To be clear: The ideal female mate is young. You’re going to want three kids, and to do that you really need to get going by 25. My wife had our first in her early 30s and at the hospital she was wheeled through a door that said “Geriatric Mothers.” I thank my lucky stars we were able to defy biology and churn out three so late in life. I know you twentysomethings are convinced you don’t want kids, and I was the same way at your age, but you’re wrong. Talk to social workers who deal with the elderly. The deathbed moans from those with no kids are all about their total lack of legacy. Defying the biological imperative isn’t empowering. It’s a curse. So if you settle down with a woman over 35, you are making a huge mistake.
That being said, I’m not into women under 35. I remember having sex with young women when I was a young man and it sucked. Teenagers were the worst. It was like we were both trying to go through a doorway at the same time as we grunted, “Not there,” and apologized. My single friends often text me pictures of the twentysomethings they’re paired up with and I almost feel sorry for them. Sex lasts, what, 10 minutes? Now you have 23 hours and 50 minutes to talk to someone who says “like” every third word. The sex is terrible, too. They pump away like they’re working at a pump factory and there’s no intellect or imagination involved. It’s like playing tennis with a toddler. I want a woman who has been around the block and knows what she’s doing. I’ll spare you the details, but there are techniques you learn with time that only a wife can know.
Gavin McInnes, “In Praise of the Benjamin Button Babes”, Taki’s Magazine, 2015-07-24.
March 16, 2017
QotD: Sex and the twentysomethings
March 14, 2017
“Most policy ideas are bad” (especially in US healthcare)
Megan McArdle says that the best plan the Republicans could come up with to deal with Obamacare is to do nothing, at least in the short-term:
For a policy columnist, “Don’t do that” is the easiest column to write. Most policy ideas are bad. If you simply blindly oppose everything that anyone ever puts forward, you’ll end up being right most of the time.
However, that’s not very useful for politicians. If they just sit around Congress playing tiddlywinks all day, voters will get cranky. Congress is supposed to do things. So, having spent a few days saying unkind things about the Republican health-care plan, it probably behooves me to state what I think they should do.
Well, boy, that’s a hard question. Here’s the thing: For all the unkind words I’ve said, I get the forces that have brought Republicans to this point. As I wrote Thursday, Democrats built a shoddy and unworkable structure out of the political equivalent of concrete: nearly impossible to repair or renovate, and darned expensive to demolish. The task is made even harder by the fact that Democrats currently control just enough votes in the Senate to keep Republicans from passing any sort of clean, comprehensive bill.
[…]
What would I do in this situation? Well, the first thing I’d do is accept, deep in my heart, that there are no great outcomes possible at this point. The second thing I’d do is remember that nothing is always a policy option: If you can’t do something better than the status quo, don’t do anything. It’s what I said to Democrats in 2009, and it’s what I’m saying to Republicans now.
So what would I do to minimize the damage, within the constraints of political reality? Well, I foresee two potential futures for the current status quo. One, the exchanges where individuals buy policies could fail, leaving people unable to buy insurance. Or two, the exchanges don’t fail, and we’re left with an unsatisfactory but still operational system.
In either case, the Republicans’ best option is to wait. Why? Because what they can do now — hastily, without touching the underlying regulations that have destabilized the individual market — is worse than either of those outcomes. The partial-reform structure they think they’ll be able to get through the Senate is likely to make the problems in the individual market worse, not better. And the fact that they’ve tinkered with the program means that Republicans will take 100 percent of the blame.
She also re-iterates her own ideal solution (which she admits wouldn’t fly with the American public):
Longtime readers of my column know that my pet proposal is a radical overhaul of the whole system in which we zero out all the existing subsidies and just have the government pick up 100 percent of the tab for medical expenses that exceed 15 or 20 percent of a family’s adjusted gross income: basically, a single-payer catastrophic-care system for expenses that no one can realistically save for. Let people buy insurance for expenses below that, or, if it’s not too expensive taxwise, let people set aside more money tax-free in Health Savings Accounts. And make some more generous provisions for people closer to the poverty line, such as prefunding Health Savings Accounts for them. That’s the whole program. It fits on a postcard, though the finer details — like which cancer treatments we’re actually willing to pay for — obviously aren’t.
However, this is completely politically infeasible, because voters don’t want genuine insurance, by which I mean a pool that provides financial assistance for genuinely unforeseeable and unmanageable expenses. Voters want comprehensive coverage that kicks in at close to the first dollar of spending, no restrictions on treatments or their ability to see a doctor, nice American-style facilities, and so forth. They are also fond of their health-care professionals and do not wish to see provider incomes slashed and hospitals closed, nor do they want their taxes to go up, or to pay 10 percent of their annual income in premiums. This conflicting set of deeply held views is one major reason that Obamacare — and American health-care policy more generally — has the problems it does.
March 13, 2017
“It’s not really a debate over Obamacare, it’s a debate over Medicaid”
Robert Tracinski explains why the Republicans are having such a hard time with their oft-promised “repeal” of Obamacare:
House Republicans have released their proposed measure to “repeal and replace” Obamacare, and the whole enterprise is already losing steam right out of the gate. The measure is too small and incremental, less a repeal of Obamacare and more of a repair of it, keeping numerous basic features intact.
If you want to know why Republicans have bogged down, notice one peculiar thing about the Obamacare debate so far. It’s not really a debate over Obamacare, it’s a debate over Medicaid. That’s because Obamacare mostly turned out to be a big expansion of Medicaid. The health insurance exchanges that were supposed to provide affordable private health insurance (under a government aegis) never really delivered. They were launched in a state of chaos and incompetence, and ended up mostly offering plans that are expensive yet still have high deductibles. Rather than massively expanding the number of people with private insurance, a lot of the effect of Obamacare was to wreck people’s existing health care plans and push them into new exchange plans.
Ah, but what about all those people the Democrats are claiming were newly covered under Obamacare? A lot of them — up to two-thirds, by some estimates — are people who were made newly eligible for a government health-care entitlement, Medicaid. But shoving people onto Medicaid is not exactly a great achievement, since it is widely acknowledged to be a lousy program.
Conservative health care wonk Avik Roy explains why: “[T]he program’s dysfunctional 1965 design makes it impossible for states to manage their Medicaid budgets without ratcheting down what they pay doctors to care for Medicaid enrollees. That, in turn, has led many doctors to stop accepting Medicaid patients, such that Medicaid enrollees don’t get the care they need.” Partly as a result, a test in Oregon found no difference in health outcomes between those with access to Medicaid and those without.
March 9, 2017
“… we’re psychologically training an entire swath of the population to be crazy”
At Ace of Spades H.Q., Ace talks about the huge rise in reported personality disorders among Millennials:
Therapeutic behavioral conditioning trains people how to de-trigger themselves from triggers that cause panic, anxiety, depression, or bad behavior (drinking, etc.) That sort of behavioral conditioning teaches people to be mindful of their triggers, to understand that the trigger is just a tic with no real world purpose, and to train themselves to associate the trigger not with an adverse behavioral pattern (being in crowd triggers claustrophobia-like panic) but to train the trigger to lead to some other more benign consequence (being in crowd triggers recitation of the Ode to Joy).
The idea is that your brain has miswired itself to connect an input (too many people close to me) to an undesirable psycho-somatic reaction (heart racing, extreme anxiety), and that it takes a determined attempt to reprogram the brain and untangle those wires so that the triggering input leads first to a benign output and, ultimately, no particular output at all.
This works. Allen Carr’s How to Quit Smoking the Easy Way taught me how to re-wire the trigger (the anxiety/stress one feels when one’s 45 minute nicotine clock runs down to 0) into a different behavioral pattern (go outside, gulp in some fresh air, pace around a little bit like I used to do when smoking). It also taught me that the stress of not smoking was irrational, and that it would be helpful to view the addiction as a malignant parasite inside of me trying to manipulate my brain into keeping it fed while it ruined my body.
Works.
[…]
He realized that the process could be reversed. As brains with bad triggers could be un-triggered to be healthy, so too could completely healthy brains be deliberately taught to be triggered by harmless things and bring about various mental ailments, panic, anxiety, irrational emotional outbursts, a compulsion to violence, tantrums, etc.
And he brought this theory to a social psychologist named Haidt and asked him “Is this possible?” And Haidt said, “Damn it, not only is that possible, I think you’ve hit upon a very real malapplication of psychological techniques — we’re psychologically training an entire swath of the population to be crazy.”
Okay, he didn’t really say that. But that’s kind of the gist.
Definitely read it.
There’s no great mystery to what’s going on. People who train themselves to be cool and clear of mind will find themselves becoming more cool and clear of mind.
People who train themselves to go to pieces over every damn thing will find themselves getting better and better at going to pieces over every damn thing.
When you valorize a mental disorder and turn it into a virtue to be cultivated, guess what you’re gonna get? More mental disorders.
March 6, 2017
QotD: Organic food “standards”
In December 1997 when USDA proposed standards for organic agricultural production, the original version was rejected by the organic enthusiasts, largely because it would have permitted the use of organisms modified with modern genetic engineering techniques (“GMOs”) – which would have been quite sensible in the view of the scientific community. In the end, modern genetic engineering, which employs highly precise and predictable techniques, was prohibited, while genetic modification with older, far less precise, less predictable and less effective techniques were waived through.
The resulting organic “standards,” which are based on a kind of “nature good, technology evil” ethic, arbitrarily define which pesticides are acceptable, but allow “deviations” if based on “need.” Synthetic chemical pesticides are generally prohibited, although there is a lengthy list of exceptions listed in the Organic Foods Production Act – while most “natural” ones are permitted. Thus, advocates of organic agriculture might be described as “pragmatic fanatics.” (Along those lines, the application as fertilizer of pathogen-laden animal manures, as compost, to the foods we eat is not only allowed, but in organic dogma, is virtually sacred.)
What, then, is the purpose of organic standards? “Let me be clear about one thing,” Secretary of Agriculture Dan Glickman said when organic certification was being considered, “the organic label is a marketing tool. It is not a statement about food safety. Nor is ‘organic’ a value judgment about nutrition or quality.”
Organic standards are wholly arbitrary, owing more to the dogma of an atavistic religious cult than to science or common sense. And whatever their merit, as a December 2014 report in the Wall Street Journal described, the standards are not being enforced very effectively: An investigation by the newspaper of USDA inspection records since 2005 found that 38 of the 81 certifying agents – entities accredited by USDA to inspect and certify organic farms and suppliers — “failed on at least one occasion to uphold basic Agriculture Department standards.” More specifically, “40% of these 81 certifiers have been flagged by the USDA for conducting incomplete inspections; 16% of certifiers failed to cite organic farms’ potential use of banned pesticides and antibiotics; and 5% failed to prevent potential commingling of organic and nonorganic products.”
[…]
The bottom line is that buying “certified organic” products doesn’t guarantee that they will be free of genetically engineered ingredients. Even so, buying organic should please those consumers who think that paying a big premium for something means that it’s sure to be better. We hope that at least they get the benefit of the “placebo effect.”
Henry I. Miller and Drew L. Kershen, “Fanaticism, Pragmatism and Organic Agriculture”, Forbes, 2015-07-08.
February 21, 2017
Medical Treatment in World War 1 I THE GREAT WAR Special
Published on 20 Feb 2017
Some sources say that during the four years of World War 1, medicine and medical treatments advances more than during any other four year period in human history. The chances for a soldier to survive his injury were far greater in 1918 than in 1914.
February 17, 2017
Food texture
Along with the actual flavour and aroma of food, the texture matters a great deal:
As eaters, we tend to downplay texture’s importance. A 2002 study in the Journal of Sensory Studies found that texture lagged behind taste and smell — and only occasionally beat out temperature — in terms of the perceived impact on flavor. But you only have to look at pasta to see how strongly texture impacts our perception of taste. We’ll eat macaroni and cheese in the form of spirals, shells, and noodles shaped like Spongebob Squarepants, but spaghetti mixed with florescent “cheese” powder seems anathema — it’s the texture that makes the difference.
For the longest time, food scientists downplayed texture’s importance as well. “When I was a student pursuing a degree in food science, I was taught that flavor was a combination of mainly taste and smell,” recalls Jeannine Delwiche, one of the authors of the 2002 study.
But how a food feels affects our enjoyment of the thing. There is, of course, the actual texture of the food, which scientists call rheology. Rheology focuses on consistency and flow. For example, it’s fairly evident that cotton candy has a different texture than plain sugar, even though sugar is its only ingredient. But the perception of a food’s rheology — what scientists call psychorheology — is another thing entirely. If you’ve ever wondered why sour candy always seems to come coated in rough sugar, the reason is simple: We perceive rougher foods as being more sour. Psychorheology is why we like gummy bears in solid but not liquid form, why we enjoy carbonated soda but balk at its flavor when it goes flat. It’s why we perceive gelato as creamier than ice cream — even though the latter has more fat.
Texture is an important indicator of a food’s fat content. If we can figure out how to trick our tongues into sensing more fat than is actually present in a food, we can increase satiation while decreasing a food’s calorie count. That’s why some researchers are finally turning their attention to these taste-making sensations.
February 14, 2017
Reconstructive and Plastic Surgery During World War 1 I THE GREAT WAR Special
Published on 13 Feb 2017
Filmed at Romagne 14-18 museum: http://romagne14-18.com
Plastic and reconstructive surgery saw rapid development during World War 1. Modern medical care and better equipment increased the chances of survival for the soldiers. But these survivors were often disfigured or lost limbs as a result. To help them return to a somewhat normal life, reconstructive surgeons developed methods to restore their faces and aided them with prosthetics.
February 5, 2017
Smoking – Hearing Protection – Sanitation I OUT OF THE TRENCHES
Published on 4 Feb 2017
This week Indy talks about the smoking habits of the soldiers, how sanitation was organised in the trenches and how soldiers protected their ears during fighting.
February 3, 2017
February 2, 2017
Obesity and the adoption of a “western” diet
Gary Taubes says the “case against sugar isn’t so easily dismissed”:
My concern in my essay and my books is a simple and regrettable fact: the epidemics worldwide of obesity and diabetes that occur whenever populations pass through a nutrition transition from a traditional diet and lifestyle, whatever that may be, to a western one. Something is causing that, and because obesity and diabetes, particularly type 2, are intimately linked to insulin resistance, we should be looking ultimately and desperately for the cause of insulin resistance. Geneticists would say we’re looking for the environmental trigger that reliably and often dramatically increases the prevalence of the obese and diabetic phenotype, regardless of the underlying human genotype. And because insulin resistance, obesity, and diabetes are all intimately linked to heart disease, that trigger is almost assuredly going to be a cause of coronary heart disease as well.
But in this country, nutrition and chronic disease research from the 1950s onward was obsessively focused on a very different question: the dietary cause of heart disease in the United States and Europe. When the researchers decided on the basis of exceedingly premature evidence that dietary fat was the culprit, that drove all public health debates and thinking ever after. Even hypotheses about the cause of obesity and diabetes had to be reconcilable with the belief that saturated fat caused heart disease. As such, the evidence implicating insulin resistance in the disorder (and so the carbohydrate content of the diet) was delayed by 30 years in its acceptance, as I discussed in Good Calories, Bad Calories. Its implications are still not accepted because they clash with what remains of the dogmatic belief that saturated fat causes heart disease. And this all happened because researchers were asking the wrong question (and they got the wrong answer even to that): “why CHD in America now,” rather than “why obesity, diabetes, and insulin resistance in populations worldwide whenever they westernize?”
[…]
Now that we’re almost literally neck deep in obesity and diabetes, the right question is vitally important to answer. If the sugar hypothesis is wrong, it is critically important that it be refuted definitively. That can only happen on the strength of far, far stronger evidence than Dr. Guyenet provides in his somewhat flip and casual response. And if the sugar hypothesis is unambiguously refuted, whatever hypothesis steps up as the next prime suspect has to be very carefully considered. (i.e., not the simplistic notion that people eat too much and move too little). We need a hypothesis that holds the promise of explaining the epidemics everywhere.
In stopping an epidemic, nothing is more important than correctly identifying its cause. Where we are today with obesity and diabetes reminds me of where infectious disease specialists were through most of the 19th century, when they blamed malaria and other insect-born diseases on miasma, or the bad air that came out of swamps. That was mildly effective, in that it was an explanation for why the rich in any particular town preferred to build their homes on hills, high above the miasma and, incidentally, away from the swamps and lowlands and slums where the vectors of these diseases were breeding. But only by identifying the vectors and the actual disease agents do we help everyone avoid them and eradicate the diseases. Only by unambiguously identifying the cause can we effectively design treatments to cure it. The kinds of explanations that Dr. Guyenet and Freedhoff put forth – highly palatable foods or ultra-processed foods – are the nutritional equivalents of the miasma explanation. They sound good; they might help some people incidentally eat the correct diets or offer a description of why other people already do, but they’re not the proximate cause of these epidemics. And there is a proximate cause. We have to find it. I can guarantee it’s not saturated fat, regardless of the effect of that nutrient on heart disease risk. What is it?
January 29, 2017
QotD: Perverse incentives for journalists
Unfortunately, the incentives of both academic journals and the media mean that dubious research often gets more widely known than more carefully done studies, precisely because the shoddy statistics and wild outliers suggest something new and interesting about the world. If I tell you that more than half of all bankruptcies are caused by medical problems, you will be alarmed and wish to know more. If I show you more carefully done research suggesting that it is a real but comparatively modest problem, you will just be wondering what time Game of Thrones is on.
Megan McArdle, “The Myth of the Medical Bankruptcy”, Bloomberg View, 2017-01-17.
January 28, 2017
The “fantasy of addiction”
Peter Hitchens explains how he started an argument that “will probably still be going on when I die”.
I never meant to start an argument about addiction. I had carried my private doubts on the subject around in my head for years, in the “heresy” section where I keep my really risky thoughts. And I don’t recommend disagreeing in public with Hollywood royalty, either, which is how it happened. In such a clash, most people will think you are wrong and Hollywood is right, especially if your opponent is Chandler Bing, the beloved character from Friends. Of course, he wasn’t really Chandler Bing, just an actor called Matthew Perry — but an actor with an entourage so big it filled an entire elevator at the BBC’s new studios in central London where we quarreled.
Our debate wasn’t even supposed to be about addiction. I’d been asked onto the corporation’s grand but faded late-night current affairs show Newsnight to talk about drug courts, one of many stupid ideas suggested by the idea of addiction. I reckoned my main opponent would be the other guest, Baroness (Molly) Meacher, whose name sounds like something out of The Beggar’s Opera. While she looks like the sort of harmless, kindly housewife who knits next to you on the bus, she is in fact a campaigner for the wilder sorts of drug liberalization. If this Chandler Perry wanted to horn in, well and good. Who cared? Yet when I began to sense sarcasm mingled with unearned superiority oozing from the character from Friends, I decided to let my impatience show.
Hence my rash, irreversible plunge into an argument which has been going on ever since, consuming billions of electrons on social media, and which will probably still be going on when I die. I heard myself using the words “the fantasy of addiction.” There. I’d done it. Let the heavens fall.
Chandler Bing called me various names and was even more sarcastic than before. He is extremely good at sarcasm, even if he understands very little about the drug problem. I have never heard the words “your book” pronounced with such eloquent contempt. The final “k” seemed to contain two whole syllables. Is this a Canadian thing? He was referring to my modest volume on the topic The War We Never Fought, so energetically ignored by reviewers and booksellers that it is known among London publishers as The Book They Never Bought.
January 23, 2017
Five easy fixes to improve US federal health policies
Scott Alexander finds, to his surprise, that two of the candidates for the post of FDA commissioner in the Trump administration are following his blog or social media profile. To mark that, he offers five easy-to-implement policy fixes that would make a difference:
1. Medical reciprocity with Europe and other First World countries […] Right now, Europe has a licensing agency about as strict as the FDA approving medications invented in Europe. Any pharma company that wants their medication approved in both the US and Europe has to spend a billion or so dollars getting it approved by the FDA, and then another billion or so dollars getting it approved by the Europeans. A lot of pharma companies don’t want to bother, with the end result that Europe has many good medications that America doesn’t, and vice versa. Just in my own field, amisulpride, one of the antipsychotics with the best safety/efficacy balance, has been used successfully in Europe for twenty years and is totally unavailable here despite a real need for better antipsychotic drugs. If the FDA agreed to approve any medication already approved by Europe (or to give it a very expedited review process), we could get an immediate windfall of dozens of drugs with unimpeachable records for almost no cost. Instead, in the real world, we’re cracking down on imported Canadian pharmaceuticals because the Canadians don’t have exactly our same FDA which means that for all we know they might be adding thalidomide to every pill or something. This is exactly the sort of silly anti-competitive cronyist practice that a principled intelligent libertarian could do away with.
2. Burdensome approval process for generic medications […] How come Martin Shkreli can hike the dose of an off-patent toxoplasma drug 5000%, and everyone just has to take it lying down even though the drug itself is so easy to produce that high school chemistry classes make it just to show they can? The reason is that every new company that makes a drug, even a widely-used generic drug that’s already been proven safe, has to go through a separate approval process that costs millions of dollars and takes two to three years – and which other companies in the market constantly try to sabotage through legal action. Shkreli can get away with his price hike because he knows that by the time the FDA gives anyone permission to compete with him, he’ll have made his fortune and moved on to his next nefarious scheme. If the FDA allowed reputable pharmaceutical companies in good standing to produce whatever generic drugs they wanted, the same as every other company is allowed to make whatever products they want, scandals like Daraprim and EpiPens would be a thing of the past, and the price of many medications could decrease by an order of magnitude. […]
3. Stop having that thing allowing companies to “steal” popular and effective drugs that have been in the public domain for years, claim them as their private property, shut down all competitors, and jack up the price 10x just by bringing them up to date with modern FDA bureaucracy.
4. Stop having that thing where drug companies can legally bribe other companies not to compete with them. I like this one because it sounds anti-libertarian (we’re imposing a new regulation on what companies can do!) but I think it’s exactly the sort of thing that the crony capitalists would never touch but which principled intelligent libertarians like O’Neill and Srinivasan might be open to, in order to bring more actors into the marketplace.
5. Stop thwarting consumer diagnostic products and genetic tests […] Srinivasan comes from the genetic testing world himself, so he’s likely to be extra sympathetic to this.
January 13, 2017
Jonathan Haidt on the rise of the “microaggression” concept
He is commenting on an article in Perspectives on Psychological Science (PDF):
The microaggression program teaches students the exact opposite of ancient wisdom. Microaggression training is — by definition — instruction in how to detect ever-smaller specks in your neighbor’s eye. Microaggression training tells students that “life itself is exactly what you think it is — you have a direct pipeline to reality, and the person who offended you does not, so go with your feelings.” Of course, the ancients could be wrong on these points, but the empirical evidence for the importance of appraisal and the ubiquity of bias and hypocrisy is overwhelming (I review it in chapters 2 and 4 of The Happiness Hypothesis). As Lilienfeld shows, the empirical evidence supporting the utility and validity of the microaggression concept is minimal at best.
I think the section of Lilienfeld’s article that should most make us recoil from the microaggression program is the section on personality traits, particularly negative emotionality and the tendency to perceive oneself as a victim. These are traits — correlated with depression and anxiety disorders — that some students bring with them from high school to college. Students who score high on these traits perceive more microaggressions in ambiguous circumstances. These traits therefore bring misery and anger to the students themselves, and these negative emotions and the conflicts they engender are likely to radiate outward through the students’ social networks (Christakis & Fowler, 2009). How should colleges (and other institutions) respond to the presence of high scorers in their midst? Should they offer them cognitive behavioral therapy or moral validation? Should they hand them a copy of The Dhammapada or a microaggression training manual?
It’s bad enough to make the most fragile and anxious students quicker to take offense and more self-certain and self-righteous. But what would happen if you took a whole campus of diverse students, who arrive from all over the world with very different values and habits, and you train all of them to react with pain and anger to ever-smaller specks that they learn to see in each other’s eyes?
And what would happen if the rise of the microaggression concept coincided with the rise of social media, so that students can file charges against each other — and against their professors — within minutes of any perceived offense? The predictable result of welcoming the microaggression program to campus is turmoil, distrust, and anger. It is the end of the open environment we prize in the academy, where students feel free to speak up and challenge each other, their professors, and orthodox ideas. On a campus that polices microaggressions, everyone walks on eggshells.
H/T to David Thompson for the link.
