopped selling 100LL in January of 2022.
Really? That is news to me. Googling reveals that two airports did that, both in the same county: Reid-Hillview Airport (KRHV) and San Martin Airport (E16).
> Many airports stopped selling 100LL in January of 2022.
Judging by the size of the GA fleet, and by the fact that a sizeable portion of that fleet is not certified to fly with UL94, allow me to doubt the seriousness of that news..
There's lots of room to nitpick the evidence, but the studies are published:
> The relationship between age and job performance for Air Traffic Control Specialists (ATCSs) is an issue that has been revisited many times over the past few decades (Trites, 1961; Trites & Cobb, 1962; Cobb, 1968; VanDeventer & Baxter, 1984). Researchers have consistently found a negative relationship between controller age and performance across studies that have used different ATCS options (enroute, terminal), career stages (age at entry into training,current age on the job), and criterion measures (on-the-job ratings, academy performance) (Trites, 1961;Trites & Cobb, 1962; Cobb, 1968; VanDeventer & Baxter, 1984).
Thank you! This is the kind of data and study I was looking for. In this rather large thread you are the only one as of the time of this posting actually answering the original question I asked, “why does the rule exist?”
I don’t really see a problem with discrimination like this in this context as long as there is a well published scientific background of studies demonstrating why it makes sense, and there aren’t confounding variables (like a history of discrimination) that would skew the results. In this case it looks legitimate and well studied.
My only beef/complaint otherwise is that these papers should be front and center on the application page explaining why only 30 and unders are accepted.
After the pharmacies got sued for filling opiate prescriptions (which were written by abusive doctors, but the pharmacies are the ones who got sued)[1], is it any surprise that Xanax and Adderall are being limited? If pharmacies are at risk for filling prescriptions that are more complex than antibiotics, the end result is that they make it harder to fill them.
> is it any surprise that Xanax and Adderall are being limited?
That depends on who is doing the limiting — if the pharmacy corporations are self-limiting then I would understand they are limiting their potential exposure/liability to whatever risk level they are comfortable with. I’ll still be able to find my necessary drugs at another chain which doesn’t limit.
If the government is doing the limiting, then yes, that would be surprising. That seems to be the case here, and I think it’s a very inappropriate response — totally attacks the wrong part of the system.
The article goes to lengths to describe how the government, specifically the DEA are limiting supply by issuing edicts to pharmaceutical companies. Corporations don't generally defy government edicts, especially ones that lead to raids and jail time, so we really can say it's the government's doing here, rather than particularly self-limiting behavior on the part of the pharmaceutical companies.
That the government is threatening defiance of edicts with fines and jail time and not using direct means to stop additional production is not a distinction worth making - the government is limiting the supply of these medications.
Can you please provide a cite? I tend to think this coercion probably is happening.
Agency rule making should be public and published in federal register. I don't know what the effective recourse would be. The easy track is to go to Mexico and load up on what your Dr. prescribed.
I agree should be, but unfortunately that's not the case. Not in proper detail. Broadly, the DEA's power comes from the Controlled Substances Act, originally passed in 1970 - https://en.wikipedia.org/wiki/Controlled_Substances_Act, but the modern day limits themselves are secret.
The medications described are Schedule II, which is defined as "The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions."
> Xanax and Adderall Access Is Being Blocked by Secret Drug Limits
> The Drug Enforcement Administration regulates the manufacturing, distribution and sale of controlled substances, which can be dangerous when used improperly
> the limits themselves are secret.
> A Cardinal Health document reviewed by Bloomberg News says that limits are calculated on a daily, monthly, and quarterly basis.
Someone willng to pursue a lawsuit might file a FOIA and pursue in court for non-response. A sketchy approach could be suing pharmacy for ... something ... then find the limits for that company via legal discovery.
Land of the free or not.
We might be able to get the ACLU to sign on. They've filed a number of lawsuits for patients being denied gender-affirming care in various states. Without getting into a debate about the politics of gender-affirming care, those lawsuits would seem to spell out that denial of life-affirming care that sufferers of ADHD, a federally recognized disability, have experienced could give them legal standing to sue doctors over.
> those lawsuits would seem to spell out that denial of life-affirming care that sufferers of ADHD, a federally recognized disability, have experienced could give them legal standing to sue doctors over.
As a person with adhd, why would i want to sue my provider? They have nothing to do with why there's been an adderall shortage since october. it seems to me the last thing I want to do is make providers feel averse to treating adhd out of concern for being sued.
Not a lawyer, but it seems plausible that doctors here do 'nothing' in terms of doing damages that would establish legal standing. A doctor that is prescribing medications indicated to treat a diagnosed condition at reasonable dosages isn't doing harm/inflicting damages on patients. And if there are broader social harms coming from aggregated practices of physicians in general (e.g. over-prescribing), it would be unreasonable for any individual physician or medical practice to bear the burden of punishment/compensatory payment on behalf of the industry in general.
This sort of thing is better handled through regulatory and legislative means. Perhaps it's not being handled particularly well at the moment, but the status quo seems preferable to establishing precedent that one can successfully sue a doctor for writing appropriate prescriptions for drugs that are scarce due to supply chain bottlenecks.
as per the article, the limits are being imposed by the DEA not the pharmacies and not the distributors.... a better approach would be to do a FOIA on the DEA and get all evidence about their restrictions on distributors for schedule IV narcotics (xanax, adderall, etc) and then sue the DEA maybe for interfering with interstae commerce, i dont know...
In my brooklyn neighborhood, our pharmacist is basically the neighborhood “doctor”. He’s so trustworthy and conscientious that neighbors typically check with him before going to urgent care or making a real doctor appointment for anything. Then if he doesn’t see you for a couple of days he calls to make sure you’re feeling better. It’s all very cute and the relationships and position of trust reminds of what I imagine small town family medicine practice is like.
They can and should—that’s their area of expertise. I’ve had pharmacists catch dangerous but obscure drug interactions that my doctors failed to catch, typically because the two interacting medications were prescribed by two different types of doctors. Even though both would’ve had access to the same medical records and my full medication list, and even though that data was being checked by a computer, mistakes happen and databases are sometimes incomplete.
I've had pharmacists deny me because I was paying for amphetamine without insurance. They said it was suspicious and refused to call my doctor to confirm that I wasn't some sort of criminal.
That's the kind of unreasonable power that they shouldn't have. Finding bad drug combos? I don't think anyone has an issue with that.
If you find a customer to be suspicious (I was wearing a black t-shirt, to be fair), you should be required to call the customer's doctor office and confirm the prescription.
> That's the kind of unreasonable power that they shouldn't have.
Then the government should come out and say they will not go after pharmacists for filling any and all prescriptions.
The government wants it both ways, keep doctors and pharmacists liable and randomly nail, but not clearly publish standards of rules so no one can accuse the government of intervening in people’s right to healthcare.
Government gets plausible deniability and someone to throw under the bus. No reason for the people that can get thrown under the bus to stick their neck out.
Even if you do everything right they're still often suspicious. I suspect pharmacies keep tabs of "suspicious activity" like asking for an early refill before a work trip.
These secretive DEA limits just underline a weird "moral judgment" of people who have conditions that benefit from stimulant medications. Almost like its our faults for having neurochemistry's that don't uphold the perceptions of a protestant work ethic.
The worse part is that its mostly separated from any particular religion nowadays but agencies like the DEA that essentially self-reinforce this lopsided moral code.
I concur, pharmacists have no legal basis nor license basis in determining the decision making of a licensed medical doctor. The doctor is the one that provided the care came up with the diagnosis and came up with the plan for the prescription for the medication. The only role the pharmacist has is in dispensing that medication. it's wholly inappropriate for a pharmacist to get into the business of second guessing the work of a licensed MD.
For one thing, pharmacists aren’t just retailers. For example, I take a very powerful medication. It’s essential to get the dose just right.
My health care organization employs a pharmacist who sepecializes in the medication, and sets the doses for patients in the program.
This pharmacist doesn’t dispense medication. She instructs the physicians on what dose to prescribe.
I recently had an extremely painful medical event. I was given hydrocodone, but it didn’t have any effect. A pharmacist was called in, and they figured out a drug cocktail that addresses the pain.
Pharmacists really are medical experts and a knowledgeable part of the care team. Doctors should use their expertise more than they do. And it’s completely appropriate for a pharmacist to assertively demand an explanation for what’s going on.
as mentioned throughout the comments I've also seen many situations where patients that were given prescriptions were then turned away by pharmacists because they didn't like the type of clothes that the person was wearing or they didn't think that there was a diagnosis to match the prescription, or that the doctor was too far away in a different town in the same state, Even though the patient might have been taking this medication for 20 years or more... This is only happening recently within the last few years, specifically after the multibillion dollar settlement by CVS and Walgreens that happened in November of 2022... so I'm not buying it that pharmacists are allowed to Trump the decision making of medical doctors.
I guess you are right, according to some articles online [1], a pharmacist can refuse to dispense a prescription due "moral and/or religious" reasons.... so they literally can just look at you and say well you know what I don't think you deserve this stuff sorry go somewhere else and I guess it's perfectly okay, because of a moral duty, which is vague and specious.
And that is such b.s. the one and only time I seeked medication for a certain issue, even though I went through a lot of embarassing process to get a perscription I was questioned like I was a drug dealer or something by the pharmacist in front of many people standing there.
Short of life and death situations I don't think I will be seeking any kind of medical care in the US. If it isn't urgent I'll make a vacation out of it and travel to cheaper more humane countries.
>which were written by abusive doctors, but the pharmacies are the ones who got sued
Must be nice to have a professional organization that acts like a cartel and makes lesser people pay for the sins of all but the worst of the worst actors.
It’s amusing watching the hn commentariat freak out that they can’t get their amphetamine after years of telling chronic pain sufferers to just tough it out because opiates and the Sacklers are bad.
The other way around. "Blank check companies" have existed for many many years, but were a relatively rare instrument and did very bespoke deals. Most investors never heard of them. In recent years, a standardized deal emerged that became known as a SPAC (and all the recent flavors of the month). If you look in SEC regulations, you'll see references to "blank check companies" all over the place.
Interesting. Why are SPACs getting a bad rep? Is it because of the acquisitions of shady companies or is there an underlying issue with the process followed by SPACs?
SPAC sponsors get essentially a free money trade when they merge with a company; usually this results in merging with sub-par companies with bad numbers (no revenue or even product usually) so investors can cash out massively without the company really needing to succeed at all
Case in point: most SPACs have fallen anywhere from 50-70% (evtol/lidar/battery companies) over the past year due to the fact that most don't have either a working product or poor numbers
I know there were a few people organizing on reddit too where they would ship it if you can't access it easily too! I think it was a lady on /r/opiates
Among many others:
- CAR T therapy going from lab to oncology suite (first launch 2017, but use rapidly growing)
- Approval of Keytruda and similar for many additional forms of cancer (see the 2021-2026 milestones here: https://www.drugs.com/history/keytruda.html )
- Liquid biopsy going from lab to PCP's office - starting with Grail Galleri and moving from there (yes, the NIH results were weak, but the idea of a liquid biopsy at all would be laughed off 10 years ago)
- Move of Atezolizumab and Tecentriq from infusion (hour) to injection (minutes) to increase availability
- Lower dose CT scanning for lung cancer, including for non-smokers
And a long line of immunotherapies that are making the leap from lab to chair right now.
The last 5 years have probably been the most exciting in cancer research since the launch of the monoclonal antibodies in the early 2010s. There is still incredibly far to go, but the trend is in the right direction: https://employercoverage.substack.com/p/decline-in-cancer-mo...
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