The end of the PSA as we know it?

So many men have really suffered from counter-productive prostate cancer screenings via the PSA.  The medical community has finally come around on this.  I long ago decided there was no PSA in my future unless the test were radically improved.  Here’s the latest:

Men should no longer receive a routine blood test to check for prostate cancer because the test does more harm than good, a top-level government task force has concluded.

The recommendation from the U.S. Preventive Services Task Force runs counter to some two decades of medical practice in which many primary care physicians routinely gave the prostate specific-antigen, or PSA, test to healthy middle-age men.

But after reviewing all available scientific evidence, the task force concluded that routine PSA screening will help save the life of just 1 in 1,000 men who get the test.  [emphasis mine] At the same time, the test steers many more men who would never die of prostate cancer toward unnecessary surgery, radiation, and chemotherapy, the task force concluded.

How’s this for a cost/benefit?

But after reviewing all available scientific evidence, the task force concluded that routine PSA screening will help save the life of just 1 in 1,000 men who get the test. At the same time, the test steers many more men who would never die of prostate cancer toward unnecessary surgery, radiation, and chemotherapy, the task force concluded.

An absolutely classic case of overtreatment creating far more harm than good.  It’s a shame that it took so long and caused suffering for so many men, but it’s nice to see that medicine can actually make a dramatic course correction on something like this.


Convicting the innocent

Michigan and Northwestern law schools have released a study of wrongful convictions and exonerations in recent decades (via AP):

More than 2,000 people who were falsely convicted of serious crimes have been exonerated in the United States in the past 23 years, according to a new archive compiled at two universities.

There is no official record-keeping system for exonerations of convicted criminals in the country, so academics set one up. The new national registry, or database, painstakingly assembled by the University of Michigan Law School and the Center on Wrongful Convictions at Northwestern University School of Law, is the most complete list of exonerations ever compiled.

The database compiled and analyzed by the researchers contains information on 873 exonerations for which they have the most detailed evidence. The researchers are aware of nearly 1,200 other exonerations, for which they have less data.

They found that those 873 exonerated defendants spent a combined total of more than 10,000 years in prison, an average of more than 11 years each. Nine out of 10 of them are men and half are African-American.

Nearly half of the 873 exonerations were homicide cases, including 101 death sentences. Over one-third of the cases were sexual assaults.

Not surprisingly, there’s some common failures in our system that lead to this:

In half of the 873 exonerations studied in detail, the most common factor leading to false convictions was perjured testimony or false accusations. Forty-three percent of the cases involved mistaken eyewitness identification, and 24 percent of the cases involved false or misleading forensic evidence.

In two out of three homicides, perjury or false accusation was the most common factor leading to false conviction. In four out of five sexual assaults, mistaken eyewitness identification was the leading cause of false conviction.

Certainly seems clear that we need to introduce some more safeguards with how we use eyewitness testimony.  And as for the perjury, just maybe if we stopped offering jailhouse snitches reduced time in prison to concoct jailhouse confessions that rarely seem to happen in real life, that would sure help to.  Of course, 873 is a tiny drop in the bucket of all the convictions.  Suffice it to say, though, that the 873 represent systematic flaws in our justice system that I would guess are responsible for at least 100x that amount of wrongful convictions.

Photo of the day

From the NYT’s Lively Morgue photo archive:

Nov. 23, 1968: The Times wrote about the White House photographer Yoichi Robert Okamoto, right, who produced most of the 250,000 photos of President Lyndon B. Johnson housed at the time in a laboratory in Georgetown. The reporter, Nan Robertson, called the collection the “greatest album of candid pictures ever made of an American president.” She continued: “Some persons are appalled by the size and expense of Mr. Johnson’s picture operation. Others believe the price is little enough to pay for pictures that will be priceless to historians.”Photo: George Tames/The New York Times

How much does it matter where you go to college?

There was a fairly recent study that showed that it’s not so much where you went to college that matters for future life earnings (though, that’s certainly a very incomplete measure of “success”), but rather where you got in to college.  I.e.  If you were smart and talented enough to get into Harvard, you should still succeed greatly even if you chose to slum it at NC State.   Apparently, there’s more to it than that.  In the Atlantic, Jordan Weissmann sums up the major strands of evidence on the issue:

Nope. There’s evidence that where you apply is more important than where you attend.

In studies this decade, academics have gone out in search of naturally occurring experiments to try and figure out if it’s the school that counts when it comes to earning potential, or the student. One of the best known efforts was by Stacy Berg Dale of the Andrew Mellon Foundation and Alan Kreuger of Princeton, who came to the unexpected conclusion that, in some respects, where you went to college was less important than where you applied…

The big surprise: Selectivity didn’t matter. Academic siblings ended up making just about the same wages after college regardless of how choosy their school was. In fact, where the students applied, and their final class rank in school, were much better correlated with earnings than their school’s admissions standards. If you were smart enough to get into Yale, or even take a shot at it, you were probably smart enough to earn like a Yale grad.

There was a big caveat, however. Although tough admissions standards didn’t count for much, tuition prices did. Students who went to more expensive schools consistently outearned their peers during life after college. Dale and Kreuger theorized that spending per student may have been the explanation. While an ambitious sophomore could probably find like-minded classmates to study with anywhere, they couldn’t make up for their school’s resources. The authors also allowed that students at posher colleges might come from wealthier families, which could have an effect.

I also think it is quite possible that choosing to pay the tuition premium reflects an individual who values earnings more in their career choice than an equally smart individual who chooses a much more affordable high-quality state school.  The type of person who gets into Duke and chooses UNC is different from the type of person who gets into Duke and chooses Duke.  Presumably, this personality difference may affect career choices in a way that affects earnings independent of the quality and advantages from a Duke education.

And lastly, this:

Actually, yeah. You might be.

In a 2009 paper, Texas A&M professor Mark Hoekstra used a somewhat simpler experiment to try and solve the elite college question. He compared the earnings of white, male students who had barely missed the admissions cut-off for an unnamed public flagship university to those of students who had barely been accepted. Although the subjects were roughly similar in academic terms, the differences in their future earnings were profound. Enrolling at the flagship increased wages by 20 percent, a divide illustrated vividly in the chart below.

Well, NCSU is a “co-flagship.”  Good for our students.  Presumably, better off just barely getting in than not getting in and heading off to ECU or UNC-G.  Weissman also links to an interesting (but I have to suggest dubious) chart on colleges ranked for return on investment.

Hooray for my (and Kim’s) parents.  Apparently they are great investors as Duke comes in #11.  NCSU or UNC (where I’ll be investing) come in much, much lower.

Interesting stuff.  Leaves me with two questions: 1) Just how useful a measure of what a college does for you is earnings? 2) What exactly is it that leads to higher earnings?  As for the latter, I strongly suspect that it ends up being a lot more about who you know and who you are than what the college teaches you.    That said, my Duke education was absolutely amazing and I honestly feel has been a real benefit to me in life and career.  That said, so not worth the additional money over a strong state flagship.  (Now, the basketball rooting riots, that may be worth it).

I don’t think you know what “scientific” means

Okay, I’ll preface by saying that I’m sure there’s some not-so-bright Democrats in ‘Congress, but I truly doubt that there are any this breathtakingly ignorant.  Republicans voted to end the American Community Survey, which is part of the census.  That’s a bad thing:

THE American Community Survey may be the most important government function you’ve never heard of, and it’s in trouble.

This survey of American households has been around in some form since 1850, either as a longer version of or a richer supplement to the basic decennial census. It tells Americans how poor we are, how rich we are, who is suffering, who is thriving, where people work, what kind of training people need to get jobs, what languages people speak, who uses food stamps, who has access to health care, and so on.

It is, more or less, the country’s primary check for determining how well the government is doing — and in fact what the government will be doing. The survey’s findings help determine how over $400 billion in government funds is distributed each year.  [emphasis mine]

Well, heck, who would be against that?  How about incredibly stupid, ideologically-blinded Republican members of Congress.  Most prominently, head idiot (I generally try and avoid truly perjorative language, but sometimes it’s just really necessary), Daniel Webster:

“This is a program that intrudes on people’s lives, just like the Environmental Protection Agency or the bank regulators,” said Daniel Webster, a first-term Republican congressman from Florida who sponsored the relevant legislation.

“We’re spending $70 per person to fill this out. That’s just not cost effective,” he continued, “especially since in the end this is not a scientific survey. It’s a random survey.”

Ouch– the stupid, it hurts!  And this is a member of Congress!  Needless to say, but I will for the Daniel Websters of the world, the fact that it is random is what makes it scientific.  Yowza!  Anybody who’s add Intro American Government with me knows this much (and they do, they always do well on test questions about that).  And, of course, its voluntary.  And, apparently Webster would prefer an world without bank regulators or the EPA.  How’d that work out in 1929?  Or seriously try and imagine what the air we breathe and water we drink would look like without an EPA.  And that’s Webster’s idea of a government run amok?!  Simply scary.

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