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Monday, August 31, 2020

Big tech economic hegemony and the future of markets

…Today we rightly celebrate the Sherman Antitrust Act of 1890, which gave Americans the power to break apart private corporations. But in many respects, the Interstate Commerce Act of 1887 was the more important document. This act was based on the understanding that monopoly networks like the railroad and the telegraph could be used to influence the actions of people who depend on them, and hence their power must be carefully restricted, in much the same way that we restrict the power of government. As Senator Sherman himself put it,
"It is the right of every man to work, labor, and produce in any lawful vocation and to transport his production on equal terms and conditions and under like circumstances. This is industrial liberty, and lies at the foundation of the equality of all rights and privileges."
For a century and a half, Americans used common carrier policies to ensure the rule of law in activities that depended on privately held monopolies. These rules served as a pillar of American prosperity through much of the twentieth century. By neutralizing the power of all essential transport and communications systems, the regulations freed Americans to take full advantage of every important network technology introduced during these years, including telephones, water and electrical services, energy pipelines, and even large, logistics-powered retailers. Citizens did not have to worry that the men who controlled the technologies involved would exploit their middleman position to steal other people’s business or disrupt balances of power.

In the 1970s and 1980s, Robert Bork, Richard Posner, and other neoliberal Chicago School legal scholars set out to overturn America’s antimonopoly regime, targeting the traditional prohibitions on discrimination that common carrier laws had established. Their scholarship later played a major role in the writing of Section 230 of the Communications Decency Act of 1996. In that bill, Congress simultaneously exempted internet platforms from any responsibility to police the content on their sites, and failed entirely to impose on them any requirement to provide equal and just service to all who depend on their networks.

As a result, Amazon, Google, Facebook, and other platforms were free to develop business models that treated every seller and buyer—every citizen—differently. These corporations exploited this license to the fullest, and have used their power to reorganize entire realms of human activity. Amazon, Google, and Facebook match individuals to specific shoes and clothes, specific restaurants and hotels, specific movies and music, specific jobs and schools, specific drugs and hospitals, specific sexual partners, and even specific books, articles, speakers, and sources of news.

These companies are the most powerful middlemen in history. Each guards the gate to innumerable sources of essential information, services, and products. Yet thus far no governmental entity in the United States has signaled any intention of limiting the license these corporations enjoy to serve only the customers they choose to, at whatever price they decide.

This means that Jeff Bezos, Sergey Brin, Larry Page, and Mark Zuckerberg enjoy much the same power as God did in Babel. We live in the world they manufacture for us. Their vision for what we should do, where we should go, how we should think, and who we should be is now our vision, too. As their manipulation machines increasingly deliver different information to each member of the public, it becomes harder for people to engage in debate and have any chance at bringing these companies under control…

From Harper's.

Imagine going to the supermarket or department store and being charged prices for your items based on your purchase histories and other Big-Tech-gleaned personal data. Absurd? Read the entire article (may be paywalled).


...In 2018, an Irish technologist named Dylan Curran downloaded the information Google had collected about him. All in all, Curran found, the corporation had gathered 5.5 GB of data on his life, or the equivalent of more than three million Word documents. 
In an article for the Guardian, Curran wrote that within this trove he found 
"every Google Ad I’ve ever viewed or clicked on, every app I’ve ever launched or used and when I did it, every website I’ve ever visited and what time I did it. They also have every image I’ve ever searched for and saved, every location I’ve ever searched for or clicked on, every news article I’ve ever searched for or read, and every single Google search I’ve made since 2009. And . . . every YouTube video I’ve ever searched for or viewed, since 2008." 
In addition, Curran discovered that Google keeps a detailed record of what events he attends and when he arrives, what photos he takes and when he takes them, what exercises he does and when he does them. And it has kept every email he has ever sent or received, including those he has deleted...

Ponder the implications.

It's by no means limited to Amazon, Google, and Facebook.

Uber’s vast cache of data about where people go and when provides an ever more perfect map of traffic to and from a community’s bookstores and coffee shops and churches—and to its backroom casinos and drug dealers and sex clubs.

All this information gives the corporation the ability to understand just how badly you need a ride. Do you rush off every Thursday at 8 pm to see your boyfriend? Do you like to squeeze your Sunday visit to mom in between a morning round of golf and the afternoon NFL game? Every Tuesday and Thursday at 3 pm, do you have to get to your psychiatrist and back without your boss knowing?

Well, your boss may not know, but Uber does...
Don't get me started on the con that is Uber.

I worked in subprime credit risk analytics and management (large pdf), 2000-2005. We had many, many facts regarding our customers and prospects in our own databases that we couldn't legally use in our vetting.

It's a different world now. The unregulated digital panopticon is here.
"In the world of Amazon, Google, and Facebook, not only are we subject to the will of a few private companies, manipulated moment to moment by unseen forces that rule our commerce, track our movement, and record our every thought. Each of us must now suffer alone, with less and less ability to commiserate with others about our common problems. The power of the middleman has become so great as to make each of our problems unique, solely a matter between us and the master."

Click the image.

Final thought for the moment (one mapping to the original Health IT focus of this blog). Recall how interoperable EHRs were going to bring us to the clinical nirvana of "personalized medicine?" 'eh?

Can you say "finely tuned personalized rationing by price and ability to pay, as intermediated by Big Tech?"

See also my prior post,

GAFA, Really Big Data, and their sociopolitical implications

And, my latest read:

Something broke in the American economy around 1978. It stopped functioning as well as it had for working-class people over the previous several decades. The great middle-class expansion was ending. A middle-class shrinkage was starting. At the center of it all was a divergence…

The divide was opened by technological progress and an accompanying economic evolution that shifted the business of the United States away from building or fixing things with your hands and toward helping people or solving puzzles with your brain. In a world where machines get better every year at doing work previously handled by humans, some of that evolution was inevitable. The pace and the scope of the change were not. They were stoked by policymakers, usually in Washington, and cheered on by the titans of commerce who just so happened to reap the rewards more than anyone else.

Tankersley, Jim. The Riches of This Land (p. 99). PublicAffairs. Kindle Edition.

Recommend triangulating it with these two.

My recommendation rationale will become self-evident.


Finished Jim Tankersley's book. Really enjoyable, thought-provoking work. Indeed, triangulate with the Andersen and Kendi books. The topic (of rebuilding a morally healthy economy and society) is urgent, exigent. Grist for a post of its own, ASAP.

“Surprising and enlightening and timely. The Riches of This Land turns our understanding of why America once had an economy that delivered prosperity on its head. Only when black men, women of all races, and immigrants broke through blockades of oppression did their gains flow out to everyone. And, now, as Americans seek to find their way out from another devastating economic crisis, Tankersley exposes the true heroes of American prosperity—and why they are the source of our future renewal.” —Ibram X. Kendi [pg 272]

Also germane, a book I cited in my August 23rd post:


More to come...

Friday, August 28, 2020

The Past Tense Pandemic

White House grounds, August 27th. Donald Trump's re-election convention finale.

More than 1,500 supporters compactly crowded in, hardly a mask in sight. Attendees were reportedly not screened for the coronavirus (neither via exposure questions nor testing). The audience did, however, hear at length about the existential horrors awaiting all Americans in the wake of a Biden-Harris win on November 3rd.

Senior Trump officials have repeatedly referred to the Covid19 pandemic in past tense language, notwithstanding more than 181,000 U.S. Covid deaths as of today, and mounting.

CNN--A well-known coronavirus model previously cited by the White House forecasts more than 317,000 US deaths from Covid-19 by December.

As of Friday morning, the model from the Institute for Health Metrics and Evaluation at the University of Washington projects that 317,312 people may die from the illness -- marking an increase of about 8,000 deaths from a previous estimate the model projected one week ago…


"I know it when I see it." #HatchActViolations 


Ahhh... "Norms?


Okeee dokeee, then.



More to come...

Sunday, August 23, 2020

In late 2016, Americans opted to have the cure be worse than the disease.

There are now 72 days left (and counting down) until the Constitutional opportunity via which to rectify the existential error.

My post the day after Election Day 2016. Then a month later. And then on the eve of January 20th Inauguration Day.

No, I don't like him. Seriously, (unsurprisingly to my regulars). With ample rational reason. See also my 2018 post on the midterms. He merely wanted the title of "President," not the actual job.

We have deep trouble. On myriad fronts

If our political / cultural "disease" was in large measure that of snooty anti-populist, anti-flyover country "limousine liberalism," the "cure" of Donald Trump has garishly failed to demonstrate "efficacy." Quite the contrary.

apropos, my most recent read:

29: The Plague Year and Beyond
When the original band of intellectuals and CEOs and politicians and the very rich began pursuing their dream of hijacking the U.S. political economy and dragging it back in time to the days before the New Deal, surely none of them imagined they’d wind up here. By which I mean either the scale and durability of their victory, or with such a front man—so deranged and unpleasant and idiotic, so brazenly racist and xenophobic and misogynistic, a businessman yet so completely incompetent as an executive. Today’s evil geniuses find him embarrassing and tiresome. All they and their predecessors ever really wanted was a system permanently guaranteeing them inordinate fortunes and power, with a clubbable Bush or Romney at the helm. Over the decades, however, as they decided again and again that their ends (money, supremacy) always justified any and all means (stoking racism and other hatreds, spreading falsehoods, rousing their rabble while also rigging the system against them), it was bound to end somewhere in this horrid vicinity. In 2016, as the current generation of Fausts made their darkest bargain yet, surely some of them smelled a whiff of sulfur or heard a demonic cackle as they signed away whatever remained of their souls.

The obeisance of the rich right and their consiglieri to Trump for the last four years has exposed more nakedly than ever their compact—everything about money, anything for money—and the events of 2020 pushed that along to an even more shameless, grotesque crescendo. In early spring, when COVID-19 had killed only dozens of Americans, Stuart Stevens, a strategist for four of the five previous GOP presidential nominees but now a fierce apostate, wrote that “those of us in the Republican Party built this moment,” because “the failures of the government’s response to the coronavirus crisis can be traced directly to some of the toxic fantasies now dear to the Republican Party… Government is bad. Establishment experts are overrated or just plain wrong. Science is suspect.”

He could have also listed Believe in our perfect mythical yesteryear, All hail big business, Short-term profits are everything, Inequality’s not so bad, Universal healthcare is tyranny, Liberty equals selfishness, Co-opt liberals, and Entitled to our own facts as operating principles of the Republican Party and the right. During the first six months of 2020, all those maxims drove the responses (and the nonresponsiveness) of the Trump administration and its extended family of propagandists and allies and flying monkeys...

Andersen, Kurt. Evil Geniuses (pp. 367-368). Random House Publishing Group. Kindle Edition


Just watched an Amanpour & Co interview with Jonah Berger. Bought his new book. Stay tuned.

Reactance, Endowment, Distance, Uncertainty, and Corroborating Evidence can be called the five horsemen of inertia. Five key roadblocks that hinder or inhibit change.

Each chapter focuses on one of these roadblocks, and how to reduce it. Integrating research and case studies to illustrate the underlying science behind each roadblock and the principles that individuals and organizations have used to mitigate it.

These five ways to be a catalyst can be organized into an acronym. Catalysts reduce Reactance, ease Endowment, shrink Distance, alleviate Uncertainty, and find Corroborating Evidence. Taken together, that forms an acronym, REDUCE. Which is exactly what great catalysts do. They REDUCE roadblocks. They change minds and incite action by reducing barriers to change...

Berger, Jonah. The Catalyst: How to Change Anyone's Mind (p. 13). Simon & Schuster. Kindle Edition.


Finished the book. Buy it and read it. From the Epilogue:

Behavioral scientist Kurt Lewin once noted, “If you want to truly understand something, try to change it.” But the reverse is also true. To truly change something, you need to understand it.

Too often, as potential change agents we focus on ourselves. We center on the outcome we’re looking for or the change we’re hoping to see. We’re so blinded by the belief that we’re right that we assume if we just provide more information, facts, or reasons, people will capitulate.

But more often than not, things don’t budge. And by focusing so much on ourselves and what we want, we forget the most important part of change: understanding our audience.

Not just who they are, and how their needs might be different than ours, but—as we’ve talked about throughout the book—why they haven’t changed already. What barriers or roadblocks are stopping them? What parking brakes are getting in the way?

The more we learn about what is preventing someone from changing, the easier it is to help. And to realize that things aren’t as zero-sum as they may seem.

People think that, when changing minds, someone has to lose. Either they change or I’m worse off. That things are black-and-white and there are only two ways to go.

But the truth is often more complex...
[pp 221-222] 

Goes to my interest in so-called "Deliberation Science."


Two years since my SAVR px, Aug 23rd, 2018. Grateful to still be alive, Parkinson's and all.


More to come...

Monday, August 17, 2020

Stage IV Metastatic Crazy

Props to Digby's blog

[Trump ex-wife Marla] Maples, who dabbles in wellness influencing, has periodically mentioned the global pandemic to her Instagram following of 114,000—recommending Vitamin C IV drips, morning prayer, and an idiosyncratic hand-washing method in which she pours a mug of water on her hands without soap. But Tiffany Trump’s mother has stayed largely quiet on the political dimensions of the virus, including how her ex-husband has handled it. Her Thursday post, spotted by CNN’s Betsy Klein, fed into the unfounded, but widely-held belief that Bill Gates has hatched a plot to implement tracking devices on billions of people under the guise of a COVID-19 vaccine. (Maples did not respond to requests for comment)...

Occam's Chainsaw
... Cuckoo for Covid Puffs... 


Per the Wiki:

The conspiracy theory, disseminated mainly by supporters of Trump as The Storm and The Great Awakening—QAnon's precepts and vocabulary are closely related to the religious concepts of millenarianism and apocalypticism, leading it to be sometimes construed as an emerging religious movement—has been widely characterized as "baseless", "unhinged", and "evidence-free". Its proponents have been called "a deranged conspiracy cult" and "some of the Internet's most outré Trump fans".

According to Travis View, who has studied QAnon and written about it extensively for The Washington Post, the essence of the theory is that:
there is a worldwide cabal of Satan-worshiping pedophiles who rule the world, essentially, and they control everything. They control politicians, and they control the media. They control Hollywood, and they cover up their existence, essentially. And they would have continued ruling the world, were it not for the election of President Donald Trump. Now,     Donald Trump in this conspiracy theory knows all about this evil cabal's wrongdoing. But one of the reasons that Donald Trump was elected was to put an end to them, basically. And now we would be ignorant of this behind-the-scenes battle of Donald Trump and the U.S. military—that everyone backs him and the evil cabal—were it not for "Q." And what "Q" is, is basically a poster on 4chan, who later moved to 8chan, who reveals details about this secret behind-the-scenes battle, and also secrets about what the cabal is doing and also the mass sort of upcoming arrest events through these posts.
Followers of QAnon also believe that there is an imminent event known as "The Storm", in which thousands of people, members of the cabal, will be arrested, possibly sent to Guantanamo Bay prison or to face military tribunals, and the U.S. military will brutally take over the country. The result of The Storm will be salvation and utopia on earth…
Occam's seriously gonna need a bigger chainsaw. (BTW, check out the huge market of QAnon swag on Amazon. No one ever went broke underestimating The Stupid in the U.S.)

See also The Atlantic's "QAnon is a New American Religion."



Trump (asked by a press conference reporter about QAnon): “I don’t know much about the movement, other than I understand they like me very much, which I appreciate. But I don’t know much about the movement but I have heard that it is gaining in popularity and from what I hear these are people that when they watch the streets of Portland, when they watch what happened in New York City in just he last six or seven months , but this was starting even four years ago when I came here. Almost four years, can you believe it? These are people who don’t like seeing what’s going on in places like Portland and places like Chicago and New York and other cities and states and I’ve heard these are people who love our country and they just don’t like seeing it.

So I just don’t know anything about it other than they do supposedly like me very much and they would also like to see problems in these areas, especially the areas we’re talking about go away. Because there’s no reason the Democrats can’t run a city and if they can’t we will send in all of the federal whether it’s troops or law enforcement, whatever they’d like. We’ll straighten out their problems in 24 hours or less, ok?”

Reporter: The crux of the theory is this belief that you are saving the world from this satanic cult of pedophiles and cannibals. Does that sound like something you’re behind?

Trump: “Well, I haven’t heard that. But uh, is that supposed to be a bad thing? Or a good thing? If I can help save the world from problems I’m willing to do it. I’m willing to put myself out there. And we are actually. We are saving the world from the radical left philosophy that will destroy this country and when this country is gone, the rest of the world would follow.”


See also "Herd Insanity" by Tom Sullivan. Spot-on. "QAnon feels like a digital prank that took on a life of its own."

Final note here: Cataloging The Current Crazy ought include the "Boogaloo Movement" and the "Proud Boys." The former is yet another rag-tag nitwit contingent of delusional Playtriot poseurs, while the latter is more on the conventional racist thuggery side.


Science-Based Medicine.


Dexamethasone and Hydroxychloroquine: Why Randomized Controlled Trials Matter
What does the best evidence tell us about hydroxychloroquine and dexamethasone?

With COVID-19 cases continuing to rise, and no vaccine available anytime soon, investigations into repurposing existing drugs, to treat or prevent infections, continue to be a priority. Thankfully, the evidence base has improved dramatically since the early months of 2020, where there was almost nothing to guide treatment. Initial observations, starting in China and then Europe, led to case series reports and eventually, medical professionals started to form hypotheses about potentially effective therapies. Some of these approaches sounded plausible, and weak but promising observational studies started to emerge, showing correlations between specific treatments and better outcomes for patients. At the same time, randomized controlled trials (RCTs) were launched, based on the expectation that (1) these therapies might offer some benefit and (2) better evidence was needed. Randomized controlled trials are experiments that are intended to reduce sources of bias, which can confound or distort the findings that come from observational studies. RCTs of COVID-19 treatments are now appearing regularly, as there has been adequate time to plan them, recruit patients, administer the therapy, collect data, and then evaluate and publish the results. And the conclusions of these trials show that some previously promising therapies have not been shown to work. This 180° pivot in treatment advice after only a few months may seem bewildering – after all, if the medical advice isn’t consistent, why should you believe the newest evidence? But the findings of RCTs are exactly what we should have expected when we started treating COVID-19 based on on anecdotes and research that were almost certain to have hidden biases. As more robust evidence has emerged, the evidence-based approach to treating COVID-19 is changing. And it will continue to change. That is a good thing. One way to illustrate this evidence evolution is to examine two therapies that were both initially thought to be promising: Hydroxychloroquine and dexamethasone…



More to come...

Friday, August 14, 2020

Covid19 fatality undercount?

 From the NY Times.

Interesting analysis. There remains a good bit of political contention regarding what legitimately counts as a "confirmed case" and a covid19 "cause of death."


The surprising benefits of contemplating your death
Now is the perfect time to face your fear of mortality. Here’s how.

Nikki Mirghafori has a fantastically unusual career. After getting a PhD in computer science, she’s spent three decades as an artificial intelligence researcher and scientific advisor to tech startups in Silicon Valley. She’s also spent a bunch of time in Myanmar, training with a Buddhist meditation master in the Theravada tradition. Now she teaches Buddhist meditation internationally, alongside her work as a scientist.

One of Mirghafori’s specialties is maranasati, which means mindfulness of death. Mortality might seem like a scary thing to contemplate — in fact, maybe you’re tempted to stop reading this right now — but that’s exactly why I’d say you should keep reading. Death is something we really don’t like to think or talk about, especially in the West. Yet our fear of mortality is what’s driving so much of our anxiety, especially during this pandemic.

Maybe it’s the prospect of your own mortality that scares you. Or maybe you’re like me, and thinking about the mortality of the people you love is really what’s hard to wrestle with.

Either way, I think now is actually a great time to face that fear, to get on intimate terms with it, so that we can learn how to reduce the suffering it brings into our lives…

Great interview and podcast. I've certainly reflected on my own mortality lately, given the ongoing pandemic. Grateful to simply still be alive.

See also my 2016 post "A billion tons of human bones."

I am also reminded of a recent Arthur C. Brooks article:

I suspect that my own terror of professional decline is rooted in a fear of death—a fear that, even if it is not conscious, motivates me to act as if death will never come by denying any degradation in my résumé virtues...

More to come...

Wednesday, August 12, 2020

Lock & Load: Game On


Neither were my first choices. Notwithstanding, the net choice is starkly clear. Less than 90 days to go now. The stakes could not be higher.

This morning on Twitter:

No, no racial dog-whistling there.



More to come...

Saturday, August 8, 2020

Losing focus during the Covid19 pandemic?

As the calendar turned to 2020, I, like most of us outside the epidemiologic and virology disciplines, had no idea that the rapidly spreading global Covid19 illness would escalate to consume just about all of our aggregate attention and increasingly debilitate the world's economies.

I first made a passing allusion to it in my January 18th post, subsequently initially posting the Johns Hopkins tracking site info on February 11th. On March 12th, I played my last game of hoops at the Towson BYKOTA center I'd joined back in the fall of 2019. They closed that evening until further notice (and remain thus).

Beginning Monday March 16th I began posting pretty much all Covid-related lead-in topics all the time. The coronavirus screening issues continue to bedevil us.

I mostly observed the "stay-at-home" public health advice, venturing out infrequently, only as necessary. Newly diagnosed with Parkinson's in December (w/ annoying symptoms elevating), and a year and a half out of open heart aortic valve replacement, I didn't (and still don't) like my ICU intubation/ventilator odds in the event of my encountering a case of Covid19.

Been getting caught up on a ton of reading, dozens of compelling books, in addition to my routine long list of periodicals and daily blog stops. Annie Duke's and Maria Konnivoka's books were awesome, and they sent me back to closer study of the original von Neumann "Theory of Games."

Grateful to not be in the dire economic circumstances now afflicting so many people. Grateful that my son and Eileen have not lost their jobs, and that new grandson Calvin is thriving, as is my preemie great-grandson Kai (born 7 weeks early).

Still, nearly five months of being so circumscribed (with dubious end in sight) is starting wear on my motivation, my focus apropos of topical direction going forward. I'll get back on track.

I'm sure I'm by no means alone in that regard. We slog on, I guess, amid our enervating "Concurrent Pandemics."

4.3% of world population, 25.4% of confirmed cases, 22.3% of case fatalities.



apropos of my recent prior post.

As I noted,
“Given the practical logistical impossibility of legislating, litigating, or prosecuting every last bit of contentious human interaction, consensus "norms" provide both the mediating lubricants and constraints of civil self-governance.”

Minimally, "norms" are those policies and behaviors we tolerate, often by mere passive acquiescence. They are by no means all rational or beneficent. Case in point; our recently ascendant presidential "leadership" norms of reflexive hostility toward expertise and science.


The first half of 2020 has seen extraordinary accomplishments in science. The international scientific community has described the genomic sequence of the virus that causes coronavirus disease 2019 (COVID-19) and structures of its important proteins, elucidated principal aspects of the immune response, identified neutralizing antibodies that can serve as therapeutics, and developed promising vaccines. There is much more to learn about COVID-19 and its cause, but the achievements so far are remarkable. So why doesn't this progress feel like the triumph that it is?

Public health guidance is ignored, reopening businesses happens too fast, people fight over wearing masks, and the forces that undermine confidence in vaccines proceed unimpeded. Scientists who burn the midnight oil in academia, government, and industry to decipher COVID-19 are confronted with political leaders who downplay and criticize their tireless efforts. Many are immigrants who hear that they aren't welcome in the United States. President Trump and his allies are sticking their fingers in the eyes of the very people who can lead the world out of this calamity…

Having botched the distribution of diagnostic tests to get ahead of the pandemic, disemboweled the CDC, trampled on its own experts, stoked conspiracy theories about wearing masks and the origins of the virus, pushed an unproven treatment that proved worthless, stepped on the independence of the NIH, and audaciously attacked Fauci, the Trump administration does not inspire confidence in its ability to make sound public health decisions. With no strategy, a vaccine is the government's best way out of the pandemic crisis.

It's not too late to get it right. We need clear decision-making by experts, articulated crisply and without interference. This is not a time for leading with the gut, building up false hope, or making speculative bets. It's time to let the data do the talking.

Science is doing its part. Over to you, Mr. President.

In the wake of the George Floyd murder.


More to come...

Monday, August 3, 2020

The Covid19 pandemic is not getting any better

Impressive, important long-read from The Atlantic.
How did it come to this? A virus a thousand times smaller than a dust mote has humbled and humiliated the planet’s most powerful nation. America has failed to protect its people, leaving them with illness and financial ruin. It has lost its status as a global leader. It has careened between inaction and ineptitude. The breadth and magnitude of its errors are difficult, in the moment, to truly fathom.

In the first half of 2020, SARS‑CoV‑2—the new coronavirus behind the disease COVID‑19—infected 10 million people around the world and killed about half a million. But few countries have been as severely hit as the United States, which has just 4 percent of the world’s population but a quarter of its confirmed COVID‑19 cases and deaths. These numbers are estimates. The actual toll, though undoubtedly higher, is unknown, because the richest country in the world still lacks sufficient testing to accurately count its sick citizens.

Despite ample warning, the U.S. squandered every possible opportunity to control the coronavirus. And despite its considerable advantages—immense resources, biomedical might, scientific expertise—it floundered. While countries as different as South Korea, Thailand, Iceland, Slovakia, and Australia acted decisively to bend the curve of infections downward, the U.S. achieved merely a plateau in the spring, which changed to an appalling upward slope in the summer. “The U.S. fundamentally failed in ways that were worse than I ever could have imagined,” Julia Marcus, an infectious-disease epidemiologist at Harvard Medical School, told me…

Many of the people I interviewed tentatively suggested that the upheaval wrought by COVID‑19 might be so large as to permanently change the nation’s disposition. Experience, after all, sharpens the mind. East Asian states that had lived through the SARS and MERS epidemics reacted quickly when threatened by SARS‑CoV‑2, spurred by a cultural memory of what a fast-moving coronavirus can do. But the U.S. had barely been touched by the major epidemics of past decades (with the exception of the H1N1 flu). In 2019, more Americans were concerned about terrorists and cyberattacks than about outbreaks of exotic diseases. Perhaps they will emerge from this pandemic with immunity both cellular and cultural.

There are also a few signs that Americans are learning important lessons. A June survey showed that 60 to 75 percent of Americans were still practicing social distancing. A partisan gap exists, but it has narrowed. “In public-opinion polling in the U.S., high-60s agreement on anything is an amazing accomplishment,” says Beth Redbird, a sociologist at Northwestern University, who led the survey. Polls in May also showed that most Democrats and Republicans supported mask wearing, and felt it should be mandatory in at least some indoor spaces. It is almost unheard-of for a public-health measure to go from zero to majority acceptance in less than half a year. But pandemics are rare situations when “people are desperate for guidelines and rules,” says Zoë McLaren, a health-policy professor at the University of Maryland at Baltimore County. The closest analogy is pregnancy, she says, which is “a time when women’s lives are changing, and they can absorb a ton of information. A pandemic is similar: People are actually paying attention, and learning.”

Redbird’s survey suggests that Americans indeed sought out new sources of information—and that consumers of news from conservative outlets, in particular, expanded their media diet. People of all political bents became more dissatisfied with the Trump administration. As the economy nose-dived, the health-care system ailed, and the government fumbled, belief in American exceptionalism declined. “Times of big social disruption call into question things we thought were normal and standard,” Redbird told me. “If our institutions fail us here, in what ways are they failing elsewhere?” And whom are they failing the most?

Americans were in the mood for systemic change. Then, on May 25, George Floyd, who had survived COVID‑19’s assault on his airway, asphyxiated under the crushing pressure of a police officer’s knee. The excruciating video of his killing circulated through communities that were still reeling from the deaths of Breonna Taylor and Ahmaud Arbery, and disproportionate casualties from COVID‑19. America’s simmering outrage came to a boil and spilled into its streets.

Defiant and largely cloaked in masks, protesters turned out in more than 2,000 cities and towns. Support for Black Lives Matter soared: For the first time since its founding in 2013, the movement had majority approval across racial groups. These protests were not about the pandemic, but individual protesters had been primed by months of shocking governmental missteps. Even people who might once have ignored evidence of police brutality recognized yet another broken institution. They could no longer look away.

It is hard to stare directly at the biggest problems of our age. Pandemics, climate change, the sixth extinction of wildlife, food and water shortages—their scope is planetary, and their stakes are overwhelming. We have no choice, though, but to grapple with them. It is now abundantly clear what happens when global disasters collide with historical negligence.

COVID‑19 is an assault on America’s body, and a referendum on the ideas that animate its culture. Recovery is possible, but it demands radical introspection. America would be wise to help reverse the ruination of the natural world, a process that continues to shunt animal diseases into human bodies. It should strive to prevent sickness instead of profiting from it. It should build a health-care system that prizes resilience over brittle efficiency, and an information system that favors light over heat. It should rebuild its international alliances, its social safety net, and its trust in empiricism. It should address the health inequities that flow from its history. Not least, it should elect leaders with sound judgment, high character, and respect for science, logic, and reason.

The pandemic has been both tragedy and teacher. Its very etymology offers a clue about what is at stake in the greatest challenges of the future, and what is needed to address them. Pandemic. Pan and demos. All people.
The article has embedded audio narration. Recommend you activate it and go through the entire 56:33 reading and listening. Well worth your time.

Triangulate with this:

Ch. 4: First Lines of Defence

An epidemic is a sudden disastrous event in the same way as a hurricane, an earthquake, or a flood. Such events reveal many facets of the societies with which they collide. The stress they cause tests social stability and cohesion. Dorothy Porter, Health, Civilization and the State (1999)

What does it mean to possess a health service? At the very least, it represents the commitment of people living in a society (past and present) to the twin ideas of solidarity and collective action. By solidarity I mean the feelings of empathy and responsibility we all feel and owe towards one another. Solidarity stands in opposition to the principles of individualism and competition which so dominate and shape our lives in twenty-first-century capitalist, and even authoritarian, nation-states.

The existence of, public support for, and continuous development of a health system suggests that we are prepared to make personal material contributions (e.g., through taxation) to institutions that protect and strengthen the lives not only of ourselves but also of others in our society. That willingness to act on behalf of others is the second feature of a health system – our commitment to a belief in our interdependence and reciprocal responsibility towards one another and also to the collective action necessary to make those feelings real and tangible.

The whole basis of our society depends upon these two principles. COVID-19 has tested their resilience. So many people have died, so many families are in mourning, so many communities have been left scarred by disease. We have been shocked by the power of a virus to throw our societies into chaos, to deprive us of our lives and liberties, and to destroy economies. COVID-19 invites us, calls on us, requires us to rethink who we are and what we value.

One fundamental shift in our thinking surely has to be around the concept of our security. Ever since the birth of the nationstate, security has been viewed as the protection of national borders and each country’s political sovereignty. An infectious disease such as SARS-CoV-2 transcends states, borders and sovereignty. A virus is not amenable to passport controls or military defeat, despite the frequent invocation of the idea of an ‘invisible enemy’. No person, no country, can survive in splendid isolation.

COVID-19 has taught us to reimagine security as being about people and communities, about our survival, our livelihoods and our dignity. Disease is a threat to our human security, and pandemics are the most dangerous threats of all. Pandemics disrupt every part of our society, leaving us wounded and vulnerable. Protecting our security is not only about having strong military defences. Our security also depends on strong social institutions – and an effective health system is the most important defence we have to protect that security. Think of the security of your own family if you do not believe me…

Horton, Richard. The COVID-19 Catastrophe (pp. 63-65). Wiley. Kindle Edition.
The (Lancet editor) Richard Horton book went to press in May. Ed Yong's piece is even more up to date. Taken together, they provide a comprehensive, clear picture of where we are.

As I go to post, the U.S. Covid19 fatality count at Hopkins is more than 155,000.

I first posted a Hopkins dashboard screenshot on February 11th. Worldwide cases were 20,684, global deaths 427.


“I’ve done my own research.”

“Do your own research.”

How many times have you heard various antivaxxers, cranks, advocates of pseudoscience, and conspiracy theorists repeat these phrases, or variants thereof? In medicine, advocates of what I like to call pseudomedicine—a category that encompasses antivaxxers, COVID-19 denialists and conspiracy theorists, cancer quacks, and all manner of other quacks—are particularly prone to claim that they’ve “done their research” about, for instance, vaccines, and that’s why they think the MMR vaccine causes autism and that vaccines cause sudden infant death syndrome (SIDS), autoimmune diseases, and all manner of other diseases (and, oh, by the way, their “research” has told them that vaccines don’t protect against disease and “natural immunity is better,” too).

Of course, “doing one’s own research” and then “making up one’s own mind” makes perfect sense when it comes to, for example, choosing a place to live, buying a car, pickig a smartphone, and any of a number of decisions we make in our day-to-day lives, although it should be noted that even those decisions are not necessarily so straightforward or easy to research. When it comes to science, the fact is that the vast majority of us are not capable of “doing our own research.”…
Trust science. Or, better yet, become a scientist.




That one is special. I have some looney bin Facebook friends. I may need to up the metaphorical ante to "Occam's Wood Chipper."


More to come...