Cancer medicine generates enormous revenues but marginal benefits for patients? - <AUTHOR> https://blogs.scientificamerican.com/cross-check/the-cancer-industry-hype-vs-reality/ <comment><USER2> This article is a case study in "if you say something controversial enough, people will pay attention regardless of the quality of your argument."

There's a lot of hype in the cancer industry and there are still many diseases that can't be treated effectively. But the bizarre claim that we aren't any better at treating it than we were 50 years ago is just wrong.

The timing is particularly ironic, coming after a decade of particularly rapid progress. The survival advantage conferred by immunotherapy is very meaningful, and it's being used in diseases that were previously intractable. The author waves away the benefits of immunotherapy while focusing on the cost and side effects. Undoubtedly, it is expensive, and speaking from experience, the side effects aren't fun. But the cost will come down, and the side effects are generally more manageable than chemotherapy.

If I really steelman the article, I can see a couple decent points and maybe even agree with them. I might believe that aggressive screening is counterproductive, for instance. But for an article complaining about "hype", this piece is a remarkable sequence of exaggerations, fallacies, cherry-picked data, and hand-waving.

<comment><USER3> Except for one throwaway sentence about life extension averaged across 72 drugs, the huge point the author is missing is that the mortality rate is not what matters. The drugs aren't curing cancer - they're extending the lives of those with cancer, even though those same people eventually die of cancer. That won't show up in the mortality rates that aren't improving, but it's a very important positive effect of the drugs, particularly if that extended period of life can be at an acceptable quality. The industry actually measures its success by "quality adjusted life years," not by mortality, and I think that's the correct measure.

<comment><USER4> Would you not agree that spending hundreds of thousands for a few additional months of fairly low standard of living (even if higher than before) is wasteful on the larger scale?

<comment><USER5> That depends. As long as new drugs provide incremental impact, the benefit should be cumulative over time. Maybe not the area of healthcare spend with the highest ROI, but not a waste in isolation

</comment></comment></comment></comment><comment><USER6> I get a 20 minute drip of Pembrolizumab every three weeks. I had it done two days ago. 28K per infusion.

The cancer has spread since I have been taking it. But I don't know if the cancer is spreading slower with taking it or not.

I'm 1.5 million deep in medical bills from the last year. I no longer open my mail or answer my phone. I am just waiting for the day I go in for treatment and they turn me away.

<comment><USER7> I'm so sorry for you, US healthcare research is amazing and US healthcare availability is really bad at the same time.

My girlfriend in Hungary got all her cancer treatment for free, even if it's a quite poor country compared to the US.

<comment> daniel-cussen You're confusing things.

Healthcare sometimes has a perverse supply curve, meaning the more expensive it is, the lower the quality. This is true of many drugs: there are generics whose side effects are well understood and have stood the test of time. They're so good that they are still being demanded and prescribed despite newer alternatives with incredible marketing and doctor incentives, glamorous salespersons, all-expense paid conventions in paradisiacal locales, and prestigious studies that show it's for sure at least 1% more effective which makes it a game changer. And even then it's for insurance to cover.

Really cheap healthcare is really hard to get because other reasonable economic factors still play a role. People want more of it because it's cheap and it still costs real money to provide so there's only so much budget for it. But if you manage to get it you will be way ahead. The big factor is that cheap healthcare weeds out practitioners who value your money more than your humanity. Maybe you'll also weed out a great doctor who charges a lot because he's so good, though.

</comment></comment></comment><comment><USER8> As someone who works in healthcare, I don't disagree with the entire sentiment here, with the exception of screening. In my opinion, it would be simpler and more cost effective to monitor cancerous and precancerous indicators rather than immediately go for surgery/treatment. Most people probably freak out if you tell them they have a golf ball sized growth on their kidney though.

<comment><USER9> And then to take it one step further: focusing on prevention and being proactive, which may require more research funding, however that no one can or is widespread promoting a solid set of known practices to reduce cancer is a problem.

<comment><USER10> > _however that no one can or is widespread promoting a solid set of known > practices to reduce cancer is a problem_

My friend at American Cancer Society would take issue with that statement. He flies all over the world educating public health officials about how to fight tobacco use.

Tobacco by itself is a _huge_ cause of preventable cancers.

The next big one is sun exposure, so ACS also promotes proper sunscreen use (and avoidance of tanning beds).

The ones caused by genes and random mutations are also a large percentage, but you can't teach people how to avoid those.

People should get radon tests in their home as well. Most lung cancer is either due to tobacco or radon.

After that, there isn't much advice specific to cancer: eat moderately and exercise.

<comment><USER11> There is a skin cancer pandemic since health authorities started warning people to avoid the sun. It is found mostly in people who avoid/block the sun and not eg people who work outside everyday.

[https://www.ncbi.nlm.nih.gov/pubmed/20231499](https://www.ncbi.nlm.nih.gov/pubmed/20231499)

[https://www.ncbi.nlm.nih.gov/pubmed/20541680](https://www.ncbi.nlm.nih.gov/pubmed/20541680)

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694089/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694089/)

Also, tobacco smoke seems to be an exceptionally weak carcinogen. It is near impossible to get it to cause cancer in animals (while eg, radioactive dust easily does so). Think about it, people expose themselves almost 24 hrs per day for decades and still less than 25% get lung cancer.

[https://www.ncbi.nlm.nih.gov/pubmed/15765916](https://www.ncbi.nlm.nih.gov/pubmed/15765916)

[https://www.ncbi.nlm.nih.gov/pubmed/29370344](https://www.ncbi.nlm.nih.gov/pubmed/29370344)

<comment><USER12> I'd be hesitant to call tobacco smoke a weak carcinogen, especially when there are mutational signatures known to be associated with exposure to it.

But by and large, it is a numbers / probability game. You could be exposed to a carcinogen routinely for your entire life and not have any problems. Or, you could be exposed once, and have it hit is just the wrong place. I'd say a 25% incidence rate is pretty high, and not something that I'd personally like to risk. Lung cancer rates are still high, with smoking being the primary risk factor. So, are you seriously going to argue that smoking is not something to avoid?

Skin cancer is another... the known primary risk factor is sun exposure (again, with a known mutational signature associated with UV light). Many people who avoid the sun likely already know that either a) they have a family history of skin cancer or b) they have sensitive skin that burns easily. Either of which is a good reason to avoid sun exposure.

Given the above and other comments in this thread, I'm struggling to figure out what your point here is. You keep attaching a lot of Pubmed links, but frankly, in this case at least, they aren't all that compelling and don't even begin to approach a scientific consensus. You're just cherry picking random articles.

<comment><USER11> You think there is no consensus that skin cancer rates are skyrocketing?

</comment></comment></comment></comment></comment></comment><comment><USER13> This article is absolute 100% bullshit.

-Metastatic melanoma: used to be lethal, now 50% cure rate.[1]

-Non small cell lung cancer: same, now around 25% [2, 4]

-Breast cancer used to have a terrible prognisis, now 75% survive. [3]

-Not to mention the myriad of blood cancers with new, strong, cell therapy treatment options with 40-50% durable cure rate.

I don't know this person, but seriously, whoever he is, fuck you dude. Millions of us work day and night trying to improve care, and 99% of us arent getting rich.

[1] [https://www.nejm.org/doi/full/10.1056/NEJMoa1709684](https://www.nejm.org/doi/full/10.1056/NEJMoa1709684)

[2] [https://www.nejm.org/doi/full/10.1056/NEJMoa1801946](https://www.nejm.org/doi/full/10.1056/NEJMoa1801946)

[3] [https://www.breastcancer.org/research- news/20100930](https://www.breastcancer.org/research-news/20100930)

4\. [https://investors.merck.com/news/press-release- details/2019/...](https://investors.merck.com/news/press-release- details/2019/Five-Year-Survival-Data-for-Mercks-KEYTRUDA-pembrolizumab-in- Advanced-Non-Small-Cell-Lung-Cancer-NSCLC-from-First-KEYNOTE-Trial- at-2019-ASCO-Annual-Meeting/default.aspx)

<comment><USER14> He also wrote an article called the "Death of the Proof" that was widely rejected by mathematicians and was also mostly hog wash.

He seems like a guy who likes to make edgy but wrong statements.

[https://blogs.scientificamerican.com/cross-check/the- horgan-...](https://blogs.scientificamerican.com/cross-check/the-horgan- surface-and-the-death-of-proof/)

<comment><USER15> This is far from the first time, so let me state this more explicitly: John Horgan is a provocateur with no knowledge of any field, whose only claim to fame is that he is so breathtakingly and publicly wrong that he gets people with real expertise to engage with him. Then he disingenuously frames the result as a real intellectual controversy with him at its center.

He is one of the top reasons I don't take anything from Scientific American seriously anymore, and a great example of how the incentive structures in science popularization ruin it. I find that I can tell how savvy an online community is by how much it likes his work.

<comment><USER16> > Mathematicians named a mathematical object after me. It's called the Horgan > surface, or, alternatively, Horgan non-surface. The term was intended as an > insult, but I'm honored anyway.

Neatly summarizes this guy's motivation for writing provocative bullshit. To him, infamous == famous.

</comment></comment></comment></comment><comment><USER17> Ive seen medical attempt to sell me extra services within their hospital network with my kid. 2000$ to fix Tongue Tie with surgery. Laser procedure is 600$ and done at a dentist.

The ($200-300k/yr) physician said there was data surgery is better. So I looked it up, no data, and surgeons started using laser because it heals better. Upon confronting she said- if you ask a physician they will recommend a physician. (So factionalism?)

Why is this nonscience acceptable in medical?

On a different note, hospitals somehow get patients for non hospital needs.(disclaimer my wife owns her own practice and competes) For instance if you go to a hospital for physical therapy, you will likely have 1 Dr for at least 2 patients. You get 37 minutes of treatment because they can legally bill for 1 hour. At my wife's clinic, she treats 1 on 1, and sometimes sessions go over 1 hour.

There are no advantages of a hospital for this care.

I'm not sure if overregulation or lack of patient information is to blame. I'm horrified at the thought of being sick and dealing with our medical cartels.

<comment><USER18> This would be in the US I presume? Proponents of single payer focus a lot on the issues with insurance taking profits, but I think the real problem with capitalist medicine is that the skills needed for selling medical procedures and helping patients heal are not really compatible. Doctors being forced to sell their own services creates a perverse incentive towards the most expensive procedures, which unfortunately are often also the most risky.

<comment><USER19> That person is likely not in the US. We put the $ before the digits.

</comment></comment></comment><comment><USER20> Well, this is one side of the discussion. While I agree to some extent, the author should also answer the question whether he honestly thinks he would have been better off 90 years ago if some cancer got detected with him in, say, 2 weeks from now (such things usually happen really fast).

You can of course take the stance that 90 years ago that cancer would have been misdiagnosed and left untreated and that 90 years ago he would have probably died of something else before that cancer would have got lethal. I personally rather prefer having the cancer cut out as soon as possible.

Also some arguments are not honest. It's right that e.g. most dead men have some form of undiagnosed prostate cancer, which they didn't notice. But screening programs usually are not designed for e.g. 90 years old people for who it probably doesn't make that much of a difference whether an early stage cancer gets diagnosed. Screening programs usually are for younger people who will most likely get old enough to benefit from an early diagnosis.

<comment><USER21> > Screening programs usually are for younger people who will most likely get > old enough to benefit from an early diagnosis.

You say "likely". But the problem is you don't have evidence. Noone has shown that these screening programs do have these benefits [1]. If they have I don't think anyone would argue with that.

The tricky issue is: Actually showing the benefits of these screening programs is hard. It requires large-scale studies with longterm followup. It's expensive. But it nevertheless should be done.

[1] [https://www.bmj.com/content/352/bmj.h6080](https://www.bmj.com/content/352/bmj.h6080)

<comment><USER22> People have done studies like you propose, but long term studies always lag improvements in treatment. You can't see 20 year mortality statistics for 2020's cancer treatment options until 2040.

 _CDC supports screening for breast, cervical, colorectal (colon), and lung cancers_

 _Screening for ovarian, pancreatic, prostate, testicular, and thyroid cancers has not been shown to reduce deaths from those cancers. The USPSTF found insufficient evidence to assess the balance of benefits and harms of screening for bladder cancer and oral cancer in adults without symptoms, and of visual skin examination by a doctor to screen for skin cancerexternal icon in adults._ [https://www.cdc.gov/cancer/dcpc/prevention/screening.htm](https://www.cdc.gov/cancer/dcpc/prevention/screening.htm)

PS: Showing differences in overall mortality based on differences in treatment for an uncommon disease requires truly massive study's. Failing to show a correlation is expected with noisy data and insufficient sample sizes.

<comment><USER20> The problem also is that diagnosis doesn't stop progressing. Today's opponents to cancer screening often argue with data from the 1990s. On the other hand proponents often refer to data of underpowered, badly designed trials.

Also, there exists no real guideline as to what would be "sufficient evidence". How much better would the survival of screening participants would have to be? In exchange, how much pain may be inflicted on people who get false-positive results. This discussion is extremely difficult. And once you are in the situation that you or somebody close to you get's diagnosed with cancer, it becomes really difficult to deal with arguments like: "On average the whole population does not benefit from you having diagnosed your cancer early so that after some small surgery, you'll continue living as if nothing had happened."

</comment></comment></comment></comment><comment><USER23> I was really hoping for a strong conclusion to this article - a powerful answer to the obvious question of 'so what now?'. After all, the author has just spent a lot of words tearing down the (generally well-meaning) attempts of scientists (and others) to prolong the lives of people who are diagnosed with cancer.

But all we get at the end is _" Conservative cancer medicine, as I envision it, would engage in less testing, treatment, fear-mongering, military-style rhetoric and hype. It would recognize the limits of medicine, and it would honor the Hippocratic oath: First, do no harm."_.

Fuckin' really? No details, no data, no actual suggestion (or idea?) of how to actually implement this? No analysis of how (or even whether) this will help people?

And of course, let's ignore the fundamental hypocrisy here: having just spent an article discussing how shit doctors (apparently) are at doing the best thing for their patients, he apparently wants doctors to be the ones in control of this new, 'do less' approach? Fucking clueless clickbait blog nonsense - the Scientific American should be ashamed that this made it through their editorial process as is.

-

Also, let's examine these two sections:

 _" But one study found that 72 new anticancer drugs approved by the FDA between 2004 and 2014 prolonged survival for an average of 2.1 months. A 2017 report concluded that "most cancer drug approvals have not been shown to, or do not, improve clinically relevant end points," including survival and quality of life.

Medical conservatives happily adopt new therapies "when the benefit is clear and the evidence strong and unbiased," the authors emphasize, but many alleged advances "offer, at best, marginal benefits.""_

Who, exactly, is going to serve as the judge and jury for what constitutes a sufficient improvement in clinically relevant endpoints? Should that role be given to "medical conservatives" \- i.e. people who the author thinks are more trustworthy than people who disagree with him?

(PS I fully understand the application of cost:benefit analyses to new drugs - and maybe this is a direction that the US needs to go. But note that the author's conclusion section didn't even touch on this as an option.)

<comment><USER24> _The authors worried that "the FDA may be approving many costly, toxic drugs that do not improve overall survival."_

I don't think they purport to serve as or appoint anyone to serve as judge and jury for "sufficient" improvement. The concern is the approval of drugs which provide no improvement.

<comment><USER23> That's not how I read it, although to be fair, it's not written clearly. This is the full quote from the article:

 _But one study found that 72 new anticancer drugs approved by the FDA between 2004 and 2014 prolonged survival for an average of 2.1 months. A 2017 report concluded that "most cancer drug approvals have not been shown to, or do not, improve clinically relevant end points," including survival and quality of life. The authors worried that "the FDA may be approving many costly, toxic drugs that do not improve overall survival."_

Therefore, the implication is that drugs which prolonged survival by an average of 2.1 months (which was the FDA's track record for approvals between '04 and '14) are not sufficiently "clinically relevant" to justify approval (presumably the 2017 report quoted from includes these drugs).

Therefore the question remains: if small but incremental improvements (av 2.1m) aren't sufficient to warrant approval, what level of improvement _would_ be sufficient? And who are the right people to draw this rather important line in the sand?

<comment><USER24> Perhaps the difference of our reading can be down to a difference in our interpretation of "average". It is unhelpful and imprecise allowing a variety of interpretations. I have interpreted it to be an average with a high variance - perhaps as much as 3 months. Thus some of the drugs decrease survival on average.

It seems that maybe you are considering a smaller variance with all the drugs tightly clustered around the 2.1 month average where the central question becomes - what's the cutoff and who decides?

As to who decides where the line should be drawn in the US it is the patient and in the UK it is the government (NHS). Ideally the patient should give informed consent for a treatment regime, that means realistic assessments of likely outcomes sans hype.

<comment><USER25> > As to who decides where the line should be drawn in the US it is the patient > and in the UK it is the government (NHS).

No, this is wrong. UK patients have the same access to private healthcare as Americans.

<comment><USER24> Terminally ill boy denied 'potentially life-saving' treatment by NHS 'would be given it in any US hospital'

[https://www.telegraph.co.uk/news/2017/04/03/terminally- boy-d...](https://www.telegraph.co.uk/news/2017/04/03/terminally-boy-denied- potentially-life-saving-treatment-nhs/)

The NHS decides what's necessary care and what's not, then they're supported by the courts. The illusion of "same access as the US" was shattered by Charlie Gard when reality collided with our ideals.

<comment><USER25> In the UK: The doctors come up with a plan. The parents disagree. The doctors need to go to court to get a ruling.

In the US: The doctors come up with a plan. The parents disagree. It is the parents who need to go to the courts to get a ruling.

Charlie Gard's case has absolutely nothing to do with cost. In the UK children are humans and humans have rights, and those rights are protected by the courts. Parents do not get to own children as possessions. The courts will focus on the child's best interests, because of the Paramountcy Principle which flows from Article 3(3) of the EU Treaty and Article 24 of the Charter of Fundamental Rights of the European Union, which flows from the UNCRC article 3(1). Charlie Gard's case is about someone who cannot make a choice for themself, and the courts focussing on that person's best interests, not on the interests of that person's relatives.

Charlie Gard had RRM2B MDS. This has fewer than 50 cases worldwide. There is no cure. There is no treatment. The discussion is whether to allow him to die with pain relief, or allow medical experimentation that has no hope of success but which will cause pain. Unsurprisingly the courts decided it was in his best interests to be allowed to die with pain relief.

[http://blogs.bmj.com/medical-ethics/2017/07/07/never-let- an-...](http://blogs.bmj.com/medical-ethics/2017/07/07/never-let-an-ill-child- go-to-waste/)

You may wish to read the judgments, because almost everything written by the US press was wrong.

[https://www.judiciary.uk/judgments/great-ormond-street- hospi...](https://www.judiciary.uk/judgments/great-ormond-street-hospital-v- yates-and-gard/)

[https://www.judiciary.uk/judgments/great-ormond-street- hospi...](https://www.judiciary.uk/judgments/great-ormond-street-hospital-v- yates-and-gard-24-july-2017/)

</comment></comment></comment></comment></comment></comment></comment><comment><USER26> Patient schnoz blasting right on undressed port catheter? Tsk tsk.

<comment><USER27> I'm not in the medical field, but I never wore a mask when my port was accessed (the nurses did). Sure, less exposure is better, but could you explain further?

<comment><USER26> I'm not in the medical field either, but based on my experience patients are either asked to wear a mask or turn their head away while the port is being accessed until it's removed or there is a dressing in place.

Step 7 : [https://www.specialove.org/wp- content/uploads/joomla/58f-PRO...](https://www.specialove.org/wp- content/uploads/joomla/58f-PRO_CVAD_Accessing_and_Deaccessing_Ports.pdf)

</comment></comment></comment><comment><USER19> I am disappointed in Scientific American for publishing such shoddy work. Anyone can cherry-pick one piece of evidence per point to make themselves seem well supported. That doesn't mean they are.

</comment><comment><USER28> It's the narcissistic executives that lead a decent amount of the cancer medicine companies focusing on their next round of golf or nice car. I thought medicine would be different but it's almost the exact same.

</comment><comment><USER29> Cancer is not a disease, but a state of overall body deterioration. You can't fix it; only the body can fix itself.

Stop attacking it with carbs and plant oils, and give it the fuel it needs: unprocessed animal protein and fat.

<comment><USER30> It is a disease and survival has dramatically increased because of amazing progress in treatments. Just look at the recent drop in cancer mortality in the US.

It is incorrect and irresponsible to blame people who get cancer for eating badly etc. Sometimes things go wrong at a cellular level and cancer happens.

<comment><USER29> There's no real drop, but number manipulation. They just label you as "healed" if the tumor doesn't return after a some short period of time, which gets shorter by the year.

Actually mortality rates are at all times high, globally.

<comment><USER31> Are you referring to the shift away from using overall survival to progression free survival? If so I agree that this rubbed me the wrong way as well.

However if one looks there has been tremendous progress in some cancers. As an example CML went from a swift death sentence to something approaching a chronic condition.

</comment></comment></comment></comment><comment><USER32> > if 2,000 women have mammograms over a period of 10 years, one woman's life > will be saved by a positive diagnosis. Meanwhile 10 healthy women will be > treated unnecessarily, and more than 200 "will experience important > psychological distress ...

I have never understood this argument.

I'd rather be incorrectly told I had terminal cancer 100 times over, than not be told and... die. You know what's worse than psychological distress? Dying. You knowing what's worse than an unnecessary surgery? Dying.

This is so obvious, I struggle to understand how this "overdiagnosis" argument even got started.

<comment><USER33> The problem is nobody is telling you the truth or providing a way to make an informed decision. And not just because they want to take your money, but also because they themselves simply don't know how to make such decisions. They pretty much just try various things on real people to see if they work or that can confirm the hunches they have for further interventions, ignoring consequences of doing any of it.

Like in your particular example, every unnecessary surgery actually increases your chances of dying during surgery or sometimes after it, not to mention the chances of crippling you forever, but you don't know what those chances exactly are and worse, you are assuming there isn't such risk, while it's crazy high. So high, that 100 times false positive rate absolutely makes it a no brainer to never undergo such diagnosis, it pretty much guarantees to make things worse for or kill a lot of people.

And yet nobody will give you the numbers to make a rational decision.

<comment><USER11> I met someone who went for a checkup and they convinced him to get a screening colonoscopy. It was clear but a few months later he started having problems and went back. Then they told him he had colon cancer caused by damage to the tissue during the colonoscopy.

</comment></comment></comment><comment><USER9> Watching Eric Weinstein's The Portal episode #18 yesterday - [https://www.youtube.com/watch?v=QxnkGymKuuI](https://www.youtube.com/watch?v=QxnkGymKuuI) \- where he presents the DISC (Distributed Idea Suppression Complex), made me frame this in a different way: what questions does the cancer treatment industry avoid? Why aren't all cancer companies, organizations, also researching or putting funding towards prevention? The answer is obvious to me, however why as society don't we require a sort of tax to counter (and fund) what the industry isn't aligned to do profits wise?</comment>


Passing the torch - <AUTHOR> https://lobste.rs/s/rk00gm/passing_torch <comment><USER2> What exactly does Lobsters solve? Who does this cater to?

<comment><USER3> I think that HN used to have opaque moderation - people would find themselves shadow-banned and not know why.

Lobste.rs makes different choices around moderation (including user moderation) and is a lot more transparent than HN.

Lobste.rs is a good community, and I'm glad it's sill going to be around.

Things have changed a bit on HN though. If a mod chooses to ban someone they almost always leave a message. (I think, I'm not a mod.)

<comment><USER4> Being invitation only, presumably, makes it much harder for someone who has been banned to quickly set up a new account and continue the nefarious behaviour.

Shadow banning mitigates that somewhat as it can take a little while for the person to realise they're banned.

<comment><USER5> Shadow banning is the most lowly form of moderation.</comment></comment></comment></comment>


Ask HN: Options to set up in motion an allegedly killer idea while employed? - <AUTHOR> I'm employed in a new job that will let me little time to focus on it. I will develop a document about the idea that wholly describes it and the big problem it solves and the improvements to current solutions. It's easily monetizable and it really innovates it's field, which is something humans always have done and always will do. Future proof and it will open a new market and type of job too that will grow in the future. I don't see myself doing it with my own money as I think this is the type of idea that will work much better with external funding and some dedicated team for it. I'm yet another idea guy, yeah I know. But I would like to know if there is any type of agreement I can reach with some VC about it or if I can set it up in motion another way without needing to involve VCs at the beginning. <comment><USER2> Ideas are worthless. It's all in the execution.</comment>


Reducing risk of automotive death - <AUTHOR> https://peterattiamd.com/the-killers-on-the-road-reducing-your-risk-of-automotive-death/ <comment><USER2> In addition to the sensible measures explained in the article you should also do the thing they excluded from the analysis upfront: drive less. Move closer to your job, move closer to a train station, move to a country with proper public transport. Factor in car dependence when choosing a new job or a new home.

<comment><USER3> I love your advice. I also hate driving very much. But current city planning isn't for pedestrians. Distance to office is 2 miles, it takes me 40 minutes to walk there, 20 minutes by car and at least 45 minutes by bus and subway. I would love to have an office, I can reach without driving in 30 minutes, but it is extremely seldom and expensive case.

Let's talk about vacation. Going to neighbor warm country costs 200€ by car, 180€ by plane (plus rental car) or 540€ by a night train. I'll take night train once to experience this, but other times I'll take the car.

My factor now for choosing a new job is days I can work from home and 99% time it is zero. Companies suffer heavily from "general wants to see his army" syndrome (in Germany?). Home office could reduce driving easily by at least 20%, but companies have no benefit from it. Office rent will be paid anyway.

<comment><USER4> >Companies suffer heavily from "general wants to see his army" syndrome (in Germany?).

Can confirm this. But I've usually been able to get 1 day working from home a week. (I think home office is a Denglish word btw, not sure if others will understand)

<comment><USER5> > _(I think home office is a Denglish word btw, not sure if others will > understand)_

Native English speaker here: Generally `home office` would refer to the actual office room rather than the concept of working from home.

That said, I didn't notice anything out of the ordinary until you pointed it out, it does feel like a natural way to say it. I think people will understand fine.

<comment><USER4> I've heard Americans say Handy for phone, public viewing for outdoor sports events and home office, if they've spent enough time in Germany. So I guess Germanisms can spread. I used home office as well and I was told "we don't say that here",that's why I pointed it out.

</comment></comment></comment></comment></comment><comment><USER6> Crazy how relevant this article is to what I have been reading this past week. I was recently doing some research into reducing my personal existential risk, and I concurred putting more energy into reducing/mitigating the baseline risk factors in automotive crashes and road safety in general is a worthwhile effort.

Also recommend reading this insightful article on LessWrong by an anonymous user [0]; has a few decent actionable steps one could take to reduce the risk on the road, aside from a nice collection of most risky habits one should AVOID doing to reduce their road death risk exponentially.

Additionally, I'm considering using local public transport more, and even thinking of moving to cities with better, safer public transportation as there's a MASSIVE difference in fatality rates of folks using private vehicles v/s folks using public transportation. [1]

And, QUIT using motorbikes. Exponentially higher chances of a fatality on a two-wheeler than on four wheels. [2]

[0] [https://www.lesswrong.com/posts/7XbcDaeigMaxW43EB/how-to- avo...](https://www.lesswrong.com/posts/7XbcDaeigMaxW43EB/how-to-avoid-dying- in-a-car-crash)

[1] [https://www.citylab.com/transportation/2017/01/car-bus- safet...](https://www.citylab.com/transportation/2017/01/car-bus-safety- research/514670/)

[2] [https://www.theglobeandmail.com/globe- drive/culture/commutin...](https://www.theglobeandmail.com/globe- drive/culture/commuting/why-i-quit-riding-motorcycles/article4405613/)

</comment><comment><USER7> A good piece of advice I read or heard when I first started driving was, "never trust a turn signal". This has saved me a few times when someone had their right turn signal on but kept moving forward rather than turning right at an intersection where I was about to pull out and turn left.

<comment><USER8> Watch the front wheels.... The car will go where they are pointing, and you will spot movement sooner.

That said, please remember your own turn signals are to announce your intention, not applaud your action.

</comment></comment><comment><USER9> > _Do not speed._

If only it were that simple. I'd argue that on U.S. roads, there's definitely a culture of speeding, and in many circumstances drivers who fail to speed end up slowing traffic, often provoking the ire of other drivers, who in turn reduce safety even further via way of tailgating, unsafe passing, road games/road rage—all of which is a huge distraction unto itself for everyone involved.

On most roadways I find other drivers will expect you to go 5mph over the posted limit. On expressways, this is usually as high as 10-15mph for all but the right-most lane.

I feel like driver education here tends to emphasize not speeding over maintaining traffic flow and respecting the passing lane. Combine that with a bunch of aggro pricks behind the wheel, and it's a recipe for disaster.

[https://en.wikipedia.org/wiki/Passing_lane#Misuse_and_common...](https://en.wikipedia.org/wiki/Passing_lane#Misuse_and_common_practice_in_the_United_States)

<comment><USER10> If you teach people to "maintain traffic flow", the aggro drivers will be dictating all driving.

The solution is greater detection and neutralization (fines, suspension & jail) of aggro drivers, not ramping up the speed to the point where they are no longer aggressive.

<comment><USER9> As much as I'd love living in a world where tailgaters had the book thrown at them, a more realistic solution is just getting out of their way.

If it's a single-lane road and that isn't possible, then likewise going slightly over the limit if it appeases them and defuses an otherwise unsafe situation (assuming conditions warrant).

<comment><USER10> Both. On an individual level, of course the sane thing to do is get out of their way. Doesn't mean they shouldn't also have the book thrown at them.

</comment></comment></comment></comment><comment><USER11> Fascinating, and well studied, but I don't buy the '1 in 10 distracted'. As someone who has done tons of driving, I'd honestly put the number of distracted drivers, specifically dicking with their cell phone, somewhere between 1/3 and 1/2 of all drivers. And that's just my corner of the nation, I'm sure it's more in others.

<comment><USER12> That's why in the Netherlands you are fined ~$250 for even holding a phone while driving.

Holding a device while you are on a bike will cost you around $105.

This all because there was an increase in accidents when social media became available everywhere.

<comment><USER13> I was surprised by how many people in Amsterdam would text message on bicycles. Many times without helmets on.

<comment><USER14> Cyclists in Amsterdam don't wear helmets as a rule -- YouTube is chock full of videos of Amsterdam bicycle traffic, so you can see for yourself. Therefore, it's not surprising that a texting cyclist wouldn't wear a helmet.

To be clear, texting on a bicycle is not a good idea, helmet or no helmet.

</comment></comment></comment></comment><comment><USER15> > In particular, assume one person awoke today with the explicit instruction > to kill you with their car.

My dad taught me this on day one of driving with my permit.

Assume everyone on the road is trying to kill you. Assume know one but you knows the rules.

And as you drive more, you'll gain experience in identifying the behaviors that are most likely to indicate someone who is about to try and kill you.

<comment><USER16> As a pedestrian I look at their eyes. If they're not looking at me, I get way off the road.

<comment><USER15> Yes! This applies to pedestrians as much as cars.

</comment></comment></comment><comment><USER17> I have to wonder how much legal alcohol limits reduce/increase death rates.

Go to any sufficiently large party and there'll be some guy who's drunk after an all nighter and ready to hop in his car, asserting that it's okay because he's not drunk anymore. The dude's still drunk, but once you get worn out and start coming down, you just kind of _feel_ done. It seems to me (in my uninformed view) that legal limits let these guys feel like they have some leeway and they're probably legally safe to drive (which, honestly, they might even be). It plants an idea that there's a reasonable threshold of drunkenness in which driving is still okay, which I don't think is a good idea.

I'm not generally a supporter of zero tolerance policies, but I think leaning that way is possibly better.

As a person who almost never drinks, I feel pretty off and goofy halfway through one beer. I'd probably be under the BAC limit but there's no way I'm fit to drive. I don't have confidence in my drunk driving abilities, but plenty of people do and they think they have a legal basis for it.

<comment><USER18> Legal alcohol limits are a guideline and not a solid rule. Ideally, they were designed with the idea that personal responsibility would play a role in your decision to drive after having a beer.

After all, you can have zero alcohol in your system and still be impaired in some way like other drugs, sickness, donating blood, lack of sleep, etc. This is why DUI arrests usually involve some judgement on the side of the police officer, and they can make the decision that you're driving impaired even if you are under the legal limit.

I am ambivalent on the idea of reducing legal limits. For one, it's never been easier to avoid driving drunk, with Uber and the like, and anecdotally it seems that the propaganda against drunk driving is working, with it becoming largely unacceptable among younger people these days (although this would be purely anecdotal, I have no evidence either way). Additionally, seeing how I don't drink, any reduction to the legal limit wouldn't really affect me much. On the other hand, I don't like the idea of zero tolerance laws and I think they always do more hard than good, and additionally I don't believe that farther reducing the limit will have any effect on drunk driving. I also don't much like the idea of farther restricting the decision making power of police officers, there needs to be a balance here: enough restrictions to prevent abuse but also enough freedom to allow officers to account for circumstances and not turn them into law-enforcing robots.

Increasing police budget to get better enforcement of existing laws would be another approach but doesn't seem like a good use of money. I think the most cost effective way of reducing impaired driving related fatalities has been, and will continue being, education and public transport when it comes to urban areas. Ride hailing apps and self-driving vehicles will eventually do the rest.

One kind of legislative change I'd consider taking a look at is reducing or removing penalties for sleeping in your car, particularly in rural and suburban areas. Letting someone sleep it off in their car is far better than them driving drunk, and I think any fears of homeless people setting up camp in their cars, which is the origin of many such laws, is vastly exaggerated.

</comment></comment><comment><USER19> What about reducing your chances of killing other people?

As a somewhat jaded motorcyclist (though not in the US) I'm unsurprised to see no mention of us in the article. Not sure of the US stats, but in Aus the biggest dangers to motorcyclists are (a) other drivers not seeing us [1] then (b) our own stupidity.

Not much for anyone but motorcyclists to do about (b), but I would make some appeals to car drivers:

Think about motorcyclists at junctions - we're not actually invisible, and what you miss seeing is primarily a function of your own inculcated habits of observation.

Don't tailgate motorcycles. It's frightening and forces us to deploy more attention behind us than is safe.

On undivided roads, stay to your side of the road on bends, even if there are puddles or potholes.

Thanks.

[1. known here in Australia as a SMIDSY - 'sorry mate I didn't see you']

<comment><USER20> I don't know what the stats are in Aus, but in NZ that turned out not to be true:

[https://www.rideforever.co.nz/news-and-reviews/new-single- po...](https://www.rideforever.co.nz/news-and-reviews/new-single-point-of- truth-document-reveals-the-real-facts-about-motorcycle-safety/)

 _Take the received wisdom that car drivers cause the majority of motorcycle accidents. No they don't. It turns out, motorcyclists are solely or primarily responsible for the crashes they're involved in 56% of the time. Though, if the crash involves another vehicle, it's more likely the other road user was at fault._

<comment><USER18> Taking a look at that report, it seems to be missing an important statistic when it comes to motorcycle crashes.

What is the fatality and serious injury rate when comparing when the motorcyclist is at fault vs when the other vehicle is at fault.

An accident involving just a motorcycle, intuitively, seems a lot less likely to be fatal to a properly geared person. Often times such an accident will be because of operator error and result in a low-side crash. Crashing into something on the road could result in serious damage, but that's a lot less likely than losing traction and falling off. If I recall correctly, the Hurt report supports this.

Similarly, in a two-vehicle accident where the motorcyclist is at fault, the motorcyclist is likely to see it coming and attempt to prevent it in some way. Additionally such a statistic will also include motorcyclists low-siding and then their motorcycle (or them) sliding into a vehicle.

Overall, it seems believable to me that while a in majority (56% isn't even that much more) of motorcycle crashes the rider is at fault, if we take a look at only fatal crashes and crashes resulting in serious injury, cars will bear the majority of the responsibility.

All that said, I also find that report to be a bit alarmist and disingenuous with statistics, particularly when compared to the Hurt and the MAIDS reports. I would assume this was done in the interest of "scaring" riders into safer behaviors and not with any malicious intent.

</comment></comment></comment><comment><USER21> It seems to me that you can't conclude that speeding causes accidents from these statistics. If people speed 30% of the time, then accidents will involve speeding 30% of the time if speeding doesn't influence the risk at all. I would also expect the amount of speeding to matter a lot.

<comment><USER22> You can't out statistic physics. Energy goes up with velocity squared. A small reduction in velocity means a lot less energy involved which delivers better outcomes for all involved.

<comment><USER23> But on a freeway accidents generally happen between cars traveling in the same direction, so the effective velocity is much lower than the velocity of travel.

</comment></comment></comment><comment><USER24> If you don't want to read the whole thing, scroll down to "Table 1" which summarizes the whole thing into action steps.

The rest of the article is basically describing where the data came from.

Another good thing to read is the text near "Figure 1".

<comment><USER25> Link to the table: [https://peterattiamd.com/wp- content/uploads/2020/02/200209-c...](https://peterattiamd.com/wp- content/uploads/2020/02/200209-cause-strategy-freeway-intersections-rural- weekly-email-table-1-1536x551.png)

</comment></comment><comment><USER26> Not in the article scope but something worth considering if automotive safety is truly a top concern... I'm under the impression that placing all occupants in rear-facing seats reduces fatalities. This extended claim is often made when reading about infant and child automotive safety. If true, all passenger vehicles going forward could be built this way. (And when Level 5 automated driving is available, drivers become rear-facing passengers.) Cars, vans, buses, ... starting now.

OTOH, "the view is worse" sentiment may be culturally strong enough to cast a blind spot, so to speak, over such evidence.

</comment><comment><USER27> Three things I do: \- avoid left turns like the plague \- always have a good grip on the wheel, mostly 2 hands (easier when I had a less comfortable car) \- when stopping at a turn, put your steering wheel in an angle that will cause you not to full on drive into opposite traffic if someone happens to rear end you (fun experience to be pushed through the corner with 80 km/h, narrowly missing oncoming car also going 80 km/h)

</comment><comment><USER28> Edit: I'm putting this up top because I misread, the aircraft advice mentioned is about helicopters in New York. It may be applicable there.

Always flying a twin is highly debatable, and only really counts once you're up to transport category aircraft (which you all fly on, don't worry).

</comment><comment><USER29> I try to change the oil at least every 10,000 miles to prevent automotive death.

</comment><comment><USER30> Mandatory alcohol testing when you start up the engine would be a good start.

</comment><comment><USER31> "one half of 1 percent"

Is this a common way to write 0.5%?

<comment><USER32> It's not uncommon, especially when you include the "about" that was missing from your quote. Even more common is to say "about half a percent".

Try them both out loud: "about zero point five percent" vs. "about half a percent". One rolls off the tongue much better than the other, is easier to understand, and doesn't introduce false precision.

<comment><USER31> Understood. What "confuses" me is that it doesn't say "about half a percent", it says "about half of 1 percent" which I find is a bit like saying "about half of 50" instead of "about 25".

</comment></comment></comment><comment><USER33> All States need to pass laws that when walking along roads without sidewalks pedestrians must wear full bright reflective safety vests.

I'm amazed at the people I see dressed in all black, schlepping down a two lane road with their back to traffic for they side the are walking on while wearing ear buds or headphones.

I have outstanding night vision, but in the last 6 months I've narrowly missed clipping 3 different people. Even with high beams on it's amazing how easy it is for pedestrians to get lost in the background.

</comment><comment><USER34> Another thing that you can do is drive a late model SUV. The late model can proved things like lane keeping assistance, automatic emergency braking as well as thinks like automatic traction control and curtain air bags. The SUV's large size means that the vehicle's body can absorb more of the energy of an impact.

<comment><USER35> Personally I would say if you need any of those features regularly you should not be driving a vehicle. Or at the very least stop using the atrocity which is the touch based navigation/in-car entertainment.

(Had a rental Ford with a touch based radio/sat-nav. One could not manipulate the radio without the lane control having to act.)</comment></comment>


Ask YC: Software developers at Apple? - <AUTHOR>

Apple gets so much great attention for its hardware, design, vision, taste, etc, but I was wondering what it's like there for software developers.  They write OSX, embedded (iPod, etc), applications, utilities, etc that get lots of acclaim, but you never really hear about them.  Does anyone know Apple hackers, what it's like, if it's a sought-after job (I'm sick of hearing about how everyone wants to work at Google and Facebook) or just an option, etc. <comment><USER2> It's a high stress, demanding job. Great work is usually rewarded, but Apple does have its politics. Talented engineers I know are well rewarded and recognized internally, but other engineers have been shafted due to politics or the bozo-ness of their particular department or team.

<comment><USER3> Wanna hear more! :)

<comment><USER2> That gossip is best left unsaid, but my advice if you are looking to work at Apple - choose the team you join carefully. Apple's most secretive teams are also the most talented and brilliant folks I've ever met. But they work hard to be friends of Steve.

</comment></comment></comment><comment><USER4> This is what Apple looks for in software engineers: Smart, gets things done. (I think Joel Splotskey said it first.)

99% of the software written at Apple is in C or some variant thereof. If your C code isn't up to snuff (EDIT: fixed lousy contraction. English skills aren't as important!), you might be able to get a job working in the build farms, but even those people are good coders doing shit work until they can move up.

All that being said, we have a really hard time finding people that can code their way out of a paper bag in C - so much so that we'll even take people without direct Mac OS X experience if they're talented coders. (I'd still prefer to see true macheads, though.)

<comment><USER5> Joel who?

<comment><USER4> I admire you, even if I can't spell your name.

</comment></comment></comment><comment><USER6> <http://www.folklore.org/> has stories about Apple from their early days, I couldn't stop reading it, and you learn a lot about the hackers from back then.

<comment><USER7> Every time I feel burned, I read a bit of folklore.org about how the masters of yore did their stuff, and get to work again! Oh and also "The Djinn's Wife" by Ian McDonald: <http://www.asimovs.com/_issue_0704/thedjinnswife.shtml>

The future is here and screams in our face. Do you dare heed its call?

</comment></comment><comment><USER8> Apple is a large company, so there's a large range of software development jobs, some more "glamorous" than others.

One interesting thing to note is that the average age of Apple devs is higher than those at say Google or Facebook. Of course that's probably mostly a product of Apple being a much older company. Certainly that must affect the company culture.

<comment><AUTHOR> I would have thought it was the systems/hardware focus. The kids nowadays just assume the hardware is magic and try to ignore it as much as possible while writing their billion dollar websites.

</comment></comment><comment><USER9> They work 12 hour days. Lots of clashing personalities, particularly with lifers.

<comment><USER10> .. and one needs the aggravation because?

with all the easy pickings (that pay well) out there.

i say take advantage that 80% of people don't know anything, and take it easy. 8 hr works days, and i'm at the lake.

<comment><USER9> People work at Apple to change the world. Seriously.

Steve Jobs is a genius at imbuing the concept of revolution into computing.

<comment><USER10> i guess ... but that sounds silly to me. i guess i shouldn't lurk here anymore.

<comment><USER11> I think the point is that Steve Jobs does a good job of making Apple seem like Santa's Workshop or something, which leads to a lot of people who drink the Kool-Aid wanting to come on board.

You're certainly allowed to think that Apple is simply a company that stuffs commodity hardware into particularly shiny boxes. Even if that's what you think, it's still an interesting case study in how to attract talent without paying a premium.</comment></comment></comment></comment></comment>


Kremlin Cash Fueled Yuri Milner's Rise in Silicon Valley - <AUTHOR> https://www.nytimes.com/2017/11/05/world/yuri-milner-facebook-twitter-russia.html?rref=collection%2Fsectioncollection%2Fbusiness&action=click&contentCollection=business&region=stream&module=stream_unit&version=latest&contentPlacement=2&pgtype=sectionfront <comment><USER2> Duplicate - [https://www.nytimes.com/2017/11/05/world/yuri-milner- faceboo...](https://www.nytimes.com/2017/11/05/world/yuri-milner-facebook- twitter-russia.html?hp&action=click&pgtype=Homepage&clickSource=story- heading&module=first-column-region&region=top-news&WT.nav=top-news&_r=0)

<comment><USER3> I think you mean this link: [https://news.ycombinator.com/item?id=15631084](https://news.ycombinator.com/item?id=15631084)</comment></comment>


Amazon Smartphone: First Design Images Leaked - <AUTHOR> http://www.tomshardware.com/news/amazon-smartphone-rumors,26698.html#xtor=RSS-998

<comment><USER2> That looks just like the iPhone 6 mockup.</comment>


The Best Strategy for Reducing Stress - <AUTHOR> http://blogs.hbr.org/bregman/2012/07/the-best-strategy-for-reducing.html

<comment><USER2> " He was experiencing the gap between what he expected to happen and what was actually happening.

That's the underlying cause of stress and it's afflicting us more these days than ever because our expectations keep rising, thanks in part to exponential improvements in our technology."

Oh don't flatter (or insult) mankind with such rationality. It is the gap between what we desire to happen and what is happening, and the uncertainty that this brings about, that leads to stress. If you enlarge this gap enough for a long enough time, it tends to accumulate.

"But that day on his boat, Rob was expecting his cell to work. So the cell outage far from land, where there's no alternative means of communicating his absence on an important phone call created a stressful unmet expectation."

No. Rob has bigger problems if he can't chill the fuck down and enjoy his boattrip.

The writer seems to be in love with his little theme of expectation, and consequently misses the bigger picture.

<comment><AUTHOR> Your expectations out of this article seem to be too high.</comment></comment>


Toronto tech workers now make an average of $100K per year - <AUTHOR> https://www.blogto.com/tech/2019/07/toronto-tech-workers-now-make-average-100k/ <comment><USER2> Of course, property and rent is through the roof (and let's not get into vehicle parking, insurance, etc). If $100K salaries weren't "average" then nobody would stay here. I rent in the near burbs, and $2200/month is considered typical even this far from the core.

Of course there are cheaper neighbourhoods, but you can already guess what that entails in Toronto.</comment>


Theranos closes last blood-testing lab after reportedly failing an inspection - <AUTHOR> https://techcrunch.com/2017/01/17/theranos-last-lab-inspection-test-fail/?ncid=rss&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Techcrunch+%28TechCrunch%29&utm_content=FaceBook&sr_share=facebook <comment><USER3> I'd love to have more insight into how this happened.

It seems like there's a pattern of high profile failures of highly funded science-based startups.

From the outside the science seems faulty from the start, the management team seems to have no strong scientific background.

Do investors really fund purely based on their force of personality? Personal connections? Do they see a big market and then ignore the scientific DD?

I'd love to understand this better.

<comment><USER4> > _I 'd love to have more insight into how this happened_

There's the one story that you can read in articles like this, which will provide details of the rise and fall:

[http://www.vanityfair.com/news/2016/09/elizabeth-holmes- ther...](http://www.vanityfair.com/news/2016/09/elizabeth-holmes-theranos- exclusive)

But, there's another side: it happened because you weren't allowed to question Elizabeth Holmes. The beauty of the Internet is its natural history keeping. If you want more insight into how this sort of thing happens, look no further than early discussions about Theranos on these very boards. It was difficult to be critical, and supporters implied that the naysayers were merely "sexist". Of course, this was happening when tech industry sexism was peaking in the news cycle, and I belive that quieted some criticism.

<comment><USER5> _If you want more insight into how this sort of thing happens, look no further than early discussions about Theranos on these very boards. It was difficult to be critical, and supporters implied that the naysayers were merely "sexist"._

Where?

Story from two years ago, before it blew up: [https://news.ycombinator.com/item?id=9440595](https://news.ycombinator.com/item?id=9440595) \- Lots of criticism, some even calling it a scam, yet no mention of sexism nor heavy downvotes.

The original submission: [https://news.ycombinator.com/item?id=6349349](https://news.ycombinator.com/item?id=6349349) \- Some criticism, not downvoted nor called sexism.

Tell me, where are all those comments warning us about the impending doom at Theranos and getting silenced by supporters calling them sexist?

<comment><USER4> > _Tell me, where are all those comments warning us about the impending doom > at Theranos and getting silenced by supporters calling them sexist?_

There have been nearly 500 Theranos articles posted here over the years. You conclude it didn't happen after looking at two?

As someone who participated in the conversation, I know it happened. I'm not overly concerned with combing through the articles to convince you. The OP asked "how this happens"; if you don't think "girl power" at a time when sexism in tech was all over the place was _one_ of the factors that led to an unqualified 20-something overseeing a potential giant fraud, I'm not sure what to tell you.

<comment><USER6> I'm sure you can find some examples then

<comment><USER4> I'm sure I could, as much as I'm sure I won't be bothered to.

</comment></comment></comment></comment></comment></comment><comment><USER7> This company just seems so reckless, but perhaps it's just bias since I only hear bad things about them in the news.

While I don't like to see people lose their jobs or companies close up, I feel like the company looks at safety as a roadblock to them being called geniuses and making money rather than part of their processes. Usually problems like this stem from senior management and is likely to not change unless someone else takes over entirely.

</comment><comment><USER8> Has anyone met Elizabeth Holmes? What is her leadership style?

<comment><USER9> Glassdoor can provide lots of information on questions like this. From the reviews, it would seem that her style is a classic authoritarian/machiavellian. You're in her group or you're out, and if you're out she'll pit you against other people instead of dealing with you directly. The whistleblower former employee who started the ball rolling on disclosing many of their issues has a fascinating account of what it's like to deal with her.

[http://www.wsj.com/articles/theranos-whistleblower-shook- the...](http://www.wsj.com/articles/theranos-whistleblower-shook-the- companyand-his-family-1479335963)

<comment><USER10> Paywalled

</comment></comment></comment><comment><USER11> A comment by user DarthSlack at Ars Technica was a bit chilling it said "Just think. Under a Trump FDA, Theranos probably would be highly successful."

<comment><USER12> What about a Trump FDA would make Theranos successful? Also, we really cant escape a political discussion anywhere can we?

<comment><USER13> If the director of the FDA is anti-regulation, pro-drug companies/ in their pockets etc. they would not investigate charges of fraud which would lead to continuance of the fraud.

The incoming administration doesn't even need to push through radical new laws/regulation. All it needs to do is to _choose_ not to enforce them, or delay it indefinitely (well at least until the end of their term).

<comment><USER12> Right, but that wouldn't change the fact that Theranos' product doesn't work. Their customers would find that out pretty quickly regardless of whether or not a regulator got involved. Were current federal regulators behind that discovery?

<comment><USER13> The whole point of regulations to protect consumers is to _protect_ them from spending their money on things that don't work.

</comment></comment></comment></comment></comment><comment><USER14> I had no idea they hadn't already shut down.

</comment><comment><USER15> How likely is that Holmes goes to jail?

<comment><USER13> IANAL but it probably depends on how much she was personally aware of what they were doing was fraudulent. Which does seem to be the case....

</comment></comment><comment><USER16> Can somebody provide tl;dr of what was wrong with their tests and how come they got this far if the tests were flat out wrong? Did they just used low precision tests and pass them as high precision or some such?

<comment><USER17> I don't think anyone from Theranos has come out and said anything definitive publicly.

The main criticism from outsiders all along has been that blood drawn from a pin-prick just has too much variability for reliable blood testing. Which in turn means that Theranos' approach to blood testing was never going to work for anything quantitative - it might be OK for 'is this chemical present or not' but not for anything else.

They spent a long time using traditional blood tests alongside their pin-prick versions (this is the service they were selling to Walgreens(?) - <USER2> they used their investor cash to subsidise the service & undercut their more traditional competitors) whilst trying to get the pin-prick to work but they couldn't even manage to do those correctly.

How they managed to get this far is a question of hubris and investor gullibility. There's also the possibility of outright fraud, but we don't know if that was the case at this point.

<comment><USER18> "The main criticism from outsiders all along has been that blood drawn from a pin-prick just has too much variability for reliable blood testing."

If this is the case, why the hell are we using it for blood sugar level testing in diabetic patients?

<comment><USER19> The issue is not that it can't be used for _anything_ , but that what you use it for depends on how much of whatever you're looking for will be present in any given volume of blood.

Sugar is present in sufficient quantities that the variation you get from one pinprick to another isn't going to be a big deal.

Many other things will be present in small enough concentrations that even if it is present in your blood you might not have sufficient quantities for it to be detectable in blood from a single pin-prick.

<comment><USER20> Going back to the white blood cell count. The gold standard is flow cytometry. If there is an interferent in the sample, or if the cytometer raises any flag, in some labs the backup plan is to do a manual count (100 cells) using whitefield microscopy ... are you really concerned about sampling problems?

<comment><USER19> I don't see how what you're saying relates to what I wrote.</comment></comment></comment></comment></comment></comment>


In the fundamental physics of the world, there is neither space nor time - <AUTHOR> http://nautil.us/issue/64/the-unseen/the-end-of-time <comment><USER3> I just finished reading Rovelli's book "The Order of Time." The article is the last chapter, where the author summarizes the results of the "journey" of the book.

I recommend the book, it was an enjoyable read. The author is able to explain clearly concepts that I had struggled to understand before.

Throughout the book there are a many references to philosophical ideas and to the history of science, in some cases quite emotional. This being the last chapter, is quite heavy on them. However, I found them quite useful and interesting as a tool to break from preconceived notions of time.

</comment><comment><USER4> > we have imagined the existence of "eternity," a strange world outside of > time that we would like to be inhabited by gods, by a God, or by immortal > souls

If fundamentally there is no time, then fundamentally there is only eternity.

<comment><USER5> Yes, I suspect (without further proof ATM) that this is the main reason for this quest for timelessness which Sean Carrol (cited in another comment) finds so perplexing [0]. Eternity has traditionally and in various ways been associated with (especially) monotheism. Same with infinity (of which eternity is a sort of subset).

A much simpler but perhaps more tedious way out of this apparent rational loophole for religions would be accept it. Religion may keep this final straw of rationality: we don't and can't know everything given a (probably) infinite universe. Religion is not best understood as a theory of physics anyway, but rather as a study of history, society and mind.

[0] [http://www.preposterousuniverse.com/blog/2009/06/17/timeless...](http://www.preposterousuniverse.com/blog/2009/06/17/timelessness/)

<comment><USER6> The universe IS completely unknown, and forever will be. It is like a sandbox.

As Alan Watts put it with his mischievous sense of humor:

"Science is the art of prediction"

Talking about religion, Christianity used to refer to this, then it lost its way. See eg.

[https://en.wikipedia.org/wiki/The_Cloud_of_Unknowing](https://en.wikipedia.org/wiki/The_Cloud_of_Unknowing)

<comment><USER7> > Talking about religion, Christianity used to refer to this, then it lost its > way.

This is still true, to an extent, in the Christian Orthodox world, Pseudo- Dionysius the Areopagite is still reguarded as one of the main "intellectual stars" (so to speak) of the Christian Orthodox thought. As for the "lost way" that you mention, I think that that change started in the West once the Reformartion took off and people wanted to "be sure" that they'll get to live the eternal life. Here in Eastern Europe people do not think in absolute terms about life after death, as in nobody actually believes you can "earn" your way into Heaven, it all resides in God's Will which is not possible for us to know. There's also that New Testament parable of a guy asking Jesus at some point with whom of his wives will he be married in Heaven (the guy had been previously married to a different woman) and Jesus basically answered that that is a stupid question as nobody knows anything about Heaven.

<comment><USER4> Just a nitpick, but the example the man gives is of a hypothetical woman who over time had seven husbands --- just one at a time of course, but one husband would die and then she would get married again. The question was, which one will be her eternal husband?

> Jesus basically answered that that is a stupid question as nobody knows > anything about Heaven.

Jesus said it was an ignorant question, yes, "You are in error because you do not know the Scriptures or the power of God." But he didn't say nobody knows. He said that she won't be married: "At the resurrection people will neither marry nor be given in marriage; they will be like the angels in heaven" (Matthew 22:29).

<comment><USER7> Thanks for the correction, I had last read that almost 20 years ago :)

</comment></comment></comment></comment></comment></comment><comment><USER8> I think Sean Carroll has a point:

[http://www.preposterousuniverse.com/blog/2009/06/17/timeless...](http://www.preposterousuniverse.com/blog/2009/06/17/timelessness/)

<comment><USER3> It might not be clear from the last chapter, but the book doesn't claim that time doesn't exist.

To paraphrase (but use the same example because it is funny): time doesn't appear at the fundamental concepts in physics. Cats also don't appear at the fundamental level of physics. But cats exist. Time (and our perception of it) must appear somewhere as a emergent feature.

<comment><USER9> Time does appear in fundamental concepts in physics?

In relativity it is particularly important. Timelike dimensions are treated differently in the metric, with a +1 or -1 depending on taste, ie

ds^2 = c dt^2 - dx_1^2 - dx_2^2 - dx_3^2,

so I don't think its quite fair to say that it doesn't "appear". In quantum physics unitary evolution is invertible. Decoherence is not reversible (I mean interaction - loss of entanglement).

Maybe these theories have been biased by our perception, but they are good (but incomplete) models.

<comment><USER10> Time in relativity bears almost no resemblance to the common definition of time.

1) There is no such thing as simultaneous. There is no universal now. 2) Time does not proceed at a constant rate 3) Time proceeds at different speeds for different observers.

So time as relativity defines it is certainly true. But time as people conceive it is fundamentally different. At best, common sense time is a profoundly special case that can't imagine the general case. And at worst, a nonsensical concept evolution gave us. Perhaps so erroneous it might be valid to say it does not exist.

<comment><USER11> Humans never travel at significant fractions of the speed of light with regards to other nearby things, so relativistic effects are rather hard to observe in person.

It's the same how Newtonian Mechanics is a really good approximation (and still widely used, too), and because everything around us happens to obey it very closely, it is more intuitive. The difference between what Newton's equations and Einstein's equations predict for most planetary orbits is very slight.

<comment><USER12> If time is a dimension not constraining to fundamental physics, there could be higher dimensions where more fundamental things manifest, as a way to explain it, as does string theory. If there are higher dimensions, what's to say we can't actually experience more fundamental realities through consciousness traveling. If time passes slow by in an emergency or a profoundly concentrated moment, humans if definable as the human consciousness could be traveling at relativistic speeds and not knowing. Elegantly, it's not matter doing that since matter wouldn't survive the trip.

</comment></comment></comment></comment></comment></comment><comment><USER13> I'm starting to think that there's a point where physics becomes almost as much a study of our own mind as it is of the external world.

<comment><USER14> Much of the ancient esoteric wisdom taught that we were all of one, a mind, a singularity if you will.

I think this bit of truth was purposely hidden, as Einstein himself alluded to, by a dark cabal, and has coincidentally been rediscovered albeit as a secular institution primarily through a diefication of the scientific process.

Some of our still very early study of Quantum Mechanics points right to this matrix reality we experience.

However uncomfortable that may be.

</comment></comment><comment><USER15> It's rare to read from such a sober-minded yet deeply philosophical world view. He basically outlines to most essential things in the universe - <USER2> and uncertainty. Everything else is a means to quantify the world to make it more understandable to us. At least quantum mechanics show that uncertainty is quantifiable to an extent with the means we already have. I'm not even sure whether gravity is as un-quantifiable as it seems to be. That's what scientific minds ought to figure out.

</comment><comment><USER16> > _Perhaps, ultimately, the emotional dimension of time is not the film of > mist that prevents us from apprehending the nature of time objectively.

Perhaps the emotion of time is precisely what time is for us._

The application of sufficient Time and Space can solve almost any problem. If 2 groups are in conflict, putting 10 light years and 100 million calendar years between them often removes the ability to conflict.

</comment><comment><USER17> We do have an easy way of doubting space/time real existence in form of dreams. In dream we feel sensation, experience space and time and it feels so real till the dream last. You can experience long hours or someone can experience years [0] within few seconds/minutes of a dream.

Hence to take a next big leap in understanding the cosmos we as a society will eventually need to be bold enough and open for other ideas regarding the truth of objective reality we experience in waking state. Could it be just like a dream, though a grand one, being projected by some cosmic consciousness of which we are inseparable part? Not some divine form I'm proposing here, but a formless pure consciousness awareness that each of us possess and experience it in silence. Eastern mystical traditions have long been investigating these alternative ideas and countless individuals have testified experiencing such super conscious state confirming the idea.

</comment><comment><USER18> Maybe so, but he also says ...

> To this blurring is added quantum indeterminacy. The ignorance that follows > from this determines the existence of a particular variable—thermal time—and > of an entropy that quantifies our uncertainty.

... and ...

> The variable "time" is one of many variables that describe the world. It is > one of the variables of the gravitational field: At our scale, we do not > register quantum fluctuations, hence it is possible to think of spacetime as > determined. Hence we can think of spacetime as being as rigid as a table. > This table has dimensions: the one that we call space, and the one along > which entropy grows, called time. In our everyday life we move at low speeds > in relation to the speed of light and so we do not perceive the > discrepancies between the different proper times of different clocks, and > the differences in speed at which time passes at different distances from a > mass are too small for us to distinguish.

But whatever, I am moved to read his book :)

</comment><comment><USER19> I'm not sure about entropy arguments for explaining the direction of time. On Earth, the entropy doesn't change much over time, thanks to a constant stream of low-entropy in the form of radiation from the Sun. Overall, the system is increasing in entropy. But why do we, on Earth, need to care what happens in the Sun? We could just as well go backwards in time as forwards, but influencing the past seems to be extremely difficult (just try kicking a football backwards in time).

<comment><USER20> I believe the same reasoning applies here on Earth. Imagine a pile of ash (high entropy) assembling into a copy of Shakespeare (low entropy), compared with the reverse.

You can get isolated pockets of low entropy that appear (e.g. the human brain), but I think I've heard it described that there has to be thermodynamic pathways leading to such states. We understand parts of these pathways, but there are important aspects still left to figure out.

And of course, as you mentioned, the system as a whole is still increasing in entropy the entire time.

Imagine a mountain where height inversely correlates with entropy. The summit represents the very low entropy state of the big bang, and the second law of thermodynamics is an enormous steam-roller that is currently in the process of flattening the entire mountain. Then, us humans are simply pebbles that have been shaken loose and are dancing in the foothills. In a few billion or trillion or quadrillion years, all the dancing pebbles will have been crushed into a fine dust and spread across a perfectly flat, unchanging plane.

But they will have danced beautifully in the many years before.

<comment><USER10> > very low entropy state of the big bang

This always confuses me a bit, why do we consider the first instants of the universe maximally ordered? A near homogeneous sea of per-subatomic particles seems less ordered than the later universe of galaxies and stars and hydrogen atoms with cold areas in between.

<comment><USER21> I tried to understand Roger Penrose's arguments about this in his book "Cycles of Time". I admit that I really struggled! But the idea seems to be that the initial state of the universe is very unusual compared with the rest of eternity and is essentially 1 vs nothing - and then differentiation instantaneously occurs through some physical process and immediately the universe can only be described in a complex way. The universe moved from undifferentiated high energy to and extremely complex high energy and then falls down from there back to flat.

One point that seems not to feature in these debates is that this is all (physics) fundamentally subject to the constraints of language (maths) and cognition (human), we choose to describe things in a way that appears useful to us, but these judgements and perceptions are filtered by how we understand things. We are squashy and small and it is quite silly to imagine we really are thinking about these processes in an objectively meaningful way.

</comment></comment></comment></comment><comment><USER22> Our physical world is space and time, but in the maths of physics we lose track of it. ;-)

<comment><USER23> Some books about QM include big warning about "Mathematics is not Physics!" at very beginning, but nobody reads it.

Chapter 2

The Formulation of Quantum Mechanics

2.1

Basic Theoretical Concepts

Every physical theory involves some basic physical concepts, a mathemati- cal formalism, and set of correspondence rules which map the physical concepts onto the mathematical objects that represent them. The correspondence rules are first used to express a physical problem in mathematical terms. Once the mathematical version of the problem is formulated, it may be solved by purely mathematical techniques that need not have any physical interpretation. The formal solution is then translated back into the physical world by means of the correspondence rules.

Sometimes this mapping between physical and mathematical objects is so obvious that we need not think about it. In classical mechanics the position of a particle (physical concept) is mapped onto a real number or a set of real numbers (mathematical concept). Although the notion of a real number in pure mathematics is not trivial, this correspondence rule can be grasped intuitively by most people, without any risk of confusion. The mathematical formalism of quantum mechanics is much more abstract and less intuitive than that of classical mechanics. The world does not appear to be made up of Hermi- tian operators and infinite-dimensional state vectors, and we must give careful and explicit attention to the correspondence rules that relate the abstract mathematical formalism to observable reality.

</comment></comment><comment><USER24> Certainly makes sense if the holographic principle is correct, and our universe of experience is encoded in the entropic 2D planar surface of a blackhole.

<comment><USER25> What I don't understand about this idea: What is with all the other black holes? Are the holographic universes of each black hole the same? Do they encode the other black holes in their surface?

<comment><USER26> The idea is that we are inside (or on the surface of, same thing) a black hole whose event horizon encompasses the entire universe (observed and unobserved). The black holes we can see in our universe would then be children black holes (or great-great-grandchildren, who knows how far down the holographic rabbit hole we are).

</comment></comment></comment><comment><USER27> There was a time when it seemed that science worked within the constraints of epistemology, but now it seems to be radically reshaping that domain.

</comment><comment><USER28> Makes sense. Everything can be encoded in a bitstring, which is a single number, and a single number has no sense of space and time.

<comment><USER29> Not everything, but perhaps a description of most things.

<comment><USER28> If reality is finite and discrete, then it is everything.

On the other hand, if there are non computable processes at work in reality, then not everything.

</comment></comment></comment><comment><USER30> Strangely, Julian Barbour is never mentioned.

</comment><comment><USER31> In which case it's obviously broken from the get go.

</comment><comment><USER32> Article: Spacetime is an illusion! Time isn't real! Reality: The details of time diverge a bit from common understanding. The author has an emotional reaction to this.

Who else dislikes this sort of pop-science writing? It seems to care more about evoking some mystical and philosophical idea of the universe than effectively communicating the science.

<comment><USER33> >It seems to care more about evoking some mystical and philosophical idea of the universe

What is wrong about mystical, philosophical idea of the universe? I like mystical, philosophical idea of the universe.

<comment><USER34> Nothing wrong about it per se. Just don't try to mask it as or "soften" the principles of science.

<comment><USER33> > "soften" the principles of science.

How can it soften the principles of science, if it does not masquerade as science. Can you point me in the article where it tries to pass some mysticism or philosophy as science?

<comment><USER35> "Carlo Rovelli is a theoretical physicist and writer"

</comment></comment></comment></comment></comment><comment><USER36> > The difference between past and future does not exist in the elementary > equations that govern events in the world.

Such bullshit. QM does not govern events. The probability function encodes everything about how it's governed. QM does not speak to that at all. Unitarity assumes the probability function remains correct. That doesn't mean the probability function does not have any inputs which can be influenced by change. Dumb article

<comment><USER36> Lol downvoters don't even know the Copenhagen interpretation is deeply flawed and never learned to use their words</comment></comment>


Earth and Jupiter in the Same Photo, From Mars - <AUTHOR> http://starryskies.com/The_sky/events/mars/earth_jupiter_100.jpg

<comment><USER2> It's a good photo, but I would have prefered a link to the original, more informative, page here

<http://www.msss.com/mars_images/moc/2003/05/22/>

Google Images is great for checking this sort of thing

[http://images.google.com/images?hl=en&source=hp&q=ea...](http://images.google.com/images?hl=en&source=hp&q=earth+jupiter&btnG=Search+Images&gbv=1)

<comment><AUTHOR> Sorry, I just linked to the article where I found it.

<comment><USER2> I liked the photo. Thank you for posting it. I hadn't seen it before.

</comment></comment></comment><comment><USER3> I find the picture fascinating. Not so much that both planets are in the same shot, but just how big Jupiter appears in the same frame as Earth. Jupiter is roughly 8x the distance from Mars as Earth is from Mars (I think) but Jupiter appears so much larger in the picture. It gives a great perspective on just how big that planet is.

<comment><USER4> <http://www.rense.com/general72/size.htm>

<comment><USER5> <http://www.youtube.com/watch?v=Tfs1t-2rrOM>

Video that continues passed those shots and goes to the largest star found to date (?) VV Cephei

</comment></comment></comment><comment><USER6> How can Jupiter and the Earth have light coming at them from different angles?

<comment><USER6> Never mind, I think I figured it out.

<comment><USER7> I'm curious - could you please explain?

<comment><USER8> It only seems weird because we are used to scenes where the sun's rays are roughly parallel. In this picture, the sun represents a point light source, so the objects are lit from different directions.

(Think of balls suspended in space around a lightbulb. The balls on the far side of the bulb from you will appear lit from the front, while the balls on the near side will appear lit from the back, and those between, from the side.)

</comment></comment></comment></comment><comment><USER9> If I had the money, I'd pay the trillion dollars it would take to fly to Mars (and not die on the way) just to get a view like that, not to mention being on a planet with two visible moons.

</comment><comment><USER10> How come there are no stars visible? Nice photo anyways... Space is big and perty :)

<comment><USER11> I think because Jupiter and the Earth are _way_ brighter than the stars are. The dynamic range of the picture doesn't show the stars... According to one of the sites linked in the comments, they already had to brighten the moon some to make it visible.</comment></comment>


How to build irresistible social casino games - <AUTHOR> http://blog.betable.com/how-to-build-irresistible-social-casino-games/

<comment><USER2> This was inevitable imo. FarmVille and other popular Facebook "games" were really just going after the same dopamine triggers as casino games.</comment>


I need your iPhone 3GS serial number - <AUTHOR> http://www.jgc.org/blog/2009/06/i-need-your-help-i-need-iphone-3gs.html <comment><USER2> Nice try..there is zero incentive for me to email you my phone's serial number, and a possibility (even if remote) that giving it to you might come back to bite me.

I checked the risk/reward ratio, and came up with a number that approaches infinity, so I'm not real sure how to break the news to you, but ummm you cannot have my iphone 3GS serial number

<comment><USER3> Depending on how sequential the serial numbers are, the answer (the probable range of serials) can probably be derived either from people reporting true serial + some random noise offset (of known distribution), or maybe through some zero-knowledge protocol (but I don't know if zero-knowledge proofs are practical on a many-party scale).

</comment></comment><comment><USER4> Nope, not going to happen.

</comment><comment><USER5> "Just email it to me."

For the love of science, put a textbox and a submit button, and let the gnomes do their job.

<comment><USER6> <http://www.wufoo.com>

</comment></comment><comment><USER7> don't ever give out the serial number of anything you own. it's too easy for a scam artist to report that it was stolen, and now you have to answer to the police and prove you own it.</comment>


Be my Support Group - <AUTHOR> http://www.ericsink.com/entries/TellYourGeekStory.html <comment><USER2> From the article "I know that Firefox still has my comment in memory somewhere. All I have to do is figure out how to get it."

cat /proc/foo | strings | grep</comment>


While we're on the subject of Rails security, should this be of concern? - <AUTHOR> https://github.com/search?q=Application.config.secret_token&repo=&langOverride=&start_value=1&type=Code&language=Ruby

<comment><USER2> I presume this is not strictly a Rails problem.

You can check in things that shouldn't be checked in with any language/framework.

If you _have_ done this, here's how to fix it: <http://help.github.com/remove- sensitive-data/>

<comment><USER3> Better is to change your security token and expire all sessions. Removing sensitive data should be seen as just a suggestion. Google never forgets.

</comment></comment><comment><USER4> Before we all grab our pitchforks, I have just gone through the entire first page of results and a huge majority of them were explicitly noted as test applications. Sometimes you can see this in the names:

        test / rails_app_v3 /
        test_app / config

In many other instances, things are not as the seem. For example, some of these results come from commits where the author is moving the token to an environment variable. For example: [https://github.com/cimm/blathy/blob/2d3a9550d3a0be55db8e26a2...](https://github.com/cimm/blathy/blob/2d3a9550d3a0be55db8e26a25f959a891dee1bcf/config/initializers/secret_token.rb)

I certainly agree that we should all be security conscious, but I'm also a fan of keeping perspective. Things are bad, but let's keep the truth in mind too.

<comment><USER5> Also, for the ones that were not test apps, they may be the testing/development secret keys which are different from the production secret keys. I do this myself, where the hash salt and API keys for my local development server are different from those I use on my production server.

</comment></comment><comment><USER6> Not just rails, same for django ([https://github.com/search?q=SECRET_KEY&repo=&langOve...](https://github.com/search?q=SECRET_KEY&repo=&langOverride=&start_value=1&type=Code&language=Python)) and I imagine any framework with this sort of thing in their default project skeleton

</comment><comment><USER7> This is not a language/framework based issue. This is an issue with careless and/or uneducated developers.

This is like people storing plain text passwords in publicly readable txt files on a server. It's not a problem with FTP, HTML, Apache (pick anything you'd like) it's a problem with people making poor decisions.

</comment><comment><USER8> Flagged. This is just ridiculous. I actually support Egor, but this borders on absurd. The question is stated incorrectly. The actual question is:

"Is storing your _private_ key in a public repository a security concern?"

It's a parody of a security question. This is a needless distraction in an important discussion.

</comment><comment><USER9> Could this help? <https://github.com/rails/rails/pull/5286>

</comment><comment><USER10> Soon, there will be articles on how insecure Git is because, well, it allows people to check-in sensitive stuff.

</comment><comment><USER11> Not really. At least not in the way you are insinuating.

</comment><comment><USER12> Facebook as well...

[https://github.com/search?q=FB_SECRET&repo=&langOver...](https://github.com/search?q=FB_SECRET&repo=&langOverride=&start_value=1&type=Code&language=)

Not really a "vulnerability" because you can't keep stupid people from giving out their secret key.

</comment><comment><USER13> The solution is simple. Don't use a secret token :)</comment>