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Javier E

How the Internet Is Like a Dying Star - 0 views

  • We are experiencing the same problems and having the same arguments. It’s all leading to a pervasive feeling, especially among younger people, that our systems in the United States (including our system of government) “are no longer able to meet the challenges our country is facing.”
  • The internet, as a mediator of human interactions, is not a place, it is a time. It is the past. I mean this in a literal sense. The layers of artifice that mediate our online interactions mean that everything that comes to us online comes to us from the past—sometimes the very recent past, but the past nonetheless.
  • Sacasas asks us to revise the notion of real-time communications online, and to instead view our actions as “inscriptions,” or written and visual records. Like stars in the galaxy, our inscriptions seem to twinkle in the present, but their light is actually many years old.
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  • “Because we live in the past when we are online,” Sacasas suggests, “we will find ourselves fighting over the past.”
  • my hunch is that people feel stuck or move on because online, these events feel like things that have happened, rather than something that is happening.
  • “What we’re focused on is not the particular event or movement before us, but the one right behind us,”
  • “As we layer on these events, it becomes difficult for anything to break through. You’re trying to enter the information environment and the debate, and you find layer upon layer of abstraction over the initial point of conflict. You find yourself talking about what people are saying about the thing, instead of talking about the thing. We’re caking layers of commentary over the event itself and the event fades.” This is, if you ask me, a decent description of the last five years of news cycles.
  • So, what’s changed? Why do we feel more stuck now?
  • “I think it also has to do with the proportion of one’s daily experience to dispatches from the past,” Sacasas said. Pre-internet, “the totality of my day wasn't enclosed by this experience of media artifacts coming to me.”
  • the smartphone-bound, reasonably-but-not-terminally online people—the amount they spend engaged with the recent past has increased considerably, to the point that some are enclosed in this online world and develop a disordered relationship to time.
  • Constantly absorbing and commenting on things that have just happened sounds to me like a recipe for feeling powerless.
  • “That feeling of helplessness comes out of the fact that all our agency is being channeled through these media,” he said. “We have these events that are ponderously large, like climate change or gun control, and to view them only through the lens of what happened or the abstraction of what people are saying strips away the notion of our agency and makes it all feel so futile.”
  • the social-media platforms we live on push us toward contribution, and they make it feel necessary. Yet what is the sum total of these contributions? “If I'm cynical,” Sacasas said, “what I think it generates is something akin to influencer culture. It creates people who will make money off of channeling that attention—for better or for ill. Everyone else is stuck watching the show, feeling like we’re unable to effectively change the channel or change our circumstances.”
  • ubiquitous connectivity and our media environments naturally lend themselves toward an influencer-and-fandom dynamic. If the system is built to inspire more and more layers of commentary, then that system will privilege and reward people who feed it
  • On an internet that democratizes publishing, what this might mean is that all media takes on the meta-commentary characteristics of political or sports talk radio.
  • When the Depp-Heard trial began gaining traction online in April, Internet users around the world recognized a fresh opportunity to seize and monetize the attention. Christopher Orec, a 20-year-old content creator in Los Angeles, has posted a dozen videos about the trial to his more than 1.4 million followers on Instagram across several pages. “Personally, what I’ve gained from it is money as well as exposure from how well the videos do,” he said. You can “go from being a kid in high school and, if you hop on it early, it can basically change your life,” Orec said. “You can use those views and likes and shares that you get from it, to monetize and build your account and make more money from it, meet more people and network.”
  • if you were going to design a nightmare scenario, it might look a bit like what is described in this Washington Post story from last Thursday:
  • Like the Depp-Heard coverage, the forces that Sacasas describes can be deeply cynical and destructive. They’re also almost always exhausting for those of us consuming them
  • Examining and discussing and understanding the past is important, and our technologies are enormously helpful in this respect.
  • Sacasas compared the way our media ecosystem works—and all these feedback loops—to a novelty finger trap. “Almost every action generates more difficult conditions—to struggle is to feed the thing that’s keeping you bogged down.”
  • As politicians—especially those on the far right—transition into full time influencers, they no longer need to govern even reasonably effectively to gain power. They don’t need to show what they’ve done for their constituents. Simply culture warring—posting—is enough. The worse the post, the more attention it gets, and the more power they accrue.
  • There's a reason Marjorie Taylor Greene raised $9 million and Sarah Palin has only raised $600,000. MTG has recognized something Palin used to know. Her job is to say something terrible every day so we do all her viral marketing for her.
  • One outcome of elected officials adopting the influencer model is a politics that is obsessed with, and stuck in, the past. I don’t just mean a focus on making America “great again,” but a politics that is obsessed with relitigating its recent past.
  • we are forever talking about Hillary’s emails or Hunter Biden’s laptop or Merrick Garland’s thwarted Supreme Court seat or the legitimacy of the previous election.
  • How do we break the cycle? Is silence our best weapon to starve the attention? That feels wrong. I don’t have answers, but Sacasas has given me a valuable guiding question: How do we train our attention on our present and future, when so much of our life is spent ensconced in dispatches from the recent past?
Javier E

Who Watches the Watchdog? The CJR's Russia Problem - Byline Times - 0 views

  • In December 2018, Pope commissioned me to report for the CJR on the troubled history of The Nation magazine and its apparent support for the policies of Vladimir Putin. 
  • My $6,000 commission to write for the prestigious ”watchdog” was flattering and exciting – but would also be a hard call. Watchdogs, appointed or self-proclaimed, can only claim entitlement when they hold themselves to the highest possible standards of reporting and conduct. It was not to be
  • For me, the project was vital but also a cause for personal sadness.  During the 1980s, I had been an editor of The Nation’s British sister magazine New Statesman and had served as chair of its publishing company. I knew, worked with and wrote for The Nation’s then-editor, the late Victor Navasky. He subsequently chaired the CJR. 
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  • Investigating and calling out a magazine and editor for which I felt empathy, and had historic connections to, hearing from its critics and dissidents, and finding whistleblowers and confidential inside sources was a challenge. But hearing responses from all sides was a duty.
  • I worked on it for six months, settling a first draft of my story to the CJR‘s line editor in the summer 2019. From then on my experience of the CJR was devastating and damaging.
  • After delivering the story and working through a year-long series of edits and re-edits required by Pope, the story was slow-walked to dismissal. In 2022, after Russian tanks had rolled towards Kyiv, I urged Pope to restore and publish the report, given the new and compelling public interest. He refused.
  • he trigger for my CJR investigation was a hoax concerning Democratic Party emails hacked and dumped in 2016 by teams from Russia’s GRU intelligence agency.  The GRU officers responsible were identified and their methods described in detail in the 2019 Mueller Report.  
  • The Russians used the dumped emails decisively – first to leverage an attack on that year’s Democratic National Convention; and then to divert attention from Donald Trump’s gross indiscretions at critical times before his election
  • In 2017, with Trump in the White House, Russian and Republican denial operations began, challenging the Russian role and further widening divisions in America. A pinnacle of these operations was the publication in The Nation on 9 August 2017 of an article – still online under a new editor – claiming that the stolen emails were leaked from inside the DNC.  
  • Immediately after the article appeared, Trump-supporting media and his MAGA base were enthralled. They celebrated that a left-liberal magazine had refuted the alleged Russian operations in supporting Trump, and challenged the accuracy of mainstream press reporting on ‘Russiagate’
  • Nation staff and advisors were aghast to find their magazine praised lavishly by normally rabid outlets – Fox News, Breitbart, the Washington Times. Even the President’s son.
  • When I was shown the Nation article later that year by one of the experts it cited, I concluded that it was technical nonsense, based on nothing.  The White House felt differently and directed the CIA to follow up with the expert, former senior National Security Agency official and whistleblower, William Binney (although nothing happened)
  • Running the ‘leak’ article positioned the left-wing magazine strongly into serving streams of manufactured distractions pointing away from Russian support for Trump.
  • I traced the source of the leak claim to a group of mainly American young right-wing activists delivering heavy pro-Russian and pro-Syrian messaging, working with a British collaborator. Their leader, William Craddick, had boasted of creating the ‘Pizzagate’ conspiracy story – a fantasy that Hillary Clinton and her election staff ran a child sex and torture ring in the non-existent basement of a pleasant Washington neighbourhood pizzeria. Their enterprise had clear information channels from Moscow. 
  • We spoke for 31 minutes at 1.29 ET on 12 April 2019. During the conversation, concerning conflicts of interest, Pope asked only about my own issues – such as that former editor Victor Navasky, who would figure in the piece, had moved from running and owning The Nation to being Chair of the CJR board; and that the independent wealth foundation of The Nation editor Katrina vanden Heuvel – the Kat Foundation – periodically donated to Columbia University.
  • In the series, writer Jeff Gerth condemns multiple Pulitzer Prize-winning reports on Russian interference operations by US mainstream newspapers. Echoing words used in 2020 by vanden Heuvel, he cited as more important “RealClearInvestigations, a non-profit online news site that has featured articles critical of the Russia coverage by writers of varying political orientation, including Aaron Maté”.
  • On the day we spoke, I now know, Pope was working with vanden Heuvel and The Nation to launch – 18 days later – a major new international joint journalism project ‘Covering Climate Now!‘
  • Soon after we spoke, the CJR tweeted that “CJR and @thenation are gathering some of the world’s top journalists, scientists, and climate experts” for the event. I did not see the tweet. Pope and the CJR staff said nothing of this to me. 
  • Any editor must know without doubt in such a situation, that every journalist has a duty of candour and a clear duty to recuse themselves from editorial authority if any hint of conflict of interest arises. Pope did not take these steps. From then until August 2020, through his deputy, he sent me a stream of directions that had the effect of removing adverse material about vanden Heuvel and its replacement with lists of her ‘achievements’. Then he killed the story
  • Working on my own story for the CJR, I did not look behind or around – or think I needed to. I was working for the self-proclaimed ‘watchdog of journalism’. I forgot the ancient saw: who watches the watchdog?
  • This week, Kyle Pope failed to reply to questions from Byline Times about conflicts of interest in linking up with the subjects of the report he had commissioned.
  • During the period I was preparing the report about The Nation and its editor, he wrote for The Nation on nine occasions. He has admitted being remunerated by the publication. While I was working for the CJR, he said nothing. He did not recuse himself, and actively intervened to change content for a further 18 months.
  • On April 16 2019, I was informed that Katrina vanden Heuvel had written to Pope to ask about my report. “We’re going to say thanks for her thoughts and that we’ll make sure the piece is properly vetted and fact-checked,” I was told
  • A month later, I interviewed her for the CJR. Over the course of our 100 minutes discussion, it must have slipped her mind to mention that she and Kyle Pope had just jointly celebrated being given more than $1 million from the Rockefeller Family and other foundations to support their climate project.
  • Pope then asked me to identify my confidential sources from inside The Nation, describing this as a matter of “policy”
  • Pope asked several times that the article be amended to state that there were general tie-ups between the US left and Putin. I responded that I could find no evidence to suggest that was true, save that the Daily Beast had uncovered RT attempting cultivation of the US left. 
  • Pope then wanted the 6,000-word and fully edited report cut by 1,000 words, mainly to remove material about the errors in The Nation article. Among sections cut down were passages showing how, from 2014 onwards, vanden Heuvel had hired a series of pro-Russian correspondents after they had praised her husband. Among the new intake was a Russian and Syrian Government supporting broadcaster, Aaron Maté, taken on in 2017 after he had platformed Cohen on his show The Real News. 
  • On 30 January 2023, the CJR published an immense four-part 23,000-word series on Trump, Russia and the US media. The CJR‘s writers found their magazine praised lavishly by normally rabid outlets. Fox News rejoiced that The New York Times had been “skewered by the liberal media watchdog the Columbia Journalism Review” over Russiagate”. WorldNetDaily called it a “win for Trump”.
  • Pope agreed. Trump had “hailed our report as proof of the media assault on Trump that they’ve been hyping all along,” he wrote. “Trump cheered that view on Truth Social, his own, struggling social-media platform
  • She and her late husband, Professor Stephen Cohen, were at the heart of my reporting on the support The Nation gave to Putin’s Russia. Sixteen months later, as Pope killed my report, he revealed that he had throughout been involved in an ambitious and lucratively funded partnership between the CJR and The Nation, and between himself and vanden Heuvel. 
  • As with The Nation in 2017, the CJR is seeing a storm of derisive and critical evaluations of the series by senior American journalists. More assessments are said to be in the pipeline. “We’re taking the critiques seriously,” Pope said this week. The Columbia Journalism Review may now have a Russia Problem.  
lilyrashkind

Why YouTube Has Survived Russia's Social Media Crackdown | Time - 0 views

  • In a style part investigative journalism, part polemic, the video’s hosts report that one of President Vladimir Putin’s allies, Russian senator Valentina Matviyenko, owns a multimillion-dollar villa on the Italian seafront. The video contrasts the luxurious lifestyle of Matviyenko and her family with footage of dead Russian soldiers, and with images of Russian artillery hitting civilian apartment buildings in Ukraine. A voiceover calls the war “senseless” and “unimaginable.” A slide at the end urges Russians to head to squares in their cities to protest at specific dates and times. In less than a week, the video racked up more than 4 million views.
  • TV news is dominated by the misleading narrative that Russia’s invasion of Ukraine is actually a peace-keeping exercise. Despite this, YouTube has largely been spared from the Kremlin’s crackdown on American social media platforms since Russia invaded Ukraine nearly a month ago.
  • The app had been a particular venue for activism: Many Russian celebrities spoke out against the invasion of Ukraine in their Instagram stories, and Navalny’s Instagram page posted a statement criticizing the war, and calling on Russians to come out in protest.
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  • On March 11, YouTube’s parent company Google announced that it would block Russian state-backed media globally, including within Russia. The policy was an expansion of an earlier announcement that these channels would be blocked within the European Union. “Our Community Guidelines prohibit content denying, minimizing or trivializing well-documented violent events, and we remove content about Russia’s invasion in Ukraine that violates this policy,” Google said in a statement. “In line with that, effective immediately, we are also blocking YouTube channels associated with Russian state-funded media, globally.”
  • That could leave many millions of Russians cut off from independent news and content shared by opposition activists like Navalny’s team. (It would also effectively delete 75 million YouTube users, or some 4% of the platform’s global total—representing a small but still-significant portion of Google’s overall profits.)
  • Part of the reason for YouTube’s survival amid the crackdown is its popularity, experts say. “YouTube is by far and away the most popular social media platform in Russia,” says Justin Sherman, a non-resident fellow at the Atlantic Council’s cyber statecraft initiative. The platform is even more popular than VK, the Russian-owned answer to Facebook.
  • Today, YouTube remains the most significant way for tens of millions of ordinary Russians to receive largely uncensored information from the outside world.
  • Still, Sherman says the situation is volatile, with Russia now more likely than ever before to ban YouTube. For an authoritarian government like Russia’s, “part of the decision to allow a foreign platform in your country is that you get to use it to spread propaganda and disinformation, even if people use it to spread truth and organize against you,” he says. “If you start losing the ability to spread misinformation and propaganda, but people can still use it to spread truth and organize, then all of a sudden, you start wondering why you’re allowing that platform in your country in the first place.” YouTube did not respond to a request for comment.
  • On the same day as Navalny’s channel posted the video about Matviyenko, elsewhere on YouTube a very different spectacle was playing out. In a video posted to the channel of the Kremlin-funded media outlet RT, (formerly known as Russia Today,) a commentator dismissed evidence of Russian bombings of Ukrainian cities. She blamed “special forces of NATO countries” for allegedly faking images of bombed-out Ukrainian schools, kindergartens and other buildings.
  • “YouTube has, over the years, been a really important place for spreading Russian propaganda,” Donovan said in an interview with TIME days before YouTube banned Russian state-backed media.
  • In July 2021, the Russian government passed a law that would require foreign tech companies with more than 500,000 users to open a local office within Russia. (A similar law passed previously in India had been used by the government there to pressure tech companies to take down opposition accounts and posts critical of the government, by threatening employees with arrest.)
  • The heightened risk to free expression in Russia Experts say that Russia’s ongoing crackdown on social media platforms heralds a significant shift in the shape of the Russian internet—and a potential end to the era where the Kremlin tolerated largely free expression on YouTube in return for access to a tool that allowed it to spread disinformation far and wide.
Javier E

Opinion | Do You Live in a 'Tight' State or a 'Loose' One? Turns Out It Matters Quite a... - 0 views

  • Political biases are omnipresent, but what we don’t fully understand yet is how they come about in the first place.
  • In 2014, Michele J. Gelfand, a professor of psychology at the Stanford Graduate School of Business formerly at the University of Maryland, and Jesse R. Harrington, then a Ph.D. candidate, conducted a study designed to rank the 50 states on a scale of “tightness” and “looseness.”
  • Gelfand and Harrington predicted that “‘tight’ states would exhibit a higher incidence of natural disasters, greater environmental vulnerability, fewer natural resources, greater incidence of disease and higher mortality rates, higher population density, and greater degrees of external threat.”
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  • titled “Tightness-Looseness Across the 50 United States,” the study calculated a catalog of measures for each state, including the incidence of natural disasters, disease prevalence, residents’ levels of openness and conscientiousness, drug and alcohol use, homelessness and incarceration rates.
  • Gelfand said:Some groups have much stronger norms than others; they’re tight. Others have much weaker norms; they’re loose. Of course, all cultures have areas in which they are tight and loose — but cultures vary in the degree to which they emphasize norms and compliance with them.
  • states in New England and on the West Coast were the loosest: California, Oregon, Washington, Maine, Massachusetts, Connecticut, New Hampshire and Vermont.
  • In both 2016 and 2020, Donald Trump carried all 10 of the top “tight” states; Hillary Clinton and Joe Biden carried all 10 of the top “loose” states.
  • “Rule Makers, Rule Breakers: How Tight and Loose Cultures Wire the World” in 2018, in which she described the results of a 2016 pre-election survey she and two colleagues had commissioned
  • The results were telling: People who felt the country was facing greater threats desired greater tightness. This desire, in turn, correctly predicted their support for Trump. In fact, desired tightness predicted support for Trump far better than other measures. For example, a desire for tightness predicted a vote for Trump with 44 times more accuracy than other popular measures of authoritarianism.
  • The 2016 election, Gelfand continued, “turned largely on primal cultural reflexes — ones that had been conditioned not only by cultural forces, but by a candidate who was able to exploit them.”
  • Along the same lines, if liberals and conservatives hold differing moral visions, not just about what makes a good government but about what makes a good life, what turned the relationship between left and right from competitive to mutually destructive?
  • Cultural differences, Gelfand continued, “have a certain logic — a rationale that makes good sense,” noting that “cultures that have threats need rules to coordinate to survive (think about how incredibly coordinated Japan is in response to natural disasters).
  • cultures that don’t have a lot of threat can afford to be more permissive and loose.”
  • The tight-loose concept, Gelfand argued,is an important framework to understand the rise of President Donald Trump and other leaders in Poland, Hungary, Italy, and France,
  • The gist is this: when people perceive threat — whether real or imagined, they want strong rules and autocratic leaders to help them survive
  • My research has found that within minutes of exposing study participants to false information about terrorist incidents, overpopulation, pathogen outbreaks and natural disasters, their minds tightened. They wanted stronger rules and punishments.
  • The South dominated the tight states: Mississippi, Alabama Arkansas, Oklahoma, Tennessee, Texas, Louisiana, Kentucky, South Carolina and North Carolina
  • Looseness, Gelfand posits, fosters tolerance, creativity and adaptability, along with such liabilities as social disorder, a lack of coordination and impulsive behavior.
  • If liberalism and conservatism have historically played a complementary role, each checking the other to constrain extremism, why are the left and right so destructively hostile to each other now, and why is the contemporary political system so polarized?
  • Gelfand writes that tightness encourages conscientiousness, social order and self-control on the plus side, along with close-mindedness, conventional thinking and cultural inertia on the minus side.
  • Niemi contended that sensitivity to various types of threat is a key factor in driving differences between the far left and far right.
  • She cited research thatfound 47 percent of the most extreme conservatives strongly endorsed the view that “The world is becoming a more and more dangerous place,” compared to 19 percent of the most extreme liberals
  • Conservatives and liberals, Niemi continued,see different things as threats — the nature of the threat and how it happens to stir one’s moral values (and their associated emotions) is a better clue to why liberals and conservatives react differently.
  • Unlike liberals, conservatives strongly endorse the binding moral values aimed at protecting groups and relationships. They judge transgressions involving personal and national betrayal, disobedience to authority, and disgusting or impure acts such as sexually or spiritually unchaste behavior as morally relevant and wrong.
  • Underlying these differences are competing sets of liberal and conservative moral priorities, with liberals placing more stress than conservatives on caring, kindness, fairness and rights — known among scholars as “individualizing values
  • conservatives focus more on loyalty, hierarchy, deference to authority, sanctity and a higher standard of disgust, known as “binding values.”
  • As a set, Niemi wrote, conservative binding values encompassthe values oriented around group preservation, are associated with judgments, decisions, and interpersonal orientations that sacrifice the welfare of individuals
  • Just as ecological factors differing from region to region over the globe produced different cultural values, ecological factors differed throughout the U.S. historically and today, producing our regional and state-level dimensions of culture and political patterns.
  • Niemi cited a paper she and Liane Young, a professor of psychology at Boston College, published in 2016, “When and Why We See Victims as Responsible: The Impact of Ideology on Attitudes Toward Victims,” which tested responses of men and women to descriptions of crimes including sexual assaults and robberies.
  • We measured moral values associated with unconditionally prohibiting harm (“individualizing values”) versus moral values associated with prohibiting behavior that destabilizes groups and relationships (“binding values”: loyalty, obedience to authority, and purity)
  • Increased endorsement of binding values predicted increased ratings of victims as contaminated, increased blame and responsibility attributed to victims, increased perceptions of victims’ (versus perpetrators’) behaviors as contributing to the outcome, and decreased focus on perpetrators.
  • For example, binding values are associated with Machiavellianism (e.g., status-seeking and lying, getting ahead by any means, 2013); victim derogation, blame, and beliefs that victims were causal contributors for a variety of harmful acts (2016, 2020); and a tendency to excuse transgressions of ingroup members with attributions to the situation rather than the person (2023).
  • What happened to people ecologically affected social-political developments, including the content of the rules people made and how they enforced them
  • Numerous factors potentially influence the evolution of liberalism and conservatism and other social-cultural differences, including geography, topography, catastrophic events, and subsistence styles
  • Joshua Hartshorne, who is also a professor of psychology at Boston College, took issue with the binding versus individualizing values theory as an explanation for the tendency of conservatives to blame victims:
  • I would guess that the reason conservatives are more likely to blame the victim has less to do with binding values and more to do with the just-world bias (the belief that good things happen to good people and bad things happen to bad people, therefore if a bad thing happened to you, you must be a bad person).
  • Belief in a just world, Hartshorne argued, is crucial for those seeking to protect the status quo:It seems psychologically necessary for anyone who wants to advocate for keeping things the way they are that the haves should keep on having, and the have-nots have got as much as they deserve. I don’t see how you could advocate for such a position while simultaneously viewing yourself as moral (and almost everyone believes that they themselves are moral) without also believing in the just world
  • Conversely, if you generally believe the world is not just, and you view yourself as a moral person, then you are likely to feel like you have an obligation to change things.
  • I asked Lene Aaroe, a political scientist at Aarhus University in Denmark, why the contemporary American political system is as polarized as it is now, given that the liberal-conservative schism is longstanding. What has happened to produce such intense hostility between left and right?
  • There is variation across countries in hostility between left and right. The United States is a particularly polarized case which calls for a contextual explanatio
  • A central explanation typically offered for the current situation in American politics is that partisanship and political ideology have developed into strong social identities where the mass public is increasingly sorted — along social, partisan, and ideological lines.
  • I then asked Aaroe why surveys find that conservatives are happier than liberals. “Some research,” she replied, “suggests that experiences of inequality constitute a larger psychological burden to liberals because it is more difficult for liberals to rationalize inequality as a phenomenon with positive consequences.”
  • Steven Pinker, a professor of psychology at Harvard, elaborated in an email on the link between conservatism and happiness:
  • t’s a combination of factors. Conservatives are likelier to be married, patriotic, and religious, all of which make people happier
  • They may be less aggrieved by the status quo, whereas liberals take on society’s problems as part of their own personal burdens. Liberals also place politics closer to their identity and striving for meaning and purpose, which is a recipe for frustration.
  • Some features of the woke faction of liberalism may make people unhappier: as Jon Haidt and Greg Lukianoff have suggested, wokeism is Cognitive Behavioral Therapy in reverse, urging upon people maladaptive mental habits such as catastrophizing, feeling like a victim of forces beyond one’s control, prioritizing emotions of hurt and anger over rational analysis, and dividing the world into allies and villains.
  • Why, I asked Pinker, would liberals and conservatives react differently — often very differently — to messages that highlight threat?
  • It may be liberals (or at least the social-justice wing) who are more sensitive to threats, such as white supremacy, climate change, and patriarchy; who may be likelier to moralize, seeing racism and transphobia in messages that others perceive as neutral; and being likelier to surrender to emotions like “harm” and “hurt.”
  • The authors used neural imaging to follow changes in the dorsomedial prefrontal cortex (known as DMPFC) as conservatives and liberals watched videos presenting strong positions, left and right, on immigration.
  • there are ways to persuade conservatives to support liberal initiatives and to persuade liberals to back conservative proposals:
  • While liberals tend to be more concerned with protecting vulnerable groups from harm and more concerned with equality and social justice than conservatives, conservatives tend to be more concerned with moral issues like group loyalty, respect for authority, purity and religious sanctity than liberals are. Because of these different moral commitments, we find that liberals and conservatives can be persuaded by quite different moral arguments
  • For example, we find that conservatives are more persuaded by a same-sex marriage appeal articulated in terms of group loyalty and patriotism, rather than equality and social justice.
  • “political arguments reframed to appeal to the moral values of those holding the opposing political position are typically more effective
  • We find support for these claims across six studies involving diverse political issues, including same-sex marriage, universal health care, military spending, and adopting English as the nation’s official language.”
  • In one test of persuadability on the right, Feinberg and Willer assigned some conservatives to read an editorial supporting universal health care as a matter of “fairness (health coverage is a basic human right)” or to read an editorial supporting health care as a matter of “purity (uninsured people means more unclean, infected, and diseased Americans).”
  • Conservatives who read the purity argument were much more supportive of health care than those who read the fairness case.
  • Liberals who read the fairness argument were substantially more supportive of military spending than those who read the loyalty and authority argument.
  • In “Conservative and Liberal Attitudes Drive Polarized Neural Responses to Political Content,” Willer, Yuan Chang Leong of the University of Chicago, Janice Chen of Johns Hopkins and Jamil Zaki of Stanford address the question of how partisan biases are encoded in the brain:
  • society. How do such biases arise in the brain? We measured the neural activity of participants watching videos related to immigration policy. Despite watching the same videos, conservative and liberal participants exhibited divergent neural responses. This “neural polarization” between groups occurred in a brain area associated with the interpretation of narrative content and intensified in response to language associated with risk, emotion, and morality. Furthermore, polarized neural responses predicted attitude change in response to the videos.
  • The four authors argue that their “findings suggest that biased processing in the brain drives divergent interpretations of political information and subsequent attitude polarization.” These results, they continue, “shed light on the psychological and neural underpinnings of how identical information is interpreted differently by conservatives and liberals.”
  • While liberals and conservatives, guided by different sets of moral values, may make agreement on specific policies difficult, that does not necessarily preclude consensus.
  • or each video,” they write,participants with DMPFC activity time courses more similar to that of conservative-leaning participants became more likely to support the conservative positio
  • Conversely, those with DMPFC activity time courses more similar to that of liberal-leaning participants became more likely to support the liberal position. These results suggest that divergent interpretations of the same information are associated with increased attitude polarizatio
  • Together, our findings describe a neural basis for partisan biases in processing political information and their effects on attitude change.
  • Describing their neuroimaging method, the authors point out that theysearched for evidence of “neural polarization” activity in the brain that diverges between people who hold liberal versus conservative political attitudes. Neural polarization was observed in the dorsomedial prefrontal cortex (DMPFC), a brain region associated with the interpretation of narrative content.
  • The question is whether the political polarization that we are witnessing now proves to be a core, encoded aspect of the human mind, difficult to overcome — as Leong, Chen, Zaki and Willer sugges
  • — or whether, with our increased knowledge of the neural basis of partisan and other biases, we will find more effective ways to manage these most dangerous of human predispositions.
Javier E

Millennials Are Doing Just Fine - The Atlantic - 0 views

  • Millennials, as a group, are not broke—they are, in fact, thriving economically. That wasn’t true a decade ago, and prosperity within the generation today is not evenly shared. But since the mid-2010s, Millennials on the whole have made a breathtaking financial comeback.
  • he belief that Millennials have been excluded from the implicit promises that America makes to its people—a house for most, middle-class security, a better life than your parents had—remains predominant in society and, to go by surveys and the tenor of social media, among Millennials themselves.
  • That prompts a question with implications for the cultural and political future of the United States, a country premised, to a large extent, on the idea of material progress: What if the American dream is still alive, but no one believes it to be?
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  • the mid-2010s saw the beginnings of a turnaround that has continued ever since. By 2019, households headed by Millennials were making considerably more money than those headed by the Silent Generation, Baby Boomers, and Generation X at the same age, after adjusting for inflation.
  • That year, according to the Current Population Survey, administered by the U.S. Census Bureau, income for the median Millennial household was about $9,000 higher than that of the median Gen X household at the same age, and about $10,000 more than the median Boomer household, in 2019 dollars.
  • Booms and recessions push incomes up and down, but although many media stories have tended to associate Millennials almost exclusively with the latter, they’ve now experienced both, and in a big way: Increases in income since 2014 have been steep.
  • ed since Millennials became adults. The Affordable Care Act extended health-care coverage, and federal-government support during the pandemic actually caused poverty to fall in 2020 and 2021
  • since 2014. By my analysis, Black and Latino Americans ages 25 to 44 in 2021 were making more money than Black and Latino Silents, Boomers, and Gen Xers at the same age. The U.S. is not without economic inequities, many of them racial. But Black and Latino Millennials are not falling behind previous generations when it comes to their income. Instead, most are getting ahead
  • Millennial men, on average, have not seen the income increases that Millennial women have (more on that later)—a divergence at least partly explained by the growing gap in educational attainment between men and women
  • the median income of Americans with a four-year college degree has steadily risen while the income of those with only a high-school degree has fallen. This trend is not new, though it is troubling.
  • The Great Recession was no doubt a more harrowing experience for young adults than the recession Gen X faced, but the income stagnation that followed it nonetheless lasted only a few years. Over the past half century, the longest period of falling or stagnant wages was from the ’70s to the mid-’90s, when Boomers were young workers.
  • poverty is not any more common among Millennials today than it was among previous generations.
Javier E

Ozempic or Bust - The Atlantic - 0 views

  • June 2024 Issue
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  • it is impossible to know, in the first few years of any novel intervention, whether its success will last.
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  • The ordinary fixes—the kind that draw on people’s will, and require eating less and moving more—rarely have a large or lasting effect. Indeed, America itself has suffered through a long, maddening history of failed attempts to change its habits on a national scale: a yo-yo diet of well-intentioned treatments, policies, and other social interventions that only ever lead us back to where we started
  • Through it all, obesity rates keep going up; the diabetes epidemic keeps worsening.
  • The most recent miracle, for Barb as well as for the nation, has come in the form of injectable drugs. In early 2021, the Danish pharmaceutical company Novo Nordisk published a clinical trial showing remarkable results for semaglutide, now sold under the trade names Wegovy and Ozempic.
  • Patients in the study who’d had injections of the drug lost, on average, close to 15 percent of their body weight—more than had ever been achieved with any other drug in a study of that size. Wadden knew immediately that this would be “an incredible revolution in the treatment of obesity.”
  • Many more drugs are now racing through development: survodutide, pemvidutide, retatrutide. (Among specialists, that last one has produced the most excitement: An early trial found an average weight loss of 24 percent in one group of participants.
  • In the United States, an estimated 189 million adults are classified as having obesity or being overweight
  • The drugs don’t work for everyone. Their major side effects—nausea, vomiting, and diarrhea—can be too intense for many patients. Others don’t end up losing any weight
  • For the time being, just 25 percent of private insurers offer the relevant coverage, and the cost of treatment—about $1,000 a month—has been prohibitive for many Americans.
  • The drugs have already been approved not just for people with diabetes or obesity, but for anyone who has a BMI of more than 27 and an associated health condition, such as high blood pressure or cholesterol. By those criteria, more than 140 million American adults already qualify
  • if this story goes the way it’s gone for other “risk factor” drugs such as statins and antihypertensives, then the threshold for prescriptions will be lowered over time, inching further toward the weight range we now describe as “normal.”
  • How you view that prospect will depend on your attitudes about obesity, and your tolerance for risk
  • The first GLP-1 drug to receive FDA approval, exenatide, has been used as a diabetes treatment for more than 20 years. No long-term harms have been identified—but then again, that drug’s long-term effects have been studied carefully only across a span of seven years
  • the data so far look very good. “These are now being used, literally, in hundreds of thousands of people across the world,” she told me, and although some studies have suggested that GLP-1 drugs may cause inflammation of the pancreas, or even tumor growth, these concerns have not borne out.
  • adolescents are injecting newer versions of these drugs, and may continue to do so every week for 50 years or more. What might happen over all that time?
  • “All of us, in the back of our minds, always wonder, Will something show up?  ” Although no serious problems have yet emerged, she said, “you wonder, and you worry.”
  • in light of what we’ve been through, it’s hard to see what other choices still remain. For 40 years, we’ve tried to curb the spread of obesity and its related ailments, and for 40 years, we’ve failed. We don’t know how to fix the problem. We don’t even understand what’s really causing it. Now, again, we have a new approach. This time around, the fix had better work.
  • The fen-phen revolution arrived at a crucial turning point for Wadden’s field, and indeed for his career. By then he’d spent almost 15 years at the leading edge of research into dietary interventions, seeing how much weight a person might lose through careful cutting of their calories.
  • But that sort of diet science—and the diet culture that it helped support—had lately come into a state of ruin. Americans were fatter than they’d ever been, and they were giving up on losing weight. According to one industry group, the total number of dieters in the country declined by more than 25 percent from 1986 to 1991.
  • Rejecting diet culture became something of a feminist cause. “A growing number of women are joining in an anti-diet movement,” The New York Times reported in 1992. “They are forming support groups and ceasing to diet with a resolve similar to that of secretaries who 20 years ago stopped getting coffee for their bosses.
  • Now Wadden and other obesity researchers were reaching a consensus that behavioral interventions might produce in the very best scenario an average lasting weight loss of just 5 to 10 percent
  • National surveys completed in 1994 showed that the adult obesity rate had surged by more than half since 1980, while the proportion of children classified as overweight had doubled. The need for weight control in America had never seemed so great, even as the chances of achieving it were never perceived to be so small.
  • Wadden wasn’t terribly concerned, because no one in his study had reported any heart symptoms. But ultrasounds revealed that nearly one-third of them had some degree of leakage in their heart valves. His “cure for obesity” was in fact a source of harm.
  • In December 1994, the Times ran an editorial on what was understood to be a pivotal discovery: A genetic basis for obesity had finally been found. Researchers at Rockefeller University were investigating a molecule, later named leptin, that gets secreted from fat cells and travels to the brain, and that causes feelings of satiety. Lab mice with mutations in the leptin gene—importantly, a gene also found in humans—overeat until they’re three times the size of other mice. “The finding holds out the dazzling hope,”
  • In April 1996, the doctors recommended yes: Dexfenfluramine was approved—and became an instant blockbuster. Patients received prescriptions by the hundreds of thousands every month. Sketchy wellness clinics—call toll-free, 1-888-4FEN-FEN—helped meet demand. Then, as now, experts voiced concerns about access. Then, as now, they worried that people who didn’t really need the drugs were lining up to take them. By the end of the year, sales of “fen” alone had surpassed $300 million.
  • It was nothing less than an awakening, for doctors and their patients alike. Now a patient could be treated for excess weight in the same way they might be treated for diabetes or hypertension—with a drug they’d have to take for the rest of their life.
  • the article heralded a “new understanding of obesity as a chronic disease rather than a failure of willpower.”
  • News had just come out that, at the Mayo Clinic in Minnesota, two dozen women taking fen-phen—including six who were, like Barb, in their 30s—had developed cardiac conditions. A few had needed surgery, and on the operating table, doctors discovered that their heart valves were covered with a waxy plaque.
  • Americans had been prescribed regular fenfluramine since 1973, and the newer drug, dexfenfluramine, had been available in France since 1985. Experts took comfort in this history. Using language that is familiar from today’s assurances regarding semaglutide and other GLP-1 drugs, they pointed out that millions were already on the medication. “It is highly unlikely that there is anything significant in toxicity to the drug that hasn’t been picked up with this kind of experience,” an FDA official named James Bilstad would later say in a Time cover story headlined “The Hot New Diet Pill.
  • “I know I can’t get any more,” she told Williams. “I have to use up what I have. And then I don’t know what I’m going to do after that. That’s the problem—and that is what scares me to death.” Telling people to lose weight the “natural way,” she told another guest, who was suggesting that people with obesity need only go on low-carb diets, is like “asking a person with a thyroid condition to just stop their medication.”
  • She’d gone off the fen-phen and had rapidly regained weight. “The voices returned and came back in a furor I’d never heard before,” Barb later wrote on her blog. “It was as if they were so angry at being silenced for so long, they were going to tell me 19 months’ worth of what they wanted me to hear. I was forced to listen. And I ate. And I ate. And ate.”
  • For Barb, rapid weight loss has brought on a different metaphysical confusion. When she looks in the mirror, she sometimes sees her shape as it was two years ago. In certain corners of the internet, this is known as “phantom fat syndrome,” but Barb dislikes that term. She thinks it should be called “body integration syndrome,” stemming from a disconnect between your “larger-body memory” and “smaller-body reality.
  • In 2003, the U.S. surgeon general declared obesity “the terror within, a threat that is every bit as real to America as the weapons of mass destruction”; a few months later, Eric Finkelstein, an economist who studies the social costs of obesity, put out an influential paper finding that excess weight was associated with up to $79 billion in health-care spending in 1998, of which roughly half was paid by Medicare and Medicaid. (Later he’d conclude that the number had nearly doubled in a decade.
  • In 2004, Finkelstein attended an Action on Obesity summit hosted by the Mayo Clinic, at which numerous social interventions were proposed, including calorie labeling in workplace cafeterias and mandatory gym class for children of all grades.
  • he message at their core, that soda was a form of poison like tobacco, spread. In San Francisco and New York, public-service campaigns showed images of soda bottles pouring out a stream of glistening, blood-streaked fat. Michelle Obama led an effort to depict water—plain old water—as something “cool” to drink.
  • Soon, the federal government took up many of the ideas that Brownell had helped popularize. Barack Obama had promised while campaigning for president that if America’s obesity trends could be reversed, the Medicare system alone would save “a trillion dollars.” By fighting fat, he implied, his ambitious plan for health-care reform would pay for itself. Once he was in office, his administration pulled every policy lever it could.
  • Michelle Obama helped guide these efforts, working with marketing experts to develop ways of nudging kids toward better diets and pledging to eliminate “food deserts,” or neighborhoods that lacked convenient access to healthy, affordable food. She was relentless in her public messaging; she planted an organic garden at the White House and promoted her signature “Let’s Move!” campaign around the country.
  • An all-out war on soda would come to stand in for these broad efforts. Nutrition studies found that half of all Americans were drinking sugar-sweetened beverages every day, and that consumption of these accounted for one-third of the added sugar in adults’ diets. Studies turned up links between people’s soft-drink consumption and their risks for type 2 diabetes and obesity. A new strand of research hinted that “liquid calories” in particular were dangerous to health.
  • when their field lost faith in low-calorie diets as a source of lasting weight loss, the two friends went in opposite directions. Wadden looked for ways to fix a person’s chemistry, so he turned to pharmaceuticals. Brownell had come to see obesity as a product of our toxic food environment: He meant to fix the world to which a person’s chemistry responded, so he started getting into policy.
  • The social engineering worked. Slowly but surely, Americans’ lamented lifestyle began to shift. From 2001 to 2018, added-sugar intake dropped by about one-fifth among children, teens, and young adults. From the late 1970s through the early 2000s, the obesity rate among American children had roughly tripled; then, suddenly, it flattened out.
  • although the obesity rate among adults was still increasing, its climb seemed slower than before. Americans’ long-standing tendency to eat ever-bigger portions also seemed to be abating.
  • sugary drinks—liquid candy, pretty much—were always going to be a soft target for the nanny state. Fixing the food environment in deeper ways proved much harder. “The tobacco playbook pretty much only works for soda, because that’s the closest analogy we have as a food item,
  • that tobacco playbook doesn’t work to increase consumption of fruits and vegetables, he said. It doesn’t work to increase consumption of beans. It doesn’t work to make people eat more nuts or seeds or extra-virgin olive oil.
  • Careful research in the past decade has shown that many of the Obama-era social fixes did little to alter behavior or improve our health. Putting calorie labels on menus seemed to prompt at most a small decline in the amount of food people ate. Employer-based wellness programs (which are still offered by 80 percent of large companies) were shown to have zero tangible effects. Health-care spending, in general, kept going up.
  • From the mid-1990s to the mid-2000s, the proportion of adults who said they’d experienced discrimination on account of their height or weight increased by two-thirds, going up to 12 percent. Puhl and others started citing evidence that this form of discrimination wasn’t merely a source of psychic harm, but also of obesity itself. Studies found that the experience of weight discrimination is associated with overeating, and with the risk of weight gain over time.
  • obesity rates resumed their ascent. Today, 20 percent of American children have obesity. For all the policy nudges and the sensible revisions to nutrition standards, food companies remain as unfettered as they were in the 1990s, Kelly Brownell told me. “Is there anything the industry can’t do now that it was doing then?” he asked. “The answer really is no. And so we have a very predictable set of outcomes.”
  • she started to rebound. The openings into her gastric pouch—the section of her stomach that wasn’t bypassed—stretched back to something like their former size. And Barb found ways to “eat around” the surgery, as doctors say, by taking food throughout the day in smaller portions
  • Bariatric surgeries can be highly effective for some people and nearly useless for others. Long-term studies have found that 30 percent of those who receive the same procedure Barb did regain at least one-quarter of what they lost within two years of reaching their weight nadir; more than half regain that much within five years.
  • if the effects of Barb’s surgery were quickly wearing off, its side effects were not: She now had iron, calcium, and B12 deficiencies resulting from the changes to her gut. She looked into getting a revision of the surgery—a redo, more or less—but insurance wouldn’t cover it
  • She found that every health concern she brought to doctors might be taken as a referendum, in some way, on her body size. “If I stubbed my toe or whatever, they’d just say ‘Lose weight.’ ” She began to notice all the times she’d be in a waiting room and find that every chair had arms. She realized that if she was having a surgical procedure, she’d need to buy herself a plus-size gown—or else submit to being covered with a bedsheet when the nurses realized that nothing else would fit.
  • Barb grew angrier and more direct about her needs—You’ll have to find me a different chair, she started saying to receptionists. Many others shared her rage. Activists had long decried the cruel treatment of people with obesity: The National Association to Advance Fat Acceptance had existed, for example, in one form or another, since 1969; the Council on Size & Weight Discrimination had been incorporated in 1991. But in the early 2000s, the ideas behind this movement began to wend their way deeper into academia, and they soon gained some purchase with the public.
  • “Our public-health efforts to address obesity have failed,” Eric Finkelstein, the economist, told me.
  • Others attacked the very premise of a “healthy weight”: People do not have any fundamental need, they argued, morally or medically, to strive for smaller bodies as an end in itself. They called for resistance to the ideology of anti-fatness, with its profit-making arms in health care and consumer goods. The Association for Size Diversity and Health formed in 2003; a year later, dozens of scholars working on weight-related topics joined together to create the academic field of fat studies.
  • As the size-diversity movement grew, its values were taken up—or co-opted—by Big Business. Dove had recently launched its “Campaign for Real Beauty,” which included plus-size women. (Ad Age later named it the best ad campaign of the 21st century.) People started talking about “fat shaming” as something to avoid
  • By 2001, Bacon, who uses they/them pronouns, had received their Ph.D. and finished a rough draft of a book, Health at Every Size, which drew inspiration from a broader movement by that name among health-care practitioners
  • But something shifted in the ensuing years. In 2007, Bacon got a different response, and the book was published. Health at Every Size became a point of entry for a generation of young activists and, for a time, helped shape Americans’ understanding of obesity.
  • Some experts were rethinking their advice on food and diet. At UC Davis, a physiologist named Lindo Bacon who had struggled to overcome an eating disorder had been studying the effects of “intuitive eating,” which aims to promote healthy, sustainable behavior without fixating on what you weigh or how you look
  • The heightened sensitivity started showing up in survey data, too. In 2010, fewer than half of U.S. adults expressed support for giving people with obesity the same legal protections from discrimination offered to people with disabilities. In 2015, that rate had risen to three-quarters.
  • In Bacon’s view, the 2000s and 2010s were glory years. “People came together and they realized that they’re not alone, and they can start to be critical of the ideas that they’ve been taught,” Bacon told me. “We were on this marvelous path of gaining more credibility for the whole Health at Every Size movement, and more awareness.”
  • that sense of unity proved short-lived; the movement soon began to splinter. Black women have the highest rates of obesity, and disproportionately high rates of associated health conditions. Yet according to Fatima Cody Stanford, an obesity-medicine physician at Harvard Medical School, Black patients with obesity get lower-quality care than white patients with obesity.
  • That system was exactly what Bacon and the Health at Every Size movement had set out to reform. The problem, as they saw it, was not so much that Black people lacked access to obesity medicine, but that, as Bacon and the Black sociologist Sabrina Strings argued in a 2020 article, Black women have been “specifically targeted” for weight loss, which Bacon and Strings saw as a form of racism
  • But members of the fat-acceptance movement pointed out that their own most visible leaders, including Bacon, were overwhelmingly white. “White female dietitians have helped steal and monetize the body positive movement,” Marquisele Mercedes, a Black activist and public-health Ph.D. student, wrote in September 2020. “And I’m sick of it.”
  • Tensions over who had the standing to speak, and on which topics, boiled over. In 2022, following allegations that Bacon had been exploitative and condescending toward Black colleagues, the Association for Size Diversity and Health expelled them from its ranks and barred them from attending its events.
  • As the movement succumbed to in-fighting, its momentum with the public stalled. If attitudes about fatness among the general public had changed during the 2000s and 2010s, it was only to a point. The idea that some people can indeed be “fit but fat,” though backed up by research, has always been a tough sell.
  • Although Americans had become less inclined to say they valued thinness, measures of their implicit attitudes seemed fairly stable. Outside of a few cities such as San Francisco and Madison, Wisconsin, new body-size-discrimination laws were never passed.
  • In the meantime, thinness was coming back into fashion
  • In the spring of 2022, Kim Kardashian—whose “curvy” physique has been a media and popular obsession—boasted about crash-dieting in advance of the Met Gala. A year later, the model and influencer Felicity Hayward warned Vogue Business that “plus-size representation has gone backwards.” In March of this year, the singer Lizzo, whose body pride has long been central to her public persona, told The New York Times that she’s been trying to lose weight. “I’m not going to lie and say I love my body every day,” she said.
  • Among the many other dramatic effects of the GLP-1 drugs, they may well have released a store of pent-up social pressure to lose weight.
  • If ever there was a time to debate that impulse, and to question its origins and effects, it would be now. But Puhl told me that no one can even agree on which words are inoffensive. The medical field still uses obesity, as a description of a diagnosable disease. But many activists despise that phrase—some spell it with an asterisk in place of the e—and propose instead to reclaim fat.
  • Everyone seems to agree on the most important, central fact: that we should be doing everything we can to limit weight stigma. But that hasn’t been enough to stop the arguing.
  • Things feel surreal these days to just about anyone who has spent years thinking about obesity. At 71, after more than four decades in the field, Thomas Wadden now works part-time, seeing patients just a few days a week. But the arrival of the GLP-1 drugs has kept him hanging on for a few more years, he said. “It’s too much of an exciting period to leave obesity research right now.”
  • When everyone is on semaglutide or tirzepatide, will the soft-drink companies—Brownell’s nemeses for so many years—feel as if a burden has been lifted? “My guess is the food industry is probably really happy to see these drugs come along,” he said. They’ll find a way to reach the people who are taking GLP‑1s, with foods and beverages in smaller portions, maybe. At the same time, the pressures to cut back on where and how they sell their products will abate.
  • the triumph in obesity treatment only highlights the abiding mystery of why Americans are still getting fatter, even now
  • Perhaps one can lay the blame on “ultraprocessed” foods, he said. Maybe it’s a related problem with our microbiomes. Or it could be that obesity, once it takes hold within a population, tends to reproduce itself through interactions between a mother and a fetus. Others have pointed to increasing screen time, how much sleep we get, which chemicals are in the products that we use, and which pills we happen to take for our many other maladies.
  • “The GLP-1s are just a perfect example of how poorly we understand obesity,” Mozaffarian told me. “Any explanation of why they cause weight loss is all post-hoc hand-waving now, because we have no idea. We have no idea why they really work and people are losing weight.”
  • The new drugs—and the “new understanding of obesity” that they have supposedly occasioned—could end up changing people’s attitudes toward body size. But in what ways
  • When the American Medical Association declared obesity a disease in 2013, Rebecca Puhl told me, some thought “it might reduce stigma, because it was putting more emphasis on the uncontrollable factors that contribute to obesity.” Others guessed that it would do the opposite, because no one likes to be “diseased.”
  • why wasn’t there another kind of nagging voice that wouldn’t stop—a sense of worry over what the future holds? And if she wasn’t worried for herself, then what about for Meghann or for Tristan, who are barely in their 40s? Wouldn’t they be on these drugs for another 40 years, or even longer? But Barb said she wasn’t worried—not at all. “The technology is so much better now.” If any problems come up, the scientists will find solutions.
Javier E

Who's Afraid of Early Cancer Detection? - WSJ - 0 views

  • A diagnosis of pancreatic cancer usually means a quick death—but not for Roger Royse, who was in Stage II of the disease when he got the bad news in July 2022. The five-year relative survival rate for late-stage metastatic pancreatic cancer is 3%—which means that patients are 3% as likely to live five years after their diagnosis as other cancer-free individuals. But if pancreatic cancer is caught before it has spread to other organs, the survival rate is 44%.
  • some public-health experts think that’s just as well. They fret that widespread use of multicancer early-detection tests would cause healthcare spending to explode. Those fears have snarled Galleri and similar tests in a web of red tape.
  • Early diagnosis is the best defense against most cancers,
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  • But only a handful of cancers—of the breast, lung, colon and cervix—have screening tests recommended by the U.S. Preventive Services Task Force
  • Many companies are developing blood tests that can detect cancer signals before symptoms occur, and Grail’s is the most advanced. A study found it can identify more than 50 types of cancer 52% of the time and the 12 deadliest cancers in Stages I through III 68% of the time.
  • There’s a hitch. The test costs $949 and isn’t covered by Medicare or most private insurance.
  • The trouble is that this cancer is almost never caught early. There’s no routine screening for it, and symptoms don’t develop until it is advanced. Mr. Royse, 64, had no idea he was sick until he took a blood test called Galleri, produced by the Menlo Park, Calif., startup Grail. He had surgery and chemotherapy and is now cancer-free.
  • Mr. Royse visited Grail’s website, which referred him to a telemedicine provider who ordered a test. Another telemedicine doctor walked him through his results, which showed a cancer signal likely emanating from the pancreas, gallbladder, stomach or esophagus.
  • An MRI revealed a suspicious mass on his pancreas, which a biopsy confirmed was cancerous. Mr. Royse had three months of chemotherapy, surgery and another three months of chemotherapy, which ended last February. Because pancreatic cancer often recurs, he gets CT and MRI scans every three months. In addition, he has signed up for startup Natera’s Signatera customized blood test, which checks DNA specific to the patient’s cancer and can signal its return before signs are visible on the scans
  • Grail’s test likewise looks for DNA shed by cancer cells, which is tagged by molecules called methyl groups that are specific to a cancer’s origin. Grail uses genetic sequencing and machine learning to recognize links between DNA methyl groups and particular cancers
  • The test “is based on how much DNA is being shed by tumor,” Grail’s president, Josh Ofman, says. “Some tumors shed a lot of DNA. Some shed almost none.
  • ut slow-growing tumors typically aren’t shedding a lot of DNA.” That reduces the probability that Grail’s test will identify indolent cancers that pose no immediate danger.
  • Grail’s test has a roughly 0.5% false-positive rate, meaning 1 in 200 patients who don’t have cancer will get a positive signal
  • Its positive predictive value is 43%, so that of every 100 patients with a positive signal, 43 actually have cancer
  • the legislation’s price tag could reduce political support. According to one private company’s estimate, the test could cost the government $39 billion to $145 billion over a decade. Mr. Goldman counters that analysts usually overestimate the costs and underestimate the benefits of medical interventions.
  • Because Grail uses machine learning to detect DNA-methylation cancer linkages, the Grail test’s accuracy should improve as more tests and patient data are collected
  • regulators may balk at approving the test, and insurers at covering it, until it becomes cheaper and more reliable.
  • How would the FDA weigh the risk that a false positive on a test like Grail’s could require invasive follow-up testing against the dire but hard-to-quantify risk that a deadly cancer wouldn’t be caught until it’s much harder to treat? It’s unclear.
  • some experts urge the FDA to require large randomized controlled trials before approving blood cancer tests. “Multicancer screening would entail tremendous costs and potentially substantial harms,” H. Gilbert Welch and Tanujit Dey of Brigham and Women’s Hospital wrote
  • Dr. Welch and Mr. Dey also suggested that companies should be required to prove their tests reduce overall mortality, even though the FDA doesn’t require drugmakers to prove their products reduce deaths or extend life. Clinical trials for the mRNA Covid vaccines didn’t show they reduced deaths.
  • One alternative is to rely on real-world studies, which Grail is already doing. One study of patients 50 and older without signs of cancer showed that the test doubled the number of cancers detected.
  • One recurring problem he has seen: “Epidemiologists are always getting cancer wrong,” he says. “Epidemiologists a decade ago said U.S. overtreats cancers. Well, no, the EU undertreats cancer.”
  • A 2012 study that he co-authored found that the higher U.S. spending on cancer care relative to Europe between 1983 and 1999 resulted in significantly higher survival rates for American patients than for those in Europe
  • By his study’s calculation, U.S. spending on cancer treatments during that period resulted in $556 billion in net benefits owing to reduced mortality.
  • He expects Galleri and other multicancer early-detection tests to reduce deaths and produce public-health and economic benefits that exceed their monetary costs
  • Expanding access to multicancer early-detection tests could also help solve the chicken-and-egg problem of drug development. Because few patients are diagnosed at early stages of some cancers, it’s hard to develop treatments for them
  • the positive predictive value for some recommended cancer screenings is far lower. Fewer than 1 in 10 women with an abnormal finding on a mammogram are diagnosed with breast cancer.
  • Mr. Royse makes the same point with personal force. “I would be dead right now if not for multicancer early-detection testing,” Mr. Royse told an FDA advisory committee last fall. “The longer the FDA waits, the more people are going to die. It’s that simple.”
Javier E

Opinion | Kamala Harris Isn't Bluffing - The New York Times - 0 views

  • a community of like-minded thinkers who take calculated risks for a living. These people, from poker players to venture capitalists — I call them the River, and they are from Silicon Valley, Wall Street, sports betting, crypto — make decisions based not on what they know at the moment but on expected value
  • For them, when it is time to make a decision, the question is: Do the risks outweigh the rewards?
  • The River is the rival of the group of academics, journalists and policy wonks that I call the Village. This term might be more familiar: It’s the East Coast expert class. Harvard and Yale. The New York Times and The Washington Post. Together, these communities make up only a small percent of the population — in short, they are elites.
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  • The Village tends toward risk aversion, as evident in its Covid caution and its increasing wariness about free speech (which very much can have sticks-and-stones consequences). It tends to make decisions by consensus, with dissenters punished by ostracization
  • The River has been on a winning streak in terms of its impact on society and our economy: Its core industries, tech and finance, continually grow as fractions of the economy, and Las Vegas is bringing in record revenues
  • So far in the 2024 election, the Village has been making better risk-management decisions — out-Rivering the River. The presidential race remains close, but at least for now it looks like the Village is winning.
  • At least the Village got the most important decision right: kicking President Biden to the curb. In so doing, they roughly doubled their chances of winning
  • To understand why, it helps to know that the River can be prone to contrarianism. As the Village has become bluer and bluer, some communities within the River have rebelled by becoming, to varying degrees, red-pilled in response.
  • It’s much harder to see the upside for Mr. Trump’s choice of Senator JD Vance of Ohio.
  • The poker player in me would have played the percentages and taken the calculated risk in Mr. Shapiro. The choice of Mr. Walz has grown on me as Ms. Harris has sustained her momentum in the polls — but Pennsylvania still looms large.
  • But the River is by no means a bloc, whereas the Village’s penchant for consensus helped it, when Mr. Biden stepped aside, to consolidate quickly around Ms. Harris
  • Mr. Trump himself straddles the River-Village boundary awkwardly as a former casino magnate (though not a successful one), but he’s more intuitive than analytical and obsessed with his news coverage in the Village.
  • The Trump campaign made two classic mistakes with his V.P. choice, though Silicon Valley’s conservatives cheered. One was counting their chickens before they hatched.
  • The second error was a failure to practice strategic empathy, meaning a willingness to put yourself in your opponent’s shoes.
  • This is generally something that people in the River are good at; it’s essential in poker.
  • There’s another term from the poker world that describes Mr. Trump’s recent decision-making:
  • He may be on tilt, the condition of making suboptimal choices because your emotions get in the way. Every poker player has seen it: An opponent builds up a huge stack, looks forward to treating himself to a steak dinner and bragging to his buddies. But then he loses a big pot — and before he knows it, the rest of his chips are gone as he tries to chase his losses.
Javier E

Vance, Trump, and The Politics of Hate - 0 views

  • “I think our people hate the right people,” a relaxed JD Vance confided to an interviewer three years ago.
  • By “the right people,” Vance meant liberal elites.
  • it was also clear that Vance knew one couldn’t foster hatred for liberal elites without the collateral damage of hatred for immigrants, racial and ethnic minorities, cultural nonconformists, and any of the groups whom those elites were supposedly elevating at the expense of “our people.”
  • ...17 more annotations...
  • But these past few weeks suggest that it wasn’t merely collateral damage at all. The assault on these groups really was the point. The alleged failures of liberal elites (to, say, close the border or protect manufacturing jobs) are the excuse for the assaults on immigrants and minorities that we’ve seen throughout the Trump years. That’s where the real political payoff is
  • By “hate” Vance means . . . hate. Not disagreement or even dislike. Hate.
  • Vance’s politics are the politics of hate
  • perhaps he just watched Trump’s success and internalized its lessons. But in any case, for Vance it’s all about hate.
  • And the assault on the Haitians of Springfield, Ohio, is a kind of culmination of Vance’s—and of course Trump’s—politics of hate.
  • It also represents a culmination of Vance’s and Trump’s politics of lying
  • Vance acknowledged yesterday on CNN that he had been trying to manufacture coverage of Springfield based on nothing more than a few unsubstantiated constituent phone calls. “If I have to create stories so that the American media actually pays attention to the suffering of the American people, then that’s what I’m going to do.”
  • The creation of stories. One could call that fiction. Or lies
  • It’s familiar from the last century in Europe. It’s also familiar from periods of American history, especially with respect to race and immigrants.
  • in Trump’s case, the hatred is so mixed with his distinctive showmanship and conmanship that it’s sometimes hard to see the heart of the enterprise.
  • With Vance, who’s not as much of a showman or con man, it’s all much clearer.
  • he border’s been a mess, and there are people who’ve come across the border illegally and committed crimes. So there’s plenty of grist for the mill here for a more conventional (if still mean-spirited and demagogic) anti-immigration candidate.
  • instead, Vance and Trump have gotten “distracted” into a debate about legal Haitian migrants who’ve come to Springfield to work legally. Or is it a distraction? Might Vance and Trump know what they’re doing? Perhaps a pure play on racism and nativism is more effective politically than a somewhat complicated debate about the border
  • In any case, it’s striking that Trump and Vance are willing to make this campaign so clearly a referendum on nativism and racism.
  • Such efforts have worked at other times in American history. And such efforts have been aided by sophisticated allies who don’t quite join in the campaign, but certainly don’t go out of their way to denounce it or repudiate it
  • Think of the Southern Bourbons who tolerated and benefited from the uninhibited racism of Southern populists and demagogues.
  • The sounds you hear from that establishment and those elites, from corporate boardrooms and editorial offices, in the face of disgusting bigotry and dangerous incitement from the presidential ticket they support? Those are the sounds of silence.
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