Dynamist Blog

How to Honor Breast Cancer Awareness Month

This post went out to subscribers to my Substack newsletter on October 9. Check out all the posts, including ones from the archives not reposted here, and subscribe here.

I think about breast cancer every October, and not because it’s “Breast Cancer Awareness Month,” which I find some mixture of ridiculous and distasteful. I’m all for raising money for breast cancer research and treatment. But making people “aware” by slapping pink on everything from the water in public fountains to specials at Dollar Tree doesn’t do much to save lives. When someone’s selling “breast cancer awareness” tchotchkes, any contributions won’t be more than their profit margins and quite likely less. (See this 2015 Business Insider analysis of how little money from the NFL’s breast cancer merch makes it to the cause.)

It’s not the orgy of pink that reminds me of breast cancer. It’s the Nobel Prize in Physiology or Medicine. I have a rooting interest, and so far I’ve been disappointed. I want the prize to go to UCLA cancer researcher Dennis Slamon, who in recent years has been on the Great Mentioner’s short list (an improvement since I started paying attention a decade or so ago).

Slamon’s work did two things: Beginning with HER2+ breast cancer, it demonstrated that cancers could be identified by specific genetic variants, rather than merely where they occur in the body. Then it showed that those variations could be targeted and treated with specific antibodies. The first practical result was the drug Herceptin, which treats the roughly 25 percent of breast cancer patients with an especially aggressive form. From a recent UCLA profile:

The key finding by Dr. Slamon and colleagues showed that the monoclonal antibody Herceptin binds to, and destroys, abnormal cells without harming nearby healthy tissue, much like a laser-guided missile hitting a select target. This was a major departure from then-common chemotherapies that Dr. Slamon refers to as the “hand grenade” approach, indiscriminately killing healthy as well as diseased cells. Proving that antibodies that bind to cancerous cells are an effective method for treating solid tumors transformed cancer care at a time, in the 1980s, when most cancer therapies were focused on excising tumors and developing better chemotherapies. The discovery opened up new research avenues, leading to multiple other targeted treatments that utilize antibodies to attack the disease at its genetic roots. Between 2.7 million and 3 million women have been treated with Herceptin, and women with HER2-positive breast cancer now have among the highest survival rates compared with all women with breast cancer.

Here’s a video that explains further (and includes researchers Axel Ullrich and H. Michael Shepard, who might share in the same prize, as they did in the Lasker award sometimes called the “American Nobel”).

If U.S. scientific research were more “efficiently” funded, none of this research might have happened. After the scientific triumphs of World War II, Vannevar Bush, who had directed the wartime Office of Scientific Research and Development, proposed the establishment of a similar peacetime organization through which all science funding would flow. After some legislative iterations, we got the National Science Foundation, but it has no monopoly even on federal government funding. In addition to the obvious National Institutes of Health, money flows from assorted pockets of the Defense Department, the Energy Department, and more. On top of that are many philanthropic foundations, including heavy hitters like the Howard Hughes Medical Institute, the Bill & Melinda Gates Foundation, and the American Cancer Society. To a good technocrat like Bush, it would seem like a disorganized mess.

Vannevar Bush’s proposed organization chart

Back in the 1980s, Slamon amassed a collection of different kinds of cancer tumors removed from patients, believing that analyzing their cells’ molecular biology could unlock the mystery of why the cancers spread. UCLA wasn’t a major cancer-research institution, Slamon was a nobody, and his idea was decidedly out of the mainstream. You can imagine how his grant proposals were received. When he applied for an NIH grant to fund the tumor bank, he says, “It came back with a laugh track.”

Fortunately Axel Ullrich, then at Genentech, gave a seminar at UCLA, presenting his work on growth-regulating genes. He agreed to give Slamon samples of the DNA he’d identify to test against the tissues in the tumors. To do the painstaking work on a low budget, Slamon hired a UCLA freshman named Wendy Levin:

Now a physician, Dr. Levin is an oncologist in San Diego County, but while an undergraduate, she spent nights and weekends “sometimes sleeping on the floor in the lab,” she says, extracting DNA from tumors. It was tedious work, taking a piece of tumor tissue that had been frozen in liquid nitrogen, grinding it up, extracting the DNA and looking at one gene at a time for something awry. But the work bore fruit on a Saturday afternoon in June of 1986, when she found a match between the HER2 gene and a breast cancer tumor. “My heart started thumping,” Dr. Levin says. “It was a true eureka moment.” She excitedly called Dr. Slamon at home, offering to drive out to his house to show him the results. Dr. Slamon decided it would be OK to wait until Monday.

The usual sources were still not interested in paying for research. But in 1989, Slamon was treating Hollywood honcho Brandon Tartikoff, best known for his stint as president of NBC, for Hodgkin’s lymphoma. Tartikoff’s wife Lilly was grateful for the care and asked Slamon what she might do to help him. He told her about the idea of finding a drug to treat HER2+ breast cancer. Soon thereafter, in a classic Hollywood moment, she ran into Ronald O. Perelman, who owned Revlon, at Wolfgang Puck’s original Spago restaurant. She gave him the pitch: You own Revlon. Revlon sells to women. Women get breast cancer. You and Revlon should support this research. He agreed to let his representative meet with Slamon.

At the meeting, Slamon was accompanied by his colleague John Glaspy, who is a notably blunt-spoken person. Even if they got government funding, Glaspy warned, it would take several years and by then “we’ll have a Rose Bowl full of dead women” from breast cancer. The pitch worked. As Mona Gable recounted in a 1998 article for UCLA Magazine:

Perelman not only came through for Slamon, but he made an astonishing offer: $800,000 a year for three years, a total of $2.4 million. As support from an American corporation to a single scientific group, the gift was virtually unprecedented. Just as amazing, the research funding was unrestricted. Slamon could use the money however he saw fit.

“It would have taken four concurrent National Cancer Institute grants to build the equivalent of the program Revlon funded with just the stroke of a pen,” Slamon says intently. “And there was no writing a grant, submitting it, waiting eight to 12 months to hear. This gift allowed us to follow our leads almost instantaneously, and made a huge difference in this whole story.”

Even with Revlon’s help—and money from one of those Pentagon pockets—the development of Herceptin was such a difficult journey that it became a Lifetime movie. Genentech was a young company with little margin for error and several times threatened to cancel drug development.

In 1998, the drug was approved for treatment of Stage 4 HER2+ breast cancer and in 2006 it was approved for treating early stage cancers. A year later, it saved my life. As I wrote in the acknowledgements in The Power of Glamour:

In July 2007, barely a week after receiving the final signed contract for the book, I was diagnosed with what turned out to be HER2-positive breast cancer, a particularly aggressive form of the disease. Twenty years earlier, I would have had only a fifty-fifty chance of survival, given the details of my case. Today, I am officially cured. Although I underwent the traditional treatments of surgery, chemotherapy, and radiation, what made the crucial difference was the pathbreaking biologic drug Herceptin, first approved by the Food and Drug Administration in 1998.

The research that led to Herceptin was funded not by the federal government or a traditional cancer charity but by money from Ronald O. Perelman, in his role as chairman of Revlon, and by fundraising in the 1990s at a series of star-studded events called the Fire and Ice Balls. I am deeply grateful to the many people, only one of whom I know personally, responsible for bringing Herceptin to the world: to Dennis Slamon for his scientific vision; Lilly Tartikoff for her fund-raising energy; my oncologist, John Glaspy, for his persuasive eloquence; the researchers at Genentech for development and testing; and Perelman and Revlon for their financial contributions. In a very real way, I owe my life to the glamour of makeup and movie stars.

As the ever-frank Dr. Glaspy told me, “You’re cured, and if you ever get breast cancer again, it won’t be the same cancer.”

January 2009, when my hair was coming back after chemotherapy.

AI Images, Status & Culture, and Some News

This post went out to subscribers to my Substack newsletter on October 8. Check out all the posts, including ones from the archives not reposted here, and subscribe here.

The image above is Tony Morley’s entry into my contest asking for visions of a positive future. Tony used the AI image engine from the team Midjourney with the prompt “Metropolitan skyline of a city in North Africa.” He writes that it represents, “A future where the newborn daughters and sons in Mali and Niger have the same life expectancy and living standards as those of the United Kingdom.” Follow Tony’s explorations of progress on Twitter. The deadline for entries is October 31 and the contest is described in this post. Please spread the word—and enter!

Speaking of AI image engines, I was inspired by the dismal landscape at the top of this post on nuclear power by Jim Pethokoukis to wonder why cooling towers (nuclear or otherwise) can’t be painted to look cheerful. That led to some fooling around with image generators, primarily Stable Diffusion. Attempts to create images of cooling towers painted with murals confirmed something that my long-ago Harvard Extension Hebrew teacher said: “Prepositions are the hardest part of a language.” Stable Diffusion had a tough time understanding that asking for a mural on a cooling tower is not the same as asking for a mural in a cooling tower or a mural of a cooling tower. (A few days later I saw this Astral Star Codex post, from which I learned that the difficult preposition problem is called “compositionality” in AI circles.) But I did get a few reasonable results.

Imagine the murals people with actual artistic skill might come up with. Maybe the intimidating dull gray of cooling towers reflects technical issues that water towers—like the famous Gaffney peach—don’t face. But finding a way to make cooling towers look friendlier would go a long way to improving nuclear power’s public image.

In the revitalized (now web-only) Print Magazine, Steven Heller interviews Andrea A. Trabucco-Campos and Martín Azambuja, the designers behind a project using AI prompts to create typography in the styles of iconic artists. They’ve recently published some of the results in a book titled Artificial Typography. From the interview:

Is “artificial” the best way to describe this material or is there another word that better describes what you are doing?

Artificial Typography is an obvious wordplay we loved as a book title due to its immediacy and relation to Artificial Intelligence (AI). It also lends itself to a series of books we’re thinking about publishing in the future, such as Artificial Architecture, Artificial Objects, etc.

Beyond that, “artificial” is an accurate way of describing these images if we consider the mode of creation and how this word is commonly understood: something not existing/originating in nature, rather produced by human processes. It is doubly removed from us since it is not just created by our hands with tools (think a letter drawn by a pen, brush or Illustrator), but instead produced semi-autonomously by machines and systems we’ve created.

Initially, we were also enamored by the idea of “conversation” and played with it as a title. The exchange that happens with AI machines is a form of conversation, and perhaps one of the most intellectually satisfying visual-verbal connections that have been devised between human and machine. As mentioned, you feed it a text prompt and through a simple string of words and their order, the AI system generates images that are sometimes unexpected, sometimes weird, sometimes ugly, and quite often stunning. You then can keep on iterating on the images or versioning the ones that are most successful, as well as tweak the text prompt and learn how the AI reacts to subtle or drastic shifts.

I like this notion of “conversation,” which captures the iterative process as well as the nature of the best conversations. You have a general idea in your head and you try to express it in words. The system in effect says, “Do you mean this?” And the back and forth proceeds, with the two of you trying to come to a common and pleasurable understanding that makes something new in the world.

Even in their current limited state, AI image generators are changing how we work with images in a visually saturated culture. The better image generators get, the more we’ll use them—and the more we’ll need to remember that seeing shouldn’t necessarily be believing. (The negative hot takes practically write themselves.)

Will Knight, who covers AI at Wired, has written several interesting articles on image generators, including one making the point that they can enhance human creativity.

People who have been granted early access to DALL-E have found that it elevates human creativity rather than making it obsolete. Benjamin Von Wong, an artist who creates installations and sculptures, says it has, in fact, increased his productivity. “DALL-E is a wonderful tool for someone like me who cannot draw,” says Von Wong, who uses the tool to explore ideas that could later be built into physical works of art. “Rather than needing to sketch out concepts, I can simply generate them through different prompt phrases.”

I could imagine image generators making those supposedly worthless art history degrees hot commodities. Although Stable Diffusion understands what the style of Keith Haring is, it has a much harder time grasping what makes Carlo Crivelli so weird and distinctive. (It’s not the Renaissance architecture and clothes.)

Latest writing and some news

My latest article is a review of W. David Marx’s Status and Culture for the WSJ’s fall books issue. Here’s an excerpt:

“Status and Culture” is blessedly free of the moralizing that so often mars analyses of status. Mr. Marx recognizes that status and status-seeking are human universals: “All status symbols rely on objects and behaviors with practical or aesthetic value that enrich our lives,” he writes. But the book often feels anchored in the second half of the 20th century, when the Beatles, Pop Art, and preppy style were salient examples and mass media essential to cultural diffusion. It doesn’t reach back to, say, the Italian Renaissance to more fully test its theories. Only in the final chapter does it begin to explore our own “era of vast quantities, deep specificity, and breakneck speed, where few individual artifacts, artworks, or conventions leave a dent in society or bend the curve of history.”

In today’s sea of instantly available, constantly ranked cultural production, Mr. Marx argues, everything and nothing has cachet. The result, he worries, is to “debase cultural capital as an asset, which makes popularity and economic capital even more central in marking status.” In some ways, the world he describes sounds like the 1950s, with the culture of TikTok as the new mass media, and “keeping up with the Joneses” measured in likes.

Now, however, individuals with specific passions and tastes can find the things they value far more easily. “We live in a paradise of options, and the diminished power of gatekeepers has allowed more voices to flourish,” Mr. Marx acknowledges. “The question is simply whether internet content can fulfill our basic human needs for status distinction.”

The book is a nice introduction to the literature on status—the bibliography is remarkably comprehensive—but, as those who’ve read The Substance of Style might predict, I have some disagreements with Marx’s single-variable explanation.

And now, the news….

After more than 11 years as a contributor, I’m leaving Bloomberg Opinion. When I first joined the then-new Bloomberg View in May 2011, I figured it might survive three years. Happily, it’s still thriving. But we’re parting ways, as I’m want to pursue more in-depth writing opportunities, including idiosyncratic history- and textile-related projects, and they want to focus on a tighter group of frequent contributors. It’s been a good ride: great editors, freedom to choose topics (within the constraints of a news-pegged column), and old-fashioned pay. Here’s hoping they forget to cut off my access to the other side of the Bloomberg paywall…

Assorted links

The case for abolishing the National Environmental Policy Act: It’s a strong one, made by Jeremiah Johnson at Liberal Currents.

Everything you never knew you wanted to know about Baltic birch plywood, by Anna & Kelly Pendergrast at The Prepared.

Excellent Q&A with Scott Lincicome about industrial policy, interviewed by Jim Pethokoukis (podcast and transcript). Excerpt:

What if the policy was, “Here’s how we’re going to deal with climate change: We need to pull carbon from the air”? Carbon removal technology is something that doesn't really exist right now, other than in some very experimental forms. “We're going to fund it, just like Apollo, just like the Manhattan project.” Would you favor something like that, assuming you thought there was the actual need to pull carbon from the sky?

The industrial policy approach is that we need that carbon capture technology to be made by Americans in America. And not just deployed by Americans; we need it made in America. Whereas the more free-market approach would be a prize: We don't care how it's made. We don't care who makes it, with a few security-related exceptions. If tomorrow the Korean government or Samsung or whatever comes up with the most amazing carbon capture technology in the world — it's like Mr. Fusion from Back to the Future, you just slap it on a power plant and suddenly we're zero emitters — you win the prize. We don't care that it was made by a Korean company. We don't care that they are going to be Korean jobs and not American jobs. No, the industrial policy side says, “We care a lot about who makes this stuff and that it's made in America, using American materials.” The pandemic, for all of its terribleness, provided us a pretty good example of the industrial policy approach to pandemic stuff and the market approach. And that's in the vaccines. The more free-market approach, essentially a prize but a procurement contract, was we went to Pfizer and BioNTech, and if you look at the contract for those vaccines, it said we have nothing to do with your supply chain. “We don't care how you do it. We don't care what you do. Just get an FDA-approved vaccine and we are all in, we're going to pay.” That's it. There are clauses in that contract that literally say we will have no control over how you make this whatever. A ton of global collaboration, of course. BioNTech is a German company, blah, blah, blah.

Several people have sent me this Scientific American article about Michèle Hayeur Smith and her work on what Viking textiles tell us about women’s roles. Careful readers may recall that I drew on her work in chapter five of The Fabric of Civilization, where I wrote about textiles used as money in Iceland, as well as China and West Africa. She has since published a book, and I was able to enlist her to give a talk to the Southern California Handweavers’ Guild, which you can see on my YouTube channel (please subscribe to my channel and watch my videos so that my numbers get high enough for YouTube to share the money from those annoying ads):

Stop with the "Jetsons" Nostalgia!

This post went out to subscribers to my Substack newsletter on September 12. Check out all the posts, including ones from the archives not reposted here, and subscribe here.

As I’ve said here before, I’m a big fan of Jim Pethokoukis, and I highly recommend his Faster, Please! newsletter. I’m also a fan of Adam Thierer and his arguments for the importance of “permissionless innovation” and “evasive entrepreneurs.” So I was happy to read Jim’s recent Q&A with Adam—except for one little thing. It starts with Jim’s favorite cultural obsession, nostalgia for 1960s science fiction: “The 1960s was full of optimistic sci-fi, most notably The Jetsons and Star Trek. Does the fact that the '60s were followed by the pessimistic 1970s show sci-fi simply doesn’t matter?”

In the Postrelian tradition of attacking my allies’ arguments—I call it taking them seriously, while my husband calls it stabbing people in the front—please allow me to make a few points about this fixation (not just by Jim) on 1960s pop s.f. and recent dystopian works.

1) The Jetsons was not science fiction any more than The Flintstones was archeology. It was, like its Stone Age partner, a midcentury family sitcom—I Love Lucy/The Honeymooners/Father Knows Best with different backdrops and dumber jokes.1

The commentary (such as it is) about technology mostly consists of complaints about devices breaking down and costing too much. Automation also means George and Jane Jetson do nothing all day except push a few buttons. If real, their lives would incredibly boring. (The Feminine Mystique was a bestseller for a reason.) The show is definitely not Star Trek.

The Jetsons is graphically appealing, but it only works because we don’t take it literally as a portrait of the future. The Jetsons live in a world without trees, grass, or privacy. Anyone in a flying car can peer straight into their windows, which also appear to be open all the time. People live in the sky for no reason other than it makes for cool drawings. You can’t take a walk around the neighborhood. Ever wonder, What’s on the Ground in The Jetsons? (Spoiler: “Homeless people and walking birds.”)

2) Star Trek’s fundamental appeal was not about the future or technology per se. The show portrays a setting in which smart people have new experiences and learn new things, solve important problems, and forge deep friendships. Nobody worries about money or office politics. The show’s values are humane. Everyone’s job is important and the boss deserves respect. As I learned in a big survey I did while researching The Power of Glamour, for many of its fans Star Trek represents an ideal workplace.

Star Trek’s vision of a nerd-friendly universe made the future glamorous, but only to the select few for whom that vision resonated. When originally broadcast Star Trek had lousy ratings. Most people didn’t find it especially appealing.2

Its pop culture success dates to syndicated reruns in the 1970s, which is when I saw it. (The first fan convention was in 1972.) By then, its New Frontier spirit, complete with Cold War analogies, was already out of step with the times. The show attracted fanatical devotion partly because popular culture offered few (no?) other celebrations of earnest nerds and their values.

3) Dystopias are far from Hollywood’s main products. I personally worry more about the ubiquity of pharmaceutical company villains and complex government conspiracies. (Did you ever see Scandal?) But I understand why tech horror obsesses D.C. policy wonks. They look for movies about A.I. or climate change or fill-in-the-dystopian-blank and find plenty of evidence of anti-technology attitudes infecting the culture.

But Hollywood’s biggest movies are not dystopias. You may have heard of the Marvel Cinematic Universe. It’s kind of big. It’s also technologically optimistic science fiction. Tony Stark! Wakanda! The Pym Particle! Yes, sometimes you get Ultron, but if you think Hollywood is only serving up technological gloom and doom you are definitely not reading Variety.

Meanwhile, on the prestige side, there are movies like Her (2013), Arrival (2016), and Everything Everywhere All at Once (2022). All have heart, as well as a nuanced and non-negative view of technology. And I’d argue that the future of A.I. is likely to be improved by the existence of thought-provoking movies like Ex Machina.

4) The Graduate, released in 1967, was a contemporary of the original Star Trek. A better question to ask about popular culture and the pessimistic turn is why this scene was so powerful. What made audiences find this career advice creepy and ridiculous? Not dystopian science-fiction movies.

5) In chapter three of The Future and Its Enemies I adopt a maxim from Henry Petroski to explain the open-ended nature of progress: “Form follows failure.” To quote the book:

Far from a utopian concept, this sense of progress acknowledges that life is not perfect, that any improvement requires ingenuity and work, and that different people have different notions of what constitutes a “better” idea. “Form follows failure,” is how civil engineering professor Henry Petroski, whose popular books explore the histories of such mundane objects as zippers and forks, sums it up:

The form of made things is always subject to change in response to their real or perceived shortcomings, their failures to function properly. This principle governs all invention, innovation, and ingenuity; it is what drives all inventors, innovators, and engineers. And there follows a corollary: Since nothing is perfect, and, indeed, since even our ideas of perfection are not static, everything is subject to change over time. There can be no such thing as a “perfected” artifact; the future perfect can only be a tense, not a thing.

As soon as we have something that improves over the past, we see what’s wrong with it. Unalloyed cheeriness doesn’t drive progress. Dissatisfaction does. What’s true for “made things” is also true of social and cultural artifacts and practices. One generation’s accomplishments look like unsolved problems to their successors.

The “plastics” scene in The Graduate isn’t about polymers. It’s about a young, economically privileged generation feeling trapped into pursuing inauthentic lives. To a man who lived through the Depression and World War II, the prospect of security in a growing, high-tech industry is enticing. To Dustin Hoffman’s Benjamin, it’s horrifying. He doesn’t know what he wants, but he know it isn’t a job at Dupont.

When I saw The Graduate more than a decade after it came out, I didn’t find it compelling. But if you’re concerned with preserving technological and social dynamism, you have to take seriously the discontent the movie represents. The Graduate didn’t create that discontent. It reflected it. As I wrote in this essay:

In a liberal order, however imperfect, the competition, criticism, innovation, and open-ended pursuit of better ways of doing things that characterize economic dynamism also give rise to cultural dynamism. Free individuals exercise voice and exit. They use what I’ve called “criticism by expression” and “criticism by example”—otherwise known as complaining and entrepreneurship—to shape new norms and institutions. And since the culture and the economy are not, in fact, separate spheres, the two forms of dynamism affect one another.

Culture is just as complex, dynamic, and unpredictable as science, technology, or markets—and just as driven by discontent.

In 2014, I wrote a Bloomberg column on these issues, which I will send out as a separate “From the Archives” post.

Odds and Ends

The Fabric of Civilization is on sale for $3.99. At that price, it’s worth buying even if you own a print copy, just in case you want to search it.

Also, here’s the periodic reminder that the references for The Fabric of Civilization are online here.

>How Spider-Man Led to the Invention of the Prisoner Ankle Monitor

>Will California law allow this 2,300-unit project, despite local NIMBYs? (If you read my recent column on Atherton, you might guess the answer.)

How Spock Became a Sex Symbol (Bloomberg column I wrote when Leonard Nimoy died)

Interview with me about The Power of Glamour (old but good!)

Got a positive vision of the future? Enter my contest, described at the bottom of this post.

Who would want a robot caregiver?

This post went out to subscribers to my Substack newsletter on August 23. Check out all the posts, including ones from the archives not reposted here, and subscribe here.

I recently spent time visiting my aging parents—my father will be 88 in November and my mother is 86—so I have elder care on the brain. My parents have a diversified portfolio of children to help them out. I, on the other hand, have none, which makes futuristic elder care predictions all the more salient.

What happens when the population of old people gets too big for the supply of paid and unpaid caregivers? Raising wages is the obvious answer but, as I discussed in a March 2020 Bloomberg column, the economics are terrible.1

To save you a click, I’m going to repeat the whole thing, with the critical facts highlighted, before I get to my new point:

They are the most numerous and lowest-paid U.S. health-care workers: the 4.5 million caregivers who assist elderly and disabled people with such daily activities as bathing, dressing, feeding and toileting. Compared to other medical workers, they have the most frequent and personal contact with the elderly. That puts them on the front lines of the coronavirus pandemic.

Known in the business as direct-care workers, these paraprofessionals include certified nursing assistants, who work in nursing homes, and home health aides and personal-care assistants, who often travel between multiple clients. Their median wage is $12.27 an hour, with home care workers making the least and nursing assistants the most. As the pandemic spreads, these workers are especially vulnerable and increasingly difficult to replace.

Don’t they deserve more money? The National Domestic Workers Alliance certainly thinks so:

Home care workers take action when health crises hit to protect the most vulnerable, and $11/hour isn’t fair pay. We need to invest in care workers — key first responders in this crisis. https://t.co/j9Mnmgh3FY
— Domestic Workers (@domesticworkers) March 14, 2020

But the pay isn’t low because the people who hire caregivers are greedy and mean-spirited. Neither is it because the work is easy or unimportant. It’s a much tougher problem. Caregiving is vital, but so labor-intensive that at higher wages, hardly anyone could afford it.

Consider some basic math. There are 8,760 hours in a year (8,784 this leap year). At $11 an hour, that’s $96,360. At $12.27, it’s $107,485. At $15 an hour, it’s $131,100.2

And that’s before the client pays for room, board, and other medical care. About 16% of caregiver payments come from family budgets, while private insurance covers only 11%. The rest comes from government programs, primarily Medicaid.

Not everybody requires 24/7 care, of course, but many people do. “Need” is as much a matter of what people can afford as it is an objective criterion. For families deciding how to spend dwindling resources, it can be a matter of supplementing paid with unpaid labor, which can require cutting back on a family member’s own work hours. For state legislatures allocating the Medicaid money that covers 52 percent of long-term care, it means tradeoffs between elder care and hospital reimbursements or maternity care, not to mention schools and highways.

Direct-care workers are in short supply, with skyrocketing turnover rates. In 2018, the latest year for which data is available, the turnover rate among home health aides hit a new high of 82 percent, according to the annual survey by Home Care Pulse. The agencies and institutions that employ these workers aren’t just competing with each other. They’re competing with businesses such as Amazon.com that have been raising entry-level wages.

“Turnover was so severe in 2018 that more than half of the participants had to turn away new clients because they didn’t have enough caregivers,” reported the trade publication Home Health Care News. Tight Medicaid reimbursement limits make it hard to raise pay or expand service. Higher reimbursements would permit higher pay but, again, the money would have to come from somewhere else.

We’ve seen this dilemma before: absolutely essential work that takes so long that wages remain low even as it consumes a high proportion of total expenses. Pre-industrial spinners worked for incredibly low wages, yet their pay was often the biggest expense in making cloth. And they were always in demand. “The spinners never stand still for want of work; they always have it if they please; but weavers sometimes are idle for want of yarn,” wrote the agronomist and travel author Arthur Young, who toured northern England in 1768.

Before the Industrial Revolution, Indian hand-spinners, the world’s best, took about 100 hours to produce enough cotton thread to weave the fabric for a modern pair of jeans — not including the time cleaning and preparing the fiber beforehand. Spinning the equivalent amount of wool on a European spinning wheel took about 110 hours. At the low modern wage of $11 an hour just the thread in a pair of trousers would have cost well over $1,000, not including the time spent dyeing, weaving or sewing. (For sources and an in-depth discussion, see my forthcoming book, "The Fabric of Civilization: How Textiles Made the World.") Only by finding mechanical ways to get much more thread per hour did people finally make cloth abundant, leading to the takeoff in worldwide living standards that economic historian Deirdre McCloskey calls the Great Enrichment.

Boosting productivity, and the wages it supports, is tougher for in-person services like caregiving. In his 2017 book, “Who Will Care for Us?” economist Paul Osterman advocates giving caregivers more training and allowing them to provide simple medical services like administering medications, thereby reducing the need for more expensive nurses to provide frequent care. Many people get into the field because of an interest in health care only to find themselves ignored by their medical colleagues, treated as little more than baby sitters and stymied when they seek to learn more.

Current regulations, Osterman notes, can lead to such absurd situations as caregivers guiding the hands of dementia patients to “self-administer" eye drops, skirting rules against aides doing that job. But nurses, who are well organized and politically influential, fight like crazy against any incursion on their territory.

To boost productivity more significantly, potentially improving both care and wages, start-ups are experimenting with artificial intelligence. An intriguing example is Cherry Home, which markets an unobtrusive monitoring system that distinguishes normal behavior patterns from abnormal ones, including falls, restless sleep or signs of confusion. When something looks off, the system alerts a monitoring center, which contacts caregivers, family members or emergency services as needed. The system has a privacy mode that displays stick figures rather than images of people, and it can communicate with someone in distress without requiring them to press a button. In theory, such systems could allow individuals to stay in their homes without having aides or family members present all the time.

By calling attention to the important work of aides in eldercare, the coronavirus offers an opportunity for a conversation about how to increase the respect accorded their work within the health-care system, how to improve communication between the people who spend the most time with the frail elderly and other medical professionals, and how to build their skills and widen their responsibilities. But as long as it takes thousands of hours a year to care for a single person, wages can’t go up much.

In the pre-industrial era, everyone knew that spinners were important. Before smokestacks, a spinning woman was the iconic representation of “industry.” But to raise wages, you need more than respect and goodwill. You need new technology.

Anyone looking for A.I. applications ought to be thinking about how to enhance elder care. Cherry Home’s system demonstrates that new technology may not mean anything as complicated and intrusive as a humanoid robot.

Robots for elder care tend to be pitched as substitutes for friends or pets or human caregivers. They dance! They tell jokes! But as the comments on this YouTube video suggest, people tend to find the cheery forced companionship of robot carers more than a little suspect.

Anthropomorphizing robot caregivers misses one of their biggest advantage: their impersonal nature. The typical approach reflects the widespread assumption that old people would prefer human aides. The mental model of the elder is my late mother-in-law, who treated her caregivers as new best friends. Who wants to be cared for by an inanimate object rather than a person?

The same kind of person who, all else being equal, prefers the self-checkout to the cashier or the ATM to the bank teller. For all the chatter about technology and “privacy,” nobody seems to be thinking about what it’s like to have a strange person come into your house, hang around for hours, and see you in your most intimate and vulnerable moments. The privacy that matters in everyday life has nothing to do with databases.

My fiercely independent parents have no interest in a human caregiver, even though they could use some help. And I understand why. Personally, I’d prefer a robot that acts like a helpful appliance.

Odds and Ends

I'll be giving a Zoom lecture on The Fabric of Civilization Saturday. Sign up at Lunatic Fringe Yarns. I’m adding a live demo explaining how spinning works, since even experienced spinners often don’t understand what’s going on. Let’s hope it works.

The Prepared is an excellent newsletter about “engineering, manufacturing, and infrastructure.” Their book club recently featured The Fabric of Civilization, and I answered members’ questions on Zoom. Hilary Predko did a fantastic job editing the conversation into an interesting Q&A, complete with some nice visuals.

Two fun food writers: Tamar Haspel grows her own and Howard Miller (whose bio is a story in itself) plumbs the weirdness of American food history, although his latest post is on the movie Elvis.

On Substack, there are no editors telling you what you can write about. Or, as you may have noticed, when that free post has to be finished.

Contest Reminder

In my August 6 post, I announced a contest inspired by thoughts from fellow dynamist Substackers Jim Pethokoukis and Anton Howe:

So here’s are the challenges. You can pick one or try any combination.

  1. Write an updated version of the Victorian paragraph, looking back at 2014.
  2. Write a speculative version of the Victorian paragraph, looking back at today from 2030.
  3. Come up with an inspiring illustration of a possible 2040.

I’ll publish a selection of the best here (you’ll retain rights, of course) as I receive them and will accept entries through September 30. I’ll then award the top two in each category a collection of what Jim would call “Up Wing” books. The judging process will depend on how many entries are received, and I reserve the right to award fewer than six prizes. Email them to me at [email protected]

Full background, including the model paragraph, at the original post.

The Futility of Silicon Valley NIMBYism and an Interview on Dynamism & Illiberalism

This post went out to subscribers to my Substack newsletter on August 14. Check out all the posts, including ones from the archives not reposted here, and subscribe here.

My latest Bloomberg Opinion column looks at some unfortunate, but largely futile, NIMBYism in Silicon Valley’s (and America’s) most expensive town. Here’s the opening":

Venture capitalist Marc Andreessen got caught last week engaging in housing hypocrisy. The author of a 2020 manifesto called “A Time to Build," Andreessen is a vocal opponent of NIMBYism. Yet when it came to his own town of Atherton, California, Andreessen signed a public comment opposing a plan to add 137 units of multifamily housing by rezoning nine lots. (The comment, written in the first-person singular and a style unlike Andreessen’s, seems to have been composed by his wife.)

The incident proves more than that. It demonstrates that California’s state-level housing reforms are working — not as fast as they ideally would, but working nonetheless

To see what’s going on, read the full thing on Bloomberg Opinion. If you can’t get past the paywall, you can read a version without links at the WaPo, courtesy of my subscription.

Can Liberalism Make Peace Between the Future and Its Enemies?

Aaron Ross Powell, who hosts The Unpopulist’s podcast, interviewed me about my 1998 book The Future and Its Enemies, which he said “looks more and more prescient with every passing day.” Aaron asked excellent, thought-provoking questions and I was having an articulate day. It’s a wide-ranging discussion and I highly recommend listening to the podcast or reading the transcript. Here’s a selection:

Aaron: I was in high school in the 90s. Thinking about gay marriage—you mentioned gay marriage—how dramatic the change on acceptance of gay relationships and gay marriage has been: When I was in high school, Ellen coming out on her sitcom was, like, We're going to have a gay character on television! This was national news; everyone was talking about it. Whereas now, 30 years later, it's just like, so what, there's a gay character.

It happens very quickly, and this makes me think how much of this is about—and going back to the rules, too—ambiguity versus clarity; that people want to know how things are, and how they're going to be. And a lot of rapid change is not constant. It's not uniform. It is experimentation and competing views and figuring out which is the right one, or which is the acceptable one.

All of that messiness means that things are ambiguous, and that what we want is clarity. We want to know, okay, this is the rule that I'm going to have to follow tomorrow. This is what's going to be acceptable. I'm not going to get called out for this. I'm willing to change, but I want to know what it's going to be. That dynamism is inherently ambiguous.

Virginia: Well, I think that is part of it. I think people do want to be able to make their own plans and structure their own lives in a way that it is going to work for them. I would argue that you're better off in a world where people aren't constantly making new rules, from their plans, to run your plans. That's one of the big Dynamist ideas.

But you were talking about people wanting clarity. One of the things that I've written about over the years is clothing sizes and problems of fit. Bear with me; this is relevant. People tend to think that it would be better if there were specific clothing sizes—that if you knew that every size eight dress was for a 35-inch bust and a 28-inch waist (I'm making these up) and 40-inch hips, or something like that, that would be great, because everything would be the same. You would know exactly what you were getting.

It would actually be terrible. In the ‘40s, the catalog companies actually went to the government and said, Could you please establish some standard sizes? And they did. But almost as soon as they were established, different brands started not complying with them, because it wasn't required; it wasn't a regulation.

The reason is that people's bodies come in different proportions—even two people who are the same height and weight. One will have longer legs, one will have shorter arms, one will have a bigger waist, the other will have bigger hips, et cetera. What happens is that brands develop their own fit models and their own sizes. The lack of clarity actually makes it more possible for people to find what fits. I think that is an analogy to one aspect of dynamism—that is, the fact that there isn't a single model that everyone must comply with makes it more likely that people can structure their own lives in meaningful ways.

Now that said, this goes back to this issue of nested rules. Hammering down on people because they express views that were perfectly normal 10 minutes ago, or worse yet, because they use a term in a nonpejorative way (they think), and suddenly, it's turned out that it's now pejorative: This is not good. This is a kind of treating as fundamental rules things that should be flexible and adjustable and tolerant. There is this idea of tolerance when we talk about tolerance as a liberal value, a liberal virtue, but there's also mechanical tolerances. I think a society needs that kind of tolerance as well. That allows for a certain amount of differentiation and pliability; that allows things to work, and it allows people not to be constantly punished. Zero tolerance is a bad idea. Anytime people are having zero tolerance, you're almost always going to be running into trouble.

Read or listen to the whole thing here. Buy The Future and Its Enemies on Amazon here.

A Substack Milestone and a Contest Reminder

I’ve been writing this newsletter for four months and have just crossed the 2,000 subscriber mark. Please spread the word.

In last week’s post, I announced a contest inspired by thoughts from fellow dynamist Substackers Jim Pethokoukis and Anton Howe:

So here’s are the challenges. You can pick one or try any combination.

  1. Write an updated version of the Victorian paragraph, looking back at 2014.
  2. Write a speculative version of the Victorian paragraph, looking back at today from 2030.
  3. Come up with an inspiring illustration of a possible 2040.

I’ll publish a selection of the best here (you’ll retain rights, of course) as I receive them and will accept entries through September 30. I’ll then award the top two in each category a collection of what Jim would call “Up Wing” books. The judging process will depend on how many entries are received, and I reserve the right to award fewer than six prizes. Email them to me at [email protected]

Full background at the original post. I’ve been asked about word limits on the written entries. The inspiration paragraph is about 250 words long. I suspect 250-500 words is the sweet spot, but I don’t want to put limits on readers’ imagination. The only warning is that if you go over 1,000 words you probably won’t get the judges’ full attention unless the writing is riveting.

If you’d like to nominate or donate books as prizes, please email me.

Zoning Abolition, AI Advances, and a Cultural Confidence Contest

This post went out to subscribers to my Substack newsletter on August 6. Check out all the posts, including ones from the archives not reposted here, and subscribe here.

For Bloomberg Opinion, I interviewed Nolan Gray, author of the new book Arbitrary Lines, which advocates abolishing zoning (but not land-use planning) in the U.S. Here are a couple of excerpts:

VP: Is zoning a specifically US phenomenon?

NG: Most developed countries have something resembling zoning. They will say industrial building is not allowed in certain quarters of the city, or certain portions of the metropolitan area are going to be reserved for agriculture. But US zoning is unique in at least two ways. The first is single-family zoning. No other zoning system in the developed world, to my knowledge, demarcates specific areas only for single-family housing.

The second way that US zoning is unique is the complete orientation around the car. It’s often illegal to build an apartment building without a parking garage, or it’s illegal to build a commercial strip without a large parking lot….

VP: You write about the origins of zoning in both New York and Berkeley, California. Can you explain what drove it?

NG: Both reflect the “Baptists and bootleggers” coalition that gets us zoning. The “Baptists and bootleggers” idea is that political coalitions will normally have someone who’s cynically invested in the policy — the bootlegger who supports prohibition because he can make money off of it — and then the Baptist who provides the political movement with moral cover.

Start with the “Baptists.” During the Progressive Era there was this notion that cities and markets are too scary and chaotic. Wouldn’t it be great if we got all the smartest people in the room to come up with a big master plan for what’s going to be allowed on every single lot in our city for the next 50 years? Most modern people look back and think that’s a little crazy. But that was the ethos.

The bootleggers were the landlords who — in the Manhattan context — think, “Way too much office supply is being built in lower Manhattan and it’s lowering the value of my assets.” In the Berkeley case, if you read the zoning promotional materials, one paragraph will say, “We need to adopt zoning so we can keep industry out of residential neighborhoods.” With modern eyes, you read that and think, Yeah, that makes sense. You don’t want an oil refinery next to your house. But then the next paragraph explains what industries they’re concerned about. It’s Chinese laundries. Or dance halls that are bringing African Americans into the neighborhood.

In New York City, shopkeepers on Fifth Avenue were worried about loft manufacturing moving closer to the shopping district. Again, you read that with modern eyes and think, OK, factories. There must have been smoke or noise or vibrations. But the shopkeepers’ specific concern was that poor Jewish factory girls are coming to window-shop along the corridor, and they’re scaring off our elite clientele. Zoning is much more of a social project than it is a good-government process.

VP: You repeatedly make the point that zoning “cannot build a building. It can only ever stop something from being built.” Why is that an important distinction?

NG: When Minneapolis abolished single-family zoning recently, some of the media coverage said that it was banning new single-family homes. But that’s not what they did. They got rid of single-family zoning, which was just a prohibition on apartments. They were getting rid of a prohibition.

In L.A., there are a lot of conversations about getting rid of minimum parking requirements. And people say, “Come on, you’ve got to have somewhere to park.” But getting rid of minimum parking requirements isn’t saying to developers that you’re not allowed to build any more parking. It’s saying that we’re not going to force you to build any parking. We’re not going to mandate things that you wouldn’t otherwise have done. It’s a really important difference.

You can read an ungated version here, courtesy of my WaPo subscription. Our conversation was much longer than what I was able to publish, and, of course, the book goes into further depth. The discussion of Houston, the great American unzoned city, is particularly interesting.

America’s Secret Sauce & the Faux Sophistication of Critique

Speaking of interviews, I highly recommend this conversation between Persuasion founder Yascha Mounk and Eboo Patal, the founder of Interfaith America and the author of We Need to Build: Field Notes For Diverse Democracy. It’s excellent throughout. Patel has a particular appreciation of the success of America’s dynamist approach to religion and how it plays out in the constant evolution of civic associations. I also appreciated the early discussion of the appeal and limitations of the “critique” approach Patal embraced as a college student. “I thought sophistication meant only telling the most negative story possible,” could be the slogan not only of the academic left but of many libertarians and conservatives.

The 21st Century Seems Like Science Fiction…even if it doesn’t look like old science fiction illustrations.

I’ve spent the week interviewing people at synthetic biology startups. I’ve eaten salmon sushi grown from a few cells, with no fish killed and no impurities (parasites, heavy metals, microplastics, whatever). I’ve eaten cream cheese made from whey protein excreted by fungi. You can read more later this year, in a longer article elaborating on the themes in this column from last year. As Greg Benford argued in this 1995 Reason article, ours is the Biological Century: “Beyond 2000, the principal social, moral, and economic issues will probably spring from biology's metaphors and approach, and from its cornucopia of technology. Bio-thinking will inform our world and shape our vision of ourselves.”

The biological advances proceed not just from greater biological understanding, however, but also from advances in computing power and now increasingly in machine learning. Last week brought the news that protein folding is no longer a mystery. The AI company DeepMind, owned by Alphabet (Google’s parent company), announced:

In partnership with EMBL’s European Bioinformatics Institute (EMBL-EBI), we’re now releasing predicted structures for nearly all catalogued proteins known to science, which will expand the AlphaFold DB by over 200x - from nearly 1 million structures to over 200 million structures - with the potential to dramatically increase our understanding of biology.

What will come of this information remains to be seen, but it promises to be big, with implications for medicine, agriculture, and more. My Bloomberg Opinion colleague Lisa Jarvis, a former skeptic, wrote (ungated version here):

Since the early 1990s, scientists have been trying to train computers to predict a protein’s structure based on its genetic sequence. AlphaFold had the first taste of success in 2020, when it correctly predicted the structures of a handful of proteins. The next year, DeepMind put on its server about 365,000 proteins.

Now, it’s put the entire universe of proteins up for grabs — in animals, plants, bacteria, fungi and other living things. All 200 million of them.

Much as the gene-editing tool Crispr revolutionized the study of human disease and the design of drugs to target genetic errors, AlphaFold’s feat is fundamentally changing the way new medicines can be invented.

“Anybody who could have thought that machine learning was not yet relevant for drug hunting surely must feel different,” said Jay Bradner, president of the Novartis Institutes for BioMedical Research, the pharma company’s research arm. “I'm on it more than Spotify.”
Count me as one of the former skeptics. I hadn’t discounted the possibility that AI might have an impact on the drug industry, but I was weary of the many biotech firms hyping often ill-defined machine-learning capabilities. Companies often claimed that they could use AI to invent a new drug without acknowledging that the starting point — a protein structure — still needed to be worked out by a human. And so far, people have had to first invent drugs for the computer to improve upon them.

Producing the full compendium of proteins is something entirely different — and outside the usual hype cycle. It’s little wonder that executives at biotech and pharma companies are widely adopting AlphaFold’s revelations.

For more background on AlphaFold’s approach and the potential, see this Technology Review article from February.

On a more disturbing note, this AI-written letter to Glenn Loury fooled me completely. And I dread having to be on the lookout for AI-written student papers. (If you don’t want to learn, please don’t take my course!)

Envisioning the Future and the Recent Past

I am a huge fan of Jim Pethokoukis and his Substack newsletter, “Faster, Please!” But I’ve spent too much time thinking about glamour to share his enthusiasm for 20th-century visual depictions of the glorious future. They leave out too much—glamour always does!—and those omissions have had some perverse consequences, particularly in urban planning.1 I don’t want to live in the world of The Jetsons for the same reasons I don’t want to live in 1965. Plus there’s more to progress than faster transportation and robot maids. Surely our images can do better, including more human-scale views rather than grand visions that abstract away individual experience.

Meanwhile over at another Substack newsletter I enjoy, Anton Howes writes about Victorian confidence, quoting an 1859 document arguing for a successor to the Great Exhibition of 1851 (known for the Crystal Palace). It describes the previous eight years:

Looking back for that period in England, we find that several new arts and industries have arisen, and old ones have been extended. Scarcely more than ten years have passed since the submarine telegraphs were unknown; the screw propeller applied to our steam-vessels; the glass-duty removed; the great improvements and advancement in the trade and products of the Staffordshire potteries effected; the manufacture of bricks left free to take such form as may be required; the excise duty on soap got rid of; photography and chromatic printing introduced and perfected as arts; gutta percha and many vegetable oils from our Colonies, such as the Bassia Latifolia and the Cahoun Palm, introduced as new raw materials in commerce; whilst the declared value of our exported manufactures has risen from £65,756,000 in 1851 to £122,155,000 in 1857. Add to the above the fact, that within ten years the resources of our Colonies have been largely developed, and the commercial world has acquired three additional emporia: two on the shores of the Pacific, and one on the great American Lakes, viz., San Francisco, Melbourne, and Chicago, none of which are even named in the edition of Mr M’Culloch’s Dictionary of Geography, published in 1849; also that China and Japan have now been opened to trade with England; and we cannot but come to the conclusion that ten years is a period fully sufficient to justify the Society of Arts in proposing to hold an Exhibition in 1861.

Anton comments: “The contrast to today is marked. It is striking that so many intellectuals — particularly in the UK, but also in the US and elsewhere — believe economic and technological stagnation to now be an unavoidable fact of life. Although I don’t subscribe to the view that we’ve been seeing stagnation, I do think we’re falling far short of our potential. It’s worth imagining what kind of Victorian-style paragraph we can write about our last eight years, and what we would hope to write about the next.”

So here’s are the challenges. You can pick one or try any combination.

  1. Write an updated version of the Victorian paragraph, looking back at 2014.
  2. Write a speculative version of the Victorian paragraph, looking back at today from 2030.
  3. Come up with an inspiring illustration of a possible 2040.

I’ll publish a selection of the best here (you’ll retain rights, of course) as I receive them and will accept entries through September 30. I’ll then award the top two in each category a collection of what Jim would call “Up Wing” books.2 The judging process will depend on how many entries are received, and I reserve the right to award fewer than six prizes. Email them to me at [email protected]

Periodic reminders

  1. The references for The Fabric of Civilization are online here. They’re particularly useful if you have the audio version, which leaves them out. And if you don’t have the book, please buy it now.
  2. I welcome comments, but unless they’re personal, please leave them below rather than emailing me, so that other readers can read them as well.

Shrinkflation, Disqualiflation, and Depression and more

This post went out to subscribers to my Substack newsletter on July 29. Check out all the posts, including ones from the archives not reposted here, and subscribe here.

My latest Bloomberg Opinion column is explained well in an excellent subhead (contrary to popular assumptions, writers don’t craft the headlines or subheads that appear on their work): “Packaging less stuff for the same price doesn’t fool consumers or economists. But diminishing quality imposes equally maddening extra costs that are almost impossible to measure.” Excerpt:

If a 16-ounce box contracts to 14 ounces and the price stays the same, I asked Bureau of Labor Statistics economist Jonathan Church, how is that recorded? “Price increase,” he said quickly. You just divide the price by 14 instead of 16 and get the price per ounce. Correcting for shrinkflation is straightforward.

New service charges for things that used to be included in the price, from rice at a Thai restaurant to delivery of topsoil, also rarely sneak past the inflation tallies any more than they fool consumers.
But a stealthier shrinkflation is plaguing today’s economy: declines in quality rather than quantity. Often intangible, the lost value is difficult to capture in price indexes.

Faced with labor shortages, for example, many hotels have eliminated daily housekeeping. For the same room price, guests get less service. It’s not conceptually different from shrinking a bag of potato chips. But would the consumer price index pick up the change?
Probably not, Church said.

This phenomenon, which Doug Johnson aptly dubbed “disqualiflation” in a Facebook comment, is widespread. One example is the four-hour airport security line I chronicled in an earlier Substack post. Another is the barely trained newbie who screws up your sandwich order—a far more common experience today than four years ago. It’s the flip side of a phenomenon I wrote about in The Substance of Style and in economics columns in the early 2000s (see here and here).

During the 2000s and 2010s, inflation was probably overstated because of unmeasured quality increases. Now there’s the opposite phenomenon. Quality reductions have become so pervasive that even today’s scary inflation numbers are almost certainly understated.

If you can read the column at Bloomberg, please do. But if you run into the paywall, which allows a few articles a month, you can use this link to the WaPo version, which doesn’t have links.

Depression feels as foreign and irresistible as the flu.

You may have heard that the “chemical imbalance” theory of depression has been disproved. A typical summary is this one, from a post by a Facebook friend who shall remain nameless:

The pseudoscientific idea that “depression” is a “chemical imbalance in the brain” has been among the most pernicious for the happiness of humans, but among the most convenient for big pharma. “You don't need to rethink your life. Just take this pill.” The same logic behind drug addiction.

Here’s a popularization by the authors of the scientific paper. The study is not about whether the general idea of a chemical imbalance is correct. Nor is it about whether antidepressants work. It is specifically about the theory that “depression is a result of abnormally low or inactive serotonin.” Saying depression isn’t caused by abnormally low serotonin is a long way from saying it’s just the world telling you to rethink your life.

I do not need to rethink my life. I have a wonderful husband, meaningful work, financial security, generally good health. I had a loving family and a happy childhood. But from adolescence onward, I have suffered from bouts of depression. “But I can’t be depressed!” I long thought. I had a happy childhood!

But when this Zoloft commercial originally ran in 2001, I completely identified with the little blob—only I was much more miserable and worthless feeling. And I had already rethought my life. I had quit my job as editor of Reason, driven at least in part by a desire to stop feeling like a failure, and embarked on a career as an independent writer. My career was going well, but my mood was as black as ever.

I did eventually talk with my internist, who diagnosed depression. When she asked whether I ever felt suicidal, I said no, never, but I understand why other people do. She prescribed fluoxetine, aka Prozac, because it was available as a cheap generic. It made me less passionate and gave me weird dreams but allowed me get a rational grip on my depressive cycles. After a number of years, I went off the drug. When my depression returned a few years ago, thankfully not in as intense a form, my doctor prescribed sertraline (aka Zoloft), which is much, much better. It simply makes me feel normal, without the numbing effects of fluoxetine.

Depression feels as foreign and irresistible as the flu. If you think it is mere sadness, you don’t know what you’re talking about. We may not understand why antidepressive medication works, which makes it like many other medications, but I have to wonder at the urge to tell people who suffer from this crippling disease that they should just get their acts together.

Of course, I’m just a single data point. If you want to read some expert reactions, here’s a collection of short responses to the new findings. A couple of examples, from the same institution, University College London, as the review’s co-authors:

Dr Michael Bloomfield, Consultant Psychiatrist and UKRI Principal Clinical Research Fellow, Translational Psychiatry Research Group Head, UCL, said:

“The hypothesis that depression was caused by a chemical imbalance in serotonin was a really important step forward in the middle of the 20th century. Since then, there is a huge of amount of research which tells us that the brain’s serotonin systems plays very important roles in how our brains process different emotions.

“The findings from this umbrella review are really unsurprising. Depression has lots of different symptoms and I don’t think I’ve met any serious scientists or psychiatrists who think that all causes of depression are caused by a simple chemical imbalance in serotonin. What remains possible is that for some people with certain types of depression, that changes in the serotonin system may be contributing to their symptoms. The problem with this review is that it isn’t able to answer that question because it has lumped together depression as if it is a single disorder, which from a biological perspective does not make any sense.

“Many of us know that taking paracetamol [acetaminophen] can be helpful for headaches and I don’t think anyone believes that headaches are caused by not enough paracetamol in the brain. The same logic applies to depression and medicines used to treat depression. There is consistent evidence that antidepressant medicines can be helpful in the treatment of depression and can be life-saving. Antidepressant medicines are one type of treatment alongside other types of treatment like psychotherapy (talking therapy). Patients must have access to evidence-based treatments for depression and anyone taking any treatment for depression who is contemplating stopping treatment should discuss this with their doctor first.”
Prof David Curtis, Honorary Professor, UCL Genetics Institute, said:
“This paper does not present any new findings but just reports results which have been published elsewhere and it is certainly not news that depression is not caused by “low serotonin levels”. The notion of depression being due to a “chemical imbalance” is outmoded, and the Royal College of Psychiatrists wrote that this was an over-simplification in a position statement published in 2019. Nor is it the case that SSRI antidepressants increase serotonin levels. Their immediate action is to alter the balance between serotonin concentrations inside and outside neurons but their antidepressant effect is likely due to more complex changes in neuronal functioning which occur later as a consequence of this. It is very clear that people suffering from depressive illness do have some abnormality of brain function, even if we do not yet know what this is, and that antidepressants are effective treatments for severe depression whereas interventions such as exercise and mindfulness are not. It is important that people with severe depression are not discouraged from receiving appropriate treatments, which can make a huge difference to them and those around them.”

And here’s Freddie deBoer, who knows serious mental illness all too well.

Misc. short takes

Show, don’t tell: One of the small, pervasive changes that makes news stories seem both patronizing and politicized is the increasingly common practice of inserting judgmental adjectives into otherwise descriptive sentences. Telling readers that a statement is “false” while repeating it may be justified, if intrusive, but in other cases it’s an unnecessary tic.

Gone is the assumption that readers are intelligent people who can draw their own conclusions from a compelling presentation of the facts. Journalists now seem to live in fear that their readers won’t think correctly. Take this sentence from interesting article on the evolution of American Sign Language: “For a portion of the 20th century, many schools for the deaf were more inclined to try to teach their students spoken English, rather than ASL, based on harmful beliefs that signing was inferior to spoken language.” (Emphasis added.)

If you read the article, you are highly unlikely to come to the conclusion that signing is anything less than a full-blown language, not inferior to spoken English. But the article never gives evidence that this incorrect 20th-century belief was harmful. It doesn’t discuss the pluses and minuses of signing, or why one belief was succeeded by another. That’s a different story. In the context of this story, the adjective is unnecessary, distracting, and insulting to the reader’s intelligence.

In a word, chintz: This article from House and Garden (UK) examines “the debt British interior design owes India” and quotes The Fabric of Civilization, which the magazine reviewed earlier this year:

Postrel’s The Fabric of Civilization is a relatively academic analysis made accessible to casual readers. It’s full of amazing anecdotes, too: you will learn, for example, that a 100sqm sail for a Viking ship would take 60 miles of yarn to weave, and took longer to make than the ship itself. Postrel also visits modern textile-production facilities and weaving schools, to understand the technology behind the huge uptick in global availability of fabric.

And a favor to ask of my British readers: Please review The Fabric of Civilization on Amazon UK, so that the folks mad that the illustrations aren’t in color don’t predominate!

Just for fun:

Do Upwardly Mobile Latino Plumbers Have Anyone to Vote For?

This post went out to subscribers to my Substack newsletter on July 23. Check out all the posts, including ones from the archives not reposted here, and subscribe here.

I spent the morning with a young plumber who owns a growing company known for excellent work. He came with his cool camera-snake—a technology plumbers under 40 take for granted—to see why our condo complex’s pipes are backing up. We talked tree roots and hydrojetting, not politics. But my experience with this competent and upwardly mobile entrepreneur, whose fluent English still has a Latin American lilt, gave some recent political discussions additional resonance.

Last week Ruy Teixeira, co-author of the famous 2004 book The Emerging Democratic Majority,1 posted an essay on his Substack with the self-explanatory title “Working Class and Hispanic Voters Are Losing Interest in the Party of Abortion, Gun Control and the January 6th Hearings.” It hit some themes he’s long been trumpeting, including the growing defection of Latino voters from the Democratic party.

In current polls, he wrote, “Democrats lose among all working class voters by 11 points, but carry the college-educated by 23 points. This is less a class gap than a yawning chasm.” Citing specific issue differences, he concluded, “Strong progressives clearly live in a different world than Hispanic and working class voters.”

Both activist Democrats and Trumpist Republicans tend to equate “working class voters” with older white Rust Belt men, not upwardly mobile, often self-employed Latinos. But in my neck of the woods at least, the latter predominate. And I don’t see them represented in our political options. Trumpists portray them as criminals, welfare leeches, and job stealers, while progressives depict them as victims of racist capitalism. Both reflect zero-sum thinking. Neither rings true.

But, given a choice, increasing numbers of upwardly mobile working-class Latinos, especially men, are opting for the party that respects work, if not workers. That’s bad news for Democrats. It’s also bad for those of us who worry about Trumpism’s threat to American institutions but would rather not see the “racist capitalism” view of the world triumph. Although Teixeira and I have different policy preferences, like him, I’d like to see Democrats wise up.

They don’t even need to leave their progressive bubbles to get insights into the exotically ordinary world of working-class Latinos. They could just read the Los Angeles Times. It’s a liberal paper with a rare commitment to telling their stories as not as symbols but as normal people who speak for themselves. It’s old-fashioned local reporting. Here are samples from today’s edition:

There’s the heart-wrenching story of how Gustavo Flores Álvarez, a Mexican immigrant who owns a cabinet-making business, lost his family’s house to a fire from a homeless encampment on a long-vacant piece of city land nearby.

Álvarez said he thinks the man who built the encampment behind his house sparked the fire while trying to steal power. He had notified the police about the man, who would often get high and play loud music. But nothing happened.

The man has now set up a new camp a short distance down the same pathway, and more fires have occurred, terrifying others on the block.
“Do you know how scary it is to get a call that says there is another fire behind your home?” asked Álvarez’s next-door neighbor, Yvonnette Brown. “I constantly live in fear of something happening at the back of my house.” [Emphasis added.]

It’s a sidebar to a long feature on the city’s failed promises to use the land to bring jobs to Watts. Prospective developers couldn’t navigate the barriers. One example:

Seeing 10 acres of vacant land, Craig Furniss’ first thought was, “This is unbelievable. There must be something wrong.”

Finding nothing demonstrably wrong, Furniss and his partner, fresh from success in building the Alameda Trade Center produce market in downtown, took a chance. Partnering with the Watts Labor Community Action Committee, a jobs and social services nonprofit born out of the 1965 Watts riots, they made a winning bid in 2004 to build food-processing facilities.

Five years later, worn down by a plethora of bureaucratic setbacks, they gave up, Furniss said.

The neighborhood never got behind the plan, he said, and the city kept adding demands.

“They just kept layering these things,” he added.

Among those, he recalled, were building setbacks, job-creation targets with penalties for falling short and pre-approval of property transfers.

Then a change in mayoral administrations brought a new planning director and a new requirement: The city wanted a percentage of any profits.

The most productive approach would be to sell the land at market rates and let somebody build whatever seems to make sense for the area—likely some combination of housing and light industry or retail. But why cede control when you can “layer on demands?” So the land stays unused and, thanks to conflicting jurisdictions, unmaintained. If it gets used at all, the property will likely go to provide “interim housing, tiny homes, safe camping or trailers” to replace the encampment. You can see why hard-pressed strivers like Álvarez might find that disillusioning.

Meanwhile, in Boyle Heights, a rich businessman and philanthropist wants to turn a massive now-unoccupied Art Deco Sears distribution center into the “Los Angeles Life Rebuilding Center.” The center would offer housing, medical and mental health services, job training, immigration help, and drug treatment to as many as 10,000 currently homeless people.

Boyle Heights is a traditionally working-class neighborhood, the first stop for immigrants going back to Jews in the early 20th century. In recent years, it has gentrified as even households with six-figure incomes have trouble finding places they can afford to buy. That has caused tensions with long-term residents, who are also none-too-fond of the plans for the Sears building. They showed up at a recent meeting to protest the idea. From Andrew J. Campa’s LAT report:

Now, an outsider was telling them that the landmark Sears building, once the pride of the community, would house not hundreds, but thousands, of homeless people.

“It was like a whole bunch of things were said, but nothing made sense,” lifelong Boyle Heights resident Jasmine Flores, 21, said after the meeting. “It seemed very much an unrealistic dream that we were being sold, while real solutions, things that could help people from Boyle Heights, weren’t considered.”

Some felt aggrieved that their community, already reeling from COVID-19 deaths and environmental pollution, was now supposed to “fix” Los Angeles’ massive homelessness crisis.

Others lamented that basic services they’ve demanded from city and county officials — street cleaning, affordable housing and better security — continued to be neglected, while homelessness has taken center stage.

Flores was one of more than 30 people who spoke against the project. She said her family nearly wound up homeless on a few occasions during her childhood, and many in Boyle Heights are still barely making ends meet.

Like several other speakers, she considered it unfair that so many resources would be devoted to a transient community, rather than to residents who have been struggling for years. [Emphasis added.]

The scheme raises all sorts of practical questions, but neighborhood residents are less concerned with financing or architectural plans than with why someone wants to help vagrants rather than financially pressed people who are managing to keep their lives together.2 Why couldn’t someone turn the building into inexpensive housing for working families? Or expensive housing that gives affluent people a place to live without squeezing out existing neighbors? Because it’s too damned hard to develop housing in Los Angeles. Too many people get a veto and there are too many rules and too many delays. As Nolan Gray says in his new book on zoning Arbitrary Lines, “Housing delayed is housing denied.” (Coming soon: my interview with Nolan.)

Finally, columnist Gustavo Arellano, who represents an uneasy combination of fierce progressivism and what he calls “rancho libertarianism,” excoriates supposedly liberal local pols for cracking down on Latino street food vendors.

In my hometown of Anaheim, councilmember Jose Moreno — who fought a lonely fight for years against corruption at City Hall and is the chair of the longtime civil rights group Los Amigos of Orange County — shocked supporters when he asked city staff last week to look into cracking down even further on street vendors, even though Anaheim already has some of the most stringent regulations in Orange County.
After mumbling about supporting those micro-entrepreneurs as “a matter of philosophy and the need for people to make a living,” Moreno — who’s a professor of Chicano and Latino studies at Cal State Long Beach — nevertheless said “when they start setting up right in front of restaurants … that’s an affront to our small-business folks, the neighborhood, the community.” [Emphasis added.]
Profe, you’re sounding like a Trumpster.

Street vendors are, of course, themselves small-business folks. And if you think eating from a street vendor is an equivalent experience to sitting down in a restaurant, you don’t understand market segmentation (or chairs).

The theme running through all these stories is simple: Government doesn’t work and it particularly doesn’t work for ordinary people trying to make better lives for themselves. You have to either have money and connections—to have made it already—or you have to be seen as a victim, despite ignoring your responsibilities for yourself and those around you.

Along similar lines (but not from the LAT), Josh Barro puts his finger on an issue much more likely to cost Democrats votes than transgender athletes:

The ambivalence of liberals about whether they even want lower gasoline prices — and the steps the Biden administration has taken to discourage domestic oil production, for example by placing holds on oil and gas lease auctions — reflects the values of the highly educated, disproportionately affluent and educated demographic that dominates the Democratic Party’s staffers and donor base. Many of these people care a lot about carbon emissions and don’t care very much about whether gasoline is cheap, and that’s a real disconnect from lower- and middle-income voters across the ideological spectrum for whom cost of living is of paramount concern.

Unfortunately, this is a harder problem to solve than not saying “Latinx.” The policy concessions progressives would need to make on energy to stop weighing down the party are substantive and important.

A lot of progressives arrive at environmentalism not through cost-benefit analysis but through an essentially moral view that abundance — population growth, more energy, new homes — is itself harmful to the earth. There is an unbridgeable disconnect between that view — the philosophy that underlies the urge for “de-growth” — and the desire of most normal people to have a continually rising standard of living, with large cars and better appliances and air conditioning. And as shortages persist as a major theme in the world economy, this disconnect will become a larger and larger problem.

Upwardly mobile people have a stake in dynamism and abundance. If Democrats offer only stagnation, rationing, and neglect, those voters will turn to the alternative.

DIY plumbing snake/camera for less than $60

If you ignore the political train wrecks, the 21st-century is amazing.

Jet Lag and an Overdue Installment

This post went out to subscribers to my Substack newsletter on July 13. Check out all the posts, including ones from the archives not reposted here, and subscribe here.

The term “jet lag” is younger than I am, dating back to roughly 1966. Whoever coined it wasn’t yet talking about flying 11 hours through eight time zones, which is what I did over the weekend. (Having learned my lesson, I altered my original itinerary through Amsterdam and went Heathrow to LAX, which gave me a nice day in London.) And I hadn’t even gotten over my L.A.-to-Europe jet lag when I returned after two weeks. Must be getting old. Older than jet lag…

That’s my sorry excuse for not getting a newsletter out this weekend or even on Monday.

While in Italy, I made this video at the Filatoio Rosso di Caraglio, which I wrote about in The Fabric of Civilization.

There are two different machines: one to twist silk filaments into strong silk thread and a second one to load those finished threads onto spindles for transport. Here they are in the museum.

While researching The Fabric of Civilization I visited three different museums that feature these machines. Here’s a video I shot at Civico museo setificio Monti in Abbadia Lariana, where the throwing machine dates to 1818, making it relatively recent.

There’s also an excellent museum, the Civico Museo della Seta Abegg, in Garlate, not far from Como on a different finger of the lake that splits at Bellagio.

I went back to Caraglio because I’m going to try writing some children’s books about textile history, starting with one set there. The books would feature fictional child protagonists and stories but historical facts.1 It’s amazing how much you realize you don’t know when you move from nonfiction to fiction and have to flesh out a setting. Even though I’d supposedly done the research, I realized how little I knew about exactly what life was like in these mills. Silk cocoons are harvested in the spring and summer and the filaments need to be reeled off as soon as possible. I knew this when I was writing The Fabric of Civilization—it comes up in discussions of incremental Chinese innovations—but hadn’t thought about the implications for the labor force in Italian mills. The maestre who expertly reeled the filaments were working very intensely but only a few months a year. The mills were a supplement to agricultural labor.

1 I might, however, try a purely nonfiction biography of Agostino Bassi.

Travel Hell Isn't Just an American Phenomenon

This post went out to subscribers to my Substack newsletter on July 5. Check out all the posts, including ones from the archives not reposted here, and subscribe here.

After attending a conference in Utrecht, on Saturday I flew to Italy to do some follow-on textile research. Leaving Amsterdam’s Schiphol airport, however, required first standing in a four-hour line, longer any line I’ve seen in my 62+ years of life. Thousands of people, several miles long (I estimate 6 km based on the Pokemon Go count). Staff handed out bottles of water in a couple of places and gave us cookies to keep up our strength. We’d go through a massively long line in one room, only to emerge into another room or outside staging area at least as long. The longest imaginable Disneyland line would equal perhaps one of these segments.

The problem arises from staff shortages in security. It’s been pretty well reported in Europe but aside from Bloomberg (e.g., here and here) and specialty sites (e.g., here and here) the massive delays at this major hub have gotten relatively little attention in the U.S. I got to the airport more than three hours before my flight, naively imagining I’d have time to spare. Instead, I only made my flight to Florence because it was seriously delayed and even so, the doors were closed when I arrived at the gate. As the agents were telling me I couldn’t board, a pilot came out and said to let me on.

My itinerary calls for a return through Schiphol after an overnight stay in Amsterdam. I’m trying to figure out a way to avoid those lines.

In Praise of MRIs

Raymond Damadian, Paul Lauterbur, and Sir Peter Mansfield, who gave us the MRI machine, are the latest in HumanProgress.org’s series on Heroes of Progress.

Damadian created the world’s first MRI scanner after he realized that cancerous cells would produce different magnetic resonance signals when compared to normal, non-cancerous cells. Prompted by Damadian’s discoveries, Lauterbur developed a way for MRI machines to visualize these cells’ signal differences and produce a clear image of inside a patient’s body. Finally, Mansfield created a technique for MRI scans to be conducted in just seconds, rather than hours, and for the image that the scanners produced to be significantly clearer, and therefore more accurate. Each year, hundreds of millions of MRI scans take place. Thanks to their use, untold millions of lives have been extended or saved.

Mine is one of those lives. In 2007, I was diagnosed with what appeared to be a minor case of breast cancer. The tumor was tiny and it looked like I’d get surgery to cut it out and then possibly radiation treatment. The day before surgery, I went in for an MRI to map the cancer so that acupuncture-like needles could be inserted the next day to guide the surgeon. When I showed up for the surgery, I learned that the MRI had revealed massive amounts of lymphovascular invasion that had been completely undetected on mammograms. The cancer was much more serious than expected. That surgery, which failed to get clean margins, was followed by chemotherapy, more surgery, radiation, and—critically important—the miracle drug Herceptin.

Speaking of medical progress…

Why you can’t get the best sunscreens in the U.S.: An Atlantic article on one of the pet peeves of my friend Amy Alkon, who is even paler than I am. (Her site is having some technical issues, so if you click on the link it may not work unless you’re using Safari.)

And a plaque honoring a hero of progress: Agostino Bassi, whose hometown I visited this week. You can read about his work in The Fabric of Civilization.

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