“Talk Less. Smile More. Don’t Let Them Know What You’re Against or What You’re For.”

I recently, finally listened to the entire soundtrack to Hamilton, the play based on the life of Alexander Hamilton. The story is a study of the lives of two people, Alexander Hamilton and Aaron Burr. As you may know from your history lessons, Aaron Burr killed Alexander Hamilton in a duel in 1804. However, the story of how they got there begins in New York in the 1770s, according to the play.

When Hamilton first approaches Burr, Hamilton just talks and talks and talks, wanting the American Revolution to get on so Hamilton could prove his worth. You see, Hamilton was born into a very dire situation in the British West Indies (present day St. Kitts and Nevis). When his mentors saw potential in him, they scraped up money to send him to New York, which was a British colony at the time. Nevertheless, Hamilton considered himself an immigrant.

On their first meeting in the musical, Hamilton talks a big game. He wants to serve in the coming war and help America become independent. To this, Burr advices Hamilton to “Talk less. Smile more. Don’t let them know what you’re against or what you’re for.” He warns Hamilton that only fools talk so much, and that they often wind up dead. Talk about foreshadowing.

In New York, Hamilton also meets the Marquis De Lafayette, John Laurens and Hercules Mulligan. Together with Burr, these four would go on to be instrumental in winning the Revolutionary War. After the war, Hamilton and Burr go on their parallel paths in law and politics. Hamilton, as you might know, becomes the first Secretary of the Treasury. Burr, after a career in law, becomes a US Senator. The two would have a contentious relationship.

In the end, Burr loses the election of 1800 to Thomas Jefferson, partly because Hamilton endorses Jefferson. As a result, Burr talks badly about Hamilton, and Hamilton replies in kind. It all came to a head in July of 1804. Although Burr was the Vice President of the United States, he still participated in the duel in which he shot Hamilton dead. (The runner-up in presidential elections became VP back then, and can you imagine Hillary Clinton as VP to Trump?!)

The musical leads you to believe that the duel was precisely because Hamilton didn’t just smile and stay quiet. He spoke truth to power wherever he could, and he paid the consequences. Hamilton is also portrayed as a bit of a hothead, something his son unfortunately inherited. You see, his son died in a duel not too long before Hamilton did (in 1801). George Eacker, a lawyer, had criticized Alexander Hamilton. In response, Philip Hamilton challenged Eacker to a duel, and losing. (Eacker would die in 1804 from Tuberculosis.)

At the end of the play, Eliza tells the story of how she tried to continue Alexander’s work. She lived to be 97 years old, a feat in those times. In that time, she put together Alexander’s biography, organized the multitude of papers he wrote, and advocated for the abolition of slavery. But it was in her re-telling of his habit of writing that we get yet another warning that words can put their author in peril.

As you can imagine, this all kind of hit close to home for me. I write a lot. (And I do mean a lot.) The blog is but a small sample of what I have floating out there in the big bad world. From time to time, these words have gotten me into trouble. From the time that antivaxxers came after my work (twice) at the health department, to angering my bosses because I couldn’t keep quiet over some situation… Or talking back to people who should have known better but didn’t.

On the other hand, I don’t think I’m enough of a hothead to go getting myself into duels. As far as violence goes, I couldn’t hurt a fly. So maybe I’m safe in that regard? Yet there is no telling what some people are willing to do to force their views and opinions on the rest of us in this well-armed society we live in. But, like Hamilton did, as long as I know what I’m doing is for the good of the world, everything else is just background noise… Right?

The Epidemic of Violence in Baltimore Continues

Back in 2017, I received a message from one of the automated bots I’ve deployed to the web to look for information for me to consume. As I was working on my doctoral dissertation on homicides in Baltimore, one bot reported that a firebombing had occurred in Baltimore, killing two teens.

The main suspect in that firebombing (and a shooting at the same location a few days before that) was Mr. Antonio Wright, a 27 year-old Black man. After being named “Baltimore’s Public Enemy Number One,” Mr. Wright turned himself in to the authorities. Throughout his arrest and trial, he continued to assert that he was innocent.

A few weeks ago, Mr. Wright was found not guilty on all counts. Because of his background and this incident, Mr. Wright was advised by his lawyer to move out of the area, start anew somewhere else:

Continue reading

The Sadness of It All

When I was in high school, I participated in a magnet school program called Health Occupations Students of America. The program was aimed at attracting high school students who were looking for a career in, you guessed it, health occupations. Of course, most of the kids in the program wanted to be physicians or nurses. Very few of us were at other stuff as well.

I was particularly discouraged from anything to do with cancer because of the stories told to us by one of the teachers. She had been a pediatric oncology nurse, and she had seen more than her share of children die from cancer. Each time she told us a story, she would do so with a very deep kind of sadness. “Children shouldn’t die,” she said each time she finished a story.

I don’t know how she dealt with that much sadness, but I certainly hope that she found a way to cope. That kind of sadness can really wear you down and even kill you. You need to find a way to deal with it or get rid of it, or something.

I tell you this because I’ve been dealing with a lot of sadness in working on my dissertation. The stories I read day after day of violent crime in Baltimore can be too much, especially if they’re accompanied with an expanded description of the victims’ lives.

For example, just over the past weekend, a kid by the name of Ray Glasgow III was shot dead. By all accounts, he was a great kid with a bright future. This is from The Baltimore Sun:

His father, Ray Glasgow Jr., 35, called Ray III — his only biological son — a “daddy’s boy” and “a better me.”
“My son was everything I wanted to be growing up,” Glasgow said Monday. The two had recently visited Hampton University to tour the historically black university’s campus. It was Ray’s No. 1 pick for college, Glasgow said.
“He was a better me. I used to tell him that all the time. If I could be anybody in the world I would want to be him, because the sky was the limit for him. He was an unbelievable kid.”

A Better Me

That phrase by the dad really punched me in the gut. After all, my biggest hope for Baby Ren is that they become a better me, too. My goal is for that baby to have all of my strengths and none of my weaknesses, and to bridge the two cultures they were born into. If anything were to happen to Baby Ren, it would be decades before the world could recover. Yes, I can be that much of a monster.

Or maybe not. I don’t know. I don’t want to think about it.

But I’ve obviously been thinking about it. I think about it when I hear about a child being killed for absolutely no reason, whether it be in Baltimore or Gaza or Uganda. Children should be absolutely hands off to violence, to death. But they’re not, and that really hurts me.

So what do you do, Ren?

What I’ve been doing is a lot of introspection and rationalization of the things that I read about. I run the numbers in my head over and over again until I am convinced that there is very little danger to Baby Ren, and that the odds are that we’re all going to be alright. Yeah, bad things happening is possible, but it is extremely improbable.

The other thing I’ve been doing is having a readily available chat with a mental health counselor. There is just something very satisfying about talking about all my anxieties with someone who is impartial and knows how to ask all the right questions. My wife says that we should all have an assigned counselor, and she is very right. We could deal so much better with all that anger and sadness and other feelings that make us do stupid things.

What can I do, Ren?

My biggest word of advice is that you take a moment or two every day to take inventory of how you are feeling if you are in an environment that is triggering feelings of sadness or anger, or anxiety of any form. Recognize that something is happening and seek help. Go chat with someone and tell them all about it, even if that someone is not a trained professional. The best thing is to get it out of your head by analyzing what you’re feeling. Write about it, even. But don’t bury it. Those things fester in your head (rent-free, mind you), and they end up manifesting themselves at the worst possible time.

The Dissertation Defense Cometh

I’m going to be diving even deeper into my dissertation as I prepare to defend it. In the weeks and days leading to the final defense, I’m going to be almost completely submerged in the data and the stories of thousands of deaths in Baltimore over the last decade and a half. Each one of those data points on my maps or numbers on my tables are people who had loved ones, people who are missed. But I’m going to work hard to not let the sadness of it all consume me. I’m no good to anyone, especially Baby Ren, when I’m consumed like that.

The Risks We Like To Take

With every passing day, the chances that I will die continue to approach certainty. It’s a slow approach to that 100% chance, but it’s happening. All I can do is slow down that acceleration to oblivion (and beyond?) by doing certain things and not doing others. For example, I have to go for a jog/swim/run/bike ride more often, eat more veggies, and get yearly check-ups with my doctor. I also have to wear a helmet when riding the bike and my seatbelt when driving.

You know, simple things.

Still, plenty of people around the world do things that accelerate their demise and fail to do things that delay their end. Admittedly, if they didn’t, I’d be out of a job. Still, I wish more people did the simple things that keep them from dying.

The only exhibit I need to explain my case is one that is not rare at all. Last week, a family of four from Omaha, Nebraska, were on their way back home through Utah from a vacation in California. The driver of the van likely fell asleep while driving. Out of the five people in the van, four were killed when it rolled over. According to police, none were wearing their seatbelts, not even the 10-month old (who should have been in a car seat.)

Here we have four adults who decided that they were not going to wear the one thing that has improved the safety record of cars more than most other improvements to car design. Their decision led to the very early death of a fifth person, a baby. (As a father, that’s the part that really grinds my gears.) Why they made that choice boggles my mind. One can reasonably argue that they were aware of the benefits (and the laws) concerning seat belts.

So what do we do? How do we prevent those excess deaths and injuries? Pass more laws? Well, laws can only take us so far, as we see with seat belts. Every state has a law regarding their use, but we still have about 15,000 deaths from injuries in automobile accidents where the victims were not vaccinated strapped into their seatbelts. How do we get to those last 15,000? Better cars and better drivers, of course… All from better public health science and policy recommendations. And all that science and recommendations comes from research.

Can you imagine if we were prohibited from doing research into better cars and better drivers by Federal law? Can you imagine if the big car companies paid policymakers to pass those laws? The uproar would be phenomenal… But that’s the case for gun manufacturers. They’ve successfully bribed lobbied Congress to pass laws prohibiting agencies like CDC and NIH from researching gun deaths.

That all is for another post at a later time.

Good Night, Good Dog

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Callisto, the wonderful dog we adopted seven years ago, passed away peacefully after a short battle with disease. She leaves a dog-shaped hole in our hearts as she was very much our daughter. My wife and I wished she could have stuck around to meet the baby, but the universe has a funny way of balancing equations. One life leaves us just as another is arriving.

Good night, good dog. You were the best friend a man could have on any adventure. I miss you dearly, but I’m happy you’re not suffering anymore and you’re in that place where dogs go to chase bunnies eternally.

Vaya con Dios.

Baltimore’s Cycle of Violence Continues Apace

In the first 30 days of January, there have been 32 homicides in Baltimore City. It’s not appropriate to compare these first 30 days to last year’s first 30 days, however, because homicide (like other crime) is not directly related to the time of the year. Or, rather, the time of the year has some influence, but that influence is not absolute. (More on that later.)

On January 24, the Baltimore Police Department posted an announcement on their Facebook page that there had been an incident where two men were found with gunshot wounds. One of those men, Kelvin Armstead, died at the hospital from his injuries. He was 34 years old.

That wasn’t the first time Mr. Armstead had been in the presence of a gun. Ten years ago, Mr. Armstead is alleged to have been one of three men who killed Ricardo Paige:

“The neighbors knew Ricardo Paige as “Pops,” a kind man who lived and worked as a handyman in the Pen Lucy neighborhood renovating vacant houses for landlords.

But Paige, police and prosecutors believe, unknowingly crossed the wrong people in the neighborhood. Authorities believe that drug dealers who used vacant houses on the block thought Paige might have turned over a drug stash to police. On March 20, 2007, they confronted him in the house where he was living and working, in the 500 block of E. 43rd St., and shot him six times, including once in the mouth.

Police eventually arrested three suspects in the case, including one who was caught in Georgia last year after Paige’s killing was featured on America’s Most Wanted.”

Mr. Armstead was the one featured on America’s Most Wanted (Season 22, Episode 2, September 2008). He was convicted of second degree murder and conspiracy to commit murder. He was sentenced to life in prison, and the appeals court upheld the conviction. At some point, Mr. Armstead was released from prison only to be killed last week:

“Crime tape wrapped more than half of the 3900 block of Kenyon Avenue in the Belair-Edison neighborhood as homicide detectives looked for evidence at a rowhouse where two men, ages 24 and 34, were shot. Both victims were transported to Johns Hopkins Hospital, where the older man was pronounced dead. The younger man was in serious but stable condition, Baltimore police spokeswoman Detective Nicole Monroe said.”

He’s not the only one caught up in a cycle of violence that ends in their death. The first homicide of the year was that of Sheamon Pearlie, a 20-year-old:

“Two men were shot and killed in separate incidents in West Baltimore Sunday, the first homicides in the city in 2017. One shooting took place in the same block as the Western District police station.

Officers were on patrol about 3:15 p.m. when they heard gunshots from the 1800 block of W. Fayette Street in the Franklin Square neighborhood. There they found a man with a wound to his upper body, and he was pronounced dead at the scene.

On Monday, police identified the victim as Sheamon Pearlie, 20, of the 4600 block of Reisterstown Road.”

As with Mr. Armstead, Mr. Pearlie had been in the presence of a gun before. Back in December of 2015, Baltimore Police posted on Facebook that they had arrested Mr. Pearlie with a loaded weapon. That post has been deleted in the last month. However, here is the court record of the arrest.

From the Baltimore Sun’s mapping of incidents, we can see that the homicides for this year have been in the same general areas as in previous years, namely, the poorer and more disadvantaged areas of Baltimore:

screenshot-2017-01-30-10-20-48

Of the 32 homicides so far, all but three were committed by firearm. Two were stabbings, and one was blunt-force trauma. Almost all were male, with the exception of two females. Almost all were Black, with the exception of 4 whites and 2 hispanics. The average age was 31 years. The youngest was 17, and the oldest was 59.

Finally, one more visualization. I took the information on the number of homicides from the Baltimore City open data site and calculated the number of homicides per day for the last 365 days. For example, for January 15, I took the number of homicides in the previous 365 days and divided that number by 365.25 (the 0.25 to account for leap year). For the following day, I took the number of homicides going back 365. This is a sort of rolling average of the number of homicides per day for the previous years, and it helps stabilize the rate without having to adhere to calendar years. It allows for better comparison on the rate per day across time and across particularly violent days.

homicides_per_day

The red dot represents April 25, 2015, the day of the Freddie Gray riots. Before that day, around March of 2015, the rate of homicides per day began to increase, peaking around April of 2016, when the rate started to drop. Unfortunately, there’s been an upwards tendency again in late December of 2016 and January of 2017.

It would be great if one encounter with violence somehow “immunized” the person against subsequent encounters. The world doesn’t work that way, so other interventions are needed to keep people who have not been exposed to violence from being exposed and those who are from being re-exposed. All is easier said than done.

 

Everyone Was Looking For Answers

My wife and I went to a town hall meeting in Carroll County, Maryland, yesterday. The meeting was about the opiate drug abuse epidemic and what different agencies and people were doing about it. The keynote speaker was an agent with the Drug Enforcement Agency (DEA). He gave the usual statistics on number of deaths and overdoses, and what his agency has been doing to counter them. He also talked about how most of the heroin being used in Virginia, Maryland, Pennsylvania and West Virginia flows from Baltimore on what is called “the heroin highway.” (Of course, he clarified that heroin and other opiates are being illegally imported from Mexico.) We then got to hear from people in the community who run different intervention programs. Included in those presentations was one by the local hospital. It went “dilaudid-free” this year, and they’ve seen the number of “seekers” go down along with an increased positive response about pain control from other patients. In essence, not everyone needs dilaudid — a powerful opiate-based analgesic — for things like sprained ankles or strained backs.

People from the local and state health departments also spoke about their agencies’ efforts to curb the epidemic. Locally, they’re raising awareness about the link between abusing prescription painkillers and getting hooked on heroin. They’re also using recovering addicts to talk to peers about prevention. And, of course, they’re distributing Narcan to friends and family of people abusing opiates and heroin in order to prevent deaths from overdoses. Statewide, new rules are coming online to keep track of what opiates and how many are being prescribed. In that vein, a lot of finger-pointing was done at dentists who give prescriptions for 30 days of OxyContin for tooth extractions or installation of braces. A lot of the attendees — many of them parents whose children were prescribed these opioids for “simple” procedures — said that it seemed to them that prescribers (e.g. dentists) didn’t want to deal with a complaint about pain, so they just prescribe the strongest thing in their arsenal.

Most painful of all were the stories of parents whose children died recently from heroin overdose. One parent, a pharmacist, talked about a “pill mill” not far from our location. He wanted something done about that because his child started off addicted to OxyContin. Another parent said that she still has some heroin from her child at the home, and she wanted the local sheriff to take it and analyze it to see if they could trace it back to the source. (Something that is very difficult, if not impossible, to do.) Other parents gave similar stories of otherwise “normal” children who fell into opioid drug abuse and then moved onto heroin, which is easier to acquire and quite cheap.

I say that these stories were painful not only because of the loss of life, the loss of their children. It was painful because it was obvious that they wanted answers, they wanted someone to pay the price for their loss. But there was no one to blame, at least not in the room. For the parents who wanted the drugs analyzed in order to maybe find a dealer, it’s probably not going to happen. And, even if they do track down the dealer, the chance of the dealer being charged with their son’s death are low. And I can see how that must be incredibly frustrating. Someone, somewhere, made the conscious decision to manufacture and sell poison to their kids. Someone profited from their deaths. Even if the chances of people “in the game” are likely that they’ll get killed or seriously hurt for being in it, someone is getting away with hurting those who overdose and/or die.

However, the answers to the epidemic are almost as varied as the drugs that are being used. You can seal up the border to keep heroin from coming in through Mexico, but you’ll have it come in from Asia via Canada. Or you’ll have designer opiates (like all the Fentanyl variants) being made here in the US. And, of course, you’ll have prescription opiates being handed out like candy by people who don’t want to hear your whining about your broken leg. Or could severely restrict prescriptions, piss-off the pharmaceutical industry, and have people move to heroin as they can’t get their pills. Then you could do both, but the underlying social and mental health issues that drive people to addictions are not addressed and they go to other dangerous/illicit drugs (or some licit ones like alcohol and marihuana in several states).

In a perfect world, you would dismantle drug cartels by taking away the demand for drugs. You’d take away the demand by solving social problems that lead people to want to escape their situations by abusing heroin and other drugs. You’d also have mental health readily available to help people who have something happen in their life that leads them to want to escape. Or, if they’re there already, you’d have recovery services ready to help. You’d also have clean needles to prevent infections and people from dying, or Narcan in every public place (like Automated Electronic Defibrilators are now) and in the hands of every addict and their immediate circles in order to keep them alive.

Of course, there are other things that work which I might be forgetting.

While some at the meeting were being optimistic that maybe the epidemic was subsiding, I’m not as optimistic. Looking at the trends, this thing is happening in waves. As Baltimore and other major cities get “dangerous” during the summer, people turn to other drugs to fill their needs. Then they go back to buying heroin once things calm down in the cooler/colder months. Heroin overdoses seem to wax and wean like that, just like almost everything else in epidemiology. I certainly hope that it is calming down. I hope that more parents aren’t looking for more answers. But I don’t know… I just don’t know.

That’s Weird. Radical Islam Is Not an Existential Threat, According to WHO and the World Bank

There’s this thing that you do when you work in public health. You try to look at the top causes of death and disability so you can better understand what you need to do in order to save lives “millions at a time” or some such. To do this, you need to be mindful of all sorts of things, like your sources of data, the quality of the data, and the best way to compare your populations with reference populations. There’s a whole series of courses in public health about this, and they’re very neat to listen to because you get an understanding of why epidemiologists don’t panic.

Seriously, we never panic.

corgie_swing
This dog is an epidemiologist during a pandemic.

The reason we don’t panic is because there are always bigger fish to fry, so to speak, when it comes to death and disability. For example, while the deaths of thousands from Ebola is a tragedy — especially because of the delayed response from “The West” — those deaths were a very small number compared to other infectious diseases hitting Africa, hard.

In 2012 alone, there were between 473,000 and 789,000 deaths from malaria in the world, with 90% of those deaths occurring in Africa. (Source: WHO) In 2014, between 690,000 and 990,000 people in Africa from HIV/AIDS. (Source: WHO) Thankfully, advances in antiretroviral therapy for HIV infection and better nets and repellents for mosquitoes are making a dent in all those deaths.

When people started talking about the end of the world because of Ebola, I didn’t panic. (I hope you didn’t, either.) I actually called into a radio show (Michael Smerconish on Sirius-XM satellite radio) and told the dude that the fly was coming. In America, on any given flu season, between 3,000 and 69,000 people die from influenza, a vaccine-preventable disease. (Source: Me. I know a thing or two about influenza.) To panic over one or two cases of Ebola making their way to the US from the returning healthcare workers was not the best thing to do. “We’ll see,” the dude said.

Yeah, we saw.

I told you the other day about the Republican candidate for the presidency making it sound in his rhetoric like the US was in shambles, all immigrants were roaming the streets raping and killing, and Muslims were ready to take out America. And that was just from reading the speech. I’ve listened to it since then, and, Jesus Christ, he made me fear for my life for 2.3 seconds. Then I remembered that the world is at an all-time low in terms of violence, and so is the United States of America. (Sources: The Washington Post and Slate.com)

Have you ever been afraid of flying on a plane? I have. My fear doesn’t come from ever being in a plane accident. Heck, none of the flights I’ve been on have ever even had to diver or go-around on landing. I’ve been afraid at times because my brain races to the worst possible outcome when flying. Any little jump, and the plane is going down.

shark_plane
Or worse.

And it all comes from watching stupid television shows about plane crashes, or YouTube videos, or hearing stories from people who have been in an accident. Because I know these things can happen, the brain tries to tell me that they will happen. It’s that weird ability of the brain to conjure up the worst possible scenarios in order to keep me alert and ready that has made me get a little clammy when flying through turbulence.

pilot_ren
I’m still getting my pilot’s license one day, dammit!

So there is this group of evil people out in Syria and Iraq — some in Lybia and Egypt — who are convinced that the only way they’re going to get their way is through fear. They put up some really awful videos of people being beheaded or drowned to death, or worse. They “inspire” people in other parts of the world to just go berserk and kill people for the hell of it. And they do it all, according to them, in the name of Islam.

A quick aside:

Now, I don’t know about you, but if these bozos decided to say that they were doing these horrible things in the name of Christianity, we would probably not call them Christians. And that’s because these horrible things go against every single tenet of Christianity. However, for some weird reason, people in the United States and other “Western” countries are quick to call them “Islamic” or “Muslim” terrorists. They’re terrorists, alright, but they’re not Muslims. Muslims don’t do these things that these terrorists do.

But, whatever, you want to play the name game. Go ahead.

Back to our blog post:

Anyway, these terrorists do all these crazy things, and the number of people they hurt and/or kill — although a tragedy and something that needs to be stopped — is very small in comparison to the big killers out there in the world today. The top 20 killers, according to WHO, are:

  1. Ischaemic heart disease
  2. Stroke
  3. Lower respiratory infections
  4. Chronic obstructive pulmonary disease
  5. Diarrhoeal diseases
  6. HIV/AIDS
  7. Trachea, bronchus, lung cancers
  8. Diabetes mellitus
  9. Road injury
  10. Hypertensive heart disease
  11. Preterm birth complications
  12. Cirrhosis of the liver
  13. Tuberculosis
  14. Kidney diseases
  15. Self-harm
  16. Liver cancer
  17. Stomach cancer
  18. Birth asphyxia and birth trauma
  19. Colon and rectum cancers
  20. Falls

Falls! You’re more likely to die from living to be so old that a fall will kill you than from being killed by terrorists. And, according to projections from WHO and The World Bank, the top 20 killers in 2030 will be:

  1. Ischaemic heart disease
  2. Stroke
  3. Chronic obstructive pulmonary disease
  4. Lower respiratory infections
  5. Diabetes mellitus
  6. Trachea, bronchus, lung cancers
  7. Road injury
  8. HIV/AIDS
  9. Diarrhoeal diseases
  10. Hypertensive heart disease
  11. Cirrhosis of the liver
  12. Liver cancer
  13. Kidney diseases
  14. Stomach cancer
  15. Colon and rectum cancers
  16. Self-harm
  17. Falls
  18. Alzheimer’s disease and other dementias
  19. Preterm birth complications
  20. Breast cancer

Notice anything interesting? By 2030, your chances of growing to an old age are so good that you’ll be more likely to die from Alzheimer’s disease (and other dementias) than from terrorists. Note that “homicide” is not on the top 20 lists above.

Of course, you could play Devil’s Advocate and say that these projections don’t take into account a major war, a major famine (maybe from climate change?), or a major pandemic. You would be correct, but those things are not taken into account because their probability of happening is still very, very, very small.

devils_advocate
Devil’s Advocate is very tiresome, by the way.

Of course, these numbers are for the world over. There can and will be pockets of concentration of things like pestilence and war. We could have some big, elaborate plot carried out by terrorists that would kill another 3,000 people like those who died on September 11, 2001. (Another 3,000 died that same day in the US, by the way. And another 3,000 the next day and pretty much every day.) Vladimir Putin could get a bug (further) up his ass and decide to invade the Baltic States.

These are not reasons to carry out the wet dreams of authoritarian people on any side of the political spectrum. If either Orange or Hillary tell you that anything outside of that top 20 list up there is an existential threat to the American way of life, do not believe them. And if either of them takes away research dollars to fight obesity, heart disease, vaccines, cancer, safer cars, mental health and diseases of ageing… Fight them. Fight them until you can’t fight them any more.

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Or until they can’t fight. Whichever.

The things that will kill you

Just listening to the news, you’d think that all of us were going to get killed tomorrow from a massive terrorist attack. Heck, some of my colleagues have been going on so much about Zika that they make it seem like we’re all going to die from Zika… Or that a whole generation of children are going to be born microcephalic.

No, you’re not going to die tomorrow from a terrorist attack. Yes, Zika is a big deal, but it’s not the biggest deal out there.

Take a look at the following table:

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If you read it closely, you’ll see that there are a lot of things out there that can kill you, but you should also see that what is likely to kill you varies depending on your age. If you’re under the age of one, you’re very likely to die from a congenital abnormality. (This shouldn’t surprise you if you know about the great advances in delivering and keeping alive — albeit for a short time — children with conditions which would have resulted in stillbirths previously.)

Throughout childhood and into adulthood, unintentional injuries are the most likely to kill you. But take a look at homicides and suicides. Note how suicides appear in the 10-14 age group and how homicide disappears from age 45 onwards. This speaks to behavior and other risk factors, like socioeconomics.

Speaking of socioeconomics… The table up there is only looking at age groups. When you start breaking down the numbers by race/ethnicity, family income, etc. The numbers start looking a little different. Diabetes probably moves up in ranking in the older age groups, as does heart disease. Homicide is probably at the top in the younger age groups. And so on and so forth.

So if you’re worried about Zika killing you, don’t be. But still wear mosquito repellent. If you’re worried about your plane crashing, don’t be. But still put on your seat belt. If you’re worried about ISIS, don’t be. But still say something if you see something.