Author: Art Diamond

“You Can’t Wait for Somebody to Make a Giant Study”

(p. A6) In April [2020], researchers published an article in the Journal of the American Medical Association suggesting many Covid-19 patients with respiratory distress might require a different treatment approach than typically used for ARDS.

. . .

Maurizio Cereda, an anesthesiologist and head of the surgical ICU at the Hospital of the University of Pennsylvania, said doctors normally use standardized tables to match the level of oxygen in the blood with the amount of PEEP needed. Penn tends to use a table with lower PEEP values, he said, but even those lower levels seem to damage the lungs of some of his Covid-19 patients. As a result, he disregards the table entirely at times, he said, even though some in his institution disagree with his approach.

“You can’t wait for somebody to make a giant study,” Dr. Cereda said. “You are alone with your clinical observation. A lot of people don’t feel comfortable with that because they want to have big guidelines. People seem to be afraid they’re going to do something wrong.”

. . .

At Maimonides Medical Center in Brooklyn, critical-care and emergency-medicine doctor Cameron Kyle-Sidell said he was initially seeing much higher mortality rates from Covid19 patients on ventilators than he would have expected from classic ARDS, possibly because physicians were sticking to PEEP levels used to treat traditional ARDS.

“There are people who are treating this the way they would have treated any other ARDS,” he said. “Then there’re people on the flip side—and I am on that flip side—that think you should treat it as a different disease than we treated in the past.”

For the full story, see:

Sarah Toy and Mark Maremont. “Doctors Split on Best Way To Treat Coronavirus Cases.” The Wall Street Journal (Thursday, July 2, 2020): A6.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the story has the date July 1, 2020, and has the title “Months Into Coronavirus Pandemic, ICU Doctors Are Split on Best Treatment.” The online version quoted above includes a couple of added sentences quoting Dr. Cereda, beyond the single sentence quoted in the print version.)

Chinese Communists Have Failed to Reform Toward Free Markets

(p. B6) China is the only major world economy reporting any economic growth today. It went first into Covid-19 and was first out, grinding out 3.2% growth in the most recent quarter while the U.S. shrank 9.5% and other advanced economies endured double-digit declines. High-tech monitoring, comprehensive testing and aggressive top-down containment measures enabled China to get the virus under control while others struggled. The Middle Kingdom may even deliver a modest year-over-year economic expansion in 2020.

This rebound is real, but behind the short-term numbers the economic restart is dubious. China’s growth spurt isn’t the beginning of a robust recovery but an uneven bounce fueled by infrastructure construction.

. . .

An honest look at the forces behind China’s growth this year shows a doubling down on state-managed solutions, not real reform. State-owned entities, or SOEs, drove China’s investment-led recovery.

. . .

For years, the world has watched and waited for China to become more like a free-market economy, thereby reducing American security concerns. At a time of profound stress world-wide, the multiple gauges of reform we have been monitoring through the China Dashboard point in the opposite direction. China’s economic norms are diverging from, rather than converging with, the West’s. Long-promised changes detailed at the beginning of the Xi era haven’t materialized.

Though Beijing talks about “market allocation” efficiency, it isn’t guided by what mainstream economists would call market principles. The Chinese economy is instead a system of state capitalism in which the arbiter is an uncontestable political authority. That may or may not work for China, but it isn’t what liberal democracies thought they would get when they invited China to take a leading role in the world economy.

For the full commentary, see:

Daniel Rosen, and Kevin Rudd. “China Backslides on Economic Reform.” The Wall Street Journal (Wednesday, September 23, 2020): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Sep. 22, 2020, and has the same title as the print version.)

Amazon’s Culture “Asks a Lot of Questions”

(p. B2) John Mackey helped popularize organic food when he co-founded Whole Foods Market four decades ago. Over the past several months, his chain of more than 500 stores has scrambled to adapt to another major shift in how Americans buy groceries.

. . .

The pandemic has accelerated an online-grocery movement that Whole Foods was already seeking to capitalize on as part of Amazon.com Inc. Mr. Mackey sold Whole Foods to the online-retail juggernaut for $13.4 billion in 2017, one of the decisions he recounts in his new book out this month, “Conscious Leadership: Elevating Humanity Through Business.”

. . .

WSJ: What merger challenges have you’ve learned from?

Mr. Mackey: Amazon has a culture that asks a lot of questions. We took a little longer to get used to that, but that’s no big deal. That’s how you learn things. They’re trying to understand our business. They want to know everything. And I think that’s healthy.

WSJ: What’s the biggest leadership lesson you’ve adopted from Jeff Bezos?

Mr. Mackey: Amazon wants you to write up a document explaining your ideas, defending them, and then you can have discussions. That’s a practice Whole Foods has adopted. Amazon’s also very data-driven. As opposed to acting from the gut, Amazon says, “Show us the data.” That’s been a good discipline for us. We do it ourselves, even when we’re not talking to Amazon.

For the full interview, see:

Jaewon Kang, interviewer. “BOSS TALK; Rugged Individualism in the Grocery Aisle.” The Wall Street Journal (Saturday, September 12, 2020): B2.

(Note: ellipses added. In both the print and online versions, “WSJ” and “Mr. Mackey” are bolded, as are the questions asked by Jaewon Kang. The bolding is not visible in the theme used for this blog.)

(Note: the online version of the interview has the date Sep. 11, 2020, and has the title “BOSS TALK; Whole Foods CEO John Mackey Says Many People Are Done With Grocery Stores.”)

The book co-authored by Mackey and mentioned above is:

Mackey, John, Steve Mcintosh, and Carter Phipps. Conscious Capitalism: Elevating Humanity Through Business. New York: Portfolio, 2020.

Apple Is First U.S. Firm to Reach Two Trillion in Market Value

(p. B1) Apple Inc. on Wednesday [Aug. 19, 2020] became the first U.S. public company to eclipse $2 trillion in market value, a dizzying achievement that highlights the iPhone maker’s commanding role in the world economy.

Shares of Apple rose as much as 1.4% to $468.65, eclipsing the $467.77 mark needed to reach the milestone. They ended the day up 0.1% at $462.83, putting the company’s market value just below $2 trillion.

For the full story, see:

Amrith Ramkumar. “Apple’s Stock-Market Valuation Touches $2 Trillion Mark Intraday.” The Wall Street Journal (Thursday, August 20, 2020): B1-B2.

(Note: bracketed date added.)

(Note: the online version of the story was updated Aug. 19, 2020, and has the title “Apple Surges to $2 Trillion Market Value.”)

California Government Allowed “Buildup” of “Fuel for Future Blazes”

(p. A1) California is one of America’s marvels. By moving vast quantities of water and suppressing wildfires for decades, the state has transformed its arid and mountainous landscape into the richest, most populous and bounteous place in the nation.

. . .

(p. A16) The intensity of the fires . . . reflects decades of policy decisions that altered those forests, according to Robert Bonnie, who oversaw the United States Forest Service under President Barack Obama. And the cost of those decisions is now coming due.

In an effort to protect homes and encourage new building, governments for decades focused on suppressing fires that occurred naturally, allowing the buildup of vegetation that would provide fuel for future blazes. Even after the drawbacks of that approach became clear, officials remained reluctant to reduce that vegetation through prescribed burns, wary of upsetting residents with smoke or starting a fire that might burn out of control.

That approach made California’s forests more comfortable for the estimated 11 million people who now live in and around them. But it has also made them more susceptible to catastrophic fires. “We’ve sort of built up this fire debt,” Mr. Bonnie said. “People are going to have to tolerate smoke and risk.”

For the full story, see:

Christopher Flavelle. “Mankind’s Feats Place California At Climate Risk.” The New York Times (Monday, September 21, 2020): A1 & A15.

(Note: ellipses added.)

(Note: the online version of the story has the date September 20, 2020, and has the title “How California Became Ground Zero for Climate Disasters.”)

Natural Experiments Are Equal to Randomized Double-Blind Clinical Trials in Showing Causality

(p. B6) . . . randomized controlled trials are the gold standard in medicine. Using randomization (by, say, flipping a coin to assign patients to a new treatment or not) is the best way to determine whether treatments work.

Unfortunately, randomized trials take time — which is a problem when doctors need answers now. So doctors and public health officials have been turning to available real-world data on patient outcomes and trying to make sense of them.

. . .

“Large-scale randomized evaluations have been less common in economics, prioritizing the need for economists to identify often creative but sometimes narrow natural experiments to estimate the causal effects of treatments,” said Amitabh Chandra, an economist at the Harvard Business School and the Kennedy School of Government.

Ashish Jha, recently appointed the dean of the Brown University School of Public Health, said that while “natural experiments have causal interpretations, typical associational studies in medicine do not, which may make some medical researchers less comfortable interpreting the results.”

. . .   Most doctors can relate to recent comments by the Food and Drug Administration director Stephen Hahn in last week’s congressional pandemic hearing. “In a rapidly moving situation like we have now with Covid-19,” he said, decisions are made “based on the data that’s available to us at the time.”

For the full commentary, see:

Anupam B. Jena and Christopher M. Worsham. “THE UPSHOT; What Coronavirus Researchers Can Learn From Economists.” The New York Times (Thursday, July 2, 2020): B6.

(Note: ellipses added.)

(Note: the online version of the commentary has the date June 30, 2020, and has the same title as the print version.)

Boeotia Was “an Early Model of Democratic Federalism”

(p. C12) Mr. Cartledge, a professor emeritus at Cambridge and author of popular history books such as “The Spartans,” “Thermopylae,” “Alexander the Great” and “Democracy: A Life,” has picked an opportune time to look afresh at Thebes and Boeotia. The modern city of Thebes, an uninspiring market town, would not normally attract tourists, but is home to a glittering new museum, among the most up-to-date in Greece, featuring exhibits of archaeological finds (many unique in type) and historical objects from prehistory to the present. (One exhibit is titled, provocatively, “The Intellectual Radiance of Boeotia.”) There is a book forthcoming, from scholar James Romm, about Thebes’s “Sacred Band,” its elite unit of soldiers, made up of pairs of devoted homosexual lovers. Thebes is in the spotlight.

. . .

The biography of the Theban leader Epaminondas (418 B.C.-362 B.C.) written by Plutarch is, unfortunately, lost. Even so, his reputation shines. Admired by figures from Cicero and Montaigne to Sir Walter Raleigh (who called him “the worthiest man that ever was bred by the nation of Greece”), Epaminondas seems to have had a philosophical bent as well as a brilliant military mind.

. . .

Perhaps his greatest act, . . ., even if it might have been intended more to inconvenience the Spartans than as a benevolent deed, was freeing the helots of Messenia, a people that had been enslaved by the Spartans for 300 years. He helped found a new capital city for the Arcadian federation (Megalopolis), and also for the ex-helots (Messene). Maybe Epaminondas was not only the Nelson of his age, but the Lincoln as well. He died in battle and was buried alongside his male beloved, Caphisodorus, with an epitaph that listed his children (daughters, being female) as the cities Messene and Megalopolis; it ended “Greece is free.”

Mr. Cartledge’s command of the historical material is effortless and exhaustive, and his appreciation of Thebes is persuasive. Between the radical but self-destructive democracy of Athens and Sparta’s totalitarian oligarchy (both imperialist), Thebes and Boeotia stand in the middle as an early model of democratic federalism—the “united states” of Boeotia, for instance, shared a currency. It was Thebes that dealt a critical blow to Spartan domination, and a Theban leader who freed a long-enslaved people. Alexander the Great himself adopted military tactics from Epaminondas. If Thebes’s period of hegemony was brief—barely a decade—it also changed the course of the ancient world.

For the full review, see:

A.E. Stallings. “Greece’s Mythic Heartland.” The Wall Street Journal (Saturday, September 12, 2020): C12.

(Note: ellipses added.)

(Note: the online version of the review has the date Sep. 11, 2020, and has the title “‘Thebes: The Forgotten City of Ancient Greece’ Review: Mythic Roots.”)

The book under review is:

Cartledge, Paul. Thebes: The Forgotten City of Ancient Greece. New York: Abrams Press, 2020.

Advanced Colon Cancer Patients Lived Longer When They Drank Coffee

(p. D6) Researchers studied 1,171 patients diagnosed with advanced or metastatic colon or rectal cancer who could not be treated with surgery.

. . .

Compared with people who drank none, those who drank a cup a day had an 11 percent increased rate of overall survival, and a 5 percent increased rate of living progression-free. The more coffee they drank, the better. Those who drank four or more cups a day had a 36 percent increased rate of overall survival and a 22 percent increased rate of surviving without their disease getting worse. Whether the coffee was decaf or regular made little difference.

The study, in JAMA Oncology, controlled for race, smoking, alcohol intake, aspirin use, diabetes, and the addition of milk, nondairy creamers or sweeteners to the coffee.

For the full story, see:

Nicholas Bakalar. “Coffee for Better Outcomes.” The New York Times (Tuesday, September 29, 2020): D6.

(Note: ellipsis added.)

(Note: the online version of the story was updated September 23, 2020, and has the title “Drinking Coffee Tied to Better Outcomes in Colon Cancer Patients.”)

The article in JAMA Oncology mentioned above is:

Mackintosh, Christopher, Chen Yuan, Fang-Shu Ou, Sui Zhang, Donna Niedzwiecki, I-Wen Chang, Bert H. O’Neil, Brian C. Mullen, Heinz-Josef Lenz, Charles D. Blanke, Alan P. Venook, Robert J. Mayer, Charles S. Fuchs, Federico Innocenti, Andrew B. Nixon, Richard M. Goldberg, Eileen M. O’Reilly, Jeffrey A. Meyerhardt, and Kimmie Ng. “Association of Coffee Intake with Survival in Patients with Advanced or Metastatic Colorectal Cancer.” JAMA Oncology (published online in advance of print on Sept. 17, 2020).

New York Times’s “Inexcusable” Reporting Ignored Sophia Farrar, Whose Actions Belied the Kitty Genovese Narrative

(p. A24) The story of Kitty Genovese, coupled with the number 38, became a parable for urban indifference after Ms. Genovese was stalked, raped and stabbed to death in her tranquil Queens neighborhood.

Two weeks after the murder, The New York Times reported in a front-page article that 37 apathetic neighbors who witnessed the murder failed to call the police, and another called only after she was dead.

It would take decades for a more complicated truth to unravel, including the fact that one neighbor actually raced from her apartment to rescue Ms. Genovese, knowing she was in distress but unaware whether her assailant was still on the scene.

That woman, Sophia Farrar, the unsung heroine who cradled the body of Ms. Genovese and whispered “Help is on the way” as she lay bleeding, died on Friday [Aug. 28, 2020] at her home in Manchester, N.J.

. . .

The murder was reported in a modest four-paragraph article in The Times. Two weeks later, its interest piqued by a tip from the city’s police commissioner, The Times produced a front-page account of the killing that transformed the murder into a global allegory for callous egocentrism in the urban jungle and undermined the innocent-bystander alibi.

. . .

That account — epitomized by one neighbor’s stated excuse that “I didn’t want to get involved” — galvanized outrage, became the accepted narrative for decades and even spawned a subject of study in psychology: how bystanders react to tragedy. Except that with the benefit of hindsight, the number of eyewitnesses turned out to have been exaggerated; none actually saw the attack completely; some who heard it thought it was a drunken brawl or a lovers’ quarrel; and several people said they did call the police.

. . .

In several retrospectives decades after the murder, The Times reassessed the original account, concluding that more neighbors might have heard Ms. Genovese’s screams than actually witnessed the attack. But only one Times article, during Mr. Moseley’s trial, even mentioned Mrs. Farrar’s name, reporting that she and Ms. Zielonko found the victim in the vestibule.

Since Mrs. Farrar was interviewed on camera in “The Witness,” though, among those who criticized The Times’s failure to report her presence in earlier accounts of the crime was Joseph Lelyveld, who was the executive editor of The Times in the 1990s. He has called the omission “inexcusable.”

For the full obituary, see:

Sam Roberts. “Sophia Farrar Dies at 92; Belied Indifference to Kitty Genovese Attack.” The New York Times (Friday, September 4, 2020): A24.

(Note: ellipses added.)

(Note: the online version of the obituary has the date Sept. 2, 2020, and has the same title as the print version.)

Litan and Mankiw Endorse Paying People to Take Vaccine

(p. 5) What’s the best way to get the economy back on track after the Covid-19 recession? Simple: Achieve herd immunity. And what’s the best way to achieve herd immunity? Again, simple: Once a vaccine is approved, pay people to take it.

That bold proposal comes from Robert Litan, an economist at the Brookings Institution. Congress should enact it as quickly as possible.

. . .

Recent research by the University of Chicago economists Austan Goolsbee and Chad Syverson has found that the government-mandated shutdowns account for just a small part of the decline in economic activity. The main reason people aren’t spending is that they are afraid to leave their homes and contract the virus. That hypothesis explains my own behavior. I have not stepped foot on an airplane or inside a restaurant for six months.

. . .

Immunology, meet economics. One of the first principles of economics — perhaps the most important — is that people respond to incentives. Applying this principle to the case at hand, Mr. Litan recommends that the government pay $1,000 to whoever gets the vaccine. With a large enough incentive, most Americans are likely to get vaccinated.

This proposal is textbook economics. (I’ve written some of the textbooks.) As all economics students learn, when an activity has a side effect on bystanders, that effect is called an externality. In the presence of externalities, the famous theorems of economics that justify laissez-faire do not apply. Adam Smith’s vaunted invisible hand can no longer work its magic.

A classic example of a negative externality is pollution, and the simplest and least invasive policy solution is a tax on emissions. In economics-speak, such a tax internalizes the externality: It induces polluters to take the cost of pollution into account by giving them a financial incentive to cut emissions. That’s why I have written here many times that a tax on carbon emissions is the best way to deal with global climate change.

Vaccination confers a positive externality. When you get vaccinated, you benefit not only yourself but also your fellow citizens by helping society take a step toward herd immunity. In this case, internalizing the externality requires not a tax but a subsidy, as Mr. Litan suggests.

For the full commentary, see:

N. Gregory Mankiw. “A Vaccine Subsidy Licks 2 Crises With One Shot.” The New York Times, SundayReview Section (Sunday, September 13, 2020): 5.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Sept. 9, 2020, and has the title “Pay People to Get Vaccinated.”)

The Robert Litan op-ed mentioned above is:

Litan, Robert E. “Want Herd Immunity? Pay People to Take the Vaccine.” Brookings Institute Op-Ed. (Tues., Aug. 18, 2020) URL: https://www.brookings.edu/opinions/want-herd-immunity-pay-people-to-take-the-vaccine/.>

The Goolsbee and Syverson NBER working paper mentioned above is:

Goolsbee, Austan, and Chad Syverson. “Fear, Lockdown, and Diversion: Comparing Drivers of Pandemic Economic Decline 2020.” NBER Working Paper #27432, June 2020.

“Operation Warp Speed, . . . , Is More Imaginative Than the Bureaucratic Norm”

(p. 11) . . . the blundering of the Trump administration, while real and deadly, may not be responsible for the bulk of America’s coronavirus fatalities.

. . .

. . . : the absence of challenge trials for vaccines (in which young, healthy participants agree to be vaccinated and then infected with the virus), the predictable expert resistance to at-home testing. But the most important one was the straightforward bureaucratic calamity at the C.D.C. that delayed effective testing for a fateful month.

An effective president might have addressed some of these problems. (Although Operation Warp Speed, the White House’s vaccine initiative, is more imaginative than the bureaucratic norm.) But overall they are problems with structures and habits rather than personalities — an institutional decadence that predated Trump and will persist when he is gone.

. . .

. . . the third thing you see when you look beyond Trump [is] the fact that so many countries in Western Europe, to say nothing of our neighbors in the Americas, have had death rates similar to ours.

This reality speaks not of exceptionalism but of convergence — and the possibility that the trends of the early 21st century have left us sharing more in common not only with France and Spain but also with Mexico and Brazil than most Americans might expect.

This, too, may matter long after Trump is gone. Where there are crises, in this dispensation, they are likely to be general rather than just American. Where there is decadence, it is the shared experience of late modernity. And if renewal comes to an exhausted West, it will not necessarily come through America alone.

For the full commentary, see:

Ross Douthat. “What Isn’t Trump’s Fault.” The New York Times, SundayReview Section (Sunday, September 13, 2020): 11.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Sept. 12, 2020, and has the same title as the print version.)