Showing posts with label health. Show all posts
Showing posts with label health. Show all posts

Sunday, April 24, 2022

If you've ever handled a penny, the government's got your DNA.

File this under: Wanted: new conspiracy theories—all ours came true.

When DNA testing and genomic profiling was first rolling out as a mass-market product, I remember hearing people objecting to it saying things like, "I don’t want them to have my DNA". 

These worries were summarily dismissed by science-supporting elites as paranoia on the part of anti-science or antisocial bumpkins. 

It turns out an ounce of caution here was warranted

And then COVID happened . . .


And now 23andMe has come full circle:

Wojcicki says that’s just not going to happen. “We’re not evil,” she says. “Our brand is being direct-to-consumer and affordable.” For the time being she’s focused on the long, painful process of drug development. She’d like to think she’s earned some trust, but she hasn’t come this far on faith.
Caution continues to be warranted by at least some elites (Macron refuses Russian COVID test), and I don't blame them--be sure to click through to the Atlantic story about the lengths to which the White House goes to protect the president's DNA. 

I understand Macron and the White House taking extreme precautions in this area. I also do not think it is highly likely that anything bad would come of genetic data gathering in general. In fact I tend to be supportive of the secondary (or ulterior) uses that genetic data could provide--provided there are adequate disclosures on the front end and transparency throughout the process. Trust but verify is the right approach.

The level of trust is inversely proportional to the extent to which people's fears get realized even if they are only partially realized. In other words the level of trust is directly proportional to the degree of proven trustworthiness.



Thursday, May 13, 2021

Great News, Everybody! They Are Just Stupid. Not Evil.

Consider this graph from the COVID-19 vaccine page on the CDC's website: 



Notice the red trendline, which is the 7-day moving average of first doses, and how it peaks around April 11. Notice also how it is now as of May 8th (as reported May 13th) lower than it has been at any time since January 12th. 

What happened on April 11th??? Well, that was when the CDC and the FDA began floating concerns about the Johnson & Johnson (Janssen) vaccine. Concerns that would manifest themselves two days later in a "pause" of administration of that particular vaccine. 

From not allowing experimentation and wide-scale testing, to not allowing challenge trials, to insisting on doing their own, slow trials on vaccines, to delaying the information and launch of the vaccines, to not doing first doses first, to not approving the Oxford-AstraZeneca vaccine, to not doing half doses or using more efficient needles, etc. we have seen over and over our medical regulatory state fail us. The cost is unnecessary deaths, unnecessary and compounding hardship (emotional and economic), and deterioration in the confidence people have in public health. 

So how is this great news? Consider this:

Summary of Recent Changes
  • Update that fully vaccinated people no longer need to wear a mask or physically distance in any setting, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance
  • Update that fully vaccinated people can refrain from testing following a known exposure unless they are residents or employees of a correctional or detention facility or a homeless shelter

The CDC and federal officials in general are backpedaling fiercely from every policy and limitation they adamantly were insisting upon over the past several months. It is clear they are in panic mode over the plunging rates of vaccination. They probably correctly understand that there was a coming falloff from both the most vaccine resistant as well as those who had COVID and didn't feel a vaccine was necessary. All of this snowballing against vaccination as cases and deaths decline rapidly.

The great news is they actually do care and don't want a good portion of the U.S. population to die. One would be forgiven for thinking otherwise given the above list of mistakes. But it turns out they are not evil. They just are stupid. Hanlon's Razor for the win!

Thursday, October 8, 2020

What Explains Country Variation in COVID Deaths?

I see a lot of vague or implied speculation on why there are such large differences in COVID-19 death rates (et al.) among various countries and regions. But many of these have internal tensions once we think a little deeply about the arguments being hinted at. Biases are leading to a lot of lies of omission if not just outright bad reasoning.

Why is Sweden different than Finland? What explains Japan, Taiwan, and South Korea versus France, Italy, and Spain? Germany versus Belgium? USA NE versus Texas versus Florida versus USA Midwest?

Here is a partial list of the usual and some unusual suspects:

  • General health in the population
  • Partial immunity including from prior coronavirus exposures
  • Climate including ability to comfortably be outdoors and in open-air environments (definitely relative to when the virus struck)
  • Prior and continued use of various drugs and treatments
  • Proportion of at-risk people especially elderly
  • Quality of procedures for protecting the vulnerable
  • Quality of testing
  • Quality of tracing
  • Population density (within cities and otherwise relative to where people actually live; e.g., excluding most of Canada when measuring for Canada)
  • Government NPIs including lockdowns and other policies but not test and/or trace
  • Degree of movement within and among various communities (city to city, within a city, cross sociodemographic, in and out of country, et al.)
  • Strain(s) of C-19 virus affecting country and timing of the infection
I suspect that the error term in any formal analysis might prove to contain all the variation. Remember, "the greatest trick the devil ever pulled was convincing the world he did not exist."

The Forrest Gump Diet: A few simple rules for a better diet

Most dieting plans are nonsense. And most dieting is not about losing weight--it is about signaling that one would like to lose weight, is involved in a struggle, and would like sympathy. If people really wanted to lose weight, they would

Diets come in a thousand varieties, but it is clear that while each might work for a while for some people, they fail (or people fail them) as often as they work. That we know so very little about this highly desired realm of knowledge, it is a big economic paradox. My guess is that it is highly dependent on individual circumstances (extreme heterogeneity) and these are both governed by external environmental factors including cultural influences as well as genetic factors. As such, one size fits more than one might not be true. And yet I do think some guiding principles can be derived that can greatly help us on our journey:

  1. Eat when you are hungry. (Note that this pushes back against intermittent fasting.) 
  2. Eat slower. You are not in a speed contest. 
  3. Eat less. You are not in a volume contest. This can most easily be achieved by simply not ever completely finishing what you have been served.
  4. Eat less of the things that you want to eat. It is very likely that your desire is to eat more of the things that are not as good for you.
  5. Eat more of the things that are not as desirable to you. This is the converse of the prior point.
  6. Eat a greater variety. This likely helps with the gut microbiome, and it makes life more interesting. That said, some things may just not be right for your body, and that is fine.
  7. Eat less processed foods and prepackaged foods. This one helps with #s 2, 3, and 4 by making food less convenient especially food that is generally nutritionally poorer for you.
  8. Look to make good choices at the margin, but diet over weeks and months not hours and days. No one ever starved to death by missing a single meal, and no one ever became obese by indulging oneself one time. 
    • The first key is to avoid temptation by avoiding bad situations. 
    • The second key is to routinely seek to make a slightly better choice at each opportunity. 
    • The final key is to be able to look back over weeks and months to see if you have generally been making good choices and improving choices. While this might entail the need to keep a journal, which is contrary to the spirit of this list of keeping things simple, evaluations over longer periods of time are essential to understanding if you’re making progress.

P.S. This is the diet that worked for me. I lost 20 pounds and it definitely improved some aspects of my health. Had I wanted to lose another 20 pounds, I would more devoutly follow it, but I want other things in life more. At least I'm honest with myself.

Wednesday, September 2, 2020

In Case of Pandemic Break Glass

Here is a message to future generations for when they find themselves in the next pandemic. This is subject to change, but you would already know that if you had started reading the list.

These are the rules and guidelines I would suggest for the next pandemic: 
(Yes, there is redundancy and overlap in this list. That is a feature not a bug.)

1) Be Willing To Change - Adaptation >>> plans. Your plan is great as a starting point. Grey board beats white board. But an eraser and a willingness to use it is best. Your plan will not entirely survive first contact with the virus. This is as ironclad of a law as you'll get in this realm.

2) Protect The Vulnerable - How is this not obvious? Well, it seems it very much wasn't this time around. And know this: you cannot always predict who the vulnerable will be. 

3) Practice Good and Improving Hygiene - Tighten up. Here is an example of where general pushback against conventional wisdom reverses and we need to speedily go in the other direction--side with conventional wisdom of being more hygienic during a pandemic. We have been getting cleaner and cleaner as a society. As we've gotten richer, we have gotten less tolerant of risk in general and health risk specifically. This long-term trend has an unintended consequence: we over protect--especially children. "Rub some dirt on it" is an exaggeration, but it has some truth. We should pushback generally against the tide of puritanical cleanliness. We need exposure to germs. But in the face of an acute and new health threat, this reverses. Then is no time to develop hardiness--at least not until we know a lot more about what we're up against. Hand shaking shouldn't be abandoned per se, but the norm should probably be to quickly pause the practice when a health risk arises.

4) Test, Test, Test, and Test Some More - Each of these links have unique, subtle points along the general line of the importance of testing. Yes, there is redundancy, but that is the point I'm trying to hit you over the head with. At the hope of repeating myself, testing is a key ingredient to knowledge in a pandemic. Here is the idea by analogy: You're suddenly in a pandemic . . . oh, no problem, we know how to pandemic, bro. No, you certainly do not. Each one has different features and each time the environment has changed (economically, normatively, politically, etc.). Image I put you in a large, completely dark room and told you there are dangerous things in the room and you need to escape. I hand you a dim flashlight as your only tool. It works sparingly requiring you to flip it on and off repeatedly to get some light. Not ideal but you would be quite foolish to toss the flashlight to the side and grope around blindly instead.

5) Don't Believe In or Rely On Magic - ..... masks, hand washing, existing drugs with non-obvious potential for help, experimental drugs, ventilators, et al. may help. None are perfect cures or magic bullets. Many ideas will have very large costs that may in fact greatly outweigh the benefits. Try lots of stuff (see #7 below), but don't rely on any one thing or set of things. And don't latch on to that first idea and refuse to let go (see #1 above)

6) Invest in Options Including the Value of Delay - "Flattening the curve" evolved into a constant moving of goalposts in order to justify desired policies. This was a combination of the wrong way to interpret #1 above and the exact problem #5 above and #8 below are opposed to. But the idea had immediate traction because it had a very plausible initial value--delaying even the inevitable can make the inevitable more manageable if not largely reduced in magnitude. Every month after March brought new developments in treatment and most likely a lower severity in the disease itself via natural mutation. But delay isn't costless (see the links in #5 above). Though options require premiums, they are still vastly undervalued. Testing and isolating and distancing (see #3 and #4 above) create options. And don't just do something, stand there actually can be an option-preserving strategy. 

7) Experiment (Let 1,000,000 Flowers Bloom) - Let people take risks. This is both a principled position as well as a pragmatic one. We need ideas from the most unlikely of places. We need discovery.

8) Don't Attempt To Centrally Plan - It never works well for general problems and it is downright disastrous in a fluid, developing emergency. The knowledge problem is most applicable and important in dynamic, high volatility, low confidence environments. For central planning to succeed even in theory the unknowns must be minimal and the variance must be low. Simple is better. Fewer cooks in the kitchen (i.e., Congress and lobbyists and the alphabet soup of agencies and a politically myopic U.S. President and risk-averse though power-happy governors ...) would prevent entangled messes that do little to help, too much to harm, and a lot to hurt. The bureaucracy is the nature of the state. Leveraging government in times of crisis maximizes its every shortcoming, hindrance, and corruption. 

9) Trust The Market - Allow prices to adjust (don't worry about 'price gouging'; rather embrace it). Allow profits. For God's sake if there is ever a time when you want to reward risk takers and resource providers, it is in a time of dire crisis. See below for more on why you don't need to worry about people taking advantage. People want to help. There are many avenues for social and normative guidance. Man desires not just to be loved but to be lovely--let him! Do not let your personal envy or hypothetical fears prevent those standing ready to help.

10) Trust People - Lord of the Flies was wrong. People respond to incentives and information. If you give them good and updating versions of both, you can expect good and improving results. If for no other reason than their personal self-interest, people will tend to make sensible and safe decisions. In fact they are very likely to be overly risk averse

11) Question Authority - Challenge the motives and knowledge of every solution provider in direct proportion to how confident or authoritative they claim to be.

12) Communicate, Communicate, Communicate (honestly and don't censor) - Lies undermine productive efforts and credibility.  Censoring prevents much needed experimentation and fosters distrust. If restricting dangerous activities including potential superspreader events is desired, say so. Give guidance and elevation and promotion to good advisors. Be open to and have a high tolerance for new ideas, debates and debatable positions, and mistakes. There will be mistakes. It is not how you prevent them as much as it is how you adapt to them once they occur. Because adaptation >>> plans . . .

Friday, August 7, 2020

What To Root For

In late summer every football fan begins to dream about the season to come with aspirational hopes for one's team and general excitement for what autumn will bring. That is every normal late summer. 

But this is 2020. So, here we go. 

I am torn as to what I should want to see happen. On the one hand I do not think cancellation of the season is the prudent choice from a health perspective. I would rather see options kept alive as the developing situation continues to play out. And this is strengthened by two underlying convictions as controversial as they may be: the health risk is generally minimal and people should have the liberty to choose for themselves what risk they wish to face. 

Note that there is a wide gulf between being completely back to a regular football season and no football season whatsoever. Minimal fans with abundant spacing and many other procedures can be a prudent compromise. No fans initially with potentially many or full fan attendance later in the season is also a possibility (keep your options alive). 

The pandemic is not completely understood, but we know A LOT more about it today than 6 months ago. And we are a lot further along all the curves including toward herd immunity. In just about every action we take we are potential externalities for our fellow man. And do remember that those run in both flavors (positive and negative externalities) and to many varying degrees. Magnitude matters. 

Are we so certain that this disease is too misunderstood, too deadly or otherwise too harmful, too contagious, and simply too terrible for people to make their own choices about exposure? For many people the answer to that question is yes, which raises interesting questions about many other activities and diseases. I do not believe the evidence supports this point of view. If we cannot have football in any manner, then how different should the rest of our lives be? Trust me, I know how some are willing and eager to answer that question. 

My threshold for the use of force is much higher than that. Like Bryan Caplan, "I accept a strong presumption in favor of human liberty. You cannot rightfully shut businesses and order people to 'stay at home' out of an 'abundance of caution'. Instead, the burden is on the advocates of these policies to demonstrate that their benefits drastically exceed their costs..."

Who am I to say an elderly man living with terminal cancer should not come to a football game? I am referring to a specific, very devoted fan and personal friend. I believe he should have the freedom to make that choice. I am a strong believer in freedom, fair dealing, and justice. 

Deciding for others is an invitation for injustice. Unfair bargaining is a method of unfairly restricting the freedom of others. All of which brings me to the other hand . . . The players.

The general data for the typical college age-person shows very low health risk associated with COVID. While particular individual players very certainly have underlying conditions or other circumstances like close contact with at-risk people, most do not. For those that do, accommodation and excuse from the risk is very much the right thing to do. 

It is not the player's health risk per se that I believe gives rise to an "other hand" concern, but rather it is the general injustice of players not being compensated with the added burden of a health concern bringing this disparity into sharp relief. 

Most people when confronted with this idea ask the wrong question--"Why should we pay players?" The correct question is the opposite--"Why should we NOT pay players?" The default presumption in a free society is that people should be paid for their labor. If you want the services of another person, you should expect to do so by reaching a mutually agreeable arrangement.

"But the players have agreed to play, and they are paid. Haven't you of scholarships?" is the typical response. That response is as wrong as it is common. That "agreement" is made repeatedly in a very one-sided deal between the individual player on one side and a very powerful buyer of services on the other--college universities. These colleges act in concert under the rubric of a pure cartel organization--the NCAA. This is not a pejorative, emotional charge nor is it name calling. It is a very well established factual depiction. And the power and extent of the NCAA is supported explicitly and implicitly by government action at every level. This shouldn't be a surprise as cartels do not withstand the inevitable forces of competition and free markets without state support.

As a cartel the NCAA and its member institutions conduct themselves as a single buyer of college athlete services--the technical term for this is monopsony. This affords them considerable economic power and leverage, which they use to enforce an arrangement that is very good for themselves at the expense of the athletes. The reason why college football and basketball programs are limited to what they can provide athletes is because doing otherwise would unleash that terrible scourge upon the Earth unto the halls of college sport purity--the free market with its evil property rights and competition. More specifically, the athletic departments and universities and all those who individually benefit financially from the current arrangement would have to share. 

The most succinct way to explain why athletes are not currently paid what they are worth is to simply ask why would NCAA regulations on what athletes can earn be necessary if they were currently earning their market wage. The more detailed way is to do the economic analysis as sports economist Dr. David Berri among others have done repeatedly

About those scholarships . . . There are two very strong arguments against the common refrain that they’re getting a college education. The first is that that college education is something they could attain anyway and do so with little to no expense. Most of these players would be eligible for need or merit-based scholarships as well as grants that would cover the cost of college. The second is that that college education is in fact not worth very much to many of them. For many people college is not the right decision. We push way too many people through the college system inside and outside of sports. For many a different route through trade school or other education or flat out immediate pursuit of a job would be a better option.

There are many other bad arguments made in defense of the system that we know. These include:

What will happen to the schools who can't afford to pay? and This will just mean that football ends at many places and only the biggest programs will survive. While a radical change may and probably will result in a lot of disruption, the market is more dynamic than its opponents' imaginations. Plenty of room exists for true amateur and other types of football aside from a professional college league. And it is very wrong to assume that Alabama, Ohio State, Oklahoma, and other blue bloods in football as well as Kentucky, Duke, Kansas, and other blue bloods in basketball would benefit from a world where direct, open payments were able to be made to players. These programs benefit the most from a limit on the very important competition dimension of wage compensation. Alabama does not hurt for the top talent in football. Paying players would be a pure expense for them with little to no incremental benefit. Oh, and are you soooooo sure players aren't already being paid in many cases. Black markets of illicit payments to athletes are alive and thriving in this world of prohibition. And they do so with all of the horrible consequences associated with black markets.

How will they be paid? Will it be a free-for-all? Will players make different amounts? I don't know and I don't have to solve this problem to be correct about much higher compensation being the rightful world to strive for. I don't know how much the local grocery employee should make. I don't know how much the CEO of Exxon should make. Hell, I am not quite so certain about how much I should make. The market is a marvelous process that reveals this knowledge to us and constantly refines it. Let the market work.

No one wants to see college kids make that type of money. While this is not true as professional sports, entertainment in general, and many other areas of life attest--IT DOESN'T MATTER. An unfair deal is not made fair because a beneficiary (direct or indirect) prefers it. 

They aren't worth that much. Supposing you have ignored the vast research in this area including that referenced above, let me give you a simple example using a different sport as this will also defeat some of the false arguments that relate to worries about other sports and athletes. At my favorite university, The University of Oklahoma, Patty Gasso is an extremely good coach of the extremely good OU softball team. Coach Gasso makes about $1.2 million per year for her services. Of her many talents, two of them relate directly to athletes--recruitment and player development. So I ask, how good do you think Gasso's OU softball team would be if she were required to randomly pull her players from the pool of all female OU students and how well would the team do if the women selected to play were redrawn at random before each game? More to the point, how much would Coach Gasso be paid in this hypothetical? To the degree players add value above random replacement we get some idea about the added value talented players bring and are worth.

Title IX completely disallows this in fact or in economic result. This is Myth #6 in economist Andy Schwarz's 13 Excuses, Not Reasons: 13 Myths About (Not) Paying College Athletes

There are other bad arguments. Many play upon our biases and jealousies. These too must be called out for what they are. Two wrongs don't make a right. Frustration that there are great rewards for great, rare talents is common but unjustifiable. There is no reason or virtue in adhering to the rules of the past when those rules are revealed to be wrong for today.

Simply put, any argument justifying the current arrangement must address the central question--why should we NOT pay college athletes.

If ever there were a season to make a change, this is it. Beyond the pandemic and all the economic and health disruptions, we of course are in the midst of an opportunity to take a major leap forward in the name of justice. Perhaps 2020 will eventually come to be remembered as the year when significant racial progress started. When old institutions were challenged and remade. When we realized it doesn't just have to be this way because it has always been this way. 

This is another example of my theory that the pandemic has accelerated already present trends. In this case we may be witnessing some version of the universities of the Power 5 conferences separating themselves from the NCAA and beginning of the dissolution of the NCAA cartel. Let us hope a new cartel does not rise in its place. My optimism for change is tempered and I know that any new result will be with its flaws. Don't let the perfect be the enemy of the good. Don't forsake progress for the fear or even the certainty that change will be flawed.

Perhaps a lost season is not required. Compromise with true pre-commitment to reform could be a way out. Let the universities call the players bluff, but also let the universities come back to the table with solutions. Make them put up contractual commitments, earnest money, and public promise of specific and explicit change. The road map at this point of the journey is quite blurry and very undecided. The most we can expect is to have a destination, boundaries for the eventual route to be found, and a burning of the bridge of retreat once the journey begins.

That is what I am rooting for.

I stand with the players. 

Tuesday, January 23, 2018

Highly Linkable - Food and Health Myths

As you know, one of my soft spots is counter-conventional wisdom. Here are a few recent ones in the health and nutrition and food spaces.

From Vox, the science is in: exercise won’t help you lose much weight. Count this (that exercise helps weight loss) among the many things I adamantly believed up until few years ago.

In this James Altucher podcast Dr. Aaron Carroll explores some of his book The Bad Food Bible: How and Why to Eat Sinfully. Quit looking for magic food. Quit worrying about toxic food. Eat what works for you. Stay away from processed foods and too much (i.e., added) sugar.

Slate explores the implications of the junk science used to ban smoking on grounds of secondhand dangers. I believe we are in an age of rising puritanism. Tobacco is the drug in the cross hairs. It is low brow. Interestingly alcohol and marijuana are higher and rising status. Once again, mood affiliation and out-group shaming guides public policy. (HT: Robin Hanson)

On a more upbeat note, here is a great guide to finding a restaurant. Lots here about correctly interpreting the signals being given--both intentional and unintentional. (HT: Tyler Cowen)

Monday, February 23, 2015

Highly Linkable

First, some housekeeping. Now that I have broken the streak, allusions will continue, but not necessarily in all posts.

I could watch this all day--a toy world that is the real world of Iceland and Norway. (HT: Tyler Cowen)

Along that theme, the world is a splendid, big place.

Driverless cars > race car drivers. (HT: Tyler Cowen)

Economic reality > good intentions.

(Public choice) economic reality (is also) > good intentions.

This piece by Megan McArdle hits several good points; namely that it is basically impossible to defend the Crusades and crusaders, Christianity was not and is not the Crusades, and disassociating oneself from something ugly that one was in fact never associated with is a cheap political gimmick.

And now a bit about diet, nutrition, and health:

  • The [arguable] truth about "miracle" foods. (I'm a little uncomfortable with this otherwise very good article's appeal to regulatory authority.)
  • Speaking of the regulatory authority's lack of credibility . . . dietary cholesterol isn't a worry . . . what'chu talkin' 'bout Willis?
  • This Ask Altucher with Ari Whitten of The Low Carb Myth gives a view that speaks very closely to my own, novice view. It is short and rewarding, but takes a minute to get going.