I notice on the list of potential fixes for 'undersupply of therapists' decreasing people's needs for therapists isn't on the list. Also note that this woman's assumptions are basically 'once you start seeing a therapist 1 hour a week you are going to keep going for the rest of your life'. This is a tacit admission of not thinking that therapy works, if you could go 3-5 times a week for 6 months and then be done it would be costly, but plausibly worth it over a lifetime. If a good therapist could significantly help a person over 3 hours a week for 24 weeks, and handle 10 patients at a time, over a 40 year career then you only need 1 therapist per 800 patients, and at a 25% of the population needing therapy you need 1 per 3,200 people in the population.
If every car needed 1 hour of repairs a week to stay on the road then we wouldn't have enough mechanics. Yeah, that sounds pretty obvious and just as obvious would be the silliness of stating 'to fix this problem encourage friends who want to become mechanics', and finally just as obvious would be 'why do we have so many lemons on the road?'
Not allowed to ask that last one though, abelist don't you know.
He talks about the 50% heuristic as shorthand because he believes many of the interventions are near 50% effectiveness and simplicity is a virtue that makes the whole thing practical.
I think therapist opinions run all the way from 'people always needed them this much, we simply sucked at this forever and told them to suck it up' to 'people used to have friends and family to talk to' to 'no seriously something new is veery wrong.'
The middle one is the first thought I came to... a lot of what's needed in a therapist is just a captive audience that's willing to listen and speak and won't react in an outrageous way if you say things that make little sense to them. There are a lot of areas where therapists are imperfect here (anything involving suicidality, for one, as I'd consider placing someone in a hold to be in the spirit and letter of "outrageous reaction"), but they do mostly satisfy this desire of someone to talk to without having to risk exclusion from what few friend groups one may have.
> Be aware that these efforts continue, and that by the logic underlying Public Health left unchecked, ordinary life and its joys would cease to be. In some places, this seems to be succeeding, such as in some dance events.
The primary reason masks are required is due to a small fraction of judges and event staff who will refuse to work the event and make a big fuss on social media if masks aren't required. And then they often don't wear masks themselves while at the event. Sigh.
KN95s ninety percent effective and N95s ca 100 percent? Has Wachter ever worn these masks? This is completely unbelievable. What is his basis for saying this?
I’m begging, please don’t do this: “Zika vaccine for **assigned females at birth**.” This is a red-flag of anti-scientific nonsense, and it’s so painful to see it here.
To disagree, I was happy to see him use that phrase. It's a good way to be precise, if transgender women aren't eligible for the trial, but transgender men and cisgender women who've had hysterectomies are.
In this case it may or may not. Zika is mostly a big deal if you catch it when pregnant, so a Zika trial might want to only take on people who still have a uterus/ovaries, so they can see the impact of the treatment on the person's reproductive equipment.
The study chose to use this terminology so I used their wording exactly, partly as a 'don't yell at me, this is exactly what they said' shield and partly to avoid potential confusions.
I notice that I do not know what language is being requested that one use instead, for the category in question, that is not anti-scientific and won't get anyone yelling at me, if I need to refer to the concept on my own in 2023.
Fair enough. Mostly I yell so that all the yelling isn't on the other side, and it's clear that some of us find this language really Orwellian.
The point of the phrase "sex assigned at birth" is to support the pretense that biological sex doesn't exist. In educational materials (like the gender unicorn) it is introduced along the lines of: "Your gender identity is whether you *feel* like a man or a woman, but when you were born, no one could tell what your gender identity was, so the doctors looked at you and made a guess. This was your "sex assigned at birth," but you can decide if it really fits you." The goal is the dissolution of the concept of biological sex and the substantiation of gender identity as something that matters.
Perhaps there are interpersonal experiences where we can humor people who want to pretend that they do not have a biological sex (I think this is fraught for many reasons, but whatever). But in a study where biological sex is extremely important, we should be clear. [See this recent study for an example of the chaos that results when you pretend that trans women and women are biologically similar. The mental effort required to sort out who in this study has a penis (the relevant point) is crazy: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02187-0/fulltext]
So my preference for the language to be used would be "biological women." (Or perhaps, as a society, we agree that it's ok to use the term "female" for biological women and "women" for people who "feel" like women.) Both of these will get you yelled at, it's true.
> We dropped down to the 1hr a week default for many reasons, including cost and therapist availability, not because it works better.
Granted, measuring stuff like this is always a bit tricky - adherence rates, style fit etc all play a major role. But while I'm not super familiar with the evidence, my own knowledge (non-clinician but well educated in psychology) plus my skimming of the literature suggests that by many measures, CBT does work better than psychoanalytical approaches.
Now, it's not too hard to find studies arguing that psychoanalysis or related approaches work better, but in my view they tend to have pretty serious flaws in how they're conducted, so I place less weight on them.
Of course, the comment does not argue that CBT or whatever is less effective than PA, just that that wasn't the motivation. And that may well be the case - that's a whole other skill set to determine, although my intuition is that things like that are never for one single reason, and the multiple reasons tend to bleed into each other. If CBT works faster (for example), that makes it cheaper, which makes it more accessible, which means we would skew that way even if end outcomes are comparable.
Regarding the last part, whenever I think about aging and causes of death I usually lump intentional deaths of all kinds into their own category because they're a matter of humans being too capable at executing their intent (pun not intended) instead of not capable enough. This category in general is focused on far too much, perhaps as part of an overarching cultural narrative that the way to solve problems is to stop something instead of start something (and innovate in medical care, etc).
I'd say the most important deaths to consider as a society in the present time are those causes which increase exponentially with age, because there are so damn many of them and the root cause of a slowly decaying body steals lots of quality away during life as well (while accidental and intentional deaths tend to be rather sudden).
The sesame thing rhymes with ongoing worldwide egg shortage, which I have the pleasure of re-explaining to people daily while working in grocery...
*People don't actually want to pay the market-clearing price to get what they want (certified sesameless goods, eggs)
*A company that raised prices to offer such goods anyway would likely be accused of "profiteering" or "price gouging"
*The real culprit is systemic design choices far above the paygrade of even large companies to meaningfully affect; sesameless goods means no mass mechanized production or economies of scale, adequate eggs during avian flu pandemic means no factory farming. Loops back to "people won't pay enough to change it".
*The optimal amount of sesame or bird flu is not zero.
Although it raises an important question, why isn't more attention/funding paid to treating allergies or preventing people from getting them in the first place? More and more common ingredients showing up in the Majorly Harms Substantial Numbers Of People category sure seems like heading for a future with significantly diminished food choices, population, or both. Seems bad!
As far as I can tell, the price of eggs is adjusting quite a lot (the Odd Lots episode with the bakery said 60%+) and mostly that's working fine like in micro 101? And from what I can tell, the stores have both basic eggs and special expensive cage-free organic eggs or something, for very different prices, and that also is working like micro 101? What am I missing there?
The sesame thing seems like a straightforward case of it not being economical to care about it in most cases because the number of people who care is so small, presumably in a large enough supermarket there's reason for someone to be the one offering it.
Also, as I understand how allergies work, putting trace amounts of sesame into lots more things is an excellent way to prevent future sesame allergies!
Markets might be saner in NYC. The company I work for refuses to adjust egg prices, so we've been sold out early basically every single day for weeks now (if shipments arrive in the first place). We're not allowed to sell basic eggs anymore either, due to concessions to PETA-types. Never negotiate with activists, and all that. So only special expensive cage-free, but not necessarily organic, eggs are potentially for sale...which I imagine doesn't help with supply issues! (Lots of egg-substitute and liquid eggs, but of course ~no one wants that. Not really fungible for most use cases.)
As far as I've heard, this generalizes to other grocers in SF. The holdouts who still sell basic eggs have an easier time, but it's not easy for anyone. Restaurants also aren't as egg-shorted, since...the whole thing about parallel supply chains and "beater" eggs, and how a retail egg != a restaurant egg. I do know there were threats of legal action for egg price gouging in CA specifically, so that's perhaps a lingering-worry-causing-overcaution that wouldn't apply elsewhere.
I do optimistically think allergies tend to be caused by under- rather than over-exposure, yet the literature seems pretty messy overall. The increasing prevalence of trace soy/corn/wheat/peanut/whatever in otherwise-unrelated processed foods ought to hypothetically track with a general decline/slower rising of allergies to said common food allergens...but this doesn't seem broadly true? I think? One gets the sense that food allergies were much less common in the past.
Genuinely unsure, I didn't test the bounds of trust cause the story seemed plausible to conditions on the ground. Local news frames it as a Worldwide Shortage, and that's how management encourages us to explain it to angry customers as well. If this ends up being another Well Run Progressive State self-own thing, I'm gonna be annoyed. Like a miniature version of the Fake Formula Shortage...if things aren't good enough, no one's allowed to have things.
Wow that's weird. I live in rural amercia, lots of people have chickens and you can buy eggs at the side of the road. (Or just talk to my neighbor across the road, he's always trying to give me extra eggs... )
The issue is allegedly a super-bad wave this year of bird flu, exacerbated by factory farming conditions, and affected farmers being strongly disincentivized to vaccinate* their birds cause this makes the resulting poultry products ineligible for most export sales...so it sounds about right for old-fashioned farming to be unaffected.
*unlike covid shots, the bird flu vaccine is more like regular-flu vaccine, and this year's seems to have fallen on the lower end of crapshoot effectiveness anyway...so even less incentive
This is so weird. 'The holdouts who sell basic eggs.' Nope, in NYC everything is fine, there are eggs at every supermarket all the time and the prices are higher than I'd like but nothing unreasonable.
Price gouging + banning reasonably priced versions -> persistent shortages makes sense and I don't really know what anyone was expecting.
Something something greedflation, probably. Turn those golden egg "excessive" profits into real eggs for the people. The same mindset that believes there isn't a literal shortage of gas, it's just stubborn capitalists refusing to pump for a "fair" price. (It's not stereotyping if I'm just pulling news and press release headlines!)
If you don't mind me asking for calibration purposes, what would eggs have generally cost for you back in 2019 before all the troubles, and what's the current market-clearing markup? I'm sorta wondering now if progressive market skepticism is partially founded on...living around dysfunctional markets, and assuming that's normal.
Oh boy egg prices in 2019. I'm going to guess ~$1.50/ doz. with sale/ coupon weeks where they would sell for $0.99. I think I paid $4.xx the other day. I just wanna say the west coast seems somewhat crazy, like they've forgotten how capitalism works. (Then again I hear stories from everywhere of people being accused of price gouging when selling items in short supply.)
...wow, yeah, sometimes it really hits me just how insane SF's cost of living is. I work at a chain known for generally-pretty-affordable prices. A dozen eggs here used to cost $1.79 (maybe even less? been like 4 years) back when we still sold basic eggs, with the most expensive Morally Superiour ones around $4.49. After switching over to Baseline Moral Eggs, the cheapest went up to $2.29 or so.
And the prices these days, after all the adjustments to accommodate supply-side disruptions and a huge surge in demand...are...basically still that. I'd bet we'd have fewer egg problems if our prices went up in similar proportion to what you're paying now. Corroborating evidence: nearby competitor Whole <s>Wallet</s> Foods charges at least a dollar more for every version of their eggs, and they're stocked more consistently than we are. Not exactly the same suppliers, obviously, but clearly There Are Eggs To Be Found. If one is willing to pay/able to charge appropriately.
I notice on the list of potential fixes for 'undersupply of therapists' decreasing people's needs for therapists isn't on the list. Also note that this woman's assumptions are basically 'once you start seeing a therapist 1 hour a week you are going to keep going for the rest of your life'. This is a tacit admission of not thinking that therapy works, if you could go 3-5 times a week for 6 months and then be done it would be costly, but plausibly worth it over a lifetime. If a good therapist could significantly help a person over 3 hours a week for 24 weeks, and handle 10 patients at a time, over a 40 year career then you only need 1 therapist per 800 patients, and at a 25% of the population needing therapy you need 1 per 3,200 people in the population.
If every car needed 1 hour of repairs a week to stay on the road then we wouldn't have enough mechanics. Yeah, that sounds pretty obvious and just as obvious would be the silliness of stating 'to fix this problem encourage friends who want to become mechanics', and finally just as obvious would be 'why do we have so many lemons on the road?'
Not allowed to ask that last one though, abelist don't you know.
He talks about the 50% heuristic as shorthand because he believes many of the interventions are near 50% effectiveness and simplicity is a virtue that makes the whole thing practical.
I think therapist opinions run all the way from 'people always needed them this much, we simply sucked at this forever and told them to suck it up' to 'people used to have friends and family to talk to' to 'no seriously something new is veery wrong.'
The middle one is the first thought I came to... a lot of what's needed in a therapist is just a captive audience that's willing to listen and speak and won't react in an outrageous way if you say things that make little sense to them. There are a lot of areas where therapists are imperfect here (anything involving suicidality, for one, as I'd consider placing someone in a hold to be in the spirit and letter of "outrageous reaction"), but they do mostly satisfy this desire of someone to talk to without having to risk exclusion from what few friend groups one may have.
> Be aware that these efforts continue, and that by the logic underlying Public Health left unchecked, ordinary life and its joys would cease to be. In some places, this seems to be succeeding, such as in some dance events.
Also many MTG events.
Yeah, my desire to go to such an event goes way down if I have to mask the whole time.
The primary reason masks are required is due to a small fraction of judges and event staff who will refuse to work the event and make a big fuss on social media if masks aren't required. And then they often don't wear masks themselves while at the event. Sigh.
> by the time they exist their flights
Typo, "exists" should be "exit".
KN95s ninety percent effective and N95s ca 100 percent? Has Wachter ever worn these masks? This is completely unbelievable. What is his basis for saying this?
He does not say, and if it wasn't clear I do not believe this.
Honestly I'm tempted to move him to my crackpot category, I'm not sure he's any saner than Bret Weinstein
I’m begging, please don’t do this: “Zika vaccine for **assigned females at birth**.” This is a red-flag of anti-scientific nonsense, and it’s so painful to see it here.
To disagree, I was happy to see him use that phrase. It's a good way to be precise, if transgender women aren't eligible for the trial, but transgender men and cisgender women who've had hysterectomies are.
In this case it may or may not. Zika is mostly a big deal if you catch it when pregnant, so a Zika trial might want to only take on people who still have a uterus/ovaries, so they can see the impact of the treatment on the person's reproductive equipment.
I'd still take AFAB over, say, "birthing persons".
The study chose to use this terminology so I used their wording exactly, partly as a 'don't yell at me, this is exactly what they said' shield and partly to avoid potential confusions.
I notice that I do not know what language is being requested that one use instead, for the category in question, that is not anti-scientific and won't get anyone yelling at me, if I need to refer to the concept on my own in 2023.
Fair enough. Mostly I yell so that all the yelling isn't on the other side, and it's clear that some of us find this language really Orwellian.
The point of the phrase "sex assigned at birth" is to support the pretense that biological sex doesn't exist. In educational materials (like the gender unicorn) it is introduced along the lines of: "Your gender identity is whether you *feel* like a man or a woman, but when you were born, no one could tell what your gender identity was, so the doctors looked at you and made a guess. This was your "sex assigned at birth," but you can decide if it really fits you." The goal is the dissolution of the concept of biological sex and the substantiation of gender identity as something that matters.
Perhaps there are interpersonal experiences where we can humor people who want to pretend that they do not have a biological sex (I think this is fraught for many reasons, but whatever). But in a study where biological sex is extremely important, we should be clear. [See this recent study for an example of the chaos that results when you pretend that trans women and women are biologically similar. The mental effort required to sort out who in this study has a penis (the relevant point) is crazy: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02187-0/fulltext]
So my preference for the language to be used would be "biological women." (Or perhaps, as a society, we agree that it's ok to use the term "female" for biological women and "women" for people who "feel" like women.) Both of these will get you yelled at, it's true.
Correction: the Zika trial takes place in Baltimore, not DC.
> We dropped down to the 1hr a week default for many reasons, including cost and therapist availability, not because it works better.
Granted, measuring stuff like this is always a bit tricky - adherence rates, style fit etc all play a major role. But while I'm not super familiar with the evidence, my own knowledge (non-clinician but well educated in psychology) plus my skimming of the literature suggests that by many measures, CBT does work better than psychoanalytical approaches.
https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2013.12121511
https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2013.12081125
https://www.sciencedirect.com/science/article/pii/S0005796715000686
Now, it's not too hard to find studies arguing that psychoanalysis or related approaches work better, but in my view they tend to have pretty serious flaws in how they're conducted, so I place less weight on them.
Of course, the comment does not argue that CBT or whatever is less effective than PA, just that that wasn't the motivation. And that may well be the case - that's a whole other skill set to determine, although my intuition is that things like that are never for one single reason, and the multiple reasons tend to bleed into each other. If CBT works faster (for example), that makes it cheaper, which makes it more accessible, which means we would skew that way even if end outcomes are comparable.
Regarding the last part, whenever I think about aging and causes of death I usually lump intentional deaths of all kinds into their own category because they're a matter of humans being too capable at executing their intent (pun not intended) instead of not capable enough. This category in general is focused on far too much, perhaps as part of an overarching cultural narrative that the way to solve problems is to stop something instead of start something (and innovate in medical care, etc).
I'd say the most important deaths to consider as a society in the present time are those causes which increase exponentially with age, because there are so damn many of them and the root cause of a slowly decaying body steals lots of quality away during life as well (while accidental and intentional deaths tend to be rather sudden).
The sesame thing rhymes with ongoing worldwide egg shortage, which I have the pleasure of re-explaining to people daily while working in grocery...
*People don't actually want to pay the market-clearing price to get what they want (certified sesameless goods, eggs)
*A company that raised prices to offer such goods anyway would likely be accused of "profiteering" or "price gouging"
*The real culprit is systemic design choices far above the paygrade of even large companies to meaningfully affect; sesameless goods means no mass mechanized production or economies of scale, adequate eggs during avian flu pandemic means no factory farming. Loops back to "people won't pay enough to change it".
*The optimal amount of sesame or bird flu is not zero.
Although it raises an important question, why isn't more attention/funding paid to treating allergies or preventing people from getting them in the first place? More and more common ingredients showing up in the Majorly Harms Substantial Numbers Of People category sure seems like heading for a future with significantly diminished food choices, population, or both. Seems bad!
As far as I can tell, the price of eggs is adjusting quite a lot (the Odd Lots episode with the bakery said 60%+) and mostly that's working fine like in micro 101? And from what I can tell, the stores have both basic eggs and special expensive cage-free organic eggs or something, for very different prices, and that also is working like micro 101? What am I missing there?
The sesame thing seems like a straightforward case of it not being economical to care about it in most cases because the number of people who care is so small, presumably in a large enough supermarket there's reason for someone to be the one offering it.
Also, as I understand how allergies work, putting trace amounts of sesame into lots more things is an excellent way to prevent future sesame allergies!
Markets might be saner in NYC. The company I work for refuses to adjust egg prices, so we've been sold out early basically every single day for weeks now (if shipments arrive in the first place). We're not allowed to sell basic eggs anymore either, due to concessions to PETA-types. Never negotiate with activists, and all that. So only special expensive cage-free, but not necessarily organic, eggs are potentially for sale...which I imagine doesn't help with supply issues! (Lots of egg-substitute and liquid eggs, but of course ~no one wants that. Not really fungible for most use cases.)
As far as I've heard, this generalizes to other grocers in SF. The holdouts who still sell basic eggs have an easier time, but it's not easy for anyone. Restaurants also aren't as egg-shorted, since...the whole thing about parallel supply chains and "beater" eggs, and how a retail egg != a restaurant egg. I do know there were threats of legal action for egg price gouging in CA specifically, so that's perhaps a lingering-worry-causing-overcaution that wouldn't apply elsewhere.
I do optimistically think allergies tend to be caused by under- rather than over-exposure, yet the literature seems pretty messy overall. The increasing prevalence of trace soy/corn/wheat/peanut/whatever in otherwise-unrelated processed foods ought to hypothetically track with a general decline/slower rising of allergies to said common food allergens...but this doesn't seem broadly true? I think? One gets the sense that food allergies were much less common in the past.
Genuinely unsure, I didn't test the bounds of trust cause the story seemed plausible to conditions on the ground. Local news frames it as a Worldwide Shortage, and that's how management encourages us to explain it to angry customers as well. If this ends up being another Well Run Progressive State self-own thing, I'm gonna be annoyed. Like a miniature version of the Fake Formula Shortage...if things aren't good enough, no one's allowed to have things.
Wow that's weird. I live in rural amercia, lots of people have chickens and you can buy eggs at the side of the road. (Or just talk to my neighbor across the road, he's always trying to give me extra eggs... )
The issue is allegedly a super-bad wave this year of bird flu, exacerbated by factory farming conditions, and affected farmers being strongly disincentivized to vaccinate* their birds cause this makes the resulting poultry products ineligible for most export sales...so it sounds about right for old-fashioned farming to be unaffected.
*unlike covid shots, the bird flu vaccine is more like regular-flu vaccine, and this year's seems to have fallen on the lower end of crapshoot effectiveness anyway...so even less incentive
I have no idea, around here the people with chickens treat them mores as pets vs produce. Very small scale. I mostly buy eggs from the super market.
This is so weird. 'The holdouts who sell basic eggs.' Nope, in NYC everything is fine, there are eggs at every supermarket all the time and the prices are higher than I'd like but nothing unreasonable.
Price gouging + banning reasonably priced versions -> persistent shortages makes sense and I don't really know what anyone was expecting.
Something something greedflation, probably. Turn those golden egg "excessive" profits into real eggs for the people. The same mindset that believes there isn't a literal shortage of gas, it's just stubborn capitalists refusing to pump for a "fair" price. (It's not stereotyping if I'm just pulling news and press release headlines!)
If you don't mind me asking for calibration purposes, what would eggs have generally cost for you back in 2019 before all the troubles, and what's the current market-clearing markup? I'm sorta wondering now if progressive market skepticism is partially founded on...living around dysfunctional markets, and assuming that's normal.
Oh boy egg prices in 2019. I'm going to guess ~$1.50/ doz. with sale/ coupon weeks where they would sell for $0.99. I think I paid $4.xx the other day. I just wanna say the west coast seems somewhat crazy, like they've forgotten how capitalism works. (Then again I hear stories from everywhere of people being accused of price gouging when selling items in short supply.)
...wow, yeah, sometimes it really hits me just how insane SF's cost of living is. I work at a chain known for generally-pretty-affordable prices. A dozen eggs here used to cost $1.79 (maybe even less? been like 4 years) back when we still sold basic eggs, with the most expensive Morally Superiour ones around $4.49. After switching over to Baseline Moral Eggs, the cheapest went up to $2.29 or so.
And the prices these days, after all the adjustments to accommodate supply-side disruptions and a huge surge in demand...are...basically still that. I'd bet we'd have fewer egg problems if our prices went up in similar proportion to what you're paying now. Corroborating evidence: nearby competitor Whole <s>Wallet</s> Foods charges at least a dollar more for every version of their eggs, and they're stocked more consistently than we are. Not exactly the same suppliers, obviously, but clearly There Are Eggs To Be Found. If one is willing to pay/able to charge appropriately.
In case we need something to gawk at in your next covid update: https://www.newyorker.com/news/annals-of-activism/the-case-for-wearing-masks-forever
(I had not heard of "the people's CDC" before this article, and I hope that continues.)