The opioid crisis


You’re moving the goalposts. No one said people don’t die needlessly in America. You’re responding to something that no one is saying.

The very specific issue was a comment that the income for most Americans means it isn’t a first world nation for most Americans. Which is just ridiculous.Timex is just unquestionably right about that being ridiculous.

It was a silly, overreaching statement, and changing the statement to “Yeah, but we have problems in America” is a completely different, correct statement that no one (including Timex, I believe) argues against. But it’s not the statement that was originally made.


All that aside, I want to chime in and say one thing:

Comparing the relative financial well being of the average person internationally based on converting local incomes or wealth if fucking dumb.

Because, let me assure you, this does not work. Based on raw numbers the average American is 8-10x better off than the average Indian. Which… ha, no.

Raw income or wealth numbers are meaningless and actively interfere with reasonable discussion without doing an adjustment for purchasing power.


I think that some economists actually try to work with that, based on actual purchasing power, etc. Hence the well-known (if a bit simplistic) Economist’s Big Mac index, where they talk about the actual cost to buy a Big Mac in various counties. (

You’re exactly right I think - it’s kind of comparable to saying that someone in San Francisco makes 1.5 times as much as someone living in Charlotte so they must be 1.5 times better off materially.


Yeah even the ‘Big Mac Index’ misses a world of difference in every day costs.

Put some real numbers there. In India some things were relative, others not. A cell phone costs nearly the exact same price when converted from local currency to USD. In fact most electronic goods followed a similar pattern.

Food, however, was far more relatively cheap. I could eat out at a restaurant for <$2 and get a reasonably good meal. One that would run probably $10+ Back home. Food typically ran a 2-5x multiple compared to home. (A Big Mac was closer to the 2x spectrum, though I didn’t see any while there. Basing this on KFC)

Housing however? Even in their big cities, the equivalent to living in LA or NYC the pricing was at least a 10x multiple. Shit, it was 10x compared to Chicago for comparable living conditions. And Chicago is not Bay Area priced.

So there is a lot of nuance to draw there. All said and done a person of roughly comparable wage levels in India vs US (which I can do quite easily, as I know the pay for the same level employees) is probably close to ~1.5-2x better for the American. There are differences, sure, and things I can do that are unfathomable for them such as international travel, but by and large they mostly are small and unnessecary. Their housing situation is good, they eat well, they just don’t have a car or as many electronic goods as I have. Otherwise? Not too different really.

But if you looked at raw numbers? I’m about 10x better off based on income. It simply doesn’t work out like that in reality.


Here’s a Purchasing Power Parity table showing exchange rates adjusted for variations in costs of goods and services, including housing.


That is exactly what I’m thinking.

So to put my numbers in there. For the same position an employee in the US is paid $70k, one in India 450,000 rupees. When converting currency directly at the 2017 rate of 64:1 you get a salary of about $7k USD.

However, as I was saying, this tells a misleading at best story. When run through your PPP comparison numbers you get, instead, an equivalent of about $32k, at the 14 rate for 2017. So while in raw numbers I’m making 10x pay, when factoring in purchasing power I’m slightly over 2x, ranging between 2-3x depending on the vagaries of currency exchanges.


See… I think that they probably are. But the difference lies in things which are effectively incomprehensible for Americans.

For instance, an example of bad stuff in America was the Flint water crisis, or sections of Detroit having their water turned off. That is unquestionably bad.

But when we compare that to something like the situation for rural folks in India:

So, you’ve got hundreds of thousands of Indians who die every year due to not having access to clean water. 163 million Indians don’t have access to water near their homes, and have to walk for MILES to get water, every single day. On average, a woman in rural India is walking 3-12 miles every single day just to fetch water.

Or sub-Saharan Africa, where you’ve got 5 year old kids making this same kind of daily trek to get water. Not clean water, mind you, but just water at all. They are walking miles, every day, to fetch dirty water.

This kind of thing just isn’t a thing that happens in America, anywhere.
That isn’t to say that we don’t have any issues at all. There are certainly parts of America where they have issues with access to clean water. Such things can be laid out here:

But we don’t have millions of people who are walking for miles to carry water by hand every day. Even a homeless person in America can get access to drinking water through prolific public facilities.

Again, this isn’t meant to minimize the plight of the poor in America, but merely to point out that millions of people around the world have it so much worse.

The big difference here is the difference between poverty, which we see at non-trivial numbers in the US, and EXTREME poverty, defined as living on less than $1.90 per day (normalized purchasing power). Now, even in the case of extreme poverty, the US has about 1% of its population in this category. But so do other countries like Spain, or Italy.

But if you look at a country like say, Mozambique, you see that they have over 60% of their population which lives below this threshold.

And its this concentration of extreme poverty which creates an entirely different overall experience. In America, even if you live in extreme poverty, you’re still living within a modern society which provides certain niceties that are expected by those who aren’t extremely poor, and you benefit from this. As I said, there are certain things which we have access to in America for free, which you don’t have in third world countries, like public water sources connected to modern treatment systems. And that’s why we don’t generally have people die from things like dehydration in America, ever. (except when cops kill folks in jail)


Which is slightly over 10% of the population.

And, yeah, there are some pretty stark divides. The urban rural divide is real there. However there is a very large and real middle class, many working in the tech industries. You see the crushing poverty in ways you wouldn’t in the US, the little ‘villages’ of huts made from repurposed materials like corrugated metal and vinyl signage. But this is not the majority, it is not the average. And there are social programs to mitigate this, not enough by a long shot though.

But for that growing middle class there is a difference in standard of living that is not captured by looking at the raw income levels. And that’s what I take issue with. The ‘the average Indian makes $5k’ type comparisons, as a way to say they make 1/10th what Americans do. Which… simply isn’t true. Not in any meaningful sense.

It’s a pet peeve of mine, doing straight currency conversions without accounting for what local pricing is. And I saw it going on up thread, from both sides of the argument.


I am not at all surprised you decided that I moved the goal post when I was not even part of the original argument. Timex literally said the poorest person in America is better off, and it’s very likely the poorest American probably died yesterday after he said it. If he wants to talk aggregates, stop dropping to individual claims like that. Simple.

Also, lead kills.


Deaths from actual accute lead poisoning in the US are essentially zero at this point, and all of those cases are generally from industrial use.

Most recently, there has been one study which suggests that high concentrations of lead exposure in the 80’s and 90’s MAY have a correlation to overall mortality decades later. They observed that individuals in the 90th percentile of blood lead concentrations had an increase of 37% in overall mortality twenty years later (generally, via cardiovascular health issues). But this is, again, only a single study, whose results were dramatically higher than previous studies.

Folks in sub Saharan Africa, or rural India, would kill to have access to water like Flint’s, because possibly dying early 20 years in the future is of laughable concern compared to dying from actual dehydration or the various water borne illnesses that kill millions of people annually.

(also, fun fact, basically a quarter of Indians are walking around with lead poisoning)


I’m aware that lead poisoning is slow and a long term issue. I even mentioned it, right here. You’re the one that claimed they don’t die as if lead poisoning isn’t a known issue. There’s a reason we don’t sweeten water and wine and add it to makeup anymore.

So like I said, before, it’s not like drinking raw sewage. I, and probably everyone else here, am perfectly aware that the agonizing deaths for people who bathe, drink and drop waste in the same water is worse. But this…

You even capitalized it.


That statement is clearly talking about dying in the near future from consumption of Flint’s water.

And, as I said, look at India… a quarter of their entire population is walking around with what we consider actual lead poisoning. That is, they had a blood lead level of over 10 micrograms per deciliter.

By comparison, in Flint, which is basically our baseline in America for the worst in recent memory, was nowhere near that bad. In the single ward of Flint where it was the worst anywhere, you had 15% of kids with a BLL of over 5 ug/dl. Not 10 ug/dl like we’re talking about in India (or everywhere in the US prior to 1978). Half that. Only 15% of kids, in only the worst ward of Flint, had half of that level.

Drinking Flint’s water isn’t going to kill you any time soon. It MAY cause long term health effects, although even there the effects are going to primarily on children as a result of developmental damage. Although even these such things are really based on fairly novel EPA standards. Up until quite recently, it was quite normal for people to have much higher concentrations of lead in their blood than they do today in America.

For instance, prior to 1978 when we banned things like lead paint, and actually learned about the dangers of lead,a full 90% of children and the vast majority of adults had blood-lead levels of over 10 ug/dl. 90%! Basically everyone in the entire country had lead levels which were DRAMATICALLY higher than what we were seeing in Flint at the height of the crisis. Because lead was used in damn near everything. Your parents, for instance? It’s basically guaranteed that they had much higher blood lead levels at some point in their lives.

That’s why I said that drinking Flint’s water wasn’t going to kill you. Hell, it certainly won’t kill you today, where now WLL and BLL have been reduced to historic lows, with mean BLL’s of only 1 microgram per deciliter. We are much more sensitive to lead now than we used to be, because we know so much more about it… but it’s not the same kind of danger that I’m talking about when I’m talking about extreme poverty in third world countries.


Well I can’t speak for anyone else, but i never said it was.

My first statement about this was this:

And then I responded to the same data and statement you made now earlier with this:

The mentally ill, the drug addicts, chronically ill and poor and very aged can certainly experience very poor, lethal living situations. Dying due to a number of scenarios others associate with these other countries, but it still happens here. It’s statistically very small, and unlike other countries, it is almost always preventable here… there is no reason for it.

I think those lives still matter, so I am not going to callously dismiss them, but at no point did I say we have entire regions suffering mass feminines and dirty water like these countries you are speaking of.

I think you are grossly under estimating the harm that was done in Flint. Decades from now we’ll know more about that, and I don’t think you were ready to go live there because of how harmless that water is.


PPP is not a good measure for what you want to measure in this discussion. PPP is a “real exchange rate” that shows imbalances when it differs with the nominal one.

For example, the PPP index used that way would indicate that Spain is significantly more expensive than the US, which is certainly bollocks for most high ticket items (health care, education and housing) and also for common goods like food.

What you want to look at is at Comparative Price levels. Sadly there’s no data for India there.


So then we’re in agreement?

While it may be true, the data I just pointed out suggests that it certainly isn’t going to be worse than what virtually every american in the entire country endured as recently as 1978 (indeed, later, since the lead didn’t all disappear when we banned its use in a number of industrial applications).

Lead is not good for you. It’s toxic. It causes developmental and behavioral problems.

But at the same time, in the concentrations we’re talking about existing in Flint, it’s not really as high as many people seem to think… or rather, many people don’t realize that such blood lead levels (much higher ones, actually) were considered normal quite recently.


I understand what you’re saying. I’m a kid of the 80s. I’m sure i sucked on brightly colored led toys, put my mouth against lead painted walls and we all played around too much with pencils. I think Flint is worse than that but it also sounds like that’s not the case anymore. I will certainly hope and pray that that population will do okay, and not just them, generations from them that might also have lasting affects. We won’t fully know probably for years. We know if humans and animals drink and defecate in the same water… it’s horrific. As much as I appreciate modern medicine, the biggest change to health in recent history is really sanitation.

For the most part yes, I just can’t bring myself to downplay the people that fall through the cracks, here… but they are cracks, not like regions, or entire populations. It’s frustration because it’s tragic, largely preventable, and often overlooked because it is so few.


Police take down another dealer.

A federal jury convicted the Wichita doctor for the 2015 death of Nick McGovern. Prosecutors alleged McGovern, who received prescriptions from Henson, died of an overdose of the anti-anxiety drug alprazolam and methadone, which is used to wean addicts off heroin.

The government presented evidence at trial that Henson wrote prescriptions in return for cash, postdated prescriptions and wrote them without a medical need or legitimate medical exam.




Why in the world would a doctor risk that?!


Second world was communist in the cold War era.