A good strength workout includes a push, a pull, and legs. When I can get to the gym I like to alternate bench press and incline press for the push; rows and pulldowns for the pull; and squats and deadlifts for the legs. But with a baby to take care of at home, its been hard to find time for the gym. Between driving, waiting for equipment, and the actual lifts, the gym takes an hour. Doing a similar workout at home can take just 10 minutes, and has the advantage that you can watch a baby while doing it.
But the big challenge with home workouts was finding a good leg exercise. Pushes are easy: just do pushups. Pulls are pretty easy: just buy a $15 pullup bar to hang over a door. But how to do a good leg workout without costly barbells and plates that take up lots of space? Enter the pistol squat.
The idea is simply to start from a stand and lower yourself down almost to the ground on a single leg, then come back up on one leg, with the other leg out front for balance:
Source: Snapshot from this video, which shows how to do the standard pistol plus many variations
I find this to be about as difficult as doing a traditional two-legged barbell squat with 1x bodyweight on the bar. The traditional squat has two legs lifting 2x bodyweight (your body itself, plus 1x bodyweight on the bar); the pistol squat has one leg lifting 1x bodyweight (just your body itself), which is about equal. This was perfect for me because I was doing about 3 sets of 5 reps of squats with 1x bodyweight on the bar, so I just do the same number of pistol squats. But what if you’re not exactly at that weight?
Going lighter is easy– just put one hand on something sturdy nearby like a table and lean on it until it takes enough of your weight that you can do the squat. This helps with balance too if that is an issue. Going heavier is harder, but you could carry something heavy in your hands, turn the rise into more of an explosive jump, or just do more reps.
I’d still rather be at the gym, but the complete home workout seems like a good application of the Pareto Principle– you get most of the benefits of the gym while paying only a small fraction of its time and money costs.
Cold symptoms are personally unpleasant, and also have economic aspects. In 2011, Americans directly spent some $40 billion on cold medicines, and the societal costs of workers and students staying home are much greater.
Having dealt with one or two colds a year for quite a few decades, I have significant experience with cold remedies. Also, being a habitual researcher, I have nosed around the internet looking at various studies of the effectiveness of medications.
The biggest problem I have with colds is the nasal drippage at night. In the daytime, I can just blow my nose, but at night this can keep me from sleeping, and also leads to nasty coughing and even bronchial infection if the stuff goes down into my lungs.
There are various so-called first-generation antihistamines out there. They all have some sedative affects. Second-generation antihistamines (e.g. fexofenadine, loratadine, and cetirizine) have fewer sedating qualities, since they do less crossing of the blood-brain barrier, but they tend to be only effective for allergies and less effective for colds.
The best antihistamine for colds which I have found, which seems to be confirmed on the internet, is chlorpheniramine maleate. This was the key ingredient in classic Coricidin, and now appears in Coricidin HPB. HPB stands for high blood pressure. It seems to be always accompanied with some acetaminophen (Tylenol).
(Side comment: the internet seems to say that in general antihistamines are not a problem for people with high blood pressure. Decongestants are. I guess the manufacturer turned the lack of a decongestant in this formulation into a virtue, by calling it “safe for high blood pressure.”)
Coricidin HPB exists in many different incarnations on drugstore shelves. The one I go for is the Cold and Flu package, see below. It just has the chlorpheniramine maleate plus acetaminophen:
Most of the other variants have the word “cough” in the title, such as “Cough and Cold,” and contain dextromethorphan cough suppressant. I find the combination of the dextromethorphan plus the antihistamine to be extremely soporific. In my medicine cabinet I label them “zombie pills, since they leave me feeling torpid even 24 hours after taking them. The plain antihistamine version (Cold and Flu) also slows me down, but not nearly as much as the cough suppressant version.
I have also found generic versions (e.g. CVS brand) of chlorpheniramine maleate. However, less than half the pharmacies I check have this stuff on their shelves, for some reason. I guess it is not as heavily promoted as the Vicks NyQuil, which contains the heavily sedating doxylamine succinate (active ingredient in Unisom sleep aid) as the antihistamine component.
I recently ran across an article by Parkview Health which happens to come to the same conclusions I have. I will share their recommendations here in italics, with a little further commentary of my own. On antihistamines for runny nose:
In patients older than 12 years of age: Nyquil™ (doxylamine succinate), Tavist (clemastine fumarate), chlorpheniramine maleate or Benadryl® (diphenhydramine) may help relieve symptoms, although these may cause sleepiness. Chlorpheniramine maleate is the least sedating of the products listed above.
For Nasal Congestion:
The best oral medication would be Sudafed® (psudoephedrine) [sic], which is a medication behind the counter in the pharmacy. There is a medication that is similar and available over-the-counter, Sudafed PE® (phenylephrine), but it’s not nearly as effective as plain Sudafed®. These medications have precautions in some disease states so it is best to consult your physician before treating your nasal congestion.
The best nasal spray medication is Afrin® (oxymetazoline) and while this medication is very effective. It should only be used for 3 days due to the potential side effect of rebound congestion.
Nearly all the meds on the drugstore shelves for stuffy nose use phenylephrine, which is known to be essentially useless. Go figure. Anyway, go for the good stuff, the pseudoephedrine. I use the 12-hour slow-release formulation, keeps me going all day. This med does jazz up your nervous system, so some folks may find the racing brain to be unpleasant. Truck drivers use it to stay awake at night, but for the rest of us, don’t take this at bedtime. I take the antihistamine at night (half hour before bedtime, and typically once in the middle of the night, since it only lasts about four hours), and the decongestant in the morning.
If I can’t afford to be slow-brained the next day, or if I am at peak nasal congestion, I might use the nasal spray at night once or twice, but I know from experience that using it too much leads to permanent stuffiness.
Pseudoephedrine can be used in the manufacture of methamphetamine, so you can’t just load up your shopping cart with boxes of it. In the U.S., you typically have to go to the pharmacist’s counter, and they dole all out maybe two boxes at a time, noting your driver’s license, and entering it into some national database.
I’ll let the good folks at Parkview Health offer the closing wisdom here on cold and flu meds:
Cough:
The best way to address cough is to assess what kind of cough it is. When you cough is it dry and non-productive? Or is it wet and mucus exits with the cough?
If the cough is dry and non-productive:
Utilize Delsym® (dextromethorphan)
If the cough is wet and produces mucus:
Drink water to make the mucus thinner
Utilize Mucinex® (guaifenesin)
Fever/Sore throat: The best medication for fever and/or sore throat is plain Tylenol® (acetaminophen) or NSAIDs such as Motrin® (ibuprofen).
What medications are best to treat the symptoms of the common cold in children? Many medications that are used in the common cold for adults should not be used in children because there have been few trials supporting their use in infants and children. Therefore, the best treatment is Children’s Tylenol® (acetaminophen) or Children’s Motrin® (ibuprofen) for fever or uncomfortable symptoms due to the common cold.
Other than the medications listed, the best way to help your infant or child get rid of the common cold is drinking an adequate amount of fluids. If further help or direction is needed, contact your physician.
What medication(s) are best to treat the flu? Unfortunately, the flu is much harder to treat over-the-counter, as there aren’t medications to really treat this viral infection. The best measures to take are to get plenty of rest, drink enough fluids and utilize Tylenol® (acetaminophen) for fever.
There are medications that can be prescribed by your physician to help shorten the duration of the flu although studies have shown the medications shorten the flu by only a day.
The best way to prevent the flu by getting the flu shot
Other Types of Cold Remedies
The above discussion covered plain vanilla, non-prescription (over the counter) medications. There are other more exotic and expensive meds to be had by prescription, as well as a plethora of folk remedies. Here is a link to about a dozen such nostrums, such as garlic and cognac, vinegar and cayenne pepper, and sauerkraut.
My paper “Missouri’s Medicaid Contraction and Consumer Financial Outcomes” is now out at the American Journal of Health Economics. It is coauthored by Nate Blascak and Slava Mikhed, researchers at the Federal Reserve Bank of Philadelphia. They noticed that Missouri had done a cut in 2005 that removed about 100,000 people from Medicaid and reduced covered services for the remaining enrollees. Economists have mostly studied Medicaid expansions, which have been more common than cuts; those studying Medicaid cuts have focused on Tennessee’s 2005 dis-enrollments, so we were interested to see if things went differently in Missouri.
In short, we find that after Medicaid is cut, people do more out-of-pocket spending on health care, leading to increases in both credit card borrowing and debt in third-party collections. Our back-of-the-envelope calculations suggest that debt in collections increased by $494 per Medicaid-eligible Missourian, which is actually smaller than has been estimated for the Tennessee cut, and smaller than most estimates of the debt reduction following Medicaid expansions.
We bring some great data to bear on this; I used the restricted version of the Medical Expenditure Panel Survey to estimate what happened to health spending in Missouri compared to neighboring states, and my coauthors used Equifax data on credit outcomes that lets them compare even finer geographies:
The paper is a clear case of modern econometrics at work, in that it is almost painfully thorough. Counting the appendix, the version currently up at AJHE shows 130 pages with 29 tables and 11 figures (many of which are actually made up of 6 sub-figures each). We put a lot of thought into questioning the assumptions behind our difference-in-difference estimation, and into figuring out how best to bootstrap our standard errors given the small number of clusters. Sometimes this feels like overkill but hopefully it means the final results are really solid.
For those who want to read more and can’t access the journal version, an earlier ungated version is here.
Disclaimer: The results and conclusions in this paper are those of the authors and do not indicate concurrence by the Agency for Healthcare Research and Quality or the US Department of Health and Human Services. The views expressed in this paper are solely those of the authors and do not necessarily reflect the views of the Federal Reserve Bank of Philadelphia or the Federal Reserve System. Any errors or omissions are the responsibility of the authors.
In the true definition of a worst-case scenario, an unnamed California bride-to-be is reported to have called off her entire non-refundable wedding reception worth $15,000, after learning something about her fiance.
But…she took the disaster and turned it on its head, donating the reception party complete with dinner, dessert, drinks, DJ, dancing, and photo booth to a non-profit called Parents Helping Parents which provides community support to parents with children who have special needs.
…Organizers at PHP sent out invitations for the “Ball for All” and had all the seats reserved 48 hours before the event. … “Nearly everyone [there] was a young adult with special needs, their parent or a member of the care team,” Daane said. “Their joy and delight really told the story about how special and unique this event was—the moment the ballroom was opened, and we all filed into a beautiful candlelit room with tables draped in white linen.”
Yay!
This cheering item is on the “Good News Network”, which I had never heard of before. Other headlines on this site include:
Irishman Whips Out Fiddle to Entertain Passengers in Flight–and People Dance a Jig in the Aisle (WATCH)
Singing or Playing Music Throughout Life is Linked with Better Brain Health While You Age
and
She’s a Pet Detective Who’s Tracked Down and Reunited 330 Lost Dogs with Owners for Free–Using Thermal Imaging.
I think it is great to publicize such civic acts. Let’s make this the new normal.
When you look across countries, it appears that the first $1000 per person per year spent on health buys a lot; spending beyond that buys a little, and eventually nothing. The US spends the most in the world on health care, but doesn’t appear to get much for it. A classic story of diminishing returns:
This might tempt you to go full Robin Hanson and say the US should spend dramatically less on health care. But when you look at the same measures across US states, it seems like health care spending helps after all:
Source: My calculations from 2019 IHME Life Expectancy and 2019 KFF Health Spending Per Capita
Last week though, I showed how health spending across states looks a lot different if we measure it as a share of GDP instead of in dollars per capita. When measured this way, the correlation of health spending and life expectancy turns sharply negative:
Source: My calculations from 2019 IHME life expectancy, Gross State Product, and NHEA provider spending
Does this mean states should be drastically cutting health care spending? Not necessarily; as we saw before, states spending more dollars per person on health is associated with longer lives. States having a high share of health spending does seem to be bad, but this is more because it means the rest of their economy is too small, rather than health care being too big. Having a larger GDP per capita doesn’t just mean people are materially better off, it also predicts longer life expectancy:
Source: My calculations from 2019 IHME life expectancy and 2019 Gross State Product
As you can see, higher GDP per capita predicts longer lives even more strongly than higher health spending per capita. Here’s what happens when we put them into a horse race in the same regression:
The effect of health spending goes negative and insignificant, while GDP per capita remains positive and strongly significant. The coefficient looks small because it is measured in dollars, but what it means is that a $10,000 increase in GDP per capita in a state is associated with 1.13 years more life expectancy.
My guess is that the correlation of GDP and life expectancy across states is real but mostly not caused by GDP itself; rather, various 3rd factors cause both. I think the lack of effect of health spending across states is real, between diminishing returns to spending and the fact that health is mostly not about health care. Perhaps Robin Hanson is right after all to suggest cutting medicine in half.
State health care spending usually gets reported in terms of dollars per capita, leading to maps like this that show Alaska as the highest-spending state and Utah as the lowest:
But states differ greatly in how rich they are and how much they have to spend. I wanted to know the states where health care takes up the largest and smallest share of the economy, so I got the data:
Health Care Spending as Share of State Gross Domestic Product in 2019:
You can see that health spending as a share of GDP looks pretty different from health spending in raw dollars. We’ve gone from a high-spending North and low-spending South to more of a mix. Health spending is now highest in West Virginia, where it makes up more than a fourth of the economy; and lowest in Washington State and Washington D.C., where it makes up less than one ninth of the economy.
The biggest change when considering things this way is in Washington D.C., which has the highest spending in $ terms but the lowest as a share of GDP because it has an enormous GDP per capita. Many other states that spend a lot in $ also fall a lot in the rankings due to high GDP per capita, including Alaska, New York, and Massachusetts. The states that rise the most in this ranking are poor states like Arkansas, Alabama, and Mississippi. Mississippi rises the most, gaining 37 spots in the rankings of highest-spending states when we go from $ per capita to share of GDP.
I share the data here so you can do your own comparisons:
The other day I was chatting on Zoom with a friend. She noted that she and a couple of girl friends go on an interesting vacation each year. They start off by each of them writing down their top three destinations, and then comparing notes. This year, it is a tour of the Danube region.
Thinking of a similar “Where do we go next year for kicks, guys?” scenario in the movie City Slickers, I jokingly suggested running with the bulls in Pamplona. That is kind of a guy thing (50-100 injuries each year, occasional fatal goring), but it triggered a comeback from her: “Well, maybe the tomato festival instead.”
So of course I started poking around the internet to see what was up with tomato festivals. They sounded less than exhilarating, on a par with a midwestern pumpkin growing contest. Now, in Lancaster County, PA (Amish country), some of the tomato festivals feature..wait for it….a bounce house! That’s nice, but maybe not worth a plane flight to get there.
Nashville goes all out with their Tomato Art Fest, with food vendors, live performances and people walking around costumed as giant tomatoes. This year’s theme was, ““THE TOMATO: A Uniter, NOT A Divider! – Bringing Together Fruits & Vegetables.” In Leamington, Ontario they get really physical by putting a layer of tomatoes in kiddie pools on the ground, so you can take off your shoes and socks and step in and squoosh those tomatoes under your bare feet. Woo hoo!
But it turns out the real action is La Tomatina in Bunol, near Valencia (Spain). Excitement builds as truckloads of ripe tomatoes are brought into town:
Then there is the greasing of a tall pole with lard; a ham is perched at the top of the pole. And then (since the pole is unclimbable), enthusiastic people pile their bodies up around the pole till someone can reach the top of the pole and cast down the ham, whereupon a signal cannon fires.
That is the signal for total mayhem to erupt – 20,000 people (you have to buy a ticket beforehand) hurling tomatoes at each other, until the whole town square is deep in squishy red pulp. Participants are asked to hand-squash each tomato before throwing it.
After an hour, a second cannon fires to signal cease firing. Local residents may hose you off, or you can go wash off in the river. (Tips include bringing a change of clothes, because you aren’t allowed on the train or bus with your gooey clothes). Afterward, the firetrucks come and hose down the town square. Reportedly, due to the annual rinsing with acidic tomato juices, the town streets appear remarkably clean. During the days leading up to the main event, there are local parades and tours and a paella cooking contest. (Paella is an amazing local rice-based dish, worth of a blog article of its own)
So if you want to do something memorable in Spain but you are too lazy to walk 500 miles on the Camino de Santiago pilgrimage, or you are too chicken to run in front of a crowd of angry bulls, put La Tomatina on your bucket list.
Wall Street analysts love to get out ahead and tout The Next Big Thing. Earlier this year it was Generative AI that was going to Change Everything. I am old enough to remember a surge of enthusiasm when fractal number sets were going to Change Everything (“How did we manage to get along without fractals?” was a question that was really asked), so I tend to underreact to these breathless hot takes.
Well, The Next Big Thing as of last week seemed to be the new generation of weight loss drugs. With names like Ozemic and Wegovy and Mounjaro (who thinks up these names, anyway?), these are mainly GLP-1 blockers which up till now have been mainly used in treating Type 2 diabetes.
These drugs mimic the action of a hormone called glucagon-like peptide 1. When blood sugar levels start to rise after someone eats, these drugs stimulate the body to produce more insulin. The extra insulin helps lower blood sugar levels.
Lower blood sugar levels are helpful for controlling type 2 diabetes. But it’s not clear how the GLP-1 drugs lead to weight loss. Doctors do know that GLP-1s appear to help curb hunger. These drugs also slow the movement of food from the stomach into the small intestine. As a result, you may feel full faster and longer, so you eat less.
I’ll append a table at the end with a bunch of these drug names, for reference. At this point, most of them are only FDA approved for diabetes treatment, but are being prescribed off-label for weight control. It is no secret that obesity is rampant in America, and is spreading in other regions. The knock-on health problems of obesity are also well-known. So, these treatments might be very helpful, if they pan out.
What does Wall Street think of all this? Well, there is first the potential profit to accrue to the makers of these wonder drugs. You typically take them via daily or weekly skin injections, similar to insulin shots. A month’s worth of these meds may cost a cool $1000. Cha-ching right there, for makers like Novo Nordisk and Eli Lilly.
But wait, there’s more – Jonathan Block at Seeking Alpha calls out a number of possible financial angles for these drugs:
While at first glance the impact of these medications — known as GLP-1 agonists — might just impact food and beverages, the reality is that they could influence many other consumer industries.
Apparel retailers, casino/gaming names, and even airlines are just some of the industries that could see an impact from the growing popularity of weight loss drugs.
The thinking is that folks who lose 15 pounds will go out and buy a whole new wardrobe, which is good for clothing makers and retailers. On the other hand, gambling is highly correlated with obesity, so maybe casino business will fall off. There are claims that kidney health is so improved with these drugs that purveyors of dialysis equipment may be under threat.
Fuel represents some 25% of airlines’ expenses, so somebody with a sharp pencil at Jefferies sat down and calculated that for one airline (United) the cost savings would be $80 million per year if the average passenger shed 10 pounds. And who know, if people get really thinner, maybe the airlines can pack in an extra row of seats…
Analysts estimate that nearly 7% of the U.S. population could be on weight loss drugs by 2035, which could lead to a 30% cut in daily calorie intake due to the consumption changes for the targeted group. There is also some conjecture that the increased attention to dieting and weight loss in general could have a downstream impact on the consumption of snacks and sweets.
Real World Efficacy of Weight Loss Drugs May Fall Short of Clinical Trials
Throwing buckets of cold water on these scenarios of slenderized Americans is a study by RBC Capital Markets suggesting that the actual impact of these meds may be much less than indicated by clinical trials:
“Unlike clinical studies, insights from real-world use of these drugs imply weight loss can be limited or short-lived as a result, making it difficult for some users to justify the treatment’s lofty price tag,” RBC analyst Nik Modi said. “Recent insurance claims data on 4k+ patients who started taking GLP-1s in 2021 indicate only 32% remained on therapy and just 27% adhered to treatment after 1 year, citing an increase in healthcare costs.” He mentioned one study on 3.3k subjects that found after a year on the drugs, patients saw an average of just 4.4% weight loss. That is significantly less than declines cited by Novo Nordisk (NVO) and Eli Lilly (LLY) in their studies.
Also, he said IQVIA data found that the growth in GLP-1s is due mostly to new prescriptions, not refills, “making us question its sustainability.” Given this information, “we believe GLP-1s have genuine hurdles to prolonged use that have the potential to limit their long-term societal/economic impact.” To back up his argument, Modi provided several real-life examples of drugs or products where hype that it would shake up a consumer segment ended up falling flat.
The clinical trials for the GLP-1 blockers were paid for by the manufacturers, so they tend to be skewed to the positive. It is not clear whether these flattish real-world results are due to the drugs themselves not being so effective, or to other factors. These factors include side effects, unpleasantness of self-injection, and the huge out-of-pocket cost (~ $12,000/year). Weight loss drugs are often not covered by insurance, since obesity is considered a behavioral outcome, not a disease.
My guess is the final outcome will fall somewhere between mass weight loss and nothing. We hope that progress continues to be made in this area, since so many other health conditions are worsened by being overweight. For instance, fellow blogger Joy Buchanan recently linked to an article by Matt Iglesia in which he described significant and long-lasting weight loss from bariatric surgery.
And as promised, that list of diabetes/weight-loss meds:
On X.com Matt Yglesias posted a chart that sparked some conversation about child safety:
One thing about the much-lamented rise of more intensively supervised childhood activities is that kids have in fact become a lot less likely to die. pic.twitter.com/MTjR7spLM8
Of course, it was probably more his comment about the “rise of more intensively supervised childhood activities” that generated the feedback and pushback. And I assume his comment was partially tongue-in-cheek, as often happens on Twitter, and designed to generate that very discussion. Still, it is worth thinking about. Exactly why did that decline happen?
I’ve posted on this topic before. In my March 2023 post, I looked at very broad categories of child death. While all death categories have declined, about half of the decrease (depending on the age group, but half is about right) is from a decline in deaths from diseases, as opposed to external causes. And fewer disease death can largely be attributed to improvements in healthcare, broadly defined. Good news!
Of course, that means that about half of the decline is from things other than diseases. What caused those declines? Let’s look into the data. Specifically, let’s look into the data on deaths from car accidents.
We reported last month on yet another COVID surge beginning, driven by yet another new, highly transmissible variant. When I checked in on the state of affairs this week, I found two different narratives.
With the demise of widespread public testing, it has become more difficult to track the progress of the disease. One means to do so now is to monitor hospital admissions for COVID. The New York Times provides this service, and it shows a continued uptrend in cases, at least through September 8:
The chart above is for the whole country. It turns out that these cases are highly localized in certain hot spots, especially along the Atlantic seaboard (Delaware through South Carolina), plus the region of St. Joseph, Missouri:
An alternate means of monitoring the progress of COVID is to do ongoing testing of municipal wastewater. The virus is “shed” (to put it delicately) in sewage, and can be detected there some days before a person reports any symptoms. Most recent wastewater analyses indicate that incidence of the disease is plateauing for now, according to an NBC News article by Erika Edwards:
Biobot Analytics, a company that tracks wastewater samplesat 257 sites nationwide, said that the current average Covid levels across the United States are approximately 5% lower than they were last week.
“All fingers crossed,” Cristin Young, a Biobot epidemiologist said, “this wave is plateauing and may be declining.”
After a mid- to late-summer rise, the CDC’s Covid wastewater surveillance now shows declines in mid-Atlantic states, such as Virginia and Maryland.
The findings are backed up from surveillance in North Carolina, said Jessica Schlueter, an associate professor in the department of bioinformatics and genomics at the University of North Carolina Charlotte. Her lab is responsible for testing 12 sites across the state.
The increase in Covid wastewater samples during the last six months “seems to be peaking and starting to taper off,” she said. …Wastewater collection sites in the Midwest and the Northeast, however, show a steady uptick in Covid spread.
Hospitalizations and deaths are lagging indicators, whereas wastewater analysis provides something of a leading indicator. Putting it all together, it may be that what we are seeing now is the usual late summer COVID increase, which may come down in the next two months, to be followed by another winter surge. Do get your latest booster shots.
Economist Writing Every Day 
