"Think of the Children," COVID Edition: Lockdowns, School Closures, and Mask Mandates Negatively Impacted Children

Children have been used as political pawns on numerous occasions. Think of how much the argument "think of the children" has been used to push a political agenda. The Religious Right used it to incorrectly argue that same-sex couples are incapable of raising children. It has been used to advance universal preschool and bans on violent video games. It is an argument that does not die because of the emotions that children can invoke invoke in voters. Look at the recent news cycle. The mass shooting at a school in Uvalde, Texas has revitalized the call for more gun control. Those who are upset of the overturning of Roe v. Wade criticize the other side for not caring about children once they are out of the womb. This argument, of course, erroneously assumes that the only way to care about people is if you are in favor of government largesse, but I digress. 

When it comes to public health policy related to the pandemic, it becomes more and more clear over time that there was little to no foresight, cost-benefit analysis, risk assessment, or empirical evidence involved with the response to COVID in most countries. As much as COVID policy impacted adults, I really wish that politicians, especially those on the Left in the United States, thought of the children and the policy implications before proceeding because children got walloped as a result of poorly planned COVID health measures. 

It was evident from the beginning that children were not at high risk for COVID. In June 2021, the New York Times posted death rates based on CDC data (see below). They show that children are less likely to die from COVID than they are other causes of death, including drowning, car accidents, and homicide. 

If that were not enough, we can compare COVID deaths to the deaths from a previous pandemic: the H1N1 flu. From April 2009 to April 2010, there were 19.5 million infections and 1,282 deaths for those aged 0-17 (Shrestha et al., 2011). This would make the H1N1 mortality rate for children to be 0.0066 percent. What about COVID? According to CDC data, there were an estimated 25.8 million infections and 645 deaths between February 2020 and September 2021. This would make the COVID infection fatality rate for children 0-17 (as opposed to case fatality rate) to be 0.0025 percent. This would mean that COVID is about 62 percent less lethal than H1N1 for children aged 0-17 years. In 2022, the Lancet published an article showing that COVID has been much less deadly for children than it has been for older demographics, especially those over 75 years of age. 

The fact that children were less likely to suffer and die from COVID makes the costs that children had to undergo more unconscionable. The benefit of COVID policy to children was therefore less than it was for adults. Let us examine how these policies affected children specifically. 

Lockdowns

I first expressed my concerns about lockdown in March 2020. I detailed in May 2020 a list of potential problems, ranging from economy to physical health to mental to not doing much to save lives. As the data come in, we have seen that lockdowns actually caused greater excess death while coming with social costs, which puts a dent into the argument that we needed lockdowns and school closures to protect the elderly or teachers. What were the costs of lockdown to children? 

The United Nation's International Children's Emergency Fund, better known as UNICEF, released a report in October 2021 answering this very question. The results were unflattering for lockdowns. Children experienced higher rates of anxiety and depression. Those who were exposed to pre-existing childhood abuse and neglect experienced higher levels of stress. There is also concern of higher risk of trauma, suicide, loss of family and friends, violence, loneliness, isolation, and sleep deprivation. A longitudinal study from Cambridge University confirms these adverse impacts by showing that children's mental health deteriorated substantially as a result of lockdown (Bignardi et al., 2020). A February 2022 analysis from the British Broadcasting Network (BBC) found a 77 percent increase in self-harm and suicidal ideation as a result of lockdowns. Harvard University has acknowledged the effects that the lockdowns had on the mental health of children. 

If that were not enough, a UNICEF technical note from September 2020 estimated that lockdowns attributed to the 150 million children that were pushed into poverty as a result of everything that has happened. Given how millions of families were teetering on the financial edge prior to the pandemic, it makes sense how shutting down large swathes of the economy and depriving people of their employment had effects for their children, including in health, education, and social development. One peer-reviewed study looked at how the lockdowns reduced the access to housing, nutrition, sanitation, and health services (Cardona et al., 2022). Their global estimate is that 253,500 to 1,157,000 children under five died as a result of the economic downturn in which lockdowns played a major role. 

School Closures

It was not only businesses that ended up shutting down during the pandemic, but also schools. In 2020, the CDC Director Robert Redfield pointed out that it was not their recommendation to close schools, but it happened throughout much of the United States. The Chief Medical Officer of the United Kingdom also said that it was worse for children to miss school than it is to get COVID. I covered the topic of school closures in July 2020 and illustrated how the costs of school closure exceeded the benefits, but I think the topic is worth revisiting. School closures were part of the overall lockdown policy, but school closures came with their own specific costs. 

One major cost was in terms of academic delay. As this 2022 report from the Government Accountability Office (GAO) on pandemic learning illustrates, 52 percent of teachers had more students start the 2020-21 school year behind compared to a pre-pandemic year. 45 percent of teachers had at least half of their students end the academic year behind. The impact of school closures disproportionately impacted vulnerable students, including those who were high-poverty, English learners, or in special education. To quote UNESCO, "School closures carry high social and economic costs for people across communities. Their impact however is particularly severe for the most vulnerable and marginalized boys and girls and their families." 

None of this gets into the challenges facing teachers (including burnout) or how school closures increased childcare obligations for millions of parents. The increased childcare obligations becomes increasingly apparent for parents who work in the healthcare sector and need to be attentive to help fight COVID and other ailments. With all the trauma from the lockdowns, it is no wonder that academic achievement fell behind. These academic and social-economic delays are not merely short-term. They are going to have a ripple effect years out into the future. Here are a few studies:

• The Organization for Economic Cooperation and Development (OECD) found that the loss of three months is the equivalent of losing 2.5 to 4 percent of one's life income (Hanushek and Woessmann, 2020, p. 9). 
• A joint report from UNESCO, UNICEF, and the World Bank put the estimate at $17 trillion in lifetime earning in present value, which 14 percent of today's GDP (2021, p. 5). 
• Consulting firm McKinsey calculated that by 2040, the economic impact of these learning delays could lead to annual losses of $1.6 trillion, or 0.9 percent of the global GDP. 
• One study from JAMA found that it is not about economic impact or a diminishment of wages, but a matter of diminished life expectancy for our current children (Christakis et al., 2020). Their decision analytical model calculated that missed instruction during 2020 caused an estimated 13.8 million years of life lost in the United States. 
• A report from the United Kingdom's Office for Standards in Education shows how the restrictions resulted in the delay of babies' physical development, babies struggling to crawl and communicate, infants having issues in facial recognition, and a regression in children's independence. No doubt that the impact will be more pronounced as these infants get older and develop.  
• A May 2022 World Bank report found that children experienced a learning loss the average of 0.17 of a standard deviation, or a half a year's worth (Patrinos et al., 2022). One of the authors in this paper also found that a half year's loss in education translates into future earnings being 4 to 5 percent lower (Patrinos and Psacharopoulos, 2018). 
• A study from the National Bureau of Economic Research concluded that 10.1 of the 14.2 percentage point decline in passing rates for mathematics courses was due to school closures (Halloran et al., 2021).

Face Masks

Face masks have been politically contentious since the beginning of the pandemic in no small part due to their symbolism. I have written on face masks a number of times, most recently in a two-part analysis (see here and here). The long and short is that face masks did very little to nothing to mitigate the spread of COVID. Maybe masking children was different, especially given all the hullabaloo with masking children at schools. Alas, it was not any different. Arguably, it is less effective given how COVID is much less likely to adversely affect children in the first place. 

The Left-of-Center The Atlantic called children wearing masks "an intervention that provides little discernible benefit" in which we do not have evidence that they work. A preprint report with The Lancet replicated the CDC's methodology using a more robust and longitudinal data set. Their multivariate regression analysis demonstrates that there is not a relationship between school masking and pediatric COVID cases (Chandra and Høeg, 2022). A study from the United Kingdom government similarly found that face coverings in education settings found no statistically significant impact on COVID transmission.

Not only do I want to hammer the point that face masks did nothing statistically significant to protect children, I have to wonder if there was any harm done by face masks in the process. 

• A German-wide study that used a database of over 25,000 German parents (Schwartz et al., 2021), a study that admittedly has methodological limits, pointed out a number of concerns for children wearing masks, including irritability, headaches, difficulty concentrating, less happiness, more reluctance to attend schools, malaise, impaired learning, and drowsiness. The "still face experiment" shows us that children need facial expressions. The lack thereof causes emotional distress (e.g., Weinberg et al., 2008).
• A case study published in the Journal of Infectious Diseases and Epidemiology examined the effects of prolonged mask usage on healthcare workers in New York City (Rosner, 2020). Some of the causes of concern include headaches, acne, skin breakdown, and impaired cognition. 
• A preprint study from Italy (Martellucci et al., 2022) expresses concern about what happens when people inhale their own carbon dioxide and have a reduction in blood oxygen saturation as a result.  
• It is not only the physical aspects of wearing face masks that bother me. In my previous piece on the topic of face masks, I cover the social and emotional costs of face masks. Since children are more impressionable and are in their formative stages of development, the social and emotional costs for face masks are more pronounced with children. I worry that face masks keep children trapped in fear and anxiety, adversely affect how they perceive themselves (e.g., "there must be something intrinsically wrong with me"), make it difficult to communicate, sullies or deprives human interactions that are vital for development, and dehumanizes others by making people more suspicious of others (e.g., "they are vectors of disease, not human beings"). Given what we know about child development, it is not exactly a stretch to find that face masks negatively impacted children of having a normal, emotionally healthy childhood. 

The challenge of determining harm of face masks is not simply because it is a more subtle public health measure than lockdowns or school closures. It is that the evidence base for "face masks and children" is quite limited and not strong, which is why I hesitate to say anything conclusive about actual harm caused by face masks to children. Even so, everything in life has tradeoffs and that at least some of the aforementioned issues are quite plausible given the nature of face masks and children. Furthermore, given the lack of evidence that masks do anything significant to help people generally or children specifically when it comes to COVID, we should be safe rather than sorry and not force face masks on children. 

Conclusion

The more evidence that we come across, the more evident it becomes that the toll COVID policy exacted on children was tremendous. Children had to deal with greater anxiety, depression, and overall stress, as well as lower quality of life, physical health, academic achievement, and life expectancy. This did not need to happen, especially since children are 99.999 percent likely to survive COVID if contracted. The moral failing for how children were treated as a result of subpar and poorly-executed COVID policy cannot be overstated. It is going to take years to reverse the damage COVID policies inflicted upon children. My hope is that we learn for the next time and actually follow the science instead of peddling fear and being needlessly strict to no avail.

Supreme Court Ruling in Bruen Case Reaffirms the Importance of Concealed Carry

As if the recent mass shootings did not do enough to bring gun control back to the news cycle, the Supreme Court of the United States (SCOTUS) added fuel to the fire. Back in 2007, SCOTUS ruled in District of Columbia v. Heller that the Second Amendment established a right to bear arms in the name of self-defense within the home. 

However, state governments that wanted to find workarounds with the Heller case did so. This is where the state of New York comes in. New York state created a law in which those who wanted to carry a concealed handgun in public need to show a special need ("proper cause") to defend themselves. This past week, SCOTUS ruled in New York State Rifle and Pistol Association v. Bruen (see ruling here) that this New York state-level handgun law is unconstitutional. According to this ruling, the Second Amendment protects a broad right "to carry a handgun outside the home for self-defense." This ruling is the first major case for gun rights that SCOTUS has heard in over a decade. 

This ruling might be limited in its scope. It may very well be restricted to concealed-carry licenses, as opposed to any and all public possession. Even so, it is a win for gun rights. The first point I would bring up is that this case affirms freedom. If the right to life is meant to be an inherent one, then the right to self-defense is part of that inherent right. Not only does my religion of Judaism allow for self-defense, but our modern-day, secular concept of self-defense was influenced by such political philosophers as Thomas Hobbes and John Locke.  The Second Amendment was meant to protect the right to self-defense, and it is nice to see SCOTUS confirm the protection of that right more broadly. 

But let's look at this from a consequentialist point and see what the public policy implications are. The justification of defensive gun usage (DGU) is not something that is merely a concoction of the imagination of the Far Right. As I covered last November after the Kyle Rittenhouse case, DGU is quite common. The exact number of DGUs is in dispute. A 2013 study commissioned by the CDC put the range between 500,000 and 3 million. Another study from Georgetown University put the number at around 1.67 million instances of DGU (English, 2021). Even if you assume that 10 percent of DGU saved a life, that number would still exceed the 39,707 U.S. firearm deaths.   

There are those out there who would argue that concealed carry in the public sphere would have terrible public policy implications. For those who are against it, allowing for trigger-happy, impulsive individuals would make it akin to the lawlessness of the Wild West. Does that conception play out in reality based on the evidence? 

There are some empirical aspects of the gun control/gun rights debate that are more clear-cut. For example, I can tell you that we have tried assault weapon bans on the federal and state levels. Assault weapons bans do not work in lowering homicide rates. A similar argument can be made for high-capacity magazine bans and the bump stock ban. Waiting periods are shown to be effective for lowering gun suicides (not for gun homicides), which goes to show that I do not oppose actual common-sense gun laws. It is that I would be more inclined to some common-sense regulations if you can at least show they are effective in what they are meant to do without significant erosion to the right to self-defense. 

As for concealed carry laws, what makes the concealed carry debate interesting is that the evidence base is mixed. I am not going to go through the entire academic literature on this topic, but pick some representative studies to show you how mixed it is. One study from the National Bureau of Economic Research shows that right-to-carry laws (RTC) increases violent crime (Donohue et al., 2017). A study from the Journal of the American College of Surgeons found that "there was no significant association between shifts from restrictive to nonrestrictive carry legislation on violent crime and public health indicators" (Hamill et al., 2019). Although it is more dated of a study, the National Academies of Science could not find a causal link between RTC laws and crime rates (Wellford et al., 2004). 

To get through the ambiguity, I would go with an organization such as Rand Corporation both because of its reputation and because it is one of the few think-tanks that does not have an explicit ideological leaning. What did Rand come up with? Rand Corporation found that the evidence is limited in terms of proving that concealed-carry laws might increase violent crime. This is more telling because, as Rand Corporation points out, we have more evidence on RTC laws than we do on any other gun policy. If we have a large enough evidence base but it is still inconclusive about whether RTC laws lower crime, it would suggest that RTC does not have a major impact on violent crime.  

There is some intuition as to why those who are carrying would not be a major driver of crime. Those carrying concealed carry licenses are less likely to commit crimes since these licenses in most states require a background check and fingerprinting. This intuition bolsters what I brought up in 2018, which is that there is a lack of correlation between gun ownership and homicide. It very well could be that this lack of correlation is due to the deaths caused by the trigger-happy are neutralized by the ones using guns for legitimate DGU, thereby creating a more net neutral effect on homicide rates.  

I have a couple of additional points to make on the previously mentioned intuition. One, the number of concealed-carry licensees has increased 304 percent between 2007 and 2019 (Lott, 2019) while violent crime has decreased from 1993 to 2019 (Pew Research). If RTC were that terrible, you would see a rise in gun homicides or violent crime as a result of more people carrying handguns vis-à-vis RTC laws. Two, as the Heritage Foundation illustrated in 2019, concealed-carry licensees accounted for 0.7 percent of firearm homicides while accounting for 5.5 percent of the overall population, thereby indicating that they are not a major contributor to gun homicides. 

As the Supreme Court reaffirmed in the Bruen case, we are talking about a right as inalienable as the right to self-defense. To quote Justice Clarence Thomas from the Bruen ruling, "We know of no other constitutional rights that an individual may exercise only after demonstrating to government officers some special need." At the same time, I do not believe that the Second Amendment should be a free-for-all in owning whatever sort of weapons you want. After the Charlottesville attack, I made the point that a violation of the "fighting words doctrine" to incite violence with one's speech is an exception and curtailing of freedom of speech. Yes, I very much believe in freedom of speech, but there are some notable and exigent exceptions. 

I believe the same goes for the Second Amendment. The right of self-defense to be paramount to the ideals of life, liberty, and pursuit of happiness. I also think there are some limits on what one should own. For example, I think most people would think that we do not need nuclear weapons for self-defense. As for fully automatic weapons, it is more debatable than nuclear weapons, but most people would agree that fully automatic weapons are not necessary. 

My point is that there can be some actual common-sense gun regulations that could help minimize violent crime while still preserving the right to self-defense. Calling a policy "common-sense" while it is not shown to keep the public safer is not common sense at all. Given the evidence we have for RTC laws, that would seem to be the case here. If the government is going to pass a gun law that is actually common sense, the burden of proof goes to the government to show that RTC increases crime, not to a subset of gun owners that are shown to overall be law-abiding.

Why I Cannot Stand the Practice of Asking for Preferred Gender Pronouns

The older I get, the more I realize that anything has the potential to be politicized. This was increasingly apparent during the pandemic. Look at face masks, lockdowns, and vaccines. We should have looked at the efficacy of those measures, determined if the tradeoffs were worth the measure, and do our best to have the science inform policy decisions. As we saw throughout the pandemic, this was far from being the case. This is 2022. Things are so polarized that we have politicized grammar, specifically the politicization of pronouns. 

A pronoun is a word or word phrase that is used to replace a noun. This subclass of noun comes in multiple forms (e.g., subject, possessive, reflexive). Not only do pronouns shorten sentences and make them less repetitive. They have the potential to convey certain information. It can show how many people there are (e.g., "I" versus "we"). There are languages where a pronoun can convey the formality or informality of a relationship. For example, in Spanish, the word "tú" is the singular, informal; whereas "Usted" is the singular formal for the word "you." In Hebrew, pronouns do not only indicate number. Hebrew pronouns are gendered (e.g., את/אתה), meaning that the pronoun has to agree with the verb in gender. 

In recent years, we have seen people relate to their pronouns differently through what is called "preferred gender pronouns." You might have heard someone ask "what are your preferred pronouns" or simply "what are your pronouns?" You might have seen in an email signature or LinkedIn profile someone identifies as "He/Him/His," "She/Her/Hers," or the gender-neutral "They/Them/Theirs." 

The increased emphasis on gender identity has spurred such social practices around preferred gender pronouns (PGPs). The premise of PGPs is based in equity, as well as inclusion of transgender and individuals that identify as gender non-binary. The Human Rights Campaign (HRC), which is the largest LGBT organization in the United States, believes that "using a person's chosen name and pronouns is essential to affirming their identity and showing basic respect."

You can identify however you want as a form of human agency or as a part of your pursuit of happiness. If the use of PGPs were only an issue of respect or self-identity, I would say, "it's your life; more power to you." Upon further examination, the usage of PGPs in social interactions is far from it. 

My biggest issue about the practice of requesting one's PGPs is the coercive nature of it. I mostly air my grievances about government coercion. However, I have the same reaction when someone attempts this form of coercion in a social setting, such as when someone asks me what my pronouns are. University of Illinois Professor of Gender Studies M.J. Murphy labels such a practice as "a form of social coercion that only masquerades as inclusion" because "such requests 'position' the recipient of the request against their will and without their permission." Professor Murphy goes on to detail how the only responses to such a "request" are either compliance, lying, or refusal. Professor Murphy concludes by saying that "a public request for 'your pronouns' isn't a request at all. It's a subtle but powerful demand that effectively disables the recipient of the request and threatens negative consequences for any questioning, resistance, or refusal." 

This rings even more true considering that this practice most commonly occurs when meeting someone for the first time. There are some contrarian individuals, people who lack social tact, or those who will stick up for their beliefs regardless of the social situation. But for most people, they are going to want to make a good first impression instead of starting a relationship in an antagonistic fashion. While it is subtle, it is nevertheless a power play used to prompt a certain behavior. 

There is another coercive element of the PGP practice I want to elucidate upon further. When someone decides to introduce themselves with their PGPs, they use third-person pronouns, the most common being "he," "she", and "they." I cannot emphasize this grammatical point enough. When I talk to someone directly (in the second-person), regardless of their biological sex, sexual orientation, or gender identity, which pronoun do I use in the English language? I use the gender-neutral pronoun of "you." 

When do we use third-person pronouns? Sometimes, if someone is present but are not being addressed directly. If someone is in the room and I refer to the individual in the third-person, odds are that I would simply use their name. But most of the time, third-person pronouns are used when said individual is not present. People who impose the practice of PGPs want to control how you behave and think of a certain individual even when said individual is not in the room. 

As long as we are in a free society, I want to be able to exercise my freedom of speech and express my opinions, including what I think of others. If you think someone is an asshole, you should be able to call them an asshole and complain about why you think they are an asshole. If you think someone is a saint, you should be able to laud their praises. If you think something is a bad idea, you should be free to call out a bad idea. To hammer this point home, I will point out a relevant court case. Last year, the Sixth Circuit Court ruled that forcing someone to use a transgender student's PGP is a violation of the First and Fourteenth Amendment rights (see Meriwether v. Hartop et al.). This hearkens back to the idea of "I support your First Amendment right to use pronouns if you want, but I take issue when you compel someone else to do so."    

The court case above reminds us that speech is a fundamental form of expression. Yet the HRC recently tweeted that we should begin a conversation with "Hi, these are my pronouns. What are yours?" I disagree vehemently with the HRC. I should be free to express myself in a way I see fit. Why is it that gender identity should be one of the first things to learn about me or another individual you just met? Why do we pick gender identity specifically? I understand that pronouns are a commonly used part of speech, but why confine people to that single attribute? There are so many facets to identity, which can include race, ethnicity, religion, age, sexual orientation, level of educational attainment, socioeconomic status, profession, or pastimes. A better way to go about this while still allowing for authentic self-expression would be with an open-ended request of "Give us your name and one interesting fact about yourself." The practice of "requesting" PGPs limits the way one chooses to express their identity and can reduce the complexity of an individual to biological sex or gender. 

We don't go around the room and ask people what their sexual orientation is because then we would be outing LGB individuals, which would be in poor taste. But by "requesting" PGPs, you're forcing someone who is questioning their gender or who has not come out as transgender to either lie or come out sooner than they would like. Another example of "hurting some of the people that were intended to be helped." If we forced people to disclose their level of educational attainment, it very well could shame or embarrass someone. Could you imagine applying such a practice to race or religion? We do not expect this level of coercion on other aspects of expressing one's identity and individuality. An individual should be allowed to express their identity and various aspects of their identity in whatever way feels comfortable to them. To reiterate, such a "request" is an imposition on freedom of speech and expression. 

There are other reasons that people might not care for being asked a question apart from having their freedom of speech limited. Some individuals, especially those of older generations, are not going to understand the question. For example, Pew Research found that 39 percent of Americans do not know what gender-neutral pronouns are. Pew Research also found that 58 percent of Americans do not know a transgender individual. Asking most Americans what their PGPs are is going to be an awkward interaction. 

There are some individuals that consider themselves to be "gender critical." These individuals are opposed on ideological grounds (more in the next paragraph) because they believe that the idea of sex is "real, important, and immutable," and should not be conflated with gender identity. For those who are gender critical, male-to-female transgender individuals are not really women, and vice versa. The Heritage Foundation encapsulates this view as one for those "who refuse to bend the knee to leftist groupthink, the kind that forces a subjective and manipulable view of one person's self to become a defining reality for everyone else." If you want my nuance on this particular controversy behind "sex versus gender," you can read the analysis I wrote in January 2020. 

This segues into another point. Aside from it being an issue of freedom of speech, the forcing of divulging PGPs is also an issue for freedom of conscience. The ideas of sex being immutable; whether or not there is a major difference between "sex versus gender;" whether identifying with the social roles or stereotypes of masculinity or femininity makes you a man or woman; the prevalence of non-binary genders; if gender is a societal construct that needs to be deconstructed; whether personal pronouns should be based on biological sex or some other factor; and whether gender identity is important are all ideological debates that are embedded in the asking of PGPs. 

In 2022 America, when you state your pronouns and/or ask someone for their pronouns, that is a political statement. It is a statement that you are on the political Left (most probably the Far Left/woke Left) and that you accept certain premises on topics related to sex and gender that I mentioned above. As we will see in the next paragraph, asking about one's PGPs is all but superfluous given certain demographic data. Language exists in part to express and convey information. For almost everyone, stating one's pronouns clarifies nothing. As such, asking for one's PGPs is primarily an act of virtue signaling to let people know that you are part of a certain in-group.

There are others who do not see the point of asking such a question in light of demographic reality. The vast majority of the population is cisgender, i.e., one's gender identity matches their biological sex. Let's take a look at statistics to confirm that notion.

• The Washington Post points out last year how there are over one million individuals that are nonbinary (or about 0.3 percent of the U.S. population). 
• The Left-leaning Center for American Progress found that 0.5 percent of Americans have clinically identifiable variations that would deem them to be intersex. 
• The most recent estimate of transgender individuals is from the pro-LGBT Williams Institute in 2017 when they estimated that 0.6 percent of the population is transgender.

When you add up the percentages for transgender (0.6%), intersex (0.5%), and nonbinary (0.3%)? You get a total of 1.4 percent of the population. That would mean that about 1 in 71 individuals either do not anatomically fit the male/female biological sex binary or their gender identity does not conform with their biological sex. That also excludes that most transgender individuals identify with the gender to which they transitioned, which would probably bring the figure closer to 1 in 125 individuals. While the entire world does not exist in a strict male/female binary, running through these demographic data reminds us that over 98 percent of people exist on one end of the spectrum or the other. 

Take India as another example. Yes, India has historically had hijras, who are individuals that do not fit the male/female binary (e.g., eunuch, intersex, transgender). But India's two main languages, Hindi and Urdu, have a gender binary. There was an acknowledgment of exceptions to the norm while still running society on the norm of a male/female binary. I can recognize that a small subset of individuals do not fit a certain norm while recognizing that almost everyone does. Another way to phrase this point is the following. If you use someone's name, picture of said individual on social media, listen to their voice on the phone, or use other visual cues, odds are that you will have enough information that you would be correct in guessing what their pronouns are without having to ask. 

Up until a few years ago, that is the way the world worked. I could listen to or see someone and guess with a high level of accuracy as to whether they are a man or woman. What happens in the off chance that I am incorrect? I remember growing up and seeing other families' babies. There were times when I thought it was a baby boy and it turned out to be a baby girl, or vice versa. When I made the mistake, I was not scolded or accosted. I was politely corrected by the parents and we moved on. Those seemed like simpler times. 

In 2022, if you refer to someone with a pronoun that is not to their liking, it is treated with indignation as if it were a capital offense, especially if you are dealing with someone who is on the Far Left. Whether someone uses a different pronoun on purpose or simply did not know one's gender identity, there is not an assumption of goodwill. It goes well beyond being a faux pas for these individuals. It is perceived as a microaggression or a form of harassment. Last year, a human rights tribunal in the Canadian province of British Columbia went as far as ruling that intentionally misgendering someone is a human rights violation. The University of Wisconsin-Milwaukee states that "It is privilege to not [to] have to worry about which pronoun is going to use for you based on how they perceive gender." That is not privilege. 

There are millions on this planet dealing with abject poverty and are figuring where their next meal is coming from. Some do not have access to clean water. Such countries as Ukraine and Venezuela are in such dire shape that the geopolitical events in these countries are creating refugees. Others are dealing with homelessness or living paycheck-to-paycheck. You want to know what privilege is? Privilege is when you have so few hardships that one of your biggest complaints in life is whether or not someone uses certain pronouns in reference to you. Not only is disproportionately complaining about microaggressions privilege, it provides a skewed perspective on the world because it puts minuscule gripes on par with legitimate problems. 

In a free society, there is no right to not be offended. Why? It is not only because being offended is such a subjective, arbitrary, and nebulous concept. I'm sure those on the Left that use PGPs don't care about whether those who are compelled to use PGPs feel offended or not. An essential component to a free society is freedom of speech. As I explained after the controversial Dave Chapelle special aired last year, freedom of speech has an implicit right to offend. You have to deal with the fact that not everyone is going to view the world the same as you. Not everyone views sex and/or gender the same as you. Not everyone is going to understand if you insist on asking for other people's pronouns. Part of being in a pluralistic, democratic society is learning to interact with those who do not think, speak, or act in the same way as you do.

There is no need to command specific language in a free society. Policing word choice by telling me how to speak is as bad as telling me to be silent. Much like it is with political correctness more generally, asking for PGPs is not about convincing others or being understanding. It is an attempt at conformity and groupthink. As author and University of Toronto Professor Jordan Peterson put it, asking for PGPs is about gaining linguistic supremacy in public discourse using compassion as a guise, a similar phenomenon we see with the woke attempt to make a linguistic shift with the word "Latinx." But if I get you to accept anyone's identity or perception of reality, regardless of whether it is based in reality or not, how powerful is that? What do you call it when you force someone to agree with your conception of life, how things should work, and subsequently act on it by joining in the validation of it? That is a trademark of a totalitarian way of life.

As a side note, you should not be seeking external validation or forcing others to provide that validation to you. If you are comfortable and confident where you are at with how you interact with or perceive your biological sex and/or gender, it should not matter what someone else thinks. Use your pronouns and forget whatever anyone else thinks. If you feel the need to compel instead of convince, it signals a weakness in your argument and your character. It you ask for someone's PGPs and you are offended by a response that does not comport with your worldview, it says more about your woke fragility than it does about the person who objects to being asked what their PGPs are. If someone does not agree, we should peacefully discuss those points while still respecting other' differences in the interim. The coercive nature of asking for PGPs seeks to further divide and cause resentment. 

I will end today's thoughts with a quote from Frederick Douglass: "Liberty is meaningless when the right to utter one's thoughts and opinions has ceased to exist. That, of all rights, is the dread of tyrants. It is the first right which they first of all strike down." 

8 Reasons Why a Menthol Cigarette Ban Should Go In the Ash Heap of History

A little over a month ago, the Food and Drug Administration (FDA) released a proposal to ban menthol cigarettes. Why go after menthol cigarettes specifically? As Harvard University points out, menthol is an agent added to cigarettes to create a cooling sensation that masks the harshness of cigarette smoke. There are bronchodilatory properties that allow for deeper penetration of cigarette smoke into the lungs. Because these cigarettes are smoother and easier to smoke, Harvard University points out that there is greater potential for addiction. By removing a more addictive version of cigarettes off of store shelves, the FDA hopes to reduce tobacco deaths, which are a leading cause of death in the United States. The CDC found that about one in five deaths (or 480,000 deaths) are caused from tobacco smoking. If a menthol cigarette ban could make a major dent in tobacco-related deaths, perhaps a ban could be justified, or so goes the argument. However, as we shall see shortly, the argument for a menthol cigarette ban is nowhere as credible as it seems at first glance. 

1. Past menthol cigarette bans do not have a great track record of reducing smoking. The Canadian banned menthol cigarettes in October 2017. This is significant because Canada is the country with the longest enacted menthol cigarette ban. Prior to 2017, menthol cigarettes were enacted on a province-by-province bases. How did their ban turn out? According to a study from BMJ Journals, 21.5 percent quit smoking. 59.1 percent switched to non-menthol cigarettes and 19.5 percent still smoked menthols (Chung-Hall et al., 2021). Keep in mind that a social desirability bias (i.e., a response bias in which the respondent wants to give an "acceptable" answer) is in play and could very well be over inflating the quit rates. Plus, there is nothing to be said about the possibility of relapse. 

A study from the National Bureau of Economic Research (NBER) diminishes the BMJ Journals' findings (Carpenter and Nguyen, 2020). Although menthol cigarette sales dropped, non-menthol cigarette sales were unaffected. There was no net effect on youth smoking rates because of substitution, which is noteworthy since the FDA made particular mention of youth in its proposal. For adults, there was more evasion than substitution. Instead of going for non-menthol cigarettes, adults purchased menthol cigarettes from areas in Canada that did not have the menthol cigarette ban. In either case, the ban did not have "any significant effects on population rates of cigarette smoking or quit behaviors for either youths or adults." 

Massachusetts is another example of these phenomena. Massachusetts is the only U.S. state to have banned menthol cigarettes, which has been part of a greater ban on flavored cigarettes. Yes, it is true that menthol sales in Massachusetts plummeted. What is also true, which the Tax Foundation illustrates, is that Massachusetts-based menthol cigarette smokers travelled to other states to get their menthol cigarettes. This form of evasion all but completely negated the effects of Massachusetts' flavored cigarettes ban.

In 2020, the European Union banned menthol cigarettes. According to a post-ban survey conducted by the Foundation for a Smoke-Free World, only eight percent of menthol smokers in eight European countries quit menthol smoking. As a side note, the University of Waterloo estimates that 1.3 million people would quit with such a ban (Fong et al., 2022). With an estimated 30.8 million smokers in the U.S. (CDC), that would mean a quit rate of 4.2 percent, which is an even lower quit rate than the EU post-ban survey suggests.

I do want to caveat that the data and findings from past menthol bans have their limits. The ban in the European Union is too recent to draw anything too definitive. The data we have on the Canadian menthol ban was prior to 2018 when menthol cigarette bans were on a provincial level in Canada. What the FDA proposes is on the federal level. At the same time, the experiences of Canada and Massachusetts show that demand for menthol cigarettes is high enough where people are willing to find workarounds, whether that is in the form of substitution or evasion.

2. A ban would drive menthol cigarette smokers into underground markets. Since we do not have data from national-level menthol cigarette bans, the best proxy we have is what happens when the government bans a widely-used product in the name of public health. Look at the War on Drugs or the prohibition of alcohol. Those bans did not reduce demand. They gave criminal dealers greater power while driving consumers into underground markets with riskier products. For more on the economic, health, and enforcement costs of the War on Drugs, you can read this Cato Institute policy brief here. 

This country already has an illicit tobacco market that accounts for 8.5 to 21 percent of the U.S. tobacco market, according to the National Academies of Science. Given that a) menthol cigarettes accounted for 37 percent of cigarettes smoked in the U.S. from 2019 to 2020 (CDC), b) the menthol cigarette market has a large customer base, and c) menthol cigarettes are a profitable product, international cartels and U.S.-based gangs are going to want to seize that opportunity to make more money. As such, it is reasonable to assume that such a ban would likely create a larger market for illicit cigarettes while driving cigarette smokers towards an even unhealthier cigarettes, as well as possibly towards harder drugs. 

3. Menthol cigarettes are not more dangerous than non-menthol cigarettes. The Journal of National Cancer Institute found that a menthol smoker's risk of cancer is lower than that of a non-menthol cigarette smoker (Rostron, 2012), which is an interesting finding considering this is the report that the FDA cited in its recent proposal. The risk of lung cancer could be up to 30 percent lower for menthol cigarette smokers versus non-menthol cigarette smokers (Blot et al., 2011). This might have to do with the fact that menthol smokers smoke fewer cigarettes a day (ibid.). In 2020, the U.S. Surgeon General admitted that there is not adequate evidence to infer that menthol cigarettes are more dangerous than non-menthol cigarettes (p. 12). 

4. Menthol cigarettes are not more addictive than non-menthol counterparts. Advocates for a ban stipulate that one of the issues with menthol cigarettes is that they are more addictive. However, that seems to not be the case. A 2022 study from the Journal of the National Cancer Institute, which was released a couple of months ago, entailed a large-scale study of 16,425 smokers. This study revealed similar quit rates between menthol and non-menthol smokers (Munro et al., 2022). Furthermore, there is not even a positive relationship between the distribution of menthol cigarettes and youth smoking rates (Bentley and Rich, 2020), which further undermines the argument that menthol cigarettes are more addictive.

5. A menthol ban would exacerbate disparities in criminal justice. According to the FDA, 85 percent of African-American smokers use menthol cigarettes, as opposed to 47.7 percent of Hispanic smokers, 41.1 percent of Asian smokers, or 30.3 percent of Caucasian smokers. Yes, smoking menthol cigarettes is an unhealthy habit, regardless of the race or ethnicity of the smoker. But it has also been a perfectly legal habit disproportionately enjoyed by African-Americans. Proponents of a ban argue for health benefits (especially for the African-American community), although that argument has been refuted above (See Points #3 and #4). 

What becomes an issue is that for a ban to take into full effect, it needs to be enforced. Who is going to enforce this ban? Local police officers, amongst other actors. A menthol cigarette ban would give law enforcement a reason to interact with individuals committing a victimless crime. Since menthol cigarettes are disproportionately smoked by black smokers, the brunt of the police enforcement of that ban will be in black neighborhoods. As the ACLU illustrates, a menthol cigarette ban will "disproportionately impact people of color, as well as prioritize criminalization over public health and harm reduction." Not only will there be more police enforcement, but criminal activity and violence will increase, especially in black neighborhoods (See Point #2). As we will see below (Point #6), there are better ways to lower smoking rates than a menthol cigarette ban. 

6. Menthol cigarette bans are not necessary when we have alternatives. As previously pointed out (Point #2), prohibition is a drastic, draconian response with multiple unintended consequences. The response makes even less sense when there are other viable options. There are patches, nicotine gum, or heat-not-burn devices that are alternatives. More to the point, e-cigarettes are shown to be a safer alternative to traditional cigarettes. Cochrane, which is a revered global group of health researchers, also found that e-cigarettes are more effective in helping with smoking cessation than traditional means (Hartmann-Boyce et al., 2020). Our focus should not be on criminalization, but incentivizing smokers to either find other methods to quit or at least use less damaging alternatives such as e-cigarettes (i.e., harm reduction).

7. Menthol cigarette bans come with costs. In public policy, there are no silver bullets. Public policy is about tradeoffs and whether or not the benefits have an acceptable cost. Calling for a menthol cigarette ban is not as simple as "saving lives." Even something as noble as saving lives or improving quality of life for current smokers has a cost. As already alluded to, there are going to be increased costs to enforcing the ban and the other costs related to the criminal justice system (Point #2). There will be the cost of increased criminalization and violence as a result. There is the matter of lost tax revenue. The Tax Foundation calculates that this will cost $6.9 billion of federal and state tax revenue during the first year of implementation (Boesen, 2022). There are also the costs of economic output and the jobs of manufacturers, wholesalers, and retailers of menthol cigarettes (see NYC-specific study here).

The costs as it relates to healthcare are not as straightforward. I brought up this point a decade ago when analyzing a cigarette sin tax in California. The Attorney General's Office (AGO) of California realized that disincentivizing smokers has a cost. If a smoker ceases being a smoker and lives longer, that means incurring future costs for healthcare and social services that would not otherwise be incurred. As such, the net fiscal cost is unknown (AGO, p. 17). As we will see below (Point #8), the decision as to whether one risks dying sooner from smoking or lives longer is not up to the FDA, but up to said individual.

8. Adults should smoke whatever cigarette they would like. This isn't the 1950s when smoking was commonplace and society was unaware of the unhealthy effects. We have education on the effects of smoking, public health campaigns, excise taxes, and indoor smoking bans, all of which exist to deter smoking. If people decide to smoke in spite of all of these deterrents, that is their choice. As the Reason Foundation brings up, "Adults in a free society should be allowed to make their own calculations of costs and benefits when it comes to what they put in their bodies, so as long as they are not harming others." 

Menthol cigarettes do not provide an additional threat in comparison to their non-menthol counterparts, so why should the government ban them? If the government is going to be this paternalistic, what's next? Should the CDC go around mandating that we all exercise three times a week or that we eat daily five servings of fruits and vegetables because obesity rates in this country are so high? Most Americans do not get enough sleep. Maybe the government should monitor our sleeping behaviors and mandate how much sleep we should get. There is no overriding, substantiated public health rationale that can justify such paternalistic intervention, and that includes a menthol cigarette ban.  

Postscript

To recap, menthol cigarettes are not shown to be more dangerous or addictive than non-menthol cigarettes. The evidence we have on menthol bans do not show they are particularly effective in lowering smoking rates. Instead, we see a large amount of substitution and evasion. It does not make sense to ban menthol cigarettes when we have other methods to lower smoking rates that do not involve the heavy costs and unintended consequences of prohibition. If the FDA does indeed end up criminalizing menthol cigarettes, it would be a step backwards both for public health and criminal justice. 

An Assault Weapons Ban Is An Assault on the Notion of "Common-Sense Gun Policy"

Mass shootings have been making their way into the news cycle once more. There were two mass shootings of note that took place in May. One was in a supermarket in Buffalo, New York that killed ten people and injured three others with a semiautomatic rifle. The other was at an elementary school in Uvalde, Texas. This school shooting was the deadliest in about a decade, which took the lives of 21 individuals with 18 additional injuries. Mass shootings, especially ones that take place at school, are emotionally jarring events. These shootings were so disturbing that some Republicans are treading lightly. Texas Lieutenant Governor Dan Patrick and Congressman Dan Crenshaw (R-TX) cancelled their appearances at the National Rifle Association (NRA) Convention. Congressman Adam Kinzinger (R-IL) responded to the shootings by saying that he is open to an assault weapons ban. I would like to spend today focused on that policy proposal.  

First, what is an assault weapon? The definition of an assault weapon can vary from jurisdiction, but the most common one is a semi-automatic firearm with a detachable magazine. An assault weapon could also include such features as a vertical forward grip, barrel shroud, and a flash suppressor. The premise behind banning what the American Academy of Pediatrics calls "dangerous, military-style guns" is to prevent would-be killers from maximizing their kill count in the shortest amount of time. Plus, the combat-style features allow for shooters to have better control of the weapon while discharging large amounts of ammunition. This sounds like a fine example of what gun control advocates like to refer to as "common-sense gun policy." However, upon closer examination, an assault weapons ban is anything but. 

Yes, mass shootings strike quite the chord. The amount of senseless violence in a civilian setting outside of a war zone is unnerving. It is equally true that mass shootings are statistically rare in the United States, in spite of what you see on the news. I have made this point multiple times in my blogging, most recently in 2018. I pointed out that from 1999 to 2013, mass shootings never exceeded 300 victims per annum. Pew Research looked at 2020 data, which included 19,384 gun homicides in 2020. Pew said it mattered on the definition of "mass shooting" used. The FBI's definition had it at 38 homicides (0.2 percent), whereas the Gun Violence Archive had it at 513 deaths (or 2.6 percent of all gun homicides). Pew Research admits that "regardless of the definition used, fatalities in mass shooting incidents in the U.S. account for a small fraction of gun murders that occur nationwide each year." 

Furthermore, gun homicides do not account for a majority of gun deaths; gun suicides do. In 2019, gun suicides were 60 percent of gun deaths (UC-Davis). In 2020, it was 54 percent (Pew Research), which means that mass shootings account for less than one percent of gun deaths in the U.S. As perturbing as mass shootings are, we should not make major shifts on policy that are based on statistically rare events. 

Another issue is that an assault weapons ban is poorly targeted policy. Mass shootings constitute a small fraction of overall gun homicides. Even if you wanted to focus on this small subset of gun homicides, an assault weapons ban is not the best way to go about it. Why? Because a majority of mass shootings have historically not been carried out using rifles. The Department of Justice's National Institute of Justice conducted research on mass shootings from 1969 to 2019. One of the findings was that 77.2 percent of mass shootings were committed with handguns, whereas 25.1 percent of mass shootings were committed with rifles. In overall gun homicides, the figure is even smaller. In 2019, rifles were used in six percent of gun-related homicides (or 394 homicides), according to FBI data. Consider that there are 20 million AR-15 rifles in the United States, which means that in a given year, over 99.999 percent of rifles are not used to murder anyone. 

Another reason that assault weapons bans are not effective is because what constitutes as an assault weapons is based on such cosmetics as pistol-grip design or folding stock. In other words, certain "assault weapons" are banned because the gun looks scary. When people bring up such a weapon as the AR-15 rifle, it's not about caliber, muzzle velocity, rate of fire, or anything else having to do with the lethality of the weapon. Once you get past the looks of an AR-15 rifle, it is functionally more similar to a handgun than it is an automatic, military-grade rifle. Plus, as an article from the Left-leaning Vox points out, an AR-15 rifle has multiple legitimate uses, including hunting, target shoot, and home defense. I covered the topic of defensive gun usage last November, but I will add that assault weapons are especially helpful in self-defense of marginalized groups, senior citizens, and the physically disadvantaged. 

None of this covers the fact that during the Clinton Administration, Congress enacted a Federal Assault Weapons Ban. This Ban was in effect from 1994 to 2003. A subsequent study from the U.S. Department of Justice did not find any evidence that the ban worked (Koper, 2004). The study's main takeaway? "Should it be renewed, the ban's effects on gun violence are likely to be small at best and perhaps too small for reliable measurement." The effects were so minimal that "we cannot clearly credit the ban with any of the nation's drop in gun violence." This net neutral effect on gun homicide rates might have something to do with the substitution effect, i.e., offenders ended up buying guns that were not covered by the assault weapons ban. This is not the only research showing a lack of evidence for assault weapons bans:

• The Journal of General Internal Medicine looked at state-level gun policy, which included assault weapons bans. The study concluded that there was no correlation between state-level assault weapons bans and homicide rates (Siegel et al., 2019). 
• Research from Applied Economics Letters found that "assault weapon bans did not significantly affect murder rates at the state level" (Gius, 2013).
• A report from the Journal of the American Medical Association, or JAMA, similarly concluded that assault weapons bans are not associated with changes in firearm homicide rates (Lee et al., 2017). 
• A 2020 analysis from the renowned RAND Corporation found the evidence of assault weapons bans on mass shootings (as opposed to gun homicides generally) to be inconclusive. 
• Another study from RAND (this one from 2018) concluded that there are no qualifying studies that bans on the sales of assault weapons decreased any of the eight outcomes that RAND studied, including the impact on violent crime. 

Conclusion

Assault weapons bans miss the mark on multiple levels. These bans are enacted to try to prevent a statistically rare occurrence. The bans are poorly targeted not only because they focus on the cosmetic appearances of the guns over functionality. Most mass shootings and gun homicides generally are not committed with semi-automatic rifles, which means such a policy would not cover the majority of gun homicides. Most importantly, assault weapons have been tried on the federal and state levels in the United States. In spite of such laws in place, they have shown to be ineffective in lowering homicide rates. Instead of having emotional knee-jerk reactions, we should ask ourselves what works best. Much like we have seen with the bump stock ban, a high-capacity magazine ban, or a gun buyback program, assault weapon bans are another example of good-intentioned gun policy that are a far cry from being a silver bullet. We should strive for better instead of clinging to policies that do not work. 

Lockdown Advocates Were Wrong to Mock Sweden's COVID Policy Strategy

When the pandemic began, multiple countries reacted in panic with lockdowns, school closures, mask mandates, and travel bans. There was one country that tried a light-touch, more laissez-faire approach: Sweden. Sweden had mask recommendations starting in June 2020, but never a mandate. Sweden never locked down or imposed curfews, although there were bans on crowds over five-hundred people, and later fifty people. Restaurants and bars in Sweden had more restrictions, but businesses by and large stayed open. There were moments where secondary schools went to remote learning, but primary schools and preschools stayed open. Sweden did not have a complete travel ban, but did ban those outside of the European Union, a policy that has since been rescinded. 

It is not as if Sweden did nothing to slow the spread. Sweden still had COVID-related restrictions in place, but that did not stop Sweden from getting walloped with criticism. Fortune called Sweden a failure. The New York Times referred to Sweden as "the world's cautionary tale." Foreign Policy thought Sweden's approach was botched. The Guardian believed it was a catastrophe. The fear ramped up to the point where being strict, regardless of outcome, was optimal. Anything else was seen as selfish, careless, and bordering on sociopathic. It turns out that the lockdown advocates were wrong to mock Sweden. Here are five reasons as to why:

1. Sweden's economy held up without lockdowns. There were those who thought that there was no tradeoff between lockdowns and the economy. Some prominent economists thought that we needed more aggressive lockdowns at the beginning because earlier control of the virus would have meant a smoother return to a pre-pandemic level of economic productivity. If short-term pain in the form of lockdowns were the solution, Sweden's economy should have performed terribly since they never had a lockdown. However, that was not the case. The Economist ranked 23 wealthy countries on their economic performance during the pandemic using multiple factors, including GDP, household per income, share prices, investment, and public debt to GDP. Sweden ended up ranking third on this list. Sweden's performance helped to disprove the hypothesis that the lockdowns were needed for longer-term economic performance. 

2. Number of total COVID deaths in Sweden have been way fewer than predicted. The Imperial College model, which was the model that scared the United Kingdom into locking down in 2020, predicted that in early 2020, as many as 40 million people would die if we did not take drastic measures (e.g., lockdowns). The Imperial College model inspired a similar study in Sweden (Gardner et al., 2020). This study's modeling predicted that without lockdowns, Sweden would have experienced a median 96,000 COVID deaths by the end of July 2020. That sounds scary, doesn't it? That would have been terrible for Sweden. Where did Sweden actually end up by the end of July 2020? According to the Swedish Health Minister's data from Folkhälsomyndigheten, at 5,723 deaths. The scary modeling exaggerated the threat by a factor of almost seventeen. This is May 2022. Where is Sweden at now? As of May 22, 2022, Sweden has had 18,941 COVID deaths, which is still about a fifth of the deaths that the scary modeling predicted. 

3. Sweden's COVID death rate in comparison to other countries is relatively low. Mortality data from Johns Hopkins University show Sweden has one of the lowest COVID death rates per 100,000 people in Europe. As of May 22, 2022, Sweden has 187.55 deaths per 100,000 people. Sweden has fared better than about 50 countries that had more heavy-handed COVID regulations, including Peru (646), the United States (304), Chile (302), Argentina (285), Greece (284), Belgium (276), Italy (274), the United Kingdom (273), France (228), and Spain (226).

4. Sweden's mortality rate did not spike due to COVID. If Sweden's policy were really that careless, we would have seen a huge surge of death in Sweden. However, the historical mortality rate data from the Swedish government's Statistiska Centralbyrån show that COVID did not cause major spikes in Sweden's death rate. The 2010-2019 average morality rate for Sweden was 9.27 deaths per 1,000. In 2020, that figure was 9.48 deaths, which was a 2.3 percent increase. In 2021, the mortality rate dropped to 8.83 deaths per 1,000, which is a 6.9 decrease from the previous year. When comparing Sweden to past years within its own history, its COVID response does not suggest a calamity befell Sweden. 

5. Sweden's excess death rate is one of the lowest among developed nations. A more superior metric is the excess death rate. As the Left-leaning Washington Monthly illustrates, excess mortality includes all deaths, whether from COVID, deaths caused by COVID policy (e.g., lockdowns, delayed non-COVID healthcare, mental health caused by social isolation), or another cause. It removes underlying differences between regions and countries. Another point I would like to make is that excess deaths are a better metric in the sense that you do not need to get into the debate of "death with COVID" (i.e., incidental death) versus "death because COVID" versus "COVID was not the primary cause, but was a contributing factor."

Using this metric of excess death rate, Sweden fared even better than it did on COVID-specific death rates. A Kaiser Family Foundation found that Sweden was the only wealthy country that did not have any excess mortality for those under 75 years old (Amin and Cox, 2021). Earlier this month, the World Health Organization released global data on excess death rates in 2020 and 2021. It turns out that in 2020 and 2021, Sweden had one of the lowest excess death rates in Europe (see below).  

This does not surprise me in the least. When I took the time in June 2021 to analyze the available literature on lockdowns, I came across a study from scholars at Rand Corporation and the University of South California (Agrawal et al., 2021). The study analyzed 43 countries and all 50 states in the United States, and found that lockdowns actually increased excess death rates. 

Side Note About Comparing Other Nordic Countries to Sweden

There are some that like to lambast Sweden because their death rates are higher than their Nordic counterparts of Denmark, Finland, and Norway. While the the WHO shows that was indeed the case, I have pointed out in response that for much of the pandemic, Oxford's COVID-19 Stringency Index showed that Sweden was more stringent than the other Nordic countries for much of the pandemic. There is also the "dry tinder" hypothesis, which states that Sweden had higher deaths in 2020 and 2021 because they had fewer flulike deaths in previous years (e.g., Klein et al, 2020). There was also the issue with the Swedish strategy shielding the elderly (Rizzi et al., 2022), a point I made in August 2020. The "dry tinder" likely exacerbated the nursing home policy in Sweden. Since this was likely the major driver in Sweden's COVID deaths, it still has no bearing on the discussion of whether lockdowns, mask mandates, or school closures were necessary. 

Conclusion

Pointing out the Swedish case study does not by itself refute the pro-mandate side. A single case study can be suggestive, but you need more evidence than a single case study to prove something true or false. Conversely, if keeping business shut down or having mask mandates were that vital to public health, Swedish health metrics should have been a disaster relative to countries. Yet that was far from being the case. The "Swedish experiment" adds to the evidence base that lockdowns are harmful, mask mandates are ineffective, and school closures were by and large unnecessary. I'm not here to say that Sweden got everything right. The main flaw is that at the beginning of the pandemic, Sweden did not handle its nursing home pandemic policy in a fashion that would have adequately protected its most vulnerable. Even so, as this report from a Swedish government commission concludes, Sweden's light-touch approach to the pandemic was "broadly correct."

The facts mentioned above help explain why the "better safe than sorry" crowd cannot stand the Swedish example. It means that argument of "If we didn't have lockdowns, it would have been much worse" does not withstand scrutiny. It means that the lockdowns were not needed to avoid disaster and mask mandates (or masks generally) were not statistically significant in helping quell COVID transmission. It means that the lockdowns did come with considerable costs. 

I do not think the doubling down of lockdown advocates is simply a matter of ego or an incapability of admitting one was wrong. If these advocates were to accept that Sweden was successful in its overall approach, it would mean that delaying children's education, denying people freedom, disrupting (or in so many cases, causing the loss of) employment of millions, or exacerbating physical and mental health issues were undergone for no reason whatsoever. It is difficult to be on the side that took a sledgehammer to multiple institutions and to our way of life. The takeaway from the Sweden example should not simply be that the overly and unnecessarily stringent approach was the improper approach. It should be that we learn from this painful lesson so that we do not make the same mistake of panicking and ignoring best practices when the next pandemic happens.

5 Government Policies That Brought on the Baby Formula Shortage

Taking care of a baby can be challenging with the sleepless nights and the demands on free time. In 2022, raising an infant has become more challenging because baby formula has become harder to find. As grocery and retail data firm Datasembly shows, the out-of-stock (OOS) rate for baby formula has skyrocketed in the first half of 2022. Major distributors such as Wal-Mart, Target, and Kroger are rationing baby formula. This is significant since CDC data on breastfeeding show that a majority of infants use formula. While switching over to breastfeeding might be possible for some, other mothers might not be able to breastfeed (e.g., allergies, medical conditions) or are have time constraints. This shortage has the potential to truly impact pediatric health. 

So how did we get here in the first place? The most recent shock to the U.S. baby formula market was in February 2022 with a contamination problem at an Abbott plant that produces baby formula. This caused the FDA to recall formula from Abbott. While the OOS rates are higher in recent months, we can see from the above graph that OOS rates were still high in 2021. Part of this was due to the pandemic-induced hoarding in 2020, followed by lower demand in 2021. There is also the inflationary pressure, a phenomenon that the Federal Reserve Bank of San Francisco points out has been more prevalent in the United States than in other countries due to its larger-than-average government stimulus during the pandemic (Jordà et al., 2022). Since 2021, we have more generally found ourselves in a supply chain crisis. As I pointed out in October 2021, some of this was going to happen regardless because of the pandemic. At the same time, there was plenty of government policy that negatively attributed to the supply chain crisis. 

The infant formula manufacturer market was struggling with the same things other manufacturers were struggling with, whether that is labor, materials, transport, and logistics. The extent to which the government is responsible for the trends on a macroeconomic level does not change that the government has a heavy-handed approach when it comes to infant formula. As the New York Times reported in March 2021, "Baby formula is one of the most tightly regulated food products in the U.S." How bad is it? Here are five ways in which the government made the infant formula shortage as dire as it is. 

1. WIC Vouchers and Market Concentration. WIC stands for Women, Infants, and Children. It is a supplemental nutrition option program from the U.S. Department of Agriculture that is aimed to safeguard the health of low-income women, infants, and children. What could such a seemingly innocuous government program have to do with the shortage? Formula companies are heavily subsidized by WIC through the voucher program. In exchange for offering lower prices on infant formula in the form of rebates, the formula companies receive "the exclusive right to provide their product to the state's WIC participants." This means that the companies with the greatest number of lobbyists can vie for this exclusive right to a de facto state-level monopoly in this market segment for infant formula. This cannot be overstated since it is through these WIC vouchers that about 50 percent of infant formula is provided nationwide (Choi et al., 2020). Abbott holds 42 percent of the market share for infant formula, according to market research firm Euromonitor. This favoritism makes it hard for new companies to enter the market, which leads to market concentration. If the WIC vouchers did not attribute to this market concentration, one plant closing would not make mothers in the United States so vulnerable to such a supply shock. 

2. FDA's Non-Tariff Trade Barriers. Not only have FDA regulations gotten in the way of such things as making prescription drugs cheaper or e-cigarettes more available, the latter of which being a healthier alternative to traditional smoking. The FDA has specific labeling requirements and ingredient requirements, as well as a mandate stating that retailers wait 90 days before marketing a new infant formula. The excess of labeling regulations in particular make European infant formula illegal in the U.S. (DiMaggio et al., 2019). These onerous regulations provide little incentive to non-U.S. businesses to sell their formula to U.S. retailers. 

3. Infant Formula Tariffs. For the few brands of formula that can past the FDA gatekeeping, they are subjected to tariffs up to 17.5 percent (also see here). Looking at the economics of tariffs, tariffs are an import tax. Who pays that tax? The domestic consumer through higher costs of foreign goods or services. Between the tariffs and FDA regulations, is it any wonder that 98 percent of baby formula consumed in the United States comes from producers in the United States?  

4. Trump's Trade Deal and Export Fees. Part of the Trump Presidency was the enactment of NAFTA 2.0, which is better known as the United States-Mexico-Canada Agreement (USMCA). During the negotiations in USMCA, one of the sticking points was with the dairy industry. The U.S. dairy industry wanted certain provisions to protect themselves. Part of this negotiation had to do with China. Prior to the enactment of USMCA, Chinese baby food producer Feihe invested $225 million into building a manufacturing plant in Kingston, Ontario, Canada. Part of USMCA is limiting how much infant formula Canada can export, not only to the United States but globally. If Canada exceeds exporting 40,000 metric tons of infant formula, they are walloped with an export fee of $4.25CAD for each kilogram. While Trump was trying to screw over China, he ended up screwing over the American people by discouraging Canadians from producing baby formula that we clearly need. 

5. Marketing Orders. A marketing order is a series of price and income supports imposed by the USDA (see Cato Institute brief for more information). Looking at the economics of milk marketing orders, such orders drive up the price of milk (e.g., Chouinard et al., 2005). Since dry milk is an essential ingredient in baby formula, it is reasonable to assume that these marketing orders are attributing to the increased cost in baby formula. As Cato Institute scholar Gabriella Beaumont-Smith points out, there are import barrier provisions in the marketing orders that dampen U.S. producers' demand for foreign milk, which makes infant formula all the more scarce in a time of emergency. 

Postscript

Without a doubt, the pandemic threw the infant formula market in disarray, as the pandemic did with so many markets. The panic buying and hoarding in 2020 garbled market signals on infant formula demand in 2020 and 2021. The pandemic also had its role in contributing to the supply chain crisis and affecting various inputs of infant formula production. The factory of the leading domestic producer of infant formula in the United States does not do any favors. But make no mistake: government policy is a major culprit. USDA subsidies for large infant formula manufacturers increased market concentration. If the market were fragmented, the Abbott manufacturing plant closure would not have made the infant formula market so vulnerable. If trade barriers and FDA regulations were not so onerous and excessive, there would have been a U.S. demand for internationally produced infant formula that could have helped fill the gaps while the Abbott manufacturing plant worked on getting open again. In short, if it were not for government meddling in the infant formula market, mothers would not be scrambling to feed their children. This infant formula shortage serves as another reminder that instead of regulating its people to death, the government is much more likely to do a better job at improving our lives by deregulating and getting out of the way.