‘Fourth Wave’ of Opioid Epidemic Crashes Ashore, Propelled by Fentanyl and Meth



The United States is knee-deep in what some experts call the opioid epidemic’s “fourth wave,” which is not only placing drug users at greater risk but is also complicating efforts to address the nation’s drug problem.

These waves, according to a report out today from Millennium Health, began with the crisis in prescription opioid use, followed by a significant jump in heroin use, then an increase in the use of synthetic opioids like fentanyl.

The latest wave involves using multiple substances at the same time, combining fentanyl mainly with either methamphetamine or cocaine, the report found. “And I’ve yet to see a peak,” said one of the co-authors, Eric Dawson, vice president of clinical affairs at Millennium Health, a specialty laboratory that provides drug testing services to monitor use of prescription medications and illicit drugs.

The report, which takes a deep dive into the nation’s drug trends and breaks usage patterns down by region, is based on 4.1 million urine samples collected from January 2013 to December 2023 from people receiving some kind of drug addiction care.

Its findings offer staggering statistics and insights. Its major finding: how common polysubstance use has become. According to the report, an overwhelming majority of fentanyl-positive urine samples — nearly 93% — contained additional substances. “And that is huge,” said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.

Author(s): Colleen DeGuzman

Publication Date: 21 Feb 2024

Publication Site: KFF Health News

Problematic Paper Screener

Link: https://dbrech.irit.fr/pls/apex/f?p=9999:1::::::




🕵️ This website shows reports the daily screening of papers (partly) generated with:► Automatic SBIR Proposal Generator► Dada Engine► Mathgen► SCIgen► Tortured phrases… and Citejacked papers 🔥⚗️ Harvesting data from these APIs:► Crossref, now including the Retraction Watch Database► Dimensions► PubPeer

Explanation: https://www.irit.fr/~Guillaume.Cabanac/problematic-paper-screener/CLM_TorturedPhrases.pdf

Author(s): Guillaume Cabanac

Publication Date: accessed 16 Feb 2024

I Am Afraid of Early Cancer Detection

Link: https://www.sensible-med.com/p/i-am-afraid-of-early-cancer-detection?utm_source=post-email-title&publication_id=1000397&post_id=141592311&utm_campaign=email-post-title&isFreemail=true&r=15zk5&utm_medium=email



Looking a bit more closely you see why Grail’s test is actually useless, or dangerous, or both. Let’s start with the sensitivity of the test. For a cancer screening test to work, it must find disease before it has caused symptoms — when it is in an early or premalignant stage. Say what you want about lung cancer screening, mammography, PSA, and colonoscopy (I’m talking to you Drs. M and P) but at least they look for, and succeed at finding, early stage/premalignant disease. Here is the sensitivity of the Galleri test by stage: stage 1, 16.8%; stage 2, 40.4%; stage 3, 77%; stage 4, 90.1%.

The test is nearly worthless at finding stage 1 disease, the stage we would like to find with screening. The type of disease that is usually cured with surgery alone.

How about specificity? Let’s consider a fictional, 64-year-old male patient who presents to his internist worried about pancreatic cancer. I pick pancreatic not only because it is a scary cancer: we can’t screen for it, our treatments stink, and it seems to kill half the people in NYT obituary section. I also chose it because it is the anecdotal disease in the WSJ article.


Working through the math (prevalence 0.03%, sensitivity 61.9%, specificity 99.5%), this means our patient’s likelihood of having pancreatic cancer after a positive test is only 3.58%. For our patient, we have caused anxiety and the need for an MRI. You almost hope to find pancreatic cancer at this point to be able to say, “Well, it was all worth it.” If the MRI or ERCP is negative, the patient will live with fear and constant monitoring. (You will have to wait until next week to consider with me the impact of this test if we were to deploy it widely).

If the evaluation is positive, and you have managed to diagnose asymptomatic, pancreatic cancer, the likelihood of survival is probably, at best, 50%.

Let’s end this week with two thoughts. First the data for the Galleri test is not good, yet. The test characteristics are certainly not those we would like to see for a screening test. Even more importantly, good test characteristics are just the start. To know that a test is worthwhile, you would like to know that it does more good than harm. This has not even been tested. The WSJ article scoffs at the idea that we would want this data.5

Author(s): Adam Cifu, MD

Publication Date: 15 Feb 2024

Publication Site: Sensible Medicine, substack

Climate risk vs. interest-rate risk

Link: https://www.bloomberg.com/opinion/articles/2024-01-18/coinbase-trades-beanie-babies


An important meta-story that you could tell about financial markets over the past few years would be that, for a long time, interest rates were roughly zero, which means that discount rates were low: A dollar in the distant future was worth about as much as a dollar today. Therefore, investors ascribed a lot of value to very long-term stuff, and were not particularly concerned about short-term profitability. Low discount rates made speculative distant-future profits worth more and steady current profits worth less.

And then interest rates went up rapidly starting in 2022, and everyone’s priorities shifted. A dollar today is now worth a lot more than a dollar in 10 years. People prioritize profits today over speculation in the future.

This is a popular story to tell about the boom in, for instance, tech startups, or crypto: “Startups are a low-interest-rate phenomenon.” In 2020, people had a lot of money and a lot of patience, so they were willing to invest in speculative possibly-world-changing ideas that would take a long time to pay out. (Or to fund startups that lost money on every transaction in the long-term pursuit of market share.) In 2022, the Fed raised rates, people’s preferences changed, and the startup and crypto bubbles popped. 

I suppose, though, that you could tell a similar story about environmental investing? Climate change is, plausibly, a very large and very long-term threat to a lot of businesses. If you just go around doing everything normally this year, probably rising oceans won’t wash away your factories this year. But maybe they will in 2040. Maybe you should invest today in making your factories ocean-proof, or in cutting carbon emissions so the oceans don’t rise: That will cost you some money today, but will save you some money in 2040. Is it worth it? Well, depends on the discount rate. If rates are low, you will care more about 2040. If rates are high, you will care more about saving money today.

We have talked a few times about the argument that some kinds of environmental investing — the kind where you avoid investing in “dirty” companies, to starve them of capital and reduce the amount of dirty stuff they do — can be counterproductive, because it has the effect of raising those companies’ discount rates and thus making them even more short-term-focused. And being short-term-focused probably leads to more carbon emissions. (If you make it harder for coal companies to raise capital, maybe nobody will start a coal company, but existing coal companies will dig up more coal faster.)

But that argument applies more broadly. If you raise every company’s discount rate (because interest rates go up), then every company should be more short-term-focused. Every company should care a bit less about global temperatures in 2040, and a bit more about maximizing profits now. Maybe ESG was itself a low-interest-rates phenomenon.

Anyway here’s a Financial Times story about BlackRock Inc.:

BlackRock will stress “financial resilience” in its talks with companies this year as the $10tn asset manager puts less emphasis on climate concerns amid a political backlash to environmental, social and governance investing.

With artificial intelligence and high interest rates rattling companies globally, BlackRock wants to know how they are managing these risks to ensure they deliver long-term financial returns, the asset manager said on Thursday as it detailed its engagement priorities for 2024.

BlackRock reviews these priorities annually as it talks with thousands of companies before their annual meetings on issues ranging from how much their executives are paid to how effective their board directors are.

“The macroeconomic and geopolitical backdrop companies are operating in has changed. This new economic regime is shaped by powerful structural forces that we believe may drive divergent performance across economies, sectors and companies,” BlackRock said in its annual report on its engagement priorities. “We are particularly interested in learning from investee companies about how they are adapting to strengthen their financial resilience.”

There is a lot going on here, and it is reasonable to wonder— as the FT does — whether BlackRock’s shift from environmental concerns to high interest rates is about the political and marketing backlash to ESG. But you could take it on its own terms! In 2020, interest rates were zero, and BlackRock’s focus was on the long term. What was the biggest long-term risk to its portfolio? Arguably, climate change. So it went around talking to companies about climate change. In 2024, interest rates are high, and the short term matters more, so BlackRock is going around talking to companies about interest-rate risk.

I don’t know how AI fits into this model. For most of my life, “ooh artificial intelligence will change everything” has been a pretty long-term — like, science-fiction long-term — thing to think about. But I suppose now “how will you integrate large-language-model chatbots into your workflows” is an immediate question.

Author(s): Matt Levine

Publication Date: 18 Jan 2024

Publication Site: Bloomberg

The Feds Shouldn’t Subsidize Fancy, Risky Beach Houses

Link: https://reason.com/2024/01/10/the-feds-shouldnt-subsidize-fancy-risky-beach-houses/



Sen. John Kennedy (R–La.) is upset because Sen. Rand Paul (R–Ky.) wants to limit federal flood insurance.

But Paul is right. In my new video, Paul says, “[It] shouldn’t be for rich people.”

That should be obvious. Actually, federal flood insurance shouldn’t be for anyone. Government has no business offering it. That’s a job for the insurance business.

Of course, when actual insurance businesses, with their own money on the line, checked out what some people wanted them to insure, they said, “Heck no! If you build in a dangerous place, risk your own money!”

Politically connected homeowners who own property on the edges of rivers and oceans didn’t like that. They whined to congressmen, crying, “We can’t get insurance! Do something!”

Craven politicians obliged. Bureaucrats at the Federal Emergency Management Agency even claim they have to issue government insurance because, “There weren’t many affordable options for private flood insurance, especially for people living in high-risk places.”

But that’s the point! A valuable function of private insurance is to warn people away from high-risk places.

Author(s): John Stossel

Publication Date: 10 Jan 2024

Publication Site: Reason

Is Ed Kane’s “Gathering Crisis” Still Gathering Steam?

Link: https://govmoneynews.com/bills-blog/f/is-ed-kanes-gathering-crisis-still-gathering-steam


Back in 1985, Ed Kane penned a prophetic volume identifying a blooming mess in financial markets. His book, The Gathering Crisis in Federal Deposit Insurance, reliably warned of taxpayer exposure to losses ultimately unleashed in the savings and loan crisis. 

Cycles of ensuing regulatory reforms, crises and scandals have only reinforced the timeliness of the lessons that Kane offered us decades ago. Those lessons became particularly poignant in light of the failure of Silicon Valley Bank and several other large banks earlier this year. 

Kane’s 1980s warnings remain worthy of scrutiny and reflection, and underscore questions whether industry and regulatory reforms have simply left us on the edge of another precipice. The financial conditions of the FDIC and the Federal Reserve – and their implications for the U.S. Treasury and American taxpayers – deserve close scrutiny, as well as recommendations for fundamental reform.


“In an economic environment in which deposit institutions are highly levered and entering new businesses every day and in which interest rates are highly volatile, systematically mispricing deposit insurance guarantees encourages deposit institution managers to position their firms on the edge of financial disaster. Metaphorically, deposit-insurance authorities are paying deposit-institution managers to overload the deposit-insurance jalopy, to drive it too fast, and even to break dance on its hood as it careens through interest rate mountains and over back-country roads. Reformers’ ultimate goals must be to confront institutions whose risk-taking imposes socially unacceptable risks on its federal guarantors with a combination of reduced coverages and increased fees sufficient to move them to adopt safer modes of operation.” (p. 147)

“Of course, just how safe, reliable, and comfortable a ride the nation enjoys depends also on the macroeconomic policies that the government follows. If Congress could bring government spending under long-run control, monetary policy would not have to push interest rates over so wide a cycle. Reducing the volatility of interest rates would relieve the car’s drivers of the need to take it over quite so dangerous a set of roads.” (p. 165)

Author(s): Bill Bergman

Publication Date: 20 Dec 2023

Publication Site: Bill’s Blog at GovMoneyNews

A Conversation With Benny Goodman

Link: https://www.lifehealth.com/a-conversation-with-benny-goodman/



PEK: Your research reveals a conundrum when comparing a variable annuity with systematic withdrawals from investment accounts (assuming similar investment returns): the annuity will generally outperform. How do we convey this very basic equivalency to our clients? 

BG: In my experience, I’ve seen that when some people get to retirement, they may have upwards of a half a million dollars in their accounts. Financial planners owe their clients more than just plans to help them accumulate assets and some well-wishes. Most people do not understand how to generate income from their savings that will last the rest of their lives.

Savings are exposed to market risk that can erode account balances before or in retirement, as we saw in The Great Recession of 2009 and the economic contraction during the coronavirus pandemic. And fifty percent of the population can expect to live beyond the average life expectancy in retirement, exposing them to longevity risk.

The practical reality is that most individuals cannot insulate themselves from risk on their own. Annuitizing a portion of a portfolio’s assets can help mitigate these issues.

PEK: You demonstrate that delaying the start of an annuity by five years may cost 5% in future income, which delaying ten years may cost 15%. Please talk about the time factor and the cost of delay.  

BG: The concept is based on something called “mortality credits.” When buying an annuity, you join an annuity pool. Every time someone dies early (before he spent all the money he contributed) the leftover money stays in the pool and is shared by all those still in the pool. The money becomes a mortality ‘credit’ for those who did not die. These mortality credits allow the former to get lifetime income. They start adding value from the day someone enters the pool. Those who purchase the annuity at a later time were not in that pool and do not get that credit. Purchasers only receive mortality credits for those people who died after the purchasers joined the pool. Lower mortality credit means lower lifetime income. Mortality credits have value by adding to income.


PEK: Likewise, how real is the prospect of outliving one’s assets today?

BG: It’s very real. Data from EBRI indicates that about 40% of Americans face the risk of running out of money in retirement.

Now, not many people continuously spend and then one day look at their account and say, “Oh no! There is no money left!” But well before that day, they will start adjusting their spending downward so as to make sure they don’t outlive their money. And some have to make drastic and painful decisions, like choosing between paying for rent or healthcare; to pay for the electric bill or for medicine. Some retirees will even take half the dosage of their prescribed medicine to conserve it. It may even require that retirees move in with a child rather than live in poverty. In certain family dynamics, living with elderly parents is expected, but it may not be ideal for many.

Author(s): P.E. Kelley, Benjamin Goodman

Publication Date: 30 Oct 2023

Publication Site: Advisor Magazine

The insurance industry’s renewed focus on disparate impacts and unfair discrimination

Link: https://www.milliman.com/en/insight/the-insurance-industrys-renewed-focus-on-disparate-impacts-and-unfair-discrimination


As consumers, regulators, and stakeholders demand more transparency and accountability with respect to how insurers’ business practices contribute to potential systemic societal inequities, insurers will need to adapt. One way insurers can do this is by conducting disparate impact analyses and establishing robust systems for monitoring and minimizing disparate impacts. There are several reasons why this is beneficial:

  1. Disparate impact analyses focus on identifying unintentional discrimination resulting in disproportionate impacts on protected classes. This potentially creates a higher standard than evaluating unfairly discriminatory practices depending on one’s interpretation of what constitutes unfair discrimination. Practices that do not result in disparate impacts are likely by default to also not be unfairly discriminatory (assuming that there are also no intentionally discriminatory practices in place and that all unfairly discriminatory variables codified by state statutes are evaluated in the disparate impact analysis).
  2. Disparate impact analyses that align with company values and mission statements reaffirm commitments to ensuring equity in the insurance industry. This provides goodwill to consumers and provides value to stakeholders.
  3. Disparate impact analyses can prevent or mitigate future legal issues. By proactively monitoring and minimizing disparate impacts, companies can reduce the likelihood of allegations of discrimination against a protected class and corresponding litigation.
  4. If writing business in Colorado, then establishing a framework for assessing and monitoring disparate impacts now will allow for a smooth transition once the Colorado bill goes into effect. If disparate impacts are identified, insurers have time to implement corrections before the bill is effective.

Author(s): Eric P. Krafcheck

Publication Date: 27 Sept 2021

Publication Site: Milliman

Despite vehicle safety improvements, US pedestrian deaths soar

Link: https://scrippsnews.com/stories/despite-vehicle-safety-improvements-us-pedestrian-deaths-soar/



Samuel’s death is part of a growing trend in America, where pedestrian and cyclist fatalities are up 60% since 2011 to more than 8,000 last year.

In the past 25 years, the percentage of people who died in road crashes — while inside a vehicle — dropped from 80% of all road deaths to 66%. At the same time, the share of pedestrian and bicyclist deaths climbed sharply – making up 20% of all road deaths in 1997, to now accounting for 34% of all road deaths.

Nicole Brunet is with the nonprofits Bicycle Coalition of Greater Philadelphia and Families for Safe Streets. She says street design is part of the issue.

“If you’re somebody in a car, the street is designed perfect for you,” Brunet said. “The ideal street is balanced: A street that’s built for a pedestrian and a bicyclist, somebody that has mobility issues. We need to think about the most vulnerable user of the road.”

Author(s): Maya Rodriguez

Publication Date: 5 Oct 2023

Publication Site: Scripps

SBF Was Reckless From the Start

Link: https://www.bloomberg.com/opinion/articles/2023-10-04/sbf-was-reckless-from-the-start?srnd=undefined#xj4y7vzkg


First: “A Jane Street intern had what amounted to a professional obligation to take any bet with a positive expected value”? Really? I feel like, if you are a trading intern, you are really there to learn two things. One is, sure, take bets with positive expected value and avoid bets with negative expected value.

But the other is about bet sizing. As a Jane Street intern, you have $100 to bet each day, and your quasi-job is to turn that into as much money as possible. Is betting all of it (or even $98) on a single bet with a 1% edge really optimal?[6] 

People have thought about this question! Like, this is very much a central thing that traders and trading firms worry about. The standard starting point is the Kelly criterion, which computes a maximum bet size based on your edge and the size of your bankroll. Given the intern’s bankroll of $100, I think Kelly would tell you to put at most $10 on this bet, depending on what exactly you mean by “this bet.”[7] Betting $98 is too much.

I am being imprecise, and for various reasons you might not expect the interns to stick to Kelly in this situation. But when I read about interns lining up to lose their entire bankroll on bets with 1% edge, I think, “huh, that’s aggressive, what are they teaching those interns?” (I suppose the $100 daily loss limit is the real lesson about position sizing: The interns who wipe out today get to come back and play again tomorrow.) 

But I also think about a Twitter argument that Bankman-Fried had with Matt Hollerbach in 2020, in which Bankman-Fried scoffed at the Kelly criterion and said that “I, personally, would do more” than the Kelly amount. “Why? Because ultimately my utility function isn’t really logarithmic. It’s closer to linear.” As he tells Lewis, “he had use for ‘infinity dollars’” — he was going to become a trillionaire and use the money to cure disease and align AI and defeat Trump, sure — so he always wanted to maximize returns.

But as Hollerbach pointed out, this misunderstands why trading firms use the Kelly criterion.[8] Jane Street does not go around taking any bet with a positive expected value. The point of Kelly is not about utility curves; it’s not “having $200 is less than twice as pleasant as having $100, so you should be less willing to take big risks for big rewards.” The point of Kelly is about maximizing your chances of surviving and obtaining long-run returns: It’s “if you bet 50% of your bankroll on 1%-edge bets, you’ll be more likely to win each bet than lose it, but if you keep doing that you will probably lose all your money eventually.” Kelly is about sizing your bets so you can keep playing the game and make the most money possible in the long run. Betting more can make you more money in the short run, but if you keep doing it you will end in ruin.

Author(s): Matt Levine

Publication Date: 4 Oct 2023

Publication Site: Bloomberg

[109] Data Falsificada (Part 1): “Clusterfake”

Link: https://datacolada.org/109



Two summers ago, we published a post (Colada 98: .htm) about a study reported within a famous article on dishonesty (.htm). That study was a field experiment conducted at an auto insurance company (The Hartford). It was supervised by Dan Ariely, and it contains data that were fabricated. We don’t know for sure who fabricated those data, but we know for sure that none of Ariely’s co-authors – Shu, Gino, Mazar, or Bazerman – did it [1]. The paper has since been retracted (.htm).

That auto insurance field experiment was Study 3 in the paper.

It turns out that Study 1’s data were also tampered with…but by a different person.

That’s right:
Two different people independently faked data for two different studies in a paper about dishonesty.

The paper’s three studies allegedly show that people are less likely to act dishonestly when they sign an honesty pledge at the top of a form rather than at the bottom of a form. Study 1 was run at the University of North Carolina (UNC) in 2010. Gino, who was a professor at UNC prior to joining Harvard in 2010, was the only author involved in the data collection and analysis of Study 1 [2].

Author(s): Uri Simonsohn, Leif Nelson, and Joseph Simmons

Publication Date: 17 Jun 2023

Publication Site: Data Colada

The Moral Hazards of Being Beautiful

Link: https://www.wsj.com/articles/the-moral-hazards-of-being-beautiful-94346e61


Beauty has its privileges. Studies reliably show that the most physically attractive among us tend to get more attention from parents, better grades in school, more money at work and more satisfaction from life. A study published in January in the Journal of Economics and Business found that good-looking banking CEOs take in over $1 million more in total compensation, on average, than their lesser-looking peers. “Good looks pay off,” the authors write.


Scientists attribute the human tendency to give attractive people better treatment to something called the halo effect. Basically, we tend to assume that good looks are a sign of intelligence, trustworthiness and good character and that ugliness is similarly more than skin deep. “Personal beauty is a greater recommendation than any letter of reference,” Aristotle observed. This may help explain why attractive people are less likely to be arrested or convicted, even after controlling for criminal involvement, according to a 2019 study of nationally representative data published in the journal Psychiatry, Psychology and Law.


Yet those of us who never got that genetic golden ticket should take heart: The halo effect appears to go both ways. A number of studies show that goodness often enhances our looks. A paper in PLOS One in February, for example, reports that people found faces in photos more attractive when they learned the subjects were honest, kind and not aggressive. The results suggest that “facial attractiveness is malleable,” the authors write. Or as Sappho observed: “What is beautiful is good and what is good will soon be beautiful.”

Author(s): Emily Bobrow

Publication Date: 10 June 2023

Publication Site: WSJ