Tag: <span>COVID</span>

Eschatologist #15: COVID and Ukraine (The Return of Messiness)

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These days everyone worries about the dangers of technology. With the Russian invasion of Ukraine these worries have become very focused on one specific technology: nuclear weapons. Despite this danger and the other dangers technology has introduced, there are still many people who expect the exact opposite, that technology will be our salvation. I brought this dichotomy up in my very first newsletter. Looking back I might have given the mistaken impression that whichever it ends up being, salvation or destruction, that it will be simple. We will either be permanently saved or permanently destroyed.

This is not just my mistake, most people make this mistake, particularly when it comes to our current worry, nuclear war. They take a horribly complicated event and simplify it down to a single phrase: “The end of the world.” And nuclear war is not the only technological danger where this simplification happens. People often use similar language when talking about climate change.

On the other side of things, the imagined salvation is perhaps not as dramatic or as sudden, but it is imagined as being just as straightforward. Last week I attended a lecture by Steven Pinker, who made the argument that progress is continuing and things will just keep getting better, a subject he has written several books about. In support of this argument he offered numerous graphs showing that trends in everything from violence to wealth have been steadily improving for decades if not centuries. From this he asserted that there is no need to worry, just as we solved all of our past problems we will solve all of our future problems as well.

The belief in humanity’s unstoppable progress and the fear that we will annihilate ourselves in a nuclear war represent the extremes of optimism and pessimism. On the one hand is the claim that science and progress have solved or will solve all of our problems, on the other hand is the claim that if the situation in Ukraine escalates 7.9 billion people will die. Neither of these claims are true, but we have a tendency to think in extremes because they’re easier to understand.

As it turns out, even a war involving all of the nukes will not kill everyone. Recently a Reddit user put together a simulation which predicted that around 550 million people would die from the war, and the ensuing fallout and nuclear winter. That’s about 7% of everyone. Obviously the simulation could be wildly inaccurate, though it does claim to be based on data from the International Atomic Energy Agency, the UN and CIA, but even if it was off by an order of magnitude that would still only be 70% or 5.5 billion people, leaving 2.4 billion people alive. An inconceivable tragedy, but not the end of the world. Also, these people might wish they were dead, because living after a nuclear war would be exceedingly difficult.

However, historically life has always been exceedingly difficult, not to mention messy. The Native Americans survived the loss of 90% of their total population. During the Black Death, Europeans survived death rates of up to 50%, with some people suggesting it was as high as 60%, very close to the extreme estimate of 70% above. 

Despite this sort of messy middle being the historical default, we don’t like it. We want either the steady and implacable march of progress, or a quick end that absolves us of hard work. Even when we imagine surviving “the end”, we cut out most of the messy stuff, like raising crops, and making tools in favor of more simple apocalyptic stories, where there’s always plenty of canned food and lots of guns and ammo—even when we imagine a gigantic mess, we cut out all the truly difficult bits.

The modern world has made a lot of things easy that used to be incredibly complicated. It has made a lot of things possible that were previously impossible. In the process it has weakened our ability to deal with complicated and messy situations. We want the pandemic to go away if everyone just wears a mask, or if everyone gets vaccinated, or if we just ignore it. We want the invasion of Ukraine to stop if we implement the right level of sanctions, or institute a no fly zone, or, again, if we just ignore it. But the truth is that simplicity and ease are temporary aberrations, messiness has returned and we’d better get used to it.


You may not have realized that nuclear war would only kill 550 million people. If you feel any appreciation for this comforting fact, and would like more comforting facts in the future, consider donating.  


The 12 Books I Finished in January

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  1. Empire of Pain: The Secret History of the Sackler Dynasty by: Patrick Radden Keefe
  2. Viral: The Search for the Origin of COVID-19 by: Matt Ridley and Alina Chan
  3. Exact Thinking in Demented Times: The Vienna Circle and the Epic Quest for the Foundations of Science by: Karl Sigmund
  4. Columbus Day: Expeditionary Force, Book 1 by: Craig Alanson
  5. SpecOps: Expeditionary Force, Book 2 by: Craig Alanson
  6. Paradise: Expeditionary Force, Book 3 by: Craig Alanson
  7. Row Daily, Breathe Deeper, Live Better: A Guide to Moderate Exercise by: Dustin Ordway
  8. Indistractable: How to Control Your Attention and Choose Your Life by: Nir Eyal
  9. What is a p-value anyway? 34 Stories to Help You Actually Understand Statistics by: Andrew Vickers
  10. The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth by: Sam Quinones
  11. Empire of the Summer Moon: Quanah Parker and the Rise and Fall of the Comanches, the Most Powerful Indian Tribe in American History by: S. C. Gwynne
  12. Heart: The City Beneath by: Grant Howitt and Christopher Taylor

As you can see I read more than the average number of books this month. I was supposed to go on a mini vacation to Vegas with a friend, but a couple of days beforehand he came down with COVID and consequently they wouldn’t let him out of Canada. As such I had some extra time on my hands.

This is not the most books I’ve ever finished in a month, but it is the second most. As such I’m going to try and keep both the intro and the reviews short.


I- Eschatological Reviews

Empire of Pain: The Secret History of the Sackler Dynasty 

by: Patrick Radden Keefe

560 Pages

Briefly, what was this book about?

The history of the Sackler family, their philanthropy, their wealth, but mostly the radical changes they made to pharmaceutical marketing.

Who should read this book?

If you don’t feel that you’re angry enough about the Sackler’s role in the opioid crisis, and you want to be angrier, this is the book for you. Beyond that it’s a fascinating book about the history of selling drugs, and how Arthur Sackler, the oldest brother in the Sackler clan, changed it forever. That part will also make you angry. 

General Thoughts

It has been said that “Behind every great fortune there is a crime.” I’m inclined to believe that this is not true in all cases, but it’s definitely more true than fans of Ayn Rand would have you believe. Regardless of whether it’s true in general, it is definitely true in the case of the Sackler fortune. The Sacklers were the owners of Purdue Pharma, and Purdue Pharma had/has essentially one product: OxyContin. Perhaps you know the crime of which I’m speaking? This crime—kickstarting the opioid crisis—which might plausibly encompass the deaths of hundreds of thousands, is made all the worse by the fact that thus far the Sacklers have entirely escaped any sort of liability or punishment. At least Bernie Madoff went to jail for his crimes, which were less severe by basically any measure.

Should I make this point to certain friends of mine, they would say that the reason Madoff was punished, while the Sacklers will probably escape punishment, is that Madoff took money from rich people, while the Sacklers just killed poor people. And that this is the case because of the wickedness of capitalism.  I would probably argue that there’s more to the disparity than that, but I will say that capitalism does not come out of this book looking good. And neither does the FDA, Rudy Giuliani, McKinsey, or high-powered attorneys. 

Beyond the story of the Sacklers, which is truly appalling, there’s the story of corruption more broadly. There’s a good argument to be made that the crisis would not have been nearly as bad if a sympathetic FDA official (who later went to work for Purdue) hadn’t let the Sacklers turn the insert for OxyContin into essentially a marketing brochure. One which included the infamous line, “Delayed absorption as provided by OxyContin tablets is believed to reduce the abuse liability of a drug.” A line which the Purdue sales reps spun into the idea that prescribing the drug was nearly risk free.

I could go on listing crimes and corruption, but I’m planning on taking this book and The Least of Us (also reviewed in this post) and maybe one other book, if I find one that looks good, and doing a post on the current state of the drug crisis. 

Eschatological Implications

Going into the book I had heard that of the three Sackler brothers and their descendents, only two of the branches were involved with Purdue, and that the descendents of Arthur Sackler were upset because despite having no involvement they too had been caught up in the scandal. Before reading the book this seemed obviously unfair, why should Arthur’s descendents suffer for what their uncles and cousins did? 

After reading the book, I would agree that there’s probably still a little bit of unfairness in play, but less than you would think, because the success of OxyContin was entirely based on techniques of pharmaceutical marketing that had been pioneered by Arthur. As one of his employees said, “When it came to the marketing of pharmaceuticals, Arthur invented the wheel.”

What was this wheel? Arthur weaponized science in the service of marketing. And as a byproduct he probably permanently perverted science as well. This great innovation would later be applied to OxyContin, but it was initially applied to Valium. Valium was said to be a mild tranquilizer, completely without any potential for addiction, so safe that it could be given to children, and useful for just about anything. In fact, according to the book, it was prescribed for “such a comical range of conditions that one physician, writing about Valium in a medical journal, asked, ‘When do we not use this drug?’” All of this was a reflection of Arthur’s ability to bend “science” into saying exactly what the marketing needed it to say. In particular it needed to show that Valium was safe. That if it was used properly people wouldn’t become addicted. Decades later Arthur’s brothers and their descendents would be making the same claims about OxyContin.  It’s scary how much the debate about Valium is nearly identical to the debate decades later about Oxycontin. From the book:

Even so, there were actual cases, increasingly, of real consumers becoming hopelessly dependent on tranquilizers. Confronted with this sort of evidence, Roche offered a different interpretation: while it might be true that some patients appeared to be abusing Librium and Valium, these were people who were using the drug in a nontherapeutic manner. Some individuals just have addictive personalities and are prone to abuse any substance you make available to them. This attitude was typical in the pharmaceutical industry: it’s not the drugs that are bad; it’s the people who abuse them. “There are some people who just get addicted to things—almost anything. I read the other day about a man who died from drinking too many cola drinks,” Frank Berger, who was president of Wallace Laboratories, the maker of Miltown, told Vogue. “In spite of all the horror stories you read in the media, addiction to tranquilizers occurs very rarely.” In 1957, a syndicated ask-the-doctor column that appeared in a Pittsburgh newspaper wondered whether “patients become addicted to tranquilizers.” The answer assured readers that contrary to any fears they might harbor, “the use of tranquilizers is not making us a nation of drug addicts.” The newspaper identified the author of this particular piece of advice as “Dr. Mortimer D. Sackler.”

Mortimer was Arthur’s brother. 

This general idea of science being weaponized is an enormous subject, which is right in the center of the debates being had about the pandemic, and it is to do it a severe injustice to treat it so briefly. But it’s one of the huge tragedies of our current situation that we had such high hopes for science, that by doing it correctly it would save us from making the tragic mistakes of the past. Instead, it proved far too easy to misuse, and ended up empowering a whole new class of tragedies. 


II- Capsule Reviews

Viral: The Search for the Origin of COVID-19

by: Matt Ridley and Alina Chan

416 Pages

Briefly, what is this book about?

Investigative journalism into the origins of the COVID-19 pandemic, which ends up concluding that it was most likely a lab leak.

Who should read this book?

Anyone who is curious about the origin of the pandemic, or who, more importantly, is interested in preventing future pandemics.

General Thoughts

I already covered this book in my pandemic retrospective, as such I’ll only briefly discuss it here. In fact this is a good opportunity to have something of a meta discussion about the role of books like these. 

To start with, imagine that you’re pursuing a PhD in philosophy, and you have selected Greek Metaphysics as your dissertation topic. In this scenario it’s unimaginable that you wouldn’t read everything Plato and Aristotle had ever written. Should it ever come out that you hadn’t, people would immediately stop taking you or your dissertation seriously. 

It’s completely understandable for this standard to be applied at the highest levels of academia, but to what extent should we apply that standard to commentary more broadly? Certainly if someone was going to do their dissertation on the origins of the pandemic we would have good reason to believe that they would read this book, in the same fashion that a philosophy PhD is expected to read Aristotle. But what if they just want to tweet about the origins of COVID? Should we ignore such tweets unless we have good reason to believe that they read this book first?

I think there’s various ways of answering that question, but for me the primary standard would be to consider the importance of the topic. You can imagine that opining about Kim Kardashian’s latest divorce should not require the same level of familiarity with “the literature” as claiming that Russia will definitely not invade Ukraine, or that COVID indisputably had a zoonotic origin.  

However, this standard of importance presents a problem. The more important something is, the more people feel that offering their opinion is not only a right, it’s a necessity. But what is this opinion based on? How strong should that foundation be before it’s worthwhile for someone to add their own spin on it? 

This takes us to a second standard. I think before commenting you need to have a sense of what sort of fight you’re taking sides in. To get more concrete, I don’t think you necessarily have to read Viral before commenting on the lab leak, but it’d be nice if you had read a review of Viral, or something which fairly presented the argument it was making. Presumably, not having read the book yourself, your own comments would not stray very far from the condensed information you found in the review. For example, you’re allowed to disparage the lab leak hypothesis if you’ve read a review of Viral which presents a credible argument against the hypothesis, and you can fairly represent that argument. This is certainly not as good as reading the book yourself, but I would say it’s definitely a level at which comments are allowed.

Down still further is the standard picking a set of authorities and just parroting their comments. The problem here is that if the authorities have read all the books, they would have read Viral and they wouldn’t be in this category, they’d be in the previous category. Also the ideological fractures which appear to have penetrated every nook and cranny of our world makes finding true authorities, people who are genuinely unbiased and objective, and trusting them that much harder. And remember we’re not talking about what you should believe personally, we’re talking about what you’re trying to convince others of. We’re talking about commenting and opining on the issue. In that respect I think we’ve crossed the line, at this point you shouldn’t be commenting. That at most you should be linking or retweeting these authorities, but that you are too far removed from the actual debate to get to weigh in.

I could go on, but I’ve already spent a lot of space in this review not talking about the book. So to return to that, my point is much the same now as it was in my previous post. The origin of COVID is an enormously complicated, but also an enormously important subject, and it deserves the most informed discussion possible, rather than being dismissed out of hand. This is a great book if you want to be informed enough to participate in that discussion.


Exact Thinking in Demented Times: The Vienna Circle and the Epic Quest for the Foundations of Science 

by: Karl Sigmund

480 Pages

Briefly, what was this book about?

The Vienna Circle, which ends up being at the center of modern philosophy. The list of names in the circle’s orbit includes Einstein, Gödel, Mach, Boltzmann, Popper, and Wittgenstein, and those are just the ones you might have heard of. There are many more who are only slightly less impressive. 

Who should read this book?

I think anyone who enjoys great history would love this book. It’s very well written. It’s also interesting for its insights into philosophy, ideology, math, politics and the interwar period.

General Thoughts

Several years ago I read The World of Yesterday by Stefan Zweig, which was all about Vienna before World War II and during the interwar period. I remember being struck by the difference between Vienna before the fall of the Austro-Hungarian Empire, and Vienna after. But Zweig was mostly talking about literature and culture. From Exact Thinking I discovered that Vienna still had a lot of math and philosophy magic left in it during the interwar years—that is until the Anschluss, which spelled the final doom of what was once one of the premier cities in Europe.

Sigmund ends up being the perfect person to chronicle the Circle. He got his PhD in Vienna in the late 60s which was still close enough to the time of the events that he knew quite a few people from the era, who could give him first hand accounts. After getting his PhD he was only away from Vienna for six years before he returned as a professor. As a consequence of his close association with the people and the place his familiarity with the subject is very apparent. This is one of the better history books I’ve read, and there’s so much else in it about the development of math and philosophy that you’re really getting a lot for the time invested in reading it.

Of course as interesting as the Vienna Circle was its brand of philosophy, logical positivism, is basically dead and buried. Karl Popper takes credit for killing it, though I’m pretty sure it wouldn’t have survived even without his intervention. And it’s the same problem we see over and over again, starting with Plato and probably going all the way down to the current rationalist movement. Science and rationality end up being unable to carry all of the ambitions people place upon them. We saw this in Plato and we saw it in the Vienna Circle. (Who incidentally mostly hated Plato, while loving Wittgenstein.) And when those ambitions eventually grow too heavy, they end up crushing the foundation, no matter how much science was poured into it. 


Expeditionary Force Series

By:  Craig Alanson

Book 1: Columbus Day

305 Pages

Book 2: SpecOps

277 Pages

Book 3: Paradise

283 Pages

Briefly, what is this series about?

Military science fiction about humanity suddenly discovering that the galaxy is full of super powerful warring aliens, and their attempts to avoid being collateral damage in those wars.

Who should read this book?

If you like pulpy, kind of silly military sci fi, I think you’ll really like this series. (At least the three books I’ve read so far.)

General Thoughts

Something about this series reminds me of Inherit the Stars by James P. Hogan. The premise of that book was that in the near future we find a dead guy in a spacesuit on the Moon. That’s not the weird part, the weird part is that he’s been dead for 50,000 years. When I first picked up Inherit the Stars, the mystery of how someone ended up on the moon 50,000 years ago was so enthralling that I read the book in a single sitting. I’m not sure if it’s the first time I did that, but it’s the time that sticks in my memory.

I was similarly hooked by the Expeditionary Force series. I didn’t listen to it all in one go, but it was pretty close to that, as you can see by the fact that I’ve already burned through three books (though there are 10-12 more books depending on how you count). I think it’s once again the mystery part that I find so compelling. In this case you’ve got the typical setup of an advanced progenitor race who has mysteriously disappeared, and despite the galaxy crawling with other alien species, the people in the eponymous expeditionary force end up on the forefront of the investigation into what has happened to them. All while trying to fulfill their primary mission of protecting humanity from aliens with vastly superior technology. 

Beyond the mystery other positives include: Alanson’s solution to Fermi’s Paradox, and I like his solution to the inevitable tech disparities between humans and aliens, and I really like the world building. 

On the negative side, you’re going to need to get really comfortable with deus ex machina because there’s a lot of it. Also there is a certain repetitiveness to things. Imagine it’s a sitcom where each episode has a similar format and each character makes the same kind of jokes in each of those episodes. We’ll see if that begins to get old, but it’s been just the mindless pulpy break I need.


Row Daily, Breathe Deeper, Live Better: A Guide to Moderate Exercise

by: Dustin Ordway

168 Pages

Briefly, what is this book about?

The advantages of developing a daily rowing habit.

Who should read this book?

If you’re looking for a new low impact exercise, and you’re curious about rowing this is a good introduction.

General Thoughts

I really need to start paying closer attention to a book’s rating before I pick it up. Both this book and the next two have less than 4 stars on Good Reads, which may not sound bad, but given that the average rating appears to be 4 anything less than 4 is below average. This was a perfectly fine book. It assumes the reader has zero rowing experience and if that’s actually the case then it’s a great book. On the other hand if you do have even a little experience, and you don’t need any motivation to row daily, then the book has very little to add to what you probably already know.  


Indistractable: How to Control Your Attention and Choose Your Life 

by: Nir Eyal (A-all)

290 Pages

Briefly, what is this book about?

Making yourself immune to distraction. 

Who should read this book?

Those who will read any book on personal improvement no matter how niche. Also anyone who thinks that distractions are ruining their life.

General Thoughts

In some respects the majority of current advice on personal productivity revolves around eliminating distractions, so this is not new territory. Consequently if you’ve already read a lot in this space then much of Eyal’s advice will not be new. Where he does break slightly new ground is in his answer on where the problem lies. Since I’ve already reviewed one book on drugs and I’m about to review another, let’s pretend being distracted is like being addicted. 

There are various theories why some people get addicted while others don’t, and why some people can break their addiction while others can’t. Some say it’s genetic, others admit that they’re not sure, and still others say it all has to do with whether a person has a strong network of support, and is generally happy otherwise, that if that’s the case addiction is not a problem. Applying this framework to technological distractions, Eyal is in the latter camp. That being distracted is entirely under our control, and that it’s just a matter of mastering our internal motivations, and being content. I’m not sure if he feels the same way about actual drugs, I just thought the comparison was useful and germane to the post as a whole, because…

Just like I don’t think we should let the Sacklers off the hook (see my first review) I don’t think we should let the tech companies off the hook either. To see why I might say this, let’s take one of the stories from the book. This particular story concerns a female professor who got some kind of fitness band which tracked her steps and other activity. The company making the band did everything in their power to “gamify” this device. You could compete with friends, there were daily challenges, there was a point system with rewards and a leaderboard. So one night around midnight, she’s getting ready for bed and it flashes an alert telling her that she can get triple points if she just climbs 20 stairs, which seems so easy that even though she was just about to go to bed she decided to do it, but as soon as she finished it flashed another offer for triple points if she would do another 40 stairs. And then she got yet another offer. I’ll let the book describe what happened next:

For the next two hours—from midnight until two in the morning—the professor treaded up and down her basement staircase as if possessed by some strange mind-controlling power. When she finally did come to a standstill, she realized she had climbed over two thousand stairs. That’s more than the 1,872 required to climb the Empire State Building.

Eyal goes on to explain that this seemingly ridiculous behavior corresponded to an incredibly stressful time in the professor’s life, and that’s why it happened. Eyal’s theory is that all behavior is an attempt to resolve discomfort, and that if she hadn’t had the discomfort of the stress she would have never found herself climbing the Empire State Building in the middle of the night.

Sure that’s obviously part of it, but let’s imagine that she had exactly the same level of stress but without the fitness tracker. I’m guessing that she would have just gone to bed at midnight. And yes, one imagines that she might have tossed and turned for a half hour or even an hour, but she still would have been better off than mindlessly walking the stairs for two hours. The point is that even if discomfort is a necessary element, tech companies prey on this discomfort, and more than that, they amplify create and amplify discomfort as well.


What is a p-value anyway? 34 Stories to Help You Actually Understand Statistics

by: Andrew Vickers

224 Pages

Briefly, what is this book about?

Statistics and the many ways they can be abused.

Who should read this book?

If you have a basic understanding of statistics and math, and you’re looking to go a little bit deeper this book might be worthwhile.

General Thoughts

I was underwhelmed by this book. For concepts where I did have a pretty good understanding the book was fine, but didn’t add much, and where he was introducing something I hadn’t come across, the book was generally too dry to be engaging. On the latter point, I think the title is misleading. I went in expecting 34 interesting extended metaphors for statistical principles, but instead the “stories” generally consisted of a short self-deprecating joke at the beginning of the chapter—yeah, we get it, you’re the cool statistician!—with the remainder of the chapter being more akin to a text book. If I had really been interested in getting into the meat of statistics the book could have been good. But I was looking for something a little lighter.

Additionally, I think Taleb may have permanently turned me against “normal” statistics, and I mean that in a formal sense, as in statistics which focus on a normal/Gaussian/bell curve. As near as I can tell Vickers’ discussion of statistics never really steps outside of assuming some degree of “normality”. The closest he appears to come is in a chapter which describes calculating the “average” salary of everyone in a diner. Most of the time you would use the mean, but if Bill Gates walks in, then the mean becomes meaningless. (Ha! Get it?) Vickers says in that case all you need to do is switch to using the median instead. Which seems to oversimplify the situation to the point of ridiculousness. Taleb would point out that the diner (and the world) have become very different places when billionaires arrive on the scene.

Now, I may be exaggerating a little bit, and as I previously said I wouldn’t claim that I brought my A-game when I read the book, but nowhere in it did I detect any acknowledgement of the difference between what Taleb calls mediocristan and extremistan. A difference that’s very, very important.


The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth

by: Sam Quinones

432 Pages

Briefly, what is this book about?

This is something of a sequel to Quinones’ book Dreamland. (Which I talked about here.) [POST] Dreamland was about OxyContin and heroin, this brings the story to the present day by talking about fentanyl and meth.

Who should read this book?

If you read and enjoyed Dreamland, then I think this is a valuable sequel. If you’re looking for a book on the drug crisis and you’re trying to choose between this book and Dreamland, I would probably recommend Dreamland. This is because without understanding how the crisis started it would be difficult to understand how it got so bad.

General Thoughts

As I mentioned in a previous review it is my intention to do a full post on the current drug crisis. So some of the juicy stuff will have to wait until then, in this space I’m going to talk about homelessness. I’ve been curious about homelessness for a while (here’s a post I did back in 2018) and just based on the number of homeless people I see and encounter, the problem seems to be getting worse. Quinones agrees with this assessment and his book has passages like this:

In 2018, when the Los Angeles Times reported that “L.A.’s Homelessness Surged 75% in Six Years,” this made a lot of sense to Eric Barrera. Those were exactly the years when supplies of Mexican “weirdo” meth really got out of hand. “It all began to change in 2009 and got worse after that,” he told me as we walked through a homeless encampment in Echo Park, west of downtown Los Angeles. “The way I saw myself deteriorating, tripping out and ending up homeless, that’s what I see out here. They’re hallucinating, talking to themselves. Now, it’s people on the street screaming. Terrified by paranoia. These are people who had normal lives.”

The “weirdo” meth is meth made using the P2P method rather than the old method of using ephedrine. We’ll be talking a lot more about weirdo meth in the eventual drug post, but this book makes the argument (as you can tell from the excerpt) that homelessness is increasing and that P2P meth is a major driver of that. And as I said this increase mostly matches my experience, though I was unaware of a possible connection to a change in the way meth was manufactured. But then just in the last few days, Matthew Yglesias was asked whether he thought there was a connection between drug use and homelessness, and he said:

Homelessness fell pretty steadily from 2007-2017 even while the opioid problem was getting worse and worse, so I don’t think the rebound since then can plausibly be attributed to drugs.

And then he provided this graph:

This of course doesn’t match the LA Times statistic Quinones mentions, nor my experience. Nor does Yglesias provide a source for these numbers, nor does he appear to be aware of the meth connection. And he offers all of this up in support of his argument homelessness is primarily driven by a lack of affordable housing. I’ll allow Quinones a chance to retort:

When asked how many of the people he met in those encampments had lost housing due to high rents or health insurance, Eric could not remember one. Meth was the reason they were there and couldn’t leave. Of the hundred or so vets he had brought out of the encampments and into housing, all but three returned.

I’m hoping to be able to get to the bottom of this before I do my post on the drug crisis, but Quinones makes a pretty persuasive case, so for the moment count me as a member of Team Meth. (A phrase I never thought I’d say…)


Empire of the Summer Moon: Quanah Parker and the Rise and Fall of the Comanches, the Most Powerful Indian Tribe in American History 

by: S. C. Gwynne

384 Pages

Briefly, what was this book about?

The history of the Texan and federal government’s battles against the Comanches.

Who should read this book?

Anyone who’s interested in the history of Texas, or the Indians, or who’s interested in history period.

General Thoughts

I can’t think of many books I’ve seen recommended in more places and by more people than this one. As such I am long overdue for reading it. It was indeed a fantastic book, well written with amazing stories and engaging characters. As such, I would add my recommendation to the others. That said, it wasn’t quite the transcendent experience I was expecting based on the effusive reviews. And it’s possible that I came into the book with impossible expectations, but it’s also possible that at least some of the people reviewing it have not read any other truly great history books, and so when they encountered one it was revelatory. Certainly Empire of the Summer Moon belongs in the category of great history books, it’s just not alone in that category.

As far as the actual content of the book, my favorite chapter was chapter 10 about John Coffee Hays and the creation of the Colt Revolver. The way the US ended up forgetting how to fight the Indians reminded me of the way that we forgot the cure for scurvy (but maybe that’s just me.) Other than that, the book is about what you’d expect, but it gave me new respect and interest for both the history of the Plains Indians and the history of Texas. 


Heart: The City Beneath

by: Grant Howitt and Christopher Taylor

220 Pages

Briefly, what is this book about?

It’s the sourcebook for an independently published role-playing game.

Who should read this book?

If you like Dungeons and Dragons or role-playing in general you’ll probably like this book. The setting is great and the system is inventive.

General Thoughts

It’s been awhile since I reviewed a role-playing sourcebook, which is not to say I haven’t been reading them, just that I normally skim them, as opposed to finishing them (see title of post). Heart was the exception. In part this is because it’s just a great system and beautiful book, but the bigger part is that I’m going to be running a campaign in the setting. The first session was actually this last Saturday. Obviously if I’m going to run it, it’s important to know my stuff. I won’t bore non-gamers out there with any further minutia other than to say that I’m really intrigued by the system, and I look forward to seeing how it plays out in practice.


Should you end up reading and enjoying any of these books let me know. Emails are always appreciated, but of course the best way to let me know you enjoy this stuff is by donating. These books don’t buy themselves.


The Tricky Business of Reality Construction

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I.

I was recently at a meetup with some Slate Star Codex readers, and I decided to bring up my impressions of The Deep Places by Ross Douthat, which I had recently read and reviewed. For those who may have missed the review, the book was a chronicle of Douthat’s struggles with chronic Lyme disease (CLD). The problem, both in the wider world and at the meetup, is that there are serious questions about the reality of this condition. Or as Wikipedia says:

Despite numerous studies, there is no evidence that symptoms associated with CLD are caused by any persistent infection…

From this we might say that in “reality”, at least as constructed by most doctors and at least some of the people attending the aforementioned meetup, CLD does not exist. According to them, Douthat was not suffering because he still had Borrelia burgdorferi bacteria (the cause of Lyme disease) in his body. On the other hand, the “reality” Douthat constructed asserts the exact opposite.

Recently this business of reality construction, or more formally, the discipline of epistemology, has become a lot more complicated, and for me the primary appeal of Douthat’s book was that he explained the minutia of his reality construction project—down to the studs as they say. His own journey from CLD doubter to CLD believer, and all the empirical evidence he collected which supported this transition.

One assumes that when the doctors and the participants of the meetup take issue with the existence of CLD that they are taking issue with this journey, and the manner in which Douthat has gone about constructing this reality. These issues presumably extend to other sufferers, and of course the rogue doctors who do believe in the existence of CLD.

We’ll get to the conflict within the healthcare establishment in a bit, but first I want to consider the pushback I got at the meetup. I’ll confess I was surprised by the certainty that was exhibited. First I would think that someone’s priors on the assertion “mainstream medicine never makes mistakes” would have taken a significant hit during the pandemic. Second, the people pushing back weren’t dogmatically committed to all of the claims of mainstream medicine. More than one fringe idea had already been asserted as being true by the people pushing back.

For example, one of the most vociferous anti-CLD arguments came from someone who had already claimed that soap doesn’t work. So in the reality he had constructed, CLD was all in one’s head, but so were the benefits of using soap when showering. Of course both things may be true in some objective sense, but I’m interested in how he arrived at each of them given that one—his rejection of CLD—is totally in line with constructing reality using the “lumber” of medical authorities, while the other—his rejection of soap—is the exact opposite. But of course these days one has all sorts of material to choose from when constructing a reality, and perhaps his technique for getting at “truth” involves using different material depending on the seriousness of the subject (is this a load bearing wall?) and the quality of the evidence. And perhaps one can construct a perfectly secure foundation upon which both facts can rest.

The point is not to criticize his particular construction methodology, but to point out how many methodologies the modern world has given us, and the difficulty of determining which of them to use, particularly since combining different ones may in fact produce the best results.

To use Douthat as an example of how things have changed. In the not too distant past he would have had a handful of doctors available to consult, who had a handful of medicines to recommend, and that was it. These days the number of specialized doctors has multiplied, and some of them might have a podcast or a blog. The number of medicines has also vastly increased. To this can be added a nearly infinite variety of supplements. Douthat could also exchange info with sufferers from all over the world on social media. And even if he’s trying to be exceptionally rigorous and go straight to scientific papers, there are hundreds of those as well. Beyond all this, perhaps the biggest change is that Lyme disease only became endemic over the last 50 years.

On the other hand, it could be argued that having so many methodologies and materials to choose from has been, on net, a bad thing. That having wide agreement on something that’s 80% true may be better for society than having the ability for a small number of people to get to 99% truth.

Before moving on, I should hasten to add that while I used this one person as an example, I’m not in any sense trying to make him look bad or prove him wrong. In fact part of my point is that without coming to a consensus on a decision making framework it might not even be possible to “prove” him wrong. Also I like this guy, he’s obviously smart, probably smarter than me. And interestingly enough he wasn’t even the only “anti-soaper” at the meetup. What I’m mostly interested in is how the construction of reality and the pursuit of truth has become so fractured recently. 

II.

Obviously Douthat is not the only person trying to get down to the “studs” of reality, and I thought his book was interesting and useful not only because of its detail, but because of its subject matter. Discussing the “reality” of a disease would appear to be more tractable than a discussion of the “reality” of racism. While we might someday discover a way of detecting lingering Borrelia burgdorferi bacteria in sufferers of CLD, we are unlikely to come up with some similar methodology for detecting racial animus in the human soul. Also, everyone is currently involved in their own, similar reality construction project with respect to COVID, and many of the questions Douthat was asking about CLD are being asked in various forms by billions of people and thousands of organizations.

As interesting as it might be to wade into that mess, it might be more productive to look at how reality was constructed during the 1918 flu pandemic. 

Obviously the tools available to doctors in 1918 were much more limited than the tools we have available now. Vaccination was still in its infancy, and the first flu vaccine was still 20 years away. But they did have some drugs available. In particular, people tried using aspirin and quinine to combat the disease. Hydroxychloroquine is a synthetic version of quinine, which provides one of the many fascinating parallels between the two pandemics. In both cases, the best science says that they were/are ineffective. The story of aspirin, however, is where it gets interesting.

Aspirin had not been around for very long at this point, and it truly was (and still is) kind of a wonder drug, but there was also a lot that wasn’t understood about it. Doctors, unable to do much of anything else, recommended that people take a lot of aspirin—as in an amount that these days is considered dangerous. Meaning that overuse of aspirin may have contributed to the death rate. This idea was first proposed in a 2009 paper, and it’s worth quoting the abstract of that paper in full:

The high case-fatality rate—especially among young adults—during the 1918–1919 influenza pandemic is incompletely understood. Although late deaths showed bacterial pneumonia, early deaths exhibited extremely “wet,” sometimes hemorrhagic lungs. The hypothesis presented herein is that aspirin contributed to the incidence and severity of viral pathology, bacterial infection, and death, because physicians of the day were unaware that the regimens (8.0–31.2 g per day) produce levels associated with hyperventilation and pulmonary edema in 33% and 3% of recipients, respectively. Recently, pulmonary edema was found at autopsy in 46% of 26 salicylate-intoxicated adults. Experimentally, salicylates increase lung fluid and protein levels and impair mucociliary clearance. In 1918, the US Surgeon General, the US Navy, and the Journal of the American Medical Association recommended use of aspirin just before the October death spike. If these recommendations were followed, and if pulmonary edema occurred in 3% of persons, a significant proportion of the deaths may be attributable to aspirin.

I only uncovered this fascinating bit of information in the course of writing this post. Which was surprising, I would have thought that it would be one of the major pieces of evidence brought forward by the anti-medical establishment crowd. (And maybe it is and I just missed it.) I am not interested in using it in this fashion. I’m more interested in using it to illustrate the differences between now and then. Back then there were conspiracy theories about aspirin killing people, but they all revolved around the idea that aspirin was made by Bayer and Bayer was a German company. And, when the Spanish Flu emerged, and during that October death spike, we were still at war with Germany. We know now that they were right to be cautious about aspirin (though for the wrong reasons), but it took until 2009 for us to figure out the “reality” of the situation.

Not only is this example more productive because it avoids current, unresolved controversies, it’s productive because it provides a contrast between the reality construction materials available in 1918 and those available today. The primary difference being of course the scarcity of our metaphorical construction materials back then as compared to the abundance we currently possess. In 1918, authority and science were far more monolithic. The number of potential treatments was far smaller. To the extent people were looking for nefarious schemes the narrative of these schemes was simpler. “We’re at war with Germany! They must be behind it!” But of all the differences perhaps the most consequential is that there was far, far, far less data.

Had the same thing played out during the current pandemic (and it has though perhaps in reverse with ivermectin) there might still be people blaming the Germans, but they would also be blaming the Chinese and the Russians, Big Pharma, and Bill Gates. There would also be people pointing out the results of past studies about the harms of aspirin; new studies would be conducted,and huge debates would erupt over the methodology of all of these studies and their statistical significance. Some people would start refusing to take any aspirin for any reason and some would make it a point of pride to take exactly the recommended dosage. There would be pro- and anti- aspirin blogs, and subreddits and message boards and personalities dedicated to each side. 

The big advantage of all the data, of all the methodologies, of all the reality construction materials available to us, is that unlike the doctors of 1918 we would almost certainly uncover the truth. We would also uncover 99 other explanations for things that weren’t the truth, and some people, perhaps many, would have a hard time deciding which of the 100 explanations to believe. Now to be fair, I’m probably exaggerating the uncertainty. Our science is powerful enough that we would reach consensus on the harmful effects of taking 31 grams of aspirin (31 grams!! I still can’t get over that) pretty quickly. But here we arrive at another difference between today and 1918. We have plucked all the low hanging fruit. In those places where reality was straightforward to construct it has already been built. The questions we need to form opinions on today are far more subtle. 

III. 

As I was writing this post I finished reading Why Liberalism Failed, by Patrick Deneen. (You can find my review here.) As is so often the case, after coming across a new idea, you’re tempted to think it explains everything. It almost certainly doesn’t, it’s just the idea is recent, but while that’s the case I’m going to dig into what it explains about this problem. Deneen makes a particular point of talking about the bifurcation of liberalism, that there is a massive increase in individualism coupled with a massive increase in government authority. While this split manifests in lots of different ways, I think the problems Deneen describes mostly stem from how this results in two different levels of reality construction. We have pushed it to the very highest levels as well as to the deepest recesses of the soul.

The promise of science is that if we devote enough resources toward answering a particular question we can arrive at the Truth, or at least an answer with a high probability of being true. When the question is “What are the effects of taking 31 grams of aspirin every day?” our methodology works pretty well. But what about the effects of taking less than 100 milligrams a day? Since 2007 doctors have recommended that people over 40 with a heightened risk of cardiovascular disease take a small daily dose of aspirin, generally in the 75 mg to 100 mg range. But now 15 years later they have backed off of the recommendation somewhat, particularly for older individuals, recommending that people over 70 avoid it entirely. 

I and others have written about the difficulties of creating a broad scientific consensus, so I don’t want to spend too much time rehashing that, but the presence and difficulty of such efforts should be kept in mind as we continue our exploration of how people construct the reality of their own lives, of what happens in the “deepest recesses of the soul”. Here again disease, and more broadly health and wellness in general, provide a great arena for this investigation.

The internet has empowered individual reality construction to a remarkable degree, but when considering health and wellness what’s striking is the degree to which it has also legitimated these individualized efforts. If you tell someone that you found some advice online or a technique or some other wisdom and you tried it out and it made you feel better, most people would, at minimum, applaud you for being proactive and responsible. Beyond that, even if they had doubts about whether a particular bit of wisdom was actually backed by science, a majority would nevertheless congratulate you on your improved sense of well-being. The assumption being that however bizarre your beliefs, how could they ever be more of an authority on your health than you are?

This is the other big thing about individual health and wellness: the empiricism is individual as well. To return to the anti-soapers, this appears to be what happened. They discovered some advice on the internet that recommended showering without soap. Something that would never have happened 30 years ago. They then tried it out, did their own n=1 experiment and decided that it produced a better outcome as far as health, and moved to make it part of their lifestyle. And as I mentioned it’s weird that at least one of them (maybe both, I don’t recall) objected to Douthat’s description of CLD, because that’s precisely what he did as well, only he spent much more time and went much deeper with his efforts.

In my review of Douthat’s book I ended with some questions for those who doubted his assessment. I’m going to end this section and begin the next by revisiting them.

First, the question I’m most curious about: what do these people (the doubters) imagine they would do if they were in Douthat’s shoes? If they had the same symptoms and those symptoms all responded in the same way to the same things? Would they still not believe in CLD? Or do they imagine that it couldn’t happen to them and thus the question is irrelevant? (Asserting their own immunity seems to be something of a matter of faith so we should probably set it aside.) Finally, what do they think is going on? Even if you believe that it’s all in someone’s head, which I think is what the guy from the meetup was claiming, you’re still unlikely to think that the right argument or the right set of facts will make someone go from experiencing symptoms to not experiencing them. (“This brochure cured me!”) Particularly given that the person suffering from the disease is probably, as illustrated by Douthat, actually open to any argument if it will just bring them relief

Still, I would be interested in taking a closer look at any advice the person might have on alternative reality construction methods Douthat should have used instead of the one he did. Because I think he tried most of them, which is another thing that made the book so impactful for me. Douthat starts with the mainstream view of CLD, he really wants to believe there’s no such thing, it’s only when his symptoms persist that he is eventually convinced. Which is why I’m so curious what doubters imagine they would do if they were in Douthat’s shoes.

It’s time to finally jump from diseases to a broader discussion of the problems of reality construction. Which takes us to the next question from my review. What is your position on fringe diseases and other fringe beliefs? Do your views entirely conform to those held by the mainstream medical establishment? 

To come at it from a different angle, we can imagine that there are some problems that are basically part of everyone’s reality: flu, cancer or broken bones as diagnosed by an x-ray. And then there are health issues almost no one thinks are real, like electromagnetic hypersensitivity (If you’ve seen the TV show Better Call Saul it’s what his brother Chuck suffers from.) But then there is clearly a large gray area between these two extremes. 

Where does one draw the line between real problems and fake problems? Your first impulse might be to make an argument around evidence and data. Or if either of those is insufficient, to gather more. To draw the line by referring to science or conducting more of it. If you really wanted to go the extra mile you could assign probabilities, perhaps as some sort of Bayesian exercise. This brings me to another question from my review: When someone says they don’t believe in CLD or for that matter electromagnetic hypersensitivity, what certainty level does this equate to? 51%? 90%? 100%? How certain are they that it’s made up? It might be said that my chief argument for this post is that modernity rather than delivering certainty has ended up burning it under a mountain of data subject to endless revisions. And it might be said that my chief argument with respect to Douthat’s book is that it should be impossible for someone to read it and reach the end possessing the same certainty they had going in.

What does one do with this large area in the middle? With diseases that are neither completely understood, nor obviously in someone’s head? Or to expand it out, most people obviously believe that COVID is real, but there’s still a huge debate over how dangerous it is, how best to deal with it, and whether such measures have unintended consequences, debates which I won’t rehash here. Beyond that is a whole universe of issues unrelated to disease where the science isn’t clear. 

We have long imagined that the tools of modernity, most especially science, would allow us to increase our certainty and end these debates. That they would make us better at the business of reality construction. But it seems increasingly clear that the opposite has happened. Why is that? 

I’ll conclude by trying to gather together the elements I have already discussed, while also introducing a couple of new ones:

  1. All of the problems we have left are subtle ones: We have picked all the low-hanging fruit and now all that’s left are issues where the data is messy and hard to collect.
  2. People recognize the power of science and so it’s become a weapon: This can range from researchers trying to make a name for themselves with exciting results to science being twisted to political ends.
  3. The bifurcation: We have individuals who feel empowered to collect and disseminate their own “science” on the one hand, and the government trying to generalize all data into something they can recommend universally. The former generates too much nuance, the latter too little.
  4. The flood of data: Closely related to the above, we have an enormous quantity and variety of reality construction tools available to us. Not only are there the standard observations about the internet, but we’re also doing far more science. There are dozens of studies just on the effectiveness of ivermectin. 
  5. What’s possible: Something I haven’t seen mentioned a lot, and perhaps it deserves its own post: modernity has increased the number of possible realities. In 1918 you could imagine that the flu was a disease or you could imagine that Bayer was doing something to aspirin tablets, and really only the first withstood scrutiny. These days you can imagine that COVID is natural, that it’s a natural virus which leaked from a lab, that it’s an artificial virus which was created using gain of function research which then leaked from a lab, or possibly something else, and find plenty of data to support any conclusion. Beyond that because we have DNA-sequencing and can identify how different omicron is, it’s possible to have an entirely different set of answers for this variant vs. the alpha variant. And I’m just scratching the surface.

Modernity has given us far more tools and far more materials with which to construct our individual realities. Some have taken these tools and materials and done great things with them. But some have taken them and used them in unintended and strange ways. By and large because reality construction has become so tricky, we’ve mostly gotten a lot worse at it, both individually and collectively. And if we can’t build a secure and consensual “reality”, well… we’re not going to be doing much of anything else either.


COVID spelt backwards is DIVOC and as our own battle against COVID seems to be traveling that direction it’s worth asking what DIVOC going on. Thank you folks, I’m here every week. If you appreciate that, consider donating.