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Amazon shows how trickle-down inequality works

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Sarah Jones writes in the “Intelligencer” section of New York:

Bill Bodani liked his old job. He cleaned slag out at the Sparrows Point steel mill in Maryland, cleared the flues and the broken brick out of the blast furnace. He loved it despite the asbestosis it gave him, writes Alec MacGillis in his new book, Fulfillment. “I enjoyed the people,” Bodani told MacGillis. “They made it enjoyable. The Black, the white. It was a family thing. I don’t care if you knew them for five minutes, they took you in. No matter how bad I got hurt, or how bad things got, there was always a bright side. You had those guys with you.”

Until he didn’t. The mill closed, and Bodani needed a new job. He found one with Amazon, working in a Baltimore-area fulfillment center. He started out at $12 an hour — much less than he’d made at the mill. He’d traded his old friends for a place that would, as MacGillis put it, fire workers “by algorithm.” And Bodani had a problem. He was older, and he needed to use the bathroom more often than did his younger co-workers. When he had used up his breaks, he resorted to an undignified option. He’d piss in a corner of the warehouse, using a forklift as a privacy shield.

MacGillis completed Bodani’s story before the Retail, Wholesale, and Department Store Union announced that it would try to unionize the first Amazon warehouse in the country in Bessemer, Alabama. Workers there reported their own versions of Bodani’s problem. The company regimented their days so strictly that they often didn’t have the time they needed to use the restroom. The union still lost, an election now contested before the National Labor Relations Board. Despite the outcome, the stories stick. Workers said they couldn’t stay six feet apart from each other in the middle of a pandemic, spoke of dirty workstations that never got clean. Amazon, they insisted, was a bad place to work. Why, then, are cities so desperate to bring Amazon home?

In Fulfillment, MacGillis, a reporter for ProPublica and the author of 2014’s The CynicThe Political Education of Mitch McConnell, offers answers. The digital economy has fattened a handful of cities while others, often old industrial hubs, fall behind. There is historical precedent for industries to cluster: “History,” he writes, “is the story of cities with the right confluence of people in close quarters to spin the world forward, whether in classical Athens or Renaissance Florence or industrial-age Glasgow.” That dynamic, however, has “trebled” in recent years, he claims, with innovation the new resource to mine. Amazon and Microsoft swelled Seattle, brought it new wealth, a new class of resident, and a new set of problems. That wealth never reached a number of Seattle’s long-term residents, who could recall an older, more livable version of a vibrant city. What dispersed out from Seattle was not wealth, either, but something else. Inequality trickled down.

MacGillis understands the bargain Amazon offers the public and explores the consequences of that bargain with a sharp, humane eye. He succeeds in telling a story about Amazon from the bottom up — the right way to scrutinize a company that projects a progressive image. Amazon wants us to believe it treats its workers well: It pays them $15 an hour now, a fact it has repeatedly tweeted to its congressional critics. Other companies, even governments, ought to follow Amazon’s stellar example, the company says. MacGillis argues that governments have already been too eager to take Amazon at its word, and that the consequences, for workers and for the places they live, have been catastrophic.

To cities in need of jobs, Amazon can look like a savior. But salvation is an exchange: a soul for a different future. MacGillis argues that this trade is good for Jeff Bezos alone; workers and cities lose out in both a psychological and material sense. Bill Bodani has nothing to offer the new economy but his body. Amazon accepts, and forces him to accept something even more nefarious than a pay cut. To take a job at the mill was to join a community. Young high-school graduates, MacGillis writes, had walked into a union and the welcoming arms of their uncles and fathers. By contrast, the warehouse is a sterile place. Workers are welcomed not with warm introductions but with “a sheet of paper scrawled with AMAZON” and representatives for an Amazon subcontractor. The job itself can be isolating, as Amazon workers themselves have reported; steep quotas and pervasive surveillance offer few opportunities to socialize. This is a useful union-avoidance strategy. It’s also a spiritual blow.

Once cities like Sparrows Point offer up their souls, Amazon gives them a cheap future. Corporations rarely make decisions out of abundant public spirit; Amazon is no exception to the rule. Instead, it eludes taxes. MacGillis calls Amazon’s approach to tax avoidance “a veritable Swiss Army knife, with an implement to wield against every possible government tab,” and the description lines up with reality. Amazon paid no federal income tax for two years before coughing up a paltry $162 million in 2019. It settles upon cities and towns like a locust, chewing up tax breaks totaling $2.7 billion by 2019, according to MacGillis. In 2018, Amazon threatened to cancel a planned expansion in Seattle, its home turf, over an employee-hours tax intended to address the city’s homelessness crisis. The city council passed it, only to reverse itself less than a month later.

In smaller cities, the costs of attracting Amazon can be especially steep. Consider . . .

Continue reading. There’s more.

Written by LeisureGuy

13 April 2021 at 2:53 pm

Curbing gun violence in the United States

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In a post yesterday, I set out the reasons that suicide should, like homicide, be viewed as part of the serious gun violence problem the US has. What can be done to implement ways of combating gun violence? Colleen Walsh describes in the Harvard Gazette some steps that could be taken.

In the wake of several deadly mass shootings, President Biden announced a list of executive orders last Thursday aimed at reducing gun-related violence, and called for Congress to ban assault weapons and high-capacity magazines. Biden’s orders included better regulation of “ghost guns” — homemade weapons that lack traceable serial numbers — and stabilizing braces that transform pistols into more lethal, short-barreled rifles. They also called for increased support for violence-intervention programs, and model “red flag” legislation to make it easier to get guns away from people who pose a danger to themselves or others.

Stopping gun violence will take myriad approaches, including a range of public health efforts, according to David Hemenway, professor of health policy at Harvard T.H. Chan School of Public Health, director of the Harvard Injury Control Research Center, and author of the 2006 book “Private Guns, Public Health.” Hemenway, who is working on a new book about firearms and public health while the Elizabeth S. and Richard M. Cashin Fellow at Harvard Radcliffe Institute, spoke with the Gazette about what needs to be done to curb gun violence in the U.S.

Q&A with David Hemenway

GAZETTE: What was your impression of Biden’s executive orders around gun control?

HEMENWAY: Biden’s overall plan seems excellent—a response that is more than just more law enforcement — and these executive actions are good first steps to reduce the terrible problem of firearm violence in the U.S. There are various specific actions taken, such as beginning to address the issues of ghost guns (which aren’t subject to background checks), and they are all important. He could do more, but there are so many important things he can’t do by himself with executive orders. Overall, I think it’s a nice first step, but he needs Congress to work with him to do many of the most important things.

GAZETTE: What are some of those things?

HEMENWAY: Universal background checks need to be passed by Congress, but even more important than that would be universal gun-licensing laws (which implies universal background checks) and handgun registration. Just as everyone who drives a motor vehicle needs to have a license and vehicle registration, the same should be true for anyone who owns a firearm. Only a few U.S. states have gun licensing, but as far as I can tell, virtually every other developed country has some form of gun licensing, and their levels of gun violence are all far lower than ours. Licensing and registration helps keep guns out of the wrong hands.

There are so many other actions the federal government could take to help further reduce firearm violence. For example, the federal government could model what good training for gun owners should look like. In our work at the School of Public Health, we sent people out to take dozens of basic gun training classes throughout the Northeast. Some of the trainings were excellent, but some were horrible. Only half of the trainers discussed how you should store your guns appropriately, while a few said if you have kids you can just hide your guns. Almost no one discussed the role of guns in suicide, the curiosity of children, methods of de-escalating conflict, alternative methods of self-defense, or the type of continual training one needs to effectively use a gun in self-defense. The federal government could play an important role in helping to create and model rules around training.

We also need better gun-safety standards. Many children (and some adults) don’t know that when you take out the magazine from a semi-automatic pistol, the gun is still loaded, not realizing that there is a bullet left in the chamber and that if you pull the trigger you could kill somebody. This is the most common way that children are killed unintentionally with guns in this country. Even better than teaching every child or even having guns that make it apparent when they can still be fired, semi-automatic pistols can be made so the gun won’t fire when the magazine has been removed. We should also have childproof guns. Many 2- to 4-year-olds kill themselves when they find a loaded firearm. We made childproof aspirin bottles because children would find aspirin bottles and die from ingesting the aspirin, but we still make it too easy for toddlers to find guns and kill themselves.

I also think we need strict liability laws for gun owners. One of the reasons accidental pool drownings decreased in many parts of the world is because people who don’t properly fence and protect their pools became liable in the case of accidental injury, especially to children who gained access to the pool and drowned. The same should be true for something as dangerous as a gun. If you own TNT, or anything which is extremely dangerous, you have to be safe and responsible with it. Right now, that’s not the case for many guns, which are too commonly stored insecurely. Roughly 350,000 guns are stolen each year and end up in the wrong hands.

GAZETTE: Picking up on the issue of liability, Biden said during his press conference if he could do one thing it would be to eliminate immunity for gun manufacturers.

HEMENWAY: That’s certainly important. The reason the law was passed during the Bush administration was to protect the gun manufacturers and distributors who saw what had happened in the tobacco arena, and they didn’t want it to happen to them, so they got Republicans to pass a law giving them incredible immunity compared to other products. So yes, that would be a useful thing.

GAZETTE: Why do you think there is so little appetite in America, even after so many mass shootings, for any additional controls on the sale and use of guns?

HEMENWAY: I think it’s a combination of misinformation and the culture wars. I looked at Google news this morning, and the headline about the Biden initiatives was from Fox News: “Sen. Hawley: Biden ultimately seeks civilian gun confiscation while permitting rioters and crime.”

GAZETTE: What do you think of Biden’s pick to head the ATF, David Chipman?

HEMENWAY: I know David. I think he’s great. He’s very smart, very personable, hard-working, and quite experienced. He was an ATF agent for years ­— he’s certainly well-qualified. It would be good if he could strengthen the ATF’s oversight of gun dealers. The agency has been hamstrung through the years, and there seem to still be too many bad-apple gun dealers who make it too easy for the wrong people to gain access to firearms.

GAZETTE: Biden’s plan also calls for a new report on gun trafficking to be conducted by the Justice Department. In your mind, why is that data so important?

HEMENWAY: Reports are good, but perhaps even more important would be

Continue reading.

Written by LeisureGuy

13 April 2021 at 12:07 pm

How spanking may affect brain development in children

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I earlier blogged about studies that show that physically punishing children (by spanking, for example) adversely affect them, leading to social and emotional problems later on. Those studies demonstrated the cause and effect relationship but did not focus on the mechanism by which the result followed. Manisha Aggarwal-Schifellite has an article in the Harvard Gazette that describes the likely mechanism. The article begins:

Spanking may affect a child’s brain development in ways similar to more severe forms of violence, according to a new study led by Harvard researchers.

The research builds on existing studies that show heightened activity in certain regions of the brains of children who experience abuse in response to threat cues.

The group found that children who had been spanked had a greater neural response in multiple regions of the prefrontal cortex (PFC), including in regions that are part of the salience network. These areas of the brain respond to cues in the environment that tend to be consequential, such as a threat, and may affect decision-making and processing of situations.

“We know that children whose families use corporal punishment are more likely to develop anxiety, depression, behavior problems, and other mental health problems, but many people don’t think about spanking as a form of violence,” said Katie A. McLaughlin, John L. Loeb Associate Professor of the Social Sciences, director of the Stress & Development Lab in the Department of Psychology, and the senior researcher on the study, which was published Friday in the journal Child Development. “In this study, we wanted to examine whether there was an impact of spanking at a neurobiological level, in terms of how the brain is developing.”

According to the study’s authors, corporal punishment has been linked to the development of mental health issues, anxiety, depression, behavioral problems, and substance use disorders. And recent studies show that approximately half of parents in U.S. studies reported spanking their children in the past year and one-third in the past week. However, the relationship between spanking and brain activity had not previously been studied.

McLaughlin and her colleagues — including Jorge Cuartas, first author of the study and a doctoral candidate in the Harvard Graduate School of Education, and David Weissman, a postdoctoral fellow in the Stress & Development Lab — analyzed data from a large study of children between the ages of 3 and 11. They focused on 147 children around ages 10 and 11 who had been spanked, excluding children who had also experienced more severe forms of violence.

Each child lay in an MRI machine and watched a computer screen on which were displayed different images of actors making “fearful” and “neutral” faces. A scanner captured the child’s brain activity in response to each kind of face, and those images were analyzed to determine whether the faces sparked different patterns of brain activity in children who were spanked compared to those who were not.

“On average, across the entire sample, fearful faces elicited greater activation than neutral faces in many regions throughout the brain … and children who were spanked demonstrated greater activation in multiple regions of PFC to fearful relative to neutral faces than children who were never spanked,” the researchers wrote.

By contrast, “There were no regions of the brain where activation to fearful relative to neutral faces differed between children who were abused and children who were spanked.”

The findings are in line with similar research conducted on children who had experienced severe violence, suggesting that “while we might not conceptualize corporal punishment to be a form of violence, in terms of how a child’s brain responds, it’s not all that different than abuse,” said McLaughlin. “It’s more a difference of degree than of type.”

Researchers said the study is a first step toward . . .

Continue reading. There’s more (and no paywall).

And note these earlier posts on parenting in general: first, a better way to parent; second, avoiding having bossy, unhelpful kids; and third, best practices in parenting.

Written by LeisureGuy

13 April 2021 at 4:20 am

Hearing Aids for the Masses

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Full disclosure: I wear hearing aids, and they did cost several thousand dollars for the pair, but they also greatly improved my quality of life. My step-father, who worked around (loud) power tools most of his life had fairly severe hearing loss, and at the time hearing aids were fairly bulky and uncomfortable. When we were in a group conversing, he smiled a lot, and when my own hearing worsened, I noticed I was doing the same: if you can’t quite make out what people are saying, you tend to just smile and nod.

Shira Ovide in the NY Times discusses some developments that are promising. Emphasis added by me:

Today, let’s talk about relatively simple technology and a change in government policy that could unleash more innovation for Americans who have difficulty hearing.

I’ve been speaking with audiologists, consumer advocates and technology companies about what could be a revolution for our ears — hearing aids at a fraction of the cost and hassle of conventional devices.

Here’s how things stand now: Hearing loss is a pervasive and serious health problem, and many people are reluctant or can’t afford to get conventional hearing aids. Nearly 38 million American adults report some degree of hearing loss, but only a minority of people who could benefit from hearing aids have ever used them.

Hearing aids typically cost thousands of dollars, require multiple visits to specialists and often aren’t covered by health insurance. Untreated hearing loss is associated with cognitive decline, dementia and other harms. Overcoming barriers to hearing treatment may significantly improve Americans’ health.

The federal government is poised to help. Congress in 2017 passed legislation that would let anyone buy hearing aids approved by the Food and Drug Administration without a prescription from an audiologist. The F.D.A. has missed a deadline to release draft guidelines for this new category of over-the-counter hearing aids.

Experts told me that when the F.D.A. moves ahead, it’s likely to lead to new products and ideas to change hearing aids as we know them.

Imagine Apple, Bose or other consumer electronics companies making hearing aids more stylish and relatively affordable — with people having confidence that the devices had been vetted by the F.D.A. Bose told me that it’s working on over-the-counter hearing aid technology.

Barbara Kelley, executive director of the Hearing Loss Association of America, an advocacy organization, told me that she can’t wait for more affordable and accessible hearing help. “I’m really excited for the market to open up to see what we got and see how people are reacting,” she said.

It is already possible to buy a hearing helper — they can’t legally be called hearing aids — without a prescription. These devices, called personal sound amplification products or PSAPs, vary wildly in quality from excellent to junk. But when shopping for them, people often can’t tell the difference.

(The Wall Street Journal also recently wrote about hearing helper technologies, including earbuds that can amplify quiet sounds. And Consumer Reports has a useful guide to hearing aids and PSAPs.)

Nicholas Reed, director of audiology at the Johns Hopkins Cochlear Center for Hearing and Public Health, told me that the F.D.A. process should provide a path for the best PSAPs to be approved as official over-the-counter hearing aids. He expects new companies to hit the market, too.

You may doubt that a gadget you buy next to the toilet paper at CVS could be a serious medical device. Dr. Reed’s research, however, has found that some hearing helpers for $350 or less were almost as good as prescription hearing aids for people with mild-to-moderate hearing loss.

Dr. Reed described the best lower-cost devices as the Hyundai of hearing help. (This was a compliment.) They aren’t flashy, but they will get many people safely and effectively where they need to go. He also imagines that the F.D.A. rules will create the conditions for many more people to buy hearing aids — both over the counter and by prescription.

Over-the-counter hearing aids won’t be able to help everyone, experts told me. And the traditional hearing aid industry has said that people are best served by customized devices with expert help.

There is also more technology brewing at  . . .

Continue reading.

Written by LeisureGuy

12 April 2021 at 4:13 pm

Toilets – what will it take to fix them?

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Josie Glausiusz has an interesting book review in Nature:

Pipe Dreams: The Urgent Global Quest to Transform the Toilet Chelsea Wald Avid Reader/Simon & Schuster (2021)

Waste: One Woman’s Fight Against America’s Dirty Secret Catherine Coleman Flowers The New Press (2020)

Since the sixth century BC, when the Romans began building their Cloaca Maxima (“Greatest Sewer”), a safe sewage system has epitomized civilization. More than two millennia later, one Victorian novelist called a good sewer “nobler” and “holier” than the most admired Madonna ever painted. For sound reasons: the construction of a massive London sewer network in the 1860s ended waterborne epidemics of cholera that had killed tens of thousands of people. In 2007, more than 11,300 readers of The BMJ chose the sanitary revolution — the introduction of clean water and sewage disposal — as the most important medical milestone since 1840.

The need for innovative toilets is enormous. In 2017, two billion people lacked a minimally adequate toilet, and 673 million people still had to defecate in the open. Poor sanitation is linked to the transmission of diseases including cholera, typhoid, polio, hepatitis A and trachoma. Access to clean water and sanitation for all by 2030 is one of the United Nations’ Sustainable Development Goals (SDGs), but the cost of achieving this is tens of billions of dollars per year, as two new books explore: Pipe Dreams, by Chelsea Wald; and Waste, by Catherine Coleman Flowers.

Today, “toilets no longer look quite so miraculous as they once did”, writes Wald in her deeply researched, entertaining and impassioned exploration of sanitation ancient and innovative. As cities grow, their aged sewage infrastructures become overwhelmed, especially during storms. Once-noble conduits are now frequently clogged by fatbergs, vast accretions of grease and wet wipes with the consistency of concrete and the weight of several elephants.

“Modern sanitation infrastructure has created the illusion that our excreta just disappear like magic,” Wald writes. “But poop doesn’t just drive down the highway into the sunset.” Often, it remains untreated, poisoning people and ecosystems. A new generation of toilets is needed, she argues: one that squanders less water, nutrients and energy. And so Wald travels from Alaska to Indonesia and many places in-between, interviewing scientists, public-health officials and toilet entrepreneurs.

Many countries are edging their way towards the SDGs by implementing inventive sanitation projects at minimal expense. In the town of Sneek in the Netherlands, Wald visits a company called DeSaH, which has put vacuum toilets into more than 200 apartments, whooshing away waste and treating it in a small local facility. Each toilet uses 1 litre of water per flush, compared with the usual eight. Vacuum systems are in use at sites in wealthy nations including the Netherlands and Sweden, and at Bloomberg’s European headquarters in London. But scaling up this water-saving technology on a global scale is challenging, Wald notes, given financial and other hurdles.

In Kenya, a social enterprise named Sanivation collects human faeces, treats it and presses it into “poop briquettes” for fuel, Wald writes. The company has sold 1,500 tonnes of the small spheres so far, saving 88 trees for every tonne. In Indonesia, where there are few sewers, Wald shadows “sanitation entrepreneur” Koen Irianto Uripan, who put thousands of fibreglass septic tanks in the yards of homes in the city of Surabaya. With jokes and a papier-mâché poop prop, Uripan markets a cheap, easily installed indoor toilet connected to one of these tanks, in which bacteria break down waste. The work is part of a much larger, countrywide campaign to reduce the number of people who have to defecate in the open.

Our universal disgust over excretion inspires both humour and anxiety. The ancient Babylonians recognized a privy demon called Šulak that could trigger bad luck, injury or illness. In the Jewish tradition, rabbis composed blessings for angels who accompanied a person to the “house of the chair” and waited outside, and a blessing is recited on exiting the lavatory.

But fear is all too real for those without secure and hygienic toilets. Women who must share with strangers, or go outdoors, are at greatly increased risk of being raped, studies in South Africa and India have shown1,2. Toilets with doors that lock from the inside, and have shelves for clean menstrual products, can help women and girls — cisgender and transgender — to feel safe and dignified; and those still at school will be less likely to skip classes. In Durban, South Africa, among other places, city planners have refitted shipping containers for the purpose. . .

Continue reading. There’s more.≠

Written by LeisureGuy

12 April 2021 at 4:02 pm

Suicide and impulse

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Suicide can be a considered choice — for example, an elderly person in the grasp of a painful and incurable terminal illness might decide to end his life early rather than suffer — or it can be a passing impulse — for example, a person with clinical depression who encounters a temporary setback and impulsively makes a suicide attempt.

In the US the most common suicide method is with a firearm. Consider this chart (source):

If a person has a suicidal impulse and has easy access to a firearm (not unusual in the US), the firearm is likely to be used in an attempt at suicide, and the outcome is almost always fatal. Indeed, in looking at gun deaths in the US, suicide outnumbers homicide (source):

In discussing deaths due to gun violence, some object to including suicides in the total because (they believe) “if a person’s going to commit suicide, they’ll find a way to do it, with or without a gun.” That belief is false for as impulsive suicide, and impulsive suicide is much more common than considered suicide.

If a person experiencing a suicidal impulse picks a method that requires several steps and involves time and effort, the impulse is likely to dissipate before the attempt is made, and if the method is not instantly fatal so that recovery is possible (as in taking an overdose of medicine), the person may possibly be saved and not reattempt suicide.

Years ago I read an account by a man who, walking across the Golden Gate bridge and feeling depressed about his current situation (as I recall, he had just lost his job), decided to kill himself by jumping off the bridge. He was, as he later wrote, fully committed, but he wanted to face the city lights when he jumped, and he was on the side of the bridge away from the city, so that he would be facing only darkness.

He could not cross immediately to the other side because of traffic and traffic barriers, so he decided to walk to the end of the bridge, cross there, and return to jump, facing the city. By the time he reached the end of the bridge, however, the impulse had dissipated, and he simply continued on his way home (which is why we know the story). The impulse never returned.

The Harvard School of Public Health has an article that speaks to this:

Nine out of ten people who attempt suicide and survive will not go on to die by suicide at a later date. This has been well-established in the suicidology literature. A literature review (Owens 2002) summarized 90 studies that have followed over time people who have made suicide attempts that resulted in medical care. Approximately 7% (range: 5-11%) of attempters eventually died by suicide, approximately 23% reattempted nonfatally, and 70% had no further attempts.

Even studies that focused on medically serious attempts–such as people who jumped in front of a train (O’Donnell 1994)–and studies that followed attempters for many decades found similarly low suicide completion rates. At least one study, published after the 90-study review, found a slightly higher completion rate. This was a 37-year follow-up of self-poisoners in Finland that found an eventual completion rate of 13% (Suominen 2004).

This relatively good long-term survival rate is consistent with the observation that suicidal crises are often short-lived, even if there may be underylying, more chronic risk factors present that give rise to these crises.

The relationship between suicide attempts and completions is a complex one.

  • Most people who die by suicide in the U.S. did not make a previous attempt. Prevention efforts that focus only on those who attempt suicide will miss the majority of completers. An international review of psychological autopsy studies found that approximately 40% of those dying by suicide had previously attempted (Cavanagh 2003). The proportion was lower (25-33%) among studies of youth suicide in the U.S. (Brent 1993, Shaffer 1996). A history of previous attempts is lower among those dying by firearm suicide and higher among those dying by overdose (NVISS data).
  • Most people who attempt suicide will not go on to complete suicide. [Though if a gun is used, the suicide attempt almost always results in death. – LG]
  • Still, history of suicide attempt is one of the strongest risk factors for suicide. 5% to 11% of hospital-treated attempters do go on to complete suicide, a far higher proportion than among the general public where annual suicide rates are about 1 in 10,000.

Footnotes and sources are found at the link. The big problem with guns is that a suicide attempt using a gun is almost always successful.

This came to mind this morning as I read a New Yorker article by D.T. Max, which includes this passage:

Suicide is often a response to extreme personal struggles, but the immediate catalyst can be little more than a bad grade on a test or a weekend when a student’s friends have gone out of town. A widely cited 1978 study of some five hundred people who were stopped from jumping off the Golden Gate Bridge suggests how impulsive the urge to kill oneself can be: only about five per cent of the subjects later died by suicide [that is, 95% did not later commit suicide – LG]. (Studies such as this helped lead to the now ubiquitous signs on bridges with the National Suicide Prevention Lifeline number: 1-800-273-8255.)

In the past two decades, the suicide rate in the United States has risen by some thirty-five per cent, and the problem is especially acute among the young. According to the Centers for Disease Control and Prevention, by 2018 suicide had become the second most common cause of death among Americans between the ages of ten and twenty-four, exceeded only by accidental death. Experts describe as precipitating factors everything from mounting economic pressures to the broadcasting of distress on social media. At the University of Pennsylvania, more than a dozen students have died by suicide since 2013, and in late 2019 the director of the school’s mental-health services jumped from the seventeenth floor of a building. A 2018 study by researchers affiliated with Harvard University found that one in five American college students had had suicidal thoughts the previous year. Will Newman, a professor of forensic psychiatry at Saint Louis University, told me, “The percentage of freshmen seeking mental-health services is on a steady incline, and universities have to quickly adjust to keep up.” Meanwhile, the covid-19 pandemic has deepened the isolation of many Americans. More than ten per cent of respondents to a C.D.C. survey last June said that in the previous month they had seriously considered killing themselves.

Written by LeisureGuy

12 April 2021 at 3:08 pm

Americans are still spanking their kids. A new study shows how harmful that is.

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I have long maintained that parents should not strike their children, and now research backs up that idea. Caitlin Gibson reports in the Washington Post:

When developmental psychologist Liz Gershoff began studying the effects of spanking and harsh parenting discipline in the 1990s, the topic was still the subject of intense debate in scientific circles: Was physical punishment actually harmful to kids?

In the decades since, a growing body of research has offered a clear and resounding answer. Spanking and other forms of severe discipline — such as verbally berating or humiliating a child — have been repeatedly linked to behavioral, emotional, psychological and academic problems, a conclusion that prompted the American Academy of Pediatrics to issue a new policy statement in 2018, strengthening its stance that parents should not use physical punishment.

But spanking is still prevalent in American families, and legal in all states. Though it appears to be steadily falling out of favor among younger generations, the 2018 General Social Survey — a long-running biennial national survey of American adults — found that 66 percent of Americans agreed that “a good, hard spanking” is sometimes necessary to discipline a child.

Why you just can’t choose: Parenting through pandemic decision fatigue

And one common argument in support of spanking has lingered: How can we be sure that a child’s lack of achievement or antisocial behavior can be traced back to physical punishment specifically, versus an innate or genetic factor?

Gershoff, a professor of human development and family sciences at the University of Texas at Austin, set out to settle the question of nature vs. nurture with her newest study, published in the March volume of Psychological Science. Gershoff and her research team analyzed more than a thousand pairs of twins — including more than 400 identical twins, who share the same DNA — many of whom were disciplined differently by their parents. The researchers found that the child who was hit or yelled at more often was consistently more likely to display delinquent or antisocial behavior.

“Identical-twin studies are sort of the classic way that psychologists have of differentiating what is innate behavior from what is learned behavior, so this study follows in a long tradition,” says Robert Sege, a pediatrician at Tufts Children’s Hospital and director of the Center for Community-Engaged Medicine at Tufts Medical Center who co-authored the American Academy of Pediatrics’s 2018 statement. “This is yet another, different way of looking at this, but all the data points to the same direction. As a scientist, when you see that, no matter how you do the experiment, no matter how you ask the question, you get the same result — that’s conclusive.”

Gershoff spoke with The Washington Post about her decades of research into physical discipline in parenting, and the implications of her newest study. The conversation has been edited for length and clarity.

Q: You’ve been studying the effects of spanking for a long time. How has the scientific understanding of this issue changed over your career?

A: When I began studying physical punishment, there was a lot of resistance to the idea that it might be harmful. I went into this with an open mind, thinking, ‘Well, maybe parents are right, maybe it does work, maybe that’s what the research shows.’ By then we had several-hundred studies that had been looking at it, but no one had taken an overview to say, ‘What did we find overall?’ So that’s what I did in 2002. There have been many, many more studies since then, and they have all continued to show that the more children are physically punished, the worse their behavior, the worse their mental health. Now we also have research showing they do worse in school, they have lower achievement.

Q: It seems like those conclusions are generally accepted among scientists and pediatricians, but what have you observed about our social and cultural perceptions of spanking?

A: It used to be that we only learned how to parent from our own parents, that was it, and maybe a couple friends. I think in the last 20 years we’ve seen more parents have access to parenting information from parenting books, from the Internet. Now we can talk to people across the world and find out how they’re parenting, what works for them. There has been more public discussion about physical punishment that we hadn’t really seen before — you started seeing figures like Oprah talk openly about how she was physically punished, and how harmful she thought that was. That was a big deal.

But there are still many parents who are under the impression that you have to hit children in some circumstances. That pattern cuts across cultural groups and racial groups and different areas of the country. So yes, there are still some parents to convince.

Q: Tell me about your new study, and why you focused on twins specifically. .. .

Continue reading. There’s much more. Later in the interview:

. . . parents see twins as individuals, they’re not parenting them as a set. And that much is good, but it’s just too bad that one kid is getting singled out for the harsh parenting. We didn’t ask them about the circumstances, so we don’t know why. But what we found was that the twin who was spanked more or yelled at more within each pair, they were the ones who had more antisocial behavior. It was the same for the kids who were identical twins and for kids who were not identical twins. The amount of genetic material they shared didn’t matter. It came down to how much harsh parenting they received.

And the interview concludes:

Q: Do you think this study settled that question then, of whether a child’s innate characteristics might be to blame for their behavior, rather than harsh discipline?

A: We are pretty convinced that this is definitive. There is just absolutely no evidence for a genetic component.

Q: You mentioned earlier that there are still clearly some parents left to convince. In light of these results, what would you most want those parents to know?

A: To me, it’s just further evidence that the way we parent our children really does impact them. And if parents are on the fence about physical punishment, this is just additional evidence that it’s not doing any good for the children, and in fact it seems to be making their behavior worse. And that in turn makes our jobs harder as parents — that’s the irony. People are trying to improve their children’s behavior when they’re using physical punishment, but they’re in fact making it worse.

See also the book Hunt, Gather, Parent: What Ancient Cultures Can Teach Us About the Lost Art of Raising Happy, Helpful Little Human.

Written by LeisureGuy

12 April 2021 at 11:17 am

Vaccine Refusal Will Come at a Cost—For All of Us

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Edward Isaac-Dovere writes in the Atlantic:

Imagine it’s 2026. A man shows up in an emergency room, wheezing. He’s got pneumonia, and it’s hitting him hard. He tells one of the doctors that he had COVID-19 a few years earlier, in late 2021. He had refused to get vaccinated, and ended up contracting the coronavirus months after most people got their shots. Why did he refuse? Something about politics, or pushing back on government control, or a post he saw on Facebook. He doesn’t really remember. His lungs do, though: By the end of the day, he’s on a ventilator.

You’ll pay for that man’s decisions. So will I. We all will—in insurance premiums, if he has a plan with your provider, or in tax dollars, if the emergency room he goes to is in a public hospital. The vaccine refusers could cost us billions. Maybe more, over the next few decades, with all the complications they could develop. And we can’t do anything about it except hope that more people get their shots than those who say they will right now.

If the 30 percent of Americans who are telling pollsters they won’t get vaccinated follow through, the costs of their decisions will pile up. The economy could take longer to get back to full speed, and once it does, it could get shut down again by outbreaks. Variants will continue to spread, and more people will die. Each COVID-19 case requires weeks of costly rehabilitation. Even after the pandemic fades, millions of vaccine refusers could turn into hundreds of thousands of patients who need extra care, should they come down with the disease. Their bet that they’ve outsmarted the coronavirus or their insistence that Anthony Fauci and Bill Gates were trying to trick them will not stop them from going to the doctor when they’re having trouble breathing, dealing with extreme fatigue, or struggling with other lasting effects of COVID-19. (A new study found that 34 percent of COVID-19 survivors are diagnosed with a neurological or psychological condition within six months of recovering from the initial illness.)

The economic costs of vaccine refusal aren’t yet a major part of the political conversation. That’s likely to change as we move past the first year of the pandemic. “You have a liberty right, and that unfortunately is imposing on everyone else and their liberty right not to have to pay for your stubbornness. And that’s what’s maddening,” Jay Inslee, the governor of Washington, told me. Inslee is 70, and fully vaccinated. The three-term Democrat was in a good mood because he was on his way to see his baby granddaughter, whom he hadn’t hugged in a year. But after what he’s gone through since early 2020—the first American COVID-19 outbreak and the first explosion of COVID-denialist demonstrations were both in Washington—he’s angry and sad that so many people are refusing to get their shots.

He had the latest numbers: 15 Washingtonians had died of COVID-19 the day we spoke. More than 300,000 state residents who had been eligible for a vaccine for at least three months still hadn’t gotten one, including 27 percent of those over 65. Some of those people hadn’t been able to get appointments. Some may have been nervous, but would eventually get a vaccine. Some had just refused, and will continue to do so. Those people are “foisting [their] costs on the rest of the community,” Inslee said. “There’s a long, long economic tail of disease prevalence as a result of people who refuse to get vaccinated.” But, he stressed, “it pales in comparison to people losing their lives.”

Inslee read me some data he had gotten from the Republican messaging maven Frank Luntz, which the governor said was going to inform new public-awareness campaigns that the state is developing to break through to Republican men, the people most likely to say they won’t get vaccinated, according to polling. Two appeals seem to work best: First, the vaccines are safe, and they’re more effective than the flu vaccine. Second, you deserve this, and getting vaccinated will help preserve your liberty and encourage the government to lift restrictions. (That last idea is what Jerry Falwell Jr. focused on in the vaccination selfie he posted this week, captioned, “Please get vaccinated so our nutcase of a governor will have less reasons for mindless restrictions!”) Inslee hopes that emphasizing those points will persuade more Republican men to get their shots. But he’s not sure it will work.

The prospect of lower health-care costs has led conservatives to back health-related regulations in the past. In 1991, Pete Wilson, then the Republican governor of California, signed a law mandating helmets for motorcyclists, and made a conservative argument for the new regulation. “We don’t know exactly how much money and how many lives will be saved with this legislation,” Wilson said at the signing ceremony, which was held at a hospital in the state capital. “But we do know that the cost of not enacting it is too great for a civilized society to bear.” Then again, President Ronald Reagan was famously resistant to seatbelt and airbag laws, which also reduce health-care spending.

Though there are some notable vaccination holdouts among Republican officials, most in Congress and in state leadership positions have encouraged their constituents to get the shots. “I saw on some program last week that Republican men, curiously enough, might be reluctant to take the vaccine. I’m a Republican man, and I want to say to everyone: We need to take this vaccine,” Senate Minority Leader Mitch McConnell said at an event in Kentucky this week. Brad Wenstrup, who worked as a podiatrist before becoming a Republican congressman from Ohio, has been so eagerly promoting the vaccines that he got trained to administer them. But the Republican politics around COVID-19 remain treacherous, and when I reached out to several Republican members of Congress, telling their aides I’d be eager to have them make a Wilson-esque fiscally conservative argument for vaccination, I couldn’t find anyone willing to make that case to me.

Calculating the exact long-term costs is tricky; we have only a year’s worth of data on the lasting health consequences of COVID-19, and even less on the efficacy of the vaccines and Americans’ resistance to getting them. Krutika Amin, who conducts economic and policy research for the Kaiser Family Foundation, tried to sketch out what the taxpayer bill might be. Before the pandemic, about . . .

Continue reading. There’s more.

Written by LeisureGuy

11 April 2021 at 11:17 am

How to make friends as an adult

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I found this article by Marisa G Franco interesting (and useful):

Need to know

Friends are a treasure. In an uncertain world, they provide a comforting sense of stability and connection. We laugh together and cry together, sharing our good times and supporting each other through the bad. Yet a defining feature of friendship is that it’s voluntary. We’re not wedded together by law, or through blood, or via monthly payments into our bank accounts. It is a relationship of great freedom, one that we retain only because we want to.

But the downside of all this freedom, this lack of formal commitment, is that friendship often falls by the wayside. Our adult lives can become a monsoon of obligations, from children, to partners, to ailing parents, to work hours that trespass on our free time. A study of young adults’ social networks by researchers at the University of Oxford found that those in a romantic relationship had, on average, two fewer close social ties, including friends. Those with kids had lost out even more. Friendships crumble, not because of any deliberate decision to let them go, but because we have other priorities, ones that aren’t quite as voluntary. The title of the Oxford paper summed up things well: ‘Romance and Reproduction Are Socially Costly’.

Such is the pace and busyness of many people’s adult lives that they can lose contact with their friends at a rapid rate. For instance, a study by the Dutch sociologist Gerald Mollenhorst found that, over a period of seven years, people had lost touch with half of their closest friends, on average. What’s especially alarming is that many of us seem to be losing friends faster than we can replace them. A meta-analysis by researchers in Germany published in 2013 combined data from 177,635 participants across 277 studies, concluding that friendship networks had been shrinking for the preceding 35 years. For example, in studies conducted between 1980 and 1985, participants reportedly had four more friends on average, compared with the participants who’d taken part in studies between 2000 and 2005.

If we’re not careful, we risk living out our adulthoods friendless. This is a situation that’s worth avoiding. Friends are not only a great source of fun and meaning in life, but studies suggest that, without them, we’re also at greater risk of feeling more depressed. It’s telling that in their study ‘Very Happy People’ (2002), the American psychologists Ed Diener and Martin Seligman found that a key difference between the most unhappy and most happy people was how socially connected they were. Friends give us so much, which is why we need to invest in making them. Here’s how.

What to do

Making more friends in adulthood is going to take some deliberate effort on your part. It’s an exciting challenge in theory, but one of the first obstacles you’ll encounter is having enough confidence. Especially if you are shy by nature, putting yourself out there can seem scary, triggering fears of rejection. These fears might lead you to engage in two types of avoidance that will inhibit your ability to make friends. First, you might practise ‘overt avoidance’, by not putting yourself in situations where it’s possible to meet new people. Instead of going to your friend’s movie night, with the chance to meet others, you end up staying at home. Second, you might find yourself engaging in ‘covert avoidance’, which means that you show up but don’t engage with people when you arrive. You go to the movie night, but while everyone else is analysing the film after it’s over, you stay silent in the corner, petting someone’s pet corgi and scrolling through Instagram.

Assume that people like you

Both these forms of avoidance are caused by understandable fears of rejection. So imagine how much easier it would be if you knew that, were you to show up in a group of strangers, most of them would love you and find you interesting. This mindset actually has a self-fulfilling quality – an American study from the 1980s found that volunteers who were led to believe that an interaction partner liked them began to act in ways that made this belief more likely to come true – they shared more about themselves, disagreed less, and had a more positive attitude. This suggests that if you go into social situations with a positive mindset, assuming people like you, then it’s more likely that this will actually turn out to be the case.

Of course, you might still be reluctant to assume others like you because you don’t believe it’s true. If this is you, you might take comfort from research that found, on average, that strangers like us more than we realise. The paper, by Erica J Boothby at Cornell University and colleagues, involved having pairs of strangers chat together for five minutes, to rate how much they liked their interaction partner, and to estimate how much their partner liked them. Across a variety of settings and study durations – in the lab, in a college dorm, at a professional development workshop – the same pattern emerged. People underestimated how much they were liked, a phenomenon that Boothby and her colleagues labelled ‘the liking gap’.

What wisdom should we take from this research? It can remind us to go into new social events assuming that people will like us. It can keep us from being paralysed by fears of rejection, pushing us to question some of these fears. Try working on your internal dialogue, your inner voice that perhaps makes overly negative assumptions about how people will respond to you. Doing this will help give you the confidence to go out there and start initiating friendly contact with strangers.

Initiate

In We Should Get Together: The Secret to Cultivating Better Friendships (2020), Kat Vellos describes being inspired to write her book after a moment of feeling utterly alone. She was looking for a friend to hang out with, so she posted on Facebook: ‘Who wants to go eat French fries and talk about life with me?’ Everyone who responded lived in another state; her local San Francisco Bay Area friends were all booked up. As she put it:

I didn’t just want to eat snacks and talk about life. I was craving a different kind of life – one that would give me abundant access to friends who wanted to see me as much as I wanted to see them.

This experience made Vellos realise that she needed more friends, so she created and executed a plan to make some. Eventually, she was running two successful meetup groups, and had established friendships with people she liked and wanted to get closer to. How did she change her life? She initiated. Vellos set aside time to reach out to people regularly, to revitalise old relationships and to awaken new ones, to check in, to find time to hang out. Her story reveals how initiative can change the course of our friendships.

To embrace the importance of initiating, you must to let go of the myth that friendship happens organically. You have to take responsibility rather than waiting passively. Science backs this up. Consider a study of older adults in the Canadian province of Manitoba. The participants who thought friendship was something that just happened based on luck tended to be less socially active and to feel lonelier when the researchers caught up with them five years later. By contrast, those who thought friendship took effort actually made more effort – for example, by showing up at church or at community groups – and this paid dividends, in that they felt less lonely at the five-year follow-up.

But it’s not just showing up that matters, it’s saying ‘hello’ when you get there. This means introducing yourself to other people, asking them for their phone numbers, following up and asking them to hang out. Initiating is a process, one that we must do over and over again to make new friendships.

Initiation is particularly important for people who find themselves in new social settings – such as people who have moved to a new city, started a new school or job. In a study of first-year undergraduates at the University of Denver in 1980, it was those students who rated themselves as having superior social skills who managed to develop more satisfying social relationships. Moreover, in the Fall, when everyone was new, it was specifically ‘initiation skill’ that was most important. Once friendships were more stable, it didn’t matter as much.

Although we might fear that other people will turn us down if we initiate with them, the research finds that this is a lot less likely than we might think. When the American psychologists Nicholas Epley and Juliana Schroeder asked research participants to open up conversations with their fellow train commuters, can you guess how many of them were shot down? None! Epley and Schroder concluded that: ‘Commuters appeared to think that talking to a stranger posed a meaningful risk of social rejection. As far as we can tell, it posed no risk at all.’

Keep showing up

Once you’ve initiated some new contacts, the challenge . . .

Continue reading. There’s much more. And the article ends with links to more resources.

Friendship is important for one’s mental health and sense of well-being, so developing friendships is worth doing.

Written by LeisureGuy

10 April 2021 at 1:00 pm

How an Abstinence Pledge in the ’90s Shamed a Generation of Evangelicals

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Clyde Haberman reports in the NY Times:

To the uninitiated, Christianity’s evangelical movement can seem like a monolith that brooks no dissent on certain core issues: Same-sex relationships are sinful, men’s spiritual dominance over women is divinely ordained and, on the political front, Donald J. Trump was an improbable but nonetheless valued protector of the faith.

Not everything is what it appears to be. The movement is in fact rife with division, a reality reinforced last month when Beth Moore, an evangelical writer and teacher with a huge following, formally ended her long affiliation with the Southern Baptist Convention, principally because of its tight embrace of the licentious, truth-challenged Mr. Trump.

It was a rupture several years in the making. As Ms. Moore told Religion News Service, disenchantment took hold when Mr. Trump became “the banner, the poster child for the great white hope of evangelicalism, the salvation of the church in America.” But the former president’s behavior is not the only issue buffeting the evangelical movement. White supremacy, male subjugation of women, a spate of sexual abuse cases, scandals involving prominent figures like Jerry Falwell Jr. — all have combined to undermine the authority of religious leaders and prompt members like Ms. Moore to abandon the Southern Baptist Convention.

Retro Report, which examines through video how the past shapes the present, turns attention to an artifact of religious conservatism from the movement. This is the so-called purity pledge, taken in the main by teenagers who pledged to abstain from sex until they married. Some swore to not so much as kiss another person or even go on a date, for fear of putting themselves on the road to moral failure.

Devotion to this concept took hold in the early ’90s, when fear of AIDS and other sexually transmitted diseases bolstered the evangelical movement’s gospel of teen abstinence. It was a view put forth as God-commanded and had the support of like-minded political leaders, from the White House of Ronald Reagan to that of Mr. Trump.

Many people certainly found lifelong contentment because of having waited for the right mate. But for others, as the Retro Report video shows, the dictates of the purity movement were so emotionally onerous that their adulthoods have been filled with apprehension and, in some instances, physical pain. They are people like Linda Kay Klein, who embraced the movement in her teens but left it in disenchantment at 21, two decades ago.

She described the trauma and the shame she felt this way: “I would find myself in tears and in a ball in the corner of a bed, crying, my eczema coming out, which it does when I’m stressed, and scratching myself till I bled, and having a deep shame reaction.” Ms. Klein found she was far from alone. She collected tales of enduring anxiety in a book, “Pure: Inside the Evangelical Movement That Shamed a Generation of Young Women and How I Broke Free” (Touchstone, 2018). “We went to war with ourselves, our own bodies and our own sexual natures,” she wrote, “all under the strict commandment of the church.”

It was under the aegis of the Southern Baptist Convention that the vow of virginity took distinct form, in True Love Waits, a program begun in 1993. As the movement grew in the ’90s, estimates of teenage adherents reached as high as 2.5 million worldwide. Youngsters wore purity rings, signed purity pledge cards and attended purity balls, with girls dressed in white and escorted by their fathers.

The fundamental message, inspired by a verse from Paul the Apostle’s First Epistle to the Thessalonians, was this: “I am making a commitment to myself, my family and my Creator that I will abstain from sexual activity of any kind before marriage. I will keep my body and my thoughts pure as I trust in God’s perfect plan for my life.”

Separate from religious imperatives, American teenagers in general have become warier of premarital relations — and certainly of unprotected sex. According to the federal government, there were 61.8 births in 1991 for every 1,000 young women in the 15-to-19 age group. By 2018, that figure had dwindled to 17.4, a decline that cut across racial and ethnic lines.

Among those who regarded purity in terms of spiritual enlightenment, few in the ’90s came to be more celebrated than Joshua Harris, a young man who preached that even sex-free dating was a dangerous first step on the slippery slope of a compromised life. His 1997 book “I Kissed Dating Goodbye” sold roughly a million copies. In his writings and speeches, Mr. Harris advocated courtship under the watchful eyes of a couple’s parents.

His message back then, he recalled for Retro Report, was that one should avoid conventional dating just as an alcoholic ought to steer clear of a bar. “It was, like, if you don’t want to have sex,” he said, “then don’t get into these sorts of short-term romantic relationships where there is an expectation to become intimate.”

Controlling teenage hormones, however, is easier said than done. Mr. Harris, who lives in Vancouver, eventually pulled his book from circulation, and has apologized for the role he played in causing anyone feelings of shame, fear and guilt. Today, he no longer considers himself a Christian.

Part of the problem for some critics of the movement is . . .

Continue reading.

Written by LeisureGuy

8 April 2021 at 7:49 pm

Heart Stents and Upcoding: How Cardiologists Game the System

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Written by LeisureGuy

7 April 2021 at 12:48 pm

Why tearing down Fauci is essential to the MAGA myth

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Michael Gerson was a speechwriter for George W. Bush and is currently a columnist. Here’s a recent column that appeared in the Washington Post that reflects the despair of traditional Republicans (among whom he counts himself) in the face of MAGA madness:

MAGA political philosophy is not systematic, but it is comprehensive. Right-wing populism offers a distorted lens to view nearly all of life.

Through this warped lens, progress toward equal rights is actually the oppression of White people. Free and fair elections, when lost, are actually conspiratorial plots by the ruthless left. But perhaps the most remarkable distortion concerns the MAGA view of covid-19.

We have all seen the basic outlines of pandemic reality. Experts in epidemiology warned that the disease would spread through contact or droplets at short distances, which is how it spread. The experts recommended early lockdowns to keep health systems from being overwhelmed, and the lockdowns generally worked. The experts said Americans could influence the spread of the disease by taking basic measures such as mask-wearing and social distancing. The disease was controlled when people did these things. The disease ran rampant when they did not, killing a lot of old and vulnerable people in the process.

There were, of course, disagreements along the way about the length of lockdowns and the form of mandates. But on the whole, American citizens have witnessed one of the most dramatic vindications of scientific expertise in our history. We have been healthier when we listened to the experts and sicker when we did not.

This is the context in which the MAGA right has chosen to make Anthony S. Fauci — the director of the National Institute of Allergy and Infectious Diseases since 1984 — the villain in their hallucinogenic version of pandemic history.

It is worth disclosing when a columnist has a personal connection to a public figure. I have known Fauci since I was in government during the early 2000s and watched him help create the President’s Emergency Plan for AIDS Relief. He is the best of public service: supremely knowledgeable, personally compassionate, completely nonpolitical, tenacious in the pursuit of scientific advancement and resolute in applying such knowledge to human betterment. He has no other ambition or agenda than the health of the country and world.

Yet slamming Fauci was a surefire applause line at the Conservative Political Action Conference in February. Former Trump administration officials continue to target him. Republican members of Congress vie with one another to put Fauci in his place.

For Trump officials, including Donald Trump himself, this makes perfect sense. If Fauci has been right about covid, then playing down the disease, mocking masks, modeling superspreader events, denying death tolls, encouraging anti-mandate militias and recommending quack cures were not particularly helpful. If Fauci has been right, they presided over a deadly debacle.

When former Trump trade adviser Peter Navarro claims that Fauci is “the father of the actual virus” or former chief of staff Mark Meadows complains about Fauci’s indifference to the (nearly nonexistent) flow of covid across the southern border, the goal is not really to press arguments. It is to create an alternative MAGA reality in which followers are free from the stress of truth — a safe space in which more than half a million people did not die and their leader was not a vicious, incompetent, delusional threat to the health of the nation.

Metaphorically (but only barely metaphorically), there is a body on the floor with multiple stab wounds. The Trump administration stands beside it with a bloody knife in its hand. It not only claims to be innocent. It claims there is no blood. There is no body. There is no floor.

Congressional Republicans who criticize Fauci to prove their populist manhood are even more pathetic. Their self-abasement is voluntary. Watching Sen. Rand Paul (R-Ky.) debate science with Fauci during committee hearings is like watching Albert Einstein being disputed by his dry cleaner. Fauci is often reduced to making obvious points in a patient voice. Fauci deserves his Presidential Medal of Freedom just for his heroic forbearance.

All these critics of Fauci have chosen to attack the citadel of science at its strongest point. With squirt guns. While naked and blowing kazoos.

This useless exertion is somehow wrapped in the language of freedom. Freedom from the servitude of a piece of cloth on your face that might save your neighbor’s life. Freedom to light off fireworks below a potential avalanche. . .

Continue reading. The column concludes:

Fauci is practicing epidemiology. His critics are practicing idiocy. Both are very good at their chosen work.

Written by LeisureGuy

6 April 2021 at 12:11 pm

The health-care industry doesn’t want to talk about this single word

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A clear example of the extent of systemic racism in the United States is offered in a Washington Post column by Ron Wyatt, co-chairof the Institute for Healthcare Improvement’s equity advisory group and faculty for the IHI Pursuing Equity Initiative. Wyatt was the first Black chief medical resident at the Saint Louis University School of Medicine. He writes:

When I write about health policy or speak with medical colleagues about barriers to care, there is one word — and one word only — that evokes a wide range of responses. Some respond with silence; others with avoidance. Some respond with anger and defensiveness.

The word appeared at the top of a paper I submitted to the Journal of the American Medical Association in 2015 with David R. Williams, a professor of public health and African American studies at Harvard University. The title: “Racism in Health and Healthcare: Challenges and Opportunities.”

The editor of the journal at that time, Howard Bauchner, advised us that the word could not be published and that “racial bias” would be substituted into the title before publication. Using “racism,” he said, would result in “losing readers.” As authors and scientists, we compromised. We agreed to the change, and the article was published.

Just a few weeks ago, six years after that decision to compromise, Bauchner and I spoke by phone. He apologized, saying that progress has been made since then.

Has progress been made? JAMA recently announced that following controversial comments on racism in medicine made by a deputy editor, Bauchner was placed on administrative leave on March 25 while an independent investigation is completed.

Entrenched systemic racism — and the deliberate omission of the word in patient safety circles — is the cause of an astonishing level of preventable harm and death among communities of color that have been devalued and discounted for more than 400 years.

The covid-19 pandemic has laid bare the racial inequities of the U.S. health-care system. Too many health-care executives still perpetuate the ahistoric perspective that our country’s model provides safe and equal care for all. Yet the disproportionate number of deaths to covid-19 among racial and ethnic minority groups exposes the systemic and lethal barriers to care.

Last month, a major health-care trade magazine accepted another article that I contributed to with three colleagues, once again with “racism” in the title. When our editor sent us the final authors’ agreement, we noticed the word had been removed from the title and replaced with “intolerance.” This time, we were not willing to compromise. Our editor later informed us that the article would not be published in the May/June issue as scheduled. We were not given a reason.

I have worked all over the United States and internationally as a champion of addressing health inequity. I can say without hesitation — both as a doctor and a citizen — that racism in the United States is a public health crisis.

Having lived in rural Alabama, my family experienced these inequities personally. When my great uncle, who was like a father to me, fell ill, he was taken to a clinic that was segregated by skin color, and was subsequently admitted to a hospital in Selma in 1973. He died one day later. In 2015, I learned he had a ruptured appendix and was never seen by a physician.

I have advised and worked with large, complex health-care systems in the United States, Britain, Australia and Africa. I have collaborated with organizations such as the American Medical Association, the American Hospital Association and the Joint Commission. I have even discussed race as a risk factor for death with White health leaders, such as former president of the Institute for Healthcare Improvement Don Berwick.

Yet, I still sometimes feel that survival mechanism kick in to compromise and veil the truth that structural and systemic racism is a root cause of preventable harm and death across U.S. health care. I have been warned that if I did not continue to compromise, I would be labeled an “angry Black man” and that colleagues would distance themselves from me.

The days of compromise are over.

Solving systemic racism in public health must start with naming it. We must publish the word. We must say the word. If health-care providers are to be competent in caring for communities that have been marginalized and oppressed for centuries, then they must understand the role racism plays in poor health. This includes . . .

Continue reading.

Racists don’t like it when you point out their racism.

Written by LeisureGuy

5 April 2021 at 5:51 pm

Ending the Pandemic and Vaccine Resistance: Modern Questions, Long History

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Johns Hopkins School of Public Health interviews Graham Mooney, PhD, associate professor of the History of Medicine at the Johns Hopkins School of Medicine, and Jeremy Greene, MD, PhD, MA, director of Johns Hopkins’ Institute of the History of Medicine.

How do pandemics end?

Jeremy Greene: This question is often left to a relatively optimistic popular imagination that epidemics end with eradication—either [a virus] burns its way through a community and just ends through some sort of natural process, or it is blocked through successful containment strategies and the ability to actually get the reproduction quotient down.

But only a few epidemics in human history have been eradicated through intentional means. And so oftentimes when we tell stories about epidemics ending, what we’re really talking about is the point at which we stopped focusing on them. And that is located in place and in social position.

What did we learn from the 1918 Influenza Pandemic?

JG: The 1918 pandemic is thought to have gone through three major waves. But many historians who have revisited the epidemiology suggest that there are a higher number of deaths from flu and flu-like illnesses that happened in 1919 and 1920. And it may well be that there was a fourth wave and a fifth wave, and they just weren’t perceived. So even pinpointing exactly when the 1918 pandemic ends, it’s easier to pinpoint the moment in which we stopped attending to it as a pandemic than the moment in which there was an absolute freedom from this particular biological scourge throughout the world.

What have we learned from HIV/AIDS?

JG: The HIV/AIDS pandemic, which clearly was understood as a new, emergent threat of infectious disease of global importance when it was first detected in the early 1980s, was described in terms very similar to the way that COVID-19 is described: a new, lethal, frightening infectious agent of significant epidemic spread.

So at what point did the AIDS epidemic stop being an epidemic in the popular imagination? It still kills millions of people each year. We have not cured it. We don’t have a vaccine for it. But it’s become something that we have learned to live with, such that when people talk about AIDS in epidemic terms, they often talk in past tense.

What about polio?

JG: The same could be said even for polio, which we’ve had much more success in developing a vaccine with. But if you look at the question of when the polio epidemics ended, the real question is, for whom, and where?

My colleague Dora Vargha points out that many people still live with the complications of polio, and there are still polio epidemics breaking out in certain parts of the world. So to talk about the polio epidemic in the past tense is not actually historically true. Polio epidemics continue.

When we think about what this means for COVID-19, the real question is, what will happen when enough people are vaccinated within countries like the United States that the attention begins to shift away from calling a pandemic a pandemic, even though it’s still ravaging many parts of the world? And we don’t have a good answer to that question yet.

Can history help explain vaccine resistance?

Graham Mooney: One of the biological ways a pandemic ends is . . .

Continue reading.

Written by LeisureGuy

2 April 2021 at 10:14 am

Bob Pape was a beloved father and foster carer. Did ‘eat out to help out’ cost him his life?

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Sirin Kale writes in the Guardian:

Amanda Pape didn’t want to go on a city break to Birmingham during a pandemic, but her husband, Bob, a 53-year-old lawyer, insisted. “Bob was convinced that the government would not allow people to travel if it wasn’t safe,” says Amanda, a 56-year-old former teacher. Bob was persuasive – he was a lawyer, after all – so she relented. Along with her daughter, Jazzy, 19, one of Jazzy’s friends and a child Bob and Amanda were fostering, they booked three nights in a Holiday Inn from 2 August 2020.

The family, from Altrincham, Greater Manchester, stayed from Sunday to Wednesday, to make the most of the government’s “eat out to help out” (EOTHO) scheme, which offered food and soft drink discounts on Mondays to Wednesdays in August. Right until they left for Birmingham, Amanda was uneasy. She was on the verge of cancelling. It felt wrong.

In the end, they had a wonderful time. They visited Cadbury World, where Bob got overexcited and bought too much chocolate at the gift shop. They ate at Five Guys, a Jamaican restaurant and a brewery. “Me and Amanda visited the local Brewdog for a pint,” Bob wrote in his diary. “It was almost normal!” Most mornings, Bob fetched breakfast for everyone from McDonald’s. Amanda would shove a bottle of hand sanitiser at him before he left and remind him to use it.

On their final night, they had dinner at Wetherspoon’s with the kids. There was a bit of ugliness – a man at a nearby table was leering at Jazzy, so they moved seats. “I was concerned as some guys were getting lairy,” Bob said in his diary. Bob took Amanda and their foster child back to the hotel before returning for the girls. It was just as well because Jazzy was a bit the worse for wear. Bob hauled her home and put her to bed.

Where did Bob contract Covid? From the touch-screen he used to place his McDonald’s orders? At Five Guys, where they were careful to sit at a large table, away from everyone else? Amanda thinks about this now, late at night, running through all the places they visited on that weekend when everything was still right in the world and her partner of 11 years was by her side, smiling and carefree, and she thought this blasted pandemic was coming to an end.

Driving home, Amanda was in ebullient spirits. She was silly to have worried. They had had a great trip. Life was good.

There were two Bob Papes. If you had met the first, you would have seen a man dressed in a Hawaiian shirt, most likely with a beer in hand. He was cheerful, gregarious and loved to travel. Bob had no volume control and his constant wisecracking made some people wince. “His entire existence was about embarrassing me,” says Jazzy, a law student, with a sigh. “He wore Hawaiian shirts everywhere. And he was so loud when we were out. I would tell him to be quiet because people were looking.” Bob would look at you intently, make bad jokes, ask you questions about your life and really want to know the answers. “He collected people in the way some people collect bottles,” says Amanda. “He would talk to a stranger in a bar for hours.”

The second Bob was different. This was the lawyer who specialised in child support issues. He was respected and competitive. “If the judgment went his way, he’d say: ‘1-0,’ and wink,” remembers his friend and sometime legal adversary Mike Smith. But Bob preferred to keep his cases out of the tribunal courts, if possible, concerned for the welfare of the child. Most of the time, Bob would encourage his clients to come to an agreement out of the courtroom. If Smith was the opposing counsel, Bob would call him up and ask: how can we resolve this? It was better for the child that way. Less acrimony.

And woe betide a parent who was trying to hide their assets, to cheat their former partner out of child support. He would force them to come clean – even if they were his own client. “His big thing was fairness,” says Smith. “Just because you and your partner have separated doesn’t mean you can walk away from your responsibilities to the child. He was a great believer in that.”

Bob was born in Boston, Lincolnshire. His father was a telecoms engineer; his mother a homemaker. His childhood was wild and carefree. “They all had weird nicknames and would chuck themselves off bridges into the river and hope they didn’t break their necks,” says Amanda. At 16, Bob began temping in a law firm. He was not ambitious and lacked focus. “His first job had been collecting trolleys at the local supermarket, but he’d got fired from that for not paying attention,” says Amanda. “His dad wondered how long it would be before he got sacked from the law firm.”

Bob’s job there was to move boxes around and sort paperwork. On slow days, he would read the files. He started asking the lawyers about their cases. One of the senior partners at the firm began to take an interest in him. “He took Bob under his wing and said: ‘If you want to learn, I will teach you. I will pass on to you everything I know if you promise me that you’ll teach someone else one day,’” says Amanda. Bob founded his own firm, specialising in child support cases, in 1997.

When the senior partner died, he left Bob his wig in his will. On hearing this, . . .

Continue reading. There’s much more. Later in the article, the thorn:

When the chancellor, Rishi Sunak, announced EOTHO in a statement to parliament last summer, Covid cases were falling. Just 640 were reported in the UK on that day, 8 July. “I know people are cautious about going out, but we would not have lifted the restrictions if we did not think we could do so safely,” said a bullish Sunak, the second-youngest chancellor in history.

Sunak was the driving force behind EOTHO; promotional images for the initiative had his signature on them. He was riding high at the time, basking in approval ratings higher than those of the prime minister. A political unknown just six months previously, he was now beloved by the British public for turning on the spending taps. The government-funded scheme gave consumers 50% off the cost of food and soft drinks, up to a maximum discount of £10 a person, in participating businesses on Mondays, Tuesdays and Wednesdays in August. A total of 160m meals were claimed at 78,116 participating outlets that month, meaning that about 1.5 meals were claimed for each person in the UK.

Two days before Sunak’s announcement, Prof Lidia Morawska of Queensland University of Technology published an open letter, warning the World Health Organization (WHO) and national healthcare authorities of the dangers of airborne transmission of Covid. Her letter was signed by 239 scientists from around the world. “We are 100% sure about this,” Morawska said at the time, warning governments that 1- or 2-metre social distancing rules in indoor settings did not protect people from infection via airborne Covid particles. “These rules are completely arbitrary,” Morawska says. “They just prevent people from inhaling very large particles. But very small particles, which come out of a person’s mouth or nose when they are speaking, can stay in the air for a very long time and go much further than 1 metre.”

These Covid-19 particles range in size from less than a micrometre up to 100 micrometres, roughly the width of a strand of human hair. Even an asymptomatic person can shed them simply by breathing and talking; people with Covid are the most infectious in the first week of infection, often before the onset of symptoms. In an indoor restaurant setting, particularly one with poor ventilation or reliant on air-conditioning, these particles may circulate freely in the air, infecting people at tables metres away from the infected person. “Imagine you’re in a restaurant with a smoking area,” says Morawska. “There’s no one smoking in the area you’re in. But you can still smell the smoke from the other area. In the same way, the virus can travel with this air flow.”

It is impossible to estimate how far airborne Covid particles can travel in an indoor setting. “They will travel as far as the airflow takes them,” says Morawska. “That may be metres or tens of metres.” UK government guidance requires that restaurants space tables at least one metre apart, with rules to mitigate risk, such as removing multiuse items including menus, mandating table service to avoid people clustering together at the bar, requiring face coverings when not eating or drinking and improving ventilation.

Han Liu of the University of Minnesota has modelled the transmission of Covid in restaurant settings. “Only keeping 6ft [1.8 metres] away from each other is not enough in some circumstances,” says Liu. He cites other factors, such as air-conditioning, ventilation and even the way body heat can cause air particles to rise and circulate. “All of these factors will create a complex flow pattern that will drive small droplets further than 6ft from a spot and infect other people.” Although Liu’s study was published in February 2021, he points me towards a paper published in July 2020 that examined a Covid outbreak in a restaurant in Guangzhou, China. It came to similar conclusions.

Did the government consult scientists before the introduction of the EOTHO scheme? Speaking at an Institute for Government briefing in November 2020, Prof John Edmunds, a member of the government’s Scientific Advisory Group for Emergencies (Sage), said that Sage was not informed in advance about EOTHO. The Treasury has never said if it sought advice from other, non-Sage-affiliated, scientists prior to the introduction of the scheme. In January 2021, the Labour MP Bridget Phillipson asked Sunak if he would publish a copy of the epidemiological advice he received before introducing EOTHO. The Treasury minister Jesse Norman said the scheme was designed in “a safe and responsible manner”, but his department has failed to publish any advice.

Had the government consulted Sage or other scientists before the introduction of EOTHO, they could have warned the chancellor about the risk of airborne transmission of the virus in indoor restaurant settings. The evidence was already there. “We knew this was a respiratory virus and we knew all along that it was transmitted by the air,” Morawska says. “If the government was telling people to eat out in restaurants in August, but didn’t do anything to protect people from airborne transmission, then it was just exposing people to the virus.”

The day after Morawska’s open letter, the WHO publicly acknowledged the risk of airborne transmission of Covid. The day after that, Sunak stepped up to the dispatch box and announced the EOTHO policy. Afterwards, he travelled to a central London branch of the restaurant chain Wagamama. In front of photographers, a grinning chancellor served customers with his sleeves rolled up. He did not wear a mask. . .

Written by LeisureGuy

30 March 2021 at 1:24 pm

The Real Reason Republicans Couldn’t Kill Obamacare

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Adapted from The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage, St. Martin’s Press 2021, and quoted from the Atlantic:

The affordable care act, the health-care law also known as Obamacare, turns 11 years old this week. Somehow, the program has not merely survived the GOP’s decade-long assault. It’s actually getting stronger, thanks to some major upgrades tucked in the COVID-19 relief package that President Joe Biden signed into law earlier this month.

The new provisions should enable millions of Americans to get insurance or save money on coverage they already purchase, bolstering the health-care law in precisely the way its architects had always hoped to do. And although the measures are temporary, Biden and his Democratic Party allies have pledged to pass more legislation making the changes permanent.

The expansion measures are a remarkable achievement, all the more so because Obamacare’s very survival seemed so improbable just a few years ago, when Donald Trump won the presidency. Wiping the law off the books had become the Republicans’ defining cause, and Trump had pledged to make repeal his first priority. As the reality of his victory set in, almost everybody outside the Obama White House thought the effort would succeed, and almost everybody inside did too.

One very curious exception was Jeanne Lambrew, the daughter of a doctor and a nurse from Maine who was serving as the deputy assistant to the president for health policy. As a longtime Obama adviser, going back to the 2008 transition, Lambrew was among a handful of administration officials who had been most responsible for shaping his health-care legislation and shepherding it through Congress—and then for overseeing its implementation. Almost every other top official working on the program had long since left government service for one reason or another. Lambrew had stayed, a policy sentry unwilling to leave her post.

On that glum November 2016 day following the election, Lambrew decided to gather some junior staffers in her office and pass out beers, eventually taking an informal survey to see who thought Obama’s signature domestic-policy achievement would still be on the books in a year. Nobody did—except Lambrew.

Yes, Republicans had already voted to repeal “Obamacare” several times. But, she knew, they had never done so with real-world consequences, because Obama’s veto had always stood in the way. They’d never had to think through what it would really mean to take insurance away from a hotel housekeeper or an office security guard on Medicaid—or to tell a working mom or dad that, yes, an insurance company could deny coverage for their son’s or daughter’s congenital heart defect.

A repeal bill would likely have all of those effects. And although Republicans could try to soften the impact, every adjustment to legislation would force them to sacrifice other priorities, creating angry constituents or interest groups and, eventually, anxious lawmakers. GOP leaders wouldn’t be able to hold the different camps within their caucuses together, Lambrew believed, and the effort would fail.

All of those predictions proved correct. And that wasn’t because Lambrew was lucky or just happened to be an optimist. It was because she knew firsthand what most of the Republicans didn’t: Passing big pieces of legislation is a lot harder than it looks.

It demands unglamorous, grinding work to figure out the precise contours of rules, spending, and revenue necessary to accomplish your goal. It requires methodical building of alliances, endless negotiations among hostile factions, and making painful compromises on cherished ideals. Most of all, it requires seriousness of purpose—a deep belief that you are working toward some kind of better world—in order to sustain those efforts when the task seems hopeless.

Democrats had that sense of mission and went through all of those exercises because they’d spent nearly a century crusading for universal coverage. It was a big reason they were able to pass their once-in-a-generation health-care legislation. Republicans didn’t undertake the same sorts of efforts. Nor did they develop a clear sense of what they were trying to achieve, except to hack away at the welfare state and destroy Obama’s legacy. Those are big reasons their legislation failed.

Obamacare’s survival says a lot about the differences between the two parties nowadays, and not just on health care. It’s a sign of how different they have become, in temperament as much as ideology, and why one has shown that it’s capable of governing and the other has nearly forgotten how.

Democrats were so serious about health care that they began planning what eventually became the Affordable Care Act more than a decade earlier, following the collapse of Bill Clinton’s reform attempt in the 1990s. The ensuing political backlash, which saw them lose control of both the House and Senate, had left top Democrats in no mood to revisit the issue. But reform’s champions knew that another opportunity would come, because America’s sick health-care system wouldn’t heal itself, and they were determined not to make the same mistakes again.

At conferences and private dinners, on chat boards and in academic journals, officials and policy advisers obsessively analyzed what had gone wrong and why—not just in 1993 and 1994 but in the many efforts at universal coverage that had come before. They met with representatives of the health-care industry as well as employers, labor unions, and consumer advocates. Industry lobbyists had helped kill reform since Harry Truman’s day. Now they were sitting down with the champions of reform, creating a group of “strange bedfellows” committed to crafting a reform proposal they could all accept.

Out of these parallel efforts, a rough consensus on substance and strategy emerged. Democrats would put forward a plan that minimized disruption of existing insurance arrangements, in order to avoid scaring people with employer coverage, and they would seek to accommodate rather than overpower the health-care industry. The proposal would err on the side of less regulation, spending, and taxes—basically, anything that sounded like “big government”—and Democrats would work to win over at least a few Republicans, because that would probably be necessary in Congress.

Proof of concept came in 2006, in Massachusetts, when its Republican governor, Mitt Romney, teamed up with the Democratic state legislature to pass a plan that fit neatly into the new vision. It had the backing from a broad coalition, including insurers and progressive religious organizations. Ted Kennedy, the liberal icon and U.S. senator, played a key role, by helping secure changes in funding from Washington that made the plan possible. “My son said something … ‘When Kennedy and Romney support a piece of legislation, usually one of them hasn’t read it,’” Kennedy joked at the signing ceremony, standing at Romney’s side.

Kennedy’s endorsement said a lot about the psychology of Democrats at the time. No figure in American politics was more closely associated with the cause of universal health care and, over the years, he had tried repeatedly to promote plans that looked more like the universal-coverage regimes abroad, with the government providing insurance directly in “single-payer” systems that resembled what today we call “Medicare for All.” But those proposals failed to advance in Congress, and Kennedy frequently expressed regret that, in the early 1970s, negotiations over a more private sector-oriented coverage plan with then-President Richard Nixon had broken down, in part because liberals were holding out for a better deal that never materialized.

Kennedy was not alone in his belief that the champions of universal coverage would have to accept big concessions in order to pass legislation. The liberal House Democrats John Dingell, Pete Stark, and Henry Waxman, veteran crusaders for universal coverage who’d accrued vast power over their decades in Congress, were similarly willing to put up with what they considered second-, third-, and even fourth-best solutions—and they were masters of the legislative process, too. Waxman in particular was an expert at doing big things with small political openings, such as inserting seemingly minor adjustments to Medicaid into GOP legislation, expanding the program’s reach over time. “Fifty percent of the social safety net was created by Henry Waxman when no one was looking,” Tom Scully, who ran Medicare and Medicaid for the Bush administration in the early 2000s, once quipped.

Obama had a similar experience putting together health-care legislation in the Illinois state legislature—where, despite proclaiming his support for the idea of a single-payer system, he led the fight for coverage expansions and universal coverage by working with Republicans and courting downstate, more conservative voters. He also was a master of policy detail, and as president, when it was time to stitch together legislation from different House and Senate versions, he presided over meetings directly (highly unusual for a president) and got deep into the weeds of particular programs.

Obama could do this because the concept of universal coverage fit neatly within . . .

Continue reading. There’s much more.

Later in the column:

Another problem was a recognition that forging a GOP consensus on replacement would have been difficult because of internal divisions. Some Republicans wanted mainly to downsize the Affordable Care Act, others to undertake a radical transformation in ways they said would create more of an open, competitive market. Still others just wanted to get rid of Obama’s law and didn’t especially care what, if anything, took its place.

“The homework that hadn’t been successful was the work to coalesce around a single plan, a single set of specific legislative items that could be supported by most Republicans,” Price told me. “Clearly, looking at the history of this issue, this has always been difficult for us because there are so many different perspectives on what should be done and what ought to be the role of the federal government in health care.”

The incentive structure in conservative politics didn’t help, because it rewarded the ability to generate outrage rather than the ability to deliver changes in policy. Power had been shifting more and more to the party’s most extreme and incendiary voices, whose great skill was in landing appearances on Hannity, not providing for their constituents. Never was that more apparent than in 2013, when DeMint, Senator Ted Cruz of Texas, and some House conservatives pushed Republicans into shutting down the government in an attempt to “defund” the Affordable Care Act that even many conservative Republicans understood had no chance of succeeding.

The failure to grapple with the complexities of American health care and the difficult politics of enacting any kind of change didn’t really hurt Republicans until they finally got power in 2017 and, for the first time, had to back up their promises of a superior Obamacare alternative with actual policy. Their solution was to minimize public scrutiny, bypassing normal committee hearings so they could hastily write bills in the leadership offices of House Speaker Paul Ryan and, after that, Senate Majority Leader Mitch McConnell.

Written by LeisureGuy

28 March 2021 at 4:52 pm

Did the Black Death Rampage Across the World a Century Earlier Than Previously Thought?

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David Parry writes in Smithsonian:

For over 20 years, I’ve been telling the same story to students whenever I teach European history. At some point in the 14th century, the bacterium Yersinia pestis somehow moved out of the rodent population in western China and became wildly infectious and lethal to humans. This bacterium caused the Black Death, a plague pandemic that moved from Asia to Europe in just a few decades, wiping out one-third to one-half of all human life wherever it touched. Although the plague pandemic definitely happened, the story I’ve been teaching about when, where, and the history of the bacterium has apparently been incomplete, at best.

In December, the historian Monica Green published a landmark article, The Four Black Deaths, in the American Historical Review, that rewrites our narrative of this brutal and transformative pandemic. In it, she identifies a “big bang” that created four distinct genetic lineages that spread separately throughout the world and finds concrete evidence that the plague was already spreading from China to central Asia in the 1200s. This discovery pushes the origins of the Black Death back by over a hundred years, meaning that the first wave of the plague was not a decades-long explosion of horror, but a disease that crept across the continents for over a hundred years until it reached a crisis point.

As the world reels beneath the strains of its own global pandemic, the importance of understanding how humans interact with nature both today and throughout the relatively short history of our species becomes more critical. Green tells me that diseases like the plague and arguably SARS-CoV-2 (before it transferred into humans in late 2019 causing Covid-19) are not human diseases, because the organism doesn’t rely on human hosts for reproduction (unlike human-adapted malaria or tuberculosis). They are zoonotic, or animal diseases, but humans are still the carriers and transporters of the bacteria from one site to the other, turning an endemic animal disease into a deadly human one.

The Black Death, as Monica Green tells me, is “one of the few things that people learn about the European Middle Ages.” For scholars, the fast 14th-century story contained what Green calls a “black hole.” When she began her career in the 1980s, we didn’t really know “when it happened, how it happened, [or] where it came from!” Now we have a much clearer picture.

“The Black Death and other pre-modern plague outbreaks were something everyone learned about in school, or joked about in a Monty Python-esque way. It wasn’t something that most of the general public would have considered particularly relevant to modernity or to their own lives,” says Lisa Fagin Davis, executive director of the Medieval Academy of America. But now, “with the onset of the Covid-19 pandemic, suddenly medieval plagues became relevant to everyone everywhere.”

The project that culminated in Green’s article unfolded over many years. She says that the first step required paleogenetic analysis of known victims of the plague, including a critical study 2011Paleogenetics is the study of preserved organic material—really any part of the body or the microbiome, down to the DNA—of long dead organisms. This means that if you can find a body, or preferably a lot of bodies, that you’re sure died in the Black Death, you can often access the DNA of the specific disease that killed them and compare it to both modern and other pre-modern strains.

This has paid off in numerous ways. First, as scientists mapped the genome, they first put to rest long lingering doubts about the role Y. pestis played in the Black Death (there was widespread but unsubstantiated speculation that other diseases were at fault). Scientists mapped the genome of the bacterium and began building a dataset that revealed how it had evolved over time. Green was in London in 2012 just as findings on the London plague cemetery came out confirming without a doubt both the identity of the bacterium and the specific genetic lineage of the plague that hit London in June 1348. “The Black Death cemetery in London is special because it was created to accommodate bodies from the Black Death,” she says, “and then when [the plague wave] passed, they closed the cemetery. We have the paperwork!”

Green established herself as the foremost expert in medieval women’s healthcare with her work on a medical treatise known as The Trotula. Her careful analysis of manuscript traditions revealed that some of the text was attributable to a southern Italian woman, Trota. Other sections, though, revealed male doctors’ attempts to take over the market for women’s health. It’s a remarkable text that prepared Green for her Black Death project not only by immersing her in the history of medicine, but methodologically as well. Her discipline of philology, the study of the development of texts over time, requires comparing manuscripts to each other, building a stemma, or genealogy of texts, from a parent or original manuscript. She tells me that this is precisely the same skill one needs to read phylogenetic trees of mutating bacteria in order to trace the history of the disease.

Still, placing the Black Death in 13th-century Asia required more than genetic data. Green needed a . . .

Continue reading.

Written by LeisureGuy

28 March 2021 at 10:13 am

Does a low-carb/ketogenic diet help diabetes? or make it worse?

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As it turns out, a low-carb/ketogenic diet can reduce diabetes symptoms (high blood glucose readings) — as aspirin can reduce a fever — while having no effect on the disease — as aspirin will not cure pneumonia. In fact, it’s even worse: a low-carb/ketogenic diet can reduce the symptoms while making the disease worse. It is an example of “bending the needle”: responding to a dangerous situation, where the needle on the gauge has moved into the red zone, by bending the needle so it’s no longer in the red: not really a solution and can lead to disaster.

Watch this brief video (and persist through the awkward metaphors in the middle: he does return to study results).

And for a more detailed explanation of how a low-carb/ketogenic diet has detrimental effects on one’s health:

Written by LeisureGuy

28 March 2021 at 6:42 am

The paraquat poisoning problem carefully being ignored

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Sharon Lerner reports in the Intercept:

JON HEYLINGS WAS 34 when he found the notebook that would upend his life. A junior scientist at Imperial Chemical Industries, Heylings happened upon it in 1990 as he was trying to solve a mystery. Trained in toxicology, he had been brought to the company three years earlier to lead a team that would work to reduce the health risks of ICI products that contained the pesticide paraquat. He had spent much of that time testing formulations that did appear to be safer. Yet to Heylings’s puzzlement, the company hadn’t put them on the market. Curious about how ICI had arrived at the chemical concentrations in the version of the pesticide it was selling, he did some research in the corporate archives. There he came across the old book of notes that Michael Rose, a senior scientist at the company, had handwritten years earlier.

Heylings knew Rose and had seen his findings, which were known within the company as the Rose Report. ICI had used the report to justify the concentration at which it added a chemical called PP796 to its paraquat products. But the numbers and graphs he saw jotted in the notebook didn’t support the conclusion that Rose drew in his official report. “When I compared the data in his report to the original pharmaceuticals clinical trial data, I found they were different,” Heylings told The Intercept. “You know, very different.” While an accurate analysis would consider all the outcomes in an experiment, Rose had “cherry-picked,” according to Heylings. “He took some data out, he put some data in.”

The young scientist decided that he had to tell his bosses about his discovery — very carefully. “It’s taking a risk to criticize senior managers of fabrication, you know?” he said recently. “This wasn’t something to be discussed over coffee.” So he wrote up a memo documenting the problems with the data and explaining that based on the evidence he had just found, the concentration of PP796, an additive intended to protect against poisoning, should be 10 times higher than the amount in the Rose Report — and 10 times higher than the levels in Gramoxone, ICI’s bestselling paraquat product. He sent the memo to his manager, who assured him that he would send it on to the senior agrochemicals team. Satisfied that he had done the right thing, Heylings, a self-described “company man,” stayed in his job for another 18 years.

Heylings’s 1990 memo and the Rose Report, first drafted in 1976, are among almost 400 internal documents reviewed for this investigation, which The Intercept conducted in collaboration with the French newspaper Le Monde. More than 350 of those documents were disclosed by Syngenta, the successor to ICI, and other defendants in the course of ongoing litigation over the companies’ responsibility for personal injuries due to paraquat exposure. The nonprofit organizations Public Eye and Unearthed, an affiliate of Greenpeace, which have extensively researched both paraquat and PP796, supplied about three dozen more. Together, the thousands of pages of scrawled notes, stained letters, and meeting minutes, many of which are marked “company secret” and “confidential,” tell the story of corporate intransigence in the face of a dangerous but profitable product — what Heylings describes as “a conspiracy within the company to keep this quiet.”

Syngenta maintains that the concentration of PP796 that Rose calculated — the concentration still used in many of the company’s products today — is safe. “Our detractors have willfully misrepresented and mischaracterized a limited number of documents, which ordinarily form part of an entire dialogue on product design, and focused on them, making false accusations related to the weight we give to cost when considering safety,” Saswato Das, a spokesperson for Syngenta, wrote in an email.

But in the more than 40 years since Rose made his consequential calculations, many of the company’s own scientists have questioned his assertions. And during that time, tens of thousands of people have died from paraquat poisoning.

The Speedy Killer

Paraquat is prized for the speed at which it kills weeds. The chemical begins to disrupt plants’ cell membranes and interfere with photosynthesis on contact, causing them to visibly wither within hours. Because it acts so swiftly, paraquat was heralded as an agricultural breakthrough when it was introduced in the 1960s. Since then, hundreds of millions of pounds of the herbicide have been used in the U.S. alone. More than 10 million pounds were sprayed on corn, soybeans, grapes, and other fruits and vegetables in 2017, the last year data was available. And paraquat use is now on the rise, according to data from the U.S. Geological Survey.

The problem with paraquat — or one of them — is that the chemical that so quickly and effectively kills plants is also extraordinarily toxic to humans.

Continue reading. There’s more, and it is — or should be, were we not so desensitized — shocking.

Written by LeisureGuy

27 March 2021 at 3:25 pm

In the gut microbiome, at least, it’s nurture, not nature

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Clea Simon writes in the Harvard Gazette:

We are what we eat, and so are our microbiomes. A new study shows that alterations in diet, along with other environmental factors, had a major impact on gut biomes over time as animals were domesticated. In a process that closely tracks changes in the human diet since industrialization, this shift had implications on the health of domesticated animals — and possibly on humans as well.

The question that challenged human evolutionary biologist Rachel Carmody was one of nature vs. nurture. Her study “Effects of domestication on the gut microbiota parallel those of human industrialization,” published today in eLife, answered it definitively.

“Evidence in humans and many animals to this point suggests that, surprisingly, genetics plays a small role compared to environmental influences,” said Carmody, an assistant professor in the Department of Human Evolutionary Biology and principal investigator of the department’s Nutritional and Microbial Ecology Lab.

Carmody and Aspen Reese, a junior fellow in her lab, looked at nine different pairs of wild animals and their domesticated descendants, such as wolves and dogs, wild boars and pigs, and wild European rabbits alongside the domestic variety. Though the pairs differed profoundly from one another, the tame counterparts have encountered many common environmental changes during domestication, including shifts in population density, physical activity, patterns of reproduction, medical interventions such as exposure to antibiotics, and human contact.

In addition, “We’ve changed their diets,” said Carmody. “For example, many domesticated animals are eating foods originally cultivated for human use, in processed forms that are relatively easily digestible, and that tend to be richer in fat.” While the microbiomes of wild and domesticated animal pairs resembled one another, “The process of domestication shifted the divergent microbiomes of these different species in a common direction. In other words, we were able to detect a global signature of domestication,” she said.

The fact that environment rather than genetics drove that shift became apparent as researchers switched a single environmental variable between wild and domesticated pairs — feeding wolves dog chow, for example, and raw meat to dogs. “We used diet as one example of an environmental factor that we know has changed with domestication and with industrialization in profound ways,” Carmody said.

The researchers then sampled and sequenced the microorganisms in the animals’ fecal matter. With just a short-term diet change, the wolves’ gut microbial community became dog-like, and the dogs’ wolfish. This discovery confirmed earlier work done in Carmody’s lab with mice and humans that revealed how diet not only changed the gut biome but did so relatively quickly. “Within 24 hours of seeing a new diet, the gut microbiome looks and behaves very different,” she said.

To bring the study closer to home, researchers also looked at the closest parallels in human evolution, comparing chimpanzees’ gut biomes with those of modern humans. While the evolutionary distance between chimps and humans is greater than that between, say, wolves and dogs, the same kinds of changes were seen. Notably, the shifts were clearest in humans living in industrialized societies, who have experienced the greatest changes in diet, population density, physical activity, antibiotic use, and other factors that were also involved in animal domestication.

The implications are considerable. “We know that the gut microbiome has really important effects on human health,” said Carmody. Indeed, this internal environment has been linked to “a range of human diseases,” she said, including metabolic diseases like atherosclerosis and Type 2 diabetes, cancer, neurodegenerative diseases, and autoimmune disorders.

“In some ways, it’s great news that the gut microbiome is so sensitive to environmental conditions, as this means we can manipulate it more easily to improve human health,” Carmody said. “But it’s a double-edged sword, as all the changes our recent lifestyles have had on the microbiome may create opportunities for mismatch with human biology, which changes on much slower timescales.”

This study also  . . .

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Written by LeisureGuy

24 March 2021 at 12:10 pm

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