December 8, 2025

NO BODY’S PERFECT:

Why Some Doctors Say There Are Cancers That Shouldn’t Be Treated (Gina Kolata, Dec. 8, 2025, NY Times)

The idea that finding a cancer early is not always a good thing is not easy for many patients and their families to accept. And it is true that lives can be saved by treating cancer early.

Autopsy studies repeatedly find that many people die with small cancers they were unaware of. A review of these studies in prostate cancer reported that the cancer can appear in men as young as their 20s. The older the men were, the more likely they were to have undetected prostate cancer. By their 70s, about a third of white men and half of Black men had undetected prostate cancer.


A study of thyroid cancer in Finland found that at least a third of adults had undetected tumors. Less than one percent of people die from thyroid cancer

The problem is that it is impossible to know if someone’s cancer will be deadly or not. And if the cancer is gone after treatment, there is no way to know if it needed to be treated.

But there’s a way to know on a population level if an increase in diagnoses is a false alarm or a danger signal, said Dr. H. Gilbert Welch of Brigham and Women’s Hospital of Harvard Medical School. Look at the number of deaths from that cancer. If more lethal cancers are being found, there should be more deaths. But if the death rate remains steady as the incidence of that cancer spikes, many of those patients did not need to receive diagnoses.

That happened, for example, with thyroid cancer in South Korea. The incidence of thyroid cancer soared with the introduction of widespread ultrasound screening. But deaths did not increase. It was estimated that 90 percent of the cancers that were discovered and treated in women did not need to be found.

Well aware of such incidents, Dr. Vishal R. Patel of Harvard, Dr. Welch and Dr. Adewole S. Adamson of Dell Medical School in Austin, Texas, asked whether the current spike in diagnoses in younger people of those eight cancers is tied to more deaths.

It is not, they reported in a recent paper examining trends over the past three decades.

For all but two of the eight cancers whose incidence has soared in younger people, death rates are flat or declining.

BAN GAMBLING:

Lost Vegas: Everyone inside America’s most flailing destination city has a theory for what’s wrong. Now I have my own. (Luke Winkie, Nov 18, 2025, Slate)

The Mehaffeys escorted me past the blinking slot machines and into the pit, where we sidled up alongside a gaggle of players peering over the wheel—watching the silver ball zip along the rim. John explained the math: A standard roulette table has 36 numbers—half red, half black. Hit your number, and you’re paid 35 to 1; bet on a color, and you double your money. Quantitatively speaking, a roulette wheel fashioned this way would be totally fair. “Theoretically, over a million spins, you’d get 100 percent of your money back,” said John.


Where the house maintains its edge is in the two additional numbers foisted upon the roulette wheel, a single zero and a double zero, both painted green. With those digits in place, betting on red or black is no longer a 50/50 proposition, and if a player is lucky enough to score a win on a 7, or a 12, or a 28, they’re still making what they bet back by a multiplication of just 35—despite the fact that those green spaces allow for 38 potential outcomes. All this is to say that each zero added to a roulette table increases the revenue it scrapes from players by 2.7 percentage points. So, in a moment of incredible audacity, the power brokers of Las Vegas decided to sharpen their advantage, festooning a gauche and unsightly triple zero to their wheels, plundering our wallets more efficiently than ever before.

Why would anyone put up with those bad odds? That’s not quite the right question to ask. Later on in the day, I watched a bachelor party descend upon a triple-zero wheel, despite that, right next to them, bathed in fluorescent light, a double-zero table—encircled by empty seats—waited for customers. The serene, vodka-buzzed tourists either didn’t know or didn’t care that they were inches away from a much better deal. Vegas happily feasted upon that ambivalence all night long.

Vegas seems to have exported its triple-zero philosophy across the Strip. Another casualty is blackjack, which remains the most popular casino attraction in the city. Historically, the game has followed a golden rule. If you are dealt 21—an ace and a 10—you’ve hit blackjack, and your wager is paid out on a 3-to-2 ratio. (A $100 bet nets $150, and so on.) But Vegas has since altered the rules. Now, on most tables, blackjack is rewarded with a 6-to-5 equation; that same $100 kicks back only $120, significantly curtailing just how lucky someone is allowed to get. Again, it’s not hard to see why Vegas casinos made the change. “They’re tripling the house edge,” John told me. “It went up from about 0.66 percent to 2 percent.”

Even if a gambler is willing to tolerate these perversions of tradition, the price of admission in Vegas has skyrocketed. According to John’s research, in 2020, 38 casinos in the greater Las Vegas gambling market featured tables dealing 3-to-2 blackjack capped at a $5 minimum bet. (As in, to play, you need to risk at least $5 per hand.) These days, that group has dropped to six casinos. Prowl through the Strip after dark, sift through the pits, and you’ll feel the difference. Most table games in 2025 force patrons to sacrifice painful amounts of cash to its maw—$25 minimums are basically standard. Fifty-dollar minimums aren’t uncommon either. Even more deviously, some Vegas properties force customers to pay a premium to access friendlier rules. I came across exactly one ultra-rare single-zero roulette wheel on the Strip, which felt a little bit like uncovering the hutch of the last surviving dodo. Naturally, it was stowed away in a high-limit room.

John told me that Vegas initially ratcheted up its minimums during the pandemic in reaction to the crunch of COVID-era gambling. Social-distancing mandates limited the number of players that could gather at casino tables, so operators made up the difference in scale—squeezing more money out of the few gamblers risking infection to play. It is less clear why those juiced wagers stuck around once the coronavirus receded, outside of the obvious: Gamblers are willing to pay them.

Oliver Lovat, a real-estate consultant at the Denstone Group who serves as an adviser to several Vegas casino properties, said I needed to understand that cheaper games are no longer economically prudent in the city. Between inflation, upkeep, and labor costs—including a Nevada minimum wage that jumped to $12 last year—Lovat argued, the salad days of low-minimum blackjack have been legislated out of the fray. After all, it is telling that no matter how much Vegas tourism declines, the city’s gambling revenue continues to tick upward. In August, gaming revenue on the Strip increased by 5.5 percent. Downtown, it was by over 8 percent, and the Boulder Strip was up almost 10.

“It’s not viable to run a $5 blackjack table anymore. You will lose money running $5 blackjack,” Lovat said. “Now, some places still have it. But they’re running it at a loss.”