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From the comments, on CDC reform

These are the word of commentator Sure:

The reasons you cannot change the CDC have little to do with remote work the major issues are:

1. The people who staff the place could either make a lot more money doing something else or they believe they could. This means that they selected into working here and did so precisely because they like some combination of the present culture and the mission as presently understood. Asking them to change is going to be treated as something tantamount to taking a major pay cut at best.

2. It is overrun with academics. The director of NIOSH has 5 advanced degrees. And something like half the upper leadership has at least two runs through the academic gauntlet (granted the MPH is vastly easier than the MD or PhD) and pretty much all of them have reasonable output of academic papers. Many look at the CDC as complementary to an academic career and even the lifers have CVs at least compatible with going academic. This means a lot of the work product and setup is geared more toward publication, conference presentation, and deliberative work rather than rapid response.

3. The place has gone monocultural. Talking about the Obama era largely means talking about the old dinosaurs who retired out as the times changed. Since 2015, their political donations have been 99.94% to Democrats. This means that they get bogged down in the latest vanguard concerns of the Democratic base and that they are increasingly ignorant about and isolated from the bulk of the populace. Things that make some sense in dense urban corridors where few people get dirty at work make little sense in sparsely populated areas with significant morbidity burdens from work.

4. The hiring is completely incestuous. A huge number of low-level folks have parents who worked there or at related institutions (e.g. NIH) and even larger proportions involve folks who share educational pedigrees (universities, med schools, advisers). And even if a president wants to change this, there are civil service protections, congressional limitations (being a specifically delegated remit of authority), and of course that would require either Democrats to eat a lot of flak from their base among the educated or the Republicans signing up for a mass whipping for being “anti-science” and attribution of any cataclysm to this sort of personnel purge regardless of the real merits.

5. The activists are running rampant. Culturally competent pandemic management, as taught by the CDC, suggests that in a pandemic public health officials should not criticize cultural or ethnic leaders unnecessarily. They also suggest that you cannot shame or browbeat people into compliance with public health efforts, and that attempts to do so often backfire by having identity groups (religious, ethnic, national, etc.) respond to your nociceptive stimuli by rejecting previously accepted public health interventions. The worst messaging coming out of the CDC, particularly anonymously, violates all the guidelines I have seen the CDC issue when working overseas with MSF.

6. Doing your job well is boring. Most of the time you should be just making certain that resources (e.g. antibiotic stockpiles) are in place and that the same things that worked last time are ready to be implemented again (e.g. surge vaccination). And your ability to innovate and come up with something useful is pretty unlikely as there have been 50,000 people before you who give it their best stab. This leads to people “innovating” for the sake of “innovating”. This leads to people amplifying secondary concerns like “representation”, “equity”, “sustainability”, or the like. And a couple iterations of promoting the “innovators” over the maintainers will rapidly lead to atrophy of core capabilities. Zika or H1N1 represent less than 2% of the total work burden of the CDC, most of being agile is about maintaining capabilities when they are never used. And that is boring and at least currently not great for career advancement.

Remote work, in my best guess, would likely be a boon for the long-term flexibility of the CDC. Getting folks out of Atlanta and DC, having more capability for folks to work from the breadth of the country, and potentially even letting late career clinical folks have more access to the institution without having to disrupt their lives with a cross-country move are all to the good.

But until a bunch of people get fired, the CDC is unlikely to effectively change. On my more pessimistic days, I figure the real solution would involve burning the place to the ground.

Here is the original post.

Dose Stretching for the Monkeypox Vaccine

Photo Credit: NIAD. https://www.flickr.com/photos/niaid/52103767506/

We are making all the same errors with monkeypox policy that we made with Covid but we are correcting the errors more rapidly. (It remains to be seen whether we are correcting rapidly enough.) I’ve already mentioned the rapid movement of some organizations to first doses first for the monkeypox vaccine. Another example is dose stretching. I argued on the basis of immunological evidence that A Half Dose of Moderna is More Effective Than a Full Dose of AstraZeneca and with Witold Wiecek, Michael Kremer, Chris Snyder and others wrote a paper simulating the effect of dose stretching for COVID in an SIER model. We even worked with a number of groups to accelerate clinical trials on dose stretching. Yet, the idea was slow to take off. On the other hand, the NIH has already announced a dose stretching trial for monkeypox.

Scientists at the National Institutes of Health are getting ready to explore a possible work-around. They are putting the finishing touches on the design of a clinical trial to assess two methods of stretching available doses of Jynneos, the only vaccine in the United States approved for vaccination against monkeypox.

They plan to test whether fractional dosing — using one-fifth of the regular amount of vaccine per person — would provide as much protection as the current regimen of two full doses of the vaccine given 28 days apart. They will also test whether using a single dose might be enough to protect against infection.

The first approach would allow roughly five times as many people to be vaccinated as the current licensed approach, and the latter would mean twice as many people could be vaccinated with existing vaccine supplies.

…The answers the study will generate, hopefully by late November or early December, could significantly aid efforts to bring this unprecedented monkeypox outbreak under control.

Another interesting aspect of the dose stretching protocol is that the vaccine will be applied to the skin, i.e. intradermally, which is known to often create a stronger immune response. Again, the idea isn’t new, I mentioned it in passing a couple of times on MR. But we just weren’t prepared to take these step for COVID. Nevertheless, COVID got these ideas into the public square and now that the pump has been primed we appear to be moving more rapidly on monkeypox.

Addendum: Jonathan Nankivell asked on the prediction market, Manifold Markets, ‘whether a 1/5 dose of the monkey pox vaccine would provide at least 50% the protection of the full dose?’ which is now running at a 67% chance. Well worth doing the clinical trial! Especially if we think that the supply of the vaccine will not expand soon.

Have we seen peak social media?

That is the question I raise in my latest Bloomberg column.  Please note it is one scenario, not a prediction.  Here is one bit:

If I consider my own social media use, it is WhatsApp (also owned by Meta) that is steadily on the rise, which is consistent with the trend toward private and small-group messaging.

So is writing for a private, selected audience poised to eclipse writing for a broader public on social media? What would more private messaging, more texting and more locked social media accounts mean for public discourse?

Public intellectuals might still write on open social media, but the sector as a whole would shift toward more personal and intimate forms of communication. Again, this is not a prediction. But is it such an implausible vision of the future?

One of the more robust forms of social media is online dating, though these companies do not have the largest valuations. The percentage of couples who have met online continues to rise, and that trend is unlikely to reverse anytime soon. But online dating may not be as “social” as other forms of social media: People view some profiles and then switch fairly rapidly to private communications.

Private communications would seem to solve many of the problems cited by critics of social media. Social media wouldn’t corrupt so much public discourse because there would less public discourse to corrupt. And criticizing the new manifestations of these (formerly?) social media platforms would be akin to criticizing communication itself.

I do consider video, YouTube, and TikTok, all likely to prove robust in my view, in the broader piece.

My YouTube viewing habits

Abe emails me:

Tyler, I really enjoyed your recent podcast with Russ Roberts talking about favorite books and reading strategies. On the podcast, you mentioned YouTube a couple of times. I was hoping Russ would ask you about your YouTube habits, but he didn’t, so I thought I’d email to ask. What type of things do you watch on YouTube? Do you have any favorite channels or strategies for finding good content? I think it would be interesting to hear your thoughts on the subject.

My habits here are primitive, and not recommended for most of you sophisticates, but here goes:

1. I don’t subscribe to YouTube channels.

2. I watch some reasonable percentage, at least in part, of what people send me.

3. I watch prospective guests for CWT, to experience their conversational rhythms and mannerisms and “tics.”

4. I listen to music, especially when I am traveling, mostly classical music recitals or “world music,” to use a much-abused phrase.  For many “world musics,” the visual element is all-important.  I love Led Zeppelin, but I don’t click on them in this medium.  Piano and guitar recitals I enjoy much more than orchestral music, at least on YouTube.

5. Sometimes I watch videos on science, or occasionally econometrics.  It is often the best way to learn new concepts in these areas.

6. I watch Magnus Carlsen play BanterBlitz and engage in related chessboard antics in other forums, mostly while I am exercising on the Peloton.  If you understand chess reasonably well, he is one of the greatest entertainers of our time, in addition to being the best chessplayer ever.

7. I don’t listen on speeds other than 1x.  Doing so would disrupt the purposes mentioned above!  If I am just trying to absorb information rapidly, typically I would prefer a book.  The information from #5 usually is difficult enough for me to stick with 1x.  If it is just someone blabbing, typically I care about the true human rhythms of speech, or I just won’t do it.

What else?

My excellent Conversation with Roy Foster

Here is the audio, video, and transcript.  Here is part of the episode summary;

Roy joined Tyler to discuss why the Scots got off easier than the Irish under British rule, the truths and misconceptions about Ireland as a policy laboratory for the British government, why spoken Irish faded more rapidly than Welsh, the single question that drove a great flowering of Irish economic thought, how Foster’s Quaker education shaped his view of Irish history, how the Battle of the Somme and the 1916 Easter Rising cemented the rift between the Northeast and the rest of the country, what went wrong with Irish trade policies between the 1920s and 1970s, the power of Irish education, why the re-emergence of The Troubles in the 1960s may not have been as inevitable as many people believe, the cultural effects of Ireland’s pro-Allied neutrality in World War II, how Irish visual art is beginning to be looked at in a similar way to Irish literature, the social and economic changes of the 1970s that began to radically reshape Irish society, the reasons for Ireland’s openness to foreigners, what Irish Americans misunderstand, and more.

Here is an excerpt:

COWEN: If we think of the 19th century, as you know, I think it’s in 1831 that free universal schooling comes to Ireland. Are there ways in which, in the 19th century, Ireland is more modern than Britain?

FOSTER: That’s a very interesting and subtle question.

There is a theory that Ireland is used as a laboratory for British government and that they will apply further afield, in India and the Caribbean, models and lessons that they’ve learned in Ireland, which is sometimes referred to as Britain’s oldest or England’s oldest colony.

I have a slight problem with that, because Ireland is a very special kind of colony, if it’s a colony: it’s a metropolitan colony. The original inhabitants remain, one could say, in a far stronger position than in many of the areas of the British Empire, where they are effectively either enslaved or wiped out. But the point is really that what’s happening in Ireland in the 18th and 19th century is, as I’ve said earlier, a kind of dispossession.

But at the same time, there are elements — and this is true from the Act of Union, which abolishes the old, very elite Irish Parliament in 1800 — there are elements of experimentation in the British government of Ireland which aren’t (I have to say this) entirely malign, and you zero in on education. The attempt that was being made in the early 1830s was to introduce a nondenominational form of primary education for the Irish people.

Ireland being Ireland, it was rapidly denominationalized: the Catholics used it for their purposes and the Protestants used it for their purposes. But the theory of it was that you had to overcome the religious differences, which by the early 19th century seemed to dictate everything that was happening in Ireland.

The great novelist William Thackeray, who was married to an Irish woman, said when he did a tour of Ireland and wrote his Irish Sketch Book, “Where to get at the truth in this country: it is not possible. There are two truths, the Catholic truth and the Protestant truth.” By the early 19th century, this seemed all too true.

Substantive throughout, in my view one of the very best CWTs in some while.

U.S.A. fact of the day

But the 10 fastest growing counties last year accounted for nearly 80 percent of the national total, a testament not so much to the rapid pace of change in these places, but to the lack of significant growth in the rest of the nation.

Here is more from the New York Times, with useful maps as well.  And this:

https://twitter.com/mattyglesias/status/1506995138173837318

Monday assorted links

1. Devon Zuegel on inflation.  And should Devon try to get Omicron Covid? But her “best” interlocutor — cited in the thread — doesn’t consider that the booster shot will wear off in effectiveness, the costs of not getting Covid, whether Omicron is a “special” variant due to its rapid spread, or how about cross-immunities, or the travel/events benefits of getting Omicron out of the way, and the probabilities of various events (Devon is young and I believe healthy).  Does she really think that, ceteris paribus, natural immunity is a negative?  That was the best answer?

2. Harvard freshman becomes youngest person to serve in Icelandic parliament.

3. Does religious diversity undermine personal morality?

4. “Ultimately, he was far too Right-wing to accept Nazism.

5. Saliva test is best for Omicron detection.

6. Speculative study of Covid worriers.

One scenario for Omicron

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

How will institutions react to a proliferation of cases?

Imagine that a significant percentage of students in a school test positive, but no one is seriously ill. Will that school feel compelled to shut down and move to remote learning?

One possibility is that administrators will realize that virtually everyone is going to catch omicron anyway, articulate that reality to their constituencies, and plough ahead with face-to-face instruction. An alternate scenario is that the mere mention of Covid will prove so scary that closure will be inevitable. After all, how much will be known a month or two from now about the prospects of getting Long Covid from omicron? I am expecting a lot of school closures.

Another habit that will be hard to break is tracking the severity of the virus by counting cases. Until now, cases have been pretty good predictors of subsequent hospitalizations and then deaths. If cases become more detached from bad outcomes, will institutions and authorities be able to respond rapidly to that new reality? By the time they adjust, if they do, omicron might have come and gone.

To those who are inclined to worry, it will be scary how quickly omicron cases accumulate. It might feel as if the apocalypse has arrived, even if a lot of that short-term case activity is simply an acceleration of illness rather than an increase in the year’s total. (How scared would we get if most of the year’s murders happened in the first six or eight weeks of the year?) In any case, hospitals will have to be ready. But it is likely that a lot of health-care professionals might test positive early next year as well.

There is much more at the link.

Two all-purpose pieces of advice: small groups and mentors

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

The first piece of advice stems from what has been dubbed in Silicon Valley “the small group theory.” It goes like this:

  • When working on any kind of problem, task or question, embed yourself in a small group of peers with broadly similar concerns.

And:

The second near-universal piece of advice is this:

  • Get mentors.

Those two pieces of advice, unlike most advice, hold for a very broad variety of contexts.  Do read the column, but here is some further detail:

Mentorship can be general or specialized. I have had classical-music mentors, art-market mentors, country-specific mentors when I lived in Germany and New Zealand, foreign-language mentors, chess mentors, economics mentors, philosophy mentors, writing mentors and friendly mentors to help with the basic emotional issues of life. I’ve tried to find mentors for just about everything. Sometimes the relationship lasts only a week or a month, other times for years.

Aside from providing teaching and advice, the mentor, like the small group, helps make an issue or idea more vivid: A living, breathing exemplar of success stands before you. The mentor makes a discipline feel more real and the prospect of success more realistic.

As a corollary, in addition to trying to find mentors, you should be willing to become a mentor yourself. Even if you do not have advanced understanding in some particular area, almost certainly there is someone who knows less than you do and who could use assistance. Being a mentor also helps you understand how to learn and appreciate your own mentors.

A mentor doesn’t have to be older than you, and in fact some of your mentors probably should be younger, especially since technologies are starting to change more rapidly. If you are 50 years old, the idea of an 18-year-old crypto mentor isn’t crazy. If the metaverse turns into a reality, don’t look to the graybeards for tutelage.

Recommended.

Carlsen vs. Nepo

Here is my Bloomberg column on that topic:

He [Carlsen] recently opined that he is lucky to be facing Nepo rather than two other potential challengers, Fabio Caruana or Ding Liren. That’s the kind of trash talk most sports competitors frown upon for fear of motivating opponents.

Carlsen also has been engaging in online marathons of “bullet chess,” exactly the kind of attention-disrupting, energy-draining stunt contenders are supposed to avoid. In a bullet game, each player has only one minute for all the moves. The pace is so rapid the games are hard to watch, much less play. Carlsen also made a recent appearance in Dortmund, Germany, in part to pose for a photo with a Norwegian soccer player. Nepo, in contrast, claims to have done an “insane amount of work” for the event.

Will the fast thinking of bullet chess help Carlsen see more moves during the much slower time controls of the match with Nepo? (A championship game can easily last four hours or more.) Or maybe the bullet success will intimidate Nepo?

Carlsen also is making it clear that for him, chess is a business proposition. His parents set up a company in his name when he was 16, and the commercial empire since has expanded. Carlsen has worked as a fashion model, endorsed an online sports betting site, and worked with a Norwegian water company. He sponsors a leading chess app and has organized his own series of online chess tournaments, played with more rapid time controls, during the pandemic. Those events arguably have attracted more attention than any of the mainstream tournaments.

Carlsen is probably at the point where even a loss in the match would barely affect his income stream, and that is a dangerous motivational place to be…

Nepo is considered a super-talented but inconsistent player, one who does not bounce back well from adversity. But if he stays focused he could pose a formidable challenge. He was never expected to be a challenger in the first place, so he may feel he has little to lose and, in accord with his naturally aggressive style, he can take all the chances he wants. Carlsen is considered the superior player, perhaps the greatest ever, and remains a heavy favorite with the sports betting sites.

I am picking Carlsen to win.  And on the future of chess:

Carlsen has argued that the mainstream matches of classical chess are too slow and yield too many draws. He would prefer a time limit of around 25 minutes per game per player to become the default. Why shouldn’t the world of chess switch over to a system that spectators seem to prefer?

If Carlsen retains his title, he may well lead such a switch, and it would be hard for the chess establishment to resist. If Nepo wins the match, Carlsen might secede from the current system, causing the chess world to splinter.

What we are seeing in the lead-up to this match is this: A healthy chess world is going to be a more diversely organized chess world, with a lot of disagreement over which forms of chess are most important. Twitch streaming and YouTube already have joined the mix. Chess is likely to retain its recent popularity, but in doing so it will fully realize its destiny as the esport it has already become. The good news is that if you don’t like the outcome of the upcoming chess drama, you can find another one to watch the next day.

Recommended.

Why is inflation so bad?

That is the theme of my latest Bloomberg column, here is part of the final bit:

I am left with two major worries. First, higher rates of inflation redistribute wealth in a disruptive manner. For better or worse, more and more Americans are employed in the relatively bureaucratic service sector, which includes education, health care and government. If price inflation spikes as high as 6%, most of those workers do not rapidly receive an offsetting wage hike to restore their previous standards of living.

They might get higher pay by getting a new job, or by credibly threatening to leave. But that’s often a tense and unsettling position, from both a personal and professional standpoint. People might even have received stimulus dollars earlier in the pandemic, either directly or indirectly, and thus broken even or come out ahead. Still, with inflation, they will experience a loss of purchasing power, and they will hate it.

The second major worry is that inflation tends to require a subsequent disinflation, if only because people hate inflation so much. And we macroeconomists know that disinflations (or outright deflations) tend to bring recessions. When the U.S. Federal Reserve tightens monetary policy by a significant amount, aggregate demand in the economy falls, leading to losses in output and employment.

Of course, that’s a funny way of explaining why higher rates of price inflation are bad: Essentially, inflation is bad because it has to end. A subtler version of this theory is that workers and voters have only a limited tolerance for disruptions — and when they occur, we end up making blunders in our efforts to get out of them.

The proper critique of inflation is thus quite general. A pandemic is also a disruption, and we’ve made many mistakes in our efforts to end that as well. One of those mistakes, in fact, has been excess inflation. It will not be our last mistake, as we are still building our ever-widening circle of errors.

Recommended.

Tuesday assorted links

1. Creeque Alley (that was then, this is now).

2. “We further document that the labor-market premium to action-oriented personality traits has rapidly increased over the past two decades.”  And here is a new paper on Finnish extraversion (not joking).

3. Banning non-compete agreements in Austria didn’t really help worker earnings.

4. On the benefit of early promotion.  Suandi is on the job market from Berkeley.

5. “We find that the introduction of potatoes led to a sizeable and permanent reduction in conflict.”  Joris Mueller on the market from Northwestern.

6. Lots of interesting job market candidates from Northwestern this year in economic history, political economy.

Clement and Tribe Predicted the FDA Catastrophe

Paul Clement and Laurence Tribe

Laboratory developed tests are not FDA regulated–never have been–instead the labs are regulated under the Clinical Laboratory Improvement Amendments (CLIA) as overseen by the CMS. Laboratory developed tests are the kind your doctor orders, they are a service not a product and are not sold directly to patients. Labs develop new tests routinely and they do not apply to the FDA for approval. Despite this long history, the FDA has claimed that it has the right to regulate lab tests and they have merely chosen not to exercise this right for forty years. In 2015, Paul Clement, the former US Solicitor General under George W. Bush, and Laurence Tribe, considered by many to be the leading constitutional lawyer in the United States, wrote an article that rejected the FDA’s claims writing that the “FDA’s assertion of authority over laboratory-developed testing services is clearly foreclosed by the FDA’s own authorizing statute” and “by the broader statutory context.”

Despite lacking statutory authority, the FDA has continued to claim it is authorized to regulate laboratory tests. Indeed, a key failure in the pandemic happened when the FDA issued so-called “guidance documents” saying that any SARS-CoV-II test had to be pre-approved by the FDA. Thus, the FDA reversed the logic of emergency. In ordinary times, pre-approval was not necessary but when speed was of the essence it became necessary to get FDA pre-approval. The FDA’s pre-approval process slowed down testing in the United States and it wasn’t until after the FDA lifted its restrictions in March that tests from the big labs became available.

Clement and Tribe rejected the FDA claims of regulatory authority over laboratory developed tests on historical, statutory, and legal grounds but they also argued that letting the FDA regulate laboratory tests was a dangerous idea. In a remarkably prescient passage, Clement and Tribe (2015, p. 18) warned:

The FDA approval process is protracted and not designed for the rapid clearance of tests. Many clinical laboratories track world trends regarding infectious diseases ranging from SARS to H1N1 and Avian Influenza. In these fast-moving, life-or-death situations, awaiting the development of manufactured test kits and the completion of FDA’s clearance procedures could entail potentially catastrophic delays, with disastrous consequences for patient care.

Clement and Tribe nailed it. Catastrophic delays, with disastrous consequences for patient care is exactly what happened.

Addendum: See also my pre-pandemic piece on this issue, Our DNA, Our Selves.

Monday assorted links

1. Jodi Ettenberg interview.  Recommended.

2. “No evidence for cumulating socioeconomic advantage. Ability explains increasing SES effects with age on children’s domain test scores.

3. Unite America, for ranked choice voting.  And the sugar lobby is alive and well.

4. “We find that access to a plasma donation center reduces demand (inquiries) for payday and installment loans by 6.5% and 8.1%, respectively, with larger effects (13.1% and 15.7%, respectively) on younger borrowers. Moreover, foot traffic increases by 7-10% at essential and non-essential goods establishments when a new plasma center opens nearby. Our findings suggest that plasma donation helps households smooth consumption without appealing to high-cost debt.”  Link here.

5. “Thus, six-year-olds appear to more flexibly use multiple sources of information than both younger children and adults…

6. “An additional study (N = 2,172) shows that both Democrats and Republicans perceived the social network Facebook to be biased against their side.

7. “License plate readers are rapidly reshaping private security in American neighborhoods, bringing police surveillance tools to the masses with an automated watchdog that records 24 hours a day.

Who are the best Irish artists?, part III, Mainie Jellett

Mainie Jellett, 1897-1944, born in Dublin to a well-to-do Protestant family of Huguenot origin.  She studied with William Orpen in Dublin and then moved to England, where she developed an attractive figurative style.  But soon thereafter her work turned abstract  when she studied Cubism in Paris in the early 1920s.  She was part of what might be the most significant (and rapid) revolution in the history of art, although the Irish branch of that revolution usually receives little attention.  She and Evie Hone led the introduction of modern art to Ireland, and arguably still represent the peak of that tradition.  “Like James Joyce, who had ‘not become modern to the extent that he ceased to be Irish’, Jellett made modernism Irish.” (source)

She blended cubism on top of Christian devotional ideas and also structures and images from the Book of Kells and other medieval Celtic sources.  At its best, her work is just perfect — you would not wish for the curves or angles or colors to go any other way.  Here is a classic Jellett image, also drawing on some Chinese influences:

Here is her painting “Abstract Crucifixion”:

For a point of contrast, see her homage to Fra Angelico.  Her Anglo-Irish background led to some hostility, and her deliberate invocation of specifically Catholic images is sometimes interpreted as a project for Irish cultural reconciliation.

Here is a less typical but still fine representational work:

I can’t bring myself to call her the greatest Irish artist ever, as perhaps she is not tops in breadth or multiplicity of perspectives, but she was one of the very best and I do not tire of viewing her work.  She is the equal of many of the better-known modernist artists from other countries and she excelled also in watercolors and sketches.  Her life was cut tragically short by pancreatic cancer.