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Javier E

The inadequacy of the stories we told about the pandemic - 0 views

  • Increasingly, it feels possible to take stock not just of what happened but also of the inadequacy of some of the stories we told ourselves to make sense of the mess.
  • This week, I want to consider two prominent frameworks about the pandemic that are nevertheless rarely considered alongside each other: disparities in Covid mortality by race and by partisanship.
  • Partisanship was a huge driver of that more significant second-year failure, since Republican resistance to vaccination explains a large share of cumulative American Covid mortality
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  • Black mortality was 65 percent higher and Hispanic mortality 75 percent higher.
  • at least in Ohio and Florida, despite what seemed at the time to be almost unbridgeable divides over things like mask wearing and school closures, social distancing and lockdowns, the excess mortality gap between Republicans and Democrats in the pre-vaccine phase of the pandemic was relatively small, with Republican excess mortality only 22 percent higher than the death rate among Democrats.
  • The country clearly stumbled in 2020. And yet before vaccines were widely available, and when we tried to slow the spread of the disease through behavioral measures, the scale of the failure was relatively small compared with what followed in the years after.
  • In 2020, American death rates and excess mortality fell merely at the worse end of its peer countries — above Germany and barely France but below Britain, Italy and Spain, for instance
  • In the vaccine era of the pandemic, American performance has been much worse, with our death rates becoming much more conspicuous and dramatic outliers — enough to make the country by far the worst performing of its peers.
  • Overall — from the beginning of the pandemic until the arrival of Omicron — Republican excess mortality in Ohio and Florida was 76 percent higher than Democratic excess mortality.
  • only 62 percent of Republicans have completed their primary vaccinations, compared with 87 percent of Democrats.
  • income and education tell a similar story: Only 67 percent of Americans with household incomes below $40,000 have completed their primary vaccinations, compared with 85 percent with household incomes above $90,000
  • What does this all mean for the next pandemic fall and winter? Well, thankfully, the racial and ethnic gaps around vaccination have almost entirely closed, which is one major reason the mortality gap has, too: According to Kaiser, 74 percent of Black and Hispanic Americans have been vaccinated, compared with 77 percent of whites
  • The demographic gaps for boosters are slightly larger: 50 percent of white adults have been boosted, according to Kaiser, compared with 43 percent of Black adults and 40 percent of Hispanic adults. (Only 31 percent of Republicans have been boosted.)
  • while the news from Europe isn’t especially reassuring, it would probably take an Omicron-like curveball to deliver a new American peak like those we experienced each of the previous two winters, and there does not seem to be anything like that on the horizon.
  • But according to The Times’s global vaccination tracker, Americans are doing almost exactly as poorly with boosters as we did with the first round of vaccines, not worse. The country ranks 66th globally in the share of population that has completed a primary vaccination course. For a first booster, it ranks 71s
  • One set of answers is implied by the story of vaccination and mortality by race, and the way improvements on one measure changed the trajectory of the other: more first shots and more boosting. This is the central strategy offered by the Biden administration. But the vaccinated share of the country has barely grown in months, and the uptake of next generation bivalent boosters looks, in the early stages, quite abysmal.
  • yet Americans are still dying at an annualized rate above 100,000 — a rate that may well grow as we head deeper into the fall. What are we doing about that?
  • another possible set of responses suggests itself too, one that wouldn’t require a reversal of vaccination trends or a transformation of the pandemic culture war either: an approach to public health infrastructure, both literal and legal, that would reduce spread through background interventions without meaningfully burdening individual Americans at all.
  • in a perverse way the arrival of vaccines seemed to almost retire them from public discussion. They include better ventilation in public buildings, particularly schools
  • Testing could help, too, of course, though culturally it seems to have been dumped into a bucket with masks, as an individual tool and individual burden, rather than one with investments in ventilation improvements, as part of an invisible Covid-mitigating infrastructure
  • Over the last six months, an individual risk approach to Covid has predominated — both at the level of public health guidance and for most individuals navigating the new, quasi-endemic landscape
  • This argument is unhelpful, not just because it is needlessly toxic but also because the terms themselves are inadequate. One of the lessons of that early phase of the pandemic, and especially its racial disparities, is that mitigation is not strictly a matter of individual risk management. Spread matters, too, as do structural factors. We have tools to help both, without returning the country psychologically to the depths of Covid panic.
  • And although the partisan gap grew with the arrival of vaccines, it never grew as large as the racial gap had been in early 2020. In 2021, Republican excess mortality in those two states was at its highest, compared to Democratic levels: 153 percent. At the peak of racial disparity in the pandemic’s first wave, Black Americans were dying more than three times as much as white Americans.
  • structural factors — not only race but class and education, too — appear to loom just as large, complicating any intuitive model of what went wrong here that emphasizes the pandemic culture war above all else.
  • Especially in the initial phases of spread, it can be hard to disentangle the effects of policy and behavioral response from somewhat random drivers like where the virus arrived first, what sorts of places those were and what kinds of people populated them, and even what the weather was like
  • This dynamic changed almost on a dime with the introduction of vaccines, with an enormous gap opening up between Democrats and Republicans in 2021
  • the excess mortality data collected here suggests that however self-destructive red states and Republican individuals seemed to be, in 2020, the ultimate cost of that recklessness was less dramatic.
  • For Americans without college degrees, the number is also 67 percent, compared with 85 percent of college graduates. For uninsured adults under 65, it is just 60 percent
Javier E

12 Rules for Life: An Antidote to Chaos (Jordan B. Peterson) - 0 views

  • RULES? MORE RULES? REALLY? Isn’t life complicated enough, restricting enough, without abstract rules that don’t take our unique, individual situations into account? And given that our brains are plastic, and all develop differently based on our life experiences, why even expect that a few rules might be helpful to us all?
  • “I’ve got some good news…and I’ve got some bad news,” the lawgiver yells to them. “Which do you want first?” “The good news!” the hedonists reply. “I got Him from fifteen commandments down to ten!” “Hallelujah!” cries the unruly crowd. “And the bad?” “Adultery is still in.”
  • Maps of Meaning was sparked by Jordan’s agonized awareness, as a teenager growing up in the midst of the Cold War, that much of mankind seemed on the verge of blowing up the planet to defend their various identities. He felt he had to understand how it could be that people would sacrifice everything for an “identity,”
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  • the story of the golden calf also reminds us that without rules we quickly become slaves to our passions—and there’s nothing freeing about that.
  • And the story suggests something more: unchaperoned, and left to our own untutored judgment, we are quick to aim low and worship qualities that are beneath us—in this case, an artificial animal that brings out our own animal instincts in a completely unregulated way.
  • Similarly, in this book Professor Peterson doesn’t just propose his twelve rules, he tells stories, too, bringing to bear his knowledge of many fields as he illustrates and explains why the best rules do not ultimately restrict us but instead facilitate our goals and make for fuller, freer lives.
  • Peterson wasn’t really an “eccentric”; he had sufficient conventional chops, had been a Harvard professor, was a gentleman (as cowboys can be) though he did say damn and bloody a lot, in a rural 1950s sort of way. But everyone listened, with fascination on their faces, because he was in fact addressing questions of concern to everyone at the table.
  • unlike many academics who take the floor and hold it, if someone challenged or corrected him he really seemed to like it. He didn’t rear up and neigh. He’d say, in a kind of folksy way, “Yeah,” and bow his head involuntarily, wag it if he had overlooked something, laughing at himself for overgeneralizing. He appreciated being shown another side of an issue, and it became clear that thinking through a problem was, for him, a dialogic process.
  • for an egghead Peterson was extremely practical. His examples were filled with applications to everyday life: business management, how to make furniture (he made much of his own), designing a simple house, making a room beautiful (now an internet meme) or in another, specific case related to education, creating an online writing project that kept minority students from dropping out of school by getting them to do a kind of psychoanalytic exercise on themselves,
  • These Westerners were different: self-made, unentitled, hands on, neighbourly and less precious than many of their big-city peers, who increasingly spend their lives indoors, manipulating symbols on computers. This cowboy psychologist seemed to care about a thought only if it might, in some way, be helpful to someone.
  • I was drawn to him because here was a clinician who also had given himself a great books education, and who not only loved soulful Russian novels, philosophy and ancient mythology, but who also seemed to treat them as his most treasured inheritance. But he also did illuminating statistical research on personality and temperament, and had studied neuroscience. Though trained as a behaviourist, he was powerfully drawn to psychoanalysis with its focus on dreams, archetypes, the persistence of childhood conflicts in the adult, and the role of defences and rationalization in everyday life. He was also an outlier in being the only member of the research-oriented Department of Psychology at the University of Toronto who also kept a clinical practice.
  • Maps of Meaning, published nearly two decades ago, shows Jordan’s wide-ranging approach to understanding how human beings and the human brain deal with the archetypal situation that arises whenever we, in our daily lives, must face something we do not understand.
  • The brilliance of the book is in his demonstration of how rooted this situation is in evolution, our DNA, our brains and our most ancient stories. And he shows that these stories have survived because they still provide guidance in dealing with uncertainty, and the unavoidable unknown.
  • this is why many of the rules in this book, being based on Maps of Meaning, have an element of universality to them.
  • We are ambivalent about rules, even when we know they are good for us. If we are spirited souls, if we have character, rules seem restrictive, an affront to our sense of agency and our pride in working out our own lives. Why should we be judged according to another’s rule?
  • And he felt he had to understand the ideologies that drove totalitarian regimes to a variant of that same behaviour: killing their own citizens.
  • Ideologies are simple ideas, disguised as science or philosophy, that purport to explain the complexity of the world and offer remedies that will perfect it.
  • Ideologues are people who pretend they know how to “make the world a better place” before they’ve taken care of their own chaos within.
  • Ideologies are substitutes for true knowledge, and ideologues are always dangerous when they come to power, because a simple-minded I-know-it-all approach is no match for the complexity of existence.
  • To understand ideology, Jordan read extensively about not only the Soviet gulag, but also the Holocaust and the rise of Nazism. I had never before met a person, born Christian and of my generation, who was so utterly tormented by what happened in Europe to the Jews, and who had worked so hard to understand how it could have occurred.
  • I saw what now millions have seen online: a brilliant, often dazzling public speaker who was at his best riffing like a jazz artist; at times he resembled an ardent Prairie preacher (not in evangelizing, but in his passion, in his ability to tell stories that convey the life-stakes that go with believing or disbelieving various ideas). Then he’d just as easily switch to do a breathtakingly systematic summary of a series of scientific studies. He was a master at helping students become more reflective, and take themselves and their futures seriously. He taught them to respect many of the greatest books ever written. He gave vivid examples from clinical practice, was (appropriately) self-revealing, even of his own vulnerabilities, and made fascinating links between evolution, the brain and religious stories.
  • Above all, he alerted his students to topics rarely discussed in university, such as the simple fact that all the ancients, from Buddha to the biblical authors, knew what every slightly worn-out adult knows, that life is suffering.
  • chances are, if you or someone you love is not suffering now, they will be within five years, unless you are freakishly lucky. Rearing kids is hard, work is hard, aging, sickness and death are hard, and Jordan emphasized that doing all that totally on your own, without the benefit of a loving relationship, or wisdom, or the psychological insights of the greatest psychologists, only makes it harder.
  • focused on triumphant heroes. In all these triumph stories, the hero has to go into the unknown, into an unexplored territory, and deal with a new great challenge and take great risks. In the process, something of himself has to die, or be given up, so he can be reborn and meet the challenge. This requires courage, something rarely discussed in a psychology class or textbook.
  • Jordan
  • views of his first YouTube statements quickly numbered in the hundreds of thousands. But people have kept listening because what he is saying meets a deep and unarticulated need. And that is because alongside our wish to be free of rules, we all search for structure.
  • the first generation to have been so thoroughly taught two seemingly contradictory ideas about morality, simultaneously—at their schools, colleges and universities, by many in my own generation. This contradiction has left them at times disoriented and uncertain, without guidance and, more tragically, deprived of riches they don’t even know exist.
  • morality and the rules associated with it are just a matter of personal opinion or happenstance, “relative to” or “related to” a particular framework, such as one’s ethnicity, one’s upbringing, or the culture or historical…
  • The first idea or teaching is that morality is relative, at best a…
  • So, the decent thing to do—once it becomes apparent how arbitrary your, and your society’s, “moral values” are—is to show tolerance for people who think differently, and…
  • for many people one of the worst character flaws a person can have is to be “judgmental.”* And, since we don’t know right from wrong, or what is good, just about the most inappropriate thing an adult can…
  • That emphasis on tolerance is so paramount that for many people one of the worst character flaws a person can have is to be “judgmental.”* And, since we don’t know right from wrong, or what is good, just about the most inappropriate thing an…
  • And so a generation has been raised untutored in what was once called, aptly, “practical wisdom,” which guided previous generations. Millennials, often told they have received the finest education available anywhere, have actually…
  • professors, chose to devalue thousands of years of human knowledge about how to acquire virtue, dismissing it as passé, “…
  • They were so successful at it that the very word “virtue” sounds out of date, and someone using it appears…
  • The study of virtue is not quite the same as the study of morals (right and wrong, good and evil). Aristotle defined the virtues simply as the ways of behaving that are most conducive to happiness in life. Vice was…
  • Cultivating judgment about the difference between virtue and vice is the beginning of wisdom, something…
  • By contrast, our modern relativism begins by asserting that making judgments about how to live is impossible, because there is no real good, and no…
  • Thus relativism’s closest approximation to “virtue” is “tolerance.” Only tolerance will provide social cohesion between different groups, and save us from harming each other. On Facebook and other forms of social media, therefore, you signal your so-called…
  • Intolerance of others’ views (no matter how ignorant or incoherent they may be) is not simply wrong; in a world where there is no right or wrong, it is worse: it is a sign you are…
  • But it turns out that many people cannot tolerate the vacuum—the chaos—which is inherent in life, but made worse by this moral relativism; they cannot live without a moral compass,…
  • So, right alongside relativism, we find the spread of nihilism and despair, and also the opposite of moral relativism: the blind certainty offered by ideologies…
  • Dr. Norman Doidge, MD, is the author of The Brain That Changes Itself
  • so we arrive at the second teaching that millennials have been bombarded with. They sign up for a humanities course, to study the greatest books ever written. But they’re not assigned the books; instead they are given…
  • (But the idea that we can easily separate facts and values was and remains naive; to some extent, one’s values determine what one will pay…
  • For the ancients, the discovery that different people have different ideas about how, practically, to live, did not paralyze them; it deepened their understanding of humanity and led to some of the most satisfying conversations human beings have ever had, about how life might be lived.
  • Modern moral relativism has many sources. As we in the West learned more history, we understood that different epochs had different moral codes. As we travelled the seas and explored the globe, we learned of far-flung tribes on different continents whose different moral codes made sense relative to, or within the framework of, their societies. Science played a role, too, by attacking the religious view of the world, and thus undermining the religious grounds for ethics and rules. Materialist social science implied that we could divide the world into facts (which all could observe, and were objective and “real”) and values (…
  • it seems that all human beings are, by some kind of biological endowment, so ineradicably concerned with morality that we create a structure of laws and rules wherever we are. The idea that human life can be free of moral concerns is a fantasy.
  • given that we are moral animals, what must be the effect of our simplistic modern relativism upon us? It means we are hobbling ourselves by pretending to be something we are not. It is a mask, but a strange one, for it mostly deceives the one who wears it.
  • Far better to integrate the best of what we are now learning with the books human beings saw fit to preserve over millennia, and with the stories that have survived, against all odds, time’s tendency to obliterate.
  • these really are rules. And the foremost rule is that you must take responsibility for your own life. Period.
  • Jordan’s message that each individual has ultimate responsibility to bear; that if one wants to live a full life, one first sets one’s own house in order; and only then can one sensibly aim to take on bigger responsibilities.
  • if it’s uncertain that our ideals are attainable, why do we bother reaching in the first place? Because if you don’t reach for them, it is certain you will never feel that your life has meaning.
  • And perhaps because, as unfamiliar and strange as it sounds, in the deepest part of our psyche, we all want to be judged.
  • Instead of despairing about these differences in moral codes, Aristotle argued that though specific rules, laws and customs differed from place to place, what does not differ is that in all places human beings, by their nature, have a proclivity to make rules, laws and customs.
  • Freud never argued (as do some who want all culture to become one huge group therapy session) that one can live one’s entire life without ever making judgments, or without morality. In fact, his point in Civilization and Its Discontents is that civilization only arises when some restraining rules and morality are in place.
  • Aleksandr Solzhenitsyn, the great documenter of the slave-labour-camp horrors of the latter, once wrote that the “pitiful ideology” holding that “human beings are created for happiness” was an ideology “done in by the first blow of the work assigner’s cudgel.”1 In a crisis, the inevitable suffering that life entails can rapidly make a mockery of the idea that happiness is the proper pursuit of the individual. On the radio show, I suggested, instead, that a deeper meaning was required. I noted that the nature of such meaning was constantly re-presented in the great stories of the past, and that it had more to do with developing character in the face of suffering than with happiness.
  • I proposed in Maps of Meaning that the great myths and religious stories of the past, particularly those derived from an earlier, oral tradition, were moral in their intent, rather than descriptive. Thus, they did not concern themselves with what the world was, as a scientist might have it, but with how a human being should act.
  • I suggested that our ancestors portrayed the world as a stage—a drama—instead of a place of objects. I described how I had come
  • to believe that the constituent elements of the world as drama were order and chaos, and not material things.
  • Order is where the people around you act according to well-understood social norms, and remain predictable and cooperative. It’s the world of social structure, explored territory, and familiarity. The state of Order is typically portrayed, symbolically—imaginatively—as masculine.
  • Chaos, by contrast, is where—or when—something unexpected happens.
  • As the antithesis of symbolically masculine order, it’s presented imaginatively as feminine. It’s the new and unpredictable suddenly emerging in the midst of the commonplace familiar. It’s Creation and Destruction,
  • Order is the white, masculine serpent; Chaos, its black, feminine counterpart. The black dot in the white—and the white in the black—indicate the possibility of transformation: just when things seem secure, the unknown can loom, unexpectedly and large. Conversely, just when everything seems lost, new order can emerge from catastrophe and chaos.
  • For the Taoists, meaning is to be found on the border between the ever-entwined pair. To walk that border is to stay on the path of life, the divine Way. And that’s much better than happiness.
  • trying to address a perplexing problem: the reason or reasons for the nuclear standoff of the Cold War. I couldn’t understand how belief systems could be so important to people that they were willing to risk the destruction of the world to protect them. I came to realize that shared belief systems made people intelligible to one another—and that the systems weren’t just about belief.
  • People who live by the same code are rendered mutually predictable to one another. They act in keeping with each other’s expectations and desires. They can cooperate. They can even compete peacefully, because everyone knows what to expect from everyone else.
  • Shared beliefs simplify the world, as well, because people who know what to expect from one another can act together to tame the world. There is perhaps nothing more important than the maintenance of this organization—this simplification. If it’s threatened, the great ship of state rocks.
  • It isn’t precisely that people will fight for what they believe. They will fight, instead, to maintain the match between what they believe, what they expect, and what they desire. They will fight to maintain the match between what they expect and how everyone is acting. It is precisely the maintenance of that match that enables everyone
  • There’s more to it, too. A shared cultural system stabilizes human interaction, but is also a system of value—a hierarchy of value, where some things are given priority and importance and others are not. In the absence of such a system of value, people simply cannot act. In fact, they can’t even perceive, because both action and perception require a goal, and a valid goal is, by necessity, something valued.
  • We experience much of our positive emotion in relation to goals. We are not happy, technically speaking, unless we see ourselves progressing—and the very idea of progression implies value.
  • Worse yet is the fact that the meaning of life without positive value is not simply neutral. Because we are vulnerable and mortal, pain and anxiety are an integral part of human existence. We must have something to set against the suffering that is intrinsic to Being.*2 We must have the meaning inherent in a profound system of value or the horror of existence rapidly becomes paramount. Then, nihilism beckons, with its hopelessness and despair.
  • So: no value, no meaning. Between value systems, however, there is the possibility of conflict. We are thus eternally caught between the most diamantine rock and the hardest of places:
  • loss of group-centred belief renders life chaotic, miserable, intolerable; presence of group-centred belief makes conflict with other groups inevitable.
  • In the West, we have been withdrawing from our tradition-, religion- and even nation-centred cultures, partly to decrease the danger of group conflict. But we are increasingly falling prey to the desperation of meaninglessness, and that is no improvement at all.
  • While writing Maps of Meaning, I was (also) driven by the realization that we can no longer afford conflict—certainly not on the scale of the world conflagrations of the twentieth century.
  • I came to a more complete, personal realization of what the great stories of the past continually insist upon: the centre is occupied by the individual.
  • It is possible to transcend slavish adherence to the group and its doctrines and, simultaneously, to avoid the pitfalls of its opposite extreme, nihilism. It is possible, instead, to find sufficient meaning in individual consciousness and experience.
  • How could the world be freed from the terrible dilemma of conflict, on the one hand, and psychological and social dissolution, on the other? The answer was this: through the elevation and development of the individual, and through the willingness of everyone to shoulder the burden of Being and to take the heroic path. We must each adopt as much responsibility as possible for individual life, society and the world.
  • We must each tell the truth and repair what is in disrepair and break down and recreate what is old and outdated. It is in this manner that we can and must reduce the suffering that poisons the world. It’s asking a lot. It’s asking for everything.
  • the alternative—the horror of authoritarian belief, the chaos of the collapsed state, the tragic catastrophe of the unbridled natural world, the existential angst and weakness of the purposeless
  • individual—is clearly worse.
  • a title: 12 Rules for Life: An Antidote to Chaos. Why did that one rise up above all others? First and foremost, because of its simplicity. It indicates clearly that people need ordering principles, and that chaos otherwise beckons.
  • We require rules, standards, values—alone and together. We’re pack animals, beasts of burden. We must bear a load, to justify our miserable existence. We require routine and tradition. That’s order. Order can become excessive, and that’s not good, but chaos can swamp us, so we drown—and that is also not good. We need to stay on the straight and narrow path.
  • I hope that these rules and their accompanying essays will help people understand what they already know: that the soul of the individual eternally hungers for the heroism of genuine Being, and that the willingness to take on that responsibility is identical to the decision to live a meaningful life.
  • RULE 1   STAND UP STRAIGHT WITH YOUR SHOULDERS BACK
  • Because territory matters, and because the best locales are always in short supply, territory-seeking among animals produces conflict. Conflict, in turn, produces another problem: how to win or lose without the disagreeing parties incurring too great a cost.
  • It’s winner-take-all in the lobster world, just as it is in human societies, where the top 1 percent have as much loot as the bottom 50 percent11—and where the richest eighty-five people have as much as the bottom three and a half billion.
  • This principle is sometimes known as Price’s law, after Derek J. de Solla Price,13 the researcher who discovered its application in science in 1963. It can be modelled using an approximately L-shaped graph, with number of people on the vertical axis, and productivity or resources on the horizontal.
  • Instead of undertaking the computationally difficult task of identifying the best man, the females outsource the problem to the machine-like calculations of the dominance hierarchy. They let the males fight it out and peel their paramours from the top.
  • The dominant male, with his upright and confident posture, not only gets the prime real estate and easiest access to the best hunting grounds. He also gets all the girls. It is exponentially more worthwhile to be successful, if you are a lobster, and male.
  • dominance hierarchies have been an essentially permanent feature of the environment to which all complex life has adapted. A third of a billion years ago, brains and nervous systems were comparatively simple. Nonetheless, they already had the structure and neurochemistry necessary to process information about status and society. The importance of this fact can hardly be overstated.
  • evolution works, in large part, through variation and natural selection. Variation exists for many reasons, including gene-shuffling (to put it simply) and random mutation. Individuals vary within a species for such reasons. Nature chooses from among them, across time. That theory, as stated, appears to account for the continual alteration of life-forms over the eons.
  • But there’s an additional question lurking under the surface: what exactly is the “nature” in “natural selection”? What exactly is “the environment” to which animals adapt?
  • Nature “selects.” The idea of selects contains implicitly nested within it the idea of fitness. It is “fitness” that is “selected.” Fitness, roughly speaking, is the probability that a given organism will leave offspring (will propagate its genes through time). The “fit” in “fitness” is therefore the matching of organismal attribute to environmental demand.
  • But nature, the selecting agent, is not a static selector—not in any simple sense.
  • As the environment supporting a species transforms and changes, the features that make a given individual successful in surviving and reproducing also transform and change. Thus, the theory of natural selection does not posit creatures matching themselves ever more precisely to a template specified by the world. It is more that creatures are in a dance with nature, albeit one that is deadly.
  • Nature is not simply dynamic, either. Some things change quickly, but they are nested within other things that change less quickly (music
  • It’s chaos, within order, within chaos, within higher order. The order that is most real is the order that is most unchanging—and that is not necessarily the order that is most easily seen. The leaf, when perceived, might blind the observer to the tree. The tree can blind him to the forest.
  • It is also a mistake to conceptualize nature romantically.
  • Unfortunately, “the environment” is also elephantiasis and guinea worms (don’t ask), anopheles mosquitoes and malaria, starvation-level droughts, AIDS and the Black Plague.
  • It is because of the existence of such things, of course, that we attempt to modify our surroundings, protecting our children, building cities and transportation systems and growing food and generating power.
  • this brings us to a third erroneous concept: that nature is something strictly segregated from the cultural constructs that have emerged within it.
  • It does not matter whether that feature is physical and biological, or social and cultural. All that matters, from a Darwinian perspective, is permanence—and the dominance hierarchy, however social or cultural it might appear, has been around for some half a billion years.
  • The dominance hierarchy is not capitalism. It’s not communism, either, for that matter. It’s not the military-industrial complex. It’s not the patriarchy—that disposable, malleable, arbitrary cultural artefact. It’s not even a human creation; not in the most profound sense. It is instead a near-eternal aspect of the environment, and much of what is blamed on these more ephemeral manifestations is a consequence of its unchanging existence.
  • We were struggling for position before we had skin, or hands, or lungs, or bones. There is little more natural than culture. Dominance hierarchies are older than trees.
  • The part of our brain that keeps track of our position in the dominance hierarchy is therefore exceptionally ancient and fundamental.17 It is a master control system, modulating our perceptions, values, emotions, thoughts and actions. It powerfully affects every aspect of our Being, conscious and unconscious alike.
  • The ancient part of your brain specialized for assessing dominance watches how you are treated by other people. On that evidence, it renders a determination of your value and assigns you a status. If you are judged by your peers as of little worth, the counter restricts serotonin availability. That makes you much more physically and psychologically reactive to any circumstance or event that might produce emotion, particularly if it is negative. You need that reactivity. Emergencies are common at the bottom, and you must be ready to survive. Unfortunately, that physical hyper-response, that constant alertness, burns up a lot of precious energy and physical resources.
  • It will leave you far more likely to live, or die, carelessly, for a rare opportunity at pleasure, when it manifests itself. The physical demands of emergency preparedness will wear you down in every way.21
  • If you have a high status, on the other hand, the counter’s cold, pre-reptilian mechanics assume that your niche is secure, productive
  • You can delay gratification, without forgoing it forever. You can afford to be a reliable and thoughtful citizen.
  • Sometimes, however, the counter mechanism can go wrong. Erratic habits of sleeping and eating can interfere with its function. Uncertainty can throw it for a loop. The body, with its various parts,
  • needs
  • to function like a well-rehearsed orchestra. Every system must play its role properly, and at exactly the right time, or noise and chaos ensue. It is for this reason that routine is so necessary. The acts of life we repeat every day need to be automatized. They must be turned into stable and reliable habits, so they lose their complexity and gain predictability and simplicity.
  • It is for such reasons that I always ask my clinical clients first about sleep. Do they wake up in the morning at approximately the time the typical person wakes up, and at the same time every day?
  • The next thing I ask about is breakfast. I counsel my clients to eat a fat and protein-heavy breakfast as soon as possible after they awaken (no simple carbohydrates, no sugars,
  • I have had many clients whose anxiety was reduced to subclinical levels merely because they started to sleep on a predictable schedule and eat breakfast.
  • Other bad habits can also interfere with the counter’s accuracy.
  • There are many systems of interaction between brain, body and social world that can get caught in positive feedback loops. Depressed people, for example, can start feeling useless and burdensome, as well as grief-stricken and pained. This makes them withdraw from contact with friends and family. Then the withdrawal makes them more lonesome and isolated, and more likely to feel useless and burdensome. Then they withdraw more. In this manner, depression spirals and amplifies.
  • If someone is badly hurt at some point in life—traumatized—the dominance counter can transform in a manner that makes additional hurt more rather than less likely. This often happens in the case of people, now adults, who were viciously bullied during childhood or adolescence. They become anxious and easily upset. They shield themselves with a defensive crouch, and avoid the direct eye contact interpretable as a dominance challenge.
  • With their capacity for aggression strait-jacketed within a too-narrow morality, those who are only or merely compassionate and self-sacrificing (and naïve and exploitable) cannot call forth the genuinely righteous and appropriately self-protective anger necessary to defend themselves. If you can bite, you generally don’t have to. When skillfully integrated, the ability to respond with aggression and violence decreases rather than increases the probability that actual aggression will become necessary.
  • Naive, harmless people usually guide their perceptions and actions with a few simple axioms: people are basically good; no one really wants to hurt anyone else; the threat (and, certainly, the use) of force, physical or otherwise, is wrong. These axioms collapse, or worse, in the presence of
  • individuals who are genuinely malevolent.27
  • I have had clients who were terrified into literally years of daily hysterical convulsions by the sheer look of malevolence on their attackers’ faces. Such individuals typically come from hyper-sheltered families, where nothing
  • terrible is allowed to exist, and everything is fairyland wonderful (or else).
  • When the wakening occurs—when once-naïve people recognize in themselves the seeds of evil and monstrosity, and see themselves as dangerous (at least potentially)— their fear decreases. They develop more self-respect. Then, perhaps, they begin to resist oppression. They see that they have the ability to withstand, because they are terrible too. They see they can and must stand up, because they begin to understand how genuinely monstrous they will become, otherwise,
  • There is very little difference between the capacity for mayhem and destruction, integrated, and strength of character. This is one of the most difficult lessons of life.
  • even if you came by your poor posture honestly—even if you were unpopular or bullied at home or in grade school28—it’s not necessarily appropriate now. Circumstances change. If you slump around, with the same bearing that characterizes a defeated lobster, people will assign you a lower status, and the old counter that you share with crustaceans, sitting at the very base of your brain, will assign you a low dominance number.
  • the other, far more optimistic lesson of Price’s law and the Pareto distribution: those who start to have will probably get more.
  • Some of these upwardly moving loops can occur in your own private, subjective space.
  • If you are asked to move the muscles one by one into a position that looks happy, you will report feeling happier. Emotion is partly bodily expression, and can be amplified (or dampened) by that expression.29
  • To stand up straight with your shoulders back is to accept the terrible responsibility of life, with eyes wide open.
  • It means deciding to voluntarily transform the chaos of potential into the realities of habitable order. It means adopting the burden of self-conscious vulnerability, and accepting the end of the unconscious paradise of childhood, where finitude and mortality are only dimly comprehended. It means willingly undertaking the sacrifices necessary to generate a productive and meaningful reality (it means acting to please God, in the ancient language).
  • So, attend carefully to your posture. Quit drooping and hunching around. Speak your mind. Put your desires forward, as if you had a right to them—at least the same right as others. Walk tall and gaze forthrightly ahead. Dare to be dangerous. Encourage the serotonin to flow plentifully through the neural pathways desperate for its calming influence.
  • Thus emboldened, you will embark on the voyage of your life, let your light shine, so to speak, on the heavenly hill, and pursue your rightful destiny. Then the meaning of your life may be sufficient to keep the corrupting influence of mortal despair at bay. Then you may be able to accept the terrible burden of the World, and find joy.
  • RULE 2   TREAT YOURSELF LIKE SOMEONE YOU ARE RESPONSIBLE FOR HELPING
  • People are better at filling and properly administering prescription medication to their pets than to themselves. That
  • It is difficult to conclude anything from this set of facts except that people appear to love their dogs, cats, ferrets and birds (and maybe even their lizards) more than themselves. How horrible is that? How much shame must exist, for something like that to be true? What could it be about people that makes them prefer their pets to themselves?
  • To understand Genesis 1, the Priestly story, with its insistence on speech as the fundamental creative force, it is first necessary to review a few fundamental, ancient assumptions (these are markedly different in type and intent from the assumptions of science, which are, historically speaking, quite novel).
  • those who existed during the distant time in which the foundational epics of our culture emerged were much more concerned with the actions that dictated survival (and with interpreting the world in a manner commensurate with that goal) than with anything approximating what we now understand as objective truth.
  • Before the dawn of the scientific worldview, reality was construed differently. Being was understood as a place of action, not a place of things.31 It was understood as something more akin to story or drama. That story or drama was lived, subjective experience, as it manifested itself moment to moment in the consciousness of every living person.
  • subjective pain. That’s something so real no argument can stand against it. Everyone acts as if their pain is real—ultimately, finally real. Pain matters, more than matter matters. It is for this reason, I believe, that so many of the world’s traditions regard the suffering attendant upon existence as the irreducible truth of Being.
  • In any case, that which we subjectively experience can be likened much more to a novel or a movie than to a scientific description of physical reality.
  • The Domain, Not of Matter, but of What Matters
  • the world of experience has primal constituents, as well. These are the necessary elements whose interactions define drama and fiction. One of these is chaos. Another is order. The third (as there are three) is the process that mediates between the two, which appears identical to what modern people call consciousness.
  • Chaos is the domain of ignorance itself. It’s unexplored territory. Chaos is what extends, eternally and without limit, beyond the boundaries of all states, all ideas, and all disciplines. It’s the foreigner, the stranger, the member of another gang, the rustle in the bushes in the night-time,
  • It is, in short, all those things and situations we neither know nor understand.
  • Chaos is also the formless potential from which the God of Genesis 1 called forth order using language at the beginning of time. It’s the same potential from which we, made in that Image, call forth the novel and ever-changing moments of our lives. And Chaos is freedom, dreadful freedom, too.
  • Order, by contrast, is explored territory. That’s the hundreds-of-millions-of-years-old hierarchy of place, position and authority. That’s the structure of society. It’s the structure provided by biology, too—particularly insofar as you are adapted, as you are, to the structure of society. Order is tribe, religion, hearth, home and country.
  • Order is the public façade we’re called upon to wear, the politeness of a gathering of civilized strangers, and the thin ice on which we all skate. Order is the place where the behavior of the world matches our expectations and our desires; the place where all things turn out the way we want them to.
  • But order is sometimes tyranny and stultification, as well, when the demand for certainty and uniformity and purity becomes too one-sided.
  • In order, we’re able to think about things in the long term. There, things work, and we’re stable, calm and competent. We seldom leave places we
  • understand—geographical or conceptual—for that reason, and we certainly do not like it when we are compelled to or when it happens accidentally.
  • When the same person betrays you, sells you out, you move from the daytime world of clarity and light to the dark underworld of chaos, confusion and despair. That’s the same move you make, and the same place you visit, when the company you work for starts to fail and your job is placed in doubt.
  • Before the Twin Towers fell—that was order. Chaos manifested itself afterward. Everyone felt it. The very air became uncertain. What exactly was it that fell? Wrong question. What exactly remained standing? That was the issue at hand.
  • Chaos is the deep ocean bottom to which Pinocchio voyaged to rescue his father from Monstro, whale and fire-breathing dragon. That journey into darkness and rescue is the most difficult thing a puppet must do, if he wants to be real; if he wants to extract himself from the temptations of deceit and acting and victimization and impulsive pleasure and totalitarian subjugation; if he wants to take his place as a genuine Being in the world.
  • Chaos is the new place and time that emerges when tragedy strikes suddenly, or malevolence reveals its paralyzing visage, even in the confines of your own home. Something unexpected or undesired can always make its appearance, when a plan is being laid out, regardless of how familiar the circumstances.
  • Our brains respond instantly when chaos appears, with simple, hyper-fast circuits maintained from the ancient days, when our ancestors dwelled in trees, and snakes struck in a flash.32 After that nigh-instantaneous, deeply reflexive bodily response comes the later-evolving, more complex but slower responses of emotions—and, after that, comes thinking, of the higher order, which can extend over seconds, minutes or years. All that response is instinctive, in some sense—but the faster the response, the more instinctive.
  • Things or objects are part of the objective world. They’re inanimate; spiritless. They’re dead. This is not true of chaos and order. Those are perceived, experienced and understood (to the degree that they are understood at all) as personalities—and that is just as true of the perceptions, experiences and understanding of modern people as their ancient forebears. It’s just that moderners don’t notice.
  • Perception of things as entities with personality also occurs before perception of things as things. This is particularly true of the action of others,34 living others, but we also see the non-living “objective world” as animated, with purpose and intent.
  • This is because of the operation of what psychologists have called “the hyperactive agency detector” within us.35 We evolved, over millennia, within intensely social circumstances. This means that the most significant elements of our environment of origin were personalities, not things, objects or situations.
  • The personalities we have evolved to perceive have been around, in predictable form, and in typical, hierarchical configurations, forever, for all intents and purposes. They have been…
  • the category of “parent” and/or “child” has been around for 200 million years. That’s longer than birds have existed. That’s longer than flowers have grown. It’s not a billion years, but it’s still a very long time. It’s plenty long enough for male and female and parent and child to serve as vital and fundamental parts of the environment to which we have adapted. This means that male and female and parent and child are…
  • Our brains are deeply social. Other creatures (particularly, other humans) were crucially important to us as we lived, mated and evolved. Those creatures were…
  • From a Darwinian perspective, nature—reality itself; the environment, itself—is what selects. The environment cannot be defined in any more fundamental manner. It is not mere inert matter. Reality itself is whatever we contend with when we are striving to survive and reproduce. A…
  • as our brain capacity increased and we developed curiosity to spare, we became increasingly aware of and curious about the nature of the world—what we eventually conceptualized as the objective…
  • “outside” is not merely unexplored physical territory. Outside is outside of what we currently understand—and understanding is dealing with and coping with…
  • when we first began to perceive the unknown, chaotic, non-animal world, we used categories that had originally evolved to represent the pre-human animal social world. Our minds are far older than mere…
  • Our most…
  • category—as old, in some sense, as the sexual act itself—appears to be that of sex, male and female. We appear to have taken that primordial knowledge of structured, creative opposition and…
  • Order, the known, appears symbolically associated with masculinity (as illustrated in the aforementioned yang of the Taoist yin-yang symbol). This is perhaps because the primary…
  • Chaos—the unknown—is symbolically associated with the feminine. This is partly because all the things we have come to know were born, originally, of the unknown, just as all beings we encounter were born of mothers. Chaos is mater, origin, source, mother; materia, the substance from which all things are made.
  • In its positive guise, chaos is possibility itself, the source of ideas, the mysterious realm of gestation and birth. As a negative force, it’s the impenetrable darkness of a cave and the accident by the side of the road.
  • Chaos, the eternal feminine, is also the crushing force of sexual selection.
  • Most men do not meet female human standards. It is for this reason that women on dating sites rate 85 percent of men as below average in attractiveness.40
  • Women’s proclivity to say no, more than any other force, has shaped our evolution into the creative, industrious, upright, large-brained (competitive, aggressive, domineering) creatures that we are.42 It is Nature as Woman who says, “Well, bucko, you’re good enough for a friend, but my experience of you so far has not indicated the suitability of your genetic material for continued propagation.”
  • Many things begin to fall into place when you begin to consciously understand the world in this manner. It’s as if the knowledge of your body and soul falls into alignment with the knowledge of your intellect.
  • And there’s more: such knowledge is proscriptive, as well as descriptive. This is the kind of knowing what that helps you know how. This is the kind of is from which you can derive an ought. The Taoist juxtaposition of yin and yang, for example, doesn’t simply portray chaos and order as the fundamental elements of Being—it also tells you how to act.
  • The Way, the Taoist path of life, is represented by (or exists on) the border between the twin serpents. The Way is the path of proper Being. It’s the same Way as that referred to by Christ in John 14:6: I am the way, and the truth and the life. The same idea is expressed in Matthew 7:14: Because strait is the gate, and narrow is the way, which leadeth unto life, and few there be that find it.
  • We eternally inhabit order, surrounded by chaos. We eternally occupy known territory, surrounded by the unknown. We experience meaningful engagement when we mediate appropriately between them. We are adapted, in the deepest Darwinian sense, not to the world of objects, but to the meta-realities of order and chaos, yang and yin. Chaos and order make up the eternal, transcendent environment of the living.
  • To straddle that fundamental duality is to be balanced: to have one foot firmly planted in order and security, and the other in chaos, possibility, growth and adventure.
  • Chaos and order are fundamental elements because every lived situation (even every conceivable lived situation) is made up of both.
  • you need to place one foot in what you have mastered and understood and the other in what you are currently exploring and mastering. Then you have positioned yourself where the terror of existence is under control and you are secure, but where you are also alert and engaged. That is where there is something new to master and some way that you can be improved. That is where meaning is to be found.
  • The serpent in Eden therefore means the same thing as the black dot in the yin side of the Taoist yin/yang symbol of totality—that is, the possibility of the unknown and revolutionary suddenly manifesting itself where everything appears calm.
  • The outside, chaos, always sneaks into the inside, because nothing can be completely walled off from the rest of reality. So even the ultimate in safe spaces inevitably harbours a snake.
  • We have seen the enemy, after all, and he is us. The snake inhabits each of our souls.
  • The worst of all possible snakes is the eternal human proclivity for evil. The worst of all possible snakes is psychological, spiritual, personal, internal. No walls, however tall, will keep that out. Even if the fortress were thick enough, in principle, to keep everything bad whatsoever outside, it would immediately appear again within.
  • I have learned that these old stories contain nothing superfluous. Anything accidental—anything that does not serve the plot—has long been forgotten in the telling. As the Russian playwright Anton Chekhov advised, “If there is a rifle hanging on the wall in act one, it must be fired in the next act. Otherwise it has no
  • business being there.”50
  • Eve immediately shares the fruit with Adam. That makes him self-conscious. Little has changed. Women have been making men self-conscious since the beginning of time. They do this primarily by rejecting them—but they also do it by shaming them, if men do not take responsibility. Since women bear the primary burden of reproduction, it’s no wonder. It is very hard to see how it could be otherwise. But the capacity of women to shame men and render them self-conscious is still a primal force of nature.
  • What does it mean to know yourself naked
  • Naked means vulnerable and easily damaged. Naked means subject to judgment for beauty and health. Naked means unprotected and unarmed in the jungle of nature and man. This is why Adam and Eve became ashamed, immediately after their eyes were opened. They could see—and what they first saw was themselves.
  • In their vulnerability, now fully realized, they felt unworthy to stand before God.
  • Beauty shames the ugly. Strength shames the weak. Death shames the living—and the Ideal shames us all.
  • He tells the woman that she will now bring forth children in sorrow, and desire an unworthy, sometimes resentful man, who will in consequence lord her biological fate over her, permanently. What might this mean? It could just mean that God is a patriarchal tyrant, as politically motivated interpretations of the ancient story insist. I think it’s merely descriptive.
  • women pay a high price for pregnancy and child-rearing, particularly in the early stages, and that one of the inevitable consequences is increased dependence upon the sometimes unreliable and always problematic good graces of men.
  • then God banishes the first man and the first woman from Paradise, out of infancy, out of the unconscious animal world, into the horrors of history itself. And then He puts cherubim and a flaming sword at the gate of Eden, just to stop them from eating the Fruit of the Tree of Life.
  • Perhaps Heaven is something you must build, and immortality something you must earn.
  • so we return to our original query: Why would someone buy prescription medication for his dog, and then so carefully administer it, when he would not do the same for himself?
  • Why should anyone take care of anything as naked, ugly, ashamed, frightened, worthless, cowardly, resentful, defensive and accusatory as a descendant of Adam? Even if that thing, that being, is himself?
  • We know how we are naked, and how that nakedness can be exploited—and that means we know how others are naked, and how they can be exploited. We can terrify other people, consciously. We can hurt and humiliate them for faults we understand only too well. We can torture them—literally—slowly, artfully and terribly. That’s far more than predation. That’s a qualitative shift in understanding. That’s a cataclysm as large as the development of self-consciousness itself. That’s the entry of the knowledge of Good and Evil into the world.
  • Only man could conceive of the rack, the iron maiden and the thumbscrew. Only man will inflict suffering for the sake of suffering. That is the best definition of evil I have been able to formulate.
  • with this realization we have well-nigh full legitimization of the idea, very unpopular in modern intellectual circles, of Original Sin.
  • Human beings have a great capacity for wrongdoing. It’s an attribute that is unique in the world of life. We can and do make things worse, voluntarily, with full knowledge of what we are doing (as well as accidentally, and carelessly, and in a manner that is willfully blind). Given that terrible capacity, that proclivity for malevolent actions, is it any wonder we have a hard time taking care of ourselves, or others—or even that we doubt the value of the entire human enterprise?
  • The juxtaposition of Genesis 1 with Genesis 2 & 3 (the latter two chapters outlining the fall of man, describing why our lot is so tragedy-ridden and ethically torturous) produces a narrative sequence almost unbearable in its profundity. The moral of Genesis 1 is that Being brought into existence through true speech is Good.
  • The original Man and Woman, existing in unbroken unity with their Creator, did not appear conscious (and certainly not self-conscious). Their eyes were not open. But, in their perfection, they were also less, not more, than their post-Fall counterparts. Their goodness was something bestowed, rather than deserved or earned.
  • Maybe, even in some cosmic sense (assuming that consciousness itself is a phenomenon of cosmic significance), free choice matters.
  • here’s a proposition: perhaps it is not simply the emergence of self-consciousness and the rise of our moral knowledge of Death and the Fall that besets us and makes us doubt our own worth. Perhaps it is instead our unwillingness—reflected in Adam’s shamed hiding—to walk with God, despite our fragility and propensity for evil.
  • The entire Bible is structured so that everything after the Fall—the history of Israel, the prophets, the coming of Christ—is presented as a remedy for that Fall, a way out of evil. The beginning of conscious history, the rise of the state and all its pathologies of pride and rigidity, the emergence of great moral figures who try to set things right, culminating in the Messiah Himself—that is all part of humanity’s attempt, God willing, to set itself right. And what would that mean?
  • And this is an amazing thing: the answer is already implicit in Genesis 1: to embody the Image of God—to speak out of chaos the Being that is Good—but to do so consciously, of our own free choice.
  • Back is the way forward—as T. S. Eliot so rightly insisted
  • We shall not cease from exploration And the end of all our exploring Will be to arrive where we started And know the place for the first time.
  • If we wish to take care of ourselves properly, we would have to respect ourselves—but we don’t, because we are—not least in our own eyes—fallen creatures.
  • If we lived in Truth; if we spoke the Truth—then we could walk with God once again, and respect ourselves, and others, and the world. Then we might treat ourselves like people we cared for.
  • We might strive to set the world straight. We might orient it toward Heaven, where we would want people we cared for to dwell, instead of Hell, where our resentment and hatred would eternally sentence everyone.
  • Then, the primary moral issue confronting society was control of violent, impulsive selfishness and the mindless greed and brutality that accompanies it.
  • It is easy to believe that people are arrogant, and egotistical, and always looking out for themselves. The cynicism that makes that opinion a universal truism is widespread and fashionable.
  • But such an orientation to the world is not at all characteristic of many people. They have the opposite problem: they shoulder intolerable burdens of self-disgust, self-contempt, shame and self-consciousness. Thus, instead of narcissistically inflating their own importance, they don’t value themselves at all, and they don’t take care of themselves with attention and skill.
  • Christ’s archetypal death exists as an example of how to accept finitude, betrayal and tyranny heroically—how to walk with God despite the tragedy of self-conscious knowledge—and not as a directive to victimize ourselves in the service of others.
  • To sacrifice ourselves to God (to the highest good, if you like) does not mean to suffer silently and willingly when some person or organization demands more from us, consistently, than is offered in return. That means we are supporting tyranny, and allowing ourselves to be treated like slaves.
  • I learned two very important lessons from Carl Jung, the famous Swiss depth psychologist, about “doing unto others as you would have them do unto you” or “loving your neighbour as yourself.”
  • The first lesson was that neither of these statements has anything to do with being nice. The second was that both are equations, rather than injunctions.
  • If I am someone’s friend, family member, or lover, then I am morally obliged to bargain as hard on my own behalf as they are on theirs.
  • there is little difference between standing up and speaking for yourself, when you are being bullied or otherwise tormented and enslaved, and standing up and speaking for someone else.
  • you do not simply belong to yourself. You are not simply your own possession to torture and mistreat. This is partly because your Being is inexorably tied up with that of others, and your mistreatment of yourself can have catastrophic consequences for others.
  • metaphorically speaking, there is also this: you have a spark of the divine in you, which belongs not to you, but to God. We are, after all—according to Genesis—made in His image.
  • We can make order from chaos—and vice versa—in our way, with our words. So, we may not exactly be God, but we’re not exactly nothing, either.
  • In my own periods of darkness, in the underworld of the soul, I find myself frequently overcome and amazed by the ability of people to befriend each other, to love their intimate partners and parents and children, and to do what they must do to keep the machinery of the world running.
  • It is this sympathy that should be the proper medicament for self-conscious self-contempt, which has its justification, but is only half the full and proper story. Hatred for self and mankind must be balanced with gratefulness for tradition and the state and astonishment at what normal, everyday people accomplish
  • You have some vital role to play in the unfolding destiny of the world. You are, therefore, morally obliged to take care of yourself.
  • To treat yourself as if you were someone you are responsible for helping is, instead, to consider what would be truly good for you. This is not “what you want.” It is also not “what would make you happy.”
  • You must help a child become a virtuous, responsible, awake being, capable of full reciprocity—able to take care of himself and others, and to thrive while doing so. Why would you think it acceptable to do anything less for yourself?
  • You need to know who you are, so that you understand your armament and bolster yourself in respect to your limitations. You need to know where you are going, so that you can limit the extent of chaos in your life, restructure order, and bring the divine force of Hope to bear on the world.
  • You need to determine how to act toward yourself so that you are most likely to become and to stay a good person.
  • Don’t underestimate the power of vision and direction. These are irresistible forces, able to transform what might appear to be unconquerable obstacles into traversable pathways and expanding opportunities.
  • Once having understood Hell, researched it, so to speak—particularly your
  • own individual Hell—you could decide against going there or creating that.
  • You could, in fact, devote your life to this. That would give you a Meaning, with a capital M. That would justify your miserable existence.
  • That would atone for your sinful nature, and replace your shame and self-consciousness with the natural pride and forthright confidence of someone who has learned once again to walk with God in the Garden.
  • RULE 3   MAKE FRIENDS WITH PEOPLE WHO WANT THE BEST FOR YOU
  • It would be more romantic, I suppose, to suggest that we would have all jumped at the chance for something more productive, bored out of our skulls as we were. But it’s not true. We were all too prematurely cynical and world-weary and leery of responsibility to stick to the debating clubs and Air Cadets and school sports that the adults around us tried to organize. Doing anything wasn’t cool.
  • When you move, everything is up in the air, at least for a while. It’s stressful, but in the chaos there are new possibilities. People, including you, can’t hem you in with their old notions. You get shaken out of your ruts. You can make new, better ruts, with people aiming at better things. I thought this was just a natural development. I thought that every person who moved would have—and want—the same phoenix-like experience.
  • What was it that made Chris and Carl and Ed unable (or, worse, perhaps, unwilling) to move or to change their friendships and improve the circumstances of their lives? Was it inevitable—a consequence of their own limitations, nascent illnesses and traumas of the past?
  • Why did he—like his cousin, like my other friends—continually choose people who, and places that, were not good for him?
  • perhaps, they don’t want the trouble of better. Freud called this a “repetition compulsion.” He thought of it as an unconscious drive to repeat the horrors of the past
  • People create their worlds with the tools they have directly at hand. Faulty tools produce faulty results. Repeated use of the same faulty tools produces the same faulty results.
  • It is in this manner that those who fail to learn from the past doom themselves to repeat it. It’s partly fate. It’s partly inability. It’s partly…unwillingness to learn? Refusal to learn? Motivated refusal to learn?
  • People choose friends who aren’t good for them for other reasons, too. Sometimes it’s because they want to rescue someone.
  • it is not easy to distinguish between someone truly wanting and needing help and someone who is merely exploiting a willing helper. The distinction is difficult even for the person who is wanting and needing and possibly exploiting.
  • When it’s not just naïveté, the attempt to rescue someone is often fuelled by vanity and narcissism.
  • But Christ himself, you might object, befriended tax-collectors and prostitutes. How dare I cast aspersions on the motives of those who are trying to help? But Christ was the archetypal perfect man. And you’re you.
  • How do you know that your attempts to pull someone up won’t instead bring them—or you—further down?
  • The same thing happens when well-meaning counsellors place a delinquent teen among comparatively civilized peers. The delinquency spreads, not the stability.65 Down is a lot easier than up.
  • maybe you’re saving someone because you want to convince yourself that the strength of your character is more than just a side effect of your luck and birthplace. Or maybe it’s because it’s easier to look virtuous when standing alongside someone utterly irresponsible.
  • Or maybe you have no plan, genuine or otherwise, to rescue anybody. You’re associating with people who are bad for you not because it’s better for anyone, but because it’s easier.
  • You know it. Your friends know it. You’re all bound by an implicit contract—one aimed at nihilism, and failure, and suffering of the stupidest sort.
  • Before you help someone, you should find out why that person is in trouble. You shouldn’t merely assume that he or she is a noble victim of unjust circumstances and exploitation. It’s the most unlikely explanation, not the most probable.
  • Besides, if you buy the story that everything terrible just happened on its own, with no personal responsibility on the part of the victim, you deny that person all agency in the past (and, by implication, in the present and future, as well).
  • It is far more likely that a given individual has just decided to reject the path upward, because of its difficulty. Perhaps that should even be your default assumption, when faced with such a situation.
  • failure is easy to understand. No explanation for its existence is required. In the same manner, fear, hatred, addiction, promiscuity, betrayal and deception require no explanation. It’s not the existence of vice, or the indulgence in it, that requires explanation. Vice is easy.
  • Failure is easy, too. It’s easier not to shoulder a burden. It’s easier not to think, and not to do, and not to care. It’s easier to put off until tomorrow what needs to be done today,
  • Success: that’s the mystery. Virtue: that’s what’s inexplicable. To fail, you merely have to cultivate a few bad habits. You just have to bide your time. And once someone has spent enough time cultivating bad habits and biding their time, they are much diminished.
  • I am not saying that there is no hope of redemption. But it is much harder to extract someone
  • from a chasm than to lift him from a ditch. And some chasms are very deep. And there’s not much left of the body at the bottom.
  • Carl Rogers, the famous humanistic psychologist, believed it was impossible to start a therapeutic relationship if the person seeking help did not want to improve.67 Rogers believed it was impossible to convince someone to change for the better. The
  • none of this is a justification for abandoning those in real need to pursue your narrow, blind ambition, in case it has to be said.
  • Here’s something to consider: If you have a friend whose friendship you wouldn’t recommend to your sister, or your father, or your son, why would you have such a friend for yourself?
  • You are not morally obliged to support someone who is making the world a worse place. Quite the opposite. You should choose people who want things to be better, not worse. It’s a good thing, not a selfish thing, to choose people who are good for you.
  • It is for this reason that every good example is a fateful challenge, and every hero, a judge. Michelangelo’s great perfect marble David cries out to its observer: “You could be more than you are.”
  • Don’t think that it is easier to surround yourself with good healthy people than with bad unhealthy people. It’s not. A good, healthy person is an ideal. It requires strength and daring to stand up near such a person.
  • RULE 4   COMPARE YOURSELF TO WHO YOU WERE YESTERDAY, NOT TO WHO SOMEONE ELSE IS TODAY
  • IT WAS EASIER FOR PEOPLE to be good at something when more of us lived in small, rural communities. Someone could be homecoming queen. Someone else could be spelling-bee champ, math whiz or basketball star. There were only one or two mechanics and a couple of teachers. In each of their domains, these local heroes had the opportunity to enjoy the serotonin-fuelled confidence of the victor.
  • Our hierarchies of accomplishment are now dizzyingly vertical.
  • No matter how good you are at something, or how you rank your accomplishments, there is someone out there who makes you look incompetent.
  • We are not equal in ability or outcome, and never will be. A very small number of people produce very much of everything.
  • People are unhappy at the bottom. They get sick there, and remain unknown and unloved. They waste their lives there. They die there. In consequence, the self-denigrating voice in the minds of people weaves a devastating tale. Life is a zero-sum game. Worthlessness is the default condition.
  • It is for such reasons that a whole generation of social psychologists recommended “positive illusions” as the only reliable route to mental health.69 Their credo? Let a lie be your umbrella. A more dismal, wretched, pessimistic philosophy can hardly be imagined:
  • Here is an alternative approach (and one that requires no illusions). If the cards are always stacked against you, perhaps the game you are playing is somehow rigged (perhaps by you, unbeknownst to yourself). If the internal voice makes you doubt the value of your endeavours—or your life, or life itself—perhaps you should stop listening.
  • There will always be people better than you—that’s a cliché of nihilism, like the phrase, In a million years, who’s going to know the difference? The proper response to that statement is not, Well, then, everything is meaningless. It’s, Any idiot can choose a frame of time within which nothing matters.
  • Standards of better or worse are not illusory or unnecessary. If you hadn’t decided that what you are doing right now was better than the alternatives, you wouldn’t be doing it. The idea of a value-free choice is a contradiction in terms. Value judgments are a precondition for action.
  • Furthermore, every activity, once chosen, comes with its own internal standards of accomplishment. If something can be done at all, it can be done better or worse. To do anything at all is therefore to play a game with a defined and valued end, which can always be reached more or less efficiently and elegantly.
  • We might start by considering the all-too-black-and-white words themselves: “success” or “failure.” You are either a success, a comprehensive, singular, over-all good thing, or its opposite, a failure, a comprehensive, singular, irredeemably bad thing.
  • There are vital degrees and gradations of value obliterated by this binary system, and the consequences are not good.
  • there is not just one game at which to succeed or fail. There are many games and, more specifically, many good games—
  • if changing games does not work, you can invent a new one. I
  • and athletic pursuits. You might consider judging your success across all the games you play.
  • When we are very young we are neither individual nor informed. We have not had the time nor gained the wisdom to develop our own standards. In consequence, we must compare ourselves to others, because standards are necessary.
  • As we mature we become, by contrast, increasingly individual and unique. The conditions of our lives become more and more personal and less and less comparable with those of others. Symbolically speaking, this means we must leave the house ruled by our father, and confront the chaos of our individual Being.
  • We must then rediscover the values of our culture—veiled from us by our ignorance, hidden in the dusty treasure-trove of the past—rescue them, and integrate them into our own lives. This is what gives existence its full and necessary meaning.
  • What is it that you actually love? What is it that you genuinely want? Before you can articulate your own standards of value, you must see yourself as a stranger—and then you must get to know yourself. What
  • Dare to be truthful. Dare to articulate yourself, and express (or at least become aware of) what would really justify your life.
  • Consult your resentment. It’s a revelatory emotion, for all its pathology. It’s part of an evil triad: arrogance, deceit, and resentment. Nothing causes more harm than this underworld Trinity. But resentment always means one of two things. Either the resentful person is immature, in which case he or she should shut up, quit whining, and get on with it, or there is tyranny afoot—in which case the person subjugated has a moral obligation to speak up.
  • Be cautious when you’re comparing yourself to others. You’re a singular being, once you’re an adult. You have your own particular, specific problems—financial, intimate, psychological, and otherwise.
  • Those are embedded in the unique broader context of your existence. Your career or job works for you in a personal manner, or it does not, and it does so in a unique interplay with the other specifics of your life.
  • We must see, but to see, we must aim, so we are always aiming. Our minds are built on the hunting-and-gathering platforms of our bodies. To hunt is to specify a target, track it, and throw at it.
  • We live within a framework that defines the present as eternally lacking and the future as eternally better. If we did not see things this way, we would not act at all. We wouldn’t even be able to see, because to see we must focus, and to focus we must pick one thing above all else on which to focus.
  • The disadvantage to all this foresight and creativity is chronic unease and discomfort. Because we always contrast what is with what could be, we have to aim at what could be.
  • The present is eternally flawed. But where you start might not be as important as the direction you are heading. Perhaps happiness is always to be found in the journey uphill, and not in the fleeting sense of satisfaction awaiting at the next peak.
  • Called upon properly, the internal critic will suggest something to set in order, which you could set in order, which you would set in order—voluntarily, without resentment, even with pleasure.
  • “Excuse me,” you might say to yourself, without irony or sarcasm. “I’m trying to reduce some of the unnecessary suffering around here. I could use some help.” Keep the derision at bay. “I’m wondering if there is anything that you would be willing to do? I’d be very grateful for your service.” Ask honestly and with humility. That’s no simple matter.
Javier E

America Fails the Civilization Test - The Atlantic - 0 views

  • The true test of a civilization may be the answer to a basic question: Can it keep its children alive?
  • For most of recorded history, the answer everywhere was plainly no. Roughly half of all people—tens of billions of us—died before finishing puberty until about the 1700s, when breakthroughs in medicine and hygiene led to tremendous advances in longevity. In Central Europe, for example, the mortality rate for children fell from roughly 50 percent in 1750 to 0.3 percent in 2020. You will not find more unambiguous evidence of human progress.
  • ow’s the U.S. doing on the civilization test? When graded on a curve against its peer nations, it is failing. The U.S. mortality rate is much higher, at almost every age, than that of most of Europe, Japan, and Australia.
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  • compared with the citizens of these nations, American infants are less likely to turn 5, American teenagers are less likely to turn 30, and American 30-somethings are less likely to survive to retirement.
  • I called the U.S. the rich death trap of the modern world. The “rich” part is important to observe and hard to overstate. The typical American spends almost 50 percent more each year than the typical Brit, and a trucker in Oklahoma earns more than a doctor in Portugal.
  • A series about big problems and big solutions
  • the typical American is 100 percent more likely to die than the typical Western European at almost every age from birth until retirement.
  • A series about big problems and big solutions
  • magine I offered you a pill and told you that taking this mystery medication would have two effects. First, it would increase your disposable income by almost half. Second, it would double your odds of dying in the next 365 days. To be an average American is to fill a lifetime prescription of that medication and take the pill nightly.
  • 1.8 figure as “the U.S. death ratio”—the annual mortality rate in the U.S., as a multiple of similarly rich countries.
  • By the time an American turns 18, the U.S. death ratio surges to 2.8. By 29, the U.S. death ratio rockets to its peak of 4.22, meaning that the typical American is more than four times more likely to die than the average resident in our basket of high-income nations.
  • The average American my age, in his mid-to-late 30s, is roughly six times more likely to die in the next year than his counterpart in Switzerland.
  • The average U.S. death ratio stays higher than three for practically the entire period between ages 30 and 50, meaning that the typical middle-aged American is roughly three times more likely to die within the year than his counterpart in Western Europe or Australia.
  • One could tell a similar story about drug
  • I expected that these three culprits—guns, drugs, and cars—would explain most of our death ratio
  • Americans drive more than other countries, leading to our higher-than-average death rate from road accidents
  • America suffers not from a monopoly on despair and aggression, but from an oversupply of instruments of death. We have more drug-overdose deaths than any other high-income country because we have so much more fentanyl, even per capita
  • he argued that Americans’ health (and access to health care) seems to be the most important factor. America’s prevalence of cardiovascular and metabolic disease is so high that it accounts for more of our early mortality than guns, drugs, and cars combined.
  • Disentangling America’s health issues is complicated, but I can offer three data points
  • First, American obesity is unusually high, which likely leads to a larger number of early and middle-aged death
  • Second, Americans are unusually sedentary. We take at least 30 percent fewer steps a day than people do in Australia, Switzerland, and Japan
  • Finally, U.S. access to care is unusually unequal—and our health-care outcomes are unusually tied to income.
  • voters and politicians in the U.S. care so much about freedom in that old-fashioned ’Merica-lovin’ kind of way that we’re unwilling to promote public safety if those rules constrict individual choice. That’s how you get a country with infamously laissez-faire firearms laws, more guns than people, lax and poorly enforced driving laws, and a conservative movement that has repeatedly tried to block, overturn, or limit the expansion of universal health insurance on the grounds that it impedes consumer choice.
  • Among the rich, this hyper-individualistic mindset can manifest as a smash-and-grab attitude toward life, with surprising consequences for the less fortunate. For example, childhood obesity is on the rise at the same time that youth-sports participation is in decline among low-income kids
  • What seems to be happening at the national level is that rich families, seeking to burnish their child’s résumé for college, are pulling their kids out of local leagues so that they can participate in prestigious pay-to-play travel teams. At scale, these decisions devastate the local youth-sports leagues for the benefit of increasing by half a percentage point the odds of a wealthy kid getting into an Ivy League school.
  • The problem with the Freedom and Individualism Theory of Everything is that, in many cases, America’s problem isn’t freedom-worship, but actually something quite like its opposite: overregulation
  • In medicine, excessive regulation and risk aversion on the part of the FDA and Institutional Review Boards have very likely slowed the development and adoption of new lifesaving treatments.
  • Are Americans unusually sedentary because they love freedom so very much? It’s possible, I guess. But the more likely explanation is that restrictive housing policies have made it too hard for middle- and low-income families to live near downtown business districts, which forces many of them to drive more than they would like, thus reducing everyday walking and exercise.
  • America is caught in a lurch between oversight and overkill, sometimes promoting individual freedom, with luridly fatal consequences, and sometimes blocking policies and products, with subtly fatal consequences.
Javier E

Opinion | With Covid, Is It Really Possible to Say We Went Too Far? - The New York Times - 0 views

  • In 2020, many Americans told themselves that all it would take to halt the pandemic was replacing the president and hitting the “science button.”
  • In 2023, it looks like we’re telling ourselves the opposite: that if we were given the chance to run the pandemic again, it would have been better just to hit “abort” and give up.
  • you can see it in Bethany McLean and Joe Nocera’s book “The Big Fail: What the Pandemic Revealed About Who America Protects and Who It Leaves Behind,” excerpted last month in New York magazine under the headline “Covid Lockdowns Were a Giant Experiment. It Was a Failure.”
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  • we can’t simply replace one simplistic narrative, about the super power of mitigation policy, for another, focused only on the burdens it imposed and not at all on the costs of doing much less — or nothing at all.
  • Let’s start with the title. What is the big failure, as you see it?
  • McLean: I think it gets at things that had happened in America even before the pandemic hit. And among those things were, I think, a failure to recognize the limits of capitalism, a failure of government to set the right rules for it, particularly when it comes to our health care system; a focus on profits that may have led to an increase in the bottom line but created fragility in ways people didn’t understand; and then our growing polarization that made us incapable of talking to each other
  • How big is the failure? When I look at The Economist’s excess mortality data, I see the U.S. had the 53rd-worst outcome in the world — worse than all of Western Europe, but better than all of Eastern Europe.
  • McLean: I think one way to quantify it is to take all those numbers and then put them in the context of our spending on health care. Given the amount we spend on health care relative to other countries, the scale of the failure becomes more apparent.
  • o me, the most glaring example is the schools. They were closed without people thinking through the potential consequences of closing down public schools, especially for disadvantaged kids.
  • to compound it, in my view, public health never made the distinction that needed to be made between the vulnerabilities of somebody 70 years old and the vulnerabilities of somebody 10 years old.
  • In the beginning of the book you write, in what almost feels like a thesis statement for the book: “A central tenet of this book is that we could not have done better, and pretending differently is a dangerous fiction, one that prevents us from taking a much needed look in the mirror.”
  • This claim, that the U.S. could not have done any better, runs against your other claim, that what we observed was an American failure. It is also a pretty extreme claim, I think, and I wanted to press you on it in part because it is, in my view, undermined by quite a lot of the work you do in the book itself.
  • Would the U.S. not have done better if it had recognized earlier that the disease spread through the air rather than in droplets? Would it not have done better if it hadn’t bungled the rollout of a Covid test in the early months?
  • McLean: Everything that you mentioned — the point of the book is that those were set by the time the pandemic hit.
  • in retrospect, what we were doing was to try to delay as much spread as we could until people got vaccinated. All the things that we did in 2020 were functionally serving or trying to serve that purpose. Now, given that, how can you say that none of that work saved lives?
  • McLean: I think that the test failure was baked into the way that the C.D.C. had come to operate
  • But the big question I really want to ask is this one: According to the C.D.C., we’ve had almost 1.2 million deaths from Covid. Excess mortality is nearly 1.4 million. Is it really your contention that there was nothing we might’ve done that brought that total down to 1.1 million, for instance, or even 900,000?
  • McLean: It’s very — you’re right. If you went through each and every thing and had a crystal ball and you could say, this could have been done, this could have been moved up by a month, we could have gotten PPE …
  • When I came to that sentence, I thought of it in terms of human behavior: What will humans put up with? What will humans stand for? How do Americans act? And you’ve written about Sweden being sort of average, and you’ve written about China and the Chinese example. They lock people up for two years and suddenly the society just revolts. They will not take it anymore. They can’t stand it. And as a result, a million and a half people die in a month and a half.
  • Well, I would tell that story very differently. For me, the problem is that when China opened up, they had fully vaccinated just under two-thirds of their population over 80. So to me, it’s not a failure of lockdowns. It’s a failure of vaccinations. If the Chinese had only achieved the same elderly vaccination rate as we achieved — which by global standards was pretty poor — that death toll when they opened up would have been dramatically lower.
  • What do you mean by “lockdown,” though? You use the word throughout the book and suggest that China was the playbook for all countries. But you also acknowledge that what China did is not anything like what America did.
  • Disparities in health care access — is it a dangerous fiction to think we might address that? You guys are big champions of Operation Warp Speed — would it not have been better if those vaccines had been rolled out to the public in nine months, rather than 12
  • . But this isn’t “lockdown” like there were lockdowns in China or even Peru. It’s how we tried to make it safer to go out and interact during a pandemic that ultimately killed a million Americans.
  • McLean: I think that you’re absolutely right to focus on the definition of what a lockdown is and how we implemented them here in this country. And I think part of the problem is that we implemented them in a way that allowed people who were well off and could work from home via Zoom to be able to maintain very much of their lives while other people couldn’t
  • And I think it depends on who you were, whether you would define this as a lockdown or not. If you were a small business who saw your small business closed because of this, you’re going to define it as a lockdown.
  • n the book you’re pretty definitive. You write, “maybe the social and economic disasters that lockdowns created would have been worth it if they had saved lives, but they hadn’t.” How can you say that so flatly?
  • I think there are still open questions about what worked and how much. But the way that I think about all of this is that the most important intervention that anybody did anywhere in the world was vaccination. And the thing that determined outcomes most was whether your first exposure came before or after vaccination.
  • Here, the shelter-in-place guidelines lasted, on average, five to seven weeks. Thirty nine of the 40 states that had issued them lifted them by the end of June, three months in. By the summer, according to Google mobility data, retail and grocery activity was down about 10 percent. By the fall, grocery activity was only down about 5 percent across the country
  • Nocera: Well, on some level, I feel like you’re trying to have it both ways. On the one hand, you’re saying that lockdowns saved lives. On the other hand, you said they weren’t real lockdowns because everybody was out and about.
  • I don’t think that’s having it both ways. I’m trying to think about these issues on a spectrum rather than in binaries. I think we did interrupt our lives — everybody knows that. And I think they did have an effect on spread, and that limiting spread had an effect by delaying infections until after vaccination.
  • Nocera: Most of the studies that say lockdowns didn’t work are really less about Covid deaths than about excess mortality deaths. I wound up being persuaded that the people who could not get to the hospital, because they were all working, because all the doctors were working on Covid and the surgical rooms were shut down, the people who caught some disease that was not Covid and died as a result — I wound up being persuaded about that.
  • We’re in a pandemic. People are going to die. And then the question becomes, can we protect the most vulnerable? And the answer is, we didn’t protect the most vulnerable. Nursing homes were a complete disaster.
  • There was a lot of worry early on about delayed health care, and about cancer in particular — missed screenings, missed treatments. But in 2019, we had an estimated 599,600 Americans die of cancer. In 2020, it was 602,000. In 2021, it was 608,000. In 2022, it was 609,000.
  • Nocera: See, it went up!But by a couple of thousand people, in years in which hundreds of thousands of Americans were dying of Covid.
  • Nocera: I think you can’t dispute the excess mortality numbers.I’m not. But in nearly every country in the world the excess mortality curves track so precisely with Covid waves that it doesn’t make sense to talk about a massive public health problem beyond Covid. And when you add all of these numbers up, they are nowhere near the size of the footfall of Covid. How can you look back on this and say the costs were too high?
  • Nocera: I think the costs were too high because you had school costs, you had economic costs, you had social costs, and you had death.
  • McLean: I think you’re raising a really good point. We’re making an argument for a policy that might not have been doable given the preconditions that had been set. I’m arguing that there were these things that had been put in place in our country for decades leading up to the pandemic that made it really difficult for us to plant in an effective way, from the outsourcing of our PPE to the distrust in our health care system that had been created by people’s lack of access to health care with the disparities in our hospital system.
  • How would you have liked to see things handled differently?Nocera: Well, the great example of doing it right is San Fran
  • I find the San Francisco experience impressive, too. But it was also a city that engaged in quite protracted and aggressive pandemic restrictions, well beyond just protecting the elderly and vulnerable.
  • McLean: But are we going to go for stay-at-home orders plus protecting vulnerable communities like San Francisco did? Or simply letting everybody live their lives, but with a real focus on the communities and places like nursing homes that were going to be affected? My argument is that we probably would’ve been better off really focusing on protecting those communities which were likely to be the most severely affected.
  • I agree that the public certainly didn’t appreciate the age skew, and our policy didn’t reflect it either. But I also wonder what it would mean to better protect the vulnerable than we did. We had testing shortages at first. Then we had resistance to rapid testing. We had staff shortages in nursing homes.
  • Nocera: This gets exactly to one of our core points. We had spent 30 years allowing nursing homes to be owned by private equity firms that cut the staff, that sold the land underneath and added all this debt on
  • I hear you saying both that we could have done a much better job of protecting these people and that the systems we inherited at the outset of the pandemic would’ve made those measures very difficult, if not impossible, to implement.
  • But actually, I want to stop you there, because I actually think that that data tells the opposite story.
  • And then I’m trying to say at the same time, but couldn’t we have done something to have protected people despite all of that?
  • I want to talk about the number of lives at stake. In the book, you write about the work of British epidemiologist Neil Ferguson. In the winter of 2020, he says that in the absence of mitigation measures and vaccination, 80 percent of the country is going to get infected and 2.2 million Americans are going to die. He says that 80 percent of the U.K. would get infected, and 510,000 Brits would die — again, in the abs
  • In the end, by the time we got to 80 percent of the country infected, we had more than a million Americans die. We had more than 200,000 Brits die. And in each case most of the infections happened after vaccination, which suggests that if those infections had all happened in a world without vaccines, we almost certainly would have surpassed two million deaths in the U.S. and almost certainly would’ve hit 500,000 deaths in the U.K.
  • In the book, you write about this estimate, and you endorse Jay Bhattacharya’s criticism of Ferguson’s model. You write, “Bhattacharya got his first taste of the blowback reserved for scientists who strayed from the establishment position early. He co-wrote an article for The Wall Street Journal questioning the validity of the scary 2 to 4 percent fatality rate that the early models like Neil Ferguson’s were estimating and that were causing governments to panic. He believed, correctly as it turns out, that the true fatality rate was much lower.”
  • Nocera: I know where you’re going with this, because I read your story about the nine pandemic narratives we’re getting wrong. In there, you said that Bhattacharya estimated the fatality rate at 0.01 percent. But if you actually read The Wall Street Journal article, what he’s really saying is I think it’s much lower. I’ve looked at two or three different possibilities, and we really need some major testing to figure out what it actually is, because I think 2 percent to 4 percent is really high.
  • He says, “if our surmise of 6 million cases is accurate, that’s a mortality rate of 0.01%. That is ⅒th the flu mortality rate of 0.1%.” An I.F.R. of 0.01 percent, spread fully through the American population, yields a total American death toll of 33,000 people. We have had 1.2 million deaths. And you are adjudicating this dispute, in 2023, and saying that Neil was wrong and Jay was right.
  • hird, in the Imperial College report — the one projecting two million American deaths — Ferguson gives an I.F.R. estimate of 0.9 percent.
  • Bhattacharya’s? Yes, there is some uncertainty around the estimate he offers. But the estimate he does offer — 0.01 percent — is one hundred times lower than the I.F.R. you yourselves cite as the proper benchmark.
  • Nocera: In The Wall Street Journal he does not say it’s 0.01. He says, we need to test to find out what it is, but it is definitely lower than 2 to 4 percent.
  • Well, first of all, the 2 percent to 4 percent fatality rate is not from Neil Ferguson. It’s from the W.H.O.
  • But I think that fundamentally, at the outset of the pandemic, the most important question orienting all of our thinking was, how bad could this get? And it turns out that almost all of the people who were saying back then that we shouldn’t do much to intervene were extremely wrong about how bad it would be
  • The argument then was, more or less, “We don’t need to do anything too drastic, because it’s not going to be that big a deal.” Now, in 2023, it’s the opposite argument: “We shouldn’t have bothered with restrictions, because they didn’t have an impact; we would have had this same death toll anyway.” But the death toll turned out to be enormous.
  • Now, if we had supplied all these skeptics with the actual numbers at the outset of the pandemic, what kind of audience would they have had? If instead of making the argument against universal mitigation efforts on the basis of a death toll of 40,000 they had made the argument on the basis of a death toll of more than a million, do you think the country would’ve said, they’re right, we’re doing too much, let’s back off?
  • McLean: I think that if you had gone to the American people and said, this many people are going to die, that would’ve been one thing. But if you had gone to the American people and said, this many people are going to die and a large percentage of them are going to be over 80, you might’ve gotten a different answer.
  • I’m not arguing we shouldn’t have been trying to get a clearer sense of the true fatality rate, or that we shouldn’t have been clearer about the age skew. But Bhattacharya was also offering an estimate of fatality rate that turned out to be off by a factor of a hundred from the I.F.R. that you yourselves cite as correct. And then you say that Bhattacharya was right and Ferguson was wrong.
  • And you, too, Joe, you wrote an article in April expressing sympathy for Covid skeptics and you said ——Nocera: This April?No, 2020.Nocera: Oh, oh. That’s the one where I praised Alex Berenson.You also cited some Amherst modeling which said that we were going to have 67,000 to 120,000 American deaths. We already had, at that point, 60,000. So you were suggesting, in making an argument against pandemic restrictions, that the country as a whole was going to experience between 7,000 and 60,000 additional deaths from that point.
  • when I think about the combination of the economic effects of mitigation policies and just of the pandemic itself and the big fiscal response, I look back and I think the U.S. managed this storm relatively well. How about each of you?
  • in this case, Congress did get it together and did come to the rescue. And I agree that made a ton of difference in the short term, but the long-term effects of the fiscal rescue package were to help create inflation. And once again, inflation hits those at the bottom of the socioeconomic distribution much harder than it does those at the top. So I would argue that some of what we did in the pandemic is papering over these long-term issues.
  • I think as with a lot of the stuff we’ve talked about today, I agree with you about the underlying problems. But if we take for granted for a moment that the pandemic was going to hit us, when it did, under the economic conditions it did, and then think about the more narrow context of whether, given all that, we handled the pandemic well. We returned quickly to prepandemic G.D.P. trends, boosted the wealth of the bottom half of the country, cut child poverty in half, pushed unemployment to historical lows.
  • What sense do you make of the other countries of the world and their various mitigation policies? Putting aside China, there’s New Zealand, Australia, South Korea — these are all places that were much more aggressive than the U.S. and indeed more than Europe. And had much, much better outcomes.
  • Nocera: To be perfectly honest, we didn’t really look, we didn’t really spend a lot of time looking at that.
  • McLean: But one reason that we didn’t is I don’t think it tells us anything. When you look at who Covid killed, then you have to look at what the pre-existing conditions in a country were, what percentage of its people are elderly. How sick are people with pre-existing conditions?
  • I just don’t think there’s a comparison. There’s just too many factors that influence it to be able to say that, to be able to compare America to any other country, you’d have to adjust for all these factors.
  • But you do spend a bit of time in the book talking about Sweden. And though it isn’t precisely like-for-like, one way you can control for some of those factors is grouping countries with their neighbors and other countries with similar profiles. And Sweden’s fatality rate in 2020 was 10 times that of Norway, Finland and Iceland. Five times that of Denmark. In the vaccination era, those gaps have narrowed, but by most metrics Sweden has still done worse, overall, than all of those countries.
  • On the matter of omniscience. Let’s say that we can send you back in time. Let’s put you both in charge of American pandemic response, or at least American communication about the pandemic, in early 2020. What would you want to tell the country? How would you have advised us to respond?
  • McLean: What I would want is honesty and communication. I think we’re in a world that is awash in information and the previous methods of communication — giving a blanket statement to people that may or may not be true, when you know there’s nuance underneath it — simply doesn’t work anymore
  • o I would’ve been much more clear — we think masks might help, we don’t know, but it’s not that big of an ask, let’s do it. We think the early data coming out of Italy shows that these are the people who are really, really at risk from Covid, but it’s not entirely clear yet. Maybe there is spread in schools, but we don’t know. Let’s look at this and keep an open mind and look at the data as it comes in.
Javier E

Despair, American Style - The New York Times - 0 views

  • Even more striking are the proximate causes of rising mortality. Basically, white Americans are, in increasing numbers, killing themselves, directly or indirectly. Suicide is way up, and so are deaths from drug poisoning and the chronic liver disease that excessive drinking can caus
  • what’s causing this epidemic of self-destructive behavior?
  • If you believe the usual suspects on the right, it’s all the fault of liberals. Generous social programs, they insist, have created a culture of dependency and despair, while secular humanists have undermined traditional values. But (surprise!) this view is very much at odds with the evidence.
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  • For one thing, rising mortality is a uniquely American phenomenon – yet America has both a much weaker welfare state and a much stronger role for traditional religion and values than any other advanced country. Sweden gives its poor far more aid than we do, and a majority of Swedish children are now born out of wedlock, yet Sweden’s middle-aged mortality rate is only half of white America’s.
  • You see a somewhat similar pattern across regions within the United States. Life expectancy is high and rising in the Northeast and California, where social benefits are highest and traditional values weakest. Meanwhile, low and stagnant or declining life expectancy is concentrated in the Bible Belt.
  • What about a materialist explanation? Is rising mortality a consequence of rising inequality and the hollowing out of the middle class?
  • it’s not that simple. We are, after all, talking about the consequences of behavior, and culture clearly matters a great deal. Most notably, Hispanic Americans are considerably poorer than whites, but have much lower mortality.
  • what is going on? In a recent interview Mr. Deaton suggested that middle-aged whites have “lost the narrative of their lives.” That is, their economic setbacks have hit hard because they expected better. Or to put it a bit differently, we’re looking at people who were raised to believe in the American Dream, and are coping badly with its failure to come true.
  • I’m not the only observer who sees a link between the despair reflected in those mortality numbers and the volatility of right-wing politics. Some people who feel left behind by the American story turn self-destructive; others turn on the elites they feel have betrayed them.
  • At this point you probably expect me to offer a solution. But while universal health care, higher minimum wages, aid to education, and so on would do a lot to help Americans in trouble, I’m not sure whether they’re enough to cure existential despair.
aleija

U.S. life expectancy: Americans are dying young at alarming rates - The Washington Post - 0 views

  • Despite spending more on health care than any other country, the United States has seen increasing mortality and falling life expectancy for people ages 25 to 64, who should be in the prime of their lives. In contrast, other wealthy nations have generally experienced continued progress in extending longevit
  • Although earlier research emphasized rising mortality among non-Hispanic whites in the U.S., the broad trend detailed in this study cuts across gender, racial and ethnic lines. By age group, the highest relative jump in death rates from 2010 to 2017 — 29 percent — has been among people ages 25 to 34.
  • About a third of the estimated 33,000 “excess deaths” that the study says occurred since 2010 were in just four states: Ohio, Pennsylvania, Kentucky and Indiana — the first two of which are critical swing states in presidential elections. The state with the biggest percentage rise in death rates among working-age people in this decade — 23.3 percent — is New Hampshire, the first primary state.
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  • “It’s supposed to be going down, as it is in other countries,” said the lead author of the report, Steven H. Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University. “The fact that that number is climbing, there’s something terribly wrong.”
  • The opioid epidemic is a major driver of the worrisome numbers, but far from the sole cause. The study found that improvements in life expectancy, largely because of lower rates of infant mortality, began to slow in the 1980s, long before the opioid epidemic became a national tragedy
  • Some of it may be due to obesity, some of it may be due to drug addiction, some of it may be due to distracted driving from cellphones
  • Given the breadth and pervasiveness of the trend, “it suggests that the cause has to be systemic, that there’s some root cause that’s causing adverse health across many different dimensions for working-age adults.”
  • The risk of death from drug overdoses increased 486 percent for midlife women between 1999 and 2017; the risk increased 351 percent for men in that same period. Women also experienced a bigger relative increase in risk of suicide and alcohol-related liver disease.
  • The all-cause death rate — meaning deaths per 100,000 people — rose 6 percent from 2010 to 2017 among working-age people in the United States
  • There’s something more fundamental about how people are feeling at some level — whether it’s economic, whether it’s stress, whether it’s deterioration of family,” she said. “People are feeling worse about themselves and their futures, and that’s leading them to do things that are self-destructive and not promoting health.”
  • . The general trend: Life expectancy improved a great deal for several decades, particularly in the 1970s, then slowed down, leveled off, and finally reversed course after 2014, decreasing three years in a row.
  • Obesity is a significant part of the story. The average woman in America today weighs as much as the average man half a century ago, and men now weigh about 30 pounds more
  • Princeton professors Anne Case and Angus Deaton, whose much-publicized report in 2015 highlighted the death rates in middle-aged whites, published a paper in 2017 pointing to a widening gap in health associated with levels of education, a trend dating to the 1970s. Case told reporters their research showed a “sea of despair” in the United States among people with only a high school diploma or less. She declined to comment on the new report.
  • “When they get up into their 20s, 30s and 40s, they’re carrying the risk factors of obesity that were acquired when they were children. We didn’t see that in previous generations.”
  • Most people in the United States are overweight — an estimated 71.6 percent of the population ages 20 and older, according to the CDC. That figure includes the 39.8 percent who are obese, defined as having a body mass index of 30 or higher in adults (18.5 to 25 is the normal range). Obesity is also rising in children; nearly 19 percent of the population ages 2 to 19 is obese.
  • The average life expectancy in the United States fell behind that of other wealthy countries in 1998 and since then, the gap has grown steadily. Experts refer to this gap as America’s “health disadvantage.”
  • Death rates from suicide, drug overdoses, liver disease and dozens of other causes have been rising over the past decade for young and middle-aged adults, driving down overall life expectancy in the United States for three consecutive years, according to a strikingly bleak study published Tuesday that looked at the past six decades of mortality data.
  • The 33,000 excess deaths are an estimate based on the number of all-cause midlife deaths from 2010 to 2017 that would be expected if mortality was unchanged vs. the number of deaths actually recorded by medical examiners.
  • Outside researchers praised the study for knitting together so much research into a sweeping look at U.S. mortality trends.“This report has universal relevance. It has broad implications for all of society,” said Howard Koh, a professor of public health at Harvard University who was not part of the research team.
  • The average life expectancy in the United States fell behind that of other wealthy countries in 1998, and since then the gap has grown steadily. Experts refer to this gap as the United States’ “health disadvantage.”
  • For example, in the late 1960s and early ’70s, cigarette companies aggressively marketed to women, and the health effects of that push may not show up for decades.
  • Obesity is a significant part of the story. The average woman in the United States today weighs as much as the average man half a century ago, and men now weigh about 30 pounds more. Most people in the United States are overweight — an estimated 71.6 percent of the population age 20 and older, according to the CDC. That figure includes the 39.8 percent who are obese, defined as having a body mass index of 30 or higher in adults (18.5 to 25 is the normal range). Obesity is also rising in children; nearly 19 percent of the population age 2 to 19 is obese.
saberal

'It's easy to dismiss Black women's lives': Texas drags feet on maternal mortality cris... - 0 views

  • When medical staff prepped Shawn Thierry for an emergency C-section, she knew something was very wrong. After an epidural, excruciating pain ran through her legs. Soon, she could barely breathe.
  • The US has the highest maternal death rate among similarly developed countries and is the only industrialized nation where such deaths are rising. But according to data from the federal Centers for Disease Control and Prevention, in Texas the maternal mortality rate is above the US average, at 18.5 deaths per 100,000 live births.
  • They did not advance in 2019, or in the current legislative session which ends this weekend. Focused on restricting abortion rights, the male- and Republican-dominated state legislature has dragged its feet on maternal mortality.
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  • “It was really striking,” said Dr Amy Raines-Milenkov, a University of North Texas Health Science Center professor and member of the review committee. “We found that most of these deaths could have been prevented but the system is just not set up to prevent them. And we found a large racial disparity, which is a reflection of how we in society value women, especially African American women.”
  • the ultra-conservative Texas Senate – which ushered through extremist anti-abortion bills in March – did not pass the bill until the final minutes of its session. Even then, the legislation was not what was proposed. Without explanation, Republican Lois Kolkhorst of Brenham reduced the year of coverage to six months.
  • “Black women are dying at an alarming rate for reasons that could be prevented and our state leaders cut down the main proposal that a state-appointed committee recommended to help them – why would that even happen?” said Jones. “I think it’s because it’s so easy to dismiss Black women’s lives.”
  • In an ideological quest to punish abortion affiliates, Republicans have decimated the Texas reproductive health safety net by blocking low-income Medicaid patients from receiving life-saving preventative care at Planned Parenthood, a move resulting in reduced access to contraception and increased rates of Medicaid births, according to the Texas Policy Evaluation Project.
anonymous

1 in 14 women still smokes while pregnant, CDC says - CNN - 0 views

  • 7.2% of women who gave birth in 2016 smoked cigarettes while pregnant, CDC says
  • About one in 14 pregnant women who gave birth in the United States in 2016 smoked cigarettes during her pregnancy, according to a report released Wednesday.The findings, gathered by the Centers for Disease Control and Prevention's National Center for Health Statistics, revealed that 7.2% of all expectant mothers smoked -- but that the percentage of pregnant smokers varied widely from state to state.
  • In 2011, about 10% of women in the US reported smoking during their last three months of pregnancy, and of those women who smoked, 55% quit during pregnancy, according to data from the CDC's Pregnancy Risk Assessment and Monitoring System.Smoking while pregnant puts a baby at risk for certain birth defects. It also can cause a baby to be born too early or to have low birth weight and can raise the risk of stillbirth or sudden infant death syndrome, according to the CDC.
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  • "Women in West Virginia smoked during pregnancy more than five times as often as women in the states with the lowest prevalence,"
  • The researchers also found that prevalence of smoking during pregnancy varied by age and race. The prevalence was highest among women 20 to 24 at 10.7%, followed by women 15 to 19 at 8.5% and 25 to 29 at 8.2%.
  • The prevalence also was highest among non-Hispanic American Indian or Alaska Native women at 16.7%, followed by non-Hispanic white women at 10.5%, non-Hispanic black women at 6%, Hispanic women at 1.8% and non-Hispanic Asian women at 0.6%.
  • "We still have a serious issue with infant mortality -- prematurity and infant mortality are clearly linked to cigarette smoking, as is low birth weight -- and when you begin to explain these things to patients, it really does appear to make a difference to them," he said.Brown pointed out that some of the states in the new CDC report with the highest prevalence of smoking during pregnancy also tend to have high rates of infant mortality. A CDC data brief released in January showed that, between 2013 and 2015, West Virginia and Kentucky had infant mortality rates higher than the overall national rate.
Javier E

Trump barrels toward calamity - The Washington Post - 0 views

  • With all the foresight of Napoleon invading Russia and all the caution of George Pickett charging the Union lines, Trump barreled ahead Tuesday with his plan to send Americans back to their workplaces — and, consequently, their airplanes, subways and restaurants — within 19 days, even as the rapidly spreading pandemic builds toward a peak.
  • “We’re opening up this incredible country,” he declared midday in the Rose Garden to Fox News interviewers, hours after the World Health Organization declared a “very large acceleration” of coronavirus infections in the United States, raising the prospect of this country becoming the pandemic’s new epicenter.
  • “I would love to have the country opened up and just raring to go by Easter,” Trump declared. He went on to say he “wasn’t happy about” his public health experts’ recommendations, but he reluctantly accepted two weeks of restrictions because “we would have been unbelievably criticized for not doing it.”
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  • If Trump succeeds in getting Americans to mix again in public at the height of the pandemic (many governors are unlikely to be so foolhardy with their constituents’ health), he will be risking the lives of hundreds of thousands if not millions
  • Just a week into his tepid embrace of social distancing, he’s ready to abandon the fight against the virus and instead force Americans to accept a new strategy for dealing with a pandemic: survival of the fittest.
  • It won’t work: The economy won’t bounce back if people don’t feel safe. “There will be no normally functioning economy if our hospitals are overwhelmed and thousands of Americans of all ages, including our doctors and nurses, lay dying because we have failed to do what’s necessary to stop the virus,” Rep. Liz Cheney (Wyo.), the third-ranking House Republican said on Twitter.
  • It’s bad politics. As bodies of the elderly pile up, "GOP" will forever stand for something different: Get Old People.
  • It’s illogical: If he really sees things quickly returning to normal, what’s the point of a $2 trillion emergency spending package?
  • Above all, it’s immoral. Trump will be condemning to death the most vulnerable 1 or 2 percent who get the disease — and everybody else who can’t get medical care for heart attacks or injuries because hospitals are full.
  • “What is this, some modern Darwinian theory of natural selection?” asked an incredulous New York Gov. Andrew M. Cuomo. “We are going to fight every way we can to save every life that we can,” the Democrat added.
  • Trump seems to be acting in near-total ignorance. “You can’t compare this to 1918,” he said of the great pandemic. “That was a flu where if you got it, you had a 50/50 chance or very close of dying.” In fact, the 1918 influenza mortality rate was 2.5 percent. The WHO puts coronavirus mortality at 3.4 percent, though that’s likely to fall.
  • Trump blithely proclaimed that “we can socially distance ourselves and go to work.” He suggested more hand-washing and less hand-shaking. “We lose thousands of people a year to the flu; we never turn the country off,” he said. “We lose much more than that to automobile accidents; we didn’t call up the automobile companies to say, ‘Stop making cars.’ ”
  • The annual chance of dying in a car crash is about 1 in 8,000. Seasonal flu mortality is 0.1 percent.
  • Americans understand this. Seventy-two percent think it will take months or longer for the virus to be contained, a CBS-YouGov poll found. Americans can see it took China three months to control the virus with severe measures.
  • “This cure is worse than the problem,” he said. “In my opinion, more people are going to die if we allow this to continue.”On the basis of that uninformed speculation, a reckless Trump would sign death warrants for millions.
Javier E

The Dying of the Whites - The New York Times - 0 views

  • To many conservatives, the mortality rate shock is the latest indictment of modern liberalism’s mix of moral permissiveness and welfare-state paternalism: The first undercuts the rootedness, discipline and purpose that marriage and religion once supplied, and the latter eases people into a life of dependence and disability payments that only encourages drug abuse and suicidal thoughts.
  • But if the problem is social liberalism and the welfare state, progressives object, then why is the working class death rate only rising starkly in the United States? In the more secular and socialist territory of the European Union, Deaton and Case are at pains to note, white mortality rates have continued to decline.
  • This buttresses the longstanding liberal argument that the American working class has fallen victim, not to dependency and libertinism, but to a punishing economic climate — stagnant wages, a fraying safety net, and Republican economic policies that redistribute wealth upward
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  • Hence the European contrast: If we had the same institutions as France and Germany, our working class might still be struggling, but at least it would be protected from immiseration and despair.
  • if economic stress were all, you would expect the mortality crisis to manifest itself more sharply among black and Hispanic Americans — who have consistently higher unemployment rates than their white neighbors, and lag whites in wealth by far.
  • But in fact the mortality rate for minorities in the U.S. continued to fall between 1999 and 2013, mirroring the trend in Europe, and the African-American death rate in particular fell hugely
  • it was only white Americans who turned increasingly to drugs, liquor and quietus.
  • white social institutions, blue-collar as well as white-collar, have long reflected a “bourgeois moral logic” that binds employment, churchgoing, the nuclear family and upward mobility.
  • But in an era of stagnating wages, family breakdown, and social dislocation, this logic no longer seems to make as much sense. The result is a mounting feeling of what the American Conservative’s Rod Dreher calls white “dispossession” — a sense of promises broken, a feeling that what you were supposed to have has been denied to you.
  • For obvious historical reasons, though, Hispanic and (especially) black communities have cultivated a different set of expectations, a different model of community and family (more extended and matriarchal), a different view of success and the American story writ large
  • they may create a kind of resilience, a capacity for dealing with stagnation and disappointment (and elite indifference or hostility), which many working-class white Americans did not necessarily expect to ever need.
  • If this possibility has policy implications, it suggests that liberals are right to emphasize the economic component to the working class’s crisis. But it cautions against the idea that transfer payments can substitute for the sense of meaning and purpose that blue-collar white Americans derived from the nexus of work, faith and family until very recently
Javier E

Coronavirus fatality rate remains unknown as officials plan to reopen the economy - The... - 0 views

  • a fundamental question about the coronavirus pandemic remains unanswered: Just how deadly is this disease?
  • In Germany, fewer than three out of every 100 people with confirmed infections have died. In Italy the rate is almost five times higher, according to official figures.
  • Singapore, renowned for its careful testing, contact tracing and isolation of patients, saw only 10 deaths out of 4,427 cases through April 16. That yields a strikingly low case fatality rate of 0.2 percent, about twice the rate of seasonal influenza.
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  • No one knows exactly how many people died from influenza in 1918; estimates range from 15 million to 100 million globally. Historians estimate that the virus killed about 675,000 people in the United States across three waves of the pandemic
  • confirmed cases. But in this global crisis, both the numerator and the denominator are fuzzy.
  • the rising rate may reflect the disease’s gradual progression, combined with discoveries of additional deaths.
  • The disease is far more likely to cause severe outcomes in older people, with the oldest cohorts the most vulnerable. That said, in every age group — even 85-plus — most people who contract the disease will recover.
  • One scholarly estimate finds that the 1918-1920 pandemic killed 218 out of every 100,000 people living in the world at that time
  • In Spain, the death toll already stands at 41 out of 100,000 people; in Belgium the number is 45. In New York state, it is 63, and that number rises even higher if you consider the “probable” death toll in New York City.
  • So is the coronavirus as deadly? “This depends on how long this continues,”
  • The “virulence” of the virus — its ability to cause illness — has been steadily coming into focus.
  • But more than a month later, the WHO number has gone even higher: On April 16, the WHO showed a global fatality rate of 6.6 percent among confirmed cases.
  • Preliminary research indicates that the virus is not mutating significantly as it spreads, and so there is no evidence that some countries are dealing with a more virulent strain of SARS-CoV-2.
  • the median age of patients in Italy is 63 or 64 years; the median age of patients in Germany is 47. The mortality is much lower [in Germany] because they avoided having the older population affected.”
  • “If, in fact, the case fatality rate is higher than the 1918 flu, then this one has the potential to kill even more people,
  • “We saw it everyday. African Americans have three times the rate of chronic kidney disease that Caucasians have, and 25 percent higher heart disease. They’ve got higher rates of diabetes, hypertension and asthma,” Duggan said. “I fully expect that when people are hit hard and they are on a ventilator to breathe and their body needs to fight the infection, that people who already have compromised hearts or kidneys or lungs are that much more in jeopardy.”
  • Also critical is the nature, and robustness, of the national health system. For instance, Japan, where the current case fatality rate is 1.6 percent, and Singapore are reporting extremely high rates of hospitalization for coronavirus patients, at 80 percent and higher, figures that are unheard of in the United States. But this probably helps improve treatment and also reduces disease spread by isolating patients. The result is fewer deaths.
  • Several of the countries with low fatality rates — Germany, South Korea, Norway — have very high rates of coronavirus testing. This gave them a better look at the disease within their borders.
  • San Francisco General Hospital, noted that the hospital nearly tripled the capacity of its intensive care unit by adding doctors, nurses and technicians while the city adopted social distancing measures shortly ahead of New York.
  • “We were ready for a surge that never happened,” Balmes said. “They’re every bit as good as we are in intensive care in New York, but the system was overwhelmed. We did physical distancing just a few days earlier than New York, but it was a few days to the good.”
  • in a news conference that the global case fatality rate was 3.4 percent. That was treated as a revelation about the innate deadliness of the disease, but in fact was simply the WHO’s crude mortality ratio for confirmed covid-19 cases up to that point in time.
  • The other major factor in mortality is chronic disease. Most people hospitalized with severe cases of covid-19 have chronic health conditions such as diabetes, lung disease and heart disease. Where there is a high percentage of noncommunicable diseases like high blood pressure, the coronavirus will also be more deadly
  • A new study from researchers at Stanford, not yet peer-reviewed, looked for coronavirus antibodies in a sample population in Santa Clara County, Calif., and concluded that the actual infection rate in the county by early April was 50 to 85 times greater than the rate of confirmed cases.
  • “The story of this virus is turning out to be more about its contagiousness and less about its case fatality rate,” said David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia and a University of Pennsylvania professor of pediatrics. “It’s less fatal than we thought, but it’s more contagious.”
  • Where extensive testing has been done, estimates for the case fatality rate are often below 1 percent, The Post has found, suggesting these countries are getting closer to a rate that takes into account all infections
  • In Iceland, which has tested over 10 percent of the population, vastly more than other countries, the fatality rate is just 0.5 percent.
  • Harvard epidemiologist Marc Lipsitch has written that he and most experts suspect the fatality rate is about 1 to 2 percent for symptomatic cases. A 1 percent fatality rate is 10 times the average fatality rate for seasonal flu.
  • “It’s probably about an order of magnitude higher for covid-19,” said Viboud, the NIH epidemiologist. “It’s more severe in terms of mortality than the pandemics we’ve seen since 1918.”
Javier E

Germany's low coronavirus mortality rate intrigues experts | World news | The Guardian - 0 views

  • While the pandemic has hit Germany with full force, with Johns Hopkins University noting 22,364 confirmed infections by Sunday morning, only 84 people are so far reported to have died. This means Germany currently has the lowest mortality rate of the 10 countries most severely hit by the pandemic: 0.3% compared with 9% in Italy and 4.6% in the UK.
  • The contrast with Italy is especially surprising because the two countries have the highest percentage of citizens aged 65 or over in Europe. If anything, the Bloomberg Global Health Index would suggest Italians have a healthier lifestyle than Germans.
  • One likely explanation for the discrepancy in figures, Addo suggested, was that while northern Italy’s hospitals are being overrun with new patients, Germany’s are not yet at full capacity and have had more time to clear beds, stock up on equipment and redistribute personnel.
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  • Crucially, Germany started testing people even with milder symptoms relatively early on, meaning the total number of confirmed cases may give a more accurate picture of the virus’s spread than in other states.
lilyrashkind

Lives Cut Short: COVID-19 Takes Heavy Toll on Older Latinos | Healthiest Communities He... - 0 views

  • LOS ANGELES – In December 2020, about 10 months into the COVID-19 pandemic, Javier Perez-Torres boarded a bus from Los Angeles to Tijuana, Mexico, to buy a bracelet for the upcoming birthday of one of the five granddaughters who lived with him and his wife. Perez-Torres, 68, a Mexican immigrant, liked the selection of inexpensive jewelry available in the city just south of the U.S. border, so he made the trek, which lasted more than four hours round-trip.
  • For more than a month, Miron went to the hospital to see her husband, who’d been intubated. But nurses – following COVID-19 safety protocols – wouldn’t let her in. She’d sit on a bench outside the hospital for hours, then go home, and repeat the process.In early February of last year, a nurse called to let her know her partner of more than 40 years had died. She could now see him. “I said, ‘Why would I want to see him now?’” Alicia recalls in an interview in Spanish.
  • Overall, mortality from COVID-19 is some two to three times higher for Latinos than for non-Hispanic whites, says Dr. Michael Rodriguez, vice chair in the Department of Family Medicine at the David Geffen School of Medicine at UCLA. Rodriguez also is a professor in the Department of Community Health Sciences in UCLA’s Fielding School of Public Health.
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  • Latinos have maintained this type of edge despite generally having lower incomes, less access to health care and a greater prevalence of some chronic health issues, such as diabetes and obesity. Some researchers believe the life expectancy advantage is tied to the fact that many Latino immigrants to the U.S. are younger and healthier than many older Latinos, and have lower rates of smoking.
  • The researchers used projections of COVID-19 mortality to reach their conclusions, and a follow-up study arrived at similar findings. A CDC analysis showing provisional life expectancy estimates also pointed to a three-year drop in life expectancy for Latinos, and a shrinking gap between Latinos and whites.
  • Latino subgroups have an array of political and cultural differences. But one cultural norm that cuts across all groups is the primacy of family. Whatever country they’re descended from, it’s not uncommon for Latinos in the U.S. to live in multigenerational households that often include young children, their adult parents and a grandparent or grandparents.When young children and adults – many of whom are essential workers – live with elderly grandparents, “that increases the risk for the older people in the household,” says Dr. Luis Ostrosky, chief of the Division of Infectious Diseases at the McGovern Medical School at UTHealth Houston. “If the younger people in the household contract COVID-19, they may be OK, because younger people have stronger immune systems and tend to be healthier. Older people – who tend to be not as healthy and have chronic diseases – may become severely ill, with increased risk of hospitalization and mortality.”
  • “Once you put all those together, what you find is you have the disappearing of the Latino paradox,” Saenz says.While older Latinos have continued to have a higher rate of COVID-19 mortality than their white counterparts during each year of the pandemic, the difference in death rates has diminished over time. During the first year of the crisis, Latinos age 65 and older died of COVID-19 at 2.1 times the rate of older whites, Saenz and Garcia’s research shows. In 2021, older Latinos died at 1.6 times the rate of older whites, and into late April of this year, older Hispanics had died at 1.2 times the rate of older whites. Saenz attributes the narrowing difference to COVID-19 death rates among older whites in red states where vaccination rates are lower.
  • Transportation, language and employment. A study in 2020 from the UCLA Latino Policy & Politics Initiative found Latinos (and Blacks) in Los Angeles County and New York City were roughly twice as likely to die of COVID-19 as non-Hispanic whites as of July 20 of that year, and noted that carpooling or taking public transportation to work may raise the risk of coronavirus exposure. The study also found that 34% and 37% of the populations in Los Angeles County and New York City were foreign-born, respectively, with Latinos making up the largest share of that population in each area. Approximately 13% of the foreign-born do not speak English, according to the report, which poses a challenge to their obtaining important health information.
  • “A three-year reduction in life expectancy is huge in historical terms. We usually have not seen reductions this large except during times of war or major pandemics,” says Theresa Andrasfay, a postdoctoral scholar at the Leonard Davis School of Gerontology at USC and one of the PNAS study’s researchers. “Of course, it’s really sad to think about the individuals who died of COVID, but it also has broader implications for the family members of those who died.”COVID-19 has not only claimed the lives of many older Latinos, but many younger, working-age Latinos as well, leaving behind children, siblings, parents and grandparents who depended on them, Andrasfay says. She says she and other researchers are working on an update, tracking the effect of COVID-19 on life expectancy in 2021: “We’re finding a similar pattern (to 2020), with Latinos having the largest reduction in life expectancy.”
  • Though he wasn’t in the best of health, Salvador Macias, 83, enjoyed going to a neighborhood community center for senior activities in Long Beach, a beachside city about 25 miles south of downtown Los Angeles. He lived in a modest, tidy house with his wife, Manuela, and their adult daughter, Julie.Salvador suffered from three chronic health conditions: diabetes, high cholesterol and high blood pressure, says his son, Joe Macias.In August 2020 – four months before health care workers received the first COVID-19 vaccine – the elder Macias became ill with the disease, suffering from fatigue and severe shortness of breath. After several days, Salvador died at home. Manuela, who doesn’t have the chronic health conditions her husband had, also contracted COVID-19. She was hospitalized for a week, but survived.
Javier E

The Profound Social Cost of American Exceptionalism - The New York Times - 0 views

  • The United States is one of the richest, most technologically advanced nations in the history of humanity. And yet it accepts — proudly defends, even — a degree of social dysfunction that would be intolerable in any other rich society.
  • My first column pondered why Americans didn’t care more about the nation’s income gap, so much starker than that of any other advanced democracy. I suggested that my compatriots might come to a consensus that inequality is harmful when they realized how vast inequities could gum up the cogs of economic and social mobility
  • You can bet it has gone higher, given the bull run in the stock market since then. And Republicans just passed another round of tax cuts to offer a helping hand to the upper crust.
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  • Most interestingly, Americans still don’t care that much. Sure, two-thirds say they are dissatisfied with the way income and wealth are distributed, according to Gallup. Still, more than three out of five — compared with just over half six years ago — are satisfied with “the opportunity for a person in this nation to get ahead by working hard.”
  • As my column has aimed to highlight, too many Americans are, well, sinking. Seventeen percent of Americans are poor by international standards — living on less than half the nationwide median income. That’s more than twice the share of poor people in France, Iceland or the Netherlands.
  • Unequipped to cope with the demands of a labor market in furious transformation, they will give “social mobility” a new, all-American meaning: the tendency to move in and out of prison. It’s hard to believe any country could waste so many resources and prosper.
  • Or let’s measure our progress in terms of infant deaths. Scientists in the United States invented many of the technologies used around the world to keep vulnerable babies alive. So how come our infant mortality rate is higher than that of every nation in the Organization for Economic Cooperation and Development with the exceptions of Mexico, Chile and Turkey?
  • The impact of the nation’s fundamental paradox mostly fails the nonwhite and the poor. Black males born in the United States today will probably live shorter lives than boys born in Mexico, China or Turkey.
  • The children of poverty who survive will most likely hobble through life with mediocre educations — lagging their more affluent peers even before their first day in school and then falling farther behind, deprived of the resources that disadvantaged children in other advanced nations routinely enjoy.
  • Forget about income, though. It’s hard to square Americans’ belief in their society’s greatness with the life expectancy of its newborn girls and boys. It is shorter than in Australia, Austria, Belgium, Britain, Canada, Chile, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Norway, Portugal, Slovenia, South Korea, Spain, Sweden, Switzerland and probably a few other countries I missed.
  • America is doubling down on its exceptionalism. The rich got a tax break. Bankers got a break from the pesky rules written in the shadow of the financial crisis to protect the little guy. The poor and near poor were freed from their ability to afford health insurance.
  • populism — understood as a political movement shaped around giving the working class a “fair shake” — is pretty much dead.
katherineharron

Fact check: Donald Trump made 115 false claims in the last two weeks of February - CNNP... - 0 views

  • President Donald Trump made 115 false claims over the last two weeks of February, during which he faced a growing crisis over the coronavirus pandemic, visited India, held four campaign rallies and addressed the Conservative Political Action Conference.Trump made 67 false claims from February 17 through February 23; that was the 11th-highest total of the 34 weeks we've fact checked at CNN. He added 48 false claims from February 24 through March 1; that week ranked 25th out of 34. As usual, many of the false claims were ones he has uttered before.
  • aim: "Russia, if you're listenin
  • The fact that there is notorious video footage showing all this has not stopped Trump from making up an alternative history. He told CPAC on February 29 that he said "Russia, if you're listening" as "a joke," in front "25,000 people," and he was "laughing" afterward along with others in the crowd -- but the media cut off the clip "so quick at the end" so that people couldn't hear all of this laughing.
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  • The most revealing false claim: The flu mortality rate
  • VirusesAwareness of Ebola in 2014Comparing the coronavirus outbreak with the Ebola situation of 2014, Trump said, "At that time, nobody had ever even heard of Ebola." -- February 25 press conference in New Delhi, India "Nobody knew anything about it. Nobody had ever heard of anything like this." -- February 26 coronavirus press conference Facts First: Some Americans certainly didn't know a whole lot about Ebola before 2014, but the claims that "nobody" had ever even heard of Ebola and that "nobody" knew anything about it are absurd. Ebola was discovered in 1976. It had been the subject of considerable media coverage in the next three decades, not to mention scientific study.
  • Gupta, CNN chief medical correspondent, told Trump at a press conference, "Mr. President, you talked about the flu and then in comparison to the coronavirus. The flu has a fatality ratio of about 0.1%." Trump said, "Correct." But Trump later disputed the figure, saying, "And the flu is higher than that. The flu is much higher than that." -- February 26 coronavirus press conferenceFacts First: Even if Trump meant that the flu has a "much higher" fatality rate than 0.1% -- rather than meaning that the flu's mortality rate is "much higher" than that of the novel coronavirus -- he was wrong. The mortality rate for seasonal flu is "about 0.1%, 0.2% at the most," Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health -- who appeared with Trump at this same news conference -- told this to USA Today in mid-February, echoing the comments of other experts and Centers for Disease Control and Prevention data since 2010.
brickol

The coronavirus may be killing more men than women. The US should take note - CNN - 0 views

  • Smoking, drinking, general poor health: Researchers say these are some of the factors that could explain why more men seem to be dying from coronavirus than women.In countries such as Italy, men represent nearly 60% of people who tested positive for the virus and more than 70% of those who have died, according to the country's National Health Institute (ISS). Even in countries like South Korea, where the proportion of women who have tested positive for the virus is higher than that of men, about 54% of the reported deaths are among men.
  • But while health officials are starting to take note of these staggering numbers, the United States is not releasing the basic nationwide data that is crucial to understanding who is most vulnerable to the virus, according to a CNN analysis.
  • But across the countries for which we have data - spanning nearly a quarter of the world's population - we found that men were 50% more likely than women to die after being diagnosed with Covid-19.
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  • Comprehensive data about those who have gotten sick could help inform more effective responses to the crisis. But public health researchers say that when governments such as the United States either don't collect, or don't publish their data, it's impossible for experts to gain an accurate sense of what's going on.
  • "I am fairly sure that down to the smallest districts across the US, people have the data. What we've not seeing happening it seems is a collation, a collection of that data at state and national level with the speed which one might hope to see from the perspective of global health research."
  • "If I was designing clinical guidelines, I would very much want to understand why some people seem to have a much higher risk of mortality than others. It might for example lead to a difference in the way in which we administer clinical guidelines amongst people who have pre-existing health conditions that lead to risk of death along with those with chronic lung disease, who are more likely to be men."Hawkes also noted that reporting sex-disaggregated data on epidemics has been requested by the World Health Organization since 2007, but many countries fail to do so.
  • While necessarily partial and incomplete, the results highlight what public health experts have been warning for some time, theorizing that it is not only biology but also gendered behaviors -- the different ways in which men and women conduct their lives -- which may play a significant role in the different mortality rate for respiratory diseases.
  • From an evolutionary perspective, some research suggests that women have a stronger immune response against viral infections than men because they spend part of their lives with a foreign body inside -- their offspring -- thus granting them a survival advantage."It might have to do with hormonal changes," Ostrosky-Zeichner said. "There is actual research in animals that has shown there may be a biological basis for the sort of increasing susceptibility in the male gender and not only that but also an increased severity and response to the virus."
  • Initial reports of people with severe Covid-19 disease have found that they were likely to have underlying health conditions such as hypertension, cardiovascular disease and chronic lung disease, according to Global Health 50/50. These conditions tend to be more common among men in the six countries analyzed as well as globally, the institute said, possibly because of riskier lifestyle choices.
  • China has the largest smoking population in the world, with around 316 million adult smokers. But while over 50% of Chinese men smoke, less than 3% of women do, according to the Chinese Center for Disease Control and Prevention. In Italy, 7 million men smoke as opposed to the 4.5 million women, according to 2020 data released by the National Health Institute (ISS)The institute reported that, upon admission to hospital, "a third more Covid-19-positive smokers had a more serious clinical situation than non-smokers."
  • But the lack of data on how many men died of novel coronavirus as opposed to women, Global Health 50/50 researchers say, feels like a missed opportunity for governments to implement public health policies that target certain groups of people who are significantly more vulnerable than the rest of the population.
  • "What Covid-19 reveals is a classic case of failing to use data for decision making. For every patient there is a record of their sex. But that data is not collated and analyzed with a gender lens," Dr. Kent Buse, co-founder of GH5050 and chief of strategic policy directions at UNAIDS told CNN.
Javier E

Why Americans Are Dying from Despair | The New Yorker - 0 views

  • Outside of wars or pandemics, death rates for large populations across the world have been consistently falling for decades
  • Yet working-age white men and women without college degrees were dying from suicide, drug overdoses, and alcohol-related liver disease at such rates that, for three consecutive years, life expectancy for the U.S. population as a whole had fallen. “The only precedent is a century ago, from 1915 through 1918, during the First World War and the influenza epidemic that followed it,”
  • Between 1999 and 2017, more than six hundred thousand extra deaths—deaths in excess of the demographically predicted number—occurred just among people aged forty-five to fifty-four.
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  • their explanation begins by dismantling several others.
  • Was the source of the problem America’s all-too-ready supply of prescription opioids?
  • About a million Americans now use heroin daily or near-daily. Many others use illicitly obtained synthetic opioids like fentanyl.
  • As Case and Deaton note, most people who abuse or become addicted to opioids continue to lead functional lives and many eventually escape their dependence
  • The oversupply of opioids did not create the conditions for despair. Instead, it appears, the oversupply fed upon a white working class already adrift.
  • although opioid deaths plateaued, at least temporarily, in 2018, suicides and alcohol-related deaths continue upward.
  • Could deaths of despair be related to the rising incidence of obesity?
  • Case and Deaton report that we’re seeing the same troubling health trends “among the underweight, normal weight, overweight, and obese.”
  • Is the problem poverty?
  • Overdose deaths are most common in high-poverty Appalachia and along the low-poverty Eastern Seaboard, in places such as Massachusetts, New Hampshire, Delaware, and Connecticut. Meanwhile, some high-poverty states, such as Arkansas and Mississippi, have been less affected. Black and Hispanic populations are poorer but less affected, too.
  • How about income inequality? Case and Deaton have found that patterns of inequality, like patterns of poverty, simply don’t match the patterns of mortality by race or region.
  • A consistently strong economic correlate, by contrast, is the percentage of a local population that is employed
  • In the late nineteen-sixties, Case and Deaton note, all but five per cent of men of prime working age, from twenty-five to fifty-four, had jobs; by 2010, twenty per cent did not.
  • What Case and Deaton have found is that the places with a smaller fraction of the working-age population in jobs are places with higher rates of deaths of despair—and that this holds true even when you look at rates of suicide, drug overdoses, and alcohol-related liver disease separately. They all go up where joblessness does.
  • Conservatives tend to offer cultural explanations
  • People are taking the lazy way out of responsibilities, the argument goes, and so they choose alcohol, drugs, and welfare and disability checks over a commitment to hard work, family, and community. And now they are paying the price for their hedonism and decadence—with addiction, emptiness, and suicide.
  • Yet, if the main problem were that a large group of people were withdrawing from the workforce by choice, wages should have risen in parallel.
  • Case and Deaton argue that the problem arises from the cumulative effect of a long economic stagnation and the way we as a nation have dealt with it
  • For the first few decades after the Second World War, per-capita U.S. economic growth averaged between two and three per cent a year. In the nineties, however, it dipped below two per cent. In the early two-thousands, it was less than one per cent. This past decade, it remained below 1.5 per cent.
  • Different populations have experienced this slowdown very differently
  • Anti-discrimination measures improved earnings and job prospects for black and Hispanic Americans. Though their earnings still lag behind those of the white working class, life for this generation of people of color is better than it was for the last.
  • Not so for whites without a college education. Among the men, median wages have not only flattened; they have declined since 1979. The work that the less educated can find isn’t as stable: hours are more uncertain, and job duration is shorter
  • Among advanced economies, this deterioration in pay and job stability is unique to the United States.
  • In the past four decades, Americans without bachelor’s degrees—the majority of the working-age population—have seen themselves become ever less valued in our economy. Their effort and experience provide smaller rewards than before, and they encounter longer periods between employment.
  • The problem isn’t that people are not the way they used to be. It’s that the economy and the structure of work are not the way they used to be
  • Today, about seventy-five per cent of college graduates are married by age forty-five, but only sixty per cent of non-college graduates are
  • Nonmarital childbearing has reached forty per cent among less educated white women.
  • Religious institutions previously played a vital role in connecting people to a community. But the number of Americans who attend religious services has declined markedly over the past half century, falling to just one-third of the general population today.
  • Case and Deaton see a picture of steady economic and social breakdown, amid over-all prosperity.
  • climate—the amount of social and economic instability not only in your life but also in your family and community—matters, too. Émile Durkheim pointed out more than a century ago that despair and then suicide result when people’s material and social circumstances fall below their expectations.
  • why has the steep rise in deaths of despair been so uniquely American
  • The United States has provided unusually casual access to means of death.
  • The availability of opioids has indeed played a role, and the same goes for firearms
  • The U.S. has also embraced automation and globalization with greater alacrity and fewer restrictions than other countries have. Displaced workers here get relatively little in the way of protection and support.
  • And we’ve enabled capital to take a larger share of the economic gains. “Economists long thought that the ratio of wages to profits was an immutable constant, about two to one,” Case and Deaton point out. But since 1970, they find, it has declined significantly.
  • A more unexpected culprit identified by Case and Deaton is our complicated and costly health-care system.
  • The focus of Case and Deaton’s indictment is on the fact that America’s health-care system is peculiarly reliant on employer-provided insurance.
  • As they show, the premiums that employers pay amount to a perverse tax on hiring lower-skilled workers.
  • According to the Kaiser Family Foundation, in 2019 the average family policy cost twenty-one thousand dollars, of which employers typically paid seventy per cent.
  • “For a well-paid employee earning a salary of $150,000, the average family policy adds less than 10 percent to the cost of employing the worker,” Case and Deaton write. “For a low-wage worker on half the median wage, it is 60 percent.”
  • between 1970 and 2016, the earnings that laborers received fell twenty-one per cent. But their total compensation, taken to include the cost of their benefits (in particular, health care), rose sixty-eight per cent. Increases in health-care costs have devoured take-home pay for those below the median income.
  • this makes American health care itself a prime cause of our rising death rates.
  • we must change the way we pay for health care. Instead of preserving a system that discourages employers from hiring, retaining, and developing workers without bachelor’s degrees, we need to make health-care payments proportional to wages—as with tax-based systems like Medicare.
  • So far, the American approach to the rise in white working-class mortality has been to pour resources into addiction-treatment centers and suicide-prevention programs. Yet the rates of suicide and addiction remain sky-high. It’s as if we’re using pressure dressings on a bullet wound to the chest instead of getting at the source of the bleeding.
  • Case and Deaton want us to recognize that the more widespread response is a sense of hopelessness and helplessness. And here culture does play a role.
  • When it comes to people whose lives aren’t going well, American culture is a harsh judge: if you can’t find enough work, if your wages are too low, if you can’t be counted on to support a family, if you don’t have a promising future, then there must be something wrong with you
  • We Americans are reluctant to acknowledge that our economy serves the educated classes and penalizes the rest. But that’s exactly the situation, and “Deaths of Despair” shows how the immiseration of the less educated has resulted in the loss of hundreds of thousands of lives, even as the economy has thrived and the stock market has soared.
  • capitalism, having failed America’s less educated workers for decades, must change, as it has in the past. “There have been previous periods when capitalism failed most people, as the Industrial Revolution got under way at the beginning of the nineteenth century, and again after the Great Depression,” they write. “But the beast was tamed, not slain.”
  • Today, the battles are over an employer-based system for financing health care, corporate governance that puts shareholders’ interests ahead of workers’, tax plans that benefit capital holders over wage earners.
  • We are better at addressing fast-moving crises than slow-building ones. It wouldn’t be surprising, then, if we simply absorbed current conditions as the new normal.
katherineharron

Why New York has been hit so hard by coronavirus (opinion) - CNN - 0 views

  • New York state reached a tragic milestone this week: It now has more Covid-19 patients than any country in the world, aside from the United States.
  • Of the 20,389 deaths in the United States, 8,627, or 42%, have occurred in New York. Its mortality rate is 4.7%, compared with 3.4% in the rest of the country, according to CNN's figures based on data from the Johns Hopkins University Center for Systems Science and Engineering.
  • New York is by far the nation's most populous city, with more than 8 million people, twice as many as Los Angeles. But New York also has eight or nine times more cases than any other city — so what gives? No other city or county has a fraction of the cases of New York City.
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  • New York City and its suburban counties — Nassau, Suffolk, Westchester and Rockland — are responsible for 93% of the statewide case count
  • Covid-19 spreads most easily when people are packed together — in churches or cruise ships, in outdoor events like concerts or Mardi Gras, or perhaps in small apartments with multiple roommates or large families. New York's population density, about 27,000 people per square mile, is easily the highest in the country, though it's nowhere near the top for cities across the globe. Many cities — in Asia, for example — have a density of nearly 40,000 people per square mile.
  • Maybe it's because so much testing is being done in New York. If you test more, you find more, and if you find more, you test even more.
  • The high number of cases and rates likely do derive in some modest amount to each explanation above — plus the fact that the epidemic has been in New York City a week or two longer than many other places. A more mature epidemic is always a larger epidemic.
  • Still, a mortality rate of about 6% is quite high, even though most countries, particularly in western Europe, have seen mortality rates rise as the pandemic drags on.
  • Hopefully, the Covid-19 pandemic will force us to reckon honestly with the many shortfalls that have been exposed and build a fair, forward-thinking approach that allows doctors and nurses to care for people in need. Failure to do this will only further darken the memory of those who have died and the hearts of those who remain.
martinelligi

McConnell Rebukes Trump For His Role In Capitol Riot : Insurrection At The Capitol: Liv... - 0 views

  • For the first time since the Jan. 6 mob attack on the U.S. Capitol, Senate Majority Leader Mitch McConnell publicly denounced President Trump and his supporters for instigating the insurrection.
  • "They were provoked by the president and other powerful people, and they tried to use fear and violence to stop a specific proceeding of the first branch of the federal government, which they did not like."
  • "Dozens of lawsuits received hearings and courtrooms all across our country. But over and over, the courts rejected these claims, including all star judges that the president himself had nominated," he said at the time.
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  • McConnell has not denied the possibility of voting against Trump at a potential Senate impeachment trial, precipitated by the House vote to impeach the president for an unprecedented second time over his role in the insurrection.
  • Incoming Senate Majority Leader Chuck Schumer, D-N.Y., who will take over that role in less than 24 hours, said Tuesday the Senate will move ahead with an impeachment trial with a plan for a separate vote to bar Trump from holding any future federal office if the Senate votes to convict.
  • While millions wait for a life-saving shot, the U.S. death toll from the novel coronavirus continues to soar upwards with horrifying speed. Today, the last full day of Donald Trump's presidency, the official death count reached 400,000 — a once-unthinkable number. More than 100,000 Americans have perished in the pandemic in just the past five weeks.
  • In the U.S., someone now dies from COVID-19 every 26 seconds. And the disease is now claiming more American lives each week than any other condition, ahead of heart disease and cancer, according to the Institute for Health Metrics and Evaluation at the University of Washington.
  • Given its relatively large population, the U.S. death rate from COVID remains lower than the rate in many other countries. But the cumulative death toll of 400,000 now exceeds any other country's overall mortality — close to double what Brazil has recorded, and 4 times the death count in the U.K.
  • Is there any way we can avoid half a million deaths before the end of February?" says Ashish Jha, dean of the Brown University School of Public Health.
  • Certain parts of the country have a disproportionately high death rate. Alabama and Arizona, in particular, have experienced some of the highest death rates, given their populations. The virus continues to kill Black and Indigenous Americans at much higher rates than white Americans.
  • In rural America, the chance of dying from COVID-19 remains much higher than in the urban centers.
  • Vaccine rollout has yet to catch up with an accelerating mortality rate
  • So far, about 3 in every 100 people have gotten at least one dose of the vaccine, placing America ahead of many other countries, but behind the optimistic promises made in the early days of the rollout.
  • It is this polarity — the advent of a life-saving vaccine and hospitals filled with more dying patients than ever before — that makes this particular moment in the pandemic so confounding.
Javier E

The I.R.S. Sent a Letter to 3.9 Million People. It Saved Some of Their Lives. - The New... - 0 views

  • Three years ago, 3.9 million Americans received a plain-looking envelope from the Internal Revenue Service. Inside was a letter stating that they had recently paid a fine for not carrying health insurance and suggesting possible ways to enroll in coverage
  • these notices increased health insurance sign-ups. Obtaining insurance, they say, reduced premature deaths by an amount that exceeded any of their expectations
  • Americans between 45 and 64 benefited the most: For every 1,648 who received a letter, one fewer death occurred than among those who hadn’t received a letter.
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  • the letters may have wound up saving 700 lives
  • The experiment, made possible by an accident of budgeting, is the first rigorous experiment to find that health coverage leads to fewer deaths, a claim that politicians and economists have fiercely debated in recent years as they assess the effects of the Affordable Care Act’s coverage expansion
  • The results also provide belated vindication for the much-despised individual mandate that was part of Obamacare until December 2017, when Congress did away with the fine for people who don’t carry health insurance.
  • “There has been a lot of skepticism, especially in economics, that health insurance has a mortality impact,
  • “It’s really important that this is a randomized controlled trial. It’s a really high standard of evidence that you can’t just dismiss.”
  • “It’s an innovation to know that just sending a letter to people with information about what it means to be insured versus uninsured can substantially change coverage rates,”
  • Multiple studies showed a decline in mortality rates after states expanded Medicaid, but none could tie the outcome directly to the policy change, since states typically cannot randomly pick which residents do and don’t receive Medicaid
  • Finding any change requires a very large sample to study.
  • The Obama administration had planned to send letters to all 4.5 million Americans paying tax fines for not carrying health coverage, only to learn the budget was not quite big enough. About 600,000 uninsured taxpayers were randomly left out of the mailing.
  • This created a randomized controlled trial, which researchers generally view as the gold standard for studying the results of a specific policy intervention
  • gaining coverage was associated with a 12 percent decline in mortality over the two-year study period
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