A minor personal update, I have been sober for just over a month (it’s less serious than it sounds) and this, my first un-self-medicated menstrual cycle in a long time, is kicking my fucking ass with insomnia. I’m a lifelong insomniac and this is rough even for me. That’s why this is coming to you at 2:20 AM EST. I wrote this earlier today, before it was reported that Trump is appointing RFK Jr. to head HHS after all. Haha. All is well with me, this too shall pass, the way out is through, etc., but the world is pretty completely fucked. Nevertheless, I’ve still gotta work tomorrow, and you probably do too. After I send this I’m gonna make myself a lemon balm and valerian root tea (have you tried this shit? In normal, non-insomniac times it totally knocks me out) and restart my bedtime routine* over again for the third time tonight. Wish me luck, or don’t; whatever the case, I hope you enjoy.
We’re barely a week out from the election and Tweedle-Dee and Tweedle-Dum of the early pandemic, Leana Wen and Emily Oster, are back again. Both are in large national publications this week, doing exactly what they did with COVID: laundering fringe bullshit for respectable liberal audiences through the language of data. They shot their shot with Biden, bit the dust pretty hard, lost credibility, and now they’re trying again with Trump. Best of luck to these ladies!
Oster’s New York Times article tackles measles vaccination, fluoridation of water, and raw milk. Thankfully, she’s still pro-measles vaccination. (We’ll see how it goes once Trump is actually in power.) This is a case where the data are completely unequivocal because the measles vaccine works so well. The other two cases involve a literature that requires substantially more skill and context to interpret than Oster actually has, and she does her characteristic Freakonomics jig around a few cherrypicked instances to argue that public health experts are being too heavy-handed in pushing pasteurization of milk and fluoridation of water.
Let’s start with her claims about raw milk. (I will save fluoridation for a separate post.) She writes that while roughly 11 million people who report consuming raw milk per year in the US, there are only around 760 reported cases of foodborne illness from consuming raw milk per year. This comes out, using her numbers, to a fairly low incidence of 6.91 cases per 100,000 people per year. There are two issues here. The first is that the number is almost certainly an undercount. A lot of foodborne illnesses go unreported and unconfirmed; that 760 number reflects illnesses that are reported, confirmed, and linked to a specific source. So the actual number, we can be sure, is larger, but we don’t know how much larger.
Second of all, reality is more complex than an econometric model, and some types of selection bias, randomness, and unmeasured/unmeasurable causal processes are operating here. Federal law prohibits the sale of raw milk across state lines, which means that most milk from large companies and industrial farms sold in the grocery store has to be pasteurized. Several states do permit the sale of raw milk within state lines. According to an analysis covering 2012-2019, states where the sale of raw milk is permitted have more than three times the number of outbreaks of foodborne illness associated with raw milk than states that don’t. Many of these illnesses occur (and occur most severely) in young children; one of the reasons for the huge decline in US infant mortality observed in the first half of the 20th century was, indeed, regulations requiring the pasteurization of dairy products.
Oster dismissively refers to a recent salmonella outbreak linked to raw milk in her New York Times piece (complete with a minimizing comparison to another outbreak, a favorite technique perfected through her COVID writings: “In 2023 and early 2024, there was a salmonella outbreak linked to raw milk from one farm, though it resulted in fewer infections than a similar outbreak involving cantaloupe around the same time.” This might be somewhat convincing if only there were some way to pasteurize cantaloupe.). In an earlier article about the same outbreak in the same fucking publication, the reporters note that those most at risk of serious illness in these outbreaks are young children — 40% of the reported cases in the 2023-24 salmonella outbreak linked to Raw Farms were children. Michael Osterholm is quoted in the article, saying correctly that the actual number of illnesses caused by consuming Raw Farms milk is likely much higher. Why, pray tell, is our nation’s foremost expert on data-driven parenting, saying that consuming raw milk is basically fine? That yes, if more people drink raw milk because public health people stop being so scoldy, more people will get sick (many if not most of them children), but that’s okay? (“But the overall picture here is of a slightly elevated risk, and one that is in the range of other risks people take, especially for healthy individuals.”)
Because she’s a free-market economist with an anti-regulation agenda, that’s why. My impression is that she is trying to kiss up to the Trump administration to raise her national profile once again; my further impression is that, in her mind, it would be basically fine if regulations prohibiting the national availability of biohazardous milk were completely dropped across the board to let the market and the data sort it out. It just doesn’t work like that, though, and all the harebrained 50-page economics papers torturing a data set with parametric regression models in the world simply won’t change that.
The relatively low incidence of raw milk-linked infections per year has an irreducible character of stochasticity. The more access to raw milk there is, and the more people consume it, the more illnesses there will be; it’s not a fixed property of milk in general. It is the pinnacle of economics-brain to treat it like it is a fixed property of milk in general. An economist ought to know better; ought to understand that in reality there is a huge patchwork of practices and standards among producers of raw milk, that the specific pathogens present in raw milk and their virulence or ability to cause illness depend not only on these standards and practices but also on innumerable possible qualitative changes in the health of our country’s dairy herds such as, I dunno, say, a massive outbreak of H5N1 avian influenza in cattle. Oster dismisses the link I just provided, claiming that the evidence that H5N1 in raw milk can cause infection is based only on mouse studies and not yet borne out by transmission of H5N1 to humans via milk. This is true, but it should be noted that those mouse studies were actually intended to demonstrate that pasteurization is effective at killing H5N1 and rendering it untransmittable from drinking pasteurized milk, even if the milk contained H5N1 to begin with. Which it did demonstrate: pasteurization makes milk safe to drink by killing the nasty pathogens that raw milk is positively teeming with. The takeaway here is, thank God pasteurization is still largely required, especially for big multi-state industrial dairy operations most heavily impacted by the H5N1 outbreak. The New York Times article quotes Dr. Michael Payne of the Western Institute of Food Safety and Security at UC Davis: “Drinking raw milk has always been playing Russian roulette with your health.”
The roulette analogy is apt, and is exactly the one I used in a previous draft. It’s not really possible to predict which pathogens are going to be in which batch of raw milk, when or where. That’s the point of pasteurizing all the milk — we have a very effective and already widespread tool that makes all this roulette-playing irrelevant and unnecessary. Would you give your child raw milk? More importantly, would Emily Oster? I suspect the answer she would give is, probably not, but that it’s patronizing for the big bad public health establishment, which did after all lose so much trust during COVID (cue a rueful melody played on the world’s tiniest violin here), to tell people what to do, or especially to tell women how to parent, what choices they can and can’t make for their kids. Per all of her published books, Emily Oster wants empower mothers to make the choices that are right for them based on a nuanced reading of the data, mothers like Mary McGonigle-Martin. From the same NYT article:
“In 2006, then-7-year-old Christopher Martin was infected with a dangerous strain of E. coli from raw milk from Organic Pastures [ed note — this is what Raw Farms, linked to the current outbreak, was previously called]. He developed hemolytic uremic syndrome, a severe condition that affects the kidneys, and was hospitalized for 56 days, said Mary McGonigle-Martin, his mother. ‘I made a choice that almost killed my child,’ she said.”
In my opinion, Emily Oster is an unscrupulous person who massages these just-so stories about the data to argue for a return to the world of The Jungle (the 1905 novel about meatpacking and socialism so disgusting that it spurred the implementation of the food safety regulations that RFK Jr. wants to roll back). This is, in my view, a reasonable opinion to form about a free-market economist — such an orientation accords with her general worldview. And the worldviews of the billionaire creeps that fund her and prop her up as a general expert. In my opinion, she doesn’t give a flying fuck about workaday moms, their children, or anybody else.
Why don’t the MAHA people and their aspiring gadflies like Oster and Wen get mad about a real health threat, like plastics? Plastics are a clear and present danger to the health of children and adults alike. The literature is voluminous and becoming clearer by the day. And yet, crickets on that. Instead, a feinting defense of raw milk. Why? Because addressing the health threat of plastics would entail regulating the supply side, which would entail regulating the fossil fuel industry in some way. And that would make their billionaire buddies (that are, again, using them to launder a ruthless right-wing economic agenda as somehow empowering to women) very unhappy.
RFK Jr. has made some vague claims about a worm that ate part of his brain. (This could reasonably be the larvae of a Taenia or pork tapeworm, but this dude makes shit up all the time, so who knows.) The worms in Emily Oster’s brain are metaphorical rather than literal, they got there via advanced graduate training in economics.
* My bedtime routine, which usually works ok, involves brushing my teeth and sipping a soporific tea (no sugar or honey!) in bed while I read, until I get sleepy, often listening to a new age tape such as: