Astral Codex Ten Podcast

https://slatestarcodex.com/2020/04/24/employer-provided-health-insurance-delenda-est/ My last post didn't really go to deep into why I dislike the way we do health insurance so much. Of course, there are the usual criticisms based on compassion and efficiency. Compassion because poor people can't get access to life-saving medical care. Efficiency because it's ruinously expensive compared to every other system around. I agree with these arguments. And they're strong enough that asking whether there are any other reasons is kind of like the proverbial "But besides that, Mrs. Lincoln, how did you like the play?" But I had already internalized the compassion and efficiency critiques before becoming a doctor. After starting work, I encountered new problems I never would have expected, ones which have yet to fade into the amorphous cloud of injustices we all know about and mostly ignore. Most of my patients have insurance; most of them are well-off; most of them are intelligent enough that they should be able to navigate the bureaucracy. Listen to the usual debate around insurance, and you would expect them to be the winners of our system; the rich people who can turn their financial advantage into better care. And yet barely a day goes by without a reminder that it doesn't work this way. Here are some people I have encountered – some of them patients, some of them friends – who have made me skeptical that our system works for anyone at all:

https://slatestarcodex.com/2020/04/20/the-amish-health-care-system/ I. Amish people spend only a fifth as much as you do on health care, and their health is fine. What can we learn from them? A reminder: the Amish are a German religious sect who immigrated to colonial America. Most of them live apart from ordinary Americans (who they call "the English") in rural communities in Pennsylvania and Ohio. They're famous for their low-tech way of life, generally avoiding anything invented after the 1700s. But this isn't absolute; they are willing to accept technology they see as a net positive. Modern medicine is in this category. When the Amish get seriously ill, they will go to modern doctors and accept modern treatments. The Muslims claim Mohammed was the last of the prophets, and that after his death God stopped advising earthly religions. But sometimes modern faiths will make a decision so inspired that it could only have come from divine revelation. This is how I feel about the Amish belief that health insurance companies are evil, and that good Christians must have no traffic with them.

https://slatestarcodex.com/2020/04/17/depression-the-olfactory-perspective/ Depressed people have worse sense of smell, and people with worse sense of smell are more likely to get depressed. Kohli 2016 tries to figure out what's going on. They review six studies testing how well depressed people can smell things. Most use something called "The Sniffin' Sticks Test" (really!) where people are asked to say which of two sticks has an odor; the strength of the odorous one is then decreased until the subject can no longer consistently get it right. This determines olfactory threshold – how sensitive the subject's smell is. Depressed subjects did marginally (but significantly) worse on this test than controls (6.31 ± 1.38 vs. 6.78 ± 0.88; P = 0.0005) – I think this corresponds to an effect size of about 0.2. They also do a couple more tests to see if depressed people are worse at identifying odors and get similarly small results. Also, some neuroimaging studies directly correlate depression and olfactory bulb volume, and find that olfactory areas of depressed people's brains shrink.

https://slatestarcodex.com/2020/04/14/a-failure-but-not-of-prediction/ I. Vox asks What Went Wrong With The Media's Coronavirus Coverage? They conclude that the media needs to be better at "not just saying what we do know, but what we don't know". This raises some important questions. Like: how much ink and paper is there in the world? Are we sure it's enough? But also: how do you become better at saying what you don't know? In case you've been hiding under a rock recently (honestly, valid) the media not only failed to adequately warn its readers about the epidemic, but actively mocked and condescended to anyone who did sound a warning. Real Clear Politics has a list of highlights. The Vox tweet saying "Is this going to be a deadly pandemic? No." Washington Post telling us in February "Why we should be wary of an aggressive government reponse to coronavirus (it might "scapegoat marginalized populations"). The Daily Beast complaining that "coronavirus, with zero American fatalities, is dominating headlines, while the flu is the real threat". The New York Times, weighing in with articles like "The pandemic panic" and "Who says it's not safe to travel to China". The constant attempts to attribute "alarmism" over the virus to anti-Chinese racism. Etc, etc, etc. One way people have summed this up is that the media (and the experts they relied on) did a terrible job predicting what would happen. I think this lets them off too easy.

https://slatestarcodex.com/2020/04/10/coronalinks-4-10-second-derivative/ The second derivative is the rate of growth of the rate of growth. Over the past few weeks, the second derivative of total coronavirus cases switched from positive (typical of exponential growth) to zero or negative (typical of linear or sublinear growth) in most European countries. Over the past few days, it switched from positive to zero/negative in the United States and the world as a whole. These are graphs of the rate of growth – notice how they go from shooting upward to being basically horizontal or downward-sloping (source). This graph shows the numbers a little differently, (source), but you can see the same process going on in individual US cities It would be premature to say we're now winning the war on coronavirus. But we've stopped actively losing ground. If we were going to win, our first sign would be something like this. Current containment strategies are working. As before, feel free to treat this as an open thread for all coronavirus-related issues. Everything here is speculative and not intended as medical advice. The Bat Flu SSC reader Trevor Klee has a great article on why humans keep getting diseases from bats (eg Ebola, SARS, Marburg virus, Nipah virus, coronavirus). He explains that because bats expend so much energy flying, they run higher body temperatures than other mammals, which degrades their DNA. Their DNA is such a mess that the usual immune system strategy of targeting suspicious DNA doesn't work, so they accept constant low-grade infection with a bunch of viruses as a cost of doing business. Sometimes those viruses cross to humans, and then we get another bat-borne disease.

https://slatestarcodex.com/2020/04/08/2019-predictions-calibration-results/ At the beginning of every year, I make predictions. At the end of every year, I score them (this year I'm very late). Here are 2014, 2015, 2016, 2017, and 2018. And here are the predictions I made for 2019. Strikethrough'd are false. Intact are true. Italicized are getting thrown out because I can't decide if they're true or not. All of these judgments were as of December 31 2019, not as of now. Please don't complain that 50% predictions don't mean anything; I know this is true but there are some things I'm genuinely 50-50 unsure of. Some predictions are redacted because they involve my private life or the lives of people close to me. A few that started off redacted stopped being secret; I've put those in [brackets].

https://slatestarcodex.com/2020/04/07/never-tell-me-the-odds-ratio/ [Epistemic status: low confidence, someone tell me if the math is off. Title was stolen from an old Less Wrong post that seems to have disappeared – let me know if it's yours and I'll give you credit] I almost screwed up yesterday's journal club. The study reported an odds ratio of 2.9 for antidepressants. Even though I knew odds ratios are terrible and you should never trust your intuitive impression of them, I still mentally filed this away as "sounds like a really big effect". This time I was saved by Chen's How Big is a Big Odds Ratio? Interpreting the Magnitudes of Odds Ratios in Epidemiological Studies, which explains how to convert ORs into effect sizes. Colored highlights are mine. I have followed the usual statistical practice of interpreting effect sizes of 0.2 as "small", of 0.5 as "moderate", and 0.8 as "large", but feeling guilty about it.

https://slatestarcodex.com/2020/04/06/sscjc-real-world-depression-measurement/ The largest non-pharma antidepressant trial ever conducted just confirmed what we already knew: scientists love naming things after pandas. We already had PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus) and PANDA (Proton ANnhilator At DArmstadt). But the latest in this pandemic of panda pandering is the PANDA (Prescribing ANtiDepressants Appropriately) Study. A group of British scientists followed 655 complicated patients who received either placebo or the antidepressant sertraline (Zoloft®). The PANDA trial was unique in two ways. First, as mentioned, it was the largest ever trial for a single antidepressant not funded by a pharmaceutical company. Second, it was designed to mimic "the real world" as closely as possible. In most antidepressant trials, researchers wait to gather the perfect patients: people who definitely have depression and definitely don't have anything else. Then they get top psychiatrists to carefully evaluate each patient, monitor the way they take the medication, and exhaustively test every aspect of their progress with complicated questionnaires. PANDA looked for normal people going to their GP's (US English: PCP's) office, with all of the mishmash of problems and comorbidities that implies.

https://slatestarcodex.com/2020/04/01/book-review-the-precipice/ I. It is a well known fact that the gods hate prophets. False prophets they punish only with ridicule. It's the true prophets who have to watch out. The gods find some way to make their words come true in the most ironic way possible, the one where knowing the future just makes things worse. The Oracle of Delphi told Croesus he would destroy a great empire, but when he rode out to battle, the empire he destroyed was his own. Zechariah predicted the Israelites would rebel against God; they did so by killing His prophet Zechariah. Jocasta heard a prediction that she would marry her infant son Oedipus, so she left him to die on a mountainside – ensuring neither of them recognized each other when he came of age. Unfortunately for him, Oxford philosopher Toby Ord is a true prophet. He spent years writing his magnum opus The Precipice, warning that humankind was unprepared for various global disasters like pandemics and economic collapses. You can guess what happened next. His book came out March 3, 2020, in the middle of a global pandemic and economic collapse. He couldn't go on tour to promote it, on account of the pandemic. Nobody was buying books anyway, on account of the economic collapse. All the newspapers and journals and so on that would usually cover an exciting new book were busy covering the pandemic and economic collapse instead. The score is still gods one zillion, prophets zero. So Ord's PR person asked me to help spread the word, and here we are.

https://slatestarcodex.com/2020/03/31/ssc-journal-club-macintyre-on-cloth-masks/ Content warning: this is a complicated analysis of something people care about a lot right now. I'm not confident in my analysis, the post comes to no clear conclusion and there are no easy answers about how to proceed. If I see this on Twitter with some headline about it DESTROYING somebody, I am going to be so mad.] The New York Times says that It's Time To Make Your Own Face Mask. But MacIntyre et al (2015) says it isn't. The surgical masks used in hospitals are made out of non-woven fabrics that are pretty different from anything you have at home. But in some developing countries, health care workers instead use masks made of normal cloth. Laboratory tests find that improvised cloth masks block 60 – 80% of virus particles. Respirators and real surgical masks block 95%+, but 60-80% still seems better than nothing. And most of the masks ordinary people wear in Asian countries are cloth, and they seem to do pretty well. So there's some circumstantial evidence that these cloth masks might be helpful. Most experts in the early 2000s agreed that these masks were probably better than nothing. In 2015, an Australian team set out to prove it with a randomized controlled trial.