Reducing Respiratory Diseases

Major progress on reducing respiratory diseases is possible and is both technologically and economically feasible.

A century ago, waterborne diseases levied similar costs to those posed by respiratory viruses like colds and influenza today: endemic, periodically epidemic, and widely accepted as an inevitable feature of human life. Then, at the turn of the twentieth century, we decided they didn’t have to be. Pharmaceutical advances and clean water infrastructure made cholera, typhoid, and dysentery rare across much of the world within a matter of decades.

Why haven’t we already seen the same kind of transformation with respiratory viruses? Last August we hosted a symposium at Stripe with ~40 leading scientists, pharma R&D leaders, biotech venture capitalists, and regulatory experts to better understand if this is technically possible and, if so, why it hasn’t happened yet.

We heard two main reasons. First, it’s just technically very challenging: respiratory viruses represent hundreds of distinct, mutating strains across several families. Fortunately, new platform technologies, advances in our understanding of human immunology, biological data sets, and protein design tools mean we have our strongest ever suite of approaches for tackling it.

Second, the development of the broad-spectrum solutions needed to solve the first problem has historically been underfunded, neither a great fit for philanthropic nor commercial funding. While COVID generated a burst of activity around preventing and understanding respiratory infections through an influx of new funding, that hasn’t been sustained.

We believe that with enough focus and funding, these problems are tractable. Intercept is a $500 million philanthropic initiative that will take advantage of these new tools to catalyze the development of two types of products: broad-spectrum preventatives and air cleaning technologies. Together, these technologies can radically reduce the burden of respiratory infections, and can eventually help eliminate them altogether. 

Why this matters

Today, we treat respiratory infections like the cold and influenza as a minor nuisance. The evidence increasingly suggests otherwise.

* Healthy people spend roughly 15-25 days each year—about 5% of their lives—sick with respiratory infections like the common cold and influenza.1

* Common respiratory infections can lead to severe outcomes. In 2021 alone, there were 12.8 billion infections globally, mostly caused by viruses.2 Annually, over 65 million3 4 of these progress to serious lower respiratory disease and account for around 7% of deaths from major causes in the U.S.5 6 7

* Respiratory infections raise our risk of serious illness, often years later. While researchers are still early in establishing these connections, it seems plausible that society has meaningfully underestimated the significance of seemingly benign infections on short and long-term health, e.g.:

** 9.8x asthma risk by age 6 if infected with HRV between birth and age 3 in a high-risk cohort8

** 6.1x heart attack risk for 7 days after influenza infection9

** 4.5-5x dementia risk after severe influenza10

** 2.6-4.1x Alzheimer’s risk after severe influenza and pneumonia11

** 2.2-3x schizophrenia potential risk for infant if mother is infected by influenza during pregnancy12 13

** 1.3x risk of heart failure after RSV infection compared to influenza14

* Routine respiratory illness imposes a massive, persistent economic burden, driving 1–1.5% annual productivity losses—roughly $600B globally, or ~0.6% of global GDP—in non-pandemic years.15

* Emerging evidence suggests that severe prenatal16 17 and early postnatal18 respiratory infections might lead to reduced adult earnings and educational attainment later in life.

* Achieving broad protection against respiratory pathogens would meaningfully reduce pandemic risk, serving as a critical first line of defense—alongside air disinfection—against both natural outbreaks and increasingly accessible engineered biological threats. 

Two technologies, working together

No single technology can accomplish population-level infection reduction across all of these pathogens. A shot or pill that provided >90% protection against >90% of respiratory viruses (we’ll call these broad-spectrum preventatives or BSPs), but achieved ~60% uptake (a realistic ceiling based on existing vaccine uptake), would still fall short of of the population immunity required to dramatically reduce sustained transmissions.

This is because there are so many different kinds of respiratory viruses, many of which are highly contagious. It’s helpful to revisit the concept of R0 from the COVID pandemic: the number of people an infected person will infect in a fully unprotected population. While we can’t change the intrinsic R0 of a given virus, we can reduce any given virus’s effective reproduction number (Re): how infective a virus is in a given environment inclusive of interventions. To eliminate a virus, its Re needs to drop below 1. The vast majority of seasonal respiratory viruses have an R0 between 1 and 3. To eliminate an R3.0 virus, you need roughly 67% of the population to be protected.

So, to get closer to elimination, we also need a way to reduce the virions circulating in high density environments. During COVID the world experimented with various interventions like social distancing and personal protective equipment. But to reduce transmission durably for a large number of common respiratory viruses that are perennially circulating, we need solutions that are convenient and minimally disruptive.

We think the most promising category of products that accomplish these goals are those that remove pathogens from the air, particularly in high-density environments like offices, schools, and public transit. We’ll call these air cleaning technologies (ACTs) like air filtration and far-UVC antimicrobial light.

The uptake required for BSPs or for ACTs to be effective by themselves is extremely high. As a benchmark, commercial fire sprinkler penetration is about 40% in the US. Getting to 100% uptake would be extremely difficult. But when deployed together at realistic levels, BSPs and ACTs could achieve our goals.

From the Intercept blog which estimates that breakthroughs can be made with half a billion dollars. 

40 Acres

An acre was traditionally meant to be the amount of land that a farmer could plow in a day with a farm animal's assistance.

40 acres was traditionally the amount of land necessary for a single family of unmechanized subsistence farms to support themselves. It is the most typical economic unit in which farmland and vacant land is sold, even today.

40 acres and a mule was what post-U.S. Civil War advocates for reparations to former slaves had advocated for (and obviously, did not achieve).

A square 40 acre plot is a quarter mile on each side (a.k.a. 1320 feet a.k.a. 440 yards), with a one mile circumference and a 16th of a square mile area.

The population density of subsistence farmers at this traditional pre-modern scale is about 100 people per square mile.

A survey township has 36 square miles (6 miles a side) and was traditionally the presumptive size of the smallest unit of local government, which at subsistence farming population density would have had about 3,600 people, and perhaps a bit more for a hamlet of perhaps 400 people who would make up the 10% or so of non-farmers who would have been present in a predominantly subsistence farming pre-modern society at the technology level that would have prevailed around the time of the American Revolution (250 years ago), so it might have had a total population of about 4,000 people. Non-farmers in hamlets like this would often include clergy, craftsmen in the skilled trades, doctors, veterinarians, and merchants.

In the brief period where there was democratic government and a predominantly pre-modern subsistence farming economy, people under age twenty-one couldn't vote, and neither could women, so perhaps 400-500 of those people would have been eligible to vote and/or participate in town meetings (in areas without slavery, as slaves couldn't vote either and were usually used to farm cash crops in any case).

In townships that were not governed in the town meeting style of New England towns, a typical town council would have had three elected trustees and sometimes an elected town clerk as well, so about one voter per 100 to 167 people would have been elected officials. This rate is similar to the rate at which people serve as precinct organizers in modern political parties.

A community of this size might have a single church that doubled as a community center and while pre-mechanized subsistence farming largely predated universal public education, a township would typically have something on the order of 2,000 school age children.

In that era about a quarter of children would have died in their first year and about half would have died before reaching adulthood. In any given childbirth, about 1% of pregnant mothers would have died in childbirth, and a typical woman would give birth six to eight times in a lifetime, leading to an excess of widowers over widows. There would be post-menopause age grandmothers in the community, but far fewer, proportionately, than there are today. Most elderly people would have lived with extended family. Then, as now, about a third of pregnancies would have ended in a miscarriage or stillbirth.

It would be unusual for a subsistence farming community to have more than a handful of people with post-secondary education (perhaps a priest and a government official or lawyer), and the percentage of people with the equivalent of a full high school education today would have been comparable to the percentage of people with graduate degrees today, although in some regions, a significant number of people without formal second education would nonetheless have been quite well-read autodidacts. Journalists and school teachers and merchants would typically not have a post-secondary education and would often not have the equivalent of a high school diploma today.

Quick Health Hits

* Fatty liver disease drugs found.

* A blood test to detect Alzheimer's disease early developed.

* A breakthrough in stopping the Epstein-Barr virus, which is found in 95% of people and causes mono, MS, and lupus.

* Bread, rice, and wheat make you gain more weight with the same amount of calories, by changing your metabolism.

* A new toothpaste would kill gum disease causing bacteria while leaving the rest of the mouth's good microbiome in place.

* A new biochemical cause of aging has been discovered.

* Guinea worm infections have been virtually eliminated. In 1986, there were 3.5 million people infected worldwide, and there is still no cure.

New Health And Climate Research

* They're well along in developing a toothpaste or mouthwash that with treat gum disease by stymying harmful mouth bacteria that cause it, while leaving the good parts of your mouth's microbiome alone. Current mouth washes like Listerine kill everything and the bad bacteria often recover quicker.

* The drought is a problem in surprising ways.

For years, water managers have been puzzled as the Colorado River kept delivering less water than expected—even when snowpack levels looked promising. New research reveals the missing piece: spring rain, or rather, the lack of it. Warmer, drier springs mean plants are soaking up more snowmelt before it can reach rivers, fueled by sunny skies that boost growth and evaporation. In fact, this shift explains nearly 70% of the shortfall, tying the mystery directly to the long-running Millennium drought.

* The same, yet different:

New research reveals that obesity affects men and women in surprisingly different ways. Men are more likely to develop harmful abdominal fat and signs of liver stress, while women show higher inflammation and cholesterol levels. These differences could help explain why health risks vary between sexes. Scientists say this could lead to more tailored treatments for obesity.

* Genes greatly influence your chance of dying from age related health conditions: 

For years, scientists believed our lifespan was mostly shaped by environment and chance, with genetics playing only a minor role. But a new study from the Weizmann Institute flips that idea on its head, revealing that genes may actually account for about half of the differences in how long people live. By analyzing massive twin datasets—including twins raised apart—and using innovative simulations to filter out deaths from accidents and other external causes, researchers uncovered a hidden genetic influence that had been masked for decades.

* A possible alternative to GLP-1 drugs would have less side effects, but some of those side effects like greater executive function and an ability to fight addictions might be good ones:

A newly discovered molecule could reshape the future of weight loss treatments by mimicking the powerful appetite-suppressing effects of drugs like Ozempic — but without many of the unpleasant side effects. Identified using artificial intelligence, this tiny peptide, called BRP, appears to act directly on the brain’s appetite-control center, helping animals eat less and lose fat without nausea or muscle loss.

* Another study suggests that an early dinner and an early breakfast might help you lose weight:

A major study suggests that when you eat could play a key role in staying lean. People who fast longer overnight and start their day with an early breakfast were more likely to have a lower BMI years later. Scientists think this is because eating earlier aligns better with the body’s internal clock. But skipping breakfast as part of intermittent fasting didn’t offer the same advantage—and may even be tied to unhealthy habits.

* Colonoscopies are a big deal and aren't fun. An alternative stool test may be almost as good of a diagnostic test:

A breakthrough in microbiome research could change how colorectal cancer is detected—no colonoscopy required. Scientists used AI to map gut bacteria at an unprecedented level of detail, revealing subtle microbial patterns linked to cancer. By analyzing simple stool samples, their method identified 90% of cases, rivaling one of medicine’s most trusted diagnostic tools.

* Alzheimer's disease attacks your sense of smell early on, which would be very helpful if there were effective treatments for the disease, which there aren't (yet):

Losing your sense of smell might signal Alzheimer’s far earlier than expected. Scientists found that immune cells in the brain actively destroy smell-related nerve fibers after detecting abnormal signals on their surfaces. This damage begins in early stages of the disease, well before cognitive decline. The discovery could help identify at-risk patients sooner and improve treatment timing.

* Also, while I'll find the link again another day, the Epstein-Barr Virus, that caused mono, cold sores, and M.S., also causes lupus. The case for developing an EBV vaccine has just gotten a lot stronger.

Better Isn't Impossible, Other Countries Do It

 

The Case For Socialized Sidewalk Snow Removal And Mainteance

A 70 year old friend of mine writes on Facebook that she just got a new electric snowblower because her "HOA dues no longer cover snow shoveling driveway and sidewalk."

There are lots of reasons that HOAs are horrible institutions. But one of the things that they do often do well is that they make removal of snow from sidewalks a collective neighborhood function, rather than something that must be done by each individual in the neighborhood.

When are people going to wake up and realize that decentralization and private responsibility is not the solution to all problems?  We seem to understand this for roads, but not for sidewalks.

Collective neighborhood snow shoveling is much more efficient since you can mechanize it with industrial grade snow blowers and snow clearing equipment. 

Even if the work is outsourced to landscaping companies so that it can be mechanized, it is still less efficient to have many separate landscaping companies do the work in the neighborhood in a patchwork fashion, rather than having one provider do it, in addition to being more expensive per unit or for the neighborhood as a whole, despite not providing the service for everyone in the neighborhood.

Also, if the HOA bought its own snow clearing equipment and hired someone directly to do the job (as many municipal governments and school districts do), cutting out the middle man which its scale would often make feasible, it could do it more cheaply than hiring a landscaping firm to do the job, since it wouldn't have to cover the landscaping firm's profit and overhead costs (e.g. marketing, office and insurance costs that the HOA already incurs, billing and debt collection costs that the HOA already incurs, etc.). It could even provide a measure of economic relief to HOA members by preferring to hire residents to do the work (also reducing commuting times and demands on local road infrastructure, and making an inability to do the job at all or on  time due to heavy snow making roads less passable less of a concern).

Collective sidewalk snow clearance also produces much better returns because sidewalks are a network. One delayed or not done at all link in clearing snow from sidewalks dramatically reduces the value of the sidewalk system for everyone, even if everyone else does a perfect and timely job of clearing the sidewalk in front of their house. And, in real life, perfect compliance with early sidewalk cleaning by each homeowner rarely happens for understandable reasons like being out of town, or being sick or infirm, or working atypical shifts like three twelves or having to work multiple jobs, so that you are at work when it snows.

The same logic applies to maintaining sidewalks in good condition when they crack. A badly broken sidewalk in front of one house makes the entire sidewalk network less useful for everyone who uses sidewalks in the neighborhood.

Sidewalks are a good that everyone in the community benefits from, and the homeowner benefits little from having the sidewalk in front of their own home clear. Clearing sidewalks is something you do for the benefit of your neighbors. 

There is a collective action problem which HOAs solve when they correctly treat sidewalks as a common element owned by the community as a whole and managed by an entity that is responsible to the entire community.

This is less true of driveways. Mechanization from economies of scale is still present, although it can be moderated with outsourcing to landscaping companies. But the benefits of driveway snow clearing primarily inure to the homeowner whose driveway is cleared. There isn't the same network functionality problem.

But, of course, in the HOA suburbs no one cares about sidewalks because everybody drives everywhere, which also makes not only the people in the HOA less healthy, but also makes the community less vibrant.

And, then there is the issue that 70 year olds face a vastly elevated risk of serious physical harm when they try to shovel their own driveways and sidewalks. This is true for driveways as well.

The other lurking issue is that many suburbanites in HOAs are cash poor and time rich. Paying HOA dues or a more efficient landscaping company to do the job costs money which many people in these communities don't have. Doing it yourself with a cheap and inefficient snow shovel doesn't cost money, even though you are effectively valuing your own time and effort at a tiny hourly rate when comparing the time it takes you to the time it takes a professional to do it with the proper equipment.

The tradeoff between doing things in the monetary economy v. doing things in the non-monetary household or by barter or volunteering is an understudied issue in economics.

New Almanac Data Points

I have my 2026 World Almanac now and there are some statistics I keep a close eye on.

* As of March 31, 2025, the U.S. had 1,307,679 active duty military personnel. This is as small as the U.S. military has been by that measure since before World War II. At its peak, it was more than 50% bigger. Roughly 55% of U.S. active duty military personnel are non-Hispanic white men (with significant variation from one military service to another).

* Birth rates for women in all age categories under age 25 were at their lowest for all of recorded history and prehistory in North America.

* Infant mortality has increased each year since 2020. The anti-vax movement and the impact of the ban on abortions in many states could be factors.

Cheese Is Good, Teens Are Tame, Crime Is Down, Lot Of Americans Are Immigrants

* A study linked eating cheese to lower dementia risk.

* Teen alcohol, nicotine, and drug use in the U.S. is at record lows, and cocaine and heroin use, while not at record lows, it much lower than it was a few decades ago.

Teen use of alcohol, nicotine and marijuana remains at record lows, according to national survey results released Wednesday. . . .

Two-thirds of 12th graders this year said they hadn’t used alcohol, marijuana, cigarettes or electronic cigarettes in the previous 30 days. Thirty years ago — before the advent of e-cigarettes — the figure was closer to about one-third.

Among 10th graders, 82% said they hadn’t used any of those substances recently. Among eighth graders, 91% didn’t use any of them. Both are records for those ages in the annual survey. . . .

The new results come from the federally funded Monitoring the Future survey, run by the University of Michigan. The annual survey has been operating since 1975 and has long been considered a top source of national data on teen substance abuse. This year’s findings are based on responses from about 24,000 students in grades 8, 10 and 12 in schools across the country. It was conducted from February to June this year.

Teen drug use has been gradually declining for decades, and fell dramatically at the beginning of the COVID-19 pandemic, when students across the country were told not to go to schools and to avoid parties or other gatherings. Experts expected at least a bit of a rebound as pandemic restrictions eased, but that hasn’t happened.

The 2025 results show no increases in teens’ use of alcohol, marijuana, cigarettes or nicotine vapes in any of the three grade levels. In 2024, researchers had noted an uptick in the use of nicotine pouches, but that too held steady this year, the survey found.

Energy drinks are as popular as ever, with daily consumption reported by 23% of 12th graders, 20% of 10th graders and 18% of eighth graders.

The survey also found a striking increase in heroin use. Use by 12th graders in the previous 12 months rose to 0.9% in 2025, from 0.2% the year before. Use by 10th graders hit 0.5%, up from 0.1%. And use by eighth graders also rose to 0.5%, up from 0.2%.

Cocaine use held steady for 10th graders, but rose for eighth graders — to 0.6% — and 12th graders — to 1.4%.

Teen heroin and cocaine use are “leagues below what they were decades ago,” but the increases warrant close monitoring, said Richard Miech, survey team lead at the University of Michigan.

The teen heroin and cocaine figures are small enough that they could just be mostly a statistical random sampling variation.

* Teens in the U.S. are having sex less (from an AP news story of May 13, 2023):

[A]ccording to a recent survey by the Centers for Disease Control and Prevention . . . 30% of teens in 2021 said they had ever had sex, down from 38% in 2019 and a huge drop from three decades ago, when more than half of teens reported having sex.

Teen pregnancies and the teen birthrate are also at record lows for all of history and prehistory in North America.

* As noted in the previous post, property crime rates are at record lows. And, violent crime rates are also very low.

* Meanwhile, prior to Trump taking office, the percentage of Americans that were foreign born was at an all time high.

Empirical Tests Of Economic Theories

Experience tells us which economic theories are right and which are not, often with unexpected results.

* In theory, a higher minimum wage should greatly increase unemployment. In reality, the effect is almost immeasurable at U.S. levels.

* The evidence from Brexit and from Trump 2.0 and the Smoot-Hawley tariffs demonstrate that globalism is very important for a healthy economy and that departing from free trade does great harm, as does discouraging immigration.

* While a shallow microeconomic analysis would suggest that immigration hurts the job market for native born Americans, experience shows that immigration has the opposite effect, improve the job market and prosperity.

* The evidence from Eastern Europe in the post-Cold War era illustrates that securities laws to reduce the likelihood of things like Ponzi schemes are actually very important even when other protections of property laws and contract laws are in place.

* Economic development studies tend to show that economic development is quite localized and culture driven, rather than being primarily driven by national laws, although national laws do matter quite a bit as shown by comparing the economies of communities on either side of a national boundary where the laws are quite different.

* Notably, lots of the litmus tests for economic development: municipal water quality, roads in good repair, regular trash collection, effective legal enforcement of debts, unambiguous real estate ownership, good quality K-12 education, and the availability of trauma center hospitals, are mostly provided at the local government level, rather than at the regional or national level.

* During the Financial Crisis, two different methods of managing the risk of high loan to value residential loans were compared which have very different regulatory regimes. 

One approach was to make a conventional mortgage at 80% loan to value, and then to have a second mortgage for the next 10-15% of loan to value that was subordinate to the conventional mortgage. This is subject to securities regulation of mortgage backed securities, with risks assessment mostly delegated to thinly regulated and thinly capitalized bond rating agencies (which are basically just credit reporting agencies for the bond market).

The other approach was to issue a single mortgage for the entire loan and to secure mortgage insurance, paid for by the borrower to protect the lender, which covered the lenders' losses if the value of a foreclosed home resulted in a deficiency judgment. This was subject to state insurance regulation.

In the financial crisis, insurance regulation was decisively proven to be superior, with no mortgage insurance firms going out of business, while essentially all of the subprime lenders, mortgage backed securities firms that packaged second mortgages for investors, and investment banks that organized this activity either ceased business entirely, underwent bankruptcy reorganization, or were saved only by bailouts with purchases of the failed firms by healthy large financial companies.

Excessive Drinking By U.S. County

 

U.S. counties with the highest and lowest rates of excessive drinking.

Observations:

* There are legitimately low levels of drinking in the deep South, Appalachia, and Oklahoma. It could be that people there can't afford to buy alcohol. Religion could be another factor. The fact that people in these states behave so badly while being more sober than average isn't impressive.

* Low rates of drinking in Utah and parts of Idaho (which is heavily Mormon as well) are unsurprising.

* Low rates of drinking in almost all of New Mexico, the Indian Reservation area of Arizona are mildly surprising.

* Low rates of excessive drinking in Las Vegas are very surprising.

* Wisconsin is well known for its heavy drinking. Alaska and Montana are unsurprising on that score. North Dakota and Colorado are mildly more surprising.

The Vaccine Divide

States Go Their Own (and Contradictory) Ways on Vaccine Policy

California, Oregon and Washington said they would work together to review scientific data, saying the C.D.C. could no longer be trusted. But Florida said it would abolish all vaccine mandates.

From the New York Times.

Florida ignores science and undermines public health (and is also dropping flouride in drinking water). This is one of many ways that Florida is undermining itself.

The Pacific coast states are backfilling in the face of the federal government's dereliction of duty.

Meanwhile, in Colorado:

Colorado issues order allowing pharmacies to provide COVID vaccines without prescription: CVS, Walgreens have said they would need to require prescriptions due to lack of federal vaccine recommendation

Labor Day Musings

* The state of labor in one chart:

The failure of businesses to share productivity increases with their workers starting in the early 1970s is the root cause of a lot of the current political reality in the United States. In my view, the decline of private sector union membership is more a product of declining worker economic power than a cause of this shift, but that's an open question in economics.

* The number of immigrants in the U.S. labor force has fallen by 1.2 million since Trump started his second term. According to the Wall Street Journal: "With zero net immigration, Apollo Chief Economist Torsten Slok estimates, the U.S. economy would be able to sustainably add only about 24,000 nonfarm jobs a month, compared with an average 155,000 from 2015 through 2024."

Agriculture (overwhelmingly in "red America") in the U.S. is particularly suffering both due to tariffs and due to the immigration crackdown that is cutting into the agricultural labor workforce. Nebraska and Iowa saw their state GDPs fall at an annualized rate of 6.1% in the first quarter of 2025.  Those tariffs were found to be mostly illegal by the U.S. Court of International Trade in a ruling affirmed by the U.S. Court of Appeals for the Federal Circuit in a 7-4 ruling. The effect of the ruling is on hold until mid-October pending a petition for certiorari to the U.S. Supreme Court which has consistently ruled in favor of Trump despite his weak legal arguments.

The anti-immigrant fervor is driven by two main factors: (1) the economic stagnation of working age men without any college education who native born white men attribute to immigrants, international trade, and civil rights for women and minorities, and (2) the fear of white protestants in places with few immigrants that their culture will cease to be dominant.

* Courts in India are very slow.

[I]n one recent example a Delhi court concluded a property dispute after 66 years. Both the original litigants were dead. Still, the lawyer for one of the warring parties cautioned that the conclusion was in fact not the end, as the ruling would be appealed.

Three years ago, after pondering a dispute for 16 years, the supreme court sent back a 60-year-old land case for fresh adjudication to a lower court, which had already taken over 30 years to give its judgment in 2006.

A 2021 study of Mumbai real estate found that more than a quarter of the projects under planning or construction and 43 per cent of all “built-up spaces” in the city were under some litigation. My apartment block was one of them.

…One of the reasons for this accumulation is human resources. India has around 16 judges per million people, compared to over 150 for the US. In 2016, the issue brought the country’s chief justice, TS Thakur, to tears during a speech as he requested that the government hire more judges to wade through the “avalanche” of backlog.

For what it is worth, there are far fewer judges per capita in the U.S. than in Europe, even though the total number of legally trained professionals in the U.S. and in Europe per capita are similar.

The lack of state capacity in the area of courts means that property and contract rights and other forms of private law are weaker, which is bad for the economy.

* Adults in the U.S. are having sex less often (the decline is at least as great among high school students). It is basically a coincidence, but my children were conceived right around "peak sex" in the recent history of the United states.

* Wildfires are at record high in Europe due to climate change.

* The U.S. housing market is starting to favor smaller single family homes again after a peak in roughly 2014. Single family houses in the U.S. are still, on average, much larger than they were 30 years ago.

* A mere 6.0 magnitude earthquake in Afghanistan, shortly before midnight on August 31, 2025, was enough to cause at least 800 deaths and 2500 injuries.

* "Flukewarm": That feeling when you're reluctant to make a recipe, because the last time you made it, it came out perfectly. But it was a fluke, you're not sure what you did right, and you're worried you won't be able to repeat your past success.

* Last Saturday, I went to a store to buy a blind spot warning system for my car. They weren't available in 2015 when I bought it. But, I couldn't. Tariffs have delays shipments of cars parts like that one by more than a month and have greatly increased the price of those parts.

* As our country devolves into a civil war, ICE agents in unmarked cars wearing masks and not displaying their badges are unlawful combatants, and are thus they are not entitled to the protections of the Geneva Conventions. Instead, they are terrorists who are not entitled to the protections of legitimate combatants under the laws of war. They also aren't entitled to the peacetime protections and privileges of law enforcement officers.

* Rhode Island has the lowest state murder rate in the United States. Louisiana has the highest (or very nearly so) and has about ten times as many murders per capita.

* The lion's share of the counties in the U.S. with life expectancies lower than North Korea are (1) in the South and majority black or nearly so, (2) include Indian Reservations (or the Alaskan equivalent), or (3) are in Appalachia. The outliers are still in the South.

* Non-U.S. central banks are substituting gold for U.S. Treasury Bonds.

* The U.K. electrical wall plug design is safer than the U.S. design.

* People are dying on overloaded boats trying to emigrate from Gambia (in West Africa) to Europe. "More Than 130 People Are Feared Dead in West Africa Boat Tragedy: Around 150 people boarded a boat in Gambia that was thought to have been headed for Europe. The boat capsized after traveling about 380 miles."

* A judge ordered Alligator Alcatraz in Florida closed on the petition of an Indian tribe with an interest in the land, because an environmental impact statement wasn't done. The debacle cost $250 million. All detainees at the location which was inhuman and defective have been moved to other detention centers in Florida.

* Finland (which is the source of about half of my genetic ancestry) is a genetic outlier in Europe (for reasons that are well understood and closely related to the fact that it is also a linguistic outlier). 23andme was able to correctly pinpoint the place of origin of my Finnish ancestors to a region about the size of a U.S. county. The other half of my ancestry (which I know to some detail due to genealogy) is basically a European mutt that can't be localized from genetics much at all.

Other places with significant Uralic populations, Basque country, historically Celtic areas (despite the putative cultural origin of the Celts in the vicinity of Czechia which is being used as a baseline in the chart above), and places with significant Islamic migration since the 700s CE, also stand out in  this map. Sardinia is the closest modern match to the genetics of Europe prior to the arrival of the Indo-Europeans.

* It doesn't take a history genius to understand why South America, in general, and Argentina, in particular, has so much Italian ancestry (to a significant extent, because a lot of Italian Nazis fled there after World War II).

* The Holocaust has an immense effect:

* New Mexico is, by a variety of measures like education and poverty, much more like red states than blue states. But it has stayed blue because the GOP has historically made its Hispanic and Native American residents feel unwelcome and tried to persecute them. 

Utah is, by a variety of measures like education and poverty, much more like blue states than red states. But, its predominantly Mormon religion's conservative tenets have kept it out of the Democratic party fold.

* The cost of living is about 30% greater in the highest cost of living states in the U.S. than in the lowest cost of living state (Arkansas). Most of the difference is due to real estate prices.

* A plausible observation:

* Louisiana still hasn't recovered from Hurricane Katrina twenty years ago. It permanently reduced the population of the state, and of New Orleans, in particular (predominantly due to migration away from it, not due to the fatalities themselves).

* Almost every country in Western Europe has supplied Ukraine with military equipment. So have quite a few other countries (mostly in what could be called the Western European diaspora).

* Most of North America was once home to Buffalo, although the size of the herds may have been exceptionally large because the Native American populations that hunted them were decimated by European diseases not long before European migrants first documented them.

* Almost all of the land on Earth was connected about 200 million years ago.

* Republicans in Congress have grown less likely to have attended elite universities (while Democrats have grown more likely to have done so), mirroring the shift in college educated people towards the Democratic party.

* Data centers v. office building construction.

* Soil quality in Europe.

* Firefighting employment in Europe.

The U.S. figure is 0.2% (there are about 1.019 million firefighters out of 163.3 million employees, but two-thirds of them, who are not included in the 0.2%, are volunteers). This is similar to the European average.

* The twenty years from 1807 to 1827 did a lot to shape the political map of the Americas.

* Squirrels v. people.

* Women didn't start wearing underwear (i.e. panties and bras) in Europe until the 19th century, for the most part.

* Modern musical notation was invented by a Benedictine monk, Guido of Arezzo in 1025 CE and he also invented the Do-Re-Me system. Recognizable modern musical notation is older than Middle English.

* Billionaires have lower effective tax rates than the upper middle class and even less than for the average person.

We estimate income and taxes for the wealthiest group of US households by matching Forbes 400 data to the individual, business, estate, and gift tax returns of the corresponding group in 2010–2020. In our benchmark estimate, the total effective tax rate—all taxes paid relative to economic income—of the top 0.0002% (approximately the “top 400”) averaged 24% in 2018–2020 compared with 30% for the full population and 45% for top labor income earners. 

This lower total effective tax rate on the wealthiest is substantially driven by low taxable individual income relative to economic income. First, the C-corporations owned by the wealthiest distributed relatively little in dividends, limiting their individual income tax unless they sell their stocks. Second, top-owned passthrough businesses reported negative taxable income on average in spite of positive book income, further limiting their individual income tax. The top-400 effective tax rate fell from 30% in 2010–2017 to 24% in 2018–2020, explained both by a smaller share of business income being taxed and by that income being subject to lower tax rates. 

Estate and gift taxes contributed relatively little to their effective tax rate. Top-400 decedents paid 0.8% of their wealth in estate tax when married and 7% when single. Annual charitable contributions equalled 0.6% of wealth and 11% of economic income in 2018–20.

* Japan has the lowest housing prices in its major metropolitan areas of any comparable cities in the world. It isn't clear to me how much of this is due to lax land use laws arising from handling that function at a regional level rather than locally, and how much of this is due to its low birthrates and modest immigration rates.

Why Do Distance Runners Have More Precancerous Colon Growths?

Are Marathons and Extreme Running Linked to Colon Cancer? A small, preliminary study found that marathoners were much more likely to have precancerous growths. Experts aren’t sure why.

From the New York Times. 

My initial take is that marathoners and extreme runners aren't dying of cardiovascular diseases or pulmonary disease (including lung cancer), but eventually have to die of something, and that something is often colon cancer.

Another non-causal explanation could be that marathoners and extreme runners are more health conscious, and hence more likely to get their colonoscopies done, causing their colon cancers to be noted statistically, while less health conscious people skip their colonoscopies (an entirely understandable sentiment) and so if they have precancerous growths at the same age, they go undetected and aren't noted statistically.

In the same vein, almost no one discovers that they have precancerous pancreatic cancer growth, or even pancreatic cancer itself, because it is usually asymptomatic until it is very advanced.

Or, it could just be a statistical fluke, which is something that is common in small studies and is further influenced by a bias towards only publishing results showing a potential positive or negative disease correlation (which creates a "look elsewhere effect"  that reduces the statistical significance of the studies that are published since only locally statistically significant outlier results get published). The look elsewhere effect is widely recognized but can be hard to quantify.

It could be more than that. It is certainly plausible that a more stressed body might be more prone to cancer, and long distance running does indeed stress your gastrointestinal system. This is especially plausible if the true effect size is modest. Indeed, the confounds noted above could turn a small effect size into a seemingly much larger one.

But it also might be just be entirely due to some of the non-intuitive aspects of how epidemiology and health statistics work. 

The Witches Road (Only Minimal Spoilers)

"The Witches Road" (2025) by Kate Elliott, can be summed up as The Apothecary Diaries x Shannara x Kabaneri of the Iron Fortress. 

In typical Kate Elliott style, there is extensive world building that experiment with novel norms and social structures unfamiliar to many readers, there are richly developed characters, and cliche tropes and genre conventions are frequently turned on their head. 

It is part of a two book series, with the second volume to be released in November, and while it is not her magnum opus, something reserved for her seven volume pair of series in the Jaran universe, or her seven volume Crown of Stars series, it is still a very solid and immersive slow burn high brow fantasy romance in a lovingly crafted and fully realized world.

In this post-apocalyptic world, deadly instantly mutagenic spores associated with the "Pall" have enveloped huge swaths of land in a rigidly hierarchal empire with vague East Asian vibes. The empire is organized at almost every level to permit civilization to survive in the face of the scourge that is the Pall. It isn't entirely clear what lies beyond the oceans and the ocean-like barrier that is the Pall.

The part of the empire that we see, far from the emperor's palace in the heartland, is predominantly agricultural and organized around other primary industries like farming, herding, fishing, forestry, stone quarrying, and mining. The empire is a rigidly hierarchical, but intrigue filled, feudal society where aristocrats jockey for power united under a single emperor who has united all territory up to its natural boundaries. Many key professions like surveying, engineering, and serving as soldiers and as archivists, which one must enter something like a holy order at age seventeen, are also limited to children of aristocrats, above the level of servants assigned to support the professionals who may be commoners, although some professions, like couriers and midwives, need not be aristocrats, and meritocracy is creeping into upset the privileges of aristocratic rank within those professions. Education is limited mostly to aristocrats and the very promising commoner students of liberal aristocrats, with literacy being perhaps about as common as a college education was in the 1960s in the U.S. Themes of found family, sexual identity, servitude, child exploitation, overcoming trauma, and the role of single, adult, childless women in society, are explored in detail.

The empire has pre-industrial, roughly 17th to 18th century level technology (without gun powder, but with fairly easily available contraception and midwives that can safely assist women in obtaining abortions). It has steel, bows, crossbows, spy-glasses, portable fire starting kits, finely crafted clothing, precious metal coins (but not paper currency), accurate surveying and extensive written record keeping, carriages, Roman era grade plumbing and civil engineering, ships that can travel along ocean coasts, libraries but not printing presses, traveling theatrical companies, and significant amounts of travel and trade with all roads leading to the capital in the heartland. 

There are isolated elements present in the empire, like ancient triple towers of stone and a set of roads magically immune to spores and the Pall that are also conduits for telegram-like messages, which pre-date the empire and are associated with a legendary era associated in lore with ancient sorcerer-kings. Silk road style hostel-cities (also similar to inns along ancient roman roads), provided for when the roads were built, dot the ancient "witch roads" in enclaves that are also engineered to be free of the Pall and its spores if properly managed, although rural villages have far inferior defensive measures, and it isn't safe to travel at night due to spores, various forms and races of marauding bandits, and deadly wild animals. 

The current empire has a class of fairly modestly potent magic users under the strict control of the empire via its dominant religion, the Heart Temples, which is more pagan than quasi-Christian. But the people of the empire, who are apparently all nominally adherents to this religion, are not meaningfully more superstitious or religiously minded than their more magical than ours world warrants. Other, mostly lost and forgotten, magic exists as well.

While humans are predominant, their are minorities of several other sentient races - a race of indestructible giants that can read and write and understand human language but not speak it who go dormant at night, a race of three horned dwarves who ride wild cats in small groups through forests and sell themselves a mercenaries, a race of elf-like folk who can be hard to distinguish from humans broken into two hostile groups called the Sea Wolves and the Blood Wolves, and a more peaceful group known as Forest Wolves, and a couple of other sentient races who are mentioned by name in passing, but are not described or introduced in the first volume. Some of these humanoid minority races are refugees, sometimes more recently but often generations ago, from areas devastated by the Pall (as are, we eventually learn, our main character and her deceased sister). Aristocratic messengers riding griffins provide limited air mail service. A few kinds of fantasy creatures, as well as magically powered animal golems, fill the place of heavy machinery, for example, pulling fast carriages. The more advanced, prosperous, and magical days of the sorcerer-kings of legendary history also apparently had dragons and various kinds of powerful chimeric warriors.

The visible presence of, and attitudes towards, LGBT folks (several of whom are important or secondary characters) is comparable to that of the 21st century in the U.S. (with attitudes mixed between more liberal and more conservative aristocrats), although acceptance of concubinage, indentured servitude, roles of women, and the like are more or less in line with those of 17th-19th century East Asia albeit with gender equality approaching late 19th century to early 20th century Western levels or what is seen in modern Islamic countries, and attitudes towards psychology and appropriate interpersonal interactions to deal with people's emotions that are very modern.

Refreshingly, the main character is neither the 17 year old young man about to declare his profession, nor the handsome but arrogant prince who is second in line, together with his sister who is trying to undermine him, to the throne, after the incompetent and ill tempered young crown prince. Instead, it is the young man's 31 year old never married aunt who has served for ten years as a deputy courier, delivering messages by foot over a route that takes weeks to walk while keeping her eye open for spore outbreaks in order to stop them immediately before they get out of hand, and reporting generally on local conditions to the local junior aristocrat who runs the local way station along the imperial road and provides county-level type governmental supervision to the local rural villages.

Most of the characters, including our main character's sister who died a couple of years earlier in an avalanche while on bad terms with her child, have deep dark traumatic pasts that are only revealed bit by bit.

The nominal core plot revolves around our main character guiding the handsome prince with a secret mission on a shortcut past an avalanche blocked canyon (a problem his rival sister hid from him in an effort to one up him, or to create an opportunity to assassinate him in royal succession politics), off the safe and ancient witch roads, together with her nephew, both of whom are urgently escaping their dark pasts trying to catch up with them. But this mission gets a new twist when a charming, wiser, more open minded, and ancient "haunt" temporarily possesses the prince so it can travel to the same destination as the one where the prince was bound on a mission of its own.

I have no quarrel with the fact the she introduce many important terms and concepts long before they are fully explained. But, a small nitpick is that she invents many proper names and creature type names that it is hard to know how to pronounce, such as Xilsi, for which the pronunciation is the "X" is unclear. Given the neo-East Asian setting, I pronounced it in my mind as if it was a transliteration of Chinese with an "sh" sound, rather than the "ch" sound used for X as an initial letter in words of Greek origin. But the proper pronunciation of this name, and several other names and terms used in the book, is less than clear.

Conclusion That Egg Consumption Reduces Alzheimer's Disease Not Very Significant

A study in the peer reviewed Journal of Nutrition claiming a 47% reduction in clinical diagnosis of Alzheimer's during life due to eating at least one egg a week, is much weaker than it appears at face value. 

The results (based upon a clinical diagnosis during life) were consistent with benefits as low as 17% within the margin of error.

 

And, the clinical diagnosis rates weren't very accurate. Post-mortem examination of the brains of more than half of the sample (578 cases) found a 56% false negative rate for clinical diagnosis during life and an 18% false positive rate for clinical diagnosis during life. This casts doubt on whether the lifetime clinical diagnosis data is meaningful at all, given its immense inaccuracy. 

The results when based on autopsies were consistent with benefits as low as 10% for two or more eggs a week.

Both these results are only modestly better than the p=0.05 statistical significance threshold, and the fact that the cases where Alzheimer's disease was accurately diagnosed showed less of a benefit, also casts doubt on the significance of this study. None of the evidence supporting the author's hypothesis that dietary choline intake was the protective factor was statistically significant, and none of the results were significant at anything close to the p=0.01 level. This significance, moreover, is overstated, because the study fails to adjust for the inaccuracy of the clinical diagnosis process or for the uncertainty in the result caused by self-reporting of what people ate. 

Dietary self-reporting is particularly problematic in a population where a large percentage of the reporters will ultimately be diagnosed with Alzheimer's disease in less than ten years. It could be that many people who don't report weekly egg consumption did so because their memory was not good enough to remember everything that they ate in the last month due to having undiagnosed or subclinical levels of Alzheimer's disease, rather than being due to actually eating fewer eggs.

The sample size is small, so the statistical significance of the result is modest. The total sample was 1024 people, and only 370 of them did not eat at least one egg a week.

Also casting doubt on the result is the fact that there was no dose-response effect (i.e. eating more than one egg a week is no better than eating one egg a week, and eating no eggs is not significantly different from eating 1-3 eggs a month) and indeed, eating more than one egg a week reduced the benefit in individuals who had post-mortem exams done, relative to those who had one egg a week.

The average diagnosis at 6.7 ± 4.8 years from the start of the study is also soon enough after the study began, that given strong evidence in the literature (which is not mentioned in the literature review in the study) that Alzheimer's disease starts at sub-clinical levels decades before it is diagnosed in many cases. So, the diet of the people in the study during the study period probably didn't influence the outcomes.

Finally, while the study controls for 13 potential confounding factors (of which some, like education, didn't vary significantly between the subgroups), it could easily have omitted an important factor. And, it doesn't prove cause and effect either. For example, it could be that having undiagnosed Alzheimer's disease influences your body in a way that you don't like eating eggs as much.

Thus, while the study might justify further research, its conclusion the weekly egg consumption greatly reduces Alzheimer's disease onset risk is too weak to make a life choice based upon, or to recommend clinically, despite the fact that their best fit benefit purports to be as much as a 47% reduction in the risk of getting Alzheimers. Indeed, if anything, the details of the data tend to favor some uncontrolled for confounding factor that is merely mildly correlated with egg consumption.

The failure of the study to engage with many of these issues in a forthright manner also casts doubt on the quality of the peer review at the Journal of Nutrition for this study.

The study and its abstract are as follows:

Background: Alzheimer’s disease (AD) is a neurodegenerative disorder with increasing prevalence due to population aging. Eggs provide many nutrients important for brain health, including choline, omega-3 fatty acids, and lutein. Emerging evidence suggests that frequent egg consumption may improve cognitive performance on verbal tests, but whether consumption influences the risk of Alzheimer’s dementia and AD is unknown.

Objectives: To examine the association of egg consumption with Alzheimer’s dementia risk among the Rush Memory and Aging Project cohort.

Methods: Dietary assessment was collected using a modified Harvard semiquantitative food frequency questionnaire. Participants’ first food frequency questionnaire was used as the baseline measure of egg consumption. Multivariable adjusted Cox proportional hazards regression models were used to investigate the associations of baseline egg consumption amount with Alzheimer’s dementia risk, adjusting for potential confounding factors. Subgroup analyses using Cox and logistic regression models were performed to investigate the associations with AD pathology in the brain. Mediation analysis was conducted to examine the mediation effect of dietary choline in the relationship between egg intake and incident Alzheimer’s dementia.

Results: This study included 1024 older adults {mean [±standard deviation (SD)] age = 81.38 ± 7.20 y}. Over a mean (±SD) follow-up of 6.7 ± 4.8 y, 280 participants (27.3%) were clinically diagnosed with Alzheimer’s dementia. Weekly consumption of >1 egg/wk (hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.34, 0.83) and ≥2 eggs/wk (HR: 0.53; 95% CI: 0.35, 0.81) was associated with a decreased risk of Alzheimer’s dementia. Subgroup analysis of brain autopsies from 578 deceased participants showed that intakes of >1 egg/wk (HR: 0.51; 95% CI: 0.35, 0.76) and ≥2 eggs/wk (HR: 0.62; 95% CI: 0.44, 0.90) were associated with a lower risk of AD pathology in the brain. Mediation analysis showed that 39% of the total effect of egg intake on incident Alzheimer’s dementia was mediated through dietary choline.

Conclusions: These findings suggest that frequent egg consumption is associated with a lower risk of Alzheimer’s dementia and AD pathology, and the association with Alzheimer’s dementia is partially mediated through dietary choline.

Yongyi Pan, et al., "Association of Egg Intake With Alzheimer’s Dementia Risk in Older Adults: The Rush Memory and Aging Project" 154(7) The Journal of Nutrition 2236-2243 (2024). https://doi.org/10.1016/j.tjnut.2024.05.012.