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Epistemic Sunk Costs and the Extraordinary, Populist Delusions of Crowds?

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Here’s a thought about the Trudeau incident. (Remember that?) Possibly an obvious thought. Or obviously wrong. (You tell me.)

The first rule of persuasion is: make your audience want to believe. Trump has a talent for that. But I think it’s fair to say that he has often lived his business life by a different maxim: if you owe the bank $100 it’s your problem. If you owe the bank $100 million it’s the bank’s problem. There is a sense in which that works at the persuasion level, as epistemology. In the Trudeau case there are two options as to things you might believe.

1) Justin Trudeau is a weak, nefarious dairy extortionist.

2) 1 is just fucking ridiculous.

If 2 is true, Trump voters ought to be ashamed of themselves. Anyone can make mistakes. But the President of the United States should not be ridiculous.

If you have to choose between being being ashamed of yourself or thinking Justin Trudeau is going to hell for dairy-related reasons, the latter option is far superior on grounds of psychic comfort. (Exception: you yourself are Justin Trudeau.)

But it adds up. I don’t just mean: you get wronger and wronger. It gets harder and harder to doubt the next ridiculous thing – since admitting Trump said or did one thing that was not just wrong but ridiculous would make it highly credible that he has done or said other ridiculous things. But that would raise the likelihood that you, a Trump supporter, have already believed or praised not just mistaken but flat-out ridiculous things, which would be an annoying thing to have to admit. So the comfortable option is to buy it all – the more so, the more ridiculous it threatens to be.

There is nothing uniquely Trumpian about epistemic over-investment. But Trump does seem to have a Too Big To Fail talent for locking folks in, by deliberately getting them deeper and deeper in epistemic hock.

Do you think it’s deliberate? Trump knows he gets his base to buy huge, ridiculous lies – things that don’t even matter – just so, when he says the next ridiculous thing, they have to buy that, too? Is it a deliberate group-bonding strategy?

It might seem that this point is pretty basic and obvious and I’m just belaboring it. Namely, people don’t like to be told they are wrong; they are, generally, loss-averse. And that goes for political arguments, too. But it’s a bit more specific: people don’t like to be made to look ridiculous. The media is constantly getting blamed for disrespecting voters in Trump Country. But Trump himself makes it the case that there are really only two options. Either Trump is the greatest US President – the only one with the genius to penetrate the Matrix of Canadian lies – or else he is, at best, totally ridiculous. There really isn’t a third way, so take your pick. And tomorrow it will be some other damn thing. As a result, there is no way to conceptualize the red-blue divide except as a red pill-blue pill divide, so to speak. The reason Trump talks constant lies is, in part, to ensure the debate frame can only be: which side is constantly lying? He can’t grow his base that way, but he can lock it in.

Am I just saying there is polarization? (If so, I should take a number: only about 1 million books and articles and blog posts about increasing partisan polarization have been written in the last couple years.) Again, it’s more specific. It’s impressive that partisanship maintains its high level on the right while ‘conservativism’ – which is now Trump – is, on the surface, ideologically exploded. I buy Corey Robin’s basic model. On that model, Trump isn’t such a surprise. Nevertheless, I am impressed with the rapidity of the change in rhetorical tone on the right. It isn’t just that Trump is saying the soft parts out loud. He isn’t saying what used to be the loud parts even softly. The philosophical veneer is just … gone. That’s the thing about a veneer. You can strip it away. But I’m surprised it is happening so fast. As Henry wrote a while back, it’s hard to see what conservative intellectuals are for these days.

In Orwell’s 1984 there are two things that are impressively awful about the future. One, the degree to which ideology rules everything, and there is no room for dissent or free thought. The party is everything, and the party is, largely, an idea. The other awful thing is sort of the opposite. The sheer, reversible capriciousness of it. The way Big Brother can say any damn thing he wants and everyone has to believe. This feels like a wise paradox: only an ideology – a para-consistent system of ideas strategically sealed off from reality-checks – can afford that sort of sheer arbitrariness. What impresses me about Trump is not so much that he can take over the tribe so completely, or that being a member of a tribe means believing what everyone else believes, but that a modern political tribe can be so groupthink lockstep without being more pseudo-coherent, ideologically. You would think a ‘we have always been at trade war with Canada/North Korea is our friend’ switcheroo would take some serious philosophical spin-doctoring to pull off. But, apparently, not. Tribalism plus charisma, invested in the leader. Very old school. I’ve been lied to by dystopian literature about how much our sucky future needs a Matrix to make it suck, in a red pill/blue pill kind of way. All it takes is the right person speaking weirdly random-seeming falsehoods about Canada.

Someone’s going to say: but here’s a false thing some progressive has said about Trump! (Don’t be that guy. The time you spend writing that comment, and waiting for it to clear moderation, you could have spent growing a seedling sense of proportion.)

Someone else is going to say: FOX News. Ah, fair point.

UPDATE: I also don’t mean to bad-mouth research into paraconsistent logic.

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DGA51
5 days ago
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If you believe the first ridiculous lie, it becomes easier to believe the next one. And the next one...
Central Pennsyltucky
duerig
5 days ago
Or perhaps 'ridiculous' isn't properly an adjective attached to assertions. It is an adjective describing our reactions to assertions. Each change in ourselves is a synthesis of our pre-existing ideas and the ideas we are engaging with. If those ideas seem in line with our own ideas, then we are likely to accept them. And then that new synthesis becomes the basis of the pre-existing ideas we bring to the next engagement. Each step is reasonable in its own terms. But by the end you have a cult that literally drinks the kool-aid. Or a political party that stands behind a traitor who emboldens our enemies and pushes away our friends.
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Worried About Judge Jeanine?

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Don’t be.

It’s gonna be a little difficult for her to explain what Alfredo over at the Dairy Queen dug up about Jeanine Pirro to entertain us at The World’s Most Dangerous Beauty Salon weekly business meeting Fantastic Fête Friday and Hunger-Buster Coven.

It seems as though Judge Jeanine might have a tough time being named Attorney General or to the Supreme Court considering that she has some unpaid political bills.

Alfredo always has visuals at his lunchtime presentations, which is appreciated because this stuff is such fun.

In 2006, Jeanine ran against Hillary Clinton for the senate seat in New York. She polled so badly and made some shockingly bad teevee appearances, that she dropped out of the race. She still has $600,000 in unpaid bills from that campaign.  Here ya go.  She quit paying the past due bills in 2010.

However, senate campaign committees are required to continue to file FEC reports until all the committee’s debts have been extinguished.  Pirro hasn’t filed ANY FEC reports since 2012.  This is the most recent of 25 failure to file letters she has received from the FEC since 2013: Here ya go.

Now that right there is the cherry on top of the banana split. You won’t see this on CNN or in the New York Times because they never show up at the Dairy Queen for lunch with Alfredo. Fools.

Thanks to … well, Alfredo for the heads up.

 

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DGA51
10 days ago
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Central Pennsyltucky
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Do You Know What’s In Your Nail Polish?

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EPA Won’t Release Study that Says Formaldehyde—Used in Building Materials, Paints, Even Cosmetics—Causes Leukemia

Scott Pruitt’s EPA is said to be sitting on a study that concludes—for the second time—that formaldehyde causes leukemia.

Three Democratic senators wrote Pruitt on May 17, asking when the assessment will be released.

“It appears that the agency may be succumbing to pressure from industry in its attempt to delay or block the publication of the formaldehyde health assessment,” they wrote.

A 2010 study by Luoping Zhang, an adjunct professor at the University of California, Berkeley, and other researchers found that Chinese factory workers exposed to high levels of formaldehyde had an increased risk of leukemia. The EPA relied on that study in 2010 when it first concluded formaldehyde causes leukemia.

Action Box/What You Can Do About It

Tell EPA Administrator Scott Pruitt your thoughts via his Facebook and Twitter sites. His email is Pruitt.scott@Epa.gov

His phone number is 202-564-4700.

Write him at:

EPA Headquarters
William Jefferson Clinton Building
1200 Pennsylvania Avenue, NW
Mail Code: 1101A
Washington, D.C. 20460

Contact your representative and senators.

The Environmental Defense Fund, which supports stronger regulations for chemicals, can be reached at 800-684-3322 or at 1875 Connecticut Ave., NW, Suite 600, Washington, D.C. 20009.

 

The American Chemistry Council, the industry mouthpiece, has been trying to trash Zhang’s study since then. The council sued to get the data underlying her study and funded another study, this one done by scientist Kenneth Mundt known for biased research for the tobacco industry.

Mundt, who found flaws in conclusions by the National Cancer Institute on low-tar cigarettes, also found problems with Zhang’s work. The EPA redid its assessment, the one Pruitt and other Republican appointees at the EPA are now blocking from being released.

Formaldehyde is used in building materials, insulation, glues, paints, cosmetics and dishwashing liquid. An EPA assessment that formaldehyde causes leukemia would lead to more regulation and expense for the chemical industry. The U.S. allows workers to be exposed to more formaldehyde than other countries.

Sen. Edward Markey (D-Mass.), one of the letter signers, asked Pruitt in January when the assessment would be released. Sen. Thomas Carper (D-Del.), another letter signer, asked about it in February. The third senator is Sen. Sheldon Whitehouse (D-R.I.)

Pruitt’s staffers involved in blocking the assessment from being released include Byron Brown whose wife has been a lobbyist for an oil and gas company, Bill Wehrum, who sued the agency at least 31 times as a corporate lawyer, and Clint Woods, who used to work for a nonprofit funded by the Koch brothers.

The Toxic Substances Control Act, passed by Congress in 1976, regulates chemicals, but it was so weak that the EPA couldn’t use it to ban asbestos. Congress amended the act in 2016 to give the agency more power to regulate dangerous chemicals by using “the best available science,” not junk science such as that practiced by Mundt and his ilk.

 

 

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DGA51
24 days ago
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Central Pennsyltucky
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A primer on fentanyl(s)

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The synthetic opioids – usually referred to both in the press and by law enforcement as “fentanyl” – have now outstripped both the prescription opioids such as oxycodone and heroin in terms of overdose deaths, and (as you can see below) the trend line is almost vertical.

Image result for opioid overdose deaths

Keith Humphreys warns of “fentanyl’s potential to permanently alter illegal drug markets.”

Kevin Drum asks about the causes of the change:   “Fentanyl has been around for a long time, and only recently has its use become widespread. Why?”

Why, I thought you’d never ask. Settle back; this is a complicated story, and it’s going to take a while to tell. But Keith is right: this is a BFD. So it’s worth understanding.

First, a little bit of chemistry and pharmacology. “Fentanyl,” in its precise use, is the name of a single molecule. It’s a purely synthetic opioid: that is, it binds to the same μ opioid receptors as oxycodone or heroin does and has most of the same effects, but it’s not made from the opium produced by the poppy plant; its raw materials are chemicals, not crops. It’s about thirty times as “potent” as morphine: that is it takes about thirty times as much morphine as it does fentanyl to get the same pain relief. (Here’s a handy chart.) Morphine is the standard reference molecule here; note that both diamorphine (heroin) and oxycodone are about 1.5x as potent as morphine itself. Potency also varies with route of administration; injection is about 3x as effective as swallowing a pill.

For a person who hasn’t developed a tolerance (and who enjoya the psychological effects of opioids: most people don’t) 5mg. of oxycodone (by mouth) is enough to get high on; that’s also the dose that will handle moderate pain, and the amount in a Percocet. That same person would likely get the same effect with about 1.5 mg. of injected heroin.  But it would only take about 1/20th of a milligram – that’s 50 micrograms – of injected fentanyl.

In medical practice, injected fentanyl is most common as part of surgical anaesthesia; as a pain reliever – generally for people with severe, chronic pain – it’s more usually administered as a transdermal patch, from which the molecule gradually leaches into the bloodstream, or as a lozenge.

But the “parent” fentanyl compound turns out to be one member of a very large chemical family, known generically as “fentanyls,” each with its own name and a varying set of pharmacological properties. Some of them are astoundingly potent: carfentanil, for example, has something like 100 times the potency of fentanyl itself, which makes the effective dose for a human a fraction of a microgram. (And yes, it’s literally used – in dart guns – as an elephant tranquilizer.) Legally, those other molecules are “fentanyl analogues.”

The opioids as a class have what is known as a “narrow therapeutic window,” where the “window” is the range between the median effective dose (ED50) – the dose that’s effective in half the population – and the median lethal dose (LD50). The larger the LD50/ED50 ratio (the wider the “window”) the safer the drug will be in terms of overdose risk. For the opioids, the ratio is typically about six, which sounds like a reasonable margin of safety until you remember that individuals differ, individual vulnerabilities differ from occasion to occasion (especially with the presence of other drugs, notably alcohol), and people make mistakes, especially when drugs are made and distributed illicitly rather than in pharmaceutical factories and taken by people who are not always at their sharpest mentally. Given all that, a factor of six is an uncomfortably narrow window.

The narrow therapeutic window explains why overdose death is so much more common with the opiods than with the stimulants or the benzos or alcohol. And the smaller the intended dose, the harder it is to measure out precisely. So the potency that can be an advantage clinically (allowing less painful injections and the use of things like transdermal patches) can be a nightmare on the street. To make things even worse, neither users nor dealers have reliable ways of knowing just what’s in the white powder they’re consuming or selling: someone who injects what he thinks is the right dose of heroin, but has in fact purchased fentanyl, is likely to stop breathing. Even someone who intends to take fentanyl could die if he’s actually been given, say, 3-methylfentanil or some other high-potency analogue.

Which – finally – brings us back to Kevin’s question: “Why is this stuff just getting popular now?” Fentanyl was patented as a pharmaceutical nearly 60 years ago. It was in limited use as a street drug – some diverted from medical use, some illicitly synthesized (back then, mostly domestically) by the early 1980s. From a trafficker’s viewpoint, high potency meant high value-to-bulk, making it much easier to ship illegally without getting caught. But from a user’s viewpoint, it was Russian Roulette. A street dealer buying fentanyl from a higher-level supplier and “stepping on it” – diluting it with mostly inert chemicals – would have had to remarkably skilled to ensure that every dose had just 50 micrograms of the active agent and that none had the 300 micrograms – roughly the weight of a grain of table salt – that could be deadly. So fentanyl never really caught on.

At the same time, the price of heroin started to fall, and kept falling. In 1979, a milligram of pure heroin delivered to an illegal consumer in the U.S. sold for about $2.40; that’s something like $9 in today’s money. Today, that same milligram costs sells for something less than a quarter. The causes of that decline – and similar declines seen over the same time period in the prices of cocaine and cannabis (adjusted for its rising potency) – aren’t entirely clear. It certainly hasn’t been for want of vigorous enforcement; we have about thirty times as many drug dealers behind bars today as we had in 1980 (450,000 v. about 15,000). My guess is that it’s mostly learning-by-doing: over time, drug dealers develop smoother and smoother procedures for doing business and avoiding enforcement, helped along by the falling prices of transportation and information and the rising volume of international and long-distance commerce. (Falling homicide rates also reduced one major risk of drug-selling.)

Then we got hit with wave of prescription-opioid (mostly hydrocodone and oxycodone) diversion and dependency that started around 1992 and was accelerated by the introduction of Oxycontin in 1996 and its relentless marketing by Purdue Pharma. The widespread availability of diverted prescription opioids – available in pharmaceutical bottles, in every neighborhood, often from friends or at least from people who didn’t look as scary as old-fashioned heroin dealers, and cheap enough to be taken orally rather than using the more efficient, but ickier, injection route – created a widespread national demand for opioids. As those oxycodone users built up habits they could no longer afford, or lost access to a script-happy M.D. or a “pill mill” pharmacy, the falling price of heroin enticed many of them to “trade down.” Milligram-for-milligram, heroin cost about a quarter as much as oxycodone (25 cents vs. a dollar).

At the same time, people in the U.S. were learning how to buy chemicals unavailable here – banned drugs, cheap unbranded pharmaceuticals, Human Growth Hormone, you name it – by mail-order from illicit or quasi-licit outfits in China, ordering over the Internet (and, when law enforcement made that dangerous, over the “Dark Web”) often paying in cryptocurrencies. Instead of using complicated smuggling schemes, sellers simply put these products in the mail; for about $20, you can get a package of up to four pounds mailed from China to New York.

It didn’t take long for some of those Chinese outfits to start making fentanyl; unlike heroin dealers, they didn’t need a source of opium. The chemistry involved isn’t especially challenging (not, for example, like making LSD). Fifty grams  of fentanyl – an ounce and a half – has the potency of a kilogram of heroin, and it’s way, way cheaper.

Somewhere in here someone figured out a technique for diluting the stuff with enough accuracy to reduce the consumer’s risk of a fatal overdose: far from perfectly, but enough to create a thriving market. And for a retail heroin dealer, the financial savings from buying fentanyl (or an analogue) rather than heroin, and the convenience of having the material delivered directly by parcel post rather than having to worry about maintaining an illegal “connection,” constituted an enormous temptation.

For law enforcement, the parcel-post approach makes a hard problem nearly impossible. The volume of legitimate parcel post from China to the U.S. means that there’s no way to scan every package, or even a high enough fraction to make the traffic uneconomic. As more and more potent molecules appear, I’d expect another shift, from parcel post to regular international mail, moving the drugs in quantities of a gram or less, perhaps dissolving them, soaking a sheet of ordinary paper in the solution, typing a letter on the paper, mailing it, and then extracting the drug at the other end of the process.

So that’s why the fentanyls are a big factor now when they weren’t before. And I don’t see a snowball’s chance in Hell of stopping the flow. It’s possible that, with adequate urging from the U.S., the Chinese authorities might succeed in cracking down on illicit manufacture and sale. But there’s nothing magical about China. India also has skilled chemists and a huge flow of mail to the U.S.  So, for that matter, does Canada. And so does the U.S.; if international sources dry up, the stuff will be made here.

On top of that, the “technology” of illicit retail drug distribution has been transformed by the introduction of mobile phones.

Thirty years ago, illicit retail drug transactions were characteristically carried out either in public locations (parks or street corners) or in dedicated drug-dealing locations (e.g., crack houses). Those locations tended to cluster heavily in low-income, high-crime urban neighborhoods where police had other priorities and neighbors were reluctant to call the police. Having to travel to such a location – risking arrest or robbery – constituted a significant barrier to illicit acquisition. Moreover, for open-air transactions, a buyer had to search for a willing seller–usually, a seller with whom he had an established connection – and that search took time (45 minutes was not uncommon) and sometimes failed entirely. Search time and risk constituted a second kind of “price” of illicit drugs, perhaps as significant (especially to new consumers) as the money price.

From the retailer’s point of view, that style of dealing meant exposure to both enforcement risk and the risk of robbery. It also greatly decreased the number of transactions a dealer could consummate in an hour, since most of his time was spent waiting for customers to arrive. Much of the retail price of illicit drugs represented compensation to the retail dealer for those risks and costs.

But with mobile phones, texting, and social media, transactions can now be arranged electronically and completed by home delivery, reducing the buyer’s risk and travel time to near zero and even his waiting time to minimal levels. In the recent Global Survey on Drugs, cocaine users around the world reported, that their most recent cocaine order was delivered in less time, on average, than their most recent pizza order.

These efficiencies reduce retailer’s costs and thus the margins they need to earn to stay in business. That in turn reduces the retail price. Bottom line: the stuff is cheap and easy to get, just about anywhere in the country. The websites will cheerfully sell in consumer quantities, cutting out the middlemen entirely.

So I’m tempted to reach a fairly grim conclusion: Preventing people from harming themselves by falling into substance use disorder – which often also means harming other people – through making abusable drugs more expensive and harder to get by making laws against selling them and enforcing those laws becomes a less and less workable policy over time. And no, I don’t believe in “drug prevention” (or in the Tooth Fairy). Making people genuinely resilient in the face of temptation can’t be done by chanting “Just Say No,” or by inventing ever more creative lies to tell to schoolchildren. Lots of people are going to be addicted, when strongly habit-forming and highly pleasurable drugs are available to them, for the same reason lots of them are going to wind up obese when they’re offered all the sweet, fatty, and salty food they can stuff themselves with, plus unlimited sedentary amusements.

At best, we might make it easier for people who want to use heroin and not the fentanyls to tell the difference by allowing them to have test kits, and maybe make the penalties for selling much higher for fentanyls than for heroin to give dealers a disincentive. But I wouldn’t bet the farm either that we will do those things or that they would work if we did them. So I think we’re going to wind up just making sure that naloxone is available to reverse as many otherwise-fatal overdoses as possible (it’s already reversing more than half) and that methadone and buprenorphine are available to help people with opioid dependency when they’re ready to stop risking their lives.

It’s likely that the current opioid epidemic will burn itself out, as the younger brothers and sisters, and children, of today’s problem opioid users decide to profit from the bad example of their elders. But the fentanyls aren’t going to be the last class of purely synthetic and super-potent recreational chemicals; they’re just the first.

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DGA51
24 days ago
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More than you wanted to know but almost everything we should know
Central Pennsyltucky
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#YoungLivesMatter: US Infant and Child Mortality

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Including Santa Fe High School, I count 32 deaths from school shootings so far in 2018. It’s a shocking number. Nevertheless, school shootings are an uncommon cause of death. What has received less attention are the high overall mortality rates for US children and youth. I want to examine these deaths and then comment on the light they shed on US population health.

Here’s why I think that too many US children die. In Health Affairs, Ashish Thakrar and colleagues analysed US infant (birth to the first birthday) and child (1-19 years old) mortality rates (hereafter, I’ll say pediatric to refer to both age groups). They compared these mortality rates to 19 peer countries* in the Organisation for Economic Co-operation and Development (OECD). Thakrar et al. estimated age-specific mortality rates from the pooled OECD data. They then applied these age-specific OECD mortality rates to the age-structure of the US pediatric population, for the years 1960-2010. This allowed them to calculate the number of deaths that would have occurred in the US during these years if, counterfactually, the US had had the mortality rates of the OECD. The counterfactual death counts based on the OECD mortality rates were lower which, conversely, meant that the US had an excess of pediatric deaths. Thakrar:

The United States has poorer child health outcomes than other wealthy nations despite greater per capita spending on health care for children… While child mortality progressively declined across all countries [from 1960 to 2010], mortality in the US has been higher than in peer nations since the 1980s. From 2001 to 2010 the risk of death in the US was 76 percent greater for infants and 57 percent greater for children ages 1–19.

Childhood mortality has been falling in the US and the OECD throughout this period. Epidemiologists saw this and celebrated the progress. What they didn’t notice was that, as the graph shows, mortality rates weren’t falling as fast in the US as in the rest of the OECD.

Changes in US and OECD infant and child mortality rates.

To appreciate what this difference means, it’s helpful to convert rates into counts. We’ll focus on the most recent period, from 2001 to 2010. US infants had a mortality rate of 68.8 deaths/10,000 infants during this decade, but the OECD infant mortality rate was only 39.0 deaths/10,000 infants.§ So,

Excess Infant Deaths/10,000 = 68.8 Deaths/10,000 – 39.0 Deaths/10,000

= 29.8 Excess Infant Deaths/10,000.

This is a small probability: 29.8 Excess Infant Deaths/10,000 is an additional probability of 0.00298 that an infant will die.

So, how many excess infant deaths are there? It turns out that small probabilities can have big consequences. There are about four million children born in the US each year. Therefore,

Excess US Infant Deaths = Probability(An Excess Death)/Year × Infant Population

= 0.00298/Year × 4 million Infants = 11,920 Excess Infant Deaths/Year.

Likewise, the US mortality rate for children aged 1-19 years, 3.1 deaths/10,000 children, was higher than the 2.0 deaths/10,000 children that would have occurred if the US had had the OECD child mortality rate. This means there were 1.1 Excess Child Deaths per 10,000 children. There are 76 million children aged 1-19 years during any given year, so

Excess US Post-Infant Deaths/Year = 0.00011 × 76 million Children 1-19

= 8,360 Excess Child Deaths/Year.

Finally,

Excess Pediatric Deaths/Year = 11,920 Infants + 8,360 Children

= 20,280 Pediatric Deaths/Year.

This is greater than the number of AIDS deaths each year. It’s about half the number of motor vehicle deaths (for all ages). Hurricane Katrina caused 1,833 deaths. If we scale excess pediatric deaths in Katrina units, then the annual excess US pediatric deaths comprise just over 11 Katrinas.

However, the comparison to Katrina understates the problem. This is because the children who suffered excess deaths were about five years old when they died, on average. At that age, the Social Security Administration estimates that they had 74 years of life expectancy remaining. Call this Years of Life Lost/Death or YLL.  The Katrina victims were on average 69 years old when they died. At that age, Social Security estimates that they lost 16 years of life.

If so, then the Total Years of Life Lost (TYLL) for Katrina was

TYLL(Katrina) = Katrina Deaths × YLL(Katrina)/Death

= 1,833 Deaths × 16 Years Lost/Death

= 29,328 Years.

Whereas for excess US pediatric deaths, we have

TYLL(US Pediatric) = Excess Pediatric Deaths × YLL(US Pediatric)

= 20,280 Deaths × 74 Years Lost/Death

= 1,500,720 Years.

If you want to recall one number from this, it might be that there are 1.5 million years of life lost each year due to excess pediatric deaths. Or, roughly, 70 Katrinas.

Now, how should we interpret these calculations? They are dependent on our choice of a benchmark and several assumptions. No one went out and determined whether a given dead child was an expected or excess death. You should attach wide error bars to these numbers. Nevertheless, the magnitude of the number of excess US pediatric deaths is huge and will remain large even if we substantially shrink these numbers to reflect our uncertainty.

This is more evidence that US population health is far worse than it should be. Recent discussions of US mortality have focused on alarming increases in opioid deaths, adult mortality in economically deprived areas, and a decrease in overall life expectancy. Large numbers of excess pediatric deaths are part of this story.

There is no single cause for this. The US fell behind the OECD in reducing pediatric mortality rates in the 80s and has stayed there since, across many administrations, so there is no reason to make this a partisan issue. We should just study the causes of infant and child mortality and address them. Thakrar:

Policy interventions should focus on infants and on children ages 15–19, the two age groups with the greatest disparities [between the US and the OECD in cause-specific mortality rates], by addressing perinatal causes of death, automobile accidents, and assaults by firearm.

We could approach this as litigation for or against the United States, debating whether Americans have, collectively, neglected their children. But this makes little sense. Excess deaths are inferred, not witnessed. Let’s view this as an opportunity: We have discovered that each year there are 20,000 lives that could be saved.


*The OECD comparison countries were Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland, and the United Kingdom. Canada, by the way, also performs worse than the OECD average, although better than the US.

§Unfortunately, the deaths of premature infants are counted differently in the US and some other countries. Some countries do not count the deaths of infants with very low gestational age (e.g., 24 weeks or earlier) as infant deaths, whereas the US does. This problem will tend to inflate the estimated number of excess infant deaths. Thakrar et al. acknowledge this problem, but they could not correct it using the available data. However, CDC analyses show that the US has higher infant mortality even after adjusting for this. There would be substantial numbers of US excess infant deaths, even if this problem could be corrected.

Many analysts argue that calculations of YLL should not use the raw life expectancy that a person had at the time of their premature death, but rather a life-expectancy that discounts the value of future years of life, conventionally at a rate of 3%/Year. For discount rate r and undiscounted life expectancy K, the formula for calculating this is

Discounted(YLL) = ∑ (1 + r)k,

where the summation is from k = 0 to K – 1. Using this, Discounted YLL(Katrina) = 12.9 Years/Death. This means that

Discounted TYLL(Katrina) = 23,751 Years.

Carrying out a similar calculation for US children, we have

Discounted TYLL(US Pediatric) = 618,418 Years.

Then the annual total years of life lost due to excess US child deaths, in discounted years, is 26 Katrinas.

@Bill_Gardner

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DGA51
25 days ago
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If you are a person interested in demographics, this should be interesting.
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This Is Iran Plan B?

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Pompeo’s Blustery Threats Further Isolate the U.S. From Russia, China and Our Allies

Now that Trump has taken the United States out of the multi-national Iran nuclear weapons treaty, the question is what are we doing in its place?

We got the first stab at a Plan B from Secretary of State Mike Pompeo, who on Monday threatened to impose “the strongest sanctions in history” on Iran unless it takes dramatic steps, including permanently abandoning its nuclear program, halting missile tests and withdrawing military forces from Syria.

Of course, if that were the case, we wouldn’t have needed Plan A, which required threading the needle among European allies, Russia and China in a tentative alliance that, despite strains, seemed to be holding. Only Trump decided while a candidate that the original deal hadn’t gone far enough in non-nuclear areas. Thus, the deal.

There were critics who quickly called Pompeo’s new demands unrealistic and warned that they put the U.S. on a dangerous new collision course with Tehran—as well as with European allies who oppose Trump’s crackdown on Iran and who presumably will face potential U.S. sanctions from continuing to do business with the country.

Supporters said the speech outlined a robust approach to dealing with Tehran, following the administration’s decision to withdraw from an international deal in which Iran agreed to curb its nuclear weapons program in exchange for economic sanctions relief.

Pompeo stopped just short of issuing a military threat against Iran and again denounced the nuclear deal, formally known as the Joint Comprehensive Plan of Action, as a misguided attempt to prompt the Iranian government into better behavior on the regional and world stage.

The words were direct and certain: “The sting of sanctions will be painful if the regime does not change its course from the unacceptable and unproductive path it has chosen to one that rejoins the league of nations. These will indeed end up being the strongest sanctions in history when we are complete,” Pompeo told the Heritage Foundation. “Iran will be forced to make a choice: either fight to keep its economy off life support at home or keep squandering precious wealth on fights abroad. It will not have the resources to do both.”

In Iran, President Hassan Rohani said Tehran does not accept the United States making decisions for it, in a defiant response to Pompeo’s announcement of tough economic sanctions against Iran. “The world today does not accept that the United States decides for the world. Countries have their independence,” Rohani said.”Who are you to decide for Iran and the world?”

Columnist Josh Rogin in The Washington Post said Pompeo’s speech left huge questions about the “new strategy” unanswered. Pompeo could have outlined how the United States will continue to negotiate with European allies for a supplemental agreement to strengthen the Iran deal, but he did not. “That is certainly their decision to make. They know where we stand,” Pompeo e said. “We understand our re-imposition of sanctions and the coming pressure campaign on the Iranian regime will pose financial and economic difficulties for a number of our friends. But you should know that we will hold those doing prohibited business in Iran to account.”

In all, Pompeo called on Iran to fulfill 12 huge demands—including removing its forces from Syria—but didn’t mention that Trump still wants to end U.S. involvement in that country. But Pompeo offered no specifics on what happens next if Iran doesn’t buckle under the new pressure and change its ways.

Pompeo did not mention Russia or China. He never really offered the Iranian view of why that country would not agree.

Perhaps we are seeing the Trump escalation to threat as part of imagined negotiation over smaller issues, which is how these people explain what may become a success with North Korea.  But success in North Korea looks newly problematic, and Iran is no North Korea. It is not easy to isolate, and there is no unanimity among American allies and partners.

“This is what happens when the United States makes foreign policy based on Trump’s long-held instincts and biases and his obsessive urge to do the opposite of whatever the Obama administration did. The rest of the world is left to fall into line or suffer punishment at the hands of the United States. The fact that the European countries that are party to the Iran deal are even considering choosing punishment over cooperation should shock those who care about the transatlantic alliance,” argued Rogin.

It is even possible that despite sanctions, Iran remains in the deal, adhering to all the restrictions and inspections that now exist. But it still doesn’t solve the problem Pompeo says he is focused on Iran’s aggression all over the Middle East.

Pompeo did not “present a diplomatic roadmap to achieve a new security architecture and a better security framework, a better deal, following Trump’s decision to end America’s participation” in the Iran deal. What Pompeo delivered fell far short of that.

Punishing Iran is not a successful path. Doing so alone obviously will not be successful either. Sanctions are not a strategy.

Pompeo also offered a warning to the Iranian government against restarting its nuclear program: “It will mean bigger problems, bigger problems than they’ve ever had before.”

Mark Dubowitz, who heads the hawkish Foundation for the Defense of Democracies and was an intense critic of the Iran deal who nonetheless advocated against scrapping it told Politico that “Pompeo provided a clear Plan B: Intensify the Iranian regime’s ongoing liquidity and political crisis to force fundamental changes in its behavior across a range of malign activities with the promise of a big diplomatic deal if they do,” Dubowitz said in a statement issued through the foundation. “In short: Maximum diplomacy backed by maximum pressure.”

I’d watch for a more coherent strategy from Israel.

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DGA51
26 days ago
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Undoing things isn't all that easy after all.
Central Pennsyltucky
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