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In the U.S., many hospitals have some sort of patient navigator or advocate. I’m aware of at least some insurance companies even offering such services (although I can’t speak to whether they are necessarily well aligned with patient interests). See if you can request these services.

A trusted family member is always a huge help at appointments: even if it’s infeasible to go in person, ask to listen in remotely. I’ve been in those shoes too.

Be overcommunicative, be the squeaky wheel: for our part, we know the difference between even zealous advocacy (great!) from disruptive behavior (not so great!).

Sorry, the system can suck. I promise you that every oncologist has had to make those unanswered calls too, so we do know something of this end of things. But you and your loved ones don’t deserve to suffer for it, so don’t be shy.

Good question!

There is a standard practice at cancer centers which would be more the equivalent of PR review. Often it’s called “tumor board” but names vary (ours is called “case conference”). Depending on the institution and department, all, most (anything but the most straightforward), or some (unusual, advanced, prompted by patient discussion, etc.) cases are brought up for a consensus opinion. Like PR review, the format and formality of this process will differ institutionally, but some version of it is standard as part of the “workflow.”

If the specific department reviews all or most cases as a matter of course, it may not even be mentioned to patients (let alone requiring them to ask for it) unless the consensus opinion alters the original plan. Pathology or radiology consensus interpretations if they occur usually precede the issuance of a final report (so as to avoid giving one interpretation that’s potentially acted on but then amended) and are notated with specific verbiage.

A second opinion generally means transferring records and tissue samples outside the original institution. Think of it more like assigning the same bug report to two teams. There is a role for this, but I wouldn’t think of it as PR review.

(I treat patients at a cancer center, but opinions are my own and not those of my employer.)

I fully encourage any patient who wants another opinion to get one. Definitely really good advice to seek one out before you start on your treatment plan, if it can be done without undue delay. I think of planning cancer treatment like lining up to take off for a flight: some plans even if imperfect are more dangerous to alter than continue if they've already been put in motion. There are--rarely, thankfully--times where we don't end up concurring at all in the diagnosis or treatment, and this is all best sorted out before the first treatment.

But a second opinion isn't a waste just because it agrees with the initial plan. In my experience, that's actually the most common outcome, and I think it's a really good thing if a second opinion can give deserved reassurance that your original team is doing everything by the book. For many common cancers, there's consensus as to the most appropriate first-line treatment because there's peer-reviewed evidence and agreement on how to apply that evidence. When all of it points towards an effective treatment, down to a standardized dose and schedule, and it's a really good thing!

There's some subtlety that arises when there isn't a clear consensus as to which of (say) two reasonable approaches used by different comprehensive cancer centers is best. If you look at guidelines, both of those approaches would be listed as appropriate, but patients might be recommended one plan at center A and a different one at center B.

What it can come down to is that center A delivering treatment A demonstrates comparable results to center B delivering treatment B. In that scenario, if a patient lives down the street from center A and travels hundreds of miles to see me for a second opinion at center B, I would almost always agree with getting treatment A at center A. Not because I'm trying to manage what center A would think of me, but because I'd truly believe it's in that specific patient's best interest. First, all else being equal, I'd have no grounds to think that traveling hundreds of miles to get treatment B at center B would be better than staying local. Second, in general, I'd strongly doubt that getting treatment B at center A (which wouldn't be the plan they'd have the most experience with) would be superior to getting treatment A at center A.

And, yes, I absolutely have recommended when appropriate for patients to transfer care to our center, and I have also recommended when appropriate for patients to leave our center to go elsewhere (for example, for a particularly promising clinical trial option). I've seen every one of my colleagues do the same without hesitation.

This is all just from one person's perspective, of course. I know patients and families can come from different and totally valid vantage points. But to sum it up, please don't worry about managing your doctors' emotions about getting a second opinion, and find a place where you can be confident that the folks giving you their second opinion likewise aren't thinking about managing your doctors' emotions. Hopefully, they'll earn your trust that a concurring opinion means they really do think your original team has laid out the plan that's best for you.

Yeah, I can see why someone might assume that the activation lock would be disabled in that scenario. But on the other hand, I can also see why someone would absolutely expect that it wouldn't be.

I might want (and have wanted) to reinstall macOS and start fresh without any intention of relinquishing or transferring ownership of the physical device. And I might want to log out of iCloud because I don't want to sync my personal stuff on that computer anymore, or because something funky is happening with how messages or photos are syncing and I just want to reset it all. I'd be pretty pissed if, six months after reconfiguring everything, someone nabbed my laptop and I discovered that activation lock had been automatically disabled for me the whole time without my explicitly doing so.

Given these mutually irreconcilable user expectations, I can see why Apple would opt for a design that favors the more cautious approach where you have to press a very specific sequence of buttons to disable the lock. Maybe I'm just selfish, but knowing a laptop I sent away couldn't be repurposed but ended up as e-waste would make me feel a little guilty, but knowing a laptop I didn't want to lose got stolen with all my stuff on it exposed to the thief would make me apoplectic with rage.

I think they've got a fair point, though, that a number of those issues with the eSIM reflect reliance on factors outside their control (for example, whether or not one's carrier has competent backend systems) where before swapping a SIM card was a physical action within their control. It's a frustrating feeling when a new technology takes something out of your hands in the name of convenience but, far from being seamless, actually introduces problems that are entirely out of your hands to fix.

Engineering the virus doesn’t mean making gain-of-function mutations. “Function” has a specific meaning and it’s not a synonym for “does anything.” Instead, in broad strokes, think of “function” as referring to biological activities that give the virus some advantage over its host.

To make a simplistic analogy (necessarily imperfect but sufficient for these purposes), consider instead a computer virus. If an antivirus company patches the binary in order to make it easier to study its behavior (for example, in order to make it more debuggable), that’s “engineering” the virus but it’s not “gain-of-function.” If the company instead patches the virus so that it can take advantage of a new 0-day exploit and spread further, that’s “gain-of-function.”

Whether gain-of-function research is capable of revealing new insight into transmissible diseases not obtainable elsewhere is a point of debate among biologists, but one can be well assured that a for-profit operation isn’t going to touch it with a ten-foot pole. Engineering the virus on the other hand, or in other words making mutations in viral components, is basically a description of “doing basic molecular biology” and is non-optional.

The sort of allegation that Pfizer is responding to is more or less the equivalent of someone recording an engineer calling themselves “hackers,” visiting “Hacker News,” then writing an exposé claiming that this proves Company X is in the business of computer crime.

The activity mentioned in the Pfizer press release that skirts closest to “gain-of-function” is actually a bit you didn’t mention at all, where they’re required by regulatory bodies to determine how the virus might resist an antiviral. Unlike computer viruses, biological ones mutate under treatment pressure. The closest analogy for a computer virus might be if it phones home and downloads a new payload to modify its behavior when it detects the presence of some antivirus software. For obvious reasons, studying how a pandemic virus would mutate in response to approved drugs is both necessary and icky, hence why Pfizer discussed its biosecurity measures. The distinction they make (rightly) between this research and a “directed evolution” or “gain-of-function” experiment, is that they’re reading out an answer to the question “Does the virus mutate when we treat with this antiviral drug, and if so, how?”, not culturing viruses iteratively in the presence of drug until they obtain an optimized treatment-resistant virus.

I don’t use dictation often, but I’ve not had any issues on iOS 16 (US English, iPhone 12).

One caveat is that I’d been using the betas, so I didn’t upgrade straight from iOS 15 to 16.0 as released, but I really haven’t encountered any difficulties with dictation in any of the betas or in the final release.

This report worried me, but it was timely because I was literally in the process of upgrading to macOS 11.2.3.

So, while the update was downloading, I changed my firewall settings specifically to allow built-in software to receive incoming connections, but disallow downloaded signed software. I also specifically set GarageBand to block incoming connections but not other programs among those listed.

I'm happy to report that all of these settings were maintained after updating to macOS 11.2.3 exactly as-is. I wonder if the OP is referring to a different update (none that I'm aware of recently).

There is no Privacy > Advertising > Limit Ad Tracking setting on macOS 11.2.2 or 11.2.3: there's a checkbox for "Personalized Ads," which remains turned off after the update also, just as it was before.