When I saw the tweet about adderall prescriptions I also saw some follow-ups that claimed this does not represent e.g. 41.4 million *people* getting prescriptions in a given year, but N people getting prescriptions that need to be renewed several times during the year so that the total number of prescriptions given in the year is 41.4m ≫ N. I didn't look into this any further than the assertions in the tweets, but I'd want to know which interpretation is true before I draw too many conclusions from this data.
I know that in general, in at least most states, it is illegal to prescribe a schedule II controlled substance with "refills" or for more than 30 days. A "refill" is where you can fill one Rx multiple times. It *is* legal to write a new Rx without necessarily examining the patient anew every time. So I would suggest that 41.4 million Rx likely equals 4.14m / 12 = 3.45 million, or about 1% of the population.
Thanks for this useful clarification. I really don't like tweets like that one because they are provocative and quickly shared whereas the more accurate clarifications are a lot less engaging to read. The original tweet has 339 likes but the person who noted that prescriptions =/= people got 15 likes.
I think the increase might even be illusory due to an increase in the number of prescriptions per person. I was on Ritalin/Concerta from 1999 to 2018, and throughout most of that time, I was able to get 90-day prescriptions. When I moved to Oklahoma, I discovered I could only get 30-day scripts, and that combined with some poor insurance decisions was enough to switch me to Modafinil. If you're just tracking prescriptions, then a state going from 90 days to 30 days would triple the number of scripts there without any increase in the number of pills.
As a long term unemployed person I'll probably need Adderall (or something like it) just to have any hope of returning to the workforce, but since unemployment is so low right now I presume most people getting new prescriptions are already employed. Maybe they feel they need it to keep up with peers.
When I was employed nobody talked about it either but I suspect some people were on it. If I already had a job I personally wouldn't go on it either unless I felt like I was really struggling. My last job was close to that, but the company was also wasting my time and attention by having me sit in meetings for hours on end, no way I'm going to just medicate myself to compensate for corporate stupidity.
It's a strange contrast whenever I read about Stimulant Use Common Among Those With Office Jobs. At the other end of the employment spectrum, people I work with are much more likely to be on depressors if they're drugging at work...usually weed, but every once in awhile the classic workplace drunk too. I think cause retail work is inherently deeply repetitive and boring, so there's more comparative advantage to zoning out than being energized. What would you spend it on? There's so few avenues for mental exercise...
(A weirdly high proportion of younger employees do smoke cigarettes, which keeps striking me as weird. Thought that was on its way out generationally and culturally.)
Hard to compare, since the smokers I know are a neat cross-section of the BMI range. None of them explicitly smoke for appetite-suppression reasons, that I'm aware of anyway. Some are beanpoles, others are hefty. The most common phenotype at work by far has always been Generic Skinny White Girl From SoCal (for reasons no one's been able to figure out) or Stereotypically Slim East Asian (makes more sense), so baserates are low to begin with. If any one thing unites the smokers, it's class affiliation; these are not pretentious folks, at all.
My favourite retort from a former coworker, whenever criticized about her cigarette habit, was "I'm vegan so I'm allowed to smoke".
Iron's pretty interesting. I think Elizabeth's research seems right and matches some anecdotal evidence - I remember in at college at least two occasions when my casual "that kind of sounds like anemia, have you considered iron?" remark reportedly produced huge changes for some young women I knew. (Of course it's not hard to diagnose "I feel very faint after my period"...)
By contrast though I've read some admittedly broscience that suggests for modern man iron overdose is much more common. We evolved in an iron poor environment and given the importance we try very hard to hold onto it. Given that I eat as much meat as I want and very rarely bleed, seems very plausible I've got too much.
The people who talk about this advocate regular bloodletting, basically. If you're clinically indicated doctors will just do this but it's very hard to convince them. Regular donation seems reasonable, but I've been ineligible my whole life due to a year in England in 1990. They just changed the rule so I have been thinking about doing it.
Is this the first issue with subscriber-only content? I'd be interested in more on your reasoning to add a paywall - partly because I'm disappointed to see it, but also curious what drove your decision.
If this is paywalled that is me clicking the wrong button somewhere. Did I lock something behind a paywall? If so I'll fix it but I don't see what I did?
The post ended for me at "Another visualization of the key predictor of obesity is not genetics, it is what year it is." and the accompanying graphic, which just seemed kind of abrupt given how your posts normally read. But if that was really the end of it, I withdraw my comment and am really glad you aren't paywalling it!
The obesity numbers are interesting. Will you ever try a deep dive? I read some of SlimeMoldTimeMolds take, but they seemed to go off the rails at some point. So a list of my own random thoughts on the topic.
1.) I assume this is an onion problem, there are lots of layers (causes) and the outmost layer for one person may not be the same for another.
2.) Better tasting food and too much eating is a layer.
3.) Some environmental contaminant may be a layer. The contaminant (some plastic?) maybe acts by setting our fat set point, to more fat.
4.) There looks to be and income and sex difference in obesity. Low income women are fatter and high income men are fatter. This is a little weird.
5.) I wonder if men prefer fatter women, sex selection... of course it would take more than a generation for this to be noticeable.
6.)Lifestyles. We spend (in general) more time these days sitting on our butts. Does this have an effect on fat retention? Is there a feedback pathway that says, "oh we are sitting around a lot now, it would be a good idea to put on more fat."
7.) I was looking at obesity as a function of occupation, and if you squinted at the data you might say that a job where you are on your feet much of the day makes you thinner. (I realize there could be other explanations.)
if #3 were true there wouldn't be such strong correlation with social factors (e.g. if it's environment why would the husband be fatter than the wife?)
re: #4 this is explained by social pressure. it's socially acceptable for successful men to be a little fat. not true for women.
PSA for those who are prescribed Adderall and cannot get it because of the shortage: Ask your doctor about switching to dextroamphetamine, which is chemically very similar. My pharmacist, who is usually well-informed and accurate, says there’s no shortage of it.
Comment about the AEA conference (from an economist who attended annually 2012-20 but not this year): Historically, the main draw of the conference was that it was where employers would interview graduating PhD students seeking jobs. (Bourne's write-up doesn't mention this at all.) So graduating PhD students were obligated to attend, anyone interviewing them was obligated to attend, and that in turn meant that even if you weren't interviewing or presenting, you had a reason to go and see lots of friends. After the conference was forced to be fully online in 2021-22, this year it was held in person again, but job interviewing was kept online (for various reasons, Covid being only one of them). This probably accounts for most of the drop in attendance. The conference lost money because hotel bookings were made years in advance and couldn't be canceled by the time this decision was made.
My school district in Bellevue, Washington is on the path to close three of its twelve elementary schools. They've presented this is a foregone conclusion, and it's now just a matter of deciding which schools to close. I think they're in denial about the impacts of their pandemic policies.
Their stated reasons for this is that the population of children is declining, and they've forecasted that it will be in decline through 2030. They point to falling birth rates, high housing costs, and pandemic-related work patterns as causes of this decline.
All the metrics I can find contradict this.
Enrollment in public schools has indeed declined. They went from 21,764 to 19,647 between 2019 and 2021. Numbers aren't yet published for the 2022-2023 school year.
However, the U.S. Census estimates the child population in our city has grown, even through the pandemic. In 2019 they estimate 17,331 kids aged 5-14 in our city, for 2021 18,383.
Private school enrollment has also grown in our city, going from 3,341 in 2019 to 4,214 in 2021.
I don't have numbers on home schoolers, but the district should. In Washington state home school students are required to register with their local school district.
Anecdotally, neighborhood Facebook groups have parents sharing that they took their kids out of public schools and either homeschooled or put them in private schools.
Have you seen this happening anywhere else? Any tips on how to stop it? I feel like confronting the district with data just isn't going to work. I wrote to my school board member last Friday when this was announced and haven't heard back yet.
I also wrote the demographer who the district commissioned to make the forecast to ask about his methods. I got a friendly reply back within fifteen minutes saying that he used linear cohort survival analysis. That reply also copied the deputy superintendent who announced the closure plans. I replied back with some follow up questions, but haven't heard back.
Only realistic answer is... move or switch to a private school. Western Washington still has a few pockets of Republican voters, I'd move to their school district or pack up for greener pastures.
The iron thing is interesting. I'm an omnivore, technically, but don't eat meat all that often due to the hassles in proper preparation...if it's more complicated than cracking an egg, I won't bother more than maybe once a week tops. Supplementation and fortification helps, but I know the combined totals from those don't reach 100% on their own.
I also work with a lot of young women who are vegans, and generally not ones I'd class as "high-energy"...likewise a common refrain from former-vegans I've heard is something along the lines of "yeah I feel much better now". I know this isn't an inherent limitation of veganism when done correctly, so makes me wonder whether a lot of people are Doing It Wrong. Maybe it's iron, maybe it's B12, which come from the same sources often.
**Infections and deaths so far** (note this was released Jan 17, 2023):
> Airfinity’s new model increases our estimate for the total number of cases since the 1st December from 72.9 million on 17th Jan to 99.5 million. While the total number of infections expected in this wave has remained the same at 228 million cases, our model now estimates these have occurred faster than previously expected.
> The same is true for our estimates on deaths. Our new model estimates daily deaths to be 32,200 on the 17th January where the previous outlook predicted 23,700. Our new forecast estimates cumulative deaths from the 1st December 2022 to be 608,000 up from our previous estimate of 437,000.
**Predictions for this month:**
> In our updated model, cases could peak at 4.8 million a day with 62 million infections predicted across a fortnight between 13th-27th January before beginning to fall.
> Deaths are forecast to peak at 36,000 a day on the 26th of January during the Lunar New Year Festival. This is up from our previous estimate of deaths peaking at 25,000 a day.
When I saw the tweet about adderall prescriptions I also saw some follow-ups that claimed this does not represent e.g. 41.4 million *people* getting prescriptions in a given year, but N people getting prescriptions that need to be renewed several times during the year so that the total number of prescriptions given in the year is 41.4m ≫ N. I didn't look into this any further than the assertions in the tweets, but I'd want to know which interpretation is true before I draw too many conclusions from this data.
I know that in general, in at least most states, it is illegal to prescribe a schedule II controlled substance with "refills" or for more than 30 days. A "refill" is where you can fill one Rx multiple times. It *is* legal to write a new Rx without necessarily examining the patient anew every time. So I would suggest that 41.4 million Rx likely equals 4.14m / 12 = 3.45 million, or about 1% of the population.
Source: I used to work in opioid enforcement.
Thanks for this useful clarification. I really don't like tweets like that one because they are provocative and quickly shared whereas the more accurate clarifications are a lot less engaging to read. The original tweet has 339 likes but the person who noted that prescriptions =/= people got 15 likes.
I think the increase might even be illusory due to an increase in the number of prescriptions per person. I was on Ritalin/Concerta from 1999 to 2018, and throughout most of that time, I was able to get 90-day prescriptions. When I moved to Oklahoma, I discovered I could only get 30-day scripts, and that combined with some poor insurance decisions was enough to switch me to Modafinil. If you're just tracking prescriptions, then a state going from 90 days to 30 days would triple the number of scripts there without any increase in the number of pills.
As a long term unemployed person I'll probably need Adderall (or something like it) just to have any hope of returning to the workforce, but since unemployment is so low right now I presume most people getting new prescriptions are already employed. Maybe they feel they need it to keep up with peers.
When I was employed nobody talked about it either but I suspect some people were on it. If I already had a job I personally wouldn't go on it either unless I felt like I was really struggling. My last job was close to that, but the company was also wasting my time and attention by having me sit in meetings for hours on end, no way I'm going to just medicate myself to compensate for corporate stupidity.
It's a strange contrast whenever I read about Stimulant Use Common Among Those With Office Jobs. At the other end of the employment spectrum, people I work with are much more likely to be on depressors if they're drugging at work...usually weed, but every once in awhile the classic workplace drunk too. I think cause retail work is inherently deeply repetitive and boring, so there's more comparative advantage to zoning out than being energized. What would you spend it on? There's so few avenues for mental exercise...
(A weirdly high proportion of younger employees do smoke cigarettes, which keeps striking me as weird. Thought that was on its way out generationally and culturally.)
Hard to compare, since the smokers I know are a neat cross-section of the BMI range. None of them explicitly smoke for appetite-suppression reasons, that I'm aware of anyway. Some are beanpoles, others are hefty. The most common phenotype at work by far has always been Generic Skinny White Girl From SoCal (for reasons no one's been able to figure out) or Stereotypically Slim East Asian (makes more sense), so baserates are low to begin with. If any one thing unites the smokers, it's class affiliation; these are not pretentious folks, at all.
My favourite retort from a former coworker, whenever criticized about her cigarette habit, was "I'm vegan so I'm allowed to smoke".
Iron's pretty interesting. I think Elizabeth's research seems right and matches some anecdotal evidence - I remember in at college at least two occasions when my casual "that kind of sounds like anemia, have you considered iron?" remark reportedly produced huge changes for some young women I knew. (Of course it's not hard to diagnose "I feel very faint after my period"...)
By contrast though I've read some admittedly broscience that suggests for modern man iron overdose is much more common. We evolved in an iron poor environment and given the importance we try very hard to hold onto it. Given that I eat as much meat as I want and very rarely bleed, seems very plausible I've got too much.
The people who talk about this advocate regular bloodletting, basically. If you're clinically indicated doctors will just do this but it's very hard to convince them. Regular donation seems reasonable, but I've been ineligible my whole life due to a year in England in 1990. They just changed the rule so I have been thinking about doing it.
Donating blood is a great way to avoid iron overdose!
Is this the first issue with subscriber-only content? I'd be interested in more on your reasoning to add a paywall - partly because I'm disappointed to see it, but also curious what drove your decision.
If this is paywalled that is me clicking the wrong button somewhere. Did I lock something behind a paywall? If so I'll fix it but I don't see what I did?
I do not see a paywall but I do see an "upgrade to paid" button at the very bottom of the email.
The post ended for me at "Another visualization of the key predictor of obesity is not genetics, it is what year it is." and the accompanying graphic, which just seemed kind of abrupt given how your posts normally read. But if that was really the end of it, I withdraw my comment and am really glad you aren't paywalling it!
The obesity numbers are interesting. Will you ever try a deep dive? I read some of SlimeMoldTimeMolds take, but they seemed to go off the rails at some point. So a list of my own random thoughts on the topic.
1.) I assume this is an onion problem, there are lots of layers (causes) and the outmost layer for one person may not be the same for another.
2.) Better tasting food and too much eating is a layer.
3.) Some environmental contaminant may be a layer. The contaminant (some plastic?) maybe acts by setting our fat set point, to more fat.
4.) There looks to be and income and sex difference in obesity. Low income women are fatter and high income men are fatter. This is a little weird.
5.) I wonder if men prefer fatter women, sex selection... of course it would take more than a generation for this to be noticeable.
6.)Lifestyles. We spend (in general) more time these days sitting on our butts. Does this have an effect on fat retention? Is there a feedback pathway that says, "oh we are sitting around a lot now, it would be a good idea to put on more fat."
7.) I was looking at obesity as a function of occupation, and if you squinted at the data you might say that a job where you are on your feet much of the day makes you thinner. (I realize there could be other explanations.)
if #3 were true there wouldn't be such strong correlation with social factors (e.g. if it's environment why would the husband be fatter than the wife?)
re: #4 this is explained by social pressure. it's socially acceptable for successful men to be a little fat. not true for women.
3.) Well there are layers, so different layers are different... It's possible some sort of plastic effects women more than men.
4.) Yeah that works for the rich. Why amongst the poor are the men thinner?
I'm not sure the answer is easy...
Im curious that diet soda becoming common place didn't make a dent, soooo many less calories.
PSA for those who are prescribed Adderall and cannot get it because of the shortage: Ask your doctor about switching to dextroamphetamine, which is chemically very similar. My pharmacist, who is usually well-informed and accurate, says there’s no shortage of it.
Comment about the AEA conference (from an economist who attended annually 2012-20 but not this year): Historically, the main draw of the conference was that it was where employers would interview graduating PhD students seeking jobs. (Bourne's write-up doesn't mention this at all.) So graduating PhD students were obligated to attend, anyone interviewing them was obligated to attend, and that in turn meant that even if you weren't interviewing or presenting, you had a reason to go and see lots of friends. After the conference was forced to be fully online in 2021-22, this year it was held in person again, but job interviewing was kept online (for various reasons, Covid being only one of them). This probably accounts for most of the drop in attendance. The conference lost money because hotel bookings were made years in advance and couldn't be canceled by the time this decision was made.
My school district in Bellevue, Washington is on the path to close three of its twelve elementary schools. They've presented this is a foregone conclusion, and it's now just a matter of deciding which schools to close. I think they're in denial about the impacts of their pandemic policies.
Their stated reasons for this is that the population of children is declining, and they've forecasted that it will be in decline through 2030. They point to falling birth rates, high housing costs, and pandemic-related work patterns as causes of this decline.
All the metrics I can find contradict this.
Enrollment in public schools has indeed declined. They went from 21,764 to 19,647 between 2019 and 2021. Numbers aren't yet published for the 2022-2023 school year.
However, the U.S. Census estimates the child population in our city has grown, even through the pandemic. In 2019 they estimate 17,331 kids aged 5-14 in our city, for 2021 18,383.
Private school enrollment has also grown in our city, going from 3,341 in 2019 to 4,214 in 2021.
I don't have numbers on home schoolers, but the district should. In Washington state home school students are required to register with their local school district.
Anecdotally, neighborhood Facebook groups have parents sharing that they took their kids out of public schools and either homeschooled or put them in private schools.
Have you seen this happening anywhere else? Any tips on how to stop it? I feel like confronting the district with data just isn't going to work. I wrote to my school board member last Friday when this was announced and haven't heard back yet.
I also wrote the demographer who the district commissioned to make the forecast to ask about his methods. I got a friendly reply back within fifteen minutes saying that he used linear cohort survival analysis. That reply also copied the deputy superintendent who announced the closure plans. I replied back with some follow up questions, but haven't heard back.
Only realistic answer is... move or switch to a private school. Western Washington still has a few pockets of Republican voters, I'd move to their school district or pack up for greener pastures.
The iron thing is interesting. I'm an omnivore, technically, but don't eat meat all that often due to the hassles in proper preparation...if it's more complicated than cracking an egg, I won't bother more than maybe once a week tops. Supplementation and fortification helps, but I know the combined totals from those don't reach 100% on their own.
I also work with a lot of young women who are vegans, and generally not ones I'd class as "high-energy"...likewise a common refrain from former-vegans I've heard is something along the lines of "yeah I feel much better now". I know this isn't an inherent limitation of veganism when done correctly, so makes me wonder whether a lot of people are Doing It Wrong. Maybe it's iron, maybe it's B12, which come from the same sources often.
For China, Airfinity seems to be the independent estimate that most people are citing. https://www.airfinity.com/articles/china-to-see-one-longer-more-severe-covid-wave-as-lunar-festival-fuels
**Infections and deaths so far** (note this was released Jan 17, 2023):
> Airfinity’s new model increases our estimate for the total number of cases since the 1st December from 72.9 million on 17th Jan to 99.5 million. While the total number of infections expected in this wave has remained the same at 228 million cases, our model now estimates these have occurred faster than previously expected.
> The same is true for our estimates on deaths. Our new model estimates daily deaths to be 32,200 on the 17th January where the previous outlook predicted 23,700. Our new forecast estimates cumulative deaths from the 1st December 2022 to be 608,000 up from our previous estimate of 437,000.
**Predictions for this month:**
> In our updated model, cases could peak at 4.8 million a day with 62 million infections predicted across a fortnight between 13th-27th January before beginning to fall.
> Deaths are forecast to peak at 36,000 a day on the 26th of January during the Lunar New Year Festival. This is up from our previous estimate of deaths peaking at 25,000 a day.
Head of China's CDC has now said 80% of the Chinese population (1.13 billion) has been infected https://twitter.com/YanzhongHuang/status/1616893056250175489. As of January 21st.