Medicine

Table 1 shows that adding estimates from the literature suggests that economists have already explained 177% of the rise in average BMI.

That is from this new NBER paper, by Courtemanche, Pinkston, Ruhm, and Wehby, which seems to be one of the most careful studies to date.  They do it right and then offer some more commonsensical conclusions:

A growing literature examines the effects of economic variables on obesity, typically focusing on only one or a few factors at a time. We build a more comprehensive economic model of body weight, combining the 1990-2010 Behavioral Risk Factor Surveillance System with 27 state-level variables related to general economic conditions, labor supply, and the monetary or time costs of calorie intake, physical activity, and cigarette smoking. Controlling for demographic characteristics and state and year fixed effects, changes in these economic variables collectively explain 37% of the rise in BMI, 43% of the rise in obesity, and 59% of the rise in class II/III obesity. Quantile regressions also point to large effects among the heaviest individuals, with half the rise in the 90th percentile of BMI explained by economic factors. Variables related to calorie intake – particularly restaurant and supercenter/warehouse club densities – are the primary drivers of the results.

Here is a much earlier ungated version of the paper, with differing numerical estimates, use with caution.  A few related studies you will find here.

The excellent Kevin Lewis has pointed my attention to this paper by Robertson, Yokum, Sheth, and Joiner:.  The idea will sound like common sense to an economist, namely give people some cash if they turn down special treatments of uncertain value.  The funnier thing is, there is now some evidence it might actually work:

Traditional cost sharing for health care is stymied by limited patient wealth. The “split benefit” is a new way to reduce consumption of high-cost, low-value treatments for which the risk/benefit ratio is uncertain. When a physician prescribes a costly unproven procedure, the insurer could pay a portion of the benefit directly to the patient, creating a decision opportunity for the patient. The insurer saves the remainder, unless the patient consumes. In this paper, a vignette-based randomized controlled experiment with 1,800 respondents sought to test the potential efficacy of the split benefit. The intervention reduced the odds of consumption by about half. It did so regardless of scenario (cancer or cardiac stent), type of split (rebate, prepay, or health savings account), or amount of split (US$5,000 or US$15,000). Respondents viewed the insurer that paid a split as behaving fairly, as it preserved access and choice. Three-quarters of respondents supported such use in Medicare, which did not depend on political party affiliation. The reform is promising for further testing since it has the potential to decrease spending on low-value interventions, and thereby increase the value of the health care dollar.

My concern of course is that on a larger scale eventually this would be gamed, and faux treatment offers will be generated for the purpose of transferring wealth to patients, with doctors and hospitals, one way or the other, in on the act.

Claire Jones at the FT reports:

The European Central Bank is set to unveil a programme of mass bond buying next week to save the eurozone from deflation, but has bowed to German pressure to ensure that its taxpayers are not liable for any losses incurred on other countries’ debt.

This is not a surprise.  Alen Mattich had a good Twitter comment:

How could you trust ECB promise to “do whatever it takes” if it doesn’t accept the risk of holding national sov debt on its books?

Guntram B. Wolff has an excellent, detailed analysis, worth reading in full, here is one bit:

So the purely national purchase of national sovereign debt would either leave the private creditors as junior creditors, or the national central bank has to accept negative equity. What would negative equity mean for a central bank? De facto it would mean that the national central bank, that has created euros to buy government debt, would have lost the claim on the government. It would still owe the euros it has created to the rest of the Eurosystem.(4) The Eurosystem could now either ask the national central bank to return that liability, which it is unable to do without a recapitalisation of its government. Or, the Eurosystem could decide to leave the claim standing relative to the national central bank. In that case, the loss made on the sovereign debt would de facto have been transferred to the Eurosystem. In other words, the attempt to leave default risk with the national central bank will have failed.

…Overall, this discussion shows that monetary policy in the monetary union reaches the limits of feasibility if the principle of joint and several liability at the level of the Eurosystem is given up.

An important open issue is whether the ECB could buy Greek bonds, given that they are up for restructuring and (presumably) the Bank cannot voluntarily relieve Greece of any debt (see Wolff’s discussion).  There are plenty of rumors that Greece will indeed be excluded from any QE program, unless you imagine they settle things with the Troika rather more quickly than they are likely to.  Yet a bond-buying program without Hellenic participation doesn’t seem so far from hurling an “eurozone heraus!” painted brick through their front window in the middle of the night.

Overall, shuffling assets and risk profiles between national monetary authorities and national fiscal authorities would seem to accomplish…nothing.  Not buying up the debt of your biggest problem country also seems to accomplish nothing, in fact it is worth than doing nothing.

Here is my 2012 column on how the eurozone needs to agree on who is picking up the check.  They still haven’t agreed!  In the meantime, Grexit is a very real possibility, through deposit flight, no matter how badly Greek citizens may wish their country to stay in.

So, so far I am not so optimistic about this whole eurozone QE business, even though in principle I very much favor the idea.  It is again a case of politics getting in the way of a problem which does indeed have a (partial) economic solution.  The only way it (partially) works is if it (implicitly) bundles debt relief with higher rates of price inflation.  Have a nice day.

Ezra Klein has an excellent essay on this topic, reviewing the (very good) Philip Klein book.  Here is one bit:

Klein’s book is a service: it’s far and away the clearest, most detailed look at conservative health-policy thinking in the post-Obamacare world. But it can leave a reader with the impression that the important cleavages in conservative health-policy thinking are between the Replacers, the Reformists, and the Restarters.

It’s not. It’s between those in the party who want to prioritize health reform and those who don’t. And it’s worth being clear: those who don’t have a case. Health reform is an incredibly tough, painful project. Everything you do has tradeoffs, some of them awful.

And to sum up, the Democrats really cared about health care reform (for better or worse), but:

…that’s really the problem for conservative health reformers. For all the plans floating around, there’s little evidence Republicans care enough about health reform to pay its cost.

I am less positive on Obamacare than is Ezra, but still the piece is interesting throughout and a good challenge to would-be reformers.

Arrived in my pile

by on January 14, 2015 at 1:25 pm in Books, Economics, Medicine | Permalink

1. Lives of the Laureates: Twenty-three Nobel Economists, edited by Roger W. Spencer and David A. Macpherson.  I know an earlier edition of this book, my favorite piece is the essay by Thomas Schelling but it is a good book throughout.

2. Eric Topol, The Patient Will See You Now: The Future of Medicine is in Your Hands.  I don’t have the time to read a book on medicine just now, but it looks quite interesting, a rebuttal to the claim that consumers are helpless in the world of medicine.

Here is one bit of many:

The embedded papers by Louise Sheiner of Brookings, Chapin White of the Rand Corporation, and Thomas Getzen of Temple University are recommended. To be simplistic, there was agreement that much of the slowdown was likely the result of the recession and sluggish recovery, as slow economic growth translated into less health spending and also slower wage growth for health care workers. But not all of it.

Sheiner finds that outside of spending on prescription drugs — which has been flat since 2008 because of the patent cliff — there actually hasn’t been any unexplained slowdown in health spending relative to the fifteen years before the recession. In this context, “unexplained” means a change in health spending that can’t be attributed to the business cycle. She also adds the intriguing observation that in a downturn, more health workers join the labour force, often because their spouses have lost their own jobs — but wages for health workers fall. The shortage of registered nurses mostly evaporated after the recession of 2008, she said.

White looked more closely at the Medicare slowdown and believes that the Affordable Care Act’s price cuts did have an impact, as did a recent crackdown on fraud by the Centers for Medicare & Medicaid Services.

I hope the rest is not “too gated” for you, hat tip goes to Claudia Sahm.  And Philip Greenspun reports on the meetings.

Catherine Rampell reports:

While engineers, mathematicians and scientists today are (unfairly) stereotyped as awkward nerds who don’t know how to interact with the opposite sex, in 1950 they were among the occupations most likely to be married. Today, the most commonly conjugated occupations are instead more often medical professionals with doctorates, starting with dentists (81 percent of whom are hitched)…

The top of the list looks like this:

1) Dentist
2) Chief executive
3) Sales engineer
4) Physician
5) Podiatrist
6) Optometrist
7) Farm product buyer
8) Precision grinder
9) Religious worker
10) Tool and die maker

We also learn this:

Turns out that in 1950, many of the occupations whose members were most likely to end up divorced were creative or artistic ones (artist, writer/director, dancer, designer, writer), which perhaps reflects the communities that were most accepting of divorce at the time. In 2010, the occupations with the highest divorce rates were predominantly in manufacturing or other areas that have been subject to downsizing (drilling machine operator, knitter textile operative, force operator, winding machine operative, postal clerk). This seems to support the idea that economic stability is a good predictor of marital status.

Do read the whole thing.

The method, which extracts drugs from bacteria that live in dirt, has yielded a powerful new antibiotic, researchers reported in the journal Nature on Wednesday. The new drug, teixobactin, was tested in mice and easily cured severe infections, with no side effects.

Better still, the researchers said, the drug works in a way that makes it very unlikely that bacteria will become resistant to it. And the method developed to produce the drug has the potential to unlock a trove of natural compounds to fight infections and cancer — molecules that were previously beyond scientists’ reach because the microbes that produce them could not be grown in the laboratory.

Studies on people will start in about two years, the NYT article is here.  Here is the underlying Nature article.

Alternatively, here is a claim that James Harden is the future of basketball.

I thank numerous MR readers for related pointers.

Marcella Alsan has a new paper in the American Economic Review:

The TseTse fly is unique to Africa and transmits a parasite harmful to humans and lethal to livestock. This paper tests the hypothesis that the TseTse reduced the ability of Africans to generate an agricultural surplus historically. Ethnic groups inhabiting TseTse-suitable areas were less likely to use domesticated animals and the plow, less likely to be politically centralized, and had a lower population density. These correlations are not found in the tropics outside of Africa, where the fly does not exist. The evidence suggests current economic performance is affected by the TseTse through the channel of precolonial political centralization.

You will find ungated versions here.

According to forecasts from Match.com and Plenty of Fish, two of the country’s largest dating sites, the single most popular time for online dating — the window when the most people sign up, log on and poke around — will be Jan. 4, from roughly 5 to 8 p.m. Zoosk, another data-focused dating site, backs that estimate up; in 2014, it’s most trafficked time was on the Sunday after New Year’s.

The full article is here, via Ninja Economics.  Might it mean that a) online dating is a kind of palliative against holiday depression?  Or that online dating is a kind of New Year’s resolution, a willingness to undergo a brutal experience for a supposed potential long-run benefit?  Or a bit of both?  Personally, I engage in some of my least productive work on Sunday evenings.

Your model, by the way, should not neglect these corollary facts:

Interestingly, this cycle doesn’t just play out on dating sites — in fact, it’s far broader than that. Researchers have also observed a post-holiday spike in searches for porn, for instance, and a 2012 study by Facebook’s data team found that people are far more likely to change their relationship status in January or February than they are at any other time of year. Offline, the holiday season tends to see a jump in both condom sales and conceptions.

Markets in everything: discomfort furniture

by on December 15, 2014 at 1:55 pm in Medicine | Permalink

Sitting for longer than four hours a day increases a person’s chance of suffering chronic disease.

Now, inspired to address the lack of physical activity in modern work life, one French designer believes he might have created the answer.

With just two legs, the ‘Inactivite’ chair relies on the user engaging the muscles in their core to keep it upright.

Benoit Malta, the man behind the creation, said he wanted to encourage movement for those office workers who spent around 70 per cent of the day sitting down.

There is video and further description at the link, and for the pointer I thank Mark Thorson.

*Do No Harm*

by on December 12, 2014 at 1:35 am in Books, Medicine, Science | Permalink

I loved this book, which is written by a neurosurgeon with a knowledge of behavioral economics (he even has designed a talk  “All My Worst Mistakes,” based on Daniel Kahneman’s work).  The subtitle is Stories of Life, Death, and Brain Surgery and the author is Henry Marsh.  Here is one bit:

…as the brain has the consistency of jelly a sucker is the brain surgeon’s principal tool.

Here is another:

All that really matters is that I am as sure as I can be that the decision to operate is correct and that no other surgeon can do the operation any better than I can.  This is not as much of a problem for me now that I have been operating on brain tumours for many years, but it can be a moral dilemma for a younger surgeon.  If they do not take on difficult cases, how will they ever get any better?  But what if they have a colleague who is more experienced?

And another:

Few anaesthetists believe what surgeons tell them.

How about this one?:

‘There are operations where one really doesn’t know what’s going to happen,’ I muttered to Mike.

Highly recommended, it is already out in the UK, in the U.S. coming out in May 2015.  It has made many best of the year lists in the UK.  Here are some related videos.

Large numbers of doctors who are listed as serving Medicaid patients are not available to treat them, federal investigators said in a new report.

“Half of providers could not offer appointments to enrollees,” the investigators said in the report, which will be issued on Tuesday.

Many of the doctors were not accepting new Medicaid patients or could not be found at their last known addresses, according to the report from the inspector general of the Department of Health and Human Services. The study raises questions about access to care for people gaining Medicaid coverage under the Affordable Care Act.

That is from Robert Pear, there is more here.  And about one-quarter of actual providers had wait times of over a month.  Once again, it is the supply-side problems in American medicine which are paramount.

Some of the White House economists were dubious and privately called Mrs. Clinton’s health care team “the Bolsheviks.” In return, according to Ms. Rivlin, the economists were “sometimes treated like the enemy.” Their suggested changes were ignored. “We could have beaten Ira alone,” said Mr. Blinder. “But we couldn’t beat Hillary.”

There is more here from the NYT, mostly about Hillary, not about that episode.

The mainland – which has long been criticised by international human rights groups for using organs harvested from executed prisoners as its main source of organ transplants – will completely ban the practice from next year.

All organs used in future transplants must be from donors, the Southern Metropolis News quoted Dr Huang Jiefu as saying. Huang is former deputy director of the health ministry and director of the China Organ Donation and Transplant Committee.

Major transplant centres had already stopped using executed prisoners’ organs, said Huang, who chaired an industry forum in Kunming on Wednesday.

There is more here, via Mark Thorson.  The article notes China has one of the lowest voluntary organ donation rates in the world.  0.6 individuals out of a million sign up to donate their organs after they die, and that means the number of actual donors is lower yet.  If you google around, you will find some ambiguity as to whether the donation rate or the “register to donate rate” is that low, but as far as I can tell (try this Chinese source) it is the actual register to donate rate, in part because they just aren’t many ways to register right now.  Please let us know if you have additional information on this point.

Wikipedia by the way reports:

The wait times for organ transplants for organ recipients in China are much lower than elsewhere in the world, and there is evidence that the execution of prisoners for their organs is “timed for the convenience of the waiting recipient.

Here are some of Alex’s earlier posts on a market for transplanted organs.