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The History of Splurging

Question: Historically speaking, why are Americans compelled to spend money?

Lee Eisenberg: I think we've got it into our head now that we are a nation of shopaholics, that we are all incredibly greedy; we don't know our limits. And that's true; a lot of us don't know our limits. And you know, the economic meltdown that we've experienced the last couple years is to a very large degree because our eyes were bigger than our wallets. But I think that's a mischaracterization in some ways; I think that's too broad an indictment of the American people overall. But I also think it's rooted in this very strong conflict that exists and has existed in the American character. As we all remember from school, if not from buying experience, we were really a nation founded on frugality, and waste not, want not; you know, the Benjamin Franklin credo, and a century or two in which good character was defined by not spending money but by abstinence.

And then beginning in the 19th century things began to change in a very accelerated and radical way. Global industrialization brought all kinds of good that were increasingly affordable to more and more people beginning in the early 19th century, and you had these -- actually not far from this studio, just around the block, on this street in fact -- these incredible department stores in the form of Italian palazzos that started springing up in the early 1900s, where not only the upper class, but working class men and women could come into these fantastic emporia piled high with goods from all over the world, and we had never seen anything like that before. And the department store, as we came to know it, was started. So suddenly there was this beginning of this tremendous sort of shift that had to happen, and I think the conflict, which is on the one hand you had a very strong sense of puritanical Yankee frugality colliding head-on with this world, this explosive world, of material abundance and ever increasing wages. And I think to a much greater degree than a lot of current observers give us credit for, most of us are still racked by that conflict.

It’s easy to say that we spend and spend and spend, and again, many people do, and they overspend. But for most people that I talk to, everyday people, normal people out there, there is still this pleasure/pain principle at work. You know, we may spend money freely and often recklessly, but not without some feeling of anxiety or guilt. Some people don't feel that, but a lot of people do feel that. And I think what's happening now, now that we're living in very challenging economic times, is that that pendulum is swinging a little bit back. It's not going all the way back to waste not, want not -- although there are anti-consumerists out there who would have us do that -- but swinging back from what in the book I call a romantic form of shopping, which is shopping because we are emotionally satisfied or aroused by shopping, back to what I call sort of a classic mode of shopping, which is putting a premium on all kinds of things such as practicality or utility or durability, getting fair value for a given price, getting quality for a price; a more mindful kind of shopping.

I don't suggest, as I just said, that we're going to revert into some kind of Victorian age of careful spending, but I do think that at least for the foreseeable future, some of those old values that we thought had gone away beginning in the '50s may well come back to at least occupy part of our psyches when we go into a store.

Recorded on November 9, 2009

We may spend money freely and often recklessly, but not without some feeling of anxiety or guilt.

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A new hydrogel might be strong enough for knee replacements

Duke University researchers might have solved a half-century old problem.

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  • Duke University researchers created a hydrogel that appears to be as strong and flexible as human cartilage.
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Predicting PTSD symptoms becomes possible with a new test

An algorithm may allow doctors to assess PTSD candidates for early intervention after traumatic ER visits.

Image source: camillo jimenez/Unsplash
Technology & Innovation
  • 10-15% of people visiting emergency rooms eventually develop symptoms of long-lasting PTSD.
  • Early treatment is available but there's been no way to tell who needs it.
  • Using clinical data already being collected, machine learning can identify who's at risk.

The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.

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