Medicine

The Right to Try

by on February 8, 2016 at 7:25 am in Economics, Law, Medicine | Permalink

Here is a powerful video from the Tomorrow’s Cures Today Foundation on the right to try experimental medicines. I sometimes worry that we hold out too much promise to patients. Tomorrow’s drugs are rarely cures. Tomorrow’s drugs are a little bit better than today’s and that is how progress is made. What really matters is not the right to try per se but speeding up the process, reducing costs, and increasing investment in pharmaceutical R&D.

Nevertheless, I support the right to try. Watch the video.

Addendum: I have no direct connection to the Foundation but Bartley Madden is on the advisory board, as is Nobelist Vernon Smith, so I am delighted to promote.

That is the topic of a new paper by Meyer R and Desai SP, here is the abstract:

News of the successful use of ether anesthesia on October 16, 1846, spread rapidly through the world. Considered one of the greatest medical discoveries, this triumph over man’s cardinal symptom, the symptom most likely to persuade patients to seek medical attention, was praised by physicians and patients alike. Incredibly, this option was not accepted by all, and opposition to the use of anesthesia persisted among some sections of society decades after its introduction. We examine the social and medical factors underlying this resistance. At least seven major objections to the newly introduced anesthetic agents were raised by physicians and patients. Complications of anesthesia, including death, were reported in the press, and many avoided anesthesia to minimize the considerable risk associated with surgery. Modesty prevented female patients from seeking unconsciousness during surgery, where many men would be present. Biblical passages stating that women would bear children in pain were used to discourage them from seeking analgesia during labor. Some medical practitioners believed that pain was beneficial to satisfactory progression of labor and recovery from surgery. Others felt that patient advocacy and participation in decision making during surgery would be lost under the influence of anesthesia. Early recreational use of nitrous oxide and ether, commercialization with patenting of Letheon, and the fighting for credit for the discovery of anesthesia suggested unprofessional behavior and smacked of quackery. Lastly, in certain geographical areas, notably Philadelphia, physicians resisted this Boston-based medical advance, citing unprofessional behavior and profit seeking. Although it appears inconceivable that such a major medical advance would face opposition, a historical examination reveals several logical grounds for the initial societal and medical skepticism.

File under “@pmarca bait.”

Hat tip goes to Neuroskeptic.

“Unemployment is really hard to handle,” said U Saw Tha Pyae, whose six elephants have been jobless for the past two years. “There is no logging because there are no more trees.”

Myanmar’s leading elephant expert, Daw Khyne U Mar, estimates that there are now 2,500 jobless elephants, many of them here in the jungles of eastern Myanmar, about two and a half hours from the Thai border. That number would put the elephant unemployment rate at around 40 percent, compared with about 4 percent for Myanmar’s people.

“Most of these elephants don’t know what to do,” Ms. Khyne U Mar said. “The owners have a great burden. It’s expensive to keep them.”

Adult elephants, which each weigh about 10,000 pounds, eat 400 pounds of food a day and, other than circuses and logging, have limited job opportunities.

Logging is arduous. But elephant experts say hard work is one reason Myanmar’s elephants have remained relatively healthy. A 2008 study calculated that Myanmar’s logging elephants, which have a strict regimen of work and play, live twice as long as elephants kept in European zoos, a median age of 42 years compared with 19 for zoo animals.

Here is the full NYT story, via Michelle Dawson and Otis Reid.  The story is interesting throughout, you will note the elephants had strong labor law protections:

The military governments adhered to a strict labor code for elephants drawn up in British colonial times: eight-hour work days and five-day weeks, retirement at 55, mandatory maternity leave, summer vacations and good medical care. There are still elephant maternity camps and retirement communities run by the government. In a country where the most basic social protections were absent during the years of dictatorship, elephant labor laws were largely respected.

Interesting throughout — I wonder what is the natural rate of unemployment for elephants in a freer labor market…?

German Lopez at Vox reports:

If you look at the data, there’s no evidence to support the idea that Europe, in general, has a safer drinking culture than the US.

According to international data from the World Health Organization, European teens ages 15 to 19 tend to report greater levels of binge drinking than American teens.

This continues into adulthood. Total alcohol consumption per person is much higher in most of Europe. Drinkers in several European countries — including the UK, France, Belgium, Denmark, Sweden, and Iceland — are also more likely to report binge drinking than their US counterparts.

Younger teens in Europe appear to drink more, as well. David Jernigan, an alcohol policy expert at Johns Hopkins University, studied survey data, finding that 15- and 16-year-old Americans are less likely to report drinking and getting drunk in the past month than their counterparts in most European countries.

File under Wisdom of the Mormons.

Clinton

I found the article and its photos interesting throughout.  Here is commentary from Robin Hanson.

Fragments of note

by on January 19, 2016 at 1:25 pm in Current Affairs, Law, Medicine | Permalink

…OxyContin abuse kills three times more people than gun homicides yearly.

That is from Scott Alexander, USA only, and here is Scott’s earlier post on guns, follow-up here.

Addendum: Do note the comment from GregS, this comparison may not be correct.  Here is an update.

Wow!! Remember that increasing death rate among middle-aged non-Hispanic whites? It’s all about women in the south (and, to a lesser extent, women in the midwest). Amazing what can be learned just by slicing data.

I don’t have any explanations for this. As I told a reporter the other day, I believe in the division of labor: I try to figure out what’s happening, and I’ll let other people explain why.

That is from Andrew Gelman, there is more at the link.

south

Economists on FDA Reciprocity

by on January 14, 2016 at 7:05 am in Economics, Law, Medicine | Permalink

Daniel Klein & William Davis surveyed economists about whether it would be an improvement to reform the FDA so that “as soon as a new drug is approved by any one of five [FDA approved international] agencies, that drug automatically gains approval in the United States.” They report:

Of the 467 economists who answered the question and did not mark “Have no opinion,” 53 percent agreed that the reform would be an improvement, while 29 percent disagreed. (The remainder said they were “neutral.”) Moreover, those favoring the reform were more likely to say they held their belief “strongly.” Hence, the balance of economist judgment certainly leaned in favor of the liberalization.

Economists are not the only ones in favor of reciprocity. Others are also coming around, at least partially. In Generic Drug Regulation and Pharmaceutical Price-Jacking I argued in response to the massive increases in the price of Daraprim (generic name Pyrimethamine) that we ought to allow importation:

Pyrimethamine is also widely available in Europe. I’ve long argued for reciprocity, if a drug is approved in Europe it ought to be approved here. In this case, the logic is absurdly strong. The drug is already approved here! All that we would be doing is allowing import of any generic approved as such in Europe to be sold in the United States.

In a paper in JAMA discussing the same case, Drs Jeremy Greene, Gerard Anderson, and Joshua M. Sharfstein agree, writing:

A second option is to temporarily permit the importation of drug products reviewed by competent regulatory authorities and approved for sale outside the United States. For example, Glaxo, the original manufacturer of pyrimethamine, sells a version of the drug approved for use in the United Kingdom at less than $1 per tablet.

Dr Sharfstein by the way was Principal Deputy Commissioner of the US Food and Drug Administration from March 2009 to January 2011.

Addendum: I will be discussing/debating pharmaceutical policy with Dr. Sharfstein at on event sponsored by the Council on Foreign Relations in Washington, DC the morning of Monday January 25. Invitation only but email me if you want an invite.

I don’t think climate change is the right framing for this effect, nonetheless this is an interesting result, with the subtitle “Evidence from a billion tweets.”  Here is the abstract:

What is the welfare cost of environmental stress? The change in amenity values resulting from temperature increases may be a substantial unaccounted-for cost of climate change. Because there is no explicit market for climate, prior work has relied on cross-sectional variation or survey data to identify this cost. This paper presents an alternative method of estimating preferences over nonmarket goods which accounts for unobserved cross-sectional and temporal variation and allows for precise estimates of nonlinear effects. Specifically, I create a rich dataset on hedonic state: a geographically and temporally dense collection of updates from the social media platform Twitter, scored using a set of both human- and machine-trained sentiment analysis algorithms. Using this dataset, I find limited evidence of temperature effects on hedonic state in low temperatures and strong evidence of a sharp decline in hedonic state above 70◦F. This finding is robust across all measures of hedonic state and to a variety of specifications.

That is the job market paper (pdf) by Patrick Baylis, a job candidate from UC Berkeley.

And here is a new result that Canadians are more polite on Twitter, I wonder what happens if you control for temperature…

For the pointer I thank Samir Varma.

Arbel, Ben-Shahar, and Gabriel have a newly published paper on this topic, here is the abstract:

Research findings show that disabled persons often develop physical and psychological mechanisms to compensate for disabilities. Coping mechanisms may not be limited to the psychophysiological domain and may extend to cognitive bias and loss aversion. In this study, we apply unique microdata from a natural policy experiment to assess the role of loss aversion in home purchase among nondisabled and disabled households. Results of survival analysis indicate that the physically disabled are substantially less loss averse in home purchase. Furthermore, loss aversion varies with other population characteristics and attenuates with degree of disability. Findings provide new evidence of diminished cognitive bias and more rational economic decision-making among the physically disabled.

There are alternative versions of the paper here.

For the pointer I thank the excellent Kevin Lewis.

Obamacare in 2016

by on January 6, 2016 at 2:25 am in Current Affairs, Economics, Law, Medicine | Permalink

During the election season Democrats can’t admit Obamacare is broken and Republicans can’t admit it won’t be repealed.

An excellent post from Robert Laszewski, read the whole thing.

Death trends

by on December 22, 2015 at 2:09 am in Data Source, Law, Medicine, Political Science | Permalink

deathtrends

So, once you get past the mood affiliation, where is the big story?

Link here.

Yuval Levin has a very good piece on this, here is one bit:

They’re [the Democrats] no longer offering themselves up as a sacrifice to protect every last bit of the law[Obamacare], as they have done at enormous political cost for the last five years. Now, they’re spending their capital to protect key constituencies (and therefore themselves), even at the cost of allowing the structure of Obamacare to become even more incoherent and unsustainable.

There is a less polemic but still true version of that sentence, if you are so inclined.  Here is another bit:

…They’re thinking past Obamacare, like the Republicans are. Of course, Democrats have a different vision of what comes after Obamacare. Hillary Clinton has started articulating that vision here and there: It’s a move in the direction of the original Hillarycare from 1993, which would add on to elements of Obamacare stricter price controls and more federal micromanagement of the provision of care. (Scott Gottlieb considered what this might look like in National Affairs this summer.)

And this:

The omnibus bill contains a provision, identical to one in last year’s bill, which requires that risk-corridor payments in the Obamacare exchanges be budget neutral.

That will make Obamacare much more difficult to manage.

Furthermore, in the bill Congress restricts federal funding for CRISPR.

Here is a more general piece on the Omnibus.  Overall I would say a lot of gridlock is gone, the Republicans have returned to being bigger spenders, and no one in town — once again — worries about the deficit.  The sequester was a very temporary victory.

A handful of firms are offering employees free or subsidized tests for genetic markers associated with metabolism, weight gain and overeating, while companies such as Visa Inc., Slack Technologies Inc., Instacart Inc. recently began offering workers subsidized tests for genetic mutations linked to breast and ovarian cancer.

The programs provide employees with potentially life-saving information and offer counseling and coaching to prevent health problems down the road, benefits managers say.

Screening for genetic markers linked to obesity is the latest front in companies’ war on workers’ weight woes.

Obesity-related conditions such as Type 2 diabetes comprise a large share of overall health-care costs, estimated to run more than $12,000 a worker this year, according to a recent survey from Towers Watson and the National Business Group on Health.

Employers are hoping to help bend the cost curve—and make their workers healthier—by more aggressively targeting obesity and coaxing workers to lose weight.

Fortunately, none of that information ever will be used against the interests of workers, nor will any worker face pressure, explicit or implicit, to submit to such a test…

The story is here, here is another path in.

Consider Arlington, Va., our best guess for where you might be reading this article.

That is from an excellent NYT piece on health care and prices.  The very interesting original research is here (pdf), main point is that where (properly adjusted) Medicare spending is high is surprisingly uncorrelated with where private health care spending is high.  Furthermore policy may have been encouraging too many hospital mergers.

Here is Kevin Drum summarizing the study’s results on the importance of competition.