Sorry! Insomnia brain still whirring. One more thing that I want to note: the elision Oster makes of the distinction between individual-level and population level constructs of “risk.” Here, again, is what she says in the article:

“There is no good evidence of any health benefits associated with raw milk. 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.”

BZZZZZT! Wrong! The population-level incidence of illness linked to raw milk is not an index of the individual-level likelihood of becoming sick from drinking raw milk. If you drink 100 bottles of raw milk and 99 of them are uncontaminated (or uncontaminated with a sufficient number of pathogens to make you sick), you won’t get sick. You might conclude from this that raw milk is basically safe because 99/100 is pretty good. The risks are low, on par with others we take in normal life!!! (or whatever horseshit she’s serving, it’s always an argument like that). But if the 100th is contaminated with E. coli 0157:H7, you will get very sick and you might get hemolytic uremic syndrome and/or kidney failure. It’s spinning a roulette wheel, but you have even less information than you do about a roulette wheel. A roulette wheel has 37 or 38 numbers. The combinatorial mathematics can get complicated, but you can work them out. You have no idea what is in a given batch of raw milk. There are very good reasons to suspect that it might be something really nasty. There are also very good reasons to suspect that with RFK Jr. in charge of the FDA, regulations on the productions and sale of raw milk are about to get much more lax. More spins of the wheel, more potential for bad bets.

Do not be fooled by the Freakonomics parenting lady scowling in the fugly MM Lafleur. She does not know what the fuck she’s talking about.

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!

About a year ago, I was working with a friend and colleague on a vague idea for a piece along the lines of "abortion is health care... and health care sucks!" I gave a guest lecture on some of the themes we were exploring, we both got busy, the piece (God do I hate the word "piece") never developed further. Well, now here we are, sitting with the "puzzling" result that ballot measures protecting abortion at the state level did well while Kamala Harris bit the fucking dust in the presidential race. What could explain this? I don't expect the Democrats to do any reflection on this, but here on Closed Form we can say and do whatever we want.

A few years ago I wrote a profile of Leana Wen (she's baaaaaaaack!). I didn't have much as much space as I would have ideally liked to go into a detailed critique of her tenure as president of Planned Parenthood, but I came to take major issue with her "abortion is health care" campaign. Here's what I wrote then:

In 2018, Wen left Baltimore to accept a new job as the sixth president of Planned Parenthood — the first Asian-American woman and the second doctor to ever hold the role. Less than a year later, Wen was dismissed from the position, with a flurry of news reports describing differences in vision and strategy for the organization. The most insurmountable differences derived, in part, from her center-aisle approach to business; Wen’s vision, in her telling, was to depoliticize abortion by rebranding Planned Parenthood as a general health-care provider. In Lifelines [Wen’s memoir], this is framed as a concession to sensible moderates, based on her previous interactions with some Title X grant recipients who were leery of attending meetings where Planned Parenthood would be present. “If Planned Parenthood was seen as too controversial,” Wen writes, “then reproductive health was at risk of becoming even more cut off from the rest of health care.”

Wen’s goal was to resituate abortion within the spectrum of “regular” health care, but she confused cause and consequence: abortion is siloed off from other health care precisely because it is so politicized, and it is politicized because of fundamental values conflict over reproductive autonomy. Thus, with longstanding political conflicts increasingly placing reproductive rights at jeopardy, the head of the single largest provider of reproductive health services in the nation was busy placating a phantom constituency of moderates.

Good morning to everyone out there in internet-land. I am having some nice strong coffee and listening to jazz, enjoying the golden sunshine of a daylight savings morning. I hope your Saturday is treating you at least as well.

In general, I really want to move away from writing about Covid, because it feels completely purposeless at this point in time – just inviting pain and judgment and hatred, which I already have plenty of. I certainly don’t want to write about the election; I’m no longer enough of a left-wing narcissist to think that my “analysis” is something anyone needs any of. But today I’m going to write about both, because there’s something going on that I think is interesting.

In the days since the election result was announced, I have seen a thread by a familiar Covid grifter circulating all over the internet. The thread is an evidence-less argument that pandemics lead to fascism. The examples in support of this are: the Great Depression, and hyperinflation in Weimar Germany* (only one of those things led to fascism, but whatever?) came after the 1918 influenza pandemic, and Donald Trump’s reelection in 2024 after the pandemic began in 2020 (Trump was already elected once before, pre-Covid, in 2016, but whatever?). The mechanism proposed for how these things happened is that they “brought eugenics into the mainstream” or some such. Obviously, this is not true. Eugenics long predates, and was mainstream long prior to, 1918. The ideology and movement first coalesced in the 1880s; the US state of Indiana passed the world’s first compulsory sterilization law for the “unfit” in 1907. In 1911, the Carnegie Institution – hardly a fringe outfit – released a report proposing several methods for removing the genetically unfit from the general population, including euthanasia by gas chamber. The connection between eugenics and fascist ideology is clear. What I’m saying is that this connection predates, and is only remotely and tenuously connected to, the influenza of 1918 or the Covid-19 of 2020.

I could take a weathered desire path here and argue that these analyses are politically dangerous in addition to being ignorant; that they misidentify the culprits, misunderstand the problems, point people galvanized to “get involved” down dead-end paths. Someone else can make those arguments. I want to talk about something weirder: the funky thread of esotericism running through the beautiful tapestry of the Covid grifter community and through its associated epistemological stance. I read a really fun paper by Susannah Crockford yesterday that reviews the “sociology of secrecy” in an analysis of esotericism, neoliberalism, and the Goop jade vaginal egg (my essay about Goop Lab, which covers some of the same ground, is here). The relationship between esotericism and what we now call science is long, complicated, and fuzzy, but for our purposes, some simple definitions will suffice.

Verso books, man. Why are they like this?

I picked up a copy of Justin Joque's 2022 book Revolutionary Mathematics: Artificial Intelligence, Statistics, and the Logic of Capitalism -- sounds promising, right? Wrong.

I wanted to like it. Obviously! This book is way up my alley, judging from the title alone -- in fact, at first glance I was worried that it had sort of scooped the idea for my own (glacially progressing) book project. But the book is simply, where the thread of argument is briefly intelligible, like a dark street illuminated by a flash of lightning, wrong. At least, this is my take on it about three turgid chapters (of eight) in. I've read three chapters, and I still have absolutely no fucking clue what this book is trying to argue about statistics and its relationship to capitalism. A few of my stray thoughts are below.

Joque describes a "revolution" in statististical inference which seems to refer to... a move to Bayesian inference? This is hardly a revolution. For one thing, the move to Bayesian inference techniques over the more familiar midcentury frequentist techniques is far from total. I guess many so-called AI models (which are really "machine learning," which is to say, statistical learning models) use some kind of Bayesian methodology, but if you look around, frequentist statistics are very much the norm (hah hah) in many other fields. I work as a statistician facilitating (really subpar) clinical research; I reside in, have my mail forwarded to, frequentist-land. I spend my days arguing with pompous surgeons about why a p-value doesn't mean what they think it means (I do not want to be doing this, so please, if you've got any job leads, or are looking for writers or book reviewers for hire, please reach out).

The 2019 version of me would have been shocked and horrified at what I’m about to say: Nancy Krieger is incredibly fucking tedious to read. I’m so over it. I’m particularly tired today (and particularly exhausted lately), but today is not the problem. I’ve been incubating an idea for this essay for months at this point — a take on Krieger’s arid 50-page 2012 paper “Who and what is a ‘population’? Historical debates, current controversies, and implications for understanding ‘population health’ and rectifying health inequities.” I haven’t published anything yet because I simply can’t get through the fucking thing. Even trying to say the title out loud is tiresome to the jaw muscles, like trying to break down a Tootsie pop. Not that I don’t have a high tolerance for boring text. (I’m a Marxist, after all. Ask me how many yards of linen to make a coat.)

I can barely even even bring myself to open the document again, honestly. It’s not even really necessary. Like all Krieger papers, the “argument,” if we can call it that, is an extremely pedestrian non-point buried under a sludge of dictionary definitions. (Literally. And if that’s not annoying enough, she archly close-reads dictionary entries for “population” according to a completely arbitrary and occult set of criteria — Miriam-Webster defines population this way, but they don’t specify exactly what a population is, that kind of grating vibe.) Here’s a quote from the paper: “Consequently, apart from specifying that entities comprising a population individually possess some attribute qualifying them to be a member of that population, none of the conventional definitions offers systematic criteria by which to decide, in theoretical or practical terms, who and what is a population, let alone whether and, if so, why their mean value or rate (or any statistical parameter) might have any substantive meaning.” Okay? What I want to get into here is… what are the epistemic assumptions, or the system of thought, behind the idea that having “systematic criteria” to decide “who and what is a population” is something that we really need.

At issue is the concept of population, “core to epidemiology” (as Krieger says) or some such nonsense, and a rather interesting story.

Have you ever thought much about what an average really is? It’s kind of a funny joke about the “average American” with 2.5 kids, which of course corresponds to no actual person, living or dead. The joke, which makes fractional children possible, is that the average is an abstraction, a reified statistical object, that we nevertheless endow with some kind of meaning or authority as a representation of a group of things. How did we get here?

Numbers have a qualitative dimension. Or, the same number doesn’t always mean the same thing. If we had COVID-19 transmission numbers (we don’t, and beware grifters trying to tell you we do), they would not mean the same thing today as they did this time in 2020. The population of the US has changed, the virus itself has undergone several transformations, we have vaccines and therapeutics now that we didn’t have in 2020. This makes the medical (versus the social) end of a pandemic highly ambiguous.

We saw some outlines of this with the fruitless “epidemic or endemic?” arguments that have circulated in the COVID discourse, less and less frequently in recent years. I’ve done some public-facing work around this and given a couple of interviews, the upshot of which is that epidemic vs. endemic is a qualitative rather than a quantitative distinction. By this I mean that there is no threshold of infection or transmission below which an epidemic disease becomes and endemic one. Diseases are rendered as endemic via a complex socio-ecological process — adaptations are installed or not, pandemic income supports go away, the business of life, for those of us still here, must go on somehow.

Other examples I can think of. COVID cases are certainly much more numerous than cases of locally-acquired dengue in the US, but the dengue is more concerning to me as an epidemiologist. At this point, COVID is the devil everyone knows; one dark cloud on the horizon, for me, is the recrudescence of mosquito-borne illness in the USA. (Another one is pandemic influenza… although the COVID grifters are trying to latch on to it, it’s mercifully not an emergency; not yet, anyway.)

Or, to use a non-infectious-disease example, pregnancy-related mortality. The numbers tell a jarring story: Black and Indigenous people are unnervingly more likely to die in pregnancy or childbirth than their white counterparts. These numbers have a qualitative dimension that is expressed in quantitative terms as “relative” or “absolute” rates of mortality. Relative to white people, Black and Indigenous people have extremely high risk. In absolute terms, though, even the demographic groups with the most social privilege (white people) have alarming rates of pregnancy-related death. Which is to say, Black and Indigenous people bear the brunt, but the picture is not good even for white people. What to make of this?

Good day, freaks — and my apologies for a lack of content over the last few weeks. I have several things I want to publish here in the works and I keep getting mired in perfectionism (which I do have the power to change) and life stress (which I don’t). So, thanks for hanging in there with me.

This is just to alert you all that both parts of the episode of Last Born in the Wilderness I recorded recently are now available. You can find the Soundcloud links to both parts at this page here.

To my chagrin, I didn’t know about this podcast until the host reached out to me to appear on it. It is fantastic — I’ve been catching up on past episodes over the last few weeks, and I highly recommend subscribing to the show on Patreon if you have a couple bucks to spare.

More of substance from me soon, I promise!

Quick note here. I wrote this a few months ago and am still kind of workshopping it. But I was revisiting it today and I think this fragment is sufficiently developed to send out.

A little while ago, I wrote some posts about Goran Therborn and ideology: here and here.

As I was reading Therborn’s book, and writing those posts, I (Carrie Bradshaw voice) couldn’t help but wonder: what is the ideology of public health? (In the interest of limited time, I am not going to rehash Therborn’s analysis in depth here. You can go back and read my posts if you’d like to, but basically, following Althusser, Therborn argues that ideology “interpellates” different kinds of human subjects; ideology is a process that subjectifies you and also qualifies you for certain kinds of social roles and responsibilities.)

Who does public health “subject and qualify”? What kind(s) of subject(s) does it interpellate? Immediately, I think there are already two distinct ways to talk about this: the ideological processes of public health interpellate 1.) public health professionals and also interpellate 2.) “the public” that public health is addressed to. Bringing Therborn back in, he argues that ideology interpellates human subjects according to: ontology (what is), possibility (what could be), and normativity (what is good or desirable).

Good morning, everyone. This is just a quick bulletin to let you know that my new radio show, A COURSE IN MIRACLES, starts today. It will be this evening (and every subsequent Sunday evening) from 5-7 PM, Eastern time. You can stream it at www.wrct.org. If your heart is tender or heavy then I hope you find the show as therapeutic to listen to as I do to put it together.

Till next time!

Though this isn’t its most vernacular meaning, “embodiment” has a second life as a term of art in a marginal subdiscipline of epidemiology, so-called “social” epidemiology. Depending on the day and my mood, I could articulate social epidemiology as the heir to some kind of real public health, before molecular medicine got in the way, or as the part of epidemiology that traffics the most cynically and shamefully in trauma questionnaires and DEI ambulance-chasing. It is supposed to be, I guess, the part of epidemiology that deals with social conditions and gives them primacy over individual factors like genotype or health behaviors. Social conditions are a hugely important aspect of population health and this is (or at least can be) a hugely powerful line of inquiry — look into any public health problem that is formulated as such (to be a public health problem is to be a technical problem amenable to technical manipulation) and there is a sense of vertigo as one realizes how deeply the roots of the technical problem reach into social organization and history. The concept of “embodiment” (in overwrought language about how “bodies tell stories”) is basically The Body Keeps the Score for the population health scientist — we in-corp-orate, quite literally, the social conditions in which we live. I, for example, embody the thick fug of particulate air pollution constantly lying over my neighborhood, which is a historically redlined one… you get the picture.

But, I have soured a little bit on social epidemiology in recent years. One reason is pretty obvious — this shit is not original. It might be compelling, but it’s not original. It might have been original for Rudolf Virchow in 1848, but it’s absolutely no longer in 2024, though people make interminable, monotonously prolific careers out of announcing over and over again that social conditions matter. Yes, I am subtweeting Nancy Krieger, the person who coined the term “embodiment” in its epidemiological application. I used to really love and admire Krieger’s work, but am coming to view it as quite unsatisfying. This is connected to another of my objections to social epidemiology as such right now, that there’s not really much “there” there. True that everything is connected to everything else. True that we are not isolated laboratory subjects. So what? What are we supposed to do with this information? How to actually link the insights derived from thinking about epidemiology through embodiment with actual practice of public health? It’s not clear, and the practice of social epidemiology seems to be little more than an endless iteration and explication of a familiar parade of social ills: capitalism, racism, environmental destruction, and so on. (Wouldn’t you know? All bad for your health!)

The last reason I will mention and the one I want to focus on is: the very existence of social epidemiology effects the same artificial severance of living individuals from social context that social epidemiology is (at least ostensibly) meant to mend. Are history and “social conditions” external to the human beings that constitute them? Is there any place for experience in public health? A very familiar reference point for me is Lewontin’s Gene, Environment, Organism — tl;dr, all three actively constitute and “make” each other, all the time. A very new and unfamiliar reference point for thinking about this stuff (for me) is Maurice Merleau-Ponty’s Phenomenology of Perception.

Merleau-Ponty makes use of embodiment in a different sense and to a different end, but one that I think is generative for thinking about stale public health concepts. His concern was a philosophical treatment of perception, and as far as I understand it, in Phenomenology of Perception he is trying to argue against both “empiricist” notions of perception (perception is a causal process of sense-experience or stimulus-response, for example, light of a certain wavelength striking certain receptors in my eyes and giving my brain the perception of the color red; unidirectional influence of world on mind) and “intellectualist” notions (my mind synthesizes different objects in the world into a perception of the color red; unidirectional influence of mind on world) in favor of a secret third thing, something like gestalt theory. From the Stanford Encyclopedia of Philosophy entry:

A couple of weeks ago, the Pandemic Mitigation Collaborative rolled out some updates to their models, which I’ve posted about before: here and here. Since then, I’ve seen Eric Topol, director of the Scripps Research Translational Institute and member of the National Academy of Medicine, cite the “one million cases per day” pseudo-statistic on PBS Newshour, which sucks. I’ve seen the figures from this model cited all over the news — in the absence of real information, grifters like Hoerger fill the void, and with the sorry state of media today, nobody is any the wiser and his bullshit claims get spun up and amplified into synthetic truths. It’s really awful to watch. I am critiquing these models as a PhD epidemiologist. This is exactly my lane, this is exactly my expertise, and people like me and our insights are being completely marginalized as the pandemic grifters crowd us out with fake data, hyperbole, truly horrendous and stigmatizing claims about “airborne AIDS,” and all other manner of dog shit.

The PMC published a “technical appendix” about the updates to their models. I reviewed the technical appendix and it is one of the most bizarre documents I’ve ever laid eyes on. So, in today’s bonus edition of this newsletter, let’s close-read it — or at least some of it (I will get to anything I don’t cover today, a Friday evening, at a later time). The TL;DR: Dr. Hoerger definitely read my previous posts (LOL) but doesn’t really have a response to any of the critiques in them, and the technical appendix doesn’t go far enough in elucidating exactly what their modeling methodology is or how accurate it is. I am repeating my call for the PMC to publicly share the code they use to run these models (this can be done easily on GitHub and is in fact common practice among working scientists, at least in epidemiology) and will reiterate it at the end.

I’m going to take it by sections as they appear in the appendix, with heading titles italicized and bolded and direct quotes of text from the appendix italicized. My commentary will appear below any text quoted, not italicized.

What’s new?

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.