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Biden won in 2020, but absentee voting remains a tangible threat to U.S. elections

By Kent R. Kroeger (Source: NuQum.com; July 26, 2022)

Regardless of what we hear today in the national news media, the potential for voter fraud has been and remains a critical issue in U.S. elections, even though past U.S. elections have not experienced widespread voter fraud (including the 2020 presidential election).

One reason for this is that leaders in both the Republican and Democratic parties, at least before 2020, generally agree that protecting the integrity of the voting process is vital to election legitimacy. And efforts to ensure that legitimacy identify absentee voting as one of the weakest links in the voting process.

To illustrate, during a North Carolina voting commission meeting in 2018, the state’s Attorney General, Josh Stein, a Democrat, said “the bulk of voter fraud is by absentee.”

At the time, that was not a controversial statement. Academic research and investigative journalism on vote fraud has frequently found absentee voting is vulnerable to fraud (examples herehereherehere and here). A North Carolina congressional race would have been stolen by the Republicans in 2018 through ballot harvesting fraud had not one of their operatives, the recently deceased McCrae Dowless, been particularly careless in paying campaigns workers to collect absentee ballots (a crime in North Carolina) and, in some cases, filling out incomplete ballots (also a crime).

Before the toxic partisanship of today’s political environment, a 2005 bipartisan study on the health of the U.S. electoral system, chaired by former President Jimmy Carter and former Secretary of State James Baker, concluded:

“Absentee balloting is vulnerable to abuse in several ways: Blank ballots mailed to the wrong address or to large residential buildings might get intercepted. Citizens who vote at home, at nursing homes, at the workplace, or in church are more susceptible to pressure, overt and subtle, or to intimidation. Voting buying schemes are far more difficult to detect when citizens vote by mail. States therefore should reduce the risks of fraud and abuse in absentee voting by prohibiting “third-party” organizations, candidates, and political party activists from handling absentee ballots.”

The Commission on Federal Election Reform (CFER) concluded that “absentee ballots remain the largest source of potential voter fraud,” and proposed mitigating the risks of absentee balloting — which the Commission considered a necessary component of an electoral system designed to maximize voter participation — by limiting those who can handle a voter’s ballot to:

  • the voter,
  • a family member,
  • the U.S. Postal Service (or legitimate shipper of U.S. mail),
  • and election officials.

As of May 2022, 25 states allow some form of “ballot harvesting” where a third-party, approved by the voter, can deliver a completed ballot to election officials. Within those 25 states, laws vary on who qualifies to vote absentee, on who may not deliver completed ballots, and on the number of ballots that designated third-parties can deliver.

Sadly, on the issue of absentee voting and third-party ballot handling, the recommendations of the CFER have gone largely ignored.

And here we persist, today, in the shadow of a 2020 election that was unique in many ways, not the least of which was the percentage of votes cast through absentee ballots due to the COVID-19 pandemic.

Why do some people remain convinced there was widespread voter fraud in the 2020 election?

I have not seen any proof of systemic vote fraud in the 2020 election, but some people believe it did exist — often citing very sketchy evidence.

Case in point: Dinesh D’Souza’s documentary film, 2000 Mules. While provocative and worth viewing, the film was only a first step in what should have been a more thorough and scientific investigation. Instead, the film’s most important conclusions were almost entirely predicated on odd coincidences, not irrefutable proof.

Can we conclude that there was election fraud if people who delivered absentee ballots at drop-off boxes are known — through geolocation data from cellphones — to have passed by those drop-off boxes multiple times over the course of the election? No, we cannot.

Coincidence, while it can prompt more thorough scientific investigations into important questions about reality, cannot be offered as final proof of anything. If there is one thing statistics has taught me, it is that life is full of coincidences that provide no substantive information for explaining the world.

Yet, if I were a Donald Trump partisan, the coincidences from the 2020 election as portrayed in the graphics in Figures 1 and 2 below — generated from New York Times public-access voting data — would launch me into low-Earth orbit.

Figure 1: Cumulative 2020 Presidential vote results by day and time (Michigan)

Graph by Vote Integrity (Data source: The New York Times)

Figure 2: Cumulative 2020 Presidential vote results by day and time (Wisconsin)

Graph by Vote Integrity (Data source: The New York Times)

Lumber back in time with me and imagine you are a Trump voter who goes to bed around midnight on election night believing (based on reported voting results) that Trump was comfortably ahead in Michigan and Wisconsin, only to find out the next morning he was behind and in a neck-to-neck battle with Joe Biden.

As we now know, those sudden spikes in the blue lines (Biden votes) in the wee-wee hours of November 4th were the result of absentee ballot counts in large, urban districts being reported in bulk (i.e., predominately Democratic voting areas).

Why couldn’t those absentee votes have been reported earlier? In some states, like Wisconsin, the law mandates absentee ballots cannot be counted before Election Day. But it is fair to ask why absentee ballots, such as in Wisconsin, cannot be included in vote totals on election night?

But this country has never had elections like 2020 in the past, which probably explains why so many people remain dubious of that election’s results. In previous elections, absentee ballots were a minor proportion of total vote totals and rarely were the deciding factor in election outcomes.

That all changed in 2020 — and for good reason, as we were in the midst of a global pandemic and the thought of masses of people converging on in-person voting locations seemed socially irresponsible.

The fact absentee balloting was so essential to the 2020 election is hard to second-guess. It was an unusual year, as was the election itself.

Still, as a natural cynic, I do wonder if this drastic alteration in traditional voting methods did, in fact, play a deciding role in the final outcome in 2020. The Democrats were uniquely positioned to exploit this change in voting mode.

This thought is not the same as saying, the 2020 results were the product of voter fraud. I have no reason to reject the absentee vote totals. To the contrary, I assume, with no contradictory evidence proving otherwise, that everyone that filled out an absentee ballot in 2020 were eligible voters who expressed their true vote preferences on those ballots. Furthermore, I also assume the election officials in all 50 states (plus the District of Columbia) employed state-of-the-art methods to ensure that every absentee voter was eligible and did not vote more than once.

At this juncture, I suspect readers are dividing into one of two groups: One group thinking, ‘Yeah, I believe the state’s have the capacity to ensure the validity of absentee ballots.’ And the other thinking, ‘There is no frickin’ way state election officials knew for certain that every absentee ballot was legitimate.’

Cautiously, I stand with the former group — state’s do, in fact, have validated database methods to ensure the legitimacy of absentee ballots. Was their due-diligence perfect in 2020? Probably not. But idiosyncratic failures in confirming absentee voting do not constitute a conspiracy to steal the 2020 election.

However, I understand why Trump voters feel absentee voting in 2020 distorted the final results.

It doesn’t take a conspiracy theorist to question the 2020 election results, it just takes strong partisanship and dose of human nature.

Vote Integrity, an analytic project headed by Matt Braynard, Trump’s former Campaign Director of Data and Strategy (so take its findings with the necessary caution), conducted an analysis of state-level 2020 presidential votes by the time of each vote update. Their analysis rendered the following conclusion:

This report studies 8,954 individual updates to the vote totals in all 50 states and finds that four individual updates — two of which were widely noticed on the internet, including by the President — are profoundly anomalous; they deviate from a pattern which is otherwise found in the vast majority of the remaining 8,950 vote updates. The findings presented by this report suggest that four vote count updates — which collectively were decisive in Michigan, Wisconsin, and Georgia, and thus decisive of a critical forty-two electoral votes — are especially anomalous and merit further investigation.

We further find that if these updates were only more extreme than 99 percent of all updates nationally in terms of their deviation from this generally-observed pattern, that, holding all else equal, Joe Biden may very well have lost the states of Michigan, Wisconsin, and Georgia, and that he would have 42 fewer Electoral votes — putting Biden below the number required to win the Presidency. Either way, it is indisputable that his margin of victory in these three states relies on four most anomalous vote updates identified by the metric developed in this report.

Contrary to Vote Integrity’s conclusions, it is not a mystery why Michigan, Wisconsin and Georgia had anomalous vote updates in 2020 — those were states identified as “battleground” states by both parties and where the Democrats employed the most aggressive absentee and vote harvesting methods, and where the Republicans put up aggressive resistance to those voting methods. (Note: Vote harvesting is where third-parties are allowed to handle completed ballots before they are delivered to election authorities)

Vote Integrity did not discover evidence of voter fraud — they discovered evidence that the Democrats were better prepared for the pandemic-driven changes in how people voted in 2020.

The 2020 presidential vote results in Michigan, Wisconsin, and Georgia represent the fact the Democrats possessed a far more sophisticated approach to absentee voting than the Republicans.

But in the midst of the Democrats’ superior vote collecting methods, could there still have been some nefarious activities that distorted the 2020 outcome?

One statistical test that might reveal that type of fraud is Benford’s law. The test’s rational is that in any large, randomly produced set of natural numbers, which some argue U.S. national and state elections follow, will find around 30 percent of those numbers will begin with the digit 1, 18 percent with 2, and so on, with the smallest percentage beginning with 9. A similar distribution exists for second digits.

Benford’s law analysis of the 2020 presidential election found possible evidence of vote fraud in the county-level Pennsylvania vote. Wrote the study’s authors, Brooks Groharing and Dr. David McCune, “The argument that the failure of Biden’s county-level votes in Pennsylvania to follow Benford’s law is an indication of voter fraud is interesting and cannot be dismissed entirely.”

Yet, the authors concluded based on comparisons with previous presidential election data, “The (vote fraud) argument fails.”

Fair enough. Benford’s law is not the last word on vote fraud. But are U.S. elections immune from electoral chicanery?

Of course not.

Was it vote fraud or were the Democrats better positioned demographically in 2020?

I’m comfortable saying there was no concrete evidence of systematic vote fraud in the 2020 election — but I’m equally comfortable saying the rise of absentee voting, particularly allowing partisan third-parties to handle completed ballots, is a recipe for a future election disaster.

The statistical and forensic tools available to identify the some ways in which an absentee ballot can be corrupted (e.g., voter intimidation, ballots completed by someone other than the voter) are limited.

At a minimum, the rise of absentee voting has increased the number of election races where the results are not just untimely (i.e., outcome not known for days, or weeks, after Election Day), but has increased instances where vote totals have changed dramatically well after the close of

This type of election volatility breeds distrust in the election system and promotes concerns about vote fraud — and that is a problem that cannot be coldly brushed off as a ‘conspiracy theory.’ It is human nature and we cannot build and promote an electoral system that ignores our inherent frailties.

The popular assumption is that Republicans want to limit the electoral franchise through vote eligibility and mode restrictions — which disproportionately disadvantages non-white voters — while the Democrats aim to expand the franchise in opposition to such restrictions, thereby maximizing non-white vote turnout.

That assumption is mostly true, but it presupposes the false belief that the Democrats have an impenetrable advantage over Republicans in attracting non-white voters.

The opinion survey evidence suggests the Republicans remain competitive with the Democrats for congressional votes, despite the Supreme Court’s June 24th decision to overturn Roe v. Wade (see Figure 3).

Figure 3: Generic congressional vote for 2022 (RealClearPolitics)

Source: RealClearPolitics (as of 24 July 2022)

The news is also hopeful for the Republicans in attracting Hispanic voters — the country’s fastest growing voter bloc.

A small-sample New York Times-Siena College poll in July 2022 found that the vote intentions of Hispanics was equally divided between the two major parties (41% preferring Democrats versus 38% preferring Republicans).

Even with the fact that polling Hispanic voters remains a difficult task for U.S. pollsters, any assumption that non-voting Hispanics are guaranteed Democrat voters is dubious.

Biden won the 2020 presidential election, in part, because his party executed the most sophisticated vote harvesting methods in U.S. election history.

If the Republicans were to match the Democrats’ vote harvesting prowess in the future, it is reasonable to assume they would be more than competitive electorally going forward.

According to demographic data and exit polls, 45 million white Americans did not vote in 2020, compared to 16 million Hispanics, 11 million Blacks, 5 million Asians, and 4 million “other” races and ethnicities.

Assuming the Republicans can dominate vote preferences among white low-likelihood-voters similar to 2020 (56% vs. 34%) and are competitive among low-likelihood voters who are Hispanic, Asian or “Other,” they are certainly viable in future presidential elections. And if the GOP were to ever reach anything near 15 percent of the Black vote, future presidential elections likely will be dead-heats in the popular vote (My statistical analysis leading to this conclusion is available on GitHub).

My point is that the Democrats’ advantage in vote harvesting could be negated if the Republicans had any initiative to match the Democrats at that vote collection method. The 2020 gap in absentee ballot voting was substantially in Biden’s favor (65% for Biden versus 33% for Trump), with 46 percent of the vote being cast that way. For the GOP to win another presidential election, that gap must close.

Nonetheless, I am not advocating for the expanded use of vote harvesting and absentee voting, in general. To the contrary, it fundamentally violates the requirements of a strong electoral system (see Appendix for the attributes of a good electoral system) and increases the potential for systematic voter fraud — even if such fraud did not occur as some have claimed in the 2020 presidential election.

My stack of multiple absentee ballots mailed to me for the 2020 election stands as testament to one of that voting method’s most dangerous flaws.

  • K.R.K.

Send comments to kroeger98@yahoo.com

Appendix: An Inventory of Election System Attributes

Building upon the conclusions of the Commission on Federal Election Reform (CFER), and incorporating research from scholars such John M. CareyGary CoxHarry Eckstein, and Arend Lijphart, I created an inventory of key attributes that can be used to judge the health and effectiveness of a country’s electoral system.

The five attributes of an electoral system, including a letter grade (A to F) I collectively gave U.S. and state election laws on each attribute, are:

  1. Inclusiveness of franchise — Are there groups legally or effectively excluded from the vote franchise (e.g., felons)? Does partisan gerrymandering systematically diminish the importance/impact of some voters? (A-)
  2. Voting barriers—How easy is it to register to vote? Are there early voting and absentee voting options? (B+)
  3. Vote integrity — Are election results timely or prone to long delays? What rules govern an individual ballot’s chain of custody? Are vote tabulations independent of political bias? Are reliable processes in place to identify ineligible voters or tampered ballots? (C+)
  4. Relevant electoral choices — Do parties respond to voter preferences in the candidate selection process (e.g., primaries)? (Democrats = D- GOP = B+)
  5. Policy responsiveness — Do elections matter in terms of the public policies implemented? (F)

Overall, I’d give the U.S. a gentleman’s C for the inclusiveness, integrity and effectiveness of its electoral system.

Hey, at least we beat Russia on this scale (who I give a solid F).

Traditional news still towers over us like a colossus, but here comes Rogan

By Kent R. Kroeger (Source: NuQum.com; July 17, 2022)

The following essay uses only open source data and is available — along with computer scripts used for data transformations and index constructions — on Github (here). As always, all errors remain mine.

“Americans’ confidence in newspapers and television news has plummeted to an all-time low, according to the latest annual Gallup survey of trust in U.S. institutions.”

This was the lead in a recent Axios article announcing Gallup’s results on Americans’ confidence in its institutions.

Americans do not trust their primary news sources. And why should they? Our main sources of news routinely (deliberately?) misrepresent reality. The mainstream media (MSM) is the “principle disseminator of fake news,” according to Tsfati et al. (2020), who conclude that “most people hear about fake news stories not from fake news websites but through their coverage in mainstream news outlets.”

According Gallup’s latest numbers, 16 percent of Americans have confidence in newspapers and only 11 percent have confidence in television news (see Figure 1).

Most Americans have little confidence in the news they receive from their primary news sources, and this confidence has been falling consistently since at least the early 1990s.

Figure 1: Confidence in newspapers and television news over time (Source: Gallup Poll)

Data source: Gallup Poll; Graphic by Nicki Camberg (Axios)

Why the declining confidence in the news media?

Some proposed causes of declining confidence in the news media include (but are not limited to):

  • a general decline in the public’s confidence with all social institutions,
  • the rise of alternative news sources which often justify their existence by expressing harsh critique’s of the MSM,
  • a growing elitism within the ranks of MSM journalists and editors,
  • an increasing disconnect between “reality” and what is reported in the news,
  • the rise of partisan news organizations (e.g., Fox News), and
  • the wider spread and amplification of “fake” news (see Tsfati et al. [2020]) which research suggests Americans over-estimate their ability to spot.

The explanation of declining news media confidence may be found in all of these factors, but something else may also be at play. There has been a perceptible decline in accountability within the MSM when it gets a story wrong (e.g., Richard Jewell and the Centennial Olympic Park bombing in 1996, Iraq and WMDsRussiagateRussians alleged hack of U.S. electricity grid, to name a few).

The New York Times fired Judith Miller, one of their star journalists, because of her inaccurate reporting on alleged weapons of mass destruction leading up to the Iraq War. And she didn’t deliberately falsify information — she simply relied on biased or bad sources.

She was fired and forever banned from employment in the “respected” news media.

Fast forward to today, and not a single New York Times or Washington Post journalist was dismissed or reprimanded for spreading what turned out to be false information about Donald Trump and alleged collusion with Russia prior to the 2016 election. A sitting president was basically smeared for four years and not one journalist or organization was held accountable for the poor and often false reporting that occurred during Trump’s term in office.

We are all adults here. We know why this happened. The political and economic establishment wanted Trump out of office any way possible.

Comedian and popular podcaster Jimmy Dore loves to tell his audience that the MSM’s central function is to spread propaganda for the political and economic elites. “When you lie at the behest of the establishment, there is never a price to pay…ever,” Dore said during an interview in 2019 with Matt Taibbi and Katie Halper. “The people who consider themselves journalists have no idea how they’ve been groomed for that job. They’re chosen and guys like me are not chosen to work for (mainstream news organizations), and if they do, they fire my ass.”

Dore’s observation is hardly novel. Academics and media critics have been making this argument for years, most famously by Edward S. Herman and Noam Chomsky in their seminal book Manufacturing Consent:

“The mass media serve as a system for communicating messages and symbols to the general populace. It is their function to amuse, entertain, and inform, and to inculcate individuals with the values, beliefs, and codes of behavior that will integrate them into the institutional structures of the larger society. In a world of concentrated wealth and major conflicts of class interest, to fulfil this role requires systematic propaganda.” (Manufacturing Consent, 1988)

The Fox News effect is also frequently mentioned when discussions of declining news media confidence arise. [Such arguments are found here and here.] According to this argument, Fox News is that one bad apple that spoiled the whole bunch. “Things were fine before Fox News” is a common syllogism within this line of reasoning.

Unfortunately, it is not that simple.

The decline is, in fact, common across partisan preferencesWhile Democrats have more confidence in the news media than Republicans, their confidence has also declined for both TV news and newspapers in the past year (see Figure 2).

Figure 2: Changes in confidence in institutions between 2021 and 2022 (Source: Gallup Poll)

Source: Gallup Poll

Rumors of the MSMs demise are greatly exaggerated

But for all the pissing I’ve done on the MSM in my past blogs, and repeatedly imploring Americans (and all world citizens, for that matter) to diversify their news and information sources, I should acknowledge that the MSM is far from dying or obsolete. Not only is the MSM very much alive, it still dominates our daily news ecosystem — even in the Age of Joe Rogan.

The New York Times has seen its subscriptions, revenues and profitability consistently rise since 2016 (did the ‘Orange Man’ help?), and while the viewership for cable TV news networks has dropped from Trump-administration-era highs, these news outlets are not on the brink of financial collapse.

Granted, CNN, MSNBC and Fox News are no longer just competing among themselves for America’s news-watching eyeballs — they must now contend with those eyeballs fleeing to the digital world to watch personalities like Joe Rogan, Ben Shapiro, Lex Fridman and Jimmy Dore, or to watch news podcasts from The Hill and Breaking Points.

Based on my previous research, Google Trends may be useful in measuring the public’s attention to various news outlets, particularly given the many points-of-access now available to news consumers — such as TV, newspapers, radio news websites, YouTube, and podcast streaming services. The broadcast and streaming media ratings measurement services have a titanic challenge in capturing the degree to which Americans interact with their favorite news and information sources.

In previous posts, I’ve used Google Trends to assess levels of interest across selected media properties and found, generally, that Google search behavior mirrors and often predicts levels and changes in audience sizes for these media properties (see the Appendix below for a back-of-the-envelope comparison of Google Trends and streaming viewership for Netflix’s Stranger Things and Disney’s Obi Wan Kenobi).

Thus, I believe Google Trends may be appropriate for assessing the public’s interest in major news organizations and personalities.

The news and information landscape is more fragmented than ever in terms of available options, but in terms of the public’s attraction (as measured by Google searches), the traditional media outlets still rule (see Figure 3).

Figure 3: Changes in confidence in institutions between 2021 and 2022 (Source: Gallup Poll)

According to the sum of the weekly Google Trends Index (GTI) from January 2020 to June 2022, Fox News (GTI = 2,855), CNN (GTI = 2,288), and the New York Times (GTI = 914) dominated Google searches over that period.

Seven of the top 10 news and information entities were traditional media outlets, with only Joe Rogan (GTI = 170), the Huffington Post (GTI = 156), and BuzzFeed (GTI = 138) representing new media among the top news and information sources.

In comparison, between January 2016 and June 2018, the Huffington Post and BuzzFeed were the only two new media entities in the top 10 on Google Trends (data not shown, but available upon request).

Ostensibly, the big mover in public’s attraction has been Joe Rogen (The Joe Rogan Experience) — arguably the most important and influential podcaster in the country today — but beyond the dominant news outlets (i.e., Fox News, CNN, the New York Times, the Washington Post, and MSNBC), ten of the next 21 top news and information outlets are new media properties (Rogan, HuffPost, BuzzFeed, Politico, Ben Shapiro, Candace Owens, The Hill, The Daily Wire, Call Her Daddy, and Alex Jones).

Yes, Alex Cooper’s Call Her Daddy probably can’t be categorized as a news or information program, but it is often political in content and it ranks highly compared to other news and entertainment properties.

If we factored in the operational costs associated with each of the entities in Figure 3, Rogan, Shapiro, Owens, Dan Bongino, Call Her Daddy and Jones would undoubtedly be the most economically efficient attractors of the public’s interest in today’s news and information landscape. It is not hyperbole to suggest new investments in news and information would be most profitable in the podcast, not traditional media, arena.

Final Thoughts

I believe Joe Rogan has maxed his audience and influence. Just a hunch. But that is not the same as saying his media model isn’t relevant for the future.

Low-cost, opinion-oriented podcasts are not going away. To the contrary, their central role going forward is to interpret the biased news we receive from the mainstream media. We shouldn’t need these podcast interpreters of the news, but we do.

For good reason, Americans do not trust the mainstream media — you decide the fundamental reason for that empirical fact.

In the meantime, understand that the quest for media ratings and success in electoral politics is little more than a popularity contest, not that dissimilar from the interpersonal forces that determined popular kids from unpopular ones in high school. Our electoral process is that shallow.

The objective facts in politics are subordinate (but never irrelevant) to the narrative that supports the interests of established elites, who will do everything in their power to kill anti-establishment points-of-view circulated on such on podcasts like The Joe Rogan Experience and Breaking Points.

Will the establishment win or fail in their anti-free-speech project? The answer is up to us.

  • K.R.K.

Send your comments to kroeger98@yahoo.com

Appendix: Strangers Things vs. Obi Wan Kenobi

I am both a fan of Netflix’s Stranger Things and George Lucas’ Star Wars. So when Disney’s Obi Wan Kenobi series and Netflix’s Stranger Things released new episodes at the same point in time, not only did I have watch both, but I was intrigued as to how each performed in terms of audience interest.

I was also interested to see if interest in the two shows on Google Trends corresponded to reported audience measurements (i.e., Nielsen streaming ratings).

The correspondence was positive and striking (see Figure A.1).

Figure A.1: Audience levels and Google searches for Stranger Things and Obi Wan Kenobi between May 15 and June 15, 2022 (Source: Nielsen and Google Trends)

The ratio of audience viewing levels and the relative number of Google searches was nearly identical for both Stranger Things and Obi Wan Kenobi (3.24 vs. 3.22).

The U.S. healthcare system cost many lives during the COVID-19 pandemic

By Kent R. Kroeger (Source: NuQum.com; July 6, 2022)

Cross-national data analyzed in this essay can be found on Github==>Here

“Pandemic or not, America has the best healthcare in the world,” declared a 2020 cross-national study of COVID-19 survival rates by the Acton Institute, a free-market-promoting think tank. “When President Donald Trump fell ill with COVID-19, there was absolutely no contemplation of moving America’s head of state to another country to receive healthcare services.”

Unintentionally, the Acton Institute’s study highlights exactly why the U.S. healthcare system is not the world’s best by most objective measures. The healthcare received by our president is not the same healthcare received by a large percentage of Americans.

And no issue has been a bigger motivator for this blog than the systemic underperformance of the U.S. healthcare system.

Although my family has adequate insurance coverage, unpredictable healthcare costs could compromise our financial well-being in a jiffy moment.

The COVID-19 pandemic brought that possibility to the fore when my entire family came down with the novel coronavirus within days of one another, and while none of us suffered too greatly from its effects, the night I had a 103-degree fever and prayed for a quick and merciful death suggests it could have turned out differently had I not been vaccinated and in reasonably good health.

Still, it would have taken just one extended hospital stay among us to have fundamentally changed our financial well-being.

On average, a one-night hospital stay in the U.S. costs $11,700. For most Americans, health insurance covers most of that cost, but what about for the 31 million uninsured or 75 million underinsured? The answer is often tragic.

According to Debt.org, between 60 and 65 percent of all bankruptcies are due to medical expenses, and a 2018 study by The Commonwealth Fund found that 41 percent of underinsured adults had postponed important health care due to cost. Even among adequately insured Americans, 23 percent reported delaying needed care.

Early within the COIVD-19 pandemic, the U.S. Centers for Disease Control and Prevention (CDC) warned that delaying care could increase the country’s morbidity and mortality rates associated with COVID-19. In a survey conducted by the CDC in June 2020 discovered that “an estimated 40.9 percent of U.S. adults have avoided medical care during the pandemic because of concerns about COVID-19, including 12.0 percent who avoided urgent or emergency care and 31.5 percent who avoided routine care.”

A policy analysis by Yale’s Center for Infectious Disease Modeling and Analysis appears to confirm the CDC’s concern about delayed care. “Universal healthcare could have alleviated the mortality caused by a confluence of negative COVID-related factors,” concluded the June 2022 study published in Proceedings of the National Academy of Sciences USA. “Incorporating the demography of the uninsured with age-specific COVID-19 and nonpandemic mortality, we estimated that a single-payer universal healthcare system would have saved 212,000 lives in 2020 alone. We also calculated that US$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a Medicare-for-All system.”

The same study concluded 330,000 American lives could have been saved over from 2020 to 2021 had this country had a universal healthcare system.

But as I would tell students, rarely can one study end the discussion on an important policy-related question, and has solid as the policy analysis methodology was for the Yale study, a cross-national comparison of COVID-19 death rates is warranted.

A Comparison of National Healthcare Systems (Type vs. Quality)

Perhaps it is analytic hubris to believe it is possible to categorize national healthcare systems into a small number of mutually-exclusive categories, but contributors to Wikipedia gives it a decent shot:

  • Universal government-funded health system (e.g., Australia, Brazil, Canada, Denmark, Norway, Sweden, Taiwan, and U.K.)
  • Universal public insurance system (e.g., Belgium, China, France, India, Japan, Russia, and South Korea)
  • Universal public-private insurance system (e.g., Austria, Germany, Mexico and Turkey)
  • Universal private health insurance system (e.g., Israel, Netherlands, and Switzerland)
  • Non-universal insurance system (e.g., Indonesia, Nigeria, Pakistan, Uganda, and U.S.)

However, on its face, this categorization appears problematic for analytic purposes as it is hard to agree that Pakistan and the U.S. have similar healthcare systems, despite both being categorized has having non-universal insurance systems, or that South Korea and China have objectively similar universal public insurance systems.

Consequently, during the model-building process to explain cross-national differences in COVID-19 death rates, the type of healthcare system did not achieve consistent statistical significance after controlling for other national factors such a population size, age distribution, vaccination rates, and GDP per capita. [See the full linear model estimates for the model including controls for healthcare system types in Appendix A.]

In contrast, the quality of a nation’s healthcare system, as measured in a 2021 global survey of 196,000 respondents conducted by the Global Business Policy Institute (GBPI) in partnership with CEOWORLD magazine, proved consistently significant in explaining variation in COVID-19 death rates.

Figures 1a-b display the Top and Bottom 10 healthcare systems in 2021, according to GBPI and CEOWorld Magazine. Topping the list are South Korea, Taiwan, Denmark, Austria and Japan. Of the Top 10 healthcare systems, three of five system types were represented (Universal government-funded health system, Universal public insurance system, Universal public-private insurance system). Conversely, two of the Bottom 10 countries had universal government-funded healthcare (Ireland and Ukraine), while the remaining countries in the Bottom 10 had non-universal healthcare or could not be classified.

Figure 1a: Top 10 healthcare systems in the world (Source: CEOWorld Magazine)

Figure 1b: Bottom10 healthcare systems in the world (Source: CEOWorld Magazine)

Likewise, Figure 2 (below) plots the quality of a nation’s healthcare system by COVID-19 deaths per 1 million people. Ostensibly, there does not appear to be a strong linear relationship between those two variables.

Figure 2: A cross-national comparison of healthcare system quality and COVID-19 deaths per capita.

However, in a linear model controlling for COVID-19 incidence (i.e., confirmed cases per capita), population size, age distribution, GDP per capita, vaccination rate, and the stringency of COVID-19 policies, the quality of a nation’s healthcare system proved significant across all of the models tested. The parameter estimates (and diagnostics) for the final, reduced model are shown in Figure 3.

Figure 3: A linear model explaining COVID-19 deaths per capita in 85 countries.

Modeling and analytics by Kent R. Kroeger (The 85 countries in the analysis are listed in the datafile on Github)

Methodological Note:

One of my subscribers asked how the results in Figure 3 would change if China and Venezuela were removed from the analysis, as many analysts have contended that both countries have not been forthright in their COVID-19 reporting.

Their removal did not change the substantive findings in Figure 3, and though I don’t report the results excluding China and Venezuela here, I can provide them upon request. And, as always, the raw data is available on Github for others to analyze.

Based on their standardized parameter estimates, the number of confirmed cases per capita (β = 1.03),a country’s population size (β = 0.24) and the quality of its healthcare system (β = -0.24) were the best predictors of COVID-19 deaths per capita.

The higher a country’s population, the higher the number of COVID-19 deaths per capita.

The better the quality of country’s healthcare system, the lower the number of COVID-19 deaths per capita.

Other significant predictors of COVID deaths per capita were vaccination rates, the percentage of citizens over 70, and the average stringency of COVID-19 policies (from 1 January 2020 to 23 June 2022).

Overall, the reduced linear model in Figure 3 explains 73 percent of the variance in COVID-19 death rates. [The reduced model’s residuals are plotted in Appendix B.]

Some will be perplexed that the regression parameter for policy stringency is positive — which implies that the stricter the COVID-19 policies, the higher the COVID-19 death rate per capita.

In a static, cross-sectional analysis this analytic outcome makes empirical sense. It is not surprising that countries facing the worst COVID-19 outcomes would impose the strictest policy measures. This finding, however, does not in any way suggest that COVID-19 mitigation policies didn’t work. In fact, my own time-series analysis in this area says otherwise: Proactive COVID-19 policies worked better than reactive policies.

In any case, simple assumptions about the effectiveness of mask mandates, vaccine dictates, business shutdowns, school closings and social distance requirements should always be subject to empirical analysis.

But the purpose of this data essay is not to argue the effectiveness of COVID-19 policies — it is to argue whether human lives could have been saved in the U.S. had the country a better healthcare system.

Using the parameters in Figure 3, we can estimate how many U.S. lives would have been saved had the country’s healthcare system been of a higher quality. The results support the conclusions of the Yale study. If the U.S. had a more equitable healthcare system, hundreds of thousands of lives would have been saved.

Figure 4 presents an estimate of the number of U.S. COVID-19 deaths that could have been avoided had the U.S. a healthcare system comparable in quality to other countries.

Figure 4: How many lives would have been saved if the U.S. had a better healthcare system?

Modeling and analytics by Kent R. Kroeger

If the U.S. had a healthcare system comparable to our neighbor to the north (Canada), we would have saved almost 100,000 COVID-19 deaths.

A U.S. healthcare system similar to Germany’s hybrid system would have saved a 175 thousand lives. And a U.S. healthcare system at the U.K.’s level of quality would have saved 258 thousand lives.

And if the U.S. had the best healthcare system in the world, as asserted by the Acton Institute, there would be 356 thousand more Americans alive today.

Some last thoughts

The findings from this data essay argue that the U.S. healthcare system is not only inadequate, it has systematically failed at its number one job of taking care of all Americans.

It is not acceptable that American doctors and pharmaceutical executives are millionaires while a million Americans die from a virus that other countries — with superior healthcare systems — were able to contain at a fraction of the human carnage experienced within the U.S.

Dr. Abdul El-Sayed, a physician and progressive candidate in Michigan’s 2018 Democratic gubernatorial primary election, describes the five reasons Medicare-for-All (universal healthcare) is superior to private healthcare:

  1. Despite political rhetoric suggesting otherwise, there are no free markets in private healthcare
  2. There is no financial incentive for prevention in private healthcare
  3. American healthcare is expensive because insurers and hospitals negotiate (collude) with each other
  4. Sixty-five percent of our healthcare system is already public (Medicare/Medicaid, TRICARE, Veterans)
  5. Money spent inefficiently on healthcare is money not spent on other important problems (e.g., climate change)

Historical trends in U.S. healthcare expenditures reinforces Dr. El-Sayed’s fifth point. In 2020, health spending accounted for one-fifth (19.7%) of the total U.S. economy (see Figure 5). Fifty years ago, it was a mere 6.9 percent of the economy.

Figure 5: Annual U.S. health expenditures (US $ per capita, 1970–2020)

Source: Peterson-KFF

While exacerbated by the COVID-19 pandemic, the upward trend in U.S. healthcare spending established itself long before 2020. In a country where treatment of a snake bite can cost over $140,000 (if helicopter transport is required), the rise in healthcare costs is not an economic abstraction. It is real. And we will never contain these cost increases until we abandon half-measure reforms (think: Obamacare) and, instead, pursue fundamental, structural reform.

And, according to Yale’s Center for Infectious Disease Modeling and Analysis, the most logical and attainable policy choice is universal public healthcare under a Medicare-for-All system.

Will it happen? I doubt, as we have two Right-leaning parties dominating our political system right now.

  • K.R.K.

Send comments to kroeger98@yahoo.com

Appendix A: Full linear model with GDP per capita, Central/South America, and healthcare system type controls (Dependent Variable: COVID-19 deaths per capita)

Appendix B: Linear model residuals (Dependent Variable: COVID-19 deaths per capita)

The Three Pillars of Gun Violence

By Kent R. Kroeger (Source: NuQum.com, June 14, 2022)

[Data used in this essay can be downloaded from GITHUB.]

Last month’s Buffalo supermarket and Uvalde (Texas) Elementary School massacres that killed 31 people in total has rekindled what is now a recurring ritual in our country: Democrats lamenting that substantive gun control legislation is sorely needed, and Republicans expressing their sympathy for the victims and their families while simultaneously lamenting that Democrat-supported gun control legislation will not significantly reduce gun violence.

Sadly, the public dialogue in the aftermath of these human atrocities has more in common with performance art than it does with legitimate policy debate.

Yet, there is a reason to be optimistic that actual gun control legislation will be passed by the U.S. Congress this year.

This week a group of U.S. Senators, including ten Republicans, announced it had arrived at a tentative proposal to pass the most substantive gun control measures since the Bill Clinton administration. The U.S. House has already approved gun regulation measures — though it is unlikely that bill in its current form will ever pass the U.S. Senate.

While the legislative details on the Senate bill have not been finalized, the general agreement is that it will include:

  • financial incentives for states to pass “red flag” laws designed to prevent dangerous individuals from purchasing firearms,
  • money for school safety and mental health programs,
  • tougher background checks for gun buyers under age 21, and
  • restricting people from buying weapons for people who cannot pass a background check.

For the eventual bill to pass the U.S. it will require the support of ten GOP senators.

Assuming the bill passes both chambers and receives President Biden’s signature — and that is strong assumption — is there any reason to expect a significant firearm-related deaths?

Why is it so hard to pass stricter gun control laws in the U.S.?

It was 1994 when the U.S. Congress last passed substantive gun control legislation (the Public Safety and Recreational Firearms Use Protection Act). The law expired in 2004 and its effectiveness remains the subject of debate.

Yet, it baffles many of us as to why the U.S. fails to pass laws that materially restrict the ownership of semi-automatic firearms with high-capacity magazines, which are typically the weapons used in mass shootings. OK, you can keep your handguns and hunting rifles — but who really needs a semi-automatic rifle like an AR-15 that, when modified by a bump stock, can fire 400 rounds per minute?

But there are, in fact, passionate arguments opposing restrictions on semi-automatic firearm sales, ranging from:

  • ownership of these firearms are constitutionally-protected,
  • the fear that criminals will still find ways to obtain these weapons, while law-abiding citizens will be the ones denied access to them,
  • these types of firearms are necessary to protect ourselves from government tyranny.

The last argument generally inspires derision from gun control advocates: Do guardians of the Second Amendment honestly believe 10-rounds of ammunition in their rifle’s magazine will stand between them and the U.S. government?

Yes, in fact, there are thoughtful, highly-educated people who believe ‘tyranny prevention’ is at the core of the Second Amendment’s importance.

Writes lawyer Skylar Petitt:

If the (Second Amendment’s) core is limited to “self-defense in the home,” then it may be reasonable to conclude that military weapons of all kinds are excluded from protection. If the core purpose is merely “self-defense,” then it may be reasonable to conclude that something more than a handgun is protected. And if the core includes “tyranny prevention” (whether because “self-defense” includes “self-defense from tyranny” or because the core is later defined by the Supreme Court to include it), then some quantum of military weaponry must be protected.

But why are so many gun-rights advocates so absolutist in their defense of the Second Amendment that they won’t even entertain the most modest of gun reforms, such as passing gun registration laws? I can’t legally drive drive a car without it being registered — so why is it acceptable to own an AR-15 rifle without a similar registration requirement? [One answer is that car ownership is not a constitutionally-protected right.]

Nonetheless, it disheartening to many that the U.S. Congress is incapable of passing any kind of bipartisan gun control legislation. Are we that divided as a society? [Yes.]

According to the Gallup Poll, support within the U.S. for stricter gun control laws declined between 1981 and 2021 (going from 78 percent to 52 percent), even as gun ownership has been relatively stable (42 percent in 2021).

Some want to blame the power of the National Rifle Association (NRA) as one of the fundamental barriers to gun control reform. But it is hard to believe that the NRA spending $54.4 million on 2016 federal elections and $29.4 million in 2020 was enough to squash any chance of the U.S. Congress passing impactful gun control legislation. In total, $6.5 billion was spent on federal elections in 2016 and $14.4 billion in 2020. NRA money is a spit in the electoral ocean.

Even red-flag laws in which individuals with a known history of mental illness are restricted from gun ownership meet stiff opposition. If our societal goal is to get meaningful help for the mentally ill, it is fair to ask how such laws will work in the real world. Will people be less likely to seek mental health care if there is a chance they will lose their privacy and a constitutionally-protected right in the process?

There are no easy answers to gun violence in the U.S., particularly when violence is such an integral part of our popular culture and common heritage.

A Cross-National Analysis of Firearm-related Deaths per Capita

Across a varied range of research studies, three variables (what I call the three “pillars” of gun violence) have commonly been found to impact firearm-related deaths in the U.S.:

  • The widespread availability of firearms (Americans own 390 million firearms)
  • Relatively permissive gun control laws underpinned by a constitutional amendment protecting gun ownership (and which may be the most daunting hurdle facing future attempts at major gun control legislation)
  • A national culture that routinely rationalizes violence as a defensible means of conflict resolution.

In this data essay, I use cross-national data on gun laws, gun ownership levels, and attitudes towards violence to demonstrate their possible relationship to firearm-related deaths.

I entered into this specific analysis open to the possibility that gun control laws are generally ineffective. At first, I was going to analyze U.S. state-level data, but it became clear that spillover effects (e.g., the ease with which guns can cross state limit) mute the impact of state-level gun control policies. Besides, I believe a key factor in explaining gun-related deaths is culture — that is, in some countries, people are more open to using violence to solve interpersonal problems and that such violence is sometimes carried out using firearms.

This analytic question led me to do a cross-national analysis, as there is considerable attitudinal data from the World Values Survey on a national population’s openness to using violence for conflict resolution.

Therefore, I constructed a cross-national model explaining annual gun-related deaths per 100K people, using data obtained from the World Population Review and supplemented by data from gunpolicy.org, that included the following variables as explanatory factors (i.e., the three pillars of gun violence):

[It should be noted that the number of firearm-related deaths per capita included suicides, which typically account for a large percentage of firearm-related deaths.]

The GPI summarizes national laws related to the types of firearms permitted (long guns, handguns, semi-automatic rifles, and fully-automatic firearms) and the existence of gun registration requirements.

Forty countries were initially analyzed; however, four countries — Venezuela, Guatemala, Brazil, and Colombia — were determined to be extreme outliers and excluded from the bivariate charts (Figures 2–4) and the final regression model (Figure 5) reported in the next section.

The factors making Venezuela, Guatemala, Brazil and Colombia dramatically different from other countries — especially, income inequality and ineffectual law enforcement/judicial institutions — should, ideally, be included in the statistical model. However, my initial attempts to include these factors did not remedy the outlier problem. Therefore, I deleted the four outlier countries from the following analysis. Charts and regressions using the outlier cases can nonetheless be found in the Appendix at the end of this essay.

The Results

Social commentators from The Hill’s Briahna Joy Gray to HBO’s Bill Maher are increasingly vocal about the need to change American culture if we want to change the incidence of gun violence. In other words, is our culture driving gun policy?

Maher has been particularly pointed in his criticism of the American entertainment industry:

“The average American kid sees 200, 000 acts of violence on screens before the age of 18 and, according to the FBI, one of the warning signs of a potential school shooter is a fascination with violence-filled entertainment.

It’s funny, Hollywood is the wokest place on earth in every other area of social responsibility, but when it comes to the unbridled romanticization of gun violence…crickets.”

Hollywood feeds the world violent content because it attracts audiences. It’s not complicated.

And this attraction to violence extends beyond entertainment, it continues into our interpersonal relationships. Despite significant public support in the U.S. for stricter gun laws, Americans are more likely than people in other countries to believe violence against others is at least occasionally justified.

According to Wave 7 of the World Values Survey (conducted from 2017 to 2020 in 59 countries), 44 percent of Americans believe ‘violence against other people’ is sometimes justifiable, compared to 33 percent worldwide. Among the 59 countries where the question was asked (see question text below), the U.S. ranked 14th in the percentage of respondents who believe violence against others is sometimes justified (see Figure 1a).

World Value Survey item:

Q191: On a 10-point scale from 1 to 10, please tell me…whether you think ‘violence against other people’ can always be justified (10), never be justified (1), or something in between.

Figure 1a: The percentage of respondents who believe violence against others is sometimes justifiable (Top 20)

Data source: World Values Survey (Wave 7, 2017–2020)

The Top 20 countries for justifiable violence is an eclectic mix, ranging from Tajikistan, where 78 percent believe violence against others is sometimes justifiable!, to Guatemala at 36 percent. However, there appears to be some regional clustering in this attitude prevalence — namely, North America (Canada, Mexico, and U.S.), Southeast Asia (Vietnam, Philippines, and Malaysia) and East Asia (Mongolia, South Korea, Macau, and Hong Kong).

There are no West European countries in the Top 20.

When viewing the countries with the lowest percentage of people who believe violence against others is sometimes justifiable, geographic clustering is not as apparent (see Figure 1b).

Figure 1b: The percentage of respondents who believe violence against others is sometimes justifiable (Bottom 20)

Data source: World Values Survey (Wave 7, 2017–2020)

But the important question is, do attitudes towards violence correlate with objective gun violence measures, particularly the annual number of firearm-related deaths per capita?

Based on Figure 2 (below), the answer appears to be yes, at least when outlier countries — Brazil, Colombia, Guatemala, and Venezuela — are removed from the analysis (see Figure A4 in the Appendix for comparison). In general, countries with a relatively high percentage of citizens who believe violence is sometimes justifiable tend to have higher firearm-related death rates.

Figure 2: A bivariate scatterplot of firearm-related deaths per capita by the mean World Values Survey score (Q191) for the justifiability of violence against other people (excludes outlier countries)

We have tentative evidence that the first pillar of gun violence — a nation’s culture of violence — is potentially significant.

What about the second pillar — the availability of firearms?

In the bivariate case, the number of firearms per capita also appears to have a positive relationship to firearm-related deaths per capita (see Figure 3).

Figure 3: A bivariate scatterplot of firearm-related deaths per capita by the the number of firearms owned per 100 people (excludes outlier countries)

The U.S. position in Figure 3 is striking. The country has, by far, the highest level of gun ownership in the world and is second in firearm-related deaths per capita.

Finally, we have the third pillar of gun violence — national gun control laws and policies.

In the cross-national context, does variation in gun control laws and policies relate to differences in gun violence?

Again, the answer appears to be yes. More restrictive gun control policies are associated with fewer firearm-related deaths per capita.

Figure 4: A bivariate scatterplot of firearm-related deaths per capita by the Gun Policy Index (excludes outlier countries)

The next step is to see if these three pillars of gun violence — culture, gun availability, and gun laws — are independently related to firearm-related deaths per capita when all three factors are included in a single statistical model.

According to the linear model estimates reported in Figure 5, the answer is a solid yes. Overall, the three variable model accounts for 45 percent of the cross-national variance in firearm-related deaths per capita with all three variables achieving statistically significant parameters estimates with p-values less than the significance level (α = 0.05).

Figure 5: A linear model of firearm-related deaths per 100K people (excludes outlier countries)

Interpretation of standardized coefficients (Betas):

A change of one standard deviation in the a nation’s mean attitude-levels towards violence is associated with a change 0.35 standard deviations in the number of firearm-related deaths per capita.

A change of one standard deviation in the a nation’s gun ownership rates per 100 people is associated with a change 0.30 standard deviations in the number of firearm-related deaths per capita.

A change of one standard deviation in the a nation’s score on the Gun Policy Index (high values indicate stricter gun laws) is associated with a change -0.34 standard deviations in the number of firearm-related deaths per capita.

The unstandardized coefficient for gun ownership rates per capita (b = 0.044) is also interesting as it has implications for one particular gun control policy: buy-back laws in which a country lowers gun ownership rates by buying guns from its citizens.

If the U.S. government spent $30 billion to buyback 60 million guns (@ $500 per gun), that might lead to 3,000 fewer gun-related deaths each year in the U.S. — which is almost 7 percent of annual firearm-related deaths currently (i.e., 45,000 in 2021).

The model in Figure 5 is not proof of causation — it merely suggests the possibility that these variables are related in a cross-national context. We cannot rule out the possibility that gun violence drives culture, or similarly, that levels of gun violence drive gun laws and gun ownership levels. All directions of causation are on the table.

However, informed by this analysis, I am now more inclined to conclude that culture, gun availability, and gun laws are related to gun violence.

Final Thoughts

In his 2002 documentary, Bowling for Columbine, filmmaker Michael Moore posed an interesting question: Why does Canada experience significantly fewer gun-related deaths than the U.S., despite having a comparable gun ownership rate.

In reality, Canada does not have a gun ownership rate comparable to the U.S. (34.7 guns per 100 people versus 120 guns per 100 people). Nonetheless, Canada has significantly fewer gun-related deaths per capita than the U.S. (2.05 deaths per 100K versus 12.2 deaths per 100K).

Moore doesn’t offer an explicit explanation for this difference in his film, but he does leave his audience with an implicit one: The higher U.S. firearm-related death rate compared to other countries is, at least partially, the result of a more violent culture.

This data essay confirms that conclusion: Culture is a powerful driver of gun violence. When citizens believe violence is sometimes an acceptable approach for solving interpersonal problems, the probability that guns will be involved also increases.

We live in a country that fetishizes violence from its foreign policies to popular entertainment choices, and our perennial defense of gun ownership is just one manifestation of this seemingly irreversible cultural trait.

Independent of the importance of gun laws and the prevalence of guns in explaining gun-related deaths, culture stands as an equally important factor.

That said, my cross-national analysis suggests stricter gun laws and a incentivized reduction in gun ownership could lead to a substantial decrease in gun-related deaths.

The Second Amendment will always protect against political attempts at stricter gun laws, but there is no constitutional impediment to a gun buyback policy.

Would you have our government spend $30 billion to buyback 60 million guns (@ $500 per gun) if that, in turn, might lead to 3,000 fewer gun-related deaths each year?

I would.

  • K.R.K.

Send comments to: kroeger98@yahoo.com

Appendix — Alternative Models and Graphs

Figure A1: A linear model of firearm-related deaths per 100K people (includes outlier countries)

Figure A2: A linear model of firearm-related deaths per 100K people (using an indicator variable for outlier countries)

Figure A3: A bivariate scatterplot of firearm-related deaths per capita by the Gun Policy Index (includes outlier countries)

(Note: High values of the GPI indicate restrictive gun control laws)

Figure A4: A bivariate scatterplot of firearm-related deaths per capita by the mean World Values Survey score (Q191) for the justifiability of violence against other people (includes outlier countries)

Figure A5: A bivariate scatterplot of firearm-related deaths per capita by the the number of firearms owned per 100 people (includes outlier countries)

Where is our next Joe Strummer?

By Kent R. Kroeger (Source: NuQum.com; May 17, 2022)

Nearing the 40-year anniversary of the mostly forgotten US Festival concerts (which were held in 1982 and 1983), I am reminded of one of the bands that performed in the 1983 concert…

“The only band that matters.” That was The Clash’s moniker among the London-based punk band’s fan base.

Yes, it was a pretentious, overwrought slogan, but nearly 40 years removed from the band’s meteoric rise and fall, I’m still reminded of how different they were from other bands, past and present.

Along with The Sex PistolsThe Clash — Joe Strummer (lead singer/songwriter), Mick Jones (lead guitar/songwriter), Paul Simonon (bass), and Topper Headon (drums) — were the vanguard of the British punk movement in the mid-1970s. No exaggeration, they were The Beatles of punk rock — or, closer to what Strummer might say, they were the anti-Beatles.

[Strummer once mentioned he preferred The Rolling Stones over The Beatles, in part because The Beatles didn’t sing with British accents like The Stones.]

Where the Pistols were known more for their ceaseless, drug-fueled nihilism than their musical talent (predictably ending in the drug overdose death of their mercurial front man, Sid Vicious, in February 1979), The Clash were musically tight and smart, often preferring parabolic, socially observant lyrics over the Pistols’ self-destructive paganism. The Clash gave us elegancia punk.

[That isn’t to say the Pistols were bad — they were, in fact, great. And while most music critics will recommend their only studio album — Never Mind the Bollocks — in my view, no song better represents the Pistols than their rendition of Jingle Bells (…if that song doesn’t put you in the Christmas spirit, check your heartbeat).]

As talented and politically-conscious as U2 (and Bono) were in the 80s and 90s, their uncredited mentors were The Clash, because of all the rock bands I’ve admired over the years, no band has ever been as uncompromising and consistent in its politics, and that was a reflection of their lead singer, Joe Strummer.

The Clash were to the left of the leftiest on the left — and that is back when the term ‘left’ meant something politically in the U.S. and U.K.

Andwhen Joe Strummer sang ‘I’m so Bored with the U.S.A.,” I knew he was sincere — he really was bored with the U.S.A.

While Jones often wrote pop-influenced, self-reflective songs (“Lost in the Supermarket” and “Should I Stay or Should I Go” come to mind), Strummer would put listeners in a figurative headlock and noogie the bourgeois delusions out of them.

And no moment in rock-n-roll history better exemplifies this point than the 1983 US Festival concert held in San Bernardino, California over that year’s Memorial Day weekend.

The dreamchild of Apple co-founder Steve Wozniak and concert promoter Bill Graham, the US Festival was the Reagan generation’s answer to Woodstock —and like its 60s precursor, was a money loser.

And no concert is more poignant to Clash fans, as it would be the last time the band would perform together.

Perhaps knowing that, Strummer let out a timeless, scorching onstage rant against Western materialism and inequality, at one point taking aim at the organizers of the US Festival, the well-compensated musical acts appearing there, and even the audience itself:

“Alright, then here we are, in the capital of the decadent U.S. of A. This here set of music is dedicated to making sure that, those people in the crowd who have children, there is something left here for them later in the centuries…

…I know the human race is supposed to get down on its knees in front of all this new technology and kiss the microchip circuits. It don’t impress me ever much. It ain’t nothin but a “You buy! You make, you buy, you die!” That’s the motto of America. You get bums to buy it. And I’ll tell you those people out in East L.A., they ain’t gonna stay there forever. And if there’s anything gonna be in the future, its gonna be from all parts of everything — not just from one White way down from the middle of the road. So, if anybody out there grows up, for fucks sake!!!

Yeah, I suppose you don’t wanna hear me go about this and that and what’s up my ass, uh? Try this on for size…well, hi everybody, ain’t it groovy…ain’t you sick of hearin’ that for the last 150 years. Look, I know you’re all standin’ there lookin’ at the stage, but I’m here to tell you that the people that are on this stage and are gonna come on and have been on it already, we’re nowhere! Absolutely nowhere! Can you understand that?”

Strummer didn’t make many friends in the music industry that day, some eagerly pointing out that The Clash were paid $500,000 for their US Festival appearance — a large sum for a one-night-only performance.

Van Halen’s David Lee Roth would respond to Strummer the next day during their US Festival performance: “The only people who put ice tea in Jack Daniels bottles is The Clash, baby!”

I’m still not sure of David’s point. The Clash weren’t real rockers? The Clash were British? Who knows. I’ve never considered David Lee Roth remotely funny — which is one opinion I share in common with the late Eddie Van Halen.

A bland but more coherent response to Strummer came from U2’s Bono.

“Nobody twisted my arm to come here,” the self-consciously inoffensive Bono said during U2’s performance on the Festival’s third day. “I’m here because I want to be here.”

Bono then proceeded to pick out a big-breasted woman from the crowd, have her carried on stage next to him by a couple of stagehands, and let her bounce her ample mammaries for the next few minutes.

In the early 1980s, the political correctness memo hadn’t reached rock bands.

So went the 1983 US Festival — a four-day musical menagerie that may not have generated any additional wealth for its organizers, but nonetheless provided some great music, an entertaining pissing-match between a few bands, and one of The Clash’s greatest concert performances, albeit its last.

I can count on one hand how many times I’ve listened to an entire U2 or Van Halen album in the last twenty years. I listen to entire Clash albums at least three or four times a year — a frequency I only exceed with The Beatles, Kate Bush and Neil Young.

I don’t miss David Lee Roth’s schtick or rock vocal stylings. It had its day. And, anymore, I turn off U2 songs when they start on the radio (except when its “One”).

But I miss Joe Strummer. He was truly unique and the band that made him famous matters more than ever.

  • K.R.K.

Send comments to: kroeger98@yahoo.com

A Starter’s Guide to the “The Clash” Song Catalogue

Strummer’s singing voice is a cross between someone’s excessive gargling and a dying woodland animal.

I’ll admit, he’s not for everybody. But neither is Bob Dylan or the late Janis Joplin, and they certainly don’t have to apologize for their singing careers.

So here is my list of not necessarily The Clash’s or Strummer’s best songs, but the easiest songs to appreciate for first-time listeners, starting with songs from Strummer’s last band before his death, The Mescaleros.

Mondo Bongo” —Joe Strummer & The Mescaleros (2001)

This may be Strummer’s most famous song as it was included in Mr. and Mrs. Smith, the 2005 movie starring Brad Pitt and Angelina Jolie. But beyond the mainstream accessibility of this tune, it is also incredibly lovely and hypnotic. In fact, you’ll want to find a dance partner from the moment the song starts.

Redemption Song” — Written by Bob Marley; performed by Joe Strummer & The Mescaleros (2003)

From the album Streetcore, Strummer starts this Bob Marley masterpiece by saying, “People can change anything they want to.” Whether I agree with the sentiment, you can hear the emotion in his voice and he not only does the Marley song justice, he gives us the song’s best cover version, in my opinion.

Minstrel Boy” — Lyrics by Thomas Moore; arranged and performed by Joe Strummer & The Mescaleros (2002)

Lyrics written by the Irish poet Thomas Moore, The Mescaleros’ arrangement in combination with Strummer’s voice is heartbreaking — in a good way. It may be cliché to say the song transports you to a different place and time, but it really does.

Know your Rights” — The Clash (1982)

My favorite song from Combat Rock — The Clash’s last studio album under the original group lineup — there is probably no Clash song that could be plunked down in today’s music scene and be more pertinent. What “Know your Rights” lacks in lyrical sophistication, it more than makes up for in it’s political sensibilities. Sings Strummer:

“You have the right not to be killed. Murder is a crime. Unless it is done, by a policeman. Or an aristocrat. Oh, know your rights.

You have the right to food money. Provided you don’t, don’t mind a little investigation, humiliation…and if you cross your fingers, we have rehabilitation.

You have the right to free speech. Unless you’re not dumb enough to actually try it.”

As neoliberal political forces worldwide continue to suck the life out of working class people through their ongoing effort to stop the formation of worker unions, kill universal health care, spend public monies on ‘guns over butter’, and censor any speech they fear, this song deserves a relisten.

Atom Tan” — The Clash (1982)

The Clash loved the ‘call and response’ technique and this song from 1982’s Combat Rock album beautifully displays their penchant for that lyrical pattern. ‘Atom Tan’ is an unabashedly catchy Clash tune with lyrics I don’t fully understand…and who cares? It’s a fun listen.

The Clash’s ‘Combat Rock’ album was their most commercially successful effort, even as some hardcore fans dismissed the preternaturally catchy “Should I Stay or Should I Go?”; but for the rest of us, danceable songs like “Rock the Casbah” (the music video’s embarrassing Arab stereotypes notwithstanding) gave us some solace knowing that our favorite band would probably not survive into the next year. Strummer-Jones wrote Lennon-McCartney level songs and this album mostly proved that point.

Armagideon Time” — Written by Willi Williams; performed by The Clash (1980)

My best friend in high school would mock The Clash because they couldn’t spell ‘Armageddon.’ But the song was written by Jamaican reggae musician Willi Williams and was, by intent, a mocking critique of end-of-times theologies — the title’s improper spelling was part of the song’s point.

For me, as it wasn’t a Clash-written song, I loved how Strummer mangled Williams’ lyrics, such as when he replaced the original lyric of “remember to praise Jah-hov-iah” with “remember to kick it over.” Like John Lennon, Strummer was never against forgetting a few lyrics now and then — often for the better.

And if you love inventive drumming, pay attention to Topper Headon’s work on this song. Before heroin compromised his reliability as a band member, Headon was as good a drummer as any in the rock-era.

Hitsville U.K.” — The Clash (1980)

Sure, this song is a too consciously unpunk to be taken seriously, but at this point in the The Clash’s career, I’m not sure they cared.

“Here I am, thirty years later, in f**king Serbia, on the brink of crying because of a song celebrating bands I’ve never listened to. Is there any other band like this? Probably no,” posted gorgvalhal on YouTube about this song.

Found on The Clash’s three-album mega-opus, Sandinista!, an album that still divides Clash fans. Apart from George Harrison’s All Things Must Pass and a few live concert and best-of releases, no band had ever issued a triple-album before The Clash. In fact, The Clash gave up a good chunk of their royalties because they priced Sandinista! as a double-album release, instead of as a triple-album. Their break-up a few years later was, in part, because of this brave by costly financial decision.

Ivan meets G.I. Joe” — The Clash (1980)

Also found on Sandinista!, “Ivan meets G.I. Joe” might have been the most divisive song on the band’s most divisive album. Even I tended to skip over it.

But, in retrospect, it couldn’t be a better reflection of the times. In the context of a Cold War that was about to end, the use of video game sound effects was too unsubtle, but upon a renewed listening, the song’s goofy charm is hard to deny.

Charlie Don’t Surf” — The Clash (1980)

The Vietnam War had ended five years prior to this song, but The Clash couldn’t help but take a post-mortem slap at American military adventurism. The lyrics still work:

Charlie don’t surf and we think he should.
Charlie don’t surf and you know that it ain’t no good.
Charlie don’t surf for his hamburger.
Momma Charlie’s gonna be a napalm star.

Its another Clash song from Sandinista! that mashes any musical style they can get hold of, and they somehow make it work.

Junkie Slip” — The Clash (1980)

Elvis meets Stanley Clarke and Sid Vicious. This Sandinista! song about heroin addiction defies easy explanation. And, frankly, I’ve never met anyone who has liked this song. “It’s too kooky,” one of my fellow Clash-loving friends would say. Nonetheless, it’s on my short list of great Clash songs.

The Sound of the Sinners” — The Clash (1980)

This song combines message and humor as well as any the band ever wrote. So much so, Elvis Costello called this his favorite Clash song. The Clash have better songs, but this is one of the hidden chestnuts on Sandinista!

Death and Glory” — The Clash (1979)

This is my favorite Strummer-dominated song from their classic London Calling album, probably because I first heard it while in Catholic school and it was a bit naughty. But, forty years later, I appreciate its musical maturity, and any song with Strummer’s cackling scream and Jones’ McCartney-like harmonies ages well.

Jail Guitar Doors” — The Clash (1979)

This Jones-led song is a pure rocker with a sharp British accent.

The “Wayne” referred to in the beginning of the song is MC5’s Wayne Kramer who started a non-profit that plays concerts, donates guitars, and has song writing workshops for incarcerated people in America. He called the program “Jail Guitar Doors.”

The song was released on the U.S.-version of The Clash’s 1979 self-titled album, probably the best pure punk album ever recorded. These Strummer-featured contributions on this album are all punk rock classics: “I’m So Bored with the U.S.A.,” “Career Opportunities,” “White Riot,” and “Janie Jones.”

London Calling may have been their Sgt. Pepper, but The Clash self-titledalbum was their Revolver.

Gates of the West” — The Clash (1979)

I love the lyrics to this song that was an outtake from the band’s Give ’Em Enough Rope album:

So, I’m standing at the gates of the west.
I burn money at the lights of the sign.
The city casts a shadow of the perfect crime.
I’m standing at the gates of the east.
I take my pulse and the pulse of my friend.
The city casts a shadow, will I see you again?

Mick Jones penned this masterpiece of punk melody, as he was always Strummer’s songwriting equal. He was McCartney to Strummer’s Lennon and it worked so organically that in the short period in which they were songwriting partners, they wrote as many great songs as The Beatles did in a similar period of time.

Remote Control” — The Clash (1979)

Musically, Remote Control is one of The Clash’s most sophisticated songs. Only Strummer and Jones can write a punk song about repression and injustice and unapologetically include Beatlesque harmonies, which would have gotten any other punk band at the time jumped in an alley. “Beatlemania has bitten the dust,” Strummer once snarled, but that didn’t mean Strummer and Jones weren’t willing to occasionally pay homage to Lennon and McCartney’s musical genius.

[In my humble opinion: For all of the presented toughness of the British punk bands of the 1970s, a young John Lennon could have easily pummeled any two members of The Clash or The Sex Pistols in a straight-up fight. ]

Rush” — Big Audio Dynamite (Mick Jones)

I throw this Mick Jones post-Clash song for its great drum beat, its mashup of musical styles and its inclusion of one of my favorite lyrics of all time: “Now I’m fully grown. And I know where it’s at. Somehow, I stay thin, while the other guys got fat.”

Wishful thinking and medical research are a dangerous mix

By Kent R. Kroeger (Source: NuQum.com; May 13, 2022)

Disclaimer: I am statistician by training, freelance writer by choice, and an auditor at Amazon out of financial necessity. All grammatical errors and factual inaccuracies in this essay are mine alone. And, as always, do not make financial, medical or personal decisions based on the contents herein.

“Wishful thinking is one thing, and reality another.”
— Jalal Talabani (former President of Iraq)

“Where there is life, there is wishful thinking.”
— Gerald J. Lieberman (author)

One controversy I’ve generally avoided writing about is the disputed effectiveness of ivermectin in the treatment of COVID-19, a drug that is an empirically-proven treatment for parasites in humans and animals and whose discoverers won the 2015 Nobel Prize in Medicine for their effort.

But a drug that works for parasites is not necessarily effective in treating (or preventing) COVID-19. That conclusion requires significant direct evidence.

The initial optimism in ivermectin’s use for COVID-19 was rooted in indirect evidence with multiple pre-COVID-19-pandemic studies showing that ivermectin has antiviral properties against a variety of viruses, including influenza, Zika, HIV, and Dengue (a representation of these peer-reviewed studies is found hereherehere and here).

But the interest in ivermectin as a COVID-19 treatment accelerated after an in vitro study by Caly et al. (2020) reported that ivermectin significantly inhibits SARS-CoV-2’s replication in a cell culture model. [SARS-CoV-2 is the virus that causes COVID-19.]

At the onset of the COVID-19 pandemic there was substantial scientific evidence to warrant calls for more systematic research on the potential use of ivermectin in the treatment or prevention of COVID-19, but it was the intersection of this prior research with an understandable desire to find a cost-effective treatment for COVID-19 that ultimately drove mass interest in ivermectin.

No conspiracy theory or fake news fancy drove interest in ivermectin — to the contrary, it was scientists, physicians, and public health experts who wanted to find a cost-effective COVID-19 treatment that could be deployed in parts of the world where prohibitively expensive treatments and vaccines were not an affordable option.

The current list of “Centers for Disease Control and Prevention (CDC)-approved” COVID-19 treatments is currently defined by expensive drug treatments:

Remdesivir costs $2,340 for a five-day course treatment for COVID-19. While Pfizer’s antiviral, Paxlovid, costs $530 for a five-day course, and Merck and Co.’s antiviral, Molnupiravir, costs $700 per five-day course. In addition, Sotrovimab, an intravenous monoclonal antibody drug developed by GlaxoSmithKline and Vir Biotechnology Inc. costs $2,100 per treatment course.

By comparison, the vaccines are significantly more affordable than post-infection treatments, but in a world where two-thirds of all people live on less than $10-a-day, the costs for COVID-19 vaccinations are also exceedingly exorbitant to billions of people.

Among the mRNA vaccines (i.e., Pfizer and Moderna), the Centers for Medicare & Medicaid Services is reimbursing providers about $40 for each shot of the vaccine they administer in order to cover the labor involved.

If you are like me, you are on COVID-19 booster shot number two.

Simply put, even if these vaccines were available to everyone on the planet (they aren’t!), the costs associated with them are not an option for the majority of humans.

Hence, a deep and profound interest in cheap treatment alternatives — call it wishful thinking— has driventhe worldwide interest in drugs such as ivermectin.

In contrast, the mainstream media in the U.S. has aggressively (and cruelly) impugned the motives of anyone suggesting ivermectin is a useful treatment for COVID-19.

Unfortunately, for everyone invested in this debate, the science for and against ivermectin in the treatment of COVID-19 is not clear enough from a statisticians point-of-view to justify either side from claiming the highroad.

I do not know what value ivermectin offers in combating COVID-19.

Instead, wishful thinking seems to be driving most of the narrative on ivermectin. On one side are the ivermectin advocates who are driven by an understandable belief that affordable treatments for COVID-19 already exist and will be crucial in mitigating the impact of this virus, particularly in the developing world. On the other side are economically powerful entities (with well-funded lobbying efforts) who are determined to stamp out resistance to the proprietary, highly-profitable vaccines and treatments currently approved by the U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC). However, these anti-ivermectin forces cannot wish away the evidence showing that ivermectin may work to some degree against COVID-19.

Personally, I don’t believe the statistical evidence is strong enough to support ivermectin as a substantive treatment for COVID-19. From the reported clinical results I’ve seen, ivermectin offers, at best, only a marginal improvement in COVID-19 outcomes.

But that is not the same as saying ivermectin has no medical value in combating COVID-19. That conclusion is not obvious.

Even good science contains flaws

To shame those interested in ivermectin, the news media’s chosen posterchild for allegedly biased and fraudulent ivermectin research is an 2020 Egyptian clinical study led by Dr. Ahmed Elgazzar, a medical researcher at Benha University (Egypt). The randomized-controlled-trial (RCT) study he led of ivermectin’s effectiveness against COVID-19 was rightfully questioned for its poorly-documented random assignment protocols in which the control group (i.e., did not receive ivermectin treatment) was entirely drawn from intensive care units (ICU), but where the treatment group (i.e., received ivermectin) was drawn from both ICU and normal hospital care instances.

The critical component of an RCT study is that assignment to the control and treatment groups is entirely random. It is not clear that Elgazzar’s Egyptian study followed that requirement.

Though Elgazzar contends his study was withdrawn from publication before he was given a sufficient opportunity to address the study’s problems, the consequence is that his study contaminated the credibility of other ivermectin study’s that found some treatment effectiveness against COVID-19.

So when a meta-analysis of ivermectin’s effectiveness by Kory, Pierre, MD, et al. (“Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19.” 13 Nov. 2020) originally included the Elgazzar et al. study in its analysis (see Figure 1 below), the news media understandably questioned their conclusions.

Figure 1: Meta-analysis of the outcome of mortality from controlled trials of ivermectin treatment in COVID-19 [reprinted Figure 3 in original Kory, et al.(2021)]; (Odd-ratios estimates below 1.0 with credible intervals not containing 1.0 indicate ivermectin’s effectiveness against COVID-19)

The original publisher of the Kory et al. study sensibly issued a disclaimer:

That is exactly what good science should be doing — questioning the findings of researchers using flawed or questionable methods.

If only the large pharmaceutical companies faced similar challenges.

Dr. Kory and his coauthors issued a response to the editors of the American Journal of Therapeutics:

Their revised meta-analytic summary of ivermectin’s effectiveness was mostly unaffected by the exclusion of the Elgazzar et al. study (odd-ratios below 1 indicate ivermectin’s effectiveness against COVID-19):

Figure 2: Revised Figure 3 table in Kory, et al.(2021)

Because of the obvious flaws in the Elgazzar et al. study, are we to assume all research supporting ivermectin as an effective treatment for COVID-19 are equally suspect?

It is an archetypalexample of white European arrogance to suggest good science is not conducted in countries like Bangladesh, Brazil, India, Iraq, and Iran.

There are well-trained medical research methodologists in all of those countries.

The developed world’s impulsive rejection of ivermectin as a treatment for COVID-19 is unfortunate. The objective facts suggest ivermectin has some value against COVID-19.

Which brings us to the media-trumpeted study that purportedly proved that ivermectin does not positively impact COVID-19 outcomes.

The news media openly promotes bad research

The Together Study conducted in 2021 by Brazilian medical researchers concluded that ivermectin had no substantive impact on COVID-19 outcomes.

The American news media couldn’t be happier, as evidenced by these emphatic headlines:

Ivermectin Does Not Reduce Risk of Covid Hospitalization, Large Study Finds — The New York Times, March 30, 2022

Ivermectin does not prevent COVID-19 hospitalization, a new study says — NPR News, March 30, 2022

Study finds ivermectin, the horse drug Joe Rogan championed as a COVID treatment, does nothing to cure the virus — Fortune.com, March 31, 2022

Unfortunately, the research the mainstream media used to dismiss ivermectin was hardly better than the research supporting its effectiveness.

Like the Elgazzar et al. study, the Together Study had a curiously suspicious treatment/control group problem. A significant percentage of the control group in the Together Study (i.e., did not receive ivermectin) did not complete the study (see Figure 3). Where originally 679 COVID patients were assigned to the control group, only 228 were included in the ‘per-protocol’ analysis (i.e., followed the proper control procedures).

Figure 3: Sample disposition from the 2021 Together Study

Graphic courtesy of Phil Harper

More in-depth statistical critiques by Phil Harper and Alexandros Marinos of the Together Study can be found here and here, but the strange dropout of 451 control group participants during the course of the study begs one fundamental question: What happened during this study that would cause 451 people in the control group to violate protocols?

A plausible explanation is that these control group participants “learned” that they were not receiving the ivermectin treatment and decided to drop out of the study in order to receive that treatment. But that is pure speculation.

Harper states the potential ramifications of the control group dropout problem:

The ivermectin arm should have reported 21 deaths in 624 patients, as that’s how many patients fully completed the study. The placebo group should have reported 24 deaths in 288 patients, as that’s how many patients fully completed the study.

Instead each arm reported the number of deaths among the number of patients initially enrolled even though those patients did not complete the study. By not comparing like for like groups, all notions of ‘randomized control’ are gone from the trial, and it drastically alters the results.

These issues warrant an official response from the New England Journal of Medicine.

Putting aside the Together Study’s per-protocol sample problems, I am nonetheless drawn to the study’s statistical analyses that found a roughly 80 percent probability that ivermectin’s treatment value exceeded that of the placebo (see Figure 4). It is not significant by strict statistical standards, but it is suggestive that a more rigorous study might reveal a genuine benefit from ivermectin’s inclusion in a COVID-19 treatment program.

Figure 4: Probability of efficacy and Bayesian relative risk of COVID-19 hospitalization or extended emergency room observation for ivermectin vs. placebo taken from the 2021 Together Study

If anything, the Together Study increases my belief that ivermectin might be an effective treatment option for COVID-19 patients. But, of course, that is in direct opposition to the conclusions drawn in the news media.

We may never know the motives of control group participants who left the Together Study without significant follow-up research, but the more important point is that flawed research posed against other flawed research is not a formula for understanding the value of ivermectin against COVID-19.

Partisan and corporate interests are destroying the credibility of scientific inquiry.

That is not a good omen for our ability to incorporate quality science into the public policymaking process going forward.

Final Thoughts

As noted, there was enough circumstantial evidence at the beginning of the COVID-19 pandemic to justify calls for RCT research on ivermectin’s potential repurposing for use against COVID-19.

Did it happen? Yes, but not in the U.S. or Europe. Rather, the early ivermectin RCT research occurred in countries where there was already substantial human-treatment experience with the drug for parasites (BangladeshBrazilIndiaIraq, and Iran).

Among the first RCT U.S. studies of ivermectin and COVID-19 is ACTIV-6a nationwide, double-blind clinical study led by Duke University’s Clinical Research Institute, which announced in August 2021(!) that the study would start including ivermectin as one of the repurposed drugs to be tested (along with Fluticasone and Fluvoxamine).

August 2021? Really? If ivermectin warranted study in August 2021, why not in August 2020? Or April 2020? Why the delay? My hunch…my fear…is that the combination of powerful private interests (i.e., the pharmaceutical industry, which funds most clinical trials in the U.S.) and toxic political partisanship killed any chance ivermectin ever had to be included in the early COVID-19 treatment research.

Even ivermectin is not an effective treatment for COVID-19, the fact that it took a year-and-a-half before the U.S. medical research community took any meaningful effort to study its treatment value is scientific malfeasance. If it turns out that ivermectin is an effective treatment option, it becomes criminal negligence.

  • K.R.K.

Send comments to kroeger98@yahoo.com

The Lab-Leak Hypothesis is not dead

By Kent R. Kroeger (Source: NuQum.com; April 16, 2022)

Disclaimer: I am statistician, freelance writer and a serviceable Tex-Mex chili cook. All grammatical errors and factual inaccuracies in this essay are mine alone. And, as always, do not make financial, medical or personal decisions based on the contents herein.

Definitions:

The lab-leak hypothesis proposes that the SARS-CoV-2 coronavirus was leaked from the Wuhan Institute of Virology. While the theory does not necessarily require the virus to be “man-made,” that is often a key component of this theory.

The natural-origin hypothesis, in contrast, posits that the coronavirus is natural in origin (e.g., bats and/or raccoon dogs) and was spread from a host animal species to humans, most likely occurring initially through a food market in Wuhan, China.

When news broke last November that the first known COVID-19 case was, in fact, a Huanan Seafood Wholesale Market vendor in Wuhan, China and not an accountant with no clear link to the market, a couple of ‘I told you so’ emails appeared in my inbox.

When, four months later, a team of scientists released two papers offering the strongest statistical evidence yet that the epicenter of the COVID-19 pandemic was the Huanan market — thereby, presumptively, supporting the natural-origin hypothesis for SARS-CoV-2 — my inbox was flooded with personal rebukes.

“You should be ashamed of yourself for pushing the lab leak conspiracy theory,” said one email. “Congratulations Kroeger, you fell for another Trump con,” started another.

But the most hurtful admonition of them all was this one: “You chide others for letting their partisan biases infect their judgement. But face it. You’re no better.” My wife knows how to cut to the bone.

In my defense, I never claimed the lab-leak hypothesis was the definitive explanation of SARS-CoV-2’s origin. I said the lab-leak hypothesis should be seriously considered along with the natural-origin-theory and that partisan attempts to shut down legitimate inquiries into it only creates distrust and division.

And its not like interest in the lab-leak hypothesis has been limited to xenophobic Trumpers, anti-China activists, and garden-variety conspiracy theorists. In his January 2021 article — The Lab-Leak Hypothesis — New York Magazine writer Nicholson Baker was one of the first mainstream journalists to sincerely lay out the facts supporting the lab-leak hypothesis. He offered no smoking gun, just a compelling litany of circumstantial evidence that cut through the partisan hackery attempting to the drown the lab-leak hypothesis in its infancy.

By the time Jon Stewart appeared on The Late Show with Stephen Colbert in June 2021 mocking those still clinging to the belief that SARS-CoV-2 was a natural creation, the lab-leak hypothesis had gone fully mainstream — perhaps the dominant view.

But the natural-origin hypothesis has made a comeback, and for good reason. While not definitive, significant evidence still supports the animal-to-human scenario.

What we know with some certainty about the early pandemic

U.S. Intelligence Community assessments concluded that Chinese officials became aware of SARS-CoV-2 in November 2019 and, according to Dr. George Gao of the Chinese Center for Disease Control and Prevention, Chinese officials collected extensive environmental samples from the Huanan Seafood Market in January 2020, including from 18 animal species present at the market.

From all outward appearances, Chinese officials made the Huanan market the prime suspect from the beginning.

Along with the recently released geospatial statistical analysis that found the earliest Wuhan cases of COVID-19 clustered around the Huanan market, analytic efforts have resulted in three generally accepted findings:

(1) The first known human infection of SARS-CoV-2 was a vendor at the Huanan market and the subsequent spread of COVID-19 clustered around the that market.

(2) The two original mutations of the SARS-CoV-2 virus — lineage A (which is related to similar bat coronaviruses, though its discovery in humans has been less frequent than lineage B) and lineage B (which was the first to infect humans and has been more common in humans) — were present in the Huanan Seafood Market in early January 2020. Finding these two mutations in the same geographic location supports the theory that the jump to humans occurred at the Huanan market.

(3) While there were animals at the Huanan market capable of carrying and spreading SARS-CoV-2, among those tested in January 2020, none were found to have the SARS-CoV-2 virus. However, according to Gao, Chinese officials did not test every species available at the Huanan market, including raccoon dogs which are capable of spreading the virus to humans. Is there any wonder why conspiracies theories form when such inexplicable government decisions occur?

Was it not in the Chinese government’s interest to identify the animal origin-species for SARS-CoV-2 as fast as possible? Nothing would have killed the lab-leak hypothesis faster.

And it is not like Chinese scientists are inexperienced in the virology forensics required to identify a virus’ animal origins. They identified the probable animal source of the 2003 SARS-CoV virus within months of its spread to humans.

And, most discouraging, it may be too late to find the original animal-carrier(s) of SARS-CoV-2 and, thereby, definitively confirm the natural-origin-hypothesis.

“The clincher would be direct evidence that some mammals at the market were infected with the SARS-CoV-2 virus,” wrote Michael Le Page for the The New Scientist about the virus’ possible origins. “But that almost certainly doesn’t exist any more.”

As of now, no such direct evidence exists and perhaps never will — which is a nagging problem for proponents of the natural-origin hypothesis, whether they are willing to acknowledge it or not.

Why the lab-leak-theory will survive…for now

The fact remains, prior to the COVID-19 pandemic, no virus in nature was found to have the same (or nearly the same) genetic structure as SARS-CoV-2. The closest known match (RaTG13), found in bats in southern China, is considered by virologists, including a nationally-known virologist I consulted with before writing this essay, as too genetically different from SARS-CoV-2 for any man-made genetic modification techniques (e.g., gain-of-function research) to bridge the gap.

But there are still too many questions to close the book on the lab-leak hypothesis.

SARS-CoV-2 has no known direct antecedent in nature, and lacking concrete evidence otherwise, the lab-leak hypothesis has an oxygen supply.

Lab-leak hypothesis supporters are probably not persuaded by the geospatial studies showing the earliest COVID-19 sufferers clustered around the Huanan market. Their sample of those individuals were drawn from Chinese/WHO records and Weibo, China’s most popular social media platform — but how can we be certain they are representative of the early SARS-Cov-2 infected population in Wuhan? It is not clear from these recent geospatial studies how the investigators tested for sample biases or corrected for it if it existed.

If early assumptions about the source of the SARS-CoV-2 virus centered on the Huanan market, it is not surprising that Chinese government, WHO and social media reports may have concentrated on finding infected patients in its vicinity. It is potentially a serious selection bias problem.

Furthermore, who is to say a virus housed in the Wuhan Institute of Virology — natural or man-made — didn’t leak into Wuhan’s natural environment and subsequently emerge in its local food supply (i.e., the Huanan market)? Would that scenario play out differently in geospatial analyses?

The Huanan market resided in one of the most densely populated sectors in Wuhan. How many WIV employee lived near the Huanan market or frequented its vendors?

The latest research on SARS-CoV-2 origins is persuasive but raises as many questions as it answers, and while it has shifted my confidence between the two competing hypotheses (I now lean slightly towards the natural-origin hypothesis), it hardly closes the book on the debate.

The lab-leak hypothesis remains alive.

  • K.R.K.

Send comments to: kroeger98@yahoo.com

Was the Russia-Ukraine war predictable and preventable?

By Kent R. Kroeger (Source: NuQum.com; April 4, 2022)

Could anyone have predicted, years in advance, Russia’s February 24th invasion of Ukraine?

The answer is so emphatically ‘Yes!,’ it is hard to fathom what the counter-argument might be.

Perhaps we should start with the main instigator himself, Russian President Vladimir Putin, who said to American film director Oliver Stone four years ago during an interview, “I believe that Russians and Ukrainians are one people … one nation. In fact, when these lands that are now the core of Ukraine joined Russia … nobody thought of themselves as anything but Russians.”

And we are surprised that, as U.S. and NATO allies supplied Ukraine over the past five years with millions of dollars with some of the most sophisticated anti-armor and anti-aircraft weapons in existence, Russia would decide to respond?

Barack Obama’s administration was at war with itself over whether to significantly arm Ukraine in its defense against Russia, but it took Donald Trump’s deep-seeded insecurities to end that debate. Trump poured gas on a flammable situation when he approved the sale of anti-armor Javelin missiles to Ukraine in 2019. The Biden administration’s subsequent increase in military assistance to Ukraine, including 300 additional Javelin missiles as part of a $200 million military package delivered in January 2022, only ensured that war would break out between Russia and Ukraine.

Is Russia ultimately responsible for this war? Of course. Did the U.S., Europe and Ukraine make a credible effort to prevent it? The answer appears to be ‘No.’

Why does this debate about predictability even matter?

Because, as predictable as the invasion may have been, it was most likely preventable. And because it was preventable, what alternative paths could have been followed that could have preserved Ukraine’s independence without the current bloodshed?

Ukrainian President Volodymyr Zelensky, elected in 2019, placed a negotiated peace with Russia near the top of his agenda.

Whether or not, due to the actions of others or his own failure, Zelensky did not achieve his most central promise to the Ukrainian people.

As of today, as many as 4,600 Ukrainian soldiers have died, along with 3,400 civilians and, as yet, unknown damage has been inflicted on Ukrainian infrastructure and economic capacity.

Today, as the Russians are apparently withdrawing from areas around the Ukrainian capital, Kyiv, the Ukrainian people can’t be blamed for asking, was this bloodletting necessary to ensure Ukrainian independence? Is NATO membership for Ukraine this valuable? And is NATO even relevant anymore given Russia’s demonstrated inability to conduct an effective military operation against a significantly weaker country along Russia’s most important defensive border?

Russia’s conventional military is clearly not a meaningful threat to democratic Europe anymore. They wouldn’t get past Warsaw if they tried.

And while the Ukrainians may have won their freedom on the battlefield, at what cost did it occur? And could an equal, if not superior, outcome have been achieved without the needless bloodshed?

That is for the NATO allies to ponder and the Ukrainian people to decide when they go to the polls to elect their next president, most likely in 2024.

  • K.R.K.

Send comments to kroeger98@yahoo.com

More research needs to be done on hormone therapies meant to address gender incongruence among children

By Kent R. Kroeger (Source: NuQum.com; April 3, 2022)

The need for objective research research cannot be compromised simply because the issue is socially sensitive or politically contentious.

I recently watched a conversation between Joe Rogan and Adam Conover, the comedian host of truTV’s Adam Ruins Everything, about trans-athletes. The conversation was from two years ago, but it remains relevant, even if it was only a semi-cogent conversation between two people marginally qualified to talk about the fairness of allowing trans-women to compete in women’s sporting events.

At one point in the dialogue, Conover justified his acceptance of transwomen competing in women’s athletic competitions by citing his podcast conversation with a transwoman who had served as a U.S. Army helicopter pilot before her gender transition.

“There’s an author named Brynn Tannehill who’s a former military helicopter pilot I just interviewed. She’s one of the people affected by the Trump’s military ban on trans-service people who wrote a fantastic book called “Everything You Ever Wanted to Know about Trans (But Were Afraid to Ask),” Conover told Rogan. “She is now a researcher and went into deep detail about the medical science.”

Subsequent to the Rogan-Conover debate, the University of Pennsylvania’s Lia Thomas, a transgender athlete, winning the 500m freestyle at the NCAA swimming championships arguably offers supporting evidence to those concerned about the fairness of allowing trans-woman to compete in women’s athletics.

After agreeing to disagree on trans-athletes, the Rogan-Conover moved into whether there is enough research to understand the impact of hormonal therapies and transition surgeries on adult and pre-adult individuals.

Writes Tannehill for The Huffington Post:

“Given the level of harm involved when medical care is denied (to trans-persons), and given how unusual regret is, denying medical care to everyone based on the outliers makes no logical or ethical sense. In other words, you would do more harm to more people by denying everyone access than by keeping the system we have in place or even expanding access. Every major medical organization supports access to transition-related care and deems it medically necessary for a reason: The actual peer-reviewed evidence supports it.”

The Rogan-Conover conversation, however, turned much more combative when discussing hormonal therapies and other conversion procedures for gender incongruence among children (‘trans-children’).

Unintentionally, Tannehill’s book highlights how genuinely limited the research has been on the impact of gender-transition, hormonal therapies conducted on pre-pubescent children.

In the absence of definitive research, Rogan and Conover were left with their instinctive feelings and crude understanding of the transgender issue as it relates to children.

But, after all, that is how public opinion forms. People talking about things they don’t fully understand, helping others form opinions based mainly on gut instincts in lieu of anything more substantive. And this is O.K…that is how our social system works.

It isn’t perfect, and it typically doesn’t solve any issue to an acceptable extent. As social scientist Charles Lindblom observed many years ago, our institutions (including the scientific establishment) tend to muddle through, or to borrow a phrase from actor Will Smith’s son Jade Smith in a more contemporary context, “That’s how we do it.”

Unfortunately when it comes to effective public policy, it is usually not defensible just to say ‘that’s how we do it’ and proceed to ‘muddle through.’ At some point, analysts and policymakers must acknowledge their personal biases and intellectual limitations and help us all form more evidence-based opinions.

It’s a tough process, and not always linear in its progress.

Furthermore, it is always necessary to assess the objectivity the research, particularly when the researchers hold known, pre-existing opinions — such as Tannehill’s belief that hormonal trans-therapies are safe and optimal for pre-pubescent children.

Why would anyone reading “Everything You Ever Wanted to Know about Trans (But Were Afraid to Ask)” be surprised on the author’s conclusions? They were most likely determined before one word in the book was written.

In fact, her conclusions are far from conclusive, particularly with respect to children.

But that doesn’t necessarily mean Tannehill’s conclusions are without merit either. It does mean, the existing research doesn’t definitively inform us about the long-term effects of altering natural hormonal processes during pre-pubescent periods. There are early attempts at addressing this issue, but they are just that…early attempts.

“Gender-affirming hormone therapy is considered safe, but is not without risk,” says Julia Cartaya, MD. The benefits include a general improvement in mental health functioning, a decrease in body dissatisfaction and an improved sense of wellbeing, according to Cartaya.

But policymakers need better information than that to make long-term decisions.

The long-term impact of hormonal trans-therapies on pre-pubescent children is a legitimate analytic question that is yet to be fully answered by existing research. Admitting that and doing something about it, sooner rather than later, will be critical to moving society forward on policies related to the trans-community.

  • K.R.K.

Send comments to kroeger98@yahoo.com

The necessary takeaway from the Will Smith-Chris Rock kerfuffle

By Kent R. Kroeger (Source: NuQum.com; March 29, 2022)

Are we still so culturally backward that men have to defend the ‘honor’ of their wives when verbally attacked? Are we still in the Miocene epoch? Are we living in Saudi Arabia?

Insult my wife. She can defend herself.

Women aren’t property or frail flowers who need men to defend them. Frankly, the women in my life are especially adept at using words to turn their antagonists into puddles of feeble mush.

Too much has already been written and broadcasted about the now infamous Will Smith slap attack on comedian Chris Rock during the 2022 Oscars awards ceremony.

Apparently, Smith thought an insult by Rock directed at his wife — Jada Pickett Smith — warranted a face slap before an international audience.

Lacking any quantitative data at this point, my impression is that public opinion is evenly split as to whether Smith’s actions were justified (or, at least, understandable) given the meanness of Rock’s joke about Smith’s wife.

Shocking to me, however, is the number of celebrities and pop culture commentators who offered their support to Smith, none more surprising than British TV personality, Piers Morgan, who opined:

“Making fun of a woman who’s losing her hair isn’t funny, it’s just unkind.

As for Will Smith, as the cancel culture mob race to destroy him, hysterically demanding he be stripped of his Best Actor award and charged with assault, I find myself moved to defend him.

He was standing up for his wife, the woman from whom he blew off the dust when she was going through a rough time, and said he was going to make shine, and created a safe space for her to get healthy and to grow and define herself.

In previous eras, he’d have been saluted for defending his girl, not savaged by an overly sensitive snowflake society.

And I say that as someone who was once punched in the head by Jeremy Clarkson at the British Press Awards in 2004 after publishing something embarrassing about his private life, and I have no problem with what he did.”

Morgan may not care that he was physically assaulted for something he wrote, but I do.

If someone says something cruel or unfair about your spouse (or anyone else), you do not have the right to physically assault them. Period. There is no gray area here.

“I know we’re all still processing, but the way casual violence was normalized tonight by a collective national audience will have consequences that we can’t even fathom in the moment,” tweeted Janai Nelson, president and director-counsel of LDF, the NAACP Legal Defense & Educational Fund, Inc.

While acknowledging that Rock’s throwaway joke about Pinkett Smith was “beneath him,” Howard Stern, one of our nation’s most important cultural interpreters, made clear that the more urgent problem was with Smith, not Rock: “He (Smith) clearly has an emotional problem. Here’s Hollywood that’s so outraged by every little thing — not one person got up and said, ‘Hold on, we’ve got an out of control situation here.’ How this guy was allowed to sit there for the rest of the awards, and he’s laughing it up and having a good time with his wife… he just assaulted Chris Rock.”

I, too, didn’t think Rock’s joke about Pinkett Smith’s shaved head was funny or comprehensible (GI Jane? Who gets that reference?). But that is not the paramount issue surrounding Will Smith’s unhinged reaction to it. The issue is (and must be) whether it is acceptable for someone aggrieved by a comic’s joke — no matter how cruel — to use physical violence to relieve their anger (or appease their spouse).

Was this a criminal assault or civil assault or both? The law is unequivocal on these questions.

“The answer to both questions is ‘Yes’,” according to Drew Page, co-owner and partner of Randall Page, PC, a Virginia law firm. “In criminal law, assault and battery assault is a harmful or offensive touch of another with the intent to create reasonable apprehension of imminent harm. Will Smith went up to Chris Rock with the intention of creating a reasonable apprehension of imminent harm and actually completed that by smacking him in the face with a harmful, offensive touching to his face.”

Should Smith be arrested or possibly go to jail for this act? No. As human beings, we have to accept our inherent flaws and allow for a certain margin of error when it comes to individual behavior. While we can’t criminalize all aspects of human nature, we should always be pushing ourselves to follow “the better angels of our nature,” particularly when our instincts plead otherwise.

Smith committed a crime on an international stage, and he is unlikely to face civil or criminal charges for it because of the good nature of the man he assaulted and the complicity of the industry he works in, not the righteousness of his act.

  • K.R.K.

Send comments to kroeger98@yahoo.com

Are democracy and freedom on the run?

By Kent R. Kroeger (Source: NuQum.com; March 17, 2022)

“Truth is what you get other people to believe.” — Tommy Smothers

Larry Diamond, a senior fellow at the Hoover Institution and at the Freeman Spogli Institute at Stanford University, summarized the mainstream view of Vladimir Putin’s Russia by the American foreign policy and defense establishment in a 2016 article for The Atlantic:

“Since the end of World War II, the most crucial underpinning of freedom in the world has been the vigor of the advanced liberal democracies and the alliances that bound them together. Through the Cold War, the key multilateral anchors were NATO, the expanding European Union, and the U.S.-Japan security alliance. With the end of the Cold War and the expansion of NATO and the EU to virtually all of Central and Eastern Europe, liberal democracy seemed ascendant and secure as never before in history.

Under the shrewd and relentless assault of a resurgent Russian authoritarian state, all of this has come under strain with a speed and scope that few in the West have fully comprehended, and that puts the future of liberal democracy in the world squarely where Vladimir Putin wants it: in doubt and on the defensive.”

Replace the word “Russian” in the above excerpt with “Iranian” or “Venezuelan” or “Chinese” or “Islamic” and you’ve captured the essence of U.S. security policy since the fall of the Soviet Union in 1991: Protect existing liberal democracies, guide others into becoming one, and isolate those that resist the transition.

And have we been successful?

Figure 1 shows democracy/freedom indices that summarize current freedom levels for a selection of countries — the sum of which account for over half of the world’s population.

If the existing freedom and democracy landscape is any indication, there are tremendous success stories on display. Taiwan, South Korea, Chile, Brazil, Poland, and Indonesia are good examples of countries who have made successful transitions to democracy since the 1980s. Many of these new democracies remain fragile; but, apart from China and Russia and their few confederates, variations in the liberal democratic model dominate the international order today. If our time frame is the last 40 years, the conclusion remains that it is autocracies that not only are on the run, but cornered and isolated.

Figure 1: Freedom/Democracy Indices for Selected Countries (2020/21)

Data sources:

Human Freedom Index 2021 — World Population Review (https://worldpopulationreview.com/country-rankings/freedom-index-by-country)
The Economist Democracy Index 2021 (https://www.eiu.com/n/campaigns/democracy-index-2021/)
Quality of Democracy Index 2020 — Univ. of Würzburg
(https://www.democracymatrix.com/ranking)
Global Freedom Scores 2021 — Freedom House
(https://freedomhouse.org/report/freedom-world/2021/democracy-under-siege)
Corruption Perceptions Index 2020 — Transparency.org
(https://www.transparency.org/en/cpi/2020)

Combined Freedom Index computed by the author (K. Kroeger)

But if our time-frame is shorter, it is also apparent that liberal democracies aren’t thriving either.

As Figure 1 suggests, some countries often portrayed as “liberal democracies” in the news media are, in fact, significantly below the standards of full democracies. A noteworthy number of them are former Warsaw Pact countries (e.g., Hungary) and former Soviet Republics (e.g., Armenia, Ukraine, Georgia) — which are often called ‘hybrid’ systems as they combine characteristics from both authoritarian and democratic systems.

Common among their growing democratic deficiencies is increased governmental control of the justice system, civil society, and media, while rolling back many basic human and political rights, according to separate reports by the Civil Liberties Union for Europe, which is a Berlin-based civil rights advocacy group, and Economist Intelligence. The targeted harassment of migrant and minority groups especially has been on the rise in many of these countries.

Despite the sweeping goodwill generated by the international community’s near-unanimous condemnation of Russia’s invasion of Ukraine, can it be interpreted as an endorsement of liberal democratic ideals? Given the recent backtracking on liberal democratic principles by many of the countries now censuring Russia, it is hard to conclude one has anything to do with the other.

Are full democracies a dying breed?

At the end of the original Cold War, political scientist Francis Fukuyama conjectured: “What we may be witnessing is not just the end of the Cold War … but the end of history as such: that is, the end point of mankind’s ideological development and the universalization of Western liberal democracy as the final form of human government.”

Fukuyama has since pulled back from his original optimism, and as we stand on the brink of a new Cold War, it may be fair to wonder if we are witnessing the slow death of liberal democracies instead of their immutable primacy.

The Canadian government’s ability (and craven willingness) to freeze the bank accounts of truckers who organized or blocked roads in a three-week protest over the nation’s COVID-vaccine mandates indicates freedom and democracy are not immutable conditions.

According to Economist Intelligence (EIU), which ranks Canada as the 12th most democratic country out of 167 countries, Canada’s EIU Democracy Indexscore dropped 3 percent between 2020 and 2021 (i.e., during the pandemic).

If Canada can backslide on democracy, even if just in the margins, any country can. And, over the past 30 years, the world has witnessed cases many such cases: Democratic experiments that failed spectacularly include Egypt, Russia, and Venezuela, while some more successful new democracies like Brazil, Hungary and South Africa have experienced smaller, but significant, declines in civil freedoms — and add a disheartening coup in Tunisia last year, one of the few democracies in the Arab world.

We see these democracy declines in Figure 2 which shows changes in the EIU Democracy Index since 2006 for seven world regions. Since 2006, the EIU Democracy Index declined in every region except Asia/Australasia.

Figure 2: Economist Intelligence’s Democracy Index (2006 to 2021)

Data Source: Economist Intelligence

Democracy is on the run in many places…but not everywhere. Figure 3 offers some positive examples where democracy and freedom are on the rise.

Since 2006, the most consistent increases in EIU Democracy Index scores occurred in Israel (+0.7), South Korea (+0.3) and Taiwan (+1.2). And despite score declines since 2015, Indonesia and Nigeria nonetheless score significantly higher on the EIU Democracy Index today than they did in 2006 (+0.3 and +0.6, respectively).

Figure 3: Economist Intelligence’s Democracy Index— Selected Countries

Data Source: Economist Intelligence

Methodological issues

Are small changes (e.g., ±0.1)in the EIU Democracy Index truly significant? From a statistical perspective, the average margin of error (i.e., standard error multiplied by 1.95) for the 167 countries in the EIU dataset was ±0.16 — which is why, to be conservative, I only report changes of 0.3 points or higher in this essay.

However, before accepting the democracy/freedom indices discussed here, realize the substantial criticisms of these indices.

The criticisms include (but are not limited to):

  • Universalism versus relativism: Is democracy a universal concept understood the same way worldwide or is its understanding relative to the culture or context in which it operates? If it is a relative concept, summarizing it using one index across all countries is problematic.
  • Temporality: The concept of modern democracy has evolved over time. To the Greeks, it meant “rule by the people.” Post-American Revolution, the definition added consideration of constitution-based rights and protections, and post-WWII, the importance of free market liberalism became essential. And at what extent do these democracy/freedom measures consider the relevance of people’s freedom from worries over the availability of quality health care, housing and education? The point is that comparability over time, including potentially short periods of time, cannot be assumed for any democracy/freedom measure.
  • Non-normality: Most democracy indices are not normally distributed when all countries are tabulated. This is not necessarily a problem if that is how the world’s political systems are distributed, but if a researcher wants to use distribution-based statistical methods to test hypothesis, non-normality makes analyses somewhat thorny.
  • Interchangeability: “Different measures of democracy can lead to substantially different findings and interpretations,” according to Andrea Vaccaro, a former PhD Fellow at United Nations University’s World Institute for Development Economics Research whose research focuses on cross-national measures of democracy and state capacity.

Faced with the problems inherent in cross-national democracy measures, particularly interchangeability, Vaccaro concludes, “To overcome problems related to weak interchangeability, if a single measure cannot be credibly chosen on theoretical grounds, this author recommends users of the measures to validate their findings with multiple measures of democracy.”

Any single democracy/freedom index or aggregate combinations of them must be viewed with abundant caution, particularly given their likely normative bias that favors the liberal (“free market”) democratic model. For this reason, it is best to view the data presented in this essay as evocative rather than definitive.

Is the Russia-Ukraine war part of the democracy-authoritarianism struggle? Probably not…

Attempting to explain the timing of Russia’s invasion of Ukraine, Canadian Prime Minister Justin Trudeau recently surmised that democracies weakened through the spread of misinformation on social media prompted Putin’s decision:

“We see a bit of a slippage in our democracies — countries turning towards slightly more authoritarian leaders, countries allowing increasing misinformation and disinformation to be shared on social media turning people against the values and the principles of democracies…unfortunately (this) emboldened Putin to think that he could get away with this (invasion of) Ukraine.”

An emboldened Putin invaded Ukraine because of misinformation on social media?

That is an adventurous (reckless) claim given the evidence is substantial in other directions as to why democracy has experienced significant declines over the past decade. Near the top of that list is the COVID-19 pandemic:

“The pandemic has had a negative impact on the quality of democracy in every region of the world,” concludes EIU in their 2021 report. No world leader should know that better than Trudeau. Among the most advanced economies, only Italy and Greece have implemented more draconian pandemic restrictions than Canada, according to Oxford University’s Covid-19 Government Response Tracker (OxCGRT).

The other major stresses on democracy over the past decade have been declines in press and religious freedoms (civil liberties), political party financing increasingly dependent on wealthy elites, lack of government transparency, financial profiteering by political elites, and low accountability (e.g., incumbency advantage). “Citizens increasingly feel that they do not have control over their governments or their lives,” says the EIU 2021 report.

Could social media have contributed to citizens’ awareness of these deficiencies in their country? Absolutely.

Does some of the information passed through social media contain misinformation? Of course, as happens through establishment information sources as well.

But did social media and the misinformation passed through it break down democracies to the point Putin decided now was the time to invade Ukraine?

All I can say is, Mr. Trudeau, show us your data.

To my eyes and ears, Mr. Trudeau’s causal model seems dubious and, most likely, untestable. Ivermectin has more quantitative support than his “social media has weakened our democracies and therefore Putin attacked”-thesis. But that didn’t stop him from throwing his geopolitical folk theory into the social ether.

Trudeau’s message is clear: Canadians, if you disagree significantly with me, by definition, you are spreading misinformation and must be stopped. In other words, according to Mr. Trudeau, censor dissenting views by any legal means possible.

But it is not just in Canada. Increasingly, political (and media) elites across the globe are endeavoring to control the content and flow of information under the guise that only “they” know the truth. The democracy/freedom indices cited in this essay offer indirect but suggestive evidence of this reality.

However, such an elitist worldview as expressed by Trudeau (and others) defies the well understood dynamic on how human knowledge advances —Knowledge growth is both a bottom-up as well as a top-down processKilling one half of the process, kills both sides.

But Trudeau is only doing what democratically-elected leaders across the world are attempting to do (and increasingly succeeding at) — controlling the information allowed to disseminate over the general population.

The prevailing belief among the political class is that controlling information is tantamount to controlling their own prosperity and destiny. On that point, they are probably correct.

But if the wider goal is to protect our liberal-democratic principles and institutions, then I contend that the most dangerous threat to their existence is not Vladimir Putin’s Russia or misinformation found on social media, but rather the political and economic elites that dominate the liberal-democratic landscape.

  • K.R.K.

Send comments to: kroeger98@yahoo.com

Freedom also dies in the light of day

By Kent R. Kroeger (Source: NuQum.com; February 28, 2022)

“My definition of a free society is a society where it is safe to be unpopular.” Adlai Stevenson

“If liberty means anything at all, it means the right to tell people what they do not want to hear.” George Orwell

Freedom can never be taken for granted.

Russia’s violent and ill-advised invasion of Ukraine brings this reality into immediate focus.

But the events in Ukraine overshadow decidedly smaller, long-festering threats that nonetheless, in the collective, may be eroding freedoms worldwide with as much certainty.

One such small threat was highlighted by a recent news story that warranted little more than a minor headline on sports news websites such as ESPN.com and CBS Sports.com.

On February 25th, Callaway Golf, the largest golf equipment manufacturer in the U.S., decided to “pause” its business relationship with legendary golfer Phil Mickelson, a six-time major champion, over “controversial” remarks he made in an interview about Saudi Arabia, the country financing a new professional golf league to compete with the dominant PGA Tour.

Earlier in the week, KPMG (a Big Four accounting firm), Workday (a large U.S. software firm) and Amstel Light terminated their relationship with Mickelson.

What did Mickelson do?

He told a journalist that, while he recognized Saudi Arabia was using the new golf league to “sportswash” the country’s well-documented human rights violations, he was prepared to look past that in order to put pressure on the PGA Tour to increase compensation for that tour’s golfers.

“We know they killed (Washington Post columnist Jamal) Khashoggi and have a horrible record on human rights. They execute people over there for being gay,” Mickelson told The Fire Pit Collective’s Alan Shipnuck. “Knowing all of this, why would I even consider it? Because this is a once-in-a-lifetime opportunity to reshape how the PGA Tour operates.”

Mickelson, who also described the Saudi’s as “scary,” issued an apology within days of news getting out about his Saudi-related comments:

“Although it doesn’t look this way now given my recent comments, my actions throughout this process have always been with the best interests of golf, my peers, sponsors and fans,” he wrote on Twitter. “There is the problem of off-the-record comments being shared out of context and without my consent, but the bigger issue is that I used words that do not reflect my true feelings or intentions. It was reckless, I offended people, and I am deeply sorry for my choice of words. I’m beyond disappointed and will make every effort to self-reflect and learn from this.”

Mickelson’s fellow golfers offered little support to the backlash over his comments, exemplified by Rory McIlroy who called Mickelson “naive, selfish, egotistical, (and) ignorant.” [A description that could apply to almost every celebrity I’ve ever met.]

Rarely mentioned or hyperlinked in the news reporting about Mickelson’s comments were details of Saudi Arabia’s most egregious human rights violations. So here is an attempt to remedy that oversight:

Human Rights Watch 2021 Report on Saudi Arabia

Amnesty International 2020 Report on Saudi Arabia

U.S State Department 2020 Report on Saudi Arabian Human Rights Practices

It is understandable to think the public admonishment of a multi-millionaire golfer over critical comments about Saudi Arabia is not relevant to the average citizen, but consider this — If an independently wealthy golf hero can be forced to publicly prostrate himself over statements he made based on widely accepted fact, imagine how an average schlub would be disciplined? Or someone from a marginalized community? Or someone who dares to challenge the status quo or the powerful?

The words of Stevenson and Orwell have never been more germane, but it is perhaps this quote that is more pertinent: “In a time of universal deceit, telling the truth is a revolutionary act” (a quote falsely attributed to George Orwell).

I respect the right of private corporations and entities to censor those who use their services or are under their employ. But it is unfortunate when the news media fails to challenge them for such practices.

It is particularly worrisome when people who speak their mind in good faith are then threatened with the loss of their livelihood.

The tyranny of the thought police does not always operate in darkness. Anymore it appears to happen in the light of day.

  • K.R.K.

Send comments to: kroeger98@yahoo.com

State policies mattered during the COVID-19 pandemic

By Kent R. Kroeger (Source: NuQum.com; February 24, 2022)

In a previous essay, I shared a statistical model that partitioned variation in COVID-19 death rates across the 50 U.S. states (plus the District of Columbia) based on a variety of factors, including the stringency of state COVID-19 policies, vaccination rates, preexisting economic conditions, the availability of nurses in nursing homes, and the healthiness of the state’s population.

The primary conclusion was that stringent state-level COVID-19 policies had a discernable association with death rates, all else equal, but that preexisting levels and changes in a state’s unemployment rate had a comparable, if not stronger, relationship.

Lockdowns and other COVID-19 mitigation policies worked in minimizing COVID-19 death rates, but their positive impact was betrayed somewhat by the extent to which they harmed a state’s economy and employment levels.

In the midst of a worldwide virus pandemic, unemployment and economic distress can kill just as ruthlessly as a virus.

It is far too easy in our highly partisan political environment to see the world in oversimplified motifs such as: Democrats trust the science and Republicans deny it.

That lazy conceit is not only inaccurate, it is unconstructive to a public debate on how to handle a viral pandemic.

Throughout this public health crisis, the science has been understandably tentative, sometimes ambiguous and too often nakedly political.

Wear masks. Don’t wear masks. Just kidding…wear masks…properly…but they must be the good ones.

People exposed to COVID-positive individuals should quarantine for 10 daysmake that 5 days.

If you are vaccinated, you don’t need to wear a mask…scratch that…yes, you do.

Getting the virus doesn’t produce a natural immunity comparable to the vaccines…or, maybe, it does.

And why would anyone expect the public policies issued in this environment to be consistent and coherent?

The reality is that the science on COVID-19 is evolving along with the virus itself. Science is never perfect. It makes mistakes. Politicians and media personalities can lecture others to “trust the science,” but actual scientists don’t have that luxury. They can’t trust the science. By training, it is their job to always question it. Poke it. Prod it. Unrelenting skepticism is a virtue in their line of work, not a vice.

More crucially, science doesn’t operate in a vacuum. When science is translated into policy — as it has been throughout the COVID-19 pandemic — it is a political act. Scientists can’t be expected to understand the social implications of their research findings and recommendations — which is why, in our system of government, we purposefully put elected representatives between the scientists and their policy recommendations. The U.S. is a representative democracy, not a technocracy — and for good reason, policymaking requires a wholistic view of issues that few scientists possess.

In an article for the American Institute for Economic Research, economist Jon Murphy outlined how the disconnected perspectives between elected leaders and scientists explain the cascade of mistakes and contradictions that regrettably define many of the policy decisions made during the COVID-19 pandemic:

“Experts are just like us. They are experts in their specific fields, but not beyond them. The problem with a pandemic is that it is not simply a medical phenomenon. There are economic issues at play, political issues at play, mental health issues, educational issues, etc. Dr. Fauci may be a brilliant immunologist, but he is no economist.”

State policies mattered during the COVID-19 pandemic

At the beginning of the pandemic, World Health Organization Director General Tedros Adhanom Ghebreyesus warned that “this virus does not respect borders.”

Two years later, he has been proven right — no jurisdiction has been spared.

But a handful of Republican governors confused the easy transmissibility of the coronavirus with the belief that strict, broadly-targeted statewide policies could not contain the virus’ spread and reduce the number of deaths. [Early in the pandemic, I believed the same thing.]

They (including me) were dead wrong.

However, these same governors rightfully recognized that strict COVID-19 lockdowns also cause significant economic harm, particularly to people who were financially vulnerable heading into the pandemic. Florida Governor Ron DeSantis repeatedly resisted lockdown policies because, in his words, they would “hurt families who can’t afford to shelter in place for six weeks.”

Was he wrong?

The answer is complicated. Still, I prefer simple displays of data whenever possible.

So, my first stab at answering the question is looking at a basic bivariate plot of state-level COVID-19 deaths per capita versus the average daily stringency of state-level COVID-19 policies from March 1, 2020 to December 1, 2021.

Figure 1 is that initial plot…

Figure 1: COVID-19 deaths per 1 million people by the OxCGRT Policy Stringency Index (March 2020 to December 2021)

Data sources: Oxford University’s OxCGRT and RealClearPolitics.com

It is evident from Figure 1 that Republican states disproportionately pursued less stringent COVID-19 policies and suffered disproportionately higher COVID-19 deaths per capita.

Mississippi, Arizona, Alabama, and South Dakota are not COVID-19 success stories. They largely ignored the virus and the consequences can be measured in deaths among their residents. In contrast, Hawaii, Vermont, Maine, Alaska, Oregon and Washington seemed to do pretty well. They instituted strict COVID-19 policies which resulted in significantly fewer deaths per capita.

But Figure 1 does not consider the economic impact of COVID-19.

Figure 2 plots COVID-19 deaths per capita at the state-level versus the change in unemployment.

Figure 2: COVID-19 deaths per 1 million people by the Change in Unemployment Rate (March 2020 to December 2021)

Data sources: U.S. Bureau of Labor Statistics and RealClearPolitics.com

Now we have a better picture as to which states performed better than others during this pandemic.

Figure 2 is quadrant analysis. The upper-left-hand quadrant (high COVID-19 death rates and small changes in the unemployment rate) and the lower-right-hand quadrant (low COVID-19 death rates and large increases in the unemployment rate) are non-exemplary cases. These states either chose to minimize the pandemic and suffered disproportionately high numbers of deaths, or chose to shutdown their economies and suffered economically.

The other two quadrants separate out the genuine failures and leaders of the COVID-19 pandemic. In the failure category are states like New York, New Jersey, Michigan and Massachusetts — all “Blue” states — who suffered high COVID-19 deaths rates and large increases in unemployment.

Their COVID-19 policies failed by any objective measure.

On the positive side are states that minimized COVID-19 deaths rates while keeping their economies relatively strong. Those states include Vermont, Utah, Washington, New Hampshire, Nebraska, North Carolina, Minnesota, and Wisconsin — three of which are “Trump” states.

It is convenient to assume “Blue” states outperformed “Red” states during the COVID-19 pandemic. If COVID-19 death rates are your preferred metric, they did. But when considering the impact of COVID-19 policies on state economies, the biggest failures were, by far, some of the biggest “Blue” states and a meaningful percentage of the successful states were “Red.”

Mississippi and Arizona kept their economies open (and successful) during the pandemic and paid a significant price in human lives.

In contrast, Hawaii, Maine, California and Maryland shut their economies down during the pandemic and saved many lives in the process.

Who was right and who was wrong?

In the end, voters will decide which states pursued the best COVID-19 policies…but don’t assume voters will choose human lives over economic growth.

  • K.R.K.

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State COVID measures made a difference, both positive and negative

By Kent R. Kroeger (Source: NuQum.com; February 14, 2022)

Recently, Dr. Anthony Fauci declared the COVID-19 pandemic in the U.S. is “exiting the full-blown stage.”

Unfortunately, Dr. Fauci, like the rest of the medical and scientific community, has been more hostage to the coronavirus than a prescient sage as to its future trajectory.

Like a broken analog clock, Dr. Fauci may be right this time, but what a price the world continues to pay for a virus whose behavior often has been unpredictable and whose origins still remain unknown.

However, getting more attention than Dr. Fauci’s declaration about the next phase for COVID-19 was a working paper (i.e., not peer-reviewed) by three economists who conducted a meta-analysis on the effects of public policy on COVID-19 mortality. In this study, economists from Johns Hopkins University, Lund University (Sweden), and the Center for Political Studies in Copenhagen, Denmark — Jonas Herby, Lars Jonung, and Steve H. Hanke — found that “lockdowns in Europe and the United States only reduced COVID-19 mortality by 0.2 percent on average.”

Apart from the predictable efforts by news media elites to smear the credentials of the study’s authors and the intellectual value of a non-peer-reviewed working paper, sober academics and medical experts found the study interesting but far from conclusive. [For example, the study only covered outcomes during 2020.]

Dr. Vinay Prasad, MD MPH, offers a balanced perspective on the this new lockdown study: “(This) early meta-analysis suggests (lockdowns) didn’t do that much. I don’t find it that incredible but I also think it’s not the right moment to do a meta-analysis because the lockdown’s effect is a massive perturbation on the economy and society (and) it’s not just about the short-run mortality. What about the long-run mortality? What about the mortality you’re paying for down the road because of all the disruptions to society?”

A common analytic tool employed in the studies analyzed by Herby, Jonung, and Hanke was Oxford University’s Covid-19 Government Response Tracker (OxCGRT) which collects systematic information on policy measures that governments have taken to tackle COVID-19. Included in their tracking data is a “stringency index” summarizing these policy measures for each U.S. state which is computed on a daily basis and made available to the public on GITHUB.

According to the creators of the OxCGRT Stringency Index, the index summarizes the strictness of COVID-19 policies that primarily restrict people’s behavior, including containment, closure, economic, health system and vaccination policies.

[All variables used in this analysis are available in my personal GITHUB repository or can be obtained directly from the original sources listed at the bottom of Figure 2.]

Figure 1 shows 12 selected U.S. states to represent three levels of the stringency index (High Stringency States, Medium Stringency States, and Low Stringency States).

Figure 1: Stringency Index scores for selected U.S. states from February 1, 2020 to February 2, 2022

On its face, the OxCGRT Stringency Index appears to strongly correlate with a common understanding of the states that have implemented restrictive COVID-19 policies and those that did not during this two-year pandemic.

A linear model of state-level COVID-19 death rates

Is there any evidence that stringent state-level COVID-19 policies helped reduce death rates?

Since it is unwise to make causal statements in the context of a linear model using aggregated, cross-sectional data, the answer is an emphatic ‘maybe.’ But the associations in the state-level COVID-19 data are strong enough to increase the plausibility of such conclusions.

[In general, I tried to avoid causal statements in this essay and preferred to use terms such as ‘association’ and ‘correlation.’]

Using the variables displayed in Figure 2, I estimated a linear model to explain state-level variations (51 cases) in the number of COVID-19 deaths per 1 million people.

[Model estimates and diagnostic measures can be seen in the Appendix below. More detailed diagnostics are available upon request.]

Figure 2: The relative importance of predictor variables on state-level COVID-19 death rates from February 1, 2020 to February 2, 2022

According to the linear model, state-level unemployment rates at the beginning of the pandemic, changes in those unemployment rates between March 2020 and December 2022, and the number of confirmed COVID-19 cases (per 1 million people) are positively associated with higher state-level death rates. In other words, states with relatively weak economies heading into the pandemic and states that experienced the most economic stress during the pandemic have significantly higher death rates. In fact, they are the two variables most associated with COVID-19 death rates.

But what factors helped to lower state-level COVID-19 death rates?

Among those factors which associate with lower state-level death rates, the number of nursing staff hours per nursing home resident day appears to be the strongest, followed by aggregate measures of people’s exercise habits, the strictness of COVID-19 policies, and a state’s vaccination rate.

By interpreting the standardized regression coefficients in Figure 2, the concrete impact of the predictor variables are stunning.

For example, given that state-level COVID-19 death rates have a standard deviation of 740 deaths per 1 million people, a one standard deviation increase in the unemployment rate change associates with an increase of 363 deaths per 1 million people (or about 117,600 nationally if the unemployment rate change is applied to all 50 states and the District of Columbia).

If every state entered the pandemic with a higher unemployment rate by one standard deviation, the COVID-19 death rate might have been higher by 296 deaths per 1 million (or about 96,000 people).

By comparison, a one standard deviation increase in the stringency index associates with 200 fewer deaths per 1 million people (or about 65,000 people nationwide).

Cautionary note: Due to the high level of collinearity between state-level vaccination rates and COVID-19 stringency policies, it is preferable not to interpret their standardized coefficients separately and more instructive to combine these parameters to estimate their combined impact.

When we do that, it appears the reduction in COVID-19 deaths rates associated with higher vaccination rates and stronger COVID-19 policies is comparable in their impact to similar changes in unemployment rates.

The implication is that policymakers in the future would be smart to explicitly weigh the potential costs and benefits of those COVID-19 policies before making decisions. Through their impact on state economies, strict COVID-19 measures (such as lockdowns) have the potential to kill as many people as they save.

Final thoughts

A complete analysis of the impact of policy choices on COVID-19 death rates should also consider “collateral” deaths, which are deaths not directly related to COVID-19 but the result of strains on hospital resources such as ICU bed utilization rates and staffing availability.

This analytic augmentation would bring to the forefront the question of the total impact of the unvaccinated on state-level death rates.

In other words, the unvaccinated not only increase their personal risk of dying from COVID-19, but they increase the probabilities that other people will die of other causes when hospital and ICU beds are filled to capacity.

How many collateral deaths should be added to the current U.S. COVID-19 death count of almost 950,000 people?

A credible estimate of collateral deaths comes by way of a statistical model computed at the Centers for Disease Control and Prevention (CDC) which calculates the number of “excess” deaths occurring in the U.S. each week. Through these models, the CDC estimates “excess” deaths caused by COVID-19 and “excess” deaths by other causes.

Since the widespread availability of the COVID-19 vaccines after March 2021, the CDC estimates almost 80,000 non-COVID-19 “excess” deaths have occurred through January 1, 2022, almost all of which occurred during COVID-19 surge periods when the most stress was placed on hospital resources (beds, staff availability, etc.). Even if we deduct the probable impact of vaccinated people hospitalized for COVID-19 during this period, the unvaccinated still account for about 66,000 collateral deaths, according to the CDC numbers.

That is a big number which accounts for around three percent of all U.S. deaths during that period, or about 270 collateral deaths per day.

When President Biden said last July that anti-COVID-19 vaccine propagandists are “killing people,” he was articulating what most fully vaccinated Americans believe — the unvaccinated are indirectly guilty of killing thousands of their fellow citizens.

Was he right in saying that?

In a simplistic sense, yes, but not if one rightfully considers why so many Americans remain skeptical of the COVID-19 vaccines, effective as they are in preventing severe illness from the virus.

As I’ve written elsewhere, despite my own aggressive eagerness to vaccinate myself and my family, I understand why many people are resistant to receiving these vaccines.

The reasons are easy to list:

(1) The COVID-19 mRNA vaccines are based on a new technology with debatable levels of long-term research to add confidence in their widespread use,

(1) The mainstream U.S. news media too often serves partisan interests and subsequently is untrustworthy to dispense non-partisan public health recommendations according to millions of Americans.

(2) The U.S. government’s acquiesced to pharmaceutical companies’ insistence on liability immunity for the COVID-19 vaccines which were developed under President Trump’s taxpayer-financed Operation Warp Speed.

(3) The pharmaceutical industry’s ongoing intransigence in releasing their full vaccine testing data to independent researchers.

(4) Research suggesting the risks associated with the COVID-19 vaccines and myocarditis incidence among young males (i.e., they have a minimal risk of dying from COVID-19 and are more likely to experience myocarditis [heart inflammation] from the receiving the vaccines than from the catching the virus itself).

(5) Two scientists from the Food and Drug Administration’s vaccine advisory committee resigned last year over what they believed to be a rushed (‘political’) decision to recommend booster shots in relatively young populations. Writing with a group of other scientists in a September 2021 Lancet editorialthey said: “Although the benefits of primary COVID-19 vaccination clearly outweigh the risks, there could be risks if boosters are widely introduced too soon, or too frequently, especially with vaccines that can have immune-mediated side-effects (such as myocarditis, which is more common after the second dose of some mRNA vaccines [footnote],or Guillain-Barre syndrome, which has been associated with adenovirus-vectored COVID-19 vaccines [footnote]). If unnecessary boosting causes significant adverse reactions, there could be implications for vaccine acceptance that go beyond COVID-19 vaccines. Thus, widespread boosting should be undertaken only if there is clear evidence that it is appropriate.

According to Dr. Prasad, as yet, there is no persuasive evidence suggesting that boosting is necessary in healthy people between the ages of 12 and 50.

I don’t expect unvaccinated Americans are closely following the scientific debates over COVID-19 vaccines in medical journals, but I am constantly amazed in my interviews with the unvaccinated how often they possess at least a basic familiarity with some of the more complicated issues within the vaccine research community (e.g., myocarditis).

Yes, misinformation is abound about COVID-19 in the cyberverse — but so is a lot of valid information finding its way into the everyday conversations people have over these vaccines and the COVID-19 pandemic in general.

Some people want to assume the unvaccinated are stupid. I believe the exact opposite is true — they are awash in information and given their overactive levels of distrust and skepticism, are over-thinking what should be a fairly simple decision.

Furthermore, I find it immoral to incriminate the unvaccinated when other European countries with a similar percentage of unvaccinated still have a substantially lower number of COVID-19 deaths per capita.

According to the New York Times, 65 percent of Americans are fully vaccinated, which is comparable to Europe (64%) as a whole.

And, yet, when we observe countries with similar vaccination rates to the U.S., they have substantively lower COVID-19 death rates:

Netherlands — 71% vaccination rate (1,242 deaths per 1M)
Greece — 69% vaccination rate (2,300 deaths per 1M)
Switzerland — 68% vaccination rate (1,532 deaths per 1M)
Austria — 68% vaccination rate (1,624 deaths per 1M)
Israel — 66% vaccination rate (1,066 deaths per 1M)
U.S. — 65% vaccination rate (2,882 deaths per 1M)

Why are they doing better?

It is still too early to draw strong conclusions when the pandemic is ongoing. But early research is finding that a health care system’s characteristics have helped some countries better handle the exigencies of the COVID-19 crisis.

Among those characteristics are country’s health profile, the number of nurses and doctors, the availability of hospital and ICU beds, and the level of trust citizens hold towards their fellow citizens, government, and health care experts.

The U.S. health care system is left wanting on these factors.

As evidence, since 1960, the U.S. has seen a consistent decline in the number of hospital beds per 1,000 people. According to World Bank data, the U.S. went from 7.9 hospital beds in 1970 to 2.9 in 2017.

The U.S. clearly wasn’t preparing for a future pandemic when it allowed so many rural hospitals to close over the past 50 years.

When comparing the European countries with similar COVID-19 vaccination rates to the U.S. by the number of hospital beds per one thousand people, the U.S. comes in dead last, according to the World Bank:

Netherlands — 3.2 hospital beds per 1K
Greece — 4.2 hospital beds per 1K
Switzerland — 4.6 hospital beds per 1K
Austria — 7.3 hospital beds per 1K
Israel — 3.0 hospital beds per 1K
U.S. — 2.9 hospital beds per 1K

But it is not just hospital beds that put the U.S. at a disadvantage in handling the coronavirus pandemic, it is a health care system in which job loss and financial insecurities drive too many citizens to forgo early and sometimes life-saving medical care.

The U.S. was not pandemic-ready in early 2020, and that is not the fault of the unvaccinated — it is the fault of our political, news media, health insurance, and medical community leadership.

Before shaming and blaming the unvaccinated — which doesn’t vaccinate one person and most likely leads to greater resistance to the jab — would it not make more sense to address the structural problems in a health care system where the most economically vulnerable suffer disproportionately during a national health crisis?

If anything, we all share in the blame for a national health care system that has been outperformed by Mexico in the COVID-19 pandemic (2,823 deaths per 1M vs 2,386 deaths per 1M, respectively). If we were doing as well as Mexico — where about 60 percent of its citizens are fully vaccinated — the U.S. would have 144,000 fewer deaths right now.

But it is so much easier just to blame the unvaccinated.

  • K.R.K.

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Appendix: Linear model estimates and selected diagnostics.