Yet decades of transactional, episodic, payment-driven infrastructure undermined the patient–physician relationship at the center of health.
Financing models have stripped Primary Care form its primary role.
That said, Healthcare AI will not be won on automation. Winners will likely optimize for three things simultaneously:
Outcomes
Experience — patient and physician
Economic impact on total cost of care long term
But most healthcare AI investments are mispriced because they target short term transactional efficiency, not long term strategic value creation.
I'm thinking that Ribitzky's need to interpreted in terms of idolatry. Why? Because they reduce humans to mechanisms to be optimized rather than being cared-for.
Health Secretary Robert F. Kennedy Jr. has canceled nearly $500 million of grants and contracts for developing mRNA vaccines, the Department of Health and Human Services announced on Tuesday.
It is the latest blow to research on this technology. In May, the Department of Health and Human Services revoked a nearly $600 million contract to the drugmaker Moderna to develop a vaccine against bird flu.
The new cancellations dismayed scientists, many of whom regard mRNA shots as the best option for protecting Americans in a pandemic.
“This is a bad day for science,” said Scott Hensley, an immunologist at the University of Pennsylvania who has been working to develop an mRNA vaccine against influenza.
Today, the nuclear taboo is on the verge of collapse. The current wars in Europe and the Middle East involving nuclear-armed states, in which there are strong grounds for believing international law is being violated on a regular basis, and threats by the belligerents to use nuclear weapons are weakening the taboo over deploying them. India and Pakistan thankfully did not use their nuclear arsenals in a recent conflict, but the skirmish reminded us how wars between nuclear powers can happen.
Our Nobel Peace Prize sends a message to younger people that they need to be aware that we are facing an emergency — and the need to see a larger movement of young activists working to address the nuclear threat. Even here in Japan, not enough people see this as a pressing issue.
We have the solution in our hands: the United Nations Treaty on the Prohibition of Nuclear Weapons. The treaty not only bans nuclear weapons and all activities related to their production, deployment and use, but also mandates that countries that joined the treaty provide support for people harmed by nuclear weapons in the past and for the cleanup of areas that were used for nuclear testing.
In downtown Berkeley, an old hotel has become a temple to the pursuit of artificial intelligence and the future of humanity. Its name is Lighthaven.
Covering much of a city block, this gated complex includes five buildings and a small park dotted with rose bushes, stone fountains and neoclassical statues. Stained glass windows glisten on the top floor of the tallest building, called Bayes House after an 18th-century mathematician and philosopher.
Lighthaven is the de facto headquarters of a group who call themselves the Rationalists. This group has many interests involving mathematics, genetics and philosophy. One of their overriding beliefs is that artificial intelligence can deliver a better life if it doesn’t destroy humanity first. And the Rationalists believe it is up to the people building A.I. to ensure that it is a force for the greater good. [...]
Many of the A.I. world’s biggest names — including Shane Legg, a co-founder of Google’s DeepMind; Anthropic’s chief executive, Dario Amodei; and Paul Christiano, a former OpenAI researcher who now leads safety work at the U.S. Center for A.I. Standards and Innovation — have been influenced by Rationalist philosophy. Elon Musk, who runs his own A.I. company, said that many of the community’s ideas align with his own. [...]
But these tech industry leaders stop short of calling themselves Rationalists, often because that label has over the years invited ridicule. [...]
“Religion is text and story and ritual,” said Ilia Delio, a Franciscan sister and professor of theology at Villanova University. “All of that applies here.”
Chao Cao, Lin Yang, Tianlin Xu, Patricia A. Cavazos-Rehg, Qinran Liu, Daragh McDermott, Nicola Veronese, Thomas Waldhoer, Petre Cristian Ilie, Shahrokh F. Shariat, Lee Smith, Trends in Sexual Activity and Associations with All-Cause and Cause-Specific Mortality Among US Adults, The Journal of Sexual Medicine, Volume 17, Issue 10, October 2020, Pages 1903–1913, https://doi.org/10.1016/j.jsxm.2020.05.028
Abstract
Background
Sexual activity can be referred to as a health behavior and may also act as an indicator of health status.
Aim
To evaluate temporal trends in sexual activity and to examine associations of sexual activity with all-cause and cause-specific mortality risk.
Methods
We examined the trends and prevalence of sexual activity and association of sexual activity with all-cause and cause-specific mortality in a nationally representative sample using data from the US National Health and Nutrition Examination Survey from 2005 to 2016 and the National Health and Nutrition Examination Survey 2005-2014 Linked Mortality File (through December 31, 2015).
Outcomes
All-cause, cardiovascular disease, and cancer mortality.
Results
A total of 15,269 US adults (mean age, 39.1 years [standard error, 0.18 years]) were included in the trend analysis. In the 2015-2016 cycle, while 71.7% (95% CI, 67.7–75.7%) US adults aged 20-59 years engaged in sexual activity ≥ 12 times/year (monthly), only 36.1% (95% CI, 31.6–40.7%) of them engaged in sexual activity ≥ 52 times/year (weekly). Since the 2005–2006 cycle, the estimated prevalence of sexual activity, ≥52 times/year and ≥12 times/year, were both stable over time among overall and each age group (all P for trend >0.1). During a median follow-up of 5.7 years (range, 1–11 years) and 71,960 person-years of observation, among 12,598 participants with eligible information on mortality status, 228 deaths occurred, including 29 associated with cardiovascular disease and 62 associated with cancer. Overall, participants with higher sexual activity frequency were at a lower risk of all-cause death in a dose-response manner (P for trend = 0.020) during the follow-up period. In addition, the multivariable-adjusted hazard ratios for all-cause mortality, CVD mortality, cancer mortality, and other cause mortality among participants who had sex ≥52 times/year compared with those having sex 0–1 time/year were 0.51 (95% CI, 0.34 to 0.76), 0.79 (95% CI, 0.19 to 3.21), 0.31 (95% CI, 0.11 to 0.84), and 0.52 (95% CI, 0.28 to 0.96), respectively.
Clinical Implications
Sexual activity appears to be a health indicator of all-cause and cancer mortality in US middle-aged adults.
Strengths & Limitations
Clear strengths of the present study include the large representative sample of the noninstitutionalized US population as well as the identification of precise estimates in relation to sexual activity and mortality. However, because of the observational nature of the study design, causality could not be determined.
Conclusions
Sexual activity was found to be associated with a lower risk of mortality from all cause and cancer.
The Trump administration released a report last week that it billed as a “clear, evidence-based foundation” for action on a range of children’s health issues.
But the report, from the presidential Make America Healthy Again Commission, cited studies that did not exist. These included fictitious studies on direct-to-consumer drug advertising, mental illness and medications prescribed for children with asthma.
“It makes me concerned about the rigor of the report, if these really basic citation practices aren’t being followed,” said Katherine Keyes, a professor of epidemiology at Columbia University who was listed as the author of a paper on mental health and substance use among adolescents. Dr. Keyes has not written any paper by the title the report cited, nor does one seem to exist by any author.
Administration response: "Eh":
Dr. Oransky said that while he did not know whether the government had used A.I. in producing the report or the citations, “we’ve seen this particular movie before, and it’s unfortunately much more common in scientific literature than people would like or than really it should be.”
Asked at a news conference on Thursday whether the report had relied on A.I., the White House press secretary, Karoline Leavitt, deferred to the Department of Health and Human Services. Emily Hilliard, a spokeswoman for the department, did not answer a question about the source of the fabricated references and downplayed them as “minor citation and formatting errors.” She said that “the substance of the MAHA report remains the same — a historic and transformative assessment by the federal government to understand the chronic-disease epidemic afflicting our nation’s children.”
Here are three of my favorite joy-boosting tips that the panelists shared.
1. Reach out to your people.
Want to live a longer, happier life? Tend to your relationships, said Dr. Robert Waldinger, a professor of psychiatry at Harvard Medical School who oversees the longest-running study of human happiness. That study has found that strong relationships are one of the biggest factors in people’s well-being as they age. [...]
2. Embrace joyful movement.
Kelly McGonigal, a health psychologist at Stanford University, was in a remedial physical education class as a kid. So it’s surprising, she explained, that she has built a career around joyful movement. [...]
3. Live every day like it’s your first.
Suleika Jaouad, the memoirist and author of a new best seller, “The Book of Alchemy,” was diagnosed with leukemia in her 20s. Last summer, she had a recurrence, and the advice a lot of people offered was to live each day like it was her last. But every time she heard that sentence, she felt an “intense sense of panic,” Jaouad said.
This video is based on information from the two studies below.
Chao Cao, Lin Yang, Tianlin Xu, Patricia A. Cavazos-Rehg, Qinran Liu, Daragh McDermott, Nicola Veronese, Thomas Waldhoer, Petre Cristian Ilie, Shahrokh F. Shariat, Lee Smith, Trends in Sexual Activity and Associations with All-Cause and Cause-Specific Mortality Among US Adults, The Journal of Sexual Medicine, Volume 17, Issue 10, October 2020, Pages 1903–1913, https://doi.org/10.1016/j.jsxm.2020.05.028
Abstract
Background: Sexual activity can be referred to as a health behavior and may also act as an indicator of health status.
Aim: To evaluate temporal trends in sexual activity and to examine associations of sexual activity with all-cause and cause-specific mortality risk.
Methods: We examined the trends and prevalence of sexual activity and association of sexual activity with all-cause and cause-specific mortality in a nationally representative sample using data from the US National Health and Nutrition Examination Survey from 2005 to 2016 and the National Health and Nutrition Examination Survey 2005-2014 Linked Mortality File (through December 31, 2015).
Outcomes: All-cause, cardiovascular disease, and cancer mortality.
Results: A total of 15,269 US adults (mean age, 39.1 years [standard error, 0.18 years]) were included in the trend analysis. In the 2015-2016 cycle, while 71.7% (95% CI, 67.7–75.7%) US adults aged 20-59 years engaged in sexual activity ≥ 12 times/year (monthly), only 36.1% (95% CI, 31.6–40.7%) of them engaged in sexual activity ≥ 52 times/year (weekly). Since the 2005–2006 cycle, the estimated prevalence of sexual activity, ≥52 times/year and ≥12 times/year, were both stable over time among overall and each age group (all P for trend >0.1). During a median follow-up of 5.7 years (range, 1–11 years) and 71,960 person-years of observation, among 12,598 participants with eligible information on mortality status, 228 deaths occurred, including 29 associated with cardiovascular disease and 62 associated with cancer. Overall, participants with higher sexual activity frequency were at a lower risk of all-cause death in a dose-response manner (P for trend = 0.020) during the follow-up period. In addition, the multivariable-adjusted hazard ratios for all-cause mortality, CVD mortality, cancer mortality, and other cause mortality among participants who had sex ≥52 times/year compared with those having sex 0–1 time/year were 0.51 (95% CI, 0.34 to 0.76), 0.79 (95% CI, 0.19 to 3.21), 0.31 (95% CI, 0.11 to 0.84), and 0.52 (95% CI, 0.28 to 0.96), respectively.
Clinical Implications: Sexual activity appears to be a health indicator of all-cause and cancer mortality in US middle-aged adults.
Strengths & Limitations: Clear strengths of the present study include the large representative sample of the noninstitutionalized US population as well as the identification of precise estimates in relation to sexual activity and mortality. However, because of the observational nature of the study design, causality could not be determined.
Conclusions: Sexual activity was found to be associated with a lower risk of mortality from all cause and cancer.
Banerjee S, Anderson P, Davis WS. Connection Between Depression, Sexual Frequency, and All-cause Mortality: Findings from a Nationally Representative Study. Journal of Psychosexual Health. 2024;6(1):35-44. doi:10.1177/26318318241256455
Abstract:
We used the 2005–2010 National Health and Nutrition Examination Survey (NHANES), constructed to evaluate health of adults in the United States using consolidated data from interviews and physical exams that were conducted to obtain data for this study. The analysis sample was representative of noninstitutionalized US adults aged 20–59 years. When considering sexual frequency, overall, only female participants with lower sexual frequency were at a higher risk of all-cause death in a dose-response manner with a hazard ratio (HR) of 1.70 (95% CI 1.38–2.10, p trend < .001) during the follow-up period. This relationship was not significant in males. However, when sexual frequency was categorized (<52 times/year vs. ≥52 times/year), the adjusted HR was elevated [2.97 (CI 1.20–7.32, p = .02)] among individuals who had depression and low sexual frequency, but it was close to 1.0 (1.75, CI 0.50–6.07, p = .36) among individuals who had depression and high sexual frequency after adjusting for medical (obesity) and demographic (age, gender, education, and ethnicity) risk factors, indicating a 197% increase in mortality among individuals with low sexual frequency and depression than depression alone. Sexual activity is important for overall cardiovascular health possibly due to reduction of heart rate variability and blood flow increase.
00:00 Intro
01:06 Set Point Theory
11:24 Calories In / Calories Out
18:47 Biggest Hurdles To Weight Loss
23:05 What Is Bariatric Surgery?
30:10 Success Rates
36:08 BMI
40:50 My 600 Pound Life
48:22 Side Effects of Surgery / Patient Satisfaction
54:23 Ozempic vs. Surgery
1:06:42 Life After Ozempic
1:10:28 Is Ozempic Unethical?
1:15:18 Food Addiction / Muscle Loss
1:18:05 The Process / Misconceptions
1:25:35 Innovation / Motivation
The Biden administration, in one of its last major policy directives, proposed on Tuesday that Medicare and Medicaid cover obesity medications, a costly and probably popular move that the Trump administration would need to endorse to become official.
The proposal would extend access of the drugs to millions of Americans who aren’t covered now.
The new obesity drugs, including Wegovy from Novo Nordisk and Zepbound from Eli Lilly, have been shown to improve health in numerous ways, but legislation passed 20 years ago prevents Medicare from covering drugs for “weight loss.”
The new proposal sidesteps that restriction, specifying that the drugs would be covered to treat the disease of obesity and prevent its related conditions.
“We don’t want to see people having to wait until they have these additional diseases before they get treatment,” said Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services, or C.M.S., noting the growing medical consensus that obesity is a chronic health condition.
What will the Trump administration do?
Given Mr. Kennedy’s skepticism, and the new drugs’ potentially large cost, Trump officials might not have proposed a coverage requirement. But they may now face pressure to approve it.
Demand for the drugs is strong, and some Medicare beneficiaries are already taking them, even paying full price themselves. A recent survey from KFF, a health policy group, found that 61 percent of Americans support Medicare coverage for these drugs. The Biden administration’s proposal will set off a public comment period, in which doctors and patients will share their views on the decision with government officials.
Ever since I was a teenager, I have dreamed of shedding a lot of weight. So when I shrank from 203 pounds to 161 in a year, I was baffled by my feelings. I was taking Ozempic, and I was haunted by the sense that I was cheating and doing something immoral.
I’m not the only one. In the United States (where I now split my time), over 70 percent of people are overweight or obese, and according to one poll, 47 percent of respondents said they were willing to pay to take the new weight-loss drugs. It’s not hard to see why. They cause users to lose an average of 10 to 20 percent of their body weight, and clinical trials suggest that the next generation of drugs (probably available soon) leads to a 24 percent loss, on average. Yet as more and more people take drugs like Ozempic, Wegovy and Mounjaro, we get more confused as a culture, bombarding anyone in the public eye who takes them with brutal shaming.
This is happening because we are trapped in a set of old stories about what obesity is and the morally acceptable ways to overcome it.
An experiment:
One scientific experiment — which I have nicknamed Cheesecake Park — seemed to me to crystallize this effect. Paul Kenny, a neuroscientist at Mount Sinai Hospital in New York, grew up in Ireland. After he moved in 2000 to the United States in his 20s, he gained 30 pounds in two years. He began to wonder if the American diet has some kind of strange effect on our brains and our cravings, so he designed an experiment to test it. He and his colleague Paul Johnson raised a group of rats in a cage and gave them an abundant supply of healthy, balanced rat chow made out of the kind of food rats had been eating for a very long time. The rats would eat it when they were hungry, and then they seemed to feel sated and stopped. They did not become fat.
But then Dr. Kenny and his colleague exposed the rats to an American diet: fried bacon, Snickers bars, cheesecake and other treats. They went crazy for it. The rats would hurl themselves into the cheesecake, gorge themselves and emerge with their faces and whiskers totally slicked with it. They quickly lost almost all interest in the healthy food, and the restraint they used to show around healthy food disappeared. Within six weeks, their obesity rates soared.
After this change, Dr. Kenny and his colleague tweaked the experiment again (in a way that seems cruel to me, a former KFC addict). They took all the processed food away and gave the rats their old healthy diet. Dr. Kenny was confident that they would eat more of it, proving that processed food had expanded their appetites. But something stranger happened. It was as though the rats no longer recognized healthy food as food at all, and they barely ate it. Only when they were starving did they reluctantly start to consume it again.
Satiety:
Drugs like Ozempic work precisely by making us feel full. Carel le Roux, a scientist whose research was important to the development of these drugs, says they boost what he and others once called “satiety hormones.”
Once you understand this context, it becomes clear that processed and ultraprocessed food create a raging hole of hunger, and these treatments can repair that hole. Michael Lowe, a professor of psychology at Drexel University who has studied hunger for 40 years, told me the drugs are “an artificial solution to an artificial problem.”
Yet we have reacted to this crisis largely caused by the food industry as if it were caused only by individual moral dereliction. I felt like a failure for being fat and was furious with myself for it. Why do we turn our anger inward and not outward at the main cause of the crisis?
We've got two culture-wide tropes working against us:
When Pope Gregory I laid out the seven deadly sins in the sixth century, one of them was gluttony, usually illustrated with grotesque-seeming images of overweight people. Sin requires punishment before you can get to redemption. [...]
The second idea is that we are all in a competition when it comes to weight. Ours is a society full of people fighting against the forces in our food that are making us fatter. It is often painful to do this: You have to tolerate hunger or engage in extreme forms of exercise. It feels like a contest in which each thin person creates additional pressure on others to do the same. Looked at in this way, people on Ozempic can resemble cyclists like Lance Armstrong who used performance-enhancing drugs. Those who manage their weight without drugs might think, “I worked hard for this, and you get it for as little as a weekly jab?”
The bottom line:
Early indications are that the new anti-obesity drugs are moving people in a similar radically healthier direction, massively reducing the risk of heart attack or stroke. But these drugs may increase the risk for thyroid cancer. I am worried they diminish muscle mass and fear they may supercharge eating disorders. This is a complex picture in which the evidence has to be weighed very carefully.
But we can’t do that if we remain lost in stories inherited from premodern popes or in a senseless competition that leaves us all, in the end, losers. Do we want these weight loss drugs to be another opportunity to tear one another down? Or do we want to realize that the food industry has profoundly altered the appetites of us all — leaving us trapped in the same cage, scrambling to find a way out?
The overall finding is that healthy relationships with others is the single most important determinate of happiness. What does that imply about living in a world of "intelligent" machines? I hear and read people wondering, What will we do when machines are smarter than any of us? Setting aside the fact that I don't (really/quite) know what that means, perhaps that worry is misplaced. Perhaps we should be thinking about guiding the development and deployment of AI in directions that allow us to develop more fruitful relationships with others.
Back in my undergraduate years at Johns Hopkins I took a half-dozen or so courses from Richard Macksey. He always had one of more guest lecturers in his classes. One of these guests was an Episcopal priest named Ralph Harper. I forget just what he brought Harper in to talk about, but it may have been mysticism, which is certainly one of the things I thought a great deal about in those days (still do). I remember Macksey recommending a book that Harper had written. I forget the title, but it might have been Human love: Existential and mystical. In fact, I'm sure that's the book, which I got (and is now in storage somewhere in suburban New Jersey). In there Harper said something to the effect that the answer to the question, What is the meaning of life? is not some kind or proposition or statement. It is something we can do. What can we do?
Love? Cultivate our relationships? If so, isn't that orthogonal to this strange and wonderful technology we're now developing?
CARPI, Italy — The older woman asked to hear a story.
“An excellent choice,” answered the small robot, reclined like a nonchalant professor atop the classroom’s desk, instructing her to listen closely. She leaned in, her wizened forehead almost touching the smooth plastic head.
“Once upon a time,” the robot began a brief tale, and when it finished asked her what job the protagonist had.
“Shepherd,” Bona Poli, 85, responded meekly. The robot didn’t hear so well. She rose out of her chair and raised her voice. “Shep-herd!” she shouted.
“Fantastic,” the robot said, gesticulating awkwardly. “You have a memory like a steel cage.”
The scene may have the dystopian “what could go wrong?” undertones of science fiction at a moment when both the promise and perils of artificial intelligence are coming into sharper focus. But for the exhausted caregivers at a recent meeting in Carpi, a handsome town in Italy’s most innovative region for elder care, it pointed to a welcome, not-too-distant future when humanoids might help shrinking families share the burden of keeping the Western world’s oldest population stimulated, active and healthy.
Italy's elders:
Robots are already interacting with the old in Japan and have been used in nursing homes in the United States. But in Italy, the prototype is the latest attempt to recreate an echo of the traditional family structure that kept aging Italians at home.
The Italy of popular imagination, where multigenerational families crowd around the table on Sunday and live happily under one roof, is being buffeted by major demographic headwinds.
Low birthrates and the flight of many young adults for economic opportunities abroad has depleted the ranks of potential caregivers. Those left burdened with the care are often women, taking them out of the work force, providing a drag on the economy and, experts say, further shrinking birthrates.
Yet home care remains central to the notion of aging in a country where nursing homes exist but Italians vastly prefer finding ways to keep their old with them.
For decades, Italy avoided a serious reform of its long-term care sector by filling the gap with cheap, and often off-the-books, live-in workers, many from post-Soviet Eastern Europe — and especially Ukraine.
“That’s the long-term care pillar of this country,” said Giovanni Lamura, the director of Italy’s leading socio-economic research center on aging. “Without that, the whole system would collapse.”
Amish people spend only a fifth as much as you do on health care, and their health is fine. What can we learn from them?
A reminder: the Amish are a German religious sect who immigrated to colonial America. Most of them live apart from ordinary Americans (who they call “the English”) in rural communities in Pennsylvania and Ohio. They’re famous for their low-tech way of life, generally avoiding anything invented after the 1700s. But this isn’t absolute; they are willing to accept technology they see as a net positive. Modern medicine is in this category. When the Amish get seriously ill, they will go to modern doctors and accept modern treatments.
[...] But by some miracle, the US government played along and granted the Amish exemptions from all the usual health care laws. They don’t have to pay Medicare taxes or social security. They aren’t included in the Obamacare mandate. They can share health care costs the way they want, ignoring any regulations to the contrary. They are genuinely on their own.
They’ve ended up with a simple system based on church aid. Everyone pays tithes to their congregation (though they don’t call it that). The churches meet in houses and have volunteer leaders, so expenses minimal. Most of the money goes to “alms” which the bishop distributes to members in need. This replaces the social safety net, including health insurance. Most Amish go their entire life without needing anything else.
About a third of Amish are part of a more formal insurance-like institution called Amish Hospital Aid. Individuals and families pay a fixed fee to the organization, which is not-for-profit and run by an unpaid board of all-male elders. If they need hospital care, AHA will pay for it. How does this interact with the church-based system? Rohrer and Dundes, my source for most of this post, say that it’s mostly better-off Amish who use AHA. Their wealth is tied up in their farmland, so it’s not like they can use it to pay hospital bills. But they would feel guilty asking their church to give them alms meant for the poor. AHA helps protect their dignity and keep church funds for those who need them most.
Well on in the article we find this:
Careful price-shopping can look very different from regular medical consumption. Several of the articles I read talked about Amish families traveling from Pennsylvania to Tijuana for medical treatment. One writer describes Tijuana clinics sending salespeople up to Amish Country to advertise their latest prices and services. For people who rarely leave their hometown and avoid modern technology, a train trip to Mexico must be a scary experience. But prices in Mexico are cheap enough to make it worthwhile.
Meanwhile, back in the modern world, I’ve written before about how a pharma company took clonidine, a workhorse older drug that costs $4.84 a month, transformed it into Lucemyra, a basically identical drug that costs $1,974.78 a month, then created a rebate plan so that patients wouldn’t have to pay any extra out-of-pocket. Then they told patients to ask their doctors for Lucemyra because it was newer and cooler. Patients sometimes went along with this, being indifferent between spending $4 of someone else’s money or $2000 of someone else’s money. Everything in the US health system is like this, and the Amish avoid all of it. They have a normal free market in medical care where people pay for a product with their own money (or their community’s money) and have incentives to check how much it costs before they buy it. I do want to over-emphasize this one, and honestly I am surprised Amish health care costs are only ten times cheaper than ours are.
A plurality of respondents said they are unsatisfied with the Trump administration’s handling of the coronavirus (47 percent) while 42 percent said they are satisfied, and 10 percent said they are neither satisfied nor unsatisfied. As expected, there is a huge partisan divide, with 81 percent of Democrats saying they are unsatisfied, and 79 percent of Republicans saying they are satisfied. A slight majority of independents (51 percent) say they are dissatisfied, and 29 percent satisfied, with the Trump administration’s handling.
However, there was a small shift in attitudes over that period. The authors conclude:
These trends show that, as the crisis persists, more Americans are worried, but also slightly more Americans are satisfied with the administration’s handling of the crisis, transcending the partisan divide. At the same time, the lack of trust in President Trump has remained high, even increased. How does one explain the increase in American satisfaction—even if most Americans remain unsatisfied?
There are likely two principal reasons. First, the administration did move to announce some dramatic actions during this period—on March 13, Trump declared a national emergency; on March 14, the administration said that it would ban travel from the United Kingdom and Ireland; on March 16, the White House issued guidelines to Americans urging them to avoid bars and restaurants, to limit gatherings to 10 or fewer people, and to work from home and engage in homeschooling; and on March 18, the administration closed the U.S.-Canada border to nonessential traffic.
Second, as the crisis intensified, and Americans measurably became more worried—the president even called himself a “wartime president”—one might expect some rallying around the flag, even in a polarized time. In fact, the surprise here is not that there is some effect but that the effect seems relatively small in comparison to other crises: President George W. Bush, who had a contentious election in 2000, had an approval rating as low as 51 percent divided along partisan lines before the 9/11 attack; immediately after, his approval rating spiked to 90 percent.
Still, the full scale of the coronavirus crisis remains unknown, and, after announcing dramatic steps during the nine-day period of our poll, the president recently signaled he may soon change course. There is nothing we see in the poll to suggest that Americans will come together behind Trump’s handling of the crisis.
Thomas Bollyky and Samantha Kiernan, No Nation Can Fight Coronavirus on Its Own, Lawfare, February 12, 2020: "Infectious diseases were the first global problem that nation-states realized they could not solve without international cooperation." This came about in the mid-19th century:
For most of human history, plagues, parasites and pests were a domestic affair. Quarantine was the principal means by which nations contained the microbes that were brought by invading armies and the passengers, both human and vermin, on trading ships and caravans.
Those isolation measures proved ineffective, however, against the six pandemics of cholera that swept the United States, the Middle East, Russia and Europe in the 19th century. A terrifying disease that struck seemingly healthy people, cholera killed tens of thousands in the cities of Europe and the United States—and, very likely, many more in India, where the pandemics originated. The economic costs of uncoordinated quarantines hurt nations and merchants alike.
In 1851, European states gathered for the first International Sanitary Conference to discuss cooperation on cholera, plague and yellow fever. That convention, and those that followed, led to the first treaties on international infectious disease control and—in 1902—the International Sanitary Bureau, which later became the Pan American Health Organization. These international initiatives were the early models for later agreements and agencies on other transnational concerns, such as pollution, the opium trade and unsafe labor practices.
Microbes have continued to inspire episodes of cooperation among even bitter rivals. The WHO, the United Nation’s first specialized agency, was created in 1946 in response to the horrors of World War II. Its early days were devoted to international campaigns against the great scourges of that era, such as malaria, smallpox and tuberculosis. At the height of the Cold War, the smallpox immunization campaign motivated the United States and the Soviet Union to join forces in an effort that succeeded in eradicating the disease in 1980. In El Salvador, an international vaccination campaign against pediatric infections led to a pause in the country’s 14-year civil war for the sole purpose of immunizing children.
And the current coronavirus epidemic?
There is much we do not know yet about how easily the virus spreads or its severity. But there is reason to think that the scale of this coronavirus outbreak and the likelihood of epidemics of the virus occurring outside China may inspire more cooperation than even the five previous occasions that the WHO designated as international public health emergencies: the H1N1 influenza pandemic (2009), the re-emergence of polio in several nations (2014), the Ebola outbreak in West Africa (2014), the Zika virus outbreak (2016) and the Ebola virus outbreak in the Democratic Republic of Congo (2019).
In a little over one month, the coronavirus has more than five times the number of laboratory-confirmed cases (43,114 as of Feb. 11) than the outbreak of SARS did in four months (8,096). The novel coronavirus has already spread to at least 26 countries, far more than the current outbreak of the Ebola virus in the Democratic Republic of Congo, its predecessor in West Africa in 2013-2015, or during the resurgence of polio in Afghanistan, Nigeria and Pakistan in 2014. The mortality rate for known cases of the novel coronavirus has been about 2-3 percent, deadlier than the Zika virus or the 2009 H1N1 swine flu. [...]
Perhaps a pandemic of novel coronavirus, if it occurs, would be a sufficiently frightening antagonist to force international cooperation, even at a moment that otherwise has proved inhospitable to global governance. If so, this novel coronavirus will do what climate change, tariff threats and the prospect of nuclear proliferation on the Korean peninsula could not: force nations to work together.
Something startling is happening to middle-aged white Americans. Unlike every other age group, unlike every other racial and ethnic group, unlike their counterparts in other rich countries, death rates in this group have been rising, not falling.
That finding was reported Monday by two Princeton economists, Angus Deaton, who last month won the 2015 Nobel Memorial Prize in Economic Science, and Anne Case. Analyzing health and mortality data from the Centers for Disease Control and Prevention and from other sources, they concluded that rising annual death rates among this group are being driven not by the big killers like heart disease and diabetes but by an epidemic of suicides and afflictions stemming from substance abuse: alcoholic liver disease and overdoses of heroin and prescription opioids.
The analysis by Dr. Deaton and Dr. Case may offer the most rigorous evidence to date of both the causes and implications of a development that has been puzzling demographers in recent years: the declining health and fortunes of poorly educated American whites. In middle age, they are dying at such a high rate that they are increasing the death rate for the entire group of middle-aged white Americans, Dr. Deaton and Dr. Case found.
It's not clear what's going on.
Dr. Case found that the number of whites with mental illnesses and the number reporting they had difficulty socializing increased in tandem. Along with that, increasing numbers of middle-aged whites said they were unable to work. She also saw matching increases in the numbers reporting pain and the numbers reporting difficulty socializing, difficulty shopping, difficulty walking for two blocks.
With the pain and mental distress data, Dr. Deaton said, “we had the two halves of the story.” Increases in mortality rates in middle-aged whites rose in parallel with their increasing reports of pain, poor health and distress, he explained. They provided a rationale for the increase in deaths from substance abuse and suicides.
Could it be loss of hope for the future? This reminded me of a passage from Health of Nations (Basic Books 1987, p. 184), by Leonard Sagan:
The history of rapid health gains in the United States is not unique; the rate at which death rates have fallen is even more rapid in more recently modernizing countries. The usual explanations for this dramatic improvement—better medical care, nutrition, or clean water—provide only partial answers. More important in explaining the decline in death worldwide is the rise of hope ... [through] the introduction of the transistor radio and television, bringing into the huts and shanties of the world the message that progress is possible, that each individual is unique and of value, and that science and technology can provide the opportunity for fulfillment of these hopes. [emphasis mine, BB]
Obama's decided to spend a pile of money on "precision" medicine. Michael Joyner remarks that we've been down this road before and don't have much to show for it:
The idea behind the “war on cancer” was that a deep understanding of the basic biology of cancer would let us develop targeted therapies and cure the disease. Unfortunately, although we know far more today than we did 40-plus years ago, the statistics on cancer deaths have remained incredibly stubborn. The one bright spot has been tobacco control — again highlighting the dominant role of culture, environment and behavior versus biological destiny in what ails most of us.
Given the general omertà about researchers’ criticizing funding initiatives, you probably won’t hear too many objections from the research community about President Obama’s plan for precision medicine. But I am deeply skeptical. Like most “moonshot” medical research initiatives, precision medicine is likely to fall short of expectations. Medical problems and their underlying biology are not linear engineering exercises, and solving them is more than a matter of vision, money and will.
We would be better off directing more resources to understanding what it takes to solve messy problems about how humans behave as individuals and in groups. Ultimately, we almost certainly have more control over how much we exercise, eat, drink and smoke than we do over our genomes.
Given my current hobbyhorses, this is yet another example of how anxiety about the unknown, and death, leads us to expend great effort in ways that are ineffective in achieving stated objectives. One certainly gets the impression that progress is a crapshoot. Is this one source of the blind variation driving long-term cultural evolution?
Beth Israel Medical Center in New York City led the research, conducted in 11 hospitals, which found that live music can be beneficial to premature babies. In the study, music therapists helped parents transform their favorite tunes into lullabies.
The researchers concluded that live music, played or sung, helped to slow infants’ heartbeats, calm their breathing, improve sucking behaviors important for feeding, aid sleep and promote states of quiet alertness. Doctors and researchers say that by reducing stress and stabilizing vital signs, music can allow infants to devote more energy to normal development...
The study, published Monday in the journal Pediatrics, adds to growing research on music and preterm babies. Some hospitals find music as effective as, and safer than, sedating infants before procedures like heart sonograms and brain monitoring. Some neonatologists say babies receiving music therapy leave hospitals sooner, which can aid development and family bonding and save money.