Addiction Nation: The Numbers Behind the Crisis

This post is part of a series on my brother’s upcoming book Addiction Nation: What the Opioid Crisis Reveals about Us, discussing some of the science and stats he used throughout the books. Read the intro post here, or find the book here.

Okay! So last week Tim couldn’t introduce himself because he was busy getting married, so let’s kick off with a few words of introduction from Tim. Say hi to the nice people Tim!

Tim: Greetings Graph Paper Diary readers! If any of you have ever wondered if correcting other’s use of data and scientific research is something BS King only does on her blog, I can tell you it is a passion she pursues in all areas of her life. Luckily, I figured out how to take my older sister’s insistence on always being right into a way of getting her to do my homework for me. 

That assistance made a huge difference. Addiction is an area that is rife with a poor understanding of science or a complete disregard for it. This can be especially true when looking at the mixture of faith/spirituality and addiction recovery. Since parts of the book draw on my own religious experiences, I wanted to be especially careful not to make some big category errors. 

You say “getting her to do my homework” I say “pointing out your faults by request.

Sibling rivalry aside, I wanted to start off this week by talking about how big the opioid crisis actually is and why we’re all suddenly hearing about it. The blurb for your book actually starts with the stat “Opioids claim the lives of 115 people per day. One of them could have been me.” so let’s start there.

What amazes me about this stat is that it actually is already outdated…the current numbers from the CDC say it’s 130/day. That’s a big jump in just a year or two.

Tim: Ya. The first time I published on the topic was 2016 and the number I was using then was 78 a day. Overall drug overdoses were at 110 a day when I was working on that article.

There’s a paper you start off with that has some really interesting graphics about the crisis, “Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016“. You weren’t able to include the graphs in the book, but this image here is quite striking:

So basically for most of our childhood, the rates of overdose deaths were 2-4 deaths per 100,000. Since 2001 though, the death rate has quadrupled. No wonder we’re hearing so much about it.

The next graph is interesting too, as it shows big increases in heroin ODs in the 20-40 age range, but also big increases in prescription opioid overdoses in the 40-60 age range. Heroin overdoses for the 40-60 year old crowd are now more common than they were in the 20-40 year age range even 10 years ago. That’s crazy.

The weirdest part about this paper is that it specifically cites 2010, the year you got sick, as sort of a turning point for prescription opioids. It’s apparently when they started to crack down, but also when deaths started going up. As the authors say:

Since 2010, the mortality curves for all drug types have been increasing, except for methadone and for unspecified drugs and narcotics. Each drug’s mortality curve shows some variability. For example, the mortality rate from prescription opioids decreased slightly in 2012, whereas the mortality rates from heroin and synthetic opioids have been increasing rapidly. These trends may be related because several epidemic interventions may have reduced the impact of prescription opioids around 2010, including the reformulation of OxyContin in 2010 (6), implementation of pain clinic laws and mandatory checking of Prescription Drug Monitoring Program data by prescribers (7), the reduction in the amount of opioids prescribed (8), and the rescheduling of hydrocodone compounds in 2014 (9). Although these changes may have reduced the overdose deaths from prescription opioids, it is possible that they may have led some opioid-dependent persons to switch to illicit opioids, such as heroin and fentanyl.

That’s kind of scary, because it really highlights how a good public health measure can have unintended consequences. Your own doctor’s wisdom in partnering with you to slowly easing you off prescription pain killers keeps looking wiser and wiser.

Tim: Unintended but not necessarily unexpected. Those early reforms only focused on the supply side of the problem. The demand for the drugs was still there so the black market grew. That market then became incredibly profitable, completely unregulated and exponentially more dangerous. Take a highly motivated market of people who are ready to buy and a large pool of people who see a shot for an income they otherwise couldn’t dream of, and you are creating the perfect conditions to intensifying the problem.

Yeah, it’s clear the worst part is those reforms didn’t even do much to stem the tide (Tim: and actively made things worse), as between 2013 synthetic opioid overdoses would go from 1 death per 100k to almost 6 in the next 3 years.

Going back to the heat map above though, I was interested to see how regional some drug problems are. Any thoughts on why that is?

Tim: High population-wide levels of addiction seem to have a whole confluence of factors from economic and political to social and cultural. Sam Quinones does an excellent job tracking some of these factors in his book Dreamland.

  • Stress: High-stress environments, especially those that result in childhood trauma, are going to be petri dishes for addictions to grow. There is good reason to believe that living in an environment with intermittent access to resources creates a higher level of ongoing stress than a low resource environment. Poverty is often a driver of this kind of stress, but not necessarily so.
  • Cultural: Binge drinking is known to spike among college students, but only those who live on campus. Cultural expectations and levels of usage shift dramatically based on your peers.
  • Social: We’ll dive into this one in a future post but there is good reason to believe that social dislocation is a primary driver behind addiction.
  • Supply: While I note before that only focusing on supply is a recipe for disaster, supply is still a factor. Drugs needs supply chains and distributors. These can take a while to set up. The higher the demand, the higher the profit and the more risks people will be willing to take to move into new markets.

Interesting! One region that’s been particularly hard hit of course is the state we grew up in, New Hampshire. New Hampshire had the dubious distinction of skyrocketing to the top of the state opioid overdose list. You cited a report by Dartmouth School of Medicine that said that a bag of fentanyl laced heroin was selling for less in New Hampshire than a 6 pack of beer. Wow. New Hampshire is where us Massachusetts folks go to get our cheap beer.

Apparently though, New Hampshire is also where Massachusetts drug dealers send a lot of fentanyl. According to the report, they can charge higher prices in NH. There have been some major busts trying to stop this pipeline, but NH appears to be a bit of a target. Any idea why that is?

Tim: The Dartmouth researchers noted that NH is a standout in being a pretty wealthy state in comparison to many of the others that have been hardest hit. One possible explanation is that NH has small pockets of poverty spread throughout the state and these are the communities that have shifted statewide averages. They also note that NH has one of the lowest per capita spending for recovery services in the country. 

But one other theory they posit is, in essence, the “Live Free or Die” mentality. I’m proud of the state motto and love the sense of independence in our home state. But, it can have a dark side. One of the ideas I explore in the book is that addiction began for me not in a loss of control but in my seeking of control. 

When I was in the hospital, one of the few things I could control was my ability to push a button for more narcotics. It wasn’t just relief from pain but a sense of comfort and as if I still had agency in my life. 

I would not be surprised if some of my fellow Granite-Staters, from a variety of different circumstances, might have started there own addictions out of wanting to maintain a sense of independence and control in their own lives. Then later, the solution they relied on, slowly unraveled.

That theory makes a lot of sense! New Hampshire definitely seems to have something going on. It’s interesting that while you went through most of your addiction journey in and around Washington DC, it was actually moving back to New Hampshire that clued you into the extent of the crisis. DC and New Hampshire overdose rates are shockingly similar given that DC is totally urban and New Hampshire is not. Normally those are two populations we’d avoid comparing due to the dramatic differences, but here they seem to have converged. Not a good sign for NH.

It looks like overall it’s pretty clear the crisis has been growing, though it does appear things may be leveling off slightly. All the sources seem to point to an increase in the number of available prescription and synthetic opioids, but there’s clearly something societal going on as well. I know that’s a lot of what your book is about, but any quick thoughts on just the scope of these numbers before we wrap up?

Tim: To put some of these numbers in perspective. More Americans will die from a drug overdose this year than those who died in the Vietnam and Korean Wars combined. More Americans will die from the opioid crisis than all of World War II. 

When we open up the lens a little more and realize that the opioid crisis is just one part of a broader failure of how we understand and treat addiction, the numbers continue to climb. Millions of more lives are lost in a criminal justice system that can exacerbate addiciton, not cure it. 

 Man, that’s a depressing thought. Hopefully in the next few posts we’ll get more in to some things that do and don’t work.

PS: Great text from my brother after we finished this. Someone’s a little nervous about getting his facts straight!


Addiction Nation: The Data Behind the Book (Intro Post)

Well hello hello good people! I’ve got some exciting news here on the blog today, as this marks the begging of a new and somewhat personal blog series here on GPD.

For those of you who have been reading for some time now, you may remember me mentioning my brother’s article about his experience with opioid addiction, and my subsequent references to the book deal that came out of it.  That little manuscript has finally taken shape in to a full fledged book called Addiction Nation, and is due out June 11th.

In honor of its publication we thought it would be fun to do some blog posts on some of the studies he uses throughout the book. I got to play science editor during the writing process, and my brother and I talked for months about how to properly represent studies in a book that wasn’t actually a science book. In this blog series I wanted to actually go a little further in to some of those conversations….you know, what made it in, what got cut, why certain things are phrased the way they are, why certain studies were picked for use. The whole book writing and editing process was totally unfamiliar to me until I went through it by proxy, so I thought it would be fun to share some of the discussions we had along the way. Tim will be joining me on these posts to tell you a little more about his thought process while writing as well.

Want to know more? Okay, here are the details!

The book itself:
The full title is “Addiction Nation: What the Opioid Crisis Reveals about us”, and it’s got a good cover:

The book is part memoir/part sociology of addiction/part theological treatise/part a lot of things. Here’s how Tim explains it in his intro:

But this is not a memoir, although it does tell parts of my story. Nor is this a self-help book, although I do hope it is helpful. Addiction Nation is not a complete history of the opioid crisis or public policy manifesto, although it will provide insight into both. It is not a scientific analysis or a medical diagnostic manual, but it does try to use the perspectives as tools.

This book is the story of someone who has stood at the edge. It is an exploration of what this crisis says about us, all of us.

My involvement:
Since I’ve been correcting the science citations of everyone around me for years, my brother thought it would be wise to let me read during the editing phase rather than after the fact when it was too late to change anything. Despite science not really being the point of the book, my brother didn’t want to fall in to the “attempt to use science to bolster your claims but don’t get anything right but the name of the paper” trap so many nonfiction writers fall in to.

I had intended to have Tim introduce himself this week, but he actually got married yesterday (congrats bro!!!!) and was a little too preoccupied to write anything. Excuses excuses.

Alright, so there you have it! We have four posts planned so far on a few different topics:

  1. Week 1: The Numbers Behind the Crisis
  2. Week 2: What Hurts, What Helps
  3. Week 3: Controversial or Disputed Research
  4. Week 4: Recovery and Hope

Looking forward to introducing my bro next week!

Rubin Vase Reporting

Jesse Singal had an interesting post in his (subscriber only) newsletter this week about a some articles promoting an Amnesty International report that ran under the headline “Amnesty reveals alarming impact of online abuse against women“.  I was intrigued because I love dissections of survey data, and this didn’t disappoint. He noted some inappropriate extrapolations from the results (the Mozilla article claimed that data showed women were harassed more than men online, but the Amnesty survey didn’t survey any men and thus has no comparison), and also that the numbers were a little lower than he thought. Overall in 8 countries, an average of 23% of women had experienced online harassment, with an average of 11% saying they’d experienced online harassment more than once.

This statistic struck me as interesting, because it sounds really different depending on how you phrase it. From the Amnesty article:

Nearly a quarter (23%) of the women surveyed across these eight countries said they had experienced online abuse or harassment at least once, ranging from 16% in Italy to 33% in the US.

If you reverse the language, it reads like this:

“Over three quarters (77%) of the women surveyed across these eight countries said they had never experienced online abuse or harassment even once, ranging from 84% in Italy to 67% in the US.”

Now it is possible those two paragraphs sound exactly the same to you, but to me they give slightly different impressions. By shifting the focus from the positive responses to the negative, two reporters could report the exact same data but give slightly different impressions.

While reading this, all I could think of was the famous Rubin Vase illusion. If you don’t recognize the name, you will almost certainly recognize the picture: 

It struck me as a good analogy for a certain type of statistics reporting, enough so that I decided to give it a name:

Rubin Vase Reporting: The practice of grounding a statistic in either the positive (i.e. % who said yes) or negative (i.e. % who said no) responses in order to influence the way the statistic is read and what it appears to show.

Now of course not every statistic is reported this way intentionally (after all you really do have to pick one way to report most statistics and then stick with it), but it is something to be aware of. Flipping statistics around to see how you feel about them when they’re said in the reverse can be an interesting practice.

Also, I have officially updated my GPD Lexicon page, so if you’re looking for more of these you may want to check that out! I have 19 of these now and have been pondering putting them in to some sort of ebook with illustrations, just for fun. Thoughts on that also welcome.

What I’m Reading: April 2019

Familiar topics in this Nature article, but a good title….the Four Horsemen of the Reproducibility Crisis. P-hacking, low power, publication bias and HARKing (oh my!).

Given my ongoing interest in YouTube search results, I found this profile of the YouTube CEO quite fascinating.

A little late to the party, but I loved the WaPo “Mueller Book Report” take.

Related to the two above, a Twitter thread about which videos about the Mueller report got recommended the most by YouTube.

This article debates the current assertion that religious affiliation is going down, and caused a lot of discussion in an email group I’m part of this week. The basic argument seems to be that the rise of the “no affiliation” label is coming mostly by way of those who previously claimed to be religious but reported they never went to church, so the core of religious sentiment remains unchanged. I’ll admit I’m unconvinced by this. The underlying paper suggests that religious behavior (going to church, etc) are holding steady among the religious, which goes counter to the idea that the label-without-participating people are the only ones who left. If they were, we’d expect to see the remaining religious people engaging in MORE religious behavior, as the lower tier wouldn’t be bringing down the average any more. Still, it isn’t wrong to point out that the typical “nones are on the rise!” story may have been oversold.

The Calling Bullshit guys posted that there’s a new entry in to the field of bullshit studies: Bullshitters, who are they and what do we know about their lives? This clever paper asked people about themselves, then asked them about their knowledge levels for 16 statistical/mathematical techniques. 3 of them (Proper Number, Subjective Scaling and Declarative Fraction) were fake. The study was done on teenagers in 9 countries. Findings: boys are much more likely to bullshit than girls in all countries, high socioeconomic status kids were more likely to bullshit than lower SES kids in all countries, immigrants are sometimes more likely to bullshit, sometimes not depending on the country, the US and Canada are huge bullshitters. Bullshitters were more to rank themselves as good in other things (popularity, mathematical ability) and interestingly, more likely to give “right” answers when asked how they would solve a problem. For example, when asked what they’d do if their cell phone broke, they say they’d first consult the manual rather than “push all the buttons to see if it turns back on”. Now to note: all countries studied were WEIRD, but still an interesting paper.



When Bad Stats Mean Good Things

As someone who has to pay attention to blood/infectious disease issues for work, I’m on a couple email lists that report current issues. I got one of these this week that really caught my eye, with a headline that stated that the incidence of hemophilia appears to be going up.

Since hemophilia is a genetic disorder, I was curious why this would be. Clicking on the article, I was surprised to find that the researchers actually believe this is a positive development caused by getting a better handle on HIV and infectious disease standards. For those unfamiliar with hemophilia, it’s a disorder that impacts your blood’s ability to clot. Though in some rare cases women can some forms of it, the disorder is almost exclusively found in men. Men with this require blood transfusions frequently, and thus were impacted when HIV in the 80s before blood and blood donors were screened with the standards we use today. Ryan White, whose case prompted many of the legal protections we have for people diagnosed with HIV today, was one such case. The first person I knew who had HIV (Norm Cataract) was another such case. He was a friend of my parents and dedicated the last few years of his life to giving public talks about how HIV was acquired and trying to reduce fear. It’s hard to remember now, but in the late 80s there was a lot of misinformation about HIV floating around, and with no treatment available it was met with a lot of hostility. I’ve never forgotten Norm’s bravery in fighting for understanding and right information. It’s a shame he didn’t live long enough to see HIV become more manageable disease.

Anyway, now that HIV is more manageable, the blood supply is cleaner, and hemophilia is a less risky disease. The less risky it is, the more likely hemophiliacs are to actually live and have children, which given the genetic nature of the disease means there will be more hemophiliacs. In other words, despite the negative connotations of “rates going up”, this is all a good thing.

A couple other examples of “bad” stats hiding good things:

  • More wounded veterans. Previously more men died on the battlefield or shortly thereafter due to a lack of medical care in the field, now 90% of men wounded in battle survive.
  • Smoking rates (possibly). Working in a cancer hospital, I have a lot of coworkers who (pretty understandably) dislike smokers. I like to remind them that smoking rates are very high among recovering addicts, so we don’t always know if the smoking was a bad choice or a good choice. Smoking isn’t healthy, but I think we can all agree it’s better than heroin.

I don’t have a clever name for this, but I’d be open to suggestions!

McDonald’s: 46 Years Later

A few years ago, James mentioned his idea for a “Follow-Up Gazette“, a news outlet that would report “All the things we found out later”. I loved this idea, particularly the thought of it having a science section. I think about this concept often, as it fascinates me how often we assume that we will never see things differently than we do right now.

I was thinking about this again this past week, because our drive to NYC and back meant I ended up eating some form of fast food 3 days in a row. We even stopped at McDonald’s AND Burger King in the same 48 hour timeframe, which is something I haven’t done in a long time. It reminded me of an article someone posted on Twitter recently: a Time magazine feature on McDonald’s written in 1973.

Written just over 2 decades after Ray Kroc joined McDonald’s and started its upward trajectory, the article is an interesting look at how complaints about McDonald’s have morphed in the last 5 decades. Now that critical statements about McDonald’s have become an industry of their own, its interesting to see how  the initial complaints hold up. The article is 9 pages long, so I’m going to take this page by page. Lets take a look, shall we?

The article starts out pretty well, much the way an article about fast food would today, with this quote:

The next few paragraphs recite the key stats about McDonald’s business, most of which have obviously changed since then. It’s notable that the whole idea of mega corporations seemed much newer, as the numbers that seem sensational and the reach of McDonald’s seems more novel. The article talks about their sign reading “12 Billion Hamburgers sold”, I remember a kid noting that they’d stopped tracking around 99 billion.

Page 1 Rating: Holds up, if no longer novel. Stats were accurate at the time they were reported, though would be less impressive now.

The next section starts off with an interesting complaint: that customers don’t get “discretion”.

This is followed by a few paragraphs about worker standardization, high turnover, tedious conditions, and machines taking human work…pretty current complaints. They also mention “Hamburger University”, which is apparently still around.

They then drop in an interesting tidbit about the dress code:

Page 2 Rating: Mostly holds up. Fast food restaurants are so ingrained in our culture that I’m not sure I’ve heard anyone complain about the lack of menu choices in a while. You basically know what you’re getting. Worker complaints are still being made, though the dress code has apparently loosened substantially.

Page 3 kicks off with a quote from a pop sociologist about McDonald’s, claiming that it shows America is all about blandness and sterilization, and that we’re too responsive to advertising. Then comes this paragraph, which I found fascinating:

Scurvy? You can eat it without teeth? That’s a fresh take. Of course this article was prior to the obesity crisis, so they “these seem like a bad idea nutritionally” folks didn’t have much to go on.

The architectural blight charge was also interesting, and not one I’d heard before. The rest of the page talks about about the appeal of McDonald’s (you know what you’re getting, food comes fast) and the cheap price. You know, pretty much all the things people still like about it today.

There is an interesting tidbit about how McDonald’s responded to inflation rampant in the early 70s (raised prices less than others) and the trivia that McDonald’s makes its money on the fries.

Page 3 Rating: Mixed. The nutrition complaints are wrong in details, but their spirit is now widely accepted as true. The architecture concern seems to have passed, the positives are pretty much the same.

Page 4 kicks off with an amusing quote that I somehow doubt many people would say today:

In 2019, it’s both hard to imagine someone feeling this way AND finding many towns without a McDonald’s. I checked out some brand loyalty ratings, and 5 Guys is the only burger place that ranks nationally. Its interesting that while McDonald’s didn’t retain its brand loyalty, it helped change the culture enough that it and places like it still have a home.

Page 4 Rating: An interesting snapshot of the history. Those of us who grew up with these corporations already in place can’t always conceptualize that these places were once the “new thing”.

The end of page 4 and beginning of page 5 cover Ray Kroc, and his now famous issues with the McDonald’s brothers, though it doesn’t dwell on them much before moving on. They highlight his foresight in serving the suburbs (other fast food places focused on cities) and his subsequent marketing directly to children. This ranges from the obvious (Ronald McDonald as a mascot) to the less obvious (leaving napkins and straws out on the counter so children could get them).

Of course this marketing innovation has caused most of their problems for the last few decades, as more people have blamed them for increasing youth obesity and violating bans against advertising to minors.

Page 5 Rating: A little cringe-worthy.

The next section wraps up the kids marketing and then moves in to some standards that seem almost quaint in retrospect. They talk about how Ray Kroc demanded everything be clean, and used to inspect stores to make sure they were as clean as possible. While most McDonald’s I’ve been in aren’t horrible, I think the idea that they’re supposed to scrape gum off the walkways out front has gone by the wayside. McDonald’s as a paragon of high standards is an odd thought.

Page 6 Rating: Quite the throwback

Page 7 is interesting, as it talks substantially about McDonald’s dedication to charity work and the terms of their licensing agreements. While it appears the franchisee deal is still largely the same (though with a lower percentage of the profits going to corporate headquarters), it doesn’t appear the requirement to do charity work has kept up. In fact the recent controversies with McDonald’s have seemed to center around how much charity work they actually do. I couldn’t find many hard numbers about the franchisee charity work, so I’m a little mixed on this.

Page 7 Rating: Not enough data

Page 8 has some more interesting data about what it took to open a McDonald’s franchise. I was interested to find out that anyone who put up more than half the money for a franchise was actually required to work there. There’s an interesting anecdote about a former cop named Lee Dunham who opened a McDonald’s in Harlem and took on the local gangs to keep the store running. Apparently he ended up giving a bunch of gang members jobs. I Googled him and found a glowing obituary from 2011, praising his work with the community, much of which started with his McDonald’s stores.

Page 8 Rating: Glad to see this one turned out well.

Page 9 has some interesting commentary about McDonald’s expansion, particularly in to Europe. I loved this paragraph:

I’d shake my head at that, but I’m pretty sure I actually went to the McDonald’s on the Champs-Elysees. It has a marble sculpture in the middle, as one does. I also took refuge in one in Bucharest Romania after a particularly harrowing overnight ride on the train.

It continues to talk about Kroc’s aggressive plans for expansion, wondering if he can keep it up with new competitors on the horizon. Page 10 concludes with a final moment from Kroc, saying that every day was a new Broadway show.

Page 9  and 10 Rating: Good. McDonald’s expansion continued in this country until 2015, the first year in its history it closed more stores than it opened.

Overall impressions: Overall the article didn’t fair too badly, though it’s interesting to see how our norms have changed since it was written. Large multinational corporations are a standard (if not always well loved) part of our society now, and while McDonald’s survives it no longer inspires much brand loyalty in the US. However, it is still one of the most recognized brands in the world, and allegedly the golden M is more recognized than the cross.

Within the overall correctness though, it’s interesting to note that not everything has held up. Scurvy is not the big nutritional concern, workers are not really known for being the most well trained. Many previously novel things like cleanliness regressed to the mean.

Of course there’s an interesting bias in reading an article like this at all….we’re interested in articles like this solely because the growth continued and the business survived. If Time had run an article on another juggernaut that fizzled, I wouldn’t be looking it up.

One way or another, its interesting to see how people a few decades ago saw things, and to think about how our thinking may change 50 years from now about things we think today. What will fall by the wayside, what will normalize and what will prove true are always interesting questions.

On that note, I’m going to go get a hamburger.


Gender Ratios at Public Events

I’m out of town this weekend indulging in a very non-stats related hobby: pro wrestling.

Those of you who follow such things will know that this is WrestleMania weekend and it’s in New Jersey/just outside of NYC this year, and just so happens to coincide with my husbands birthday. Convenient.

Given the throngs of wrestling fans converging on one spot, there were quite a few other shows put on by other groups looking to capitalize on the crowds. One such show was a New Japan pro wrestling/Ring of Honor joint venture held last night at Madison Square Garden.

We went to this one, and I was interested to note it had one of the more lopsided gender ratios of any event I’ve been to. I’ve mentioned previously that I have a habit of counting such things, and last night was no exception. Normally I like to estimate the ratio of mono-gender groups, but despite all my looking I never found a women only group at this event.

I ended up switching to the number of women I could see in each row – rows were about 15 to 20 seats each. Rows almost always had 2 to 3 women in them. I never found a row with 4 women. I’d estimate the ratio at 7 to 1 male to female.

Other notes:

  • There were more women in the expensive seats than the cheap seats. I’d never explicitly noted uneven distribution of gender before, but I’ll watch for it from now on.
  • The gender ratio changed as the place filled up. When we first got there it was probably closer to 10 to 1, but more women showed up the later it got.
  • Men with long hair were a major confounder. When I count rows from far away I’m mostly looking at hair first, but I had to proceed slowly here.

Obviously those first two bullet points emphasize that this is a male dominated fandom, which I’m sure is not surprising to anyone. This was not a show aimed at the more popular or mainstream fan, but the “willing to tolerate half the show being announced in Japanese” type fan.

Tonight I expect the gender ratio to be more even, as WrestleMania has a broader spectrum of appeal and their women’s division is currently on FIRE. I’ll report back with my estimate tomorrow. Go Becky Lynch!

Update: The gender ratio at Wrestlemania ended up being about 4 or 5 to 1 male:female. Interestingly, the “extra” women were almost entirely younger girls, mostly there with their dad. One ahead of us walking in was even fully in costume (as Bailey), carrying a replica title belt and started trying to lead the “Woooooooooooo” cheer on the escalator. I think the strategy of pumping up their women’s division is paying off.