I often hear “public health has failed us” bandied about in the discourse these days, axiomatically, and usually in response to COVID policy. While I agree in broad strokes, I think the circulation and repetition of this phrase implies a coherence to “public health” that public health simply doesn’t have, and — as I have perhaps mentioned here before — assumes the existence of a golden era of public health at some point in the past where public health was “succeeding.” I don’t think there has ever been such a golden era, and I think it’s really, really worth thinking about what it means for public health to succeed. What does success in public health look like?

For some reason, I still get the Morbidity and Mortality Weekly Report emailed to me. My curiosity was recently piqued by a report of travelers returning to the US from Brazil and Cuba with something called “oropouche virus.” I looked it up. I suspected mosquitos and while mosquitos can transmit oropouche, its main vector is actually biting midges. I don’t know exactly what those are, but sounds bad?

The symptoms of oropouche are reportedly similar to those of mosquito-transmitted viruses like dengue (called “break-bone fever,” to give you a sense of what dengue is like), chikungunya (which was, confusingly, called dengue for a long time; after being absent from the Americas for roughly 200 years it was detected again in 2013 in St. Martin), Zika (which you may remember from the epidemic in 2015-2016), yellow fever, and malaria. These are predominantly transmitted by two Aedes mosquito species, Aedes aegypti and Aedes albopticus, which are both present in the United States and whose geographic ranges (where the conditions are favorable for them to reproduce) are expanding as climate change heats up the country.

Anthony Fauci just had West Nile, another mosquito-transmitted virus. This one is transmitted by Culex pipiens, which are all over southwestern Pennsylvania; every year since 2002, my county (Allegheny) has reported cases of West Nile in humans. Fauci was hospitalized with the virus, and described the experience as like “being hit by a truck.” The symptoms, again, are similar to other arboviruses (viruses that are spread by arthropods, a.k.a. insects, like mosquitos, ticks*, and — ugh — midges): headache, nausea, joint pain, fever, encephalitis or meningitis in severe cases, fatigue that can last for weeks or months after acute infection.

“All models are wrong, but some are useful.”

Are the Pandemic Mitigation Collaborative models — which are wrong — useful?

I wrote a post about this already, about the wastewater-to-cases conversion that the model purports to do; I found this to be extremely unconvincing, to say the least. Here, I want to get a few quick thoughts in about the forecasting model. A new version of the forecasting model launched today. Here is Dr. Hoerger’s X post about it. The only thing that is different is that the underlying data sources have changed; instead of relying exclusively on Biobot wastewater data, they are now relying on Biobot and CDC wastewater data. According to the post: “Essentially, we link all three data sources, which have been active over different points of the pandemic to derive a composite ‘PMC’ indicator of true levels of transmission.”

These three sources are, again, Biobot and CDC wastewater data, and modeled IHME case estimates from prior to April 2023. No matter which way you slice it, this is not good data; converting wastewater to cases remains impossible to do reliably, and the PMC do not have access to any actual “ground truth” data about COVID transmission. They are as in the dark about it as any member of the general public. Claims about the greatness of the data are simply exaggerations. I remain skeptical that reliable modeling of wastewater concentrations to daily new cases is even possible, let alone forecasting based on those new case estimates.

Did you all know I have a radio show? I do. (A show on college radio: the hallmark of someone whose Life Is Going Well.) You can listen to it live on Thursdays at 11 AM EST on www.wrct.org — though a fall semester time change is likely and imminent — and listen back to the most recent two episodes here. Our cursed DJ software only keeps recordings for two weeks; I am one day going to figure out how to record my broadcasts and upload them somewhere for posterity, but for now, you’ve got to catch them while they’re (relatively) fresh.

I jokingly called today’s show the “vagus nerve regulation mix.” I put it together yesterday when, instead of pushing myself through a fug of stress and depression-induced mental chaos to make mediocre edits to my book proposal, I decided to try to just listen to myself and accept how I was feeling. I went for a walk in the park instead of procrastinating work, and composed the mix while I did it. I listened to it on my way home and laughed to myself a little bit because I had clearly made it to chill myself out. (I usually play blistering psychedelia and Steely Dan deep cuts.)

Hence the vagus nerve stuff. Vagus nerve regulation is a deeply silly area of new age healing horseshit and one that is a perennial joke among my friends, many of whom work in mental health and think this shit is a big eyeroll, and I. The “vagus nerve” is actually two big branching nerves that regulate your parasympathetic nervous system (the cooling one; the activating one is your sympathetic nervous system).

Like many obscure psychiatric concepts that are being chopped up, recombined, and disseminated on social media platforms, the vagus nerve bullshit is based on so-called polyvagal theory, proposed in the early 1990s by a psychologist named Stephen Porges. I’m in a hurry, so instead of going over the components of polyvagal theory and why they’re wrong, I’ll just refer interested readers to this article from last year. TL;DR, it’s a mess in there, a real hash of galaxy-brain evolutionary psych bogus and incorrect neuroscience. Everybody knows this is bullshit, except for Bessel van der Kolk, who everybody loves to dickride because of The Body Keeps the Score. Some day I would like to do a really deep dive into this stuff — the trauma-industrial complex and the suite of associated MLM scams you can enter into to receive “therapies” for diffuse “traumas.” But I’m just one lady being nibbled to death by work, family, and social responsibilities right now and this is a free newsletter — you get what you pay for, at least until I find my Engels.

* Many thanks to Nate Holdren for his feedback on this post. He does a companion newsletter to mine which you can read and subscribe to at: https://buttondown.email/nateholdren.

* Also, a disclaimer at the top: I am no longer affiliated with Death Panel and none of my views expressed in this newsletter reflect the views of the show.

“Catastrophe — to have missed the opportunity.” - Walter Benjamin

A short disclaimer about Death Panel up top: I am no longer affiliated with the podcast. The TL;DR is: my views do not reflect the views of the show, don’t harass them if you don’t like this post. Don’t harass them if you do, either. Basically, don’t harass them at all. If you have any feelings about the podcast in relation to this post, I encourage you to go subscribe to the show, or write an entry in your journal about how much you hate my guts, or both.

The aim of this post is to give you, the reader, some tools to understand what you’re looking at when you see figures and estimates from the Pandemic Mitigation Collaborative (PMC). If you are online at all, you have probably seen these figures and estimates, as I have many times (just in the past few days, I have seen this model cited in outlets as diverse as the World Socialist Web Site, Current Affairs, Self Magazine, and People Magazine). Before I launch into my detailed critique of the model, a few general considerations. In my opinion, it is not “COVID minimization” to want to know the truth about COVID, to want other people to know the truth about COVID, even when this truth is less comforting than fabricated certainty. People have a lot of different ideas, some unconscious, about how scientific claims translate into political or social activity, or change in “the real world.” I think exaggeration and outright fabrication of claims about COVID, its impacts, and the level of transmission currently underway in the country right now correspond to a well-meaning but (in my opinion) incorrect theory of change – the idea that if enough people understand how bad it is, some kind of corrective action will be taken (just look at climate change). If the idea is to use scientific data to develop programs for political organizing, it is crucial to subject the truth claims supported by the data to verification.  Organizing that is built around incorrect interpretations of scientific data is self-undermining, sooner or later. You don’t need to agree with my critique or my analysis, because the point is not that I have some kind of correct answer or magic bullet (one weird trick to solve the pandemic!) that other people don’t. I’m making this critique because it is part of my praxis as a leftist and a scientist to subject scientific claims with political import to scrutiny. That’s it. 

Proper identification of the problem is key to strategizing about the problem politically. “I have to wear a mask everywhere and individually take on the burden of COVID precautions because COVID is airborne HIV and it is surging out of control worse than at almost any time previously” is a different articulation of the political pickle we are in now than “I must always assume the worst and individually take on the burden of COVID precautions because we have only very vague and belated indicators of where the virus is spreading thanks to the federal government’s abandonment of COVID monitoring.” If the idea is to make continuing or reinstating COVID precautions seem reasonable, I think a more effective way to do that is to emphasize the uncertainty people are being forced to live with rather than asserting a false certainty that things are secretly much worse than anyone knows. To be extremely, excruciatingly clear, I have no issue with people continuing to take whatever COVID precautions they can. I even think it’s a good thing to take COVID precautions right now and in general (I’m an epidemiologist, after all!). At the same time, a lot of the precautions discourse (much of which hinges on things like estimates from the PMC model) smooths over how burdensome and outright impossible it is to access “the tools” at this point in time. Masks are really expensive, and people are really broke. I was trying to find rapid antigen tests in the grocery store the other day and straight up couldn’t – four grocery stores, two drug stores, and half a tank of gas later, my friend came through in the clutch with some tests he had at home.  

Finally, I am absolutely not saying that COVID infections aren’t up or increasing right now. From where I live, and from my anecdotal experience, it is clear that COVID is on the rise again. Just how much is unclear, and this is the crux of the problem. I look at my local county health department website and see that cases are increasing in recent weeks, but still lower than cases during this past winter; I don’t know if this is because transmission is really lower, or because more people are asymptomatic, or because more people are doing rapid antigen tests or not testing at all. It’s probably some combination of the three, which is all I can really say – and that is a problem. 

I actually started writing this yesterday morning, before someone tried to assassinate DJT at a rally in Butler County, PA (about a 45-minute drive from where I live in Pittsburgh). I have a lot of thoughts about what this means and what is going to happen from here (none of them involve rosy predictions for the future of the US left) that I am not going to elaborate on. Instead, I’m going to present the post below, which I do think is deeply relevant both for how we think about the recent past and how we should strategize about the future.

I’ve been reading (listening to, more accurately) Vince Bevins’s new book If We Burn: The Mass Protest Decade and the Missing Revolution on the recommendation of a friend. There are several interesting things going on in the book, one of the most bracing being its frank confrontation of something that I have wondered through countless grueling political and organizing experiences: what the fuck are we actually doing here? Bevins examines, obliquely but effectively, the deep structuring effect that social media has had on the mechanics of street protest. (McLuhan is right — the medium is the message. More than that, the medium is the tactic, which in a lot of US left-wing formations and movements has completely displaced the idea of strategy. I’m sure I don’t need to tell you this, I’m sure you’re already familiar with “street contention” — Bevin’s great term — optimized for engagement. I can think of dozens of examples of this but one that sticks out in my mind is the response of the politically and ideologically vague, but vaguely left-wing, American Jewish group If Not Now to the Trump administration’s scandalous mass imprisonment of migrant children in 2019. Pick a target — just about any will do — recruit some people, stage a sit-in, make sure to livestream it, try to get arrested, end the livestream after the arrests.) Related to the replacement of strategy with tactics, I think there is something going on ideologically here as well.

[Here, I had written several paragraphs about my experiences in protest movements and various forms of organizing over the decade that Bevins covers. Maybe some other day, or maybe I’ll save these for another post about Hannah Proctor’s Burnout, or The Romance of American Communism. Hah. I will speak in generalities below; these generalities are informed by the particularities of my experiences which, of course, are not universal. I make no claim that they are. Moreover, everything I criticize below, I have done and taken part in myself. This is self-criticism as much as anything else.]

An idea of Lenin’s runs through Bevins’s book like a golden thread. This idea is usually read through the caricature of Lenin as “against spontaneity” and indeed there’s some truth to that (Rosa Luxemburg ably criticized Lenin’s stance in The Mass Strike). But Lenin is, unsurprisingly, correct. He argued in What Is To Be Done? that, as Bevins paraphrases, spontaneous uprisings will take on whatever ideology is “in the air” around them. (Rosa Luxemburg, as I understand her argument, which it has been several years since I’ve read, asserts — also correctly, in my view — that quasi-spontaneous uprisings are the form of motion of the proletarian masses. Interesting!) This, as Bevins’s book documents in contemporary example after contemporary example (mercifully few of them based in the US), is how big uprisings can create power vacuums, how the incredibly abstract and heterogeneous “demands” that issue from such uprisings are susceptible to appropriation, perversion, and to stunning reversals of momentum and fortune.

Hello everybody, just a quick note at first because there are some new people here. Welcome! I hope you like my silly posts. If you are new to me, I am an epidemiologist (by training), a statistician (by profession, reluctantly), and a longtime leftist (by an inborn tendency to masochism, I guess). I am working on this newsletter as part of a long and open-ended collaboration with Nate Holdren developing a theory of social murder in service of a Marxist analysis of COVID-19 and public health more generally. I am also in the proposal phase of writing a critical book about statistics — the idea, at this point, is that it will teach you some statistics as it simultaneously teaches you to hate statistics. Fun! You may send me distance reiki, good vibes, prayers, incantations, and whatever other psychic tokens you’d like in support of this. Whatever.

I mention these two strands of my “work” not only because there are some new readers here, but because the two converged in a project I worked on in my day job recently. The details of the project aren’t important; what is important is that it was a data analysis related to the surgical treatment of carpal tunnel syndrome. You’ve certainly heard of carpal tunnel syndrome — remember Janice’s carpal tunnel from pulling espresso shots in The Sopranos? I was interested to discover, in the course of the project, that there actually is no “gold-standard” diagnosis for carpal tunnel syndrome.

The carpal tunnel is the name given to the little lacuna in the bones and ligaments, located on the palm side of the hand, that the important “median nerve” passes through to connect the hand to the wrist. Carpal tunnel syndrome is one of a number of so-called “repetitive strain injuries” and is most often caused by — you guessed it — repetitive hand motions that can cause the carpal tunnel to narrow, pinching the median nerve, causing a number of symptoms like pain, numbness and tingling, and in many cases resulting in inability to use the affected hand.

A random book I picked up recently from a used bookshop — Allard E. Dembe’s Occupation and Disease: How Social Factors Affect the Conception of Work-Related Disorders — devotes nearly a hundred pages to carpal tunnel and other “cumulative trauma disorders” (another, more vague, term for “repetitive strain injuries”). I have not finished reading this chapter, but two interesting aspects of the book are already apparent. First — I will take this back up shortly — how the politics of scientific evidence come into play in instances of complex causality. Something like the loss of a finger is causally straightforward. Second, repetitive strain injuries have been recognized since, literally, antiquity (not Hippocrates describing the arm paralysis of a worker long engaged in twisting twigs!). Unsurprisingly, repetitive strain injuries of the hand, wrist, and arm exploded with the industrial revolution and corresponding increases in repetitive, mechanized factory work and also the associated clerical work required to do capitalism. “Writers’ cramp”: worse than it sounds.

Good evening, sickos. I hope Pride month has been treating you well and that everybody is staying relatively safe out there. I am (finally!) firmly into the heave-ho portion of trying to get two big writing projects off the ground; it’s going well, but it eats a lot of time even as it gives me a lot of good ideas for shorter newsletter posts and things like that. As part of this reading, I’ve been deep in Foucault on biopower and population for the fifth or sixth time in my public health career. (Nate wrote an excellent post touching on biopolitics here.) I want to get through the minimum about of theory necessary, as quickly as possible, in order to get to my point.

Basically (and this is very hard to summarize because, as a friend of mine recently put it, Foucault’s “archeological” method means that the history is the argument, which makes it almost impossible to extract terse little nuggets of insight from his texts or lectures) Foucault charts a “dual seizure of power over the body” in the seventeenth and eighteenth centuries. The first movement he traces is what he calls disciplinary power, a power of the individual body. Schools, prisons, barracks, hopsitals… all the classic Foucauldian disciplinary institutions have as their goal the inscription of control in the smallest movement, the most minute gesture. In school, you are being disciplined to sit quietly for long periods of time, to look like you’re paying attention (even if you’re not — I know most people can relate to this). Discipline and Punish, his book-length treatment of this phenomenon, spends as much time on the extreme exactitude of the techniques of French military training as it does on enumerating the exquisitely barbaric medieval tortures corresponding to the right of the sovereign (the monarch) to take life. Foucault eventually (in a series of lectures at the Collège de France in the late 1970s) calls this an “anatomo-politics of the body.”

He also charts another kind of power that emerges a bit later, in the second half of the eighteenth century. This type of power is not disciplinary, it is regularizing. It’s not concerned with disciplining the individual body, optimizing the productive discipline (for education, for industrial work, for martial purposes) that can be wrung from an individual body. This type of power doesn’t care much about the individual body at all; its object is, instead, the population, the mass of individual bodies. This type of power sort of lets the chips fall where they may in terms of what happens at the level of this or that individual body; its explicit concern is the management of the population at the population level — birth rates, endemic illness (Foucault has a really interesting digression on epidemic vs. endemic read through these modes of power in one of his lectures that maybe I will write about one day), death rates, and so on. This is biopower.

Biopower doesn’t replace disciplinary power. Foucault stresses that these two are complementary, they exist at different levels (the individual body vs. the “social body” of the population) without nullifying each other. That much seems clear. The way Foucault describes the relation between the two forms of power is interesting: he describes biopower as “infiltrating” and “permeating” disciplinary power.

There was a bit of Discourse today about COVID mortality reporting and what — if anything — it means that we are currently in a trough of COVID deaths, with weekly COVID deaths at their lowest point since the beginning of the pandemic in the USA in March 2020. The Discourse issues from the altogether predictable confusion about what the hell is still being tracked or reported as far as COVID indicators. A lot of people know that huge components of COVID surveillance have just been straight up nuked and discontinued, most notably electronic case reporting (aka “transmission” or “case” data); the changes to data reporting and presentation have been rolled out in the most confusing and befuddling manner possible (this, I think, is half on purpose and half down to typical bureaucratic bullshit); and people aren’t really trusting that official figures capture the true state of the pandemic anymore. That is all valid and true. However, death reporting has basically not changed, even with the end of the public health emergency (PHE) last May.

The federalized system of death reporting in the USA sucks and I’m not here to defend it. (You can read a previous edition of this newsletter where I talk about how much it sucks in detail, with regards to perinatal death or “maternal mortality,” here). Nevertheless, the process for death reporting remains much as it always has been — not great, but almost certainly not hugely and systematically undercounting COVID deaths. I will tell you why.

When someone dies, a death certificate is filled out, typically by a physician, a medical examiner, or a coroner. (There are lots of issues here that I will not get into, just know that this means that there are wildly different processes for completing death certificates at the level of an individual death and they aren’t all equally good or accurate.) Part of the death certification process is listing contributing causes of death on the death certificate — also an imperfect and uneven process that I will touch on briefly in a moment. I won’t pretend to be an expert on the ins and outs of cause of death certification, but there are guidance documents from the National Vital Statistics System (NVSS) on COVID-19 death certification, including an expanded guidance document about accurately certifying deaths related to Long Covid. Once a death certificate has been completed, it is transmitted to the state vital statistics office, which then transmits it to the National Vital Statistics System. This is how we get death data for all deaths, due to COVID or otherwise.

This process has not changed. Although, one would be forgiven for thinking that it has. The CDC itself, always with its finger on the pulse of what would be maximally confusing to the public, really made it sound like reporting had changed. They did this by touting their “new metrics” for COVID mortality data presentation (which is not in fact a new metric, but rather a maneuver in data abstraction — COVID deaths are now presented not as raw numbers but as a percentage of all total deaths in the country, clearly a move to make it harder for someone looking at the CDC website to understand whether COVID deaths are high or low right now) and using a flurry of confusing language to make it sound like they had revamped death reporting to be some cool new process.

[Note: what follows is my Gravity’s Rainbow, a metatextual meditation on the subject of entropy… my fancy way of saying that it starts fairly structured and then degenerates into a lot of notes and questions I’m asking myself. One of my personal purposes for this newsletter is to let go of perfectionism and just put stuff out there even if it’s unfinished, tentative, sketchy, or otherwise imperfect. So, that’s what’s happening with the marked shift in tone and deterioration of the prose structure after the block quote towards the end.]

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For some time now I have been vaguely alluding to the  “discursive power of data” (I think we can all agree that data and numbers do have something like “discursive power”) and trying to locate its origins somewhere in the productive structure of the real economy, i.e., being a good little Marxist. This strategy has been unsatisfying, because it limits the discursive power of data to a ratifying or legitimating role vis-a-vis some kind of ideology that is encoded in and enacted through the productive structure. Now, however, I think I have been focusing on the wrong aspect, and I have (record scratch) Jean Baudrillard to thank for that. In thinking so much about the social construction (production) of data, I have been trying to link the social processes of data construction with the various functions that data perform out in the world, but sort of missing the bridge to be able to do it. Is it because statistics is eugenicist? Not exactly. Is it because of “methodological individualism?” Also not exactly. All to say, in thinking so much about the production of data, I have neglected to think about its consumption. Borrowing some language from semiotics and a lot of conceptual framework from Baudrillard, I want to venture the hypothesis that the discursive authority of data issues from the sign function of data and its operation in the symbolic logic of consumption.

This is not a base/superstructure argument. The symbolic economy and social logic of consumption (which Baudrillard develops extensively, and which I will not recapitulate here) is not some kind of epiphenomenon of the productive economy; rather, production/consumption are two chambers of the same heart, two aspects of an organic whole. To borrow from Ursula Le Guin, consumption is the “left hand” of production. Here, social and psychic logic operate according to the code of signs. (In semiotics language, the sign is the atomic unit of meaning composed of signified – a thing itself – and the signifier – the concept referring to the thing.) The meaning or value of signs depend on their relationships to other signs. Signs perform particular “signifying” functions within the symbolic and psychic logic of consumption – this is one of Baudrillard’s major (early) hypotheses.

As you probably know by now, I do this newsletter as part of a tandem project with Nate Holdren, one of the aims of which is to develop a concept or theory of social murder adequate to explaining, in general, the role of capitalism in shaping population health, and in particular, the COVID-19 response. As part of this, Nate has been encouraging me for awhile now to do a post on what exactly public health is. This post is going to be one approach to this idea, an attempt to explain what public health is, but in a peculiar and hopefully interesting way.

Of course, public health is a lot of things — a public service, a complicated federalized bureaucracy, a private academic discipline, a vibe, an ideology, a loose constellation of methods. I have seen the serviceable analogy that medicine is to the individual body as public health is to the social body. What I want to address, primarily, is this interesting characterization along the lines of “individual vs. collective” orientation. The heuristic dualities here break down into public vs. private, collective vs. individual, social vs. biological, and so on. I want to propose something a little bit different: that the “individual/collective” framework actually flattens out the different levels of structural organization within which complex social phenomena play out.

Capitalism and the population distribution of disease or debility are both emergent properties of human social interaction and organization; they emerge, however, at a level above the individual, in the realm of the social or the collective or whatever you want to call it. This is absolutely different from a mindset orientated towards individual or collective phenomena, which is what people almost always mean when they bellyache about “individualism” getting in the way of public health (not hating, I’ve done my fair share of such bellyaching).

Population health is emergent at a higher level of social organization than the individual or groups of individuals — at the population level. Public health is, supposedly, the technocratic field that “manages” (but in actuality, usually ratifies) the population distributions of health and disease. “Social murder” can then be said to characterize the form of population health under capitalist social organization, what Tony Smith calls “dissociated sociality.”

As part of my recent exposure to continental philosophy, I just read Hegel for the first time ever. I am going to try to sketch through a vague idea that I had reading part of the Phenomenology of Spirit (which, by the way, I loved, because and not in spite of its crabbed incomprehensibility). I’ve read a lot of Marx in my life, which definitely made it easier to grasp Hegel’s method and structure — the Phenomenology of Spirit is an incredible, four-dimensional work, the three-dimensional, spiraling aspect of the dialectical method, plus time. In Marx, and in Hegel, the phenomena under investigation are processes, always in motion, developing in accordance with their essential internal tensions and contradictions. There’s really no wonder biologists love both Hegel and Marx so much; there’s something very organic about investigating the “totality” of a given system this way.

One “moment” in Hegel’s dialectical investigation involves the development of self-consciousness, which he posits not as a property that people have or don’t have but as a process of mutual recognition by and of others. These helices of Aufhebung are all over Marx as well, most strikingly (to me anyway) in the concept of value. In Capital, value is a property of commodities that is realized when privately-undertaken production is socially validated through the process of exchange.* (The dialectic never stops, of course; value the resolves the internal tension between the use-value and exchange-value of commodities but further internalizes a contradiction between concrete and absolute labor, which is further resolved… and so on.)

This makes very clear, on a deep level, von Hayek’s insight that markets are mechanisms of transmitting information. Exchange is how you “know” the value of whatever you’re selling. I have mentioned it in this newsletter before, but von Hayek is actually responsible for the idea of the first neural net, which was supposed to approximate the action of a market, not of a human brain. (The brain is the metaphor for the computer, not vice versa.) Which brings us, of course, to cybernetics yet again. We, as a species, keep inventing (or realizing, or manifesting, as with capitalism itself) variations on the cybernetic idea — distributed nodes, self-organization, feedback, control. There is something super seductive about self-organization and homeostasis as a metaphor across distinct disciplines and domains of human social organization. Consider again Hegel and biologists — entelechy, self-organization, dialectical movement and relation of parts to wholes, all much more intuitive and appealing than linear, mechanistic, reductionist explanations.

People are liking this lately, these metaphors referencing the self-organization of nature, and I don’t think that this is without meaningful content. I was going to write a whole big thing about why Emergent Strategy (a self-help book incorporating many of these cybernetic metaphors from nature) is WRONG. But I actually think it’s much more fruitful to explore why these metaphors are so widely appealing. Why do we keep inventing and iterating on this idea, again and again? What if we understood capitalism as the deeply weird psychic thing that it is — yet another manifestation of this cybernetic impulse, arising (emerging) from human social relations at a higher level or organization (planetary, trans-national), this almost God-like (or Geist-like) thing we all participate in making without wanting to. Marx’s mystical language doesn’t seem so silly from this vantage.

I’m reading a lot more continental philosophy lately than I ever have before (I know — I know. I know!) and been having an interesting thought about epidemiology and the practice of science that I want to share — mostly because I’m genuinely not sure what I think yet, and on top of that, I don’t really know enough yet to begin to determine what I think. The basic idea is this: epidemiology as it is taught and learned is basically a deconstructive project. This is distinct from how epidemiology functions in the social and political spheres. I will try to illustrate with an example that I am actually capable of handling — Derrida is like Beetlejuice, I’m afraid to invoke him directly too many times for fear he’ll jump-scare materialize behind me in a striped suit.

The best part of science education is the venerable institution of journal club. In my opinion, we don’t do journal clubs nearly enough, which is to say, we don’t do nearly enough close-reading of scientific texts. My original home discipline is biology; journal clubs in biology are a lot of fun. Journal clubs in epidemiology are much more rare (not surprisingly — very boring managerial discipline lurching hard into Vox-style smug irrelevance post-2020) but when they’re good, they can be really good, for a really specific reason.

The way I usually like to think about things in my field is: “data are compatible with multiple states of reality.” Developing the intuition necessary to imagine what these states of reality might be and how they might have converged to produce the data collected and analyzed in a given article is the real work of journal club — epidemiologic critique as tacit acknowledgment that there is no interpretation of a given piece of data analysis that closes the interpretive act for good, or brings the process of interpretation to a definitive end. Iterative and open-ended critique of a given journal article is supposed to excavate, like dusty buried artifacts, not only the investigator decisions (implicit or explicit) and values structuring the analysis, but also the stuff lurking out there in the “real world” that may explain a given set of findings better than the authors’ interpretation or cut against the interpretation supplied. (From the Wikipedia page on deconstruction: “Derrida refers to the — in his view, mistaken — belief that there is a self-sufficient, non-deferred meaning as metaphysics of presence. Rather… a concept must be understood in the context of its opposite.”)

There’s a lot to deconstruction and I am simply not pretending I know. I don’t know shit. Just want to be very clear about that, because a lot of what follows is over my head and maybe sounding even more addled than the rest of this post. But considering deconstruction in the technical sense, we have to consider also what the binary opposition at stake in journal club is. To my mind, it’s something like “real/not real” or “true/not true,” pertaining to the findings or overall declarative statement about what a particular paper “shows.” This opposition can never be definitively resolved or synthesized, and in fact the two sides of the binary are sort of mutually haunted by their opposites, as illustrated by the sheer number of epidemiologic findings that seem to be both true and not true simultaneously — for example, are coffee or wine supposed to be good or bad for you? What’s the consensus this week?

One of the purposes of this newsletter is to work through some theoretical materials to excavate whatever in them might be useful to developing a more sophisticated structural account of the failures of the COVID pandemic and response in the United States. To this end, I finally started reading Tony Smith's Beyond Liberal Egalitarianism, a favorite recommendation of Nate's.

I don't think anybody is on the edge of their seat waiting for it at this point, but J*stin's and my planned book about COVID is not happening anymore. One of the rocks we dashed ourselves on is: what is the appropriate level of analysis of the general social structure as concerns COVID and the COVID response? He wanted to focus much more on a retelling of the Merchants of Doubt story, adapted to the pandemic, chronicling the corruption of various governments and scientific advisory bodies, the distortions of the scientific process and its outputs imposed by well-funded private interests, and how these things, combined with a lack of organizing among scientists and the susceptibility of the scientific community to reasonable-sounding bad ideas (like those advanced in the Great Barrington Declaration), ultimately undermined the pandemic response.

I, on the other hand and controversially (?), wanted to focus on the structural overdetermination of the failures of the pandemic response. By which I mean: by digging into the history of public health, its roots in the industrial revolution and its inseparability from the "abstract social logic of capital," its individualizing and managerial ethos, and how the structures and imperatives of capitalism shape knowledge production as well as the politics of social coordination and emergency response, I wanted to show how little there was (by way of some kind of robust, democratic organization of science at the societal level) to undermine. I wanted to show how the pandemic response was rotted from the inside out rather than subverted by a handful of malevolent actors -- in my view, this more than anything else explains how the Republican and Democratic presidents of two different administrations overseeing the pandemic response converged on essentially the same set of policy actions, just glossed with different rhetorics (but not that different, at the end of the day), although both stories are obviously true and complementary at different levels of analysis and different levels of social organization.

In any case, an interesting and not altogether encouraging thought struck me reading through Chapter 3 of Smith's book. This chapter is devoted to placing liberal egalitarianism and Marxian theory in some kind of dialogue or juxtaposition with each other to illuminate the mutual misunderstandings in each approach's view of the other. As Smith writes (p. 64):

Good evening, sickos. I am preparing to record an episode of Death Panel duck-hunting Sandro's new-ish book, Within Reason: A Liberal Public Health for an Illiberal Time. It's a doozy, not in the sense of being packed with ideas but in the sense of being one of the worst books I have ever read in my life. It fails on every level as a book (at the level of idea, the level of argument, the level of prose). Big ups to the University of Chicago press for binding a bunch of this man's toilet paper scribbles (blog posts) into a book and selling it to rubes and bitter bitches like me. Anyway, I wrote some rambling notes on the first parts of the book as a way to get back into it and jog my memory for recording. These are just notes, please don't hate me because they're sketchy and full of block quotes. I'm trying to synthesize the common threads that make this so shitty and so of a piece with what passes for thinking about the pandemic in my cursed field... but this is not that. Proceed with the knowledge that this is raw process!

Big thoughts

• He managed to write an entire book about “liberalism” and “public health” without once advancing a serious definition (let alone a serious thought) about either

• … Because UChicago Press paid him to print out and bind some of his ice cream brain blog posts. I guess this is the level of COVID analysis that publishers (the public??) are looking for. 

• The unifying theme is how hackneyed and fucking irritating he is while saying absolutely nothing at all. 

• He loves to talk about “marginalizing forces” and “disparities” and “structural determinants” but doesn’t ever complicate the narrative – that liberalism itself is one of these marginalizing forces and structural determinants. (I’ve skipped several grade levels over Sandro here)

• He doesn’t even aspire to internal consistency. 

  • “Narratives” – are they good or bad?

• Overidentifies public health with “Enlightenment science” which is just wrong. The techniques of public health were not developed in the enlightenment. Public health itself developed during the industrial revolution. Was this a time of flourishing liberalism? No. This was a time when the contradictions and weaknesses of liberalism were exposed. 

• Does liberalism transcend time and place? According to Sandro, both yes and no. (Because he’s too fucking dense to be bothered sorting it out.) He takes pains to let us know that racial justice and other forms of social justice are important to liberalism – which is decidedly not true of many, many episodes in the history of liberalism. The liberalism of the Enlightenment is not the same thing in any way as the liberalism of today. But public health is failing because we’ve forgotten our “liberal roots” and Enlightenment values (reason?? Whose reason and who decides?). 

• It’s crazy this book got published because the basic thesis of it is so fucking confused. 

• He wants the nice parts of liberalism but none of the nasty parts. He doesn’t even know there are nasty parts. He’s allowed to do this because he’s a Spreadsheets Doctor, nobody expects him to know anything.

• Phenomenology of reading this book: despair. This is what passes for serious scholarly discourse in my field. It makes me want to KMS. 

I'm currently preparing to record an episode of Death Panel about my most important niche interest: counting deaths in pregnancy and postpartum. This is in the news recently due to a new study in the American Journal of Obstetrics and Gynecology (hereafter AJOG) entitled "Maternal mortality in the United States: are high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance?" This study made the news because it purports to show, contrary to the popular narrative, that the rising rates of perinatal death we've been hearing so much about are not real increases, but rather artifacts of inaccurate perinatal death surveillance. It has been known since at least 2018 that the current method used to count these deaths is inaccurate and likely inflates death counts. The CDC pushed back on the study in a characteristically confusing way, taking issue with the alternative methodology the study's authors used to count perinatal deaths (known to result in substantial undercounting), even as it acknowledged that its own current method of counting results in overcounting.

So what's going on here? Indulge me as I pull back the veil on the social construction and social life of mortality data before getting into some more general (and more interesting) theoretical considerations. It all starts with the system of death reporting in the US. Death reporting is done at the state level; local officials or health authorities typically fill out death certificates then transmit those death certificates to the state vital statistics office, which then forwards them along to the National Vital Statistics System (NVSS), which tabulates mortality data from the whole country.

Accurately reporting pregnancy-related and pregnancy-associated deaths (more on the difference between these two presently) has been a huge challenge for the United States, even though it ain't rocket science to count deaths in pregnancy. The UK, for example, has a prospective obstetric surveillance system (called UKOSS for, straightforwardly enough, the UK Obstetric Surveillance System) that works very well. Not so in the US, which had problems harmonizing state-level mortality rates due to state-level differences in death reporting practices, especially around pregnancy. It was known through the 1980s and 1990s, furthermore, that the NVSS was severely undercounting pregnancy-related deaths. To remedy this problem, a so-called "pregnancy checkbox" was added to the 2003 Revised Standard Death Certificate. The purpose of the checkbox was to indicate whether the decedent was pregnant at the time of death or within 42 days of death (42 days post-delivery is the arbitrary cutoff we use to bracket the "postpartum period," although very good arguments can be made -- using so-called "late" pregnancy-associated deaths -- that this restriction leads to undercounting).

States didn't all adopt the revised death certificate at the same time, however. The US was unable to report a national maternal mortality rate (embarrassing, tbh) between 2003 and 2017 due to staggered adoption of the new death certificate across states. It is well-known that the checkbox estimates overcount perinatal deaths (this was highly publicized in Texas in 2018). Despite these issues, every state is now using the death certificate with the checkbox, so NVSS is once again able to tabulate national perinatal mortality rates. The results have been grim. NVSS documents a near-doubling of the already-high perinatal mortality rate from 17.4 deaths per 100,000 live births in 2018 to 32.9 deaths per 100,000 live births in 2021, with these overall rates masking emergency-level rates among Black and Indigenous women -- for example, 70 deaths per 100,000 live births among Black women that same year. For comparison, national perinatal mortality rates in the UK (not even one of the countries with the lowest rates) are on the order of 7-8 deaths per 100,000 live births annually. (COVID was definitely related to this increase, with 2021 appearing to be a high-water mark; provisional data seem to indicate these rates coming down, ever so slightly, in 2022.)

Hey everyone. I really am sorry. I am doing a really shitty job keeping up with this newsletter, and it hasn't really been because I'm busy, but more because I'm struggling to have thoughts that feel interesting. It has been a year of a lot of inner turmoil (and growth!), I guess I am busy, but busy with non-remunerable life stuff that doesn't scan as real to anyone in our capitalist hellscape. (Sidebar: I saw a pastel-colored pop psych infographic about "internalized capitalism" and its symptoms today.)

Maybe internalized capitalism isn't as silly as it sounds... maybe it's just alienation, in the psychological sense or the phenomenological sense (the feeling of being alienated) rather than the strictly Marxist sense of the products of my labor being alien-able from me. The container for all my tedious crises and upsets, the big nesting doll that holds them all, is my journey through and out of academia, which is to say my journey of identity dissolution, formation, and dissolution again. This is why I don't have any good ideas right now. Since I am no longer an academic, I'm no longer subjectified as an ideas-haver. There's no nice sticky matrix of connective tissue holding me in relation to other people who are thinking, or writing. I've only been spiraling one way, inward, away from people and the kind of intellectual exchange that keeps the little flame burning. I feel like I have a gray heap of cold, spent embers right where my diaphragm is.

I was so fucking good, as an academic. I was also killing myself in a million ways, and the killing myself was what made me so good. I was bright, original, overflowing with great ideas, and diligent enough to execute a fair number of them. What happened to me? I got disenchanted. I was always pretty disenchanted with the system of academia. I got disenchanted with the work itself, the only kind of work I have ever really loved and wanted to do. It was starting to happen pre-2020. You allow yourself to question what one psychometric scale or Census-derived social inequality index is really measuring, or what regression models really are, and heretical thoughts start creeping in. What really did me in, though, was obviously COVID, the spectacle of all of it, how eager I was to be a dog in everyone else's fight (I think this was a good quality for some very worthwhile COVID fights, but is a trait I would like to get better at recognizing in myself so I can counter it as far as day to day operations of living are concerned).

One of the minor tragedies of this journey for me is that COVID intensified the heretical thoughts, and for a time, it seemed like -- for the first time ever -- somebody was listening. Original thinking of any kind in epidemiology is flatly unwelcome; we are to memorize the Healthy People 20XX objectives, complete the modules, perform the rote statistical operations, compose the awkward papers, try to get some money, and repeat. Suddenly, everyone's eyes were on my field, and it turned out I had a valuable perspective to share that people wanted to hear. For a moment. This is where the Marxist sense of alienation comes in. I'm a big dumbass, tweeting all my good thoughts, because good thoughts are free and should be shared. Or so I thought. Good thoughts are also alienable, and time and time again, it has been demonstrated to me that my ideas are desirable and productive -- and even more so when they aren't attached to me but rather free-floating, Vogelfrei, appropriable by anyone with some institutional credentials to just plug-and-play in their templates for doing equity-focused research or whatever the fuck.

Before 2020, nobody knew what epidemiologists did -- I can track the normalization of COVID-19 by the number of people who, upon meeting me, ask if that's like, some kind of skin doctor or something. The beginning of the pandemic was a weird, sudden intrusion of everyone in the world into my cozy little academic space. A similar thing happened last year around this time in a very different corner of my life. The reality show I had religiously followed since its 2013 debut suddenly became national, even international, news following the spectacle of a cheating scandal among the cast members. The Scandoval, while pretty run of the mill drama for Vanderpump Rules, took over the actual news cycle for awhile and catapulted the cast members into realms of fame they weren't ready for. Tom Sandoval, the titular cheater, became (as a days-old New York Times magazine cover story put it) the most hated man in America. Rachel Leviss, his affair partner, was skinned alive in the media, by her fellow cast members, and in every possible public venue and wisely checked herself into a trauma treatment facility in Arizona. And Ariana Madix, who Tom Sandoval cheated on, has been rather puzzlingly lionized and showered with lucrative career opportunities, doing sponcon for real brands now (like Glad and Lay's and Uber Eats) and playing Roxy Hart on Broadway.

Just to get things out of the way, I am Team Rachel to the core. Yes, she did a bad thing. But it's a bad thing that has to be understood in its proper context. It really is Tom Sandoval's MO to scoop women up right out of deeply abusive relationships and kind of love bomb them (Rachel had been engaged to a very volatile cast member, an alcoholic DJ named James, for a long time). In fact, this is what he (Tom) did with Ariana, the woman he would later cheat on: it was a major plot point for several early seasons that Tom Sandoval cheated on his previous girlfriend Kristen with Ariana; he and Ariana both, as a united front, spent years (literally years, on national television) calling Kristen crazy and dragging her name through the mud. This is just scratching the surface of the reality TV drama in the background here, but these swirling questions of guilt, responsibility, and atonement are what make Ariana's utterly imperious attitude towards everyone so hard to take. Everyone who has ever been on Vanderpump Rules is guilty of the exact same behavior (and worse -- remember when Jax tried to dump Laura-Leigh moments after her Narcotics Anonymous meeting?). What has made the show work for all these years -- some years better than others -- is that there are no lines in the sand, no untransgressable boundaries, and really no consequences for any of these folks' incredibly fucked up and harmful behavior towards each other. (Keep it coming, I do not care about these people or their lives except insofar as they want to debase themselves for my entertainment!)

It might seem like kind of a curveball to bring in 19th century Russian literature at this point -- but hear me out. I've been working my way through The Brothers Karamazov for the last few months. I suppose it's my One Big Book for this winter (I always have exactly one every year). I've read it before but it was a long time ago; now, as a grownup, I'm really struck by how hilarious and real it is, and how funny and idiosyncratic Dostoevsky's sensibility is. He has an incredibly sympathetic knack for seeing the absolute transcendence at the heart of even the most degraded and ridiculous human drama. I think he would have absolutely loved Vanderpump Rules. I also think he would have loved really miserable airport travel -- the more delays and the bigger the crowds, the better -- for the same reason. The depths of human wretchedness and the heights of human transcendence are one and the same. A phrase that recurs throughout the book is "for all and on behalf of all," from the Russian Orthodox liturgy, meaning that we are all guilty of all the world's sins, in front of God and everyone. What this really means is that we are all really connected, we are all responsible for each other. This idea recurs again and again, in the words and actions of different characters, from the monk Father Zosima to his disciple, young Alexei Karamazov, to the group of schoolboys that look up to Alexei, to Grushenka, the "fallen woman" common to Dostoevsky's works, to Dmitri Karamazov, accused of patricide.

I have been trying and struggling to write an essay about Emergent Strategy and what rubs me the wrong way about it. Writing this just now has clarified one thing. We are all connected, we do all share in each other's guilt and responsibility. In Emergent Strategy, this idea hinges on a worn-out appropriation of the concept of a fractal. Because fractal objects are self-similar at different scales, the author argues, this is also how reality actually is, and small actions are the same as big actions -- e.g., being in an annoying workbook polycule and intentionally trying to form "Liberated Relationships" is exactly the same thing as political work and urgent struggles for justice on the macro scale because "micro is macro."

Let's see... can I write about the second chapter of this book in a fun and engaging way?

Nobody wants to look at the hole COVID blew in our collective psyche anymore. Boo hoo for me. You could analogize it to Walter Benjamin's angel of history; I would analogize it more to trying to outswim the sinking Titanic (like COVID itself, another smashing success for capitalist society).

Here's a general summary of the first chapter of this book, at least up to the part that I find really interesting (there's more, a four-part typology of different types of ideologies, that I will cover later).

• Subjectivity refers to acting as a subject in a given context; it is not the same thing as personality.

• Ideology interpellates human beings as subjects. This is Althusser again, who describes ideology as a "quadruple system" of 1. interpellating individuals as subjects; 2. subjecting them to the big-S Subject (like God, or the king, that kind of thing); 3. facilitating mutual recognition between Subject and subject, subject and subject, subject and self; and 4. "the absolute guarantee that everything is really so" (Therborn's words). Althusser's system can be summarized, tersely, as interpellation-recognition and subjection-guarantee.

• Keeping Althusser's concept of interpellation-recognition (following from above), Therborn modifies the description from Althusser's original subjection-guarantee to subjection-qualification. Subjection to some kind of ideological discourse process in turn qualifies the subject for various kinds of roles.

Happy New Year, everybody. I'm looking forward to getting back into some heavy theory posting and navel gazing in 2024. To ease us all back in, I'm sharing the short essay I wrote about the Netflix series Goop Lab back in February 2020. It's interesting to revisit my perspective on this after... the events that transpired in the rest of 2020 and subsequently. Hope you enjoy!

What condition my condition is in (02/10/2020)

A few weekends ago, I gave into peer pressure and morbid curiosity and queued up Goop Lab: the Netflix series by Goop, Gwyneth Paltrow’s “lifestyle and e-commerce” company. I knew very little about Goop, except that they sell really expensive stuff, that they were sanctioned for making unsubstantiated medical claims about their infamous jade vaginal eggs, and that the promotional image for the show was hilarious. The show consists of six short episodes, each featuring a wellness trend, treatment, or subject. Every episode is hosted by Gwyneth Paltrow and Goop “chief content officer” Elise Loehnen, who has the screen presence of a stunned hostage. And in each episode, a trim, young collection of fresh-faced Goop staffers try out the featured treatment, exercise, or experience. If that doesn’t already seem like a potential HR nightmare, the show adopts a “monster of the week” format where the monster in each episode is the personal trauma or health struggle of someone that Gwyneth and Elise directly employ.