Medicine

The United States has been called the OPEC of blood plasma because it exports hundreds of millions of dollars worth to other countries. Why does the US dominate the blood plasma industry? Because in the U.S. it’s legal to pay donors which increases supply. Some provinces in Canada have also allowed paid donors but 80% of the blood plasma given to Canadians is imported from the United States and, to make matters worse, some provinces have banned or are considering banning paid donation. A very good letter opposes the ban:

We are professional ethicists in the fields of medical ethics, business ethics, and/or normative ethics, and academic economists who study how incentives and other mechanisms affect individual behaviour. We all share the goal of improving social welfare.

We have strong reservations regarding any Act or legislation (hereafter: “Acts”) that would prohibit compensation for blood plasma donations…….Both the ethical and the economic arguments against a compensatory model for blood plasma for further manufacture into PDMPs are weak. Moreover, significant ethical considerations speak in favour of the compensatory model, and therefore against the Acts.

The letter carefully discusses many of the objections such as that paid donations will drive out unpaid:

The compensatory model leaves open the possibility of donors’ opting out of compensation, or the operation of a parallel non-compensatory model. The United States does just this, and has an approximately 50% higher voluntary, unpaid, per capita blood donation rate than Canada. Germany, Austria, and the Czech Republic, where plasma donors can be compensated, likewise all have higher rates of voluntary, unpaid per capita blood donation than Canada.

Is paid blood plasma less safe?

Dr. Graham Sher, the CEO of Canadian Blood Services, has said, “It is categorically untrue to say, in 2015 or 2016, that plasma-protein products from paid donors are less safe or unsafe. They are not. They are as safe as the products that are manufactured from our unremunerated or unpaid donors.”

The letter is signed by two Nobel Prize winners in economics, Alvin Roth and Vernon Smith, by philosophers like Peter Jaworski, who did most of the heavy lifting, and by experts who have studied incentives and blood donation closely like Nicola Lacetera and Mario Macis. I am also a signatory.

Crime Imprisons and Kills

by on January 15, 2018 at 7:26 am in Economics, Law, Medicine | Permalink

…the most disadvantaged people have gained the most from the reduction in violent crime.

Though homicide is not a common cause of death for most of the United States population, for African-American men between the ages of 15 and 34 it is the leading cause, which means that any change in the homicide rate has a disproportionate impact on them. The sociologist Michael Friedson and I calculated what the life expectancy would be today for blacks and whites had the homicide rate never shifted from its level in 1991. We found that the national decline in the homicide rate since then has increased the life expectancy of black men by roughly nine months.

…The everyday lived experience of urban poverty has also been transformed. Analyzing rates of violent victimization over time, I found that the poorest Americans today are victimized at about the same rate as the richest Americans were at the start of the 1990s. That means that a poor, unemployed city resident walking the streets of an average city today has about the same chance of being robbed, beaten up, stabbed or shot as a well-off urbanite in 1993. Living in poverty used to mean living with the constant threat of violence. In most of the country, that is no longer true.

That’s Patrick Sharkey writing in the New York Times.

More police on the street is one cause, among many, of lower crime. It’s important in the debate over better policing that we not lose sight of the value of policing. Given the benefits of reduced crime and the cost of police, it’s clear that U.S. cities are under policed (e.g. here and here). We need better policing–including changes in laws–so that we can all be comfortable with more policing.

Yes, it would seem.  The subtitle is “The Effect of Medical Marijuana Laws on US Crime,” the authors are Evelina Gavrilova, Takuma Kamada, and Floris Zoutman, and the outlet is The Economic Journal.  Here is the abstract:

We show that the introduction of medical marijuana laws (MMLs) leads to a decrease in violent crime in states that border Mexico. The reduction in crime is strongest for counties close to the border (less than 350 kilometres) and for crimes that relate to drug trafficking. In addition, we find that MMLs in inland states lead to a reduction in crime in the nearest border state. Our results are consistent with the theory that decriminalisation of the production and distribution of marijuana leads to a reduction in violent crime in markets that are traditionally controlled by Mexican drug trafficking organisations.

Here is the link to the paper, here are earlier versions.  For the pointer I thank Peter Metrinko.  That said, I learn from Kevin Lewis that the high school graduate rate goes down.

Norwegian psychiatrist Ørnulf Ødegaard has studied personality types.  He has shown that relatively more Norwegian-born persons in Minnesota suffered from mental illness, especially schizophrenia,in the 1920s than did members of Norway’s population.  He maintained that the greater frequency of illness might be due in some degree to the greater strains the emigrants were exposed to in a foreign society, but he also held that people who were disposed to this illness were more restless and found it easier than other personality types to break out of their environment.

That is from Ingrid Semmingsen, Norway to America: A History of the Migration, and I believe the original reference is to ” Immigration and Insanity: A Study of Mental Disease Among the Norwegian-born Population of Minnesota,” Ø Ødegaard – Acta psychiatrica Scandinavica, Suppl, 1932.”  Here is a related post on gene-culture interaction.

A Twitter battle over the size of each “nuclear button” possessed by President Donald Trump and North Korea’s Kim Jong-un has spiked sales of a drug that protects against radiation poisoning.

Troy Jones, who runs the website www.nukepills.com, said demand for potassium iodide soared last week, after Trump tweeted that he had a “much bigger & more powerful” button than Kim — a statement that raised new fears about an escalating threat of nuclear war.

“On Jan. 2, I basically got in a month’s supply of potassium iodide and I sold out in 48 hours,” said Jones, 53, who is a top distributor of the drug in the United States. His Mooresville, N.C., firm sells all three types of the product approved by the Food and Drug Administration. No prescription is required.

Here is the full piece, via the excellent Mark Thorson.

Not long ago, over lunch, I asked Robin who he wanted to see rise and fall in status, as a result of his book with Kevin Simler.  As for who should rise, he cited the book’s epigram to me:

To the little guys, often grumbling in a corner, who’ve said this sort of thing for ages: you were right more than you knew. —Robin

So yes the little guys, but I also stress the cynics as well, or maybe it is the gentle cynics who go through life with a smile.

And who should decline in status?  Robin’s lunch answer was again to the point: policy analysts.  Policy analysis, while it often incorporates behavioral considerations, when studying say health care, education, and political economy, very much neglects the fact that often both the producers and consumers in these areas have hypocritical motives.  For that reason, what appears to be a social benefit is often merely a private benefit in disguise, and sometimes it is not even a private benefit.  Things that feel good aren’t always good for you, or for the broader world.  Here is Robin’s take on that:

Our new book, The Elephant in the Brain, can be seen as taking one side in a disagreement between disciplines. On one side are psychologists (among others) who say of course people try to spin their motives as being higher than they are, especially in public forums. People on this side find our basic book thesis, and our many specific examples, so plausible that they fear our book may be too derivative and unoriginal.

On the other side, however, are most experts in concrete policy analysis. They spend their time studying ways that schools could help people to learn more material, hospitals could help people get healthier, charities could better assist people in need, and so on. They thus implicitly accept the usual claims people make about what they are trying to achieve via schools, hospitals, charities, etc. And so the practice of policy experts disagrees a lot with our claims that people actually care more about other ends, and that this is why most people show so little interest in reforms proposed by policy experts. (The world shows great interest in new kinds of physical devices and software, but far less interest in most proposed social reforms.)

In ignoring hypocrisy, policy analysts are themselves hypocritical, and thus Robin wishes to downgrade their status, perhaps doubly so.  Sorry people!

I find these status questions to be a useful means of thinking about many non-fiction books, sometimes fiction too.  I would note it is sometimes hard to market books with the “group X ignores well-known truth from field Y” spin, but perhaps that also means there are intellectual arbitrage gains to be had from studying such works.

Oregon has just passed a law that gives gas stations in rural counties the option of allowing self-pumping (in some rural counties this is allowed only between 6 p.m. and 6 a.m.!) As you have probably heard, this incomplete lifting of an absurd restriction has some Oregonians upset and afraid.

“I don’t even know HOW to pump gas and I am 62, native Oregonian . . . I say NO THANKS! I don’t like to smell like gasoline!” one woman wrote.

“No! Disabled, seniors, people with young children in the car need help. Not to mention getting out of your car with transients around and not feeling safe. This is a very bad idea. Grrr,” another woman wrote.

“I’ve lived in this state all my life and I REFUSE to pump my own gas . . . This [is] a service only qualified people should perform. I will literally park at the pump and wait until someone pumps my gas.”

Most of the rest of the America–where people pump their own gas everyday without a second thought–is having a good laugh at Oregon’s expense. But I am not here to laugh because in every state but one where you can pump your own gas you can’t open a barbershop without a license. A license to cut hair! Ridiculous. I hope people in Alabama are laughing at the rest of America. Or how about a license to be a manicurist? Go ahead Connecticut, laugh at the other states while you get your nails done. Buy contact lens without a prescription? You have the right to smirk British Columbia!

All of the Oregonian complaints about non-professionals pumping gas–“only qualified people should perform this service”, “it’s dangerous” and “what about the jobs”–are familiar from every other state, only applied to different services.

Once we got familiar with self-pumping it didn’t seem like a problem, but it’s surprising we ever got self-pumping as it would have been easy to scare people into voting no. After all, the case for trained gas pumpers is far stronger than for licensed barbers. Perhaps we were less risk averse and complacent in the past. I don’t think we could build the Hoover Dam today either.

It’s easier to scare than to inform and we fear losses more than we desire gains so collective decision-making defaults toward stasis.

We have innovations like Uber and Airbnb and many others only because entrepreneurs didn’t have to ask for permission. Had we put these ideas to the vote they would have been defeated. Allow almost anyone with a car to drive customers around town? Stranger danger! Let any house be turned into a hotel? Not in my neighborhood! Once the innovations were brought into existence, the masses saw the benefits but they would not have seen those benefits if the idea had been put to a vote. Demonstration is more powerful than imagination.

More and more, however, the sphere of individual action shrinks and that of collective action grows. Thus, I do not laugh at the Oregonians and their fear of gas pumping freedom. We are all Oregonians in one form or another.

The authors are Kevin Simler and Robin Hanson, and now it is out!

Robin reports:

On press coverage, back in July Publishers Weekly had a paragraph on it, the Boston Globe did an interview of me back then that they just released, Vice interviewed me recently so I expect that out soon, and I’m told that a Wall Street Journal review is forthcoming. Amazon now has 5 reviews, Goodreads has 7, and 2 reviews have appeared on blogs.

I am pleased to be doing a Conversation with Robin about the book, and other matters too.  But don’t forget — conversations aren’t about talking!

Canada facts of the day

by on December 26, 2017 at 11:36 am in Data Source, Law, Medicine | Permalink

The estimate comes from Canada’s bureau of statistics, which studied marijuana consumption between 1960 and 2015.

The government has promised to research the drug’s affect on the economy and society as it ramps up its plans to legalise cannabis next summer.

The report also found that use has gone up over the years as it has become more popular with adults.

In the 1960s and 1970s cannabis was primarily consumed by young people, according to Statistics Canada.

But in 2015, only 6% of 15-17 year olds smoked cannabis recreationally, compared to two thirds of adults over 25.

Here is the story, via Mark Thorson.

Uber as an ambulance substitute

by on December 26, 2017 at 2:37 am in Medicine, Travel | Permalink

Using an ambulance to travel to the hospital in an emergency can cost upwards of $1,000 USD. Now research demonstrates that a significant number of people are instead choosing Uber to perform the same service.

The paper – currently being peer reviewed – examines the effect on ambulance usage as Uber was introduced to 766 cities across 43 states. According its findings, even the most conservative estimate shows a seven percent reduction in people traveling via ambulance where the service is available.

Here is the full story, via Jeffrey Deutsch.  File under “Even with surge pricing, bending the cost curve.”

So says Keith A. Meyers, job candidate from University of Arizona.  I found this to be a startling result, taken from his secondary paper:

During the Cold War the United States detonated hundreds of atomic weapons at the Nevada Test Site. Many of these nuclear tests were conducted above ground and released tremendous amounts of radioactive pollution into the environment. This paper combines a novel dataset measuring annual county level fallout patterns for the continental U.S. with vital statistics records. I find that fallout from nuclear testing led to persistent and substantial increases in overall mortality for large portions of the country. The cumulative number of excess deaths attributable to these tests is comparable to the bombings of Hiroshima and Nagasaki.

Basically he combines mortality estimates with measures of Iodine-131 concentrations in locally produced milk, “to provide a more precise estimate of human exposure to fallout than previous studies.” The most significant effects are in the Great Plains and Central Northwest of America, and “Back-of-the-envelope estimates suggest that fallout from nuclear testing contributed between 340,000 to 460,000 excess deaths from 1951 to 1973.”

His primary job market paper is on damage to agriculture from nuclear testing.

Here is the abstract to The Geography of Poverty and Nutrition: Food Deserts and Food Choices Across the United States (free version) by Allcott, Diamond, and Dubé:

We study the causes of “nutritional inequality”: why the wealthy tend to eat more healthfully than the poor in the U.S. Using two event study designs exploiting entry of new supermarkets and households’ moves to healthier neighborhoods, we reject that neighborhood environments have economically meaningful effects on healthy eating. Using a structural demand model, we find that exposing low-income households to the same food availability and prices experienced by high-income households would reduce nutritional inequality by only 9%, while the remaining 91% is driven by differences in demand. In turn, these income-related demand differences are partially explained by education, nutrition knowledge, and regional preferences. These findings contrast with discussions of nutritional inequality that emphasize supply-side issues such as food deserts.

This is a good paper with a credible research design and impressive data from some 35,000 supermarkets covering 40% of the United States. Moreover, because of the widespread attention given to “food deserts” this paper probably had to be written. But color me un-surprised. The results are obvious.

Indeed, I feel that in recent years I am reading a lot of papers that aim massive firepower on weak hypotheses. As an explanation for obesity and poor eating habits, the idea of “food deserts” was absurd. The reasons are manifold. Even in food deserts it’s actually not that difficult to get healthy food and, contrary to popular belief, healthy food is not especially expensive. Try an Asian supermarket for plenty of cheap produce. Indeed, in any part of the United States you can find plenty of poor-people eating healthy foods and plenty of rich people eating unhealthy foods.

The food deserts idea was especially implausible for America because Americans spend less of their income on food consumed at home (6%) than any other nation. The Dutch, for example, spend (12%) of their income on food, the Italians and Japanese (14%), the Vietnamese (35%). There is plenty of room in the American food budget for healthy eating. Finally, Allcott, Diamond, and Dubé show that relative to unhealthy food, healthy food is actually a bit cheaper in low-income areas.

More importantly, just open your eyes. Walk into a fast food joint in a food desert and ask yourself, do the customers really want brussel sprouts but are reluctantly settling for Chips Ahoy? The idea is ridiculous and not a bit insulting in denying agency to the people who live in low-income areas. If what people living in food deserts wanted was brussel sprouts, they would get them.

The Whole Foods class think their kale and kombucha are so obviously superior to what the poor eat that the only possible explanation for poor eating is that poor people are denied choice. Yet put an inexpensive but colorful produce stand next to a McDonald’s and you can be sure that the customers will differ by class. Why the poor choose to eat differently than the rich is an interesting and important question but one more amenable to answers focusing on culture, education and history than price and income. The idea applies widely.

Understanding the purpose of sex is a fundamental unresolved problem in evolutionary biology. The difficulty is not that there are too few theories of sex, the difficulty is that there are too many and none stand out. To distinguish between theories, we ask: Why are there no triparental species with offspring composed of the genetic material of three individuals? A successful theory should confer an advantage to biparental sex over asexual reproduction without conferring an even greater advantage to triparental sex. Of two leading theories (red queen and mutational), we show that only one is successful in this sense.

That is a new Economic Journal paper by Motty PerryPhilip J. Reny, and Arthur J. Robson.  Of course the core question is a classic example of thinking at the margin.  The core conclusion is that mutations continue to rise with the number of sex-participating partners, but in simple Red Queen models the limiting features of the genotypes is the same whether there are two, three, or more partners.  The argument on pp.2739-2741 is not readily blog-summarizable, and I do not grasp it fully, but at the moment I have the following intuition.  If a parasite attack comes, the species needs only move away from the targeted genome to continue reproducing, due to some all-or-nothing assumptions about the nature of the attack.  This differs from the mutational game, where there is always some marginal (expected value) gain from moving yet further away from the initial nature of the species.  Playing a game against an identified opponent brings a better-specified and more stable and less varying response strategy than playing a game against an as-yet-unidentified opponent.  That isn’t how the authors put things, but…

Since we don’t observe much three-party reproduction (hardly any in fact), that suggests the Red Queen model is more likely to apply.

For the pointer I thank TEKL.

Are there genetic vulnerabilities for depression across cultures?

Genetic vulnerability differs substantially from country to country. East Asian contexts, for example, show a high prevalence of genes associated with depression. Yet, despite these vulnerabilities, they develop fewer cases of the disorder. One hypothesis is that genetic vulnerabilities have co-evolved with culture, creating extra protective factors (in this case, extra interdependence). However, when these people leave their cultural contexts, they have a higher risk of developing depression.

That is an interview with Yulia Chentsova-Dutton, associate professor of psychology at Georgetown, and a researcher in this area.  You can imagine further applications of this mechanism.  The interview has other interesting points, for instance:

What is the role of emotion regulation?

Emotion regulation is increasingly becoming understood as a core factor in all affective disorders. In western societies, we don’t see enough adaptive strategies like reappraisal: learning to tell yourself a different story that would eventually lead to different emotions. There is also not enough social regulation of emotion, which occurs by sharing our emotions with others. Research shows that cultures can facilitate functional regulation strategies. For example, Igor Grossmann’s work shows that Russians make rumination (generally considered a dysfunctional strategy) more functional by encouraging people to ruminate about the self from another person’s perspective, making rumination almost reappraisal-like in its quality.

Do read the whole thing.

NZ Ministry of Health: People who donate a kidney or part of their liver can now do so knowing they can be fully compensated for lost earnings as a result of their donation surgery.

The Ministry of Health will be implementing compensation for live organ donors from 5 December. People who donate a live organ will be fully recompensed for lost earnings for up to 12 weeks while they recover. This will be paid weekly following the donation surgery. In the past donors received some assistance in the form of a benefit for this.

Former GMU student, Eric Crampton, now Senior Fellow at University of Canterbury had a role in the design.

Hat tip: Frank McCormick.