I calibrate the [spatial] model to the U.S. economy and find that the rise in regulation accounts for 23% of the increase in wage dispersion and 85% of the increase in house price dispersion across metro areas from 1980 to 2007. I find that if regulation had not increased, more workers would live in productive areas and output would be 2% higher. I also show that policy interventions that weaken incentives of local governments to restrict supply could reduce wage and house price dispersion, and boost productivity.

That is from Andrii Parkhomenko (pdf), a recent job candidate, there are 62 pp. at the link, and for the pointer I thank Tyler Ransom.

Here is a related column by Noah Smith.

Thursday assorted links

by on May 18, 2017 at 11:52 am in Uncategorized | Permalink

BMJ: In a national sample of elderly Medicare beneficiaries admitted to hospital with medical conditions, we found that patients treated by older physicians had higher 30 day mortality than those cared for by younger physicians, despite similar patient characteristics. These associations were found among physicians with low and medium volumes of patients but not among those with high volumes.

…Our findings suggest that within the same hospital, patients treated by physicians aged <40 have 0.85 times the odds of dying (1.00/1.17) or an 11% lower probability of dying (10.8/12.1), compared with patients cared for by physicians aged ≥60 (table 2⇑). This difference in mortality is comparable with the impact of statins for the primary prevention of cardiovascular mortality on all cause mortality (odds ratio of 0.86)39 or the impact of β blockers on mortality among patients with myocardial infarction (incidence rate ratio of 0.86),40 indicating that our observed difference in mortality is not only statistically significant but arguably clinically significant. In addition, if our results are causal, an adjusted risk difference of 1.3 percentage points suggests that for every 77 patients treated by doctors aged ≥60, one fewer patient would die within 30 days of admission if those patients were cared for by physicians aged <40.

The paper has data on over 700,000 Medicare admissions and over 18 thousand hospitalist physicians. Physicians are assigned to patients more or less randomly depending on admission time so there are no significant differences between patients assigned to younger and older physicians. Older physicians are more likely to be male and, of course, to be trained during a different time period so the paper can’t fully distinguish age effects from cohort effects. The authors do find that older physicians who work a lot perform well–perhaps these physicians update their training or perhaps they are a self-selected vigorous sample. Continuing medical education and assessment requirements are probably very valuable.

Hat tip: Eric Topol.

Sentences to ponder

by on May 18, 2017 at 3:17 am in Current Affairs | Permalink

National Security Council officials have strategically included Trump’s name in “as many paragraphs as we can because he keeps reading if he’s mentioned,” according to one source, who relayed conversations he had with NSC officials.

This second bit I am fully in accord with:

Trump likes to look at a map of the country involved when he learns about a topic.

Here is the Reuters article, via Brad Jaffy and Brendan Nyhan.

That title made me think of the woodchuck…anyway, here is the abstract:

Fact-checking has gained prominence as a reformist movement to revitalize truth-seeking ideals in journalism. While fact-checkers are often assumed to code facts accurately, no studies have formally assessed fact-checkers’ performance. I evaluate the performance of two major online fact-checkers, Politfact at Tampa Bay Times and Fact Checker at Washington Post, comparing their interrater reliability using a method that is regularly utilized across the social sciences. I show that fact-checkers rarely fact-check the same statement, and when they do, there is little agreement in their ratings. Approximately, 1 in 10 statements is fact-checked by both fact-checking outlets, and among claims that both outlets check, their factual ratings have a Cohen’s κ of 0.52, an agreement rate much lower than what is acceptable for social scientific coding. The results suggest that difficulties in fact-checking elites’ statements may limit the ability of journalistic fact-checking to hold politicians accountable.

That paper (pdf) is by Chloe Lim, political science at Stanford.  For the pointer I thank Andrew Hall, some interesting political science papers on his home page.  Here is his very interesting book manuscript on how the devaluing of political offices drives polarization, worthy of a top publisher…

Wednesday assorted links

by on May 17, 2017 at 1:48 pm in Uncategorized | Permalink

Vix is up 16% today, a sign that a Trump presidency is now seen as having a much more uncertain future.  I agree with Charles Cooke that the 25th amendment is not really an option, nonetheless investigations will be proceeding, with the FBI and many Republicans not really on Trump’s side.  It is not obvious that Trump will handle himself well during that process.  The chances for tax and health care reform are dwindling.  Many Republican leaders are pondering the logic of Timur Kuran, namely when they should flip out of their preference falsification and state their real views.

I think also that Trump’s instructions to Comey to halt the Flynn prosecution are significant.  I view much of the press coverage as overstated or sometimes even hysterical, including for the Russia leaks, but the Comey business fits into the category of “impeachable offense.”  A normal president would not be impeached for it, but Trump is not a normal president.  The instructions to Comey would not be the actual reason he would be impeached, but they create a path along which an impeachment inquiry could proceed, nudged along by other “non-impeachable but unpopular and objectionable actions” Trump might take in the meantime, and what information might be revealed in the meantime.  There are many shoes yet to drop.  So my estimate of the chances of a Trump impeachment or resignation have gone up from about 5% to about 25%, in less than a two-day span.

Addendum: Do consider the remarks of Philip Wallach.

Here’s an excellent story about Chris Carr who played in the NFL for 10 years and is now about to graduate from law school. That’s unusual but not so unusual, the late U.S. Supreme Court Justice Byron R. White also played in the NFL. What makes this story special is that Carr will specialize in immigration law. Why?

Carr grew interested in immigration law a few years ago, after reading Thomas Sowell’s “Ethnic America.” (“A really cool book,” he said.) That made him reflect on the country and “just how unique the American experiment was.” He read blog posts by Bryan Caplan, an economist at George Mason University, and the writing of Michael Huemer, a philosophy professor at the University of Colorado.

Hat tip: Fabio Rojas.

Hemingway: 80

Twain: 81

Melville: 126

Austen: 128

J.K. Rowling: 140

E L James: 155

That is from the new and interesting Nabokov’s Favorite Word is Mauve, by Ben Blatt.  The Hemingway book with the highest usage rate for -ly adverbs, True at First Light, was released only after his death and is considered one of his worst works.  The same pattern is true for Faulkner and Steinbeck, namely that the most highly praised works have relatively low rates of -ly adverb usage.  Among other notable authors surveyed, D.H. Lawrence seems to be the most obvious exception to this regularity.

In the novel The Hobbit, J.R.R. Tolkien used the word “she” only once.  In The Prime of Miss Jean Brodie, however, she relative to he is used 79% of the time, the highest ratio of the classics surveyed.  Female authors are very strongly represented on that side of the curve, let me tell you.  And male authors do the “he” far more, in relative terms, than female authors do the “she.”

You also will learn from this book that David Brooks starts more sentences with “The” than any other word, whereas for Paul Krugman that place of honor goes to “But.”  And, for better or worse, Krugman uses far less anaphora.

D.H. Lawrence leads for the number of animal similes.

That is the query motivating my latest Bloomberg column, here is one bit:

Second, the higher health-care spending for women is partly because of services related to childbearing. Society may have an obligation to help out babies (and mothers), plus they will someday finance our retirement, so let’s make childbearing easy. That said, governments have numerous means of subsidizing childbearing — direct payments, tax credits, free clinical services and public education — and it’s not obvious that regulating insurance pricing is this best way to achieve this end.

And:

Uniform pricing also gives insurance companies less incentive to attract female policyholders. To be sure, as a matter of law the companies cannot turn women away. But if writing policies for women is less profitable, or perhaps unprofitable altogether, the insurance companies will allow or encourage their provider networks to evolve in a way that is more attractive to men than to women. Services for women, including for childbearing, might end up underprovided or stagnate in quality. That also would be a kind of differential treatment, with potentially dire consequences.

There is much more at the link, controversial throughout.  You’ll find plenty of overwrought reactions on Twitter, simply because I am saying there is a trade-off, and we do not yet know what is the right margin to seek.

Tuesday assorted links

by on May 16, 2017 at 2:26 pm in Uncategorized | Permalink

A British prison has become the world’s first to use a new system designed to stop drones flying over perimeter walls to drop contraband into jails.

The device creates a 2,000ft (600m) shield around and above a prison that will detect and deflect the remote-controlled devices.

It uses a series of “disruptors”, which are sensors to jam the drone’s computer, and block its frequency and control protocols. The operator’s screen will go black and the drone will be bounced back to where it came from.

Drones have become a major security problem in Britain’s prisons and are increasingly used to smuggle in drugs, weapons, phones and other valuables.

The new system, called Sky Fence, is being introduced at Les Nicolles prison on Guernsey, where around 20 “disruptors” will be installed on the perimeter and inside.

The Channel Island jail was initially going to install a drone detection system, but went a step further to put in the technology that stops drones in-flight.

Here is the article, via Tyro.  By the way, the newly available BBC TV show, Planet Earth II, is an amazing illustration of the use of drones to track and film nature (that includes us!).

In The Failure of Solanezumab –How the FDA Saved Taxpayers Billions, an article in the NEJM, Sacks, Avorn and Kesselheim (SAK) defend the FDA by arguing that its high standards prevented the Alzheimer’s drug, Solanezumab, from being approved and thus saved the taxpayers billions in Medicare payments.

It is, of course, not the job of the FDA to approve or fail to approve a drug based on its effect on taxpayers. The FDA has historically stood independent of this kind of politics and that has been all to the good. But the SAK article is a reminder that under socialized medicine every FDA decision moves money from one patient group to another and between patients and taxpayers thus FDA decisions become a tempting leverage point to control allocation through collective choice.

I do not favor collective, which is to say politicized, choice and find much else objectionable in the SAK article–it attempts, for example, to evaluate a rule by examining a single decision when a system-wide, long-run analysis is called for. Rather than go into detail, however, let’s instead point to a much better article by Vradenburg, Fillit, Morgan, Sabbagh, Aisen, and Mohs, a group of leading physicians and scientists who treat Alzheimer patients and research the disease.

Rather than support or criticize an isolated FDA decision, Vradenburg et al. call for a change to the rule/norm currently used to evaluate Alzheimer’s drugs:

The analysis…recommends that the FDA approve new medicines that demonstrate a proven benefit on at least one therapeutic endpoint – either cognition or function. The current FDA standards require a new drug to show benefits on both proven endpoints, an unnecessarily challenging hurdle the authors say may be inhibiting investment in new Alzheimer’s treatments.

The authors make three excellent points about such a change. First:

…the success rate of drugs tested for Alzheimer’s disease has been extraordinarily low when compared with drugs in other therapeutic areas. Of the 244 compounds that were tested in 413 clinical trials between 2002 and 2012, only one resulted in approval of a new chemical entity, in 2003. No others have been approved since that time; the failure rate in clinical trials conducted over the last decade exceeds 99.6%. This staggeringly high failure rate has adversely impacted investment in Alzheimer’s disease research at precisely the time when new advances are most needed.

The failure rate reflects how difficult the problem is but also policy. Either way, when firms look at the billions of dollars in research and development that haven’t led to a single approved drug they are naturally wary about spending more. Breakthroughs don’t happen randomly, however, they happen after lots of trial and error. To stimulate such trial and error firms need revenues and thus to stimulate more swings at the bat it may be justified to approve drugs with relatively small benefits.

Second, as I have noted previously, the FDA needs to be careful not to commit an error of composition. Three ineffective drugs need not add up to an ineffective treatment.

Many drugs in development for Alzheimer’s disease have complementary mechanisms of action. Even if each of these might, individually, deliver a modest clinical benefit, when used in combination or adjunctively, the benefit could become more substantial. If the FDA were to reject, individually, several safe and well-tolerated therapies with complementary mechanisms of action that each demonstrate a modest clinical benefit, it would unwittingly deprive patients of potentially substantial advances in the quality of treatment over the long run with a combination of therapies.

Third, it is ultimately the patient that matters, especially with regard to Alzheimer’s where so much depends on the patient’s internal experiences, and thus we ought to be careful before rejecting their perspective:

The ultimate perspective on clinical meaningfulness, of course, comes from the patient….Efforts to identify what matters, what matters most and how much change matters to patients should become a priority for the field, focused on all stages of the disease. The requirements of the recently-passed 21st Century Cures Act are instructive in this regard.

Hat tip: Abhay Moghekar

Crunching data from disparate states, Mr Chinoy says state borrowing rose by a whopping 32% in the year to March 2017, after a 25% rise in the previous year…

Bihar, the country’s poorest, with a budget deficit of nearly 6% of its state GDP last year and a hole in its finances after it banned alcohol sales…

That is from The Economist.

About my earlier China post, from Harrison Searles of GMU:

On the comparison of China and Rome, one of the factors that immediately came to my mind was a combination of (2) and (4): The Roman Empire faced a much more complex logistical problem of maintaining territorial integrity than did China and its territorial integrity could be destroyed from a sea campaign.

These two themes actually did greatly contribute to Rome’s unraveling during the Crisis of the 5th Century: One of the under-appreciated aspects of the Crisis of the 5th Century that led to the Fall of the Roman Empire was the loss of North Africa to the Vandals. Peter Heather provides a short description of how destructive the loss of North Africa was to the empire in The Fall of the Roman Empire (2006):

“No other single blow could have done the Empire so much harm. At a stroke. Geiseric had removed from Aetius’ control the richest provinces of the Roman west, with the result that financial crisis looked How was it allowed to happen? Presumably, after four and a half years of relative peace, and thinking that Geiseric was going to keep the treaty made in February 435, people took their eyes off the ball. There was, I suspect, simply too much instability in other parts of the empire for troops to be left in Carthage on a ‘what if?’ basis. The Visigothic war in particular, brought to an end just before Geiseric made his move, had probably demanded every available man. So with the Carthage garrison at minimum strength, the cunning Vandal had taken full advantage.” (p. 289)

Here, I see the theme of (4) in your blog post: “[China] has a large space of relatively flat plains.” Chinese generals did not face the same complex logistical problems that Roman ones did in deploying their military force across their nation.

When North Africa was lost, retaking it to reassert territorial integrity was not as easy as simply marching a couple of legions there. If it were that easy, I very much doubt the Vandals could have held onto North Africa. Instead, the Roman Empire needed to launch a sea campaign, which is theme (2) of your post: “when it comes to naval warfare — more common for Europe — small countries have a chance to punch above their weight, witness England and Portugal.”

In 468 both the Western and Eastern Empires launched a massive joint campaign to take back North Africa. However, the armada they had launched was smashed at the Battle of Cape Bon by a much smaller Vandal fleet that had the weather gauge to its advantage. Punching above their weight, the Vandal kingdom of North Africa was able to beat back a campaign manned and funded by both Ravenna and Constantinople—a feat that would have been close to impossible on land.

The failure of that armada to land on North Africa doomed half of the Roman world to extinction, for without the North African provinces, the Western Roman Empire could not reassert its hegemony over the centrifugal forces now at full force across Gaul and Hispania. The difficulties of maintaining optimal deployments of troops in an empire largely bifurcated (at least in scale of importance) by a sea and the hazards of warfare at sea conspired to make the problem of maintaining imperial territorial integrity too difficult for Roman politics to solve during the Crisis of the 5th Century, contributing to the total collapse of that integrity in the west. Had the Western Roman Empire not been encumbered by (2) and (4) the survival of said integrity is certainly imaginable—and within the capability its resources offered it.