Alcohol Kills More Than Opioids

From Newsweek:

Alcohol is killing more adults in the U.S. than the opioid epidemic according to the Institute for Health Metrics and Evaluation at the University of Washington. The opioid epidemic kills an average of 72,000 people per year, while alcohol kills 88,000. In those 88,000 deaths are 2.5 million years of potential life lost, according to the Center for Disease Control and Prevention.

The surge of alcohol related deaths is new. In ten years, the number of deaths by alcohol have increased 35 percent according the new report shared by USA Today on Friday. The statistics are based on findings from 2007 to 2017.

Most affected by the rising alcohol epidemic are young women. Among women, deaths rose 67 percent, while for men, the percentage rose only 27 percent.

The article concludes with a quotation from psychologist Benjamin Miller: “Culturally, we’ve made it acceptable to drink but not to go out and shoot up heroin. A lot of people will read this and say ‘What’s the problem?’”

I wonder when we’ll start caring about the mounting evidence.

How much of gender is a social construct?

Check out this National Geographic article “How science is helping us understand gender.” Author Robin Henig outlines different intersex conditions that can be more complicated than the typical XX vs XY binary. But here’s the quote that really caught my eye:

Gender is an amalgamation of several elements: chromosomes (those X’s and Y’s), anatomy (internal sex organs and external genitals), hormones (relative levels of testosterone and estrogen), psychology (self-defined gender identity), and culture (socially defined gender behaviors).

This is a good summary of the factors that could contribute to a person’s understanding of gender, but it also helps demonstrate why conversations about gender get confusing fast. Two thoughts:

1. Intersex =/= Transgender

To my understanding (which I admit is limited), intersex issues are not the same as transgender issues, and in fact people with intersex conditions don’t necessarily appreciate being used as the wedge to push society to accept transgender issues.

Intersexuality is not the same as a transsexuality (gender dysphoria) and is not a transgender state. Neither of the latter terms is one that we recognise as belonging in any general discussion of intersex. We are not happy with the recent tendency of some trans groups/people to promote transgender as an umbrella term to encompass, for example, transsexuality, transvestitism and intersex. We object to other organisations/individuals putting us in categories without consulting us, especially categories that imply that interexed people, of necessity, have gender identity issues.

2. Gender cannot be just a social construct.

If gender were only a social construct, it would be hard to explain why a trans man could not more easily exist simply as a masculine cis woman, i.e. a tomboy or someone similar. If gender is unrelated to sexuality and genitalia, transitioning seems like an unnecessarily difficult undertaking (financially, emotionally, physically, and socially).

That’s not suggest that gender is wholly unrelated to culture. It seems intuitive to me that at least some aspect of gender, especially society’s understanding of gender, is based more on cultural norms than biology. The extreme and perhaps tired example is that girls like pink and boys like blue. Presumably if we birthed children in a society where the opposite was the norm, they’d just go with it. But here and now dressing a baby in pink is a way to signal to others “this baby is a girl,” and while of course you can dress your baby girl in blue, you will probably confuse strangers who think you’re signaling “this baby is a boy” instead of just “I like blue.” Maybe you don’t care about that (I don’t) but that’s the cultural norm and I expect it influences the relative proportion of boys and men willing to wear pink. I digress.

What does it mean, for example, for a person to have all the biological traits (chromosomes, sex organs, genitalia, and hormone levels) of a male but “feel” female? What is the difference between a biological male who identifies as female and a biological male who identifies as a male who is partial to activities and preferences culturally viewed as female? This distinction especially gets confusing when we add in the idea that your sexuality and sexual preferences are not related to your gender. So what drives the difference between a cis straight male who is comfortable with the color pink, being a stay-at-home parent, and [insert female stereotypes here] versus a homosexual trans woman who also likes all of those things?

I ask these questions sincerely. I recognize that people feel very differently about these topics and I don’t begrudge anyone that. And, in terms of policy, I don’t think it’s a good idea for the government to get very strict about what constitutes male and female, not only because intersex conditions complicate matters but also because it’s not hard to imagine situations that would put trans people in danger if they are narrowed to the options of traditional cis sexuality. As the New York Times explains:

Several agencies have withdrawn Obama-era policies that recognized gender identity in schools, prisons and homeless shelters.

I suspect that as we learn more about human physiology and particularly neurology, we’ll gain more insight into the phenomenon of transgenderism. But if that turns out to be the case, to my mind it would be further evidence that gender is biological, as long as we recognize that biology includes more than our genitalia. National Geographic hints at this possibility (same article linked above) when Henig explains:

At least a few brain characteristics, such as density of the gray matter or size of the hypothalamus, do tend to differ between genders. It turns out transgender people’s brains may more closely resemble brains of their self-identified gender than those of the gender assigned at birth. In one study, for example, Swaab and his colleagues found that in one region of the brain, transgender women, like other women, have fewer cells associated with the regulator hormone somatostatin than men. In another study scientists from Spain conducted brain scans on transgender men and found that their white matter was neither typically male nor typically female, but somewhere in between.

Maybe all of this musing is getting to a broader question: can psychology exist independent from biology? If someone is psychologically male can we assume, by definition, that some part of that person’s brain structures, neural connectivity, whatever, will look more similar to cis male brains? I’m interested to see what we learn as time goes on.

Does the U.S. Subsidize Global Health Care?

From a USC study earlier this year:

What we pay for medicines today affects the number and kinds of drugs discovered tomorrow. Empirical research has established that drug development activity is sensitive to expected future revenues in the market for those drugs. The most recent evidence suggests that it takes $2.5 billion in additional drug revenue to spur one new drug approval, based on data from 1997 to 2007.

Another study assesses the Orphan Drug Act, passed in 1982 to stimulate development of treatments for rare diseases. Its key feature was the granting of market exclusivity that would restrict entry by competitors— in other words, allow for higher prices. The result was a dramatic increase in the number of compounds brought into development to treat rare diseases (figure 3). This linkage may not help patients with tuberculosis today in Nigeria and Indonesia — two poor countries hardest hit by tuberculosis—but it is currently benefiting patients in the same countries who have HIV. Decades ago, demand for HIV treatment in wealthy countries spurred medical breakthroughs that have since found their way — albeit more slowly than we would like — into the poorest corners of the globe. As of July 2017, 20.9 million people living with HIV were accessing antiretroviral therapy globally; 60 percent of them live in eastern and southern Africa.

American consumers may feel some philanthropic pride about the benefits they have spurred for the world’s poorest HIV patients. But similar benefits are also enjoyed by German, British, and French HIV patients, and were financed by the same revenues generated, in large part, by high American drug prices. Whether one sees this as philanthropy on the part of American drug buyers, or free-riding on the part of other wealthy countries who pay much less for the same drugs, America clearly contributes more to pharmaceutical revenue, and hence incentives for new drug development, than its income and population size would suggest (pg. 2).

The study goes on to point out that Americans pay 3 times as much on drugs as Europeans and 90% more as a share of income. American consumers “account for about 64 to 78 percent of total pharmaceutical profits, despite accounting for only 27 percent of global income…American patients use newer drugs and face higher prices than patients in other countries” (pg. 2-3). Most policy discussions focus on lowering American prices. But what if we instead raised European prices? The researchers write,

Increasing European prices by 20 percent — just part of the total gap — would result in substantially more drug discovery worldwide, assuming that the marginal impact of additional investments is constant. These new drugs lead to higher-quality and longer lives that benefit everyone. After accounting for the value of these health gains — and netting out the extra spending — such a European price increase would lead to $10 trillion in welfare gains for Americans over the next 50 years. But Europeans would also be better off in the long run, by $7.5 trillion, weighted towards future generations. This is because European populations are rapidly aging, and they need new drugs too…At the end of the day…evidence conclusively demonstrates that higher expected revenues leads to more drug discovery, with the most recent numbers suggesting that on average every $2.5 billion of additional revenue leads to a new drug approval (pg. 4).

In short, “if other wealthy countries shouldered more of the burden for medical innovation, both American and European patients would benefit” (pg. 5). Recent research confirms that the difference between U.S. and European healthcare is driven mainly by prices. The authors suggest that more can be done through trade, international harmonization of regulatory standards, and further research on the costs of free-riding. “As incomes in less-developed countries rise,” they conclude, “they will face the challenges of fighting conditions like diabetes, heart disease, and even dementia. Spending a bit more now to ensure their populations have access to effective treatment is in everyone’s interest (pg. 5).

Medical innovations are vital to increased well-being and the U.S. dominates in this arena.

Drug Discovery, 1996-2017
Medical Laboratory Technology, 1996-2017
Medicine, 1996-2017

Even when compared to the European Union as a whole, the United States still comes out on top.

As the authors of the two graphs above explain,

Although many factors are surely relevant, one likely contributor is differences in monetary compensation. Other things being equal, individuals and firms will tend to invest more in medical innovation when (a) they expect a larger return; (b) the returns will last for a longer period of time; and (c) the returns arrive sooner rather than later…Americans pay more for pharmaceuticals because of the nature of our health care system. Single-payer and other centrally organized health care systems, like those in much of Europe, are characterized by a great deal of monopsony (buyer) power that pushes down compensation…In addition to pushing down prices, centrally organized health care systems also limit the use of new drugs, technologies, and procedures. Those systems “control costs by upstream limits on physician supply and specialization, technology diffusion, capital expenditures, hospital budgets, and professional fees.” The result is that those countries use new innovations less extensively than the United States (pg. 8).

They conclude (and I agree), “The healthcare debate should address more than just covering the uninsured and controlling costs. It should also consider whether proposed policies will promote or hinder the ability of creative individuals to innovate” (pg. 11).

Global Study: Alcohol Is Bad For You (Surprise)

Image result for why is the rum gone gif
Because it’s bad for you.

From CNN:

If you’re one of the third of all humankind who drinks alcohol, take note: There’s no amount of liquor, wine or beer that is safe for your overall health, according to a new analysis of 2016 global alcohol consumption and disease risk. Alcohol was the leading risk factor for disease and premature death in men and women between the ages of 15 and 49 worldwide in 2016, accounting for nearly one in 10 deaths, according to the studypublished Thursday in the journal The LancetFor all ages, alcohol was associated with 2.8 million deaths that year. Those deaths include alcohol-related cancer and cardiovascular diseases, infectious diseases such as tuberculosis, intentional injury such as violence and self-harm, and traffic accidents and other unintentional injuries such as drowning and fires.“The most surprising finding was that even small amounts of alcohol use contribute to health loss globally,” said senior study author Emmanuela Gakidou, a professor at the University of Washington’s Institute for Health Metrics and Evaluation. “We’re used to hearing that a drink or two a day is fine. But the evidence is the evidence.”

It continues:
University of Cambridge epidemiologist Steven Bell co-authored a separate study published in April in The Lancet that found drinking is beneficial in lowering the risk for heart attack. However, that study’s big takeaway was that even one drink a day could shorten life expectancy; long-term reduction in alcohol use added one to two years to life expectancy at age 40. He points out that his study looked only at drinkers, but the new research compared drinkers to non-drinkers in accessing risk and is one of the first to look at data from low- and middle-income countries. “Based on these findings,” Bell said, “at no point … is there a level of consumption that appears to lower the overall risk of developing any of the wide array of diseases investigated in comparison to non-drinking. The take-home message being that people shouldn’t drink under the belief that it will lower their risk of disease,” he said, “and those of us who opt to drink should minimize our intake if we wish to prolong our life and well-being.”
The evidence against alcohol consumption is growing year after year.

Men, Religion, and Hormones

Related imageWomen worldwide tend to be more religious than men. In the United States, for example, self-identified Christian women are more religious than self-identified Christian men. Numerous possible reasons have been offered, from the social to the genetic. Last year, I highlighted a study that found religion to be less analytical and more pro-social: “In a series of eight experiments, the researchers found the more empathetic the person, the more likely he or she is religious. That finding offers a new explanation for past research showing women tend to hold more religious or spiritual worldviews than men. The gap may be because women have a stronger tendency toward empathetic concern than men.” As noted by economist Bryan Caplan, “Stereotypes about personality and gender turn out to be fairly accurate: on both Myers–Briggs thinking–feeling and FFM agreeableness, there are large male–female gaps in the expected directions. Women are about half a standard deviation more agreeable than men; on the binary Myers–Briggs measure, the thinking–feeling breakdown is about 30/70 for women versus 60/40 for men.” According to Pew,

Under the “nature” umbrella are theories that variously attribute gender differences in religious commitment to physical or physiological causes such as hormones, genes or biological predispositions.

For example, Baylor University sociologist Rodney Stark postulates that men’s physiology – specifically their generally higher levels of testosterone – accounts for gender differences in religion. His argument rests on what he views as increasing evidence that testosterone is associated with men’s greater propensity to take risks, which he argues is why men are less religious than women. By inference, women are more religious because they have less risk-promoting testosterone.

A new study offers some evidence for the testosterone theory:

From the analysis of over 1000 men, [Aniruddha] Das found that men with higher levels of the sex hormones testosterone and dehydroepiandrosterone (DHEA) in their bodies had weaker religious ties.

“Religion influences a range of cultural and political patterns at the population level. Results from the current study indicate the latter may also have hormonal roots,” says Das. “There is therefore a need for conceptual models that can accommodate the dynamic interplay of psychosocial and neuroendocrine factors in shaping a person’s life cycle.”

He believes that more studies should be done to better understand how hormones, in particular, shape a person’s religious patterns in later life. This is of importance, as religion has been shown to have a positive influence on how people age and ultimately experience their later years. According to Das, the findings further point to biological reasons behind the particular personal networks and social affiliations that people form during the course of their lives.

Testosterone has been shown to reduce empathy, perhaps explaining why women tend to be more empathetic–and therefore, more religious–than men. As Steven Pinker explains, “Women have more intimate social relationships, are more concerned about them, and feel more empathy toward their friends, though not toward strangers.”

It’ll be interesting to see what future research finds.

The DR Book Collection: Catch-Up #5

This is part of the DR Book Collection.

I’m once again behind on my book reviews, so here’s a list of the books I’ve read recently, their descriptions, and accompanying videos.

Image result for a universe from nothingLawrence M. Krauss, A Universe From Nothing: Why There Is Something Rather Than Nothing (Free Press, 2012): “Bestselling author and acclaimed physicist Lawrence Krauss offers a paradigm-shifting view of how everything that exists came to be in the first place. “Where did the universe come from? What was there before it? What will the future bring? And finally, why is there something rather than nothing?” One of the few prominent scientists today to have crossed the chasm between science and popular culture, Krauss describes the staggeringly beautiful experimental observations and mind-bending new theories that demonstrate not only can something arise from nothing, something will always arise from nothing. With a new preface about the significance of the discovery of the Higgs particle, A Universe from Nothing uses Krauss’s characteristic wry humor and wonderfully clear explanations to take us back to the beginning of the beginning, presenting the most recent evidence for how our universe evolved—and the implications for how it’s going to end. Provocative, challenging, and delightfully readable, this is a game-changing look at the most basic underpinning of existence and a powerful antidote to outmoded philosophical, religious, and scientific thinking” (Amazon).

Image result for alive at workDaniel M. Cable, Alive at Work: The Neuroscience of Helping Your People Love What They Do (Harvard Business Review Press, 2018): “In this bold, enlightening book, social psychologist and professor Daniel M. Cable takes leaders into the minds of workers and reveals the surprising secret to restoring their zest for work. Disengagement isn’t a motivational problem, it’s a biological one. Humans aren’t built for routine and repetition. We’re designed to crave exploration, experimentation, and learning–in fact, there’s a part of our brains, which scientists have coined “the seeking system,” that rewards us for taking part in these activities. But the way organizations are run prevents many of us from following our innate impulses. As a result, we shut down. Things need to change. More than ever before, employee creativity and engagement are needed to win. Fortunately, it won’t take an extensive overhaul of your organizational culture to get started. With small nudges, you can personally help people reach their fullest potential. Alive at Work reveals:

  • How to encourage people to bring their best selves to work and use their greatest strengths to help your organization flourish
  • How to build creative environments that motivate people to share ideas, work smarter, and embrace change
  • How to enhance people’s connection to their work and your customers
  • How to create personalized experiences that help people feel a deeper sense of purpose

Filled with fascinating stories from the author’s extensive research, Alive at Work is the inspirational guide that you need to tap into the passion, creativity, and purpose fizzing beneath the surface of every person who falls under your leadership” (Amazon).

Image result for saints slaves and blacksNewell G. Bringhurst, Saints, Slaves, & Blacks: The Changing Place of Black People Within Mormonism, 2nd ed. (Greg Kofford Books, 2018): “Originally published shortly after the LDS Church lifted its priesthood and temple restriction on black Latter-day Saints, Newell G. Bringhurst’s landmark work remains ever-relevant as both the first comprehensive study on race within the Mormon religion and the basis by which contemporary discussions on race and Mormonism have since been framed. Approaching the topic from a social history perspective, with a keen understanding of antebellum and post-bellum religious shifts, Saints, Slaves, and Blacks examines both early Mormonism in the context of early American attitudes towards slavery and race, and the inherited racial traditions it maintained for over a century. While Mormons may have drawn from a distinct theology to support and defend racial views, their attitudes towards blacks were deeply-embedded in the national contestation over slavery and anticipation of the last days. This second edition of Saints, Slaves, and Blacks offers an updated edit, as well as an additional foreword and postscripts by Edward J. Blum, W. Paul Reeve, and Darron T. Smith. Bringhurst further adds a new preface and appendix detailing his experience publishing Saints, Slaves, and Blacks at a time when many Mormons felt the rescinded ban was best left ignored, and reflecting on the wealth of research done on this topic since its publication” (Greg Kofford).

Image result for out of poverty powellBenjamin Powell, Out of Poverty: Sweatshops in the Global Economy (Cambridge University Press, 2014): “This book provides a comprehensive defense of third-world sweatshops. It explains how these sweatshops provide the best available opportunity to workers and how they play an important role in the process of development that eventually leads to better wages and working conditions. Using economic theory, the author argues that much of what the anti-sweatshop movement has agitated for would actually harm the very workers they intend to help by creating less desirable alternatives and undermining the process of development. Nowhere does this book put ‘profits’ or ‘economic efficiency’ above people. Improving the welfare of poorer citizens of third world countries is the goal, and the book explores which methods best achieve that goal. Out of Poverty will help readers understand how activists and policy makers can help third world workers” (Amazon).

Pro-science = Pro-nuclear energy

Every time I see a meme like this…

…I can’t help but notice it’s missing a few lines. GMOs are safe. Humans begin as zygotes. And nuclear energy is efficient.

Ronald Bailey, the science correspondent for Reason, brought that last fact to my mind when he recently published the article “How We Screwed Up Nuclear Power.”

The Oyster Creek Nuclear Generating Station in New Jersey opened in 1969. It cost $594 million (in 2017 dollars) and took four years to build. America’s newest nuclear plant, at Watts Bar in Tennessee, opened in 2016. It cost $7 billion and took more than 10 years to complete.

What happened? Anti-nuclear activism and regulation.

In general, scientists are a lot less concerned about nuclear power than the general public is. According to Pew Research, 65% of AAAS members–including 75% of working engineers and 79% of working physicists Ph.D’s–favor building more nuclear power plants, compared to only 45% of the public. If we are defining “pro-science” as “recognizing and agreeing with the majority view of scientists in the field,” then being pro-science would include being pro-nuclear energy.

Vaping: The Safer Alternative

Another example of perfect being the enemy of the good and good intentions paving away:

Image result for vaping gifFlavor bans for e-cigarettes and menthol in combustibles are pressing policy issues that have received relatively little empirical study. Now that the FDA has the power to regulate flavors in both combustible and e-cigarettes, it has again been considering flavor bans for all types of cigarettes (FDA, 2017). Thus, there is an urgent need for an analysis of the impact of flavor bans on public health. Despite the need for this information, there are no studies predicting the impacts of alternative bans on the use of combustibles, e-cigarettes, and neither. We provide such information for adult smokers and recent quitters using a DCE and a large, nationally representative survey.

We find that flavors themselves serve as an attribute that drives choices across combustibles and e-cigarettes and choosing none. We conclude that flavor bans can be effective levers that affect smokers’ choices. Alternative flavor bans can either enhance protection of the health of the public or worsen it. Specifically, our results indicate that banning flavors in e-cigarettes, while allowing them to remain in combustibles, would result in the greatest increase in smoking of combustible cigarettes; and the use of e-cigarettes would decline (10.3 percent).

By comparison, we find that a ban on menthol combustible cigarettes would produce the greatest reduction (4.8 percent) in the use of combustible cigarettes across the flavor bans that we study. Much of this movement from combustible cigarettes would be to e-cigarettes (3.5 percent) and the remainder would be toward “none” (1.3 percent). Given that combustible cigarettes impose the most significant harms on those who smoke them, reducing the smoking rate would likely increase the health of the public. Our results suggest that policymakers need to consider simultaneously the impact of flavor policies on combustibles, e-cigarettes, and abstinence (pgs. 20-21).

One study found for “those aged 15 years and above in 2016, almost 6.6 million fewer premature deaths and 86.7 million fewer LYL due to cigarette use occur in the Optimistic Scenario. The average 15-year-old would increase their life expectancy by 0.5 years, reflecting the increased life span of those who have, or would otherwise have smoked cigarettes, switching to e-cigarettes.” Even in the Pessimistic Scenario, “a net gain of 1.6 million (1.4 million male; 0.3 million female) representing 6% fewer premature deaths and 20.8 million (17.8 million male; 3.0 million female) representing 8% fewer LYL are projected. Average life expectancy increases 0.08 years (0.14 male; 0.02 female).”

While I’d prefer that people not smoke at all, I’m all for safer alternatives that reduce premature deaths.

Image result for gandalf vaping gif

Other Minds: Peter Godfrey-Smith at Google

This is part of the DR Book Collection.

Image result for other minds the octopusWith philosopher Peter Godfrey-Smith’s Other Minds: The Octopus, the Sea, and the Deep Origins of Consciousness, I have learned more about cephalopods–squids, octopuses, and nautiluses–than I’ve ever cared to know. And it was deeply fascinating.

I have always found the ocean to be frightening and incredibly alien. The temperature and lack of oxygen in space are certainly scary, but add creatures that are weird and often predatory to the mix? No thank you. But this makes Godfrey-Smith’s exploration all the more absorbing. He weaves together philosophy, science, and personal anecdotes (he’s an avid scuba diver) in a way that causes the reader to reflect on the strangeness of life and especially the oddity of consciousness. He explains,

Cephalopods are an island of mental complexity in the sea of invertebrate animals. Because our most recent common ancestor was so simple and lies so far back, cephalopods are an independent experiment in the evolution of large brains and complex behavior. If we can make contact with cephalopods as sentient beings, it is not because of a shared history, not because of kinship, but because evolution built minds twice over. This is probably the closest we will come to meeting an intelligent alien (pg. 9).

Yet, the neurons of an octopus operate differently than those of vertebrates, spanning the creature’s entire body:

“Smart” is a contentious term to use, so let’s begin cautiously. First, these animals evolved large nervous systems, including large brains…A common octopus…has about 500 million neurons in its body…Humans have many more–something like 100 billion–but the octopus is in the same range as various smaller mammals, close to the range of dogs, and cephalopods have much larger nervous systems than all other invertebrates…When biologists look at a bird, a mammal, even a fish, they are able to map many parts of one animal’s brain onto another’s. Vertebrate brains all have a common architecture. When vertebrate brains are compared to octopus brains, all bets–or rather, all mappings–are off. There is no part-by-part correspondence between the parts of their brains and ours. Indeed, octopuses have not even collected the majority of their neurons inside their brains; most of the neurons are found in the their arms (pg. 50-51).

And that’s just getting started. These scientific and philosophical reflections go back to some of the deepest questions that have been with humanity for thousands of years:

  • What is it to be alive?
  • What is to be?
  • What is it to be conscious?

While I would have preferred a little more philosophy (even some speculation), the book is nonetheless an eye-opening read. You can see Godfrey-Smith speaking on the subject at Google below.