Alex Tabarrok

Three articles on medical breakthroughs, or not, caught my eye. The Wall Street Journal discusses a breakthrough in cancer therapy using HIV to target cancer cells. The news is mostly good but the lead researcher worries that it was only luck which prevented the FDA from ending the research prematurely:

Cytokine-release syndrome almost ended the therapy in its infancy. In 2012, Dr. June’s first pediatric patient, 6-year-old Emma Whitehead, developed a 106-degree fever and experienced multiple organ failure. “We thought she was going to die,” he recalls.

A blood analysis showed high levels of the cytokine interleukin-6, or IL-6. “I happened to know because of my daughter’s arthritis that there was a drug that could target IL-6—that had never been used in oncology,” Dr. June recalls. Fortunately, the children’s hospital where Emma was being treated had the medication, Tocilizumab, on hand. “We wouldn’t have had it at the adult hospital because it wasn’t approved at that point for adult conditions.”

Within hours of receiving the drug, Emma awoke from her coma. “It was literally one of those Lazarus conditions,” Dr. June says. Eight days after receiving the CAR T-Cell injection, she went into remission. Two weeks later, she was cancer-free. She’s now 12 and thriving.

Tocilizumab “saved the field” as well as the girl, Dr. June says. “If the first patient dies on a protocol and nobody’s been cured, you’re over.” Regulators, he adds, always “err on the side of caution.” That irks him, since most of his patients would die without the experimental treatments: “Our FDA regulations are made so that you can never have more than about 30% of people get sick with serious side effects. I think we don’t have enough leeway for side effects when you have a potentially curative therapy.”

In my TED talk I argued that the richer China and India are the better it will be for US cancer patients because the bigger the market the greater the incentive to research and develop new drugs. US patients may also get a second benefit. China is big enough to move world R&D which previously was true only for the US and to a lesser extent (because of price controls) the EU. Since the US haa by far the largest pharmaceutical market the FDA is a regulatory hegemon. With China we may get to see for the first time a serious alternative to the FDA. And according to some observers, China’s approval process is less-risk averse.

Some of those [new trials] are in the U.S., but more are taking place in China. “There’s a lot more people there, so you can do a lot more trials,” Dr. June says. “But they also put more of their GDP into medical therapy, particularly CAR T-cells.” Beijing’s drug-approval process is easier, too.

I don’t know whether that is true, but it’s a hopeful sign.

In another story, Lawrence Reed has the inspiring story of Bill Halford who has developed a not-yet-approved vaccine for Herpes. Herpes can be incredibly painful and it infects over one million people a year but the route to a vaccine has not been easy:

Impatient with Washington, Halford injected himself, his family and a group of ten herpes patients. None of his family exhibited any ill effects, evidence that the vaccines were safe. All the sufferers enjoyed dramatic pain relief, suggesting effectiveness. The early success of his research led him to co-found, along with film-maker and entrepreneur Agustin Fernandez, a company known as Rational Vaccines, Inc. (RVx)). Its mission is to fight the herpes epidemic worldwide, using the live, attenuated strains that Halford created.

Peter Theil is a lead investor in Rational Vaccines. Sadly, Bill Halford contracted cancer and died this year at just age 48. I hope his company will carry the ball over the goal line.

Should we all be taking Metformin? Metformin is a diabetes drug but researchers have found that the people taking the drug also get dramatically fewer cancers. Here is Wired:

What they discovered was striking: The metformin-takers tended to be healthier in all sorts of ways. They lived longer and had fewer cardiovascular events, and in at least some studies they were less likely to suffer from dementia and Alzheimer’s. Most surprising of all, they seemed to get cancer far less frequently—as much as 25 to 40 percent less than diabetics taking two other popular medications. When they did get cancer, they tended to outlive diabetics with cancer who were taking other medications.

As Lewis Cantley, the director of the Cancer Center at Weill Cornell Medicine, once put it, “Metformin may have already saved more people from cancer deaths than any drug in history.” Nobel laureate James Watson (of DNA-structure fame), who takes metformin off-label for cancer prevention, once suggested that the drug appeared to be “our only real clue into the business” of fighting the disease.

It’s not just Wired. Here is the title of a recent meta-analysis:

Metformin reduces all-cause mortality and diseases of ageing independent of its effect on diabetes control: a systematic review and meta-analysis.

Metformin is already approved so it could quickly be used off-label  but there is a big problem with anti-aging drugs–there is currently no way any anti-aging drug can get approved.

The assembled scientists and academics focused on one obstacle above all: the Food and Drug Administration. The agency does not recognize aging as a medical condition, meaning a drug cannot be approved to treat it. And even if the FDA were to acknowledge that aging is a condition worthy of targeting, there would still be the question of how to demonstrate that aging had, in fact, been slowed—a particularly difficult question considering that there are no universally agreed-on markers.

The FDA should provide a path to approve anti-aging drugs but if not maybe the CFDA will.

Are U.S. Cities Underpoliced?

by on August 15, 2017 at 7:25 am in Economics, Law | Permalink

Aaron Chalfin and Justin McCrary have a forthcoming paper in the Review of Economics and Statistics that takes a new approach to estimate the effect of police on crime. If you run an ordinary regression using the number of police to explain the number of crimes you typically find small or even positive coefficients, i.e. the police appear to have no effect on crime or maybe even a positive effect. The usual explanation is endogeneity. The number of police influence the number of crimes but the number of crimes also influences the number of police. The recent literature has focused on breaking this endogeneity circle by finding a change in the number of police that is exogenous, i.e. random with respect to crime. My paper with Jon Klick, for example, uses random movements in the terror alert level combined with the fact that the police go on double shifts when the terror alert level rises to estimate the effect of police on crime in Washington, DC. If the assumption of exogeneity is satisfied then you have pulled a random experiment out of natural data, hence a natural experiment. Obviously, if the exogeneity assumption isn’t satisfied the technique doesn’t work. But even if the exogeneity assumption is satisfied there is another problem–by focusing only on changes in police and crime when the terror alert level changes you are throwing out most of the variation in the data so the estimates are going to be less precise than if you used more of the variation in the data.

Chalfin and McCrary acknowledge the endogeneity problem but they suggest that a more important reason why ordinary regression gives you poor results is that the number of police is poorly measured. Suppose the number of police jumps up and down in the data even when the true number stays constant. Fake variation obviously can’t influence real crime so when your regression “sees” a lot of (fake) variation in police which is not associated with variation in crime it’s naturally going to conclude that the effect of police on crime is small, i.e. attenuation bias.

By comparing two different measures of the number of police, Chalfin and McCrary show that a surprising amount of the ups and downs in the number of police is measurement error. Using their two measures, however, Chalfin and McCrary produce a third measure which is better than either alone. Using this cleaned-up estimate, they find that ordinary regression (with controls) gives you estimates of the effect of police on crime which are plausible and similar to those found using other techniques like natural experiments. Chalfin and McCrary’s estimates, however, are more precise since they use much more of the variation in the data.

Using these new estimates of the effect of police and crime along with estimates of the social cost of crime they conclude (as I have argued before) that U.S. cities are substantially under-policed.

Hat tip Kevin Lewis.

Addendum: After writing this post I discovered that I had covered the Chalfin and McCrary paper when it was a working paper, five years ago! This tells you something about how long it can take to get an economics paper published.

If the probability of nuclear war just went up why isn’t the stock market down? The stock market also didn’t fall during the Cuban Missile Crisis, as Lars Christensen points out:

If indeed we were on the brink of a nuclear exchange, one would certainly have expected the stock market to drop like a stone. Nothing of the sort happened. Instead, the S&P500 was little changed during the 13-day standoff between the United States and the Soviet Union.

Lars argues that the market must have figured out that MAD was a brilliant policy and thus the nuclear risk wasn’t anywhere near as large as most people thought (and nuclear war didn’t happen so the markets were right, right?)

Historian Arthur M. Schlesinger Jr., who was in the White House at the time, thought the Cuban Missile Crisis was the “most dangerous moment in human history.” None of the participants thought it was a yawn. I am inclined to accept their judgment. So why didn’t the market drop like a stone? It’s not so obvious that the apocalypse is priced into the stock market.

Let’s remember why markets are good at forecasting events. If you think IBM’s dividends are going to fall then you sell IBM stock and the fall in price signals the future event. But what do you do with the proceeds from the sale of IBM stock? You buy some other asset. Since IBM is only a small share of the market there are lots of other assets to buy.

If you think a nuclear war is likely, and you sell your stocks, what do you buy? It’s pointless to buy other assets like bonds–the bond markets probably won’t exist. You could buy land but who will enforce your property right? Even cash might be useless following a nuclear war. Maybe some gold coins and canned goods would be useful but you may not be around to enjoy them.

If the apocalypse really is coming your best bet is to cash out and spend it all now. But really how much fun would that be? Sure, you could have a great week of hookers and coke but I suspect a lot of people might prefer the cheaper option of a walk in the forest.

If the apocalypse were coming, I would have a second helping of chocolate cake and maybe a third helping but utility diminishes. Since utility diminishes you get a lot less enjoyment by consuming all your wealth now than by spreading it over a lifetime.

Diminishing marginal utility means that the optimal strategy to meet the apocalypse is very costly. Suppose you expect IBM dividends to fall and so you sell your IBM stock and use the proceeds to buy something else. If IBM dividends don’t fall, you haven’t lost much. But if you expect a nuclear war, cash out and blow it all, then you’ve lost a lifetime of consumption in return for a momentary buzz.

The bottom line is that selling stock doesn’t really help you to deal with a nuclear war or even to improve your life much before the nuclear war happens. The problem isn’t markets. An information market could still be used to produce information about the probability of a nuclear war it’s just that I wouldn’t necessarily expect that probability to correlate with the broader markets. Since any actions you might take in the broader markets are fruitless or very high cost, knowing that the probability of a nuclear war has increased is mostly useless information. You might as well ignore useless information and proceed to buy and sell stock as if the information didn’t exist.

You can’t short the apocalypse. As a result, I am not much comforted by the fact that markets appear steady in the face of apocalyptic risk.

Hayek argued that support for redistribution was driven by emotions that had been optimally evolved for small, hunter-gatherer societies but that were now at tension with the rules necessary to create an extended social order such as under capitalism.

Support for Hayek’s hypothesis is given in a new paper by Sznycer et al. (et al. including Cosmides and Tooby). The authors use surveys to measure an individual’s disposition to compassion and envy. For example, for compassion there are 11 items such as “I suffer from others sorrows,” or (negative) “I tend to dislike soft-hearted people,” and for envy there are questions like “It is so frustrating to see some people succeed so easily”. In each case there is a scale from strongly disagree to strongly agree. The authors also ask whether the respondents think a tax on the wealthy would benefit them (measured on a 1 to 5 scale).

What makes these three items–compassion, envy and self-interest– interesting is that each of these can be understood as having evolved for functional reasons in the ancestral environment (see the paper for cites and arguments.)

In contrast, “fairness” is a much more abstract and difficult to define concept and because it is based on groups rather than on interpersonal relations it is not clear how it would have evolved in the ancestral environment. The authors measure the demand for distributional fairness by asking a variety of questions about hypothetical distributions and they use survey questions such as “the law of the land should apply to everyone in the same way” to measure support for procedural fairness.

The main things to be explained are support for redistribution (again measured via a questionnaire) and private giving to charity. The authors have just over six thousand participants over four countries (the U.S., India, the UK and Israel).

A key finding:

Compassion, envy, and self-interest independently predict support for redistribution in four countries with different economic histories and distributional policies. This is consistent with an evolutionary-psychological approach…the effects of fairness as a group-wide concern is unreliable and of far smaller magnitude than the effect of the emotion/motivational triplet.

A scary/sad finding:

Respondents were given two scenarios, a 10% tax on the rich that led to X dollars for the poor or a 50% tax on the rich that because it reduced incentives led to X/2 dollars for the poor. This experiment was run in America, India and the UK.

Fourteen percent to 18% of the…participants indicated a preference for the scenario featuring a higher tax rate for the rich even though it produced less money for the poor.

It’s easy to be skeptical of survey answers (I prefer measured actions) but answers on questions like this have been shown to be predictive for a variety of behaviors and there is an internal logic among the answers that suggests real motivations and behaviors are being measured. Most notably, compassion and envy both predict support for redistribution but only compassion predicts private giving to charity.

Addendum: It is a scandal that so few of Hayek’s works are available online. I believe this is a serious detriment to Hayek research.

In 2005, I thought housing prices were rising above the fundamentals and I said so. In 2008, as the fall in housing prices was well under way, I wrote a blog post and later a NYTimes op-ed saying that the housing price bubble was not nearly as big as people thought. I wrote:

I think that housing prices went beyond the fundamentals sometime around 2004…but 2004 levels are still well above long run trend.

…Prices will probably drop some more but personally I don’t expect to ever again see index values around 110.  Do you?  If we don’t see the massive drop back to “normal” levels then the run up in prices should be described as a shift to a new equilibrium…[with some overshooting, rather than as a bubble.]

To put it mildly, not everyone agreed with my argument. I certainly got the timing wrong–I didn’t think the recession would be as long or as deep as it was. Nevertheless, some people are coming round to my point of view. Karl Smith, for example, has a new post Was There Ever a Bubble in Housing Prices? which concludes more or less, as I did nearly ten years earlier, that the answer is no. What happened was greater liquidity which made housing prices gyrate more like stock prices but “the fundamental driver isn’t irrational bubble behavior. It is competition over a scarce resource.”

Let’s go back to the Shiller graph, now updated to 2017. Over the entire 20th century real home prices averaged an index value of about 110 (and were quite close to this value over the the entire 1950-1997 period). Over the entire 20th century, housing prices never once roce above 131, the 1989 peak. But beginning around 2000 house prices seemed to reach for an entirely new equilibrium. In fact, even given the financial crisis, prices since 2000 fell below the 20th century peak for only a few months in late 2011. Real prices today are now back to 2004 levels and rising. As I predicted in 2008, prices never returned to their long-run 20th century levels.

Now one might argue that there is still a bubble or perhaps another bubble in housing prices. But the United States does not look anomalous compared to other countries. In fact, in many other countries prices have risen more than in the United States. Here is the Economist’s Global Price Index of real house prices for a variety of countries. (Do note that some countries not shown, such as Germany, haven’t seen big increases in prices.) Are all these countries experiencing bubbles? Or has the equilibrium changed?

Understanding why the equilibrium has changed is a fundamental issue that I don’t think we yet have a good handle on. My view, is that it’s a combination of expected long-run lower interest rates, greater liquidity, and supply constraints on land. Lower interest rates, for example, mean that durable assets increase sharply in price, all the more so if the rates are expected to stay low. Combine this with greater liquidity (see Smith’s post) and supply restrictions and you can explain most of what is going on in the United States. What I don’t know is if the same explanations work worldwide and can the same factors also be used to explain why land prices haven’t risen in Germany, Japan or Switzerland?

Hat tip: Nathaniel Bechhofer.

Gancia, Ponzetto, Ventura provide a precis to their very interesting theory about the size and number of nations.

Before 1950, more than one third of all territorial disputes were decided by war, while after that date diplomacy prevailed in almost 90% of cases.

Why did the first wave of globalisation lead to political concentration and conflict? Why did the second wave of globalisation lead instead to political fragmentation, resolved in a more peaceful way? To answer these questions, in a new paper we develop a model to study the interaction between globalisation and political structure (Gancia et al. 2017). A key premise of our theory is that borders hamper trade and globalisation make borders more costly. We show that political structure adapts to expanding trade opportunities in a non-monotonic way. In early stages, borders are removed by increasing the size of countries. In later stages, the cost of borders is removed by creating economic unions, and this leads to a reduction in the size of countries. Moreover, while the incentive to conquer markets through aggression increases with globalisation, international economic unions remove this incentive, thereby paving the way to the rule of diplomacy.

This point is very good:

Since the size of markets grows rapidly while political borders tend to change slowly, it suggests that globalisation is likely to put more pressure on the world’s political structure. Designing political institutions that can optimally adapt may become one of the major challenges faced by modern societies.

The full paper is here.

When I was in India, I visited the High Court of Bombay. It’s surprisingly easy to get in. Wandering around the halls and offices, upstairs and downstairs, I was surprised to see stacks and stacks of papers piled up against walls all bound with….red tape.

In an excellent piece in the WSJ, Niharika Mandhana and Vibhuti Agarwal, describe a similar court in Allahabad.

Tattered stacks of case paper were piled on racks, tables, chairs and the floor. Towers of folders spilled into corridors where passersby toppled smaller stacks. Files from 2015 mixed with ones from 2016 and 2017, creating a nightmare for officers struggling to locate hundreds of them every day.

On a stuffy third floor, Amit Kumar Yadav, age 35, squeezed sideways through dust-laden stacks, then pulled himself up on his toes and vaulted over the paperwork that carpeted the floor.

After an eight-hour hunt, he was still missing 17 of 65 files for the next day’s hearings. Those cases won’t be heard.

In my review of the Marathi movie Court, I said

Court not only shows the mundane production of injustice it structures itself around that theme. Scenes drift on for longer than expected. The movie builds tension like a conversation with uncomfortable pauses. The audience begins to fidget and think “when will this be over.” That’s intentional. In a two-hour movie Tamhane makes you feel a little like what the people in Indian court must feel, trapped.

That’s not a great advertisement for a movie but you watch Court not for the watching but for the experience of having watched. Even now the tension and the feel of the movie are with me and add color to observations like this:

Waiting anxiously in the back of a nearby courtroom, Mohammad Aqeel Hasan, a 27-year-old farmer, has lost count of the number of court trips he has made from his village. He said he was sure it was fewer than his father had made in the 1983 lawsuit against their neighbor. Each side claims ownership of land between their properties.

His father had won a swift victory in a lower court, but the decision was overturned on appeal. His father’s appeal of that decision has been pending since 1986. A few years ago, when his father could no longer travel, Mr. Hasan took over.

“At this rate, the case will go on for hundred years,” Mr. Hasan said. Court appearances require a 10-hour journey by train from his village.

Mr. Hasan’s case came and went in a heartbeat. The other side’s lawyer had sent an illness slip, forcing a delay.

“Not well again?” the judge said, and he moved the hearing to another month.

Mr. Hasan was crestfallen. “Coming to court is not easy,” he said, heading to the railway station for his trip home.

See also my piece, A Twisted Tale of Rent Control in the Maximum City.

Shashi Tharoor, former Under-Secretary-General at the United Nations, bestselling author, Indian politician and current member of the Indian parliament has written a powerful brief against the British in An Era of Darkness: The British Empire in India (also published as Inglorious Empire). It’s an enjoyable read but some of the economic history is wrong and a number of the social arguments implausible.

I offer no defense of the British empire which was cruel, rapacious and racist but I do correct the record in my long-form review at the Indian journal Pragati.

Here is one bit:

Hindu and Muslim divisions run deeper than the ink marks of colonial census takers. Emperor Aurangzeb killed his brother Dara Shikoh for apostasy in 1659 and the echoes of that fratricide travel down the centuries to Partition. Aurangzeb’s tax on non-Muslims, the jizya tax, abolished in the 16th century by his great-grandfather, the third Mughal emperor Akbar, but re-imposed a hundred years later is another sign of deteriorating interreligious relations. Even some events outside of India, such as the rise of the Wahhabi branch of Sunni Islam in the 19th century, were clearly more important for Hindu-Muslim relations than were the census takers (Allen 2005, Dalrymple 2008). The rise of Wahhabism and the decline of Sufism were bound to upset Hindu-Muslim relations no matter what the British did. 

Read the whole thing.

Here’s the video of the Heritage session on occupational licensing. All the talks were good; short and to the point. Maureen Ohlhausen, Acting Chairman of the Federal Trade Commission leads off, Paul Larkin discusses some of the legal issues and legislation, my comments begin around 28:20 followed by Dexter Price who talks about his personal experience trying to get a DC license–he is more than qualified for his job in property management but DC requires that in order to manage property he needs a very expensive and time consuming realtor’s license even though he has no interest in buying and selling property.

From the Museum of Anatolian Civilizations in Turkey via a post on twitter from Isobel Finkel.

I will be speaking on occupational licensing on Wed. July 26, 2017, 11:00 am – 12:30 pm at Heritage. You can RSVP here and there will also be a livestream.

Our World in Data has an excellent writeup of earlier research by Eisensee and Strömberg. 

How many deaths does it take for a natural disaster to be newsworthy? This is a question researchers Thomas Eisensee and David Strömberg asked in a 2007 study. The two authors found that for every person killed by a volcano, nearly 40,000 people have to die of a food shortage to get the same probability of coverage in US televised news. In other words, the type of disaster matters to how newsworthy networks find it to be. The visualizations below show the extent of this observed “news effect”.

In other words, the famine you haven’t heard much about is more important than you think.

“We have this mythical belief that everyone will come out of it at the other end OK,” she said. “You don’t end up as a faculty member unless you did survive it. That doesn’t mean that there weren’t people in my generation who got so stressed out that they left. They did leave. We just never talked about them.”

So what is this terrible, stressful problem that not all faculty survive? Summer vacation. No really.

For nine months a year at research universities, instructors and students build communities from a transient group of academics unified by one thing: classes. Professors invest time in students, committees, and teaching; students invest time in their assignments.

…That changes in the summer. The fixed schedule disappears, the community disperses, and the work that has been building up over the school year can loom dangerously close to deadline.

…It’s in that solitude that professors and students say they experience what some call a “summer slump,” a period of isolation that can heighten symptoms of depression or anxiety for those susceptible to such disorders.

To cope with that slump, Ms. Hagen read personal testimonies and learned that the separation she feels is widespread, even normal. But her university never addressed it. “As wonderful as my adviser is, that’s not a conversation that was ever shared,” Ms. Hagen said. “We never talked about what’s important to your mental health.”

I think the conservative critique of higher education is overblown. But with articles like this in the Chronicle of Higher Education it’s no wonder that much of America is angry and dismissive of a coddled intellectual class that is utterly divorced from their own, normal life experiences. (I too am a coddled member of that class but I know how fortunate and privileged I am to have a job in academia.)

The correction only widens the gap:

Corrections (6/16/2017, 10:43 a.m.): A previous version of this article mistakenly referred to Dafina-Lazarus Stewart as “she.” Mx. Stewart uses the pronouns ze, zim, and zir.

When was the Golden Age of Conservative Intellectuals? It is easy to say when the Golden Age began; April 1947 at the first meeting of the Mont Pelerin society. Among those in attendance were:

  • Maurice Allais, Paris
  • Aaron Director, Chicago
  • Walter Eucken, Freiburg
  • Milton Friedman, Chicago
  • F. A. Harper, Irvington-on-Hudson, New York
  • F. A. Hayek, London
  • Henry Hazlitt, New York
  • Bertrand de Jouvenel, Chexbres, Vaud
  • F. H. Knight, Chicago
  • Fritz Machlup, Buffalo
  • Ludwig von Mises, New York
  • Felix Morley, Washington, D.C.
  • Michael Polanyi, Manchester]
  • Karl R. Popper, London
  • William E. Rappard, Geneva
  • Leonard E. Read, Irvington-on-Hudson, New York
  • Lionel Robbins, London
  • Wilhelm Ropke, Geneva
  • George J. Stigler, Providence, Rhode Island
  • C. V. Wedgwood, London

(Full list here). It’s more difficult to say when the Golden Age ended. If I had to pick a date I’d say at a moment of triumph, November 9, 1989.

DARE to Look at the Evidence!

by on July 12, 2017 at 11:40 am in Economics, Law | Permalink

We must have Drug Abuse Resistance Education…I am proud of your work. It has played a key role in saving thousands of lives and futures.

Speaking at the 30th DARE Training Conference, Attorney General Jeff Sessions was enthusiastic and strongly supportive of DARE, the program started in Los Angeles in 1983 that uses police officers to give young children messages about staying drug free and resisting peer pressure.

And what do our excellent colleagues at GMU’s Center for Evidence-Based Crime Policy say about DARE?

D.A.R.E. is listed under “What doesn’t work?” on our Review of the Research Evidence. 

Rosenbaum summarized the research evidence on D.A.R.E. by titling his 2007 Criminology and Public Policy article “Just say no to D.A.R.E.” As Rosenbaum describes, the program receives over $200 million in annual funding, despite little or no research evidence that D.A.R.E. has been successful in reducing adolescent drug or alcohol use. As Rosenbaum (2007: 815) concludes “In light of consistent evidence of ineffectiveness from multiple studies with high validity, public funding of the core D.A.R.E. program should be eliminated or greatly reduced. These monies should be used to fund drug prevention programs that, based on rigorous evaluations, are shown to be effective in preventing drug use.”

A systematic review by West and O’Neal (2004) examined 11 published studies of D.A.R.E. and reached similar conclusions. D.A.R.E. has little or no impact on drug use, alcohol use, or tobacco use. They concluded that ““Given the tremendous expenditures in time and money involved with D.A.R.E., it would appear that continued efforts should focus on other techniques and programs that might produce more substantial effects” (West & O’Neal, 2004: 1028).

Recent reformulations of the D.A.R.E. program have not shown successful results either. For example, the Take Charge of your Life program, delivered by D.A.R.E. officers was associated with significant increases in alcohol and cigarette use by program participants compared to a control group (Sloboda et al., 2009).