Ezra Klein Profile picture
13 Apr, 15 tweets, 3 min read
My column last week was about whether regulators in America have been too cautious, so afraid of the consequences of getting a decision wrong that they've cost lives through inaction and delay.

This is *very* relevant to the J&J issue. 🧵 nytimes.com/2021/04/01/opi…
I fall on the side that thinks they are too cautious. I think that's clear.

But it's a mistake to think these are easy decisions, or to just say that the math is 6 blood clots out of 6.5 million shots, so wtf are you thinking.

That's missing their actual fears.
Mass vaccination campaigns work only if the masses take the vaccines. As Daniel Carpenter said to me, “In this way, it’s a deeply social technology, and so the credibility is everything.”

"Effective therapies depend on credible regulation."
FDA is worried they missed something on J&J, and if it gets worse, and the public blames them for rushing the vaccine, that trust could collapse in *all* the vaccines, and in future vaccines.

The cost of that would be incalculable.
Expert vaccine Twitter is a risk tolerant place, full of people who work backwards from the appendices in pre-prints to come up with their sense of acceptable risk. In this hothouse, the danger is always doing too little.

Public psychology is less data-driven.
But here's the counterargument: There's no actual evidence the FDA knows how to manage public psychology correctly on this.

Would it be better to report the data, be honest about the risks, and tell people to make the decision that's best for them? Maybe!
Is it possible that the FDA is going to increase vaccine hesitancy here, rather than lower it? Definitely.

Let's say, in three days, they clear J&J totally. Will that get the news coverage the pause did? Will it fully end the fears the public now has? I doubt it.
The UK offers another path: They've gone to first doses first, approved Oxford-AstraZeneca (though have gotten worried about clotting issues there, too!), tried human challenge trials.

Is vaccine hesitancy higher there? No, it's lower.
On the merits, I think the FDA's skeptics are right. There are something like 6 clotting events (that we know of) out of 6.5 million shots. The danger is small and theoretical.

Meanwhile, the B117 strain is spreading across the country. The danger is huge and real.
If you're going to pause J&J, go to first doses first of Pfizer and Moderna.

Or since the clots were all in women, use J&J for men, and Pfizer/Moderna for women.

Do something to show you are as fearful of B117 as adverse vaccine events.
This is my ultimate criticism of the regulators in this. I take their fears seriously. Their job is very hard.

But they are not being creative in balancing these risks, and that means they're running too much coronavirus risk. And they may be *increasing* vaccine fears.
In a statement, the FDA said “We are recommending a pause in the use of this vaccine out of an abundance of caution."

What does an abundance of caution on B117 demand? How about an abundance of caution for those who need a vaccine and can't get one?
One place my beliefs have shifted during the pandemic: I think regulators, broadly, are too afraid of trusting the public with information and letting us weigh risks.
That doesn't work on everything. You need good information to make good decisions.

I'm not someone who thinks you should be able to take any medication by signing a release waiver. Too many people are out there trying to actively fool the sick, the dying, the scared.
But we've given 6.5m shots of J&J (including to me!). There were 6 clotting events, all women between 18 and 48. There's a lot of data here.

There were options between a screeching halt to J&J and doing nothing. Options in which the public could've been brought in as a partner.

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More from @ezraklein

14 Apr
One thing I've been thinking about since my podcast with @tressiemcphd is the difference between status and class, and how a focus on class often confuses issues of status 🧵 nytimes.com/2021/04/13/opi…?
There's been this debate in recent years about whether class should be measured by education rather than income. Or maybe by occupation rather than income.

Michael Lind wrote a whole book making this argument from the right: penguinrandomhouse.com/books/607661/t…
There's something to this: A tech CEO and an English professor at Berkeley experience more similar worlds, and vote more similarly, than the tech CEO and the owner of a plumbing company in Akron — even if the CEO and the small biz owner have closer incomes.
Read 14 tweets
13 Apr
“You’re repurposed as fodder for content generation in a way that’s just so dehumanizing. I don’t really believe in cancel culture, I think it’s a platform failure.” warzel.substack.com/p/its-not-canc…
One way I've been thinking about this is "cancel culture" is a less useful term than "cancel behavior."

There is a certain set of behaviors which, when combined the the problems of this (and other) platforms, lead to cancellation, harassment, and too many very bad days.
The key thing is the behaviors don't feel, to the people engaging in them, like a big deal. You're just dunking on someone! Or criticizing them! Or making fun of them!

You're just doing some tweets. Joining in on the game. You don't want anyone fired or harassed or swatted.
Read 4 tweets
12 Apr
Substack/Ghost/etc are a pretty straightforward tradeoff.

Institutions bring advantages and disadvantages. For writers with large, loyal audiences, you make less money than if you directly monetize your audience, but you get more audience, resources, editing, legal help, etc.
I think the focus on top incomes has obscured a lot of this.

I could make more money going to Substack. But the New York Times offers audience reach I could never get otherwise. They're read by people who'd never think of subscribing to my newsletter. That’s worth a lot to me!
But institutions also have disadvantages.

Bureaucracy, pressure to be on the news, time it takes to publish, bad management, divergence between your voice and the institutional voice, etc.

If those really bug you, and you can make more on your own, going indie is great.
Read 10 tweets
8 Apr
Always hate to disagree with Paul, but I'm not using Larry Summers as a stand-in for all economists here!

Economists in *this* administration tell me there's a difference between the weight Biden puts on their advice and the way Obama and Clinton engaged, and I believe them.
As I say in the piece, some of them think that's bad, others think it's good — a proper rebalancing of roles.

A lot of the advice economists gave in past administration was political advice masquerading as economics advice. That political advice was often very, very wrong.
And I'm not saying Biden ignores economists outright. Yellen, in particular, carries a lot of weight with him.

But in a relative sense, Biden is more skeptical of the way economists view the world — always has been — and more proudly political than some of his predecessors.
Read 7 tweets
8 Apr
There are (at least!) four big reasons why Biden's presidency has been so much bigger, so much more ambitious, than the rest of his career: nytimes.com/2021/04/08/opi…
1. The collapse of the GOP as a negotiating partner, which has unleashed Democrats to legislate the way they actually want to.

I don't think this can be overstated. It has transformed policy design. Bills are no longer pre-compromised, and Senate Dems accept that.
2. A new generation of Democratic staffers, both in the White House and in Congress, has grown up amidst skyrocketing inequality, financial crises, and climate emergency.

They see the world very differently, and they have the power now to do something about it.
Read 8 tweets
7 Apr
About a week ago I thought it would be interesting to do a quick piece on how the word “infrastructure” is changing, but when I asked some folks, the answers were boring and seemed like a distraction from more interesting questions about what the Jobs Plan does.

I stand by that.
Imagine I could prove to you, absolutely prove it, that care work isn’t infrastructure. (I cannot prove that, btw, and nor can anyone else. Categories are contested!)

Would that in any way change whether the care work provisions are good or bad?

No. No it wouldn’t.
This bill is *vast*. It’s more like an agenda than an idea. I’m having trouble covering it because there’s just so much to cover. But it demands a lot of analysis. I hope we don’t waste too much time in a semantics debate that doesn’t help us understand the bill or evaluate it.
Read 6 tweets

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