Category: Medicine

Maybe British common law wasn’t so great for colonies after all

Legal Origins and Female HIV

Siwan Anderson

More than one-half of all people living with HIV are women, and 80 percent of all HIV-positive women in the world live in sub-Saharan Africa. This paper demonstrates that the legal origins of these formerly colonized countries significantly determine current-day female HIV rates. In particular, female HIV rates are significantly higher in common law sub-Saharan African countries compared to civil law ones. This paper explains this relationship by focusing on differences in female property rights under the two codes of law. In sub-Saharan Africa, common law is associated with weaker female marital property laws. As a result, women in these common law countries have lower bargaining power within the household and are less able to negotiate safe sex practices and are thus more vulnerable to HIV, compared to their civil law counterparts. Exploiting the fact that some ethnic groups in sub-Saharan Africa cross country borders with different legal systems, we are able to include ethnicity fixed effects into a regression discontinuity approach. This allows us to control for a large set of cultural, geographical, and environmental factors that could be confounding the estimates. The results of this paper are consistent with gender inequality (the “feminization” of AIDS), explaining much of its prevalence in sub-Saharan Africa.

That is from the latest American Economic Review.  Here is an earlier version and related material.

Why is there no lead-homicide connection in Eastern Europe?

Children growing up in former communist CEE countries during the 1980s were subjected to horrific amounts of industrial pollution, including extreme levels of prolonged lead exposure. Since lead is theorized to be a primary culprit in exacerbating violent crime, you would assume there would be a sizeable discrepancy in the homicide rate between, say, former East Germany and West Germany, or Western Europe and Eastern Europe as a whole. But the difference in the homicide/violent crime rate is negligible, with many former communist CEE countries having a lower homicide rate than Western Europe. I suspect the same is true when comparing the rate of mental disorders, which is another malady that is supposedly influenced by exposure to high levels of industrial pollution.

https://object.cato.org/sites/cato.org/files/serials/files/cato-journal/1992/11/cj12n2-2.pdf

That is from commentator Aurel at SSC.

Markets in everything

Meditation app Calm provides what it calls “bedtime stories for grown-ups” (an eclectic mix of lullabies, fairy tales, and short stories in audiobook form). But it’s now added highlights from the GDPR legislation to its roster, narrated aloud by former BBC radio announcer Peter Jefferson, who is famous in the UK for his readings of the Shipping Forecast — a nightly maritime weather report that’s cherished by non-maritime listeners for its repetitive and ritual qualities.

Jefferson doesn’t read the entire legislation (“which would take more than all night”), but he picks out more than half an hour of material, which is enough to send anyone to sleep. You can listen to an excerpt for yourself below, or download the app from Google Play or the App Store. Unfortunately, you have to pay to unlock the full GDPR reading (and a number of other Calm features), but you can test them all with a seven-day free trial.

Here is more, via the excellent Samir Varma.

Dental DNA Beatle rent-seeking markets in everything

A DENTIST who bought John Lennon’s tooth is looking for potential love children of the late-Beatle in a bid to stake a claim to his £400million estate.

Dr Michael Zuk, 45, from Alberta, Canada, purchased the legendary songwriter’s decayed molar at auction in 2011 for around £20,000…

Speaking with The Sun Online, the dentist has sensationally revealed that he plans to stake a claim to the music icon’s vast estate using DNA from the body part.

He said: “I am looking for people who believe they are John Lennon’s child and have a claim to his estate and hopefully I can legitimise their claim.

“John was a very popular guy who was having sex with lots of women and I doubt birth control was on his mind.

…“I would ask anyone who is participating to sign a commission agreement which would mean if they were related they would pay my company a percentage of their inheritance.

“Like a finder’s fee.”

Here is the story, via Michael J.

P.s. Solve for the equilibrium.

Minimum wage up, fringe benefits down

Gordon Tullock used to make this claim, as have I on many occasions:

This paper explores the relationship between the minimum wage, the structure of employee compensation, and worker welfare. We advance a conceptual framework that describes the conditions under which a minimum wage increase will alter the provision of fringe benefits, alter employment outcomes, and either increase or decrease worker welfare. Using American Community Survey data from 2011-2016, we find robust evidence that state-level minimum wage changes decreased the likelihood that individuals report having employer-sponsored health insurance. Effects are largest among workers in very low-paying occupations, for whom coverage declines offset 9 percent of the wage gains associated with minimum wage hikes. We find evidence that both insurance coverage and wage effects exhibit spillovers into occupations moderately higher up the wage distribution. For these groups, reductions in coverage offset a more substantial share of the wage gains we estimate.

That is from a new NBER working paper by Jeffrey Clemens, Lisa B. Kahn, and Jonathan Meer.

Legalize pot, but don’t normalize it

That is the topic of my latest Bloomberg column.  Here is one bit:

You might wonder why we should be so worried about public marijuana use. To put it bluntly, I see intelligence as one of the ultimate scarcities when it comes to making the world a better place, and smoking marijuana does not make people smarter. Even if you think there is no long-term damage, right after smoking a person is less able to perform most IQ-intensive tasks (with improvisational jazz as a possible exception). By having city streets filled with pot, pot stores and the odor of pot, we are sending a signal that our society isn’t so oriented toward the intellect or bourgeois values. Even if that signal is reflecting a good bit of truth, it would be better not to acknowledge it too openly, just as most advocates of legalized prostitution don’t want to allow brothels on Main Street.

Basically I want full legality, but in some locales (California, Colorado) stronger restrictions on its place in the public sphere.  Do read the whole thing.

Money for Blood is Good for All

The Economist: For years [Barzin Bahardoust] has been trying to pay Canadians for their blood plasma—the viscous straw-coloured liquid in blood that has remarkable therapeutic powers. When his firm, Canadian Plasma Resources (CPR), tried to open clinics in Ontario in 2014, a campaign by local activists led to a ban by the provincial government on paid plasma collection. Undeterred, he tried another province, Alberta—which also banned the practice last year. Then, on April 26th, when CPR announced a planned centre in British Columbia, its government said it too was considering similar legislation. CPR has managed to open two centres, in far-flung Saskatchewan and New Brunswick. Even these have faced opposition.

The global demand for plasma is growing, and cannot be met through altruistic donations alone. Global plasma exports were worth $126bn in 2016—more than exports of aeroplanes.

…Only countries that pay for plasma are self-sufficient in it. (Italy, where donors are given time off work, is close to self-sufficiency.) Half of America’s plasma is shipped to Europe—20m contributions-worth. Canada imports 80% of its plasma products from America. Australia imports 40% of its plasma products, too.

It’s a very odd “ethical policy” that leads Canadian provinces to ban paying Canadians for plasma but then import paid plasma from the United States. I am one of the signatories (along with Al Roth, Vernon Smith and Gerald Dworkin among others) of a letter that argues for the efficiency and ethics of allowing compensation for blood plasma donation. The Economist riffs of this letter in a very good op-ed:

The aversion to paid plasma rests on three reasonable-sounding but largely groundless propositions. The first is that it is unsafe. Payment might encourage donors to conceal dangerous behaviour—such as intravenous drug use. In the 1980s and 1990s, tainted blood products infected half the world’s haemophiliacs with HIV, along with tens of thousands of plasma donors in China. But modern plasma products do not carry such risks. They are heat-treated and bathed in chemicals to sanitise them (an impossibility for blood for transfusion). Since the adoption of these techniques there has not been a single case of transmission of HIV or hepatitis via plasma products. Doctors agree that plasma products from paid donors are just as safe as those from unpaid ones.

A second argument is that, if people are paid for their plasma, fewer will volunteer to donate whole blood for transfusions. (Paying for whole blood would be unwise, since it cannot be sterilised as plasma can.) But there is no evidence that paying for plasma diminishes the supply of donated blood. That is why, in Canada, more than 30 economists and philosophers wrote an open letter arguing against bans on paid plasma. Americans voluntarily donate as much blood per person as do Canadians.

A third argument is that paying for plasma preys on the poor. It is possible that those selling plasma need the money and therefore might give too often. In America plasma donors can give twice a week; those in Europe can give just once a week. There is no evidence of harm to their health in either case, but more long-term study would be prudent.

Those against allowing payment suggest using voluntary donors instead. Yet every country that does not pay ends up importing plasma. And the fact that America is by far the dominant supplier carries risks of its own. The dependence on a single source leaves the rest of the world vulnerable to an interruption of supply. To protect their people, therefore, other governments need to diversify their supplies of plasma. Paying for it would make a big difference.

Euthanasia and bargaining power within the family

Let’s say more of the world moves to a Netherlands-style euthanasia law.  While euthanasia is at first based on individual consent, it usually evolves into a “in unclear cases your spouse or guardian has the actual say.”

How will this affect bargaining power within the family?  Here are a few options:

1. Family members will be much nicer to each other, ex ante, so they will be kept around for longer if they come down sick.

1b. Because of time consistency problems, family members won’t be much nicer with each other.

1c. You fear that family members aren’t willing enough to pull the plug on you, so you become actively less nice.

2. Family members will be much more anxious with each other, because they will so often be wondering how the others will wish to dispose of them, and when.

3. Some family members will make explicit ex ante deals, such as: “You can send me to my doom when the time comes, with a clear conscience, but on Tuesday nights we’re going to watch my game shows, not your reality TV.”

4. “It stresses me out that you are stressed out over my dying, so I will apply for euthanasia right here and now, even though I still have nine months to live with my cancer.  Except I will tell you that I just don’t want to live any longer, so you don’t feel bad about why I am doing this.”

5. You have no family and given your illness you are a net revenue drain on your nursing home.  If you go back to live out your final days, you’ll end up with the worst room and less spicy food and no private TV.  You agree to euthanasia, granted that they send $20,000 to your favorite charity.  You leave this earth with a warm glow, feeling that 20k probably saved at least one life.  In reality, with p = 0.68 it subsidized someone’s overhead.

What else?

Sex Redistribution and Disability

I am surprised that the subject of sex and disability has not arisen in the controversy surrounding Robin Hanson’s and Ross Douthat’s remarks on sex redistribution. The subject is one of active debate in the literature on medical ethics. Bioethicist Jacob Appel writing in the Journal of Medical Ethics in 2010 argued:

If sexual pleasure is a fundamental right, as this author believes, then jurisdictions that prohibit prostitution should carve out narrow exceptions for individuals whose physical or mental disabilities make sexual relationships with non compensated adults either impossible or high unlikely.

…A second area in which reform is desperately needed is the ‘no sex’ policies that exist in American nursing facilities, mental hospitals and group homes. Many such facilities require the doors of patients’ rooms to be open at all times, making intimacy all but impossible. The assumption underlying these restrictions is that anything short of clearly expressed wishes by a fully competent and rational individual does not fulfil a minimum standard to consent to sexual relations. The principle advanced by this approach is that institutionalised individuals require a higher degree of protection than those living outside of institutions. In many matters, this is certainly the case. However, in regard to sexual relations, this ‘higher’ standard often serves as an obstacle to meeting both the wishes and interests of individuals who cannot conform to ‘real world’ standards of consent.

More challenging than a ‘negative rights’ conception of sexual liberty is one that also embraces a ‘positive right’ to sexual pleasure for the disabled–either for those individuals who are too impaired to find mates and/or those who are so physically incapacitated that they are incapable of pleasuring themselves. Several European nations, including Germany, The Netherlands, Denmark and Switzerland, allow limited ‘touching’ services for the severely disabled through non-profit organisations.

In the UK charities exist to help match sex workers with the disabled. Similar services are available in Denmark and in the Netherlands and in those countries (limited) taxpayer funds can be used to pay for sexual disability services. The Green party has proposed such services elsewhere:

A German politician has sparked controversy by suggesting people with severe disabilities could receive “sexual assistance” paid for by the state.

The Green party’s spokeswoman for age and care policy, Elisabeth Scharfenberg, said the government could “provide grants” for sexual services to disabled people who cannot achieve satisfaction by any other means.

Such a system is currently operating in Denmark and the Netherlands, where certified “sexual assistants” with special training conduct visits to disabled people who cannot afford to pay themselves.

Regardless of the answers one gives, I think these are legitimate questions of profound and deep importance to the people involved. It’s unfortunate and wrong that someone who brings these issues to the public forum is denounced and called creepy. We can and should do better.

One estimate of the rate of return on pharma

…return on investment in pharma R&D is already below the cost of capital, and projected to hit zero within just 2 or 3 years. And this despite all efforts by the industry to fix R&D and reverse the trend.

That is from Kelvin Stott.  Keep in mind this is during a time when global demand has been growing, which suggests the supply side is all the more constipated.

Equality is a mediocre goal, aim for progress

That is the title of my latest Bloomberg column, here is one excerpt:

Take this all a step further and imagine that the next 30 years brings an enormous blossoming of medical innovation, outpacing the general rate of economic growth. Government revenue then might not grow rapidly enough to cover all or even most of these new medical miracles, some of which will be quite expensive, especially in their early stages. Governments will decline to cover more and more care.

This fiscal crunch is all the more likely if people live much longer but cannot work enough longer to fund their newly extended retirement spans.

To date, so much of the health care debate has been about whom to cover. Over time, it may be more and more about what to cover. It could be that all the citizens will have nominally the same insurance coverage, whether subsidized or guaranteed, but many medical and mental-health conditions will fall outside this coverage —  leading to rampant inequalities in access.

It’s the best problem to have. It means that medical innovation has arrived at a very high rate. If we enter the future being able to cover most medical treatments with reasonable equality, that would be a sign we failed at the task of progress. In other words, successful futures are likely to be highly unequal futures, again because medical innovation will have outpaced government revenue. (Innovations that extend working years would ameliorate this effect by adding to government revenue.)

Do read the whole thing.

My Conversation with Balaji Srinivasan

Here is the transcript and audio, and this is the intro:

Marc Andreessen has described Balaji as the man who has more good ideas per minute than anyone else in the Bay Area. He is the CEO of Earn.com, where we’re sitting right now, a board partner at Andreessen Horowitz, formerly a general partner. He has cofounded the company Counsyl in addition to many other achievements.

Here is one excerpt:

COWEN: Why is the venture capital model so geographically clustered? So much of it is out here in the Bay Area. It’s spreading to other parts of the country. Around the world, you see Israel, in some ways, as being number two, per capita number one. But that’s a very small country. Why is it so hard to get venture capital off the ground in so many areas?

SRINIVASAN: That’s actually now changed with the advent of ICOs and Ethereum and crypto. Historically, the reason for it was companies would come to Sand Hill Road. One maybe slightly less appreciated aspect is, if you come to Sand Hill Road and you get VC financing, the VC who invests in your company typically takes a board seat. A VC does not want to fly 6,000 miles for every board seat if they’ve got 10 board seats and four board meetings a year per company.

What a VC would like in general, all else being equal, is for you to be within driving distance. Not only does that VC like it, so does the next VC in the B round and the next VC in the C round. That factor is actually one of the big things that constrains people to the Bay Area, is VC driving distance, [laughs] because VCs don’t want to do investments that are an entire world away.

With the advent of Ethereum and ICOs, we have finally begun to decentralize the last piece, which was funding. Now, that regulatory environment needs to be worked out. It’s going to be worked out in different ways in different countries.

But the old era where you had to come to Sand Hill to get your company funded and then go to Wall Street to exit is over. That’s something where it’s going to increasingly decentralize. It already has decentralized worldwide, and that’s going to continue.

COWEN: With or without a board seat, doesn’t funding require a face-to-face relationship? It’s common for VC companies to even want the people they’re funding to move their endeavor to the Bay Area in some way, not only for the board meeting. They want to spend time with those people.

We’re doing this podcast face to face. We could have done it over Skype. There’s something significant about actually having an emotionally vivid connection with someone right there in the room. How much can we get around that as a basic constraint?

And here is another:

COWEN: Right now, I pay financial fees to my mutual funds, to Merrill Lynch, all over. Anytime I save money, I’m paying a fee to someone. Which of those fees will go away?

SRINIVASAN: Good question. Maybe all of them.

And:

COWEN: Drones?

SRINIVASAN: Underrated.

COWEN: Why? What will they do that we haven’t thought of?

SRINIVASAN: Construction. There’s different kinds of drones. They’re not just flying drones. There’s swimming drones and there’s walking drones and so on.

Like the example I mentioned where you can teleport into a robot and then control that, Skype into a robot and control that on other side of the world. That’s going to be something where maybe you’re going to have it in drone mode so it walks to the destination. You’ll be asleep and then you wake up and it’s at the destination.

Drones are going to be a very big deal. There’s this interesting movie called Surrogates, which actually talks about what a really big drone/telepresence future would look like. People never leave their homes because, instead, they just Skype into a really good-looking drone/telepresent version of themselves, and they walk around in that.

If they’re hit by a car, it doesn’t matter because they can just rejuvenate and create a new one. I think drones are very, very underrated in terms of what they’re going to do. 

Do read or listen to the whole thing.

Let the boy Brexit!

Pope Francis has been praying for the British toddler Alfie Evans — and the Italian government has granted the child Italian citizenship and lined up a transportation plan that could swiftly bring the sick little boy to a Vatican hospital.

But Alfie’s doctors say he cannot be healed, and shouldn’t make the trip at all.

On Tuesday, according to lawyers representing Alfie’s family, a British judge sided with the doctors, saying that the family cannot accept the offer to take Alfie to the Vatican for treatment.

Here is the full story.  The boy’s situation is dire, but he has not even received a definitive diagnosis from the British doctors.

Why are so many graduate students depressed?

PhD and master’s students worldwide report rates of depression and anxiety that are six times higher than those in the general public (T. M. Evans et al. Nature Biotech. 36, 282–284; 2018). The report, based on the responses of 2,279 students in 26 nations, found that more than 40% of respondents had anxiety scores in the moderate to severe range, and that nearly 40% showed signs of moderate to severe depression.

That is from this summary statement.  Here is the original piece.  So what might be going on here?

1. The ordeal of studying and possibly finishing is extreme, and extreme ordeals depress people.  This seems inconsistent with other evidence, however, namely rising (reported) rates of depression in prosperous, comfortable societies.

2. The task of studying and possibly finishing is correlated with a kind of extreme lassitude, and that in turn is correlated with depression.

3. Graduate students become depressed as they realize they have chosen poor life paths.

4. Graduate students become depressed as they realize, a’la Caplan, that it is mostly about signaling.

5. Graduate students are undergoing a transformation of their personalities, and being turned into intellectual elites, but this process is traumatic in several regards, thus leading to frequent depression.  The chance of depression is part of the price of admission to a select club.

6. Our graduate institutions serve women poorly (women in graduate school experience depression at higher rates — 41% vs 35% for the men).

7. It’s all just sample bias, as depressed graduate students have nothing better to do than respond to this survey.

What else?  And how much should we regard these results are symptoms of a deeper malaise?  Or is the problem confined mainly to academic life?