The T-Cell immune response that didn’t bark

T-Cell immune response (not to be confused with invulnerability) is hardly a new idea in public health. Yet what is striking is how long it took you to hear about it — from the mainstream at least — in the context of coronavirus. If you go back to February, March, even April or dare I […]

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Further thoughts on consumption and GDP

I was surprised at the amount of resistance to my recent claim that consumption is not a part of GDP, i.e. that consumption is not production. Here I’ll respond to two claims that don’t mean what people think they mean:

1. The BEA measures consumption when it is computing GDP.

2. Without consumption there would be no production.

Both are true, but these facts have no bearing on the issue. Yes, the BEA does measure consumption, but consumption is not included in GDP. Here’s how it actually works:

The BEA measures the production of all consumer and investment goods, which is GDP. (Actually, they separate out private consumer (C) and investment (I) goods production from public C and I production, with the latter called “G”, but that minor point doesn’t change anything.) Basically, GDP is the total domestic production of consumer and investment goods in a given period. That’s the textbook definition, and that’s what the BEA measures.

In order to determine the production of consumer and investment goods, they look at domestic consumption and investment spending, and then adjust for inventory changes and trade imbalances. That converts domestic spending of C and I goods into domestic production of C and I goods. But make no mistake, GDP does not includes consumption; it includes the domestic production of consumer goods plus the domestic production of investment goods.

The second point is also misleading. Yes, consumption is the primary motivation for production, indeed almost the only motivation. But that doesn’t make consumption a part of production. Some commenters tried to imagine what would happen to production if there were no consumption. Yes, it would likely decline. But it’s also true that production would decline if there were no oxygen in the atmosphere. That doesn’t mean oxygen is a part of GDP.

All this is true regardless of whether or not you accept my critique of Keynesian economics. But if we are going to discuss the merits of Keynesian economics, it’s important to start with some facts on which everyone should agree—such as that consumption is not a part of GDP. GDP measures production, not consumption.

Peter Navarro and Wilbur Ross made the opposite mistake when they claimed that imports are a negative part of GDP.  Actually, imports are not a part of GDP at all, as GDP measures domestic production.

This identity:

GDP = C + I + G + (X-M)

does more harm than good.  It leads people into all sorts of fallacies, including protectionism and fiscal stimulus.

I much prefer this identity:


Neither identity has any causal implications, but at least the equation of exchange is less likely to lead to erroneous public policies.


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Sounds Suspicious: The Dropout, Episodes 1 and 2

John Carreyrou’s book about the rise and fall of Elizabeth Holmes and Theranos is so comprehensive, it’s hard to imagine what a podcast covering the same material could add. (You can read my first post on Carreyrou’s book here.) But the first thing we hear in the first episode of the ABC News podcast, The Dropout, is an audio clip from Holmes’s deposition. 

And that means we hear Elizabeth Holmes’s voice.


Holmes’s voice is a consistent theme in Carreyrou’s book, significant enough to have its own entry in the index. In public interviews and in her deposition, Holmes’s voice is a startlingly deep baritone. Carreyrou, and others who have worked and spoken with her, say that this is a pretense. Holmes’s natural speaking voice is more traditionally feminine and higher-pitched. The baritone is something she adopted to sound more authoritative and more powerful.


Any woman in the business world can sympathize with the difficulty of being taken seriously–particularly when one has a quiet, high, “girlish” voice. But Holmes’s baritone and the long pauses she uses either for emphasis or in order to keep her voice in this lower register combine with what we now know about the level of deception practiced by Holmes and her company to emphasize just how deeply her duplicity ran.


It is a voice we hear a lot over the six episodes of The Dropout. 


The first episode is dedicated to the young Elizabeth Holmes who, from childhood, had wanted to invent something big and to change the world. Everyone’s favorite childhood anecdote about Holmes involves her drawing involved plans for a time machine at age 7. It sets the stage for her as a person with big dreams and a sense she could accomplish anything. But the second anecdote everyone tells about Holmes. A relative asks her what she wants to be when she grows up, and she says: “A billionaire.”


It would be unkind to base our understanding of anyone’s character on their childhood answers to questions like this. (I wanted to be a ballerina, after all.) But since we know how the stories of Holmes and Theranos have evolved, it is hard to remember that, and hard not to read her ferocious ambition directed towards nothing more specific than the accumulation of wealth, as the source of so many problems.


Episode one interviews some of Holmes’s high school teachers and her professors at Stanford. When Holmes was introduced to Phyllis Gardner, a professor of medicine. Gardner found her unimpressive, “It was just a 19 year old talking, who had taken one course in microfluidics, and she thought she was going to make something out of it.” With a chilly reception from Gardner, Holmes sought a mentor in the engineering department–Channing Robertson. Robertson became very involved in Holmes’s goals, introducing her to venture capitalists, and becoming a director of her nascent company. He compared her to Mozart, Beethoven, Newton, and Einstein. 


While Holmes had trouble getting funding from those with medical and pharmaceutical experience, venture capitalists with more generalized interests were excited by her dream of radically changing the world of blood testing. Donald Lucas Sr., who originally backed Oracle, is another voice we hear in the first episode of the podcast. He notes his initial skepticism about this 19 year old Stanford dropout with a big idea, but then notes that her great grandfather was an entrepreneur and the hospital in her area was named after her great uncle, “so she came by the two things that were necessary here–one medicine, and the other entrepreneur–quite naturally. And she was attractive, too.” Hearing Holmes’s staged baritone helps cement her dishonesty for podcast listeners. In much the same way, hearing Lucas marveling at Holmes’s mystic bloodline of medical innovation as well as her blonde beauty helps us understand how Holmes got so much money so early with so little to go on. 


She had a great story. 


But great stories don’t make great companies. Neither does hiring designers from Apple to make an impressive looking case, nor does redesigning Holmes’s own personal style to mimic that of her idol, Steve Jobs. 


At the end of episode one, we learn that Holmes had arranged for Theranos to be allowed to test its technology on 3rd and 4th stage cancer patients. The machines didn’t work, and the data was corrupted. The tests were just for research purposes, and were not used for diagnostic and treatment purposes. But Theranos employees did not know that. We also learn that Avie Tevanian, Steve Jobs’s right hand man who had left Apple to serve on the board of Theranos had been invited to resign for “asking too many complicated questions.” 


The ever growing level of secrecy and dissimulation at Theranos is the focus of episode two.


In this episode, Sunny Balwani enters the story. With Theranos rapidly running through its initial investment capital, and having trouble getting funding, Holmes sought loans from other sources. Balwani, who had known her since the summer before she went to college, gave her a 13 million dollar interest free loan. And he came on board to Theranos as the president and CEO. With no background in science, and with an abrasive and threatening personality, Balwani seems to have been immediately a source of tension and fear among Theranos employees.


What employees and investors did not know, however, was that Holmes and Balwani were romantically involved. The relationship may have been kept under wraps because Sunny originally met Elizabeth when she was 18 and he was 37, or because investors would have disapproved of Sunny’s involvement in the company if the relationship had been public, or to try to burnish Elizabeth’s mystique as the driven founder with no passions other than her start up. Whatever the reasons, it was never disclosed. 


Holmes and Balwani worked closely together to persuade Walgreens to adopt Theranos technology for lab testing. They told executives that the technology was “viable and consumer ready” and had been validated by the FDA, and was used by the US military. None of this was true.  When Walgreens brought outside experts into Theranos headquarters to review the technology, Balwani’s extensive security was on display, but nothing else was. Experts were not allowed to see the lab or speak with anyone but Holmes and Balwani. And when they asked to run blood tests on the Theranos tech and at an outside lab in order to compare results, Holmes and Balwani refused. In the podcast one expert comments. “I never saw anything that would indicate that the machine would do anything at all…I never got it to do anything.”


Theranos’s claim to be able to perform more than 250 lab tests on a single drop of blood was nothing but fiction.


Yet, Walgreens agreed to a deal with Theranos. By 2015 there were 41 Theranos wellness centers in California and Arizona, and they seemed poised to roll out across America.


The increasing prominence of Theranos, and the prospect of Theranos and its non-existent technology becoming a major–perhaps the major–source of lab test results in the nation, began to horrify and frighten employees. Ian Gibbons, a biochemist at Theranos, worked in the labs, trying to make Holmes’s and Balwani’s outsized promises come true. Unable to make the technology work (and as the podcast proceeds, one wonders if anyone could), he spoke in confidence with Channing Robertson–that supportive Stanford professor who compared her to Beethoven–and was fired the next day. He was rapidly hired back but demoted to HR work. At the same time, Ian Gibbons had been subpoenaed to appear in support of Theranos in a patent dispute. He did not want to testify because it would have required either perjuring himself or revealing that the Theranos tech didn’t work.


Ian Gibbons committed suicide before the court date.


Beginning episode one with the voice of Elizabeth Holmes allows listeners access to the vocal change that is a part of her extensive deceptions. Closing episode two with the voice of Rochelle Gibbons, telling her husband’s story and dissolving into anger and anguish when discussing his death makes very real the very human costs of the games being played by Holmes, Balwani, and Theranos.


And yet, there seemed to be no end to their rise.


Next time: Episodes 3 and 4


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Using Social Media to Bring Down the Power Grid

Social media are a coordination device and coordinated behavior has many advantages. Social media was used to motivate, organize and coordinate movements like the Arab Spring and Black Lives Matter. Of course, coordination can also lead to conspiracy theories like QAnon, twitter mobs that police political correctness and riots that lead to death and destruction. […]

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