My brother, Ben Stiller

Ben Stiller has disclosed that he is recovering for treatment of prostate cancer, which afflicted him at age 46. Without PSA screening that detected the cancer before it became symptomatic and (more importantly) before it metastasized, he believes he would have died.

I'm with you, Ben. That's my story, too. I was 51 when my PSA test showed a problem. Like him, my "Gleason score" was 7. Like him, I underwent laparascopic surgery assisted by a robot. Like him, I am alive today with a zero PSA level — which, after one's prostate has been removed, is an unambiguous statement that no prostate cancer remains.

Unfortunately, the U.S. Preventive Services Task Force continues to tell men that they should not have PSA testing in the absence of symptoms. It's absurd. Their position effectively condemns men like Ben and myself to an early, unnecessary death.

The argument from USPTF is that a PSA test is not specific to prostate cancer. Non-cancerous diseases of the prostate can elevate one's PSA. That's true. In order to diagnose prostate cancer, one's prostate must be biopsied. This is a painful procedure that has its own risks and has a high price tag. That's true. There is a chance that the biopsy will give a false negative (in other words, that it will not find cancer even though the cancer is present). That's true. There is a possibility that some men will panic and rush to treatment by surgery or radiation, even though their particular type of prostate cancer is so slow-growing that it would not pose a threat for 10 or 20 years. That's true. There is also a possibility that some doctors practicing defensive medicine or hungry for income will encourage patients to get treated when waiting would be a better decision. That's true.

But in cases like Ben's and mine, the situation simply doesn't play out that way. Ben and I had 35-40 years of projected lifespan ahead of us; we were not octagenarians likely to die of something else soon. Our cancers were asymptomatic; I had "digital exams" (guys, you know what that is) by at least ten physicians before surgery. None of them could feel anything amiss, and of course I hadn't noticed any symptom myself. Our cancers were fast-growing, not slow-growing. His PSA level was rising rapidly, and so was mine. In fact, in the months it took between my initial test and my surgery, I passed from the zone of intermediate risk (PSA=15) to the zone of high risk (PSA=25). Usually a PSA of 6 is considered ominous, if it continues to rise. After my surgery it came to light that my cancer had just begun to spread outside the prostate.

There is zero doubt that without PSA screening, my cancer would have become untreatable within a year and that I would not be alive today. No doctor familiar with my history believes otherwise. And when I wrote an MD at the USPTF to object, he didn't dispute my imminent and certain demise. He simply replied that in the aggregate, too much money is being spent on unnecessary treatments and the complications they cause. In other words, it's ok for men like Ben and myself to die prematurely just because other men and their doctors are making poor decisions.

I think that sucks.

Do we need a more specific test than PSA? Yes. Do we need more conservative treatment — in some cases, engaging in "watchful waiting"? Yes. Are those sufficient reasons to tell men not to get screened in the first place? No.

Someday the brotherhood that Ben and I belong to will be joined by one of physicians who participates in the USPTF. At that point, I expect to see change in the recommendation. Until then, ignore the USPTF and get screened. It could mean your life, too.

What police can and cannot do

It's always risky to comment on a developing situation whose facts are uncertain, but I wrote the following in response to a family member who opined on Facebook.

"Police officers are not 'the law' [a quote from the post of my family member]. Police officers serve the law. They are under the law like everybody else. The law grants them powers but also imposes limits and holds them accountable if they don't stay within those limits.

"Whether the dead person had, in fact, a gun is one question that ultimately a jury will have to decide. Beyond that, open-carry in North Carolina has been legal for decades and concealed-carry in North Carolina is also legal with a permit. (No one knows whether the dead person had a permit or not.)

"I'm sure the officer believes the dead person had a gun. Whether or not that was, in and of itself, justification for a command to drop the weapon is a debatable point at law and there have been several court cases about that already. It's also a debatable point at law whether a LEO is justified in shooting someone simply because the person is armed and declines to disarm. There have been court cases about this too. The question is really whether the dead person made a threatening gesture or there was some other legitimate reason for the LEO to open fire.

"It's a borderline case based on the facts that have come to light. In short, LEOs do not have unlimited discretion to open fire — even in situations where a firearm is present. This is far from open-and-shut."

Where art thou, First Union?

When it was clear in 1986 that Gail, Ryan and I would move from Atlanta to Raleigh, I wanted to open a bank account in Raleigh several months before the family would arrive. So, during a business trip I dropped by Crabtree Valley Mall and visited the branches of the "big three" banks in Raleigh at the time. Each heard the same story: I didn't have much time to talk, but I would leave my name and Atlanta home address so that they could send me a packet of available services and a fee list.

• Nothing ever arrived from NCNB.
• Wachovia sent something by first-class mail, and I received it five days later.
• First Union sent me a package overnight.

I went with First Union and became a very happy customer. Ultimately First Union was acquired by Wachovia. I had misgivings about the takeover, but Wachovia turned out to be good, too.

But Wachovia got caught playing mortgage games in 2008-2009, and along came Wells Fargo.

Only two things good have happened since: on the rare occasions when I travel in the western U.S., there are more ATMs to use; and I prefer Wells Fargo's process for accessing a safe deposit box. Otherwise I've found Wells Fargo to be generally uncooperative compared to First Union or Wachovia, and I tired long ago of being upsold everytime I talked to a Wells Fargo person, used their ATM, or used their website. Look, if I want an additional service from Wells Fargo, I'll ask you about it!

But all that upselling was indicative of an underlying management problem, it turns out. I am not surprised by the disaster now revealed. I am surprised, however, that no head has rolled yet within the bank. Let's hope that the Federal Reserve, the Department of Justice, or the Congress plows into this situation. Civil litigation by customers of Wells Fargo is inevitable, but that's insufficient. Heads must roll, and the bank and relevant executives including the CEO and the president of the consumer banking division must be prosecuted, fined, and — in the case of the executives — jailed. That's the only way to prevent this from recurring.

As to whether Gail and I will take our banking business elsewhere, we haven't decided yet.

Looking at the presidential election

When thinking about the upcoming election for President, I put the electorate into six buckets. Each bucket gets a color in my diagram:

People in the yellow bucket cannot or will not vote. The light blue and light red buckets are folks who will vote for Clinton or Trump, respectively, on the basis of party affiliation or general political stance (e.g. liberal vs. conservative) regardless of their views of the candidates personally. There are always some voters in these buckets, but in 2016 there appear to be more than ever.

At this point, no one knows how the green bucket will eventually be dispersed across the other five. No one knows how many people will step out of the yellow into a red or blue bucket — or will decide to sit on the sidelines by moving into the yellow bucket. And even if the election were tomorrow, no one can say with confidence whether Clinton or Trump would win; that is, whether the sum of the light blue and the dark blue buckets will be larger or smaller than the sum of the light red and the dark red buckets. Things to bear in mind at this point:

• The big TV money hasn't been spent yet.
• The election is nine weeks away, and a lot can happen in that time. For example, a candidate can make a profound misstatement or can score a knock-out punch. Small impacts can be decisive in close elections.
• In North Carolina, last-minute changes to the voting process as a consequence of legislation and subsequent litigation make it very difficult to predict voter turnout.

The net unfavorability ratings of both Clinton and Trump also cast doubt on outcomes of down-ballot races.

Turnout is the key. Polls have become notoriously inaccurate in predicting turnout. I call it 50-50.

The process of deciding

Life sometimes presents us, confronts us, with finely calibrated decisions where the choice between two alternatives is not easy, but the consequences of choosing rightly or wrongly are significant. I saw an example of this Monday at a baseball game. Let me tell you the story, and you don't have to be an expert on baseball to see the point.

After eight innings, neither team had scored. In fact, no runner had made it to third base and only two had reached second. You could politely call it a thrilling duel by two skilled pitchers, or you could note wryly that both teams had a sorry batting average — not surprising for the minor leagues on the last day of the season, when the better players had been called up for tryouts or injury fill-ins. Anyway, we entered the top of the ninth 0-0.

The home team's pitcher had given up only two hits. Does the manager leave him in, betting on another 3-up, 3-down inning but accepting the risk that the pitcher will tire and give up a sudden run? Or does the manager bring in a reliever with a fresh arm, but who might come to the mound flat? You know that the starting pitcher does not want to be yanked, so even if his arm is getting rubbery, he won't confess it. After all, it's the last game of the season and he wants to leave the organization with a strongly positive memory of a complete game shutout. And the catcher isn't much help to the manager in making the decision because the pitcher showed really good stuff in the eighth.

The manager opted to bring in the reliever, who gave up a hit but eventually got three outs without giving up a run.

Now it's the bottom of the ninth, still 0-0. The visiting team's manager faces exactly the same decision. His pitcher has given up six hits through eight innings, but most of them were weak singles "with eyes". The manager opts to leave his starter in. Things turn sour for the visiting team immediately: the first four pitches are balls, and the next batter hits a walk-off double to deep left that brings in the winning run.

Superficially, one manager looks like a genius and the other manager looks like a dolt. But that's not fair to either. One manager played the statistics strictly, and the other manager followed a hunch or perhaps had another objective in mind. I know that the losing pitcher will always remember the vote of confidence he got from his manager. Point is, both managers had reasonable means by which to reach their decisions. In this circumstance, one approach worked and the other didn't.

Philosophers have said, to paraphrase, that we are the sum of our choices. Maybe they're right, but it's a scary way of looking at life. In my years I have run across a few people who appear to be very adept at making finely calibrated decisions that consistently turned out well — but only a few such people. Are they so skilled or just lucky? I wonder. Meanwhile, the rest of us proceed through life doing the best we can, hoping that we find ourselves on the favorable side of a 1-0 score more often than not.

Medals per million

Athletes from the U.S. won the most medals at the 2016 Summer Olympics, but before Americans think once again that they're better than everyone else, let's calculate medals per million population. It's just logical to expect that the more populous countries win more metals than the less populous countries, right? Here are the numbers.

Jamaica 3.67

New Zealand 3.60

Croatia 2.50

Denmark 2.50

Slovenia 2.00

Azerbaijan 1.80

Georgia 1.75

Hungary 1.50

Armenia 1.33

Lithuania 1.33

Australia 1.21

Serbia 1.14

Netherlands 1.12

Sweden 1.10

U.K. 1.03

Belarus 1.00

Cuba 1.00

Kazakhstan 0.94

Czech 0.91

Switzerland 0.88

Norway 0.80

Slovakia 0.80

France 0.65

Canada 0.59

Belgium 0.55

Greece 0.55

Germany 0.51

Italy 0.47

South Korea 0.41

Uzbekistan 0.41

Russia 0.38

U.S. 0.37

Japan 0.32

Spain 0.30

Kenya 0.30

North Korea 0.29

Poland 0.29

Ukraine 0.26

Romania 0.25

South Africa 0.18

Colombia 0.16

Malaysia 0.16

Iran 0.10

Turkey 0.10

Brazil 0.09

Argentina 0.09

Thailand 0.09

Ethiopia 0.08

China 0.05

Mexico 0.04

Indonesia 0.01

For example, in proportion their populations, the Australians won three times as many medals as the Americans.

The populations in these calculations were rounded to the nearest million, so for the less populous nations, there might be some movement in the rankings if the calculations had been made to three significant digits. But the overall message of the numbers is clear.

Jamaica, of course, is at the top because of Usain Bolt. An exceptional athlete can skew his or her nation's numbers.But the U.S. had Michael Phelps and Simone Biles, among others.

Anyway, I think the U.S. Olympic Committee has something to think about — as does their counterpart in China. Host nation Brazil did poorly, perhaps distracted by logistics. Note that some countries like Sweden emphasize winter sports. Their numbers for the summer are particularly impressive.

My milk comes from Ohio?

Yes, the milk I buy at the local Costco comes from Superior Dairy in Canton, Ohio. How do I know? The retail packaging of all milk in the U.S. has a dairy code. Mine is 39-13. Find your code and then visit whereismymilkfrom.com. Canton is 500 miles by road from Raleigh. Apparently the advantages of shipping a heavy product that requires constant refrigeration outweigh the obvious disadvantages. It turns out that Superior Dairy has quite a history with Costco and Wal-Mart. But even when I buy milk at the local Harris Teeter grocery, it comes from out of state.

This came to my attention when reading a story from the Raleigh News and Observer about massive hog and poultry farms in North Carolina. The story linked to a database that included dairy farms, represented by purple dots. There aren't many of them. In fact, there are only 47,000 dairy cattle in the state. Half the fluid milk purchased in North Carolina must be imported. This surprised me because when we moved to Raleigh in 1986, dairies were still operating in Wake County — as well as Pine State Creamery, whose orange cartons you will remember if you flew Delta in the 1970s and 1980s. But all those farms were redeveloped as residential subdivisions, and Pine State went bankrupt in 1996.

Almost every southeastern state has a milk deficit. What's more shocking to me is the situation in Alabama. The Black Belt soils of central Alabama once hosted prodigious producers of dairy products such as Barber and Hall Brothers, with over 400,000 head in the 1950s. Today only 8,000 dairy cattle can be found in the state. Alabama has fallen to 45th in dairy production nationwide. What happened?

Hello, Holsteins, the black-and-white breed that supplanted the brown Jerseys and brown-and-white Guernseys. Holstein milk has less fat than the other breeds, and in the 1970s consumer demand changed to lower-fat products. More importantly, Holsteins produce more gallons per head per year than Jerseys or Guernseys. The gotcha: Holstein production falls off in hot climates. I guess I can't blame the cows for wanting to stay cool. Hot weather and competition drove dairy production out of the south. It's ironic, given that the south has taken much of the heavy manufacturing from the north.

Many of the surviving dairies in the south, such as Chapel Hill Creamery, have premium prices for their products and not enough output to satisfy the major grocers. East of the Mississippi, the major dairy states are New York (618,000 head), Pennsylvania (530,000), Michigan (408,000), and Ohio (267,000). The trend for locavores notwithstanding, it appears the dairy industry in the south as we knew it is gone for good.