A little over a month ago now, I got in to a discussion about doing another post for the True Crime Times, this time about modifying some old school scientific reasoning tools like the Bradford Hill criteria to apply to true crime type stories and evidence assessments for better thinking. Amusingly, they appear to lock posts after a certain period of time so I now can’t go back and see what exactly sparked the discussion, but I liked the idea and wrote up a draft. While I enjoyed the heck out of actually writing the whole thing and it clarified a lot of stuff I had been thinking about, I ultimately wasn’t entirely convinced it worked all that well. First, it got incredibly long. The Bradford Hill criteria are pretty lengthy, and explaining the background took a while, then it took even longer to explain each criteria, then even longer to explain why I thought they applied. All told I think it ended up at like 3000 words, which on this blog I would have probably split up over at least two posts and also made some snarky commentary to lessen the blow of that many words. Writing more formally, even I felt like it was a slog by the end.

It occurred to me that this is why I’ve always liked having a blog like this, even as blogs have fallen out of fashion, because they really are a place to work out some long form ideas without having to feel like you’re trying to get subscribers or condensing your thinking in to little snippets. It’s how I process stuff. I’ve actually taken a lot of what I’ve written here over the years and polished it up to use elsewhere, and it’s somewhat rare I’ve been able to publish something in a different outlet without working it out here first. So I realized I need to come back here and work out a few things before I tried to write anything up.

One of the reasons I like writing here so much is that in a very real way, anyone who sticks around here for any length of time tends to be, on some level, one of my type of people. When I named this site Graph Paper Diaries, I was serious. I tend to think in numbers, and I like drawing lines around things. I count things when I get bored. My first question when I hear a statistic is “hold up, where did that come from”. And most importantly “is that true?”. In other words, I like quantification over feelings, I like definitions, I like numbers, I like sources, and I like to know if I have my facts straight. It was always my goal with this site to de-emphasize debates on particular hot button topics, and instead focus on the underlying data to see if we could at least get agreement there to help inform bigger discussions. It was (and still is) my belief that agreeing on baseline facts and standards of truthfulness and certainty was a way of fostering respectful debate around important topics. I’m never going to get everyone to agree with me on everything, but I can certainly try to help create a world where I enjoy the process of disagreeing with people more.

While I get some drive by comments from people who don’t understand any of this, I think anyone who sticks around here for more than a post or two generally gets the value of at least some of this stuff. You may at times question how well I actually execute any of my goals, but I don’t think most of you question the aim. That’s a lot of fun to hang out with.

What gets a little tougher is trying to jump in to a different subculture and translate all of that stuff. I have fun here because I started with a group of people who were interested the rather number based place called “Graph Paper Diaries”, but how do I translate that to a group of people interested in to the incredibly narrative driven world of true crime?

That’s what got me thinking about Sir Austin Bradford Hill. He was a British epidemiologist who helped prove smoking caused lung cancer and subsequently came up with nine “viewpoints” from which he thought all evidence should be assessed before assuming it proved that one thing caused another thing. Epidemiology seems like a pretty uniquely good analogy for true crime since epidemiology is by definition the study of disease in messy population based conditions. Unlike lab based science where you get to control your experiments, epidemiologists are often just expected to work with what they have, and there are no redoes if they get things wrong. I think you can see why the analogies to crime investigation jumped out to me. While it would be great if you could have unlimited time or resources and have it only hit perfect victims in a more ideal location at a better time of year, in both cases, you have to go where the problem is and work with what you have.

Because in both cases, the stakes are actually pretty high. Never figuring out how to stop a disease outbreak has consequences, as does never solving a crime. It’s extremely easy to get annoyed people don’t have better evidence, but we have to accept that in life some problems are just going to have messy evidence. If we don’t accept messy evidence, we’re going to settle for no evidence. And I don’t think any of us want that.

So how do we muddle through this? Well first we obviously gather as much evidence as possible. But after that what do we do with it? As I mentioned last week all the data in the world can’t save us if we don’t have a good question, so what questions should we be asking as we look at the information we have? This is where Bradford Hill comes in. He asked people to take a look at the data they had from 9 different viewpoints to evaluate evidence. I’ve gone over these before in a strict public health context, but I’ve adapted them for true crime stories.

1. Strength: If this person were innocent, how weird would this evidence be? When we look at heavy smokers, the likelihood of lung cancer wasn’t just a little bit higher, it was 20-30 times higher. That’s a compelling piece of evidence. Similarly in true crime, some pieces of evidence are more compelling than others. One piece of strong evidence trumps 10 small coincidences.
2. Consistency: Does the same story show up when the evidence comes from different places? The smoking/lung cancer connection shows up in lots of different populations in different locations. Similarly, in crime investigations, digital data agreeing with witness testimony agreeing with physical evidence is a pretty strong story.
3. Specificity: Does this evidence actually point to one person and one version of events? Yeah, I know “they” did it. “They” are responsible for everything. But lets narrow that down just a bit.
4. Temporality: Did things happen in this order, based on what people knew at the time (not what we know now)? When you learn all the evidence during a one hour podcast, it can be incredibly hard to remember the events actually unfolded over the course of several months and that people could only react to what they knew at the time. Keeping the actual timeline in mind is important.
5. Evidence Gradient: As more evidence is added, does the story get clearer or more complicated? When hearing new evidence that contradicts something they already believe, a lot of people start to over complicate their theories without even realizing it. “Sure that evidence looks bad, but maybe it was planted” Okay, but you just traded one problem for another. You explained away the contrary evidence at the price of now needing to explain how someone planted it. That’s not a clearer theory, that’s just shuffling your problems around.
6. Plausibility: How much would have to go exactly right for this story to be true? Ocean’s 11 is a fun movie, but rarely in life are things that perfectly timed.
7. Coherence: Does this explanation fit with the physical evidence, the timeline, and how people usually behave? Much as with plausibility, if you take a step back, does a full picture start to emerge or does it get murkier?
8. Experiment: Is there any part of this that could be checked or tested instead of argued about? This isn’t the most common situation but can certainly clear some points up pretty quickly if it’s possible.
9. Analogy: Am I convinced by the facts of this case, or because it reminds me of another one? I used to read advice columns a lot and I would always be interested to see how much people would read in to situations based on what were clear issues from their personal life. I know women like this. Men like that will always act like this. While analogies can be useful in suggesting questions to ask, they can also lead you to make assumptions about people that aren’t true.

So there they are, nine questions to help people think through messy evidence when that’s the only option. While this was never supposed to be an explicit checklist that would prevent every error, it was supposed to help you look at things from enough angles that you reduced your chances of missing something or getting hung up on a pet theory as evidence mounted pointing in other directions. Because that’s a key thing with messy evidence, it’s not an easy thing to wade through, and it’s easy to get stuck on one or two piece and to start missing the big picture.

But I suspect you already know that’s a good idea. I think this way of thinking is solid, it’s worked on some of our most important public health problems after all. I’m still workshopping the delivery.

If you have thoughts on how to introduce a framework like this to a true-crime audience, I’d love to hear them. What would you lead with, what would you lose, or what would make you actually want to keep reading? I’ll keep working on the piece in the next few days, so open to any ideas! I’ll probably publish whatever I come up with here at the very least even if I don’t find another spot for it. This is just my favorite problem to noodle on at the moment.

One of the more interesting things I’ve done at points in my career is to help field data requests from a large database. If you’ve ever had to be the gatekeeper of any type of data like that, you learn rather quickly that you are going to have to ask a lot of questions that people are going to initially see as nitpicky and obstructionist and they will be terribly annoyed with you. With any luck after some gentle prodding however, they will eventually realize that their initial question was poorly formed, and that they are actually going to have to get a lot more specific before they can get the data that will help them answer the question they are really after.

For example (conversation entirely fictitious to protect the guilty, who have given me an equally hard time over similar issues):

Researcher: Can you give me all the data you have about women of childbearing age who were transplanted in the last 5-10 years? We’re doing a study.

Beleaguered database owner: Sure. A few questions though….

Researcher, sighing: It’s not hard, just everything you have:

Beleaguered database owner:, persisting: Can you clarify the timeframe? Do you want to include all the time during the COVID slowdown?

Researcher: Oh, I guess not actually. We only admitted really sick patients then, let’s just do 5 years back.

Beleaguered database owner: Ok. Did you want women of childbearing age or of childbearing potential? We actually screen women to see if they’ve had a hysterectomy or entered menopause, so we could exclude those women, otherwise we’ll give you everyone under 54. Were you looking for pediatric patients? We can start at age 12 or at those who had their first period.

Researcher: Oh, I guess I didn’t specify. I was looking at the impact of having a menstrual cycle, so we can exclude the women who didn’t.

Beleaguered database owner: Ok, one more thing. Did you want all transplants, including those who got a second transplant? Because those patients will be listed in the database twice.

Researcher: Oh, I forgot about those people. I just want individual patients. Exclude anyone who came back twice.

And so on. This can go on for a really long time, and this is with experienced researchers accessing a huge treasure trove of information.

I bring this up because I think when we’re trying to figure out “the truth” we often jump to the fact finding portion of our mission before we’ve even properly formulated our question. I was thinking about this earlier this week when the Assistant Village Idiot posted about how we still didn’t know much about the Alex Pretti shooting, and I replied that I felt there were 3 different conversations happening simultaneously:

1. Were various elected officials justified/truthful/helpful in their statements about the shooting?
2. Was the shooting legally justified?
3. Was the shooting morally justified and/or otherwise preventable in the future?

You can quibble with my list or add your own questions, but my point here is much what it is to researchers I mentioned above: if you’re not clear on what your question is, you’re going to struggle to figure out which pieces of data are actually relevant to answering it. There actually is a bit of danger in just requesting “everything” and then trying to sort through it later. If you are trying to prove that Tim Walz/Kristie Noem gave a misleading press conference, that is a different set of data than reviewing the legal justifications for use of force by a border partrol agent, which is different still from a big picture review of everything that led up to the incident. All of the data is coming from one big pool and there’s certainly overlap, but in our discussions we tend to hop around a lot. Heck even in our own minds we tends to jump around a lot, but it can pay off substantially to take a moment to figure out what your actual question is.

We worry a lot these days about “misinformation”, and I certainly stand by that concern. However, I’m also starting to get worried that even when we’re all sharing the right information we’re going to keep arguing more than necessary because we’re not stopping to agree on what we’re even arguing about first. In nearly any public event there’s always going to be multiple relevant questions that need answering, and slight changes in focus can change the relevant data set substantially. My two cents.

I like stats a lot, and the particular area I ended up in suits me pretty well. However, I often think if I had it to do over again, the two fields I would have considered more heavily would have been genetic counseling or meteorology/weather in general. The boat has probably sailed on genetic counseling, but I am continually amazed how many weather hobbyists there are out there. Might be a thing I keep getting in to as I continue to age.

So on this (likely) stormy weekend with 53% of the country (including myself) under a winter weather advisory, what are your favorite weather or storm related books/documentaries/resources? What’s your coulda woulda shoulda career?

For myself: I’ve been taking off one day a month at work to do a “nature year” program at the local Audubon society, where you go through the same trails over the course of a year to see how things change with the seasons. It’s more seasonal change than weather change, but here in New England the two are pretty intertwined. This past week we looked for animal tracks and noted the chickadees were already starting their mating calls. Apparently they’re triggered first by the increase in light, then a warmer day. Not gonna be a great weekend for them.

I’m also lucky enough to live pretty close to the major weather observatory in my area, so I’m considering checking out some of their programming. Amusingly, they were supposed to have a session on Nor’easters on Monday night that had to be cancelled due to weather.

I also will probably spend tomorrow reading a book I got my dad a few years ago for his birthday: Mighty Storms of New England: The Hurricanes, Tornadoes, Blizzards, and Floods That Shaped the Region.

Math is the most fun when we put it to use.

So, if you had it to do over again, what would you have done with yourself? And what are you up to tomorrow assuming no disasters strike?

Back when this blog had a more active comment section, one of my favorite activities was crowdsourcing new names for number or data-based errors people made a lot on the internet. Within this, one of my favorite discussions was the one where we came up with the concept of the Hrair Line, defined by our hivemind as “a somewhat arbitrary line past which all numbers seem equally large” (Definition here, original comments discussion here). The name comes from the book Watership Down, where the rabbits call all numbers greater than 4 “hrair”, and the original issue that sparked it was someone claiming that high school football coaches in Texas were making $5 million a year. When it was pointed out that number appeared to be closer to $120,000 a year, they seemed totally unphased. Both of those numbers were too much they explained, and therefore basically equal. Directionally correct, by today’s parlance.

Coming up with this term also led to one of my favorite puns, the “receding hrair line” which is when you act like a number is unfathomably large when it benefits you, but quite reasonable when it doesn’t.

I don’t know why I didn’t think of it at the time, but age is clearly the ultimate example of this. Some of this is clearly just human nature. I suspect all of us recall thinking a teacher was positively ancient when we were younger, only to age a bit and discover that they were actually 35 when we knew them. 70 seems old until you start having parents that age, at which point you realize that’s actually still quite young. We have a running joke at my work that the upper age limit for a transplant is our senior physicians age plus ten years. This also works in reverse, with new college students feeling impossibly old and worldly as opposed to high school students, and the rest of us not being able to tell them apart. I jest a bit here, but I remember feeling all of this myself. It’s part of aging.

Interestingly, this effect gets even worse if you start looking to the past. Someone who was 24 today would be apoplectic if you looked at them and said “well you know, it was really Gen Z who screwed up the housing market and the economy”, and rightfully so. And yet I routinely see people in Gen Z casually reference real estate/economic issues from 1960 and blame it on the Boomers. Well dear, guess how old Boomers were in 1960? And that’s the oldest Boomers (born 1946), that generation wouldn’t finish being born until 1964. There’s an argument of course that “Boomer” should not be taken literally and it just refers to “any old person”, but really, when would you be ok with being blamed for the economic conditions when you were 24? I think most of us, no matter our age would demand the correct people be blamed for things that happened when we were barely adults. It’s like saying millenials created the conditions that caused 9/11 or the 2008 crash or Boomers caused Vietnam or the greatest generation caused WWII, or Gen Z caused COVID. 60-70 years later it may all look about the same but if you were there it’s a pretty big difference.

For a more amusing take on this, I’m reminded of Chuck Klosterman’s book “But what if we’re wrong: thinking about the present as if it were the past“. I don’t necessarily recommend this book because the whole thing feels like smoking too much weed in a college dorm room, but he makes the point that we often collapse hundreds of years of history in to one or two data points, and some day people will do that with our era. Like all of the music of the entire 20th century may just end up being “the Beatles”, and the differences that seem so important to us now will be erased.

That being said, it’s good to remember that your perception of age will be changing throughout your life, in both directions. We tend to condense the memories of our 20s (“oh, everything just sort of works out eventually”) and forget the specifics, and we tend to totally underestimate phases of our lives we haven’t been through yet. We tend to collapse past eras in to one big mush while hyperanalyzing our own. It’s the hrair line: one, two, three, then everything else. It’s so second nature to us it didn’t even occur to me as an example when we first discussed it, but now that I’m thinking about it I think it might be the example. Interesting stuff.

Years ago, Charles Murray came up with something called the Bubble Test, a quiz that was supposed to help you determine how much of a cultural bubble you lived in. At the time, Murray’s thesis was pretty simple: there was a certain (upper) class of Americans that went about their day to day lives never encountering most of the things that another group of Americans encountered constantly. This led people to say things like “no one ever eats at Chili’s” when it was one of the most popular restaurants in the country.

While the Bubble test itself is now likely outdated, I’ve spent a lot of time recently talking to various friends of mine about a new bubble I see developing: the YouTube bubble. Or the TikTok bubble. Whatever you want to call it, as someone currently parenting a 13 year old who hangs out with lots of other people currently parenting 13 year olds (+/-), we are often amazed what a dominate force YouTube and TikTok have become for a huge portion of the population (mostly under a certain age), and yet an equally huge portion of the population has no idea.

Wanna test yourself quickly? Ok:

1. Do you know who Mr Beast is?
2. Do you know what a mukbang video is?
3. Do you understanding livestreaming and bits/superchats?

I actually ask that first one a lot in social situations, and every single person who has children (or is exposed to children) 7-18ish nods immediately yes and anyone who is childless or has smaller children looks clueless. Mr Beast is a 27 year old who is the most subscribed to YouTuber in the world, and the third most subscribed to TikToker in the world. He has substantially more subscribers (over 450 million) than the US has residents (over 350 million), and his most popular video alone ($456,000 Squid Game in Real Life!) is closing in on a billion views.

It’s an interesting test to run in mixed company because people who don’t know who he is are always a bit surprised at exactly how insanely famous (along with a likely $500 million net worth) this man has gotten without them noticing. To be clear, I don’t consider this a deficit on anybody’s part. The nature of fame has changed in the last few decades, and you no longer have to appear on mainstream shows/movies/radio to become famous. What this does mean however, is that there are a lot of these subcultures that get a lot weirder than people expect from the outside.

Which brings me to question 2 and mukbang videos. Mukbang videos, in the simplest sense, are broadcast eating. People sit on camera and talk to their audience while eating a bunch of food. That’s pretty much it. I was thinking of this earlier this week when I discovered that the third most popular true crime YouTube channel (6 million subscribers) got their start doing this while discussing true crime cases. Could you imagine suffering a horrible death in your family and then finding out a YouTuber was discussing it while performatively eating chicken wings? I’m not linking to the videos, but if you want to read her fans discussing how much they miss it here you go.

I think this is interesting for a few reasons. As covered above, this type of fame can create an interesting imbalance in the public: someone can be wildly famous with millions of people and virtually unknown with most others in a way that wasn’t totally possible even 20 years ago. 20 years ago, someone who didn’t know a particular famous person probably didn’t know almost any famous person. Now, it’s possible for someone to watch every new Netflix show/movie and still not know who Mr Beast is. Conversely, I think this has changed some of the nature of fame for these stars themselves.

First, there has been a lot of research in to the mental health of content creators, and it’s not particularly good. I couldn’t find a study that directly compared the mental health of more traditional actors or TV personalities to digital creators, but there’s a few reasons to think the mental health situation for content creators might be worse.

There’s a few reasons for this: algorithms are less predictable than bosses. One change to the way YouTube does things can increase or decrease your stats overnight. People can get strikes on their account for reasons that are often opaque. Competition is fierce and hours are long. With traditional media jobs, if you go to a try out and don’t get the part, the public doesn’t see you. With YouTube, you are still on the platform as long as you want to keep trying. You have all the same pressures a small business owner does, but in this case you are the primary product. A restaurant owner may find someone else who can cook their recipes to give them a day off, a content creator can’t have someone else make their videos for a week. Other creators may start feuds with you to boost their own profiles in a way that you can’t control.

It may not be the biggest change, but one of the most interesting changes to me that many seem unaware of is that changing nature of parasocial relationships. First noted in 1956, a parasocial relationship is basically when a person feels an emotional bond with a person or character they have never met. In the 60 year review of the concept, the authors lead with the example of a student whose aunt dressed up the day two of her favorite TV characters got married because “she didn’t want to let them down”. That’s a parasocial relationship. These relationships are often called “one sided” and can bring their own problems, but the advent of livestreaming brought about a new type of creator/fan interaction: the one and a half sided relationship.

This brings me to the answer to that third question. That last paper takes a look at the livestreaming platform Twitch. The authors start by noting that ” “microcelebrities” via live streaming has shifted the nature of parasocial relationship away from the classic one-sided relationship and towards a “one-and-a-half” sided relationship characterized by the potential for reciprocal communication, strong community affiliation, fandom cultures, wishful identification, high emotional engagement, and increased presence.” During livestreams, fans can submit questions or comments (superchats), give creators gifts, or do other things with their money to get direct shout outs from the creators themselves.

In other words, unlike people who used to have a favorite celebrity they could only ever dream of meeting, people who follow content creators who livestream can regularly interact with them…for a price. This is not just a business model on YouTube, TikTok and Twitch, but is a lot of how OnlyFans works. It’s a rather unsettling set up when you realize that those most prone to extreme parasocial relationship were already those most prone to other addictions. As noted, all of this actually creates more dedicated fan bases than we have seen previously, as they actually are interacting with their favorite celebrity and others in the community regularly.

So what is the point of all of this? Well, as I mentioned in my true crime post, when I started to see these dynamic pop up in my town, I was taken by surprise. Failure to know about the YouTube ecosystem does not exempt you or anything you love from becoming fodder for it. But more than that, when I’ve talked to people about this, they are often in denial about how influential these YouTubers can be (surely I would have heard of them!), how normalized bizarre content can be (no one would ever just watch people eat!), and how dedicated their fans can be (how bad can it be???). That’s not reality, that’s your bubble speaking. If you don’t recognize the name of a YouTuber who has more subscribers than the US has citizens, what makes you think you’d understand the influence of one of the smaller ones?

My point here is that Bubbles like Murray talked about don’t just form based on class or where you live, they can form for all sorts of reasons. I think the next frontier in this is the changing nature of fame and how we process culture. Already with nearly every major event, people are showing up trying desperately to record a viral moment, they see events through the lens of content creators we may have never heard of but that they feel extremely attached to, and they try to push the envelope with trends that seem completely opaque to outside eyes. YouTube is set to surpass Disney in terms of media revenue (excluding parks, etc), and yet due to the less historic and more fractured nature of it’s content, people still think of it as a niche interest. If that’s how you view it, it might be worth poking around taking a look at what you’re not seeing. It’s a wild world out there.

We are now entering the time of year when I become obsessed with daylight gains, an obsession I’ll hold on to through at least February. While January is long and cold it hits a few cool milestones that can brighten up the season.

This weekend for example, we hit perihelion, the day when the earth was closest to the sun. Relatedly, we hit the point where we are gaining daylight in both the morning and the evening. We started gaining back evening light in early December (about 2 weeks before the solstice), but at a slower rate than we were losing morning light. At the solstice this reversed: we kept losing morning light but at a slower rate than we gained evening light. Now we are gaining both evening and morning light, so our overall light gain becomes more noticeable. At least in the Boston area, this means Monday is the first day we gain a full extra minute of sunlight in one day. By the end of January, we’ll be gaining over 2 minutes a day.

A meteorologist on Facebook put up this graphic that shows how much daylight each region of the country can expect to gain total during January:

Obviously the regions that had the shortest days to begin with will gain the fastest, but it’s interesting to see where the cutoffs are.

Overall if you want to track your own daylight gains, this site is the one I use. It gives me some nice data to hold on to as we continue to slog through winter.

When it comes to current day financial woes, it is common to hear people focus on three things specifically: housing, higher education and health care costs. This will often be accompanied by something like Mark Perry’s “chart of the century” that shows the increase in prices vs wage increase since the year 2000:

Of the 5 categories of spending that outpaced average wage growth, 2 are in healthcare. But those healthcare categories are much trickier than the remaining 3 categories. If I bring up childcare spending, college textbooks or even college tuition and fees, you pretty much know what that covers. Even if you haven’t personally used it in a while, you probably know what a daycare or bachelors degree entails, and I think we all have the same memories of college textbooks. But how do you compare the cost of healthcare in the year 2000 to today? What are we even comparing when we say “hospital services”? How do we add in the fact that there is simply more healthcare available now than there was 25 years ago?

As it turns out, this is an incredibly tricky problem no one has quite solved. The data above comes from the BLS medical CPI data, which tracks out of pocket spending for medical services. It states that in general “The CPI measures inflation by tracking retail prices of a good or service of a constant quality and quantity over time.” But as someone who has worked in various health care facilities since just about the year 2000, I am telling you no one actually wants to revert back to the care they got then. Additionally, CPI tracks the price of something, but not how often you need it or why you needed it.

Here’s an example: when I started in oncology, all bone marrow transplants were done inpatient. Then, people started experimenting with some lower risk patients actually getting their transplants outpatient. People really love this! They sleep in hotel rooms with more comfortable beds, and walk in to clinic every day to get checked up on. However, this means that your average inpatient transplant is now more complex, the “easy” patients who were likely to have a straightforward course of care were removed from the sample. I don’t often look at what we charge, but I wouldn’t be surprised to see that the cost for an admission for bone marrow transplant has continued to trend upward. But this doesn’t mean the cost has actually gone up for most patients. In this case, comparing the exact same hospital stay for the exact same diagnosis as 25 years ago is not comparing the same thing. Innovation didn’t change that some patients need a hospital stay, it meant that fewer patients needed one.

While this is one example, I suspect rather heavily that’s a big reason why hospital services cost has gone up so much. The big push in the last 2 decades has been all about keeping people out of the hospital unless they really need to be there, which will have the effect of making hospital stays more expensive while keeping more people out of the hospital.

This run off can also increase the cost for outpatient medical services, the other category we see above. This past year for example, I got my gallbladder removed. In the year 2024, 85% of people who got a gallbladder removed went home the same day, as did I. In the year 2000 however, that was hovering at around 30%. So again, we see that the hospitals are now caring for just the sickest people, but one also assumes that outpatient follow up visits might be more complex than they were 25 years ago. Having 50% of patients change treatment strategies is a huge shift in the way care is delivered, even if it shows up as “the exact same visit type for the exact same diagnosis”. From the standpoint of CPI, a ‘gallbladder removal’ looks like the same service. From the standpoint of reality, it has become a fundamentally different care pathway.

Now this is just one graph, and it’s true there are other graphs that get passed around that show an explosion in overall healthcare spending. This is also true, but fails to reflect that the amount of healthcare available since <pick your year> has also exploded. Here’s a list of commonly used medical interventions that didn’t exist in the year 2000:

1. Most popular and expensive migraine drugs (CGRP inhibitors)
2. GLP 1s for diabetes/weight loss (huge uptick in the past 5 years)
3. Cancer care (CAR-T cell therapy and immune checkpoint inhibitors)
4. Surgical improvements (cardiac, joint replacement, etc)
5. Cystic fibrosis treatment (life expectancy has gone from 26 to 66 since 2008)
6. HIV treatment (life expectancy was 50-60 in 2000, now is the same as the rest of the population)
7. ADHD medication (this one is more an expansion in diagnosis, was $758 million in 2000, now estimated at $10 to $12 billion. I bring this up as a tangential rant because for some reason I’ve seen 2 people recently mention that insurance annoyed them because they didn’t use it because they were healthy, but they or their children were on ADHD medication. If you are going to complain about healthcare costs, it’s good to make sure you are accurately assessing your own first.)

Childcare or higher education have made no similar changes in the same time period.

My point here is not that healthcare has no inflation, it almost certainly does. Rising wages, increased IT needs, increased regulatory burden and increased cost of supplies would all hit healthcare as well. But when you compare healthcare in the year 2000 and the year 2025, you are comparing two different products. Go further back with your comparison and the differences will be even more stark. We are never going to control healthcare costs as long as we are constantly adding new, cool and really desirable things to the basket. There is not a world in which we can both functionally cure cystic fibrosis AND do it for the same price as not curing cystic fibrosis. Not all cost increases are the same.

I have a Substack piece up today on the True Crime Times: What True Crime Can Learn from the Science of Getting Things Wrong.

This is an abbreviated version of my True Crime Replication Crisis series, albeit aimed towards a true crime audience rather than my usual folks here. I was pleased to see the first comment was from someone who also likes to rant about statistics. If you’re looking for that, I’m always here for you. Please see my Intro to Internet Science series for details.

When you talk about the economy and the state of young people today, you will almost always here about how young people are drowning with student debt. I took this statement at face value, until a few months ago when I saw someone make a comment that college cost creep had largely slowed down. I didn’t follow up much more on it until I saw the recent Astral Star Codex post about the Vibecession data, and he confirmed that the high water mark for student loan debt was actually 2010 (Note that this is debt per enrolled student, so those numbers aren’t impacted by changes in enrollment):

His theory is that 2010 is around when large numbers of people first started maxing out the $31k cap on many government loans, and that that cap hasn’t moved. I think there’s two other things going on:

1. The youth (16-24) unemployment rate was above 15% for about 4 solid years after the 2008 crash: 2009-2013. This is the worst youth unemployment since the early 80s and it actually hasn’t been replicated. The COVID unemployment spike lasted about 5 months (April-August 2020). It dropped back below 15% by September 2020 and was below 10% by June 2021. 4 years of bad job prospects leads to a “well may as well finish my degree/go back to grad school” type thinking in a way 5 months of bad job prospects don’t.
2. 2012 is generally considered the inflection point for smartphones/internet adoption, and this opened up a lot of low cost options for online college. I don’t have good comparison numbers, but today in 2025 you can get a bachelor’s degree for $10k/year at Southern New Hampshire University, and they helpfully point out some of their “pricey” competitors are $15k/year. Adjust for inflation, that would be the equivalent of a 2010 student being able to get tuition for about $6800/year. I was not shopping for a degree at that time, but Google tells me you would have paid triple that for my state school that year.

Now you can find websites that say student loan debt is going up, but from what I can find these graphs don’t inflation adjust their data. The complaints about how a $100,000 salary isn’t what it used to be are accurate, but by the same token a $100,000 debt isn’t what it used to be. Looking at the top graph on this website for example, you wouldn’t know that a $17.5k loan in the year 2000 is actually about $34k today, remarkably close to the $35k they say 2025 graduates are taking out.

Ok, so that’s debt, but what about the sticker price? Well, the College Board puts together a pretty useful report on the topic that shows a few things:

For public universities, we see a slow down in tuition increases starting about a decade ago, and for private schools the change happens about 5 years ago. For all schools we see the inflation adjusted cost is currently lower than it was a decade ago. But wait, there’s more!

The above graphs are just the sticker price. The College Board also tracks the “real cost” after factoring in grants. Here’s the data for private 4 year colleges:

Note the “grant aid” line, which slowed during the 2008 crash, but then has been ticking upward starting in 2013 and hasn’t stopped. To emphasize, those are grants, not loans. That’s just money off the sticker price. According to the College Board, the net cost of attendance of a college in 2024 was less than in 2006. I won’t keep pummeling you with graphs, but for private 4 year, public 4 year and public 2 year colleges, the “real” cost peaked in 2016.

I am not an economist, but the numbers suggest a pretty clear story to me. When unemployment for those under 25 was high in 2009-2013, going to college, any college, seemed like a good financial move. For many, it probably was. Then, as employment picked up, students were able to get choosier and consider the cost of student loan debt in their choices. Very quickly colleges started upping the amount of grants offered, and then stopped increasing the sticker price. With recent inflation, the price increases actually dropped below the inflation line and now the real cost of college is dropping.

Additionally, technology improvements allowed online schools to start offering cheaper tuition at a large scale. This might have only made a small dent, except then the pandemic happened and traditional campus life was upended. This made the difference between going to a traditional college and an online college much smaller, and based on those I know with kids that age a lot of kids opted for at least a year or two at a cheaper online school rather than pay through the nose to sit in their dorm room all day. This put additional cost pressure on schools, and we see the prices tick down further.

All that being said, there is a not-small group of people who were pretty slammed by college costs: those who were coming of age during the 2008 financial crash and it’s aftermath. However, most of those people are actually in their late 30s now, and it’s important to note that state of affairs did not persist for those who came after them. Times change, sometimes for the better.