Archives for April 2019

Revising Public Health Practice

Sanitation, vaccines, control of various environmental factors that affect health, and much more have greatly improved our quality of life and our average lifespan. But while public health practice has come a long way, there are still numerous areas of improvement. Not only must public health practice improve in terms of communication with the public, but we must also work on improving how quickly scientific knowledge is used to update public health practice. Additionally, public health policy involving zoonotic disease (diseases which are contracted from animals) and protection of the health of livestock and pets, also requires serious attention.

Pseudoscience

The antivax movement, the push for homeopathy, and great deal of other pseudoscientific movements are hurting public health practice. While there’s still lot that we do not know about recent outbreaks of various diseases such as measles and whooping cough, medical science absolutely justifies the use of vaccines in the prevention of dangerous symptoms associated with these diseases. Meanwhile, the link between vaccines and autism has long since been debunked, and yet a large portion of the population still believes in it.

Furthermore, a number of people are choosing to forgo “traditional” medicine and instead use homeopathic treatment. Unfortunately, based on systematic review of available literature, there is no indication that homeopathy works any better than a placebo. There is also no scientific justification for a mechanism through which it should work. Homeopathy literally has every trace of active ingredient diluted out of the product, to the point where a person is just consuming a sugar pill. While the placebo effect can be a powerful medicine in and of itself, it is not a substitute for recognized gold standards of care.

Better science communication, and better education in philosophy, both should improve individual understanding of how science works and acceptance of standard medical treatments. However, there are still other issues. There are cases where our standard of care is outdated.

Living Systematic Review

One of the greatest concerns with public health practice is that it takes a very long time for new scientific evidence to become part of the public health practice. One estimate places the lag time between findings and implementation at 17 years.

Unfortunately, in order to alter public health practice, we need to have more than just a single investigation indicating efficacy. Public health practice relies heavily on systematic reviews. There are two options for systematic reviews. A systematic review can periodically be conducted to see if there’s additional information available. This option is the traditional route. Alternatively, a systematic review can be ongoing, where data is added at regular intervals and the conclusion is reevaluated.

This process is called a living systematic review. This option is fairly new. As of 2017, protocols for the process were still being developed. Elliott JH et al. 2017 discusses the importance of living systematic reviews (LVRs), and suggests that they may be most useful when there’s a lot of new research being done on a topic, when there’s still a lot that we don’t know about the topic, and when new information might change current protocol.

Maintaining Trust

Unfortunately maintaining trust is going to be difficult even if we can update our protocols more quickly. Long standing recommendations being overturned can be problematic because people may wonder why it took so long for the medical community to realize their mistake. Meanwhile constantly changing recommendations to fit new data could establish a view that the medical community is fickle.

People may also become even more confused about what to do for proper health. While this issue isn’t as problematic for people who regularly see a doctor for checkups, some don’t, and current medical recommendations do not actually suggest that they are necessary. This lack of necessity is likely to change if public health policy is updated on a more regular basis though, so this factor needs to be taken into consideration.

Call to Research Format

Even with living systematic reviews, new research needs to be conducted and we need to communicate limitations of existing research. One of the issues that prevents public health policy, and science as a whole, from being as up to date as possible, and evolving at a fast enough pace, is a failure to communicate. I have written numerous papers on concerns about current medical science practices and limitations of our understanding. These papers are not research papers in the normal sense. They fellow what I call the “call to action format.”

Most of my focus has been on vaccines. I’ve written on the issue with understanding recent measles outbreaks, as well as our limited understanding of how asymptomatic infections influence Whooping Cough epidemics. While there is a lot that we know about vaccines and their efficacy, there seems to be a lot that we do not know. And these unknowns are not being discussed in enough detail or frequency to drive new research that can be used to fuel living systematic reviews.

The Format

The first half of the call to research format is similar to a systematic review, but it’s more focused. It looks for specific gaps in our understanding, and summarizes them. It might take into account personal observations by the author, as well as specific questions that they have come across. Questions may also be pulled from existing systematic reviews.

The second half of the paper is a discussion on potential theories on the matter, and studies that can be conducted. The discussion isn’t as detailed as a research proposal, but a single call to research paper could have many suggestions on types of research that can be performed. There should be at least enough detail that a person reading the paper could take the suggestion and turn it into a full research paper.

Zoological Public Health Policy

The second half of this discussion is going to focus on a different aspect of public health. A lot of Americans have pets. While these figures are old, at least as of 2006, approximately 60% of Americans had some kind of pet, according to Gallup. 44% of Americans specifically own a dog, and 29% own a cat. And almost 80% of pet owners have both a dog and a cat.

The lack of information on how many people even have pets is one example of how public health policy needs to be improve. But why is such information important? What do pets have to do with public health? We can look to an article by A. S. Deller, who wrote an interesting piece on zombies, but not quite the zombies of science fiction. Various pathogens alter the brain function of their hosts and actually create what might as well be considered zombies. One such pathogen is Toxoplasma gondii (toxoplasmosis or T. gondii). This pathogen does affect humans, but the way in which it impacts its human hosts is not well known.

According to the CDC, 11% of of the population, aged six and up, have experienced a T. gondii infection. The pathogen can be contracted from eating exposed food, but a major source of infection is zoonotic (animal) sources. While T. gondii doesn’t cause humans to become zombies and seek out cats, it does seem to have neurological effects. In humans, the pathogen seems to be associated with increased risk of psychological conditions such as schizophrenia.

The length in time that it’s taken to even realize the issue, and the lack of protocol developed to deal with it, goes back to the first half of this discussion. Public health policy isn’t being updated fast enough. But the problem also shows that we need to be hyperaware of potential threats from pets, as well as livestock.

There is work being conducted on creating a vaccine for T. gondii, but it’s far from complete. I think that there are two reasons why there is currently no vaccine. One is simply the difficulty in creating the vaccine. The other is in the failure to consider it a problem. Yes, T. gondii infects a lot of our pets, but the public health community never really considered that too much of an issue, because we didn’t consider the potential risk to humans.

But we also need to be more aware of the risks that diseases pose to our pets. We need to make sure that vaccine schedules are up to date, that they receive the right vaccines, enough vaccines, and not too much vaccines. We have a responsibility to protect our pets, because they did not choose to live with us. And therefore public health practice really should dedicate more of its attention to veterinary public health. There are programs available, including MPH-VPH programs, but the attention paid to zoonotic disease, especially risks to pets and risk from pets, simply isn’t enough.

The post Revising Public Health Practice appeared first on The Spiritual Anthropologist.

The Socioeconomics of Mall-Towns

By politicoid Leave a Comment Apr 17

I’ve been thinking about this town in a mall concept for quite a long time. It’s been years since I first wrote my original article on the idea. At the time, I didn’t know much about blockchain or cryptoassets, but then again, neither did anyone else. In fact, back in 2012, when I first wrote my initial article on a city in a building concept, the grandfather of all cryptocurrencies, Bitcoin, was only 3 years old. Now I have a body of writing on cryptocurrency and blockchain, and how it will impact our future. So I’d like to integrate all of these ideas together into one theoretical project.

Blockchain Use as Citizenship

Those who use various blockchains and cryptoassets are tied together economically and socially. This is true, even with the very limited functionality of current blockchain architectures. As blockchain applications expand, and we begin to really use the technology to manage contractual agreements between individuals and groups, whether it’s through Agora Coin, or some other platform, a blockchain system will end up feeling more and more like a community.

In the future, I predict that pretty much all social programs will be managed by blockchain systems. Universal basic income, if it is implemented in the world, will be implemented through blockchain. The same goes with universal health coverage, social security, and other programs.

But like with current blockchain systems, there are bound to be disagreements, and those disagreements will result in forks or alternative systems, just as we saw Bitcoin give birth to Litecoin, BTC, and others. In a future world managed by blockchain, instead of changing citizenship, a person might simply change which platform they use.

Users might need to keep using the old chain for certain things, like paying certain bills that are attached to the old system, but even then it’s likely that there will be a lot of interchain compatibility. It would be very similar to obtaining new citizenship and maintaining dual citizenship, only much more voluntary. If a person doesn’t like the kind of social programs being managed by one chain, they just stop supporting it. If they don’t like the tax rate (inflation rate), then they would choose not to use the cryptoasset associated with the chain.

And if none of the blockchain systems fit what a person needs, or if they think there’s a better way of doing things, they can create a new system or fork an existing one. Some have even likened the forking of bitcoin and other blockchain systems to civil wars. And in many ways, there’s a lot of overlap, only again, its all voluntary!

One question I have about this future is whether people will identify based on what blockchain system they use. Will people start to say “I’m a Bitcoiner” in the same way that they say “I’m an American?” It’s possible. Already crypto investors seem to identify, to an extent, with which blockchain system they prefer.

Economics

If this technology is integrated into a town in a mall concept, then the answer to my previous question is likely to be “yes,” especially if each town has its own blockchain to manage local operations. This idea brings us to the next issue. How do people start interacting with the local economy?

Trading posts are necessary components of the economics of a Blockchain supported “town in a mall” concept.

Trading posts were iconic in early American history. Dungeons and Dragons players are also probably familiar with the concept. They were part of the American frontier. But modern Americans probably haven’t had much experience with them. The closest analog in modern society would be a consignment or pawn shop.

If a town in a mall utilizes a blockchain and cryptocurrency pair that’s either not that common outside of the mall, or unique to the mall itself, then there must be a way for an individual who wants to shop in the mall to get spendable currency. Therefore every mall should have a trading post, which would function as a currency exchange, a consignment shop, and a pawn shop, all in one. A person could then walk in with either USD or something else of value, and exchange it for either something else of value that the shop happens to have, or exchange it for locally used cryptocurrency.

This trading post operation would also be a great place to create an identity (citizenship) and obtain any necessary hardware. In my discussion on universal basic income and beyond, I talked about the idea of having a tablet system which would integrate with the blockchain and cryptoasset ecosystem in order to allow access to a whole host of features. The trading post is a perfect place to pick up such a device, or register an existing device with the ecosystem.

Beyond Mall-Towns

The integration of blockchain citizenship with the concept of the town in a mall idea essentially turns malls into micronations. Every person who lives in the mall-town will basically be a citizen of the mall-town. These ideas however can be expanded to larger scales. The mall-town idea is great, but I would really eventually love to see entire cities run this way. The mall idea is simply a prototype for self sufficient smart cities, surrounded by agricultural districts, and connected to one another through high speed transportation.

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Money and Wealth

By politicoid Leave a Comment Apr 11

Imagine being an early farmer, working along the Nile. Times are tough, and your plot of land isn’t producing nearly as well as you need it to in order to feed your family. You have a neighbor further up the river, and his land is performing much better. You need to feed your family, but all you have is your poorly producing land. What are you to do?

Your options are limited, so you give your land to your neighbor, and in return, he agrees to let you work the land in return for some of the food. Over time, more neighbors do the same, and the quality land owners acquire more and more land, and more and more workers. Eventually the very few winners end up with extensive wealth, while the rest of the population has little.

This story, while not exact, is likely similar to how events played out in the early pre-dynastic period, as the Egyptian population moved from an egalitarian society to a hierarchical one. And it is in part for this reason that currency is so useful.

Here we can see that wealth accumulation in no way relies on money. Nor does the obsession with wealth accumulation necessarily derive from the existence of money alone. It existed long before money did. But money has helped us, in many ways, and one of the reasons why this kind of story does not play out the same way today is because of money.

Money and currency are often used interchangeably, and in this discussion, I’ll probably use both in similar ways. But there are some distinctions. Money is any unit of exchange within a transaction. A system of commonly accepted money is called “currency.” And in many ways, a currency is simply just a form of barter. Instead of bartering a piece of land for food, one could barter a piece of land for a number of pieces of gold. Then that gold could in turn be bartered for food.

But unlike with other forms of barter, a currency allows us to separate our transactions across time and space. Instead of selling our piece of land for say 26,000 pounds of beef, which is going to go bad over any reasonable amount of time, we can sell our house for $100,000, rent an apartment for $1,000 a month, and buy food for $200 a month. And that land which we sold may have been in New Jersey, while we’ve long since moved to San Diego.

While this example is somewhat contrived, it shows just how much freedom we can obtain from the existence of a system of commonly accepted money. And money has existed for a very long time, in some form or another. Precious metals, shells, even tea have been used as mediums of exchange.

Monetary Theory

While not as old as money itself, monetary theory dates back a couple of thousand years. Plato and Aristotle were among the first to develop theories of money, and their two viewpoints couldn’t have been any more different. Aristotle thought that, among other qualities, a currency should have intrinsic value. It should be a physical asset that has its own value, outside of being used as a currency. Meanwhile, Plato thought that money should be abstract, and act solely as an intermediary in the exchange process.

In many ways, Plato would be happier with the monetary systems used today, rather than gold standards and other systems of hard assets as currency. Fiat currency is often defined as currency without any intrinsic value. However, intrinsic value can be difficult to define in and of itself. Instead, I prefer to define fiat currency as any currency which part of its demand is derived from other means beyond its use as a currency. The US dollar, and essentially every government currency, is therefore fiat. The only value that the USD has is the value provided by its acceptance as a currency.

Obscuring Economics with Money

It’s interesting how the existence of money has obscured so much of what we do. It’s also interesting to see how people think about money. It’s fairly different from the way we think about other components of the economic system, including other commodities. But currency is just a universal item of barter. And it’s very important that we have one, or many, systems of currency.

Money, as well as law, separates employees from employers. It separates consumers from providers. And for this reason, economics is overly complicated. Consider the employee. The employee provides labor to the employer. The employer in return pays the employee. If we didn’t have money, we might have a system like the following instead.

Suppose that you were a baker, and you baked a lot of bread for a restaurant. In return, you were able to eat means at that restaurant. In this situation, there is no employee or employer. But suppose that you were tired of eating at that restaurant. Your only option would be to stop trading bread for meals.

With money, on the other hand, you can provide your bread to the restaurant, and in return, the restaurant will give you money. Now we have a division between producer and consumer, and between employee and employer, or at least contractor and contractee.

Wealth Accumulation

“Money is the root of all evil” is a misinterpretation of the biblical quote “the love of money is the root of all evil.” But even then, it’s not that liking money and wanting more of it is bad. It’s really part of our own human nature to wish to acquire wealth and be successful. The problem is when the acquisition of money becomes the primary goal, especially when that money is fiat currency, as there is nothing of value to the money, aside from its use as a currency.

But in many ways, money is able to allow more people to accumulate wealth, and be better off. Instead of a few people amassing almost all of the resources in a community, the average person can make a decent living. Again, money helped a lot to get us to where we are. So money does not imprison us. It frees us.

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