Looks like they did flip a switch, but not a medical one, according to my AI friend:
Around 1990, several key shifts occurred in U.S around cancer:
- Federal Advertising Restrictions (1980s → 1990s trend)
- Cigarette ads were already banned from TV and radio since 1971, but by the late '80s and early '90s, there was increasing pressure to further restrict tobacco marketing, especially to youth.
- Synar Amendment (1992)
Required states to prohibit the sale of tobacco to individuals under 18.
States risked losing federal funding if noncompliant.
- Local and State Laws
Late 1980s to early 1990s: many cities and states began passing clean indoor air laws restricting smoking in workplaces, restaurants, and public areas.
Examples: San Luis Obispo, CA (1990) banned smoking in all indoor public places.
- Surge in Litigation
States began exploring lawsuits against tobacco companies for Medicaid costs related to smoking-related illnesses.
- Rise of Public Health Advocacy
CDC established the Office on Smoking and Health as a national anti-smoking effort.
American Nonsmokers' Rights Foundation and other groups pushed for local ordinances.
- Increased Tobacco Taxes
Several states raised cigarette taxes as a deterrent and revenue tool.
- EPA Classification and Risk Assessments
EPA expanded its Integrated Risk Information System (IRIS), classifying substances based on carcinogenic risk.
Substances like benzene, formaldehyde, dioxins, and asbestos were formally assessed and increasingly restricted.
- Clean Air Act Amendments (1990)
Major overhaul targeting hazardous air pollutants (HAPs), including 189 known or suspected carcinogens.
Mandated technology-based emissions standards for industries emitting these substances (Maximum Achievable Control Technology - MACT).
Examples: emissions from chemical plants, refineries, dry cleaners.
- OSHA Activity
Occupational Safety and Health Administration tightened exposure limits for carcinogens (e.g., formaldehyde, cadmium).
Enforcement of hazard communication (HazCom) standards requiring MSDS labeling for toxic/carcinogenic workplace chemicals.
- Right-to-Know Laws
Expansion of EPCRA (Emergency Planning and Community Right-to-Know Act), empowering communities to track local industrial emissions via the Toxics Release Inventory (TRI).
Helped spotlight local exposure to carcinogens.
- Superfund and Toxic Cleanup
CERCLA (Superfund) activity peaked; sites with carcinogenic contamination (e.g., PCBs, VOCs) were targeted for cleanup.
Public concern about cancer clusters near toxic waste sites gained visibility.
- California Prop 65 (1986 → active in 1990s)
Required businesses to label products or areas with chemicals “known to the state to cause cancer or reproductive toxicity.”
Influential beyond CA due to market pressure on manufacturers.
Not to remove credit from doctors, but the best treatment for cancers is to not create them from the start.
One of the best wins for longevity historically has been hygiene, safety design for products/places/processes, avoiding wars, and using fossil fuel to replace slavery. Medicine helped (particularly vaccines, antibiotics, and emergency surgery), but you can't offset society-level problems with it, especially since it's more expensive to scale.
So when I see such a graph, I always look for more general reasons first.
We'll see a similar drop once we tackle sugar, weight gain, and various legal and illegal addictive substances.
Fair. Pay attention though to the safety systems in place and the cost of those versus drivers. I suppose in the end these are hypotheses about human behaviour in specific situations and we will find out who is right in due course.
People are pretty great and I will be happy to be proven wrong.
French postal service offers this, which is very convenient for legal letters because it stores a copy of it so people can't pretend they received something else.
I use this constantly when I have an online document I need to send through the mail. I just use the online postal service to send it directly. It's probably a lot environmentally friendly since they can just print as close as possible to the destination. Instead of sending it across the country etc...
No, AirBnB just became much more expensive. And it's disguised as processing fees, cleaning fees, etc.
So if I ever take the risk of getting an Airbnb instead of a hotel, then I know the next time I book I'll pay cash directly with the host because it will be that much cheaper.
It's like uber: the bait and switch to a service that becomes less good and more expensive is costing them because the competition survived the first wave.
Also, the regulations caught up with them.
Basically, they wanted to win by scummy means, like a lot of American startup that calls doing illegal or immoral stuff "growth hacks".
Still worked well, they are a leader, but not enough to kill the game, and now they have to fight.
> ...the next time I book I'll pay cash directly with the host because it will be that much cheaper.
This probably won't work for you. It specifically violates Airbnb's TOS to attempt this, and Airbnb scans all messages between you and the host to ensure that you are not attempting this.
As for arranging it with a F2F conversation with the host, it's been years since I've rented an Airbnb and met a host F2F. That doesn't happen much any more.
The next ones I'll do it and I know it will work because I've been doing it regularly for years. I always get the personal phone number of the host, AirBnB can't do jack about it.
In fact, it's not legal for AirBnB to prevent it in my country.
In France we have still a bit of competition with a super small company called delicity.
They have surprisingly survived the past few years by making drivers a priority. Basically, all drivers recommend delicity in my area because they pay more, and they tell restaurants to sign up.
Doctors are trained to be arrogant, dismissive of unknown unknowns, and with a terrible understanding of statistics.
Add to that:
- They have a lot of patients and not enough sleep.
- They need to pay back a huge student loan.
- They hold terrible responsibilities and risk being sued.
- They don't have much time for themselves, let alone update their knowledge.
- Most patients are overreacting idiots, so it's a winning strategy to ignore what they tell you most of the time.
- They are not trained nor selected for empathy or open-mindedness.
And you get so many medical errors.
Basically, you have to double-check everything they do, and endure their cynical rebuttal when you make suggestions, ask questions or try things they didn't request.
I had to face many such errors myself, two almost lethal.
When you can, shop for one that is both good and is open to discussion. But even then, there is a limit. At some point, your doctor WILL fail you, so you have to take responsibility, usually when you're weak and at a low point in your life.
And if you are wrong, people will tell you you should have listened to your doctor, but if the doctor is wrong, well, shit happens.
One of my practitioners is a friend of 15 years, I literally lived with him, he is considered top in his specialty. I'm surrounded by people working at the hospital.
He saved my life once.
Even that is not enough. I still have to double check stuff every time.
> At some point, your doctor WILL fail you, so you have to take responsibility, usually when you're weak and at a low point in your life.
The two times I've been hospitalized in my adult life, I've been incredibly thankful for my parents stepping in to act as my patient advocates, including pushing back on doctors when necessary. (The first hospitalization was guilliane-barre and the other a rare hemotological condition, so i wasn't in a great place in either scenario to advocate for myself).
A pediatrician in my family has said that patients get significantly better outcomes when they have a patient advocate, because even if they are directly related to you (i.e. parents or sibling), they are going to be far better at being objective on the situation than you, the person being affected by it, is
It's purely anecdotal but does have some provenance going back at least to the 19th century, with one of the early liver specialists.
He was reportedly at a cocktail party one evening when a messenger burst in and informed the esteemed doctor that one of his patients appeared to be dying from a heart attack.
"My good man," he replied, "that can't possibly be true. When I treat a patient for liver disease he dies of liver disease."
I suspect AI chosen by an organization trying to maximize profits could be really bad.
This is an industry that places people’s lives as vastly less important than minor scheduling issues as someone working 12+ hours is seen as perfectly normal.
One can debate its merit right now, the upside / downside equation. In 10-20 years? Game over. Doctors will largely be the physical space touch point. AI will in effect use meatbags to interact with the patients.
I think I'm feeling the effects of Gell-Mann amnesia here. The same is said about software engineers, but I'm not as confident as you that there won't be a need for the profession in 10-20 years.
It makes more sense when you realize most of the time it’s not <disease>. Doctors see thousands of patients per year and 99% of them have common conditions with straightforward diagnosis.
Add on top vague symptoms that can’t actually be measured and are subjective and you end up with challenging diagnoses.
I do agree that patients should educate themselves and advocate for themselves. Doctors aren’t perfect and they don’t know everything.
But it helps to have some perspective of what doctors deal with on a day to day basis.
"Basically, you have to double-check everything they do, and endure their cynical rebuttal when you make suggestions, ask questions or try things they didn't request."
I had frequent headaches and the student health service referred me to a well-known and very respected hospital for tests as an outpatient. The doctor to whom I was referred was a well-known neurologist with papers to his name—probably the most eminent neurologist in the country at the time (even now, some decades after his death, his name appears on Wiki as someone of eminence).
He then sent me for a series of tests at the hospital and they extended over a number of days although not consecutive (which was inconvenient). Those tests were rather exhaustive and included amongst others neurological tests, brain x-rays, electroencephalographs and testing my eyes including injecting fluorescein into my veins to improve the contrast of the photos they took of my eyes/retina—afterwards I was pissing out that brilliant florescent yellow dye for the better part of a day.
Keep in mind that those tests involved other doctors and clinicians who would have examined the neurologists report, so decisions weren't taken in isolation.
After all that and multiple visits to the hospital he said that they could find nothing wrong with me and suggested that I be admitted for at least three days for further tests! I declined as I was about to have uni exams and never did return to be admitted.
Several months later I visited a local GP practitioner because I'd had a bad dose of the flu and after he'd dealt with that I mentioned my ordeal at the hospital.
He was palpably furious and mumbled quietly under his breath which was just audible enough for me to hear "fucking idiots". Within a split second he went on to say "presumably during all this testing no one actually suggested that you might have migraine?" to which I replied "no". That made him even more annoyed.
He then prescribed a common Parke Davis formulation called Ergodryl, which, back then, was a common go-to drug for migraine, it's a formulation of egotamine tartrate, caffeine and diphenhydramine (a well-known antihistamine).
Problem solved, that drug completely killed my headaches. I've never forgotten that incident and although I've experienced similar inept performances I've never experienced one on that scale again. Ever since I've never fully trusted a medical diagnosis unless confirmed by second options and backed up with tests. It pays to be not only cautions but also to do one's own independent investigations.
From my experience, not all doctors are mediocre to the extent that I'd wished I'd seen another, some I've visited are quite exceptional and have an innate ability to cut to the core of a problem immediately, or at least start investigations on the right footing. Unfortunately, from my experience, they seem few and far between in numbers.
I was once introduced to a state director of health (the State's top medical officer) through a common interest outside of medicine and I got to know him relatively well. Some time later I mentioned that incident and he said to me without hesitation that he would not trust 90% of his profession to make a competent diagnosis, and he went on to say that if I were ever to be stricken by some dangerous life-threatening disease that I was to give him a call and he'd provide me with a short list of the competent ones who he'd trust—one's that he would go to if he became sick. Fortunately, to date I've never had need to take up his offer.
Frankly, for the lay person this has to be a significant worry. How on earth does one know who is competent and who is not, especially if it's at short notice?
Yeah, unless you're doing k8s for the purpose of learning job skills, it's way overkill. Just run a container with docker, or a web server outside a container if it's a website. Way easier and it will work just fine.
Django definitely wins at CRUD because that's what it is. It calls itself a web framework but really it's a web-crud-app framework. Flask and Pyramid are web frameworks.
Dealing with the session object seems a small price to pay for the flexibility in architecture that it gets you.
Around 1990, several key shifts occurred in U.S around cancer:
- Federal Advertising Restrictions (1980s → 1990s trend)
- Cigarette ads were already banned from TV and radio since 1971, but by the late '80s and early '90s, there was increasing pressure to further restrict tobacco marketing, especially to youth.
- Synar Amendment (1992)
- Local and State Laws - Surge in Litigation - Rise of Public Health Advocacy - Increased Tobacco Taxes - EPA Classification and Risk Assessments - Clean Air Act Amendments (1990) - OSHA Activity - Right-to-Know Laws - Superfund and Toxic Cleanup - California Prop 65 (1986 → active in 1990s) Not to remove credit from doctors, but the best treatment for cancers is to not create them from the start.One of the best wins for longevity historically has been hygiene, safety design for products/places/processes, avoiding wars, and using fossil fuel to replace slavery. Medicine helped (particularly vaccines, antibiotics, and emergency surgery), but you can't offset society-level problems with it, especially since it's more expensive to scale.
So when I see such a graph, I always look for more general reasons first.
We'll see a similar drop once we tackle sugar, weight gain, and various legal and illegal addictive substances.