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Health Update—So Far Filed Under "Huh?"

| Mon Feb. 1, 2016 1:19 PM EST

So what was the dexamethasone thing about last night? Here's the story.

During my first round of chemotherapy I took a three-med cocktail. One of the meds was dexamethasone, a corticosteroid. It helps the other drugs work better, and also seems to program cancerous myeloma cells to die on their own, which is a handy attribute. But one of the side effects is sleep disruption. For the first few weeks, it had no effect. But then it started disrupting my sleep on the day I took it. Then for a couple of days. Then all the time. Then even more. It was a pain in the ass, but for the most part kept under control with sleeping meds that varied over time.

Now I'm on a second round of chemo, and it's not working as well as we'd like. So a couple of weeks ago we added dex to the mix. It was half the dose I was taking last year, so I was hopeful the sleep disruption would take a long time to show up and would be milder than before. No such luck. Perhaps the first round created a heightened sensitivity to it? In any case, on the very first day I was up until 2 am. Hmmph. But maybe that was just a placebo effect I had talked myself into.

Again, no such luck. It's a weekly dose, and I took the second one on Saturday morning. I didn't sleep at all that night. Nor was I tired at all. In fact, kind of buzzed. I stayed awake all day Sunday, too. But last night I fell asleep normally and slept for nearly nine hours.

So how will this play out going forward? No telling. I'm in terra incognita. If it stays like this, it's not really a big deal. I'll just have a sleepless but otherwise pleasant night once a week. If it gets worse, though, I'll have lots of sleepless nights and start to feel like crap. We'll see! I'd just as soon not get back on the sleep meds, so hopefully it doesn't get worse. Unfortunately, I suspect that's a forlorn hope.

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Here Are Your Final Iowa Poll Results Until 2020

| Mon Feb. 1, 2016 12:55 PM EST

It's neck and neck in Iowa! Who will have the best ground game? What will the weather be like? Who will scoop up Martin O'Malley's votes in the absurdly convoluted Democratic caucuses?

You'll find out tonight. In the meantime, here are the final Pollster aggregates. I've turned off smoothing this time in order to provide the most current possible results.

This Chart Shows Why Your Conspiracy Theory Is Really Dumb

| Mon Feb. 1, 2016 12:48 PM EST

Update, 2/2/2016: Chris Bauch, an editor for PLOS ONE, said in an email that the author of the study we reported on below "should have used a different model for some of the analyses" and that the author "is working on submitting errata." Bauch added, however, that he is "pretty sure the correction will not change the conclusions” and that he does not "foresee a retraction.” We'll update when we know more.

By now, climate change has joined the moon landing and the JFK assassination in the upper echelons of fodder for conspiracy theories. Back in 2004, Sen. James Inhofe (R-Okla.) called global warming the "greatest hoax ever perpetrated on the American people." A few years later, Inhofe told our own David Corn that the climate hoax was most likely being perpetrated by Barbra Streisand. Donald Trump, meanwhile, thinks it was "created by and for the Chinese." I could go on.

There's plenty of evidence that these conspiracy theories are garbage, starting with the overwhelming scientific consensus about climate science and the fact that 2015 was the hottest year on record. But in case you're still not convinced, here's another bit of proof.

In a new peer-reviewed paper in the journal PLOS ONE, an Oxford physicist devised a mathematical formula for the lifespan of conspiracy theories—that is, how long it would likely take for them to be publicly unveiled if they were in fact true. It's not long: In the case of climate change, it's about 27 years if you assume the cover-up is perpetrated by only published climate scientists—and just four years if you assume it includes the broader scientific community.

The author, David Robert Grimes, found similar maximum life spans for a few other prominent conspiracy theories:

Grimes, PLOS 2016

Let's pick, somewhat arbitrarily, preeminent climatologist James Hansen's 1988 testimony to Congress about global warming as the beginning of the great fraud. According to Grimes' formula, climate change would have been publicly outed as a hoax by 1992 if it were carried out by a broad coalition of scientific organizations. And it would have been exposed by 2015 if it were carried out only by published climate scientists. Unless I missed something, that didn't happen. (Sorry, the "Climategate" emails definitely don't count.)

conspiracy chart
Here's how long it would take for four big conspiracies to fall apart: (a) moon landing hoax, (b) climate change hoax, (c) vaccination conspiracy, and (d) suppression of a cure for cancer. Grimes, PLOS 2016.

Grimes' model is based on the statistical probability that one person within the conspiracy (one climate scientist, for example) would intentionally or accidentally let slip the truth. The odds of that happening go up as the number of people involved in the conspiracy increase—hence the shorter life span for the climate fraud if it involved broad scientific organizations (whose membership Grimes totals at more than 400,000). To help in that analysis, Grimes studied a few actual conspiracies, including the National Security Agency's widespread spying on US citizens that was exposed by Edward Snowden.

Anyway, climate change is not a hoax. And we did land on the moon. And there isn't a hidden cure for cancer. And you should go get your vaccinations, dammit.

H/T: The Skeptics Guide to the Universe

Happiness Tip of the Day: Ditch the Commute

| Mon Feb. 1, 2016 12:01 PM EST

From Alex Tabarrok on homebuying:

One final point: behavioral economics tells us that we quickly get used to big houses but we never get used to commuting. So when you have a choice, go for the smaller house closer to work.

A thousand times yes. Obviously not everyone has this choice, and it's not practical to move every time you get a new job. But yes, if you have the option, try to keep your commute under 20 minutes.

Want something more quantifiable? Here are two of "The Rules" from Joel Garreau's Edge City, a dated but wonderful book about the building of suburbia:

The maximum desirable commute, throughout human history, regardless of transportation technology: 45 minutes.

Cevero's law of the value of time wasted in traffic jams: People view the time they waste in a traffic jam as equal, in dollar value, to half their hourly wage. For example, if you make $50,000 per year, that's $25 per hour. That means you'll pay $3.12 each way per day to cut 15 minutes off your commute. That's about $125 per month, which scales to about $30,000 in the price of a house.

That sounds low to me—in Southern California that's a rounding error in the price of a home—but it's at least a good starting point. If you can buy a house 15 minutes closer to work for $30,000 more, grab it. If it's $50,000 more, behavioral economics says you should ignore your financial angst and grab it anyway. If it's $100,000 more, you might need to think things through a little harder. Or, as Tabarrok suggests, settle for a small house near work at the same price as the bigger house in the burbs. You probably won't regret it.

Anyway, from personal experience I can tell you that short commutes are great. And the greatest commute of all? A walk down the stairs each morning. That's hard to beat.

Guess Where Jeb Bush Is Spending Iowa Caucus Night? (Hint: Not in Iowa.)

| Mon Feb. 1, 2016 11:50 AM EST

As the campaigns of Donald Trump, Ted Cruz, Marco Rubio, Ben Carson, and even Rand Paul—and their Democratic counterparts—prepare big parties Monday night to celebrate the Iowa caucuses, Jeb Bush supporters will have nowhere obvious to go. Because instead of spending the caucus night in Iowa, Bush will be in New Hampshire.

The mammoth super-PAC backing Bush has spent more than any other on ads in the state, pouring $15 million into Iowa. When you ask Iowans about the direct mail flooding their mailboxes, they often cite Bush as the candidate they get the most mail about. Bush was never as good a fit in the socially conservative Iowa Republican race as he hopes to be in New Hampshire. But Mitt Romney came in a close second in Iowa in 2012, proving that there is space for an establishment-style candidate to do well in Iowa if the state's more moderate Republicans can rally around one person.

In 2016, that person is not Bush. When the highly anticipated Des Moines Register poll came out Saturday night, Bush was at just 2 percent. Time to move on to more promising territory, even if his superior poll numbers in New Hampshire still put him in a distant fourth place, with less than a third of the support enjoyed by the front-runner, Trump.

 

What Donald Trump’s Short Fingers Mean for His Presidency

| Mon Feb. 1, 2016 10:26 AM EST

For Achilles, it was the heel. For Samson, it was the hair. For Beast, twas' beauty. Donald Trump may appear impervious to the sharpest Republican barbs, but he has one proven weakness over the course of his four decades in overly public life: stubby fingers.

Trump has presumably had short fingers for as long as he's had fingers, but it wasn't until 1988 that anyone called attention to it. That year, Spy magazine began the practice of needling Trump at every opportunity by referring to him in virtually every story as a "short-fingered vulgarian." ("Queens-born casino profiteer" would also do.) Trump defended his honor in the New York Post, stating that "my fingers are long and beautiful, as, has been well-documented, are various other parts of my body."

In an essay last fall, former Spy editor Graydon Carter revealed how much this pissed Trump off: To this day, the Republican presidential front-runner continues to mail Carter photos of himself, and "[o]n all of them he has circled his hand in gold Sharpie in a valiant effort to highlight the length of his fingers." The most recent one even included a message: "See, not so short!" On Friday, Republican Sen. Ben Sasse of Nebraska even joined in on the fun, responding to an insult from Trump by joking, "you'd think I asked Mr abt the length of his fingers or something important like that."

So just what do Trump's Bart Simpson hands have to do with making America great again? According to Madame La Roux's 1993 treatise on palm reading, The Practice of Classical Palmistry, quite a lot!

Google Books
Google Books

Disdain for detail? Impulsive? Impetuous? Hot-headed? Pushy? Obsessed with doing "big" things like building enormous buildings?

This sounds like someone we know.

Now, I don't think Trump's baby-carrot fingers have any bearing on his presidential temperament. But then, I'm not the one who routinely cites the results of post-debate online surveys conducted by the Drudge Report as some kind of science and believes that the "concept of global warming was created by and for the Chinese in order to make U.S. manufacturing non-competitive." It's only a matter of time before this shocking revelation hits voters in New Hampshire.

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Late Night Miscellany—Powered by Dexamethasone!

| Mon Feb. 1, 2016 1:13 AM EST

I am currently taking a drug that appears to be supercharging my brain. I even almost got into a Twitter argument today, which is surely the biggest waste of gray matter known to man. But I was full of energy, so off I went. I was also full of energy all last night, and I have to say you guys are all a bunch of slackers. At 3 am there were no new blog posts, no one making clever remarks on Twitter, no new email, no nothing. I was reduced to reading a book. If this keeps up, I'm going to have to make more friends in Australia and Europe to pick up the slack.

So anyway, let's see what's going on right now. First off, here is Donald Trump explaining how politics works:

At a meeting with The Times’s editorial writers, Mr. Trump talked about the art of applause lines. “You know,” he said of his events, “if it gets a little boring, if I see people starting to sort of, maybe thinking about leaving, I can sort of tell the audience, I just say, ‘We will build the wall!’ and they go nuts.”

The charming thing is that he's willing to admit this on the record to a bunch of reporters. He just doesn't care, and he knows his supporters don't care either. Basically, they're all in on the con and enjoying themselves, so a little peek behind the scenes—"The Making of the Trump Campaign"—just piques their interest rather than disillusioning them. Not that they read the Times in the first place, so it probably doesn't matter much what he says to their editorial board anyway.

And speaking of Trump, here is Thoreau explaining that he loves the guy because he's smashing the Republican Party for us:

Some of you might doubt that Trump is deliberately doing good, and you’re probably right. But, hell, when the Hulk is smashing bad guys, do we really know for sure that he’s acting on his good side rather than just smashing for fun? Still, he’s smashing what we need him to smash. Well, same for Trump. I mean, FFS, he already dashed Scott Walker’s hopes of ever having a political career in Washington. That alone should make him the greatest liberal hero of the 21st century thus far.

What else? Gallup is always good for a laugh. They report this weekend that 50 percent of Americans think they're better off economically today than they were eight years ago. But wait. Here's how it breaks down by party affiliation:

In other words, this poll result is completely meaningless. I think it's safe to say that both Democrats and Republicans have done about equally well over the past eight years, and Gallup even presents some more detailed polling results that pretty much prove this. But when you ask a very general question, even if it's on a specific topic, what people hear is "Do you like President Obama?" And that's the question they're answering. It's all pure affinity mongering, and I'm sure the results would have been the mirror opposite if the question were asked in 2008 instead of 2016.

And as long as we're at the Gallup site, here are the top ten results for economic confidence by state in 2015. I'm showing them to you for two reasons. First, California handily beat Texas. Hah! Second, Washington DC is simply on another planet—with Beltway neighbors Virginia and Maryland also doing pretty well, though in a more earthbound way. Conservatives are constantly griping about the way that folks who feed at the federal trough always manage to do great no matter how poorly the rest of the country is doing, and it seems like they might have a point.

And now I'm off to bed. Whether I'm also off to sleep remains an open question. I'll let you know Monday morning.

At the SAGs, It's All About the Bragging

| Sun Jan. 31, 2016 7:18 PM EST

The folks at the Screen Actors Guild sure do seem pleased with themselves:

[Idris] Elba...summed up the tone of the evening onstage with this play on words: “Welcome to diverse TV.”

The talk of the evening, onstage and behind the scenes, was the show's strong display of inclusiveness....Laura Prepon...“This is what we talk about when we talk about diversity.”...Viola Davis...“They won because the actors have craft, they have a level of excellence that reaches people.”...Uzo Aduba...“It's amazing to see actors have the opportunity to celebrate other actors' work and to feel empowered by the voting process so they can see whatever actor they want reflected up there."

....From the outset, the show made a point of presenting the diversity of its membership and nominees. The ceremony opened with several actors — Rami Malek, Queen Latifah, Jeffrey Tambor, Anna Chlumsky, Kunal Nayyar — talking about what it means to be in their profession.

SAG Awards Committee Chair JoBeth Williams said the actor-focused awards show has “worked very hard to reflect the real world.” Williams noted its roster of presenters and nominees as proof of that.

OK, two things. First, these guys sound a lot less interested in diversity than in bragging about their nobility and getting in some digs at the Oscars. Second, I'd be a lot more impressed by their crowing if they had a better record of honoring black actors. The only reasonable comparison with the Academy Awards is in the solo film acting awards, and the chart on the right tells the story. In the past decade, 9 percent of all Oscar acting nominations have gone to black actors. For SAG, it's a whopping 10 percent. In the past two years, there have been no black actors nominated for Oscars and a grand total of 1 for a SAG. The SAGs are doing better, but they probably shouldn't sprain their arms patting themselves on the back for their performance.

Donald Trump Isn't Really Anything New Under the Republican Sun

| Sun Jan. 31, 2016 2:00 PM EST

Is Donald Trump a sign of things to come? Or is he sui generis?

I tend toward the latter. I think Trump is basically the culmination of a series of conservative populist blowhards who have run for president recently. It started with Ross Perot, a Mexico basher like Trump. He was pretty popular with all his charts and his giant sucking sound. But in the end, he didn't really get many votes. Pat Buchanan ran in a similar mold, and he even won New Hampshire and almost won Iowa. Coincidentally, he was another Mexico basher! But he lost. In 2008 we were treated to the true proto-Trump, Sarah Palin. Unfortunately, she had major flaws: she was a woman;1 she had very limited experience; her version of word salad was truly incomprehensible; and she was terrifyingly ignorant about practically everything and unable to paper over it. She and John McCain lost. The 2012 primaries brought us a series of minor-league pseudo-populist blowhards in Michele Bachmann, Herman Cain, and Newt Gingrich. Coincidentally, they made Mexico bashing into a true team sport! And they all lost.

So now we have Trump. Like Palin, he has an almost animal instinct for what the conservative base wants. He was smart enough to make Mexico bashing his key calling card. His version of word salad is entertainingly stream-of-conscious-y, but almost always makes sense. He's 69 years old. He's male. He has lots of executive experience. He's a billionaire who doesn't need to beg for money. He's usefully flexible when it comes to abandoning the unpopular parts of conservative ideology. He's terrifyingly ignorant, but has an innate talent for changing the subject or simply blowing off the problem with some version of "It'll be easy. Just wait and see." And he's uncommonly skilled at self-promotion and projecting dominance on TV. He's the ideal conservative populist blowhard.

And he's showing signs of winning. But I don't think he's blazing a trail here. He just happens to be perfect for the part, and he has a style that comes to him naturally. Not many people can pull that off, and you can't really teach it.

So there's nothing all that new here. We've seen Trump's schtick before in Perot, Buchanan, Palin, Bachmann, Cain, and Gingrich. Nobody should be surprised that a big chunk of the Republican base likes this stuff. They've liked it for a long time. Trump is just doing it better than all these others.

In the end, though, I think he'll meet the same fate. He'll do better than any of his predecessor blowhards, but that won't be enough to actually win. And though I might eat my words in 2020, I don't think we'll see his like again. In the end, he doesn't represent an existential threat to the Republican Party; he just represents business as usual pulled off with more flair than usual. He's sui generis.

1I'm not defending this, just reporting it. Like it or not, she's a young woman who oozes a smirking sort of pulchritude, and that's not a recipe for being taken seriously in this country. Plus all the other stuff, of course.

Lead and Race In Flint—And Everywhere Else

| Sat Jan. 30, 2016 10:06 PM EST

Marcy Wheeler comments today on the lead disaster in Flint: "Think about how effects of lead poisoning feeds the stereotypes about race and class used to disdain the poor."

Yep. Lead poisoning is equally bad for everyone, but certain groups were far more exposed to lead poisoning than others. Here's a chart showing the percentage of children who displayed elevated blood lead levels over the past four decades. The data is taken from various studies over the years that have reported data from the CDC's long-running NHANES program:

All the rest of the data on lead poisoning is exactly what you'd expect. Not only is it higher among blacks than whites, but it's higher in inner cities and it's higher among low-income families. And of course, this is on top of all the social problems these kids already have from being black, poor, and living in rundown neighborhoods.

Needless to say, lead didn't cause institutional racism. But lead sure made it worse. White children were severely affected by the postwar lead epidemic, but it produced nothing less than carnage among black kids. Before we finally got it under control in the late 80s, lead poisoning had created nearly an entire generation of black teenagers with lower IQs, more behavioral problems in school, and higher rates of violent behavior—which, as Wheeler says, feeds into already vicious stereotypes of African-Americans and the poor. The only good news is that as lead poisoning has declined, it's declined in blacks more than among whites. The difference today between black and white kids is fairly modest.

But what about Flint? The big problem with lead is that it does its damage in children, and once the damage is done the brain never recovers. We're seeing lower levels of violent crime today because most crime is committed between the ages of 17-25—and that age cohort was all born after 1990, when atmospheric lead had dropped close to zero. But the effects of lead continue to dog people in their 40s and 50s. Once it's there, it's there.

This is what makes Flint so scary: if elevated lead levels damage young children, they'll be damaged forever. So how much damage was actually done? And how much damage is still being done?

Those are hard questions to answer for two reasons. First, we don't have as much hard data as we'd like. Second, lead is a horror show. Nobody wants to say anything that quantifies the damage and runs the risk of minimizing it. Public health experts are dead serious when they say the only safe level of lead is zero. Because of this, they simply don't want to publicly declare that any specific rise in elevated blood lead levels is...is...anything. I don't want to say it either. It's just bad, full stop, and it needs to be fixed.

That means I was surprised to see this in the New York Times today:

“Our kids are already rattled by every kind of toxic stress you can think of,” Dr. [Mona] Hanna-Attisha said....She emphasized, however, that not every child exposed to lead would suffer ill effects. Kim Dietrich, a professor of environmental health at the University of Cincinnati College of Medicine, said that based partly on the blood lead levels of children in Dr. Hanna-Attisha’s study, he did not think serious long-term health problems would be widespread.

I've spoken with Dietrich, and he's not a guy who takes the effects of lead lightly. If he says the long-term effects in Flint are likely to be modest, I'd pay attention to him.

But why would the effects be modest? Three reasons. First, lead levels in Flint were elevated for about 18 months. That's a long time, but it's a lot less than having elevated levels for your entire childhood up to age five. Second, the use of filters and bottled water helped reduce the lead levels in the drinking water. And that in turn means that, third, the rise in kids with blood lead levels above 10 m/d was less than one percentage point—and the rise was less than three percentage points even if you use the more conservative level of 5 m/d. As recently as 2008, the levels seen during the Flint water crisis would have been cause for celebration.

And what about now? Data here is frustratingly hard to get. Marc Edwards, the water-treatment expert who first blew the whistle on Flint's water supply, says that (a) Flint's pipes are probably back in satisfactory shape now that water has been coming from Detroit for the past three months and is being properly treated, (b) the water is "much, much better than it was last August," and (c) there's a 50-50 chance it could even pass a full-bore federal testing regime. Beyond that, preliminary state data suggests that blood lead levels in children are now down to about where they were before the water crisis. That's good news, but it's tentative.

More recently, the US Public Health Service announced that 26 out of 4,000 water samples in Flint had lead levels above 150 parts per billion. This is important because above that level it's possible that filters won't work effectively. But it doesn't really tell us much about current lead levels in Flint's water. We can say that 99.4 percent of homes have levels below 150 ppb and are probably safe if the water is filtered. But how many are below the EPA "action level" of 15 ppb? And what's the "90th percentile" lead level, the standard way of measuring lead in tap water? We don't know any of that, even though 4,000 samples is enough to give us a pretty good idea. Overall, Flint's water is obviously much improved, but it's hard to say precisely how good or bad it still is.

Put this all together and what do we get? Several educated guesses:

  • At a public services level, the Flint water crisis was an unbelievable fiasco.
  • The long-term damage to Flint's kids is very real, but probably not catastrophic.
  • The water today appears to be safe in nearly all homes that use a filter.
  • However, there are also a small number of homes with astronomical lead levels in their water. It's unclear why, but these homes need to be the target of immediate crash remediation.

If anything positive comes out of the Flint debacle, it will be a better understanding of the dangers of lead. Ironically, though, it's not lead pipes that are really the biggest problem nationwide. Thousands of towns and cities have old lead pipes, and they generally don't cause any problems except when some bonehead decides to stop treating the water properly and the scale inside the pipes corrodes away. Rather, the biggest problems now are lead paint and lead in soil. Everyone knows about lead paint, and abatement programs are widely available. But lead in soil, the product of decades of leaded gasoline settling to the ground, just sits around forever and gets kicked back into the air every summer when the soil dries up. It remains a serious problem, and not surprisingly, it's most serious in heavily black, urban neighborhoods that had the highest levels of lead poisoning in the first place. You can read more about this in my piece about lead and crime (scroll to the bottom) or in this recent Vox piece by Matt Yglesias specifically about lead in soil.