Showing posts with label Public Health. Show all posts
Showing posts with label Public Health. Show all posts

12 August 2024

Our Diets Are Not Getting More Toxic


More children died of starvation in the United States 90 years ago, in 1934, than in any other year in the last century plus.

So, don't believe the utter bullshit implication of the following meme which is has a bogus and misleading implication, and is basically a bald faced lie fueled by ignorance and hysteria.
 


The idea that "new" food is making us sick couldn't be further from the truth. Little things like iodized salt and enriched flour have made us vastly healthier today. 

Not "eating local" has prevented myriad deaths from famine and has greatly reduced malnutrition too. 

Our very civilization's existence hinges on the fact that almost none of us grow our own food as our primary source of sustenance.

The fact that we understand what ails us, and can give it a name, rather than merely chalking most deaths up to "natural causes" is not a bad thing. You can't cure a disease you don't know that you have.

24 July 2024

Abuse In Orphanages

New Zealand's government is hardly the most corrupt or ill-intentioned in the nation. But there, as is the case almost everywhere, going back to at least as far as the Old Testament, orphans get a raw deal and are frequently abused. 

More than 30% of people in care in New Zealand from 1950 through 2019 were abused and many more were neglected. I suspect that as horrible as this is, that it is worse in many other countries (probably including the U.S.).

The mix of problems in New Zealand is multi-faceted. 

Most children in care were Maori (i.e. indigenous Polynesian), even though New Zealand is currently only about 18% Maori, usually in cases where they were removed from their families, putatively, for abuse or neglect. It is a fair guess that Maori children were also on the receiving end of a disproportionately share of the abuse suffered by children within the system. This has echoes of the notorious residential schools in Canada and the U.S., long ago, in addition to the other issues with abuse in orphanages without ethnic bias and issues of the treatment of indigenous people thrown in.

The culpability of New Zealand’s Catholic, Methodist and Anglican churches is also predictable and has been mirrored in Canada, the U.S., and the U.K., as well as many other places. Partially related is the religious affiliation of Maori people, of whom there are about 1,075,000 in the world (mostly in New Zealand, but with about 1/6th in Australia and about 21,000 elsewhere):

Given the total population, 0.1% corresponds to about 500 to 1500 people, and 0.2% corresponds to about 1500 to 2500 people.

Of course, while this is dismal, surely a large share of children in care in New Zealand genuinely were victims of abuse and neglect before the government stepped in and removed them from their families.

New Zealand deserves credit, at least, for a thorough investigation, for apologizing, and for resolving to take action. It is also worth noting that New Zealand apparently has a "no-fault accident compensation system" that makes sense as basically a more seamless version of a system where everyone has casualty insurance (it is discussed at the end of this post).

More than 200,000 people are estimated to have been abused by state and religious organizations in New Zealand that had been entrusted with their care, according to the final report from a landmark independent inquiry released on Wednesday.

The abuse included sexual assault, electric shocks, chemical restraints, medical experimentation, sterilization, starvation and beatings, said the report from the Royal Commission of Inquiry Into Abuse in Care. Many of the victims were children who had been removed from their families and placed in state, religious or foster care.

“For some people this meant years or even decades of frequent abuse and neglect,” the report said. “For some it was a lifetime; for others it led to an unmarked grave.” . . .

The inquiry, established in 2018 by the New Zealand government, involved interviewing nearly 2,500 survivors as it examined orphanages, foster care systems, mental health facilities and other forms of care that were charged with supporting 655,000 people from 1950 through 2019. The inquiry’s leaders described it as the widest-ranging examination of its kind in the world.

The report noted that most children in care were Indigenous Maori, even though the group makes up a minority of the country’s overall population of five million people, and said that “Maori were often targeted because of their ethnicity.”
Beyond the 200,000 people estimated to have been abused, the report said countless others had suffered neglect. . . .
The inquiry found that even when abuses by government and religious leaders were discovered, the leaders “were rarely held to account for their actions or inactions, which emboldened them to perpetrate further abuse.”

Among the inquiry’s 138 recommendations were calls for public apologies from the pope, the archbishop of Canterbury, and New Zealand’s police commissioner and its top civil servant. It also urged the government to overhaul the country’s no-fault accident compensation program to provide tailored support for survivors of abuse.

The report prompted New Zealand’s Catholic, Methodist and Anglican churches to promise change. “We will ensure that action follows our review of the inquiry’s findings,” Steve Lowe, president of the New Zealand Catholic Bishops Conference, said in a statement. “We owe it to survivors,” the Anglican Church said in another statement.

The report follows decades of complaints from survivors. “Survivors repeatedly called for justice but were unheard, disbelieved, and ignored,” according to the report. “Significant resources have been used to deny survivors their voice and to defend the indefensible. This must stop.”

From the New York Times (July 24, 2024).

The core forward looking recommendations of the report are here and focus on creation of a single national regulatory system for both secular and religious care systems.

National No Fault Accident Compensation

According to an article in a medical journal that is very opposed to the tort system of medical malpractice:
In 1974 New Zealand introduced a publicly-funded accident compensation scheme with the goals of minimising the incidence and impact of injury. 
The scheme provides assistance with the cost of treatment and rehabilitation for all personal injuries, regardless of fault, and in exchange bans suing for compensatory damages. Medical injury has always been covered under the scheme. Consequently, in New Zealand there is no culture of suing doctors for damages and doctors pay comparatively low medical indemnity fees of around £790 per annum. Doctors are held to account under separate processes including the Medical Council of New Zealand’s competence and fitness to practise processes, an independent patient complaints system, and a separate disciplinary process. 
The patient complaints system was introduced in 1994 on recommendation of a 1988 government report that found wanting the prior accountability processes in an environment where patients were unable to sue. In New Zealand, patient complaints are not a demand for financial recompense but a demand that an individual be held to account for perceived wrongdoing. A patient may lodge both a claim for treatment injury compensation and, regardless of injury, a complaint against a practitioner.

Although medical injury has always been covered under the scheme, the compensation of medical injury has not always been without fault for doctors. Prior to 2005, patients could obtain compensation by proving medical error. Because all findings of error were reported to the Medical Council, compensation could bring disciplinary repercussions for doctors. Fear of punishment and/or reputational damage discouraged some doctors (and some patients) from participating in the compensation claims process, unfairly restricting access to compensation for injured patients. This situation was rectified in 2005 under the ‘no-fault’ legislative reforms. The reforms extended eligibility to all injuries caused by treatment and replaced the prior reporting duties with a new duty to report ‘risk of harm to the public’ to the ‘authorities responsible for patient safety’. These changes freed doctors to participate in the compensation claims process with little fear, and improved information flows within the system.

The program explains itself here:

Our no-fault scheme covers everyone, including visitors, who are injured in an accident in Aotearoa New Zealand. It can include events that result in mass casualties, and covers children, beneficiaries, and students. You’re covered if you’re working, unemployed, or retired.

There are some limits to the support we can provide. These limits are set by Parliament, which makes laws about what we can and can’t support.
If you're injured in an accident, make sure you go and see your doctor or health provider first. They can make a claim for you. Claims can be made up to 12 months after your injury. We may still consider claims made after this time if there’s a good reason for the claim not being made sooner. 
What is no-fault cover?

No-fault cover means it doesn't matter what you were doing when you were injured or who was at fault. We'll cover you, as long as the injury falls within our legislation.

The cover we provide helps pay for costs to support your recovery and get you back on your feet. It includes payment towards medical bills, treatment, help at home and work and help with your income. 
Physical injuries we cover

A physical injury is when there is actual damage to your body. This includes: 
  • sprains or strains - such as the ankle, back, knee or shoulder sprains
  • wounds - cut, broken or bruised skin
  • burns
  • fractures
  • dislocations
  • dental injuries
  • hearing loss
  • concussion and loss of consciousness
  • maternal birth injuries which occurred on or after 12:00am on 1 October 2022.
We cover most physical injuries if they're caused by: 
  • an accident
  • sexual violence
We can cover injuries or conditions that happen over time and are caused by the type of work you do. This is known as gradual process conditions. We have to establish if your work tasks or workplace environment are causing your condition.

We can also cover injuries that are long-term, permanent or that happened at birth. 
Injuries caused by treatment

Sometimes getting treatment can cause an injury. We can cover a treatment injury if: 
  • the treatment directly caused your injury
  • a registered health professional was treating you
  • it's not a normal side-effect of your treatment.
We can also cover injuries caused by treatment for an injury we've already covered. 
Conditions that come on gradually from work

We can cover injuries or conditions that happen over time and are caused by the type of work you do. This could be things like: 
  • tendonitis from overusing muscles or heavy lifting
  • deafness caused by noise at work
  • infections or diseases from exposure to certain environments. 
Serious injuries and disabilities

We can cover injuries that cause long-term effects and disabilities including spinal and traumatic brain injuries (TBI), such as concussion.

Find out how we're working to reduce the number, severity, and impact of TBIs:

Mental injuries we cover

If we accept your claim for a physical injury, we can also cover mental injuries resulting from that injury. For example, post-traumatic stress disorder after a physical assault.

If your physical injury is caused by medical treatment we may also be able to cover a resulting mental injury, even if the physical injury isn’t covered.

We also cover mental injuries if you've experienced, seen or heard a traumatic event at work such as working in a retail shop when a robbery takes place. This is even if you haven't been physically injured. 
Sexual abuse

We provide support for anyone in Aotearoa New Zealand, including visitors to the country, who has experienced sexual abuse and assault. We may also be able to help if you're an Aotearoa New Zealand resident and have experienced sexual abuse while travelling overseas. It doesn't matter if the event happened recently or a long time ago.

If you've experienced sexual abuse, use the Find Support website to see the organisations that have therapists who can support you. This support is fully funded and you can start whenever you're ready. There are also services available for your family.

If you're having trouble getting in touch with the right therapist, contact us. We'll help you to make an appointment. 
Dental injury

We can pay for dental injuries caused by: 
  • an accident
  • sporting injury
  • as a result of medical or dental treatment.
We don’t pay for: 
  • damage to your teeth or dentures due to normal wear and tear, eg chewing or biting
  • damage to your teeth due to decay or gum disease
  • damage to your dentures while you were not wearing them
  • treatment that was done by someone that’s not a registered dentist, eg a dental technician.
Your dentist will help you to make a claim if you have an injury we cover.

Injuries causing death

We give financial help if someone dies as a result of: 
  • an accident
  • a work-related disease or infection
  • a treatment injury we're covering
  • a self-inflicted injury (in some circumstances). 
Maternal birth injuries

If you have experienced an injury while giving birth on or after 1 October 2022, we may be able to help with your recovery. We have guidance on what's normal and what's not.

This is essentially "no-fault" automobile insurance and worker's compensation on steroids and has a lot to be said for it in some form. The tort system does a poor job of compensating people with smaller injuries, and people who have suffered from bad outcomes and accidents when fault is less clear cut. The tort system is also slow, uncertain, and involved immense transaction costs.

15 July 2024

Facts About Rare Diseases

The linked post discusses whether it is better to spend money on treating rare diseases or using genetic screening (pre-conception and post-conception, potentially linked with fertility treatments related screening) to address them. But a predicate to that debating that intelligently is understanding the underlying problem.
Rare diseases cost Americans around 8 trillion dollars a year. About half of that is direct medical costs. If families are lucky, they may go bankrupt paying for treatment of often questionable effectiveness. The unlucky families may go bankrupt just trying to find a cure; unfortunately less relevant as only about 5% of rare diseases have treatments. . . .

In the United States, a rare disease is defined as one that affects fewer than 200,000 Americans. Despite each disease affecting no more than .06% of the population, there are about 7,000 different rare diseases, meaning roughly 10% of the U.S. population has a rare disease.

These numbers may seem large, but it makes sense if you consider the complexity of human genetics and development. Humans have around 20,000 genes. Mutations in some genes are lethal. Mutations in some genes lead to normal human variation; you may not even know the person has a mutation. And mutations in others lead to rare diseases; not lethal at or before birth, but often quite deleterious. Around 80% of rare diseases are genetic and many of these diseases are discovered in children – the mutations are severe enough to be noticed early.

30% of children with rare diseases do not live past the age of 10. The devastation of rare diseases stems from their chronic, progressive nature and the fact that many involve multi-organ system failure or neurological impairments.
From here.

The average rare disease in the U.S. affects about 4,760 people.

Part of the economic issue is that curing a rare disease generally has a cost comparable to curing a non-rare disease, but benefits fewer people. Yet, a single medical grade genetic test can screen for all genetic diseases.

19 June 2024

Military Quick Hits

* The assumption that a large scale amphibious assault in a hostile entry, like the D-Day invasion, remains an important capability of the U.S. military, is unfounded. There hasn't been a significant amphibious assault anywhere in the world since the Korean War in the 1950s. What country would the U.S. invade that way? China? North Korea? Russia? Iran? It is hard to come up with plausible scenarios to motivate the need for this capability.

* Republicans in Congress are pro-disinformation. The U.S. Defense Department shamefully spread anti-vax disinformation about Chinese vaccines during the COVID epidemic.

* The U.S. Air Force isn't sure if it will move forward on building a "Next Generation Air Dominance" warplane, basically a successor to the F-22 and F-35. There is speculation that this may be driven by dissatisfaction with Boeing and Lockheed Martin, the only domestic defense contractors capable of building such a plan. Cost and viable alternatives are also factors:

Paying for this next-gen fighter, which is expected to cost about $300 million a pop, will be tough as the service expects to spend increasing amounts of money in the coming years on F-35s, the new B-21 Raider, and the next-gen Sentinel intercontinental ballistic missile. And in addition to budget constraints, new technology developments and drones have the service rethinking the future of air dominance.

NGAD may be the only place the Air Force can take a reduction, said Bryan Clark, a senior fellow at the Hudson Institute, given all the other programs the Air Force needs to pay for, and the desire to grow its new collaborative combat aircraft program.

The service also may be rethinking its overall concept of operations to rely on B-21, CCAs, and stand-off weapons [i.e. long range missiles] rather than a traditional aircraft, Clark said. But given emerging technologies, it’s still unclear what air dominance is exactly going to look like in the future.

The collaborative combat aircraft program, sometimes called the "loyal wingman" program, is a drone aircraft that supports a manned jet fighter. 

* In the short run it looks like naval warfare between China and the Philippines is more likely than war between China and Taiwan.

21 May 2024

Things That Aren't True

One of the most serious problems with the current political climate is that large numbers of people believe things that aren't true. And, the absurdity of some of those beliefs is extreme.

Consider this example:
The outcome of the 2022 race for Governor in Colorado did not hinge on Republican Heidi Ganahl’s bizarre obsession with the ridiculous idea that public schools in Colorado were infested with children dressed up as animals (which she referred to as “furries“). . . . The final six weeks of that campaign were dominated mostly by Ganahl’s bizarre insistence on bringing up the widely-debunked conspiracy theory that public schools were catering to children who wore elaborate cat costumes in class. This is the same nonsense conspiracy theory that other Republican politicians have used to claim that schools were providing “litter boxes” for students; a Nebraska State Senator publicly apologized for the suggestion in March 2022. . . . 

Long after the 2022 gubernatorial race had ended, Ganahl was still talking about furries as she pushed to start up a “Moms for Liberty” chapter in Colorado — an idea that brought “Furry-Lago” full circle. Ganahl launched herself down this insane rabbit hole in 2022 at least in part at the suggestion of a Jefferson County woman named Lindsey Datko, who runs a Facebook page for like-minded idiots called “Jeffco Kids First.” Datko’s involvement was detailed in a story by Rylee Dunn of Colorado Community Media (publisher of the Arvada Press) that explained how “Jeffco Kids First” tried very hard to prove the existence of the invisible furry menace:
Over the summer, the members of a Facebook group called Jeffco Kids First began shifting their concern away from pandemic policies in schools to identities it deemed disruptive to learning. A leading voice in the group told parents to empower their children to find “furries,” kids who dress up in animal accessories, and to record them.
“If any of your kids would be willing to record anonymous audio of their experiences with furries hissing, barking, clawing, chasing, and how it affects their school day, please send to me or let me know ASAP!” Jeffco Kids First creator Lindsay Datko, a parent in Jefferson County Public Schools, posted.

Details like these have not been widely publicized because the Facebook group is private, meaning only members can see what is posted. After being denied entry to the group, Colorado Community Media gained access through a member who wanted the group’s content to be public.

School officials say the group’s activities can be disruptive and harmful to kids. But it has some strong backers, including Heidi Ganahl, the Republican Party’s nominee in this fall’s Colorado gubernatorial race. She’s also a member of the group.

There are other common falsities out there, some of which influence politics or are otherwise harmful:

* The false belief that election fraud is widespread and frequently impacts election results in the U.S. for the benefit of liberals. It is in fact, vanishingly rare, usually unintentional, is at least as common in benefiting conservatives as liberals, and almost never influences election outcomes before being caught. When election administration issues influence close elections voter suppression by conservatives, and unintentional bureaucratic and technological errors, are the main causes of outcome changing impacts.

* The false belief that almost everyone in the U.S. has a valid photo ID (about 11% of adults do not).

* The false belief that Donald Trump won the 2020 Presidential election.

* The false belief that the United States was established as a Christian nation.

* The false belief that many or most leading Democratic politicians are involved in child sex trafficking. 

* The false belief that ritual Satanic abuse is, or was ever, common.

* The false belief that transgender identity doesn't exist.

* The false belief that male to female transgender individuals present a high or elevated risk of sexual abuse of women or girls, for example, when using a women's restroom.

* The false belief that homosexuality is merely an immoral choice.

* The false belief that immigrants (or undocumented immigrants) commit more non-immigration crimes than native born persons.

* The false belief that illegal immigration across the Mexican border is a source of people who commit acts of terrorism in the United States. 

* The false belief that immigrants are a net economic burden on taxpayers.

* The false belief that vaccines are more harmful than beneficial.

* The false belief that Young Earth Creationism is accurate.

* The false belief that everything in the Bible is literally true. 

* The false belief that evolution isn't real, or that it isn't a conclusively scientifically established scientific reality.

* The false belief that the Earth is flat.

* The false belief that literal demons are real. Of course, the "demons" in the metaphorical sense of past traumas, addictions, and anti-social impulses do exist.

* The false belief that demon possession is an important cause of physical or mental illnesses.

* The false belief that IQ and almost all other human behavioral traits have no significant genetic component and are predominantly and even overwhelmingly a product of nurture. In fact, IQ is heavily genetic and more than a third to more than a half of a great many human behavioral traits are attributable to one's genetic inheritance, while the parental nurture impact on a great many human behavioral traits is widely overestimated.

* The false belief that substance abuse lacks of strong genetic component. In fact, it is one of the most strongly genetic human behavioral traits. 

* The false belief that atheists believe in and follow a literal Satan.

* The false belief in the reality of transubstantiation.

* The false belief that meteorologists control the weather.

* The false belief that U.S. Presidents have a significant ability to influence the inflation rate.

* The false belief that U.S. Presidents have a significant ability to influence gasoline prices.

* The false belief that owning a gun reduces your risk of being a victim of a violent crime.

* The false belief that successful, legal, self-defense from crime with a gun (including by brandishing it) is common.

* The false belief that crime rates are high and rising in the year 2024.

* The false belief that personal injury and malpractice lawsuits are usually frivolous.

* The false belief that climate change isn't real.

* The false belief that climate change isn't caused by human caused pollution.

* The false belief that nuclear power is more of a threat to public health and safety than fossil fuels. There are reasons to be concerned about nuclear power (e.g., the risk that nuclear fuel will be diverted to nuclear weapons), but that is not one of them.

* The false belief that someone who has not committed any crimes more than seven years after finishing a sentence for a previous crime is at highly elevated risk of committing a crime in the future compared to a comparable person with no prior criminal record.  

* The false belief that rape can't cause a pregnancy. 

* The false belief that abortion is more dangerous for abortion patients than giving birth.

* The false belief that miscarriage is rare (something on the order of 1/4 to 1/3 of known pregnancies end in miscarriage, and this is an underestimate of the total miscarriage rate because it excludes miscarriages before someone knows that they are pregnant).

* The inaccurate belief that income taxes cause people to earn less (a concept associated with the Laffer Curve) at income tax rates much lower than the rates at which this is actually true. The peak of the Laffer Curve is actually at tax rates of about 70%.

* The false belief that high tax rates are strongly correlated with low economic growth.

* The false belief that prayer itself (as distinguished from community support and knowledge of community support) influences anything.

* The false belief that astrology is valid.

* The false belief that literal ghosts are real. Of course, "ghosts" in the metaphorical sense of recollections of people who have died are real.

* The false belief that the United States has very nearly the best health care outcomes.

* The false belief that driving is safer than commercial air travel. 

20 May 2024

Improving Government

Government has a mix of problems. Sometimes it regulates too much, sometimes too little, sometimes it owns too much, sometimes too little, sometimes it is just operated in the wrong way. This post is a grab bag of ideas about improving it.

* Sidewalks should be publicly owned and maintained. Individual responsibility of property owners for this doesn't work because low rates of non-maintenance (including lack of prompt snow removal) makes the network of sidewalks much less valuable.

* Bicycles should usually not share roads with cars and trucks. They should use sidewalks or dedicated, protected bike paths and lanes.

* Amtrak has failed and should be shut down outside the Northeast Corridor.

* The U.S. Postal System worked well for a long time, but in the era of widespread parcel delivery services and e-mails and texts, it no longer does. Strong Veteran's preferences and higher pay than private sector equivalents don't justify it. Free mail for incumbents in Congress don't justify it. Delivering junk mail is not a good enough reason for a massive public enterprise. Fewer and fewer letters of significance are delivered that way. Money orders are no longer economically important and can be provided by private commercial banks and money services. Subsidizing rural living isn't a good reason for it.

* Occupational licensing is required when it shouldn't be. When it is required, requirements like a lack of a criminal record are often inappropriate for people who have been non-recidivist for a long enough time (about five to seven years) when the risk of future crime fades to the background level. Worse yet is construction trade licensing at the local level when it should be at the state level, fostering a high level of non-compliance. Independent legal para-professions should be allowed much more liberally, although licensing that might be appropriate. There should be a common database of licensing discipline since many disqualifying acts for one profession should also apply to others.

* Zoning and land use regulation should be dramatically paired back and places like Colorado finally realize that this is true and driving high housing prices. Deregulating is better than mandating affordable housing or rent control. Development fees to mitigate externalities of government costs caused by development, however, make sense. 

* Involuntary landmark designation is almost always a bad idea and an unfunded mandate. If it is important enough historically to preserve the government should buy it and rent it.

* Building codes are critical and non-compliance with permit requirements is far too high. But building codes are also too restrictive and the processing of building permits is much too slow. A system of private building code compliance auditors similar to the CPA system might be better.

* We should do a better job of discouraging people from building disaster prone housing in flood zones, fire zones and other "stupid zones".

* We should do a better job of encouraging off site manufacturing of buildings and large building modules.

* Property taxes are a decent way to finance local government (and shouldn't exempt non-profits and governments other than the one imposing them) but are a bad way to finance public K-12 education which is the main way that they are used now.

* Electing coroners, treasurers, clerks, surveyors, secretaries of state, engineers, and judges (even in routine judicial retention elections) is a horrible idea.

* Electing sheriffs and district attorneys and attorneys-general isn't as horrible an idea, but is still a worse idea than having elected officials appoint them, directly or indirectly.

* State and local school and college boards would be better not elected by the general public. Local school boards should be elected by student's parents. College boards could be elected by alumni or appointed by the elected official who make their funding decisions. State school boards should be appointed by the state officials who fund state K-12 education.

* Shorter ballots are better. In the England, there is one nation election in which you vote for a single legislator on a partisan ballot in a single district, irregularly, but not less than every five years absent a world war, for a government that does everything that the state and federal governments do in the U.S., with no primary elections since parties nominate their own candidates internally, and there is one set of partisan local council elections for one or two posts, and there are few referenda a lifetime, and they are democratic enough, despite having a monarchy and a house of lords. Very modest public electoral input is enough.

* I don't favor a system quite as simple as England's. But we should still have much shorter ballots.

* Rare recall elections make sense for officials who serve longer terms and perhaps for judges and other public officials who are now elected but shouldn't be.

* State constitutions and local charters should have less detail and so that changes to them should be things that require voter approval and not housekeeping measures.

* Some referenda on tax and debt issues is appropriate, but Colorado, with TABOR overdoes it. New taxes, and not new revenues from existing taxes, should get public votes. Maybe bond issues that commit a government to substantial tax obligations from general revenues but not renewals of them.

* Citizen initiatives have their place in overcoming systemic flaws in the legislative system and making elections interesting to voters. But it should be a bit harder and more structured and generally should avoid spending and taxing decisions that need to be made globally.

* Colorado mostly does the probate process right, although probate procedure could use more structure. Most states make the process too intrusive.

* When there is a single post in a candidate election, dispensing with primaries, having a majority to win requirement, and having runoff elections would be preferable to first past the post elections and to instant runoff elections.

* There would be merit to electing state legislatures and state congressional delegations by proportional representation.

* There would be merit to making state legislatures unicameral.

* The electoral college should be abolished in favor of a direct popular vote.

* The franchise should be expanded. The voting age should be reduced to sixteen. Non-citizens should be allowed to vote. Felons, even felons in prison, should be allowed to vote (in their pre-incarceration place of incarceration).

* HOAs are horrible but sometimes necessary institutions. They should be abolished or replaced where possible, and be restructured with fewer powers and less discretion where not possible. HOA covenants are routinely unreasonably restrictive.

* Municipal ordinances related to zoning and land use should have fines or other civil penalties, not criminal penalties.

* Arbitration on the U.S. model is usually a bad idea and should be banned in many circumstances.

* We should have a more pro-active way of intervening in cases where people are mentally ill or cognitively impaired, and the system for adjudicating these cases is too cumbersome.

* Single judges should not handle parenting time and parental responsibilities cases, and the best interests of the child standard should have more detailed substances to guide it. Alimony should also be less discretionary.

* There should be a right to counsel in all cases involving "persons" such as child custody cases, protective proceedings, and immigration cases.

* Forum shopping in the federal courts needs to be better restrained, and allowing a single forum shopped judge to issue national injunctions is problematic.

* After some rocky starts, regulation and technical private management of junk faxes, junk telephone calls, and even junk email has made some real progress. Social media junk is less well regulated.

* Privacy regulation often does more harm than good. Juvenile justice privacy does more harm than good in most cases, educational privacy goes too far, and Europe's GDPR goes too far. Secrecy around ownership of closely held companies is too great and the exception under the Corporate Transparency Act is far too complicated. There are places for privacy regulation but it needs to be cut way back. Secrets are often harmful in hard to quantify ways.

* Cryptocurrency serves few, if any, legitimate purposes, is an environmental disaster, and should be discouraged.

* Programs to help the poor need to have much less paperwork and red tape; means testing is rarely a good choice unless it is integrated into the tax system.

* Some tax credits for poor and middle income people, like the Earned Income Tax Credit and the Obamacare insurance premium subsidies, are far too complicated.

* State and local government funded free wi-fi for all would make lots of sense.

* There is a logic to allowing vouchers for religious private K-12 schools, but on balance it does too much to support religious institutions at public expense. Charter schools, i.e. public schools with autonomy from school boards, are a better approach. School choice of some kind does make sense among public ordinary and charter schools, ideally, statewide, rather than only within a school district.

* Boarding schools attached to high schools in more urban areas would be a better alternative to highly subsidized tiny rural high schools.

* We do a horrible job of managing the business of health care. The requirement that doctors be the sole owners of medical practices also forces them into being small business owners when they are ill suited to that part of their jobs and leads to bad systems and poor health care administration and bad financing arrangements. Almost every other country, in many varied models, does a better job. The current system results in overpaid health care providers (doctors, nurses, drug companies, medical equipment companies, private hospital system owners, etc.), for inferior results. Our drug prices and medical equipment prices and ambulance prices and ER prices are all vastly higher than in other countries and this isn't mostly driven by private pay medical education or medical malpractice lawsuits.

* We need to create more medical school slots. We have too few doctors and are compensating for that with too many senior paraprofessionals like nurse practitioners, physician's assistants, and midwives. We should also allow more non-M.D.'s to provide the care that psychiatrists do since the knowledge base for psychiatrists doesn't overlap heavily with that of M.D.'s and where it does overlap can be taught separately.

* The substance of pass-through taxation in taxing closely held business income once at roughly individual tax rates while allowing limited liability, is good, but the actual pass-through tax mechanism is not. Subchapter K of the Internal Revenue Code is not a good approach for taxing closely held limited liability entities, it complexity, it phantom income, and more don't work well. A double taxation reducing or limiting variation on the C-corporation model would be much better.

* We do a poor job of taxing hot assets in international taxation.

* We lack adequate guidance for remote worker labor and tax regulation, and haven't updated our laws adequately to reflect the era of independent contractors.

* We over regulate many prescription drugs and under regulate supplements and herbal remedies and the like. Homeopathic remedies and other supplements need to be regulated more like drugs. Prescription drug approval when approved elsewhere should be easier. Prescription approval for experimental drugs for the terminally ill, or in a pandemic, should be easier. More non-abuse prone prescription drugs should be available over the counter or with pharmacist approval.

* Prostitution should be decriminalized or legalized to a greater extent.

* We vastly under-regulate firearms and explosives and military equipment.

* We do a poor job of commercial air travel security, imposing too much of a burden and delay for too little benefit in a security theater way, at an excessive cost and a greatly excessive externality cost. We also do a crap job of managing luggage charges and checked luggage, and we are more inefficient than we need to be in how quickly commercial aircraft are loaded and unloaded.

* Uber, etc. revealed that we over-regulate taxis, but that we do need some regulation to assure riders are safe from dangerous or dangerous to them drivers.

* Buses and intracity rail won't thrive until we make them feel safer and comfortable.

* Public energy utilities do mostly a good job, except in Texas which opted out of the national energy grid.

* Clean water and good sewage treatment should be expanded urgently to places like Indian Reservations and Flint, Michigan.

* To better disentangle church and state, the charitable income tax deduction (but not the gift and estate tax deduction) for contributions to religious organizations (but not the tax exemption for churches) should end, the parsonage exemption should end, the property tax and sale tax exemptions for churches should end, the investment income of churches should be taxed as a corporation, and the ban on politics by churches should end.

* There should be more power to compel road maintenance below some standard.

* There should be a power to compel HOAs to do their jobs for all members, similar to landlord-tenant maintenance claims.

13 March 2024

The State Of The Union Is Strong

By a variety of measures, the U.S. is in a time of record or near record peace, prosperity, and well-being, although blue states (i.e. those that lean towards the Democratic party) are generally better off than red states (i.e. those that lean towards the Republican party). 

This should provide a political boost to President Biden in his rematch seeking re-election against former President Donald Trump. Biden should also be helped relative to the 2020 Presidential election by his incumbency, by the fact that the electorate is less white and less Christian, by the fact that many of the oldest voters in 2020 have been replaced by younger voters, and by the fact that younger voters and Democrats have been turning out more reliably in 2020 and 2022 than in prior elections with overall voter turnout reaching record highs, and with a rolling back of felon disenfranchisement laws in many states. And, of course, Donald Trump is facing four sets of felony criminal prosecutions on more than 90 charges, and has had other legal problems such as two civil judgments against him for a combined amount of more than half a billion dollars for fraud, rape, and defamation. Fox News is wounded, after paying an immense defamation settlement to a voting machine company and facing other similar massive pending lawsuits, and almost all non-Fox News outlets have made Trump's short fallings clear. Trump's three U.S. Supreme Court appointments as part of a six to three conservative majority overruled Roe v. Wade in  a highly unpopular decision and has been plagued by evidence of corruption leading to recover lows in its credibility, which has mobilized pro-choice voters and removed the urgency on the part of conservatives to vote for Trump to secure a conservative U.S. Supreme Court majority. 

But the polls, nationally and in swing states, show that the Biden-Trump Presidential race in 2024 (there is essentially no possibility that either major political party will pick a different nominee) is a toss up, and the polls understated Trump support in both the 2016 and 2020 Presidential elections. 

Violent crime rates in the U.S. are at their lowest level since 1970, down about 51% since 1991. The murder rate in big cities that bounced up in the pandemic (2020-2021) has fallen again (down 5% in 2022 and down another 12% so far this year compared to the same time period in 2022) to return to almost pre-pandemic levels which are comparable to murder rates in the early 1960s and are down about 50% from the peak levels in the early 1980s. Property crime rates are down 62% since 1991 and declined steadily until a slight bump upwards in 2022. Crime rates are generally higher in red states and lower in blue states.

The teen pregnancy rate is lower than it has been at any time in all of history and prehistory in North America. The teen pregnancy rate is down 75% since 1991. It is down 79% in that time period for black teens, 77% for Hispanic teens, and 76% for white teens. Teen pregnancy rates are lower in blue states and higher in red states.

After reaching a 50-year record low for two consecutive years (2020 and 2021 at 14.0 divorces per 1,000 married women), the divorce rate rose slightly in 2022 to 14.56 divorces per 1,000 married women. But, divorce rates are still lower now than at any time from 1970 to 2019. There is a class divide in marriage, however. For Americans in the top third income bracket (mostly college educated), 64% are in an intact marriage, meaning they have only married once and are still in their first marriage, comparable to 1960s and earlier levels. In contrast, only 24% of Americans in the lower-third income bracket (mostly people with no college) are in an intact marriage. Divorce rates are lower in blue states than in red states. 

U.S. unemployment is at its lowest level in 54 years. The economy added 2.7 million jobs in 2023. The U.S. has had positive job growth for 38 consecutive months, putting the current streak in 5th place of the longest job streaks in US history (since 1939). Inflation-adjusted disposable personal income rose 4.2 percent in 2023.

The U.S. poverty rate in 2023 was 11.5%. It has been lower than that in only three of the last 60+ years: 2019 (10.5%), 2000 (11.3%), and 1974 (11.1%), and in none of those years was it dramatically lower. By comparison, the U.S. poverty rate was 15.1% in 1993 and 2010, was 15.2% in 1983, and was 19.0% in 1964 (and was 15.1% or more in 1965 and 1966). Poverty rates are higher in red states and lower in blue states.

The percentage of Americans who don't have health insurance is at record lows (mostly due to Obamacare). A greater percentage of people don't have health insurance in red states than in blue states.

GDP growth in the U.S. has been solid during Biden's administration after experiencing an unprecedented plunge four years ago in the final year of Trump's Presidency due to the COVID pandemic. The stock market (which is a leading economic indicator of the economy's future direction) is at an all time high, despite upward trends in interest rates. The dollar is at 20 years plus highs in strength relative to other major world currencies. Per capita GPD and household net worth is much higher in blue states and blue regions of states than in red states and red regions of states.

Most economic activity has returned to pre-COVID levels. Inflation has come back to normal after a COVID/Ukraine War driven spike. Gasoline prices are close to their long term average in inflation adjusted dollars.

The percentage of Americans age 25 or older who have have high school diplomas (91.1%) was an all time high in 2022, and the percentage who had college degrees (37.7%) in 2022 was just slightly below the all time high of 37.9% in 2021. In 1960, only 41.1% of Americans age 25 or more had high school diplomas and only 7.7% of Americans age 25 or more had college degrees. Educational attainment is higher in blue states and lower in red states.

The number of Americans in active duty military service relative to the population is as low as it has been at any time in the last 83 years. The draft ended in the U.S. 51 years ago. U.S. military spending as a percentage of GDP is 3.48%, slightly above its post-1960 lows from 1997 to 2002 when it reached its modern low of 3.09% in 1999. In 1967 it was 9.42% of GDP. People in red states are more likely to serve in the military than people in blue states.

COVID deaths and hospitalizations are way, way down. COVID death rates were generally higher in red states (mostly due to lower vaccination rates) and lower in blue states.

U.S. deaths from AIDS are at a record or near record low, down more than 90% from the peak number of deaths per 100,000 people in 1995. One of the four major strains of influenza has gone extinct sometime in the last four years.

The average share of electricity generated from coal in the US has dropped from 52.8% in 1997 to 19.7% in 2022 and is still falling. The United States got nearly 17% of its electricity from solar, wind and geothermal power in 2022 and is still rising. That's up from just over 5% in 2013. Fourteen states produced the equivalent of more than 30% of the electricity they used from solar, wind and geothermal in 2022. That is up from just two states in 2013.

The U.S. produced 2.5% more energy in 2022 than it consumed. 2022 marked the highest level of US energy independence since before 1950. By comparison, in 2005 the U.S. consumed 44% more energy than it produced.

The percentage of Americans who identify as non-religious, 30%, is at an all time high and the percentage of Americans who identify as Christian is lower than it has been at any time since European colonization of North America. Among Americans aged 18-29 who are indicative of the future trend, 43% are not religious, 52% are Christian, and 4% adhere to some other religion. Red states are more Christian and less secular, while blue states are less Christian and more secular.

In 2022, immigrants made up 13.9% of the U.S. population, the highest percentage in more than a century. It was last this high sometime between 1910 (when it was 14.7%) and 1920 (when it was 13.2%). This is higher than in the 1900 census (13.6%), the 1880 census (13.3%), the 1860 census (13.2%), and the 1850 census (9.7%), but lower than in the 1890 census (14.8%) and the 1870 census (14.4%). The year 1970 census had the smallest foreign born population in the period from 1850 to the present at 4.7%, about a third of the current foreign born population percentage. Blue states have higher percentages of immigrants than red states.

The percentage of people living in urban areas (80.0%) v. rural areas (20.0%) in the 2020 census was essentially the same as in the 2010 census which set an all time high of 80.7% urban, with most or all of the difference from 2010 to 2020 being due to a stricter definition of what counted as urban in 2020. The percentage of the population that is urban is projected to grow steadily over the next thirty years as it has for almost all of U.S. history, and over the last 20 years, there has been much more population growth in urban areas than in rural areas. Blue states are generally more urban than red states. 

25 January 2024

A One Time Anti-Aging Drug Works Wonders In Mice

A single shot of a treatment already approved in humans as a cancer treatment can dramatically extend the lives of mice, dramatically reducing age associated ailments, without significant side effects.

Scientists have found a way to reprogram T cells to fight aging. After using them to eliminate specific cells in mice, the scientists discovered they lived healthier lives and didn't develop aging-associated conditions like obesity and diabetes. Just one dose provided young mice with lifelong benefits and rejuvenated older mice. . . .

They discovered CAR T cells could be manipulated to eliminate senescent cells in mice. As a result, the mice ended up living healthier lives. They had lower body weight, improved metabolism and glucose tolerance, and increased physical activity.

All benefits came without any tissue damage or toxicity.

"If we give it to aged mice, they rejuvenate. If we give it to young mice, they age slower. No other therapy right now can do this, " says Amor Vegas.

Perhaps the greatest power of CAR T cells is their longevity.

The team found that just one dose at a young age can have lifelong effectsThat single treatment can protect against conditions that commonly occur later in life, like obesity and diabetes.
. . .

CAR T cells have been used to treat a variety of blood cancers, receiving FDA approval for this purpose in 2017.

From Science Daily, citing:

Corina Amor, et al., "Prophylactic and long-lasting efficacy of senolytic CAR T cells against age-related metabolic dysfunction." Nature Aging (2024) DOI: 10.1038/s43587-023-00560-5.

05 December 2023

How Many Deaths Did COVID Cause In U.S. Prisons?

Prison inmates of all ages had significantly increased COVID-19 death rates relative to the general population.
U.S. prisons were especially susceptible to COVID-19 infection and death; however, data limitations have precluded a national accounting of prison mortality (including but not limited to COVID-19 mortality) during the pandemic. Our analysis of mortality data collected from public records requests (supplemented with publicly available data) from 48 Departments of Corrections provides the most comprehensive understanding to date of in-custody mortality during 2020. 
We find that total mortality increased by 77% in 2020 relative to 2019, corresponding to 3.4 times the mortality increase in the general population, and that mortality in prisons increased across all age groups (49 and under, 50 to 64, and 65 and older). COVID-19 was the primary driver for increases in mortality due to natural causes; some states also experienced substantial increases due to unnatural causes
These findings provide critical information about the pandemic’s toll on some of the country’s most vulnerable individuals while underscoring the need for data transparency and standardized reporting in carceral settings.
Naomi F. Sugie, et al., "Excess mortality in U.S. prisons during the COVID-19 pandemic", 9(48) Science Advances (December 1, 2023) (open access).

From the results section:
Across 49 DOCs (including 47 states, the Federal BOP, and Washington, D.C.), the number of people who died in U.S. prisons was substantially higher in 2020 (6088 deaths) than in 2019 (4206 deaths). This comparison of total deaths does not account for changing custody populations, which decreased during the 2020 pandemic; therefore, rates of in-custody deaths were even higher in 2020. For DOCs with information about manner of death in 2020 (N = 41 DOCs, N = 5134 deaths), 4118 deaths (80%) were due to natural causes, 534 deaths (10%) were due to unnatural causes, and 482 deaths (9%) were due to unknown causes. For DOCs with information about COVID-19–related deaths (N = 19 states, N = 1714 total deaths), 496 deaths (29%) were related to COVID-19.

14 November 2023

Cigarette Sales Down Dramatically Over Last 41 Years

The U.S. has done lots of things poorly from a public health perspective, but is a world leader when it comes to reducing rates of tobacco use. 

Also, note that the chart below isn't adjusted for a rising population, which grew 45% in the time period shown. Per capita, cigarette sales are down 81.2% in this 41 year time period.

The average American smokes about 520 cigarettes per year, although, of course, really, a modest percentage smoke far more cigarettes per year, and most people smoke none. According to the Center for Disease Control:
In 2021, an estimated 11.5% (28.3 million) of U.S. adults currently smoked cigarettes.

The average adult cigarette smoker in the U.S. smokes about 6,131 cigarettes a year (about 17 cigarettes a day, a little less than a full pack of 20 cigarettes each day). So, the typical American cigarette smoker is a pack a day smoker. In Colorado, a pack of cigarettes costs $7.99 on average. 


The World Health Organization estimates, considering all kinds of tobacco use, are much higher for the U.S. than CDC figures for adult cigarette smokers (possibly due to a less restrictive definition of who counts as a smoker), but are probably still useful for international comparisons. By that ranking, the U.S. has the 54th highest smoking rate out of 148 countries. Many countries with the lowest smoking rates have low smoking rates because they are too poor to afford tobacco.

At any rate, this doesn't discount the big improvements that the U.S. made made over the last four decades, in an approach that has treated tobacco smoking as a public health problem, rather than as a criminal justice matter.

Some improvements among men who smoke (and men are still more likely to smoke than women in the U.S. by any measure) have been offset in this time period by increased numbers of women smoking (or at least, by a slower rate of improvement among women).

05 October 2023

Who Dies Young?

Americans with different levels of education die at different rates, and the least-educated Americans have seen their death rates surge in a way that more-educated Americans have not.

But the relevant divide does not seem to be between people who earned a bachelor’s degree — who remain a minority among American adults — and people who didn’t. Other research suggests that the problem is concentrated in specific areas of the US, and between the very least-educated Americans (particularly high school dropouts) and the rest of the country, rather than between college grads and non-grads.

Moreover, the cause of the divergence between high school dropouts and the rest of the country does not seem to be caused by “deaths of despair.” There is no doubt that the opioid epidemic in particular has wrought spectacular damage in the US. But some researchers are finding that stagnating progress against cardiovascular disease is an even bigger contributor to US life expectancy stalling out, and to mortality divides between the most- and least-educated Americans.

Cardiovascular disease differences in this case would be mostly due to smoking, alcohol use, stress, and a low quality diet. 

Exercise could also contribute to the difference, but I am skeptical that it actually does. The jobs of less educated people are, on average, less sedentary and provide at least as much exercise as more educated people secure.  There is also no good reason to think that the non-work time of less educated people is more sedentary than the non-work time of more educated people.

21 September 2023

The Delusional Party

A P.R.R.I. poll in 2021 found that 23 percent of Republicans agree that “The government, media and financial worlds in the U.S. are controlled by a group of Satan-worshipping pedophiles who run a global child sex-trafficking operation.” Even now, some two-thirds of Republicans believe that President Biden was not legitimately elected. Only 40 percent of Republicans say that the benefits of Covid vaccines outweigh the risks (which is why research suggests that Covid may have disproportionately killed Republicans).

07 September 2023

There Is Lots Of Room For Progress In Medicine

The state of the art technology in 2023 is closer to long term theoretical limitations in some areas than others. Some technologies, like aircraft and nuclear power, have only modest room for improvement beyond their theoretical limits.

But, there is particularly great room for improvements with profound societal implications during my lifetime and the lifetime of my children in the area of medical science and technology.

Consider, in particular, the quest for a cure for cancer. We have a decent biochemical understanding of cancer. We have some treatments for cancer in our arsenal that work for some kinds of cancer in some circumstances. It is an area for which there is lots of funding for research.

We know that curing or dramatically reducing the lethality of cancer is possible in principle because we've identified animals, and even some select human subpopulations that have dramatically lower cancer rates than those of the average humans.

We know that certain kinds of cancer are caused by viruses and have a good idea about how to develop vaccines against those viruses, one of which, vaccines for the main viruses that cause cervical cancer, is already in wide use.

We are also making good progress on drugs to treat cancer once you develop it. Some of these drugs can be targeted on an individualized basis to the cancer in a particular person. Some of these drugs have far fewer side effects than earlier chemotherapies because they have effects that better distinguish between cancer cells and normal cells. Some of these drugs have broader application to multiple kinds of cancer.

And, we are making progress in more accurately diagnosing cancer's onset early when it is easier to treat and has done less harm.

It isn't unreasonable to think that in twenty to forty years that advances in cancer diagnosis and treatment could reduce cancer death rates by 80%-90%, on top of incremental but steady reductions in cancer death rates that have already been made by possible through medical research and its wide dissemination.

Now, cancer is one of the two leading causes of all deaths, and makes up an even larger share of deaths of "natural causes" in old age (the other one is cardiovascular diseases like heart attacks and strokes). But advances in cancer diagnosis and treatment could lead cancer to join the ranks of leprosy, the bubonic plague, and HIV as a disease that is still devastating if not treated, but whose lethality can be dramatically reduced as a matter of course with effective treatments.

Dramatically reducing the lethality of cancer would profoundly extend the life expectancy of people around the world and would in short order have a transformative effect on society.

Now, the benefits of dramatically reducing the lethality of cancer also shouldn't be overstated. Old age involves a wide array of declines in body functionality. It just so happens that cancer and breakdowns of the cardiovascular system are most often the first to manifest in a way that can be deadly. But if cancer becomes much less deadly, people who otherwise would have died of cancer will often instead often die of some other geriatric condition, not all that many years later in many cases. 

They will die of geriatric falls. They will die because they drive to drive despite declining vision and reaction times. They will die from breakdowns of their cardiovascular systems, or kidney failure, or liver failure, or complications of old age associated dementia. They will die from medical mistakes. They will die from the flu or COVID.

Old age makes your body break down and this can make death by some means or another associated with these break downs almost inevitable. And, the vast majority of animals have a lifespan that is quiet similar measured in units of heartbeats per lifetime, so it is medically more challenging to come up with treatments that stop, slow down, or reverse the global cellular aging process itself.

But there are a handful of animal models of animals that appear to surpass the barrier of the biochemical cellular aging progress itself. 

We don't understand the process and the mechanisms for modifying cellular aging quite as well as we understand cancer, but we do have a fairly good big picture understanding of how the aging process works, and we have had a few small successes in trying to modify it (at least in animal models). There is no fundamental theoretical scientific reason that we shouldn't be able to stop, slow, or reverse the aging process. Ultimately, learning how to do this is just one more biochemical engineering problem that is solvable in principle, even though it is difficult and complicated.

Slowing down the aging process is a holy grail of medical research because it has such potentially broad applicability. If you can develop a treatment that causes someone to have a body that biochemically looks like it is 50 years old at age 75, a one-third reduction in the rate at which the aging process proceeds without actually even stopping or reversing the process, the number of people who could live long past age 100 would soar.

Slowing down the aging process would dramatically reduce the death rates from basically all geriatric causes of death simultaneously at any given age, and would also increase the health of older people receiving the treatments at every age thus improving their quality of life.

Taken together a dramatic reduction in the lethality of cancer, followed perhaps two or three decades later by treatments that significantly slow down the aging process, would profoundly change human society forever going forward.

And, along the way, there are other major killers which are likewise basically just bioengineering problems to solve, for which there is no good reason to think that they can't be overcome with enough time, money, and brainpower devoted to the maladies.

We now know that M.S. is predominantly caused by a virus and can probably develop a vaccine to immunize people against that virus in a decade or so. We are making good progress in developing vaccines and treatments that greatly reduce the toll of malaria. We are making good progress in being able to cure HIV. There is promising research on a "vaccine" that would dramatically reduce the vulnerability of people treated with it to tooth decay and gum disease in the next decade or two. Wide spectrum, long lasting vaccines for many variations of the flu and of the common cold look viable in the next decade or two. There is no good reason that an effective vaccine for syphilis couldn't be developed.

Gene therapy may soon be able to cure a wide array of single mutation Mendelian genetic disorders and conditions. We are finding more and more ways to replace organs and other body parts that have failed, either with transplants, or custom grown replacements, or with mechanical substitutes whose quality is greatly increasing.

We aren't anywhere close to reaching immortality and curing all diseases and maladies. But a huge swath of medical conditions seem likely to go the way of measles, mumps, rubella, polio, small pox, cholera, leprosy, the bubonic plague, tuberculosis, gangrene, bacteria infections, scurvy, rickets, lead poisoning, mercury poisoning, maternal mortality, infant death, and folate deficiency, all of which had an immense public health impact a century or two ago, and are now important primarily for their historic impact.