Tag: <span>Government</span>

Finding “The Answer”

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I just finished the book The Aristocracy of Talent: How Meritocracy Made the Modern World by: Adrian Wooldridge. I’ll obviously provide a review of it in my monthly book roundup at the beginning of December. If, for some reason, you need to decide before then whether or not to read it I will say that it spends more time than I would have expected on the history of meritocracy. But if history is precisely what you’re looking for then you should enjoy it.

This post is not going to be a review—though it may end up being one incidentally—rather I bring up the book because it was the inspiration for this post. The book helped illuminate a broader category. A category which contains many possibilities, of which meritocracy is only one. For thousands of years people have been asking, “What is the best way to organize society?” Meritocracy is one of many answers to that question, though up until fairly recently most people thought that it was not merely an answer, but The Answer. As I mentioned this has recently changed and people have started to have doubts, assuaging these doubts is one of the reasons why Wooldridge wrote his book. He still believes it’s The Answer. He even calls meritocracy the “Golden Ticket”. But as I said this is not a review, nor is it the place to dissect Wooldridge, rather I want to fit meritocracy into the broader search for “The Answer”. 


Somewhat hypocritically, after accusing Wooldridge of focusing too much on history, that’s where I’m going to start as well. After all he does have a point, in order to understand current conditions it’s critical to understand how we got here. In order to understand The Answer of the present we need to understand how people answered this question in the past.

The most obvious answer for how to organize a society and the one underlying all other answers is “survival”. You must first organize your society such that it survives, because, as I often point out, if it can’t survive it can’t do much of anything else. 

Closely related to survival is The Answer of “power”. Anyone who has the power to organize society will almost always organize it such that it benefits them. Or to put it another way, imagine that everyone, individually, gets asked, “How should society be organized?” To which everyone naturally answers “To my benefit!” And those who have or can acquire power are the ones who are able to turn that answer into reality. As you have probably already deduced, power is another thing which ends up being foundational to structuring how the world works.

Unfortunately for those exercising power, and perhaps fortunately for those who are powerless, organizing society for the benefit of the powerful often conflicts with organizing society such that it survives—particularly over the long term. Thus, in order for societies to continue, checks on the powerful must necessarily become part of the system by which the society is organized. This can, perhaps, be seen most clearly when it comes to warfare. The powerful can’t win wars on their own, and any society better able to marshal all of its resources will have an advantage in such conflicts. As a consequence of this, societies evolve systems and traditions that work towards these ends. It might be a culture which encourages child-bearing. Or an ideology which inspires people to feel pride in their tribe or nation, and to sacrifice for the benefit of those close to them. Or a hierarchical system designed such that the most powerful can grant power to others in a structured and useful fashion.

Eventually all of this gets packaged up and turned into something that might be called a religion, though one that only loosely resembles modern religions. But for the purposes of our topic the comparison is a useful one, since for modern religions providing The Answer is the whole point. And we see something similar here, though early on most religions were regional, and they didn’t aspire to provide The Answer, just answers. Which is to say that at the time there wasn’t a lot of zeal for evangelization, a point which will become important later on.

Obviously any discussion of religion puts us at the top of a very deep rabbit hole. We’re going to go some of the way down that hole, but in order to keep things manageable I’ll confine myself to a discussion of the civic role played by religion rather than its supernatural claims. 

At this point in our story, the various societies were still mostly focused on balancing power and survival. As they did so each society ended up with its own answers. These answers weren’t all encompassing, but rather very specific—relating to local challenges of geography, resources, and the threats posed by neighboring nations. Out of this attempt to balance power and survival, combined with all of this regional specificity, there emerged an interesting menagerie of systems. As time went on the systems grew more sophisticated, but there was still a Roman answer on how to organize things and a Chinese answer, and both were very different. 

However both were successful enough that it started to feel like their answers to the question of how to organize societies might be The Answer. This is certainly one of the reasons the end of the Roman Empire has seemed so consequential down through the ages. After being in existence for hundreds of years it seemed clear that they had The Answer and when, after centuries, that turned out not to be the case, it was a big blow. Because if the Roman empire wasn’t the answer, what was? Obviously people moved on to a reliance on Christianity, and it clearly provided The Answer to millions of individuals, but from a civic perspective its organizing powers never reached the heights achieved by the empire. More recently, one can see a very similar arc with China, and that’s where I’m going to focus. Rome is interesting, but it was long ago, and if I was going to go down that path at some point I’d have to talk about how Byzantium fits into things, and I’m not sure I’m prepared to do that.


For China, unlike Rome, The Answer had a label, it was called Confucianism, and Confucianism had a very conspicuous manifestation: the imperial examination system. Now obviously neither the exams nor the underlying ideology turned China into some kind of utopia. There were plenty of bumps in the road, some of them very large, but for over a thousand years— two thousand if we’re liberal in our assessment—even as dynasties changed and wars raged, Confucianism acted as a lodestone for the Chinese, and indeed most of East Asia. Whether it actually was The Answer seems far less important than whether people believed it was the answer. (One detects a significant amount of secular faith in this whole undertaking.)

At some point one would think that Confucianism would inevitably fall out of favor for any number of reasons, very few ideologies survive very long, and in the end it took decades of China being humiliated by the West (part of what the Chinese later labeled the “century of humiliation”) before they officially abandoned the imperial examination system in 1905. And while the examination system has not returned, Confucianism more broadly returned almost as soon as it was able. The first conference aimed at rehabilitating it was held just a few years after Mao died. (Mao having been one of its chief opponents.) Confucianism’s hold was such that it was only out of favor for around 100 years—and that only happened under extreme pressure—before it came roaring back

The abandonment of Confucianism seems to have been largely driven by a sense of survival. During the late 1800s and early 1900s China was facing an existential crisis. Which leads back to one of my original points, if you can’t survive you can’t do much of anything else. But once China’s survival appeared to no longer be threatened it was back in the picture.

This rehabilitation of Confucianism is not my primary focus, though it is interesting evidence of its staying power. I’m more interested in the way people handle things when they think that they have The Answer. That they have unlocked the secret of building a flourishing society. 

The Europeans seemed to also feel that Confucianism might be The Answer for them as well when they first encountered it. As Wooldridge points out in Aristocracy of Talent the Europeans were particularly fascinated by the Chinese exam system and the mandarins it produced. There were immediately attempts to create something similar back home. 

But, to be clear, we’re not interested in any specific answer for how society should be organized, we’re interested in the idea that there should be one answer, The Answer, a system which is better than all the rest. And it may be that hearing about the Chinese system was when this idea started to take root in the modern imagination, though by 17th century, when this was happening, lots of ideas were taking root, and it seems clear that one way or the other Europeans would have started experimenting politically just as they were beginning to be more serious about experimenting in other areas. 

Before we leave China it’s interesting to ask how they felt about this bigger idea. Separate from the virtues of Confucianism, why should it be so important or attractive for them to discover The Answer? Important enough that once the Chinese had it they held onto it for a thousand or more years? Even as conditions, leaders and the external world changed. Attractive enough that even when Confucianism was out of favor, they always landed on another candidate. If it wasn’t going to be Confucianism then it would be something else. Historically Legalism was the primary competitor, and there were also dalliances with Taoism. And we can’t forget the eventual zeal with which they embraced communism. 

One presumes that part of this tendency had to do with effectiveness. They’d seen how transformative having an answer could be, and by “they” I’m mostly talking about the rulers. Clearly if those in power had not noticed some ongoing benefit these various systems wouldn’t have been around for 2500 years. If you’ve read Seeing Like a State by James C. Scott you might be thinking of the benefits which would accrue to them from the legibility it imparted to the population. A population that was always quite massive, generally hovering at around one-fourth of the entire global population as far back as you want to look. If every part of China works the same way, that makes the country as a whole easier to manage. But perhaps the most interesting reason to adopt and seek an answer is that it gives you a goal, something to shoot for. It basically amounts to an early form of political science.

If you have arrived at a system. If you have The Answer. Then you also have a list of things you can try to make the country better. You can implement The Answer more completely in those areas which are lagging. You can refine The Answer, figure out what parts are working and what parts are unnecessary baggage, and then you can do more of the former while jettisoning the latter. You can compare slight differences in implementation and decide which of them works best. At some level all of these things happened in China, particularly with regards to the exams. One of my favorite examples is the procedure whereby all of the exams were recopied by someone else before being submitted to the judges, eliminating any potential bias that might occur if they recognized the handwriting. They also added various features to make cheating more difficult, and the exams as a whole got progressively more brutal.

As you can imagine the importance and brutality of the exam system had obvious side effects. Here’s how Wooldridge puts it:

The examination cult imposed a terrible strain on its devotees – not just on the young but on all those middle-aged and indeed elderly candidates who continued to put themselves forward. The examination halls that littered the country were widely known as ‘examination prisons’ and were sometimes subjected to riots and arson. Many of the greatest works of Chinese literature were devoted to demonizing the system.

Wooldridge even claims that my candidate for the biggest recent event no one knows about, the Taiping Rebellion, a Chinese civil war that happened at around the same time as the US Civil War in which 20-30 million people died, was “driven in part by frustrations with the civil service exam”. Which is a pretty big side effect. 

All of this is relatively easy to identify retrospectively as we look back on China, but is something similar happening today? Have we taken one answer and pushed it too far? Is it possible that it’s the quest for The Answer itself that has gotten out of hand?


The first thing we should consider as we move from an historical examination to the present day is what do we currently think The Answer is? Here, as is so often the case, we turn to Francis Fukuyama. The central claim of his book The End of History and the Last Man was that after centuries of trial and error, and contests between various systems that we had finally, and definitively answered the question of how best to organize society. The Answer turned out to be: liberal democracy. This was in part because of the many advantages of liberal democracy, but perhaps more importantly because, Fukuyama asserted, there were no remaining contenders. 

At the time Fukuyama was making this claim the strengths of liberal democracy were obvious, its weaknesses less so. As an example of one of these weaknesses, liberal democracy is not as well defined as Confucianism. Liberal democracy has no text that compares to the centrality of the Analects, and no activity that is as pivotal as the imperial examinations. Rather liberal democracy is more the assemblage of numerous good ideas, which Fukuyama defines directionally rather than absolutely. Liberal democracy is the endeavor of “getting to Denmark”.  

Denmark is a mythical place that is known to have good political and economic institutions: it is stable, democratic, peaceful, prosperous, inclusive, and has extremely low levels of political corruption.

It’s less of a definition than a goal, but with that goal to aspire to, and no remaining contenders we should basically be done, right? We’ve got The Answer, the rest is just implementation? 

Unfortunately, no. First implementation has proved to be more difficult than expected, but more importantly, not everyone agrees with Fukuyama. Certainly, as you might already have guessed, the leaders of countries like China and Russia definitely don’t agree with Fukuyama. But nor do all the citizens of the liberal democracies. Meritocracy is a great example of this. While it was not mentioned in the description of Denmark, people like Wooldridge, and many others, would nevertheless argue that it’s a central component of the liberal democratic/getting to Denmark package. But the whole reason Wooldridge wrote his book is not everyone agrees that it should be. The idea is under attack from both the left and the right. 

Nor is it the only liberal democratic idea under attack. Free trade and globalism are similarly under siege, and there are people who feel just as strongly about the centrality of these ideas as Wooldridge feels about meritocracy. Part of the reason people have turned against free trade is that it didn’t work as advertised. Back in 2001 when China was admitted into the WTO it was an article of faith for many that this opening would inevitably lead to China adopting the rest of the liberal democratic package. This was even more true when Fukuyama made his initial assertion. It was assumed that if you had true representative government, it would lead to meritocracy and free trade. Or that if you free trade and capitalism, it would lead to liberal speech norms and democracy. As we discovered to our sorrow with China this is not the case. We may have to settle for a world of free trade with illiberal nations. Or choose a system which minimizes inequality, or one which maximizes meritocracy. 

This is why people like Wooldridge have started picking pieces of the package to defend. If liberal democracy writ large is not The Answer perhaps meritocracy is. Or maybe it’s immigration. Perhaps we just haven’t given free trade enough time. Or perhaps it’s none of the above and we need a successor ideology. I’ve even seen more people moving back to communism. (Though because of the connotations they generally identify as hardcore socialists.)

In all of these efforts they are borrowing the evangelizing spirit that came about when people first thought they had The Answer. If you really have uncovered the one true way to organize society, why would you not want to spread it as widely and as deeply as possible? We can see this impulse playing out at least as early as the French Revolution. And down through the decades since then. It’s impractical to list all of the examples, but certainly Wilson, and his call to make “the world safe for democracy” comes to mind. You can also see it in Bush Jr’s invasion of Iraq, continuing up to and including our support for Ukraine in the current conflict. But this idea of evangelization wasn’t limited to liberal democracy. If anything communism had an even bigger evangelical urge, not only desiring to spread throughout the world, but going farther in their claims that it was inevitable. This was part of what made the Cold War seem so important. It was a contest between two sides that both thought that they had The Answer. 

Now, even as the liberal democratic package is fracturing, the evangelizing, if anything, is getting more intense. It’s proving difficult to be semi-meritocratic, but even more difficult to be completely meritocratic. It’s also difficult to be a semi-protectionists, but free trade has its own large set of issues. And no one says we should be semi-democratic, but everyone has their own definition of what democracy should look like, and oftentimes populism isn’t included in that definition. Don’t even get people started on the idea of being semi-unequal. 

In closing I’d like to include a long quote from a recent post from Ross Douthat. I’ve been talking about the fracturing of liberalism, he’s talking about the prospects for it’s renewal, but the underlying diagnosis is the same:

…liberalism cannot easily renew itself, because despite what certain of its detractors and some of its champions insist, it isn’t really a political-moral-theological system in full; rather, it’s a deliberately thinned-out structure designed to manage pluralism, which depends on constant infusions from other sources, preliberal or nonliberal, to generate meaning and energy and purpose. There are moments of transition and turmoil when liberalism appears to stand alone, and liberals sometimes confuse these moments for an aspirational norm. But nobody except Hugh Hefner, Gordon Gekko and a few devotees of the old A.C.L.U. can bear to live for very long under conditions of pure liberalism. Instead, the norm for successful societies and would-be society builders is liberalism-plus: liberalism plus nationalism (as in 19th-century Europe or Ukraine today), liberalism plus intense ethnic homogeneity (the Scandinavian model, now showing signs of strain), liberalism plus mainline Protestantism (the old American tradition), liberalism plus therapeutic spirituality (the mode of American culture since the 1970s), liberalism plus social justice progressivism (the mode of today’s cultural left), etc., etc. Something must be added, some ghost needs to inhabit the machine, or else society begins to resemble the portraits painted by liberalism’s enemies — a realm of atomized, unhappy consumers, creatures of self-interest whose time horizons for those interests are always a month rather than a decade, Lockean individuals moving in a miserable herd.

Douthat gets to the heart of the problem, but I don’t share his implicit optimism that liberalism can be reinfused and thereby revived. And one of the sources for the chaos of our time is that people have recognized that. Thus the fracturing. And from that fracturing a landscape where rather than having one answer there are dozens. People aren’t trying to save liberalism, they’re trying to save what they feel is the critical piece. They’re rallying around their version of The Answer. Whether it’s meritocracy or social justice or globalism or Christianity. Personally I lean towards the last one, but I also don’t see any path forward to a workable Christian Nationalism or any path back to the “liberalism plus mainline Protestantism” spoken of by Douthat.

But perhaps the beginning of any path forward is to acknowledge that we haven’t found The Answer, at least not yet.

This post didn’t come together as easily as I hoped. And then there was the whole FTX/SBF explosion in the middle which I spent way too much time reading about. This not only slowed me down, it made me reluctant to give money to anyone. If you had a similar reaction, let me reassure you. If you donate to me I won’t use the money to power an elaborate fraud. I’ll probably just use it to buy a book.

The Drug Crisis (Part 2): Wrapping Up and Maybe Some Solutions?

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I- Why Don’t Other Western, Developed Countries Have the Same Problem?

I generally don’t like breaking posts up into parts, though I’m frequently glad when I do because it often produces the best comments. If I’m in the middle of saying something then it’s more productive to interject a point or a question because it’s easier to incorporate it into what I’m already working on than it is for me to reopen a subject. 

The most interesting comment was left by Zach who pointed me at a tweet, from Max Roser, the founder of Our World in Data, which claimed that the dramatic increase in overdose deaths I talked about in the last post is strictly a US phenomenon. I confess to being embarrassed that I didn’t come across this assertion before starting my examination of the drug crisis. In particular I’m surprised that it was not mentioned in any of the books I read. I think it’s pretty easy to fall into a US centric view of events and issues, which is probably what happened to the authors of the books I read, and it’s definitely what happened to me. Regardless, now that it’s been brought to my attention it deserves a deeper discussion. 

I went to the Our World in Data page the tweet was referencing, and I can’t seem to find the exact chart Roser was using, the one that allows you to compare total overdose deaths by country. If someone else can, let me know. But I can pull a breakdown of the type of overdose deaths (opioids, meth, cocaine, other) by country, and I think the situation is a little bit more complicated than Roser claims. First off when I compare Canada and the US on this website, the percentage increase is pretty similar. Taking the period from 1999 to 2019 (the last year on the site) Canada’s opioid overdoses increased three-fold as compared to a five-fold increase in the US. The US is still worse but it appears more a matter of degree than of kind. 

Roser does include Australia on his chart, which is something, since Australia, unlike the other countries he included for comparison, had a bulge around the turn of the century, but then overdose deaths went down till around 2010 when they started to climb again. But once you look at the breakdown of deaths, Australia appears to have its own unique story to tell, because it’s the only country (as far as I can see) where overdose deaths from “other” drugs are higher than deaths from opioids. I’m not sure what the unique story is behind this phenomenon, but in five minutes of searching it looks like they might have a particularly bad problem with benzodiazepine and antidepressant overdose deaths. 

There are other countries which have seen the same steady upward trend as the US and Australia, but which do not appear on Roser’s chart, these include Finland, Sweden, and the United Kingdom. Also all the Latin American countries I looked at had a steady upward trend of overdose deaths. I don’t want to accuse him of cherry picking countries, but I think he has definitely left out some elements which complicate his narrative. This is of course the whole problem with Twitter. But, despite all of this, his central point stands, some countries are doing much better than other countries. Though I would say that the US is not quite as unique as he claims. 

The next step in this process is to determine why some countries are doing better than others and why all countries are doing better than the US. Roser offers up a Vox article which claims that the reason the US is uniquely bad is that drug programs in the US eschew medications like methadone, buprenorphine and naltrexone in favor of the 12 step program and other non-pharmaceutical interventions. I’m sure this is part of it, but does this same aversion also exist in Canada and the other countries I mentioned? I don’t have the time to research the various drug treatment regimens in all the different countries, but I’d be surprised if all these countries with their different cultures and medical setups just happened to all have the same aversion to these drugs. That Sweden and Finland have a policy similar to the US, but that Norway, sitting between them, does not. 

One answer a lot of people would give is that it has to do with the US healthcare system, which makes drugs uniquely profitable. While presumably Perdue Pharma could sell Oxycontin everywhere, the incentive to set up pill mills only existed in the United States. But then you still have to explain Canada, which has a single payer system. Certainly proximity to the US was a factor, but part of my point in the last post is that technology and progress have made every every location proximate.

This brings up the possibility that the US is on the leading edge of this trend, Canada is close behind and other countries will soon follow. While we just talked about distribution, “marketing” (for lack of a better term) is also a big factor in this upward trend. We can see it play out within the US, where for a very long time opioids were primarily a problem of white America. But recently black Americans have overtaken white Americans in opioid death rates. With the “white” opioid market effectively being saturated, it was predictable that dealers and distributors would turn to marketing to black Americans. Something similar may be coming for those countries that have thus far escaped the drug epidemic. 

Pulling all of this together, my theory at this point would be that once you’ve lost control of opioids it’s difficult to regain that control. That this is what happened in the US, and in other countries where deaths are rising. Perhaps a related thing happened in Australia, they lost control of benzos and that’s how more people are dying from benzo overdoses than from opioid overdoses. (Of course it could also be an artifact of how they collect statistics.)

I’d like to end this section by talking about China. There are actually two things worth mentioning. The first is their role in the US’s fentanyl problem, which, despite the increase in deaths from all the other drugs, is clearly the drug causing the single biggest problem. And according to the DEA, who’s the primary provider of that drug? China, at least as of January of 2020. This is obviously important for a lot of reasons, but while I was in Vegas hanging out with a friend of mine, he brought up one that I had inexplicably missed. It’s hard to overstate the role the Century of Humiliation plays in Chinese thinking, and of course one of the biggest humiliations during that period was the Opium Wars, when the UK forced China to import opium. For a country that is trying to shake off those humiliations, a reversal of that flow, pushing opioids into the US, is too perfect to resist. I am not claiming that this was a grand conspiracy, more that it was a fortuitous opportunity which was too lucrative to pass up, and is now too symbolic to do anything substantial to stop. And, as we’re seeing, China has significant power to stop things. Which takes us to the next point.

In looking through the charts it does appear that China had their own significant problem with opioid overdose deaths in the late 90’s. Deaths started falling precipitously in 2000 and leveled out at about one-fourth their peak. To get the US death total back to where it was before the epidemic we’d have to decrease the total by an even greater percentage. Do you think the Chinese did it through the use of methadone, buprenorphine and naltrexone If not, which seems likely, do you think the methods they did use would work here? I suspect just like Chinese COVID mitigation policies, that we would also be unable to duplicate their opioid mitigation policies.

Speaking of COVID…

II- The Pandemic Made Things Way Worse

Even if the problem is mostly just a US problem it’s still a problem which needs to be solved, and we’ll get to that, but first I want to look at what happened to the problem during the pandemic, because I think it gives us clues to what kind of problem it is.

If you look at graphs of overdose deaths it’s possible to make the case that by 2017 things were plateauing. Roser’s charts conveniently end in 2017, since those were the most recent numbers available to him when he tweeted in December of 2019, which was also conveniently right before the pandemic. As I mentioned in the last post, 2018 was the first year since 1990 when deaths were down from the previous year. And if you adjust for population, 2019 also had a slightly lower death rate than 2017.

Of course, even if deaths were plateauing in 2018 and 2019, it was still a very high plateau, but even a high plateau would be better than having it continue to go up, year after year, which is what it had been doing. And of course one hopes that after it plateaus that it starts gradually coming down. But then 2020 comes along and deaths jump 30%, presumably because of the pandemic. This is the highest increase on record other than the 71%(!) jump from 1998 to 1999. And preliminary numbers for 2021 indicate that it kept going up, though the rate of increase appears to have dropped all the way to 28.5%… I made this point in a previous post, but at growth rates like that everyone in the country will be dead of a drug overdose by 2057, or 35 years from now.  Obviously this rate of increase can’t continue for long, and it’s amazing that it continued for two years.

I bring all of this up for several reasons. First, to give you a sense of the scale of the problem. Obviously it’s bad, but it’s the rate at which it’s getting worse that’s truly alarming. Second, though this is tangential to my primary subject, it’s an interesting but also stark reminder that pandemic precautions were not cost free. I was in favor of most of the precautions that were taken, particularly at the beginning when uncertainty was at its highest, but no one should be under the impression that there are no trade-offs, and some of those tradeoffs consist of people dying, many from drug overdoses, but not all. Third, and most importantly, studying the manner and timing of overdose deaths, particularly when they’re increasing, might help us isolate the cause of those deaths and give us better tools for mitigation. 

Furthermore, as long as we’re talking about the current state of the crisis, I came across one other point that was worth mentioning. A recent paper suggested that up to a quarter of the drop in labor force participation might be due to “increased substance abuse”. So the great resignation might be 25% due to people being addicted to drugs. I don’t have the time to go down that rabbit hole, but it seems like a very big deal. 

I pointed out a lot of reasons in the last section for believing that the problem was not one that was unique to the US, but this is my biggest reason for being cautious. All the numbers I quoted above were from charts that ended in 2019. As I already pointed out all of Roser’s numbers were from charts that ended in 2017. I don’t think we’ll know the true scale of the problem either here or abroad until we have a full accounting of what happened over the last two years. And probably what happened this year as well. Do the pandemic overdose numbers represent a new plateau? Or are they a temporary peak, and we’ll fall back to the numbers of the late 20-teens. Or is it just going to keep getting worse as it has basically every year since 1990? I’d love to be optimistic, but so far the arc of the epidemic has always been worse than I predicted.  

Of course the pandemic was awful, but why did it make overdose deaths so much worse? As in the worst year over year increase since the epidemic started. I assume that there are various possible theories, but I prefer the simple explanation: it was the loneliness. If one could associate any emotion with the pandemic, more than fear, more than frustration, more than anger at the idiots on the other side, the dominant emotion was loneliness. I’ve seen people call these overdoses “deaths of despair”. I’ve also seen people mock this idea, but when deaths go up by 30% one year, and then almost 30% the next year, and those years happen to coincide with a pandemic, I think calling them deaths of despair is probably pretty accurate. I would also accept deaths of loneliness, but I will not accept any explanation which doesn’t include some connection to the pandemic, and I haven’t seen any better ones on offer.

Pinpointing loneliness as the cause of the increase in deaths gives us our starting point for talking about how best to reduce those deaths. 

III- The Best Way to Deal With the Problem 

As I said, all of the information I collected in preparation for this post is from a US perspective. So to the extent that this is or isn’t a problem elsewhere, it isn’t going to enter much into the discussion, though I’m sure there will be some amount of overlap even so. But even should the problem be completely unique to the United States it would still merit serious discussion. Far more than it’s getting now.

To begin with we should talk about what doesn’t work. And it’s clear that top down governmental action is one of those things. Perhaps there was a time when it might have worked, but at this point I think it’s too late. The problem is too big and the addicts are too numerous. In the course of reading several books on the subject it became clear that the federal government, and specifically the FDA, is just too far easy to hack, and beyond that, because the US is the richest country in the world, not to mention the 3rd most populous, the rewards for doing so are enormous. This is similar to the situation that existed in the early days of the internet when there were numerous viruses for Windows machines, but very few for Macs. It wasn’t that Apple machines were significantly more secure, they weren’t. It was the fact that Windows machines were far more numerous. 

Perhaps here we have stumbled on US uniqueness, not that we are uniquely bad at treating addiction, but that we were just the juiciest target for the three factors mentioned in the last post. Pharmaceutical companies were presented with a unique opportunity when the ideology of pain management changed, but where should they pursue this opportunity? Clearly if you were going to start making something like Oxycontin and begin marketing it, the only logical place was the US, and once you had a bunch of addicts, it was also the obvious target for Mexican heroin smugglers (in addition to being next door) and later for distributors of Chinese fentanyl. To reuse our analogy, the change in the terrain of pain management was the internet, and the US is Windows, the biggest attack surface. And as late as 2018 there were still more threats per Windows machine than there were for an individual Mac, but by 2019 that had flipped and there were twice as many threats for each Mac as opposed to each PC. Perhaps eventually something similar will happen, but for now, the US is still the best market for opioids the world has ever known. 

The futility of expecting the federal government and FDA to do anything was brought home most starkly by the story of Insys, told in the book The Hard Sell. As I mentioned in my review, this was a company that started marketing a fentanyl spray in 2012, and did it for five years in the most egregious fashion imaginable before they were finally stopped. If the FDA wasn’t going to pay special attention to fentanyl in 2012, then it kind of feels like they are never going to be the solution to the crisis, nor do other arms of the federal government seem to be doing much better. I’m largely with people who believe that the War on Drugs has been a pretty massive failure. Of course most of these people conclude from this that we should legalize all drugs. 

I had initially planned to spend a fair amount of time talking about legalization, but that time got taken up by dealing with the subject of differential death rates between the US and other western democracies, and given that this post is already late, I don’t have any additional time I can draw on. I will say that when I was young I was a really big fan of legalization. I remember a particular Bloom County comic strip (for those old enough to remember that strip) where drugs were legalized and all the associated drug violence stopped. The punch line was that a drug dealer was out on the lawn wondering what had happened to government price fixing, or something like that (I was unable to find the actual comic). 

I am no longer so idealistic. The problem is how do we keep bad actors from abusing the system in the fashion of Insys and Perdue? One of the arguments has always been that with a legal market at least the drugs won’t be mislabeled or cut with some other, more dangerous drug, but Insys and Perdue produced completely pure product, and that didn’t prevent it from being a gigantic problem. Also the experience we’ve had with marijuana legalization is not encouraging. To take one example California legalized weed in 2016, but five years later 80-90 percent of the market is still underground. The same thing happened in the transition from Oxycontin to heroin, people were addicted to oxy which was available and legal, but expensive, so as a result they turned to heroin which was illegal, but cheap. I would love to hear a credible framework for legalization, even if it were politically infeasible, but I haven’t come across one. Now of course decriminalization is another matter, and I do think that has some real possibilities, which I’ll touch on in just a second.

Okay I’ve talked about all the things that don’t work, it’s finally time to talk about things which might work. Let’s start at the beginning. 

While in Vietnam a significant percentage of soldiers ended up addicted to heroin, and there was widespread belief that upon their return that society would have to grapple with a massive addiction problem, but as it turned out once the soldiers were home the vast majority transitioned back to civilian life and their normal jobs without much fuss. While this was surprising, on a certain level it makes sense. You could imagine that, when faced by the horrors of war, someone might have no other option than to seek to dull things with an opioid, but that once they were home and away from those horrors that they would no longer be dependent on that stuff. 

Despite this, and it’s not clear from the numbers how much of the problem was returning soldiers and how much of the problem was other things, from 1968 to 1969 overdose deaths went up by 19%, and from 1969 to 1970 they went up by 18%. 1971 is when Nixon started the War on Drugs and whether because of this or because of the ongoing drawdown of troops from Vietnam, or because something else, the number of overdose deaths stabilized and even dropped a little bit for the rest of the decade, until 1979 when deaths suddenly more than halved and stayed at that level for several years. (The per capita death rate didn’t surpass the 1978 level until 1993. I have no idea why this happened, and perhaps it’s an artifact of the reporting methodology being changed, but it is interesting to note that when Nancy Reagen was unveiling her “Just Say No” campaign that drug overdose deaths were about as low as they’ve ever been.

The foregoing history of overdose deaths in the 70’s and 80’s was mostly included because it seemed interesting. I’m not sure there are any morals to be drawn, particularly for the sudden drop in 1979, since I have no idea why it happened. Though one might draw the weak conclusion that the initial War on Drugs was not quite the abject failure people claim. No, what I’m mostly interested in, is the lesson of the soldiers returning from Vietnam and the vast increase in deaths during the pandemic, because both phenomena, though directionally opposite, touch on the only thing that seems to be working: being part of an involved community. Soldiers who were addicts in Vietnam were able to shake that addiction when they returned home (clearly not all, but the vast majority did). When people were deprived of community during the pandemic, overdose deaths which were already stratospheric went up even more.

This is a point Sam Quinones returns to again and again in The Least of Us, that what seems to work is when a town, or occasionally something larger decides to really engage with treating the problem rather than locking people up. When they establish special drug courts, de facto decriminalization through suspending sentencing while the defendant seeks treatment, of helping them with jobs, and giving them places to sleep. It’s when an individual addict can draw on the help of several engaged individuals. When, for lack of a better term they have a tribe to draw on. It was when these things were happening that Quinones saw people successfully recovering from their addictions. As he says in the final paragraph of his introduction:

That is what fueled this book—two stories that I set out to tell here. One is the story of an ominous die-off amid a global economy producing catastrophic supplies of dope cheaper and more potent than ever. The other is of Americans’ quiet attempts to recover community through simple acts, guided by the belief—the message of our addiction crisis to those who would notice—that the least of us lies within us all.”

Now I’m not saying this is easy, or straightforward. In particular, I don’t think I can boil it down to something easily digestible in the closing paragraphs of this post. If you’re curious you should probably read the book. Nor am I saying that this is the only possible way to do it. I’d be very interested in trying methadone, buprenorphine and naltrexone as part of a treatment plan. But if you have a bunch of different communities experimenting with stuff then presumably some community will try these drugs and if they work as well as has been claimed then they’ll keep using them and more communities will follow. 

IV- Miscellaneous Points I Wanted to Cover but Didn’t Have Time For

This discussion of the failures at the lowest and highest levels, i.e. the failure of the federal government and numerous individuals reminded me of the central assertion of Why Liberalism Failed by Patrick Deneen: that we have hollowed out the middle of society. Certainly one could make the argument that that’s exactly what has happened with drugs. The federal government midwifed the problem into existence, individuals operating mostly alone acquire the problem and can’t shake it, and only communities acting in the middle can resolve the problems created by both ends. Problems that would not be nearly so bad if communities had maintained their historic strength.

They screwed up so badly with Oxycontin that, perhaps understandably, the entire medical establishment is now overreacting in the other direction—underprescribing opioids. While I do think that our primary focus needs to be on the harms of these substances, particularly while those harms still appear to be increasing, it’s important not to entirely lose sight of the benefits of opioids. One of my readers pointed me at a presentation made by a libertarian city councilor pointing out how difficult it is even for terminal patients in extreme pain to get Oxycontin and similar drugs now. That now everyone is assumed to be an addict. He also reminded me of Scott Alexander’s piece Against Against Pseudoaddiction which makes some related and very valid points. But, to go back to my argument, you could imagine that this also might be something that a strong middle is better at. It’s much easier to prescribe Oxycontin to someone that has the support of a whole community, a community you might very well belong to, that to prescribe them to someone you just met.

A big part of this whole discussion is the idea of hedonic calculus. You can imagine that people feel much happier when they are pain free, but if that comes at the cost of dying early from an overdose how are we to balance those two things? This is why the question of giving opioids to those who are dying is easy “yes”, and the question of whether we should have given opioids to people who ended up dying prematurely an easy “no”. But what about all the space in between? To illustrate I’ll end with a story.

One of my college friends, actually my roommate, had pretty bad back problems and was put on Lortab, which is ​​hydrocodone and acetaminophen. I don’t know if he was overprescribed Lortab, or if he had problems getting it, but he ended up taking a lot of it. Even today doctor’s are less worried about prescribing it because the acetaminophen is supposed to make it difficult to abuse. Because it will destroy your liver. Well that’s what happened to my friend, he died of what the doctor’s said was alcoholic hepatitis, and while I’m sure alcohol contributed, I think it was mostly the acetaminophen. And as a result he died when he was 40. If he had been taking heroin he might have actually lived longer, and one wonders if, in the final analysis, whether it would have been a better life.

I still think about him, a lot.

That ended on a sad note, and of course the whole subject is sad. But sometimes being sad is good; it spurs you to reflection or even action. I kind of doubt that action will be donating to this blog, but on the off chance that is precisely the action it inspires, here’s a link.

Eschatologist #11: Black Swans

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February 2020, the last month of normalcy, probably feels like a long time ago. I spent the last week of it in New York City. Which was already ground zero for the pandemic—though no one knew that yet. I was there to attend the Real World Risk Institute. A week-long course put on by Nassim Taleb, who’s best known as the author of The Black Swan. The coincidence of learning more about black swans while a very large one was already in process is not lost on me.

(Curiously enough, this is not the first time I was in New York right before a black swan. I also happened to be there a couple of weeks before 9/11.)

Before we go any further, for any who might be unfamiliar with the term, a black swan is an unpredictable, rare event with extreme consequences. And, one of the things I was surprised to learn while at the institute is that Taleb, despite inventing the term, has grown to dislike it. There are a couple of reasons for this. First people apply it to things which aren’t really black swans, to things which can be foreseen. The pandemic is actually a pretty good example of this. Experts had been warning about the inevitability of one for decades. We had one in 1918, and beyond that several recent near misses with SARS, MERS, and Ebola. And that was just in the last couple of decades. If all this is the case, why am I still calling it a black swan?

First off, even if the danger of a pandemic was fairly well known, the second order effects have given us a whole flock of black swans. Things like supply chain shocks, teleworking, housing craziness, inflation, labor shortages, and widespread civil unrest, to name just a few. This is the primary reason, but on top of that I think Taleb is being a little bit dogmatic with this objection. (I.e. it’s hard to think of what phrase other than “black swan” better describes the pandemic.)

However, when it comes to his second objection I am entirely in agreement with him. People use the term as an excuse. “It was a black swan. How could we possibly have prepared?!?” And herein lies the problem, and the culmination of everything I’ve been saying since the beginning, but particularly over the last four months.

Accordingly saying “How could we possibly have prepared?” is not only a massive abdication of responsibility, it’s also an equally massive misunderstanding of the moment. Because preparedness has no meaning if it’s not directed towards preparing for black swans. There is nothing else worth preparing for.

You may be wondering, particularly if black swans are unpredictable, how is one supposed to do that? The answer is less fragility, and ideally antifragility, but a full exploration of what that means will have to wait for another time. Though I’ve already touched on how religion helps create both of these at the level of individuals and families. But what about levels above that? 

This is where I am the most concerned. And where the excuse, “It was a black swan! Nothing could be done!” has caused the greatest damage. In a society driven by markets, corporations have great ability to both help and harm by the risks they take. We’re seeing some of these harms right now. We saw even more during the 2007-2008 financial crisis. When these harms occur, it’s becoming more common to use this excuse. That it could not be foreseen. It could not be prevented.

If corporations suffered the effects of their lack of foresight that would be one thing. But increasingly governments provide a backstop against such calamities. In the process they absorb at least some of the risk. Making the government itself more susceptible to future, bigger black swans. And if that happens, we have no backstop.

Someday a black swan will either end the world, or save it. Let’s hope it’s the latter.

One thing you might not realize is that donations happen to also be black swans. They’re rare (but becoming more common) and enormously consequential. If you want to feel what it’s like to have that sort of power, consider trying it out.