rank quackery was being “integrated” into medicine to produce an unholy fusion dubbed “integrative medicine” or “integrative health” by its advocates.

these data suggest that 30 cases of cancer per 100,000 women were destined to become large but were detected earlier, and the remaining 132 cases of cancer per 100,000 women were overdiagnosed

the estimated decrease in mortality attributable to mammography was 12 per 100,000 women in the earlier time period after mammographic screening was introduced. In more recent years, with better treatment, the estimated reduction in mortality was smaller, around 8 per 100,000. In comparison, the estimated reduction in mortality due to better treatment was 17 per 100,000. Thus, overall, better treatment has reduced mortality from breast cancer more than screening has.

Breast cancer mortality among women age 40+ was stable from 1975-1993 at 70-74 per 100,000, before beginning its steady decline to 48 per 100,000 in 2012 (a decline we argue is primarily treatment mediated). Stable mortality spanning the period of a 30% increase in invasive breast cancer incidence further argues that the increased incidence instead reflects the increased observational intensity associated with screening.

Rand posits that there is an objective reality we can learn about through science and reason

A is A. Facts are facts, independent of any consciousness. No amount of passionate wishing, desperate longing or hopeful pleading can alter the facts. Nor will ignoring or evading the facts erase them: the facts remain, immutable.

emergency room doctors

As for more advanced regional tumors (tumors with lymph node metastases or involvement of local structures) and metastatic tumors, the absolute numbers have also decreased, but not very much. If screening were having a huge effect on breast cancer, the expectation would be that removing tumors at a smaller stage would, nearly three decades later, ultimately result in fewer advanced cancers being detected, their having been preempted by screening and appropriate treatment by surgical excision and adjuvant therapy. (This is one reason why screening for colorectal cancer has been more effective; removal of polyps is effective at preventing the subsequent development of colorectal cancer.)

The most distressing conclusion of Esserman’s analysis is just how many patients need to be screened to save one life. It is well-accepted that screening women over age 50 for breast cancer does decrease mortality due to breast cancer by approximately 30%, but what does this reduction really mean?

Essentially, mammography reduces the odds of a 60-year-old woman dying of breast cancer in the next decade by 30%. Sounds impressive, until you look at her absolute risk: by getting her annual mammogram, her chances of dying from breast cancer are whittled from 0.9% to 0.6%. Overall, for every 1,000 women in their 60s screened for breast cancer in the next 10 years, mammograms will save the lives of 3 people but 6 others will still die

n 1973 forensic psychiatrist David Rosenhan published an experiment, titled “On Being Sane in Insane Places,” in the journal Science. His famous study concluded that psychiatrists could not distinguish sanity from insanity.

Partly in response to Rosenhan’s study, this new coalition of psychiatrists blamed the crisis in professional legitimacy on psychoanalysis. Its obscurantist theories, they argued, were more jargon than substance and had turned American psychiatry into a Tower of Babel, where psychiatrists could barely communicate meaningfully with each other. Research from as early as the 1960s showed that diagnosis among psychiatrists was not reliable statistically—that is, psychiatrists often disagreed on diagnosis even when assessing the same patient.

While the DSM-III and subsequent editions, including IV and 5, have improved diagnostic reliability, psychiatry continues to suffer from the problem of validity. In other words, the collection of symptoms that defined each condition in the DSM have still—after billions of dollars of investment—not been correlated with robust changes in our brains, blood, or genes.

At one meeting, a school board member said that, years ago, a therapist had “meddled with my teenaged son’s mind, because at that age they are most vulnerable and they want someone to talk to.” A local man got up to say that “our modern-day psychology is rooted in occultism,” noting that Sigmund Freud used drugs while writing his thesis and Karl Jung channeled spirit guides.

Leaving aside the cynical reasons the war in Iraq happened, Saddam was a fascist dictator who tortured and murdered his own citizens. If the invasion and aftermath hadn't been fucked up so badly, it could have been a net good for the world. I don't see the same argument can be made for the invasion of Ukraine.

All of them argue that mass immigration is a critical factor in making America majority non-white and therefore Democratic. And all of them are pretty much psyched