“Come live with me and be my love”

Blue jays have been swooping and screeching and carrying on in my side yard all day. Here’s a pair perched in the banana tree:

They have a nasty reputation, blue jays, but they’re lovely birds.

So glad today is Friday. This week has felt eternal. Got any big plans for the weekend?

I was thinking of joining the protests in Orlando outside Der Gropenfürher’s not-at-all-weirdly-fascist “rally” on Saturday. But some folks who don’t seem overly alarmist or kooky are warning that it might very well be a trap, that Trumpian goons might try to cause trouble to put the resistance in a bad light.

Honestly, I have no idea if that’s true or not. But it’s a good excuse to skip a dreadful trip on I-4 to Orlando and instead fulfill a long-standing ambition to ride the Beer Bus Brewery Tour all over Tampa with my sister.

Open thread!



July 3rd Capitol Hill meet-up

For a variety of reasons, I am in Washington, DC at the start of next week.

Would anyone want to go grab a beer or two around Capitol Hill on Sunday, July 3rd in the late evening.  I’ll supply the green balloons if you can recommend a good place to meet at 8:30.

 



Wednesday Evening Open Thread: Saving ‘Brawndo’ for After the Election

Per the Boston Globe:

Budweiser announced on Tuesday that it is making a drastic change to its signature beer labels this summer, renaming its lager “America” and replacing most of its branding with patriotic mottos.

The redesigned cans and bottles that hold its ubiquitous beer will be on shelves through the election season, the company said…

Anheuser-Busch, which was sold to Belgian beer-maker InBev in 2008, will introduce the cans on May 23.

Just in time for your Memorial Day adult beverage needs!

Apart from realizing that some people are treating Idiocracy as an instruction manual, what’s on the agenda for the evening?



Getting upstream of the costs

Same Facts is pushing a RAND report on 24/7 Sobriety in South Dakota.  It is showing incredible results for improved health and safety outcomes.

Examining the 24/7 Sobriety Program in South Dakota, which started as a pilot in 2005, researchers found that county implementation of the program was associated with a 4 percent drop in deaths at the county level.

The South Dakota 24/7 Sobriety Program requires that individuals with an alcohol-involved offense undergo twice-a-day breathalyzer tests, typically once in the morning and once in the evening, or wear continuous alcohol monitoring bracelets. Individuals who fail or skip required tests are immediately subject to a short jail term, typically a day or two for a failed test.

Nearly 17,000 individuals — nearly 3 percent of the state’s adult population — participated in the 24/7 program between January 2005 and June 2011. Nearly half of the participants were enrolled after a repeat DUI offense, while others were enrolled after a first-time DUI offence or being charged with assault or domestic violence….

To examine whether the program was associated with changes in mortality, researchers analyzed county-level mortality data from January 2000 through June 2011, and took advantage of the fact that counties implemented the strategy at different points in time…..

The association was evident not only for total deaths, but also among conditions sensitive to alcohol use, including circulatory conditions.

Mark Kleiman ( a big supporter of 24/7 Sobriety and more generally swift/certain/small punishment regimes) at Vox makes another point on cost effectiveness:

The program costs less than $2 per participant per day; offenders are required to bear that cost, presumably out of the money they would otherwise spend on alcohol.

Doing some very quick back of the envelope calculations, this is a $12 million dollar a year program at most ($2 per day per participant *17,000*365).  It works out to be a public health investment of no less than a penny per person per week.  This is a massive overestimate as the program was evaluated over a six year period and people came in and out of the program.  But let’s stick with $12 million as the worst case scenario is massive illuminating anyways.

The program only had to avoid two deaths per year or add 120 QALY improvements to be cost effective as a public health measure.  If the 4% reduction in mortality runs through verification, the averted deaths are orders of magnitude higher than the minimal needed to be a break even proposition.

This is an extreme example of how public health programs can be used to divert medical expenses.  South Dakota’s hospitals are most likely seeing a healthier population than they otherwise would have been seeing.  There would be fewer car crashes, fewer cirrhosis cases,  fewer cardiovascular failures than the counterfactual of having drunk drivers still drinking.  Substance abuse is a known cost driver in risk adjustment, and it is often a co-morbidity multiplier where it makes treating other issues harder and more expensive.  From a public health perspective society paying a few pennies per person per month for this type of public health intervention is a massive win.

It is a win at the immediate outcome level, and it is a win at avoiding sending people to limited detox and rehab beds at $1,000 or more per bed per night.

 



Less stupid fucking in Maryland

At least that is the the public health take-away of a recent study analyzing the public health impacts of an increase in the alcohol tax in Maryland.

The Baltimore Sun:

Maryland recorded 7,400 cases of the bacterial infection in 2010, when alcohol, like other goods, was taxed at 6 percent. But two years later, with a 9 percent levy tacked on to booze sales, gonorrhea cases in the state dropped below 5,700, even as infection rates grew nationally.

Researchers at the University of Florida say they can only find one explanation: the alcohol tax.

“We know increasing alcohol taxes decreases alcohol consumption,” said Stephanie Staras, the lead author of the study, published in the American Journal of Preventive Medicine. “We also know that people who are using alcohol are more likely to have risky sexual behavior.”

Besides being a great opportunity to for an excellent post title, this is a good illustration of how insurance design is important but far less important to general health than general socio-enviromental factors.  Maryland was looking to raise revenue and perhaps decrease drunk driving when they increased the tax.  Tertiary impacts on sexually transmitted infection (STI) rates were most likely not part of the political debate.

However, if these results hold up, and logically they make sense as alcohol consumption leads to bad decision making, avoiding seventeen hundred STI cases avoids significant treatment cost and more importantly, it avoids significant pain and risk for individuals.  Avoidance through changing the environmental and economic matrix is far more efficient treatment than post-infection treatment.

 

 



Another Sunday Open Thread

My ass is still dragging from the official time change, which is a stupid contrivance that seems designed to drive wedges between people and their pets.

We went to a spring training game yesterday — Tampa Bay Rays vs. Pittsburgh Pirates. It went to 10 innings and ended in a tie. It was a gorgeous day for a game:

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There’s a boardwalk thingy near the beer stands where you can perch over the bullpen and watch the pitchers and catchers practice:

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However, because I’m an idiot, I neglected to put sunblock on, so I got fried, even though I was wearing a hat. My nose would make Rudolph’s look like a dull, washed-out snout.

The mister and I are bottling the second batch from our nanobrewery today — a honey ale. Our inaugural batch, an IPA, was a huge hit. The third production will be a chocolate milk stout, which we’ll boil up next week.

What are you up to?



Open Thread: Beer & Futbol


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How have y’all found ways to enjoy your Saturday?