Skeptics Guide to the Universe Forums

The Skeptics' Guide to the Universe => Podcast Episodes => Topic started by: Steven Novella on June 30, 2018, 12:33:42 PM

Title: Episode #677
Post by: Steven Novella on June 30, 2018, 12:33:42 PM
What's the Word: Endophyte
News Items: DNA Testing, Anti-Smart Meter Pseudoscience, Keeping Ahead of the Expanding Universe, Roots of Alcoholism
Who's That Noisy
Your Questions and E-mails: Brit-Bashing
Science or Fiction
Title: Re: Episode #677
Post by: elert on June 30, 2018, 02:56:32 PM
The speed of sound in steel is around 15 times faster than the speed of sound in air at room temperature.
Title: Re: Episode #677
Post by: daniel1948 on June 30, 2018, 03:37:12 PM
I did 23andme a few years ago because I was curious about my ancestry. They also gave me a bunch of health information without counseling. The health info gave my probability of a bunch of different conditions, and for each, a confidence level for the prediction. I saw that I have a very slightly increased risk of developing Alzheimers, and at first that disturbed me. But then I reflected that the chances are still very small, and on top of that the confidence level of the prediction was not all that great. Bottom line: Meh! No big deal. Same for all the other medical conditions they listed.

I agree with Steve that companies should not be allowed to make bogus claims. But I feel the same way about companies that make bogus claims in any realm. Con artists that offer to sell you "life-extending" information for $2,500 are a much lower concern for me than scum like Jenny McCarthy convincing parents to not get their kids vaccinated.

I agree with Steve that companies should not be allowed to make unsupported claims. I agree with Cara that people have a right to their own information if they want to pay for the testing, or if it already exists in a data base somewhere.
Title: Re: Episode #677
Post by: bachfiend on June 30, 2018, 07:33:18 PM
For what it’s worth, I read German translations of books.  The publishers usually specify whether the book has been translated from the American or the English (and occasionally the Australian).
Title: Re: Episode #677
Post by: mddawson on June 30, 2018, 08:33:31 PM
FYI: Japan also drives on the left hand side of the road.
Title: Re: Episode #677
Post by: God Bomb on June 30, 2018, 10:57:15 PM
Other countries which are not british former colonies who drive on the left - Thailand and Indonesia.



About 23 and me, I asked this before in several places but nobody ever gave me an answer. 
Do they have any questionnaire component of the test?  Do you have to give your real name?

I'm not concerned about privacy, it's more to do with wanting a blinded test.   I wouldn't be very impressed if it asks first where my parents are from, then tells me my ancestry is from the same place.  Similarly some names give a very reliable indication of your ethnicity.
 Do you think it is worth non-whites taking this test, since as said, the vast majority of their data is from white americans and europeans.  How detailed and accurate will the ancestry info be for non-whites?
Title: Re: Episode #677
Post by: lonely moa on July 01, 2018, 01:22:19 AM
Cheese in NZ is made with rennet, derived from animal stomach lining, thank you very much.

Title: Re: Episode #677
Post by: Nigel on July 01, 2018, 07:34:14 AM
I am in the States form Pennsylvania so my thoughts about the SGU being too parochial come from this viewpoint.  I have never thought the SGU was making fun of the U.K.  If anything I sometimes wonder if they are too much is awe of it.  Although, this is a mere quibble.  I compare it to when listening to Skeptics with a K. They often make jokes of the correct way to spell a word in the British manner compared to in the U.S. or how to say the name “Cecil” correctly, and that Cecils in the U.S. say their own name inproperly.   Perhaps only once or twice in the years of listening to SWaK did I think something might have approached a line.  I got over it.  It seems to me the SGU is similar in style.  If anything SWaK I think lacks the admiration for the U.S. that the SGU shows for Britain and Australia.  (I do think British/U.S./Australian skeptics do approach certain topics of skepticism differently mainly those dealing with religion, but that is a different topic.)

I cannot say the email author is wrong to feel offended.  I cannot get inside the guy’s head, but I sure hope the SGU does not change its tone or demeanor at all.  (Sure seemed to me Dr. Novellla was projecting they were not going to change.).

Yes. Even with Connecticut only being three hours away from my home there are times that turns of phrase or pronounciation used by the brothers and Evan strike me as odd.  The most common example is the New England pronunciation of ‘aquatic.” Cracks me up each time.
Title: Re: Episode #677
Post by: lonely moa on July 01, 2018, 02:05:17 PM
Interesting that breast and prostate cancer screening didn't arise in the DNA testing discussion... but not surprised.
Title: Re: Episode #677
Post by: bachfiend on July 01, 2018, 07:34:40 PM
Interesting that breast and prostate cancer screening didn't arise in the DNA testing discussion... but not surprised.

In Swedish populations, genetics plays a role in around 50-60% of cases, in particular BRCA1 and BRCA2 confers a moderate to high risk of prostatic carcinoma in men and breast and ovarian carcinoma in women.

A summary from the NIH:

https://www.cancer.gov/types/prostate/hp/prostate-genetics-pdq

And, no, I haven’t learnt how to insert links.  I typed in the link laboriously.  Perhaps someone can tell me how to do it?  But I promise not to do a CarbShark with his block dumped lists of links.
Title: Re: Episode #677
Post by: Fast Eddie B on July 01, 2018, 07:40:13 PM
I think Steve may have gotten something wrong about the Heat Death of the universe.

He opined there would still be stuff. I think as long as there’s “stuff”, there will be gravity working on that stuff, which would involve movement and some degree of work, energy and heat.

From what I understand, the heat death will not arrive until the last proton “evaporates”. Though there are possibly more fundamental particles that will need to “evaporate” as well before Heat Death is complete.

But I’m not a physicist or cosmologist, so I’d appreciate being straightened out on this if I have it wrong.
Title: Re: Episode #677
Post by: Fast Eddie B on July 01, 2018, 07:42:49 PM


And, no, I haven’t learnt how to insert links.

Well, you have to paste the link between “url” and “/url”, each contained within square brackets.

But your url does, in fact, show as a link in Safari on an iPad.
Title: Re: Episode #677
Post by: bachfiend on July 01, 2018, 08:08:13 PM


And, no, I haven’t learnt how to insert links.

Well, you have to paste the link between “url” and “/url”, each contained within square brackets.

But your url does, in fact, show as a link in Safari on an iPad.

I should have specified that I don’t know how to insert links on an iPad.  Pasting links between brackets is also a problem.  If I was using a laptop, I wouldn’t have any problem.
Title: Re: Episode #677
Post by: Fast Eddie B on July 01, 2018, 08:53:52 PM


I should have specified that I don’t know how to insert links on an iPad.  Pasting links between brackets is also a problem.  If I was using a laptop, I wouldn’t have any problem.

As far as I can see, same way on a Mac or an iPad. Unless Im missing something.

As an aside, on my iPad I made a couple of "Text Replacement" shortcuts. "urly" types in the url tags in square brackets - all I have to do is paste between them. Really handy timesaver. You can guess what "imgy" and "quoty" do.
Title: Re: Episode #677
Post by: Friendly Angel on July 01, 2018, 09:08:06 PM

About 23 and me, I asked this before in several places but nobody ever gave me an answer. 
Do they have any questionnaire component of the test?  Do you have to give your real name?

I did it, about 2004.  Don't remember any such questionnaire, but maybe.  There were some questions about where you're from that seemed aimed at helping ancestry researchers.

The cast made a big deal about how important family history is in re medical evaluations - there are a lot of folks, like me, who have no idea what that history is.  So if you don't know one of your biological parents, or you're not sure if you're really related to Aunt Flo, these genetic testing services can be a nice fill-in.

Here's a snip from mine - if I had a big number in the colon cancer column, or if I knew there were colon cancer in my family, I would get more frequent testing... that's the value.

(https://i.imgur.com/PVlNt40.jpg)
Title: Re: Episode #677
Post by: Fast Eddie B on July 01, 2018, 10:22:40 PM
Getting away from the medical angle of DNA testing, I’m not sure if I mentioned here that I got an interesting result from Ancestry.com.

I knew that all my grandparents were Jewish and immigrated from Russia. So the result I got had one small aberration, but one I didn’t think much about:

(https://farm5.staticflickr.com/4568/24745531878_a5b256897b_z.jpg)

I’m talking about the blob over the British Isles.

I had always wondered if I was adopted - none of my relatives are tall, had curly blond hair as a child, or blue eyes.

Long story short - I was contacted by a lady who said her husband and I were either siblings or very close cousins. They also live in Georgia and we met, and had a lot in common. So far, it seems as though I share a father - not the one who raised me - with at least 3 other males and 3 other females. All of whom were born in Washington, DC between 1947 and 1955 to mothers who were having trouble conceiving. Speaking to another descendant led to a gentleman of Scottish descent in Washington, DC, who was a medical student and almost certainly the common sperm donor to at least the 6 “siblings” so far discovered. A living aunt confirmed that my mom had had trouble conceiving and had finally gotten pregnant after a “procedure”.

Just pointing out you never know what your DNA might show if you take the leap and have it checked!
Title: Re: Episode #677
Post by: Fast Eddie B on July 01, 2018, 11:03:13 PM
One more thing...

Regarding certain screenings for medical issues, Steve said something like...”If that was really effective, they’d already be doing it”.

Smacks of a fallacy, but I can’t put my finger on it.
Title: Re: Episode #677
Post by: God Bomb on July 01, 2018, 11:32:25 PM
Seems like begging the question. 

Just because something works doesn't necessarily mean it's practical or will become popular.
Title: Re: Episode #677
Post by: lonely moa on July 01, 2018, 11:53:13 PM
Interesting that breast and prostate cancer screening didn't arise in the DNA testing discussion... but not surprised.

In Swedish populations, genetics plays a role in around 50-60% of cases, in particular BRCA1 and BRCA2 confers a moderate to high risk of prostatic carcinoma in men and breast and ovarian carcinoma in women.

A summary from the NIH:

https://www.cancer.gov/types/prostate/hp/prostate-genetics-pdq

And, no, I haven’t learnt how to insert links.  I typed in the link laboriously.  Perhaps someone can tell me how to do it?  But I promise not to do a CarbShark with his block dumped lists of links.
 

Your link worked, btw. Ta.  I just click the address box, copy and paste.

The official breast screening pamphlet in NZ says screening cuts one's risk of death by 25%, that 5 of 10,000 screened women will die from breast cancer and 7 of 10,000 unscreened women will die from breast cancer annually. My beautiful wife has given mammograms a miss some time ago.

Title: Re: Episode #677
Post by: bachfiend on July 02, 2018, 03:02:07 AM
Interesting that breast and prostate cancer screening didn't arise in the DNA testing discussion... but not surprised.

In Swedish populations, genetics plays a role in around 50-60% of cases, in particular BRCA1 and BRCA2 confers a moderate to high risk of prostatic carcinoma in men and breast and ovarian carcinoma in women.

A summary from the NIH:

https://www.cancer.gov/types/prostate/hp/prostate-genetics-pdq

And, no, I haven’t learnt how to insert links.  I typed in the link laboriously.  Perhaps someone can tell me how to do it?  But I promise not to do a CarbShark with his block dumped lists of links.
 

Your link worked, btw. Ta.  I just click the address box, copy and paste.

The official breast screening pamphlet in NZ says screening cuts one's risk of death by 25%, that 5 of 10,000 screened women will die from breast cancer and 7 of 10,000 unscreened women will die from breast cancer annually. My beautiful wife has given mammograms a miss some time ago.

There’s some argument about whether mammography is worth doing.  Whether it’s picking up cancers that wouldn’t be causing a problem.

Anyway.  In the summary from the NIH there was a link to a summary on measures to prevent prostatic carcinoma also published by the NIH.  It noted that high fat diets increase the risk of prostatic carcinoma, and I thought of you and CarbShark (actually the studies were mixed - half showed an increased risk, and half showed no difference).
Title: Re: Episode #677
Post by: lonely moa on July 02, 2018, 04:34:00 AM
Interesting that breast and prostate cancer screening didn't arise in the DNA testing discussion... but not surprised.

In Swedish populations, genetics plays a role in around 50-60% of cases, in particular BRCA1 and BRCA2 confers a moderate to high risk of prostatic carcinoma in men and breast and ovarian carcinoma in women.

A summary from the NIH:

https://www.cancer.gov/types/prostate/hp/prostate-genetics-pdq

And, no, I haven’t learnt how to insert links.  I typed in the link laboriously.  Perhaps someone can tell me how to do it?  But I promise not to do a CarbShark with his block dumped lists of links.
 

Your link worked, btw. Ta.  I just click the address box, copy and paste.

The official breast screening pamphlet in NZ says screening cuts one's risk of death by 25%, that 5 of 10,000 screened women will die from breast cancer and 7 of 10,000 unscreened women will die from breast cancer annually. My beautiful wife has given mammograms a miss some time ago.

There’s some argument about whether mammography is worth doing.  Whether it’s picking up cancers that wouldn’t be causing a problem.

Anyway.  In the summary from the NIH there was a link to a summary on measures to prevent prostatic carcinoma also published by the NIH.  It noted that high fat diets increase the risk of prostatic carcinoma, and I thought of you and CarbShark (actually the studies were mixed - half showed an increased risk, and half showed no difference).

 
Quote
We conclude that dietary fat may indeed be related to prostate cancer risk, although the specific fat components that are responsible are not yet clear. Given the diverse effects of fatty acids on cellular biology and chemistry, it seems likely that the relationship is complex, involving the interplay of fat with other dietary factors, such as antioxidant vitamins and minerals, or with genetic factors that influence susceptibility.

The study you quote suggests that the best way to avoid prostate cancer is to be castrated before puberty, not something most males would be keen to do.
Title: Re: Episode #677
Post by: brilligtove on July 02, 2018, 08:54:28 AM
I think Steve may have gotten something wrong about the Heat Death of the universe.

He opined there would still be stuff. I think as long as there’s “stuff”, there will be gravity working on that stuff, which would involve movement and some degree of work, energy and heat.

From what I understand, the heat death will not arrive until the last proton “evaporates”. Though there are possibly more fundamental particles that will need to “evaporate” as well before Heat Death is complete.

But I’m not a physicist or cosmologist, so I’d appreciate being straightened out on this if I have it wrong.

If I recall correctly, the expansion of space will eventually accelerate to such an extent that it will overwhelm the strong nuclear force. Even works cannot remain bound together, there will be nothing left.
Title: Re: Episode #677
Post by: gebobs on July 02, 2018, 12:18:17 PM
I am in the States form Pennsylvania so my thoughts about the SGU being too parochial come from this viewpoint.  I have never thought the SGU was making fun of the U.K.  If anything I sometimes wonder if they are too much is awe of it.

I kind of understand it. When someone from the UK or wherever affects some American accent and says something stereotypically American, I'm not necessarily offended. But I may roll my eyes and wonder if they think all Americans speak or act that way. Of course, they probably don't. It's just funny pointing out our differences. Just so, when the rogues do their accents and say things like "Cor blimey", any Brit is probably rolling their eyes. The rogues just like doing bad accents and "Cor blimey" is funny anytime you say it.
Title: Re: Episode #677
Post by: daniel1948 on July 02, 2018, 12:25:08 PM
The study you quote suggests that the best way to avoid prostate cancer is to be castrated before puberty, not something most males would be keen to do.

And the next-best is to avoid eating excessive amounts of fat. The fact that the "best" is something most guys won't want to do, is not a reason for neglecting to do the second-best.
Title: Re: Episode #677
Post by: CookieMustard on July 02, 2018, 01:42:51 PM
One more thing...

Regarding certain screenings for medical issues, Steve said something like...”If that was really effective, they’d already be doing it”.

Smacks of a fallacy, but I can’t put my finger on it.

It seems to be the opposite of something like "If homeopathy wasn't effective  there wouldn't be so many people using it."
Title: Re: Episode #677
Post by: gebobs on July 02, 2018, 05:03:53 PM
One more thing...

Regarding certain screenings for medical issues, Steve said something like...”If that was really effective, they’d already be doing it”.

Smacks of a fallacy, but I can’t put my finger on it.

I think if he was in a debate, he would have couched his terms more carefully. And what I suppose he means is that medical science is always on the hunt for better diagnostic tools and I am sure they are watching DNA analysis quite closely. When this kind of tool becomes useful, the medical community will be tripping over themselves to get in on it.
Title: Re: Episode #677
Post by: CarbShark on July 02, 2018, 05:25:34 PM
One more thing...

Regarding certain screenings for medical issues, Steve said something like...”If that was really effective, they’d already be doing it”.

Smacks of a fallacy, but I can’t put my finger on it.

I think if he was in a debate, he would have couched his terms more carefully. And what I suppose he means is that medical science is always on the hunt for better diagnostic tools and I am sure they are watching DNA analysis quite closely. When this kind of tool becomes useful, the medical community will be tripping over themselves to get in on it.

What Steve is not mentioning is the cost benefit calculation. It's not just risk/benefit.

If full-body MRI scans and/or full genome sequencing helped 5% of people who had them done, but were inexpensive, then they'd be standard practice.

If they helped 95% of people who had them done, and cost as much as they do currently, they'd be standard practice.

In the US today, it may even be the cost/benefit analysis is given more weight than the risk/benefit analysis.

I'm wondering what the actual figures are? What percentage of people are discovered to have serious risks or conditions are by these procedures?

It's not zero, but I'm guessing it's less than 5%

Title: Re: Episode #677
Post by: bachfiend on July 02, 2018, 08:25:17 PM
One more thing...

Regarding certain screenings for medical issues, Steve said something like...”If that was really effective, they’d already be doing it”.

Smacks of a fallacy, but I can’t put my finger on it.

I think if he was in a debate, he would have couched his terms more carefully. And what I suppose he means is that medical science is always on the hunt for better diagnostic tools and I am sure they are watching DNA analysis quite closely. When this kind of tool becomes useful, the medical community will be tripping over themselves to get in on it.

What Steve is not mentioning is the cost benefit calculation. It's not just risk/benefit.

If full-body MRI scans and/or full genome sequencing helped 5% of people who had them done, but were inexpensive, then they'd be standard practice.

If they helped 95% of people who had them done, and cost as much as they do currently, they'd be standard practice.

In the US today, it may even be the cost/benefit analysis is given more weight than the risk/benefit analysis.

I'm wondering what the actual figures are? What percentage of people are discovered to have serious risks or conditions are by these procedures?

It's not zero, but I'm guessing it's less than 5%

I’m guessing that the figure would be vanishingly close to zero (not much more than rounding error) for an unselected population undergoing full body MRI scanning and and full genome sequencing in the absence of symptoms or a positive family history.  But it would throw up numerous ‘abnormalities’ either on MRI scanning which are of no significance (but which would either require further investigation or leave the person worrying) or on full genome sequencing with the presence of gene variants associated with a slight increase (of the order of less than 1% or so) in the risk of certain diseases.

If an ‘abnormality’ is detected, what do you do?  Worry yourself sick?  Henry Marsh, a retired British neurosurgeon, recounted an example in his book ‘Do No Harm.’  A patient had tension headaches, so her GP ordered a CAT scan (which was inappropriate), which showed a very small berry aneurysm on one of her cerebral arteries.  The risk is that it might rupture causing death or a stroke.  The lifetime risk of either of these two occurring is around 2% for the size of the aneurysm.  The aneurysm could be surgically clipped, removing future risk, but with a 2% risk of an intraoperative stroke or death, which occurs immediately.  The rational decision would be to do nothing, besides ensuring that the blood pressure is normal and remains normal (since high blood pressure is a risk factor for rupture).  The patient opted for immediate operation so as to avoid a lifetime of worrying about a timebomb in her head that was unlikely ever to cause her harm otherwise.
Title: Re: Episode #677
Post by: arthwollipot on July 02, 2018, 08:39:08 PM
Personally I don't get bothered by the America-centrism of the hosts. They are American, they live in America and are immersed in American culture. It's okay for them to approach things from an American viewpoint. They do at least make an effort - and a good one - to be international, and I appreciate that, because it's something that a lot of American podcasts don't bother with.
Title: Re: Episode #677
Post by: CarbShark on July 02, 2018, 08:39:15 PM

If an ‘abnormality’ is detected, what do you do?  Worry yourself sick?  Henry Marsh, a retired British neurosurgeon, recounted an example in his book ‘Do No Harm.’  A patient had tension headaches, so her GP ordered a CAT scan (which was inappropriate), which showed a very small berry aneurysm on one of her cerebral arteries.  The risk is that it might rupture causing death or a stroke.  The lifetime risk of either of these two occurring is around 2% for the size of the aneurysm.  The aneurysm could be surgically clipped, removing future risk, but with a 2% risk of an intraoperative stroke or death, which occurs immediately.  The rational decision would be to do nothing, besides ensuring that the blood pressure is normal and remains normal (since high blood pressure is a risk factor for rupture).  The patient opted for immediate operation so as to avoid a lifetime of worrying about a timebomb in her head that was unlikely ever to cause her harm otherwise.


My Medical Choice by Angelina Jolie - The New York Times (https://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html)
Quote
I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer.
My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.
Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.
Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.
Title: Re: Episode #677
Post by: bachfiend on July 02, 2018, 09:30:30 PM

If an ‘abnormality’ is detected, what do you do?  Worry yourself sick?  Henry Marsh, a retired British neurosurgeon, recounted an example in his book ‘Do No Harm.’  A patient had tension headaches, so her GP ordered a CAT scan (which was inappropriate), which showed a very small berry aneurysm on one of her cerebral arteries.  The risk is that it might rupture causing death or a stroke.  The lifetime risk of either of these two occurring is around 2% for the size of the aneurysm.  The aneurysm could be surgically clipped, removing future risk, but with a 2% risk of an intraoperative stroke or death, which occurs immediately.  The rational decision would be to do nothing, besides ensuring that the blood pressure is normal and remains normal (since high blood pressure is a risk factor for rupture).  The patient opted for immediate operation so as to avoid a lifetime of worrying about a timebomb in her head that was unlikely ever to cause her harm otherwise.


My Medical Choice by Angelina Jolie - The New York Times (https://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html)
Quote
I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer.
My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.
Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.
Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.

You don’t need to do a whole genome sequencing to detect BRCA1 (and BRCA2) mutations.  They can be looked for specifically with a simple test, and they’re already strongly recommended if there’s a family history.  BRCA2 mutations are a risk factor for prostatic carcinoma with a moderate to high probability over the lifespan.  I think two of my brothers had prostatic cancer.  Should I be tested for BRCA2 mutations?  If it’s positive, what should I do?  Have a prophylactic prostatectomy (with all of its complications)?

Whole genome sequencing would just pick up numerous gene variants associated with a slightly increased lifetime risk of some diseases such as type 2 diabetes or coronary heart disease.  And how would knowing that you’ve got a slightly increased lifetime risk change what you would (or should) be doing anyway?
Title: Re: Episode #677
Post by: brilligtove on July 02, 2018, 11:12:59 PM
People tend to say - and think - that you can never have too much information. When they do I ask, "How's your email inbox looking? Also, would you like to hear about my flesh burning under the radiation gun? Wait, you mean those both represent too much information? Hey, where are you going?"

...I may not use this tactic on people who are not assholes. Or I might stop after the first question at least.:)
Title: Re: Episode #677
Post by: drmarkf on July 03, 2018, 04:11:46 AM
So many people assume all screening is good for you (“learning you’ve got cancer early is good, surely?), but Steve is correct that the medical issues in many cases are not at all clear, and we need to do more to educate the public about this. Harm most definitely does occur, and the pre and post test probabilities are but part of the necessary assessment. There also needs to be the necessary scientific data on what should be done after the result has been obtained, and in many cases (even for quite common diseases) we don’t yet have that data.

A simple example close to the hearts of many men in their 50/60s: prostatic specific antigen testing (PSA) which is included in many commercial health screens. Levels tend to be raised in many men with prostatic cancer, but not all, and it can be raised in some common non-cancerous conditions.

It is reasonable to do the test if you have relevant symptoms (like poor pee stream) but an isolated raised PSA level discovered in a ‘routine’ medical is more trouble than it is worth. Yes, a few cancers will be detected, but there is a significant rate of false positives, the adverse event rate associated with some of the necessary further investigations is high (eg a 1.5 - 2% rate of septicaemia after trans-rectal needle biopsy), and management of true asymptomatic prostatic cancer is far from yet being an exact science. A full prostatectomy is major surgery with significant associated risks, yet a significant proportion of prostate cancers discovered at that age will not kill their owners or even cause much in the way of debilitating symptoms.

Work is going on in several relevant areas, eg less invasive diagnostic techniques, genetics of different tumours and their associated risks of acting in benign or aggressive ways etc, but we are currently not yet there.

So, the UK NHS line is do have a proper work-up if you have symptoms, and this will include a PSA, but screening is not medically advised for asymptomatic men generally.

A final point on the unexpected side effects of genetic profiling, relevant to those of us in nationally funded healthcare systems: obviously the wealthy are welcome to give their money to anyone for almost anything, but the guy before me in the waiting room to see my GP had just spent £3500 on what was described as a full screen by a private laboratory, including some genetic tests. Various ‘positives’ had turned up, and he was advised to take these to his healthcare provider. He then had an extremely long consultation with the GP who had to reassure him and explain all the issues.

So, this delayed the clinic by around half an hour, and potentially the NHS would have had to have picked up the cost of the fallout from this guy’s ‘worried well’ personal decision to waste his own money.
Title: Re: Episode #677
Post by: bachfiend on July 03, 2018, 10:46:46 PM
So many people assume all screening is good for you (“learning you’ve got cancer early is good, surely?), but Steve is correct that the medical issues in many cases are not at all clear, and we need to do more to educate the public about this. Harm most definitely does occur, and the pre and post test probabilities are but part of the necessary assessment. There also needs to be the necessary scientific data on what should be done after the result has been obtained, and in many cases (even for quite common diseases) we don’t yet have that data.

A simple example close to the hearts of many men in their 50/60s: prostatic specific antigen testing (PSA) which is included in many commercial health screens. Levels tend to be raised in many men with prostatic cancer, but not all, and it can be raised in some common non-cancerous conditions.

It is reasonable to do the test if you have relevant symptoms (like poor pee stream) but an isolated raised PSA level discovered in a ‘routine’ medical is more trouble than it is worth. Yes, a few cancers will be detected, but there is a significant rate of false positives, the adverse event rate associated with some of the necessary further investigations is high (eg a 1.5 - 2% rate of septicaemia after trans-rectal needle biopsy), and management of true asymptomatic prostatic cancer is far from yet being an exact science. A full prostatectomy is major surgery with significant associated risks, yet a significant proportion of prostate cancers discovered at that age will not kill their owners or even cause much in the way of debilitating symptoms.

Work is going on in several relevant areas, eg less invasive diagnostic techniques, genetics of different tumours and their associated risks of acting in benign or aggressive ways etc, but we are currently not yet there.

So, the UK NHS line is do have a proper work-up if you have symptoms, and this will include a PSA, but screening is not medically advised for asymptomatic men generally.

A final point on the unexpected side effects of genetic profiling, relevant to those of us in nationally funded healthcare systems: obviously the wealthy are welcome to give their money to anyone for almost anything, but the guy before me in the waiting room to see my GP had just spent £3500 on what was described as a full screen by a private laboratory, including some genetic tests. Various ‘positives’ had turned up, and he was advised to take these to his healthcare provider. He then had an extremely long consultation with the GP who had to reassure him and explain all the issues.

So, this delayed the clinic by around half an hour, and potentially the NHS would have had to have picked up the cost of the fallout from this guy’s ‘worried well’ personal decision to waste his own money.

I agree with what you’re saying about PSA screening for prostatic carcinoma.  It’s complementary to what I wrote about BRCA2 testing.

It should be noted though that most prostatic carcinomas are located peripherally in the prostatic gland and only produce urinary obstruction late (benign prostatic hyperplasia is usually the cause of a poor pee) usually after they’ve spread elsewhere and are no longer curable (in which case a PSA level is likely to be diagnostic, but alas, not a screening test).

The best screening test for prostatic carcinoma is the finger of an experienced doctor.  If you can afford it, the next best one is periodic prostatic MRI scans (and it’s a long way behind).  My GP insists on doing yearly PSAs - if they ever increase, then I’ll insist on an MRI scan instead of a biopsy to exclude a false positive.
Title: Re: Episode #677
Post by: drmarkf on July 04, 2018, 04:02:40 AM
>> It should be noted though that most prostatic carcinomas are located peripherally in the prostatic gland and only produce urinary obstruction late (benign prostatic hyperplasia is usually the cause of a poor pee) usually after they’ve spread elsewhere and are no longer curable (in which case a PSA level is likely to be diagnostic, but alas, not a screening test).

The best screening test for prostatic carcinoma is the finger of an experienced doctor.  If you can afford it, the next best one is periodic prostatic MRI scans (and it’s a long way behind).  My GP insists on doing yearly PSAs - if they ever increase, then I’ll insist on an MRI scan instead of a biopsy to exclude a false positive. <<

Yes, serial PSAs make sense logically, but to the best of my knowledge when I last looked this area up (a few years ago and, yes, I am a man in my 50/60s!) there was no evidence I could find it was better. I can't help thinking about serial MRIs that even for a billionaire your time and money would be better spent elsewhere. Think of all that mercury leaking from your fillings, for example!

Maybe there should be a separate board on here for us blokes of a Certain Age? Steve would be a member...

(Since this is a US site I'd better note that, yes, I am a retired medic who no longer has a license to practice clinically and is certainly not a urologist, so none of this constitutes medical advice  8)  )
Title: Re: Episode #677
Post by: CarbShark on July 04, 2018, 11:11:35 AM

You don’t need to do a whole genome sequencing to detect BRCA1 (and BRCA2) mutations. 

Right. I wonder if 23&Me or any of these other services look for that among the other genetic disease risks they look for.






Sent from my iPhone using Tapatalk
Title: Episode #677
Post by: CarbShark on July 04, 2018, 11:16:47 AM
http://docs.wixstatic.com/ugd/c621e5_421837f94d654e7784af18d98b5fc4d9.pdf

This is a sample report from one company. They claim they detect risks for over 100 diseases. (Including breast cancer)




Sent from my iPhone using Tapatalk
Title: Re: Episode #677
Post by: Friendly Angel on July 04, 2018, 12:23:19 PM
You don’t need to do a whole genome sequencing to detect BRCA1 (and BRCA2) mutations. 


Right. I wonder if 23&Me or any of these other services look for that among the other genetic disease risks they look for.


I don't know if it's the BRCA gene they're looking at, but my 23andMe report does list my relative risk for prostate cancer

(https://i.imgur.com/cmHjlV7.png)
(https://i.imgur.com/ji9irYt.png)
Title: Re: Episode #677
Post by: bachfiend on July 04, 2018, 06:05:22 PM
>> It should be noted though that most prostatic carcinomas are located peripherally in the prostatic gland and only produce urinary obstruction late (benign prostatic hyperplasia is usually the cause of a poor pee) usually after they’ve spread elsewhere and are no longer curable (in which case a PSA level is likely to be diagnostic, but alas, not a screening test).

The best screening test for prostatic carcinoma is the finger of an experienced doctor.  If you can afford it, the next best one is periodic prostatic MRI scans (and it’s a long way behind).  My GP insists on doing yearly PSAs - if they ever increase, then I’ll insist on an MRI scan instead of a biopsy to exclude a false positive. <<

Yes, serial PSAs make sense logically, but to the best of my knowledge when I last looked this area up (a few years ago and, yes, I am a man in my 50/60s!) there was no evidence I could find it was better. I can't help thinking about serial MRIs that even for a billionaire your time and money would be better spent elsewhere. Think of all that mercury leaking from your fillings, for example!

Maybe there should be a separate board on here for us blokes of a Certain Age? Steve would be a member...

(Since this is a US site I'd better note that, yes, I am a retired medic who no longer has a license to practice clinically and is certainly not a urologist, so none of this constitutes medical advice  8)  )

The comment about periodic prostatic MRIs as a screening test for prostatic carcinoma was more tongue-in-cheek.  I don’t think anyone would seriously consider doing it.  In Australia it’s said to cost around $400 so you wouldn’t need to be a billionaire to afford it.  I’m sceptical about PSAs as a screening test.  PSA is prostate specific, not cancer specific.  There are other causes of an elevated PSA, besides prostatic carcinoma, such as a long bike ride.
Title: Re: Episode #677
Post by: Dangbh on July 06, 2018, 08:06:49 AM
On behalf of every British listener I am utterly utterly offended, nay, disgusted.

BENNY HILL????

You think that BENNY HILL is representative of British Humour? Dear God. I mean, there is a truth to the idea that he is representative of a certain kind of British humour in the same way that 'Beautiful Like My Mom (Support The Troops)' is representative of a certain type of American music. But look, this is like if a Brit said to you 'I like American music', and you're wondering 'Nirvana? Billie Holliday? The Velvet Underground?' and then they turn around and say 'Billie Ray Cyrus'.
Title: Re: Episode #677
Post by: seamas on July 06, 2018, 09:37:47 AM
On behalf of every British listener I am utterly utterly offended, nay, disgusted.

BENNY HILL????

You think that BENNY HILL is representative of British Humour? Dear God. I mean, there is a truth to the idea that he is representative of a certain kind of British humour in the same way that 'Beautiful Like My Mom (Support The Troops)' is representative of a certain type of American music. But look, this is like if a Brit said to you 'I like American music', and you're wondering 'Nirvana? Billie Holliday? The Velvet Underground?' and then they turn around and say 'Billie Ray Cyrus'.

So Keeping Up with Appearances* it is!

One funny thing about American opinion of "British Humor" is how generational it is.
I grew up watching Monty Python's Flying Circus when it was on PBS (as well as some Benny Hill), and would regard that as British Humor.

I recall using the phrase "British humor" in front of my mother and she was a bit confused, as people of her generation  (growing up in the 1940s) used the term "british humor" as a euphemism for "not funny at all" or "dull" humor.
Title: Re: Episode #677
Post by: bachfiend on July 06, 2018, 07:47:48 PM
On behalf of every British listener I am utterly utterly offended, nay, disgusted.

BENNY HILL????

You think that BENNY HILL is representative of British Humour? Dear God. I mean, there is a truth to the idea that he is representative of a certain kind of British humour in the same way that 'Beautiful Like My Mom (Support The Troops)' is representative of a certain type of American music. But look, this is like if a Brit said to you 'I like American music', and you're wondering 'Nirvana? Billie Holliday? The Velvet Underground?' and then they turn around and say 'Billie Ray Cyrus'.

So Keeping Up with Appearances* it is!

One funny thing about American opinion of "British Humor" is how generational it is.
I grew up watching Monty Python's Flying Circus when it was on PBS (as well as some Benny Hill), and would regard that as British Humor.

I recall using the phrase "British humor" in front of my mother and she was a bit confused, as people of her generation  (growing up in the 1940s) used the term "british humor" as a euphemism for "not funny at all" or "dull" humor.

I wonder if your mother’s generation thought British humour was dull or not funny at all was because it was too subtle and understated, unlike slapstick comedy? 

Your reference to Monty Python reminds me that I have the complete collection of the episodes released for the American market.  In the ‘summarise Proust in 30 seconds’ segment, one of the contestants announced that his hobbies were golf, strangling small animals and masturbation.  It went over in dead quiet.  The MC noted that the contestant had let himself badly - golf isn’t popular around here.  And masturbation was censored from the American version, which somehow ruins the joke.
Title: Re: Episode #677
Post by: DevoutCatalyst on July 06, 2018, 07:53:40 PM
Regarding WTN, there are of course women rail workers. Jay's comment reminded me of a fascinating book about life on the Southern Pacific from the vantage point of one of the first women brakemen, and probably the only one with a PhD. Linda's description of some of her male co-workers is pretty disturbing, the job itself is dangerous and physically demanding. Paraphrasing Smithsonian "A sometimes crude, always vivid book".

(https://pictures.abebooks.com/isbn/9780044408833-us.jpg)
Title: Re: Episode #677
Post by: arthwollipot on July 08, 2018, 06:37:45 PM
Benny Hill hasn't aged well.
Title: Re: Episode #677
Post by: seamas on July 08, 2018, 11:25:33 PM
On behalf of every British listener I am utterly utterly offended, nay, disgusted.

BENNY HILL????

You think that BENNY HILL is representative of British Humour? Dear God. I mean, there is a truth to the idea that he is representative of a certain kind of British humour in the same way that 'Beautiful Like My Mom (Support The Troops)' is representative of a certain type of American music. But look, this is like if a Brit said to you 'I like American music', and you're wondering 'Nirvana? Billie Holliday? The Velvet Underground?' and then they turn around and say 'Billie Ray Cyrus'.

So Keeping Up with Appearances* it is!

One funny thing about American opinion of "British Humor" is how generational it is.
I grew up watching Monty Python's Flying Circus when it was on PBS (as well as some Benny Hill), and would regard that as British Humor.

I recall using the phrase "British humor" in front of my mother and she was a bit confused, as people of her generation  (growing up in the 1940s) used the term "british humor" as a euphemism for "not funny at all" or "dull" humor.

I wonder if your mother’s generation thought British humour was dull or not funny at all was because it was too subtle and understated, unlike slapstick comedy? 

No. I think Americans of that area were exposed to  a pretty broad array of comedy back then --not all of it was slapstick. I don't think the perception was some dullard inability to get understated humor, just the little exposure Americans had of British humor --either in film or in personal experience wasn't all that funny.

That said, two icons of American humor--Charlie Chaplin and Bob Hope were actually English--but few people perceived them that way.
Title: Re: Episode #677
Post by: stands2reason on July 09, 2018, 07:16:35 PM
MM-DD-YY  is just as wrong as DD-MM-YY.

YY-MM-DD is the most logical as it arranges units from greatest to least significant, similar to the decimal place value system. Just as it is with timestamps: HH:MM:SS.

Another way to think about it is that if you were sorting log files or screenshots (with timestamps in their filename) lexicographically (or "alphabetically") they would also sort chronogically. I also realize this is an argument in favor of 24-hour time, which I don't use unless  I am putting timestamps in a file name for this exact reason.
Title: Re: Episode #677
Post by: arthwollipot on July 09, 2018, 07:54:26 PM
MM-DD-YY  is just as wrong as DD-MM-YY.

No, it's not just as wrong. It's more wrong because it is out of sequence. DD-MM-YY is not the best format, for the reasons you state, but at least it is in a logical order: smallest, middle, largest. MM-DD-YY is in a dumb order: middle, smallest, largest. It makes no sense.
Title: Re: Episode #677
Post by: gebobs on July 10, 2018, 10:23:14 AM
MM-DD-YY  is just as wrong as DD-MM-YY.

No, it's not just as wrong. It's more wrong because it is out of sequence. DD-MM-YY is not the best format, for the reasons you state, but at least it is in a logical order: smallest, middle, largest. MM-DD-YY is in a dumb order: middle, smallest, largest. It makes no sense.

It might not make sense to you, but when we think of dates here in the US, month comes first since it's the big target and the date then provides added precision. The year is usually the current year, so it's only in the exception that the year notation takes on any importance. So you see, there are logical contortions we can use to justify any arbitrary notation. IMHO, saying that MMDDYY is "more wrong" than DDMMYY is splitting hairs. Both are wrong. If DDMMYY is less wrong, it isn't much less.

Like religion, one's preference is almost wholly based on what we are taught to prefer by our parents, teachers, etc. And also like religion, many are prone to defend that preference vigorously without much objective basis. The only notation that has any significant advantage that I can see is YYMMDD (HHSS) and is the only notation I use when identifying samples, etc. It wasn't until I started using spreadsheets about 30 year ago that I realized how badly my preconceived preference for MMDDYY was. Had I grown up with DDMMYY, that veil would have torn just as easily.
Title: Re: Episode #677
Post by: 2397 on July 10, 2018, 01:08:12 PM
I'd say DDMMYY is less wrong because you're starting at one end and working your way through the broader categories, rather than starting in the middle and going both ways. Maybe you only need DD. Maybe you need DDMM, or all three/four. Although adding that 4th level it's out of order again. So best to use YYYYMMDD.
Title: Re: Episode #677
Post by: amysrevenge on July 10, 2018, 01:37:54 PM
In a perfect world I'm YYYMMDD.  But since we're not in a perfect world, I do my best to use 3 letters for the month and all 4 digits for the year, so no matter the order it's not ambiguous.

Current preferred usage:  2007-JUL-07

Also 07-JUL-2007, or even JUL-07-2007.  Some look more awkward, but none are ambiguous.  Spare me from 07-07-07
Title: Re: Episode #677
Post by: lonely moa on July 10, 2018, 02:34:59 PM

Current preferred usage:  2007-JUL-07


I thought this is the general scientific method of describing dates. 
Title: Re: Episode #677
Post by: brilligtove on July 10, 2018, 04:01:30 PM
Some look more awkward, but none are ambiguous.  Spare me from 07-07-07

Hey, 07-07-07 is pretty unambiguous!
Title: Re: Episode #677
Post by: amysrevenge on July 10, 2018, 04:07:17 PM

Current preferred usage:  2007-JUL-07


I thought this is the general scientific method of describing dates.

Dunno.  I would have expected numbers to be the absolute standard, just because the letters are in English but the numbers are more universal.
Title: Re: Episode #677
Post by: amysrevenge on July 10, 2018, 04:09:35 PM
Some look more awkward, but none are ambiguous.  Spare me from 07-07-07

Hey, 07-07-07 is pretty unambiguous!

Haha my cousin got married on 07-07-07.  How about those three special days, their 1 day, 1 month, and 1 year anniversaries?  I've seen engineered drawings that would describe all three of those dates as 08-07-07 on the same list, one after another.
Title: Re: Episode #677
Post by: st3class on July 10, 2018, 05:29:05 PM
Some look more awkward, but none are ambiguous.  Spare me from 07-07-07

Hey, 07-07-07 is pretty unambiguous!

Do you mean 1907, 2007, or 2107?

(click to show/hide)
Title: Re: Episode #677
Post by: brilligtove on July 11, 2018, 05:49:47 AM
Some look more awkward, but none are ambiguous.  Spare me from 07-07-07

Hey, 07-07-07 is pretty unambiguous!

Do you mean 1907, 2007, or 2107?

(click to show/hide)

Pretty, in this case, means, "All the ones I'm alive for." ;)
Title: Re: Episode #677
Post by: Fast Eddie B on July 11, 2018, 08:13:09 AM

Haha my cousin got married on 07-07-07.

My son-in-law and his wife specifically selected 08/08/08 as a wedding date, to make anniversaries easier to remember!
Title: Re: Episode #677
Post by: 2397 on July 11, 2018, 08:30:04 AM
Some look more awkward, but none are ambiguous.  Spare me from 07-07-07

Hey, 07-07-07 is pretty unambiguous!

Do you mean 1907, 2007, or 2107?

(click to show/hide)

Pretty, in this case, means, "All the ones I'm alive for." ;)

So you're a half-life kind of person.
Title: Re: Episode #677
Post by: stands2reason on July 11, 2018, 12:51:19 PM
Or we could do it Japanese-style and use a counter symbol (or unit suffix) for each time unit: i.e. 2018年07月11日, although that is admittedly cumbersome.
Title: Re: Episode #677
Post by: stands2reason on July 11, 2018, 08:29:49 PM
https://en.wikipedia.org/wiki/Lexicographical_order

(https://i.imgur.com/Nw0ltIY.png)

Turns out YYYY-MM-DD is the ISO standard?
Title: Re: Episode #677
Post by: arthwollipot on July 11, 2018, 08:56:03 PM
Yeah, that's one reason why it's the better option. But it's slow to be universally adopted so in the meantime America should use the more common DD-MM-YYYY.

Incidentally, and here's an interesting factoid, the arrangement works in spoken language as well. Americans will generally tend to say "July fourth" or "December twelfth". Australians like me would say "Fourth of July" or "Twelfth of December". Which I also think is more logical. The more you know.
Title: Re: Episode #677
Post by: stands2reason on July 11, 2018, 09:06:25 PM
Yeah, that's one reason why it's the better option. But it's slow to be universally adopted so in the meantime America should use the more common DD-MM-YYYY.

Incidentally, and here's an interesting factoid, the arrangement works in spoken language as well. Americans will generally tend to say "July fourth" or "December twelfth". Australians like me would say "Fourth of July" or "Twelfth of December". Which I also think is more logical. The more you know.

1941-12-07, a datestamp which will live in infamy...

Or, 1776-07-04. Admittedly does look weird.
Title: Re: Episode #677
Post by: CarbShark on July 11, 2018, 10:13:26 PM
Yeah, that's one reason why it's the better option. But it's slow to be universally adopted so in the meantime America should use the more common DD-MM-YYYY.

Incidentally, and here's an interesting factoid, the arrangement works in spoken language as well. Americans will generally tend to say "July fourth" or "December twelfth". Australians like me would say "Fourth of July" or "Twelfth of December". Which I also think is more logical. The more you know.

1941-12-07, a datestamp which will live in infamy...

Or, 1776-07-04. Admittedly does look weird.

Yup. I think you hit it right on the head. People abbreviated dates they way they speak (and think) dates. Without regard to computer sorting (that's a fairly recent development.

People either say December 7, 1941 or the fourth of July, 1776.

And so they abbreviate it the same way
Title: Re: Episode #677
Post by: arthwollipot on July 11, 2018, 11:04:19 PM
Yeah, that's one reason why it's the better option. But it's slow to be universally adopted so in the meantime America should use the more common DD-MM-YYYY.

Incidentally, and here's an interesting factoid, the arrangement works in spoken language as well. Americans will generally tend to say "July fourth" or "December twelfth". Australians like me would say "Fourth of July" or "Twelfth of December". Which I also think is more logical. The more you know.

1941-12-07, a datestamp which will live in infamy...

Or, 1776-07-04. Admittedly does look weird.

Yup. I think you hit it right on the head. People abbreviated dates they way they speak (and think) dates. Without regard to computer sorting (that's a fairly recent development.

People either say December 7, 1941 or the fourth of July, 1776.

And so they abbreviate it the same way

But in which direction does the chain of causality go? Do they say dates because of the way they're written, or do they write dates because of the way they're said?
Title: Re: Episode #677
Post by: Quetzalcoatl on July 17, 2018, 05:26:29 PM
Personally I don't get bothered by the America-centrism of the hosts. They are American, they live in America and are immersed in American culture. It's okay for them to approach things from an American viewpoint. They do at least make an effort - and a good one - to be international, and I appreciate that, because it's something that a lot of American podcasts don't bother with.

I agree with this. I think it is really good that they try to be a podcast for skeptics worldwide, rather than only for American skeptics.

From what I recall of the listeners statistics they have mentioned over the years, 55% of listeners are in the US, and per capita, Australia is the country with most listeners.

I had also noted that the dating of the earliest podcast episodes are different than the later ones.
Title: Re: Episode #677
Post by: The Latinist on July 17, 2018, 05:38:50 PM
As an amateur genealogist, I have been burned on several occasions by dates in XX/XX/XX format.  I therefore exclusively use the date format 17 Jul 2017, using leading zero on the day where appropriate.
Title: Re: Episode #677
Post by: Friendly Angel on July 17, 2018, 05:42:21 PM
As an amateur genealogist, I have been burned on several occasions by dates in XX/XX/XX format.  I therefore exclusively use the date format 17 Jul 2017, using leading zero on the day where appropriate.

I was a yeoman in boot camp and we had to write the dates like that.  Makes sorting in a spreadsheet cumbersome though.
Title: Re: Episode #677
Post by: The Latinist on July 17, 2018, 05:52:49 PM
As an amateur genealogist, I have been burned on several occasions by dates in XX/XX/XX format.  I therefore exclusively use the date format 17 Jul 2017, using leading zero on the day where appropriate.

I was a yeoman in boot camp and we had to write the dates like that.  Makes sorting in a spreadsheet cumbersome though.

If you've configured the date format for the field correctly, it should work.  And I use genealogy software that supports the format, so that makes it even easier.  What I'm most concerned about is unambiguity in print.
Title: Re: Episode #677
Post by: gebobs on July 18, 2018, 01:24:39 PM
If you've configured the date format for the field correctly, it should work.

Good point. You can sort any date format you want chronologically.
Title: Re: Episode #677
Post by: missymocha on July 20, 2018, 02:03:39 PM
Even BRCA1 and 2 testing is not unambiguous.  Many people will have variants in a gene that may or may not affect protein function.  These are called variants of unknown significance (VUS).  If the variant causes the protein to be truncated or shortened, or deletes a big chunk of the protein there is a pretty good chance that it will affect protein function.  Or if we have data that shows that many people with this variant have developed cancer at an early age, we can assume that it probably increases risk.  However, many variants change an amino acid but we have no way of knowing if this affects protein function.  What do you do with this information?  Even if you have a family history of cancer, you don't know if its because of this variant or some other variant in another gene. 

Aside from this problem, how much do you want to trust a for profit company, whose profit model is based in large part on selling your DNA and health information, with your information?  They ask all those health and family history questions because the DNA information without that is not very useful for them to sell.  You can supposedly opt out of them selling them your information, but who is policing that?  do you trust them?  How safe is your data?  What is the potential harm vs benefit.

As for the ancestry stuff, what does it tell you about yourself if you are part whatever?  Does it define or determine  your personality? Your physical appearance? your talents?  We all came from the same ancestors if you go back far enough.  As Steve mentioned, using the SNPs that define the current inhabitants of a country doesn't tell you about the people who lived there ages ago.