Critiques of quantification and its social function (including by me) are not hard to come by. Some are annoying and hackneyed, but some are thoughtful and serious (you can judge for yourself where I fall). Theodore Porter in Trust in Numbers argues that quantification is a way of governing “at a distance,” without specific local knowledge of the objects of governance. “Objects” is the right term; it’s an objectifying worldview and we need only look at the last 200 years of imperial history for a glimpse of what the corresponding forms of governance look like. Bruno Latour’s 2004 book Politics of Nature, while not specifically about quantification per se, does touch on this objectifying function. According to Latour, institutional, capital-S Science constructs an object called “Nature” using its specialized objectifying techniques, then uses Nature to “abort politics.” His major concern is that Nature is an anti-democratic construction; he doesn’t treat “Science” and “quantification” as interchangeable or the same. So I think Latour might actually agree with me in the measured defense of quantification that I want to advance here. I want to go against the somewhat (and I do mean somewhat) fashionable grain and offer that quantification and quantitative methods fulfill an important democratic function within our institutions of public science. 

For a piece I’ve recently been working on about “polyvagal theory,” the pseudoscientific theory of nervous system regulation that is all the rage right now, I went and read the actual research literature on it. Because the authors of this literature reported their findings (badly) in a research journal, and because I understand the techniques and conventions of generating and reporting research results, I could quickly and easily evaluate their methods and results to reach the conclusion that the theory is wrong and the paltry therapeutic modalities based on it do not work. Quantitative methods, in other words, offer a transparent process for evaluating certain types of claims of public import. Take another example: the dreaded power calculation. I struggle to help clinical researchers with power calculations for grant or IRB applications on a daily bases. The struggle arises not because I don’t know how to do a power calculation (I do) but from a disjunction between how we each understand what a power calculation is for. Investigators tend to believe that the primary purpose of a power calculation is epistemological. They tear their hair out because there’s a section about power analysis on the IRB application and they think they need to do one no matter what in order to show the reviewers that they’re guaranteed to get an answer out of their research that is “right” or “true.” I, on the other hand, see the primary purpose of a power calculation as related to public accountability. Power calculations are often infeasible or inappropriate in reality. The actual purpose of the power analysis section of the IRB application is twofold. First, to demonstrate that you understand your data well enough to know if a power calculation is even needed, and second, if it is appropriate, to demonstrate using transparent and easily evaluable concepts and language that you have designed your study such that it will yield a meaningful result. These purposes are among the ways that public, democratic oversight of the research process is instantiated through the research process itself. Before staking a claim on research participants’ time or taxpayers’ money, you have to show – again, using transparent methodological steps that anyone with the right knowledge can evaluate – that these public resources you’re asking for won’t be wasted on something ill-reasoned, poorly designed, and destined to fail.  

The critiques of the 1970s and even the 1990s could afford to be somewhat indulgent, allying techniques of quantification with sinister political and ideological purposes, and they are right as far as it goes, but only as far as it goes. In our meager intellectual environment, there’s far too much transposition of older frameworks onto current events as a substitute for sustained critique. For example, reading RFK Jr. exclusively through the lens of 19th century eugenics is somewhat useful for narrow rhetorical analysis, but by imposing a coherent ideology onto an incoherent, contradictory, and opportunistic figure, this maneuver actually obscures more of the global meaning of RFK Jr.’s actions than it clarifies. Similarly, transposing poststructuralist science criticism onto current events risks rehashing well-developed critiques of quantitative practices at the expense of seeing clearly how those quantitative practices work, and why certain actors seem to hate them so much. 

Let’s stay with MAHA as a first example. One very common way to talk about MAHA is as a popular movement that is anti-science in the sense of anti-intellectual and anti-elite. This is to cast MAHA as  a fundamentally populist phenomenon. I think this is wrong. Attached to the institutions of government like lampreys to a fish, the MAHA movement is exsanguinating the structures of scientific evaluation and oversight, down to the administrative bodies and deliberative procedures of the health bureaucracies. Since the actual technicalities of scientific oversight involve a lot of specialized education and expertise, there is a strong temptation to identify MAHA as populist insurgency fueled by resentment and ignorance. What, though, is the actual purpose of this centralization of technical expertise? The federal health bureaucracy works the way it does (imperfectly, to be sure) to prevent the public from being scammed by unscrupulous actors or having their tax dollars wasted on research with no demonstrable public benefit (at best) or on enriching a handful of Substack posters (at worst). The purpose, in other words, is to safeguard the public interest in the conduct of public science, and quantitation is a big part of that. MAHA identifies here not with the average American patient or consumer of health information as the populist framework would suggest, but with the scammers. They feel entitled to scam without interference, and the structure of technical oversight around public science in the United States is a major source of interference. The aesthetics of populism or class resentment are in this case, as they are in national politics, an alibi for a deeply anti-democratic, authoritarian impulse. Tracy Beth Høeg’s purpose, for example, is to override the democratic processes of science and decide that your child, whatever your wishes, can’t get important vaccines, but that her buddies in the glucose injection affiliate marketing space can help themselves to your tax money via Medicare and Medicaid reimbursements. Subverting the processes and standards of rigorous science is a way of subverting the democratic principle that public science funding should support things that are demonstrably – through a rigorous and transparent process of demonstration – useful to the public, rather than buying ring lights for TikTok grifters. MAHA is anti-science in the specific sense of being anti-democracy.

Can we please talk about how vindicated I am by this Public Citizen report? At long last, a comprehensive and structured look at the conflicts of interest and affiliate relationships in MAHA world, timed to coincide with Casey Means’s confirmation hearings. I’ve been banging this drum for a long time. Consider this excerpt from an as-yet unpublished draft of something I wrote about MAHA, back in October:

Surgeon general nominee Casey Means, a medical residency dropout turned “functional” doctor, exemplifies many of these currents. Her philosophy (to characterize it generously) is individualistic, pseudoscientific, obsessed with weight and nutrition; her means of propounding it is affiliate marketing. Her pre-nom claim to fame, if fame it is, was a 2024 book called Good Energy: The Surprising Connection Between Metabolism and Limitless Health. She takes money from various wellness peddlers to promote all manner of creams and supplements on her social media accounts. It doesn’t stop with commissions, either, she’s no mere downline girlie. She’s also the co-founder of a health tech wearables company (wearables are things like continuous glucose monitors) called Levels. In June of this year, RFK Jr. told the House Committee on Energy and Commerce that HHS planned to launch an advertising blitz in service of Kennedy’s “vision” that “every American is wearing a wearable within four years” because “wearables are a key to the MAHA agenda.” At the beginning of Trump’s second term I joked that the end game was to get the remnants of Medicare and Medicaid to reimburse distance reiki. I didn’t quite know how right I was. Wearable technologies, according to Kennedy, “allow people [to] take control over their own health,” indeed a key MAHA theme, and as such, HHS is “exploring ways of making sure that these costs can be paid for.” Such ways may well include Means’s twin brother Calley, a self-described entrepreneur and, since 2025, Special Government Employee at HHS under Kennedy. Calley’s company Truemed, founded in 2022, is a platform that facilitates the use of tax-advantaged medical spending accounts like FSAs (flexible spending accounts) and HSAs (health savings accounts) on wellness products. How this works in practice, essentially, is that Truemed will provide a letter certifying medical need for things like the red light masks popular on Tiktok or, say, a wearable glucose monitor from Levels. Behind the sheer goofiness of what these people purportedly believe, about “mitochondria” and metabolism and seed oils and all that rest of it, is a serious effort to build the infrastructure to use HHS and other health agencies for self-dealing, just as Trump is using the presidency.

 And here’s the Public Citizen report, playing the very same tune:

Dr. Means co-founded and serves as chief medical officer and advisor to Levels, a membership-based health tech and wearables company that provides continuous glucose monitoring and lab testing for metabolic health markers, such as blood sugar and cholesterol. Levels is not marketed to people who have diabetes, the typical population wearing glucose monitors, but instead focuses on people who want to “optimize their health.” These types of products are a focus of Secretary Kennedy, who has vociferously promoted wearables and announced “one of the biggest advertising campaigns in HHS history” to encourage their use. Kennedy told the House Committee on Energy and Commerce that his “vision is that every American is wearing a wearable within four years." Kennedy specifically cited glucose monitoring wearables as having “utterly changed” the lives of some of his friends. After Kennedy’s statements, glucose-monitoring device makers saw a jump in their share price… Customers have the option to purchase Levels testing kits tax free through their Health Savings Accounts/Flexible Spending Accounts (HSA/FSAs) from Dr. Means’ brother Calley Means’ company TrueMed (which Dr. Means is also invested in). Dr. Means’ investment in Levels could be worth as much as $500,000, according to her financial disclosure. In addition to her role as a co-founder and advisor to Levels, Dr. Means also collects fees for promoting Levels on her platforms.

On the same day that the USDA unveiled a new food pyramid, an inversion of the old one (which was actually retired in 2011 and replaced with “MyPlate”), I saw a video of an ICE agent walking around Minneapolis with a grievously clenched ass. It could have been just the sheer weight of his tactical gear, but I don’t think so; the other agents weren’t walking like that, there was something ineffably different about his gait, the sort of tightassed step associated with a gravely compacted “Hank Hill” colon. Then again, I could have been hallucinating it thanks to subliminal communication from the new food pyramid. As I said, it’s upside-down, with a heavy smorgasbord of t-bone steak, whole milk, and cheese all bearing down on a single grain of brown rice. Around the same time as the food pyramid debut, the New York Times ran a feature on beef tallow, the voguish MAHA saturated fat obtained by rendering drippings from cow parts, and a dramatic chiaroscuro image of the Prince of Darkness himself was posted to the official HHS and White House Instagram pages, declaring: “WE’RE ENDING THE WAR ON PROTEIN.” 

That there’s a war on protein is news to anyone even faintly aware of the cultural atmosphere of America today. Protein is everywhere, in everything, in places it has no business being. (If you find yourself even remotely tempted to order a protein-enhanced iced coffee, seek spiritual guidance.) This is at least partially related to aggressive marketing and prescription of GLP-1 drugs like Ozempic. A high-protein diet is important for people taking GLP-1’s to prevent rapid loss of muscle tissue as the drugs do to your metabolism what a year in a high-control cult does to your mind. It’s ironic that this is driving demand for protein even higher than it already was. The Standard American Diet (aptly, “SAD”) is a menu of agricultural subsidies, principally for corn and beef. Americans’ overconsumption of protein from red meat (a tiny percent of the nation’s population consumes about half the beef eaten here annually) is a major contributor to our epidemic levels of cardiometabolic disorders, including Type II diabetes, which is what GLP-1’s were developed to treat. Amor fati, to be locked in a self-reinforcing protein death spiral with thousands of the angriest boomers in the world. 

The specter of a “war on protein,” ridiculous as it is, is still critical for RFK Jr.’s actual objective with HHS: to convert the federal health bureaucracy into a patronage network for his favored industries. Take the new food pyramid again. Though he assured this wouldn’t happen (and who among us was stupid enough to believe him?), the NYT reported that three of nine members of his panel that developed the new guidelines have gotten grants or consulted for the National Cattlemen’s Beef Association; two of those three plus one more have similar financial ties to the National Dairy Council; one is the “co-creator of a high-protein meal replacement product.” Are we really surprised at this sudden rediscovery of the supposedly occulted health benefits of waste products from these industries? Consider the market for beef tallow, valued at around $10 billion in 2024 and swelling faster than a exurban dealership guy’s duodenum. What was previously offloaded for pennies and turned into “sustainable airplane fuel” now retails for up to $15/lb and podcasters slather it on their faces. The vegan blog “Gentle World” puts it in plain terms: “This premium pricing model transforms tallow from a revenue-reducing waste product into a source of considerable profits.” Dairy industry page “The Bullvine” is similarly bullish on colostrum, the first milk a cow produces after giving birth, urging dairy farmers to “Stop Dumping Profits and Tap Your Dairy’s Liquid Gold.” Consider whey, the liquid left over from milk or cheese production. It was previously used as fertilizer or so-called “low value animal feed,” or simply dumped into waterways. Now that America is Healthy Again, you can buy it, dried out and marketed as protein powder, in $30-$60 tubs. You have to be a motherfucking idiot to think that RFK Jr. is championing the secret beneficial substances that doctors are too afraid to tell you about. What he’s doing is using the power vested in him by the US government to cram factory farming byproducts down your throat so that his friends can make more money.

Of course, as I’ve written, MAHA is marketing, and has been successful in mobilizing industrial wastes in the correct emotional register to get sales. Online, you can find plenty of illiterate gen Z “homesteaders,” storing their folate-free flour in plastic bins, feeding their newborns unpasteurized honey, and intoning, as they scramble eggs in bacon fat, that if beef tallow was good enough for our grandmothers it’s good enough for us. This is very telling. Great-grandma here is a metonym for pre- or non-industrial society. Metonymical great-grandma maybe slaughtered one cow a year if she was lucky, and needed to eat all of it for practical reasons; for her, eating beef tallow was a way to minimize waste. For us, beef tallow is waste, waste that, in order to facilitate profit accumulation and capital flows, has to find a mouth, a gullet, a small intestine to clog up. I’ve also written before about how the “productive relationship” that is disordered in MAHA is that between individual and System. Hither the MAHA neuroses about vaccines, or food safety regulations, or pasteurization – generally, the things that make the System work. It turns out, they can make you choke down endless waste products from that very same System and even induce you to pay for the privilege if they can successfully tap into and manipulate your anxieties about the modern world, about the System, and about the technological clockwork that makes it “go.” 

Saturday was Valentine’s Day and as I have been doing for several years, I took myself out for a drink at a fancy place, one where bar seating is walk-in only, early in the evening. I like to people-watch the straight couples on their dates. Even just compared to last Valentine’s Day, the vibes this year were markedly more rancid. A gendered asymmetry of effort on all levels. Sartorially: the women were dressed up for a night out, bold lips and tasteful statement jewelry, while the men were wearing zero-effort street clothing – that horrible, universal navy gingham shirt that men wear would have been an upgrade for these fellows. Conversationally: the women carried all the conversational labor of their dates, to mixed responses. Some men were “listening” to their partners, by occasionally looking at them directly, and doing so with a painfully self-conscious smirk on their faces, as if it was the most exasperating and exhausting thing in the world to be on a dinner date with the mother of their children. Other couples weren’t talking at all and just sat silently next to one another, the woman pretending to scrutinize the menu, the man taking fulsome swigs from his glass of beer. (In context, I feel that ordering a big wheaty beer on a Valentine’s date is fundamentally aggressive, anti-sexual.) I love Valentine’s Day, and I love to celebrate it alone, and I usually come away from these little solo dates with a pervading warm and fuzzy feeling of good will towards all, courtesy of the $16 whiskey drinks I’ve just bought myself. This time I came away feeling icky and depressed, like a passing car had just splashed me with rainwater and exhaust runoff. 

Then last night I saw people talking online about a new research letter in the New England Journal of Medicine. This is noteworthy because it quantifies some things that maternal mortality researchers have been warning about for years – the number of pregnancy-related deaths that go basically uncounted and unquantified because our death reporting system, especially for deaths in and around pregnancy, is so fragmented and uneven. The authors of the letter examined maternal deaths 2018-2023 by cause of death, finding the leading causes to be those our data systems are the least optimized to measure: overdose, followed by homicide, followed by suicide. I have written about these measurement problems before, including in this newsletter from nearly two years ago (sorry for the mention of the podcast in it, I mercifully haven’t been associated with them for a long time). Briefly, because of federalized death-certificate reporting practices, it’s very difficult to count pregnancy-related and -associated morbidity and mortality here compared to in a place like, e.g., Sweden, with robust national vital statistics registries and universal health care. Please indulge me in quoting extensively from that previous newsletter:

While clinical professional groups have issued gold-star statements about standards of care for treating substance use disorders in pregnancy, the actual reality does not match the standard-of-care documents. Many states criminalize not only drug use during pregnancy, but also the treatments for substance use disorders recommended by the professional associations of obstetricians (like methadone or buprenorphine treatment). Rapid opioid dose tapering and abrupt discontinuation are associated with increased rates of fatal overdose, mental health episodes, self-harm, and suicide. If someone's treatment is disrupted because they are pregnant, because of the legal environment being constructed around pregnancy, fetal personhood, and criminal liability, is their resulting death merely pregnancy-associated? Or would we be right to count it as a "true" pregnancy-related perinatal death?

Similarly, what about assault and homicide? Perinatal deaths from these causes are similarly not related to the physiological changes wrought by pregnancy itself. But to argue that they aren't related to pregnancy seems wrong. I worked for a number of years at a domestic violence hotline. It is well known, including from my professional experience, that abuse tends to begin and escalate during pregnancy, even to the point of murder. The reasons for this are cultural and social rather than physiological -- but are they any less salient? I would argue, especially in an environment where abortion and even birth control or sex education are increasingly criminalized, as they are in our country right now, that these causes are equally salient even if they are not as amenable to chopping up for a rote multivariable regression analysis.

All the talk of trends obscures what is really going on here -- the authors of the AJOG study want, probably because they are epidemiologists, clinicians, and very old hats in the realm of maternal mortality research, to restrict the counting to these physiological, clinical things; this undercount feels to them more "accurate" than the more expansive overcounting of the checkbox method. Rather than an intensification or diminution of existing trends, I think what we are experiencing is a qualitative transformation in how pregnancy is culturally, socially, and medically conceptualized. Pregnancy is increasingly a category or a state of suspicion, criminalization, dehumanization, and control as the state assumes the role of an abusive partner for all people capable of gestation. What's at stake in these arguments about how to count pregnancy-related deaths is how much or how expansively we want to politicize the public health problem of perinatal deaths.

I agree with my 2024 self that a more expansive definition of pregnancy-related mortality is appropriate to public health, but I have to admit that I don’t understand why or to what end. My impulse, as I was reading the NEJM letter this morning, was to talk righteously about how homicide as a leading cause of pregnancy-related death exposes the limits of public health thinking about social problems versus technical problems. But what does this even mean? What is accomplished here, besides a smug reiteration of some shit we already know? Technical vs. social is a level one distinction, the problem it expresses is a mere category error. The harder problem for public health involves conceptualizing the relations between analytic “levels” for issues where multiple levels are involved, like the issue of pregnancy-associated homicide – technical and social, individual and group. How can we hold onto the findings of this research letter – that homicide is a leading cause of death in pregnancy – as something that public health should be concerned about, while accepting that it is pretty far outside the technical remit of public health? 

The archipelago of concentration camps being filled by the Trump administration’s sadistic “interior enforcement” activities are a huge public health problem. There is a measles outbreak at the South Texas Family Residential Center (child prison) in Dilley, TX. According to recent reporting, ICE has simply stopped paying for medical care as the population of prisoners it oversees has doubled. Horrifying stories of medical abuse surface every day (one man was denied transplant medication; Rümeysa Öztürk, the Boston graduate student kidnapped by ICE and trafficked to Louisiana for writing an op-ed mildly critical of Israel, wrote of being denied her asthma medication). Conditions and techniques characteristic of War on Terror CIA “black sites” have been widely reported including at so-called Alligator Alcatraz. People are being increasingly menaced and detained while seeking medical care. 

Indeed, the “concentration camps” and the apparatus of violence they symbolize are an important public health issue – perhaps the most important public health issue right now. Trying to think them “through” public health recalls a recent historical example. When the Covid-19 pandemic started, something unprecedented in my lifetime happened: we started letting people out of prison and jail early. According to the Brennan Center, roughly 100,000 people (8% of the incarcerated population) were released from state and federal prisons and jails between March and June of 2020. There was a clear public health rationale for this. American prisons and jails were extremely high-risk settings for catastrophic disease spread; medical care in such settings is inadequate; carceral institutions are porous to the wider community and can drive epidemic spread outside the community. There was a clear and elegant public health demand attached to this project: “free them all for public health.” It seems only natural to revive this demand now, and especially appealing to those of us in public health who find ourselves horrified, whether for the first time or yet again, at the atrocities being committed before our eyes.

I want to think about this a little harder, because in the years since 2020 I’ve closely experienced the hard limits of making political demands in the language of public health. I want to do so by way of a consideration of historical analogies, with apologies and concessions to Nate, who planted this idea in my head (and whose writing on this you should keep an eye on). What work is the concentration camp analogy is doing in public health specifically? What does it reveal, and what does it conceal? I’m talking not about the strict definition of a concentration camp (which these ICE facilities clearly meet), but what it evokes in the cultural imagination – Nazi Germany. There are clear and obvious similarities; death and disease were rampant in the Konzentrationslager. But how do we use this analogy in the present? It’s clear that the Republicans are the Nazis, ICE are the SS… but who are the Democrats? Who are we? The concealing function of the analogy becomes clearer here. Using an analogy to a foreign country obscures the genetic lineage from our own past to the current abuses we see. And what we’re seeing is indeed continuous with the US project of incarceration and characteristics of US prisons. The litany of outrages is too long to fully enumerate here, so I offer instead some examples skimmed off the top of my head. Many prisons are situated upon toxic waste sites. Medical neglect is rampant, as is life-threatening exposure to extremes of heat and cold and to the effects of natural disasters. Shackling of pregnant prisoners during labor and delivery is common practice in this country. Even in its more routine aspects, our astronomically high incarceration rate (our reliance on incarceration as a social technology) means we lead the world in separation of families, psychological torture, and the destructon of human lives and souls.

Following this thinking, the current situation both is and isn’t a “public health issue” for the same reasons that the genocide in Gaza both is and isn’t a “public health issue.” There are identifiable public health correlates, obviously. Ultimately, though, what horrifies is not adjusted mortality rates or indices of disease spread. What horrifies is the unthinkable reality that living human beings just like us, with consciousness, with feelings, with souls, are being subjected to such brutal and dehumanizing experiences. Regardless of public health indices, and regardless of the public health rationale based on the threat that tolerating the subjection of prisoners to life-destroying conditions poses to “the rest of us,” the soul recoils at the degrading and dehumanizing treatment of other human beings, at sadism, at kidnapping, torture, and murder. Because that’s what we’re really talking about here: kidnapping, torture, and murder. 

Is MAHA fascist? If yes, why or rather how is it fascist? I think I can finally give a satisfying answer to this question that is based on something more substantial than just vibes. I am going to reconstruct my thought process about it in a more orderly sequence (basically I am describing the process of writing – I’m going to write about it) for your consideration. I know my limits; I am neither a psychoanalyst nor a critical theorist, nor a historian, nor a scholarly expert in fascism. My reading of Deleuze and Guattari to follow is secondhand, as I need time (and resources) to actually read Anti-Oedipus myself. I am offering these thoughts with humility, in case they are as constructive for anyone else as they are for me, but they remain open to revision. 

My basic answer to the titular question is: yes. As we will see, I think MAHA is a production of a certain type and style of reality; specifically, of life-destroying reality. This will make more sense, hopefully, by the end of the essay. I think that this understanding is able to hold all the apparent contradictions of the MAHA movement together in a coherent whole. The vaccine denial, the fascination with raw milk and saturated fats, the freebirthing, the embrace of supplements held in equal measure against hostility to (e.g.) folate, the disinterest in gun violence and violence towards children, the lax regulations on pesticides and real environmental contaminants, are not actually contradictory or hypocritical positions. Or rather, they’re only contradictory if you insist on holding them to the standard of technocracy – rationality. As various desires that produce and are part of a reality hostile to life, however, they’re perfectly consistent. 

It all starts with my recent reading of Klaus Theweleit’s two-volume Male Fantasies (1977). You may remember that I tried and failed to read these books a few months ago. In light of the recent escalations of state terror in the Twin Cities and elsewhere, I picked them up again and this time I was able to positively tear through them. I wasn’t necessarily expecting this to yield any insights on the MAHA question in particular, but since this question occupies a lot of my thinking it’s perhaps not surprising that my reading did generate some thoughts in this direction. I need to lay some groundwork (and work through some of my own understanding) to get to the really interesting parts, so I hope you’ll bear with me. 

Male Fantasies is a psychoanalytic reading of primary texts written by members of the German Freikorps, an association of interwar paramilitary units that transformed themselves into the Nazi Sturmabteilung (“brownshirts”) during the Third Reich.* Theweleit focuses on texts from and about the period of the “white terror,” the Freikorps’ rampage of extrajudicial violence against leftists and workers in Germany – roughly from the end of WWI until the mid-1920s. (The subtitle of Vol. 2 is “psychoanalyzing the white terror.”) Theweleit reads these texts not on the literary merits or lack thereof but “on the face.” How did the “soldier males” of the Freikorps describe what they were doing? How did they relate (or more often, fail to relate) to other people? As the title suggests, he’s particularly interested in their conceptualizations and descriptions of, and attitudes and relationships towards, women. I get the impression that Theweleit expected to apply traditional Freudian psychoanalytic concepts to these texts, but ultimately finds those concepts inadequate to make sense of his reading. What he finds is not, for example, repression of Oedipal desires erupting in violence against sexually liberated Bolshevik women; there is plenty of said violence in the texts, but actually very little repression. The authors and narrators move through the texts in hallucinatory “disintegrated ego states” where socially unacceptable desires are consciously expressed and fulfilled in paroxysms of slaughter.

The snow is coming down hard and I fucked up my lower back doing a first round of shoveling so I’m extra snowed in, sitting here with a hot water bottle behind my right hip. I don’t want to be on the computer today and am going to try to keep this short. Writing is a way to prepare the mind to rest, as I had intended to do all day yesterday, which is of course not what happened. I spent about twelve hours pacing around my apartment like a caged animal, hunched over my phone, worrying, increasingly convinced that “Breaking News” is just the name we give to participatory psychological warfare. A welcome phone call from Nate broke me out of the spiral and inspired some thinking, which inspired some jotting down, which inspired the paranoid scribblings that you are now reading.

Both Nate and I have been Doing This a long time, Nate slightly longer than I have by virtue of a bit of a seniority advantage (neither one of us is beating the “old” allegations, I fear). By “This,” I mean various actions in various protest and leftist movements of various degrees of organization. I also mean that we are both engaged in Marxist (or maybe better to say Marxian) intellectual work in the broadest sense, attempting to whittle important or interesting insights out of the solid block of current events using Marxian frameworks and conceptual tools. A fair amount of our conversation yesterday revolved around themes of mental and informational war and the constant attempt to thread the needle between being agitated enough to keep going but not so agitated that you exhaust and demobilize yourself. The fact that nobody can get used to this is a tactical point against the administration, but it’s a tactical point against us that huge technological structures exist to capture and defuse the emotional charge of constant agitation. The feeling that results is intentional and familiar for many of us: you’re addicted to the thing that depletes and paralyzes you, which is Becoming Informed by consuming emotionally pitched content on your phone. (This is a contemporary variant of left melancholy, I think.)

Nate and I talked and wondered, as we often do, about the role of intellectual work. We all tend to devalue the role of intellectual work in general just because the markets that structure our lives devalue intellectual work, but I think this is a mistake. At the end of the day, it’s only really ideas that are capable of moving people, ideas that are experienced and felt in addition to just thought. (This is the deep political significance of art, good art specifically, the kind that avoids sloganeering, lecturing, and simpleminded political allegory is the most truthful and moving.) Nobody ever picked up a brick for the labor theory of value, but people have done and continue to do it for higher wages and shorter working hours, or because they’re simply starving, like Tom Joad in The Grapes of Wrath. People are doing incredible things in Minneapolis every day, every day proving Rosa Luxemburg kind of right after all, that people’s capacities for coordination and problem-solving are profound and don’t demand much by way of technical or ideological orchestration or management, and that the tactics of resistance constantly flow like water over and around the conditions of possibility and the compositions of power and population. Daycare patrol is as much a manifestation of the mass strike as the general strike on Friday, in other words. 

Whatever passes for leftist theorizing is so often just strained attempts to fantasize about a world that would be easy to change. (Liberals, I have noticed, are considerably less burdened by these fantasies in this moment.) Americans have a strange expectation that mass politics be somehow evidence-based (we conflate “policy” and “politics” as a matter of course, another ideological current that I think is intentionally demobilizing) and that theoretical correctness should be proportionally and monotonically related to political result. But I’m actually less interested in why liberals with theoretically incoherent and aesthetically cringe politics are so activated right now than in the simple and obvious fact that they are. I view one important role of leftist intellectual work right now to be neither “educating” nor “correcting” them but in asking, and trying to be clear-eyed about, what this means and what political possibilities (and impossibilities) it constellates. 

The seventh card in the pentacles suit of the Rider Waite Smith tarot deck depicts a young man standing in a field, hands folded atop the handle of a long hoe. He’s resting his chin on his hands, looking pensively at a green bush, on which are superimposed seven large gold coins. Who doesn’t love gold coins? The coins suggest reward: hard work pays off. In the Thoth deck, whose illustrations are a good deal more abstract, the seven of disks card (pentacles are sometimes called coins or disks) is dark and heavy. Seven disks are held in place by a ramifying, dark blue-green structure set against a black background. The concept associated with this card, its name, is “failure.” In this light, the Rider Waite Smith card appears differently. I thought I was growing beets or potatoes or whatever, but I got a lot of metal coins? What the fuck? I’ve thought about the seven of pentacles a lot in trying to understand and make sense of my own experience of the Covid pandemic, now approaching its sixth anniversary. How can working so hard towards an intended result achieve such a bewildering and unintended other one? If that’s not failure, what is?

War and Peace might seem an unlikely source of insight about public health practice (except maybe insofar as people are dying left and right of gangrenous battle wounds, as they would continue to do for about a century and a half more). My friend that teaches War and Peace to undergrads first clued me in to the historical scope and interest of the book and its uses for teaching the history of the Napoleonic Wars. He (my friend) was incensed that the Battle of Borodino, which occupies much of the back quarter of the novel, was reduced – literally – to a subtitle in Ridley Scott’s Napoleon. We saw it in the theater together, where I mostly covered or averted my eyes because, believe it or not, I’m squeamish about suffering and gore. Tolstoy would have hated Ridley Scott’s Napoleon because Ridley Scott’s Napoleon is, in the manner of La Croix seltzer, “essenced” by a flavor of historiography that Tolstoy expressly condemns, and never ceases to ridicule throughout his massive novel. It assumes that Napoleon, as history’s “great man” par excellence (reading War and Peace will have you thinking you can speak French), was the principal agent of his historical context, consciously directing the events taking place around him.

There are philosophical chapters of War and Peace that explicitly detail Tolstoy’s philosophy of history. They are sparsely interleaved with the narrative chapters over the book’s infamous length, but I actually think the narrative chapters better illuminate Tolstoy’s philosophy than the philosophical ones. At the battle of Schöngraben, early in the novel, Prince Andrei Bolkonsky (the closest thing in the sprawling cast of characters to a chad) notices how commander Prince Bagration – dispatched with his small detachment on a doomed mission to hold off the French long enough for the rest of the army to beat a retreat – gives the powerful illusion of being in control of events that are fundamentally chaotic:

“As he was riding away from the battery, shots were also heard to the left, in the woods, and as it was too far from the left flank for him to get there in time himself, Prince Bagration sent Zherkov there to tell the senior general, the one who had presented the regiment to Kutuzov in Branau, to pull back beyond the ravine as quickly as possible, because the right flank would probably be unable to hold the enemy for long. Tushin and the battalion covering him were forgotten. Prince Andrei listened carefully to Prince Bagration’s exchanges with the commanders and to the orders he gave, and noticed, to his surprise, that no orders were given, and that Prince Bagration only tried to pretend that all that was done by necessity, chance, or the will of a particular commander, that it was all done, if not on his orders, than in accord with his intentions. Owing to the tact shown by Prince Bagration, Prince Andrei noticed that, in spite of the chance character of events and their independence of the commander’s will, his presence accomplished a very great deal. Commanders who rode up to Prince Bagration with troubled faces became calm, soldiers and officers greeted him merrily and became more animated in his presence, and obviously showed off their courage before him. (War and Peace, p. 182)^*

My friend said in passing that my writing reminds him of Dave Hickey’s and, not being the kind to let any kind of compliment-shaped butterfly escape my net, I picked up a book of Hickey’s essays at my local library – the only one of his many books they have – and started reading it. (I only belatedly recognized Dave Hickey as the very person to whom Terry Allen’s great song “Amarillo Highway” is dedicated, and is maybe about.) The book the library has is Perfect Wave: More Essays on Art and Democracy. It’s a slim volume and a late one, published in 2017, only a few years before Hickey’s death. The opening essay, “Baby Breakers,” tells the story of Hickey’s interesting childhood up to and including a major surfing accident. Moving to LA from Texas, getting interested in surfing thanks to the proximity of both celebrities and the ocean; not being very good at surfing, but learning from the topography of the ocean floor where good waves were likely to break, and thus earning in true Nerd Picaresque fashion the grudging and stingy respect of his fellow surfers. Then, the big accident, which is where the limitations of Hickey’s writing become really apparent. His descriptive enthusiasm outruns his narrative skill, and as a result, it’s very hard to tell what exactly happened. I think what happened is that young Hickey decided to catch a “perfect wave” despite knowing, via surfer triangulation, that it would crash him into a pier, and it crashed him into a pier. Though he long predates social media his prose style shares a grating quality with writers who are or have been inveterate Twitter posters – each sentence is written as a tweet, packed and maximalist, coiled so tight with description that it effectively chokes the breath from the piece of writing as an organic whole. It exhausts the very eyes to read. 

I’m also ill-disposed towards “Baby Breakers” because it’s a perfect example of a genre I absolutely hate: Boomer’s Interesting Childhood. I would classify Hickey, born in 1940, as not exactly a boomer, but close enough. He was born such as to have ample time to catch the actual “Perfect Wave,” the tidal sluice of money into the real economy thanks to Cold War military Keynesianism. You wouldn’t believe the type of shit our sixth grade Hickey, a reasonably bright child, was getting up to in Los Angeles, and there’s a base note of self-satisfaction about this. But how justified is that self-satisfaction? It seems like it was pretty easy for a bright child to have a rich and memorable childhood in a place like Los Angeles in a time like the 1950s, but the kind of fetishism that takes place here is characteristic of the BIC genre. The surfing culture, the affordable housing, the city infrastructure (Hickey takes a bus to the Coast Guard office to pick up ocean-floor maps), the mingling with celebrities and the much more modest GINI coefficient that mingling implies, are presented as qualities of Hickey’s – brightness, alacrity, daring, cool – rather than long-gone macroeconomic policy structures. The conditions for a 1950s American adolescence, be that adolescence cool or uncool, boring or interesting, are obsolete. 

If the base note was self-satisfaction about the interesting childhood, the top note was obliviousness to the environment that made it possible, which is what really grates. My omnibus feeling about this first essay is resentment, resentment which extends beyond the actual boundaries of my knowledge about Hickey’s work as resentment tends to do. I actually resent the confluences of history that made a career like Hickey’s possible. It pisses me off that, for a few decades, a person could make art and a living out of the mere act of discernment, of taste. (Recent attempts to recreate this within our current cultural environment – think “Perfectly Imperfect” – are desperately fucking uncool. For example, singer-songwriter Clairo, on the mass-market Bialetti Moka Pot: “It’s the best way to make coffee in my opinion, and I love it as a part of my morning ritual.”) It’s not just how the cultural and media saturation, the algorithmic accessibility of everything, the microtargeting and the slop, are degrading our experience, which they are. It’s that this degradation of our experience is attendant to another, deeper degradation; this degradation of our souls is the soft outer body around a hard endoskeleton of macroeconomic suck. This isn’t the 1970s, you can’t live in Manhattan as a part-time editor of an art magazine, spending your nights listening to records until dawn breaks as Hickey rhapsodizes about doing in his pretty-good essay about the Carpenters song “Goodbye to Love.” Goodbye to love, indeed. And why stop at love? Goodbye to free time, goodbye to disposable income, goodbye to anything open past 7 PM, goodbye to public transit, goodbye to human interaction. Would I find enjoyment in the campy excesses of a fringe-dweller life in Vegas? Probably! But my alarm is set for 7:00, and I’ve got floaters in my eyes that are bad enough already, and there’s no margin of error. You might as well ask me if I’d enjoy living on Mars. I wish it were otherwise but, unlike the boomers, I’ve got no delusions that what I want matters in either a personal or a world-historical sense. 

There exists a 2016 article about Hickey and his oeuvre in the Los Angeles Review of Books. It’s called “The Inside Outsider,” by a person named Jarrett Earnest. Hickey had, over his career, “invented a way of engaging art that is so singular and spectacular it can’t be compared with anyone else’s,” and this way consists of “theatricalizing the distance” between the inner experience of the viewer and that of the artist, on which the viewer’s vantage is “resolutely outside.” “To enact this externalized mode of inner experience,” Earnest writes, “Hickey has fashioned himself into a character in his own writing.” I don’t doubt that this has paid critical dividends; I doubt only whether I’m terribly interested in it. None other than T. Ruggles Pynchon (born 1937, a few years before Hickey, and still kickin’) wrote a whole book about externalizing the internal that couldn’t be more different. (Maybe it’s unfair to compare novels to criticism, or to compare Pynchon to Hickey, but this is my newsletter and I do what I want.)

I’m trying to avoid too much topical posting about MAHA for a couple of reasons. First and primarily, because of the other piece I have in development that works out many of the same arguments that I am going to present here and more, at much greater length; I want to be wary of cannibalizing that piece too much because it is, I think, thoughtful and coherent. Second, I try to avoid it because it feels just so bad to do. I spent some time on Friday going back through old screen shots from 2021-2022, when I was extremely online, fighting constantly with the so-called “Covid contrarians” that are now empowered to decide whether and when you can vaccinate your own child. I really couldn’t believe the frequency and enthusiasm with which I used to screen shot things that made me nauseous, panicked, or want to cry. (The brackish swirl of sewer effluvium that would eventually precipitate Moms for Liberty out chased me off of Twitter a few times in 2020, to say nothing of the multiple times I’ve been “canceled.”) The pace at which you must constantly be filtering toxic slop through your mind like a Baltimore Harbor oyster, in order to catabolize “events” and anabolize them as a coherent and timely take, is not sustainable or even survivable, and it’s not supposed to be – I’ve never been more demoralized in my life than when I was doing it regularly. But I don’t know when the other piece will be out, and events are upsetting enough to overcome my resistance, and here I go, Speaking My Truth.

The latest head-clutcher is last week’s disastrous ACIP (Advisory Committee on Immunization Practices) meeting, featuring Tracy Beth Høeg in her new role as head of the Center for Drug Evaluation and Research at the FDA. Astute or frequent readers will note that this office is in charge of regulating, among other things, several of the the currently unapproved “orthobiologics” that Høeg offers as part of her sports medicine practice, including both “autologous” treatments like platelet-rich plasma or bone marrow aspirate injections, more ambiguous from a regulatory perspective, and straightforwardly sham “proliferative therapy” or “prolotherapy,” like dextrose – sugar – injections. Tracy Beth’s appointment reflects the shallowness of the MAHA bench – every group chat has got the halfhearted podcaster, disheveled creep, and orthorexic almond mom – but any comfort in that was quickly crushed by the embarrassing spectacle of the ACIP meeting itself. The committee ultimately voted to modify hepatitis B vaccination guidelines for newborns, ending a longstanding guideline for universal vaccination at birth that, since its introduction in 1991, has been credited with reducing cases of hepatitis B in children by 99%. Who knows what, if anything, these people actually believe. What’s certain is that they are benefitting from their positions in ways that, while perhaps not yet completely clear yet, are extremely sus.

By all accounts, the MAHA people on and off ACIP are what MAHA believers at the popular level are actually afraid of: unaccountable bureaucrats with shady conflicts of interest, consigning your children to sickness and death with the stroke of a pen because it enriches them, or at the very least makes it slightly easier for them to dispense plasma injections (at up to $2000 a pop) to long-distance runners. Most of the reactions to the meeting have recognized these folks as incredibly bad actors. Director of the Center for Infectious Diseases Research and Policy (CIDRAP) at the University of Minnesota Dr. Michael Osterholm tweeted, following the ACIP vote, that the federal government “can no longer be trusted” on vaccines. (I think this one is a bad idea, the few people in America who actually think that MAHA rocks already think that the federal government can’t be trusted on vaccines, and I guarantee they do not understand that their champions now are the federal health authorities. I wish it were otherwise but Americans just are that stupid and ignorant.) Senator Bill Cassidy – MD, professional clown, and key vote for RFK Jr.’s confirmation – pulled an Urkel and urged that the acting CDC director decline to ratify the vote, which is unlikely given that the acting CDC director is seasteading longevity creep, “health investor,” and RFK Jr. adjutant Jim O’Neill. Various professional associations of physicians are issuing statements promising to ignore the guidelines and do their best to offer the vaccines as usual. These reactions are all bouncing off of a big dark object, echolocating the shape of an institutional long game that has not been explicitly elaborated: it will have served MAHA’s agenda well if they can succeed in making the federal health authorities irrelevant. Creating precedent to ignore guidelines undermines their authority, including the regulatory authority that is the MAHA movement’s real target. Disturb that authority by an inch on universal vaccination, and, they’re gambling, they can dislodge it by a foot for regulations governing – just as one example here – federal reimbursement of “orthobiologics.” 

The rank corruption and tragic loser aesthetics of the MAHA leadership are, unfortunately for all of us, connected to a segment of the public via an umbilical cord of unconscious anxieties and resentments. I’ve already explored how MAHA is marketing, as I will do at greater length in the  aforementioned piece under development. In that piece I devote a fair amount of space to the Beavis and Butthead of the MAHA movement, the Means siblings Casey and Calley. Casey is a med school dropout turned quack who Trump nominated for Surgeon General; twin brother Calley is an entrepreneur who we have to thank for introducing Trump to RFK Jr. Casey has a company called Levels, which sells wearable devices like glucose monitors; Calley’s company, called TrueMed, is a platform for spending HSA and FSA dollars on wearables and alternative therapies. The sound of one hand (EFT) tapping. Months ago, I went to Calley Means’s blog for my other piece with every intention to ridicule it in microscopic detail, but what I found was even more disquieting than the fauvist third-grader style that Calley writes in: the Means’s wellness origin story begins with the untimely and tragic death of their mother from pancreatic cancer. The Means siblings are entrepreneurs, and effective marketing is meaning-making. They may be ruthlessly monetizing their anguish over their mother’s death, but that doesn’t diminish the anguish – the scope and reality of it is what makes for good advertising. 

The other night, I was doing my weekly grocery shopping when I beheld an incredible scene. (I shop at a remote suburban store, as I told my therapist, because the vibes at the one in the city are “demonic.”) I walked through the sliding doors at roughly the same time as a family of four – mom, dad, and two girls, both in the 6-10 age range – and I got a rare chance to observe the full life cycle of an American nuclear family errand in the wild. What I saw astonished me. Mom was worked up, muttering (to herself, no one was listening) about what items they needed and darting around the produce section like a stressed aquarium fish to grab them. The two girls were wantonly misbehaving, screaming at each other, obstructing the aisles with the family shopping cart, bumping into strangers, knocking lemons and limes off their stacked pyramidal displays. And dad, ugly and inert as a barnacle, just stood there, motionless, scrolling on his phone. Occasionally he would glance up and, noting that the epicenter of the family earthquake had moved, take a few halfhearted steps in the general direction of the action. At one point, mom was several aisles away retrieving coffee (why hubby could not bag the broccoli while she got the coffee remains unresolved), and one of the girls rocked the shopping cart so riotously that she would have launched herself headfirst out of it and onto the hard floor had not big sis not reflexively rescued her at the last minute, setting the cart aright. As this went down, dad, still on his phone, looked up and inclined forward, in a way I recognized. It’s what I used to do during team sports in middle school whenever the ball came anywhere near me, an uneasy gesture at the intent to participate, but not actual movement. It ensures that somebody else will get there to deal with it first.

I beamed this man a continuous dirty look as I bagged my onions and selected my bananas. And the thing is, he actually already looked embarrassed, a flush of humiliation glowing from behind the expression he was trying just a little bit too hard to keep neutral. I recognize that look too, it’s the look of someone who feels awkward standing uselessly amid a lot of activity that they don’t understand how to correctly participate in. So while I felt contempt first and mostly for dad, I felt some also for mom. I’m allowed to say this because of my Lived Experience: straight women do get some kind of really weird jouissance from the overfunctioning they’re forced to do in straight relationships. (I’ll refer you to the infuriating recent article in The Cut about women “quiet quitting” their marriages, psychologically damaging their children by claiming to stay “for them” because they’re too weak, scared, comfortable, or crucially, subconsciously pleased to let go.) There were two interlocking and complementary gender scripts playing out in public (the eternal heterosexual kink, of playing out your psychodrama in public). Mom knows what to do and Dad doesn’t, and they both sort of hate and resent each other for it, but this is the unhappy equilibrium that they can evidently both live with.

Based on the behavior of men that I witness in real life, there is something deeply pathological going on with them at an emotional level. I think there is also a parallel disturbance in the collective psyches of  straight women. This is why the male loneliness epidemic article in the New Yorker by Jessica Winter hit like a Camel menthol and Japanese jazz – gratifying to read on a molecular level. Winter deconstructs the “loneliness epidemic” “crisis of masculinity” hysteria by closely examining some of the writings and podcast remarks of centrist male loneliness pundits, full-timers like Scott Galloway and moonlighters like Rahm Emanuel and Gavin Newsom. First, she surfaces some of the assumptions implicit in these commentators’ takes on the “crisis,” namely, that women actually are just kind of inferior, but not in a misogynist way or anything like that. In response to a Rahm Emanuel op-ed in which he’s lamenting the unaffordability of housing for young men (but don’t worry, the party’s future “is not Mamdani’s New York”), she writes: “In other words, men and women pay the same bill, but we are obligated to understand that the social and spiritual price it extracts from men is higher.” And a little bit later: “What these pundits are nudging us to do, ever so politely, is accept that women, in the main, are accustomed to being a little degraded, a little underpaid and ignored and dampened in their ambitions, in ways that men are not and never will be.” 

Reading sentences like this feels like inhaling crack cocaine. (I think.) It feels absolutely electric for somebody to just fucking say it, to pithily give voice to what we already know, that the centrist Dem’s belated and lukewarm attempt to embrace male crisis discourse amounts to so much special pleading for boys. Winter is astute; they do this because they fear socialism (or even just the whiff of popular, progressive politics) much more than they care affirmatively about anything at all. It’s special pleading because they want to design a rhetorical strategy to confront the men’s grievances in the vernacular of gender roles rather than macroeconomic realities. In other words, like the dad inclining his head forward as his daughters nearly self-destruct, they want to be seen as making a plausible effort to address men’s grievances without addressing the real causes of those grievances in the slightest. Winter musters a lot of statistics that get heavy play in male crisis discourse and shows that they actually are affecting girls and women, too – it’s an “everything crisis” (not a masculinity crisis) that affects “young people,” not just young men.

It was only a matter of time, really, before “a team” (two guys) of “AI experts” (surgeons who have alchemized AI stock hysteria into obscure assistant deanships) descended on my workplace with a “mandate” (that no one asked for) to shove some dogshit LLM tools into various aspects of my job. At least, that’s what it was at first, because these palookas don’t even know enough about what they’re doing to lie about it. When it became clear that I don’t need an LLM to “assist” me with any step of my work process, because I know how to do my job, the rationale shifted. Now, the dogshit LLM tools are supposed to “help” (deskill) my clients, and ensure they never learn how to do the stuff that I know how to do. In one of the meetings we’ve had about this, a third “expert” – a self-styled guru on AI ethics – actually suggested that all of my work interactions be filmed in order to train a model to replace me. (Excuse me, to assist the clients who are currently using ChatGPT, or whatever justification for their own existence they’ve cooked up this week.) Really! It’s so offensively stupid that they should be ashamed, but in the end it doesn’t matter how they feel, because the tools are not going to work. I mean, they might succeed in deskilling all clinical trainees and in laying me off, replacing me with a wrong-answers chatbot, but that’s all they will have done. And even though they don’t understand this, they will be worse off for it.

It really is irresistibly easy to make fun of these guys, for the same reasons we all love to hate confidently stupid people. Pride goeth before the inevitable stock market crash. It remains, however, important not to overpsychologize these folks. They are the most “they know not what they do” people in history, besides maybe the original ones. They have, to an unclear degree of conscious involvement, been conscripted into the national project of buoying obscenely overvalued tech stocks, because as soon as that stops happening, line goes down, and we all know what happens after that. The arguments against American AI are all right and still apply: the technology simply can’t and won’t ever be able to do what it is being marketed for; it’s deskilling the workforce which is something that, were it not run by senile boomers, I might caution an institution of higher learning about participating in; it’s insanely wasteful and unethical to use when a regular piece of computer software, a handheld calculator, or a human brain can do the same thing without slurping up half the world’s remaining fresh water. Tech critics have been making these and other arguments – let’s call them moral critiques – for years, and yet, the power of the tech sector has only grown over those years. And now we’re in really deep shit. Bad omens accumulate. Dead frogs keep piling up on the banks of the river that powers the data center. OpenAI sort of let it slip recently that they plan to ask for a bailout when the bubble bursts. Just yesterday Nvidia reassured Wall Street analysts that it is “not Enron.” 

This is, to ask any of the people at my workplace whose job it is to follow this stuff, probably fine! Right? It’s charitable to assume they even know about it – it’s simply not like any of these guys read the news, or understand themselves as part of a dynamic society. A timeless question thus arises again, like a perennial flower: if this is so obviously a bad idea, and so obviously unsustainable and destructive, then why is it still happening? What are the reasons for this that don’t route through the ablated psychologies of our nation’s boomer middle managers? Yesterday morning I saw a tweet from CNBC anchor Carl Quintanilla (welcome to the resistance?) citing a Goldman Sachs report partially attributing the astronomical youth unemployment rate among college graduates (8.5%!!) to AI, which noted that “a further deterioration in employment opportunities… could have a disproportionate impact on consumer spending.” Each of my chakras switched on, like the lights on a pinball machine, from root to crown. I am levitating six inches off the ground and smiling with the serenity of divine wisdom when I tell you that this is what I was writing about over the last few days as I worked on this very issue of the newsletter. The scenario that Goldman describes in the report is what David Harvey calls the “contradiction between production and realization.” 

Here’s what that looks like. Employers want to appropriate as much surplus value as possible, so they do things like lengthen the working day and depress wages. This is Volume 1 stuff. Crucially, though, the commodities workers make also need to be sold and bought to “realize” the surplus value solidified in them through the labor process. If workers don’t have any time to buy things because they’re always working, or if they don’t make enough money to afford to buy things, then a huge part of the surplus value involved in the commodity circuit can’t be realized. This is Volume 2 stuff, one of many contradictions that capitalism, to use a favorite Marxist word, “internalizes.” If we think about the labor theory of value regarding these AI innovations, this contradiction takes on an obvious, and obviously self-annihilating, appearance. AI has very little labor content; it uses instead a lot of water and coal. It functions as a “good enough” replacement for human skills and labor in a variety of industries, but it degrades the real productive economy in the process. AI might help institutions meet short-term goals of downsizing and layoffs, but in the slightly longer term, by sapping them of the thing that creates value – labor – AI sort of vitiates these firms, rendering their products and services valueless. 

I’m bumping what I had planned to work on today, a bit of critical reflection on AI, in order to write this up instead while everyone is reacting to the CDC’s addition of a web page promoting long-debunked “information” about vaccines and autism. What follows isn’t going to be as thorough as the big thing that I have coming about MAHA, but it picks up on one strand of an argument I develop in that piece.

The new CDC website in question is here. The “key points” as they appear on the page now are as follows:

• The claim “vaccines do not cause autism” is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism.

• Studies supporting a link have been ignored by health authorities.

• HHS has launched a comprehensive assessment of the causes of autism, including investigations on plausible biologic mechanisms and potential causal links.

It has me feeling a bit like Bruno Latour in “Why has critique run out of steam?” Yes, be critical about how evidence is established, but no, not like that! Wellness grifters, Covid contrarians, and regulation slashers are very skilled at using the language of scientific process and evidence to nefarious ends. It works, because one has to be fairly literate, in the sense of understanding the technical nuances of that scientific process, to immediately get why something like the above text is so infuriating and bad-faith. This literacy is what I think some scicomm people believe they are imparting. A sample of some of the Bluesky Discourse about the addition of the web page: the CDC is “disseminating disinformation” (Yaver), “now directed to push disinformation” (Cruickshank), engaged in a “stunt” to “spread vaccine/autism disinformation” (Alt CDC) or, if you prefer, a “disinformation escalation” (Offir). The accompanying tone of moral outrage is also exactly what you’d predict. It’s “difficult to overstate just how dangerous this is” (Yaver), not that anyone will refrain from trying. The “vile dribble of a webpage update needs to be removed” (Alt CDC), it’s “intentionally weaponized eugenicist rhetoric that will kill people” (Tran), it’s “an incredibly sad and devastating place for our country to be” (Jetelina). 

I hadn’t planned on writing anything. I had a really busy October, I have been traveling, and yesterday and today I’m a bit thrown by a pesky head cold. But in light of said cold, and the fact that I’m takin’ it easy at work today, and the caffeine in the several pots of tea I’ve drunk so far, and Last Night’s Events, I figured now is as good a time as any to put down some of my scattered thoughts about the political moment. In short: it was a better night than I had anticipated. I did vote yesterday, to retain the PA Supreme Court judges, mostly because I’ve been getting annoying mailers telling me to vote the opposite way because of woke or some shit like that. I guessed that it was likely to be a low-turnout election, and therefore the rare off-year election that could matter. All the judges were retained. Zohran won, of course, as well as various Dem candidates and progressive ballot measures in several states. Permission to lib out has been granted in all corners, but at the risk of sounding glib, I want to interrogate just why permission to lib out is something we feel like we need.

Our years in the political wilderness have turned us idiotic. Take, for example, the asinine discoursing around the recent No Kings protests. My own community of Perfect Leftists, politics as uncontaminated by contact with reality as the interior of a chicken egg, ridiculed the protests as an always-already-aborted failed revolutionary moment. Which, I mean, it so clearly wasn’t. In actuality, in my opinion, the massive mobilizations were something like a union organizing “stress test.” If people were willing to show up to a rally – actually get out of the house, make a sign, find parking, and go to a march – what else might they be willing to do? But to see these protests as an opportunity for the left rather than a lib-cringe eye roll demands something of us that feels too expensive in the meager emotional environment we’ve all come up in: hope. Sincere optimism of the will. Belief that better things are possible and attainable.   

Hope is in short supply. We forget that it’s not just the right wing and Facebook boomers, that we too are inundated with slop and rotting our brains out with mindless consumption of memes. When you’re getting the majority or the entirety of your news from social media (which most of us are), you’re consuming an algorithmically curated feed of pictures with captions. You are not, to put it mildly, being invited to think. The Trump people are running his second administration like a reality show, and you, yes you, are falling for it. You’re not seeing all the defeats he’s being dealt because the producers of that show don’t want you to see them. And the result is that you’re feeling exactly how they want you to feel: depressed, defeated, fatalistic, and without hope; left-melancholic, in Benjamin’s terms (“precisely the attitude to which there is no longer in general any corresponding political action”). We’re serving the illusion of their power with our self-indulgent internecine competition to be teacher’s pet in Hell. This melancholy excuses us from having to actually think about the world as it actually is, something the platforms are all too eager to encourage.  

I don’t want anybody to miss the strong current of self-criticism here. I have been extremely wrong in how I personally have approached politics for the last ten years. Maybe that was fine in 2016 and 2017, when Trump was still fairly constrained by institutional and bureaucratic power, norms of governance, and even a Republican party that hadn’t been completely captured by his own people, but it sure feels foolish now. It’s important to own that feeling of foolishness, the real failures there, and my own sanctimonious leftier-than-thou refusal to engage the world on its own terms – what was it that leftist neckbeard dudebro said about not making history as we please? And speaking of those institutions and norms, another reliable source of eye-rolls, I want to mention something that has been little remarked-upon. The second Trump administration has been demolishing those institutions and norms as quickly and carelessly as the East Wing. That’s part of what makes the administration so scary, and it’s also part of what is causing the administration, and the party that is completely in thrall to Trump, to destroy themselves from within. There’s a sense, if we can squint at it right, that the Republican party has destroyed a lot of the norms and institutions that leftists wanted to overhaul through years of protracted and laborious reform struggle, and are destroying themselves in the process. (Seriously, Trump is going to die one day, and where do they go after that? Absolutely one hundred percent of the already small number of serious people are gone. Marjorie Taylor Green’s rebrand might be cynical, but it’s smart, she has a finger in the wind and can feel the massive and fractious backlash that is coming.) We again, if we can be smart, and flexible, and tuned in to what is rather than clinging to our wounded sense of what ought to be in a perfect world, might see an opportunity here, to rebuild from scratch what has been broken. Given the choice, wouldn’t we want to have “nothing changes and things get worse” as the worst-case, rather than the best-case scenario? 

Since I am a fool, I’ve been in the market to buy a house for a little while now. It’s simply not a good time to be doing so. My gripes with the Pittsburgh-area housing market are endless and specific, and tempered only by a vague understanding that it’s even worse in other cities. I simply refuse to believe that anybody would buy an aluminum-siding rowhouse in Bloomfield, carpets grubby with tobacco resin, for half a million or more. And yet, miracles do happen, new fools are born every day. I toured one place in a beautiful neighborhood that looked passable in the listing but in reality was drooping and cracking in unacceptable places, smelling like cigarettes and mold. In the basement, there was a spot of still-wet, freshly poured concrete on the floor, and a door to the backyard was, ominously and for no reason, left open, like a hastily-abandoned crime scene. As my friend’s Russian father sagely warns about sojourning in the real estate game: “Picture always look good.” 

At least I’m not the only one with real estate woes. Jax Taylor (Cauchi) and Brittany Cartwright are getting divorced, very messily and publicly on the reality show they anchor, The Valley. A principal object of contention, more so than their 4-year-old son Cruz¹, is the $1.9 million house in Valley Village the couple purchased in 2019. The Valley Village house is fairly typical insofar as it is not actually wildly expensive for the neighborhood and the square footage and honestly not that nice. It’s blocky and black-and-white, with a corrugated aspect that aspires simultaneously “modern” and “traditional,” as any House Hunters head can plainly see. It’s the kind of place that would have those Chip and Joanna-ass sliding barn doors, if it had any interior doors. The space inside is, instead, loosely divided into two open concepts. There’s no way to describe the style of the  interior other than “California fugly” (excuse me, “modern farmhouse”). There’s cheap laminate floor in a blond shade that faintly recalls Scandinavian wood. The walls, and indeed the entire color scheme, are white and gray. There is shiplap (white). There is herringbone tile (gray). The gigantic television in the living room area is tessellated into a confusing pattern of irregular square and rectangular shelves intended to evoke bookshelves but meant to hold only pictures and tchotchkes – there is only one book in the Cauchi house, whose spine reads simply “LOUIS VUITTON.” There is a massive sectional couch encumbered by heavy pillows which have to be tossed over the back (according to Brittany) in order to sit down; Costco-sized white and gray with an occasional commemorative one (“Mr. & Mrs., est. 2019”) in the mix. The front of the house, rarely photographed, is an untouched liminal space. I think maybe there’s a dining room table in there. Various placards made of garish fake wood welcome you to the “Cauchi homestead” (abandon all hope, ye who enter here… ) but the true décor of the house is Amazon boxes. 

A few years ago I took a cursed family trip to California. We stayed in an Airbnb in the Valley in what turned out to be a learning experience for me. The abundance of sunshine in California makes a bubbled white paint-and-laminate shanty look passable in photographs even when it’s chintzy, and cheap in real life. In Pittsburgh, it takes creative subterfuge to make an ugly house photograph well; strategic placement of warm incandescent lights and inviting clutter, plants best of all, is a good strategy. Frederic Jameson writes that the postmodern “appetite” for architecture is really the appetite for photography, and that’s certainly what Jax and Brittany’s house is made for, photography and its grotesque, hyperreal cousin, reality TV. The big open TV/kitchen space can accommodate cast and production crews; we know Brittany’s not making her Mamaw’s infamous beer cheese in there, but she can stage the types of day-drinking bacchanals that the production teams set up to provoke filmable conflict. The space is also a perfect anonymous backdrop for “content creation.” During the pandemic, Brittany fought her way up through the DIFF Eyewear trenches (harder than she fought on Special Forces) and into paid partnerships with real brands like Jenny Craig, who partnered with her to chronicle her postpartum weight loss journey. This is interesting, because said weight loss journey was at once a focal point of Jax’s emotional abuse and what enabled her to become the family breadwinner. Both Brittany and Jax have openly acknowledged this role reversal as a major contributing factor to the end of their relationship.

A recent book by an economics professor named Corinne Low (Having It All: What data tells us about women’s lives and getting the most out of yours) puts a Freakonomics-style spin on the political economy of marriage. I’m ignorant of most of the book’s contents and not that interested; I mention this just to say that even the economists have realized that the social role and sign value of marriage no longer correspond even remotely to the structure of emotional, legal, and financial commitments it entails. Everyone is subject to these forces of dissolution, isolation, and “male loneliness,” but their effects are extremely amped up with Jax and Brittany because they are reality stars, and because Jax is horribly, cartoonishly evil and unredeemable – his performative stint in “the facility” for coke addiction and rage issues on the latest season of The Valley being one of the least damning things we’ve seen him do in his reality TV career. I’ve been rewatching Season 6 of Vanderpump Rules (I basically continuously watch Vanderpump Rules chronologically in a continuous loop, starting it over whenever I finish) – the one that starts with the shocking revelation that Jax cheated on Brittany with a coworker and friend, in front of the hospice patient (?) said friend was taking care of, and ends with Jax’s proposal at Neptune’s Net and Brittany’s triumphant acceptance of her reward for years of suffering and humiliation in the role of Jax’s Serious Girlfriend. A less determined woman would have left him, but Brittany held out, and we know it wasn’t only for love; she needed him to get certain things – a role on the show, a job at SUR, partnership deals, the ring, the wedding at the Kentucky Castle, the house, the son. Now, she doesn’t need any of it anymore, least of all his abysmal treatment of her. And it’s all playing out in their house (on film) and through their house (which is in a complicated tax lien situation due to Jax’s petulant nonpayment of the mortgage). 

I have to be off of social media for extended periods of time for various reasons of mental and emotional hygiene. Everything on the internet, as they say, is designed to upset you. Bluesky is the worst of all. I’m sorry. I guess it’s better than Twitter in some important respects, especially recently, but Twitter at least used to be fun. Bluesky is just a really efficient machine for inducing psychosis and suicidality. Thinkpieces have been written about how rancid the vibes on Bluesky are, how humorless and literal-minded the posters, how grating and unrelenting the discourse. A huge part of this that hasn’t received as much attention, as far as I have seen anyway (admittedly not far), is the absolutely degraded form of pseudo-political doomposting that dominates the platform and what its popularity might mean. Like it or not, a lot of people spend a lot of time online. It may be finally time for a serious reckoning with the phenomenon of Posting. 

Authoritarian creep is tending to blur the distinctions between leftists (who learned the politics from posting) and liberals (who learned their politics from MSNBC and posting). There’s also a real equivalence emerging at the level of discursive form if not necessarily content. It’s impossible not to notice (by “notice” I mean register instantly as crushing depression) that, at the level of posting, which is to say the way that most people “engage politically,” libs and the left are doing the exact same maneuver, regardless of what specifically they’re talking about. The maneuver is to identify something emblematic of a contradiction in capitalism, to point at it and to go “Look! There’s a contradiction here! And it’s Morally Bad!” Which, you know, it is. And I think I understand why this tendentious exercise has basically replaced the practice of critique. It’s because of posting, the “success” of which depends on provoking extreme emotional reactions. The platforms all do and exploit this in one way or another. You can tell yourself you’re doing it more leftistly, I guess, or in service of some greater goal. But if you’re creating content at all, if you’re posting at all,  you’re playing the game, and that’s all.

The stakes of the game are dopaminergic and emotional. The game drives the formation of political opinions and ideas, hence the devolution of sensible critique into reflexive lizard-brain moralizing and take-farming. Frederic Jameson called this kind of approach (offhandedly) the “wages of sin.” Writing of postmodernism (as he so often did, amirite?), he said that conceptualizing the phenomenon of postmodernism in terms of moral judgments is a category error – that is, if we are trying to think of postmodernism as a historical phenomenon, which is to say dialectically, and not as the appearance of evil in our day. It brings me no pleasure to say this, but I think the left in America today is too integrated into the circuits of emotional valorization to move away from this voluntarily. As far as I’m aware, the CIA doesn’t sponsor critical theory conferences anymore, and so entire livelihoods are sustained by rehearsing the appalling moral badness of the contradictions confronting us today, for audiences (not for peers, comrades, or organizations). These audiences ask nothing of critique but to be validated in their emotions, presuppositions, and resentments. Intellectual culture is so degraded that people engage Marxism as content and consume leftist podcasts and short-form videos explaining progressive ideas as therapeutic “comfort” material, no different than a season of The Office. Except the comfort is in feeling bad, not good; since no other game with no other stakes is conceivable in the leftist imagination, saturated as it is with sponcon and fearful as it is of ritual group denunciation and tattling, it is possible to construe subjecting yourself to moral condemnation of upsetting news as ascetic revolutionary sensibility. 

But the actual point of critique, I still insist, is not to correctly identify how horrible the contradictions are and wallow in moral righteousness like a pig in shit. The point is to identify the productive, or potentially productive, aspects of the contradictions within the present situation as well as the destructive ones. This is the only point from which an intellectual project capable of informing a real praxis of mass politics can possibly proceed. We are stuck, in other words, because we are materially and emotionally (one and the same online) committed to a dead-end, undialectical analysis. To quote liberally from Jameson: 

Forgive us our debts

“Now watch this drive.” - George W. Bush, 2002

I was in eighth grade on the actual 9/11. I was in school that morning. We started watching it on TV as soon as it happened, and we watched TV all day long. (My parents are not the kind to pick me up from school early, 9/11 or no 9/11.) We kept watching TV at home. We ate dinner – watery spaghetti with the last mealy few of the August tomatoes – in front of the TV, the only time I can remember doing that before or since. Sometime that evening, I started clocking the same clips from Manhattan re-running back to back on a ten-minute loop. I knew they were important images, but truthfully, they were no more alarming than any blockbuster preview. They were moving, but silent, without any diegetic noise; just the cable hosts’ repetitive vamping.

Sometimes, when I feel like putting myself on a really bad trip, I watch videos on a YouTube channel called “EnhancedWTCVideos.” The 9/11 captured in these videos is different than the “real” 9/11 as I remember it actually happening (on TV). “Content” is an anachronistic term – the fruits of the dot-com harvest cycle would have to ripen and rot for content to cohere as the form that we recognize today – but with 25 years of hindsight and brain-corrupting internet addiction, I can definitely recognize the real 9/11 as high-production-value content. The videos on EnhancedWTCVideos, on the other hand, have a Warhol-like fixity and steadiness, an attention span that feels endless today. Twelve minutes of smoke pouring from the flaming gash in the North Tower, randomly zooming in and out on a shaky handheld camcorder. Twenty-five minutes, forty minutes, of the struck towers, and the confusion on the street. The original, diegetic audio is the most striking difference between these videos and the real 9/11 that I remember and will Never Forget. Listening to the stifled pandemonium of people’s real-time reactions makes it impossible to “watch” 9/11 the way I’m accustomed to watching it, cinematically. It puts the televisual experience just a hair closer to the on-the-ground experience. Much that is left to the imagination in the official cut is no longer left to the imagination, some degree of televisual distance is collapsed, the emotional tone is several shades darker. EnhancedWTCVideos adds some of the reality back in to what most of us experienced, “for real,” as a televisual spectacle already edited and processed to fit between commercial breaks, delivering, using Baudrillard’s terms from The Spirit of Terrorism, the frisson of reality superadded to the image. But this dose of reality is not clarifying. Nothing is learned or revealed. 9/11 is so fascinating, and so perfectly postmodern, because it stubbornly confounds and elides representation. Even unedited video recordings of the event as it transpired somehow obscure it. 

In the hopes of feeding my brain some more, to better think through something I’m trying to write about MAHA for a non-newsletter project, I started reading Klaus Theweleit’s Male Fantasies last night. More accurately, I read most of Barbara Ehrenreich’s forward to Vol. 1 (of 2). I didn’t even make it all the way through the introduction before realizing, with nausea rising in my throat, that I wasn’t going to be able to read the book, which promised to be unflinching and outright gory in its depictions of the Freikorpsmänner of interwar Germany and their exuberantly gruesome violence. Not right now, maybe not ever. It’s not a total loss of effort, though, because some of what Ehrenreich wrote in the forward is still useful.

The blurb on the cover of my edition is from her introduction. Her interpretation of Theweleit’s volume as a “theory of fascism” is that “the fascist is not doing ‘something else,’ but doing what he wants to do [emphasis mine]... He [Theweleit] forces us to acknowledge that these acts of fascist terror spring from irreducible human desire.” This is a bit of a welcome challenge to me. I’ve been working with some of Wilhelm Reich’s insights from The Mass Psychology of Fascism in an attempt to reconcile the overtly irrational parts of MAHA – why do people vote for, work for, and indeed desire political movements that are contrary to their best interests, or actively and obviously harmful to them? Reich’s answer to this, surveying the population-average German fascist, is that fascism offered people satisfying emotional resolution for the intractable and intolerable contradictions plaguing their real lives, political, economic, and psychological. 

So I appreciate the challenge to hold the possibility that this – even the misery and abjection of the MAHA movement, the vaccine-preventable deaths and miscarriages induced by raw milk, the humiliating gross-out extremity of the disgusting and venous Liver King and the influencers who film themselves blitzing raw chicken in a blender and drinking it – is indeed what these people actually want. I have no doubts about the sincerity of their beliefs, beliefs that, say, getting absolutely diabolical diarrhea or a high fever after consuming raw organ meat is actually a sign that one’s body is purging “toxins,” that vaccines are chock-full of these “toxins,” and so on. I understand that such beliefs are durable against even hard indicators of lived reality, like the finality of a toddler’s unnecessary death or a brush with hemolytic uremic syndrome. I think this durability has several headsprings, one of which is the rationalizing powers of the mind, another of which is the “distrust” that is so in the news these days – and the unfortunate reality that there are many countable instances where health officials and health professionals were, in fact, lying to their patients or the public out of venal self-interest. Once again, this is why I’m inclined to believe, as Reich did, that something about the persistence of these beliefs in the face of incontrovertible contrary evidence is down to the emotional resolution they offer for intolerable material conditions for which there is no effective political recourse. But of course, I should be keeping in mind that perhaps what these folks want is no more complicated than to drink sewage and let their children develop scarlet fever, that there’s no symbolic or “acting out” dimension, that this all is, like the Freikorpsmen’s violence, in fact the entire point. Let ‘em all eat shit and the strong will survive. 

But your average German fascist was not a Freikorpsman, and I’m not at all sure about the “irreducible human desire” for fascism or violence. This is straight out of Guattari’s “micropolitics of fascism” (Ehrenreich does indeed talk about Theweleit’s work in the terms of Deleuze and Guattari, the desiring production of violence), which I appreciate, but I’m just not sure there’s an irreducible human desire for anything.* To call the Freikorpsmen’s violence an irreducible desire is to transhistoricize it, as Guattari seems to (as always with him, it’s really hard for me to tell what it is that he’s actually trying to claim), and to make a quite strong case about human nature, as I think I’ve said before on this newsletter or elsewhere. It is to situate the force of explanation for organized political violence in this human nature, where I think it’s actually a good deal more malleable, and more in reciprocal relation with social structures. The central problematic for Ehrenreich reading Theweleit is how the hatred of women – also assumed to be primordial, deep-seated somewhere in human nature, rather than socially constructed and reinforced – gets alchemized into organized fascist violence. Does she really believe this? As she herself writes in the introduction, if you’ll indulge me in quoting at length:

Does anybody on the left care about political economy anymore? Two things I’ve been reading lately put the question in my mind. For one, I started Richard Beck’s great book Homeland: The War on Terror in American Life; as a consequence of Beck’s argument about the political-economic basis of the GWOT, I then started Piketty’s Capital in the 21st Century, a second- or third-hand copy of which has been languishing in the corner of a cobwebbed bookshelf in my office for some months now. Beck’s thesis is that stagnating global economic growth since the 1970s poses a lot of economic and political problems (to put it mildly), and that the GWOT was one way – though certainly not the only possible way – for the USA, as the global hegemon and steward of the international economy, to manage those problems. Piketty’s book focuses on the form and dynamics of capital in this same context of stagnating global economic growth. His general argument is that there are tendencies internal to capitalism that narrow inequality, like diffusion of skills and knowledge (forces of “convergence”) and tendencies that exacerbate it (forces of “divergence”). The most important force of divergence for Piketty is the “capital/income ratio,” the amount of privately held capital as a percentage of national income.* Crudely, when the rate of return exceeds the rate of growth, this balloons the capital/income ratio, which drives inequality. I juxtapose these two here just to emphasize the political economic mode of reasoning – there are deep structures and logic to capitalism, as a dynamic and complex global system, and these shape but do not fully determine the landscape of political realities and possibilities at any given time at all levels – international, national, and sub-national. 

Beck’s argument was so forceful because, being a Literate Leftist myself and consequently sequestered in the dumbest possible corners of the discourse, I have gotten so used to people talking about economic growth like it’s merely ideology. All you have to do, to be a serious leftist, is skim some of the rhetorical scum from the stock pot and run with it – to talk about growth as if it’s only considered the criterion of economics and economic performance because it serves the big bad capitalists’ interests and flatters the ideological priors to do so; to dismiss growth as one more ideological bogeyman used to instill the false consciousness that we must live in a capitalist economic system. There’s one major problem with this, though, which is that we actually do live in a capitalist economic system. Whether we should or not, and whether we like it or not, we are living in and dealing with capitalism, and growth is important to capitalism. (It’s right there, in fractal form, in the valorization imperative, M must become M’.) There is a hugely important material basis to what growth is, and its determining relationship to the dynamics of capital and labor, of who gets what and how much, to the texture of what everyday life will be like for the people on earth, to the conflicts that this generates, and to the geopolitics that arise to manage all of it. Growth is a deep determinant, and its tendencies derive from the deep internal structure and workings of capitalism as a world economic system.

But we don’t talk about any of this! Much less try to think concretely about what any of it might mean for the only question of any use and interest to a working class or leftist politics, which is: what does power look like, and how do we get some of it? This was visible during the recent lead-up to the passage of the OBBBA, the “opposition” to which was a lot of posting, a lot of Refusing and Challenging Logics, a lot of Visioning Alternative Futures, a lot of discourse, and very little by way of mass politics. Most of the people I know are leftists, and I can count on two fingers the people that are doing anything on the level of mass politics around health and health care. Piketty is right that something like a global progressive tax on capital, which would work to flatten out the corrosive inequality that is everywhere growing, is very unlikely to happen given the scale of international coordination it would require alone (not to mention the scale of unified opposition it would face). That is not a defeatist statement, it is valuable information informed by an intuition for the structure and dynamics of capitalism. Given that such a global action is vanishingly unlikely, what are prospects for national-level policies to redistribute some of the resources that are currently locked up in private capital? Or, even more ambitious but still within the realm of possibility, what are the prospects for national-level politics that will create more favorable conditions for a slate of policies and approaches to dealing with the capital/income ratio, or overhauling the health care system such that wealth redistributed into it is spent on actually caring for people? 

There are a variety of tactical approaches to take here. All I am suggesting is that we might think about it, and when I say think, I mean really think. I am deeply fucking burned out on any kind of political work or organizing, which I know is supposed to be no excuse in today’s leftist culture, but it’s the reality. I’ve also been reflecting, via the unintended consequences of my Covid “work,” on the high costs of misreading or misunderstanding the power coordinates of the moment. As Colin pointed out recently, talking about the opportunist lackeys staffing the health agencies (Jay Bhattacharya, Vinay Prasad, Marty Makary) – these people started out fringe, and gained their notoriety and national profile as posters, which is to say, in pitched and combative argument online with people like me and Colin, who were in general pretty misguided in thinking we could defeat by out-arguing. How much we realize we’re participating in creating the spectacle that drives the outrage cycle that the right (not the left, not so far, anyway) is able to alchemize into real political power – how much we realize what we’re doing probably varies from person to person, and from situation to situation, and of course hindsight is perfect, but I’m tired of it. To say the least. 

One of the boulders that I am most commonly pushing uphill in my statistical work for clinicians is the recognition that missing data can be meaningful, depending on how they arise. This a subroutine of a larger program, one in which I aim to impart some kind of coherent global understanding of What We’re Doing When We Do Statistical Inference. This global understanding involves much more than just the internal mechanics of statistical estimation (t-tests and regression coefficients); it involves thinking about data distributions, how they arise, and the patterns of missing within them. In short, it involves thinking a bit more like an epidemiologist, and the way I phrase it is always some variation of “it’s more of an art than a science!” in a fake-ass chirp that gets me, more often than not, a vacant Gen Z stare. 

The epidemiology jargon for the categories of missing data is murderously stupid and confusing (“missing completely at random,” “missing at random,” “missing not at random”) and so I completely avoid using it. It’s easier and more clarifying to talk about mechanisms of missingness. Most of the data we analyze is collected observationally, which is to say, without an investigator controlling the experimental conditions and assigning an experimental treatment to different subjects at random. Usually, we’re just passively collecting data on people as they do stuff, making note of important characteristics, like exposures they might have that we’re interested in, clinical outcomes, demographic and social characteristics, and so forth. It is often the case that some of these data are incomplete – missing. This could be for completely meaningless reasons, like somebody just forgot to enter something, or a random Excel error turned a couple of fields into unreadable nonsense. Or, it could be for reasons that are, as we say, “systematic,” related somehow to the characteristics of the populations under investigation. 

Not knowing why the pattern of missing data looks the way it does can introduce serious bias when, in Doing Statistical Inference, we’re using the tools of statistics to estimate the magnitude of association between an exposure and a clinical or health-related outcome we care about. Here’s an extremely basic example. Say we want to estimate the association between a certain type of exercise and a cardiovascular disease outcome. If participants in the study with worse cardiovascular problems or general health to begin with are unable to complete the exercise, their data for the exercise field will be missing, and – if the investigator is not careful – these folks with missing exercise data will be grouped, in the analysis, with the people who could have done the exercise, but didn’t. In this case, the estimated association between the exercise and the cardiovascular outcome will (likely – it depends) be understated. 

There’s a bit of a wrinkle here. The distinction between “missing at random” and “missing completely at random” in the epi jargon (ugh, it’s so horrible) has to do with whether you can use the information that you do have in the data set you’re using (what we call the observed variables) to generate a reasonable estimate of the probability of missingness. So in our example, if we had collected information about the severity of existing cardiovascular disease, we could use that to predict whether the exercise field would be missing for a given participant. If we hadn’t, then we’d be out of luck; the exercise data would be “missing not at random.” (Various strategies for dealing with this exist, which I won’t get into here.) Crucially, this little illustration raises some general issues about what you can tell about the mechanism of missingness from within the data itself, versus what you can infer about the mechanism by looking outside the data. Investigators I work with constantly want to do formal statistical tests that will give them a p-value to decide whether their data is missing completely at random, at random, and not at random, but I never promote or encourage these tests, because the closed system of a data set and the variability therein is not really all that informative as to why certain patterns of missingness are what they are. Sooner or later, you’re better off supplying some kind of outside-the-data explanation, even if it’s just educated conjecture.