Category: Current Affairs

The Strange Death of Human Challenge Trials

A good post at the Effective Altruism Forum on all the stuff we could have done to stop the pandemic but didn’t:

Probably the biggest mistake was not intentionally infecting vaccinated volunteers. This could be done in 1 month, vs 6.5 months for the ecological trials that the entire world did out of misguided PR ethics. (2.5 is probably more realistic given signups, approvals, and big pharma’s slow data analysis and reporting. That’s still hundreds of thousands of lives.)

1DaySooner wrote a letter. The world’s foremost consequentialist signed. The world’s foremost deontologist signed. Two of the most prominent bioethicists in the world signed. 15 Nobelists signed. Dozens of philosophers who otherwise agree on extremely little signed. But they’re unethical.

Rarely do I so strongly feel the boot of others on my neck, and humanity’s neck.

The one distinctively courageous thing about the UK – the human challenge trials which got 40,000 volunteers – actually eventually started!.. In January 2021, with n=90.

I am extremely puzzled why China or one of the other ahem non-individualist governments didn’t do these.

Lots more at the link.

The Premonition

In The Premonition Michael Lewis brings his cast of heroes together like the assembling of the Avengers. In the role of Captain America is Charity Dean, the CA public health officer who is always under-estimated because she is slight and attractive, until she cracks open the ribcage of a cadaver that the men are afraid to touch. Then there is Carter Mecher, the redneck epidemiologist who has a gift for assembling numbers into coherent patterns. And Richard Hatchett the southern poet who finds himself at the head of The Coalition for Epidemic Preparedness (CEPI), the world’s most important organization during the pandemic; and Joe DiRisi the brilliant, mad scientist picked by the Chan Zuckerberg Initiative as the person most likely to cure disease…all of them. As you might expect from Michael Lewis, it’s all terribly well done, albeit formulaic and  sometimes over-the-top, e.g.

Charity’s purpose was clear….she was put on earth to fight battles, and wars, against disease. To save lives and perhaps even an entire country. p. 200-201

But Lewis has a bigger problem than over-the-top writing.

The heroes were defeated. Lewis likes to tell stories of brilliant mavericks like Billy Beane and Michael Burry who go against the grain but eventually, against all odds, emerge victorious. But six hundred thousand people are dead in the United States and whatever victory we have won was ugly and slow. Indeed, Lewis assembles his mighty team but then The Premonition trails off as the team is defeated by bureaucracy, indecision, complacency and malaise before they even have a chance to enter the real battle against the virus. It’s telling that none of Lewis’s heroes are even mentioned in Andy Slavitt’s Preventable (about which I will say more in a future post).

To be fair, Lewis’s heroes are fascinating, brilliant people who did some good. As part of the Kremer team I interacted a bit with Richard Hatchett and CEPI. Hatchett headed CEPI and understood the danger of SARS-COV-II before anyone else and with Bill Gates’s support started funding vaccine production and shoring up supply lines before anyone else was off the starting line. CEPI was magnificent and their story has yet to be told in full measure. Had Lewis’s heroes been in charge I have no doubt that many lives could have been saved but, for the most part, the heroes were sidelined. Why and how that happened is the real question but Lewis’s story-telling skills aren’t the right skills to answer that question.

If there is one central villain in The Premonition, it’s the CDC. Lewis acknowledges that his perspective has changed. In The Fifth Risk, the system (the “deep state” used non-pejoratively if you will) is full of wisdom and power but it’s under threat from Trump. In The Premonition, Trump is an after-thought, at best a trigger or aggravating factor. Long before Trump or the pandemic:

Charity had washed her hands of the CDC. “I banned their officers from my investigations,” she said. The CDC did many things. It published learned papers on health crisis, after the fact. It managed, very carefully, public perception of itself. But when the shooting started, it leapt into the nearest hole, while others took fire. “In the end I was like ‘Fuck you’, said Charity. “I was mad they were such pansies. I was mad that the man behind the curtain ended up being so disappointing.” p. 42

As the pandemic starts the CDC fails repeatedly. At the beginning of the pandemic on January 29 the government had started to repatriate Americans from Wuhan bringing some of them to a National Guard base just outside of Omaha. But shockingly the CDC doesn’t test them for the virus.

Never mind that every single one of the fifty-seven Americans in quarantine wanted to be tested: the CDC forbade it. And [James] Lawler [US Naval Commander and national security coordinator on pandemic response] never understood the real reason for the CDC’s objections…Whatever the reasons, fifty-seven Americans spent fourteen days quarantined in Omaha, then left without having any idea of whether they’d been infected, or might still infect others. “There is no way that fifty-seven people from Wuhan were not shedding virus,” said Lawler. p. 176

Many of the people brought home from China are not even quarantined just told to self-quarantine:

…When local health officers…set out to find these possibly infected Americans, and make sure that they were following orders to quarantine, they discovered that the CDC officials who had met them upon arrival had not bothered to take down their home addresses.

…[Charity] posed a rude question to the senior CDC official moved on the call: How can you keep saying that Americans are at low risk from the virus if you aren’t even testing for the virus. She’d been answered with silence, and then the official move on to the next topic. [p.206-207, italics in original]

And all of this is before we get to the CDC’s famously botched test an error which was amplified by the FDA’s forbidding private labs and state governments to develop their own tests. Charity Dean wanted California to ignore the CDC and FDA and, “blow open testing and allow every microbiology lab to develop its own test.” But Dean is ignored and so by as late as February 19, “Zimbabwe could test but California could not because of the CDC. Zimbabwe!” p. 223. The failure of testing in the early weeks was the original sin of the crisis, the key failure that took a containment strategy ala South Korea and Taiwan off the table.

Lewis’s most sustained analysis comes in a few pages near the end of The Premonition where he argues that the CDC became politicized after it lost credibility due to the 1976 Swine Flu episode. In 1976 a novel influenza strain looked like it might be a repeat of 1918. Encouraged by CDC head David Sencer, President Ford launched a mass vaccination campaign that vaccinated 45 million people. The swine flu, however, petered out and the campaign was widely considered a “debacle” and a “fiasco” that illustrated the danger of ceding control to unelected experts instead of the democratic process. The CDC lost authority and under Reagan the director became a political appointee rather than a career civil servant. Thus, rather than being unprecedented, Trump’s politicization of the CDC had deep roots.

Today the 1976 vaccination campaign looks like a competent response to a real risk that failed to materialize, rather than a failure. So what lessons should we take from this? Lewis doesn’t say but my colleague Garett Jones argues for more independent agencies in his excellent book 10% Less Democracy. The problem with the CDC was that after 1976 it was too responsive to political pressures, i.e. too democratic. What are the alternatives?

The Federal Reserve is governed by a seven-member board each of whom is appointed to a single 14- year term, making it rare for a President to be able to appoint a majority of the board. Moreover, since members cannot be reappointed there is less incentive to curry political favor. The Chairperson is appointed by the President to a four-year term and must also be approved by the Senate. These checks and balances make the Federal Reserve a relatively independent agency with the power to reject democratic pressures for inflationary stimulus. Although independent central banks can be a thorn in the side of politicians who want their aid in juicing the economy as elections approach, the evidence is that independent central banks reduce inflation without reducing economic growth. A multi-member governing board with long and overlapping appointments could also make the CDC more independent from democratic politics which is what you want when a once in 100 year pandemic hits and the organization needs to make unpopular decisions before most people see the danger.

Lewis hasn’t lost his ability to write exhilarating prose about heroic oddballs. Page by page, The Premonition is a good read but the heroes in Lewis’s story were overshadowed by politics, bureaucracy and complacency–systems that Lewis’s doesn’t analyze or perhaps quite understand–and as a result, his hero-centric story ends up unsatisfying as story and unedifying as analysis.

Bulletin!

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The origins of Wokeism

My latest Bloomberg column considers one factor (of many), here is an excerpt:

The male-female imbalance in academic life should be treated as a kind of emergency. But the institutions that address it are slow and bureaucratic.

Now enter the philosophy of wokeism. One way to think of the woke is as a bunch of people who scream about various injustices. But sometimes they don’t have a good plan to address a particular imbalance — and along the way they can inflict a good deal of unjustified damage, for instance by canceling people who make the wrong remarks about gender imbalance or other issues.

These and other criticisms of the woke may well be correct. Still, at the end of the day it has to be recognized that an unresponsive society will generate a lot of unproductive (and unresponsive) screamers. So simply dissecting the weaknesses of woke tactics and arguments misses the point. When practical solutions do not seem to exist, many people will resort to screaming.

This leads to the conclusion that wokeness won’t be defeated as an ideology until there is a more convincing and practical vision of how to undo institutional sclerosis. When that vision comes, it may not be so closely allied with wokeness, which is not excessively concerned with effective administration and incentive compatibility.

And this:

Sometimes it even seems that woke forces are effective. Recently some major museums have announced that they are sending back their highly valuable West African bronze sculptures to their countries of origin. Many of those sculptures were stolen by British colonial occupiers, and their restoration would reunite those countries with a significant part of their cultural heritage. This justified change would probably not have occurred without pressure from wokeism.

One underlying theme of the column is that the defects of the Woke — such as excess rigidity — are closely allied to the defects of the society they are protesting against.

The UAPs [UFOs] report

You can read it here.  I don’t think it clarifies much, other than to stress the multiple sources of sensor data for the observations and the inexplicability of some number of the sightings, well into triple digits.  So you can put aside Mick West, PewdiePie, and the like.  It is “real stuff” being measured, no matter how you might account for the observations, not just shaky camera movements and flocks of birds.

The report also makes clear how poorly funded and chaotic the investigation has been to date.  That is hardly a surprise, but isn’t it about time we did something properly right off the bat?

I’ll fall back on my “sincerity is the most underrated political motive” view.  I think our own government is genuinely puzzled, as I am, and as you should be.  I would stress my earlier points that we don’t have many reliable intuitions to fall back upon for thinking through this problem.

I believe the governmental message will be: “We are not sure, so for reasons of national security we have to move forward assuming some of these devices are from foreign powers.”  That will rather rapidly meld into “foreign powers.”  In any case that will keep the issue alive.  Furthermore, if it is our earthbound adversaries, at some point we will know this for sure, for reasons of intelligence or eventual public use of the devices, or our ability to construct the same.  By the way, if you are convinced by the “adversaries” take, you should update lots of your views on foreign policy!  (Will you?  Will anyone?)  America would have a lot more to be afraid of.

It is important to resist jumping to conclusions here, if only because doing so will dull your critical faculties on this issue.  In any case I will continue to follow developments in this area.

Why is it OK to be mean to the ugly?

That is the new NYT David Brooks column, here is one excerpt:

Not all the time, but often, the attractive get the first-class treatment. Research suggests they are more likely to be offered job interviews, more likely to be hired when interviewed and more likely to be promoted than less attractive individuals. They are more likely to receive loans and more likely to receive lower interest rates on those loans.

The discriminatory effects of lookism are pervasive. Attractive economists are more likely to study at high-ranked graduate programs and their papers are cited more often than papers from their less attractive peers. One study found that when unattractive criminals committed a moderate misdemeanor, their fines were about four times as large as those of attractive criminals.

Daniel Hamermesh, a leading scholar in this field, observed that an American worker who is among the bottom one-seventh in looks earns about 10 to 15 percent less a year than one in the top third. An unattractive person misses out on nearly a quarter-million dollars in earnings over a lifetime.

The overall effect of these biases is vast. One 2004 study found that more people report being discriminated against because of their looks than because of their ethnicity.

In a study published in the current issue of the American Journal of Sociology, Ellis P. Monk Jr., Michael H. Esposito and Hedwig Lee report that the earnings gap between people perceived as attractive and unattractive rivals or exceeds the earnings gap between white and Black adults. They find the attractiveness curve is especially punishing for Black women. Those who meet the socially dominant criteria for beauty see an earnings boost; those who don’t earn on average just 63 cents to the dollar of those who do.

Recommended.

USA facts of the day

A survey of almost 200 police departments indicated that retirements were up 45 percent and resignations rose by 18 percent in the year from April 2020 to April 2021 when compared with the previous 12 months, according to the Police Executive Research Forum, a Washington policy institute.

New York City saw 2,600 officers retire in 2020 compared with 1,509 the year before. Resignations in Seattle increased to 123 from 34 and retirements to 96 from 43. Minneapolis, which had 912 uniformed officers in May 2019, is now down to 699. At the same time, many cities are contending with a rise in shootings and homicides.

Asheville was among the hardest hit proportionally, losing upward of 80 officers, more than one third of its 238-strong force.

Here is more from Neil MacFarquhar at the NYT.

China fact of the day

China is still wrestling with how to rule over a diverse, ethnically mixed population that does not necessarily accept the dominance of the Han or the CCP narrative.  The challenge for the CCP is that ethnic minorities constitute only about 10 percent of the total population but inhabit 60 percent of the land mass, much of which is in sensitive border areas (the Guangxi Zhuang Autonomous region, Inner Mongolia Autonomous Region, Tibet Autonomous Region, and Xinjiang Uyghur Autonomous Region).  The national language is a recent construct and has priority in schools over the local languages.  About 30 percent of the population speaks a language at home other than the national language.

That is from the new and “must read” From Rebel to Ruler: One Hundred Years of Chinese Communism, by Tony Saich.  Keep in mind that the CCP is the most important institution in the world today — have you ever read a book on it?

How and why is Conquest’s Second Law true?

“Any organization not explicitly and constitutionally right-wing will sooner or later become left-wing.”

That is the topic of my latest Bloomberg column, here is one excerpt:

Additional forces strengthen Conquest’s Second Law. Educational polarization increasingly characterizes U.S. politics, with more educated Americans more likely to vote Democratic. Those same Americans are also likely to run nonprofits or major corporations, which would partially explain the ideological migration of those institutions.

There are, of course, numerous U.S. institutions that have maintained or even extended a largely right-wing slant, including many police forces, significant parts of the military, and many Protestant Evangelical churches. Those institutions tend to have lower educational requirements, and so they are not always so influential in the media, compared to many left-wing institutions.

Furthermore, the military and police are supposed to keep out of politics, and so their slant to the right is less noticeable, although no less real. The left is simply more prominent in mass media, so Conquest’s Second Law appears to be truer than it really is. (Note that by definition the law excludes explicitly right-wing media.)

And:

The common thread to these explanations is that left-wing views find it easier to win in spheres of reporting, talk and rhetoric — and that those tendencies strengthen over time.

It follows that, if Conquest’s Second Law is true, societies are more right-wing than they appear. Furthermore, it is the intelligentsia itself that is most likely to deluded about this, living as it does in the world of statements and proclamations. It is destined to be repeatedly surprised at how “barbarian” American society is.

There is also a significant strand of right-wing thought, most notably in opposition to Marxism, that stresses the immutable realities of human nature, and that people change only so much in response to their environments. So all that left-wing talk doesn’t have to result in an entirely left-wing society.

Conservatives thus should be able to take some comfort in Conquest’s Second Law. They may find the discourse suffocating at times. But there is more to life than just talk — and that, for liberals as well as conservatives, should be counted as one of life’s saving graces.

Racial segregation is increasing in many parts of America

Some of the nation’s largest metropolitan regions have become increasingly segregated in the last 30 years, underscoring racial inequalities that have led to poorer life outcomes in Black and brown neighborhoods, according to a study released Monday by the University of California Berkeley’s Othering & Belonging Institute.

The study found that 81% of regions with more than 200,000 residents were more segregated in 2019 than they were in 1990, despite fair housing laws and policies created to promote integration.

Some of the most segregated areas included Chicago, Milwaukee and Detroit in the Midwest and New York, northern New Jersey and Philadelphia in the mid-Atlantic.

Conversely, large metropolitan regions that saw the biggest decrease in segregation included Savannah, Georgia, San Antonio and Miami.

Here is the full story, exactly as I argued in my earlier book The Complacent Class.  Via Ilya Novak.  And from the study, don’t forget this:

Southern states have lower overall levels of segregation, and the Mountain West and Plains states have the least

Ouch…!

More on Alternative Dosing

Some quick comments in response to questions and discussion about my paper Could Vaccine Dose Stretching Reduce COVID-19 Deaths? (written with the all-star cast of Witold Więcek, Amrita Ahuja, Michael Kremer, Alexandre Simoes Gomes, Christopher M. Snyder and Brandon Joel Tan.

1) Any method of increasing vaccine supply will require other changes in the supply chain such as more needles. We think alternative dosing can increase supply quickly with the fewest supply chain disruptions.

2) If we had started Moderna with 50 ug dosing no one would be advocating for 100 ug dosing, thereby halving supply. Rather than “full” or “half-doses,” which bias thinking, we should talk about alternative dosing and ug.

3) Judging by neutralizing antibodies, a 50 ug dose of, for example, Moderna looks to be more effective than standard dosing of many other vaccines including AZ and J&J and much better than others such as Sinovac. Thus alternative dosing is a way to *increase* the quality of vaccine for many people.

4) A 50 ug dose vaccine available today is much higher quality than a 100 ug dose vaccine available one year from now.

5) There are substantial risks from following the current approach, as India and now parts of Africa illustrate. Alternative dosing has a very large upside but small downside since we could switch back to standard doses. For example, Great Britain and Canada delayed the second dose to 12 and 16 weeks respectively but have since reduced the dosing interval as more supplies have become available.

6) The greatest risk to immune escape comes from the unvaccinated. Alternative dosing protects not only those who are dosed but by reducing transmission also reduces risks to the unvaccinated.

7) The key question we face now is not whether there are objections and complications to alternative dosing (there are) the key question is what additional information, available quickly could resolve the most uncertainty? In other words, what can we learn soon that would most aid decision makers?

See the paper for details and also my previous post, A Half Dose of Moderna is More Effective Than a Full Dose of AstraZeneca.

Addendum: It should be clear that this isn’t about the United States, it is about getting high-quality vaccine to places that have little to none.

The CDC is broken, our regulatory state has been failing us

I was surprised by how good this NYT piece was, for instance here is one of the better diagnoses of the problem, or at least part of it:

Allen disputes the notion that she and her colleagues are doing work that the C.D.C. itself should be doing; in fact, she says, the task force and the federal agency have worked closely together. But she acknowledges that the interdisciplinary approach of the collaborative — it consists not only of doctors and public-health professionals but also of political scientists, economists, lawyers and M.B.A.s — enables it to spot problems that the federal institution can’t necessarily see. Infection control is a good example. “This is not a public-health problem, or even a medical one,” she says. “It’s an issue of organizational capacity.” The C.D.C. is not equipped to identify organizational issues, let alone resolve them.

And:

Around half of the agency’s domestic budget is funneled to the states, but only after passing through a bureaucratic thicket. There are nearly 200 separate line items in the C.D.C.’s budget. Neither the agency’s director nor any state official has the power to consolidate those line items or shift funds among them. “It ends up being extremely fragmented and beholden to different centers and advocacy groups,” says Tom Frieden, who led the C.D.C. during the Obama administration.

How about this?:

This funding system also hobbles emergency-response efforts, because there is no real budget for the unexpected.

Highly recommended, one of the best pieces of this year, here is the full article by Jeenen Interlandi.

It’s Time to Open the Canada-US Border

When infection rates in two areas are similar the argument for closing borders is weak. Canadian and US infection rates are now similar and both countries are highly vaccinated by world standards. The arguments for not opening are mostly psychological, a fear of foreigners. As a result, we have both Canadians fearful of opening to Americans and Americans fearful of opening to Canadians which doesn’t make sense. At least one must be wrong! Moreover, if we require even a weak proof of vaccination to cross borders then the average Canadian coming to America will be safer than the average American and the average American traveling to Canada will be safer than the average Canadian.

It’s time to open the border.

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Mexico stimulus facts of the day

“The combination of continued reopening with strong remittances and a US-led global recovery has allowed Mexico to close the gap with other Latin American economies, outperforming all of them in the first half of 2021,” said Marcos Casarín, chief economist for the region at Oxford Economics. The consultancy’s recovery tracker shows Mexico is returning to pre-pandemic levels of activity more quickly than any other Latin American country. “Mexico will grow 6.0 per cent this year and it could be higher,” said former finance minister and academic Carlos Urzúa, citing the spillover effects of US fiscal stimulus and increased remittances from Mexicans working across the border. These could reach $55bn this year and are “much more important than oil”, he added.

Here is more from the FT.