It's easy to reconcile deaths of despair being a uniquely American thing if your priors are that America is a uniquely bad place to live compared to Europe.
Translating observational data into robust conclusions in a scientific manner without resort to experimentation is damned hard. As I said below, most of them slip into charlatanism sooner or later, because you need to have ironbound control over your priors and a deep commitment to rigor to avoid doing so.
Most social scientists do not have enough of either, both in my limited personal experience and reflected in the shit they publish.
yes but the idea that Europe with its relative material scarcity can be meaningfully better than the US on a number of very important metrics (years lived!!), it is pretty challenging to a policy agenda that believes every issue can be solved by redistribution of material resources.
Also worth noting that this is even more true for wealth than for income— France, the UK, and the Netherlands all have higher median wealth per adult than the US even though mean wealth in the US is much higher.
I feel like how wealth is measured affects that a lot
like, the poorest people on earth are recent american med school grads, who have hundreds of thousands less in net wealth than goat herders in burkina faso
I recall a charity, Oxfam I think, made exactly the mistake you alluded to in a report they put out. They treated someone with a billion in assets and a billion in liabilities the same as a beggar without any assets or debt.
I think wealth in the broadest sense is related to the income you can generate both from knowledge and financial assets - which makes the medical graduate worth tens of millions of government bonds.
That is also a good way to square the disparity in wealth between someone just out of college vs. the newly retired...one has no assets (or negative with student loans) but a lifetime of earning potential, while the other has (hopefully) substantial assets and little to no earning potential (income from spending down saved assets).
Homeownership is low in Germany (about 50%) (due mainly to government policies which are very generous to renting), causing it to have a lower mean and median wealth
There's a significant difference between them in home ownership (50% to 64%). Does that add up to over 100% difference in median wealth? Hard for me to believe that. If so, think it demonstrates even more the limited use of this metric.
Excellent point ! I didn’t know that and I suspect many commenter where who like to being up us material advantage again and again don’t know this either !
Indeed— although I should add the caveat that European adults are older than their US counterparts on average and have had more time to accumulate and inherit.
Yes its true but (1) the median and probably somewhat below the median in the US have much more access to material resources than comparable Europeans and (2) rich Americans who definitely have more stuff than rich Europeans, live shorter lives.
Not at all sure about 1 when you realize resources include eg healthcrae and proper retirement savings. As for 2 - I’m not so sure about that either! I believe that sensational life expectancy study actually suggested college-educated Americas will be pretty high up on the chart? If so I’d guess that the smaller subset of rich American would be higher still?
1 has been extensively discussed here, well beyond the point of beating the dead horse into paste. The mechanics of GDP as an accounting measure make it impossible to "discount" healthcare enough to close the gap between the US and Western Europe's richest nations aside from Switzerland, Norway, and the microstates. Even if you assume that the entire excess healthcare spend in the States relative to Germany or the Netherlands has zero value and mechanistically discount it from household incomes, then adjust for transfers, taxes, and insurance premiums, the median American household is still significantly better off in real purchasing power than their German or Dutch counterpart. You've read and participated in those exchanges without ever actually rebutting or disagreeing with those arguments.
So do you actually disagree with the conclusion that the median American household is considerably richer than the median German or Dutch one, let alone the British or French?
Higher income yes, higher net worth no (although as I acknowledged above, that’s affected by European adults being older than their American counterparts).
I don’t know. Polytroposnjust said that median wealth there is higher. That not the same as purchasing power. But in any case I’m not sure if purchasing power in the abstract is the best correlating for life expectancy. Medicine and healthcare treatment in the us is almost certianly far more expensive in the us than any purchasing power advantage.
There is a tinge of “lost cause” narrative that has always seemed implied with this “deaths of despair” stuff. It’s the great white calamity, visited on innocent people because of how the outside world hated their simple and elegant ways. You see, they have no option but to drink themselves to death because eggs are more expensive, the customer service number gives them the Spanish language option FIRST, and the coal mine doesn’t hire as many people. What are they supposed to do? Literally anything else?
I mean, the deaths of despair narrative always seemed kinda counter-cultural to me because these days, “fuck those white guys who just whine and moan” seems to be the far more dominant narrative. That said, narratives should be roughly accurate to be worth listening to.
I think the interesting thing about this is that they manage to get through to the audience that is most in on hating low education white people by selling this all as a story about how we shouldn’t be victim blaming.
An odd thing with the coal mine and mill towns is that there really is a high rate of DoDs in many of those places. So it can look like the loss of jobs CAUSED the overdoses, etc..
But to a large extent that's an illusion, because when the mill closed the more together people with options and drive tended to leave, so the people who stayed behind were the people without drive or options, ie the drug addicts, those with criminal records, health problems, those who can't afford a bus ticket out of town, etc.. And the trickle of people moving back in might be disproportionately down on their luck.
I've looked at the demographic data on Kentucky and West Virginia and there are counties that have lost nearly 80% of their population since 1960. It's less that the collapse of the economy caused problems and more that the demographic change more problem-people behind in some places.
Of course, the longer you stay, the harder it is to flee, and the cycle tightens. If you've got a lot of your net worth tied up in your house, as many Americans do--well shit, what does housing demand look like in a county that's lost half its population or worse?
If you're a young homeowner you might sell at a loss and keep moving with your life. If you've lived in the house 25 years you very likely were going to stay anyway, so the price doesn't bother you as much.
@wigan i hope this is not too much of a tangent from your comment but I think the same holds true on the upswing side of things in boom towns.
It's not like the fracking boom brought a great social situation to North Dakota or whatever. If you read anything about gold rushes or oil booms or whatever, if you create a bunch of high paying jobs for young men, the results are not necessarily great. They make money but they spend their money and time doing stupid stuff, mostly.
Factories are different because there is more reward for staying with a single company because you can develop firm-specific knowledge and you can have a stable community potentially build up around an industrial cluster. But just in general I think job creation is also a pretty overrated component of health.
If it's a tangent it's a great one! I agree that job creation is overrated for health for just the reasons you're pointing out: the relation between having a job vs getting laid off and health is much more complicated than "have a job equals healthy" "no job equals not healthy"
I on the other see more than a tinge of a unique animosity and hatred towards working class whites by educated Americans. It’s curious to me that some many Americans seem to be selective in their empathy based on skin color.
I think the goal is to be empathetic to everyone, and that is super hard. Have been thinking about this a lot with the I/P issues right now -- and many ppl are very selective in their empathy/outrage
I read "I/P issues" as "intellectual property issues" at first and was trying to figure out what was generating selective "empathy/outrage" about it, then the light went off over my head . . . .
But is that even possible? We've been hearing about empathy fatigue for at least a decade. And while a noble goal--empathy for everyone--is it feasible?
I feel like this is where blanket policies can do so much good, by removing the need for empathy for any group at all, and making it a policy that will help everyone.
I think empathy is overrated, to be honest. Instead of trying to empathize with everyone, and generally failing, maybe we could just fall back to "bad things happening to people is bad, and we should try to avoid/mitigate that." You don't have to read an NYT profile about someone to know that it sucks if they die young or suffer.
I think the empathy thing has been in part an attempt to do an end run around the in group / out group thing. Instead of saying, F those people, they're on the other side, you're supposed to understand their point of view and empathize with them. But of course people are still loyal to their political tribes, so the empathy thing often doesn't work either.
So my proposal is to say screw it and just fall back to the general respect for human rights that we should have had all along. Although obviously many people fail at that as well. We live in an F-ed up world, and there's no short-term fix for that.
I dunno, I see a lot of true lefties being weirdly compassionate to a category of people they really do not know well... There's a lot of social conservatism out there in that group, and it's not all about money. These are the "cling to their religion and guns" folks that can be an obstacle to progress. Sometimes rich kids from the liberal suburbs seem to think these folks are noble savages, but they are fully-formed humans with their own beliefs and agendas.
Median incomes for non-college grads were stagnant for the four decades before Trump’s election. And still you mock. Even if the “deaths of despair” take was more hot than rigorous, the sad fact is the bottom 70% have stagnated needlessly
Why are snowboarders always sitting down on the mountain? I don't understand why I always see packs of them sitting down on the cold snow, and then laboriously trying to get up from that position.
Skiing solved this problem for you! Why you do the less good option?
We sit down to strap up our rear binding after using the lift.
I cannot speak for every snowboarder, but I skied before snowboarding. Compared to skiing I find snowboarding to be a little more interesting of a challenge*, I like only having one thing to carry, it's easier on the lower body, and the boots are vastly more comfortable.
*For people who shoot, I compare skiing to rifle and snowboarding to pistol. Snowboarding and pistol shooting both take more body control and ability to override instincts than skiing or rifle shooting.
Yeah it's difficult to overrate the boot factor. Committed skiers spend an age and lots of money finding boots that are still less comfortable than the boots a first time snowboarder will rent. Huge barrier to entry.
You can look at within-group outcomes by income levels and still find that making good choice - or really, bad choices - makes a great difference for how your life turns out. Arguably more of a difference when you are poor - when you are wealthy you have more luxury to get away with some bad decisions.
I grew up amongst the rural poor. Many of those kids were not interested in learning, but I took school very seriously as a way to escape the boondocks. My path worked as expected and I climbed up the income ladder. Most of those other kids did not. I maybe wish things were better for them, but I consistently encouraged them to be more like me & they consistently declined (to put it mildly).
This is NOT every story! But it is a real phenomenon, and there is sometimes a Lefty silliness that people have no control over their lives. This is an unhelpful attitude - oddly shared by religious extremists who expect Jesus to take the wheel vs solving their own problems.
Of course choices matters and personal responsibly matters and how good your parents were matters tons. That’s not an excuse to avoid better public policy and the huge difference in trend with Europe suggests strongly that such policy difference can make huge differences in people’s life. My big problem with the “bootstraps” rhetoric is that it seems like a way to rationalize and moralize the very morally dubious choice of avoiding policies that will dramatically save and improve tons of lives.
I agree re public policy, and I would like a stronger social safety net, better public education, and more social mobility.
I don't think I'm describing the "bootstraps" narrative in my opener, just by pointing out the relevance of individual accountability. And we do have a real American challenge around getting people to TAKE the opportunities they are given. Look at how a bunch of people refused to take a free awesome Covid vaccine. Madness, driven by individual bad decisions.
Well. Here I disagree. I don’t think Americans are “naturally” more or less likely to make good choice than Europeans. Ergo if they are on average making worse choices that itself is likely an issue to be addressed by better public policies. Vaccines are a good case in point. While the vaccines themselves were free Americans were hesitant because they’re used to paying much for healthcare, moreover being sick for one day due to side effects was *not* covered by the us government whereas Europeans have better sick leave policies and healthcare coverage for whatever side effects. Studies and polls suggests this accounts for some of the gap in “choice” of vaccines. The difference in public rhetoric presumably accounts for another slice of the gap. That’s not policy in the narrow sense but it’s still a matter of worse politics. Reducing this to individual choice is not helpful. You need to see the aggregate trend and try to account for the cumulative difference.
You mention the issue of Americans having less ability to take time off for side effects, but skip over the part about Americans being accustomed to paying for healthcare--it seemed the more relevant issue (that I saw referenced a lot) was that many people were suspicious of the vaccine on the basis of it being “rushed” (Fauci was saying it would take at least 18 months, it was approved in less than a year). The fact that it was free made some people even more suspicious of whether it was safe (if it was really that great, why give it away?)
I'm pretty sure there is a good deal of research out there showing that Americans are more individualistic and less trusting of government than Europeans. See the whole "nanny state" debate. So I think there definitely IS a cultural/psychological component to a lot of this stuff. There's not much we can do about that, so I agree it's often not helpful to spend time on, but at the same time not everything can be reduced to the impact of some government policy.
I have a goddaughter who is quite poor. I gave her baby things to play with attached to one of those plastic chains that hooks to the stroller, so the baby could amuse herself and exercise her curiosity. She would not use it. I have no idea what the rationale is to discourage your kids from learning and exploring. I have classmates who had to beg their parents to let them go to college (this was many years ago.) These values, which can perhaps be summarized by the old time country song "Don't Get Above your Raisin' " seem to be quite deep in certain impoverished cultures.
The bureaucratic world of education and government is inscrutable and threatening to a lot of people. I'm one of them. And not because my parents weren't smart and didn't do a good job, Mom went to Columbia and got her JD at Franklin Pierce, my father was a skilled craftsman. I had books and a good school and a therapist lol. I had a fine childhood, even if we were lower middle class because Mom and Dad didn't prioritize money/career. But the modern world doesn't make a lot of sense to people, and if you aren't adept at navigating it, it is very easy to fall by the wayside. This Is Not Bad Decision Making. This is a world that values paperwork and credentials that are gatekept. This is a world where the informal economy is throttled and deprecated by the State and the Elite. This is the world of Seeing Like a State. And lots of people hate it and fear it.
Now, I know a lot of this is the reason we have a fully electrified and networkes nation, and actual starvation is rare, and we have roads and schools. But it comes at a cost.
Man. I miss cigarettes. I still smoke occasionally with my brother in law, a few cigarettes a month, but have a permanent prescription to Chantix to keep me from back sliding.
But as an ex-smoker, I’m relieved that cigarettes have gotten so expensive and frowned upon. It motivates me to refrain from a vice I enjoy. (Thankfully ai don’t enjoy vaping however). I’m a living example of targeted policies working.
I’m rather curious about the long term effects of marijuana going forward. I wonder what health effects we will see as smoking weed becomes more ubiquitous among a larger group of people.
As for despair... drugs... it’s hard to gauge. I think fentanyl and meth might be extraordinarily deadly compared with cocaine or the past... but who knows. It’s it more despair or is it deadlier better drugs?
It's a combination of potency and route of administration. Powder cocaine is less dangerous than anything smoked or injected because the powder in the nose causes local vasoconstriction that itself limits the dose that is absorbed. You can't really overdose that way. There are no such limits on smoked or injected meth. Oral meth is still a problem, too., but probably mostly as a gateway to smoking or injection.
Fentanyl is so potent that it is medically dosed in micrograms. You can imagine how easily one can get too many micrograms of something, and street drug distributors and users aren't known for their precision. It's also absorbed through the skin, although the real thrill-seekers take the drug gel out of the patch and inject it.
I do quibble with Matt's argument that it's medication advertising that is the issue (though I abhor the direct to consumer (DTC) version). Medications like Oxycontin were not advertised DTC, which is what we are mostly aware of. They were advertised to providers through the usual professional channels (ads, articles in journals, conferences, paid speakers), which Europe also has (with the possibly exception of those drug company-paid lunch seminars). But I do think the fracturing and privatized nature of the US health care system makes it easier to have pill mills pop up., which drove the initial seeding of the population with oxycontin. I don't know how you'd set up a pill mill in Norway or France, or anywhere that has 1) a nationalized healthcare system and 2) fully integrated medical and pharmacy records.
>Powder cocaine is less dangerous than anything smoked or injected because the powder in the nose causes local vasoconstriction that itself limits the dose that is absorbed. You can't really overdose that way
I'm sorry what. Of course people can OD on snorting blow, they do it literally all the time
Potency dosen't necessarily imply lethality. LSD is dosed in micrograms too, but the dose that wil kill you is so high that nobody dies from it. In the hospital setting, fentanyl is used pretty frequently, but you know the exact dose, and you have Narcan on hand to reverse the effects.
Fair. It's not potency per se, but "therapeutic" window - LSD has a high threshold for harm, fentanyl a low one. My point about the accuracy of dosing outside of therapeutic use is the same as yours, though. Street dealers and users aren't going to dose accurately. They don't even know what they have. And of course the degree to which someone has a tolerance to the narcotic interacts with the dose level they get. Russian roulette.
One retort I've heard to that is "well just set up safe injection sites with staff that has Narcan on hand, and you'll reduce OD deaths to zero". I still think that's inadequate, because the staff will be reviving people left and right, and addicts are still living on the streets, living this marginalized life. My dream approach to this problem would be dispensing drugs like hydromorphone or morphine with controlled doses to addicts in a institutional setting, while slowly weaning them off in a long-term(yr or so) treatment plan, with the goal to eventually go onto a medication like Suboxone to help reduce cravings and the risk of relapse on an outpatient basis, while dealing with any other comorbid conditions they have(HIV, hepatitis, nutritional deficiencies from living on the streets) and/or job training, or psychological counseling. The current treatment programs are not long enough, or comprehensive enough to provide long-term sobriety. But, that would cost money, and community buy-in, although having residents no longer dealing with tent cities could be an incentive.
I agree completely. Harm reduction has its place but it can't be the only approach. You have to try to get people into long-term treatment, even recognizing that the relapse rate is frustratingly high. And suboxone is critical to longer-term success, but not a panacea. We could fund this if we had the will to do it. But it probably requires an even more comprehensive approach than this, to include housing support, job support, etc., and of course there will still be failures.
One simple solution is expanding drug court programs throughout the US, where you give people the option of charges being expunged if they undergo treatment, but you still need to make possession and use a misdemeanor or felony to be able to pull people into treatment, because while they may be mad at you and furious that you forced them into treatment, they may thank you months or years down the line that you did. Most addicts don't act rationally or think clearly, because their minds are clouded by drugs. It's amazing how much mentally sharper people are once they get sober. Some addicts do have coexisting or preexisting issues, like severe depression or hopelessness, but the drugs eliminate any possibility of those things getting better. That's also a place where skilled social workers can help.
there is the Swiss model -- for long-term users who have failed to quit by other means, just indefinitely give free* access to pharmaceutical heroin at safe injection sites (and in some cases, give people doses to take home). therefore no question of "relapse".
(it says here average user stays in this program for about 3 years, but 20% had never left at the time of the survey.
Also, most of those programs were set up decades ago, before methadone treatment and Suboxone were used or available as maintenance medications. I think nowadays the goal would be be either those medications for a short time or indefinitely if some patients truly couldn't handle being off methadone or Suboxone, but the ultimate goal would be sobriety. We have more options now.
Yeah, the UK has a similar program, i'd just wonder who would be liable if the patient OD, the litigation around medical malpractice in the US would be a problem.
wouldn't you also have to force addicts into the program, which is a bigger problem the longer the program has to last. And if it's really long it may upend the addicts family or work life.
Right, that is part of the problem, and it's a balancing act between personal liberty and community safety, although because these drugs are so incredibly addictive, addicts end up stealing, robbing people, becoming sex workers, forging checks, or stealing from family members to get money to get their next fix. Getting drugs becomes this all-encompassing thing, where their whole life revolves around getting high, remaining high, or buying more drugs. You only have about 3-4 hrs with opioids after the dose wears off, before you start experiencing withdrawal symptoms. I just think that addicts entrapped by the prison of drug addiction, deserve something better for their life, and if that means the state temporarily reducing their personal liberty, to give them a chance at that, then I'm willing to take that trade-off. I don't think anyone grows up hoping to become addicted to fentanyl, or envisioning their life turning out that way, but the stories are always very tragic when you hear people's backstories of why they ended up in this place.
i'm especially interested in the data on vaping. lots of negative data but i'd imagine there may be worse effects we don't know about -- huge issue for my generation
Vaping very much strikes me as a positive harm reduction avenue against tobacco smoking, so I'd be curious as to what negative data you've come across. It'd be nice if more vaping was nicotine free for those who have yet to be hooked on that, though.
Agreed on both counts--especially the nicotine free.
It's of course possible that untold harms will arise in 10 or 20 years with vaping, but we know just how harmful cigarette smoking is, and many people would make the switch to vaping with some pressure. But the anti-vaping crowd seems motivated by a desire to keep anyone from doing anything *like* smoking, no matter how different it might be, on almost puritanical grounds. At least it seems to me.
there are a surprising number of people who never smoked but do vape (or use other non-tobacco nicotine products like those pouches). many of these people now have a moderately expensive and unpleasant addiction, even if the health harms are probably quite small.
to the extent this happens to a lot of minors as a result of marketing, it does seem like a problem, although the moral panic and draconian response that happened a couple years ago were really stupid.
I once asked Matt for his take on vaping in a mailbag, and he didn't answer it. I try to avoid asking him repeat questions (HOAs were the one exception, and I somehow got lucky when he answered it from a non-mailbag comment I made), but maybe it just didn't make the cut among better questions, and I can try again after some more time has passed. Given that he's a former tobacco smoker, I think his take would be quite insightful.
As a young person (23yo, just graduated college) I don’t think I’ve ever seen a single member of my peer group smoking a cigarette in person. Meanwhile, I’ve seen dozens and dozens vaping; usually nicotine, but also weed. Most of these kids who started vaping in middle and high school were kids who would not have otherwise smoked cigarettes.
Weed use is becoming more common but I don’t know that smoking is. Edibles have been the big boom category since legalization, while vaping has been taking over smoking in parallel with how it has in tobacco.
I'm sure this varies state-by-state, but I remember when five dollars would buy a decent lunch and two packs of a cigarettes (a free lighter) were about a buck fifty; it was cheaper to smoke (which also killed my appetite) than to eat. That relationship literally inverted in less than a year with passing of huge tobacco taxes ratcheted up the price of a pack of cigarettes to five dollars. I literally could not afford my pack and a half a day habit and ended up quitting. (And gaining 20 pounds.)
I think the difference with weed is the lack of addiction. For me, having to restrict my cigarette intake was worse than abstinence, but weed was something you smoked when it was around and just didn't otherwise. Fentanyl is basically where tobacco was in the 90's; highly addictive and super cheap. Plus it kills you way faster.
A point that seems to be missed in the Slow Boring comments section is that a lot of fentanyl overdoses occur because people don't know they are using fentanyl. Dealers cut it into all kinds of drugs to enhance potency and create addiction. It also creates an addiction to an entire class of molecules (opioids). The meth heads I knew very deliberately took meth, got addicted to meth and then either went to jail, died or got off it. And they were snobs about it. They didn't like heroin or pills. They very specifically wanted the meth high.
I think the uppers and downers appeal to people in very different ways. There are some people who like both (even in combination) but there’s a good number who like one and hate the other. Both can be dangerous, but it seems that fentanyl on the downer side is much more dangerous than anything on the upper side.
It's interesting to think about who chooses which drugs (alcohol and cigarettes included) and why. The deep numbness reported from people taking Oxy, for instance, doesn't appeal to everyone. Likewise, the opposite extreme of meth for others. Let alone which are used in more social settings (weed, cocaine, alcohol).
Personally, my default setting is what you might characterize as "over caffeinated" so drugs that literally get you high (including caffeine) have little appeal to me. I had a roommate who was the exact opposite, kind of a slow, deliberate person. He was also an insomniac (sadly due to unrelated mental illness), so he worked a day job and a night job, often while on meth. (This particular place of employment was frequented by the type of people who would barter with drugs at 3:00 AM.)
But the heroin addicts I knew were just straight-up addicted. It really was all about chasing the high, almost like they were allergic to sobriety. It caused them to get into all kinds of trouble, including friends and relatives who got caught up in dealing and went to jail despite having every opportunity in life. I assume that is the case for other opioids like fentanyl.
I know one that quit as part of a plea deal and who ended up quitting *everything* and is now an incredibly fit health nut. Another shifted to alcoholism. Another went to prison for a long time, so who knows what he is doing. But all three indeed have a proclivity for addictive behavior. Personally I stayed far away from addictive drugs except nicotine, which I was heavily addicted to and had a hell of a time quitting, which sometimes makes me wonder what would have happened if I had tried heroin.
Not sure about fentanyl, but opioids such as Vicodin and Oxycontin can have the "opposite" effect on some people, giving them a feeling of euphoria and energy that's very addictive.
Ah! I didn't know that somehow. I know a lot of people (myself included) feel sick/nauseous taking painkillers like that, but I hadn't heard about an energetic component.
I think the pathway that leads to opioid addiction is multifaceted, and isn't the same for everyone. Some of the people I knew in high school started using because of dysfunctional home environments, broken homes, and found that opioids helped for a little while, until the bill came due in the form of addiction, and now they had to feed their habit. It seems that older Americans were prescribed excessive quantities of opioids like Percocet, or Oxycontin, but around 2009-2010, states began cracking down on things like a 90 day supply of Vicodin, and setting up electronic prescribing databases to see what doctors were prescribing, and how much. This is why you rarely see paper scripts anymore, you actually need a waiver from the DEA to write paper scripts, and everything is sent electronically. Many doctors who were overprescribing were scared of jail time, or losing their license, and cut patients off cold-turkey. But, you CAN'T cut patients whose bodies have become accustomed to opioids off cold-turkey. You have to slowly wean them off, if they're going to come off the medication.
I'm not a big Joe Rogan fan, but he recently interviewed Kurt Angle, the famous WWE wrestler and Olympic gold medalist, who won the gold at the 1996 Olympics in Greco-Roman wrestling. He said that despite all the injuries he suffered over the years, including breaking his neck numerous times, opioid withdrawal was the most painful thing he'd ever experienced. Every time you buy heroin, fentanyl, or any other opioid off the street, you have no idea of the purity of the drug, and it's essentially a coin flip whether you'll OD or not. Opioids are uniquely deadly, because they bind to opioid receptors in the brain, which control heart rate, and respiration, which is why you stop breathing.
It seems to me that cocaine is a "party" drugs that people are just as likely to take when they are doing well in life or having fun at a party. And meth and meth-like drugs start (for some people) as a way to cope with big workloads that they me actually be excited about, not despairing of.
The movement for the legalization of drugs is a criminal folly. I could have stomach it when it was supposedly just about weed (still a bad idea but at least to be seriously contemplated) but now it’s full steam ahead to 19th cent standards. Absolutely awful. Why on earth is our politics so dysfunctional as to allows such legalization (cf Newsom’s commensensical vetoes this week. Why is the California legislator so bonkers? Seems to me like the mirror image of gop “guns for every child” politics)
The things I heard of him vetoing were a bill to legalize cannabis lounges, and a bill to legalize psychedelic therapy. Even if you think those are going to have massive broader outcomes on those drugs than just the supposedly targeted legalization, those drugs really aren’t dangerous in these ways.
You may be right and I may be wrong! Still, psychedelics cause very few, if any, deaths, despite moral panics about people jumping out of windows thinking they can fly in 1967.
Reading more about the culture wars of the 1960s, and Timothy Leary in particular, it seems that psychedelics were the victim of a moral panic that resulted from the particular ways Leary was pushing them. If the face of psychedelics had been more Carlos Castaneda or Aldous Huxley, and there hadn't been as many people doing them at big public parties, they might never have been banned.
My teen son says weed is a "cringe old person thing." Given who was in the lines when our first dispensary opened locally last year, he may be correct. Perhaps that is because older folks have more aches and pains, and it may only grow as an "old person thing?"
Among my cusper Xer/Millennial cohorts, there was some serious ¿por qué no los dos? energy. I was never super into cannabis aside from social gatherings, though.
I think you'll see a bifurcation between casual users, who use once a month, and heavy users with problematic use, who are using every day, and go through life in a cannabis haze every day. I'm not sure what percentage of people use that frequently, but if it's even 20% of cannabis users, you end up with a lot of apathetic, unmotivated, stoned people. Driving around, I smell a lot more weed coming from people's cars than I did 5-10 years ago, which I think is incredibly reckless, but people seem to think that because it's not alcohol, it's fine.
Right, that's the inherent problem with cannabis testing is its unusual lingering in the system after consumption. I'm not inherently opposed to drug testing for professional drivers, but it needs to be a test that can actually detects impaired driving while on the job.
Eventually you'll reach an upper bound by generating a sustainable black market, and with cannabis that's proven quite daunting so far due to its ease of growth. Getting it legal everywhere would take out another aggravating factor.
When I wrote my book review on Deaths of Despair I noted how the authors completely ignored supply side factors with guns, opiates, and alcohol.
Gun proliferationists facilitated suicides. Purdue and company legalized opiate abuse for a period. We have had a relaxing of alcohol laws and increases in ABV.
Reading their book it seemed like an outsider’s take of what is going on in desindustrialized areas. It seemed very conjectural.
As an alumnus of a Big Ten school, seeing "Purdue" when talking about opioids always causes me to momentarily pause. Until today, I never actually checked why the school and the company share a name. So, in the interest of those who might share my situation:
"The pharmaceutical company was founded in Manhattan in 1892 by John Purdue Gray and George Frederick Bingham as the Purdue Frederick Company. Purdue University was founded in 1869 as Indiana’s land-grant institution, named for benefactor John Purdue."
And just to further confuse things, there is also Perdue Farms, most notable for its chicken. Also, TIL that there's no connection to the Perdues from Georgia, namely Senator David Perdue and former Trump Ag Secretary Sonny Perdue.
ABV increased for *craft* brews, but the DoD crowd don’t exactly drink those. AFAIK Bud and Miller Lite are still in the ~4.2% range they’ve always been, which is considered a session beer these days by craft snobs like myself.
So, no, ABV creeping up doesn’t have anything to do with it.
Indeed, but there's a difference between "the ABV of the average drink consumed is increasing" and "the ABV across this industry or subsegment is increasing".
For instance, as I demonstrated, the average ABV of beer can increase, but if that's mostly from craft brews that the DoD crowd don't drink, then it loses explanatory power.
However, maybe the DoD crowd shifted from beer to liquor. Okay, now we're getting somewhere! That's definitely an ABV increase, right? But again, in the liquor industry, most of the ABV-creep has come from high-end brands -- you've got Wild Turkey coming in at 94 proof, and then Wild Turkey's "Special Super Duper Select Single Barrel Angel's Ass-Crack" coming in at 110 proof and also $90 more expensive. The industry's average ABV is going up, but is the economically-pressured DoD crowd really drinking WT's SSDSSBAAC, let alone WT, or are they drinking whatever's $2 cheaper than Evan Williams down there on the bottom shelf?
Also, how much are they mixing it? Even if the average ABV across liquor is going up, maybe people are just mixing more mixer in. Or less! The point is, the amount and ABV of liquor *produced* simply can't be assumed to be directly proportional to the amount and ABV *consumed on any given night* [ed: and it's the depth and consistency of the binges that is most directly linked to liver disease. If I'm drinking 2 low-ABV beers a day and then add in 1 super-stiff drink once a month, my average ABV consumed spikes up, but I'm not going to get liver disease. But if I'm drinking a bottle of whiskey a week (or more), then the amount of mixer does start to matter on the margins, and we're really talking about margins here after all.]
Maybe it's a reasonable proxy, but the more of these "reasonable proxies" we rely on up and down the chain of the DoD argument, the less power the argument carries, and the more correct Matt is vs Dan here.
No, sir, it’s other social scientists who did the work to debunk the “deaths of despair” meme. Yglesias relied on their critiques to inform his views and is just summarizing these for us. The review and challenge around this issue is a good example of good social science.
"Mostly" is consistent with a world where all of the reasonably competent sociologists have to spend all their time wrestling the meme-friendly bullshit turned out by their hack peers back into the grave...
I think meme-friendly bullshit will exist whether or not social scientists exist (for example: Aristotle on "natural slaves"). But the "reasonably competent sociologists" who debunk the bullshit won't exist without a social science industry.
Note that this is one of the cases where *economists* (which people with your attitude often think of as the “good” social scientists) are causing the problems while other social scientists are attempting to clean it up.
I don't think of economists as any more rigorous than the rest of the social sciences, lol. If they were there would be some degree of fundamental agreement on core knowledge and there doesn't seem to be.
As I noted above, their task is legitimately hard: discover explanatory mechanisms for shit without experimentation. But so few of them seem up to it.
Yes, but economists have tremendous training in quantitative techniques that most other social scientists lack. For the past ~30 years, economists have "pinch hit" in other disciplines when a quantitative paper can make an interesting claim, to the point that I'd say it's now just part of the discipline.
You people only read about social science research that's extremely overhyped and news-prominent, and often only because it's being debunked by MattY or similar, and then you conclude it's all bullshit, thereby commiting the same selection bias error that social scientists SOMETIMES fall prey to
I actually used to read quite a lot of social science, especially back when I was a grad student with tons of journal access and very slow-running FEA models. A lot of it is bullshit, shot through with problems with methodology and statistical analysis that are glossed over in favor of reaching a desired conclusion.
But you and the other commenter are correct that my pre-coffee hot take is uncharitable.
It should be something more along the lines of "A lot of 'social scientists' are charlatans, news at 5."
Ya fair. I'm a statistics PhD and basically agree with the lukewarm take that social science broadly has some problems and econ tends to be more rigorous than like sociology/psych/public health. But I see people (especially this comments section) hyperfocus on stuff like today's topic and throw the baby out with bathwater, effectively concluding that punditry and their own hot takes are more reliable than academic research
I don't think punditry and hot takes have a particularly high success rate either, they're just low-value in terms of time to craft *and* time to consume so no one cares when something you read six months ago turned out to be wrong. For folks like those on here, I'd like to think that remembering those failures goes into people's heuristics about the future, I know I try to recall what I've read and said that turned out to be terribly wrong before talking about the issue du jour.
I have read so very many papers that turned out to be bullshit but seemed plausible at first reading, and skimmed so many more that were transparently bullshit to start.
In the hard sciences everyone is trying to produce something novel and hardly any novel results can be replicated. In the soft sciences everyone is trying to produce something counter-intuitive and the vast majority of it turns out to be bullshit.
In both instances, not enough researchers are willing to devote time to replicating other work quickly so all but the most sensationalist bullshit claims go unrebutted for years.
It's a mess. Exacerbated by the fact, as I pointed out yesterday, that journalism doesn't pay enough to attract solid, knowledgeable, capable "explainers of complicated issues" who have or can learn the necessary degree of subject matter expertise to understand, simplify, critique, and trust/not trust the experts. Most mainstream outlet reporters, at this point, don't know which bits of their interviews are relevant for quotes, let alone how to elaborate or explain their sources' statements, let alone judge their credibility!
The soft science-hard science distinction in terms of rigor seems less and less valid these days, at least according to research on potential p-hacking by field.
I won’t say you’re entirely wrong but from my (limited) observation Discourse Enjoyer’s original point still kinda stands. And in fact there’s even a almost self-congratulatory atmosphere around it. Which has an incongruous vibe to it since this comment section’s participants typically frame themselves as being better than the one they mock. But again that’s based on my limited experience here.
To your point about journalists not being paid enough, one thing I've been noticing recently is that almost no jobs pay enough to keep out hacks and charlatans. Caveat emptor!
Has any society ever gotten much value out of its least talented tenth? The least talented tenth is not a huge problem under Malthusian conditions as they are culled every time grain prices rise and this mechanically increases their genetic quality and, once grain prices moderate, improves their overall virulence.
Societies with Western levels of wealth can heavily subsidize the bottom tenth. Instead of watching them die from malnutrition or polluted water, we watch them drink and smoke and medicate themselves to death. This is, in a very real sense, what humanitarian progress looks like. Matt is certainly correct that nanny state regulations could make the bottom tenth die even more slowly, the question is whether the top 80% should sacrifice even more for a group that already contributes much less than it takes.
(Whether and to what extent the second decile is a net contributor seems complicated and contingent).
I embrace evolutionary psychology fully. However, social darwinism is an anachronism, more fit for societies with far fewer means to cultivate gardens than 2023 America. The question is to what degree should the strong and the normal sacrifice for the weakest. I do not think the answer obvious
In his defense the Lake Erie piece noted a significant gap in seatbelt usage and its effect on life expectancy.
If people are dying in 2023 because they won’t wear a seatbelt then my sympathy for their plight begins to wain. How much effort should we be putting into saving people from themselves?
>If people are dying in 2023 because they won’t wear a seatbelt then my sympathy for their plight begins to wain.<
I mean, sure? But is there something about Ohio DNA that's uniquely stupid compared to what's in the cellular nuclei of Pennsylvania and New Yorkers? My guess is no, which suggests public policy can indeed play a role in protecting people from their own ignorance. And probably should play a role in protecting people from their own ignorance.
Not following you. I didn't join the pile on at your comment, by the way, but surely I wasn't engaging in anything remotely resembling "hate" with mine. My point (I thought expressed clearly) was that petty libertarianism gets people killed if it manages to dictate public policy.
The Coast Guard risks their lives to save people stranded at sea. Cops and firefighters try to talk people off literal ledges. Doctors work to save people who injure themselves.
Note that all of these actions are seen as heroic.
I’ll use the example of mandatory evacuation orders before a hurricane. After folks have been warned repeatedly that they have to leave, I’m totally fine with police, fire, coast guard telling people they are on their own.
And they shouldn’t waste their time. Walk me through why you think people should risk their lives to save those who have repeatedly refused to abide by an evacuation order.
Aren't most of the people staying behind the ones that can't get a place to stay or way to flee? It's not like entire cities can just up and move with no issues
What could it be about the place that means that one place has more people who still don’t wear seat belts and the other place got over that in the late 1970s? Is it because one place just has worse people? Or is it because there was a different set of policies around seatbelt use adopted in the late 1970s that has had time to work on one population, but not on the other?
I doubt it's "all" about laws. The majority of people realize seatbelt wearing reduces their odds of death-by-car.
I think it's about *marginal* cases: those who are too lazy/find it uncomfortable or are uninformed as to the statistics. Some of them will wear a seatbelt to avoid getting fined.
How much effort? A lot, that's how we who smugly think we're smarter actually got here. It may seem to you self evident that folks should wear seat belts, and yet for decades seat belts sat in cars unbuckled amongst both the smartest and the dumbest. It took big pushes and coercive measures to get to the point where you have probably never not worn a seat belt, but your parents and certainly grandparents went years without wearing one. The forces and inclinations that made your grandparents too stupid to wear a seatbelt don't go away. So we, as a society, need to always continue the efforts to overcome them, it may not be as extensive a fight over time, but there's no reason to think that if we stopped now your grandkids might not bother to buckle up.
How are seat belt laws even being enforced these days anyway? Checkpoints devoted solely to that are inefficient. Tacking it on after pulling over for an unrelated moving violation could work, but it's not the main goal. I'm sure someone will mention traffic cameras, but my gut instinct is to shudder there, warranted or not.
It's the middle option for adults. You won't be pulled over for driving without a seat belt, but if you're pulled over for speeding and aren't wearing one it's an extra fine. If a minor isn't wearing a seat belt in your car, that might be enough for you to get pulled over on its own
The middle option can also be dismantled by quickly putting your seat belt on before the cop gets to your car. The question is how many non-seat belt wearers will have the wherewithal to do that.
I mean, you ignore social mobility statistics completely, for one... the bottom tenth of the income distribution is mostly very, very transient.
A lot, if not an outright majority, of the bottom half of the income distribution and more than a few folks up to the 80th percentile will find themselves at the very bottom of the heap for a year or two of their lives, and the middle-class folks are likely among the hardest hit emotionally when they do.
I think you're mostly right, but I feel like I'm kinda gonna split the difference. Social mobility is very specifically the reason not to excessively counteract the disincentives of poor decision making. Overinvesting in programs that insulate individuals from the consequences of their choices is subsidizing bad choices regardless of the psuedo-evolutionary woo in the initial take. Incentives are more important than who does or doesn't deserve a particular outcome whatever the basis on which you choose to define "deserving".
Ehh, in the abstract I agree, but that is very far away from what we actually do to soften the realities of life for the poor. We are in no danger of providing the bottom decile with a "free" standard of living that disincentivizes folks from getting back out of it, as evidenced by the very social mobility statistics we're discussing!
EDIT: You also have to recall that you're not splitting the difference at all. David is likely *more* in favor than I am of coddling the shit out of the poor. I mostly think that if we had a functioning healthcare system and squeezed the rent-seeking out of that, education, and housing, the current limited social safety net would be more than sufficient to protect people from horrible outcomes due to uncontrollable factors. The rest of our efforts should be on improving primary and secondary education and the social services which help kids escape their parents' fuckups.
There is difference in that the graphs there use quintiles, not deciles, so perhaps your claim is that post-tax-and-transfer the bottom decile is a lot worse off than the second decile? That's possible, but would imply that the second decile is a lot better off than the next 4 deciles' average....
My read of the data is that the US successfully implements social transfers that keep actual "money you end up spending on things or having spent on things for you" about flat for the bottom 60% of American households.
Now some of that "money spent on things for you" might not be spent the way you would spend it yourself, so it's very possible that the bottom 10% ends up with less disposable income in practice than people in the second quintile. That would require a bit more analysis. But that's a subtle point that would need measurement, not an obvious "no danger" slam-dunk.
there’s a lot of overlap! however, there may be some high functioning neo pastroralisr types or (dare I say) higher education students who are in the bottom tenth of the income but are quite talented.
there are plenty of old people who are in
the top half of the income distribution but whose talents have withered into oblivion. anyone in a hospice or nursing home is, almost tautologically, in the bottom tenth of the present talent distribution. ditto babies and toddlers. of course there’s also average talent over a lifetime. the world is complicated!
My brother in law was not only a fantastic human being but also a very successful and smart businessman who owned a company that large commercial construction projects.
He was a drinker like his Dad and he slowly descended into alcoholism. When the economy took a downward turn his business ran into some trouble and his drinking increased. Within about a year, the business was dead and he was drunk all the time. He kept descending, became homeless when his wife kicked him out and the rest of the family couldn’t handle him and his behavior anymore. He drifted between homelessness, various treatment programs and family. He was, by this point, physically addicted. And the story ends with his death in his mid-50’s.
He was in the top 10-15 percent until he wasn’t anymore, and his final years he was in that bottom 10 percent.
I’m not sure how to categorize him in the various schemas, but it makes me think that many in that bottom 10% are addicts or have mental health, or other issues. When he was homeless, all the people he hung out with were addicts or not right in the head.
No I said this because being wrong (which the comment of course is) is a regular occasion here on the Internet but being a horrible person is slightly less so.
I'm always aware that teenagers will do this, and once aware of this, it's fun to spar back with them when they think they know the whole world and get them caught in a logic trap. Though perhaps not as applicable for one's own teenager.
It is possible to design societies that do a much better job of protecting the lowest decile. And the reason for doing so is that as Westerners we believe that it could have been us. We could have been born into that position.
Obviously if you take the Nazi position of Survival of the Fittest, or various religious notions that the unfortunate have been granted their misfortune by God for good reasons, you would act differently
Also, for a large part of those who are in the 'bottom tenth' it doesn't have to be permanent, people's circumstances change over the course of their lives..
Unless we design things so that they die there, of course
I think I'm safely at or above the 95th percentile of Slow Boring subscribers ranked by admiration for Friedrich Nietzsche, and I don't care for this comment at all.
In the US there is no "lowest decile" in the way he thinks of it. It's a very transient status, to be that poor. Many folks are at some point in their lives, and very few of them stay that way for very long.
Definitionally, there is always a "lowest decile" of the income distribution, but it's not a concrete group of "evolutionarily unfit" people or whatever fantasy he's concocted so he can say something edgy.
To be fair, he isn't talking about the lowest decile in income. He specifically said the lowest decile in "talent".
One can quibble about how one defines "talent" but I would argue even the lowest decile still contribute meaningfully to our society (those with Down's Syndrome as an extreme example).
I elided that distinction because it just makes the whole thing even more incoherent. What's the measuring stick for "least talented," after all?
David is not stupid, and makes great points now and again, but he's obviously the sort of person who enjoys saying shit to get a rise out of people, and then calling it "thought-provoking." I've learned to just let most of it glide by, but this one was easy enough to disarm, and I hope my point defuses a bit of the tension that built up in the responses.
>It is possible to design societies that do a much better job of protecting the lowest decile.<
Virtually every rich country does better than the US in economic mobility, though there are some sizable difference within the US. Utah does a very good job, I'm told.
Americans in the bottom decile today have longer life expectancies than the Victorian gentry. My question is to what extent should normies sacrifice for the unproductive. My personal attitude is beans and rice are cheap, but once you start asking for expensive services, I’d like to know whether you 1) contributed while you were healthy or 2) might make something out of society’s grace in subsidizing you
I work at an access four-year college where I specialize in helping students who aren't ready to start as freshmen. In other words, I specialize in helping the bottom 10% (ok, maybe 5-15%, with the bottom 5 never even enrolling).
In my experience, very few of them lack the intellectual ability and moral fiber to contribute constructively to society. It's much closer to a "there but the grace of god" thing than "these are born failures" kind of thing.
It's just my anecdote, and I'm naturally inclined to think my work is useful, but the kind of analysis you have delivered here seems both deeply flawed and hopelessly heartless based on my lived experience.
This (and John's reply above) does not reflect an understanding of who open-access (meaning everybody is accepted) secondary institutions serve. We get a ton of people who dropped out of high school, come from broke-ass backgrounds, and present as marginally literate. Our attrition rates (dropouts) are super high. One comment thing we consistently see on student surveys is that about half of them never thought about attending college two months before they enrolled.
This is the real mission of public ed in the 21ist century: Reaching historically under-served populations.
Here is an anecdote to illustrate: Last month, I had to spend an entire 50-minute class session teaching students how to reply-all to an email and attach a file to their message. I had to begin with "how to save a file onto your laptop." First I showed them how to do it, and then I walked around behind all 24 of them to make sure they got it, stopping to walk about a third of them through the process individually. For several I had to repeat the instruction in a second language.
My point is that the they often present as hopeless upon arrival, more hopeless than I think many people realize.
The bottom 70% have no business going to college. That many parents are embarrassed to send their kids to trade school is a horrible indictment of America.
We need electricians much more than liberal arts grads.
This presumes that we should make public education be for the employers who will benefit from students' future labor. I feel that public education should be for the student, the overwhelming majority of whom don't want to be electricians.
What the public funds should be for the benefit of the public. That includes benefits to the students, but it should also net out to a positive for society as a whole. That way its more than self sustaining.
Its unclear to me that encouraging the bottom 50% of academic talent in the population to expend additional years of their lives in academia is a positive. This is especially true when there are other careers that don't require this additional training. Given that when the economy is strong, fewer people attend college suggests that there is a decent subsection of the population that wouldn't attend college if other good choices are available.
I doubt I end up as extreme as you, nor as nihilistic as Abbott, but one of my views that I'm guessing is quite unpopular among Slow Borers is that I don't get as alarmed about lower collective life expectancy as others do if the premature deaths are coming solely from one's own actions, and I will usually default to being resistant to policies that restrict actions to account for those sole actions of others.
Note that current policy isn’t leaving the bottom 10% to die at the same rates they have - it is accelerating the deaths of the bottom 10% least educated people. Can we stop doing that? Or is it a good thing for society to accelerate the cull?
We should stack rank society. Every year, the bottom tenth will be ground up for cat food.
However, because stopping there will just lead people toward shenanigans, we will grind the top tenth up for dog food.
This will eliminate problems, create jobs, lower the cost of having a pet (thus combatting depression), lead to a more equal distribution of income, and instill neurotic discomfort with both success and failure in everyone.
Toward the end of the original weeds lineup you guys did an episode on the decline on life expectancy. In that episode Ezra basically made the point that if this were really about "despair" people in Portugal (a country that essentially experienced an 8 year long recession) would be dropping like flies.
Ezra at some point (either in this episode or another one) proposed basically taking every single public health related policy idea and stacking them all on top of each other to see which ones would save lives the most efficiently.
I think these ideas were sort of aligned with the public health establishment's line of thinking at the time... basically we should try to do whatever it takes to save lives. At some point though it has become anathema within the Democratic party to concede that nanny state policies are super effective, which is why the prevailing public health narrative is a story about economics written by economists.
It’s not really clear to me that California has that much better public health policy than, say, Ohio. But what it does have is good weather that makes life fairly pleasant all year, without the manias and depressions induced by seasons. Portugal is probably similar.
I'm a bit more critical of the Washington Post article by Weber, et. al - Ashtabula County, OH is not that similar to Erie County, PA. The latter is naturally home to Erie Pa which apparently has 95k people. In the grand scheme of things being the biggest city between cleveland and buffalo isn't a big deal, but it makes a lot of difference in terms of what jobs exist as well as the size and quality of the hospital systems. Presumably a lot of people in Ashtabula work in Erie (or maybe Cleveland, idk), which leads to increased travel times - the census bureau estimates the mean travel time to work as being 25.8 minutes in Ashtabula and 19.9 in Erie. Traffic death statistics don't mean that much if you don't adjust for miles driven. Erie county is also somewhat richer as well though the poverty rate is similar.
Maybe that's a nitpick, and it doesn't make the conclusion wrong, there's just a lot of confirmation bias in what gets put out and then in what gets criticized. The Case & Deaton article was popular because it felt right to people, this article is good for those that support public health regulation and good for the Washington Post because it's framed in a pro-Democrat way. Is everything else not just working backwards?
Great article. One correction: There was not a “post-Floyd depolicing.” And certainly not one that remotely explains the widespread, nationwide, bipartisan-city increase in the murder rate.
I don't think de-policing is quite the right word, but arrests, stops, prosecutions, jail intakes and prison populations have fallen, on average all across the country and stayed down since 2020. It wasn't merely a covid blip. I can point you to multiple sources of data if you have specific doubts.
It's also wrong to say it's been merely about police, since everyone from crime labs to prosecutors to judges to mayors have taken little bites. Each city has had it's own story with a little more of one factor or a little less of another, but altogether that's the broad outline.
A very detailed investigation on how this has played out in Washington DC is available at this substack: https://dccrimefacts.substack.com/ Arrests and stops are way down, of arrests, prosecutions are down at least 50%. Sentences for some crimes are down. New de-escalation procedures have made time-per-arrest much higher, and the police workforce has been shrinking, which lowers time spent policing and pushes a higher share of the time to overtime.
Maybe it's not right to call it de-policing, but something changed.
The stats that I have seen have shown an increase in crime where policing is down AND where it’s not. But let’s assume for the sake of argument that policing is down everywhere that crime is up; that’s not remotely enough to suggest causation here. There was a HUGE societal disruption. Crime spiked afterwards and then has come down as we have gotten further away from that disruption. Pointing to policing as the cause rather than any of the many, many other enormous changes in society at the same time is no better than guessing.
Sure, there's always going to be guessing. But we don't see comparable surges in crime in other societies, Canada's murder rate barely budged and Mexico's murder rate actually went down, to use two very different examples.
If less people are going to prison, less people are in prison and fewer police are working in the highest crime neighborhoods of America in 2023 than in 2019 then I think there is more than a remote chance that there's some causation. The covid thing seems more like a wild guess, as there's no clear mechanism by which "I was temporarily laid off in 2020" leads to murdering someone in 2022, and areas without big temporary covid restrictions also had murder spikes.
I agree with you Wigan but I think, at least from how I’m taking your wording, you’re being a bit TOO harsh on Jeremy’s point (if that’s the best word). He’s not simply just saying “oh gotta work from home” but like the general overall disruption to everything that happened in 2020 (not to mention the lingering trauma from the experience of the first 6-10 months of covid uncertainty and loss). I think that’s definitely something worth always keeping on our minds since it was so severe.
I don't mind keeping it in mind but I think it's unhelpful in terms of understanding the crime surge. My argument is very similar to MY's in the piece we're commenting on. "Despair" and "Disruption" are too vague for analysis or response and the actual drivers were much more concrete.
And the disruption narrative does nothing to explain why crime levels have remained elevated. They are not returning to normal, either. Instead they are slowly drifting down in the same way that they've slowly drifted down for most of the last two decades, except when punctuated by upticks that always seem timed to depolicing movements gaining strength (late 2015, May 2020).
At current trends it will take another 3 or 4 years for homicide to recede to 2019 numbers and I don't know how "pandemic disruptions" can explain that?
To be fair to that point of view, my (probably unpopular) hypothesis is that good economic circumstances seem linked to HIGHER crime, and bad ones seem linked to LOWER crime, for example crime fell in 2008. In 2020 all of the sudden everyone was getting covid relief money, and that was followed by a period of very low unemployment.
Contra the expectations of most people, very little violent crime is committed b/c of hunger or to relieve poverty. Most seems to be about arguments, drug addiction, domestic disputes, jealously, ex-girlfriends, etc...The bottom 10% suddenly had a lot more money to buy drugs and live kind of wild, and that has outlasted the pandemic. So maybe that's why it's high and it has nothing to do with de-policing or the justice system.
I won’t lie, that’s a hypothesis that I’ve never heard and honestly maybe with some tweaks, sounds like it could be right. Although how would you explain the slow drift of crime rates through the 90s and so on?
Also, I’m of the mind that some of the crime talk should be better disaggregated. Like perhaps some subdivision of crimes might go up when people have a better economy (say armed robbery or theft) and others when it’s bad (domestic assault) but data constraints make that all but impossible and it’s frustrating.
In most cases, it was the police themselves who initiated the depolicing: “ But it’s clear that big cities in particular have experienced much sharper declines than that. In Seattle, traffic stops are down 90% from the pre-pandemic average; in New York City, almost 40%; in St. Louis, 22% since 2019 and 47% since 2009.”
Yes, traffic stops are down in cities that moved hardest to remote work. You know what also fell in those cities? Traffic.
That point aside, there was a major disruption to everyone’s way of life in 2020. Even if there were a robust *correlation* between a drop in policing and an increase in crime during that period (there isn’t), the idea that the policing *caused* the crime increase--rather than the huge increase in gun sales, the sudden pandemic spike in unemployment, the shuttering of neighborhood organizations, the closing of schools, etc.--is utter speculation.
Agree it is speculation, but it seems like a better speculation than these other factors you mention since they were mostly temporary and local while the murder, traffic death and overdose spikes were national and haven't reversed when pandemic restrictions ended.
Respectfully, that’s simply not correct. Violent crime spiked after the pandemic and has now started to come down.
Think of it this way. If I told you that--all at once--alcohol use would go up, gun sales would go up, schools would close, unemployment would suddenly spike, community organizations would close down, and after-school programs would end, what do you think would happen to violent crime?
I sincerely appreciate the insertion of respectfully because I do like to debate but I hate it when it generates animosity. I do disagree but I don't take any of what you're saying personally and hope you feel the same...on the argument...
I think we could bring data and common sense to each of these, with aa preference for data:
Alcohol: I'd guess crime would go up.
Gun Sales: No difference. Gun sales over time really have almost no correlation to gun crimes except at the longest time intervals. Criminals seem to be able to get guns regardless of how many guns a random NRA member has in his collection.
Unemployment: we've seen time and again that there's little correlation to crime. Crime fell in the great depression and. in the 2008 recession. And the spike in unemployment was very temporary.
School Closures: I'd be careful about assuming anything here b/c so many other "common sense" assumptions, like unemployment and gun sales, turn out to be wrong. But closures were also temporary while the homicide spike has long outlasted them.
After-school Programs: they didn't end in my super-liberal suburb. And the crime spike is much broader than school-age kids in liberal areas.
In any case: if the pandemic closures caused crime to spike, why hasn't it reversed completely instead of slowly trending down over a multi-year period? Homicide is still up 30% from 2019 numbers (I've seen the latest data from the CDC). And the increase in deaths are disproportionately in minority communities. AND the timing of the original increase was late May 2020, NOT Feb-Apr 2020. The homicide rate was actually down in Feb-Apr.
Are you sure gun sales has no relation to gun related homicides? I only ask because more guns in general just increases the likelihood of guns being used for anything. That could be guns stolen to be used in “street crime”, domestic violence becoming more deadly, mass shooting events, etc. not saying the guns cause the rise but just it’s easier to kill someone or shoot one when it’s more guns around.
On a side note: I have no idea how ghost guns factor in here either.
Do you have a citation that traffic levels post-COVID are reduced compared to pre-COVID? I don't think that's true.
Note, an increase in WFH doesn't necessarily mean a reduction in traffic, as people take advantage of the freed up road capacity to drive trips they wouldn't have before.
Incorrect. Traffic miles driven actually increased on average among large U.S. metro areas. The blip in which fewer people were driving on the roads was very short.
There aren't many cities run by Republican mayors. That said, it seems like the cities that have done the best job skirting the murder rate increase are disproportionately ones that had a Republican mayor for at least some of the time since COVID started:
For instance: Oklahoma City, Bakersfield, Jacksonville, San Diego, Miami, Virginia Beach, Dallas (I'm counting it because their mayor switched to GOP)
I suspect this isn't actually down to specific actions of the mayors, and more a matter of confounding variables - ie. communities that elected conservative-leaning mayors are more likely to be supportive of police, so police have pulled back less there.
Of course there are some cities that haven't had a GOP mayor that did well too, though they all seem to be ones with more conservative-leaning democrats. The notable exception I can see is Boston, which has avoided a pandemic murder rate jump despite being very progressive.
The uptick inn homicide was very demographically concentrated: Black homicide victims went up 50% while White victims only rose 5%, and Asians (a very urban census category) only went up 8%. Similar disparities occurred with traffic deaths and overdoses (data here: https://theusaindata.pythonanywhere.com/avoidable_deaths_after2020)
The sharp differences in demographics lead me to believe that they are the underlying drivers and not who is elected. IMHO Boston fits this theory well, as even the 20% of the population that is census category Black is majority immigrant, who as a category are a low homicide rate population.
"The uptick inn homicide was very demographically concentrated: Black homicide victims went up 50% while White victims only rose 5%"
True. There's definitely more to the story than that, though. Portland, famous for being probably the whitest major city in America, was one of the worst hit - their homicides almost tripled. Like, they went from Boston level to pre-pandemic Chicago/DC level in terms of homicides - really bad. Meanwhile, majority-black Baltimore and Detroit didn't see their increase over pre-pandemic.
I think the trends in suicide rates need to be addressed on their own, although Matt does an admirable job of covering the other key categories.
A few years ago I saw a couple of newspaper articles that were striking enough to make me write a Facebook post about them, otherwise I doubt I'd remember. The US suicide rate hit a 30-year high just as the UK suicide rate hit a 30-year low. (One of these statistics was for men only and the other was for both sexes, but I forget which.)
My random, non-evidence-based conclusion was that it probably had something to do with the existence of universal health coverage (or not) and welfare state protections more broadly. Working-class Americans and working-class Europeans may both be angry about inequality, demographic change and various other common trends and they may both vote for far-right politicians in response, but it seems to be only in America that they decide to kill themselves.
(It also occurs to me that low-skilled, nonwhite immigration might have a stronger effect on the self-esteem of low-skilled white people in America than in Europe, because there's more of it. But this is my permanent hobbyhorse, so take it with a grain of salt.)
Anyhow what I wrote back then may be wrong but unless there's a freestanding explanation for the divergence in suicide rates, I don't think the "despair" hypothesis has been refuted.
Any conversation about American suicide can’t ignore the female side. They attempt more and succeed less, but I find it hard to believe that FB and Insta had no effect.
Also, I’m curious how big a component the veteran suicide crisis is in the overall rate.
One of the big things is that women tend to attempt using pills or cutting while men to mend to attempt using guns or jumping. These attempts have different levels of effectiveness.
“Only two occupational categories, both in combat arms, had significantly elevated suicide rates: infantrymen (37.2/100 000 person-years) and combat engineers (38.2/100 000 person-years). However, the suicide rates in these two categories were significantly lower when currently deployed (30.6/100 000 person-years) than never deployed or previously deployed (41.2–39.1/100 000 person-years), whereas the suicide rate of other soldiers was significantly higher when currently deployed and previously deployed (20.2–22.4/100 000 person-years) than never deployed (14.5/100 000 person-years), resulting in the adjusted suicide rate of infantrymen and combat engineers being most elevated when never deployed [odds ratio (OR) 2.9, 95% confidence interval (CI) 2.1–4.1], less so when previously deployed (OR 1.6, 95% CI 1.1–2.1), and not at all when currently deployed (OR 1.2, 95% CI 0.8–1.8).”
Matt's answer here is that it's about the availability of guns. I don't know if that's 100% true, but that's a subset of the larger truth about suicide that it is surprisingly difficult to kill yourself, and a small change in the efficacy of a method of suicide leads to a large change in number of successful suicides (vs attempts).
And you also can't really compare suicide attempts rates, because they are in turn confounded by differences in rates of discovery and classification.
It's not just guns. When Britain changed the packaging for Tylenol to blister packs instead of bottles, suicide deaths from Tylenol overdoses declined by 43 percent. Anyone who wanted 50 pills would have to push out the pills one by one but pills in bottles can be easily dumped out and swallowed.
It's such a wildly odd quirk of human psychology that people can be both (a) so motivated by depression or other life circumstances (omitting painful terminal illnesses here) that they want to take the extraordinary step of kill themselves, but also (b) that they can also be like, "eh, I was gonna. but those stubborn aspirin packages made it too hard."
I get it, of course, in that many times the idea to kill one's self comes at a particular low point, and if a person gets through that moment without committing the act, maybe they never reach that nadir again, but still.
Sadly being close enough to the edge to make an attempt is often a long term condition, but the actual attempt are often very impulsive. One of the more horrifying programmes I saw featured interviews with some of the 1% of people who survive jumping off the Golden Gate Bridge. The majority remembered changed their mind before they hit the water.
I saw a documentary on that where they interviewed one of the jumpers that survived and it still haunts me. He said something along the lines of "as soon as my feet left the bridge, all the problems that had me so upset seemed like the smallest problems in the world, and all I wanted to do was go back to the bridge". Horrifying to think of how many others had the same thought but didn't survive the jump.
I did some work a few years back on the suicide netting that was being installed on the GGB that required me to be out on the scaffolding on the outer underside of the bridge...and it was utterly terrifying. I don't know how anyone could do it, let alone survive it.
Yeah, my apologies, of course I'm not trying to say that whatever the underlying mental health situation is transitory, just that the specific moment where somebody may want to kill themselves, and attempt to do so, may be a passing moment.
Also from Britain the change from "coal gas" to natural gas reduced suicides by making them harder.
"Prior to the 1950s, domestic gas in the United Kingdom was derived from coal and contained about 10-20% carbon monoxide (CO). Poisoning by gas inhalation was the leading means of suicide in the UK. In 1958, natural gas, virtually free of carbon monoxide, was introduced into the UK. By 1971, 69% of gas used was natural gas. Over time, as the carbon monoxide in gas decreased, suicides also decreased (Kreitman 1976). Suicides by carbon monoxide decreased dramatically, while suicides by other methods increased a small amount, resulting in a net decrease in overall suicides, particularly among females.
Over time, rates of suicide began to increase again although not to the pre-1965 levels. One author has estimated that over a ten-year period, an estimated six to seven thousand lives were saved by the change in domestic gas content (Hawton 2002)
Easier availability of guns must explain a lot of why the US suicide rate is higher in absolute terms, but it wouldn't necessarily explain why rates have risen in the US and fallen in Europe (or at least in the UK). It's true that American laws have been liberalized in recent years because of pressure from the gun lobby, but I don't know if that's enough to explain the trend.
You could try doing a state-by-state regression to tease out that effect, but I think it would be confounded by other differences between red and blue states.
It might also help to look at suicide rates in Israel and Switzerland, where household gun ownership is very widespread. (Those guns are pretty strictly regulated but I'm not sure why that would be an impediment to suicide.)
This is an anecdote, so don't take it too seriously, but my uncle, an ER nurse, mentioned to me at one point that his experience was that many suicide attempts with longarms resulted in survival because the awkwardness of trying to reach the trigger with the gun pointed at yourself resulted in twisting away and the bullet not squarely hitting you, as opposed to with handguns where it was trivial to point the gun directly at your head and pull the trigger.
It isn’t so much about “difficulty” but time and planning and opportunity to reconsider. Easy access to a handgun means it can be over 30 seconds from the decision. But getting and taking pills, for example, gives you time even after you make the attempt to reconsider and call for help.
That's a fine guess, but most guesses like that turn out to not have much support.
The biggest differentiator I can find within US populations is race / ethnicity, which it's safe to assume is due to cultural differences. The Black suicide rate is 8.8 per 100,000 while the White rate is more than double at 18.6 and the Hispanic and Asian rates are a little lower than the Black rate. The Native American rate, meanwhile, is 28 per 100,000.
These rate differences don't seem to correlate with inequality or welfare protections and are fairly consistant across state geographies and rural / urban splits; the point being it seems to be driven primarily by culture, and the UK has a different culture than us. Japan's modestly high suicide rate would also seem to be driven by culture and not inequality or gun laws.
Link to some suicide (and other deaths of despair) data:
Any discussion of suicide needs to include the way it spreads socially. We know that an article about suicide leads to more suicides. Malcolm Gladwell discusses the way this played out in Micronesia, a place where suicide was extremely rare until a single well publicized celebrity suicide led to a suicide epidemic. Trying to explain the phenomena using only economic or regulatory comparisons isn't going to shed much light on the subject. China regularly have cases of middle aged men going into schools with knives and stabbing all the children they can find while in America we have lots of school shootings but the perpetrators tend to be teenage boys. People are suggestible and one act begets another.
I'll stress that I'm indifferent to changes in suicide rates (I think it's people's own business whether they kill themselves or not), but one thing I can't help but notice is that people who do express concern about increasing suicide rates, at least from a "left" perspective, all but completely ignore that, historically, suicide was severely stigmatized in Western cultures, both religiously and civilly, going back even to the pre-Christian era. Given that all forms of stigma around suicide have been substantially reduced, either directly (e.g., repeal of property forfeiture laws for suicide victims) or indirectly (e.g., general decline in religiosity), over the past century or so, how clear is it that we're genuinely seeing an increase in suicidality versus finding the "natural rate" of suicides in the absence of stigmatization?
Yes. It’s also somewhat “contagious”-- suicides spike locally when someone in a community commits suicide, and then more broadly when a celebrity does.
Possibly not a real memory, but I'm pretty sure I was taught about suicide contagion in health class in 9th (?) grade. Seemed to check out to me, and a few years later I recall learning as an RA that the college paper had a policy of not running stories about the one or two people a year who would jump off the bridge in the middle of campus. Possibly apocryphal as well.
Fast forward to the present day, and there are suicide ads on the bus. So much of the conventional wisdom around mental health in this country seems so broken.
Shorter version TL;DR: whites are dying of despair in America because guns, drugs are too available and seatbelt laws are too relaxed, but they are *living* with despair in Europe where it's harder to kill yourself by accident or on purpose either quickly or slowly.
Ergo there's nothing wrong with US neoliberalism that more euro style paternalism wouldn't cure.
Me: But shouldn't we be asking why Western society produces so much despair in the first place and despair seems to be getting worse? Or is the neoliberal technocratic response mainly concerned with making the mortality stats better?
Is there more or less despair than there used to be? If it’s less, but people are killing themselves more anyway, then we should be focusing on the killing and just keep on keeping on with the reduction in despair. If there’s an actual increase in despair, then we should do something about it, but that is what is missing here.
My sense is yes. By most accounts ive seen, loneliness is way up, family formation is down. Mental health issues are way up especially among young people too. Matt even wrote a piece recently asking why young liberals were so depressed.
A lot has to do with the internet and social media which not only consumes lots of time that can't substitute for real friendship, but also promotes social contagion of catastrophizing belief systems.
Is it loneliness or is it not accepting we don’t like other people? I and many others I know had their loneliness evaporate during COVID because, with everyone locked up, we could accurately assess how much we really wanted to be around other people, all social pressure to do so having vanished.
Are we sure family formation is down because something broke in society or is it because children tend to make life worse in myriad ways?
Wait, so what is the "despair" you are talking about? If it's economic stagnation then the problem was pretty clearly recklessness in Wall Street. If it's just people feeling bad about their lives then...Cognitive Behavioral Therapy for Lefty's. For Righty's it's: suck it up.
That certainly is an interesting question, but I think it's pretty different than the original deaths of despair thesis that there's been this unique surge of despair for one group in the Teens. FWIW David Simon and Ed Burns wrote about this in The Corner. Their theory was there's a very real chunk of the population that isn't needed to work in factories or fill up the countries empty spaces like there was in the past do to the modern sort of post-industrial economy and so those people just get kind of discarded and ignored by society. But they were writing about the 90's so it's not really about the "Deaths of Despair" thesis.
Why would the phenomenon in the 90s be less salient today? If anything, I'd expect it to be more salient.
The "Corner" phenomenon was about inner city blacks. Now it's clear though that the decline there was a canary in the coal mine for downscale white America.
I except center right authors to ignore the problem because the existence of struggling white America undermines their whole ideology.
But it's hard to get the left to care about it either because it isn't a question of racial justice.
I sure would love a deeper dive into opioid policy, a subject I occasionally write about and ask Matt about. I grew up in one of the harder-hit areas, so the explosion of what was a local issue to me when I was a teen into a national gigantic clusterfuck has been wild to watch.
The last time I asked about this, a reasonable-sounding commentator made the case to me that the FDA didn't do anything wildly wrong- that opioids were already legal to prescribe, that the FDA can't do anything in real time about Purdue marketing, and that pharma companies are incentivized to push the envelope on their marketing before their patent runs out. I dunno, is this all true? Government policy was a non-factor in opioid deaths? The FDA is too strict about some things (as we saw during the Covid era) and helplessly hands-off on others?
And then you get the inevitable 'the deaths are all fentanyl, it's because there's a black market, just legalize drugs' crowd who will inevitably show up. Every time I point out that half or more of total opioid deaths were from *legally prescribed ones*, but that doesn't seem to make a dent with this crowd. After all, they have black markets for drugs in Europe too, but way less opioid deaths!
Painkiller, the limited Netflix series, covers this and more. My understanding is that it’s based on a well researched book by an investigative journalist. A poignant and “entertaining” (riveting but makes you want to throw up) series about Oxycontin’s rise and fall.
This articles contains a lot that is informative and good, but sentence like this “ People without a BA are a smaller, more negatively selected group than they used to be — a group increasingly composed of low-conscientiousness people.” Smacks of the worst kind of victim blaming and a lack of empathy that frankly raises the question regarding Matt’s on conscientiousness in his writing.
I'm not bothered by it, but it fits well with my take that something modern progressives have failed to deal with is that there are fewer and fewer "deserving poor," i.e., people who genuinely just need a limited "hand up" to get their lives on track, versus people whose lives are simply permanent or near permanent train wrecks and will often forgo or sabotage opportunities even when specifically given to them.
I honestly think you're reading to much into. it. This is clinically descriptive terminology. The bad version would be "People without a BA are a smaller piece of the bottom-of-the-barrel than they used to be — a group increasingly composed of crappy people.”
What would you're super-empathetic version be? There are people that are more or less conscientiousness than others, and "negatively selected" simply means that selection into the group is driven by negative factors, rather than chance or positive factors. These all seem true and I'm not sure there's a clearer way to write it that will also prevent offended misreadings.
I don’t think it’s victim blaming so much as it is explaining the fact that people with mental health issues are more likely to struggle through formal education, and because many more people are getting college degrees, people with mental health issues will end up with a larger share of the smaller group of people without college degrees.
If people do in fact differ along a dimension of conscientiousness, then it would be plausible that there would be death rate differences along this axis. Matt is telling us to emphasize the effects of policy on these death rates, while Case and Deaton are telling us it is not about this sort of risk tolerance or carelessness but is about changing emotional circumstances. That story *sounds* kinder, but I don’t think it is.
Ohh yes, this is that hot fire that I subscribe for.
You know any take with the subtitle “it’s time to be a little ruder about this” will be spicy/delicious.
He missed the opportunity to call the paper “bullshit” in the dang title!
Weak sauce from an ancestral northeasterner. I’d have dropped at least two f-bombs, bullshit, and weak-ass in there somehow.
It's none of those things--it is pure, 100%, grade-A, uncut MALARKEY.
In other words, the authors of the paper were smoking Dutch Cleanser (to use an Arlen Specter-ism).
Overly polite Upper Midwesterners, ugh. I'll do it properly:
"The Fucking Weak-Ass Deaths of Despair Narrative is Fucking Bullshit, You Candy-Ass Bitch.
It's fucking well time to be a cunt about this shite."
Oh, man, when does Season 4 of 'The Boys' drop anyway?
See, I just think this sounds childish.
Really? If my child said that she’d be sitting on her bed until at least first snowfall.
:D
Is he lacking the additional Philadelphian touch to get there?
Philly with a dash of Brit below. :p
This is pure snarky Matt. I love it.
And with a perfect target... When I heard Deaton on the Julia Galef podcast I formed the strong impression that he was a moron.
I'm only mad because I was ruder about it first.
It's easy to reconcile deaths of despair being a uniquely American thing if your priors are that America is a uniquely bad place to live compared to Europe.
Translating observational data into robust conclusions in a scientific manner without resort to experimentation is damned hard. As I said below, most of them slip into charlatanism sooner or later, because you need to have ironbound control over your priors and a deep commitment to rigor to avoid doing so.
Most social scientists do not have enough of either, both in my limited personal experience and reflected in the shit they publish.
yes but the idea that Europe with its relative material scarcity can be meaningfully better than the US on a number of very important metrics (years lived!!), it is pretty challenging to a policy agenda that believes every issue can be solved by redistribution of material resources.
Why? Europe can be poorer overall but redistribute such that it’s poorer are richer than us poor.
Also worth noting that this is even more true for wealth than for income— France, the UK, and the Netherlands all have higher median wealth per adult than the US even though mean wealth in the US is much higher.
I feel like how wealth is measured affects that a lot
like, the poorest people on earth are recent american med school grads, who have hundreds of thousands less in net wealth than goat herders in burkina faso
I recall a charity, Oxfam I think, made exactly the mistake you alluded to in a report they put out. They treated someone with a billion in assets and a billion in liabilities the same as a beggar without any assets or debt.
I think wealth in the broadest sense is related to the income you can generate both from knowledge and financial assets - which makes the medical graduate worth tens of millions of government bonds.
That is also a good way to square the disparity in wealth between someone just out of college vs. the newly retired...one has no assets (or negative with student loans) but a lifetime of earning potential, while the other has (hopefully) substantial assets and little to no earning potential (income from spending down saved assets).
Interesting to note that by wealth, the UK (151k) is doing better than the France (133k), the US (107k) and way better than Germany (66k)
https://en.wikipedia.org/wiki/List_of_countries_by_wealth_per_adult
That the median French are twice as "wealthy" as Germans makes me think the metric isn't all that useful...
Homeownership is low in Germany (about 50%) (due mainly to government policies which are very generous to renting), causing it to have a lower mean and median wealth
There's a significant difference between them in home ownership (50% to 64%). Does that add up to over 100% difference in median wealth? Hard for me to believe that. If so, think it demonstrates even more the limited use of this metric.
Excellent point ! I didn’t know that and I suspect many commenter where who like to being up us material advantage again and again don’t know this either !
Indeed— although I should add the caveat that European adults are older than their US counterparts on average and have had more time to accumulate and inherit.
Yes its true but (1) the median and probably somewhat below the median in the US have much more access to material resources than comparable Europeans and (2) rich Americans who definitely have more stuff than rich Europeans, live shorter lives.
Not at all sure about 1 when you realize resources include eg healthcrae and proper retirement savings. As for 2 - I’m not so sure about that either! I believe that sensational life expectancy study actually suggested college-educated Americas will be pretty high up on the chart? If so I’d guess that the smaller subset of rich American would be higher still?
1 has been extensively discussed here, well beyond the point of beating the dead horse into paste. The mechanics of GDP as an accounting measure make it impossible to "discount" healthcare enough to close the gap between the US and Western Europe's richest nations aside from Switzerland, Norway, and the microstates. Even if you assume that the entire excess healthcare spend in the States relative to Germany or the Netherlands has zero value and mechanistically discount it from household incomes, then adjust for transfers, taxes, and insurance premiums, the median American household is still significantly better off in real purchasing power than their German or Dutch counterpart. You've read and participated in those exchanges without ever actually rebutting or disagreeing with those arguments.
So do you actually disagree with the conclusion that the median American household is considerably richer than the median German or Dutch one, let alone the British or French?
Higher income yes, higher net worth no (although as I acknowledged above, that’s affected by European adults being older than their American counterparts).
I don’t know. Polytroposnjust said that median wealth there is higher. That not the same as purchasing power. But in any case I’m not sure if purchasing power in the abstract is the best correlating for life expectancy. Medicine and healthcare treatment in the us is almost certianly far more expensive in the us than any purchasing power advantage.
life expectancy is a synthetic measurement but Matt cites a study here that suggests rich Americans have higher death rates than average Europeans. https://www.slowboring.com/p/tackling-americas-weirdly-short-life
Skimmed it, which graph do you mean?
???? Not if the US in fact transfers less and part of its transfer is high cost health care,
There is a tinge of “lost cause” narrative that has always seemed implied with this “deaths of despair” stuff. It’s the great white calamity, visited on innocent people because of how the outside world hated their simple and elegant ways. You see, they have no option but to drink themselves to death because eggs are more expensive, the customer service number gives them the Spanish language option FIRST, and the coal mine doesn’t hire as many people. What are they supposed to do? Literally anything else?
I mean, the deaths of despair narrative always seemed kinda counter-cultural to me because these days, “fuck those white guys who just whine and moan” seems to be the far more dominant narrative. That said, narratives should be roughly accurate to be worth listening to.
I think the interesting thing about this is that they manage to get through to the audience that is most in on hating low education white people by selling this all as a story about how we shouldn’t be victim blaming.
An odd thing with the coal mine and mill towns is that there really is a high rate of DoDs in many of those places. So it can look like the loss of jobs CAUSED the overdoses, etc..
But to a large extent that's an illusion, because when the mill closed the more together people with options and drive tended to leave, so the people who stayed behind were the people without drive or options, ie the drug addicts, those with criminal records, health problems, those who can't afford a bus ticket out of town, etc.. And the trickle of people moving back in might be disproportionately down on their luck.
I've looked at the demographic data on Kentucky and West Virginia and there are counties that have lost nearly 80% of their population since 1960. It's less that the collapse of the economy caused problems and more that the demographic change more problem-people behind in some places.
Of course, the longer you stay, the harder it is to flee, and the cycle tightens. If you've got a lot of your net worth tied up in your house, as many Americans do--well shit, what does housing demand look like in a county that's lost half its population or worse?
If you're a young homeowner you might sell at a loss and keep moving with your life. If you've lived in the house 25 years you very likely were going to stay anyway, so the price doesn't bother you as much.
@wigan i hope this is not too much of a tangent from your comment but I think the same holds true on the upswing side of things in boom towns.
It's not like the fracking boom brought a great social situation to North Dakota or whatever. If you read anything about gold rushes or oil booms or whatever, if you create a bunch of high paying jobs for young men, the results are not necessarily great. They make money but they spend their money and time doing stupid stuff, mostly.
Factories are different because there is more reward for staying with a single company because you can develop firm-specific knowledge and you can have a stable community potentially build up around an industrial cluster. But just in general I think job creation is also a pretty overrated component of health.
If it's a tangent it's a great one! I agree that job creation is overrated for health for just the reasons you're pointing out: the relation between having a job vs getting laid off and health is much more complicated than "have a job equals healthy" "no job equals not healthy"
I on the other see more than a tinge of a unique animosity and hatred towards working class whites by educated Americans. It’s curious to me that some many Americans seem to be selective in their empathy based on skin color.
I think the goal is to be empathetic to everyone, and that is super hard. Have been thinking about this a lot with the I/P issues right now -- and many ppl are very selective in their empathy/outrage
I read "I/P issues" as "intellectual property issues" at first and was trying to figure out what was generating selective "empathy/outrage" about it, then the light went off over my head . . . .
Sometimes, it can feel like intellectual property issues are more intractable than even Israel/Palestine issues!
But is that even possible? We've been hearing about empathy fatigue for at least a decade. And while a noble goal--empathy for everyone--is it feasible?
I feel like this is where blanket policies can do so much good, by removing the need for empathy for any group at all, and making it a policy that will help everyone.
If not everyone than more people
I think empathy is overrated, to be honest. Instead of trying to empathize with everyone, and generally failing, maybe we could just fall back to "bad things happening to people is bad, and we should try to avoid/mitigate that." You don't have to read an NYT profile about someone to know that it sucks if they die young or suffer.
I think the empathy thing has been in part an attempt to do an end run around the in group / out group thing. Instead of saying, F those people, they're on the other side, you're supposed to understand their point of view and empathize with them. But of course people are still loyal to their political tribes, so the empathy thing often doesn't work either.
So my proposal is to say screw it and just fall back to the general respect for human rights that we should have had all along. Although obviously many people fail at that as well. We live in an F-ed up world, and there's no short-term fix for that.
I dunno, I see a lot of true lefties being weirdly compassionate to a category of people they really do not know well... There's a lot of social conservatism out there in that group, and it's not all about money. These are the "cling to their religion and guns" folks that can be an obstacle to progress. Sometimes rich kids from the liberal suburbs seem to think these folks are noble savages, but they are fully-formed humans with their own beliefs and agendas.
Yes, and strangely this lefty, for one, believes that even peole who don’t share my politics deserve to live a full life !
Yes, and I ask them to afford me that same opportunity. When they try to legislate their religious beliefs, that line is crossed...
Median incomes for non-college grads were stagnant for the four decades before Trump’s election. And still you mock. Even if the “deaths of despair” take was more hot than rigorous, the sad fact is the bottom 70% have stagnated needlessly
I'd like to write a lengthy paper that splits people into two groups
Group A makes good choices
Group B makes bad choices
Then lets all be surprised at how Group B has bad outcomes & make me a famous academic.
Goofus dies of a fentanyl overdose in a homeless encampment at age 26.
Gallant has an MBA and works in pharmaceutical marketing.
Unrelated, but as a Coloradoan and frequent snowboarder I wish ski resorts would put Goofus & Gallant comics on ski lift pillars.
"Goofus has a family meeting right in the lift unload zone. Gallant gets his children out of the way."
"Goofus sits down in the middle of the run entry to strap his bindings. Gallant goes to the side so he doesn't block everyone else."
"Goofus plays music on a Bluetooth speaker. Gallant strangles Goofus, and everyone claps while ski patrol helps hide the body."
Why are snowboarders always sitting down on the mountain? I don't understand why I always see packs of them sitting down on the cold snow, and then laboriously trying to get up from that position.
Skiing solved this problem for you! Why you do the less good option?
We sit down to strap up our rear binding after using the lift.
I cannot speak for every snowboarder, but I skied before snowboarding. Compared to skiing I find snowboarding to be a little more interesting of a challenge*, I like only having one thing to carry, it's easier on the lower body, and the boots are vastly more comfortable.
*For people who shoot, I compare skiing to rifle and snowboarding to pistol. Snowboarding and pistol shooting both take more body control and ability to override instincts than skiing or rifle shooting.
Yeah it's difficult to overrate the boot factor. Committed skiers spend an age and lots of money finding boots that are still less comfortable than the boots a first time snowboarder will rent. Huge barrier to entry.
Early contender for comment of the week. The layers of meaning make me want to go take a walk.
And we wonder why the Goofuses of the world mistrust us Gallants as we butter the shit out of our own bread under the guise of expertise and science.
This comment will haunt me the rest of my days, kudos
That's awesome.
A+ comment!
Except in the rest of the civilized world poor people don’t die as much from their so-called “choice” to be poor. This is gop level commenting here.
You can look at within-group outcomes by income levels and still find that making good choice - or really, bad choices - makes a great difference for how your life turns out. Arguably more of a difference when you are poor - when you are wealthy you have more luxury to get away with some bad decisions.
I grew up amongst the rural poor. Many of those kids were not interested in learning, but I took school very seriously as a way to escape the boondocks. My path worked as expected and I climbed up the income ladder. Most of those other kids did not. I maybe wish things were better for them, but I consistently encouraged them to be more like me & they consistently declined (to put it mildly).
This is NOT every story! But it is a real phenomenon, and there is sometimes a Lefty silliness that people have no control over their lives. This is an unhelpful attitude - oddly shared by religious extremists who expect Jesus to take the wheel vs solving their own problems.
Of course choices matters and personal responsibly matters and how good your parents were matters tons. That’s not an excuse to avoid better public policy and the huge difference in trend with Europe suggests strongly that such policy difference can make huge differences in people’s life. My big problem with the “bootstraps” rhetoric is that it seems like a way to rationalize and moralize the very morally dubious choice of avoiding policies that will dramatically save and improve tons of lives.
I agree re public policy, and I would like a stronger social safety net, better public education, and more social mobility.
I don't think I'm describing the "bootstraps" narrative in my opener, just by pointing out the relevance of individual accountability. And we do have a real American challenge around getting people to TAKE the opportunities they are given. Look at how a bunch of people refused to take a free awesome Covid vaccine. Madness, driven by individual bad decisions.
Well. Here I disagree. I don’t think Americans are “naturally” more or less likely to make good choice than Europeans. Ergo if they are on average making worse choices that itself is likely an issue to be addressed by better public policies. Vaccines are a good case in point. While the vaccines themselves were free Americans were hesitant because they’re used to paying much for healthcare, moreover being sick for one day due to side effects was *not* covered by the us government whereas Europeans have better sick leave policies and healthcare coverage for whatever side effects. Studies and polls suggests this accounts for some of the gap in “choice” of vaccines. The difference in public rhetoric presumably accounts for another slice of the gap. That’s not policy in the narrow sense but it’s still a matter of worse politics. Reducing this to individual choice is not helpful. You need to see the aggregate trend and try to account for the cumulative difference.
You mention the issue of Americans having less ability to take time off for side effects, but skip over the part about Americans being accustomed to paying for healthcare--it seemed the more relevant issue (that I saw referenced a lot) was that many people were suspicious of the vaccine on the basis of it being “rushed” (Fauci was saying it would take at least 18 months, it was approved in less than a year). The fact that it was free made some people even more suspicious of whether it was safe (if it was really that great, why give it away?)
I'm pretty sure there is a good deal of research out there showing that Americans are more individualistic and less trusting of government than Europeans. See the whole "nanny state" debate. So I think there definitely IS a cultural/psychological component to a lot of this stuff. There's not much we can do about that, so I agree it's often not helpful to spend time on, but at the same time not everything can be reduced to the impact of some government policy.
I have a goddaughter who is quite poor. I gave her baby things to play with attached to one of those plastic chains that hooks to the stroller, so the baby could amuse herself and exercise her curiosity. She would not use it. I have no idea what the rationale is to discourage your kids from learning and exploring. I have classmates who had to beg their parents to let them go to college (this was many years ago.) These values, which can perhaps be summarized by the old time country song "Don't Get Above your Raisin' " seem to be quite deep in certain impoverished cultures.
The bureaucratic world of education and government is inscrutable and threatening to a lot of people. I'm one of them. And not because my parents weren't smart and didn't do a good job, Mom went to Columbia and got her JD at Franklin Pierce, my father was a skilled craftsman. I had books and a good school and a therapist lol. I had a fine childhood, even if we were lower middle class because Mom and Dad didn't prioritize money/career. But the modern world doesn't make a lot of sense to people, and if you aren't adept at navigating it, it is very easy to fall by the wayside. This Is Not Bad Decision Making. This is a world that values paperwork and credentials that are gatekept. This is a world where the informal economy is throttled and deprecated by the State and the Elite. This is the world of Seeing Like a State. And lots of people hate it and fear it.
Now, I know a lot of this is the reason we have a fully electrified and networkes nation, and actual starvation is rare, and we have roads and schools. But it comes at a cost.
The arg here is this is largely a function of other governments outlawing or heavily taxing bad choices.
But you'd have to explain the choices.
Man. I miss cigarettes. I still smoke occasionally with my brother in law, a few cigarettes a month, but have a permanent prescription to Chantix to keep me from back sliding.
But as an ex-smoker, I’m relieved that cigarettes have gotten so expensive and frowned upon. It motivates me to refrain from a vice I enjoy. (Thankfully ai don’t enjoy vaping however). I’m a living example of targeted policies working.
I’m rather curious about the long term effects of marijuana going forward. I wonder what health effects we will see as smoking weed becomes more ubiquitous among a larger group of people.
As for despair... drugs... it’s hard to gauge. I think fentanyl and meth might be extraordinarily deadly compared with cocaine or the past... but who knows. It’s it more despair or is it deadlier better drugs?
I have some thoughts on this that I might write out when I get out of the gym…
Make sure u send me the link!
It's a combination of potency and route of administration. Powder cocaine is less dangerous than anything smoked or injected because the powder in the nose causes local vasoconstriction that itself limits the dose that is absorbed. You can't really overdose that way. There are no such limits on smoked or injected meth. Oral meth is still a problem, too., but probably mostly as a gateway to smoking or injection.
Fentanyl is so potent that it is medically dosed in micrograms. You can imagine how easily one can get too many micrograms of something, and street drug distributors and users aren't known for their precision. It's also absorbed through the skin, although the real thrill-seekers take the drug gel out of the patch and inject it.
I do quibble with Matt's argument that it's medication advertising that is the issue (though I abhor the direct to consumer (DTC) version). Medications like Oxycontin were not advertised DTC, which is what we are mostly aware of. They were advertised to providers through the usual professional channels (ads, articles in journals, conferences, paid speakers), which Europe also has (with the possibly exception of those drug company-paid lunch seminars). But I do think the fracturing and privatized nature of the US health care system makes it easier to have pill mills pop up., which drove the initial seeding of the population with oxycontin. I don't know how you'd set up a pill mill in Norway or France, or anywhere that has 1) a nationalized healthcare system and 2) fully integrated medical and pharmacy records.
>Powder cocaine is less dangerous than anything smoked or injected because the powder in the nose causes local vasoconstriction that itself limits the dose that is absorbed. You can't really overdose that way
I'm sorry what. Of course people can OD on snorting blow, they do it literally all the time
If that blow is laced with something else, sure.
Dude you are utterly, utterly wrong. I find people saying the absolute craziest stuff on the Internet lol
Potency dosen't necessarily imply lethality. LSD is dosed in micrograms too, but the dose that wil kill you is so high that nobody dies from it. In the hospital setting, fentanyl is used pretty frequently, but you know the exact dose, and you have Narcan on hand to reverse the effects.
Fair. It's not potency per se, but "therapeutic" window - LSD has a high threshold for harm, fentanyl a low one. My point about the accuracy of dosing outside of therapeutic use is the same as yours, though. Street dealers and users aren't going to dose accurately. They don't even know what they have. And of course the degree to which someone has a tolerance to the narcotic interacts with the dose level they get. Russian roulette.
One retort I've heard to that is "well just set up safe injection sites with staff that has Narcan on hand, and you'll reduce OD deaths to zero". I still think that's inadequate, because the staff will be reviving people left and right, and addicts are still living on the streets, living this marginalized life. My dream approach to this problem would be dispensing drugs like hydromorphone or morphine with controlled doses to addicts in a institutional setting, while slowly weaning them off in a long-term(yr or so) treatment plan, with the goal to eventually go onto a medication like Suboxone to help reduce cravings and the risk of relapse on an outpatient basis, while dealing with any other comorbid conditions they have(HIV, hepatitis, nutritional deficiencies from living on the streets) and/or job training, or psychological counseling. The current treatment programs are not long enough, or comprehensive enough to provide long-term sobriety. But, that would cost money, and community buy-in, although having residents no longer dealing with tent cities could be an incentive.
I agree completely. Harm reduction has its place but it can't be the only approach. You have to try to get people into long-term treatment, even recognizing that the relapse rate is frustratingly high. And suboxone is critical to longer-term success, but not a panacea. We could fund this if we had the will to do it. But it probably requires an even more comprehensive approach than this, to include housing support, job support, etc., and of course there will still be failures.
One simple solution is expanding drug court programs throughout the US, where you give people the option of charges being expunged if they undergo treatment, but you still need to make possession and use a misdemeanor or felony to be able to pull people into treatment, because while they may be mad at you and furious that you forced them into treatment, they may thank you months or years down the line that you did. Most addicts don't act rationally or think clearly, because their minds are clouded by drugs. It's amazing how much mentally sharper people are once they get sober. Some addicts do have coexisting or preexisting issues, like severe depression or hopelessness, but the drugs eliminate any possibility of those things getting better. That's also a place where skilled social workers can help.
there is the Swiss model -- for long-term users who have failed to quit by other means, just indefinitely give free* access to pharmaceutical heroin at safe injection sites (and in some cases, give people doses to take home). therefore no question of "relapse".
(it says here average user stays in this program for about 3 years, but 20% had never left at the time of the survey.
http://www.citizensopposingprohibition.org/resources/swiss-heroin-assisted-treatment-1994-2009-summary/)
*: it's not actually free, rather it is covered by compulsory private health insurance
Also, most of those programs were set up decades ago, before methadone treatment and Suboxone were used or available as maintenance medications. I think nowadays the goal would be be either those medications for a short time or indefinitely if some patients truly couldn't handle being off methadone or Suboxone, but the ultimate goal would be sobriety. We have more options now.
Yeah, the UK has a similar program, i'd just wonder who would be liable if the patient OD, the litigation around medical malpractice in the US would be a problem.
wouldn't you also have to force addicts into the program, which is a bigger problem the longer the program has to last. And if it's really long it may upend the addicts family or work life.
Right, that is part of the problem, and it's a balancing act between personal liberty and community safety, although because these drugs are so incredibly addictive, addicts end up stealing, robbing people, becoming sex workers, forging checks, or stealing from family members to get money to get their next fix. Getting drugs becomes this all-encompassing thing, where their whole life revolves around getting high, remaining high, or buying more drugs. You only have about 3-4 hrs with opioids after the dose wears off, before you start experiencing withdrawal symptoms. I just think that addicts entrapped by the prison of drug addiction, deserve something better for their life, and if that means the state temporarily reducing their personal liberty, to give them a chance at that, then I'm willing to take that trade-off. I don't think anyone grows up hoping to become addicted to fentanyl, or envisioning their life turning out that way, but the stories are always very tragic when you hear people's backstories of why they ended up in this place.
i'm especially interested in the data on vaping. lots of negative data but i'd imagine there may be worse effects we don't know about -- huge issue for my generation
Vaping very much strikes me as a positive harm reduction avenue against tobacco smoking, so I'd be curious as to what negative data you've come across. It'd be nice if more vaping was nicotine free for those who have yet to be hooked on that, though.
Agreed on both counts--especially the nicotine free.
It's of course possible that untold harms will arise in 10 or 20 years with vaping, but we know just how harmful cigarette smoking is, and many people would make the switch to vaping with some pressure. But the anti-vaping crowd seems motivated by a desire to keep anyone from doing anything *like* smoking, no matter how different it might be, on almost puritanical grounds. At least it seems to me.
there are a surprising number of people who never smoked but do vape (or use other non-tobacco nicotine products like those pouches). many of these people now have a moderately expensive and unpleasant addiction, even if the health harms are probably quite small.
to the extent this happens to a lot of minors as a result of marketing, it does seem like a problem, although the moral panic and draconian response that happened a couple years ago were really stupid.
Right. I think some people would prefer that humans never developed any vices, and I think that's a naive and potentially destructive tack to take.
To the extent that we can make vices less unhealthy, we should, taking into account explicitly that it's in our nature to seek out vices and escapes.
I once asked Matt for his take on vaping in a mailbag, and he didn't answer it. I try to avoid asking him repeat questions (HOAs were the one exception, and I somehow got lucky when he answered it from a non-mailbag comment I made), but maybe it just didn't make the cut among better questions, and I can try again after some more time has passed. Given that he's a former tobacco smoker, I think his take would be quite insightful.
As a young person (23yo, just graduated college) I don’t think I’ve ever seen a single member of my peer group smoking a cigarette in person. Meanwhile, I’ve seen dozens and dozens vaping; usually nicotine, but also weed. Most of these kids who started vaping in middle and high school were kids who would not have otherwise smoked cigarettes.
Seems like a very good topic for him--policy, regulation, public health, and personal experience?!
Hope you keep at it.
Weed use is becoming more common but I don’t know that smoking is. Edibles have been the big boom category since legalization, while vaping has been taking over smoking in parallel with how it has in tobacco.
I'm sure this varies state-by-state, but I remember when five dollars would buy a decent lunch and two packs of a cigarettes (a free lighter) were about a buck fifty; it was cheaper to smoke (which also killed my appetite) than to eat. That relationship literally inverted in less than a year with passing of huge tobacco taxes ratcheted up the price of a pack of cigarettes to five dollars. I literally could not afford my pack and a half a day habit and ended up quitting. (And gaining 20 pounds.)
I think the difference with weed is the lack of addiction. For me, having to restrict my cigarette intake was worse than abstinence, but weed was something you smoked when it was around and just didn't otherwise. Fentanyl is basically where tobacco was in the 90's; highly addictive and super cheap. Plus it kills you way faster.
A point that seems to be missed in the Slow Boring comments section is that a lot of fentanyl overdoses occur because people don't know they are using fentanyl. Dealers cut it into all kinds of drugs to enhance potency and create addiction. It also creates an addiction to an entire class of molecules (opioids). The meth heads I knew very deliberately took meth, got addicted to meth and then either went to jail, died or got off it. And they were snobs about it. They didn't like heroin or pills. They very specifically wanted the meth high.
I think the uppers and downers appeal to people in very different ways. There are some people who like both (even in combination) but there’s a good number who like one and hate the other. Both can be dangerous, but it seems that fentanyl on the downer side is much more dangerous than anything on the upper side.
It's interesting to think about who chooses which drugs (alcohol and cigarettes included) and why. The deep numbness reported from people taking Oxy, for instance, doesn't appeal to everyone. Likewise, the opposite extreme of meth for others. Let alone which are used in more social settings (weed, cocaine, alcohol).
Personally, my default setting is what you might characterize as "over caffeinated" so drugs that literally get you high (including caffeine) have little appeal to me. I had a roommate who was the exact opposite, kind of a slow, deliberate person. He was also an insomniac (sadly due to unrelated mental illness), so he worked a day job and a night job, often while on meth. (This particular place of employment was frequented by the type of people who would barter with drugs at 3:00 AM.)
But the heroin addicts I knew were just straight-up addicted. It really was all about chasing the high, almost like they were allergic to sobriety. It caused them to get into all kinds of trouble, including friends and relatives who got caught up in dealing and went to jail despite having every opportunity in life. I assume that is the case for other opioids like fentanyl.
I've known three former heroin addicts intimately, and they all quit it on their own--but became severe alcoholics afterward.
I think there's a lot to be said and learned about brain chemistry, that some people literally are wired to chase that high.
I know one that quit as part of a plea deal and who ended up quitting *everything* and is now an incredibly fit health nut. Another shifted to alcoholism. Another went to prison for a long time, so who knows what he is doing. But all three indeed have a proclivity for addictive behavior. Personally I stayed far away from addictive drugs except nicotine, which I was heavily addicted to and had a hell of a time quitting, which sometimes makes me wonder what would have happened if I had tried heroin.
Not sure about fentanyl, but opioids such as Vicodin and Oxycontin can have the "opposite" effect on some people, giving them a feeling of euphoria and energy that's very addictive.
Ah! I didn't know that somehow. I know a lot of people (myself included) feel sick/nauseous taking painkillers like that, but I hadn't heard about an energetic component.
I think the pathway that leads to opioid addiction is multifaceted, and isn't the same for everyone. Some of the people I knew in high school started using because of dysfunctional home environments, broken homes, and found that opioids helped for a little while, until the bill came due in the form of addiction, and now they had to feed their habit. It seems that older Americans were prescribed excessive quantities of opioids like Percocet, or Oxycontin, but around 2009-2010, states began cracking down on things like a 90 day supply of Vicodin, and setting up electronic prescribing databases to see what doctors were prescribing, and how much. This is why you rarely see paper scripts anymore, you actually need a waiver from the DEA to write paper scripts, and everything is sent electronically. Many doctors who were overprescribing were scared of jail time, or losing their license, and cut patients off cold-turkey. But, you CAN'T cut patients whose bodies have become accustomed to opioids off cold-turkey. You have to slowly wean them off, if they're going to come off the medication.
I'm not a big Joe Rogan fan, but he recently interviewed Kurt Angle, the famous WWE wrestler and Olympic gold medalist, who won the gold at the 1996 Olympics in Greco-Roman wrestling. He said that despite all the injuries he suffered over the years, including breaking his neck numerous times, opioid withdrawal was the most painful thing he'd ever experienced. Every time you buy heroin, fentanyl, or any other opioid off the street, you have no idea of the purity of the drug, and it's essentially a coin flip whether you'll OD or not. Opioids are uniquely deadly, because they bind to opioid receptors in the brain, which control heart rate, and respiration, which is why you stop breathing.
It seems to me that cocaine is a "party" drugs that people are just as likely to take when they are doing well in life or having fun at a party. And meth and meth-like drugs start (for some people) as a way to cope with big workloads that they me actually be excited about, not despairing of.
Meth is also very much a party drug - at least, among people who like male-male sexual parties.
Today I learned...
The movement for the legalization of drugs is a criminal folly. I could have stomach it when it was supposedly just about weed (still a bad idea but at least to be seriously contemplated) but now it’s full steam ahead to 19th cent standards. Absolutely awful. Why on earth is our politics so dysfunctional as to allows such legalization (cf Newsom’s commensensical vetoes this week. Why is the California legislator so bonkers? Seems to me like the mirror image of gop “guns for every child” politics)
The things I heard of him vetoing were a bill to legalize cannabis lounges, and a bill to legalize psychedelic therapy. Even if you think those are going to have massive broader outcomes on those drugs than just the supposedly targeted legalization, those drugs really aren’t dangerous in these ways.
I thought it was a bill to legalize psychedelics period. My bad !!
You may be right and I may be wrong! Still, psychedelics cause very few, if any, deaths, despite moral panics about people jumping out of windows thinking they can fly in 1967.
It would certainly cause social disruption I suspect. There is a reason why all this stuff was banned in the first place!
Reading more about the culture wars of the 1960s, and Timothy Leary in particular, it seems that psychedelics were the victim of a moral panic that resulted from the particular ways Leary was pushing them. If the face of psychedelics had been more Carlos Castaneda or Aldous Huxley, and there hadn't been as many people doing them at big public parties, they might never have been banned.
I also wonder if another reason was hindering social productivity. With cannabis in particular that seems plausible.
My teen son says weed is a "cringe old person thing." Given who was in the lines when our first dispensary opened locally last year, he may be correct. Perhaps that is because older folks have more aches and pains, and it may only grow as an "old person thing?"
What are the based drugs of choice for his cohorts?
Same old, same old - alcohol.
Among my cusper Xer/Millennial cohorts, there was some serious ¿por qué no los dos? energy. I was never super into cannabis aside from social gatherings, though.
Drunk people are a nuisance but tipsy people can be fun. Smoking (of all kinds) always stinks. That’s my deep philosophy on the issue.
Cannabis has long been looked down upon as a "slacker" drug, fairly or unfairly.
They smoked inside the coffee shop? How could anyone withstand the stink?
I certainly already view it that way. It’s disgusting, smelly, and ought to go the way of cigarettes.
I think you'll see a bifurcation between casual users, who use once a month, and heavy users with problematic use, who are using every day, and go through life in a cannabis haze every day. I'm not sure what percentage of people use that frequently, but if it's even 20% of cannabis users, you end up with a lot of apathetic, unmotivated, stoned people. Driving around, I smell a lot more weed coming from people's cars than I did 5-10 years ago, which I think is incredibly reckless, but people seem to think that because it's not alcohol, it's fine.
Was this just for Amazon drivers (could make some modicum of sense) or for everyone at Amazon (no way)?
Right, that's the inherent problem with cannabis testing is its unusual lingering in the system after consumption. I'm not inherently opposed to drug testing for professional drivers, but it needs to be a test that can actually detects impaired driving while on the job.
At these prices??
Good luck with that given how easy it is to grow, it's called weed for a reason.
Eventually you'll reach an upper bound by generating a sustainable black market, and with cannabis that's proven quite daunting so far due to its ease of growth. Getting it legal everywhere would take out another aggravating factor.
When I wrote my book review on Deaths of Despair I noted how the authors completely ignored supply side factors with guns, opiates, and alcohol.
Gun proliferationists facilitated suicides. Purdue and company legalized opiate abuse for a period. We have had a relaxing of alcohol laws and increases in ABV.
Reading their book it seemed like an outsider’s take of what is going on in desindustrialized areas. It seemed very conjectural.
As an alumnus of a Big Ten school, seeing "Purdue" when talking about opioids always causes me to momentarily pause. Until today, I never actually checked why the school and the company share a name. So, in the interest of those who might share my situation:
"The pharmaceutical company was founded in Manhattan in 1892 by John Purdue Gray and George Frederick Bingham as the Purdue Frederick Company. Purdue University was founded in 1869 as Indiana’s land-grant institution, named for benefactor John Purdue."
Many people are saying that potent synthetic opioids were invented as a form of palliative care for fans of Purdue football.
At least they had Drew Brees and Kyle Orton to watch back in the day. They've had it better than their in-state rival has.
Meanwhile, Notre Dame needs to be reminded that IU and Purdue play football.
And just to further confuse things, there is also Perdue Farms, most notable for its chicken. Also, TIL that there's no connection to the Perdues from Georgia, namely Senator David Perdue and former Trump Ag Secretary Sonny Perdue.
ABV increased for *craft* brews, but the DoD crowd don’t exactly drink those. AFAIK Bud and Miller Lite are still in the ~4.2% range they’ve always been, which is considered a session beer these days by craft snobs like myself.
So, no, ABV creeping up doesn’t have anything to do with it.
There are other cheap drinks besides beer though
Indeed, but there's a difference between "the ABV of the average drink consumed is increasing" and "the ABV across this industry or subsegment is increasing".
For instance, as I demonstrated, the average ABV of beer can increase, but if that's mostly from craft brews that the DoD crowd don't drink, then it loses explanatory power.
However, maybe the DoD crowd shifted from beer to liquor. Okay, now we're getting somewhere! That's definitely an ABV increase, right? But again, in the liquor industry, most of the ABV-creep has come from high-end brands -- you've got Wild Turkey coming in at 94 proof, and then Wild Turkey's "Special Super Duper Select Single Barrel Angel's Ass-Crack" coming in at 110 proof and also $90 more expensive. The industry's average ABV is going up, but is the economically-pressured DoD crowd really drinking WT's SSDSSBAAC, let alone WT, or are they drinking whatever's $2 cheaper than Evan Williams down there on the bottom shelf?
Also, how much are they mixing it? Even if the average ABV across liquor is going up, maybe people are just mixing more mixer in. Or less! The point is, the amount and ABV of liquor *produced* simply can't be assumed to be directly proportional to the amount and ABV *consumed on any given night* [ed: and it's the depth and consistency of the binges that is most directly linked to liver disease. If I'm drinking 2 low-ABV beers a day and then add in 1 super-stiff drink once a month, my average ABV consumed spikes up, but I'm not going to get liver disease. But if I'm drinking a bottle of whiskey a week (or more), then the amount of mixer does start to matter on the margins, and we're really talking about margins here after all.]
Maybe it's a reasonable proxy, but the more of these "reasonable proxies" we rely on up and down the chain of the DoD argument, the less power the argument carries, and the more correct Matt is vs Dan here.
“Social ‘scientists’ are mostly charlatans, story at 5.”
Not sure this is news…
No, sir, it’s other social scientists who did the work to debunk the “deaths of despair” meme. Yglesias relied on their critiques to inform his views and is just summarizing these for us. The review and challenge around this issue is a good example of good social science.
"Mostly" is consistent with a world where all of the reasonably competent sociologists have to spend all their time wrestling the meme-friendly bullshit turned out by their hack peers back into the grave...
I think meme-friendly bullshit will exist whether or not social scientists exist (for example: Aristotle on "natural slaves"). But the "reasonably competent sociologists" who debunk the bullshit won't exist without a social science industry.
Note that this is one of the cases where *economists* (which people with your attitude often think of as the “good” social scientists) are causing the problems while other social scientists are attempting to clean it up.
Eh, they were protected by seniority and tenure at an Ivy. I would take this as a case of ivory tower elitism.
Someone at a flyover R1 finds something important and valuable? Crickets. Someone at Harvard tweets. Accolades.
I don't think of economists as any more rigorous than the rest of the social sciences, lol. If they were there would be some degree of fundamental agreement on core knowledge and there doesn't seem to be.
As I noted above, their task is legitimately hard: discover explanatory mechanisms for shit without experimentation. But so few of them seem up to it.
It’s like the reverse Matthew Desmond effect
Yes, but economists have tremendous training in quantitative techniques that most other social scientists lack. For the past ~30 years, economists have "pinch hit" in other disciplines when a quantitative paper can make an interesting claim, to the point that I'd say it's now just part of the discipline.
You people only read about social science research that's extremely overhyped and news-prominent, and often only because it's being debunked by MattY or similar, and then you conclude it's all bullshit, thereby commiting the same selection bias error that social scientists SOMETIMES fall prey to
I actually used to read quite a lot of social science, especially back when I was a grad student with tons of journal access and very slow-running FEA models. A lot of it is bullshit, shot through with problems with methodology and statistical analysis that are glossed over in favor of reaching a desired conclusion.
But you and the other commenter are correct that my pre-coffee hot take is uncharitable.
It should be something more along the lines of "A lot of 'social scientists' are charlatans, news at 5."
Ya fair. I'm a statistics PhD and basically agree with the lukewarm take that social science broadly has some problems and econ tends to be more rigorous than like sociology/psych/public health. But I see people (especially this comments section) hyperfocus on stuff like today's topic and throw the baby out with bathwater, effectively concluding that punditry and their own hot takes are more reliable than academic research
I don't think punditry and hot takes have a particularly high success rate either, they're just low-value in terms of time to craft *and* time to consume so no one cares when something you read six months ago turned out to be wrong. For folks like those on here, I'd like to think that remembering those failures goes into people's heuristics about the future, I know I try to recall what I've read and said that turned out to be terribly wrong before talking about the issue du jour.
I have read so very many papers that turned out to be bullshit but seemed plausible at first reading, and skimmed so many more that were transparently bullshit to start.
In the hard sciences everyone is trying to produce something novel and hardly any novel results can be replicated. In the soft sciences everyone is trying to produce something counter-intuitive and the vast majority of it turns out to be bullshit.
In both instances, not enough researchers are willing to devote time to replicating other work quickly so all but the most sensationalist bullshit claims go unrebutted for years.
It's a mess. Exacerbated by the fact, as I pointed out yesterday, that journalism doesn't pay enough to attract solid, knowledgeable, capable "explainers of complicated issues" who have or can learn the necessary degree of subject matter expertise to understand, simplify, critique, and trust/not trust the experts. Most mainstream outlet reporters, at this point, don't know which bits of their interviews are relevant for quotes, let alone how to elaborate or explain their sources' statements, let alone judge their credibility!
The soft science-hard science distinction in terms of rigor seems less and less valid these days, at least according to research on potential p-hacking by field.
I mean, to be honest I kinda sympathize more with the soft disciplines.
Their hacks are hacks because their job is *hard*.
The hard sciences’ hacks are hacks because they think their job is boring.
I won’t say you’re entirely wrong but from my (limited) observation Discourse Enjoyer’s original point still kinda stands. And in fact there’s even a almost self-congratulatory atmosphere around it. Which has an incongruous vibe to it since this comment section’s participants typically frame themselves as being better than the one they mock. But again that’s based on my limited experience here.
To your point about journalists not being paid enough, one thing I've been noticing recently is that almost no jobs pay enough to keep out hacks and charlatans. Caveat emptor!
Has any society ever gotten much value out of its least talented tenth? The least talented tenth is not a huge problem under Malthusian conditions as they are culled every time grain prices rise and this mechanically increases their genetic quality and, once grain prices moderate, improves their overall virulence.
Societies with Western levels of wealth can heavily subsidize the bottom tenth. Instead of watching them die from malnutrition or polluted water, we watch them drink and smoke and medicate themselves to death. This is, in a very real sense, what humanitarian progress looks like. Matt is certainly correct that nanny state regulations could make the bottom tenth die even more slowly, the question is whether the top 80% should sacrifice even more for a group that already contributes much less than it takes.
(Whether and to what extent the second decile is a net contributor seems complicated and contingent).
This is genuinely one of the most awful comments I've seen in this comments section, ever.
That’s his thing, the resident edgy guy floating at the borders between evolutionary biology and social Darwinism.
David Abbott strikes me as the commentariat member most likely to have a personality disorder.
I embrace evolutionary psychology fully. However, social darwinism is an anachronism, more fit for societies with far fewer means to cultivate gardens than 2023 America. The question is to what degree should the strong and the normal sacrifice for the weakest. I do not think the answer obvious
In his defense the Lake Erie piece noted a significant gap in seatbelt usage and its effect on life expectancy.
If people are dying in 2023 because they won’t wear a seatbelt then my sympathy for their plight begins to wain. How much effort should we be putting into saving people from themselves?
people who make crappy choices still have kids! If nothing else, preventing harm to those who failed to choose better parents justifies plenty
if you are a big enough loser, it’s better that you die than stay home, trade your kids food stamps for malt liquor, and beat your girlfriend
>If people are dying in 2023 because they won’t wear a seatbelt then my sympathy for their plight begins to wain.<
I mean, sure? But is there something about Ohio DNA that's uniquely stupid compared to what's in the cellular nuclei of Pennsylvania and New Yorkers? My guess is no, which suggests public policy can indeed play a role in protecting people from their own ignorance. And probably should play a role in protecting people from their own ignorance.
But no can do in Ohio. Because John Galt.
I was hateful but this is just fine!???
Not following you. I didn't join the pile on at your comment, by the way, but surely I wasn't engaging in anything remotely resembling "hate" with mine. My point (I thought expressed clearly) was that petty libertarianism gets people killed if it manages to dictate public policy.
I would say Youngstown and Findley might be evidence of this, but most regions got weird places.
The Coast Guard risks their lives to save people stranded at sea. Cops and firefighters try to talk people off literal ledges. Doctors work to save people who injure themselves.
Note that all of these actions are seen as heroic.
I’ll use the example of mandatory evacuation orders before a hurricane. After folks have been warned repeatedly that they have to leave, I’m totally fine with police, fire, coast guard telling people they are on their own.
Are you aware that this is not actually what happens, and those people expend significant and risky effort to save those people anyway?
And they shouldn’t waste their time. Walk me through why you think people should risk their lives to save those who have repeatedly refused to abide by an evacuation order.
Aren't most of the people staying behind the ones that can't get a place to stay or way to flee? It's not like entire cities can just up and move with no issues
Any halfway decent state or county government has plans and resources in place to deal with that situation.
I’m thinking of the residents of barrier islands who have the means and opportunity to evacuate but chose not to.
What could it be about the place that means that one place has more people who still don’t wear seat belts and the other place got over that in the late 1970s? Is it because one place just has worse people? Or is it because there was a different set of policies around seatbelt use adopted in the late 1970s that has had time to work on one population, but not on the other?
If seatbelt-wearing is all about laws, why doesn't New Hampshire have the highest car-crash death rate in the country?
As a NH native, all people under age 18 are required to wear seat belts, so by the time you're an adult you just do it anyway.
I doubt it's "all" about laws. The majority of people realize seatbelt wearing reduces their odds of death-by-car.
I think it's about *marginal* cases: those who are too lazy/find it uncomfortable or are uninformed as to the statistics. Some of them will wear a seatbelt to avoid getting fined.
How much effort? A lot, that's how we who smugly think we're smarter actually got here. It may seem to you self evident that folks should wear seat belts, and yet for decades seat belts sat in cars unbuckled amongst both the smartest and the dumbest. It took big pushes and coercive measures to get to the point where you have probably never not worn a seat belt, but your parents and certainly grandparents went years without wearing one. The forces and inclinations that made your grandparents too stupid to wear a seatbelt don't go away. So we, as a society, need to always continue the efforts to overcome them, it may not be as extensive a fight over time, but there's no reason to think that if we stopped now your grandkids might not bother to buckle up.
How are seat belt laws even being enforced these days anyway? Checkpoints devoted solely to that are inefficient. Tacking it on after pulling over for an unrelated moving violation could work, but it's not the main goal. I'm sure someone will mention traffic cameras, but my gut instinct is to shudder there, warranted or not.
It's the middle option for adults. You won't be pulled over for driving without a seat belt, but if you're pulled over for speeding and aren't wearing one it's an extra fine. If a minor isn't wearing a seat belt in your car, that might be enough for you to get pulled over on its own
The middle option can also be dismantled by quickly putting your seat belt on before the cop gets to your car. The question is how many non-seat belt wearers will have the wherewithal to do that.
what did i say that is untrue?
I mean, you ignore social mobility statistics completely, for one... the bottom tenth of the income distribution is mostly very, very transient.
A lot, if not an outright majority, of the bottom half of the income distribution and more than a few folks up to the 80th percentile will find themselves at the very bottom of the heap for a year or two of their lives, and the middle-class folks are likely among the hardest hit emotionally when they do.
I think you're mostly right, but I feel like I'm kinda gonna split the difference. Social mobility is very specifically the reason not to excessively counteract the disincentives of poor decision making. Overinvesting in programs that insulate individuals from the consequences of their choices is subsidizing bad choices regardless of the psuedo-evolutionary woo in the initial take. Incentives are more important than who does or doesn't deserve a particular outcome whatever the basis on which you choose to define "deserving".
Ehh, in the abstract I agree, but that is very far away from what we actually do to soften the realities of life for the poor. We are in no danger of providing the bottom decile with a "free" standard of living that disincentivizes folks from getting back out of it, as evidenced by the very social mobility statistics we're discussing!
EDIT: You also have to recall that you're not splitting the difference at all. David is likely *more* in favor than I am of coddling the shit out of the poor. I mostly think that if we had a functioning healthcare system and squeezed the rent-seeking out of that, education, and housing, the current limited social safety net would be more than sufficient to protect people from horrible outcomes due to uncontrollable factors. The rest of our efforts should be on improving primary and secondary education and the social services which help kids escape their parents' fuckups.
Responding to the Edit:
I think you're right. A closer reading of Abbott has a little more of a noblesse oblige thing going on than I caught on first pass.
How do you square the "we are in no danger" claim with the data presented at https://johnhcochrane.blogspot.com/2022/12/calomiris-on-gramm-ekelund-and-early-on.html ?
There is difference in that the graphs there use quintiles, not deciles, so perhaps your claim is that post-tax-and-transfer the bottom decile is a lot worse off than the second decile? That's possible, but would imply that the second decile is a lot better off than the next 4 deciles' average....
My read of the data is that the US successfully implements social transfers that keep actual "money you end up spending on things or having spent on things for you" about flat for the bottom 60% of American households.
Now some of that "money spent on things for you" might not be spent the way you would spend it yourself, so it's very possible that the bottom 10% ends up with less disposable income in practice than people in the second quintile. That would require a bit more analysis. But that's a subtle point that would need measurement, not an obvious "no danger" slam-dunk.
Right. I think the two actual dominant strains of thinking about poverty in the US are:
1. Paternalistically imposing "better" choices on individuals than they would make for themselves.
2. Zero sum bullshit about redistributive taxation.
both of which I consider hot garbage, but others mileage will vary.
I said least talented tenth, not lowest income tenth
Then why are they the ones who starve to death amidst grain shortages, or poison themselves in poverty?
there’s a lot of overlap! however, there may be some high functioning neo pastroralisr types or (dare I say) higher education students who are in the bottom tenth of the income but are quite talented.
there are plenty of old people who are in
the top half of the income distribution but whose talents have withered into oblivion. anyone in a hospice or nursing home is, almost tautologically, in the bottom tenth of the present talent distribution. ditto babies and toddlers. of course there’s also average talent over a lifetime. the world is complicated!
My brother in law was not only a fantastic human being but also a very successful and smart businessman who owned a company that large commercial construction projects.
He was a drinker like his Dad and he slowly descended into alcoholism. When the economy took a downward turn his business ran into some trouble and his drinking increased. Within about a year, the business was dead and he was drunk all the time. He kept descending, became homeless when his wife kicked him out and the rest of the family couldn’t handle him and his behavior anymore. He drifted between homelessness, various treatment programs and family. He was, by this point, physically addicted. And the story ends with his death in his mid-50’s.
He was in the top 10-15 percent until he wasn’t anymore, and his final years he was in that bottom 10 percent.
I’m not sure how to categorize him in the various schemas, but it makes me think that many in that bottom 10% are addicts or have mental health, or other issues. When he was homeless, all the people he hung out with were addicts or not right in the head.
You say this because you can’t say “you’re wrong” and you know it.
No I said this because being wrong (which the comment of course is) is a regular occasion here on the Internet but being a horrible person is slightly less so.
It’s very social Darwinian.
I think he is perhaps my teenage son - writing things just to get a rise out of me.
I'm always aware that teenagers will do this, and once aware of this, it's fun to spar back with them when they think they know the whole world and get them caught in a logic trap. Though perhaps not as applicable for one's own teenager.
It is possible to design societies that do a much better job of protecting the lowest decile. And the reason for doing so is that as Westerners we believe that it could have been us. We could have been born into that position.
Obviously if you take the Nazi position of Survival of the Fittest, or various religious notions that the unfortunate have been granted their misfortune by God for good reasons, you would act differently
Also, for a large part of those who are in the 'bottom tenth' it doesn't have to be permanent, people's circumstances change over the course of their lives..
Unless we design things so that they die there, of course
I think I'm safely at or above the 95th percentile of Slow Boring subscribers ranked by admiration for Friedrich Nietzsche, and I don't care for this comment at all.
In the US there is no "lowest decile" in the way he thinks of it. It's a very transient status, to be that poor. Many folks are at some point in their lives, and very few of them stay that way for very long.
Definitionally, there is always a "lowest decile" of the income distribution, but it's not a concrete group of "evolutionarily unfit" people or whatever fantasy he's concocted so he can say something edgy.
To be fair, he isn't talking about the lowest decile in income. He specifically said the lowest decile in "talent".
One can quibble about how one defines "talent" but I would argue even the lowest decile still contribute meaningfully to our society (those with Down's Syndrome as an extreme example).
I elided that distinction because it just makes the whole thing even more incoherent. What's the measuring stick for "least talented," after all?
David is not stupid, and makes great points now and again, but he's obviously the sort of person who enjoys saying shit to get a rise out of people, and then calling it "thought-provoking." I've learned to just let most of it glide by, but this one was easy enough to disarm, and I hope my point defuses a bit of the tension that built up in the responses.
>It is possible to design societies that do a much better job of protecting the lowest decile.<
Virtually every rich country does better than the US in economic mobility, though there are some sizable difference within the US. Utah does a very good job, I'm told.
absolutely. the question is at what cost and how much should the people in the top decile who do the designing sacrifice for the bottom decile
Relevant https://dgardner.substack.com/p/the-just-world-fallacy
Americans in the bottom decile today have longer life expectancies than the Victorian gentry. My question is to what extent should normies sacrifice for the unproductive. My personal attitude is beans and rice are cheap, but once you start asking for expensive services, I’d like to know whether you 1) contributed while you were healthy or 2) might make something out of society’s grace in subsidizing you
1) If we financed life situation transfers out of a VAT you did.
??
I work at an access four-year college where I specialize in helping students who aren't ready to start as freshmen. In other words, I specialize in helping the bottom 10% (ok, maybe 5-15%, with the bottom 5 never even enrolling).
In my experience, very few of them lack the intellectual ability and moral fiber to contribute constructively to society. It's much closer to a "there but the grace of god" thing than "these are born failures" kind of thing.
It's just my anecdote, and I'm naturally inclined to think my work is useful, but the kind of analysis you have delivered here seems both deeply flawed and hopelessly heartless based on my lived experience.
The bottom 10% of the population is not the bottom 10% of those who attend college. The bottom 10% doesn't even think about going to college.
I think anyone who is going to college at all is in the top 70% most educated.
This (and John's reply above) does not reflect an understanding of who open-access (meaning everybody is accepted) secondary institutions serve. We get a ton of people who dropped out of high school, come from broke-ass backgrounds, and present as marginally literate. Our attrition rates (dropouts) are super high. One comment thing we consistently see on student surveys is that about half of them never thought about attending college two months before they enrolled.
This is the real mission of public ed in the 21ist century: Reaching historically under-served populations.
Here is an anecdote to illustrate: Last month, I had to spend an entire 50-minute class session teaching students how to reply-all to an email and attach a file to their message. I had to begin with "how to save a file onto your laptop." First I showed them how to do it, and then I walked around behind all 24 of them to make sure they got it, stopping to walk about a third of them through the process individually. For several I had to repeat the instruction in a second language.
My point is that the they often present as hopeless upon arrival, more hopeless than I think many people realize.
I didn’t catch that you are talking about that kind of institution!
The bottom 70% have no business going to college. That many parents are embarrassed to send their kids to trade school is a horrible indictment of America.
We need electricians much more than liberal arts grads.
This presumes that we should make public education be for the employers who will benefit from students' future labor. I feel that public education should be for the student, the overwhelming majority of whom don't want to be electricians.
What the public funds should be for the benefit of the public. That includes benefits to the students, but it should also net out to a positive for society as a whole. That way its more than self sustaining.
Its unclear to me that encouraging the bottom 50% of academic talent in the population to expend additional years of their lives in academia is a positive. This is especially true when there are other careers that don't require this additional training. Given that when the economy is strong, fewer people attend college suggests that there is a decent subsection of the population that wouldn't attend college if other good choices are available.
What a beautiful thought...
Some might say the reason society exists is so that humans can get value from it, not so that it can get value from them. But what do I know.
This is the correct answer.
My most extremist libertarian impulse is that it's absolutely my natural born right to drink myself to death in a ditch if I feel like it.
I doubt I end up as extreme as you, nor as nihilistic as Abbott, but one of my views that I'm guessing is quite unpopular among Slow Borers is that I don't get as alarmed about lower collective life expectancy as others do if the premature deaths are coming solely from one's own actions, and I will usually default to being resistant to policies that restrict actions to account for those sole actions of others.
Note that current policy isn’t leaving the bottom 10% to die at the same rates they have - it is accelerating the deaths of the bottom 10% least educated people. Can we stop doing that? Or is it a good thing for society to accelerate the cull?
Why are you the way that you are? I hate so much about the things you choose to be.
We should stack rank society. Every year, the bottom tenth will be ground up for cat food.
However, because stopping there will just lead people toward shenanigans, we will grind the top tenth up for dog food.
This will eliminate problems, create jobs, lower the cost of having a pet (thus combatting depression), lead to a more equal distribution of income, and instill neurotic discomfort with both success and failure in everyone.
"You live in a very cold, dark, sad and lonely place mentally."
Dude, be nice. Evil doesn't have to correlate with unhappiness.
Toward the end of the original weeds lineup you guys did an episode on the decline on life expectancy. In that episode Ezra basically made the point that if this were really about "despair" people in Portugal (a country that essentially experienced an 8 year long recession) would be dropping like flies.
Ezra at some point (either in this episode or another one) proposed basically taking every single public health related policy idea and stacking them all on top of each other to see which ones would save lives the most efficiently.
I think these ideas were sort of aligned with the public health establishment's line of thinking at the time... basically we should try to do whatever it takes to save lives. At some point though it has become anathema within the Democratic party to concede that nanny state policies are super effective, which is why the prevailing public health narrative is a story about economics written by economists.
I have to disagree.
It’s not really clear to me that California has that much better public health policy than, say, Ohio. But what it does have is good weather that makes life fairly pleasant all year, without the manias and depressions induced by seasons. Portugal is probably similar.
I'm a bit more critical of the Washington Post article by Weber, et. al - Ashtabula County, OH is not that similar to Erie County, PA. The latter is naturally home to Erie Pa which apparently has 95k people. In the grand scheme of things being the biggest city between cleveland and buffalo isn't a big deal, but it makes a lot of difference in terms of what jobs exist as well as the size and quality of the hospital systems. Presumably a lot of people in Ashtabula work in Erie (or maybe Cleveland, idk), which leads to increased travel times - the census bureau estimates the mean travel time to work as being 25.8 minutes in Ashtabula and 19.9 in Erie. Traffic death statistics don't mean that much if you don't adjust for miles driven. Erie county is also somewhat richer as well though the poverty rate is similar.
Maybe that's a nitpick, and it doesn't make the conclusion wrong, there's just a lot of confirmation bias in what gets put out and then in what gets criticized. The Case & Deaton article was popular because it felt right to people, this article is good for those that support public health regulation and good for the Washington Post because it's framed in a pro-Democrat way. Is everything else not just working backwards?
It's a good nitpick. Adjusting for urbanization should be standard fare.
Great article. One correction: There was not a “post-Floyd depolicing.” And certainly not one that remotely explains the widespread, nationwide, bipartisan-city increase in the murder rate.
I don't think de-policing is quite the right word, but arrests, stops, prosecutions, jail intakes and prison populations have fallen, on average all across the country and stayed down since 2020. It wasn't merely a covid blip. I can point you to multiple sources of data if you have specific doubts.
It's also wrong to say it's been merely about police, since everyone from crime labs to prosecutors to judges to mayors have taken little bites. Each city has had it's own story with a little more of one factor or a little less of another, but altogether that's the broad outline.
A very detailed investigation on how this has played out in Washington DC is available at this substack: https://dccrimefacts.substack.com/ Arrests and stops are way down, of arrests, prosecutions are down at least 50%. Sentences for some crimes are down. New de-escalation procedures have made time-per-arrest much higher, and the police workforce has been shrinking, which lowers time spent policing and pushes a higher share of the time to overtime.
Maybe it's not right to call it de-policing, but something changed.
The stats that I have seen have shown an increase in crime where policing is down AND where it’s not. But let’s assume for the sake of argument that policing is down everywhere that crime is up; that’s not remotely enough to suggest causation here. There was a HUGE societal disruption. Crime spiked afterwards and then has come down as we have gotten further away from that disruption. Pointing to policing as the cause rather than any of the many, many other enormous changes in society at the same time is no better than guessing.
Sure, there's always going to be guessing. But we don't see comparable surges in crime in other societies, Canada's murder rate barely budged and Mexico's murder rate actually went down, to use two very different examples.
If less people are going to prison, less people are in prison and fewer police are working in the highest crime neighborhoods of America in 2023 than in 2019 then I think there is more than a remote chance that there's some causation. The covid thing seems more like a wild guess, as there's no clear mechanism by which "I was temporarily laid off in 2020" leads to murdering someone in 2022, and areas without big temporary covid restrictions also had murder spikes.
I agree with you Wigan but I think, at least from how I’m taking your wording, you’re being a bit TOO harsh on Jeremy’s point (if that’s the best word). He’s not simply just saying “oh gotta work from home” but like the general overall disruption to everything that happened in 2020 (not to mention the lingering trauma from the experience of the first 6-10 months of covid uncertainty and loss). I think that’s definitely something worth always keeping on our minds since it was so severe.
I don't mind keeping it in mind but I think it's unhelpful in terms of understanding the crime surge. My argument is very similar to MY's in the piece we're commenting on. "Despair" and "Disruption" are too vague for analysis or response and the actual drivers were much more concrete.
And the disruption narrative does nothing to explain why crime levels have remained elevated. They are not returning to normal, either. Instead they are slowly drifting down in the same way that they've slowly drifted down for most of the last two decades, except when punctuated by upticks that always seem timed to depolicing movements gaining strength (late 2015, May 2020).
At current trends it will take another 3 or 4 years for homicide to recede to 2019 numbers and I don't know how "pandemic disruptions" can explain that?
To be fair to that point of view, my (probably unpopular) hypothesis is that good economic circumstances seem linked to HIGHER crime, and bad ones seem linked to LOWER crime, for example crime fell in 2008. In 2020 all of the sudden everyone was getting covid relief money, and that was followed by a period of very low unemployment.
Contra the expectations of most people, very little violent crime is committed b/c of hunger or to relieve poverty. Most seems to be about arguments, drug addiction, domestic disputes, jealously, ex-girlfriends, etc...The bottom 10% suddenly had a lot more money to buy drugs and live kind of wild, and that has outlasted the pandemic. So maybe that's why it's high and it has nothing to do with de-policing or the justice system.
I won’t lie, that’s a hypothesis that I’ve never heard and honestly maybe with some tweaks, sounds like it could be right. Although how would you explain the slow drift of crime rates through the 90s and so on?
Also, I’m of the mind that some of the crime talk should be better disaggregated. Like perhaps some subdivision of crimes might go up when people have a better economy (say armed robbery or theft) and others when it’s bad (domestic assault) but data constraints make that all but impossible and it’s frustrating.
In most cases, it was the police themselves who initiated the depolicing: “ But it’s clear that big cities in particular have experienced much sharper declines than that. In Seattle, traffic stops are down 90% from the pre-pandemic average; in New York City, almost 40%; in St. Louis, 22% since 2019 and 47% since 2009.”
https://www.washingtonpost.com/business/2023/10/10/the-decline-in-police-traffic-stops-is-killing-people/8325eac8-6760-11ee-9753-2b3742e96987_story.html#
Yes, traffic stops are down in cities that moved hardest to remote work. You know what also fell in those cities? Traffic.
That point aside, there was a major disruption to everyone’s way of life in 2020. Even if there were a robust *correlation* between a drop in policing and an increase in crime during that period (there isn’t), the idea that the policing *caused* the crime increase--rather than the huge increase in gun sales, the sudden pandemic spike in unemployment, the shuttering of neighborhood organizations, the closing of schools, etc.--is utter speculation.
Agree it is speculation, but it seems like a better speculation than these other factors you mention since they were mostly temporary and local while the murder, traffic death and overdose spikes were national and haven't reversed when pandemic restrictions ended.
Respectfully, that’s simply not correct. Violent crime spiked after the pandemic and has now started to come down.
Think of it this way. If I told you that--all at once--alcohol use would go up, gun sales would go up, schools would close, unemployment would suddenly spike, community organizations would close down, and after-school programs would end, what do you think would happen to violent crime?
I sincerely appreciate the insertion of respectfully because I do like to debate but I hate it when it generates animosity. I do disagree but I don't take any of what you're saying personally and hope you feel the same...on the argument...
I think we could bring data and common sense to each of these, with aa preference for data:
Alcohol: I'd guess crime would go up.
Gun Sales: No difference. Gun sales over time really have almost no correlation to gun crimes except at the longest time intervals. Criminals seem to be able to get guns regardless of how many guns a random NRA member has in his collection.
Unemployment: we've seen time and again that there's little correlation to crime. Crime fell in the great depression and. in the 2008 recession. And the spike in unemployment was very temporary.
School Closures: I'd be careful about assuming anything here b/c so many other "common sense" assumptions, like unemployment and gun sales, turn out to be wrong. But closures were also temporary while the homicide spike has long outlasted them.
After-school Programs: they didn't end in my super-liberal suburb. And the crime spike is much broader than school-age kids in liberal areas.
In any case: if the pandemic closures caused crime to spike, why hasn't it reversed completely instead of slowly trending down over a multi-year period? Homicide is still up 30% from 2019 numbers (I've seen the latest data from the CDC). And the increase in deaths are disproportionately in minority communities. AND the timing of the original increase was late May 2020, NOT Feb-Apr 2020. The homicide rate was actually down in Feb-Apr.
You can view the timing of the spike here and data through 2021: https://theusaindata.pythonanywhere.com/death2020
Are you sure gun sales has no relation to gun related homicides? I only ask because more guns in general just increases the likelihood of guns being used for anything. That could be guns stolen to be used in “street crime”, domestic violence becoming more deadly, mass shooting events, etc. not saying the guns cause the rise but just it’s easier to kill someone or shoot one when it’s more guns around.
On a side note: I have no idea how ghost guns factor in here either.
Do you have a citation that traffic levels post-COVID are reduced compared to pre-COVID? I don't think that's true.
Note, an increase in WFH doesn't necessarily mean a reduction in traffic, as people take advantage of the freed up road capacity to drive trips they wouldn't have before.
Incorrect. Traffic miles driven actually increased on average among large U.S. metro areas. The blip in which fewer people were driving on the roads was very short.
The timing of the homicide spike very specifically correlated with the BLM protests and not with the pandemic in general. There are lots of details on that e.g. here: https://www.astralcodexten.com/p/what-caused-the-2020-homicide-spike
There aren't many cities run by Republican mayors. That said, it seems like the cities that have done the best job skirting the murder rate increase are disproportionately ones that had a Republican mayor for at least some of the time since COVID started:
https://www.bloomberg.com/opinion/articles/2023-03-03/pandemic-murder-wave-has-crested-here-s-the-postmortem
For instance: Oklahoma City, Bakersfield, Jacksonville, San Diego, Miami, Virginia Beach, Dallas (I'm counting it because their mayor switched to GOP)
I suspect this isn't actually down to specific actions of the mayors, and more a matter of confounding variables - ie. communities that elected conservative-leaning mayors are more likely to be supportive of police, so police have pulled back less there.
Of course there are some cities that haven't had a GOP mayor that did well too, though they all seem to be ones with more conservative-leaning democrats. The notable exception I can see is Boston, which has avoided a pandemic murder rate jump despite being very progressive.
The uptick inn homicide was very demographically concentrated: Black homicide victims went up 50% while White victims only rose 5%, and Asians (a very urban census category) only went up 8%. Similar disparities occurred with traffic deaths and overdoses (data here: https://theusaindata.pythonanywhere.com/avoidable_deaths_after2020)
The sharp differences in demographics lead me to believe that they are the underlying drivers and not who is elected. IMHO Boston fits this theory well, as even the 20% of the population that is census category Black is majority immigrant, who as a category are a low homicide rate population.
"The uptick inn homicide was very demographically concentrated: Black homicide victims went up 50% while White victims only rose 5%"
True. There's definitely more to the story than that, though. Portland, famous for being probably the whitest major city in America, was one of the worst hit - their homicides almost tripled. Like, they went from Boston level to pre-pandemic Chicago/DC level in terms of homicides - really bad. Meanwhile, majority-black Baltimore and Detroit didn't see their increase over pre-pandemic.
I think the trends in suicide rates need to be addressed on their own, although Matt does an admirable job of covering the other key categories.
A few years ago I saw a couple of newspaper articles that were striking enough to make me write a Facebook post about them, otherwise I doubt I'd remember. The US suicide rate hit a 30-year high just as the UK suicide rate hit a 30-year low. (One of these statistics was for men only and the other was for both sexes, but I forget which.)
My random, non-evidence-based conclusion was that it probably had something to do with the existence of universal health coverage (or not) and welfare state protections more broadly. Working-class Americans and working-class Europeans may both be angry about inequality, demographic change and various other common trends and they may both vote for far-right politicians in response, but it seems to be only in America that they decide to kill themselves.
(It also occurs to me that low-skilled, nonwhite immigration might have a stronger effect on the self-esteem of low-skilled white people in America than in Europe, because there's more of it. But this is my permanent hobbyhorse, so take it with a grain of salt.)
Anyhow what I wrote back then may be wrong but unless there's a freestanding explanation for the divergence in suicide rates, I don't think the "despair" hypothesis has been refuted.
Any conversation about American suicide can’t ignore the female side. They attempt more and succeed less, but I find it hard to believe that FB and Insta had no effect.
Also, I’m curious how big a component the veteran suicide crisis is in the overall rate.
One of the big things is that women tend to attempt using pills or cutting while men to mend to attempt using guns or jumping. These attempts have different levels of effectiveness.
The two big wars we just had may have something to do with it.
“Only two occupational categories, both in combat arms, had significantly elevated suicide rates: infantrymen (37.2/100 000 person-years) and combat engineers (38.2/100 000 person-years). However, the suicide rates in these two categories were significantly lower when currently deployed (30.6/100 000 person-years) than never deployed or previously deployed (41.2–39.1/100 000 person-years), whereas the suicide rate of other soldiers was significantly higher when currently deployed and previously deployed (20.2–22.4/100 000 person-years) than never deployed (14.5/100 000 person-years), resulting in the adjusted suicide rate of infantrymen and combat engineers being most elevated when never deployed [odds ratio (OR) 2.9, 95% confidence interval (CI) 2.1–4.1], less so when previously deployed (OR 1.6, 95% CI 1.1–2.1), and not at all when currently deployed (OR 1.2, 95% CI 0.8–1.8).”
Conclusion: It’s complicated.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860903/
That's the problem with relying too much on anecdotes. That's really sad though, sorry to hear about it.
Matt's answer here is that it's about the availability of guns. I don't know if that's 100% true, but that's a subset of the larger truth about suicide that it is surprisingly difficult to kill yourself, and a small change in the efficacy of a method of suicide leads to a large change in number of successful suicides (vs attempts).
And you also can't really compare suicide attempts rates, because they are in turn confounded by differences in rates of discovery and classification.
It's not just guns. When Britain changed the packaging for Tylenol to blister packs instead of bottles, suicide deaths from Tylenol overdoses declined by 43 percent. Anyone who wanted 50 pills would have to push out the pills one by one but pills in bottles can be easily dumped out and swallowed.
It's such a wildly odd quirk of human psychology that people can be both (a) so motivated by depression or other life circumstances (omitting painful terminal illnesses here) that they want to take the extraordinary step of kill themselves, but also (b) that they can also be like, "eh, I was gonna. but those stubborn aspirin packages made it too hard."
I get it, of course, in that many times the idea to kill one's self comes at a particular low point, and if a person gets through that moment without committing the act, maybe they never reach that nadir again, but still.
Sadly being close enough to the edge to make an attempt is often a long term condition, but the actual attempt are often very impulsive. One of the more horrifying programmes I saw featured interviews with some of the 1% of people who survive jumping off the Golden Gate Bridge. The majority remembered changed their mind before they hit the water.
I saw a documentary on that where they interviewed one of the jumpers that survived and it still haunts me. He said something along the lines of "as soon as my feet left the bridge, all the problems that had me so upset seemed like the smallest problems in the world, and all I wanted to do was go back to the bridge". Horrifying to think of how many others had the same thought but didn't survive the jump.
I did some work a few years back on the suicide netting that was being installed on the GGB that required me to be out on the scaffolding on the outer underside of the bridge...and it was utterly terrifying. I don't know how anyone could do it, let alone survive it.
Yeah, my apologies, of course I'm not trying to say that whatever the underlying mental health situation is transitory, just that the specific moment where somebody may want to kill themselves, and attempt to do so, may be a passing moment.
Also from Britain the change from "coal gas" to natural gas reduced suicides by making them harder.
"Prior to the 1950s, domestic gas in the United Kingdom was derived from coal and contained about 10-20% carbon monoxide (CO). Poisoning by gas inhalation was the leading means of suicide in the UK. In 1958, natural gas, virtually free of carbon monoxide, was introduced into the UK. By 1971, 69% of gas used was natural gas. Over time, as the carbon monoxide in gas decreased, suicides also decreased (Kreitman 1976). Suicides by carbon monoxide decreased dramatically, while suicides by other methods increased a small amount, resulting in a net decrease in overall suicides, particularly among females.
Over time, rates of suicide began to increase again although not to the pre-1965 levels. One author has estimated that over a ten-year period, an estimated six to seven thousand lives were saved by the change in domestic gas content (Hawton 2002)
Easier availability of guns must explain a lot of why the US suicide rate is higher in absolute terms, but it wouldn't necessarily explain why rates have risen in the US and fallen in Europe (or at least in the UK). It's true that American laws have been liberalized in recent years because of pressure from the gun lobby, but I don't know if that's enough to explain the trend.
You could try doing a state-by-state regression to tease out that effect, but I think it would be confounded by other differences between red and blue states.
It might also help to look at suicide rates in Israel and Switzerland, where household gun ownership is very widespread. (Those guns are pretty strictly regulated but I'm not sure why that would be an impediment to suicide.)
In the Swiss case you'd have to break the law first by cracking open your army-issued sealed pack of cartridges and loading one into the gun.
It's insane but like the Tylenol thing I bet it makes a difference at the margin
This is an anecdote, so don't take it too seriously, but my uncle, an ER nurse, mentioned to me at one point that his experience was that many suicide attempts with longarms resulted in survival because the awkwardness of trying to reach the trigger with the gun pointed at yourself resulted in twisting away and the bullet not squarely hitting you, as opposed to with handguns where it was trivial to point the gun directly at your head and pull the trigger.
It isn’t so much about “difficulty” but time and planning and opportunity to reconsider. Easy access to a handgun means it can be over 30 seconds from the decision. But getting and taking pills, for example, gives you time even after you make the attempt to reconsider and call for help.
That's a fine guess, but most guesses like that turn out to not have much support.
The biggest differentiator I can find within US populations is race / ethnicity, which it's safe to assume is due to cultural differences. The Black suicide rate is 8.8 per 100,000 while the White rate is more than double at 18.6 and the Hispanic and Asian rates are a little lower than the Black rate. The Native American rate, meanwhile, is 28 per 100,000.
These rate differences don't seem to correlate with inequality or welfare protections and are fairly consistant across state geographies and rural / urban splits; the point being it seems to be driven primarily by culture, and the UK has a different culture than us. Japan's modestly high suicide rate would also seem to be driven by culture and not inequality or gun laws.
Link to some suicide (and other deaths of despair) data:
https://theusaindata.pythonanywhere.com/avoidable_deaths_after2020
Guns still have a role to play, at least when you look at the “success” rate of suicide and when we look at sex differences.
Any discussion of suicide needs to include the way it spreads socially. We know that an article about suicide leads to more suicides. Malcolm Gladwell discusses the way this played out in Micronesia, a place where suicide was extremely rare until a single well publicized celebrity suicide led to a suicide epidemic. Trying to explain the phenomena using only economic or regulatory comparisons isn't going to shed much light on the subject. China regularly have cases of middle aged men going into schools with knives and stabbing all the children they can find while in America we have lots of school shootings but the perpetrators tend to be teenage boys. People are suggestible and one act begets another.
I'll stress that I'm indifferent to changes in suicide rates (I think it's people's own business whether they kill themselves or not), but one thing I can't help but notice is that people who do express concern about increasing suicide rates, at least from a "left" perspective, all but completely ignore that, historically, suicide was severely stigmatized in Western cultures, both religiously and civilly, going back even to the pre-Christian era. Given that all forms of stigma around suicide have been substantially reduced, either directly (e.g., repeal of property forfeiture laws for suicide victims) or indirectly (e.g., general decline in religiosity), over the past century or so, how clear is it that we're genuinely seeing an increase in suicidality versus finding the "natural rate" of suicides in the absence of stigmatization?
Yes. It’s also somewhat “contagious”-- suicides spike locally when someone in a community commits suicide, and then more broadly when a celebrity does.
And back when there were local newspapers, the rule was not to report on suicides unless they happened in public.
For good reason.
Possibly not a real memory, but I'm pretty sure I was taught about suicide contagion in health class in 9th (?) grade. Seemed to check out to me, and a few years later I recall learning as an RA that the college paper had a policy of not running stories about the one or two people a year who would jump off the bridge in the middle of campus. Possibly apocryphal as well.
Fast forward to the present day, and there are suicide ads on the bus. So much of the conventional wisdom around mental health in this country seems so broken.
Shorter version TL;DR: whites are dying of despair in America because guns, drugs are too available and seatbelt laws are too relaxed, but they are *living* with despair in Europe where it's harder to kill yourself by accident or on purpose either quickly or slowly.
Ergo there's nothing wrong with US neoliberalism that more euro style paternalism wouldn't cure.
Me: But shouldn't we be asking why Western society produces so much despair in the first place and despair seems to be getting worse? Or is the neoliberal technocratic response mainly concerned with making the mortality stats better?
Is there more or less despair than there used to be? If it’s less, but people are killing themselves more anyway, then we should be focusing on the killing and just keep on keeping on with the reduction in despair. If there’s an actual increase in despair, then we should do something about it, but that is what is missing here.
My sense is yes. By most accounts ive seen, loneliness is way up, family formation is down. Mental health issues are way up especially among young people too. Matt even wrote a piece recently asking why young liberals were so depressed.
A lot has to do with the internet and social media which not only consumes lots of time that can't substitute for real friendship, but also promotes social contagion of catastrophizing belief systems.
Some totally unfounded things I wonder about.
Is it loneliness or is it not accepting we don’t like other people? I and many others I know had their loneliness evaporate during COVID because, with everyone locked up, we could accurately assess how much we really wanted to be around other people, all social pressure to do so having vanished.
Are we sure family formation is down because something broke in society or is it because children tend to make life worse in myriad ways?
But you’re assuming the conclusion here, about despair.
Wait, so what is the "despair" you are talking about? If it's economic stagnation then the problem was pretty clearly recklessness in Wall Street. If it's just people feeling bad about their lives then...Cognitive Behavioral Therapy for Lefty's. For Righty's it's: suck it up.
That certainly is an interesting question, but I think it's pretty different than the original deaths of despair thesis that there's been this unique surge of despair for one group in the Teens. FWIW David Simon and Ed Burns wrote about this in The Corner. Their theory was there's a very real chunk of the population that isn't needed to work in factories or fill up the countries empty spaces like there was in the past do to the modern sort of post-industrial economy and so those people just get kind of discarded and ignored by society. But they were writing about the 90's so it's not really about the "Deaths of Despair" thesis.
Why would the phenomenon in the 90s be less salient today? If anything, I'd expect it to be more salient.
The "Corner" phenomenon was about inner city blacks. Now it's clear though that the decline there was a canary in the coal mine for downscale white America.
I except center right authors to ignore the problem because the existence of struggling white America undermines their whole ideology.
But it's hard to get the left to care about it either because it isn't a question of racial justice.
I sure would love a deeper dive into opioid policy, a subject I occasionally write about and ask Matt about. I grew up in one of the harder-hit areas, so the explosion of what was a local issue to me when I was a teen into a national gigantic clusterfuck has been wild to watch.
The last time I asked about this, a reasonable-sounding commentator made the case to me that the FDA didn't do anything wildly wrong- that opioids were already legal to prescribe, that the FDA can't do anything in real time about Purdue marketing, and that pharma companies are incentivized to push the envelope on their marketing before their patent runs out. I dunno, is this all true? Government policy was a non-factor in opioid deaths? The FDA is too strict about some things (as we saw during the Covid era) and helplessly hands-off on others?
And then you get the inevitable 'the deaths are all fentanyl, it's because there's a black market, just legalize drugs' crowd who will inevitably show up. Every time I point out that half or more of total opioid deaths were from *legally prescribed ones*, but that doesn't seem to make a dent with this crowd. After all, they have black markets for drugs in Europe too, but way less opioid deaths!
Painkiller, the limited Netflix series, covers this and more. My understanding is that it’s based on a well researched book by an investigative journalist. A poignant and “entertaining” (riveting but makes you want to throw up) series about Oxycontin’s rise and fall.
This articles contains a lot that is informative and good, but sentence like this “ People without a BA are a smaller, more negatively selected group than they used to be — a group increasingly composed of low-conscientiousness people.” Smacks of the worst kind of victim blaming and a lack of empathy that frankly raises the question regarding Matt’s on conscientiousness in his writing.
I'm not bothered by it, but it fits well with my take that something modern progressives have failed to deal with is that there are fewer and fewer "deserving poor," i.e., people who genuinely just need a limited "hand up" to get their lives on track, versus people whose lives are simply permanent or near permanent train wrecks and will often forgo or sabotage opportunities even when specifically given to them.
Dog who caught the car, sort of.
I honestly think you're reading to much into. it. This is clinically descriptive terminology. The bad version would be "People without a BA are a smaller piece of the bottom-of-the-barrel than they used to be — a group increasingly composed of crappy people.”
What would you're super-empathetic version be? There are people that are more or less conscientiousness than others, and "negatively selected" simply means that selection into the group is driven by negative factors, rather than chance or positive factors. These all seem true and I'm not sure there's a clearer way to write it that will also prevent offended misreadings.
I don’t think it’s victim blaming so much as it is explaining the fact that people with mental health issues are more likely to struggle through formal education, and because many more people are getting college degrees, people with mental health issues will end up with a larger share of the smaller group of people without college degrees.
If people do in fact differ along a dimension of conscientiousness, then it would be plausible that there would be death rate differences along this axis. Matt is telling us to emphasize the effects of policy on these death rates, while Case and Deaton are telling us it is not about this sort of risk tolerance or carelessness but is about changing emotional circumstances. That story *sounds* kinder, but I don’t think it is.