*Talking to Strangers*, the new Malcolm Gladwell book

Definitely recommended, talking to strangers is one of the most important things you do and it can even save your life.  This book is the very best entry point for thinking about this topic.  Here is a summary excerpt:

We have strategies for dealing with strangers that are deeply flawed, but they are also socially necessary.  We need the criminal justice system and the hiring process and the selection of babysitters to be human.  But the requirement of humanity means that we have to tolerate an enormous amount of error.  That is the paradox of talking to strangers.  We need to talk to them.  But we’re terrible at it — and, as we’ll see in the next two chapters, we’re not always honest with each other about just how terrible at it we are.

One recurring theme is just how bad we are at spotting liars.  On another note, I found this interesting:

…the heavy drinkers of today drink far more than the heavy drinkers of 50 years ago.  “When you talk to students [today] about four drinks or five drinks, they just sort of go, “Pft, that’s just getting started,'” the alcohol researcher Kim Fromme says.  She says that the heavy binge drinking category now routinely includes people who have had twenty drinks in a sitting.  Blackouts, once rare, have become common.  Aaron White recently surveyed more than 700 students at Duke University.  Of the drinkers in the group, over half had suffered a blackout at some point in their lives, 40 percent had had a blackout in the previous year, and almost one in ten had had a blackout in the previous two weeks.

And:

Poets die young.  That is not just a cliche.  The life expectancy of poets, as a group, trails playwrights, novelists, and non-fiction writers by a considerable margin.  They have higher rates of “emotional disorders” than actors, musicians, composers, and novelists.  And of every occupational category, they have far and away the highest suicide rates — as much as five times higher than the general population.

It also turns out that the immediate availability of particular methods of suicide significantly raises the suicide rate; it is not the case that an individual is committed to suicide regardless of the means available at hand.

Returning to the theme of talking with strangers, one approach I recommend is to apply a much higher degree of arbitrary specificity, when relating facts and details, than you would with someone you know.

In any case, self-recommending, this book shows that Malcolm Gladwell remains on an upward trajectory.  You can pre-order it here.

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The very first thing to do is make political statements and see how they act. Snowflakes are a waste of time.

If college students are drinking 20 drinks at a sitting and later complain about their student loan debt I think we have found their problem. 20 drinks in a cheap bar will cost about $100. They go on to claim they drink almost everyday. Maybe tuition is not the major cause of excess student loan debt.

Anyone who drinks 20 drinks a day will be dead in fairly short order. And no bar will serve someone 20 drinks.

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you don't drink all 20 drinks in the bar, obviously. you pregame at someone's house then go to the bar already drunk.

My comment was a response to Anon's comment about the cost, not the physical feat of obtaining that much liquor.

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From the excerpts given, this book sounds depressing. We are terrible at talking with strangers, we drink until we pass out, and when we engage in the humanities we want to kill ourselves. This is self-recommending?

Well, I happen to talk to strangers as well as I talk to my loved ones!

Actually, when I put it that way, it makes me want to kill myself...

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Sounds like a Tuesday to me.

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I have no idea what "arbitrary specificity" means.

Me too. Give us an example, Tyler!

+1

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Maybe it’s that, when talking to strangers, you should give more detail in your speech because friends are more likely to signal that they’re confused whereas strangers will nod their head and pretend that they understand.

Either reaction might be apropos if you're the one who's on his 20th beer

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It's not uncommon for writers to follow a career path of starting out as a poet, becoming a lyric or imaginative or autobiographical fiction writer, and winding up as a social novelist. Writers who happen to die young are more likely to be characterized as poets because they only were in the poetic phase of their careers.

There are a few writers who follow the opposite path, such as Thomas Hardy, who published his bestseller novel Far From the Madding Crowd in his early 30s, but stopped writing novels by age 60, and penned some of his most admired poems in his 70s. If he'd died at 37 instead of 87, he'd be known as a novelist rather than a poet. But Hardy's career path is unusual enough to be mildly famous.

In Germany traditionally there is less of a distinction between “poets” and “prose writers.” Günter Grass, Hermann Hesse, and Erich Kästner all wrote lasting poetry and none of them died young.
I can also think of very long lived English speaking poets off the top of my head - Robert Frost, Donald Hall, and Lawrence Ferlinghetti. As often is the case with Gladwell, I suspect he is manipulating the evidence to come to the conclusion he wants.

"As often is the case with Gladwell, I suspect he is manipulating the evidence to come to the conclusion he wants."

Yep.

I've fallen for his stuff one too many times to trust anything he says.

Luckily, the owners of this web site will ensure that whatever he writes will get widely spread, so more people can learn that lesson for themselves.

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"If he'd died at 37 instead of 87, he'd be known as a novelist rather than a poet."

But surely Hardy IS primarily known for his novels.

It's very cool to say, "Hardy's novels are alright, I suppose, but I find them a little dull. His poetry however ..."

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I agree "poets die younger than novelists, playwrights, non-fiction writers" is not very striking. Poetry used to be so much bigger culturally (and remained so quite late in the USSR, I learned from reading "Zhivago's Children," since it missed rock and roll) and is much older a form than the novel, obviously. Pace Hitchens, everybody has not a novel but a poem inside them (where it should probably stay, yes). As a young man Marx wrote verse, I believe.

I think of Novalis. The intersection of people who wrote poems as part of a constellation of activities (poetry = slow blogging?) and people who lived when everybody died of consumption is more significant, I'd say, than any prose/poetry divide.

Plus in the 20th century, there's probably a "Heathers"-like imitation of the archetype of the depressed, fragile lady poet:

"I was much further out than you thought
And not waving but drowning."

A sort of, "I'm out farther still!" competition.

Not to dis Stevie: it's a great poem she had in her.

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There are 7.5 billion people in this world...if a few thousand youngsters in mollycoddled Western world drink themselves to death where's the loss?

Yes! I finally made it! But just remember, if you want to be me, you have to be a big C.

A blue whale's vagina!

what this web site needs is
a official osprey cam!

https://www.youtube.com/watch?v=Nk4HAS-HOr4

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Turns out™

Hoi!

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“And the grown-ups will say ‘But why are the kids crying?’ And the kids will say ‘Haven’t you heard? Rik is dead! The People’s Poet is dead!’”

That is the funniest f-ing pop culture quote I've seen in a long time. Underrated and seemingly forgotten, that show,

"Never crucify yourself, Rik. There's no way you can get the last nail in."

Glorious LOL

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how can rick be dead
when we still have his poems!

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Just started watching it with my 15 year old son. He is killing himself laughing at it. Usually humour doesn’t age well so I was surprised.

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' means that we have to tolerate an enormous amount of error. that is ....'

A nice example, actually - or a decline in the standards governing the written word. Maybe one should ask some strangers about it.

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'One recurring theme is just how bad we are at spotting liars. '

Well, good liars - bad liars are not hard to spot. But that is the sort of commonplace awareness that one does not expect from a Gladwell book.

'the heavy drinkers of today drink far more than the heavy drinkers of 50 years ago'

Maybe 50 years, but not 35 years ago, if the example provided of 20 beers/drinks is used as a guideline. But back then, such people were generally not called 'heavy drinkers,' they were called alcoholics. Whether there are more alcoholics today, drinking more alcohol than than in the past is another discussion, of course.

'It also turns out that the immediate availability of particular methods of suicide significantly raises the suicide rate'

Well, yes, but trying telling that to anyone who believes instant access to firearms is a human right, where even a waiting period is considered an unbearable infringement on the right to purchase a firearm.

George Washington was known to have a whole bottle of madeira to himself and chased that down with some rum or beer. Gladwell has no right to complain about the "heavy drinking" of today. He sounds like a prohibition era Progressive.

George W Bush and Trump are teetotalers but they could also go down in history as the worst presidents of the era. Washington and Grant on the other hand won their respective wars with a bottle in hand.

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Winston Churchill drank in amounts so prodigious, I can‘t imagine today’s undergraduate party boys keeping pace, and yet he was productive and none of his peers seemed to his drinking as anything but a minor, perhaps irritating, foible. Gladwell on shaky ground once again.

Churchill was an absolutely mediocre politician in the decades prior to WWII. He was basically just good as a public figurehead who delivered rousing speeches. I’ll also give him credit for a prescient suspicion of Russia. Neither of those things require much sobriety.

Churchill was supposedly almost never drunk as he drank low amounts throughout the day.

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Average life expectancy for George Washington's cohort was ~48. He himself only made it to 67 and his throat swelling may well have been caused or exacerbated by poor hepatic function secondary to cirrhosis. Of course, it helps to be 6 ft 3 and work extensively on horseback to burn off the calories to delay alcoholic fatty liver disease.

As long as you plan to die by 50, copious alcohol consumption is not that bad. As with cigarettes, most people engaging the behavior will not die from, just maybe a third or so. If you want to make it past 65, I would suggest not going so hard on the liver, it tends to suck to lose the ability to undergo surgery as you get older.

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The rhetoric about drinking is identical to the disconnect I experienced as an undergrad 20 years ago. Five drinks in a night was a pretty typical low-key night at the pub with my friends back then, but the school administrators lived to scold us that this constituted “binge drinking”. Now that I’m a middle-aged professional like them, I can confirm that I get sleepy after two drinks, and five seems like a lot. But it’s not. The disconnect is entirely a function of old people forgetting their own youth, not anything to do with cultural shifts.

Well for me, it is a function of seeing alcoholic hepatitis on CT scans and biopsies. It is also is a function of watching HIDA scans in binge drinkers. And of course the exponential increase in trauma that occurs with increasing ethanol dosage.

Very few people's livers can handle 5 drinks in a night without some level of hepatic toxicity. Repeated binges lead to decreased liver function and increased risk of hepatocellular carcinoma. These are evident even if your binge drinking was all in your youth (more hepatic injury leads to more hepatic growth which leads to more chances to pick up oncogenic sporadic mutations). It is basically like stabbing yourself in the level with a needle. Your body can heal, but you toss the dice every time to see if you get cancer later.

The consequences of binge drinking are the innumerable death certificates I get to sign because your liver cannot protect your brain at those drinking rates and somehow large numbers of young people end up trying to drive, swim, shoot, or do some other dumb thing while intoxicated.

'and somehow large numbers of young people end up trying to drive, swim, shoot, or do some other dumb thing while intoxicated'

Strange - decades of trying to reduce drinking in American public life apparently is not noticed by the person signing death certificates.

Yet the reduction has been real, at least when looking between the 1970s and 15 years ago (things may have gotten worse again). At least as noted by the NHTSA in Overview of MADD: Reasons for Success -

In the 1970s - About 60% of traffic deaths in America were alcohol related – an estimated 28,000-30,000 people killed yearly.

Today - 35% decline in alcohol-related traffic deaths (from 26,173 in 1982 to 17,013 in 2003)

One assumes that binge drinking is roughly the same between the 1970s and today, of course. The fact that the legal drinking age was raised from 18 to 21probably did not have too much impact, at least at the university level.

But again, how many of those are due to less drunk driving and how many are due to better care post-accident? After all we have had a seen massive change in MVC treatment protocols (e.g. damage control surgery, fluid resuscitation) and cars are vastly more survivable during crashes (e.g. airbags only became mandatory after 1998).

The overall rate of ethanol related fatalities is indeed down ... it is just that the number of crashes are up (though the number of such crashes per million vehicle miles is down).

Binge drinking is about steady at a population level. Men are less likely to binge drink, but women's increases make up for that decline. The young of today are much less likely than the young of yesterday. Unfortunately the hump of binge drinking by the Millennials is still working its way through the numbers.

The real question is how much do binge drinkers drink. At the top end of the scale there is quite a lot of price sensitivity and alcohol has never been more affordable in the US. So for the people where binge drinking has the most impact, we are moving in the wrong direction from a health standpoint.

'But again, how many of those are due to less drunk driving and how many are due to better care post-accident? '

Let us split the difference, and say 4,000 . Or would you prefer 3,000? 2,000? At some point, this just gets silly - of course there were multiple factors, but that is self-evident. Particularly since the figures are between 1982 and 2003, meaning that is not a particularly relevant point - 'airbags only became mandatory after 1998.'

Airbags began showing up on automobiles in the early 90s. Additionally the 21 years saw the advent of automatic seat belt tighteners, crash tolerant unibodies, and many other factors that made crashes more survivable. We also improved transport (e.g. cellphones became a thing through the 90s so people spent less time bleeding at the side of the road before 911 was called) and improved EMS.

In general, when you look at death data, you need to make the assumption that continued investment in various aspects of life have made insults more survivable.

During the time period in question, CDC data shows that people's self-reported drunk driving rates increased (since reverted to longer term baseline).

It is awfully hard to say that we got a lot better at the logistics of saving lives, but the same or more people died ... so incidence of the inciting behaviors must be less.

So, 50%? 33%? 25%? 10% (which would still be almost a thousand lives)?

Lots of words, little data, and a seeming inability to assume that the NHTSA might actually have some reasonable data on alcohol related traffic fatalities.

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The booze thing: is this all about self-reported boozing, or is his analysis polluted by facts?

1950's college poll subject: I, um, ahem, had a glass of 3.2 beer once

2019 college poll subject: bro I posted my keg stand on youtube

I disagree with you on most things.

I lol’d. Thanks.

Cheers.

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Poets should have majored in intersectionality studies, you know, something less useless than poetry.

And then they’d be alive?

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Re; increases in "heavy drinking", alcohol consumption per capita hasn't really moved a great deal since the beginning of records - https://ourworldindata.org/alcohol-consumption#total-alcohol-consumption-in-high-income-countries

Internationally, the relationship between GDP per capita and alcohol per capita would suggest that alcohol consumption increases rapidly from 0 to 5 litres up to $7500 then more slowly up to 10 litres at $22500, then not at all. Alcohol consumption and GDP in several countries actually followed this relationship (Australia, Germany, Denmark), though the USA did not. This relationship may be somewhat strengthened by the tendency of European (west and east) to be richer on a world scale and heavier drinking however.

Anyway no reason to suspect that any increase in consumption by high drinkers has driven a higher mean. Nor is there any evidence of greater overall incidence of teetotaling that I know of that would balance this out.

So any greater consumption by heavy drinkers must be by a very small minority of drinkers indeed, enough to not really move the dial.

Personally, I would doubt this has changed since the 1960-1970s though (the last 50 years), and the US as an affluent enough society to allow this behaviour. Certainly I would doubt it is new to the 21st century.

Actually, heavy drinking has changed significantly. Drinking 2 glasses of wine every day is not heavy drinking for a male. Drinking 12 glasses on a Saturday night is extremely heavy drinking for a male.

It has become much less socially acceptable or economically viable to show up to work regular with a mild hangover so a huge amount of drinking has shifted to the weekends. While you stomach can handle concentrating all your ethanol consumption on the weekend, your liver cannot. When you drink matters as much or more than how much you drink.

Likewise, the number of teetotalers in the US has increased. Back at peak ~70% of Americans reported that they drank in the last year. Today that number is ~60% (lifetime abstention has gone down, but both "last year" and "last month" have gone up). In 1990 the US consumed 6.5 liters of ethanol per capita, today we consume just over 7 (close to the 70s peak) and are rising.

Is it the minority of drinkers who are having problems? Absolutely . About 6.2% of the population (or about 10 - 15% of people who drink with any frequency) have sufficient negative impacts from their drinking to meet alcohol use disorder criteria. Something like 15% of the population consume at problematic rates (i.e. heavy) rates; these being defined as 7 standard drinks/week or 3 at once for females or 14/week or 4 at once for males.

Either the AUD or heavy drinking populations consume over half the ethanol consumed in the country.

The other way we can track this data is with liver disease. Shockingly, we are finding increased incidence of cirrhosis and hepatocellular carcinoma. And the numbers are basically the inverse of the prohibition era when both of those fell by over half.

So yeah, we are seeing an increased number of people who drink large quantities, often in short time frames, and whose livers definitely cannot handle their drinking long term. But that's okay, they will only cost a few hundred thousand dollars each for medical treatment that is completely avoidable.

People in the US never drunk much wine, and they don't today, though they drink more as a % of their total than they did - https://ourworldindata.org/grapher/alcohol-by-type-1890?country=USA.

Any putative increase in heavy alcohol consumption has left types of beverage largely untouched. 0.5 litres pure alcohol per capita is not a very large increase either, especially if it is mainly an increase in the prevalence of daily wine drinking as beverage types suggest. (And wine, the increasing beverage type in US drinking, correlates negatively with binge drinking).

AUD in the US is unchanged since 1990 - https://ourworldindata.org/grapher/share-with-alcohol-use-disorders?year=1990. Death rates linked to alcohol changed rise slightly (0.5%), probably due to an age shift in alcohol use (more affluent heavy users in mid-20th century continue to use) and decline in other forms of mortality.

I doubt there are heavy episodic drinking studies that go back to 1950 to answer the question of how much that has changed either way. I doubt there is much change since 1960-1970.

Gallup somewhat recontextualizes you on a change in % Americans who say they drink alcohol - https://news.gallup.com/poll/23935/us-drinkers-consuming-alcohol-more-regularly.aspx -
Decade -- %Drink - N surveys
2000s -- 63 -- 7
1990s -- 62 -- 6
1980s -- 64 -- 13
1970s -- 69 -- 6
1960s -- 63 -- 5
1950s -- 59 -- 7
1940s -- 64 -- 4

69% in the 70s is close enough to 70% I guess, but is more an outlier than the 2000s are, relative to the general tendency to stability around 59-64%.

Self-reported frequency of drinking was unchanged in Gallup's poll data since 1984. Perhaps 2000-2010 salarymen are frowned on more for being hungover than their 1960s counterparts, but I doubt it.

Are health problems from drinking concentrated in hardcore users? Yes. Has number of intense drinkers or their drinking intensity or their patterns changed over time in the last 50-60 years? I expect probably not.

You do realize that our treatments for hepatic dysfunction are MASSIVELY better than they were decades ago?

We do liver transplants now. We have TIPS procedures now. We can cure Hep C now. We have octreotide now. Hepatocellular carcinoma chemo is much better now. We have vastly better coagulopathy treatments now.

If death rates are STILL rising, what is causing that? I would submit that with the advances in medicine we should see a secular drop alcohol related mortality and quite a significant one at that.

From a medical standpoint there have been more advances in treating hepatic disease than most other causes of death. Absent changes in the population, we should expect alcohol deaths to be declining due to better treatment.

As far as your Gallop data. Thanks for confirming exactly what I said. From your own source:

"The 71% of drinkers who drank in the past week is significantly higher than the 54% who reported doing so in 1996 and the 50% who did so in 1992. "

"In the current poll, those who drink report consuming an average of 4.5 drinks per week, compared with an average of 2.8 in 1996"

It is exactly like I called it. Not a big change in total drinkers. More consumption on a binge basis. And a decrease in regular drinking. Of course you might trying looking at the most recent 13 years of data sometime.

'If death rates are STILL rising, what is causing that?'

How about alcoholics, as a group, are less likely to be health insured compared to the general population?

Not the U.S. would ever ration health care, of course.

The health insurance explanation is not correct. Deaths from liver disease have quadrupled in the UK over the last fifty years.

https://www.britishlivertrust.org.uk/about-us/media-centre/facts-about-liver-disease/

You do realize what Sure was saying in this line, right? 'From a medical standpoint there have been more advances in treating hepatic disease than most other causes of death. Absent changes in the population, we should expect alcohol deaths to be declining due to better treatment.'

So for the UK, where the link notes 'alcohol-related liver disease accounts for 60% of all liver disease,' one just might wonder what is the difference between the UK and the U.S. (or southern Europe) could be.

Try this one - 'The way people drink in different countries, and how much they drink, is changing over time. There is not a static 'national drinking culture' in contrast to how this is often being portrayed in popular media - with heavy drinking in Northern countries contrasted with moderate consumption in Southern Europe. In fact, not very long ago, it was exactly the other way round.

Since the 1970s changing alcohol consumption has led to a three- to fivefold increase in liver deaths in the UK, and a three- to fivefold decrease in France and Italy. These changes in opposite directions challenge popular notions of static ‘drinking cultures’ including the idea that in Southern Europe there has always been a culture of harmless light drinking, integrated into everyday life. The radical positive change in Southern European drinking patterns has been explained as part of a wider societal transformation since the 1960s, with growing urbanisation and related changes in working conditions as well as increased health awareness in the population.

In contrast, the change in the UK and other Northern European countries, moving from a lower base in the 1980s towards higher levels of drinking and alcohol-related harm is generally explained by increased availability and affordability of alcohol, combined with a culture of heavy, episodic drinking connected with weekends and celebrations, which are considered to have a particularly bad effect on health.' https://www.drinkaware.co.uk/research/data/comparisons/

By the way, the American average for alcohol consumption is about 8.9 liters, noticeably less than the UK's 11.4 liters.

Sure is on sure ground when talking about the effects of binge drinking, and the UK is a fine example of its harmful effects. However, it is not an example of health care, as noted by a mirror decline in Italy and France.

8.9 liters? That IS a lot for one weekend.

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An increase in Americans reporting drinking during the preceding week (which decomposes into > in last 24 hours and > last week) is an increase in frequency of drinking not really an increase in infrequent intense drinking.

It looks exactly the kind of increase in a "2 glasses of wine every day" pattern that you were initially contrasting with binge drinking.

While the frequency also increases since the 1990s (largely correlated with increase in wine consumption as said), it is at the same level as the 2000s in 1984, again, consistent with long term stability, and nothing new that hasn't happened before coming about. As a description this is a more honest treatment of the data than interpreting and describing snapshots in isolation as if there were a pattern ramping up.

If you want to post a data series showing striking change in the last 13 years relative to the last 50 rather than a bundle of anecdotes asserting recent change, you are free to do so.

Preferably in the form of direct report data on drinking as opoosed to inferring from relative death rates etc, which will be a complex quagmire of causality and shifts along a vast array of different factor.s

+1 to your data rather than anecdotal evidence M.

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Oh please. The official rates of binge drinking, directly reported by the CDC for use on national screening at the VA are:

2013 - 14.3%
2014 - 14.7%
2015 - 14.7%
2016 - 15.8%
2017 - 15.9%
(2018 data was not released in that practice bulletin, but is supposed to be above 16%)

These numbers underestimate the numbers I am provided for the counties of my hospitals' catchment areas. Numbers the hospitals give me have gone from 20%.

So thanks, I will continue to trust the reports generated from CDC data that are validated sufficient to withstand malpractice claims as opposed to random googling on the internet.

And all of this is silly. Alcohol has a dose response curve. Binge drinking 5 drinks is vastly different for your liver than binge drinking 15 drinks. At the end of the day the number of people who have not drunk in the last month or longer has increased by about 10 percentage points. The total amount of ethanol consumed has gone up by about 8 percentage points. The simple underestimate is that problematic drinking has gone up by around 20% given more near-abstainers and more ethanol per capita consumption. Using a more realistic power law we are looking at something more like a 30% increase.

We are indeed seeing a change in the distribution of alcohol consumption curve with more of the total ethanol consumption being concentrated among problematic drinkers. This dovetails nicely with the trendlines for hepatocellular carcinoma, cirrhosis, alcoholic fatty liver disease and every other alcohol related pathology.

But I suppose you have some actual data showing another reason why the correlations, seen worldwide, between ethanol consumption and liver disease should be disregarded.

Rates per month, per week, per year, what exactly? It doesn't make a lot of sense to present a rate without any information about what time period you're talking about. A source might provide one, if you've got one which you can link.

Gallup data extend to 2018, still show no change in any given week since the late 90s, which is identical to the 80s as we've covered, one no change in those who haven't drunk in over a week and no change in those who do not drink - https://news.gallup.com/poll/1582/alcohol-drinking.aspx

Given this, I'm going to assume your rate is a "% pop with one binge drinking episode in the last year" rate, since it would be insanely incompatible with the Gallup data (let alone common sense and in terms of being "contrary to the ordinary experience") as a weekly rate, and probably even as a monthly rate. Despite that we've been discussing weekly rates thus far.

(Because any dumb old sline can tell just by their normal experience of reality that 14% of the population did not weekly binge drink in 2014 and that 17% of the population does not weekly binge drink in 2019. And they can guess that this doesn't work monthly either. Anyone who can't is.... not even "tall enough to get on this ride").

I'm willing to accept then that a greater % of the population may be cycling through at leas t one binge drinking episode per year then, despite that when we sample individuals in any given week, the percentage with greater than 20 drinks per week is stubbornly fixed at 3-5%. I'll allow that possibly that may (or may not, but I do not know) result in a greater disease burden, over time.

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Here's some CDC direct data from 2015 on binge drinking prevalence, though note a step change in rates due to method change in 2014 - https://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201511_09.pdf

There is indeed an slight increase towards male-female parity (by a change on the order of 2% in females, which parallels slight increase in female Alcohol Use Disorders), but otherwise no significant change in overall rates in the data series between 1997-2013.

And these are indeed "in the past year" rates.

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Again, you are looking at the number of people who binge drink. I was initially talking about the amount of alcohol consumed by binge drinkers. There has been a small increase in the number of binge drinkers, driven mostly by females.

Like with sunburns, one bad go round does indeed damage tissue. Also like with sunburn, having more damage in that one instance correlates with worse health outcomes (e.g. 5 beers is bad, 20 can be much more toxic).

If you look at the youngest cohorts, there are increased rates of lifetime abstention. If you are claiming that overall alcohol consumption is unchanged, either there is more drinking among the young who do drink or there is more drinking among older cohorts. With an 8% increase in over all per capita alcohol consumption, this means we need to have even more alcohol consumed by other cohorts to balance the scales.

What I and my partners have seen is an increase in gross ethanol consumption by the most problematic drinkers. Binges have been getting boozier among our patients and AUD patients who come see us (the worst of the drinkers) are consuming more if they are heavy daily drinkers.

This makes sense. Alcohol has gotten cheaper over the past few decades and more affordable for those whose problem drinking is restrained by monetary concerns. Heavy drinking has become more concentrated among certain demographics and the health effects have likewise become more concentrated.

And this is why pissing around with average population demographics is so useless. The vast majority of ethanol consumption and health impacts are concentrated among the most problematic drinkers. Literally, the top 10% of Americans when it comes to alcohol all meet the formal criteria for problematic alcohol use levels. About half of the next 10% also meet these criteria. And the rest of the population barely matters. Within these cohorts we have seen people with jobs concentrate their drinking. Within these cohorts we have seen people without jobs increase their consumption as alcohol becomes more affordable. You can literally double what the bottom 50% of Americans drink and it would have less impact on alcohol consumption or health outcomes than a 20% increase in consumption by the top 10%.

One of my recent patients is pretty illustrative. He was a guy who had 3 to 6 beers a night, and maybe 12 on the weekends but started getting written up for showing up hungover. He transitioned to 1-2 beers a night and now drinks around 20 on the weekend. His overall alcohol consumption is less, but he honestly likes being drunk and now really hammers his liver. He is the perfect candidate for acute alcoholic hepatitis, which is a disease we see among people who heavily binge drink which is becoming more common.

As somebody who actually works with the heaviest drinkers, this is the pattern I personally see, what the professional societies see, and what the practice bulletins describe. It also squares the circle for steady or increasing ethanol death rates with much improved medical care for hepatic disease.

I am just not seeing how you stitch together an unchanging consumption curve with the changes seen by cohort, the medical outcomes, and female drinking rates. Concentrating drinking more among a small cohort requires only that it be difficult to get granular enough data on CDC surveys to measure. I would be shocked if that is not a good working assumption.

Well, my initial comment was "So any greater consumption by heavy drinkers must be by a very small minority of drinkers indeed, enough to not really move the dial (of per capita consumption)".

Not "no change" but that if there is change it must be taking place in a tiny, tiny subpopulation (not even "All binge drinkers" as Gladwell seemingly asserts).

None of these data are fine grained enough to say if there is some subpopulation of 0.5% of something comparable in size that didn't exist 30 years ago which routinely knock back 20 drinks a week in binge sessions while other abstaining on a daily basis - I simply doubt personally that there are any changes in that regard since the 60s or 70s. (However if there were a long term data series on that, t'would be interesting. If there's no such data, I'm not going to accept some inference based on measured and observed disease rates and indirect reasoning.)

And we've discussed that there aren't really changes in whole population abstention rates or frequency of drinking in Gallup's polling data.

I refer you to Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013. My apologies for not being able to locate the primary data sooner.

Key summary quotes below:

Twelve-month alcohol use significantly increased from 65.4% in 2001-2002 to 72.7% in 2012-2013, a relative percentage increase of 11.2%

The prevalence of 12-month high-risk drinking increased significantly between 2001-2002 and 2012-2013 from 9.7% to 12.6% (change, 29.9%) in the total population.

The prevalence of 12-month DSM-IV AUD increased significantly from 8.5% to 12.7% (change, 49.4%) in the total population.

Twelve-month DSM-IV AUD among 12-month alcohol users significantly increased from 12.9% to 17.5% (change, 35.7%) in the total population.

At the end of the day, I am still going to trust outcomes data over survey data. People lie, autopsies don't. What I know is that acute alcohol poisoning increased by 700% in 20 years. You die from acute alcohol poisoning not because you slowly got sick over years, but because you drank so much so quickly that your body is overwhelmed. And this is in spite of the medical profession getting better at hemodialysis to bring down acutely toxic ethanol poisoning.

What I also know is that alcohol related hepatic deaths bottomed out in 2003 and have since been rising rapidly (~50% increase). This is due to the fact that the generation socialized by prohibition had lower lifetime alcohol use and problematic alcohol use than the generations before or after. As that generation died off, or aged out, successive generations who drank more started refilling the hepatic wards. Even more fun for every age bracket, we are seeing more alcohol related hepatic death than we saw a decade ago for those same age brackets excepting only the youngest cohorts.

These are basically impossible to square with a thesis of no substantial change in drinking patterns. They fit quite nicely with formal epidemiological surveys showing more problematic drinking and a shift in alcohol consumption.

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My theory is we're fatter these days, so we have to drink more to get the same buzz on.

My thought was, maybe all the excellent hydrating people are doing is diluting the potent potables.

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Who knew that pointing out that GMU does (or did, at a minimum) not have much of a fraternity culture, and thus does not have much of a fraternity drinking culture, would be so controversial in this comment section.

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Cowen: "One recurring theme is just how bad we are at spotting liars." Cognitive dissonance perhaps: we believe what we want to believe. Con men are successful not because they are good at conning, but because the people they con are good at being conned. What makes conning relatively simple is that the people who are good at being conned gather in groups to makes the con man's job efficient: religious groups, investors, political parties, etc. It isn't the wisdom of crowds, it's the inanity of crowds.

+1

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Chart of America's consumption of alcohol per capita since 1860: https://vinepair.com/articles/americas-consumption-beer-wine-spirits-since/ Here's another chart: https://ourworldindata.org/alcohol-consumption

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@Tyler -- how do the benefits of interacting with strangers vary across the population? E.g. are benefits to "coastal elites" like yourself greater, less than, or equal the gains to be made by lower educated, lower income individuals? What's the theory here? My naive take might be that your heightened social status allows you are greater degree of flexibility in choosing your social interactions intentionally -- therefore, it pays to bias away from full agency and insert a bit of randomness. But a single Bronx mother on welfare -- does she need more social randomness, or less?

Excellent point.

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hiring babysitters, detecting liars, self reported binge drinking, suicide by poets....

what the heck is this book about anyway?

At least it’s not about Trump. He apparently raped a woman in a department store.

Remember when people were up in arms about Bill and a consenting intern?

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I wonder if there are gender changes in the binge drinkers? Females are more likely to have blackouts than male drinkers. Given this is self-reporting the line between passing out and blackouts might be vague. Could the use of the term blackout be more generic?

Also female heavy drinkers tend to have more health problems. So an increase in binge drinking in this group would see a more rapid increase in serious health problems.

My limited experience with the super heavy drinkers is that the use of stimulants makes such use easier to achieve. In the 70's you had cocaine, today I'm not sure but I would look for other drug use (stimulants) while binge drinking.

Nothing more pathetic than a drunk woman.

A drunk man? Equally pathetic at least?

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Possibly - the US is still low on female drinking (https://ourworldindata.org/grapher/males-vs-females-who-drank-alcohol-in-last-year), and seems likely that more turning European (more female drinking) would be frequent, low dose.

Small changes at the margins could mean changes at the tails.

However, female AUD doesn't really seem to have changed disproportionately in the US since 1990 - https://ourworldindata.org/grapher/prevalence-of-alcohol-disorders-males-vs-females.

US female AUD share was about 52.5% of male share in 1990, and 56.3% in 2017. In absolute terms 1.5% females vs 1.478% in 2017 (so relative rise compared to male, not actually an absolute terms rise).

Female AUD share is high in the US relative to Western Europe though (female rate about 38% of the male rate in Western Europe), in contrast to alcohol use pattern overall, although in absolute terms male rate only goes from 2.0% Western Europe to 2.5% United States.

The author seemed to be looking at binge drinking on campus so I'm not sure what the data on female college drinking looks like.

I do remember some time ago Rand did a study for the American military. The military was concerned about alcohol abuse in the military. Rand said that yes they drank a lot, but that 18-25-year-olds who live away from home are heavier drinkers. The military was no worse or better than the average college. Doesn't mean that some aren't coming to be a problem, just hard to prevent.

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скоро осы будут есть ваш волоконно-оптический кабель.

See, that's what happens when you talk to strangers.

+1 creepy!
+1 scary!
+1 more malcom ohenry gladwell
just so brain scan narratives!

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Me too!

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"[A]lcohol researcher Kim Fromme says . . . that the heavy binge drinking category now routinely includes people who have had twenty drinks in a sitting."

"People" or "men"? (just curious)

If common consumption of alcohol now equals 20 to 30 ounces of spirits per sitting, should we therefore be facing higher rates of alcohol poisoning?

By comparison the inventory from Rachilde on the consumption rates for Alfred Jarry, Esq. (c. 1898) :

"Jarry began his day by sinking two liters of white wine. Three absinthes marked the hours between ten o'clock and midday, and then at lunchtime he washed down his fish, or his steak, with red or white wine alternating with further absinthes. In the afternoon a few cups of coffee laced with brandy or other spirits . . . With his dinner, and of course afterward, further aperitifs, and he could still consume at least two bottles of some vintage or other, good or bad. Now, I never saw him really drunk, except on one occasion when I took aim at him with his own revolver, which sobered him up instantly."

Playwright and poet, Jarry lived to attain the age of 34.

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Hasn't "talking to strangers" already been fully explored in all those books about picking up women?

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Malcolm Gladwell. eh? Has he learned yet what igon values are?

Steven Pinker didn't know what an eigenvalue is and that's even worse since, like, those actually exist.

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"Eigen"

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Last year's non fiction: Lewis, Pollan, Pinker, Mann, Rosling, Sedaris. There were also some new-to-me authors, including Give People Money by Lowrey, Educated by Westover, David Reich's Who We Are And How We Got Here, and Saslow's Rising Out of Hatred. I'm sure there are others, and I would expect that 12 Rules and Becoming both sold like crazy. Somehow, I have this impression that this Gladwell book is the first big non fiction work of 2019. Is it just me, is the non-fiction boom faltering, or is it possible that Tyler is not posting enough about non-fiction lately?

All the oxygen in the non-fiction sector has been sucked out of the room by anti-Trump "bombshells"

To be honest, I had the same thought, but those books also came out in 2018.

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'It also turns out that the immediate availability of particular methods of suicide significantly raises the suicide rate; it is not the case that an individual is committed to suicide regardless of the means available at hand.'

Razors pain you.
Rivers are damp.
Acids stain you
And drugs cause cramp.

Guns aren't lawful,
Nooses give.
Gas smells awful
You might as well live.

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