37 Comments

Smell being in your top five favorite ways to perceive the world made me laugh out loud! I love when people sneak in little bits like this.

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Thanks for noticing!

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Me too!

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"experts aren’t supposed to make policy; they’re supposed to advise political leaders on policy, so political leaders can combine expertise with value judgments to make decisions in the interest of the public."

I think there's an even bigger problem here: people don't know what they're experts in. I touched on this in my bullshit jobs article, but one company I was at had a very high ranking executive get fired and everything ran more smoothly after his firing. A lot of workers can attest to something similar. I think this stems from the following fact: a Chief X Officer or Vice President of X may not know much about X. What they really know is how to get promoted in a corporation. That's their actual expertise.

I think the same might be true of epidemiologists and other academics. You might think someone with a PhD in epidemiology is good at epidemiology, but their actual expertise might be getting citations and popularity within academia. I think Tyler Cowen, an economist who doesn't even pretend to know about epidemiology, offered a lot more insight into the pandemic (and more accurate predictions) than the alleged experts. Funny enough, Cowen is an economist, and I disagree with him on a lot of economics. I think his expertise is probably his general ability to analyze ideas rather than economics.

I also think the lack of actual knowledge among medical academics is especially obvious in at least one other hot-button political issue, but that's a topic for another day.

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This is an excellent point. Another example is Tufekci, who is a sociologist but who is also really smart about the pandemic. She noticed a lot of issues that other, more expert observers, missed, like the importance of ventilation and the way that self-testing could have allowed us to open up much sooner.

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Why in the world would this essay be "controversial"? It's only common sense. Oh, wait, that is exactly what is missing in our current insane, hysterical world.

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Yeah, I should have specified that it would be controversial for some readers but common sense for others.

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My husband was an MP in a war in a combat zone. In the motor pool hung a sign near where they got their jeeps for patrol. Above the checkout line was a sign, "You about to enter the most dangerous part of your assignment--driving on the highway."

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Excellent example! I always find it fascinating that so many people are afraid of flying, and so few are afraid of driving.

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100% agree with your thoughts, and you expressed them clearly. I have been back at work in person since August 2020, I am still blown away by people who say they will never go back to the office. We are seeing at my institution of higher education, students that have lost the ability to think for themselves, the pandemic has robbed people of their common sense in my humble opinion. Pre pandemic people had major illnesses that made them live their lives differently to the majority of the population. A friend has cancer and went through multiple rounds of chemo and radiation therapy and two bone marrow transplants all pre 2020. She wore a mask while shopping at Costco, we all knew not to hug or shake hands or get too close, we stayed away if we had a cold. She still takes extreme caution and she and many others should, but the rest of us don’t have to anymore!

On the recipe…yum! And I watched an episode of the Chef show that featured a professional baker, she said the biggest mistake amateur bakers make is not beating the sugar, butter and eggs long enough, she recommended turning your mixer on and setting a timer for 10 minutes and walking away…now I can’t do that as I use a hand held beater, but she is right, my cake (and I assume cookies also) was so much lighter in texture..I loved it! Also on the recipe, have you seen the Friends episode with Phoebe’s grandmothers secret recipe for chocolate chip cookies? If not, I suggest you do!

Finally, yes! I have never taken my shoes off when getting on a plane to return to the US from the UK…always amused me to watch Americans automatically remove their shoes expecting to be required to! We did however adopt the liquid size/ baggie requirements which causes longer lines at screening because people forget the rule!

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Great comment! I hope we will be able to return to the days when we were able to recommend different interventions based on people's actual risk, although I am not optimistic, given the way that health authorities are making it sound like monkeypox is a threat to everyone, and not just to men who have sex with men, who account for some 99 percent of the cases.

I will have to tell my mom and daughter about your 10 minutes recommendation! Wow!

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My dad uses the tollhouse recipe but actually melts the butter and sugar together on the stovetop!

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Total dad move! Some might say it's heresy, but your dad just says, "Nah, it's easier this way and it'll be fine." And I bet it works!

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Great post. Your point about our tendency, as humans, to have greater fear for risks with smaller odds is so important.

I remember when we were still in the "frantic information-gathering" phase of the pandemic. One of the most paralyzing parts of the fear was never knowing what my risk *actually* was, who I was saving or dooming by doing or not doing certain things. I felt guilty that so many lifestyle changes I made, both going into and coming out of lockdown, were prompted more by pure emotion than by any working knowledge of their efficacy. We're not logic-driven creatures!

But calm, friendly, rational posts like this one really help. It makes thinking things through feel less lonely in a lonely couple of years. Thanks for sharing it.

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Thanks for this wonderful comment! I, too, had my freak out moments at the start of the pandemic--I remember coming back from my first foray to the grocery store in mid-March and racing to wash my hands. It took awhile to figure out how much risk I was actually facing.

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Steve Patterson makes some great points about ‘experts ‘ and how zoomed in they are. I would check him out if you haven’t already ‘Patterson in Pursuit’ podcast. The risk benefit assessment is something that was obvious to practice from the beginning. Bigger forces were at play though that wanted a certain message to prevail and anyone that attempted to do risk benefit was smeared affectively. It became partisan when it really didn’t need to.

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Thanks for the recommendation!

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Excellent. Great insights to help me with a conundrum I’m facing. Thank you.

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Oh wow! Good luck with your conundrum--I’m happy that this article was helpful!

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Great essay, Mari! One of the most important points you made was to consider incentives in media reporting. Their business model is basically to keep us afraid, which is maddening for those of just looking for answers, and terrible for our society.

I loved the film, too! The begining felt like a less glamorous "Casablanca", with a bunch of disparate characters all gathered around a bar. I don't think I've ever seen such a beautiful woman scrubbing a floor like that, lol (a certain level of beauty typically absolves someone from consideration for such menial work). Then the second half of the movie is an incredibly intense adventure and examination of the choices we make as well as the way people handle stressful situations. Loved it.

Also, I love to read Zenyep. One of the most trusrtworthy voices throughout this mess.

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Yes, that barmaid reminds me of the barmaid at the end of another great movie, Paths of Glory--improbably beautiful, but lending a moment of grace in an otherwise grim world.

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First, WAGES OF FEAR is an absolutely fabulous movie. I remember that Arthur and I saw it at International House at the U. of C. We sat on these wooden desk chairs that were really uncomfortable and that discomfort added to the over all effect of the movie since so much of it shows men driving trucks over impossible roads. The seats helped us imagine just how tense they felt. Great, great movie--even in comfortable seats.

As to your other points, I agree 100%. As you know, the newsletter before my last one made similar points about how the "experts" have not always informed us in helpful or even accurate ways, about Covid. I would say there has been too much overlap between public health and mainstream media impulses to gin up readers by stressing them out. I look forward to reading next week about how Sweden managed Covid.

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Ah, International House films! I remember them well! Matt and I saw the film in the comfort of our own living room, and it was still almost unendurable.

Thanks for speaking up in everything you write for the importance of accurate and timely medical communication!

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>>> If the Internet Says Something Crazy, Ask a Person Who Knows Something

Will be taking this, Mari ... :)

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Our family's first rule is Ask the Internet; the corollary is unfortunately also necessary!

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Does our largesse extend to smokers as well? Inspired by your cookie dough salmonella, I was thinking about risks of lung disease in smokers. While I'm sure many of them don't want to die young, many would prefer to enjoy smoking for much of their lives in exchange for fewer years. I was impressed by the analyses that, on the whole, smoking doesn't cost society in healthcare, but ultimately saves healthcare dollars because dying younger is ultimately less expensive.

My dad, a lifetime smoker and now 84, is having some health problems. His doctor told him without blinking "quit smoking" but clearly gave no thought to the psychological stress and harm that will cause him. I could not in good conscience support that recommendation.

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I think a lot of it depends on the person's age. We have an enormous societal interest in preventing people from starting to smoke in the first place, and especially keeping minors from smoking--the younger someone begins, the more likely s/he is to become addicted and also to develop lung cancer. But for heaven's sake! Once someone gets to be 84, let them smoke if it brings them a bit of pleasure!

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I'm generally not a risk-averse person (we Bay Area astrology loons blame it on being a fire sign) and have always felt a little bit like an alien among my peers for not having much patience for handwringing about unlikely threats amplified by the media (shark attacks, airplanes going down, terrorism, mass shootings, etc.) compared to day to day threats like crashing my car or developing chronic pain from a sedentary lifestyle. It's always been very easy for me to go "my likelihood of this horrible thing happening is less likely than the likelihood of me dying in a car crash today." It still baffles me sometimes that that not only isn't something other people don't do easily, but that people resist and get offended if you try to add probability into their risk calculation.

I was in a very locked-down area of the USA, and I went into the pandemic struggling with fairly pronounced bipolar disorder and addiction issues, despite being an in-shape 30-something. I was fairly clear-headed that I was at much greater risk of disability or death due to isolation and lack of access to healthcare resources than I was from Covid, and I nearly died twice from mental health complications. Whenever I tried to express my (accurate) assessment of my own risk to people to try and express that being able to access in-person therapy, see my family and maintain my physical health was a matter of life-or-death, people would tell me that covid was really bad, long covid would ruin my life, even marathon runners could die of covid, didn't I see that covid was the only threat that mattered? When I nearly died and ended up with permanent organ damage, people had the gall to tell me "you're just lucky it wasn't covid." When my loved ones have died from late-caught cancer, death by street exposure or overdoses, people have said "at least it wasn't covid."

I spent a long period of the pandemic when I was unable to go out to the gym or socialize or go to in-person therapy feeling resentful of people who were willing to reduce their risk of dying by covid by asking me and everyone else to give up the things we loved and our access to in-person healthcare services, but not willing to reduce their risk of dying by covid by improving their cardiovascular health or eating their vitamins. I know there's a variety of reasons why telling people to get in shape is unfair and why a confluence of mental illness, resources, class access, pre-existing health conditions, etc may make "improve your chances of surviving Covid by getting fit" isn't a charitable way to think about other human beings - but when I felt like my life was actively being jeopardized, it felt like a slap in the face that people were putting my life on the line to minimally reduce their covid death risk but that they wouldn't put even minor effort into improving their own baseline health to reduce their covid death risk.

But people don't see "because I am not managing my diabetes, my odds of surviving covid are 2% lower" as a factor in their risk assessment the way they see someone breathing on them maskless at the grocery store. It makes me feel like the emphasis on reducing covid risk isn't about actually reducing the risk of covid death but is instead about finding ways to feel in control, including of others.

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(anyway "didn't manage my diabetes" is the covid equivalent of "forgot driving drunk is also dangerous")

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I am so sorry that the isolation was so terrible for you, and for your loss of your loved ones. I suspect that isolation was much more difficult, and for many more people, than the mainstream media would care to admit. We are a social species, after all, and our casual contacts with other people--friends, family, neighbors, acquaintances, even strangers--are crucial for our mental health. To say nothing of hugging our loved ones! We need those connections to other people.

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I absolutely agree - I think that the impacts of isolation (particularly with the uptick in substance abuse globally and the current wave of unprevented preventable diseases hitting hospitals) are going to be felt for a very long time.

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Lewis just told me this morning that he read in the NYT that there is a high correlation between people who suffer depression, and having long covid. I recall from the 90's that people with chronic fatigue were being prescribed antidepressents. It would seem that depression exacerbates other illness, or perhaps chronic illnesses make one depressed (or both!)

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I do think the causation works in both directions, and I’ve read that depression correlates with many other physical conditions and exacerbates autoimmune illnesses, for example.

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And depression correlates with situational issues! You're more likely to be depressed if you don't have money and work in a nasty job to barely afford rent in a gross apartment, and that means you're less likely to have healthcare, so your physical healthcare outcomes are worse, and when you feel bad physically you get more depressed, and when you're constantly sick or depressed you have less energy to try and climb out of the poverty trap, and so on.

There's possibly (probably?) a variety of things going on with the long covid/depression connection:

- Depression causes people's health outcomes generally to be worse, so covid infection is more likely to cause longterm damage.

- Depression is associated with external factors that make people's health outcomes generally worse, such as financial strain, and therefore covid infection is more likely to cause longterm damage.

- Depression specifically makes long covid worse (absent all external factors, people with depression have a higher risk of or worse outcomes with long covid).

- Long covid specifically makes depression worse (depression is a symptom of long covid).

- Depression and long covid are frequently being misdiagnosed for each other based on common symptoms (brain fog, fatigue, digestive issues, anxiety, etc).

- more?

There's so much room for learning more in terms of how these factors interact and it's just not being covered in the media much, which is a shame. Anyway, greatly appreciated this post.

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These are all good points. Researchers are starting to explore how inflammation worsens myriad medical issues. Depression increases inflammation, which may be a reason it also makes so many other physical conditions worse, including long Covid.

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I remember quite clearly when we were first starting the shutdowns and my stated opinion was that they probably were an overreaction but it was worth overreacting because the potential risk was so high.

Part of the problem we encountered as a society was that once we put things in place - even if they were overreactions - we are slow to then adapt back even when new information comes in. A lot of your examples really hit this. Many people are still using a March 2020 mindset even though we live in a very different world - both in terms of what we know and what we can do to fight it.

Very thought provoking piece and I hope it doesn't wind up too controversial.

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Yes! Exactly! What were important safety measures at one point are destructive now, and measures that protect one group hurt other groups. We need to update our priors and acknowledge differences in order to target safety measures.

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