Tuesday, May 5, 2009

How Steep Is My Valley

The steepness of the US Treasury bond yield curve is once again reaching 30+ year record levels; the difference between 10- and 2-year yields is currently at 222 basis points, having previously nearly matched the record 270 bp of 2003 and 1992 (see chart below, click to enlarge).

Data: FRB St. Louis

Many analysts interpret this as a clear sign of imminent economic recovery, and so do stock market bulls. I was just speaking to an investment bank trader and he confirmed that they are using the 10y-2y spread as a market signal, both in the US and in Europe. So far, so good, it seems.

But... today's proper interpretation of yield curve spreads should be differentiated from previous years. With short-term interest rates hugging the absolute zero mark (3m T-bills are at 0.14% and 2-year notes at 0.94%), long-short spreads of 2-3% are nearly meaningless because they are mostly predicated by a basic concept of monetary theory, i.e. the term structure of interest rates.

What I mean is that in interpreting the yield curve's current shape and steepness we should also take into account the absolute level of interest rates. We are simply too close to the limit, the boundary condition imposed by the impossibility of negative nominal interest rates (we did very briefly experience negative rates for 1m T-bills at the height of the crisis). In other words, it's one thing to have a 10y-2y spread of 300 bp as a result of 7% minus 4%, but a wholly different matter when it comes from 4% minus 1%.

Furthermore, we should consider another factor: increased credit quality concerns for US Treasury bonds. A year ago the credit quality of the US was unquestioned. Today, credit default swaps (CDS) for 10-year treasuries are around 40 bp (went as high as 100 bp), meaning there is measurable and meaningful default risk. This results in yield premiums versus previous years, specifically for longer-term bonds.

CDS for 10-year US Treasury Bonds

A very obvious observation is that as credit quality deteriorates lenders may still be willing to lend short-term, but become more cautious on longer term loans. This causes the yield curve to steepen (higher 10y-2y spreads) perhaps for the exact opposite reason than bulls may suppose, i.e. a weaker economy and massive bailouts make longer-term treasuries less secure and thus long rates go up. This is not something that the US market has had to deal with in the past because its credit quality was always presumed to be AAA+.

Thus, the 10y-2y spread being at near record highs should be more closely examined, and perhaps differently interpreted, than before.


  1. Why would the US default on its treasury notes? Is it a decision between a onetime eraser of the debt vs massive devaluation (destruction) of its currency through excessive creation (printing)?

  2. Just WHO is investing in U.S. treasury bills and why ?
    American, foreign investors who have deserted stocks to put their money into treasury bonds for "security" ?
    Where/who is the "money" coming from ? Pension funds ? A close to zero "interest" rate is slim comfort in the face of prospective default.
    It sounds like you have done a fine-tuned analysis on this one, Hell, (insofar as I am able to understand, that is...)

  3. I seem to remember having gotten the silent treatment whenever I suggested a real risk of default or loss of reserve status for the $ more than a year ago; is it now more respectable to speculate on such matters:

    Allen Sloan (Fortune online 3/31/08
    "On The Brink of Disaster" towards end of article) speculating that soon foreign creditors will refuse to extend dollar denominated loans, bye-bye reserve currency status. No need to invade any more oil exporters that want to trade in Euros.

    April 1, 2008 9:20 AM
    How To (Mostly) Save The Financial System
    March 31,2008

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  5. But What do I Know?May 5, 2009 at 2:31 PM

    Great insight that we are in a new world, with manipulation of the Treasury interest rates by the Fed. For this same reason, all of the charts showing spreads to AAA and BBB bonds are misleading as well. When one large player is making non-economic decisions (market choices not based on its view of profit-maximization) then historical data no longer provides a guide to anything.

  6. The system has been so manipulated/corrupted I do not believe any metric anymore.

    I was just thinking that when the USD is rejected by all we will go hyper-I.

    The next step in this debacle is collapse. Period.

    Joe M.

  7. Who is the counterparty on these CDS trades? Goldman? Morgan?

    People can't seriously expect that they would get paid off in the event of a US gov't default, can they?

    Or are these strictly short-term trading vehicles?

  8. Just to add a dash of math to illustrate the point. The average value of a Gaussian centered at zero is 0. The average value of only the positive half of a Gaussian is sqrt(2/pi)*sigma, which is about 0.8 sigma.

    If you eyeball the plot and guess that the standard deviation is around 100 bps (it seems to spend about 1/3 of its time outside +-100), then the "signal" right now is being biased upwards about 80 bps due to the zero bound.

    140 bps is still something. But couldn't this be a signal that bond markets expect inflation to be controlled for a year or two, then to take off?

  9. Dink,
    There is nothing satirical about it; this is exactly the approach the banks used with the govt, either give us the money or we will crash the system and send the entire economy into collapse while we jet off into the sunset and enjoy our past bonuses. I think Colbert came as close to the truth as he could without getting sued by the bank CEO's.

  10. So for those like me trying to simplify your conclusion, and much along the same statements made by Marcus and Andrew Foland, would you interpret this as subtle support for the idea that treasuries are becoming "bubbly"?

    And If so, where would you find evidence for the opposite side of this bet in the capital markets?

    Is there a similar (or inverse?) marker in another asset class (say another country's debt? gold? another country's currency, real estate, etc...) that suggests investors are increasingly concerned they may need to park their money there as treasuries do poorly in the context of ongoing deflation?

    There would have to be one, no?

    Or am I way off?

  11. For anyone who needs a refresher (or intro like me) re: "... the limit, the boundary condition imposed by the impossibility of negative nominal interest rates."

    Here is a Willem Buiter link I found while trying to learn about this "boundary condition" issue.

  12. Thai,
    This is not me talking but a life-long Israeli zionist who said this in reference to Israel's true intentions for the peace process:

    "The “plan” which he is working on does not really concern the essence of this policy, but only the packaging. How to present to Obama something that will not sound like “no”, but rather like “yes, but”. Something that all the serfs of the Israeli lobby in Congress and the media can swallow painlessly. "

    Just sayin...

  13. Yoyomo, it is interesting to read your comment in the context of just returning from my youngest's elementary school international night.

    You know as well as I that getting agreement around the notion of what actually makes a nation is one of the oldest problems on this planet.

    Is it a grouping of people based on ethnicity, language, religion, political ideology, common values, some permutation of all of these, etc...?

    That Israel has not resolved this issue is no surprise at all based on both its recent origins AND the path it took to become a nation.

    That some see Israel as a nation based on a common religion- as I might remind some Americans still do- is neither surprising, nor sinister as these are one version of the truth.

    Do I think this issue is a "work in progress"- absolutely!

    You know as well as I this issue is a problem to varying degrees in most countries on this planet today (e.g. much of Africa, former Soviet States, China, European nations with new immigrant communities, etc...).

    Although I would certainly agree with you that it is a currently a bigger issue in the middle east today that many other places.

    And (fwiw) I do think there is a whole "industry" on all sides of the Arab-Israeli conflict that will do everything it can to continue conflict between Arabs and Israelis as they see their own end in peace.

    My reality says there are very very few nations on this planet that are as as far along the process of confronting "diversity" as the US and (say) Brazil. And we obviously both have a long way to go as well.

    Haven't we heard many many comments from people on this blog over the last 2+ years re: immigration and concerns over globalization, etc...

    People are indeed "feeling the heat" as it were.

    AND issues of diversity are every bit as much a problem for the nations which are "the enemies of Israel" as they are for Israel itself.

    Again, it is only MY way of looking at things but as I have said many many times before on this blog, I do see the "boundaries" of our societies slowly coming both down (for both good and bad) and together (again for both good and bad). I am much more optimistic about the future than you.

    AND I do understand that this is SIMULTANEOUSLY BOTH good and bad and that one's interpretation of these things all depends on what point of view you are looking at them from.

  14. After WW2 it was officially agreed countries were to be defined by geographical boundaries not subject to destabilization. At least that was the version presented to the world and the basis for the UN but covertly the major powers were destabilizing smaller vulnerable countries before the ink was dry on the UN charter.

    The oldest story in the bible, getting advantage at someone else's expense and guaranteeing perpetual conflict. As long as you don't mind paying then no need to fret over it.

  15. Thai,
    I've given you a slew of links recently, probably more than you have time for or interest in but this short article by Reagan's TreasSec summarizes most of the points I've tried to impress on you and why I feel a sense of urgency about it.

    If the prospects outlined in the article don't give you cramps you really are floating in a cloud of bliss.

  16. Please be nice Yo, I am reading your links.

    Is it a requirement that I agree with everything in them?

  17. Of course not, just to be aware of them in relation to their perceived importance to you. If oligarchy doesn't scare you then I am guilty of pestering you unduly.

    BTW, many of those links were not opinion pieces but made claims of fact which I believe are accurate but if you have cause to doubt them, I'm all ears.

  18. Thai, yoyo, you can understand, perhaps, why nationalism is a dirty word to me (exaggerating as usual...) and that I have NO patriotic feelings.
    Nationalism and patriotism, to me, are examples of idolatry, that is to say, putting abstractions and ideas before flesh and blood people.
    I try to resist doing this as much as possible, because I think that this tendency towards abstraction destroys empathy in us.
    And, I have a perhaps idealistic viewpoint of the Austr-Hungarian Empire, the demise of which is STILL rocking the planet, after being largely responsible for World War 1, 2, the Bosnian conflict, you name it.
    Nationalism is a reductionist way of bringing people together. It is based on EXCLUSION, and not INCLUSION.
    That's it for my string of generalizations today...

  19. Deb, I really do understand/respect your point of view (well, except maybe for the Austro-Hugarian comment but I mean no insult in rejecting that).

    In fact, a variant of situational morality- patient welfare and autonomy- has really been the cornerstone of medical ethics for as long as the medical profession has existed.

    I pretty much live most of my life in this frame of mind.

    But it does seem to me that Yoyomo is ALSO correct, though he points this out in an entirely different context (the Middle East).

    Situational morality does have as many problems with it as any other kind of moral system.

    For if I understand you correctly, your claim that symbolism ideologies (utilitarianism, nationalism, etc...) require a focus on the needs of the group at the expense of "someone else" is just as true for situational moralities. For situational morality requires omission (i.e. ignoring others to focus on the moment/person in front of you).

    This is the "floating in a cloud of bliss" that so frustrates him and which I really can relate.

    Situational morality excludes others (by ignoring their existence) just as much as symbolism morality requires ignoring others.

    It is in fact recognition of this "cognitive dissonance" that has led to greater public demands of utilitarianism within American medical ethics in general and practice patterns specifically (I am unsure if you have been following the endless debates over comparative effectiveness research going on in America, etc... which I might remind you France is much further along than the US).

    My only point to Yoyomo has always been that no matter what variant of morality we have, things will always look the same way in the end. The underlying structure of society is as immutable as gravity and that a lot of these issues he gets so worked up over are a little like getting worked up over gravity or two identical shades of blue because he thinks they look different to him.

  20. "The underlying structure of society is as immutable as gravity..."

    So I guess if I were a cab driver in Switzerland I should move to to El Salvador or South Africa because the winters are so much milder.

  21. Yo, you really have never gone down this rabbit hole before?

    I assume you see the problem with your question?

  22. Yes I do, I directed it to the Grand Gate Keeper of the rabbit hole but you have four kids who love you and I shouldn't take up so much of your time with them as we spend too much energy talking past each other. Be well.

  23. Thai, I am not following you at all.
    I have CHOSEN (insofar as any human being can choose, and we can debate this, but it will be sterile...) to resist as many situations that inscribe me, and represent me in the societal context of symbolic systems :
    i.e. I write INDIVIDUAL LETTERS TO INDIVIDUAL PEOPLE vs. publishing books addressed to a large, anonymous audience.
    I try to avoid situations that appeal to the concept of representation, and I do not authorize ANYONE to represent me. (I do not know yet if I will continue to vote, anywhere... But rest assured that if I do NOT vote, I will not whinge about what is being done NOT IN MY NAME. I will do all in my INDIVIDUAL power to bring about what I see to be good for INDIVIDUALS within the society, without deciding things in their place.)
    This by NO MEANS indicates that I have become an Alceste type figure who has retreated from all society.
    I suppose that I have retreated from dealing with "my fellow man" as a generalization, or as a statistic.
    Ironically, I think that I am probably a "product" of what liberal ideology has been moving towards since it got started on the collectivity : I am an atom, in an atomized society. (But really, there are VERY FEW atoms at a time when so many of us are frantically copying each other for reassurance...)
    So, I am definitely at odds with your philosophy, and your morality, Thai...

  24. "So, I am definitely at odds with your philosophy, and your morality"

    I understand this.

    Let me ask you a question.

    How do you feel about people choosing to not get vaccinated?

  25. Well, Thai, that really depends on what the vaccine is.
    Let's get rid of the general situation, and go to the particular one.
    When my then 18 year old son finished his first year of medical school, and thus was selected in the incredibly stupid selection process that the French have instigated because they WON'T do selection in a thoughtful manner, he was told to get a hepatitis B vaccine. Period.
    I don't like that vaccine, Thai.
    One of the reasons why I am leery about vaccines is that, in France at least, they bring mucho money to the laboratories AND prestige to the Pasteur institute, which is all about vaccines.
    But I'm not convinced about that vaccine, Thai, or its necessity. (I'm fine on tetanos, and on DTP, etc....)
    After pointing out the risks to him, I let him make up his own mind, and he got the vaccine, because it is HIS life, not mine, and for sure, it would have been very complicated for him NOT to get the vaccine...
    I am entirely capable of seeing where the INDIVIDUAL GOOD intersects the collective good, Thai. But I think that it may do so in a more restricted manner than many people currently think, you know. ;-)

  26. "I am entirely capable of seeing where the INDIVIDUAL GOOD intersects the collective good, Thai. But I think that it may do so in a more restricted manner than many people currently think, you know"

    Are you looking at this intersection from the individual's perspective or the collective's perspective?

    Which should outweigh the other? When?

    For vaccines are the classic Tragedy of the Commons.

    Supposing you don't want a measles vaccination? (which more and more people in the US are deciding today secondary to concerns re: autism, etc...).

    We are at real risk today that measles will reestablish itself again in the US (I think you need heard vaccination rates >96% to prevent its reemergence and we are around 93% today).
    So not only have the anti-vaccination people been living under the aegis of the heard immunity that all the rest of us give them, but to the extent they are correct and there is some personal risk in getting the vaccines, those who took the vaccines will have taken the risk and will probably loose most of the benefit. All because of the paranoid decisions of a growing few.

    And while I think most of the anti-vaccine movement's safety concerns are nonsense, still the kernel of truth in their concerns is that all vaccines represent a classic "risk-safety" dilemma that is at the heart of every decision we ever make in medicine. There will always be some risk and we either have to trust the people making the decisions (understanding they could be under "regulatory capture' ,etc... as Yo says) or not.

    But IF not, we may as well cut back spending on a lot of on public health measure as they won't be doing us much good if this current move toward "stay in the moment" and "I can do whatever I want" continues in society.

    We can never get away from trust-cooperation issues. And we can never get away from the fact that an enormous number of personal decisions we make are still not really personal decisions as they clearly effect others.

    This subject is what has led Marcus and I to dislike each other so much and what started our first argument about 1-2 months ago when he called me "racist" for simply pointing out this simple truth.

    I realize "personal responsibility" is not a very popular topic with many modern liberals and their culture of the "me" (when they really only mean them), but it is what it is.

    Your "situational morality" requires you to always remain "oblivious" to these issue in order to feel good about it.


    I completely agree with your criticism that "symbolism" morality has just the same problem.

    I realize there is no "correct" answer.

    But I am quite sure I am not less "moral" either for seeing this paradox.

  27. And Deb, without in any way intending to sound mean but just giving you some thoughts to consider.

    There has been a lot of discussions on these blogs about "privatizing profits and socializing losses".

    Who is paying for medical education?

    Who is paying for the treatment of hepatitis B (which in some cases can require a liver transplant)?

    Why does someone want to become a physician?

    Then remember, I have had three HIV needle-sticks already.

    I don't know about France but in the US there has definitely been talk about not allowing students to go to med school without their full immunization series (though I haven't heard about it in a number of years and don't know where the issue is today).

    As Yo says "...just sayin"

    And I truly don't intend to be mean if you read that in anything I have said.

    Hope you are well

  28. preoThai, I saw EXACTLY where you were leading me on this one.
    I didn't say that I did not advocate all vaccinations. I said that I had my doubts about hepatitis B, that's all.
    I should send you back to Molière, "Le Malade Imaginaire" to get a complete taste of where modern medicine came from. What Molière fustigates in this play is every bit as relevant now as it was when he wrote it in the seventeenth century or thereabouts...
    I am not really sure that all of our modern prevention campaigns will keep us safe from another major epidemic like the bubonic plague (I'm stubborn about this one, I still think that it was very very important, and historians seem to see things my way too...).
    I'm not a big big fan of modern prevention campaigns. Because France is a country which picks up on a basically good, or at least innocuous (American) idea and beats it to death, until it turns into a NIGHTMARE.
    I think that people should be allowed to smoke in public places. And I too think (after not having thought this way for a long long time...) that our governments, oft urged on by a worried medical caste, are far too interested in wiping our butts for us.
    I agree with you Thai, that our mushrooming numbers on this planet have done more than anything else to limit our personal freedom. And that I SHOULD (probably) docilely obey what the medical caste orders me to do.
    But I'm an irrational animal.
    And I don't like being told what to do.
    Particularly when it's for my own good.
    I really HATE THAT.
    Just like one of those rednecks who get fingers pointed at them on the majority of lefty blogs...
    And I think that if the elitist intelligentsia (of which I am nonetheless a member, even if I should try to pretend otherwise...) were REALLY intelligent, we would be finding ways to express our concerns that did NOT manage to totally turn others off, and make them want to resist, like I want to resist, too.
    Now, that would be REAL intelligence...
    And one LAST, really important point.
    I hold the medical caste VERY RESPONSIBLE for our collective denial of certain facts of life concerning death.
    1) Death is for everybody, all ages.
    2) There is no such thing as a fair or unfair death. (i.e., the fact that someone dies young does not make it LESS fair.) This is a ridiculous idea.
    3) Death is the great equalizer. EVERYBODY DIES. Rich, poor, young, old. Democracy in death, if not in life.
    4) There is no cheating for death. Ready or not, it will come for you...
    All of these FACTS of life have been consistently underrated and contested, in one form or another, by the medical caste. Perhaps inevitably.
    But this fact does us no good.
    Enough griping for today.

  29. Deb, I couldn't agree more with your points 1-4 (and I mean they are absolutely spot on).

    As an FYI, if you ever think I am disagreeing with any of these statements (and I mean ever), either I have done a poor point explaining what I mean or you are somehow misunderstanding me (or both).

    I see a lot of death (and I mean A LOT). It is never "noble". It is what it is.

    And I too agree with you that my "caste" (as you say) bears blame for the sterilization of this issue in society today. In fact I often spend a significant portion of my day dealing with this original sin.

    As for "If the elitist intelligentsia... would be finding ways to express our concerns that did NOT manage to totally turn others off, and make them want to resist, like I want to resist, too."

    I couldn't agree more.

    But again, think of the path humanity took to get to its current predicament and how many ideologies have we had to get us to some ind of "shared vision"? All have failed us in the end.

    We literally had to reach the point where we became a truly global cooperative before we couldn't pretend the zero sum nature of most (all) things exists.

    As I see it, we literally have two choices as we are at a fundamental boundary issue: either expand the boundaries of the system (e.g. get more energy from outside the system) OR continue to engage in zero sum conflicts within the one we currently have.

    Things will look the same as they always have within a bigger boundary OR things will look the same within our current boundaries.

    If you have another suggestion, I am all ears.

    Hell, fwiw, is saying it will be the latter.

  30. Thai, I do NOT understand the expression "zero sum conflicts". I don't understand what you mean by expanding the boundaries.
    Carefully reading through gives me the idea that you are defending an idea of collective progress, Thai, and I am very surprised by this.
    Progress is really a point of view.
    And one which is intricated in monotheistic ideology (careful I did not say religion...).
    I do NOT believe in progress, Thai.
    But I really DO believe, and meditate ALL the time, that really timeless truth in my book that every advantage has its disadvantage, and every disadvantage, its advantage.
    Freud thought that ambivalence was a quality to strive for within the human personality.
    I tend to think that ambivalence is a quality of human experience of ? reality ? Just what is THAT ?
    That means that you CANNOT cheat and try to separate out the bad from the good. You have to take both of them together.
    Whenever I feel like indulging in hubris, I think back on this, and OFTEN.

  31. Re: "I do NOT understand the expression "zero sum conflicts"

    LOL!!! We have been talking past each other all along. We MAY agree. :-)

    If you don't understand zero sum, you literally must not understand MOST of my points re: cooperation, religion, etc... ah, the problems of language and translation.


    Zero sum.

    Or go to my presentation (start at slide 28 and really 31+)

    We can always personally benefit from non-zero sum economics, but if we step out of our own personal point of view and look globally within the larger boundaries of the system, the transition we personally benefitted in remains zero sum. Our non-zero sum benefit did come at the expense of someone (something) else's loss and the benefit + the loss equals zero (technically it actually is negative as there is also a change in entropy which I won't go into but Hell frequently reminds us of in his reading selection).

    Zero sum = "Progress is really a point of view" and "I do NOT believe in progress"

    Do you follow now?

    Haven't you noticed some of the posts Hell has written for us on perception and reality and the economy???

    That is the oddest thing about the euphoria/despair we are all currently having about the economy. Nothing has fundamentally changed with the popping of the perma-growth bubble except our own personal perception of reality. Things are exactly the same as they were before except our view of those things.

    We can easily cooperate as a group to solve this issue- it is just the cooperation will be zero sum.

    Either we all take a small "equal" haircut, or some of us take none, some take some and some get really screwed (the likely approach). Or just a few get screwed.

    The problem is getting a majority to cooperate AND who gets screwed.

    And either way, things will look the same as they did before. The structure of society will look the same. Hence my view things are as "immutable as gravity".

    I am pretty sure Cotton sees this as well.

  32. "...those who took the vaccines will have taken the risk and will probably lose most of the benefit."

    I don't want to get you started (no reply nec) because I promised I wouldn't but the above is logically incorrect; if the vaccine is effective, they will be protected and receive all the benefit they could reasonably expect.

    That other people could get sick isn't the reason they got vaccinated; that others might expose them to the virus is but since they are vaccinated they are protected and didn't lose any of the benefit that they undertook the vaccination risk in order to get that benefit.

  33. Re: "the above is logically incorrect; if the vaccine is effective, they will be protected and receive all the benefit they could reasonably expect."

    Yo, your statement is absolutely incorrect and is the classic application of linear logic on a non-linear system that leads to so many misunderstands.

    Responses, protection and length or immunity are actually all quite non-linear in individuals. The simplified binary "protected"/"not-protected" idea was created by the "regulatory capture" folks you rail against as a way of simplifying the issue to the public.

    Herd immunity is quite important for your protection- don't kid yourself.

  34. Sorry, someone else was logged on to my computer.


  35. So, we need more honesty about the limitations of vaccines and the need for booster shots.

  36. Re: "the need for booster shots".

    So we all spend more money, and most definitely take more risk, because of the actions of the few?

    But the few get to "privatize profits yet socialize losses"?

    Your inconsistencies are starting to get exposed.

    Yo, the great paradox is that no one was dishonest- the data was "simplified" for everyone. Look it up yourself, it is there for everyone to see.

    But of course most never do.

    Weren't you the one who said "if American Idle fans don't get up off their couches, it will only get more common."?

    Our views strongly intersect here. But again, we may see different American Idol fans.

  37. If the effects of the vaccine wear-off, wouldn't that be the same as never having been vaccinated and couldn't such people spread the virus like the un-vaccinated?

    The push for vaccination against contagious viruses like measles is easier to justify than pressuring people to get vaccinated against STDs like HepB and Papilloma when they may not even be engaged in those risk behaviors.

    I saw a report on PBS about a healthy, athletic girl who became an invalid after she received Gardasil. The chance of getting cervical cancer in middle age would have been highly preferable to losing her health totally at 15.

  38. Thai, I looked up zero sum on Wikipedia, as your link directed me, and I still feel that we are basically, NOT SPEAKING THE SAME LANGUAGE.
    There is a very common misconception these days that the most important aspect of language is its capacity to send a message. And that, if our ideas APPEAR TO BE IDENTICAL in content though our words are different, well, this is just a little inconvenience that we don't need to worry about very much.
    But, in the same way as Hell tends to preach at me a little bit about PERCEPTION (yes, Hell, you do...) I can come back and tell most of you on this blog that different WORDS make different WORLDS (yuccky there I go back into my publicity mode again...).
    Thai, go read Gerard Manley Hopkins' "The Windhover : To Christ our Lord".
    It is a short poem. Difficult, but short.
    And a good read (out loud, of course) will allow you to notice just WHAT Hopkins is trying to do with words. He is trying to make words that stick so close to what he is seeing in the natural world that they BECOME the sensual experience.
    So, a few comments about zero sums.
    First, and MOST important comment : somewhere buried in there I saw the comment "assuming the logical behavior of your opponent in game theory". Whew, what an assumption ! And that is why most modern "liberal" economic theory is worth, like DIDDLY SHIT. I say, and repeat this observation. DIDDLY SHIT. I don't even think that I need to draw your attention to the extreme DENIAL involved in such theory. Ouch...
    You may have seen my observations about the four arithmetical operations. They are somewhere on this blog. Recent, too.
    Addition is like "ras des pâquerettes" (dirt bottom) level in symbolic complexity. 1+1+1+1+1 is just lumping together successive items. It has no symbolic complexity, and it has no analytic nature either, as far as I can see.
    The very idea of sums makes me suspicious. A sum, Thai, SEEMS to get rid of the individual elements behind a generalized entity. Right ?
    If you look at the history of our ideas over a long period of time, I think that you will see that the NUMBERS (another symbolic system, right ?) have become more important than what they are supposed to represent. Aren't they supposed to REPRESENT something Thai ? Isn't this the point ?
    And what happens when they DON'T represent anything to us ?
    I'm kind of speculating here. I'm not a mathematician.
    But... what is COUNTING for ?
    When you count, you necessarily abstract significant aspects of an INDIVIDUAL in order to lump him together into a generalization.
    I am EVEN suspicious of counting, you know...
    And you know something, as a shrink I realized a while ago that our minds are intuitively EXTREMELY complex. That we know tons of stuff that we don't necessarily know we know. Like, take counting, and the measurement of time (for you , Cotton...). I see more and more people every day abandoning their wristwatches (as I have done). I don't think they are necessarily aware of why they're doing it, nor necessarily even THAT they're doing it, but to me, this is a reaction against the tyranny that the MEASUREMENT of time in the occidental world has instigated. And we are collectively moving away from it. Rapidly, in fact...

  39. "The push for vaccination against contagious viruses like measles is easier to justify than pressuring people to get vaccinated against STDs like HepB and Papilloma when they may not even be engaged in those risk behaviors."


    Risk stratification and cost-benefit analysis (and don't just mean money) are a cornerstone of vaccine administration. But your going to have to trust someone to make a decision on this or do all the work on your own.

    AND my initial point was re: measles.

    But if you don't, and you start shooting heroin (a rather popular pastime where I trained in Baltimore and where I got 2 or my 3 HIV sticks). Who pays for your new liver?

    And what if people in one community don't shoot heroin for fun so much and then they get into an accident and are available as liver donors. Who gets their liver?

    Do you give it to where you need more of them (say someone from Iowa giving it to someone from Baltimore), or do you give it to the person you want to give it to (say an Iowan giving it to an Iowan)?

    Deb, then we may not be saying the same thing, who knows?

    Re: "I am EVEN suspicious of counting, you know..."

    Maybe you and Yo are saying the same thing! ;-)

  40. "But if you don't, and you start shooting heroin..."

    If you're sharing needles, you're an asshole and if you're doing that w/o getting vaccinated, you're doubly so; no liver for you unless every other more deserving candidate has already gotten one and you've got cash on the barrel.

    I'm for helping people, not paying for their selfish habits but that doesn't address Deb's son who may have had no need for the vaccine until he started working with needles and blood products. If he had done poorly in his intro courses he may have never gotten that far but was still forced to get the vaccine against his preference. And what about the Gardasil victim?, her life is no longer worth living.

    I know I swore this off but I can't resist; Link A, Link B.

    Link B makes a theological observation I had never been aware of. These are only informational and not intended to restart the tug-of-war.

  41. "Re: "I am EVEN suspicious of counting, you know..."

    Maybe you and Yo are saying the same thing!"

    That is ridiculous, I majored in accounting.

  42. Yo, it was meant as a gentle tease, honest. :-)

    But I do hope you see from my side of the computer where I find your lack of trust a little much at times. Most people are pretty good in my experience AND we are ALL selfish as well.

    Reading your comments makes me realize just how different the worlds we live in really are and how issues which are intuitively different to a health care provider are merged by non-medical types all the time in ways they really shouldn't be (but are from lack of trust).

    Re: Hep B and medical school.

    Clinical rotations (and cadaveric dissections) start day 1 in the US. I don't know how it works in France.

    Re: Gardasil

    I really don't know much about Gardasil recommendations nor its side effects (you may honestly know more about it than I as it isn't an EM item per say).

    I will say I have very definitely seen 24 year old women die of metastatic cervical CA; it is not something you want to see (maybe you have, I obviously don't know you that well).

    And, I see patients ascribe one symptom/illness for another in ways we in the medical profession reject almost daily so case reports on the news mean something but only something to me.

    Aren't you the one who agreed it is sometimes good to be a little conservative and let things "slow down"? If these issues are real, they will surface.

    Remember the family members of the people studying this stuff will use these vaccines as well.

    I do tend to trust organizations like the CDC (even though I know they can/have made bad calls).

    The FDA exists to balance safety and efficacy. It is their #1 mandate. If you don't trust them, I am not sure who you trust (I know you feel they are victims of regulatory capture, but knowing many who work there, I think this a VERY narrow view of FDA- we do make our own reality).

    AND, every vaccine is different in just about every possible way. They always will be. It is in the very nature of medicine.

    Please understand Yo, at some level, I live in a world of "least bad of many bad options"; it is what I do all day long.

    Unfortunately, I need to decide when to cease resuscitative efforts on people (with their loved ones right outside the room) and move hospital/EMS resources to the next person.

    Sometimes these pronouncements are expected; quite often they are not.

    I administer stroke drugs (tPA) knowing full well there is a 6% chance I will kill the person whether or not they get ANY benefit.

    ... AND I know I need to administer the drug within 3 hours of symptoms onset AND I need informed consent AND every second people take to decide makes the drug that much less effective/that much more dangerous AND patients/families are often like "deer in a headlight"- absolutely clueless assessing risk.

    I live in a world where I commit probably one patients per shift to psychiatric facilities against their will because of serious concerns over self harm or homicide (e.g. I act with the full power of the state to imprison people against their will for up to 72 hours without hearing as if I was the police).

    I long ago lost count of the number of people I have sent for amputations, etc.

    AND understand, I made up none of the system I work/live in. It existed before I was born and it will exist long after I am dead.

    AND in the end, all my decisions will center around:

    1. Do I know what I am doing (which really means I have to trust the wisdom of others who are far more knowledgeable than I on each illness/disease for which they develop "standards of care")
    2. What kind of character do I have.
    3. Was I looking out for the patient
    4. (if Obama gets his way) Was I looking out for society's pocketbook?

    AND I am honored to be a part of the system, I love what I do, I truly do.

    AND (for the paranoid part of you, in case you sense any kind of maverick ideas in my statements), my entire life's work is under the microscope, even if the public does not know or understand what this microscope is.

    EM is often defined as "life in a fishbowl".

    So "yes", as I said before, bad things can happen to people when they take vaccines AND the decisions around administering them are always about "the least bad of many bad options."

    None of this invalidates my point re: vaccines are the ultimate tragedy of the commons, which they are.

    I'll look at your links and respond.

    Hope you are well, I genuinely do. :-)

  43. Re: links

    Yo, I will agree that there are people who do very bad things to other people and they should be stopped.

    I know that probably won't be enough for you but it is the best I can do.


  44. In that case the med school is within its rights to require preventive vaccines for its students.

    For anything other than contagious AND dangerous pathogens I can't support giving the govt the power to mandate treatment. People can take their own chances; requiring a vaccine against an STD is going too far.

    I've never doubted your sincerity although we both irritate/exasperate each other.

  45. Can private insurers refuse to pay if you don't and you develop complications?

    Can physicians and hospitals refuse to take care of you if you can't pay AND you don't and you develop complications?

    Both scenarios are currently very much against the law.

    Again, what about privatizing profits yet socializing costs?

    I do not have the ability to refuse treatment to people (not that I really want it either for life threatening issues if the truth be told).

    You haven't "closed the loop" so to speak.

  46. And what if a person doesn't, yet develops complications and then decides to lie and tell the staff they really were vaccinated?

    And are we going to have a whole system of private detectives to tell health care providers what the truth really is?

    Who pays for this?

    For we both know patients would never lie to their physicians now would they...??? Especially if it came to life saving treatment.

    Or what if they simply change their mind but it is "after the fact"?

  47. Oh, and lest you misunderstand me, I am not at all suggesting that the government actually force people to get vaccinations.

    I am suggesting people will use stuff like this to judge each other by re: "can this person be trusted".

  48. If we ever get national health care then obviously the govt would have more leeway to set guidelines but with excruciatingly strict guidelines about lobbying and conflict-of-interest disclosure.

  49. I knew I would hit your cognitive dissonance (no foul, we all have them).

    This answer may fool many on this blog; it doesn't fool all of us and it would certainly fool no one in medicine.

    Without intending to sound rude, either you see it, or you don't as you too float in a "cloud of bliss".


  50. Well Thai, seeing the kind of dilemmas you have to put up with as a physician, and the way that the CONTEXT ultimately makes you PERCEIVE/RESPOND to your fellow man, not for anything in the world would I be in your shoes. I stopped my practice in order to avoid perceiving my fellow man through the grey ? colored glasses that my ideological framework dictated.
    And I try to see a doctor as little as possible...
    But that's on a parr with anybody living in a doctor's family, or coming from one, I think.