Rebecca Heineman has died
pcgamer.comHuge loss to the community. She was, by all accounts, an amazing programmer. I remember when she uploaded the source code of her Doom 3DO port she indicated that she had to write her own string lib because the base one sucked:
> I had to write my own string.h ANSI C library because the one 3DO supplied with their compiler had bugs! string.h??? How can you screw that up!?!?! They did! I spent a day writing all of the functions I needed in ARM 6 assembly.
https://github.com/Olde-Skuul/doom3do
I can't even imagine the level of skill required to just say, "Fine, I'll write MY OWN string lib!" while chasing a deadline.
As an aside...I wonder what will happen to her personal artifacts. There was a media blitz awhile back when Tim Cain said he doesn't have the original source code to Fallout because he was "ordered to destroy it" by Interplay when he left. But Becky then chimed in to say that she did have a surviving copy, because she was a founder. [0] I hope someone else on her behalf would be able to continue that effort, but I worry that with her death, Bethesda would assert that no one else has "legal standing" to do so.
[0] https://thisweekinvideogames.com/news/fallout-1-2-source-cod...
Not just "write my own string lib", but "write my own string lib in assembly"! Wow.
Not just strings but burgers too!
https://github.com/Olde-Skuul/burgerlib
Welcome to Burgerlib
The only low level library you'll ever need
Burgerlib is a low level operating system library that presents a common API that operates the same on numerous mobile, desktop, and video game platforms. By using the library, it will allow near instant porting of an application written on one platform to another.
Burgerlib is not meant to be considered an engine, it's a framework on to which an engine can be created on top of and by using the common API, be compatible on dozens of platforms.
Filenames and paths are standardized, all text is UTF-8 regardless of platform. Display, input, audio, music, math, timers, atomics, and typedefs operate the same.
it's not as hard as you seem to think.
plenty of people have implemented strcpy(), strlen(), etc for embedded-like platforms.
"Hard" by whose definition? I had to implement those in MIPS assembly and write a hash table in x86 assembly in school but I don't think I could do that today without a good deal of refresh. I'd venture to say that most software developers today wouldn't even know where to begin because most software written today targets a VM that doesn't expose pointer arithmetic.
Now that we shall read and comment her code and let it live forever.
Rebecca was well known in emulation circles for her high quality work on various games of the era, often pushing the hardware in unusual ways. This article is one of my favorites, detailing the wacky tricks she used to get Another World's 3D rendering system running acceptably on a Super Nintendo
https://fabiensanglard.net/another_world_polygons_SNES/
Rest in piece, you absolute legend.
She also somehow pulled off the port of Doom to the hopelessly underpowered hardware of the 3DO in just a few weeks, after others had tried and failed for much longer than that. The final release had a reduced viewport and a bad framerate, but the background music was great (recorded with a band and stored as audio tracks on the game CD).
https://github.com/Olde-Skuul/doom3do
Also, 62 years is much too young! And one month from diagnosis (because of being short of breath) to dying is really rough - although there's a lot of progress on cancer treatment, some forms have symptoms at such a late stage that they're unfortunately still a death sentence...
Gonna link SSFF's enjoyable telling of the 3DO port story: https://www.youtube.com/watch?v=yxF1_wg2d_Q
I will never get over the company CEO sending here PNGs of new weapon models and saying, essentially, "Yeah so you can just copy & paste these into the game, right?"
Hey, I got to see this code!
Back when Blizzard was still Silicon & Synapse, we got Rebecca's source code to Another World SNES from Interplay to use for a game we would develop, and they would publish, and I was the engine programmer.
I remember reading the source code, which was ... sparsely documented, and wondering what was going on. Like "you're writing to the DMA registers?!?"
The code was amazing, because it has has to draw polygons into 8x8 pixels cells that are stored in planar format at 60FPS. On a 3.5 Mhz processor. Blew my mind.
Incidentally, the game was called "Nightmare", and later became "Blackthorne", which was released for SNES, Genesis, and PC.
Yeah, Another World was an incredible feat with the hardware we had at the time.
Today I learned...
"Super Fami-Com ("FAMIly COMputer")"
Doh!
It was a sequel to the Famicom.
Commonly known as the Su-Fami!
Compare Nintendo 64 = Roku-Yon (Six-Four) and PlayStation = Pure-Sute
Many years ago I played one of her works, Bard's Tale 3: Thief of Fate and enjoyed it very much.
It was a masterful blend of RPG, dungeon crawl, and puzzles and had a memorable soundtrack.
https://www.youtube.com/watch?v=ru5kg35dNso
Having a bard in your party let you choose a soundtrack and their songs brought magical effects. For example, the Rhyme of Duotime let your party attack more frequently in combat: https://www.youtube.com/watch?v=_oR4j7w4FIY
BT3 is available on the Internet Archive: https://archive.org/details/msdos_The_Bards_Tale_3_-_Thief_O...
Interesting, I didn't know BT3 was by a different author, it definitely had its own vibe distinct from the first two, which this guy wrote (https://en.wikipedia.org/wiki/Michael_Cranford). I liked them all though.
The steam remasters are incredibly faithful to the originals - right down to the timing and flow of the turn-based combat. Makes me wonder if they are emulating the original code somehow.
I believe they’re using the PC ports, running in something like DosBox or FreeDOS
The original Bard's Tale was my first RPG and I've been hooked ever since.
BT3 was wonderful, lots of nostalgia for me. Sad to hear of her passing.
The first trilogy (including BT3) was also remastered about 7 years ago and released on Steam, it's like $15 and has many quality of life improvements.
It seems Bard's Tale 3 can be played on the DosBox emulator:
https://www.dosbox.com/comp_list.php?showID=188&letter=B
... which is available for many platforms, including Windows and Linux:
https://www.dosbox.com/download.php?main=1
although the latest version of DosBox seems to be from 2019, so maybe others can suggest a more actively-maintained emulator.
DOSBox-X is a port that is actively developed and has many features missing in vanilla DOSBox.
There are a few other ones as well. DOSBox Staging is one. Magic DOSBox seems to be the most popular on Android. There is some iOS port as well.
That sounds promising. Do they also have a "compatibility by game title" database?
"DOSBox Staging" is such a weird name for that fork / continuation.
ahh i have fond memories of this game... and the silly anti piracy attempts (decoder ring) they shipped it with.
In middle school, a friend and I 'cracked' that decoder ring by copying all the info by hand on to paper so we could both play the game from one store bought copy because we were poor. I don't think we ever finished the game, but it's still one of my happiest early gaming memories.
They remastered all three of the first Bard's Tale games a few years ago and released them on Steam with many quality of life improvements-- I bought the set without a second thought even though I know I will probably never take the time to play it all the way through. I've spent a few dozen hours on it so far, though.
It is hilarious to think if you could beat BT3 you could also crack the decoder ring
She was originally chosen to do a remaster of the series. This was eventually reassigned to another publisher.
If you purchase Bards Tale 4 you get the remastered 1,2, and 3 for free.
I have played BT 1 every year or so since the late 80s.
This breaks my heart, I will miss Burger Becky, she was the sweetest kindest person and a legendary programmer.
https://www.burgerbecky.com/becky.htm
The first "Boom & Bust" episode of Netflix's series "High Score" series told the story of her winning the first Space Invaders U.S. national championship as a kid.
I knew I'd seen her somewhere before, that was it!
I had the honor and pleasure of meeting her in 2018 at PRGE (Portland Retro Gaming Expo). She was sitting at a signing table after being on a panel. When it got to be my turn, I asked her if I could get a photo instead of a signature. She quickly said yes and I bent down to get into the frame. She was extremely kind and always cracking jokes. What I didn't know until I got my phone back and later looked closely was that she'd given me rabbit ears in the picture.
RIP, Becky.
Are you able to share said photo?
"Legend" barely begins to describe. She is up there with the Carmacks et al.
She was probably the first programmer I knew by name as a kid, following the games industry as a kid.
I was lucky to catch some of Becky's livestreams on YouTube over the years.
More than a brilliant programmer she was truly a kind soul. She never approached topics with any kind of ego. Just a joy and love for the things she'd worked on and the people she'd worked with
I didn't know her but reading the eulogies it was obvious she was a kind person who touched so many people. I hope some day my eulogies will be similar (if lower in scope).
Yeah, that's the impression I got from everyone who's saddened by her loss.
We lost a legend.
Rest in peace, Burger Becky! I really enjoyed her interview with CoRecursive a few years ago about porting DOOM to the 3DO[1] and highly recommend a listen.
[1]: https://corecursive.com/doomed-to-fail-with-burger-becky/
Admittedly I didn't dive much into this to get the full context, but it's saddening to me that a legendary game designer had a GoFundMe. I was hoping achieving that level of status in a traditionally well-paid industry would leave one well off, financially.
The games industry is not traditionally well paid, unfortunately.
It's such an erractic industry in terms of compensation. You can found a studio, make some acclaimed darlings, and still end up shuttering and being no better off than your average joe. Then there's being a "software engineer in games" where you're a cog in a wheel fixing bugs in the yearly Sportball game that gets compensated 200k and you live very well despite never truly "impacting" the industry the same way. 200k isn't mindblowing for a software engineer, but it's well beyond "average joe" range at that point.
I'm that cog. Or at least, was. Situations like this make me thing a lot about the state of the industry and where I lie in life.
You contributed to a popular game that lots of people enjoyed? Rest easy with this, friend.
This. It's consistently lower-paying than the rest of the software industry.
Yep, unfortunately that's a big part of the reason I left for a more traditional tech role. The same skills are extremely valuable at any company writing performance critical software.
Video games are an art form, the downside is they pay like one too.
Cancer and US Medical Care has a tendency to drain any savings you have. Also, it was sudden so it’s not like she was ready to retire at all.
I'm wondering if she actually got the fundraiser money, considering how quickly this moved - the last update implied it would have to go to her funeral, and I hope it pays for the bills or helps her family.
Some funds were used to cover treatments. She has arrangements with her family, and this fundraiser helps.
Not just legendary game designer, but co-founder of a game studio and publisher (Interplay).
I was hoping one wouldn't need to be well off to get treatment for an illness, but that's the US for you.
The video game industry is not a well paying one, even for programmers
The United States is the wealthiest nation on the planet according to Forbes, richer than the subsequent three nations combined.
It’s a tragedy that our own citizens are not the direct be beneficiaries of that wealth.
I think a lot about the scene in Star Trek IV when McCoy is in a hospital and says “what is this the dark ages?”
Gofundme is like a kafkaesque tragic absurdity that - hopefully - will be looked at as an indictment of the inequitable K shaped economy we’ve built, and hopefully fixed in the future.
As a lucky European, I have US labeled as “richest third world country”.
> The United States is the wealthiest nation on the planet according to Forbes, richer than the subsequent three nations combined.
This framing by Forbes (any many others really) is insidious because it doesn't take into account the population number and how unevenly wealth is spread.
For instance, Switzerland is not a huge economy - around the 20th in the world, but its citizens enjoy an extremely high quality of life because both income inequality and incomes overall are significantly better that in the US.
Population size is usually included in those calculations. It’s typically GDP per capita.
But I couldn’t agree more that the inequality and social safety net (or lack thereof) make the numbers deeply disconnected from QoL. Which I believe is the whole point.
> It’s typically GDP per capita.
If so, then the US is ~7th, or 5th among nations numbering in the millions. Still very high, just not at the top.
Considering the James Van Der Beek of Dawson's Creek fame is having to hold a fundraising auction of his memorabilia to fund his cancer treatment, cancer is expensive in the US.
How'd the theme song to that show go again?
Cancer is expensive everywhere, the difference is who pays for it.
actually a difference is also how many players along the supply chain siphon money out of the process. the more greed is allowed and acted on for the treatment, the more expensive it gets. introduce layers of insurances, hedgefonds, pension funds, lobbyism, ... it adds up to riddiculous amounts far beyond the original R&D/infrastructure/treatment costs.
And those are just the downsides of a market-based system. There are also upsides of single-payer systems, like monopsony buying power.
And also downsides, e.g. many treatments just aren't available, and many others would never have had their discovery funded without the market-based system existing.
Governments can (and do) directly fund medical research including drug discovery. This is in part because governments of even just middling competence have an incentive to keep their workforce (which also includes their military) healthy.
Nobody is advocating for eliminating a market-based system. My country (Australia) has both single-payer and a market-based private healthcare system.
You can imagine how that system, like most, is actually getting its medical advancements from the US.
This… is a think that people believe, but it’s not as simple as that. Most basic research is universities, all over the place. Many drugs are developed in Europe. A lot of medical machinery is developed and made in Europe (Siemens, Philips and Roche are huge in this space). Like most things, med tech is fairly globalised.
And let's not forget that a substantial amount of medical research performed in the USA is not market-based but rather publicly funded through the NIH.
And performed by researchers that received free education in their home country before moving to the US because they hope for a better career there...
That's not an "and" - the NIH is funded by businesses in the US.
Most of that is funded by the NIH and not by the local systems. Spending money is easy.
> This… is a think that people believe, but it’s not as simple as that.
This is a thing people believe because pharmaceutical companies keep repeating it. And to be fair, they're not entirely wrong in that getting a drug/treatment from the lab to the pharmacy is incredibly expensive because most drugs don't work and clinical trials are super expensive.
It does seem to me that a better system would be to split out the research/development and manufacturing of pharmaceuticals into the lab development (scientists), the clinical trials (should be government funded) and the manufacturing (this could easily be done via contract).
Which the US had a situation exactly like that until very recently: development labs, often at Universities, with scientists paid for by grants (some private, but the majority being public, government grants), with clinical trials overseen by government agencies like the National Institute for Health (NIH), and winning research eventually being tech transferred for cheap to Pharmaceutical companies to manufacture, distribute, and market.
The companies have the biggest PR arms, so took the most credit for a system that had been balanced on a lot of government funding in the earlier, riskier stages. Eventually the marketing got so unbalanced people didn't realize how much the system was more complex than the marketing and voted for people that decided it was a "free market" idea to smash the government funding for the hard parts of science.
> Which the US had a situation exactly like that until very recently: development labs, often at Universities, with scientists paid for by grants (some private, but the majority being public, government grants), with clinical trials overseen by government agencies like the National Institute for Health (NIH), and winning research eventually being tech transferred for cheap to Pharmaceutical companies to manufacture, distribute, and market.
Yeah, this isn't a particularly new idea. Like, most of the risk in pharma is on testing, and there's so much waste in spinning up plants for drugs that may not even succeed in Phase III. So I'd like to split that out.
> It does seem to me that a better system would be to split out the research/development and manufacturing of pharmaceuticals into the lab development (scientists), the clinical trials (should be government funded) and the manufacturing (this could easily be done via contract).
The market is there to risk money in the world of imperfect information trying to predict what would be good to pursue. That is one of the hardest parts of the process, but it's not even made your list.
Exactly. This was entirely deliberate as I (personally) believe that market signals are profoundly useless in healthcare. Like, there's no free market in life or death, nobody will quibble over cash when they're in pain so I'm not sure how a market is supposed to work.
Fundamentally, the incentives of society and private companies are misaligned with respect to healthcare. Society wants a cheap, simple treatment that basically works forever (like sterilising vaccines). However, because of how the patent system works, companies want a treatment that is recurring, and can easily be patented multiple times.
Because of this, so much money goes into lifestyle treatments for the rich world, and not enough into re-using things that can't be patented. I think this is a giant waste of resources, hence my suggestions above.
This is a comforting lie Americans tell themselves to justify being ripped off.
You pay double the OECD average, and more per person for healthcare than the Swiss - and that's only counting the publicly funded parts!
This implies the US is subsidizing the world's healthcare system and sacrificing it's own citizens for the benefit of every non-American.
You're ok with that?
I'm okay with implying that, yes. More than implying it.
This doesn't make any sense. If you make a thing, the price you set for selling that thing in a country has little to do with where you happen to be living when you made that thing.
Sorry, I don't know how your example maps on to what I was saying.
It's a lot more expensive in the US. Three years of ribociclib is US$100k here in Argentina, which dwarfs the usual costs of things like chemotherapy, radiation therapy, and surgical resection. (All of which is normally paid for either by a health plan or by the public hospital system.) In the US, if you have to go through all of that, I think the cost is going to be at least an order of magnitude higher.
This is either intentional bad faith trolling or you are not aware of the per capita spending on healthcare in the US.
https://www.healthsystemtracker.org/chart-collection/health-...
You don't think cancer is an expensive disease to treat? You don't think it involves a lot of inputs?
Very sad news. This one hit pretty hard for me as not only was she so awesome and contributed so much to so many great games, but the short timeline between "oh dang I have cancer and we're fighting it" to, well, today... was just way too short :(
You are not alone being hit hard by the pace of the cancer's progression. Dr Makis talks about his shocks lately as an oncologist. https://www.youtube.com/watch?v=0gIYQCjB_NU
Weirdly specific person to bring up. Almost cult-like. Ivermectin, again?
https://cpsa.ca/news/statement-william-viliam-makis-not-lice...
You are not alone. I can only think that her post about being very vulnerable after chemo from immune system supression made me realize how lucky you have to be to beat cancer with chemo.
My understanding is the cancer had already metastasized by the time it was discovered. Chemo was always a hail Mary sadly :(
A little late, but man this sucks, cancer sucks.
Rebecca was not only an amazing programmer, but a true hacker from the get go. From what I understand she managed to achieve what she did without even a high school diploma -- a real natural talent.
I first really learned of her from the ANTIC podcast [1] in 2015 and was just kind of blown away by this cool, intelligent, creative and humble human being.
I'm personally sad she's gone, but also really...proud? to see how she went out, with tons of witty communications to her friends and associates in her recognizable voice.
To have such a positive impact in the world is something worth achieving.
1 - https://ataripodcast.libsyn.com/antic-interview-64-rebecca-h...
Thank you so much for linking to the (ten year old now?!?!) podcast.
You're welcome. I think hearing her talk about her life and experiences in her own way is incredibly rewarding. The ANTIC podcast has done a great job of preservation of people involved in early computing and it deserves a lot of support.
>Heineman's cancer fundraiser is now collecting for her funeral.
Am I crazy or does that sentence have, I don't know how to explain it, the 'rhythm' of a joke? Feels like accidental rhyming, a mark of bad writing?
It unfortunately reads a bit like an unintentional punchline, yes.
My family would say that sentence “with a wry smile”, a useful literary phrase for that particular variant of humor.
Sounds like it’s trying to be ironic
What a true legend. The amount of people she has touched with her work is enormous.
Feeling a bit of regret. I feel like I made a poor first impression on Rebecca when I first met her a few years back at VCF East. I saw her again recently but was suffering from severe undiagnosed sleep apnea so much so that I was practically asleep at the event. I didn't know about the cancer. Thought I would have another chance. This is happening more and more in my life. :/
Let us cherish all the great moments that she helped bring to us.
> I saw her again recently but was suffering from severe undiagnosed sleep apnea so much so that I was practically asleep at the event.
Go visit a pulmonologist and get a diagnosis. Getting one and starting on a CPAP was life-changing for me.
Just began using a CPAP last week. My first attempts were to try and use a nose clip, sleep wedge, and other tools to no avail. Following a take home test I discovered my apnea was severe. I have now started with a CPAP machine. Results are promising.
Im reading this wearing a CPAP.
As a retro-enthusiast, I was captivated by the stories she shared in her interviews, particularly about working on the cancelled Half Life port to Classic Mac OS (supposedly it even ran on 68k Macintoshes, How amazing is that !?). She said that she still had a CD of the gold master on her shelf. I really fear that work may never see the light of day now...
She was responsible for a large part of my early gaming years, without me even knowing it. Another legendary account retired.
Aww I’m very sad to hear this. She was close friends to a partner of mine and I met her about ten years ago through that connection. She seemed to be a lovely person.
Running x86 server architecture in software development. PC Gamer's obituary claims she was debugged.
I'd heard the 3DO doom port story linked here before and it is absolutely wild stuff. Legend.
I saw her last few talks at VCFeast. Always extremely engaging to hear from someone with as much skill and knowledge as her. Amazing to hear how she built her own debugger for the (i believe, i have the memory of a goldfish) Atari 2600. I always tried to catch her talks if possible, if just to get a glimpse of what the past looked like. I'm going to miss having those to look forward to.
RIP
So scary to go from diagnosis to passing in such a short time.
Cherish every sunrise.
RIP, Burger.
I played BT1, BT2, and BT3 for hours and hours.
Wow. What an impactful person. I'm somewhat embarrassed to say that I did know about her till her death though I've played many of the games mentioned in the WP article about her. RIP.
Never heard of her name before, but I certainly heard of the game she developed, like many here. RIP to a prolific game programmer.
Damn I knew she had cancer but never thought it is so quick.
“We have gone on so many adventures together! But, into the great unknown! I go first!!!“
Such a legend. RIP.
Very sad news. Always appreciate her work on the 3DO Doom. Although the worst port it certainly was no fault of Rebecca. Always enjoyed reading her stories and respected her skill level as a programmer.
condolenses to her family and closest friends.
The first time I became aware of her was in the "Another World 101" series, about her SNES port:
https://fabiensanglard.net/another_world_polygons_SNES/index...
What ... this is so sad. She influenced me with her games as a young teenager. :(
Weird. I just googled it and it said her partner also died of the same thing?
Her partner died of complications of Guillain-Barre syndrome. (Her partner was also a beloved figure in the TTRPG design space.)
No, Jennell Jaquays died from Guillain–Barré syndrome, not cancer.
Was it the AI response hallucinating?
One of the greats. Not only did great things but inspired others.
rip burger o7
May her memory be a blessing
What an amazing career. RIP.
Offtopic: several of the embedded Bluesky posts at the end of the article show "The author of the quoted post has requested their posts not be displayed on external sites." Seems not to phase the PC Gamer "journalists".
It's faze, not phase. It's a common mistake.
[0] is a good article about this; not least that this has been happening since at least 1889 (to the point where I'd say we could now probably consider it a valid alternate spelling.)
[0] https://itre.cis.upenn.edu/~myl/languagelog/archives/001166.... (no, I've no idea why they're behind the wrong subdomain certificate)
Because they don't really live on that server any more. The correct URL for the languagelog archives is https://languagelog.ldc.upenn.edu/~myl/languagelog/archives/..., but none of the links will keep you on that domain.
These are quote-posts; the quote-post isn't protected but the quoted-post is. Bad choice by whoever wrote the article (in fairness the default Bluesky interface doesn't make this particularly clear), but nothing is being displayed that shouldn't be displayed.
Looks to me like it's the quoted post that's not to be displayed, not the post itself.
Meta: I think such black strip moments should be pinned at top of the hacker news while it lasts.
Please no. It would be impossible to decide the cutoff for who deserves it. Loud communities would bring drama when their favourite person doesn't get pinned. A black strip might be fine, though.
i think the comment is saying that "if there's a black strip, we should pin the article/news that justified it"
because there's currently a black strip up but there's no articles about a death on the first page
In this case, I had to search for the word died/dead/"no more" to even know who is no more.
@dang could we have a black banner please?
For posterity, we have gotten a black banner. Farewell to a true hacker. She will be missed.
RIP Burger. Thanks for all the epic games and stories.
(@dang has no effect in HN comments. Contact the mods using the footer contact link for attention to threads.)
Also, would it be possible to make the black banner a hyperlink that points directly at the HN submission?
Here is a good response/thread from last year on that
Feature request: make it so the black bar is a hyperlink and it takes you to the thread it is referring to.
This article is not on the front page so it took me a while to find what the black bar was referring to.
Pop-up when pressing back on mobile that stopped returning to HN.
Sheesh, the mobile web is really predatory. Good that I don’t use it much.
It’s not just on mobile – PC Gamer’s website does that on desktop too. Even with uBlock Origin. :(
Im inclined to blame the US healthcare system. It looks like a gofundme was setup to pay for her cancer treatment. A sensible system a) wouldn’t need patients to pay for treatment and b) might have caught it earlier through regular screening
Do you have any evidence that the cancer is a type that would have been caught by a screening regime currently in place in other countries which is not in place in the US?
Without such evidence your post reads more like propagandizing a death for political purposes than an honest argument.
> Do you have any evidence that the cancer is a type that would have been caught by a screening regime currently in place in other countries which is not in place in the US?
Do you have any evidence that it wasn't?
I honestly don't know if earlier detection was possible, or would have helped her out or not. What I can tell you is that given the state of health care in this country, you can bet that my default assumption would be "yes" until proven otherwise.
Starting with the assumption of "no" gives our system more slack than it deserves.
> Do you have any evidence that it wasn't?
Most types of cancers are not routinely screened for. The post says that the cancer was in her liver and lungs, and neither liver cancer nor lung cancer are routinely screened for (lung cancer screenings are recommended for people with a history of heavy smoking).
> What I can tell you is that given the state of health care in this country, you can bet that my default assumption would be "yes" until proven otherwise.
This is clearly a politically-motivated point rather than one grounded in science or reality. Cancer screening in the US is generally more aggressive, not less aggressive, than in other developed countries. For example, the US has historically recommended annual mammograms starting at age 40, while Europe doesn't start until age 50 and only does them every two years. US guidelines are to start screening for colon cancer at age 45 (c.f. 50 in most of Europe), and the US uses a much more invasive (and costlier) approach to colon cancer screening on top of the age gap.
If anything the US probably overinvests in cancer screening. The evidence in favor of starting mammograms at 40 is extremely dubious, as is the evidence for invasive and expensive colonoscopies (standard US practice) over fecal matter tests (standard European practice) for colon cancer screening.
> The post says that the cancer was in her liver and lungs, and neither liver cancer nor lung cancer are routinely screened for ...
If you have got cancer in your liver and lung then those are probably metastases, and most often the original cancer is in the colon.
> the evidence for invasive and expensive colonoscopies (standard US practice) over fecal matter tests (standard European practice) for colon cancer screening [is extremely dubious].
Fecal matter tests will tell if you have got a tumour and that tumour is bleeding. But not all colon tumours bleed. Colon cancer can be a silent killer, that often goes without symptoms for years until it has metastasised and become terminal.
A colonoscopy will tell if you if you have got a polyp — an early pre-stage of cancer. And a polyp can be removed right then and there during the procedure with a tiny wire-loop or claw at the end of the instrument — and then you're safe.
I recommend everyone who is 45 y/o or older to get a colonoscopy every ten years. That is how long a polyp takes to develop into a tumour .. for normal people. Myself, I have Lynch syndrome, so I have had to start earlier and get a colonoscopy every year. I had my fourteenth two days ago.
A COLONOSCOPY IS NO BIG DEAL. It is not invasive, it is not sexual, it is not demeaning. Everyone is professional, interested in your intestine, not your butt. It does usually not hurt, and if it does it is because of gas, as there are no other types of sensory nerves in the colon. If you are otherwise healthy, it is not dangerous. You can get it done it medicated, or even sedated if you want. I usually do it without any such drugs. The worst part is not the procedure but the prep — because laxatives taste bad. But if you are healthy and ask for it, a doctor could give you a stronger laxative that you don't have to drink as much of.
Screening is good. Do it!
Colonoscopies, involving inserting instruments into the body, are definitely an invasive medical procedure.
> An invasive procedure is one where purposeful/deliberate access to the body is gained via an incision, percutaneous puncture, where instrumentation is used in addition to the puncture needle, or instrumentation via a natural orifice. It begins when entry to the body is gained and ends when the instrument is removed, and/or the skin is closed. Invasive procedures are performed by trained healthcare professionals using instruments, which include, but are not limited to, endoscopes, catheters, scalpels, scissors, devices and tubes.
[1], emphasis added.
> A medical procedure that invades (enters) the body, usually by cutting or puncturing the skin or by inserting instruments into the body.
[2], emphasis added
> An invasive procedure is one in which the body is "invaded", or entered by a needle, tube, device, or scope.
[3], emphasis added
Is it a big deal? Maybe not to you, maybe to other people. Is it better than a much cheaper (and not invasive) FOBT? Questionable.
NordICC [4] found an 18% reduction in colon cancer incidence after 10 years with a colonoscopy screening program, but no statistically significant reduction in mortality (either colon cancer or all-cause). Hardcastle et al. [5] found no reduction in colon cancer incidence but a 15% reduction in colon cancer mortality after 7.8 years with a FOBT screening program.
Everyone's gungho about evidence-based medicine until the evidence fails to support their preferred procedures.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6678000/
[2] https://www.cancer.gov/publications/dictionaries/cancer-term...
[3] https://medlineplus.gov/ency/article/002384.htm
> you can bet that my default assumption would be "yes" and "yes" until proven otherwise.
That's a recipe for healthcare inflation. There are endless unproven tests and treatments.
Looking at corporate profit levels versus wage levels over the past twenty years, the U.S. as a capitalist country can afford a great deal more of healthcare inflation in order to raise the quality of life for its population.
Should its businesses afford that out of their profits?
Since households can’t afford eggs, much less health care costs, at the wages paid by businesses; so this decision is up to firms rather than households to decide. Founders, your input would especially be appreciated here.
Even if inappropriate, this reads like a normal expression of grief to me.
It's normal to be upset about the circumstances under which someone died, and to be angry if you believe it was avoidable. Under the five stages model, this would be bargaining and anger.
Another one of these? Jeez.
Whether you're right or not, it doesn't matter - this is not the time or place to bring this up.
What is the right time
Most other times that aren't "when people are mourning someone who just died"
So nobody dies or cancer in places with universal healthcare?
Something doesn't have to be perfect to be better
That's not the argument that was being made.
Well the argument certainly wasn't "nobody dies of cancer in places with universal healthcare"