Bwel1985

If the Presidential race is any guide, many Americans do not like “politicians.” Weak-kneed and compromised by campaign contributions, “politicians” imperil our virtuous Republic. Or so we are told by ideologues on the Right and Left and by a distressing number of citizens whose interest in politics is but a quadrennial event.

“Compromised.” A troubling word. Yet our system of government, with its divided powers, cannot function without “compromise” among competing interests and philosophies. Can we “compromise” without being “compromised”? Yes, and the resulting hybrid may even be superior to ideologically pure alternatives.

Single Payer Is Not ‘Medicare For All’

Health care has been a political battleground for decades but especially in the last half-dozen years. Because the issues are complex and hit close to home, politicians, and assorted parties in interest, have little difficulty stoking voter fears. Obfuscation and distortion are all too common.

Even without intentional obfuscation and distortion, political rhetoric may blur important distinctions and conceal opportunities for compromise. Recent public opinion polls about “single payer” health care are illustrative.

A recent AP-Gfk poll found that a plurality of Americans (39 percent) support “replacing the private health insurance system with a single government-run, taxpayer-funded plan.” But about 40 percent of those supporters switched to opposition if such a plan would mean an increase in their own taxes. A similar proportion of the initial supporters would abandon “single payer” if they had to give up their employer-sponsored coverage.

Bernie Sanders, famously a proponent of single payer, laments that people don’t understand that wage increases would more than offset any increase in taxes to fund single payer. Since employers would not need to spend money on health benefits, he argues, they would convert the savings into wages.

Others can debate that proposition. What about the notion that “single payer” would require people giving up their private insurance?

Proponents of “single payer” sometimes label their proposal “Medicare for All,” treating the two terms as though they were synonymous. Given the broad public support for Medicare, they are probably justified in thinking “Medicare for All” sells better. But “single payer” and “Medicare for All” are not synonymous.

Medicare does not require seniors to accept government-managed insurance in lieu of private coverage. One-third of Medicare beneficiaries use their “entitlement” to enroll in a private health plan under the auspices of Medicare Advantage. And that proportion has been growing rapidly.

A Robust Hybrid

While a heated debate has raged between proponents of “single payer” on the one hand and advocates for reforms based on private insurance on the other, “Medicare” has been transformed. It is an amalgam of a government-managed insurance plan and private health plans, a compromise forged by several generations of “compromising” politicians dating back to the Reagan Administration. Purists on the Left and Right may not like the compromise, but this hybrid form of Medicare works.

The government-managed plan and private health plans each offer seniors something different. The government plan offers patients a free choice of provider at a reasonable cost because it commands low prices from health care providers and has low administrative costs. Medicare Advantage plans, on the other hand, often have lower premiums and richer coverage than the government plan, saving money through limited provider networks, benefit design, and care-management programs focused on high-cost patients.

Medicare beneficiaries like this hybrid offering. Indeed, the Commonwealth Fund has found that Medicare beneficiaries are more satisfied with their health insurance coverage than adults with employer-sponsored coverage. Some seniors like their government-managed plan, while others like their private Medicare Advantage plan.

On first read, the aforementioned AP-Gfk poll seems to exemplify voter bewilderment about complex health care issues. Many Americans like single payer, it seems to say, at least until they understand what it means. Another way to look at the poll results, however, is that many voters might like a hybrid of government and private insurance.

A Path Forward?

Could it be that the way forward in health care is to extend Medicare’s well-functioning hybrid system to all Americans, not just seniors?

Incorporating additional features supported by conservatives, like defined contributions based on plan bids, might further strengthen the hybrid. Defined contributions are a central element of the Obamacare exchanges and increasingly common in employer-sponsored plans. Critics on the Left will object to redefining the Medicare entitlement in this manner since it would mean that seniors choosing the government-managed plan must pay higher premiums when there are lower-cost private plans available in their market. But if defined contributions are acceptable for the taxpayers who finance Medicare, why aren’t they acceptable for seniors?

In exchange for reform of the Medicare entitlement, all Americans, not just seniors, could be granted the option of enrolling in a government-managed plan (a public option), a step favored by liberals. The Right will object that this is a step toward the Federal government taking over the health care system, but rapid growth in Medicare Advantage enrollment suggests that private plans can more than hold their own in the competition.

Moreover, the government-managed plan would provide competition in markets currently dominated by a single private insurer and may even restrain the prices charged by providers to private health plans. Medicare Advantage plans usually pay providers rates that are similar to the rates paid by Medicare’s government-managed plan.

Only a cock-eyed optimist would predict such a Grand Compromise in the current political environment. The issues, furthermore, are more complex than presented here. Medicare’s hybrid system illustrates, however, that compromise can improve policy. Critics on the Right and Left may claim that legislators supporting the hybrid are “weak-kneed” or have been “bought by vested interests,” but in reality they have made government work for the people.

There’s a scene in Allison Anders’ Gas Food Lodging where sisters Trudi and Shade slouch in a truck stop diner booth. Nora, their mother, a waitress, is covering two stations. Trudi (played by Ione Skye) won’t eat because she’d rather starve then risk “smelling like grease and fish.” Trudi hates her town, the trailer park where she lives, and the busboy who spills a soda on her lap. She blames her mother for all of her bad choices, but mostly for her mother’s bad choices in men. She lashes out at her mother and her sister, but really, it’s the world that’s at fault.

The scene captures what we take for granted in teen movies—not the indignant teen, but the frustrated parent struggling to pay bills, who sometimes has to work two shifts, or double shifts, or the graveyard shift. Even in smart teen movies like Mean Girls or 10 Things I Hate About You, there’s endless money for all the fries and Cokes and movies kids want. The kids are sheltered; financial realities simply don’t exist or aren’t addressed. And understandably so—who wants their teen movie filled to the brim with our parents’ problems? Even Charlie Brown dismissed adults as background noise.

Except teen movies—and movies about teens—in the ‘80s and ‘90s, like Gas Food Lodging, delved into some heavy socio-economic plots and subplots. There was John Singleton’s groundbreaking Boyz n the Hood about three black teenage boys living in South Central Los Angeles and the demoralizing effect gang life has on them. There was the exhausted single parent in Whatever. There was the no-parent household in The Outsiders. There was the money-is-tight-let’s-move-across-country subplot in The Karate Kid. There was the parent moving to the rich suburb so his kids could go to better schools in Slums of Beverly Hills. There was the rough coming-of-age of three high school seniors in Girls Town, in which the tag line read “This ain’t no 90210.” There was the my-stepfather-is-a-lazy-piece-of-shit-drunk-who eats-all-of-our-food-while-mom-works-her-ass-off subplot in River’s Edge. There was Mi Vida Loca, about Latino teen girls living in gang-riddled Echo Park. There was the I-want-to-be-seen-as-more-than-just-another-black-girl-on-the-subway in Just Another Girl on the I.R.T. Even John Hughes, the king of rich white kids, tackled class warfare with Molly Ringwald’s character in Pretty in Pink, a romantic who lived on the “other side of the tracks,” and Eric Stoltz and Mary Stuart Masterson’s characters in Some Kind of Wonderful were poor artists/drummer/mechanics.

Fast forward today and the middle class struggle is hardly touched on in films about teens. There are 50 million people living in poverty in the U.S., according to the 2013 Census report, but we’ve only seen a tiny sample of contemporary teen movies (Thirteen, Precious, Beneath the Harvest Sky) even attempt to grasp those topics.

This isn’t to say there’s been an absence of heavy plot lines in recent teen movies. There’s been child molestation in The Perks of Being a Wallflower. There’s teenagers with cancer in A Fault in Our Stars. Even the closest contender to socioeconomic truthfulness, The Hunger Games, doesn’t quite stack up: though it’s packed with messages about reality television and oppressive starvation, poverty and extreme wealth, The Hunger Games’ dystopian backdrop feels really far away from some serious economic problems that teenagers in our country are dealing with: the rising costs of higher education, the threat of student loan debt, shrinking incomes, the complexities of health insurance.

So why are the majority of teen movies today steering clear of these socioeconomic problems?

The first reason has much to do with the economy. In the documentary Inequality For All, former Secretary of Labor Robert Reich breaks down the terrible state of the middle class. There’s a Rio Grande-sized divide between the rich and poor, as explained on his website: “The 400 wealthiest Americans make up 62 percent of wealth in America, and the poorest 47 percent of Americans have no wealth.” Last year, a study by the IRS found that between 1993 and 2012, incomes of the one percent grew 86 percent. The incomes of the 99 percent grew six percent. Just a month ago, the Fed reported that the state of inequality grew even wider during the economic “recovery.”

But you already know all this without me having to tell you about those figures—in fact, you probably just skimmed over those figures, didn’t you? The movie industry knows this, too. Middle-class struggling family stories are too familiar. A mom with two girls in a trailer park seems like a trope, the hard-working mom with the drunk boyfriend cliché is played out, the poor kid struggling is too formulaic.

Here’s what happens when people feel behind, when they feel down and out, when they’re sad or scared or concerned: they look for entertainment. They look to the movies. They turn on the TV. They don’t want reminders of how hard life is.

Take a look at filmgoing during the Great Depression. As starving, poor folks sipped their water and ketchup soup, they dished out their 15 cents and they transported themselves to another time— 80 to 110 million people a week sat in theaters, watching glamorous actresses like Ginger Rogers toe-tap around ballrooms with Fred Astaire. Those pictures were an escape. “People would go into the theater, in this darkened cavern, and it took them out of themselves. They could fantasize about what happened on the screen, about those beautiful stars that existed then,” actor Norman Lloyd told CBS News.

And maybe that concept of glamorous escapism has something to do with why real-life financial situations aren’t depicted in teen movies today. The culture of celebrity excess has never been more popular, though it’s always been something for observers to latch onto. They were even “mindless diversions” in the 1920s, as George Packer keenly wrote in the New York Times. “Celebrities were the new household gods,” he explained. Why? Because people with butlers, and tennis courts and fancy pools had it way better than you.

I don’t think Kanye was entirely wrong when he told GQ that Kim is shaping celebrity culture, because Kim is that “household God”— everyone wants be friends with Kim, or smell like Kim, or dress like Kim, or have a house like Kim, or have a second home in Paris like Kim, or work out like Kim, or get married like Kim. In droves! And maybe while you’re playing her video game, or watching her show, for a few seconds, you feel like, Yes, if I just bought that lace bib, or the leather skirt from the Kardashian Kollection, I could do Kim. Just for a second.

That has an impact of teenage storylines we see today. Contemporary teen movies mirror that kind of economically “safe” world—like Kim’s—because that’s what the movie industry thinks teens expect to see. The average reality show is equipped with the same beige interior, pool with a waterfall out back, Lam or Bentley in the driveway and Bachelor-esque McMansion. Like a Kubrick film or an old Marlboro Red commercial, reality show producers, with their subliminal messaging, engineered a decorating standard: our life is supposed to look like this.

In the ‘80s and ‘90s, movies and television shows explored storylines on the fray. They were really weird and strangely lit with cryptic-speaking characters and alternative universes—they weren’t beige and unoffensive. Dialogue in some of my favorite independent films made little sense (see Jim Jarmusch’s Stranger Than Paradise, for an example), but that’s what I craved—an abstract world that made me a slightly uncomfortable. That poked me in the ribs.

Not to mention that in the ‘80s and ‘90s, independent filmmakers were everywhere. “The indie movement critiqued the dominant culture that Hollywood represented,” wrote UCLA anthropology professor, Sherry B. Ortner in her paper, “Against Hollywood.” During that time, a slew of independent filmmakers created worlds for teens that existed outside of the John Hughes bubble because there was a fundamental disconnect between what was happening in “teen films”—in which the protagonist struggles but there’s a resolved, happy-ish ending like in Gas Food Lodging—and “movies about teens”–which the teenage protagonist’s conflict may not be resolved like in Boyz n the Hood— by indie filmmakers.

There was also a gaping divide between films about white teens and films about teens of color. (In fact, of all the movies I mentioned Allison Anders is the only director who told the stories of Latino youth—and she continues to in directorial stints of Orange Is The New Black.)

Leslie Harris’ Just Another Girl On The I.R.T. told the story of a young black girl living in Brooklyn because Harris wanted her experience to be reflected on screen. “Basically when I started I just wanted to do a film about young black women. That’s a story that hasn’t been told. I started off with two temp jobs, this idea for a script, and no money,” she told Filmmaker Magazine back in 1994. Harris went to the studios, but executives weren’t interested. “They said to make it male— I heard this!” Harris explained.

That same void drove John Singleton to make Boyz n the Hood. There was no one like him on the screen—no mirror of himself and the kind of raw “odyssey that black boys must undertake in the suffocating conditions of urban decay and civic chaos,” wrote Georgetown sociology professor Michael Eric Dyson at the time. (Singleton was even offered $100,000 not to make it so that an experienced director could take his place.)

Just Another Girl on the I.R.T. and Boyz n the Hood weren’t marketed as “teen movies,” but they spoke to teens, therefore, allowing society a fresh discussion about race, or teen pregnancy, or gang violence, or all of the above—all of which weren’t broadly discussed at that time. It was unheard of.

Go back to that era and you’ll see there weren’t many stories about teenagers of color, period. Sure, there was The Cosby Show, but as I remember it, criticism followed that show for not confronting racism. Critics accused the Huxtables for not being “black” enough, or for writing dad as a doctor and mom as a lawyer because that wasn’t “realistic.” The Cosby Show wasn’t Good Times (a 1970s sitcom about a black family living in the projects). In fact, there were hardly any bad times on The Cosby Show—and if there were, they worked that shit out. “To have confronted the audience about racism would have been commercial suicide,” wrote cultural critic Justin Lewis in Jump Cut.

The Cosby Show existed to broaden the conversation about successful black families. It was, of course, the antithesis to Boyz n the Hood. The Huxtable kids didn’t have to worry about getting shot on the way to school. Police helicopters didn’t drown out their conversations. Crack addicts didn’t live across the street. I don’t know if John Singleton or Leslie Harris could have made a movie about an upper middle-class family back then. I don’t know if they would have wanted to.

The beauty of independent films is they don’t have the marketing-directed dollars, or the must-fit-in-a-box standards that mainstream movies adhere to. They don’t have to be the “black” film or the “teen” film. But what those films were able to do is lend a gritty voice to an unrepresented population. It’s possible independent filmmakers like Singleton and Anders felt the artistic freedom to cover these stories because life during the ‘80s and ‘90s were economically sound for most people. Their films didn’t represent the majority of the culture—which wouldn’t necessarily be true if those films were made today.

I think that documentaries will be the best record of this time in our country’s history. Documentaries aren’t as hopeful as movies. They’re not as pretty either, but they’ll give it to us straight. They’ll give us the cash-poor, or the crazy, or horrifyingly illegal practices of the filthy rich, or racially-infused violence. They’ll deliver subjects that filmmakers have otherwise been avoiding.

Rich Hill, a documentary and Sundance Grand Jury Winner, directed by Tracy Droz Tragos and Andrew Droz Palermo, is this year’s shining example. In it, the filmmakers (cousins, who visited family in Rich Hill, Missouri, the town the movie is named for) unfold the story of American poverty through the point of view of three teenage boys.

“At its heart, I hope this film is an invitation to empathy, for audiences to think beyond the three kids and their families in the film (who are in a better place now, in part because of their participation in the film and audience reaction). I hope audiences also think of all the kids who don’t have movies made about their lives,” says Droz Tragos, in an interview.

There are so many of those kids. And they all have a story to tell. I hope that we get more chances to hear them.

Hayley Krischer is a writer living in New Jersey.

By Brian D. Earp (@briandavidearp)

* Note: this article was first published online at Quillette magazine. The official version is forthcoming in the HealthWatch Newsletter; see http://www.healthwatch-uk.org/.

Introduction

Science and medicine have done a lot for the world. Diseases have been eradicated, rockets have been sent to the moon, and convincing, causal explanations have been given for a whole range of formerly inscrutable phenomena. Notwithstanding recent concerns about sloppy research, small sample sizes, and challenges in replicating major findings—concerns I share and which I have written about at length — I still believe that the scientific method is the best available tool for getting at empirical truth. Or to put it a slightly different way (if I may paraphrase Winston Churchill’s famous remark about democracy): it is perhaps the worst tool, except for all the rest.

Scientists are people too

In other words, science is flawed. And scientists are people too. While it is true that most scientists — at least the ones I know and work with — are hell-bent on getting things right, they are not therefore immune from human foibles. If they want to keep their jobs, at least, they must contend with a perverse “publish or perish” incentive structure that tends to reward flashy findings and high-volume “productivity” over painstaking, reliable research. On top of that, they have reputations to defend, egos to protect, and grants to pursue. They get tired. They get overwhelmed. They don’t always check their references, or even read what they cite. They have cognitive and emotional limitations, not to mention biases, like everyone else.

At the same time, as the psychologist Gary Marcus has recently put it, “it is facile to dismiss science itself. The most careful scientists, and the best science journalists, realize that all science is provisional. There will always be things that we haven’t figured out yet, and even some that we get wrong.” But science is not just about conclusions, he argues, which are occasionally (or even frequently) incorrect. Instead, “It’s about a methodology for investigation, which includes, at its core, a relentless drive towards questioning that which came before.” You can both “love science,” he concludes, “and question it.”

I agree with Marcus. In fact, I agree with him so much that I would like to go a step further: if you love science, you had better question it, and question it well, so it can live up to its potential.

And it is with that in mind that I bring up the subject of bullshit.

Bullshit in science 

There is a veritable truckload of bullshit in science.¹ When I say bullshit, I mean arguments, data, publications, or even the official policies of scientific organizations that give every impression of being perfectly reasonable — of being well-supported by the highest quality of evidence, and so forth — but which don’t hold up when you scrutinize the details. Bullshit has the veneer of truth-like plausibility. It looks good. It sounds right. But when you get right down to it, it stinks.

There are many ways to produce scientific bullshit. One way is to assert that something has been “proven,” “shown,” or “found” and then cite, in support of this assertion, a study that has actually been heavily critiqued (fairly and in good faith, let us say, although that is not always the case, as we soon shall see) without acknowledging any of the published criticisms of the study or otherwise grappling with its inherent limitations.

Another way is to refer to evidence as being of “high quality” simply because it comes from an in-principle relatively strong study design, like a randomized control trial, without checking the specific materials that were used in the study to confirm that they were fit for purpose. There is also the problem of taking data that were generated in one environment and applying them to a completely different environment (without showing, or in some cases even attempting to show, that the two environments are analogous in the right way). There are other examples I have explored in other contexts, and many of them are fairly well-known.

An insidious tactic

But there is one example I have only recently come across, and of which I have not yet seen any serious discussion. I am referring to a certain sustained, long-term publication strategy, apparently deliberately carried out (although motivations can be hard to pin down), that results in a stupefying, and in my view dangerous, paper-pile of scientific bullshit. It can be hard to detect, at first, with an untrained eye—you have to know your specific area of research extremely well to begin to see it—but once you do catch on, it becomes impossible to un-see.

I don’t know what to call this insidious tactic (although I will describe it in just a moment). But I can identify its end result, which I suspect researchers of every stripe will be able to recognize from their own sub-disciplines: it is the hyper-partisan and polarized, but by all outward appearances, dispassionate and objective, “systematic review” of a controversial subject.

To explain how this tactic works, I am going make up a hypothetical researcher who engages in it, and walk you through his “process,” step by step. Let’s call this hypothetical researcher Lord Voldemort. While everything I am about to say is based on actual events, and on the real-life behavior of actual researchers, I will not be citing any specific cases (to avoid the drama). Moreover, we should be very careful not to confuse Lord Voldemort for any particular individual. He is an amalgam of researchers who do this; he is fictional.

Lord Voldemort’s “systematic review”

In this story, Lord Voldemort is a prolific proponent of a certain controversial medical procedure, call it X, which many have argued is both risky and unethical. It is unclear whether Lord Voldemort has a financial stake in X, or some other potential conflict of interest. But in any event he is free to press his own opinion. The problem is that Lord Voldemort doesn’t play fair. In fact, he is so intent on defending this hypothetical intervention that he will stop at nothing to flood the literature with arguments and data that appear to weigh decisively in its favor.

As the first step in his long-term strategy, he scans various scholarly databases. If he sees any report of an empirical study that does not put X in an unmitigatedly positive light, he dashes off a letter-to-the-editor attacking the report on whatever imaginable grounds. Sometimes he makes a fair point—after all, most studies do have limitations—but often what he raises is a quibble, couched in the language of an exposé.

These letters are not typically peer-reviewed (which is not to say that peer review is an especially effective quality control mechanism); instead, in most cases, they get a cursory once-over by an editor who is not a specialist in the area. Since journals tend to print the letters they receive unless they are clearly incoherent or in some way obviously out of line (and since Lord Voldemort has mastered the art of using “objective” sounding scientific rhetoric to mask objectively weak arguments and data), they end up becoming a part of the published record with every appearance of being legitimate critiques.

The subterfuge does not end there.

The next step is for our anti-hero to write a “systematic review” at the end of the year (or, really, whenever he gets around to it). In it, He Who Shall Not Be Named predictably rejects all of the studies that do not support his position as being “fatally flawed,” or as having been “refuted by experts”—namely, by himself and his close collaborators, typically citing their own contestable critiques—while at the same time he fails to find any flaws whatsoever in studies that make his pet procedure seem on balance beneficial.

The result of this artful exercise is a heavily skewed benefit-to-risk ratio in favor of X, which can now be cited by unsuspecting third-parties. Unless you know what Lord Voldemort is up to, that is, you won’t notice that the math has been rigged.

So why doesn’t somebody put a stop to all this? As a matter of fact, many have tried. More than once, the Lord Voldemorts of the world have been called out for their underhanded tactics, typically in the “author reply” pieces rebutting their initial attacks. But rarely are these ripostes — constrained as they are by conventionally miniscule word limits, and buried as they are in some corner of the Internet — noticed, much less cited in the wider literature. Certainly, they are far less visible than the “systematic reviews” churned out by Lord Voldemort and his ilk, which constitute a sort of “Gish Gallop” that can be hard to defeat.

Gish Gallop

The term “Gish Gallop” is a useful one to know. It was coined by the science educator Eugenie Scott in the 1990s to describe the debating strategy of one Duane Gish. Gish was an American biochemist turned Young Earth creationist, who often invited mainstream evolutionary scientists to spar with him in public venues. In its original context, it meant to “spew forth torrents of error that the evolutionist hasn’t a prayer of refuting in the format of a debate.” It also referred to Gish’s apparent tendency to simply ignore objections raised by his opponents.

A similar phenomenon can play out in debates in medicine. In the case of Lord Voldemort, the trick is to unleash so many fallacies, misrepresentations of evidence, and other misleading or erroneous statements — at such a pace, and with such little regard for the norms of careful scholarship and/or charitable academic discourse — that your opponents, who do, perhaps, feel bound by such norms, and who have better things to do with their time than to write rebuttals to each of your papers, face a dilemma. Either they can ignore you, or they can put their own research priorities on hold to try to combat the worst of your offenses.

It’s a lose-lose situation. Ignore you, and you win by default. Engage you, and you win like the pig in the proverb who enjoys hanging out in the mud.

Conclusion

As the programmer Alberto Brandolini is reputed to have said: “The amount of energy necessary to refute bullshit is an order of magnitude bigger than to produce it.” This is the unbearable asymmetry of bullshit I mentioned in my title, and it poses a serious problem for research integrity. Developing a strategy for overcoming it, I suggest, should be a top priority for publication ethics.

Footnote

1. There is a lot of non-bullshit in science as well!

Acknowledgement

This is a modified version of an article that is set to appear, in its final and definitive form, in a forthcoming issue of the HealthWatch Newsletter (no. 101, Spring 2016). See http://www.healthwatch-uk.org/. Please note that this essay was first published online at Quillette Magazine, here: http://quillette.com/2016/02/15/the-unbearable-asymmetry-of-bullshit/. 

Last December, the economists Anne Case and Angus Deaton published a paper in PNAS highlighting a disturbing trend: more middle-aged white Americans are dying. In particular, whites between the ages of 45 and 54 with a high school degree or less have seen their mortality rate increase by 134 people per 100,000 between 1999 and 2013. This increase exists in stark contrast to every other age and ethnic demographic group, both in America and other developed countries. In the 21st century, people are supposed to be living longer, not dying in the middle of life.

What’s going on? A subsequent statistical analysis by Andrew Gelman suggested that a significant part of the effect was due to the aging population, as there are now more people in the older part of 45-54 cohort. (And older people are more likely to die.) However, this correction still doesn’t explain much of the recent changes to the mortality rate, nor does it explain why the trend only exists in the United States.

To explain these rising death rates, Case and Deaton cite a number of potential causes, from a spike in suicides to the prevalence of obesity. However, their data reveal that the single biggest contributor was drug poisonings, which rose more than fourfold between 1999 and 2013. This tragic surge has an equally tragic explanation: in the late 1990s, powerful opioid painkillers become widely available, leading to a surge in prescriptions. In 1991, there were roughly 76 million prescriptions written for opioids in America. By 2013, there were nearly 207 million.

Here’s where the causal story gets murky, at least in the Case and Deaton paper. Nobody really knows why painkillers have become so much more popular. Are they simply a highly addictive scourge unleashed by Big Pharma? Or is the rise in opioid prescriptions triggered, at least in part, by a parallel rise in chronic physical pain? Case and Deaton suggest that it’s largely the later, as their paper highlights the increase in reports of pain among middle-aged whites. “One in three white non-Hispanics aged 45–54 reported chronic joint pain,” write the economists, “one in five reported neck pain; and one in seven reported sciatica.” America is in the midst of a pain epidemic.

To review the proposed causal chain: more white people are dying because more white people are taking painkillers because more white people are experiencing severe pain. But this bleak narrative leads to the obvious question: what is causing all this pain?

That question, which has no easy answer, is the subject of a new paper in Psychological Science by Eileen Chou, Bidhan Parmar and Adam Galinsky. Their hypothesis is that our epidemic of pain is caused, at least in part, by rising levels of economic insecurity.

The paper begins with a revealing survey result. After getting data on 33,720 households spread across the United States, the scientists found that when both adults were unemployed, households spent 20 percent more on over-the-counter painkillers, such as Tylenol and Midol. A follow-up survey revealed that employment status was indeed correlated with reports of pain, and that inducing a feeling of economic hardship – the scientists asked people to recall a time when they felt financially insecure – nearly doubled the amount of pain people reported. In other words, the mere memory of money problems set their nerves on fire.

Why does economic insecurity increase our perception of physical pain? In a lab experiment, the scientists asked more than 100 undergraduates at the University of Virginia to plunge their hand into a bucket of 34 degree ice water for as long as it felt comfortable. Then, the students were randomly divided into two groups. The first group was the high-insecurity condition. They read a short text that highlighted their bleak economic prospects:

"Research conducted by Bureau of Labor Statistics reveals that more than 300,000 recent college grads are working minimum wage jobs, a figure that is twice as high as it was merely 10 years ago. Certain college grads bear more of the burden than others. In particular, students who do not graduate from top 10 national universities (e.g., Princeton and Harvard) fare significantly worse than those who do".

The students were then reminded that the University of Virginia was the 23rd best college in the United States, at least according US News & World Report.

In contrast, those students assigned to the low insecurity condition were given good news:

"Certain college grads are shield [sic] from the economic turmoil more than others. In particular, students who graduate from top 10 public universities (e.g., UC Berkeley and UVA) fare significantly better on the job market than those who do not. These college grads have a much easier time finding jobs."

These students were reminded that the University of Virginia was the second highest ranked public university.

After this intervention, all of the students were taken back to the ice bucket station. Once again, they were asked to keep their hand in the cold water for as long as it felt comfortable. As predicted, those primed to feel economically insecure showed much lower levels of pain tolerance:

The scientists speculate that the mediating variable between economic insecurity and physical pain is a lack of control. When people feel stressed about money, they feel less in control of their lives, and that lack of control exacerbates their perception of pain. The ice water feels colder, their nerves more sensitive to the sting.

In Case and Deaton's paper on the rising death rates of white Americans, the economists note that less educated whites have been hit hard by recent economic trends. “With widening income inequality, many of the baby-boom generation are the first to find, in midlife, that they will not be better off than were their parents,” they write. Job prospects are bleak; debt levels are high; median income has fallen by 4 percent for the middle class over the last 15 years.

The power of this new paper by Chou et al. is that it tells the human impact of these facts. When we feel buffeted by forces beyond our control – by global shifts involving the rise of automation and the growth of Chinese manufacturing and the decline of the American middle class – we are more likely to experience aches we can’t escape. As the scientists point out, the end result is a downward spiral, as economic insecurity causes physical pain which makes it harder for people to work which leads to even more pain.

It shouldn’t be a surprise, then, that dangerous painkillers become such a tempting way out. Side effects include death.

Chou, E. Y., B. L. Parmar, and A. D. Galinsky. "Economic Insecurity Increases Physical Pain." Psychological Science (2016)

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I'm not often bothered by the 20 to 30 "here's more proof that millennials are an embarrassment" articles I come across on a daily basis. I'm long past offense and annoyance because, frankly, I just don't care. But when I start reading that my generation is, allegedly, anti-cereal because we're "too lazy" to clean a bowl and a spoon ... that's when I get mad.

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For every question you answer “Yes” subtract one point from 100. The remainder is your Facebook Purity.

1. Do you have a Facebook account?
2. Did you join in 2004-2005?
3. Do you remember being annoyed when Facebook started allowing high school students?
4. Click on your profile picture to see all your old profile pictures. Are there more than 20 of them?
5. More than 40 profile pictures?
6. 60?!
7. Do you have more than 1,000 friends?
8. Have you ever compared your friend count to someone else’s?
9. Do you “Friend” people immediately after meeting them, even if you’re unlikely to ever meet again?
10. Do you accept Friend Requests from anyone who has “mutual friends” with you, even if you don’t know who that person is?
11. Do you accept friend requests, regardless of the existence of “mutual friends?”
12. Do you ever friend someone yourself because you’ve noticed that you have mutual friends?
13. Do you have a Facebook “Page,” in addition to a Facebook profile?
14. Have you ever asked or encouraged your friends to become “Fans” of your Facebook Page?
15. Have you ever been in a relationship on Facebook?
16. Have you been in an “It’s Complicated” relationship on Facebook?
17. Are you currently in a fake relationship or marriage on Facebook?
18. Have you ever broken up with someone by simply changing your Facebook relationship status?
19. Have you ever announced a major life event by changing your Facebook Information (changing your status to “engaged,” changing your status to “divorced,” changing your gender, etc.)?
20. Are you trying to mask your sexuality by not answering the “Interested In” question on your profile?
21. Do you hide the year of your birth on Facebook in an attempt to look older/younger?
22. Have you ever unfriended an ex on Facebook?
23. Have you ever unfriended an ex’s friends on Facebook?
24. Have you ever friended an ex’s new significant other on Facebook?
25. Have you ever looked up an ex’s new significant other on Facebook and gotten disproportionately enraged that his/her privacy settings are set to super high so you can’t see their pictures?
26. Do you use Facebook to look up exes and try to determine whether or not you’re better off without them?
27. Have you ever deleted your Facebook account in frustration or protestation, only to eventually reactivate it later?
28. Have you ever been the administrator of a private Facebook group based on an inside joke?
29. Have you ever been the administrator of a public Facebook group that gained 5,000 or more members?
30. Are you a creator or administrator of “I Flip My Pillow Over To Get To The Cold Side,” “I Will Go Slightly Out Of My Way To Step On That Crunchy-Looking Leaf,” or “I Don’t Care How Comfortable Crocs Are, You Look Like A Dumbass”?
31. Have you ever been in a Facebook group to protest a new Facebook feature or update?
32. Have you ever poked someone?
33. Have you ever engaged in a “poking war”?
34. Have you engaged in a poking war in the last year?
35. Do you write on everyone’s wall for their birthday, even if you don’t actually know/talk to that person in real life?
36. Have you ever done anything to artificially inflate the amount of birthday messages on your own wall?
37. Have you ever, in the history of your Facebook account, purchased a Facebook gift to send someone?
38. Have you ever, in the history of your account, purchased a Facebook gift to send to yourself anonymously?
39. Have you ever written something inane on someone else’s wall, just to “mark your territory”?
40. Have you ever asked a friend to write something specific on your wall, in the hopes of someone else seeing it?
41. Have you ever tried to search for someone, but accidentally typed their name into your status instead of the search box?
42. Do you have over 1,000 photos of you tagged?
43. Are most of these photos ones you’ve uploaded yourself?
44. Are there any pictures tagged of you on Facebook in which you’re clearly intoxicated?
45. Are there any pictures tagged of you on Facebook in which you’re doing something illegal?
46. Are there any pictures tagged of you on Facebook in which you’re not wearing clothes?
47. Are there any pictures tagged of you on Facebook with an ex?
48. Are there any pictures of you on Facebook, not tagged, that would cause serious damage to your career or reputation were they to come to light?
49. Have you ever knowingly uploaded or tagged an unflattering picture of someone?
50. Have you ever been caught cheating or flirting thanks to Facebook?
51. Are you ever more excited about uploading a vacation album than you are about going on the actual vacation?
52. Have you ever knowingly uploaded pictures of yourself tagged with someone attractive because it sort of looks like you might be dating?
53. Have you ever looked through the entire “See Friendship” archive of two people, neither of whom were you?
54. Have you ever looked through every single photo of a crush, high school sweetheart, or one night stand?
55. Have you ever looked through every single photo of someone you’ve never even met?
56. Have you ever eagerly looked through the vacation or wedding albums of someone you don’t really know?
57. Do you have anyone who’s Facebook friendship is extremely valuable to you, based solely on the fact that their pictures, statuses, or general disarray of their life gives you endless voyeuristic pleasure?
58. Do you regularly update your Facebook status?
59. Have you ever put anything about an illness, personal problem, fight, or sexual proclivity in your Facebook status?
60. Have you ever uploaded a sonogram?
61. Have you ever gotten into a heated political argument with an acquaintance on Facebook?
62. Have you ever deleted a Facebook Status or post because there weren’t enough “likes” on it?
63. Have you ever “liked” someone’s picture as a way of flirting with them?
64. Have you ever accidentally “liked” someone else’s post, and then clicked “unlike?”
65. Have you ever unfriended someone in a moment of passion, and then embarrassingly had to re-friend them?
66. Have you ever stalked your friends’ little sister/brother’s Facebook page cause they’re actually really hot?
67. Have you ever pulled up someone’s picture for nefarious sexual purposes?
68. Have you ever downloaded someone’s Facebook picture onto your computer?
69. Have you ever taken someone’s private Facebook pictures and forwarded or sent them to third parties?
70. Have you updated your Facebook “Interests” in the last two years?
71. Have you ever played “Farmville”?
72. Do you ever use Facebook Chat?
73. Have you ever created a second, or a fake Facebook account?
74. Have you ever used Facebook to cheat on a significant other?
75. Have you ever created a fake Facebook account to make a significant other jealous? (By writing on your wall, etc.)
76. Have you ever gone through your Facebook Friends with a friend, pointing out everyone you’ve slept with?
77. Have you ever seen anyone in your newsfeed and had absolutely no idea who it is?
78. Have you ever logged into someone else’s Facebook account without them knowing?
79. Have you ever noticed that the person who used a public computer right before you left themselves logged in, and taken the opportunity to take a quick gander at their messages/pictures before logging them out again?
80. Have you ever left your Facebook logged in on a shared computer and been terrified about what someone could find?
81. Have you ever changed or altered someone’s Facebook profile (their status, their stats, their “Interested In,” etc.?)
82. Are you friends with your parents on Facebook?
83. Are you friends with your parents on Facebook, but only with restricted access?
84. Have you ever had to sit your mom down and have a talk about what she writes on your wall?
85. Do you spend much time looking at that girl  from high school’s crazy Facebook page because she’s so different and you just can’t believe how she turned out?
86. Do you have reason to suspect you are indeed “that girl”?
87. Have you ever done a “Facebook Friend Purge”?
88. Have you announced said purge in your status before actually doing it?
89. Have you ever RSVP’d for a Facebook Event you weren’t actually invited to?
90. Have you ever made a Facebook event and hidden the guest list to save embarrassment in case no one RSVP’d?
91. Have you ever clicked through the RSVPs on a Facebook event to see if any cute/hot/available people were going, before deciding whether you yourself would go or not?
92. Have you ever been guilty of creating a Facebook event, inviting every single one of your friends, and then bombarding them with multiple “reminder” messages?
93. Have you ever tried to use Facebook to pick someone up?
94. Have you ever successfully used Facebook to pick someone up?
95. Have you ever accidentally clicked on a virus while stalking someone else’s profile, only to have “Click Here For Disgusting Hot Girls” show up on your own wall?
96. Have you ever had to pretend you didn’t know something about someone, when in fact you’d seen it on Facebook during a late-night stalking session?
97. Have you fallen for one of those “Click Here To See Who Reads Your Profile” links?
98. If Facebook were to develop (or make public) technology that allows everyone to see exactly who has been looking at their profile, would the results be hugely, hugely damning for you?
99. Do you greatly mistrust people who aren’t on Facebook?
100. Did you actually just answer 100 questions in order to figure out your Facebook purity? You’re a little less pure, now.

Scoring

100-90% pure: You were born before 1970.

89-80% pure: You use Facebook for the games, or to post that really interesting article you naively think other people will care about.

79-70% pure:  You friend people and accept friend requests pretty frequently, and will sign on if you have a new notification. Sometimes you will use it to procrastinate, but you otherwise would rather spend your time elsewhere.

69-60% pure: You think Facebook is a great “networking tool.” You friend most everyone you meet, and have definitely spent the odd night looking up people you used to know.

59-50% pure:  You post albums, read your newsfeed when you’re bored, and will spend a good amount of time on the profiles of people who are important to your life.

49-40% pure: You post albums, read your newsfeed obsessively, and will spend a good amount of time on the profiles of people who have absolutely no bearing on your life. You use a variety of Facebook features, including games, quizzes, photo uploading, group management, etc. You user your Facebook Status as a pseudo-blog and frequently broadcast details of your life.

39-30% pure: You’ve considered giving up Facebook because you’re mildly perturbed by the amount of time you’ve spent getting sucked into the albums of people you went to high school with. You console yourself with the notion that “surely everyone stalks people on Facebook?”

29-20% pure: You don’t really talk to other people about how much time you spend on Facebook. You look people up the second you meet them, or even hear about them. You’ve figured out how to find and access the pictures of people you aren’t even friends with. You wonder if Facebook actually does you mental harm, because you’ve gotten depressed while stalking mutual acquaintences and exes. You hope your life looks as fun and happy on Facebook as other people’s lives seem to.

19-10% pure: You don’t understand how people lived without Facebook. You use it as a tool to find out information and disseminate information about yourself. You get excited for Wedding and Vacation albums that you know are coming but haven’t even been posted yet. You carefully curate your own Facebook page, and your favorite part of your birthday is seeing all your Facebook greetings, which you count, and compare to how many your friends got. You believe everyone on Facebook is fair game.

9%-0% pure: You logged on to Facebook in the Summer of 2004 and have not signed off since.

Previously: Wikipedia Entries for Every Situation.

Chiara Atik remembers life before Facebook, but just barely.

Life insurance is very important, especially when you have a family. A single genetic test, however, has the potential to bar you from ever getting coverage—regardless of how healthy you currently are.

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Never give all the heart, for love
Will hardly seem worth thinking of
To passionate women if it seem
Certain, and they never dream
That it fades out from kiss to kiss;
For everything that’s lovely is
But a brief, dreamy, kind delight.
O never give the heart outright,
For they, for all smooth lips can say,
Have given their hearts up to the play.
And who could play it well enough
If deaf and dumb and blind with love?
He that made this knows all the cost,
For he gave all his heart and lost.

Here's the teaser trailer for the Spielberg-directed adaptation of Roald Dahl's The BFG. Hmm. (via the slick new trailer town)

El volcán Turrialba registró este martes, en promedio, una erupción de ceniza y gases cada hora.

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If you're sick of the increasing commercialization of the holidays, here's a breath of fresh air. Outdoor retailer REI is closing all of its locations on Black Friday in a push to get people outside (while paying for their employees to have the day off, too).

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The Epic of Gilgamesh just got more epic. A recent find of a stone tablet dating back to the neo-Babylonian period (2000-1500 BCE) has added 20 new lines to the ancient Mesopotamian poem.

The tablet adds new verses to the story of how Gilgamesh and Enkidu slew the forest demigod Humbaba. Gilgamesh, King of Uruk, gets the idea to kill the giant Humbaba, guardian of the Cedar Forest, home of the gods, in Tablet II. He thinks accomplishing such a feat of strength will gain him eternal fame. His wise companion (and former wild man) Enkidu tries to talk him out of it -- Humbaba was set to his task by the god Enlil -- but stubborn Gilgamesh won't budge, so Enkidu agrees to go with him on this quest. Together they overpower the giant. When the defeated Humbaba begs for mercy, offering to serve Gilgamesh forever and give him every sacred tree in the forest, Gilgamesh is moved to pity, but Enkidu's blood is up now and he exhorts his friend to go through with the original plan to kill the giant and get that eternal renown he craves. Gilgamesh cuts Humbaba's head off and then cuts down the sacred forest. The companions return to Uruk with the trophy head and lots of aromatic timber.

How the tablet was discovered is notable as well. Since 2011, the Sulaymaniyah Museum in the Kurdistan Region of Iraq was been paying smugglers to intercept artifacts leaving the country, no questions asked. The tablet was likely illegally excavated from the southern part of Iraq, and the museum paid the seller of this particular tablet $800 to keep it in the country.

If you like to take amazing pictures when you travel, these are the places in the U.S. people flock to the most in order to grab the perfect photo.

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If you recut the scenes from seasons seven & eight of Seinfeld to emphasize certain aspects of Susan's death-by-envelope, you get a feel-good TV movie about George Costanza, a man who finds triumph in the midst of tragedy.

Her death takes place in the shadow of new life; she's not really dead if we find a way to remember her.

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Depending on whether or not you think puns are the highest form of humor, here's a video of the very best, or the very worst, trip to IKEA. Aussie Simon Gilmore filmed himself regaling his girlfriend, Dana, with some pretty terrible puns based on the retailer's iconic product names. I'm not sure if the best part is the puns themselves — or Dana's reactions.

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Kevin Kelly has travelled in every sort of way, from five-star hotels to penniless hitchhiking. And he says that when traveling, more time is better than more money.

When you have abundant time you can get closer to core of a place. You can hang around and see what really happens. You can meet a wider variety of people. You can slow down until the hour that the secret vault is opened. You have enough time to learn some new words, to understand what the real prices are, to wait out the weather, to get to that place that takes a week in a jeep.

Money is an attempt to buy time, but it rarely is able to buy any of the above. When we don't have time we use money to try to get us to the secret door on time, or we use it avoid needing to know the real prices, or we use money to have someone explain to us what is really going on. Money can get us close, but not all the way.

(via @craigmod)

Larry Lessig is raising funds for running for President in the 2016 election. Lessig would run as a "referendum president", whose single task would be to pass a package of reforms called the Citizens Equality Act of 2017, and then resign to allow his Vice President to take over.

The Citizens Equality Act of 2017 consists of three parts: make it as easy as possible to vote, end the gerrymandering of political districts, and base campaign funding on all eligible voters, not just corporations or the wealthy.

Four years ago, Cenk Uygur of The Young Turks told Netroots Nation, "There is only one issue in this country," and he was referring to the corrupt funding of public elections.

That corruption is part of a more fundamental inequality that we've allowed the politicians to create: we don't have a Congress that represents us equally.

Every issue - from climate change to gun safety, from Wall Street reform to defense spending - is tied to this "one issue." Achieving citizens equality in America is our one mission.

Read why he wants to run and watch his pitch:

This is a long shot (and he likely knows it), but I wish him well...it's a worthy and important goal.

After 11 years, the WireTap radio show is coming to an end. As a farewell, they put together a video of people giving advice to their younger counterparts.

Dear 6-year-old,

Training wheels are for babies. Just let go already.

Regards,

A 7-year-old.

Dear 7-year-old,

Stay weird.

Signed,

An 8-year-old.

This video is magical...give it 20 seconds and you can't help but watch the whole thing. (via a cup of jo)

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Let the countdown begin! The one and only Pumpkin Spice Latte will soon be returning to Starbucks stores nationwide, and this year there's even more reason to celebrate. That's right, for the first time ever, your PSL will contain — wait for it — real pumpkin. It's out with Class IV artificial caramel coloring and in with the pumpkin.

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Though the landscape subtly changes,
the mountains are marching in place.

The grasses take on the fading
yellows of the sun,

and cows with their sumptuous eyes
litter the fields as if they had grown there.

We have driven for hours
through bluing shadows,

as if the continent itself leaned west
and we had no choice but to follow the old ruts—

the wagons and horses, the iron snort
of a locomotive. We are the pioneers

of our own histories, drawn
to the horizon as if it waited just for us

the way the young are drawn
to the future, the old to the past.

my father always said, “early to bed and
early to rise makes a man healthy, wealthy
and wise.”

it was lights out at 8 p.m. in our house
and we were up at dawn to the smell of
coffee, frying bacon and scrambled
eggs.

my father followed this general routine
for a lifetime and died young, broke,
and, I think, not too
wise.

taking note, I rejected his advice and it
became, for me, late to bed and late
to rise.

now, I’m not saying that I’ve conquered
the world but I’ve avoided
numberless early traffic jams, bypassed some
common pitfalls
and have met some strange, wonderful
people

one of whom
was
myself—someone my father
never
knew.

We played a game called 4-Square
With a lemon-yellow ball
In the street after dinner.
We kept awaiting a call

From somebody’s parent, ordering us in,
But (amazingly) no call came,
The still-bright ball
Went round, we went on with our game—

Voices no doubt lifting
To where the Dawkinses’ grandmother lay
Winded by emphysema,
Who hadn’t been out all day

And had now minutely to ponder
How this evening’s sunset would fall
On the plaster homeland of hummocks and craters
Of the guest-room wall.

♬ With the shovel out, the ice's less dangerous / Drop the shovel, entertain us / I feel stupid and contagious / Drop the shovel, entertain us ♬

Magisterial. I love the internet. This is even better than the door that sounds like Miles Davis. (via @slowernet)

Update: Oh, and this nightstand door sounds like Chewbacca. (via @steveportigal)

Every choice is always the wrong choice,
Every vote cast is always cast away—
How can truth hover between alternatives?

Then love me more than dearly, love me wholly,
Love me with no weighing of circumstance,
As I am pledged in honour to love you:

With no weakness, with no speculation
On what might happen should you and I prove less
Than bringers-to-be of our own certainty.
Neither was born by hazard: each foreknew
The extreme possession we are grown into.

Ding.

(submitted by Iris)

Ding.

(submitted by Iris)

The post Kitchen Timer Modeling Shoot appeared first on AwkwardFamilyPhotos.com.

This is an amazing video visualization of military and civilian deaths in World War II. It's 18 minutes long, but well worth your time.

There's an interactive component as well, allowing you to explore the data. (via @garymross)