So if not daily world news, what then? Well, Axios Local is a good option for DC, and has daily newsletter for more than two dozen other cities. StreetSense is a DC-only enterprise, and more relevant for me than whatever this is from The Washington Post. If the Council does start handing out vouchers to support local news, I know where mine will be going.

Here is an obvious analogy for you: the physical world — meatspace, if you will — as “meat” of an actual body, both skeletal (muscles, ligaments, tendons and such), and visceral (entrails, the liver, vital organs); the internet as nerve impulses connecting the various parts both sensorially (how are the navels of the world doing these days?) and in effect (from Facebook groups to GoFundMe pages bringing actual change).

You know how X and other social networks made everything feel connected to everything else? Well, there is an organic counterpart to this phenomenon, and it’s called a generalized tonic-clonic — or grand mal — seizure, manifesting, in the clonic phase, in widespread convulsions of the body.

The reason why our bodies are usually not convulsing is that the nerve impulse pathways are tightly controlled in space: there are separate nerves, differentiated brain areas for different roles, and let’s not forget the biggest separation of them all: two semi-independent brain hemispheres connected only by the corpus callosum which, imagine this, is sometimes cut completely for treatment of refractory seizures. There is also chemical separation: many of the pathways are inhibitory, and the most abundant neurotransmitter in the body is not dopamine, serotonin, acetylcholine or others you’ve heard of because they go haywire, but glycin, a modest amino acid which people don’t hear about because it is so good at its job of tamping down bad impulses.

The world’s ongoing convulsions started — after an initial tonic phase — right after we have all become interconnected: Hezbollah, Hamas, and your neighborhood association all hooked up to the same firehose. There is a feeling at the edge of my consciousness that the answer to solving them is in ourselves, and not in a new age self-fulfilment way but in pragmatic steps we can take to extrapolate from this most obvious analogy.

Nassim Taleb in Antifragile: ⊕ The link points to an excerpt posted on the Farnam Street blog, which I stopped following years ago — too much noise in the form of wisdom nuggets — but still has its uses. You should really read the whole of Incerto

The more frequently you look at data, the more noise you are disproportionally likely to get (rather than the valuable part called the signal); hence the higher the noise to signal ratio. And there is a confusion, that is not psychological at all, but inherent in the data itself.

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Now let’s add the psychological to this: we are not made to understand the point, so we overreact emotionally to noise. The best solution is to only look at very large changes in data or conditions, never small ones.

Alan Jacobs today:

If you’re reading the news several times a day, you’re not being informed, you’re being stimulated. Try giving yourself a break from it. Look at this stuff at wider intervals, and in between sessions, give yourself time to think and assess.

Always good to see convergence on important topics. I now get most of my news from books.

Epsilon Theory is a Web 3.0-adjacent website which I discounted simply by the virtue of its co-founder having a laser-eyed profile on X, but their article about news coverage of recent events is spot on:

After the deadly explosion at the al-Ahli Arab Hospital, Hamas issued a statement through its Health Ministry claiming as many as 500 or more deaths as a result of an Israeli airstrike. Instead of reporting what was known – an explosion with casualties – while working to confirm details about the scale of the blast, the number of deaths and the source of the explosion, each of the major newswires simply rushed to repeat each of the claims of Hamas verbatim. The Associated Press did it. So did Reuters. So did AFP. The west’s largest English-language news organizations followed suit. The Washington Post did it. So did CNN. So did the Wall Street Journal.

None of it was a huge surprise — things haven’t changed much since the 1999 NATO bombing of Serbia, when I witnessed in real time how pure speculation from a local TV network that was literally accross the street became Sky News scrolling text within the hour — but still disheartening to see after so much ink has been spilled about fake news and sundry.

Even more disheartening: when the stakes are high and facts are uncertain, journalists error on the side of blurting out whatever will get the highest emotional reaction — for the sake of a click. When stakes are low and there is plenty of time for research — they do the same!

This is the part where I note how not all journalists are alike, and indeed they are not! James Fallows' newsletter Breaking the News ocassionally has some brilliant dissections of the prevalining narrative, though he is too often obsessed with airplanes. I already wrote about The Washington Post’s great long pieces. Even The New York Times, has moments of brilliance. And there is always the local news, which is closer to the ground, less able to test the readers' credulity, and on the chopping block.

So with useful daily news (which is to say, local) becoming extinct, and good weekly/monthly journal articles becoming ever more rare, at least the amount of cognitive noise in our lives should decrease! If only we weren’t such suckers for noise-generating machines (which is to say, most social networks).

When the “Nobel Prize for Economics” gets announced, and people cry out that well-actually it’s the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel and it’s not part of Alfred Nobel’s original endowment, it is because this joker has won it, so how valuable could it possibly be? On the other hand, the most recent award went to the genuinely brilliant Claudia Goldin — here is a good pre-award interview — and the other Nobel prizes also went to some real ding-dongs. Things are never so clear-cut.

When I last wrote about crime in D.C a man was murdered while watching a soccer game right next to my kids' elementary school. This was back in July. Since then, the murders increased even more in August and decreased to (still high!) 2022 levels in September. Then a congressman got carjacked in front of his apartment building and the news media were all over it.

I mentioned in passing how you can trace a direct line from bad decisions to even worse consequences. While there has been movement to correct some of the more egregious mistakes, I haven’t seen even a suggestion of a mea — or sua — culpa from a council member. Until now!

When the stakes are lower, such as lets say public transit fare evasion, there is more space for assigning responsibility. The press release announcing the new legislation and the history behind the reversal is as good of an example of unintended (but not unforeseen) consequences and externalities as I’ve seen. You could, of course, trace the same well-intentioned path from calls for justice to murders on the soccer field, but that would of course not be so politically palatable.

All of this has reminded me of medical reversals and the unfortunately-titled (but good!) book about ending it. ⊕ This is why it is unfortunate: medical reversal is when something that is standard medical practice despite lacking evidence of benefit goes out of fashion once data, usually from a randomized controlled trial, show it doesn’t work. Now, ending reversal could mean two things: that you keep doing the thing despite the new evidence, or that you never start doing the thing to begin with. The authors meant the latter, where my common-sense interpretation is the former. People do dumb stuff. We should promote their reversal. Now, “legislative reversal” and “legal reversal” are terms already reserved for when an appeals court overturns a lower court’s decision, so what should we call “medical reversal” for written law? There are plenty of examples: from customs enshrined in old legislation than is then abolished (like traditional medicine disappearing with evidence showing it doesn’t work) to seemingly progressive legislation which is in reality a fountain of unintended consequences becoming quickly reversed.

Whatever the name, the consequences are at least more definitive than with medical reversals, which are rarely full — people still insert intra-aortic balloon pumps and perform kypholasties, I hear — and outside of a full FDA withdrawal of approval never have as clear of a demarcation line as written law. And we shoud strive to promote it, not end it.

The 2023 Nobel Prize in Medicine went to Katalin Karikó and Drew Weissman, and deservedly so. I do not look forward to the re-writing of history that will inevitably come about the role that the NIH, University of Pennsylvania, and academia in general had in their work. As a reminder:

“Every night I was working: grant, grant, grant,” Karikó remembered, referring to her efforts to obtain funding. “And it came back always no, no, no.”

By 1995, after six years on the faculty at the University of Pennsylvania, Karikó got demoted. She had been on the path to full professorship, but with no money coming in to support her work on mRNA, her bosses saw no point in pressing on.

She was back to the lower rungs of the scientific academy.

“Usually, at that point, people just say goodbye and leave because it’s so horrible,” Karikó said.

She didn’t quit. But even when the breakthrough came, the leading journal saw it as “incremental”:

“The breakthrough, as you put it, we first sent to a Nature journal, and within 24 h, they rejected it as an incremental contribution. I started learning English only at university, so I had to look up the meaning of the word incremental! Anyway, we then sent it to Immunity, and they accepted it (3). We literally did all the work ourselves, Drew and I. Even at the age of 58, I didn’t have much help or funding to perform the experiments, so I did them with my own hands. It took us a while to publish the follow-up paper in Molecular Therapy in 2008, where we presented data on the superior translation of the pseudouridine-containing mRNA and the lack of immune activation in mice.”

The story gets more tangled from there: Karikó and Weissman co-founded a company that failed, then joined BioNTech, and in parallel Moderna started working on their own modified RNA platform, and none of it would have mattered an iota if SARS-CoV-2 hadn’t provided the unfortunate opportunity for mRNA vaccines to shine. For all of our (deserved!) ex post glorification of everyone involved, no Covid-19 — no glory.

Which reminds me very much of The Tartare Steppe’s lonely soldier Drogo who wastes away his life guarding a fortress from the barbarian hordes that don’t arrive until it is too late for him to shine in battle. How lucky for us all that humanity has enough Drogos, and how lucky for this particular pair of soldiers that their Tartars showed up on time.

There was a major update today in the Maintenance of Certification saga: the president of ASH (American Society of Hematology, which, oh what a coincidence, I mentioned just yesterday) wrote an open letter to the CEO of ABIM requesting to end MOC as we know it. In what is I am sure a completely unrelated announcement, the CEO of ABIM said he would step down in September 2024. He may want to reconsider that timeline.

A mural from the rust belt. Obscured by the gas-guzzlers in the bottom left corner is the slogan: “Without Labor Nothing Prospers”. Indeed.

A recent podcast episode and a recent blog post show how screwed up the American drug market is, and in how many different ways.

In his Healthcare Unfiltered interview focused on generic drug shortages, the FDA Commissioner Robert Califf blamed Group Purchasing Organizations for driving down the cost of generic drugs to below what’s economically feasible. The manufacturers don’t have an incentive to shore up their process, the fragile production line fails, and presto, you have a shortage. Which is fine if you are manufacturing a placebo, but in recent years the FDA’s Drug Shortages Database has been ever-growing, and as of today includes potentially currative cancer drugs like cisplatin and carboplatin, many antibiotics, and even some formulations of sugar-water. Not to be confused with placebo.

This all reminds me a bit of my childhood in Serbia back in the mid-1990s, when bread was dirt cheap and never available. But that was too much price regulation. Here, we have too efficient of a market leading to a shortage. Only, I am sure there will be hands raised wanting to tell me that — well, actually — this was a clear example of over regulation, since new factories can’t just pop up too meet the demand and make use of the temporary market inefficiency, being dependent as they are on pesky FDA regulations — like the ones about drugs being safe. If only we could price in the risk of death by sepsis, we’d be in great shape!

So, on one end we have Medicare/Medicaid paying through the nose for brand name drugs because it is forbidden by law from negotiating for a better price, and on the other private GPOs negotiating too well for generics, to the point of extinction, forcing payers to get those expensive brand name drugs. Heads, brand-name pharmaceutical industry wins, tails, payers loose.

It was encouraging to see some movement in the price negotiation area: the comically misnamed Inflation Reduction Act allows for CMS to negotiate the price of some drugs, and the list of those drugs was recently made availalbe. Ideal? Far from it — in an ideal world the federal government would not be involved in any of this; but it’s not the world we live in. This is where the blog post comes in: from Alex Tabarrok, about how we are bad at pricing drugs because of unknown externalities (true!) but also with a side-comment reframing measures the IRA takes allowing nogiation as “price controls”, linking to [a policy paper][10] which suggests yet another set of measure to mitigate the adverse effects of IRA’s proposed solutions to the drug pricing problem. ⊕ Efficient markets for me, but not for thee, as Tabarrok’s writing partner would quip. And so the measures pile up from both the pro- and anti-regulation side. Ad infinitum, I suppose.

See also: better drugs don’t cost more, and a list of a few earnest but misguided attempts at cost control.