Blood Clots for You and Me

On April 13, 2021, CDC and FDA recommended a pause in the use of Johnson & Johnson’s Janssen COVID-19 Vaccine. When I first heard that the FDA was pausing the J&J vaccine because of less than 10 blood clots out of millions of patients, I thought I’d really get to the bottom of blood clots and blog about it. Other people (some of them are the kind of doctor that helps people) have already done a pretty good job in the past few days.

First, it is a tragedy that the vaccine is not being give to every male over 50 who wants it. Doing so would free up many thousands of other types of vaccines for young women.

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Will GameStop be as profitable as “Roaring Kitty” predicted in 2019?

He’s been found and he’s talking to the press. He’s known as “Roaring Kitty” on Youtube, and his Reddit username is… something else. The WSJ even talked to his mom which tells you just how much public attention was directed at the event this week that he might be the prime mover of.

The man who convinced a Reddit “army” to drive up the price of Gamestop ($GME) says that he originally simply saw it as a value investment. He believed people would keep shopping there, even though some short sellers on Wall Street bet money on the store going the way of Borders (the way of all flesh).

One of the strange turns of this story is that now people are buying the stock as a means of self-expression. Some of them claim they don’t care if they lose the money they put in. A friend of mine described the scene thusly on his social media account:

#SaveAMC #gamestop Amid the global turmoil, some big banks made billions ‘shorting’ floundering businesses, profiting off of the struggles of failing businesses. Recently those targets were brick and mortar retailers like GameStop and AMC. But the banks got too greedy and shorted too far, so individual investors rallied to invest in these businesses to simultaneously save their favorites and stick it to the banks. Power to the people.

He describes GameStop as a “failing business” and simultaneously declares it a favorite of consumers.

The $GME episode might have been as fun as playing a video game. Will anyone think it’s exciting to shop at GameStop 2 years from now?

If the short sellers were right, then who is helped by prolonging the agony? If the short sellers were wrong, then they will pay anyway.

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Voluntary Facebook Friend Purges

Dale Carnegie wrote a famous book called How to Win Friends and Influence People. The title suggests that the more friends you have, the more influence you have.

Something I have seen from many friends since 2016 is messages about how they are cutting off ties with anyone on the political right.

Bad far-right actors mobbed the US Capitol last night. The violence scared me, and it scared people around the world who want to believe in the American Dream. After the traumatic attack, I saw one of my Facebook friends making the statement again last night.

Like most Americans, I am a Facebook user. I learn from keeping many “friends.” I understand that many of them are not actually friends providing emotional support to me, but I get to see lots of heartfelt statements from both sides of the political divide. This helps me understand how statements from media figures are landing with the public.

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The Political Center is Endogenous to You

I stumbled into a twitter conversation about this relatively innocuous breakdown of news sources:

Now there are plenty of ways to pick this apart. No, I don’t care that you are socially liberal and fiscally conservative. I also do not care that a one-dimensional political spectrum can’t capture the fine nuance of your political ethos. Yes, the farthest left and right bins equivocate between often very different levels of bias, but that’s mostly of a product of only having five bins. Obviously greater accuracy could be had by delineating into 9 bins (and yeah, there is some real weird stuff in tails of this distribution). But coarseness or inaccuracy at the margin is not what grabbed by attention. I don’t really care that the lunacy at OAN and largely evidence-based reporting at Vox are in bins of seemingly reciprocal bias, as I know that’s just an artifact of the 5 bin structure.

Rather, what I was intrigued by were the frustrations and bias attributed in the comments about news sources, such as the BBC and NPR, improperly classified as the center. I’m well aware that many people are annoyed by “centrists”. They are traitors to the cause who should know better than to side with the enemy and will, of course, be first against the wall when the revolution comes. There is, more seriously, a frustration that centrists think they can make a claim to the truth by simply splitting the difference of the political distribution, like using the mean surveyed number of jelly beans in a jar. This aggravates people partly because it is a gross misuse of the wisdom of crowds, but mostly because we often think our position is the truth against which all other political identities should be gauged. It’s an old George Carlin joke – everyone driving slower than you is an idiot, everyone driving faster than you is an asshole. The “right wing” is everyone to the right of me. The “left wing” is everyone to the left of me. As for the crazies, well, that depends on your social identity. If you think of yourself as a right (left)-of-center, well then the far left (right) is full of lunatic socialists (corporatist fascists) out to destroy everything we love. The far right (left)? Well, they are a bit much I admit, but they are just spirited activists doing their best in a hostile environment.

Everyone hates centrists in large part because so many of us, on some level, think of ourselves as the reasonable political center. For some right or left-wing yahoo to plant their flag in to the rich soil of the center and call it their own is not just an affront to our sensibilities, it’s an act of political war.

To be fair to the Twitterverse, one person did manage to bring to this cavalcade of frustration an excellent alternative chart that had 7 bins (!) and a second dimension (!!!) regarding the reliability of information. That should have calmed most people down, obviously social media is neither the time nor place for such things.

It’s in this wonderful figure that so much of the story really comes out. People are rightfully upset that honest news sources are being conflated with tabloid rags. They’re also upset, however, that excellent and reliable sources are being attributed centrist neutrality. How dare they attribute the power of veracity and truth to those well-known right-wing whackos at the BBC! We tell ourselves we ignore the BBC/NPR/Economist/WSJ because of its gross bias, but the reality is we ignore them because they’re boring and never tell us we’re smart and pretty and righteous.

The original post was trying to suggest to people they consider balancing their political diet. My suggestion would not be to balance the bias in your diet (we like what we like), but rather to focus on the most reliable sources (the green bullseye in the second figure) and cut out the fried BS. All of that rage and confirmation bias, it’s nothing but empty calories.

The Powerful Allure of R0 < 1

I categorize this as “News”, because I don’t know if we will have enough posts on medicine to justify a whole category for Medicine. Because the coronavirus is affecting life so much, it’s well worth writing about currently.

R0 is the average number of people who will contract a contagious disease from one person with that disease. If you want, you can pronounce it “R naught”.

If R0 is less than 1, and stays that way for a while, the disease will disappear. That means that the virus can still be passed around between a few people (for example, if 1 out of 1,000 people forgets to bring a mask into the grocery store), but over time it will run out of targets and we will be done with this whole thing. If R0 is above 1, that means that a few cases produces more cases and eventually most people will get infected. Once you understand the potential of R0<1 it does become tempting to engineer a lockdown.

We understand the spread of the virus better than we did when lockdowns were first discussed in the US in March 2020. It’s not as simple as every infected person giving the virus to two new people. The way the virus spreads is often through “superspreaders” and superspreader events. That’s why so many large gatherings have been cancelled and continue to be cancelled. With this wrinkle in mind, there is still the overall R0 score of whether the virus is increasing or decreasing.

If you fail to stop the initial spread of the virus (R0 > 1) then a great many people can be infected and eventually the spread will slow simply because the virus is running out of hosts. One of the more controversial topics in Spring 2020 was whether “herd immunity” is or is not something we should want to achieve as a society.

One of the absolute best places to get virus news is Today, Tyler has written a new post about herd immunity. I’ll provide some quotes. Much more at the link of course.

… these same herd immunity theorists tended to be less pessimistic than many of the mainstream forecasts…

Now, I don’t recall many of those theorists early on making a prediction about a specific number required for the herd immunity threshold to be reached.  Nonetheless, when deaths and hospitalizations collapsed in Sweden, London, and New York at about 20 percent seroprevalence, obviously it seemed that might be the critical level for herd immunity to kick in.

Then things started to go askew in the last few weeks.  First, it seems like a bad second wave came to an already fairly hard hit Madrid.  OK, you could say Madrid was never had 20% seroprevalence to begin with.  And then what appears to be a second wave has started coming to Israel, with rising hospitalizations.  Finally, it is believed that in Britian R equals about 1.7, and that a second wave of cases is on the verge of hitting London and Southeast England.

Tyler Cowen

Even though no one has all the answers, this is the conversation we should be having. In fact, I’m starting to wonder if we should make a Medicine blog post category.

It was just yesterday that the dreaded and long foreseen 200,000 deaths was confirmed.

Birmingham Mayor Randall Woodfin Interview

Birmingham, Alabama Mayor Randall Woodfin is one to watch. The city of Birmingham has been on the rise, although like all cities Covid has presented a major setback. Here’s a Rolling Stone feature on his role in removing a confederate monument from the city in the summer of 2020.

My university president recently sat down for an interview with him (35 minutes long). Mayor Woodfin talks about influences that shaped him and how he ended up in politics. He emphasizes personal experience in community service and politics as customer service. They discuss governance in the time of Covid, both the health and financial angle.

There are lots of books on race going around these days. Mayor Woodfin’s recommendation is Caste.

The city does not get much attention on the international stage. The fact that we share a name with a much larger city in the UK is problematic in a way. It’s our fault, because we stole the name from them in an attempt to assert our dominance in the steel industry over one hundred years ago.

I have seen a Trump boat parade

Are boat parades a previously underexploited means of advertising? I quickly Googled Trump boat parades before posting this and found that just about every news outlet in the country, large and small, posted about them recently. They get noticed.

I was at a harber town in Florida for the weekend and you notice the Trump boats. I saw one large yacht with a cut out of President Trump and Melania on the deck. When the boat is going away from you it almost looks like Mr. & Mrs. are on board.

I’m the kind of person who likes to ask obnoxious questions. I asked a boat captain who works in the harbor if he had ever seen a Biden boat. He laughed at me. No. In case you were wondering, although many Americans plan to vote for Biden, none have rigged up a Biden boat to compete with the Trump regatta.

I am reminded of a classic movie “The King & I” in which the young prince says that his first act as king will be to order a celebration with fireworks and boat races.