Quick hits (part II)

1) Excellent stuff (lots of good charts, too) from Noah Smith.  Just read it. “Progressives need to tell the positive story about immigration: Fortunately, it’s true.”

2) This is good and definitely reflects where my thinking has been heading, ‘Why Hospitalizations Are Now a Better Indicator of Covid’s Impact”

The world has a new Covid variant, Omicron, that’s expected to drive up cases if it becomes the dominant strain in the coming months. Much remains unknown, including how quickly Omicron will spread in more highly vaccinated areas, or whether it causes more mild disease than Delta, the variant the United States is continuing to battle.

Thankfully the variant is arriving in a different pandemic landscape in the United States: one in which vaccines, tests and, soon, oral treatments are available. The country will need a new framework for thinking about what comes next, and in highly vaccinated areas, focusing on a different set of numbers, hospitalizations, rather than case counts, can better tell us how we’re doing.

America is in the slow process of accepting that Covid-19 will become endemic — meaning it will always be present in the population at varying levels. But the United States has effective tools to deal with that reality, when it happens in the future.

Learning to live with the virus long-term will require changes in both mind-set and policy. Relying on Covid-19 hospitalizations as the most important metric to track closely will provide the most reliable picture of how an area is faring with the virus. And by focusing attention on the number of hospitalizations, health professionals can better focus on reducing them.

This becomes especially important as case counts become more complicated. A positive case of Covid-19 doesn’t mean what it used to if you are vaccinated. Most breakthrough infections, which will grow as the number of vaccinated people increases, so far remain mild. Although antibodies wane over time and may be affected by variantsT cells and B cells generated from vaccines should continue to offer protection against severe illness. Right now, in areas of high vaccination, an increase in cases does not necessarily signal a comparable increase in hospitalizations or deaths…

Some policymakers may be wary of not using case numbers as the primary metric to guide public behavior and policy. As cases become more complex, however, health departments should still monitor infection numbers, but guidance should be tied to hospitalization metrics. When rising cases do not reliably predict hospitalization surges, hitching Covid policies to cases alone is no longer effective policy — or good public health.

3) HIV has proven to be a ridiculously difficult virus to vaccinate against.  This is early phase here, but some real hope in the latest mRNA HIV vaccines.

4) This is really, really, really good. “COMMENTARY: 8 things US pandemic communicators still get wrong”

1. Overconfidence and failure to proclaim uncertainty

It is not easy to communicate uncertainty. The public doesn’t want to hear it, so to truly get it across, you have to proclaim it, not just acknowledge it.

Doing so goes against the grain for most public health agency spokespersons. They rightly think the public prefers confident-sounding officials.

But the public can tolerate official uncertainty, if it’s confidently and matter-of-factly stated: “We’re building our boat and sailing it at the same time.” Among the many benefits: The damage done when you turn out wrong is a lot lower.

Officials’ overconfidence re COVID has been too obvious to belabor. Among the early mistakes confidently asserted: There’s no reason to think the virus is spreading significantly in the USmasks are uselessthe most important thing you can do is wash your handsit’s not airborne; etc. I had dinner recently with a friend who told me, “I just don’t trust what they say anymore. They’ve been so sure and so wrong so often.”

Plenty of uncertain things are asserted with equal overconfidence today. We just don’t know yet which ones will turn out to be mistaken.

Consider this hypothetical example—and ask yourself why I can’t find many examples like this that aren’t hypothetical:

We don’t entirely know what we’re doing, we’re uncertain, we disagree among ourselves. We have made some mistakes, and we’re going to make more. We’ll keep changing our minds as we fight out our disagreements and take new evidence onboard. If you’re not sure we’re right about something, join the club: We’re not sure we’re right either. This is what it’s like to face an evolving pandemic caused by a new pathogen.

One overconfidence issue that particularly bothers me is attribution bias—particularly about surges. Every time the COVID situation gets better or worse, public health people “explain” why. Officials and experts rarely say—CIDRAP Director Michael Osterholm is a notable exception—that they don’t have a clue why something happened; that the virus does what the virus does; that we’re not steering this ship, we’re passengers.

These overconfident attributions aren’t science-based, but they’re not random. Often they seem to be based on what public health agencies and experts want the public to think and do. Bad news is attributed to not enough people doing what you asked them to do; good news is attributed to lots of people doing what you asked them to do.

Another example: I keep reading that flu disappeared in 2020-21 because of COVID precautions—even though it disappeared also in places like China, where normal life had pretty much resumed until Delta emerged.

When you overconfidently attribute events we don’t really understand, like rises and falls in case numbers, it undermines public confidence in the things you truly can confidently attribute. The fact that vaccinated people are much less likely than unvaccinated people to be hospitalized with COVID is genuinely attributable to vaccination, for example.

A good risk communication strategy is to pair something you know with something you don’t: “Even though we really don’t understand why waves of infection rose here and fell there, we are very confident that the vaccines have reduced people’s COVID hospitalization risk.” …

3. Fake consensus

Like most professions, public health is a guild, and guild members are deterred from deviating publicly from mainstream guild opinion. It can sometimes work like this: A 20% minority of the experts believe something. The 80% prevail. Most of the 20% go silent. The 2% who speak up look like cranks. And journalists and other non-experts (even non-experts within public health) get a misimpression of expert consensus.

In highly uncertain crisis situations like the COVID pandemic, fake consensus can be very harmful. Policymakers are deterred from giving the minority position the consideration it deserves. Researchers are deterred from studying the minority position; granting agencies are deterred from funding research that explores it; journals are deterred from publishing evidence that supports it. In the worst cases, the majority position becomes reified not just as the expert consensus but as inviolate scientific truth that only an anti-science denialist would dare to question.

Under these conditions, discovering that the majority position is mistaken, if it is, takes much longer. And when the news finally reaches the public that the (former) majority position was mistaken, not inviolate scientific truth after all, the loss in trust can be deep and long-lasting.

(Here again I want to acknowledge Osterholm’s unique value. For decades, he has somehow managed to assert outlier opinions without being expelled from the inner circle.)

Please note that I am explicitly disagreeing with many other risk communication experts, whose mantra on the subject is “Speak with one voice.” (We don’t all speak with one voice on the wisdom of speaking with one voice.) I agree that real expert consensus is a wonderful thing, as long as it stays tentative and open to new evidence. Fake consensus that masks real disagreement is something else entirely.

There have been several patterns of fake consensus vis-à-vis COVID. The most dangerous is shutting up the dissenters, or bashing them so badly that potential followers shy away and they can’t get a fair hearing. The maltreatment of the Great Barrington Declaration authors comes to mind. The question isn’t whether they were right or wrong to oppose last year’s lockdowns; the question is whether the mainstream was right or wrong to try to muzzle them. Wrong, I think. Badly wrong.

A less extreme case: Proponents of aerosol transmission were widely ignored for far too long, partly because many of them came from disciplines (like engineering and fluid dynamics) that public health professionals knew little about, and published in journals that public health professionals rarely read. How many lives might have been saved if Lisa Brosseau and her colleagues had been listened to sooner?

A different pattern is when both sides speak as if the other side didn’t exist, as if their half of an ongoing debate were the consensus position. 

Often the fake consensus starts with a genuine consensus regarding the scientific data, but then tacks on a faux consensus regarding what to do about it. Public health policies about COVID or anything else are necessarily grounded in both scientific judgments based on evidence and trans-scientific judgments based on values. The debate about COVID vaccine boosters in August through October 2021 is a nice case in point. The debate was never mostly about the scientific evidence. It focused instead on two trans-scientific questions: How important is it to reduce the incidence of mild breakthrough infections? And with regard to severe breakthrough infections, should we take a “better safe than sorry approach” based on preliminary data, or should we wait for stronger evidence before okaying a booster rollout?

I think the vaccine booster debate was also partly about many public health professionals’ resentment of political leaders for getting ahead of the public health consensus, making their own judgments about these trans-scientific questions instead of simply following the science. In the minds of many public health professionals, “follow the science” really means follow the scientists—that is, follow them—even with regard to choices that are about values more than science and even when there is no scientific consensus on these values choices. Their outrage that President Joe Biden got the policy horse before their scientific cart may have delayed their acceptance of the wisdom of universal COVID booster access. [emphasis mine]

5a) Love me some soda.  But, the idea of paying premium prices to just mix my beloved Diet Dr Pepper with other flavors?  Not so much.  But, enough people do that it’s a growing business. 

Samantha Durfey was a high school sophomore in St. George, Utah, when the first Swig soda shop opened its doors there. Today, at 28, Ms. Durfey, visits the shop at least three times a week. She usually orders a Save Me Jade — Diet Dr Pepper with sugar-free vanilla and coconut flavor syrups — but every now and then she’ll change her order if she wants a break from caffeine.

“They have really good carbonated-water drinks, and because carbonated water itself is disgusting they mix it with fresh fruits and sugar-free syrups and stuff,” she said, “and it makes it taste really yummy.”

Since the first Swig opened in 2010, dozens of soda-shop chains and independent soda shacks have opened from Idaho to Utah to Arizona, an area of the Mountain West sometimes called the Mormon Corridor. A significant portion of the region’s population belongs to the Church of Jesus Christ of Latter-day Saints, and the church’s prohibition on tea and coffee has spurred a niche beverage market that has intensified in the last decade, hitting a fever pitch during the pandemic.

5b) Also, my hypothesis is that if Joseph Smith understood caffeine or if soda existed when he lived, the Mormons would have banned that, too. 

6) Did you see that insane Christmas card from Thomas Massie with all the guns?  A friend of mine went to the trouble of figuring out what all those guns would cost– a lot!

On to the front row!

Starting on the left, you’ve got an M60 machine gun. Buying a legally transferable M60 is pricey. It will run you between $50,000 and $60,000. (That’s substantially more than the U.S. median income for an individual, which was only $34,100 in 2019 — the most recent year I could find numbers for.)

Next to the M60 is an UZI. That’s somewhere between $1,100 and $1,900, with an average market price of around $1,700.

The last gun pictured appears to be a Thompson M1SB, the submachine gun also termed a “Tommy Gun” — but without the distinctive ammo drum. It’ll run you between $1,200 and $2,200.

Time for some quick math! If we add up the cost range for all of those weapons, it comes to a price tag of between $56,200 and $75,100.

That’s well over the median income in the U.S.

It’s a darn sight more than a few hundred dollars for cookware.

And, to the best of my knowledge, nobody’s ever committed mass murder with a serving dish.

7) Freddie deBoer on how advanced stats ruined baseball:

Players are obsessed with launch angle, for the understandable reason that this obsession has seemingly increased homerun totals – 650 more total homers in the 2019 season than in the 2017 season, up a full 10%, to pick one remarkable stat. Teams, meanwhile, are asking players who once would have been instructed to fixate on contact to swing away. I have little doubt that the analytics departments that are asking scrawny middle infielders to approach the batter’s box as if they were Frank Thomas actually does contribute some positive win percentage compared to the previous norm of trying to slap singles or drop bunts. But it’s removed the variety of approaches at the plate that used to make baseball more interesting. Meanwhile the “Moneyball”-era focus on the value of walks and running up large pitch counts has contributed to a steady increase of pitches per plate appearance for 30 years. This means more fouls, more excitement-sapping pitcher changes as guys hit their rigid pitch count limits, and longer games.

The result of all of this is that a game that has an intrinsic tendency towards inaction and guys standing around has seen more of both. I concede that homers are fun, as are strikeouts. But the more you see, the less special they become, and the modern baseball fan sees dramatically more than a previous era’s did. Meanwhile the most athletic, fun, and unpredictable elements of baseball, fielding and baserunning, have become less and less prevalent over time. Guys launch homers or they strike out, wracking up foul balls by the score, and when that’s not happening it’s just pause after pause, long stretches of nothing. We live in an increasingly-frenetic digitally-mediated culture, and Shoeless Joe isn’t coming out of the holy cornfield to entice your kids to watch baseball. It’s really hard to see how the game competes with Twitch and YouTube moving forward, to say nothing of the NFL or the NBA…

Now. Do I think the style of play dictated by sabermetrics is the sole cause of baseball’s decline in popularity, in some simplistic way? No. But I think it is certainly an important contributor. I’m sure there’s all kinds of social trends and cultural forces at play in baseball’s current status as the weird old uncle of American sports. One way or the other, though, the only possible route to greater popularity and success is by enticing people with the game itself. That’s it, that’s all you can market yourself on, your product on the field of play. Right now, the product stinks, in my opinion.

8) This is excellent, “Why ‘both sides’ journalism fails in the face of the rising threat to our democracy

As I’ve written before, and as many others have said, we’re in the midst of a crisis of democracy. The Republican Party, already disproportionately empowered because of the Constitution’s small-state bias and the Senate filibuster (the latter, of course, could be abolished tomorrow), is working to strengthen its advantage through partisan gerrymandering and the passage of voter-suppression laws. The result could be white minority rule for years to come.

The situation has deteriorated to the point that the European think tank International IDEA now regards the United States as a “backsliding democracy.” To quote from IDEA’s report directly, “the United States, the bastion of global democracy, fell victim to authoritarian tendencies itself, and was knocked down a significant number of steps on the democratic scale.”

And the media remain wedded to their old tropes, covering political campaigns as though they were horse races and treating the two major parties as equally legitimate players with different views.

It’s a topic that was discussed at length recently on Ezra Klein’s New York Times podcast by New York University journalism professor Jay Rosen and guest host Nicole Hemmer, a scholar who studies right-wing media. Their conversation defies easy summary (the whole episode can be found here), but essentially, Rosen argued that the political press falls back on its old habits because breaking out of them is just too difficult.

“The horse race absorbs a lot of abuse from people like me,” he said. “But it can take that abuse, because it is such a problem-solver. It checks so many other boxes that even when people know it’s kind of bankrupt, it stays on.” As an alternative, Rosen proposes coverage based on a “citizens agenda,” which he has written about at his blog, PressThink. But he admitted to Hemmer that we may lose our democracy before his ideas are adopted by more than a fraction of journalists.

What I find especially frustrating is that the media have not been ignoring the Republican threat to our democracy. Far from it. As just one small example, the Times on Sunday published a front-page story by Nick Corasaniti on a multitude of actions being taken at the state level to suppress the vote and put Trump loyalists in charge of the election machinery.

“Democrats and voting rights groups say some of the Republican measures will suppress voting, especially by people of color,” Corasaniti wrote. “They warn that other bills will increase the influence of politicians and other partisans in what had been relatively routine election administration. Some measures, they argue, raise the prospect of elections being thrown into chaos or even overturned.”

So why am I frustrated? Because this sort of valuable enterprise reporting is walled off from day-to-day political coverage. We are routinely served up stories about the congressional Republican leaders, Rep. Kevin McCarthy and Sen. Mitch McConnell, going about their business as though they were latter-day versions of the late Bob Dole, sharply partisan but ultimately dedicated to the business of seeking compromise and governing. In fact, whether through cowardice or conviction, they are enabling our slide into authoritarianism by undermining the investigation into the Jan. 6 insurrection as well as by failing to call out Trump and the excesses of their worst members.

Earlier this year, Washington Post columnist Margaret Sullivan endorsed the idea of a “democracy beat,” which would look closely at attempts to subvert voting rights. Sullivan would go further than that, too. “The democracy beat shouldn’t be some kind of specialized innovation,” she wrote, “but a widespread rethinking across the mainstream media,” permeating every aspect of political and governmental coverage.

9) I will say I quite enjoyed “Sex and the City” way back when.  Not so much interest on a new series focusing on these women twenty years later and proving how much more enlightened the characters and show creators now are.  

10) Also, how had I never heard about “hip dips.”  And, yes, having an 11-year old daughter on the verge of puberty does scare me. Nice little NYT doc on teen girls discussing their difficulties.

11) Scientists trying to find the genetic determinants of what makes a good dog, “Is There a Genetic Link to Being an Extremely Good Boy?”

Good health is key for guide dogs, but temperament is just as important. They need to lead their owners around obstacles and other people while staying calm and obedient. They need to resist chasing after squirrels or getting too excited when meeting other dogs. Not every breed has what it takes. For example, the typical cocker spaniel is intelligent, affectionate, and a great option for families, but it is also too excitable. “Even if you give them the same training, you would never expect a spaniel to be a guide dog. They’re far too temperamentally unsuited, and that’s probably a genetic thing,” says Lewis.

Sixty years of breeding and research at the charity has shown that German shepherds, golden retrievers, and Labradors—especially golden retrievers crossed with Labradors—are best suited to guide blind or visually impaired people. These breeds are confident, intelligent, and eager to please; they are large enough for the harness that wraps around their torso and includes a sturdy handle for the owner; they are strong enough to pull their owners away from dangerous obstacles, and yet small enough to lie comfortably under a bus seat.

In 2019, researchers at four universities in the United States analyzed genetic information and behavior logs for more than 14,000 dogs from 101 breeds. They found some genes that contributed to 60 to 70 percent of variation among breeds for traits such as aggressiveness toward strangers or trainability, but no gene turned out to be solely responsible for any of them. This suggests that the behavioral patterns seen in dogs are an interplay of many genes and environmental influences.

 

This study, however, was based on existing genetic data sets and surveys with dog owners. That’s not ideal, because the genetic and behavioral data were from separate sample groups, and not from the same dogs. “The only reason we took the breed-average approach was to compile massive amounts of behavioral and genetic data from the existing literature,” says lead author Evan MacLean, director of the Arizona Canine Cognition Center at the University of Arizona, whose ongoing research involves DNA sampling and behavioral experiments with dogs.

The new Guide Dogs project aims to bridge this gap by collecting full genome sequences from 3,000 of their bred dogs, including puppies and their parents, and correlating that with their internal data to identify genes that determine patterns of disease and behavior. So far, staff and volunteers have collected DNA samples from 400 dogs, and sequencing will begin next year. But the project will take many years to complete; a team of researchers will study the guide dogs until their retirement, to watch for diseases that develop late in life.

12) Is it wrong of me to question whether we are at the point where we need to try and open up space to people with disabilities?  

13) Interesting study on male and female physicians lifetime earnings reveals all the complicated factors– very little is overtly paying women less for the same work– that lead to women earning less in all sorts of fields:

The researchers analyzed self-reported salary data submitted to Doximity, a social network similar to LinkedIn that claims to reach 80 percent of doctors in the United States. Comparing wages between men and women with the same amount of experience, the researchers estimated that, over a simulated 40-year career, male physicians earned an average of $8.3 million while women made roughly $6.3 million — a nearly 25 percent difference.

In their calculations, the researchers controlled for an array of factors that highly influence pay, like a doctor’s specialty, type of practice and patient volume.

More men, for example, become surgeons — the highest paid of all physician specialties — whereas more women go into primary care. And women have been shown to spend more time with their patients, leading to a lower volume of services and procedures that can be billed for.

Some of these measures are “themselves the likely manifestations of systemic bias or discrimination,” said Dr. Reshma Jagsi, a radiation oncologist and bioethicist at the University of Michigan medical school who was not involved with the new report. For example, studies have shown widespread bias against women applying for jobs in medicine that are traditionally or predominantly held by men. And women in academic medicine are less likely to get big research grants or hold leadership positions.

14) For you “Succession” fans out there (and, for my money, the best show– and funniest– currently in production), this profile of Jeremy Strong is terrific.  

When I asked Strong about the rap that Kendall performs in Season 2, at a gala for his father—a top contender for Kendall’s most cringeworthy moment—he gave an unsmiling answer about Raskolnikov, referencing Kendall’s “monstrous pain.” Kieran Culkin told me, “After the first season, he said something to me like, ‘I’m worried that people might think that the show is a comedy.’ And I said, ‘I think the show is a comedy.’ He thought I was kidding.” Part of the appeal of “Succession” is its amalgam of drama and bone-dry satire. When I told Strong that I, too, thought of the show as a dark comedy, he looked at me with incomprehension and asked, “In the sense that, like, Chekhov is comedy?” No, I said, in the sense that it’s funny. “That’s exactly why we cast Jeremy in that role,” McKay told me. “Because he’s not playing it like a comedy. He’s playing it like he’s Hamlet.”

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