The test-kit that the CDC sent to local labs had a faulty reagent, so all test requests have to be sent back to the CDC.[0]
Local labs could develop or purchase their own test kits, but during an a public health emergency, they must get FDA authorization before launching such a test.[1]
This seems to me like a giant institutional and bureaucratic screw up.
In all seriousness, why should a non-invasive diagnostic test require any sort of approval (particularly during an outbreak)? This is just RT-PCR if I understand correctly - there's nothing particularly novel going on here. Just publish the primer sequences and let the biotech industry handle things.
Edit: Oh hey they did publish an RT-PCR protocol [1] plus sequences, [2] along with a disclaimer not to use them directly on human subjects. This is just silly (IMO).
> These procedures and/or reagents derived thereof are intended to be used for the purposes of respiratory virus surveillance and research. The procedures and reagents derived thereof may not be used directly in human subjects.
My understanding is that it’s based on a law from several decades ago, when it was difficult to get your hands on a sequencer, that was meant to help empower the CDC once some kind of pandemic was declared in order to get tests out faster. Now that sequencers are commonplace, the same law instead of speeding up the deployment of these tests now slows them down.
>FDA regulates test kits but generally lab developed tests, which are designed and used in single lab, can be offered without FDA review. When HHS declares Public Health Emergency and issues declaration to support EUAs, labs must seek FDA authorization before launching new test.
Normally they can be done without approval, but there is a special regulation on the books that activates when the department of health and human services declares a public health emergency.
Because government bureaucracies cease to function in their original task and become only concerned with their preservation. It’s a lesson that happens over and over and we selectively ignore it.
Remember this folks when voting for people who advocate for a greater role of bureaucratic control of our lives.
Taken literally, you are correct and you advocate good advice - to remember this and presumably weigh it among the pros and cons. However, your phrasing could be interpreted to have a subtext suggesting less bureaucracy is always better.
There's no way to criticize any bureaucracy without having a subtext that less bureaucracy is always better, if the mere implication that less bureaucracy would have prevented the problem is enough to conjure that subtext in the minds of the readers.
Why do we always measure burocracy as an "amount" (something of which there can be "less" or "more"). Surely there can be unnecessary, pointless, frustrating, harmful, nerve-wracking acts burocracy which can require more or less time to be performed. But isn't the real measure we should have one about quality of the outcome and balancing that against any effort endured by the populace?
> Why do we always measure burocracy as an "amount" (something of which there can be "less" or "more").
Because large bureaucracies only ever get modified in the aggregate.
You have a bureaucracy that imposes 500,000 rules. If you want to know which are worth it, you have to evaluate each of the rules individually, because some may be worth it and others not.
Really evaluating 500,000 separate rules would take a large staff multiple lifetimes, so you still have to decide whether the bureaucracy as a whole is doing net good or net harm in order to determine whether it should be suspended for the years it will take to evaluate all the rules.
But by the time you finish the evaluation, years have passed since you started and the facts on the ground may have changed, or new rules proposed, so the evaluations are stale before they're completed and you have to start over.
It leaves you with only the systemic question of whether large bureaucracies are a net positive force as an institution. The answer could reasonably be no.
But notice that the answer is also related to the size. Because if the bureaucracy is smaller, you can finish the evaluation sooner, possibly soon enough that the evaluation results are still relevant by the time you finish. Having fewer rules allows you to have better rules, because the fewer you have the more time and other resources you have to make sure each is doing more good than harm.
> There's no way to criticize any bureaucracy without having a subtext that less bureaucracy is always better, if the mere implication that less bureaucracy would have prevented the problem is enough to conjure that subtext in the minds of the readers.
I would agree it is impossible to prevent all potential misunderstanding when writing for a large audience, but various methods can make this kind of misunderstanding less likely:
- Emphasize qualifiers like "some", "most", "often", "sometimes", "not all", "many", etc.
- Anticipate and explicitly disclaim possible misinterpretations
- Acknowledge valid counter arguments
- Be very precise and explicit about our intended mentioning
As opposed to corporate bureaucracies? If you think the free market magically makes everything efficient and free of politics and bureaucracy, try spending some time in a big company.
Remember this folks when voting for people who advocate for privatizing or de-regulating industries.
Corporate bureaucracies can absolutely be just as terrible. But the problem isn't that a bureaucracy exists, it's that there is a law requiring the approval of a specific bureaucracy.
If a corporate bureaucracy is slow and inefficient, that sucks, but it creates an opportunity for somebody else to be less slow and less inefficient. If a government bureaucracy is slow and inefficient, can you start your own and go into competition with them?
Well, the result of the diagnostic test could cause harm (panic, unnecessary treatment, people not quarantined when they should be) if it was not accurate enough, but they should probably fast track something given the circumstances.
You know what causes greater panic? An outbreak that only to the attention of the media when corpses start piling up at the hospital, all because an undetected cluster wasn't identified when it was starting.
> In all seriousness, why should a non-invasive diagnostic test require any sort of approval (particularly during an outbreak)?
To make sure it's a reliable test with known error bars to avoid false positives and negatives. If your data is garbage who cares how quickly you get it?
^^ This is exactly the answer! The positive predictive value of a test changes based on the prevalence of the disease in the population. With rare conditions, you can end up with way more false positives than actual positives, which can cause actual harm to people.
"Outbreak" and "Contagion" both depict mass outbreaks of deadly viruses, and the social impacts of implementing last-ditch control efforts. There's a certain point where panic about an epidemic is more damaging than the epidemic itself, and I worry we're approaching that point with coronavirus. When everybody is freaking out is exactly when we need to enforce good public health practice, not throw it by the wayside and go full wild west.
when you conduct the assay you are handling a known pathogen
doing that without proper training equipment and expertise should be discouraged, even if it isnt the original intent of the restriction it does seem to reduce a possible avenue of amplification of the problem
The thing is, you're already dealing with a patient that might be infected and medical testing labs already process potentially infectious samples on a daily basis.
The CDC has actually issued official guidance regarding Coronavirus biosafety. [1] Other than discouraging unnecessary culturing of the virus, BSL-2 (a fairly common setup) is the main recommendation.
Medical testing is very, very murky. There was a time a routine medical test for me came back, indicating I possibly had Lupus. It turns out; this test has a false positive rate of about 5%.
I am a white male, and the rate for lupus for my group is astronomically low. The rate for the worst group (black females) is like 500 in 100,000. There's some evidence the rate around white males might be six times lower.
Had I known any of this at the time, or had my doctor explained it, I wouldn't have spent weeks worrying.
The fact is, medical tests just update the probability you're sick or well. And this is why they have to be well understood.
I had a problem a couple years ago where my test showed that I had hypothyroidism. My doctor wanted to immediately put me on sythetic thyroid hormone to adjust this. The problem is that I'm thin, athletic, and have no other indicators for risk of hypothyroidism.
I said no to the doctor, and had them do another test, which said I was just fine.
The story is not so remarkable: there is no harm from taking synthetic thyroid hormone, and your TSH is monitored while taking it such that I think the mistake would have been discovered later.
>there is no harm from taking synthetic thyroid hormone
Where are you getting this crazy idea? Have you ever known anyone who took it? I have two relatives (not biological) on synthroid and even small changes in doses have massive effects on their metabolism, tiredness, etc. Taking thyroid hormone when you don't need it is not harmless, just like any drug or hormone.
there's a particularly sad story about HIV testing, which is told as a cautionary tale to medical students: during the HIV outbreak, the tests had something like a 2% false positive rate. the result letter made the mistake of telling patients there was only a 2% chance the test was wrong. people committed suicide after discovering their test came back positive.
but they neglected conditional probability. so many people were being tested that the probability they had HIV was much lower than 98%. they changed the letters to say "inconclusive" instead of "positive" and had them take the test again, which reduced the needless suicides.
From reports, the Chinese tests have fairly high false negatives, but they’re still deploying them en masse because catching as much as is possible better than not catching anything at all. I’ve seen nothing on false positives.
Yeah at the end of the day it seems by far the best outcome. I'm just thinking there may be some sort of red tape surrounding the liability aspects of that outcome. Like maybe there's a waiver of liability for passing a sick person off as healthy, except it only applies to such and such equipment, etc. I'm just using my imagination here, I have no experience in the medical industry.
If you're using an officially published primer sequence? Possible (due to supplier or user error), but _highly_ unlikely. We're pretty good at molecular biology at this point.
I'm not talking about making an entire test kit, but rather labs with existing RT-PCR abilities (ie the vast majority of molecular biology labs) having the appropriate primers and probes synthesized by the standard (non-clinical) vendors that they order from every day.
>a disclaimer not to use them directly on human subjects. This is just silly (IMO).
this is because if you truly understand the materials present in the assay kit, you can, with a well stocked genetics laboratory, begin recombinant proceedures
That... doesn't make any sense. What does the ability to run recombinant procedures (however ill advised doing so might be) have to do with running an assay on a human sample for diagnostic (as opposed to research) purposes?
To be perfectly clear:
* The CDC has already made an RT-PCR protocol plus associated primer and probe sequences publicly available.
* BSL-2 labs that do cell culture and employ viral vectors for transfection [1] are quite common in academia.
there are structural conformations that are not indicated-
you must exploit a biological system that will create a functional virion-
before you do that , if you understand genodynamics of the sequence you can start making good guesses about where to change the sequence in what way-
this can be because you want attenuation of the virus with an extreme degree of control-
this is how you make a recombinant product that is not as damaging to the host and produces a strong antigenic signal to the immune system this means you have a vaccine-
of course this is also a dualpotential technology so it could be used for evil and weaponized, so we want to have some inspection regarding who has these opportunities
Are you saying that if i had the test for corona, and then a bunch of knowhow and some wizbang machines I could start making the virus? I was always terrible at biology.
you could create an mRNA and arrange the proper signaling and delivery [hopefully] and do something very risky like try to biohack an adaptive immune response into a vaccination
I think you've misunderstood. The CDC page I linked provides a diagnostic protocol for testing samples for presence of the virus. The disclaimer explicitly forbids using the protocol as a diagnostic test in a medical setting, reminding the reader that it is not approved for such use and is to be used for research purposes only. That's the silly part - industrial biotech oligos are _more_ than reliable enough for human diagnostic testing during an active crisis.
its not about reliability its about being vetted into the process, rather than have a bunch of randos doing things and making a bunch of reporting noise.
there is a form if you want to see about trying to help out:
A bunch of randos? You mean trained lab technicians with extensive experience running RT-PCR assays on a regular basis? You mean biotech vendors that already synthesize ultra high purity custom oligos? https://www.genewiz.com/en/Public/Services/Oligo
It's quite possible I've missed some crucial piece of information about why this wouldn't work. So far though, I've seen no reasonable explanation as to why we need specially approved kits at this point. These are standard reagents and standard techniques; the lack of widespread rapid testing in the US is bureaucratic in nature, not technical.
>the lack of widespread rapid testing in the US is bureaucratic in nature, not technical.
that is the thing right there-
the federal government has OCD when it comes to a lot of things its not that you dont have a reputation as a professional, its that you/we dont have a rep with them until they check us out.
+ if you want a kit use form [1]
if you think the kit is somehow deficient goto form [2]
While publishing the negotiated prices for each procedure code would be interesting, I don't see how it would change much since it wouldn't necessarily be the price they would actually charge me, and it wouldn't help me know beforehand what sort of add-on procedure codes/bills were going to be part of my care.
The policy I would like to see is that patients should only be legally liable for costs that they sign off on up front (at least for most elective care). It never ceases to bother me that every time I go to the doctor I have no option but to give the hospital a blank check and have to cross fingers that they will not hit me a month later with ridiculous charges.
Eventually the published price will be close to the amount you are being charged. I would expect health care providers to stick with their promise to post the highest possible cost but as people being to use these prices to shop around (both these numbers are exorbitant, but this one is less so, etc.), I am confident they will abandon this gambit.
IMHO, it's kind of nuts they are even starting out with this argument.
It makes perfect sense: meat is expensive and difficult to work with, so low-cost chains like these have been serving really disgustingly low-quality meat for quite some time now; in some cases it could barely even be called meat.
Consumer advocates in the past few years have actually done a pretty good job at pressuring the top fast food chains to not dilute their beef with additives.
It's all the other stuff (the bun, the fries, etc. ) that have preservatives, fillers, and shady additives.
(When traveling, I sometimes just buy a bunch of MdD's patties a la carte. Tasty, nutritious and very filling).
This "impossible burger" trend basically reverses the work of consumer advocates. The one element of fast food that is actually an all-natural, nutritionally complex whole food is replaced with a patty that is nothing but processed food and additives -- https://faq.impossiblefoods.com/hc/en-us/articles/3600189374... The fast food restaurant will likely save money -- but because of how fashionable vegetarianism has become, instead of being condemned, they will be actually praised as being eco and health conscious.
> When traveling, I sometimes just buy a bunch of MdD's patties a la carte.
o_O
> how fashionable vegetarianism has become
I don’t think it’s a question of fashion. However tasty meat may be, it’s ethically and environmentally bad. Whether it’s in 50 or 500 years’ time, one day our descendants will look back at us and wonder: “they ate corpses?!”
However tasty meat may be, it’s ethically and environmentally bad.
I disagree entirely, but there is no need to relitigate this debate here. If by any chance you have never read the pro-meat argument, the book The Vegetarian Myth by Lierre Keith is a pretty good primer.
Instead of debating a bad book or whether meat is good or bad for you which I don't know enough about would you like to talk about the ethics? I eat meat myself.
Where do you draw the line as far as ethical behavior towards animals? I think even most who eat meat don't think things need suffer right? After you admit animals CAN suffer and that such suffering ought to be minimized the logical minimum suffering is not raising animals for food save to the degree that is required for the health of human beings. Essentially balancing the 2 factors.
I'm personally hoping that particularly knot can be untangled by artificial meat. If we can ultimately cheaply produce fake meat that is identical insofar as utility there remains zero reason at that point to justify killing animals.
I realize that sourcing wikipedia is kind of lazy but I lack the time to read entire books full of every sort of misinformation that happens to be going around.
For the earth to survive, Keith thinks, the human population needs to be reduced by more than 90 percent. She also argues that the human food-supply needs to come mainly from hunting and small-scale animal husbandry.[4]
Criticism:
Sami Grover, referencing "Jason V", says Keith's book is filled with "factual errors and fallacious thinking". Furthermore, Jason V writes that Keith fallaciously uses her ex-vegan status in an attempt to depict herself as an authority on the subject.[11]
Patrick Nicholson writes that the book misinterprets scientific articles, cherry-picks facts, uses strawman arguments and relies heavily on anecdotes and faulty generalisations.[5] Ian Sinclair writes that Keith's arguments are "full of lazy thinking, willfully ignorant logic and glaring omissions".[12]
I think its meaningful or even sane to suggest that virtually everyone stops having babies or dies and all the survivors go play hunter gatherers in the woods.
I think our present trajectory is obviously unsustainable but that doesn't make any alternative suggestion reasonable.
Our future is the stars or extinction. In between we have to find a sustainable reasonable way to live civilized lives. This probably isn't horrifically complicated we don't have to reduce our population by 90% we just have to not keep increasing it and make do with simpler and less.
>I think our present trajectory is obviously unsustainable
Curious what makes you think that, with some real hard numbers, etc.
I think we've become very good as a culture at brainwashing ourselves into a doomsday attitude when it comes to planetary resources...yet we've actually done quite well at getting rid of or minimizing bad practices as we learn they are damaging. Nukes, CFCs, noxious smokestacks...sure not 100%, but getting better over decades.
Yes I'm an optimist...I think the Earth is all we need, and based on scientific advancements and slow learning over decades (we barely even use the [deserts|seas|tundra]!), we could easily live well and without abject poverty at 100 BN+ in centuries to come.
What will kill us off...I think it more likely to be external [asteroid|aliens|supernova] or inescapable [Yellowstone|Krakatoa|Earthquakes|virus|new apex species]
I think technology and science inherently empowers a smaller and smaller number to a greater and greater degree while the size of the playing field remains the same.
It would have been virtually impossible for virtually any percentage of hunter gathers to wipe out humanity let alone the biosphere. Eventually one person crazy enough may engineer all of our doom. This could even be so without malice aforethought.
Once you get to the stage of a planetary civilization expanding further gets fantastically harder. It's entirely possible that most intelligent species go extinct between getting big enough to destroy the requirements for their continued existence and actually escaping their planets.
The more obvious answer of ecological catastrophe is actually a lot harder. We could actually be well on our way to crashing and burning and still not be able to predict well enough that far ahead.
Every book taking a stance on a controversial subject is going to have those kinds of criticisms from the opposite side. It doesn't make those criticisms true.
I don't endorse the book or her particular worldview 100% but I believe she does bring some true evidence to light about the good aspects of meat.
The criticism doesn't appear to merely come from some "opposing side" but also from disinterested observers without a particular dog in the fight.
Her only stated expertise outside of a high school education is that she spent multiple decades unhealthy because she decided to adopt a lifestyle choice and didn't bother to simultaneously read about how to eat a healthy diet without eating meat. Instead of figuring out how to eat vegetarian without being unhealthy or simply returning to a balanced diet she has decided that we ought to somehow get rid of almost all people and go back to being hunter gathers.
The problem is that she is a writer who writes about a broad range of topics she has no understanding of. Knowing how to put words together effectively can grant one an audience but it doesn't grant one any sort of expertise. She is a crank.
That is why McDonalds undergoes the painstaking process of sanitizing their meat with an ammonia wash (prompted by the 90's nationwide beef e-coli outbreaks that resulted in serious litigation against popular burger joints), then adding in artificial flavorings back in to make it taste like a burger again (furthermore this is how McDonalds achieves that "miraculous" feat often described here when this topic comes up of having their burgers taste the same and have the same consistent product everywhere for over 20 years).
For what it is worth, McDonald's says on their web site that this is not true. So either you are mistaken or McDonald's is committing fraud. Do you have a source for your claim?
"Every one of our burgers is made with 100% pure beef and cooked and prepared with salt, pepper and nothing else—no fillers, no additives, no preservatives."
"Do you use so-called 'pink slime' in your burgers or beef treated with ammonia?"
"Nope. Our beef patties are made from 100% pure beef. Nothing else is added. No fillers, no additives and no preservatives.
"Some consumers may be familiar with the practice of using lean, finely textured beef sometimes treated with ammonia, which is referred to by some as “pink slime.” We do not use this. "
Full disclaimer: Info coming from a variety of sources: some documentaries which I know have their own inaccuracies, some my own personal experience in food service, and specifically working at McDonalds, and some having an ex-girlfriend of 3 years who was the district manager of another international large fast food burger chain, so by chance that gleaned me a lot of insight into the inner workings of fast food burger chains (he was previously a DM of several Golden Arches)
I haven't read this page recently (it certainly has changed much), but on skimming through, none of the terminology McDonalds uses on their website are meaningful in the sense that the standards there is no official definition and could not be distinguished between similar competitors that make similar claims besides simply what they say, and, more importantly, there is no regulated term between what constitutes beef being “pure” or “not pure” or otherwise put. It’s just some “thing” they say about their beef and we have to take them up on their word. Now if they said “we use USDA organic ground beef” that might have some teeth. It’s the same thing between a bag of candy telling you they no longer use artificial flavors and now use “natural” flavors.
Now the question of do I believe they have changed? Possibly. Do the burgers taste different? No, so common sense tells me you don’t drastically change your process like this and still get the same tasting burger from 20 years ago.
But I will actually do something uncommon here and admit I could be wrong, and have an outdated understanding of their process.
"100% Beef Patty. Ingredients: 100% Pure USDA Inspected Beef; No Fillers, No Extenders. Prepared with Grill Seasoning (Salt, Black Pepper)."
That seems pretty clear to me. USDA defines beef as flesh of cattle. If there is anything but "flesh of cattle" in the patty, McDonald's is committing fraud.
USDA has a pretty wide definition for what constitutes as ground beef[1]:
> After a months-long evaluation, the United States Department of Agriculture’s Food Safety and Inspection Service (FSIS) determined in December that BPI’s signature product—the offering famously called “pink slime” in an ABC News exposé that got the network in a lot of trouble—can be labeled “ground beef.” Legally speaking, it’s now no different from ordinary hamburger, and could even be sold directly to the public.
McDonalds does in fact use 100% USDA-inspected beef, with "no fillers, additives, or preservatives", and explicitly does not use mechanically separated meat. It's not "organic", but then, most beef isn't.
Then I am happy to say I am happy for their recent changes, this certainly wasn’t the case a few years ago when I wrote them off, and even more not the case 10 years ago when I was still in the industry. I think it should be promoted as an example that consumer pressure and expectations can cause companies to change for the better.
I will say I remain skeptical on exactly how they can go from the ammonia wash + chemical food flavoring process to using fresh beef and not have any discernible difference in taste or food safety, but kudos to them.
I'm not saying you shouldn't write them off. McDonalds fries are solid, but everything else there is terrible. And fast food is in general bad, and I don't want to be coming off like I'm saying that people should eat more of it.
The ammonia (when it was present) was present in such small amounts that it couldn't conceivably have altered the flavor, and they were never using "chemical food flavoring." The only change they've made recently is using fresh instead of frozen for a few products. It has always been just beef.
Only the quarter pounder is fresh beef. The rest is frozen. If you look at places that review fast food, they unanimously applauded the fresh beef quarter pounder - they did have a discernible difference in quality.
The ammonia is a bad scene, but the idea of using TG to repurpose "trimmings" isn't something we should be demonizing; if you're going to kill animals to feed people, you should be maximizing the yield (of muscle protein, that is). This is just an extension of the idea that if you're going to eat pork chops, you shouldn't be grossed out by the idea of eating offal; however ecologically irresponsible it is to eat meat at all, it must be more irresponsible to waste it because it squicks you out to eat anything but a loin chop.
(TG'd meat was a faddish fine dining trend a few years back, and it's pretty neat; for instance, you can make a solid, ribeye-like slab of skirt steak by "gluing" layers of skirt together, which is pretty delicious. It's also a technique that's been used in sausagemaking for a long time.)
and a low BMI (body-mass index) indeed (I'm around 18)
A BMI that low is not a good thing. It is evidence against your diet being optimal. Mortality rates are actually higher when BMI is below 20 (https://www.bmj.com/content/353/bmj.i2156https://www.bmj.com/content/bmj/353/bmj.i2156/F3.large.jpg -- although causality is not established). And from a common sense or aesthetic perspective, such a low BMI almost certainly means you lack ideal muscle mass.
> Mortality rates are actually higher when BMI is below 20
When you see the typical Japanese centenarian, who have a BMI around 19 (mean: 19.3±0.4, median: 18.9 (11.9, 30.2), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107392/), it contradicts this statement. I'm not Asian, and I'm taller (BMI is usually lower for taller ppl)
in conclusion, people have very different morphologies, so BMI isn't so significant
Thanks for the warning, I'm around 60kg, 1.82m high. I do a lot of bike, and I'm sort of thin, for example I can join my thumb and any other finger around my wrist. You could consider someone like Hicham El Guerrouj (58/1.762 == 18.7), that 18.5 limit is not really one for some morphologies
Super-star athletes aren't really good examples to learn from. They often have to do unhealthy and extreme things to their body in order to achieve absolute peak performance at one specific task. NFL linemen and sumo wrestlers are unhealthily overweight. Boxers and wrestlers have unhealthy levels of body fat and hydration in order to squeeze into the lowest possible weight class. And long distance runners avoid developing any upper body muscle, because every pound of additional weight costs seconds on their time. That's not something a normal person should do.
60kg at 1.82m strikes me as really fricking thin. I'm your height, and have considered myself a lean, athletic guy, but at 13% bodyfat I weigh 80kg.
Yes, but I'm a developer, why would I need more upper body muscles?
My daily activity doesn't require some more particular strength (although I wouldn't consider myself weak either), it's more about endurance. I've enough core strength to not have any back problem too (I avoid sitting on a chair though, but rather lie down/stretch out in front of my laptop)
So does the New York Times owe an apology and a correction for this article? "Sitting, it would seem, is an independent pathology. Being sedentary for nine hours a day at the office is bad for your health whether you go home and watch television afterward or hit the gym. It is bad whether you are morbidly obese or marathon-runner thin. “Excessive sitting,” Dr. Levine says, “is a lethal activity.”" https://www.nytimes.com/2011/04/17/magazine/mag-17sitting-t.... And this one? "Too much time spent in a chair could shorten our lives, even if we exercise" https://www.nytimes.com/2017/09/13/well/move/get-up-stand-up...
I just find it disconcerting that the New York Times publishes an article like this, without any acknowledgement that it has been pushing a different conclusion for the past eight years. I get that that this article is from a different author, but when people go to the New York Times, they are usually trusting the overall institution and editorial controls more than the byline. I also get that new studies comes in and the evidence changes -- but that still requires some sort of acknowledgement that they were wrong before.
Anything that makes the user invest a bit in the reputation of their account before they are allowed to message strangers would do the trick. Charge $10 for signing up. Limit @-mentions until you have built up a small following and activity track record. Require an application to join the forum. Etc, etc.
If a cost is evenly moderately costly to create, and abusive comments quickly result in bans, then the ratio of abusers quickly goes down to a very low level.
The problem is that making it costly to sign up goes against the business model and growth model of sites like Twitter, Reddit, or Instagram.
Existing laws we already operate under have much more severe maximum penalties than people realize, and judges are (relatively) reasonable at applying them correctly.
I don't think the system is working well at all. We have a situation where vague laws with severe penalties allow prosecutors to grossly overcharge. This is then used to coerce the accused into waiving their rights to a trial, in return for the certainty of a more limited punishment.
In Germany "deals" are very much not liked by the law profession, and only a very limited form of it has been put into law. And even that is very sharply debated in the profession.
Add to it that prosecutors actually do look for mitigating circumstances, and do not regularly appeal a verdict that they feel is a bit too low, thus preventing the appellate court from handing down a harsher sentence, making the appeal risk-free for the defendant.
It's not all roses here, but you also shouldn't assume that this "either plead guilty and accept five years or risk three hundred years" is a universal property of judicial systems.
It seems what happened is that all the promising/useful areas of inquiry from ancient philosophy have since become their own fields. "Natural philosophy" became physics/biology/chemistry and so forth. Thus university philosophy departments were basically left with the dregs -- lots of debates over non-falsifiable claims, lots of debates caused by poor definitions of words. Ethics is the only subfield of modern philosophy I can think of that seems useful and interesting to me. Maybe political philosophy too, but that has mainly moved to the political science department.
And one might add that the branching off point was some extremely esoteric work in the foundations of mathematics and philosophy of language that would have struck most people at the time as entirely speculative and useless.
"The dollar represents a claim against the government."
What does this even mean? A claim means that I can turn in the piece of paper and get something back. I can turn in my coat check claim paper and get my coat back. Under a gold standard, I can turn in my paper bill and get gold back. But we are no longer under a gold standard. What is the thing I get back with regards to a dollar?
The actual thing bootstrapping the value of a dollar is that the dollar is legal tender for paying taxes and for "all debts public and private." The dollar isn't a claim against the government -- it's a token than can extinguish the government's claim over you.
Local labs could develop or purchase their own test kits, but during an a public health emergency, they must get FDA authorization before launching such a test.[1]
This seems to me like a giant institutional and bureaucratic screw up.
Hopefully the FDA may be finally getting its act together and fast-tracking approval of local tests: https://twitter.com/ScottGottliebMD/status/12330216819181936...
[0] https://www.politico.com/news/2020/02/20/cdc-coronavirus-116...
[1] https://threadreaderapp.com/thread/1231944326827081729.html