Total Loss Increasingly Likely If You Wreck Your Car

 We are in the midst of a “total loss” epidemic says “Car Dealership Guy” on Twitter. Pictures explain why.

Used Car and Truck Prices vs Maintenance and Repairs

CPI data, chart by Mish

Total Loss Epidemic

Car Dealership Guy Comments

We are in the midst of a “total loss” epidemic. More than *20%* of vehicles are now declared a write-off by insurers after examining claims. That’s around *five* times higher than in 1980. But why?

One big reason is that the cost of vehicle repairs has increased by almost 50% since the pandemic started—far exceeding inflation.

Another major driver: Declining used car prices. It may seem counterintuitive, but the rate at which used car prices have fallen over the past couple of years encourages salvaging instead of repair… And all that contributes to an increase in vehicle write-offs.

No wonder Copart’s stock price has gained 1,100% over the past decade…

Historical Context

If you get into a wreck and total your car, and all your insurance covers is the decreasing value of your car, what can you afford to buy?

Discretionary Spending Tumbles

Target CEO Brian Cornell said the results show “continued soft trends in discretionary categories.”

Target chart courtesy of StockCharts.Com annotations by Mish

On May 22, I commented Discretionary Spending Tumbles at Target, Shares Drop 10 Percent

We had an advance hint at Target weakness.

Are Consumers About to Throw in the Towel?

Data from the Commerce Department, chart by Mish.

On May 16, I commented Retail Sales Fall Flat, Are Consumers About to Throw in the Towel?

On a year-over-year basis, real retail sales have been negative 12 out of the last 15 months.

Real vs Nominal Advance Retail Sales Percent Change From Year Ago

The vaunted consumer is much less than portrayed.

Fed Consumer Survey

Let’s check out some charts from the latest fed survey on how well people are doing financially. This data and a new chart by me tie everything I have said about the rent and the election together.

Data from Fed Economic Survey, Chart by Mish

Please consider Fed Consumer Survey: Are You Worse Off Than a Year Ago?

Are You Worse Off Financially Than a Year Ago?

Between 2022 and 2023 the numbers improved (lead chart). However, the numbers are a disaster compared to the peak in 2019.

Can You Handle a $400 Emergency?

Millennials and Zoomers are increasingly stressed since the end of 2021.

 All of the savings from three rounds of pandemic stimulus, rent abatements, and student debt cancellations have been wiped out by rising inflation.

https://mishtalk.com/economics/total-loss-increasingly-likely-if-you-wreck-your-car/

Urine Test Could Prevent Unnecessary Prostate Biopsies

 To date, men undergoing screening through the measurement of prostate-specific antigen (PSA) levels have had a significant reduction in neoplastic mortality. Because of its low specificity, however, this practice often leads to frequent, unnecessary, invasive biopsies and the diagnosis of low-grade, indolent cancer. While guided biopsies with multiparametric MRI can improve the diagnosis of grade 2 prostate cancers, widespread implementation remains challenging. The use of noninvasive biomarkers to stratify the risk for prostate cancer may be a more practical option.

The National Comprehensive Cancer Network proposes a test consisting of six blood and urine biomarkers for all grades of prostate cancer, and it outperforms PSA testing. However, current practice focuses on detecting high-grade cancers. It has been hypothesized that increasing the number of biomarkers by including molecules specifically expressed in aggressive high-grade prostate cancers could improve test accuracy. Based on the identification of new genes that are overexpressed in high-grade cancers, a polymerase chain reaction (PCR) technique targeting 54 candidate markers was used to develop an optimal 18-gene test that could be used before imaging (with MRI) and biopsy and to assess whether the latter procedures are warranted.

Development Cohort

In the development cohort (n = 815; median age, 63 years), quantitative PCR (qPCR) analysis of the 54 candidate genes was performed on urine samples that had been prospectively collected before biopsy following a digital rectal examination. Patients with previously diagnosed prostate cancer, abnormal MRI results, and those who had already undergone a prostate biopsy were excluded. Participants' PSA levels ranged from 3 to 10 ng/mL (median interquartile range [IQR], 5.6 [4.6-7.2] ng/mL). Valid qPCR results were obtained from 761 participants (93.4%). Subsequently, prostate biopsy revealed grade 2 or higher cancer in 293 participants (38.5%).

Thus, a urine test called MyProstateScore 2.0 (MPSA) was developed, with two formulations: MPSA2 and MPSA2+, depending on whether a prostate volume was considered. The final MPSA2 development model included clinical data and 17 of the most informative markers, including nine specific to cancer, which were associated with the KLK3 reference gene.

Validation and Analyses

The external validation cohort (n = 813) consisted of participants in the NCI EDRN PCA3 Evaluation trial. Valid qPCR results were obtained from 743 participants, of whom 151 (20.3%) were found to have high-grade prostate cancer.

The median MPS2 score was higher in patients with grade 2 or higher prostate cancer (0.44; IQR, 0.23-0.69) than in those with noncontributory biopsies (0.08; IQR, 0.03-0.19; P < .001) or grade 1 cancer (0.25; IQR, 0.09-0.48; P < .01).

Comparative analyses included PSA, the Prostate Cancer Prevention Trial risk calculator, the Prostate Health Index (PHI), and various previous genetic models. Decision curve analyses quantified the benefit of each biomarker studied. The 151 participants with high-grade prostate cancer had operating curve values ranging from 0.60 for PSA alone to 0.77 for PHI and 0.76 for a two-gene multiplex model. The MPSA model had values of 0.81 and 0.82 for MPSA2+. For a required sensitivity of 95%, the MPS2 model could reduce the rate of unnecessary initial biopsies in the population by 35%-42%, with an impact of 15%-30% for other tests. Among the subgroups analyzed, MPS2 models showed negative predictive values of 95%-99% for grade 2 or higher prostate cancers and 99% for grade 3 or higher tumors.

MPS2 and Competitors

Existing biomarkers have reduced selectivity in detecting high-grade prostate tumors. This lower performance has led to the development of a new urine test including, for the first time, markers specifically overexpressed in high-grade prostate cancer. This new MPS2 test has a sensitivity of 95% for high-grade prostate cancer and a specificity ranging from 35% to 51%, depending on the subgroups. For clinicians, widespread use of MPS2 could greatly reduce the number of unnecessary biopsies while maintaining a high detection rate of grade 2 or higher prostate cancer.

Among patients who have had a negative first biopsy, MPS2 would have a sensitivity of 94.4% and a specificity of 51%, which is much higher than other tests like prostate cancer antigen 3 gene, three-gene model, and MPS. In addition, in patients with grade 1 prostate cancer, urinary markers for high-grade cancer could indicate the existence of a more aggressive tumor requiring increased monitoring.

This study has limitations, however. The ethnic diversity of its population was limited. A few Black men were included, for example. Secondly, a systematic biopsy was used as the reference, which can increase negative predictive value and decrease positive predictive value. Classification errors may have occurred. Therefore, further studies are needed to confirm these initial results and the long-term positive impact of using MPS2.

In conclusion, an 18-gene urine test seems to be more relevant for diagnosing high-grade prostate cancer than existing tests. It could prevent additional imaging or biopsy examinations in 35%-41% of patients. Therefore, the use of such tests in patients with high PSA levels could reduce the potential risks associated with prostate cancer screening while preserving its long-term benefits.

https://www.medscape.com/viewarticle/urine-test-could-prevent-unnecessary-prostate-biopsies-2024a10009ux

Louisiana Lawmakers Vote to Classify Abortion Pills as Controlled Dangerous Drugs

 Two abortion-inducing drugs could soon be reclassified as controlled and dangerous substances in Louisiana under a first-of-its-kind bill that received final legislative passage Thursday and is expected to be signed into law by the governor.

Supporters of the reclassification of mifepristone and misoprostol say it would protect expectant mothers from coerced abortions. Numerous doctors, meanwhile, have said it will make it harder for them to prescribe the medicines that they use for other important reproductive healthcare needsopens in a new tab or window, and could delay treatment.

Passage of the bill comes as both abortion rights advocates and abortion opponents await a final decision from the U.S. Supreme Court on an effort to restrict access to mifepristone. The justices did not appear ready toopens in a new tab or window limit access to the drug on the day they heard arguments.

The GOP-dominated Legislature's push to reclassify mifepristone and misoprostol could possibly open the door for other Republican statesopens in a new tab or window with abortion bans that are seeking tighter restrictionsopens in a new tab or window on the drugs. Louisiana currently has a near-total abortion ban in place, applying both to surgical and medical abortions.

Current Louisiana law already requires a prescription for both drugs and makes it a crime to use them to induce an abortion in most cases. The bill would make it harder to obtain the pills by placing it on the list of Schedule IV drugs under the state's Uniform Controlled Dangerous Substances Law.

The classification would require doctors to have a specific license to prescribe the drugs, which would be stored in certain facilities that in some cases could end up being located far from rural clinics. Knowingly possessing the drugs without a valid prescription would carry a punishment including hefty fines and jail time.

More than 200 doctors in the state signed a letteropens in a new tab or window to lawmakers warning that it could produce a "barrier to physicians' ease of prescribing appropriate treatment" and cause unnecessary fear and confusion among both patients and doctors. The physicians warn that any delay to obtaining the drugs could lead to worsening outcomes in a state that has one of the highest maternal mortality ratesopens in a new tab or window in the country.

"This goes too far. We have not properly vetted this with the healthcare community, and I believe it's going to lead to further harm down the road," said state Sen. Royce Duplessis, a Democrat who opposes the measure. "There's a reason we rank at the bottom in terms of maternal health outcomes, and this is why."

Supporters say people would be prevented from unlawfully using the pills, though language in the bill appears to carve out protections for pregnant woman who obtain the drug without a prescription for their own consumption.

The reclassification of the two drugs in Louisiana is an amendment to a bill originating in the Senate that would create the crime of "coerced criminal abortion by means of fraud." The sister of Republican state Sen. Thomas Pressly, who authored the bill, has shared her own story, of her husband slipping her abortion-inducing drugsopens in a new tab or window without her knowledge or consent.

"The purpose of bringing this legislation is certainly not to prevent these drugs from being used for legitimate healthcare purposes," Sen. Pressly said. "I am simply trying to put safeguards and guardrails in place to keep bad actors from getting these medications."

The Senate voted 29-7, mainly along party lines, to pass the legislation. In the 39-person Senate there are only five women, all of whom voted in favor of the bill.

In addition to inducing abortions, mifepristone and misoprostol have other common uses, such as treating miscarriagesopens in a new tab or window, inducing labor, and stopping hemorrhaging.

Mifepristone was approved by the FDA in 2000 after federal regulators deemed it safe and effective for ending early pregnancies. It's used in combination with misoprostol, which the FDA has separately approved to treat stomach ulcers.

The drugs are not classified as controlled substances by the federal government because regulators do not view them as carrying a significant risk of misuse. The federal Controlled Substances Act restricts the use and distribution of prescription medications such as opioids, amphetamines, sleeping aids, and other drugs that carry the risk of addiction and overdose.

Abortion opponents and conservative Republicans both inside and outside the state have applauded the Louisiana bill. Conversely, the move has been strongly criticized by Democrats, including Vice President Kamala Harris, who in a social media post described it as "absolutely unconscionable."

The Louisiana legislation now heads to the desk of conservative Republican Gov. Jeff Landry. The governor, who was backed by former President Donald Trump during last year's gubernatorial election, has indicated his support for the measure, remarking in a recent post on X, "You know you're doing something right when @KamalaHarris criticizes you."

Landry's office did not respond to an emailed request for comment.

A recent surveyopens in a new tab or window found that thousands of women in states with abortion bans or restrictions are receiving abortion pills in the mail from states that have laws protecting prescribers. The survey did not specify how many of those cases were in Louisiana.

Louisiana's near-total abortion ban only has exceptions if there is substantial risk of death or impairment to the mother if she continues the pregnancy or in the case of "medically futile" pregnancies, when the fetus has a fatal abnormality.

Currently, 14 states are enforcing bans on abortion at all stages of pregnancy, with limited exceptions.

https://www.medpagetoday.com/obgyn/abortion/110300

'Most Women Can Have Successful Pregnancies After Breast Cancer Treatment'

 The vast majority of young breast cancer survivors who attempted pregnancy after treatment were able to become pregnant and have a live birth, according to a prospective cohort study.

With more than 10 years of follow-up, 73% of women who attempted pregnancy after treatment for stage 0 to III breast cancer became pregnant at least once, with 90% having at least one live birth, reported Kimia Sorouri, MD, MPH, of the Dana-Farber Cancer Institute in Boston.

The median time from breast cancer diagnosis to first pregnancy was 48 months, and older age at diagnosis was associated with lower odds of pregnancy (adjusted OR 0.82 per year increase, 95% CI 0.74-0.90, P<0.0001) and live birth (aOR 0.82 per year increase, 95% CI 0.76-0.90, P<0.0001).

On the other hand, financial comfort at time of diagnosis was predictive of pregnancy (aOR 2.04, 95% CI 1.01-4.12, P=0.047), and fertility preservation was predictive of live birth (aOR 2.78, 95% CI 1.29-6.00, P=0.009).

"Of note, fertility preservation prior to cancer treatment consisting of freezing eggs or embryos was predictive of live births," Sorouri said during a press briefing in advance of the American Society of Clinical Oncologyopens in a new tab or window (ASCO) annual meeting.

"This suggests that in this modern cohort, with a heightened awareness of fertility, access to fertility preservation can help to mitigate the damage from chemotherapy and other agents," she added. "This highlights the need for increased accessibility of fertility preservation services for women newly diagnosed with breast cancer who are interested in a future pregnancy."

Julie Gralow, MD, chief medical officer and executive vice president of ASCO, who moderated the press briefing, noted that while oncologists "can't do a lot to impact [younger age and financial comfort at diagnosis] ... we can impact fertility preservation prior to treatment."

"It is really critical that every patient be informed of the impact of a breast cancer diagnosis and treatment on future fertility," she said. "And that we actually offer all young patients ... fertility preservation prior to beginning their treatment, and that we should have equitable access for all."

"It is impressive that this is the first study with long-term follow-up to look at fertility in pregnancy in all subtypes of breast cancer," Gralow added. "It's also impressive that 68% of the patients in this study did receive chemotherapy, which is known to reduce future fertility."

"The conclusion is that pregnancy after a diagnosis of breast cancer is indeed possible for the majority who desire pregnancy, and it is safe," she said.

In explaining the rationale behind the study, Sorouri suggested that current research on the impact of breast cancer treatment on fertility and live birth is somewhat limited. For example, she pointed out that some studies, such as the POSITIVE studyopens in a new tab or window, only included select subgroups.

POSITIVE "provided excellent data on fertility outcomes, but only for women with estrogen receptor-positive breast cancer," she said. "Other studies have short-term follow-up and -- critically -- lack prospective assessment of attempt at conception, thus the results don't truly reflect who is trying to get pregnant."

This analysis used data from the Young Women's Breast Cancer Study, a prospective cohort study of women ages 40 and younger with newly diagnosed breast cancer who were enrolled across 13 sites in the U.S. and Canada from 2006 to 2016.

Of the 1,213 eligible participants, 197 reported an attempt to get pregnant over a median follow-up of 11 years.

Among those 197 women, median age at diagnosis was 32, 74% were white, 41% had stage I disease, 35% had stage II, 10% had stage III, and 14% had stage 0. About two-thirds (68%) received chemotherapy, 57% received endocrine therapy within 1 year, and 13% were BRCA1/2 carriers.

About half (51%) of patients reported financial comfort at baseline, 28% had undergone fertility preservation consisting of egg/embryo freezing at diagnosis, and 15% reported a history of infertility before breast cancer diagnosis.

Disclosures

The study was funded by the Breast Cancer Research Foundation and Susan G. Komen.

Sorouri reported no disclosures.

Co-authors reported relationships with Alston & Bird, AstraZeneca, Blue Note Therapeutics, Daiichi Sankyo, Elsevier, Exact Sciences, Gilead Sciences, GSK, Hall Matson, Included Health, Ipsen, Knight Therapeutics, Libbs, Lilly, M. Dalton Esq. and Associates, Medtronic, Menarini, Morrison, MSD, Novartis, Olema Oncology, Perla Therapeutics, Pfizer, Pierre Fabre, Roche, Rubedo Life Sciences, Seagen, Sandoz, Springer Nature, Takeda, and UpToDate.

Primary Source

American Society of Clinical Oncology

Source Reference: opens in a new tab or windowSorouri K, et al "Fertility among young breast cancer survivors attempting pregnancy: a prospective multicentre cohort study" ASCO 2024; Abstract 1518.

https://www.medpagetoday.com/meetingcoverage/asco/110329

What feds plan to use from Hunter laptop in Delaware trial: Pictures, videos and ‘I need more chore boy’

 Federal prosecutors plan to deploy thousands of pages of electronic records from first son Hunter Biden’s “laptop from hell” and other technology — including a message demanding more “chore boy” to smoke crack cocaine, court papers show.

Whatever prosecutors from the office of special counsel David Weiss introduce will have to pass muster with federal judge Maryellen Noreika, who ruled Friday that the 54-year-old’s lawyers will be allowed to raise objections to data on a case-by-case basis. 

However, Noreika declined to block the laptop outright from evidence, rejecting defense arguments that the hard drive had been hacked and false information had been planted.

In all, the feds say, they have more than 18,000 pages of electronic records from the laptop, a hard drive and an iCloud account linked to Hunter’s iPad and iPhone XR, which they want to summarize in a chart for jurors.

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Prosecutors want jurors to see a message sent by Hunter Biden referencing the drug slang “Chore boy.”AP

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Hunter Biden said in a message “I need more Chore boy,” referencing a filter for a crack pipe.USDC Delaware

Included in the sea of data is a message from Hunter that says, “I need more chore boy,” according to court papers filed by prosecutors on Wednesday.

The feds say the younger Biden’s message used the phrase the same way he used it in his book “Beautiful Things: A Memoir,” in which he explains that a Chore Boy “is a spun-copper scouring pad” that addicts use “as a screen to hold the crack in their rose pipes.”

He noted it’s also referred to as “choy.”

“We just planted ourselves on the couch and smoked a ton of crack,” reads another passage of the book. “For endless hours, day after day, it was the same numbing ritual, over and over and over: pipe, Chore Boy, crack, light; pipe, Chore Boy, crack, light; pipe, Chore Boy, crack, light.”

Prosecutors said the chart will also include photos and videos of Hunter with a crack pipe and messages about drugs from December 2018 to March 2019.

Hunter’s lawyers warned in papers filed Thursday that they may object at trial to the introduction of some of the contents, such as “inflammatory text messages,” on the grounds that they are prejudicial to their client.

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The embattled first son goes on trial for illegally owning a gun while addicted to crack cocaine on June 3.

Hunter’s team also said they should be allowed to object to some of the laptop evidence being shown, claiming the hard drive was hacked and the incriminating evidence was planted there.

But prosecutors say they would be able to corroborate and prove the digital evidence they plan to show is authentic and taken from Biden’s own devices.

Weiss’ prosecutors also want to include messages between Hunter and “Witness 3,” previously identified by The Post as his sister-in-law-turned-lover Hallie Biden, that were sent to and from the phone of Hunter’s ex-wife Kathleen Buhle and thus “not synced to his iCloud account.”

The first son — who was in a Delaware federal court on Friday for a pre-trial conference, one day after attending a White House state dinner — faces three charges connected to allegations he bought a Colt Cobra .38-caliber revolver on Oct. 12, 2018, after denying on an application form that he was addicted to drugs, despite being in the throes of a crack cocaine dependency at the time.

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Hunter Biden also faces trial in September in a tax evasion case.

In “Beautiful Things,” Hunter admitted to being hooked on the highly addictive street drug from 2015 through 2019, which the feds claim proves he lied when he checked a box on a form saying he didn’t use drugs when he bought the gun.

The first son faces up to 25 years behind bars if convicted on all counts.

Hallie Biden ditched the gun days after Hunter bought it — prompting an angry outburst from the now-first son.

The younger Biden also faces tax evasion charges in Los Angeles, with trial in that case due to begin Sept. 5.

He’s pleaded not guilty to all charges.

Hunter had been on track to plead guilty in the gun case last year until the deal he struck with prosecutors blew up in court after the feds said they couldn’t promise he’d be clear of charges in the tax case.

A spokesperson for the Department of Justice declined to comment. Hunter’s defense lawyer didn’t immediately return a request for comment Friday.

https://nypost.com/2024/05/24/us-news/what-the-feds-plan-to-use-from-hunter-bidens-infamous-laptop-in-delaware-trial-pictures-videos-and-i-need-more-chore-boy/