Tuesday, May 26, 2020

Pharmacoepidemiology in debate

This is Joseph

Andrew Gelman was discussing the Lancet article on the safety of hydroxychloroquine. He posited three possible outcomes:

1. The criticisms are mistaken. Actually the research in question adjusted just fine for pre-treatment covariates, and the apparent data anomalies are just misunderstandings. Or maybe there are some minor errors requiring minor corrections.
2. The criticisms are valid and the authors and journal publicly acknowledge their mistakes. I doubt this will happen. Retractions and corrections are rare. Even the most extreme cases are difficult to retract or correct. Consider the most notorious Lancet paper of all, the vaccines paper by Andrew Wakefield, which appeared in 1998, and was finally retracted . . . in 2010. If the worst paper ever took 12 years to be retracted, what can we expect for just run-of-the-mill bad papers?
3. The criticisms are valid, the authors dodge and do not fully grapple with the criticism, and the journal stays clear of the fray, content to rack up the citations and the publicity.
I wrote a comment that went into what I see as a fourth possibility: the data is real and the analysis was done as stated but the question, itself, is not fit for observational analysis
I think there is a fourth possibility. We know that studies of drugs for their primary indication are fraught with risk. This was clearly articulated in the literature by 1983 (https://onlinelibrary.wiley.com/doi/abs/10.1002/sim.4780020222) bu Olli Miettinen but was built on a long tradition of problematic cases. More recently we have Tobias Kurth’s paper showing implausible results in cases with medical desperation (https://academic.oup.com/aje/article/163/3/262/59818). Treatment is not random when physicians, patients, and families are desperate.
We also saw this with hormone replacement therapy and CVD; the theory that it would help with CVD ended up channeling the drug to high SES individuals. This is why drug people insist on trials — too many results reverse direction when channeling effects are removed.
There is no possibility that these medications were being given for an indication other than covid-19. There is just not that much co-infection with malaria.
So option #4 is the study is fine. The data (despite some alarming patterns) turns out to be okay. But the result is simply wrong because they are studying an intended effect. Or they could be correct. Sometimes you end up accounting for channeling (people do, in fact, occasionally win the lottery) and the results are consistent with the causal association posited by trials. My favorite paper was looking at tricks to try and do this with observational data.
The real issue is the strength of the conclusions. Of course, the data issues are a separate and concerning factor as well. But I wish we’d show more humility with observational drug research. I do a LOT of it and it annoys me when these basics of interpretation are glossed over with bullet text about observational research having limitations (unknown confounders — grrrrr) and not a recognition that this is why we do trials — because these estimates are inherently unreliable.
#EndofRant
I see this as different than Wakefield, who faked data. Or an analysis structure that is incorrect. And people publish these studies all of the time. But they do so with known failure points and the use of the word "associated" is a thin veneer:
We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.
Obviously this paper is only of value for a general medical audience if we are supposed to conclude something about the effectiveness of hydroxychloroquine or chloroquine. I mean this stuff is kind of there in the limitations section, but the conclusion is written without these caveats. The first author, I note, is a cardiologist and not a pharmacoepidemiologist.

Now, this is a long rant but here is the other side of the  coin:  arrhythmia is not an intended effect. Yes, we can study the unintended drug effects and this paper brings up completely legitimate safety concerns, given that the issues with the data raised by Gelmen and others can be addressed. But that actual useful contribution is being buried under the far more "hot" mortality data.

James Watson even noted:
This caught my eye, as an effect size that big should have been picked up pretty quickly in the interim analyses of randomized trials that are currently happening. For example, the RECOVERY trial has a hydroxychloroquine arm and they have probably enrolled ~1500 patients into that arm (~10,000 + total already). They will have had multiple interim analyses so far and the trial hasn’t been stopped yet.
This is definitely a big point. It is totally plausible that arrhythmias could be missed (they are often in clinical practice) especially with such a sick patient population. But the mortality signal is awfully high for the trials not to have noticed (although the WHO is now checking their interim data, so maybe?). 

Anyway, I guess this is in my wheelhouse and I just wish we had a better interpretation of these studies in major journals.
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Tuesday Tweets -- "NEW from Aristocratic Murderer: Columbo Not As Smart As He Thinks He Is"




Tweets that age well.


We'll talk more about the consequences of the conservative movement losing control of the crazy.








Journalism's inability to deal with astroturf is proving costly.





Also worth noting that when billionaires do sacrifice a tiny sliver of their wealth for the public good they are praised to high heaven.
 
Fascinating example of data manipulation.



Anyone else see a potential for perverse incentives?


Calculus humor.


Speaking of the conservative movement losing control of the lunatic fringe (though in all fairness, plenty of anti-vaxxers on the left as well).
 
Not the same without the Bond  villain Nehru jacket.
 
This is going to be a difficult transition.


"Comment would be superfluous." -- Steve Allen

I'll admit it's kind of an easy one.
 
In the Coulter/Trump relationship, it's important to remember Ann has always been the Dom. That might make for some interesting developments.



Yes, they are.
 





















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Monday, May 25, 2020

More on journalistic context

This is Joseph

I want to follow up on Mark's post "The New York Times is incapable of learning part 4,234 -- Ignoring context is not part of balance". This article is a great example of ignoring the larger context of the story. The article begins:
US Rep. Alexandria Ocasio-Cortez wants to raise taxes on the rich — just not pay her own.
But as you read down further:
“The congresswoman is still in the process of contesting the tax warrant. The business has been closed for several years now, and so we believe that the state Tax Department has continued to collect the franchise tax in error,” said Lauren Hitt, an AOC spokeswoman.
“As anyone who’s tried to contest a tax bill in error knows, it takes time,” Hitt added. 
There is obviously a major difference between having a active tax dispute and not paying taxes. After all, the president has been apparently under audit (i.e., contesting taxes) for several years now.

The real interesting piece here is how this is showing up at the same time as the Supreme Court is ruling on keeping presidential taxes top secret. This does two things. One, it applies a very real double standard as to whether taxes are a private matter. Two, it removes the context of what tax information is relevant. It is quite plausible that somebody might not successfully close a business in a way that it still gets taxed or that a form could have been misplaced. Why is the question not the cumbersome and opaque nature of most taxation systems?
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Friday, May 22, 2020

The New York Times is incapable of learning part 4,234 -- Ignoring context is not part of balance





 If you look at the New York Times through an ideological lens , it’s fairly clear that on average the paper is a highly conventional establishment center to center left publication, but you won’t get much understanding beyond that. There are, however, explanatory variables that add great clarity. Hubris, the need to maintain and increase access, a profound attachment for the status quo, an upper class/Ivy League mindset, and the need to rationalize caving to pressure. Viewed in those terms, things start to make a great deal more sense. 

The Republicans got to be very good at manipulating the New York Times by playing on these weaknesses. One of the results was the obsessive embrace of false balance. Another was the related technique of discussing a candidate, particularly a Democrat, as if his or her opponent didn’t exist.

This was perhaps the essential component of the paper's coverage of Hillary Clinton in 2016. Any reasonably accurate side-by-side comparison would have so greatly favored Clinton over Trump as to infuriate Republican leaders, inevitably leading to blistering attacks and the loss of access to Republican officials and inside tips.

Just to be clear, I’m not saying that the paper set out to bias their Clinton coverage out of desire of the carrot and fear of the stick. I’m sure that the people who wrote and edited these stories honestly believed that they were upholding the highest standards of fairness and journalistic ethics. That’s the problem.

When someone is doing wrong and knows they’re doing wrong, you could argue they are more morally culpable, but it is also easier to get them to acknowledge and correct the behavior. When, on the other hand, bad behavior is rationalized and those self justifications are fully internalized, it becomes almost impossible for people to self correct.

This is why the New York Times has grown less journalistically than almost any major news organization in the country over the past five years and why they are already starting to repeat the mistakes of 2016.

Which brings us to this recent Dems-in-disarry piece by Katie Glueck, Lisa Lerer, Shane Goldmacher and Alexander Burns.
Some of the Biden campaign’s vulnerabilities were laid bare in recent weeks as he confronted an accusation of sexual assault by Ms. Reade, a former aide in his Senate office in the 1990s. After the allegation surfaced, his campaign weighed several approaches, with some arguing that it should not be elevated. Others wanted a more proactive posture.

Mr. Biden waited more than five weeks to address the matter directly, personally issuing a forceful denial only after a chorus of Democrats had urged him to speak out and several of his female surrogates fielded the issue first. In the meantime, the issue gained traction in social media posts by conservatives, Trump campaign officials and some in the liberal wing of the Democratic Party.

At one point Mr. Biden taped a video statement detailing his work combating sexual assault and harassment. But it did not mention Ms. Reade’s allegations, according to two people with knowledge of the matter, and the campaign did not release it. The campaign declined to comment on the video.

There are plenty of other problems with the piece -- more than I could cover in a blog post -- but this section is such a perfect example of how this contextless coverage lends itself to defending the indefensible.

"Because of the Tara Reade accusations, you should support Donald Trump" is not a defensible statement.This point is, of course, never spelled out in the piece but it's not a big jump and it has shown up elsewhere. It is only by ignoring aspects of Trump's history, aspects we all know, that the authors can maintain the appearance of reasonableness.

Any consistent discussion of the charges of sexual harassment and assault against the two candidates would result in a long and damning article about Donald Trump  with a couple of paragraphs near the end about Joe Biden, and this holds for every notable Biden "scandal" of the election.

"Mr. Trump has his own enormous problems politically, and he and his campaign have yet to get a handle on Mr. Biden, veering from attacks over China to personal jabs at his mental acuity and his son Hunter."

That one phrase, "has his own enormous problems politically" is as close to an acknowledgement of the elephants in the room as the article gets, and it noticeably dodges the strangest and most interesting aspects of this story.

Consider the list implicit in that sentence:

1. Corrupt business dealing by the candidate's children;

2. Mental acuity;

3. Influence by foreign powers;

And add to that the previously mentioned

4. Sexual harassment.

Would a detailed and genuinely rigorous examination of any of these issues benefit Donald Trump politically? If anything, these are topics that the campaign would want to downplay, unless they were assuming that the press would fall back into the habits of 2016, avoiding damaging comparisons and using wildly divergent standards when deciding what qualified as a newsworthy negative story.

Sadly, with  the New York Times, those assumptions may prove correct.

[The Reade story has evolved since I wrote this, but not in a way that would undercut my points here.]
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Thursday, May 21, 2020

The infection fatality rate is not a single number

This is Joseph.

So I was reading 2 preprints on covid-19 infection fatality rates (IFR). The first one concludes:
Based on a systematic review and meta-analysis of published evidence on COVID-19 until the end of April, 2020, the IFR of the disease across populations is 0.75% (0.49-1.01%). However, due to very high heterogeneity in the meta-analysis, it is difficult to know if this represents the ‘true’ point estimate. It is likely that different places will experience different IFRs. More research looking at age-stratified IFR is urgently needed to inform policy-making on this front.
The second one concludes:
The infection fatality rate of COVID-19 can vary substantially across different locations and this may reflect differences in population age structure and case-mix of infected and deceased patients as well as multiple other factors. Estimates of infection fatality rates inferred from seroprevalence studies tend to be much lower than original speculations made in the early days of the pandemic. 
So let me start with one point that I think is true: IFR varies from place to place, for reasons that we don't fully understand. I am not sure that public transit is a great candidate, but maybe I am wrong about that. I personally think that long term care facilities are a big piece of it, but all of this thinking is non-causal in nature.

But, given that caveat, a general sense of the lethality of the disease is useful. Pre-print #1:
The meta-analysis demonstrated a point-estimate of IFR of 0.75% (0.49-1.01%) with high heterogeneity 
 Preprint #2:
Infection fatality rates ranged from 0.03% to 0.50% and corrected values ranged from 0.02% to 0.40%.
 So these are quite different estimates. One big difference is the that the second report did not include any of the government reports. But in hard hit places, the IFR is reaching 0.19% (New York) and 0.16% (Lombardy).

The clue to the difference is when the second pre-print talks about New York:
Massive deaths of elderly individuals in nursing homes, nosocomial infections, and overwhelmed hospitals may also explain the very high fatality seen in specific locations in Northern Italy and in New York and New Jersey. A very unfortunate decision of the governors in New York and New Jersey was to have COVID-19 patients sent to nursing homes. Moreover, some hospitals in New York City hotspots reached maximum capacity and perhaps could not offer optimal care. With large proportions of medical and paramedical personnel infected, it is possible that nosocomial infections increased the death toll. Use of unnecessarily aggressive management (e.g. mechanical ventilation) may also have contributed to worse outcomes. Furthermore, New York City has an extremely busy, congested public transport system that may have exposed large segments of the population to high infectious load in close contact transmission and, thus, perhaps more severe disease. A more aggressive viral clade has also been speculated, but this needs further verification. These factors may explain why preliminary press-released information on a seroprevalence survey in New York State suggests a much higher IFR. With 20% estimated crude seroprevalence in New York City, including a range between 17.3% in Manhattan to 27.6% in Bronx (adjusted seroprevalence figures have not been released), IFR would be as high as 0.8% in Bronx and 1% in Queens, and even higher if probable COVID-19 deaths are included in the calculation.
 Ok, so now we see a estimate much higher than that seen in the results section. Why? The author conjectures possibilities: poor decisions, hospital transmission, public transit, hospitals were bad, and maybe the virus was different. I kind of think that "we don't know" would be the best summary, but no harm in considering possibilities. But it is where we go next that reveals the real difference:
Moreover, even in these locations, the IFR for non-elderly individuals without predisposing conditions may remain very low. E.g. in New York City only 0.6% of all deaths happened in people
This quote connects to another oddity of the second pre-print: they use studies of blood donors (i.e. very healthy and typically younger individuals). The author argues that estimates from NY are contaminated by people over 65 and with pre-existing conditions (or at least that is how I interpret his comments). This is critical as a study that concludes the IFR ranges from "0.02% to 0.40%" probably has to deal with the population fatality rate of 0.19% and rising.

And so we get back to the title of the post. IFR is an average across many strata, of age, sex, health condition, and health care. The overall summary statistic is not especially meaningful to any specific person stripped of this context. Notice both studies point out heterogeneity in their estimates and that makes sense -- there are different care, demographic, and health characteristics in different populations (as well as the stochastic feature of who happens to get infected first). So there is a big limitation to global estimates of covid-19 IFR,

But the real limitation of preprint #2 is that they are asking a different question than what the title and abstract of the paper appear to imply: "what is the IFR among young, healthy, adults with good access to care". That explains the three blood donor studies (Denmark, Scotland, and the Netherlands) and this has been a central critique. What is really missing is a clear statement of the research question as IFR among the young and healthy.

The first paper states their objective (poorly placed in the paper) as:
This paper presents a systematic effort to collate and aggregate these disparate estimates of IFR using an easily replicable method. While any meta-analysis is only as reliable as the quality of included studies, this will at least put a realistic estimate to the IFR given current published evidence.
 The second paper had a clear objective:
To estimate the infection fatality rate of coronavirus disease 2019 (COVID-19) from data of seroprevalence studies.
 But it was missing a very important caveat: "among young and healthy individuals". In that context, the results from both studies make sense. If anything, this is a lesson that the population structure is the really interesting part. Obviously, a 50 year old with hypertension might have a couple of decades of life left. The CDC estimates that 37% of adult men between 40 and 59 have hypertension. So the estimate among the young and healthy is useful, but hardly can drive policy for the population as a whole.

One also thinks these caveats are needed here too, because this appears to be accurate only if the "young and healthy" caveat is included:
However, it is helpful to know that SARS-CoV-2 has relatively low IFR overall and that possibly its IFR can be made even lower with appropriate, precise non-pharmacological choices.
 Whereas I think pre-print #1 is uncontroversial in their conclusions:
Based on a systematic review and meta-analysis of published evidence on COVID-19 until the end of April, 2020, the IFR of the disease across populations is 0.75% (0.49-1.01%). However, due to very high heterogeneity in the meta-analysis, it is difficult to know if this represents the ‘true’ point estimate. It is likely that different places will experience different IFRs. More research looking at age-stratified IFR is urgently needed to inform policy-making on this front.
 So, I think that what we are learning is that we need to be extremely precise in what we are measuring and including in our analysis of something with a complex structure like IFR. New York City might end up being a unique case, or it could be a harbinger of things to come elsewhere (especially if the speculation about strains of virus are true).

I suspect that sort of more complicated analysis is needed to really understand the policy risks of different pandemic mitigation strategies. I think what is most needed are nuanced estimates that transparently engage uncertainty and population differences. Hopefully both of these preprints will mature in the peer review process.

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Wednesday, May 20, 2020

There’s about to be a huge business travel shaped hole in the economy and we need to start thinking about how we are going to fill it up.




For most sectors, the post pandemic economy will probably look a lot like the pre-pandemic economy. For certain industries, however, we are probably looking at a permanent market contraction. In these cases, the business models will have to fundamentally change and it is likely that many of the major players will not see the end of the decade . The one sector I’m most bearish on is business travel. Both because travel in general is going to suffer from heightened pandemic concerns and because it is an industry that is long overdue a major downsizing.

One of the widely known but little talked about truths of the white-collar world is that most of the trips we take are an enormous waste of time and money not to mention being horrible from an environmental standpoint.

Ironically, the modern age of business travel started in the postwar era about the same time that modern telecommunication was about to make it increasingly obsolete. Even before the pandemic, companies were starting to catch on to the absurdity of flying people across the country to sit at a conference room and wait for 20 minutes while someone locates missing cords and tries to get the PowerPoint projection in focus on a beige wall when you could simply have everyone sitting at their own desk watching the presentations on large high definition monitors.

The one real value of these meetings was social, allowing people who had interacted only over the phone and through emails actually hang out together eat lunch and perhaps have a couple of drinks, but all too often, the participants are flying in early in the morning and flying out on an afternoon flight so their time together is spent trying to read a blurry projection rather than bonding.

Of course, some business travel is legitimately necessary, and there will certainly be at least a few companies that are still reluctant to embrace 21st-century approaches. The industry is not going to disappear in 2021. It will, however, inevitably be smaller and require leaner business models probably less dependent on the principal agent problem.

This is going to leave a hole in the economy and it is not too early to start the discussion of how we are going to fill it up.
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Tuesday, May 19, 2020

"In Georgia, either the numbers are being cooked, or they’ve accidentally fallen into the stew pot." -- a whole bunch of Tuesday tweets


 

Tesla Charts gives Musk a break and takes a hard, insightful look into airline travel. Essential thread.


  
As the New York Times grows increasingly out of step with the rest of the industry (particularly the Washington Post) on false balance, it reacts by becoming more and more invested in its own superiority. This is unlikely to work out well.

 

More on terrestrial superstations.
A few years ago, conventional wisdom insisted that over the air television was all but dead.https://t.co/sxWqCrNiEE https://t.co/DXQgtRtSVz
 
Looks bad.


More travel thoughts from the reliable James Fallows.


It is now impossible to tell the difference between scam artist and true believer (though the "Made in China" may be a clue). Either way I hope he sells a milliion.
 

Kemp's polling on the handling of the crisis is terrible. You have to wonder how it would be if the state was actually reporting the real numbers.
 
Two from actual epidemiologists.

  
For me, it's the handwritten RN badge that really sells it.

  


Related note.
 
 

Another from Fallows, one of the very few national journalists who can intelligently discuss agriculture.
  



Two steps forward, one step back.


We can't forget Musk.
 


And another favorite.
 



Somewhere out there, somebody is listening to Alex Jones.
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Monday, May 18, 2020

Challenge Trials

This is Joseph

I am a bit late to the Challenge Trial debate for covid-19. Here is a great piece written by Thomas Lumley, who points out the speed advantages in getting a vaccine to market. It is also likely that there will be several possible candidate vaccines. Derek Lowe discusses nine advanced candidates, with different approaches:
So by my count, the biggest and most advanced programs include two inactivated virus vaccines, three different adenovirus vector vaccines, two mRNA possibilities, a DNA vaccine, and a recombinant protein.
At least a couple look to be in Phase II human trials, which the the precursor to phase III (where we evaluate effectiveness). Now, one major barrier is manufacturing the doses, especially since we decided to off-shore a lot of our biomedical capacity in the name of efficiency (at the cost of robustness).

Now these are very important. First, it is possible for the vaccine to increase the cytokine storm intensity and make the disease more fatal. The good news is the immunology is suggesting good targets that should avoid this issue.  But the word "should" is important and it is rather important to be clear about this before millions of people are inoculated.

Second, we want an effective vaccine and it may be the case that candidates vary in their effectiveness. There are successful vaccines that do not grant 100% immunity. The original polio vaccines were only 60-70% effective versus one of the strains, but that still led to a vast decrease in the number of infections in the United States once vaccination became standard.

So, clearly we want trials. While manufacturing is about to be a massive hurdle, the vaccine can be focused on the most vulnerable first, which can help a lot, while slowly covering the whole population. Combined with public health measures, a vaccine would be pure good news.

Now we get to the point about medical ethics. A phase III trial takes a long time to conduct and there is some political pressure for a fast solution. It is exceedingly unhelpful that there is a US presidential election in November, as one can imagine there being a big difference in feelings towards the incumbent who botched the public health response versus the incumbent who started out poorly but managed to lead a uniquely fast solution to the crisis.

Now, if the virus is mostly under control, you need a lot of people and a long time to evaluate the effectiveness of a vaccine. People are rarely exposed so it takes a long time for differences in cases between the arms to show up. If it is not, that is a place where it is hard to run a trial. Just consider the dire conditions in New York city -- while clearly a place one could have tested a vaccine it may not be the best environment to run a medical experiment in.

Another option is the challenge trial. Likely only taking a few hundred participants, it would have no more deaths than a regular trial. But it would involve infecting people, treated with a placebo(!!), with a potentially fatal infectious disease. There are greater good arguments here, but the longer I think about them the more dubious they get to me. Informed consent for things that are so dangerous really does suggest coercion. In the comments, Thomas Lumley points out that organ harvesting could be consented to if the payout was big enough but that isn't evidence that it is ethical or morally defensible. This suggestion, for example, suggests immigration reform as a goal and not medical experiments:
If all you are asking for is “free informed individual consent”, the inhuman cruelties of first world immigration and asylum laws create plenty of opportunities where deliberate COVID-19 infection is better than any other option. 
For a healthy adult in the 20s a deliberate COVID-19 infection has a lower mortality than paying a smuggler to put him on a shaky boat over a sea hoping to get asylum elsewhere.
My concern is that the political pressure on scientists to cut corners and find ways to speed up the testing will be enormous. It isn't clear that in a crisis it is impossible to justify a challenge trial, at some point there are arguments about brave heroes and the sheer scale of the suffering (in the people killed by the virus, directly and indirectly). But I think there are a lot of issues that need to be carefully thought out first and I have concerns that the pressures of this unique situation will make it harder to think them through.


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Friday, May 15, 2020

How did we get here?

This is Joseph

From public comments by the president of the University of Washington:
As doctors, nurses, health professionals and researchers save lives threatened by the coronavirus, academic medical centers and their affiliated public hospitals and clinics on the front lines of this fight have been among the hardest hit financially. Unfortunately, UW Medicine is not immune. As you may have read, even as it has led our state and country in responding to the coronavirus – tracking its spread, treating those who fall ill and researching new treatments – UW Medicine is projecting a loss of more than $500 million by the end of this summer. While we continue to pursue federal and state emergency funding to support this critical work, without urgent mitigation efforts this shortfall jeopardizes our ongoing mission to improve the health of the public.
On Monday, UW Medicine CEO Dr. Paul Ramsey outlined the steps being taken to protect UW Medicine’s hospitals’ and clinics’ ability to care for patients. These will include temporary furloughs and reduced hours and compensation for staff, with the goal of minimizing the number of permanent layoffs that are needed. As a reminder, furloughs are temporary and allow employees to keep their benefits, including health insurance. Leaders at UW Medicine are voluntarily contributing part of their own salaries back to the University in light of these extraordinary circumstances, as are Provost Richards and I and many other UW leaders across our three campuses.
This is a consequence of ideology. Medical costs are not well aligned with free markets and, as a result, when there is an unexpected medical crisis it is actually causing the medical infrastructure to begin to fail. You will notice the exact opposite of "raise the line" to the point where using it in the US context seems disingenuous, as health system capacity is dropping and not rising.

I think this ideology is also showing up in the medical supply chain. The decision to off-shore the production of reagents for medical testing left the supply chain vulnerable when the primary exporter was the first country hit by the pandemic.   Similarly, fee trade with China ended up costing many jobs and is likely a source of discontent among those who suffered through this experience. It is fine to say that it is too late to get these jobs back now -- it likely is. Nah smith notes:
The authors suggest that real-world economies may simply be much worse at adjusting to big changes than most economic models assume. It is expensive and time-consuming for workers to train for new jobs and to move to new locations. It also takes time and money for businesses to figure out how to change their business models in response to the new landscape presented by a global economy with China in it. These adjustment costs might overwhelm the gains from trade.
In other words, it is probably a very good time to consider the costs of the economic choices that we are making. Now, please do not straw person this -- one can decide that the direction of change is misguided without calling for a socialist revolt.

But maybe the real lesson here is one of institutional strength and the building in of resilience. The love of silicon valley tech is  the love of the "fails easily but moves fast and reduces cost" model. It just happens to be a dangerous approach to pandemic mitigation.
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Thursday, May 14, 2020

What we said before, only worse


Though there were still some suckers (Rolling Stone's messianic profile was still months away), 2017 may have been the year that people really started catching on to the scam. The speed of Musk's reputational implosion was a bit surprising,but the trends have been apparent for a long time.

Tuesday, July 25, 2017

A few points to keep in mind when reading any upcoming story about Elon Musk

First, a quick update from the good people at Gizmodo, specifically Ryan Felton:

Elon Musk awoke on Thursday with the intention of sending Twitter into a frenzy by declaring that he received “verbal govt approval” to build a Hyperloop in the densest part of the United States, between New York City, Philadelphia, Baltimore, and Washington D.C. This is dumb, it’s not how things work, and requires, uh, actual government approval.

Felton goes on to contact the government agencies that would absolutely have to sign on to such a project. Where he was able to get comments, they generally boiled down to "this is the first we're hearing of it." The closest he came to an exception was the federal Department of Transportation, which replied

We have had promising conversations to date, are committed to transformative infrastructure projects, and believe our greatest solutions have often come from the ingenuity and drive of the private sector.
This is a good time to reiterate a few basic points to keep in mind when covering Elon Musk:

1.    Other than the ability to make a large sum of money through some good investments, Elon Musk has demonstrated exceptional talent in three (and only three) areas: raising capital for enterprises; creating effective, fast-moving, true-believer corporate cultures; generating hype.

2.    Though SpaceX appears to be doing all right, Musk does not overall have a good track record running profitable businesses. Furthermore, his companies (and this will come as a big slap in the face of conventional wisdom) have never been associated with big radical technological advances. SpaceX is doing impressive work, but it is fundamentally conventional impressive work. Before the company was founded, had you spoken with people in the aerospace community and asked them "what is closest to being Mars ready, who has it, and who are the top people in the field?", the answers would have been the type of engine SpaceX currently uses, TRW (which sued SpaceX for stealing their intellectual property), and the chief rocket scientist SpaceX lured away from TRW. By the same token, Tesla is pretty much doing what all of the other major players in the auto industry are doing in terms of technology.

3.    From the beginning, Musk has always had a tendency to exaggerate and overpromise. Smart, skeptical journalist like Michael Hiltzik and the reporters at the Gawker remnants have taken any claim from Elon Musk with a grain or two (or 20) of salt.

4.    That said, in recent years things have gotten much, much worse. Musk has gone from overselling feasible technology and possibly viable business plans to pitching proposals that are incredibly unlikely then supporting them with absurdly unrealistic estimates and sometimes mere handwaving.

5.    The downward spiral here seems to have started with the Hyperloop. This also seems to be the point where Musk started trying to do his own engineering rather than simply taking credit for the work of those under him. On a related note, it is becoming increasingly obvious that Elon Musk has no talent for engineering.

6.    Musk’s increasingly incredible claims have started to strain the credulity of most of the mainstream press, but the consequences have been too inconsistent and too slow-coming to have had much of a restraining influence on him. Even with this latest story, you can find news accounts breathlessly announcing that supersonic travel between New York and DC is just around the corner.

7.    Finally, it is essential to remember that maintaining this “real-life Tony Stark” persona is tremendously valuable to Musk. In addition to the ego gratification (and we have every reason to believe that Musk has a huge ego), this persona is worth hundreds of millions of dollars to Musk. More than any other factor, Musk’s mystique and his ability to generate hype have pumped the valuation of Tesla to its current stratospheric levels. Bloomberg put his total compensation from Tesla at just under $100 million a year. When Musk gets tons of coverage for claiming he's about to develop telepathy chips for your brain or build a giant subterranean slot car race track under Los Angeles, he keeps that mystique going. Eventually groundless proposals and questionable-to-false boasts will wear away at his reputation, but unless the vast majority of journalists become less credulous and more professional in the very near future, that damage won’t come soon enough to prevent Musk from earning another billion dollars or so from the hype.
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Wednesday, May 13, 2020

This post was perfect

This is Joseph

I thought that this cartoon captured the spirit of the times perfectly:


It isn't that experts do not have blind spots, they do. But replacing a blind spot with actual blindness seems to be a risky strategy in a crisis.
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Ideological versus partisan -- pandemic edition



 

There has been a ton of research (some of it good, most of it not) on the question of what makes one person ideologically inclined to be conservative and another to be liberal. Lots of issues here, particularly with tying political leanings to some innate trait (never understood why most people with the conservative gene just happened to cluster around areas with agricultural or extraction-based economies), but that’s a topic for another post. Instead, I want to step back and ask is the question meaningful at all..

Many of the best indicators of a person's political position, quite possibly the majority of the best indicators, make  no sense if you approach them in terms of either conservative/liberal ideology or psychology. They fall into place perfectly, however, when you start making the distinction between the partisan and the ideological, particularly when you add a layer of Straussian disinformation and cult of personality dynamics.

We’ve discussed this before, but the pandemic has given us a wealth of new examples.

What possible ideological basis is there for arguing for the relative contagiousness of one virus over another? Or of insisting on the efficacy of a particular drug? And yet, how one answers questions like these have become arguably the defining political positions of the day, particularly in conservative media and the far right.

I’m certain someone out there is working on a painfully epicyclic model to explain this (does R have a spirograph package?), but the picture becomes remarkably straightforward if you approach it in partisan terms.

From a conservative/Republican standpoint, when it comes to a potential collapse in support for President Trump, timing matters more than magnitude. A bad Q3 is worse for them than a terrible 2021 would be. Prematurely lifting lock downs is unlikely to buy them more than a dead cat bounce, but might be enough to avert a GOP bloodbath.

Add to that the constraint of not infuriating Trump. The base is (for the moment at least) personally loyal to him, not to the party, and temperamentally he is more than willing to bring the temple down with him.

Obviously, the memes and narratives of Fox et al. are often ideological and partisan, but when you look at the odd quadrants, you see lots of stories that advance a partisan aim with no significant ideological component, relatively few that go the other way.

This isn't to say that ideology -- it's what keeps the money flowing -- but much of what we talk when we talk politics , particularly in 2020, are non-ideological means to ideological ends, and if we want to keep our thinking clear, we have to know when to make the distinction.
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Tuesday, May 12, 2020

Tuesday Tweets -- the wheels come off the Tesla




 

 
Read this thread.



 



 












 

 



        


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