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From New Yorker

From Vox

Biden’s top candidates aren’t just very different people ideologically, they are temperamentally nothing like Trump’s evangelists for movement conservatism. If you want to discover their views on abortion, guns, or affirmative action — to take three issues that are currently pending before the Supreme Court — you’d be hard-pressed to find much in their judicial opinions or their public speeches.

So why are Biden’s possible nominees so cautious, while Trump’s were so open about just how eager they are to burn things to the ground?

One possible explanation is that Biden, like nearly every other human being who has ever drawn breath, is a more cautious person than Donald Trump. Another is that, with a Republican supermajority on the Supreme Court, liberal judges have little incentive to write bold opinions. It’s not like this Court is going to embrace such an opinion.

But an important answer to this question can be found in this Daily Kos chart by Stephen Wolf:

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Stephen Wolf/Daily Kos Elections

The fact that each state gets two senators, regardless of population, has a massive distorting effect on American politics — especially because Republicans are more likely to control low-population states. Thanks to this malapportionment, every voter in red Wyoming has 68 times more impact on the makeup of the Senate than each voter in blue California.

In the current Senate, Democrats and Republicans each control the same number of seats, but Democratic senators represent nearly 42 million more people than their Republican counterparts. Indeed, if the United States chose senators in free and fair elections where every citizen’s vote counts equally, Republicans would not have controlled the Senate since the late 1990s.

Because every federal judge must be confirmed by the Senate, Senate malapportionment is the primary reason why conservative Republicans dominate the Supreme Court — although the Electoral College, which allowed both George W. Bush and Donald Trump to occupy the White House after losing the popular vote, sure didn’t help. If the United States were governed by the principle of one person, one vote, President Barack Obama would have filled the late Justice Antonin Scalia’s seat in 2016, and none of Trump’s justices would have been confirmed.

Indeed, Republicans have enjoyed an unfair advantage in the Senate for so long that it is possible that Democrats might have succeeded in blocking Justice Clarence Thomas, who was confirmed by a 52-48 vote in 1991, if they were fairly represented in the Senate. Chief Justice John Roberts, who won confirmation in a lopsided 78-22 vote in 2005, likely would have still been confirmed in a Democratic Senate. But President Bush might have picked a more moderate nominee than the GOP partisan Samuel Alito if Republicans did not enjoy a structural advantage in the Senate.

The result of this imbalance, in other words, isn’t simply that Republicans now control at least two or three Supreme Court seats that they would not control if the Senate were fairly apportioned. Senate malapportionment means that Republican presidents can nominate the most strident Republican partisans and the most outspoken conservative ideologues, and still expect those nominees to be confirmed.

Democratic presidents, meanwhile, risk having their nominees blocked, Merrick Garland-style, even when the president enjoys majority support from the nation as a whole. And even when Democrats do control the Senate, their majority frequently depends on conservative Democrats like Sens. Joe Manchin (D-WV) and Kyrsten Sinema (D-AZ), each of whom could potentially veto a nominee they deem too liberal.

This structural imbalance, more than anything, explains why Republicans get to appoint their fantasy nominees to the Supreme Court, while Biden’s potential nominees range from dully moderate liberals to humdrum centrists.

Republicans don’t really have a credible case against any of the three most likely nominees

Ketanji Brown Jackson has had a high judicial profile for a pretty long time.

In 2016, Jackson was one of a handful of candidates President Obama interviewed for the doomed Supreme Court nomination that eventually went to Garland. She was also Biden’s very first judicial appointment — Biden promoted her from a powerful trial court in Washington, DC to an even more powerful appeals court. And Jackson is Black, which is relevant to her chances because Biden promised to name a Black woman to the nation’s highest Court.

So anyone who knows anything about judicial politics could tell that Jackson was a leading contender for a Supreme Court nomination under Biden. When Jackson faced a confirmation hearing last April, Senate Republicans had a prime opportunity to unload any dirt they’d uncovered on her, and potentially soften her up for a future Supreme Court confirmation hearing.

Yet her hearing was a stodgy, entirely forgettable affair. Sen. Mike Lee (R-UT), a hardline conservative who once claimed that federal child labors laws are unconstitutional, spent much of his question time asking about sentencing policy. A few senators spent her hearing attacking Demand Justice, a left-leaning advocacy group whose only apparent connection to Jackson is that it supported her nomination. Even Sen. Ted Cruz (R-TX) spent the bulk of his time asking how she understands vague terms like “judicial activism.”

It was obvious, in other words, that Republican opposition researchers had uncovered nothing in Jackson’s record that could be used to build a persuasive case against her, even to other Republicans.

Similar things can be said about Kruger and Childs. Profiles of Kruger bear headlines like “Potential Biden Supreme Court pick Leondra Kruger known as moderate in California,” and “Potential Supreme Court nominee Kruger is described as a moderately liberal justice on California’s top court.” And Childs has even earned some tepid praise from Senate Republicans — Sen. Tim Scott (R-SC) described her as a “strong candidate” for the Supreme Court, and Sen. Lindsey Graham (R-SC) described Childs as a “quality person” and “somebody I can see myself supporting.”

Jackson, Kruger, and Childs all have pretty boring records

Even when Jackson, Kruger, and Childs hear politically charged cases, they typically dispose of them in fairly narrow opinions.

After a criminal defendant challenged a California law requiring police to collect a DNA sample from people arrested on felony charges, for example, Kruger got rid of the case in an opinion arguing that this defendant was the wrong person to challenge the law. When Childs was assigned a case asking her to strike down South Carolina’s ban on same-sex marriage, she sat on the case until the appeals court that oversees federal trial judges in her region ruled that states may not deny marriage rights to such a couple. Then Childs struck down South Carolina’s law on the grounds that she was bound by the appeals court’s decision.

Even when these potential justices do reach decisions that might upset Republicans, moreover, those decisions are often highly caveated. In Committee on the Judiciary v. McGahn, for example, Jackson rejected the Trump administration’s argument that “a President’s senior-level aides have absolute testimonial immunity” from a congressional subpoena, after a House committee subpoenaed former Trump White House Counsel Don McGahn.

While this was a loss for the Trump administration, it was a minor one. Jackson also wrote that “the specific information that high-level presidential aides may be asked to provide in the context of such questioning can be withheld from the committee on the basis of a valid privilege.” So, while she would have required McGahn to physically present himself to the committee, he could have still refused to answer questions that are subject to executive privilege. (Jackson’s McGahn opinion sparked a partisan food fight in the appeals court, and a panel dominated by Republican judges eventually ordered the case to be dismissed in a party- line vote.)

Similarly, in Middleton v. Andino — a decision handed down at the height of the pandemic — Childs temporarily halted a South Carolina law requiring absentee voters to have a witness sign their ballots, reasoning that such a requirement increases the risk that voters could transmit Covid-19 to such witnesses, or vice versa. That decision was eventually blocked by the Supreme Court in an unsigned, two-paragraph order.

But Childs’s full opinion in Middleton is also quite modest. It rejected other voting rights claims brought by the same plaintiffs, including an argument that the state’s ban on campaign workers assisting voters with their absentee ballots violates the Constitution. And, in any event, Childs can hardly be faulted because she failed to anticipate how a Supreme Court, that frequently ignores the text of federal laws and of the Constitution in voting rights cases, would have approached the novel legal questions that arise when an election is held during a historic public health crisis.

The overarching picture that emerges from all three women’s records is that they are cautious, disinclined towards expansive decisions, and more interested in deciding the narrow legal issues that are directly before them than in sparking a revolution that overturns decades of well-established precedents.

Those are all very positive traits in anyone who aspires to lead an unelected branch of government that is not supposed to set US policy. But Democrats who hoped that Biden’s nominee might provide a proudly liberal counterbalance to Trump’s movement conservative reactionaries are likely to be disappointed.

If Republicans continue to appoint their most fervent partisans and ideologues, while Democrats struggle to appoint cautious moderates, the law will continue its march further and further to the right.

Meta CEO Mark Zuckerberg. | Drew Angerer/Getty Images
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A $250 billion question.

Facebook built one of the most amazing money machines the world has ever seen. Then Apple came and threw a wrench in the gears.

That’s one of the narratives that sprang from last week’s news, when Facebook’s parent company Meta delivered an alarming earnings report to Wall Street, which promptly cut an astonishing $250 billion out of the company’s value in a single day — a 26 percent drop. And there were a lot of narratives.

For a large and vocal group of Facebook haters, the stock crash was a chance to reaffirm your priors: If you thought Facebook was getting comeuppance for creating a toxic product that made the world worse, you could point to its first-ever loss of users. If you thought Mark Zuckerberg’s pivot to a yet-to-exist metaverse is a fantasy, you could point to the $10 billion the company said it sunk into the effort last year. And if you thought TikTok was eating Facebook’s lunch, you could cite Mark Zuckerberg himself, who acknowledged on the company’s earnings call that the video app was “so big as a competitor already, and also continues to grow at quite a fast rate off of a very large base.”

And all of those stories have a degree of truth. But the idea that Apple has hurt Facebook’s revenue in a direct and meaningful way seems the truest: Facebook says changes Apple made that affect how ads work on iOS apps — namely, that it’s now much harder for app-makers and advertisers to track user behavior — will cost it $10 billion in revenue this year.

For context: Facebook is still making an enormous amount of money from advertising — analyst Michael Nathanson estimates the company will generate $129 billion in ad revenue in 2022. But that would mean its ad business will only grow about 12 percent this year, compared to a 36 percent increase the previous year. Wall Street has prized Facebook for its ability to grow at a rocket velocity, and now that rocket may be sputtering.

What can Facebook do about it?

The background: The seeds for last week’s news were planted many months ago. In June of 2020, Apple announced changes to its mobile operating system that would give iPhone users a chance to tell app-makers not to follow them around the internet. That tracking system is the backbone of the internet’s advertising infrastructure, and you’re familiar with it even if you never think about it: It’s why, for instance, you see ads for shoes you’ve already looked at on Zappos when you’re visiting other sites. And in Facebook’s case, it’s crucial for finding people advertisers want to reach and, importantly, telling them what happens after those people see or interact with their ads.

A month later, Facebook began warning investors that those changes would hurt their ad business. The fight between the two companies got more intense after that, with both sides lobbing public attacks at each other.

While there were lots of signs that Apple’s change was in fact hurting Facebook’s ad sales, people in and out of the company also assumed that Facebook would figure out how to handle it because Facebook is a giant company flush with cash and bright engineers. And while Facebook continued to warn investors in its quarterly updates that Apple’s moves would be a problem, it used generic terms like “headwinds” when it did. More cynical observers wondered if Facebook was overplaying the problem in order to get sympathy from regulators looking to rein in Facebook’s power — or to get them to focus their attention on Apple, which is also under antitrust scrutiny.

Now Facebook is saying, in public, that Apple’s ad changes have been a really big deal, after all. The short version, as COO Sheryl Sandberg told investors last week: Facebook’s ad targeting became less accurate because it now knows less about its users. Which means Facebook advertisers have to spend more money in the hope of reaching people on iPhones — and that Facebook advertisers, who had been used to measuring the effectiveness of their campaigns down to the penny, now have to make much-less-informed guesses about whether their ad dollars are working

Another way of putting it, via Alex Austin, the CEO of Branch, a company that helps advertisers figure out how their campaigns are working: After Apple introduced its anti-tracking changes in the spring of 2021, advertisers who used Branch’s services to measure paid ads on iOS dropped by 20 percent. Instead, Branch customers spent more time using the company’s services that track “organic” marketing campaigns using tools like email, and on services for advertisers who used Google’s Android phones — where those anti-tracking measures don’t exist. “It’s clear that the market is still figuring out how to handle [Apple’s new rules] on iOS, and shifting focus to Android and organic channels on iOS,” he told Recode.

Facebook says it’s working on a fix to make things better for advertisers in the near term via an “aggregated event measurement” workaround. Which in plain English means that while it won’t be able to tell advertisers which individual users clicked on a link or downloaded an app after seeing an ad, it can tell them what a larger group of users did.

Depending on your perspective, that’s either a big improvement for users’ privacy or a large step backward for advertisers used to fine-grained accuracy on the internet. But both Google and Snap have rolled out similar products and have told investors they are working well-ish; Facebook executives concede that their version is not, yet; they think it will take months to get there.

Again: Facebook is an ad behemoth that isn’t going away anytime soon. And it’s perfectly reasonable to assume that it will muddle through this, in large part because it’s so large. If you’re an advertiser, “there’s very few other places to go,” Nathanson told Recode.

But you can also see Facebook tacitly conceding that even when their tools get better, they’re never going to be as effective on iOS as they used to be. That’s one of the reasons the company is making a renewed push into selling products on their own apps — not just Facebook’s Marketplace platform, but actual digital storefronts on Instagram and Facebook. It’s a plan that Zuckerberg laid out publicly last spring, not coincidentally as Apple’s privacy changes went into effect.

The revenue Facebook could generate from those sales is nice, but the data Facebook can legally capture about how users behave, without interference from Apple, could be invaluable. Facebook can’t tell a shoe store if someone saw their ad on the app, then clicked through to the store’s site or app and bought something — but it can tell them if a Facebook user saw the ad on Facebook and then bought the shoes on Facebook.

Other recent Facebook moves reveal how Apple’s iOS changes have permanently affected its existing ad business. For example, Facebook is making a renewed push into Reels, the TikTok copycat product it is promoting on Instagram and the traditional Facebook app, even though it’s barely running ads on Reels, for now.

The hope is to build up use and then figure out revenue later. That’s a longstanding tech tactic, and one that worked well for Facebook when it copied Snapchat’s “stories” on Instagram — which gave it a way to create a new source of ad revenue and helped slow Snapchat’s growth.

And you can also see Facebook’s Apple problem as another impetus for its metaverse push: It will take many years for Facebook’s alternate reality future to materialize — and it may never happen. But if it does, Zuckerberg will have built his company a hardware and software platform where he can interact directly with his users — and so can his advertisers — without interference from Apple or anyone else.

Which brings us back to Apple, which has always insisted that it was making its privacy changes because it values privacy and not because it would damage Facebook. And to be clear: Apple doesn’t want Facebook to go away because Apple’s users like Facebook. For hundreds of millions of people, an iPhone that doesn’t have Facebook or Instagram or WhatsApp isn’t a very useful iPhone.

But Apple has also made it clear how much disdain it has for Facebook’s core business. A year ago, for instance, Apple CEO Tim Cook, without naming the company specifically, publicly criticized businesses that were “prioritizing conspiracy theories and violent incitement simply because of their high rates of engagement,” “not just tolerating, but rewarding content that undermines public trust in life-saving vaccination,” and “seeing thousands of users join extremist groups, and then perpetuating an algorithm that recommends even more.”

“If a business is built on misleading users, on data exploitation, on choices that are no choices at all, then it does not deserve our praise,” Cook said in his speech at an international privacy conference. “It deserves reform.”

Is it possible that Apple is deeply interested in user privacy and sees an advantage in clipping the wings of one of its major rivals (while, by the way, building its own ad business)? Absolutely.

But instead of wondering what Apple’s motivations are, maybe we should spend time thinking about the power Apple has. While regulators around the world struggle to restrain Facebook’s power and influence, Apple has put its rival on its back foot with a mere tweak to its phones’ software. You may applaud that change — and still worry about what else Apple might want to change down the line.

The pandemic dramatically disrupted cancer screenings, and thousands of lives are now at stake.

Steve Serrao, chief of gastroenterology at a hospital in Moreno Valley, California, just lived through the fourth wave of Covid-19 with the omicron variant sweeping across the country. Patients in respiratory distress once again filled the hospital’s beds.

But it is another wave, one that’s starting to trickle in but is still a long way from cresting, that Serrao worries about most. He fears that the delayed diagnoses of various cancers and other chronic, life-threatening illnesses — the result of Covid-19’s disruption to routine checkups and screenings — will be the next crisis that overwhelms the US health system.

“Our next surge will be advanced chronic disease,” Serrao told me over the phone. “That’s going to be the next surge of patients who overwhelm our system. I don’t think our systems are ready.”

The Covid-19 pandemic dealt a crushing blow to the preventive services that can catch potential health problems before they become life-threatening. Screenings for several major cancers fell significantly during 2020, according to a study published in December 2021 in the journal Cancer. Colonoscopies dropped by nearly half compared to 2019, prostate biopsies by more than 25 percent. New diagnoses declined by 13 percent to 23 percent, depending on the cancer — not because there was less cancer in the world, but because less of it was being detected. The screening backlog was still growing by the end of 2020, according to this recent study, albeit at a slower rate.

“I think we are absolutely in uncharted territory,” Brian Englum, a University of Maryland surgeon who co-authored the new Cancer study, told me. “There are no examples I know of where we have seen numbers change this dramatically.”

The fear among doctors is that the pandemic’s disruption to cancer screenings and other preventive measures won’t just be a blip, although a blip would be bad enough on its own: When cancer gets diagnosed late, it’s less likely a patient’s doctors can successfully intervene, and the patient is more likely to die. Even a four-week delay in diagnosis is associated with a 6 to 13 percent higher risk of death.

But they also fear that the missed screenings will lead to a more permanent disconnect between patients and the health system. Research has found that when patients lose their primary care doctor, they tend to end up in the hospital more, with more serious health problems. People who have skipped appointments or didn’t get screenings or care may be less likely to seek it in the future, and the problems could compound.

It may take years for the consequences to become clear. Before the pandemic, some physicians questioned if the US might be conducting too many screenings. But the country is now being forced to undergo an unintended natural experiment in less screening, one with thousands of lives at stake. The collateral damage of a pandemic that has killed more than 900,000 Americans could grow even more.

“We could be years into this before we know there’s a problem,” Englum said, “and we’ve already lost a lot of people.”

“How many of these cases are out there? Nobody knows.”

Serrao described one of his patients as a Hispanic man in his 40s. When he first noticed bleeding in early 2020, the patient talked to his primary care doctor, who told him it might be hemorrhoids, Serrao said. The primary care doctor acknowledged that getting a cancer screening would be impossible on short notice because the local hospitals were so strained with Covid-19. And the patient feared he might get sick if he went to a hospital.

Ultimately, it was 18 months before the patient sought a colonoscopy. He was diagnosed with what was, by then, advanced rectal cancer, Serrao said.

If the man had come in right away, Serrao said, he might have been cancer-free after a simple polyp removal. Instead, the doctor and his team are now battling cancer that has moved into other parts of the patient’s body. His outlook is much worse than it would have been if the cancer had been caught sooner.

“How many of these cases are out there? Nobody knows,” Serrao said.

Serrao’s patient had the misfortune to notice symptoms amid the biggest disruption of medical care in US history — one that hit cancer screenings particularly hard. In April 2020, as many hospitals canceled services in order to prepare for the expected surge of Covid-19 patients, the number of colonoscopies plummeted 93 percent. Then, after a brief rebound, the late 2020 winter wave stretched hospitals and forced them to limit services. By the end of the year, there had been 133,231 fewer colonoscopies performed in 2020 compared to the 2019 baseline, 62,793 fewer chest CT scans, and 49,334 fewer fecal blood tests.

 Jon Cherry/Getty Images

A pharmacy technician passes items to a nurse from a sterile area at the James Graham Brown Cancer Center in Louisville, Kentucky, on April 2, 2021.

“The drop-off in screenings has made me born again on the importance of screening,” John Marshall, chief of oncology at Georgetown University Hospital, told me. “We’re seeing more advanced diagnoses, and people presenting at a stage where they no longer can be cured.”

It will take months for the backlog to be cleared. Carrie Saia, the CEO of a community hospital in Holton, Kansas, told me that one of her facility’s gastroenterologists had been recruited by a larger Kansas City hospital to “scope from 7 in the morning to whenever at night, doing nothing but scopes.”

“They’re 1,000 people behind and backlogged right now,” Saia said. “A certain percentage out of those patients are going to have cancer growing.”

And working to clear that backlog begets a new backlog. Patients who are just now seeking a screening are finding it harder to get appointments. Marshall said he knew of patients who first experienced symptoms in September, were recommended for a screening by their doctor, but still couldn’t get an appointment as of December because there are so many patients in need of colonoscopies, MRIs, and other screening procedures.

Covid-19 led to direct rationing in overwhelmed hospitals last summer; they were unable to take patients with acute medical emergencies and couldn’t find another facility to take them. But this more subtle kind of rationing — delaying necessary services for months because the backlog has grown so large — also takes its toll, forcing doctors to make hard choices about which patients to prioritize.

“Everything is harder,” Marshall said. “We’ve had to make trade-off and priority decisions about who’s getting the treatment before the other person, decisions we would never have had to make.”

Covid-19’s disruption of US health care is likely going to deepen disparities

Serrao practices at the Riverside University Health System in San Bernardino County, about an hour and a half drive from downtown Los Angeles. Roughly two-thirds of his patients are Black, Hispanic, or Asian/Pacific Islander. Almost all of them have government insurance, either Medicare or Medicaid.

Black Americans already experience a higher incidence of and a higher mortality from colorectal cancers than white Americans. Black and Hispanic patients also tend to be diagnosed with more advanced lung cancers than their white peers, they have higher mortality from breast cancer, and they receive fewer prostate exams. At each stage, from preventive screenings to death rates, disparities already existed.

“They already have health disparities on a good day,” Serrao told me. “These last couple of years have put them back multiple years. The setback is quite profound.”

Over the course of the pandemic, Serrao’s practice struggled to make a dent in the backlog. Just as they would gain some momentum, another surge of Covid-19 would interrupt their progress.

Last January, the GI unit at his hospital was converted to a recovery area for patients receiving radiation therapy and other cancer treatments because overflow Covid-19 patients were in the space usually reserved for oncology recovery patients. As a result, he and his team couldn’t perform any screenings.

It was a necessary step — the top priority was maintaining treatment for patients already diagnosed with cancer — but it required the postponement of screenings to identify new cancer cases. The backlog got bigger.

“I’m almost certain that there are population pockets out there that have high disparities with cancer that will show up in the next year, two years, three years with more advanced cancers,” Serrao said, “and that’s because of the disruption in health care.”

A doctor sits beside a large screen showing pictures of breast tissue collected via 
mammography. Craig F. Walker/The Boston Globe via Getty Images
In response to a drop-off in screening mammography during the pandemic, Dr.  Constance Lehman, shown here at Massachusetts General Hospital in Boston in July 2021, set up a program to make mammography easier by ensuring that all the follow-up testing can be done in one day.

The US will be living with the fallout of delayed cancer screenings for years

That problem may only be getting worse over time. Englum told me that one of the more troubling implications of their findings is that cancer screenings did not return to their pre-pandemic normal by the end of 2020.

It wasn’t a two- or three-month blip during the worst of the outbreak. By the end of the year, the drop in screenings looked more and more like a permanent setback. It’s the same problem we’re seeing with routine vaccinations: people who missed their shots and aren’t catching up even as we enter a new post-Covid normal.

“What our study shows is not only did we not make up for the blip, we didn’t even get back to baseline by the end of 2020,” Englum said. “We kept losing ground.”

The US health system struggled before the pandemic with managing people’s care in a timely fashion. It requires having an established relationship with a primary care doctor — which fewer and fewer Americans do — and then staying on schedule with recommended preventive screenings like colonoscopies and mammograms. As of 2018, according to a federal study, only 8 percent of Americans were receiving all the preventive services that are recommended for them.

Americans have now lived through two years when their primary care practice might have been closed, permanently or temporarily. The hospitals where they would have gotten a colonoscopy were postponing those non-emergent procedures. Some of them may have been afraid to go to the doctor or hospital, knowing that a highly transmissible virus was on the loose.

That only makes the challenge of getting people to stay on top of their health care harder. Doctors worry that people’s habits may be permanently changed by the pandemic — and not for the better.

“I am fearful that once people got out of that habit, they didn’t see an immediate problem,” Englum told me. “Then they say, ‘Well, I haven’t seen my doctor for six months or a year and nothing happened. I feel fine.’ They’re just out of the habit. They lost the routine.”

That means the health system is flying blind. Unless people get back in the habit of getting their recommended screenings, doctors will lose ground every year in identifying patients with serious conditions or at risk of developing them. That would limit their ability to get ahead of emerging health problems before they become chronic or even life-threatening.

In theory, Englum pointed out, this also could be an opportunity to learn whether the current screening guidelines are actually appropriate. If 10 years were to pass and there were no appreciable increase in cancer mortality, for example, maybe we could revise our recommendations for colonoscopies from every 10 years to every 12. The pandemic would have provided evidence such a delay doesn’t present a big risk at the population level.

That kind of reevaluation is happening across the health system. Health insurers are monitoring the outcomes for patients who delayed kidney treatment because of Covid-19. They are watching for any negative effects, but also for countervailing evidence that might indicate the missed care was actually unnecessary.

At every level, the pandemic has forced a natural experiment in what a disruption to the usual treatment plan means for patient outcomes. We are going to learn a lot, like it or not. The risk is that those lessons will come at the cost of thousands of lives.

Because the flip side of the optimistic scenario is that in 10 years’ time, we will see cancer mortality increasing as a result of delayed screenings.

“By then,” Englum said, “you’ve lost the opportunity to treat however many thousands of people.”

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