Mammograms

Several studies have disputed the efficacy of mammograms. I, being a man, of course ignored these when they hit the news last year. Some friends were discussing it, which got me thinking, "How could getting mammograms not help?"

Here are two articles which discuss the changing science on mamography:

• http://www.hsph.harvard.edu/news/features/vatten-mammography-screening/ (link) 
• http://well.blogs.nytimes.com/2012/11/28/ignoring-the-science-on-mammograms/ (link)

The first indicates that screening does not correlate with reductions in breast cancer mortality rates. Also, screening tends to find cancers that "would not have harmed them". The second reinforces that "that screening mammography doesn’t save lives" and "the number of cancers diagnosed at the advanced stage was essentially unchanged".

I thought about this for a while. How could screening mammograms, which find early stage cancer, not reduce advanced stage cancers or cancer deaths? I came up with five reasons:

1. The early cancers detected would not have become malignant, so finding and treating them doesn't affect mortality rates.
2. The early cancers that may have become malignant would have been caught at a later time. Treatments are now so advanced that the delay doesn't appreciably affect the mortality rate.
3. Other screening methods are finding cancers so mammogram screening is less effective at finding cancer. Maybe women who do self exams find more cancers compared to women who wait for their yearly mammograms. This would strangely lead to a correlation between mammograms and increased mortality rates.
4. The treatments may negatively affect mortality. Getting surgery or radiation or chemotherapy on early cancers or benign cancers may damage health enough to outweigh any benefits. I couldn't find a clear answer whether the mortality rates were just due to cancer, or due to anything (I'm guessing the latter).
5. The advanced cancers appear very quickly and are very deadly. This makes some sense because cancer is uncontrolled growth of previously normal cells. Fast growing cancers would seem to be the most deadly. In this case, the mammography screening rate might have to be monthly to have a hope of finding these advanced cancers in time to make a large difference in mortality.

I decided to actually read the original New England Journal of Medicine article, so see if I could understand what was going on.

• http://www.nejm.org/doi/full/10.1056/NEJMoa1206809

It enlightened the situation, and also showed the difference between scientists and science journalists. Here are some quotes for the NEJM study Discussion section:

• "Over the same period, the rate of death from breast cancer decreased considerably. Among women 40 years of age or older, deaths from breast cancer decreased from 71 to 51 deaths per 100,000 women — a 28% decrease. This reduction in mortality is probably due to some combination of the effects of screening mammography and better treatment. Seven separate modeling exercises by the Cancer Intervention and Surveillance Modeling Network investigators provided a wide range of estimates for the relative contribution of each effect: screening mammography might be responsible for as little as 28% or as much as 65% of the observed reduction in mortality (the remainder being the effect of better treatment). Our data show that the true contribution of mammography to decreasing mortality must be at the low end of this range."
• "As treatment of clinically detected disease (detected by means other than screening) improves, the benefit of screening diminishes"
• "Women now widely recognize the significance of a new breast lump and the need for diagnostic mammography. Ironically, increased awareness confers less opportunity for screening mammography to reduce the incidence of advanced cancer. ... We agree that women should understand that screening raises their risk of becoming a patient with breast cancer and that there is uncertainty about the benefit of screening. The assessment of how to cope with that uncertainty, however, remains a value judgment that we believe should be left to women and their doctors." - Authors response in Letters section

It should also be noted that the study did not follow women to see what they were doing, but looked at general statistics. It did not look at a woman's family risk of breast cancer, or whether they did self exams. Also, some fairly large adjustments had to be made to account for hormone-replacement therapy's effect on cancer rates.

What I take away from this is screening, in all forms, is useful, but results should be reflected on before health-affecting treatments are begun to make sure they are necessary. But this is a complicated subject, and my heart goes out to anyone who has to deal this these issues.

Vote For Info

If you don't vote, you can't complain.

You've heard that, probably from a coworker or friend. Voting is usually touted as the primary democratic right. And it is. But it is not the primary democratic responsibility. Your primary responsibility in a free society is to be informed.

Dictatorships are easy. You don't have to make any decisions. But when things get too bad for you to bear, then action is required. It is like getting out of a rut in a muddy path. Dirty and violent.

Change in democracies should be easy. They are a paved road; switching lanes should be as easy as turning the wheel. A wheel with 24 million hands.

Democracies require continual vigilance and Dictatorships require occasional violence.

The problem in democracies comes when people say, "I'm not into politics." That's like saying, "I'm not into oxygen." You're lungs are into it, whether you are or not. Politics affect every part of your life, unfortunately. You don't need to be an expert, but you do need an understanding of facts. Where do your tax dollars go[1]? What is the difference between debt and deficit[2]? How much of the gasoline price is taxes[3]? What industry emits the most greenhouse gases[4]?

The reason democracies required an informed population is so bullsh!t doesn't rise to the top. If someone says they are going to lower taxes, increase services, and reduce the deficit, you know they are lying. You won't vote for them. You'll vote for the guy who says, "We are spending more than we take in so, unfortunately, we will have to cut back."

The US recently had presidential debates, which is basically Presidential Idol. Some questionable "facts" were spouted that night (see this Mish article). This type of fact checking should be big news, not page 6.

People want it both ways. They want the convenience of a dictatorship, with the freedom of democracy.What happens is they get politicians whispering sweet nothings and bribing them with someone else's money. They get the US, where you can vote for a big liberal government or a big conservative government. Where a "liberal" president has prosecuted more whistleblowers than all other presidents combined.

I had a conversation with an American who thought state-run health-care was some communist plot. I pointed out that health-care in Canada is not only half[5] as expensive, per person, than US health care, but also has better outcomes. I did agreed with some of what he was saying (e.g., we could privatize some of our health care), but facts were clearly getting in the way of his argument.

I shouldn't get off-topic. I'm fiscally-conservative-socially-liberal[6], but I can be swayed by a good argument, backed by facts. Facts are what matter. Facts shame and correct democratic governments when they spout nonsense.

If you don't care about facts, don't complain if you get a used-car salesman for a leader.[7]

-----------------

[1] Can you believe $9.4B per year goes to "Public Safety"? That is 3% of your taxes!
[2] Debt is what you owe, deficit is the difference between what you earn and spend.
[3] 32%.
[4] Coal-fired electricity generation. Or maybe cows. Or electric cows.
[5] Halfish. Or something. It is less, for sure.
[6] Code for: I'm a type-A first-born of hippie parents.
[7] There is no way that quote deserved to be in italics, but its the best I could come up with. Come on, man. I have work to do. I can't spend all my time coming up with quotes you can put on matchbooks. Damn.

3D Printer - Part 1 - Setup

I was under the sink recently (and for a handyman like me, recently is last year), and I wished I had some sort of stand for the flashlight so I could see what I was doing. If you have ever wished for a small inexpensive part, then maybe you too should spend thousands of dollars on a 3D printer. Wait, that just sounds crazy.

3D printers are like 2D printers, except they print in plastic. They are like hot glue guns than deposit layer on top of layer of plastic until a 3D object is created. One of the plastics it can use is ABS, which is what Lego is made of.

I thought I'd blog about my experience, because 3D printers are not mainstream consumer-friendly devices yet. There is a learning curve. Or learning cliff.

I first bought a Solidoodle 3D printer. The wait time was going to be 8-10 months before they even built it. This is common in startup companies; it takes time for them to ramp up from a custom one-off shop to an efficient assembly line. But after a few days, I decided I didn't want to wait. Also, I was a little nervous they might go broke before they shipped mine. I was order number #3800, and they had just shipped printer #50 out the door.

So I bought the MakerBot Dual Extruder Replicator instead. It is several times more expensive than the Solidoodle, but it is an established company and product. It took 2 days to get to Canada from their shop in Brooklyn. Of course, it took over a week to get out of customs, where I had to pay GST before they'd release it. For some reason, I think I'll blame Canada Post. (Jerks.)

Unboxing and setting it up was relatively easy. The instructions are good, and their website helps you get printing right away. I got a dual extruder model, which can print two different colors of plastic, or print two parts at once. The printer comes with black and white, and I also bought red and blue. I should have bought some zombie green, because I'm going to make a whole bunch of those.

After finishing my first print, with a few hiccups, I wasn't really sure what to do. The Replicator can either print directly from your computer, or from an SD card inserted at the side. My plan was to keep the Replicator in our spare room and just bring the card in to print. The card is preloaded with shapes to print, but there is no list of what each part is. I tried a few until I got this one, a calibration cube. It is very light because the inside is mostly hollow. There is a honeycomb shape inside which keeps it structurally strong but light. 3D printers like this can't print anything parallel to the ground, because the plastic will droop (it comes out of the nozzle at 220 degree C).

I'm going to continue printing and figuring this out. More to come.

Failure is Fun and Profitable

Capitalism gets a bad rap. Some of it is deserved and some of it isn't. The worst thing is when people don't even know what capitalism is.

Pop quiz: What is the defining feature of capitalism? I bet most of you said "Greed", and you'd be partially right. I prefer to call it "Self Interest", like Adam Smith did.

Actually, the defining feature of capitalism is Failure. That's right: Failure.

Failure is the balance to Greed. While Greed might lead people to take risks with their (and other peoples) money, Failure is what helps rein in the risks.

Small failures help prevent big ones. Just like small forest fires clear out the deadwood, small failures help eliminate poor businesses from the marketplace.

This is why if you ever hear things like, "The company is too big to fail," or "We have to stop this company from going bankrupt to save jobs," or any other nonsense that implies failure is bad, you know that is not capitalism. Government bailouts are not capitalism. Government subsidies are not capitalism.

Frankly, any government jobs are not capitalism because the government cannot go broke. Government jobs are like an actor playing a role. Natalie Portman did a damn good job in Black Swan, but she will never be as good as a real dancer because real dancers have more to lose. If a government agency screws up and goes over budget, who cares? In the real world, the company would go broke. When government jobs are lost, I'm usually happy because the private sector can do it more efficiently, if it needed to be done at all. (Just to be clear, losing a job is tragic. But the idea that creating government jobs helps the economy is crazy.)

Bailing out failing companies is terrible because it not only rewards bad behavior, but it punishes good behavior. All the competitors to the failing company (yes, I'm looking at you Air Canada), who actually know what they are doing, don't get any reward.

Capitalism has many flaws, but failure isn't one of them.

European Crisis De-euphemismified

Politicians use euphemisms so no one can understand the truth. The media use euphemisms because they don't understand the truth.

Here, for your viewing pleasure, is a breakdown of the some of the terms used in the discussion about the European debt crisis*. I've used Greece and Germany as examples (represented by their flags), but this really applies to any country. For example, Iceland's government defaulted on its debt to the UK.

The key thing to understand that when people say "Greece is being bailed out", what they are really saying is "Greece is being given European taxpayer money so they can pay foreign banks back".

And as for all the self congratulating yesterday that the crisis had been averted, mark my words: Greece will default.

Oh, and if you are wondering why I'm drawing up flowcharts about economics when I'm supposed to be an engineer, it is because I have layers, like a parfait**.

* This is available in wallet size, so you can carry it around and look like a dork!
** Euphemism for "I took an economics course once and now I think I understand world economies, plus its lunchtime and I'm bored."

Poker pile-on

Full Tilt Poker, an online poker site, just recently was called a Ponzi scheme. The US governement has upped its attack on poker sites, and in the process, will cost Americans a lot of money.

Full disclosure: I have $14 in my account at Pokerstars.com. I also used my frequency player points to buy a mug and a cap. I originally deposited $50 back in 2005, took out $100 in 2006, and have vacillated between $10 and $30 in the account since then. Obviously, I have a lot riding on this. If Pokerstars goes under, I'm going to have to have that difficult conversation with the wife: "I know I've made some bad decisions. That massage chair for $800 which I never used. Those fur coats for the dogs. Three big screen TVs in 3 years, each time saying, yes, this one is finally big enough for me*. But now, its going to be Kraft dinner and tuna for the next few weeks. Wait, what?! I just found $14 in the couch ... never mind!"

Back in 2006, the US government slipped a section into the SAFE Port Act that made sending money to online gambling sites illegal. This was a big blow; some sites pulled out of the US and others declared they would still serve Americans. The next few years, online floated along in a grey area (like Canadians getting US satellite signals or picking up a chocolate bar off the ground and still eating it) and then "Black Friday" (Apr. 15, 2011), where the US government arrested representatives of the big online poker sites and shut down the websites. Their big claim is that poker site "tricked" banks by disguising charges. Now the US has made a further complaint, that Full Tilt is a Ponzi scheme and doesn't have enough money to allow players to get their deposits back.

This is so annoying. Hey, you know what else is a Ponzi scheme? CPP! The money young people give to the Canadian Pension Plan isn't invested or put in the friendly giant's mattress; it pays for the old retired fogies. But don't worry, when you're an old fogy, there will be a new batch of suckers to pay for your retirement. Or something.

That was annoying thing #1. Here's number #2**: poker players warned about this. Hey Sherlock, if you make it hard to get money out of a poker site guess what? It becomes hard to get money out of a poker site. The reality is people are going to play online poker because casinos are creepy. I'd rather sit in my underwear and play poker with my wife sitting in her nightie on the couch next to me ... wait. Okay, that's a bad example because 14% of the time you'll see that exact scene in a casino. But you get my point. And with the US government making it much harder to legitimately get money on/offline, you push poker players into having to use shadier methods. Like sending checks to the pokersite with sneaky names like the "Ace of Spades Non-Gambling Charity Foundation".

Annoying #3 is poker is not gambling! I know, you might think it is because there are cards and a dealer, like blackjack (which is gambling). But its not, because there are players that consistently win. What's that? Your aunt Sally wins at blackjack? No, actually she doesn't. She's stealing from you uncle. But the other reason why it can't be a game of chance is that you don't have to show your cards to win. You can bluff. The last reason is that you get to check your cards first before you voluntarily put money it. In blackjack, craps, and roulette you have to pay before you get your cards, the dice are rolled, or the wheel is spun (raggedy man!) Not gambling mean laws that apply to gambling don't apply to poker.

So what we have is an activity that adults freely engage in and the US government has declared war on. So what that a bunch of players are going to lose a bunch of money. Collateral damage.

Now Full Tilt isn't helping by mismanaging its funds. But the scary thing is the exactly same thing would happen if everyone decided they wanted their money in their TD checking account (worse ... see below). The US government is making a big deal about the fact Full Tilt has $400MM in liabilities and $40MM in cash. But what they don't mention is these sites make about $1MM a day in profit. Like all businesses, cashflow is much more important that net assets. But if the US would stop being so anti-online poker, these sites could set up in the US and be regulated. This is win-win, because they would pay taxes and they would be regulated so they would be required to keep some percentage of deposits available.

Okay, now something that will scare the hell out of you. Full Tilt had 10% of its deposits in reserve. In banking, this is called the "reserve rate". And Canada phased out "reserve rates" back in the 90s. Yes, that means that banks in Canada are free to lend out 100% of the money you deposit. But don't worry. Because the powers that be are dealing with this huge gambling problem.

* Phrasing!
** This is like saying "number number 2", but it made me laugh, so it stays in.

Unite without unions?

Air Canada flight attendants, members of CUPE (Canada's largest union), are planning to strike tomorrow. It was only back in June that the government nearly had to legislate the Air Canada call-centre staff back to work. Some questions come to mind when I hear all this. Why aren't there strikes at Westjet? Why does the government have to legislate people back to work? Why are unions necessary?

When I was in college, the teachers at my high school went on strike. They needed people to help the students, so I volunteered. My dad, at the time, didn't say much, as I was an adult. But I think it was pretty scandalous, me being a scab. Frankly, I needed some money, and I felt bad for the kids, so I decided to help. I didn't have to physically cross any picket line, however.

In the years that followed, I started to feel bad about doing that. That is about the time I read a lot of Noam Chomsky, and thought "the man" was screwing everyone over. I worked at a lumber mill one summer, and I remember a poster in the shop: "Your boss needs you, you don't need your boss." I've come to realize that capitalism is a heartless economic system, but it better and freer than any other system out there.

Collective bargaining is entrenched in law in Canada, while in other places it is voluntary. Here is why I think mandatory collective bargaining is not necessary.

Say I go into Walmart and I want to buy a $10 soccer ball. I say to the manager, "I want 10% off this ball." He says no, and I leave the store. Both of us are free to bargain and then agree to terms.

Now lets say I go into Walmart and I represent a soccer league (a collective). I say to the manager, "I'm going to buy 100 soccer balls and I want 10% off." There is now incentive for the manager to deal with me. He can sell a lot of balls at once and since he's just dealing with me, there are savings (rather than selling 100 balls to 100 people). He counters with 5%, and we are both free to accept or decline the terms.

Imagine that I want my 10% but he is unwilling to give me that, so I barricade his doors and shut down his store. This is essentially what Canada's collective bargaining laws are like. There is already incentives for management to deal with a group of people, rather than just each person separately. There is no need to make it law. But when it becomes law, it distorts the normal functioning of the market.

If employees bargain as a group, they gain some leverage over a company. But there needs to be balance, or else it is just legalized extortion. If a collective's demands outweigh the cost to fire all of them and retrain new employees, then the company must have that option. Of course, smart companies know that this is a last resort and would only be done if the employee collective was being totally unreasonable. But company management understands the broader picture. Public companies have stockholders who must be paid. They know the market climate. Employees are just one piece of the puzzle.

Because employers are not allowed to fire unionize employees, we end up with a system that constantly needs government interference and legislation. If collective bargaining were voluntary, like all contracts, the market would function much better.

It is tough to talk about this because I know many people with government pensions. I think talking about pensions (specifically) and unions (in general) usually gets bogged down in the historical function of unions, which was to protect workers from oppressive and unsafe working conditions. I don't really think these are an issue anymore because they are now covered by Canadian law. And I don't think non-unionized companies are unpleasant to work for.

I think my biggest concern with unions is they foster an "us" vs. "them" attitude between employees and management. This is why, I believe, Westjet doesn't have strikes. The union isn't necessarily concerned about budgets and cashflows. Its mandate is to get the best working conditions and the highest salary. I don't even think they are that concerned about maintaining workers for the future. For example, if there is a 10% cut to a school districts budget, and the teachers union declares they have to let go 10% of the teachers (mostly the new hires), they are being disingenuous. Everyone could take a 10% pay cut and then everyone could keep their job. (Of course, upper union managment couldn't afford $1000 pants anymore*.) These are the types of compromises that other companies make all the time. Smart companies know that everyone taking a pay cut while times are tough will significantly save training money in the future when business picks back up. These are the types of things that unions aren't really concerned with.

I think unions may have outlived their usefulness. I think people should be free to enter into legal contract with whoever, and however, they want. I think workers and management, pulling together with the same goal (success of the business) is a much more effective strategy. Of course, if I ever get a unionized job with a pension, forget I said any of this.

*I'm serious. I'll tell you about it someday.