On average, patients get about 11 seconds to explain the reasons for their visit before they are interrupted by their doctors. Also, only one in three doctors provides their patients with adequate opportunity to describe their situation…
In just over one third of the time (36 per cent), patients were able to put their agendas first. But patients who did get the chance to list their ailments were still interrupted seven out of every ten times, on average within 11 seconds of them starting to speak. In this study, patients who were not interrupted completed their opening statements within about six seconds.
Now solve for the telemedicine equilibrium.
Scientific output is not a linear function of amounts of federal grant support to individual investigators. As funding per investigator increases beyond a certain point, productivity decreases. This study reports that such diminishing marginal returns also apply for National Institutes of Health (NIH) research project grant funding to institutions. Analyses of data (2006-2015) for a representative cross-section of institutions, whose amounts of funding ranged from $3 million to $440 million per year, revealed robust inverse correlations between funding (per institution, per award, per investigator) and scientific output (publication productivity and citation impact productivity). Interestingly, prestigious institutions had on average 65% higher grant application success rates and 50% larger award sizes, whereas less-prestigious institutions produced 65% more publications and had a 35% higher citation impact per dollar of funding. These findings suggest that implicit biases and social prestige mechanisms (e.g., the Matthew effect) have a powerful impact on where NIH grant dollars go and the net return on taxpayers investments. They support evidence-based changes in funding policy geared towards a more equitable, more diverse and more productive distribution of federal support for scientific research. Success rate/productivity metrics developed for this study provide an impartial, empirically based mechanism to do so.
Simplifiers give one a better overall picture of how the world works, whereas constructors are trying to build something. The balance seems to be shifting, for instance in physics:
Within the Physics label…we find the simplifiers dominated three quarters of the Nobel Prizes from 1952 to 1981, but more recently constructors have edged the balance with more than half of those from 1982 to 2011.
There is also a shift toward constructors in chemistry, though it is less abrupt. In the fields of physiology and medicine, however, simplifiers reign supreme and there has been no shift across time. Three-quarters of the prizes are still going to simplifiers.
Does that mean we should be relatively bullish about progress in those areas, based on forthcoming fundamental breakthroughs?
All these points are from Jeremy J. Baumberg’s new and interesting The Secret Life of Science: How It Really Works and Why It Matters.
I will be doing a Conversation with Tyler with him, no associated public event. Here is his home page, and the About section. Here is Wikipedia on Pollan. Here is a Sean Iling Vox interview with Pollan, on his recent work on LSD and other psychedelics, and his most recent book is How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence. Pollan is perhaps best known for his books on food, cooking, and food supply chains.
So what should I ask him?
It’s well known that a large faction of medical spending occurs in the last 12 months of life but does this mean that the money spent was fruitless? Be careful as there is a big selection effect–we don’t see the people we spent money on who didn’t die. A new paper in Science by Einav, Finkelstein, Mullainathan and Obermeyer finds that most spending is not on people who are predicted to die within the next 12 months.
That one-quarter of Medicare spending in the United States occurs in the last year of life is commonly interpreted as waste. But this interpretation presumes knowledge of who will die and when. Here we analyze how spending is distributed by predicted mortality, based on a machine-learning model of annual mortality risk built using Medicare claims. Death is highly unpredictable. Less than 5% of spending is accounted for by individuals with predicted mortality above 50%. The simple fact that we spend more on the sick—both on those who recover and those who die—accounts for 30 to 50% of the concentration of spending on the dead. Our results suggest that spending on the ex post dead does not necessarily mean that we spend on the ex ante “hopeless.
…”Even if we zoom in further on the subsample of individuals who enter the hospital with metastatic cancer…we find that only 12% of decedents have an annual predicted mortality of more than 80%.
Thus, we aren’t spending on people for whom there is no hope but it doesn’t follow that it’s the spending that creates the hope. What we really want to know is who will live or die conditional on the spending. And to that issue this paper does not speak.
I will be doing a Conversation with her (no associated public event), if you don’t already know here is Wikipedia on Claire:
Claire Lehmann is an Australian psychologist, writer, and the founding editor of Quillette.
Lehmann founded Quillette in October 2015, with the goal of publishing intellectually rigorous material that makes arguments or presents data not in keeping with the contemporary intellectual consensus.
So what should I ask her?
Dane emails me:
This is a speculative solve-for-the-equilibrium-type question that I’d love to get your thoughts on:
Imagine there was a technology that allowed essentially frictionless harvesting, selling, and buying of (non-perishable) human sleep. Essentially, anyone can strap in to a machine, be put to sleep, and their time/sleep would be harvested in a way that their time sleeping could be used by anyone else who would then get all the benefits of that sleep but instantaneously instead of sleeping themselves, maybe through a painless injection or a drink perhaps.
Imagine also that this technology was relatively non-capital-intensive, or at least, cheap enough that all humans were potential suppliers/buyers of sleep. Call them sleep-workers and sleep-consumers.
Additionally, there’s nothing “free” about the technology. Any sleep-worker’s or sleep-consumer’s lifespan would be unaffected in terms of calendar time. Instead, there would be a zero-sum transfer of waking hours between persons. Even an “around-the-clock” sleep-worker could only net 16 hours of saleable sleep per day. The other 8 hours would have to go to meeting their own sleep needs.
How would this market evolve? How would society evolve? What is the market price for an hour of sleep? How would norms around sleep-working and sleep-consuming evolve? How would the economic indicators evolve (GDP, productivity, inequality, etc)? Which jobs could or could not compete with non-consciousness? How would the welfare state then evolve? How much inter-temporal saving of sleep would there be? Should prisoners be allowed to sleep-harvest for their entire sentences? Would we allow them? Would it be ethical to farm never-conscious humans for the sole purpose of harvesting sleep? Etc…
I will be having a Conversation with her, here is part of her Ordre de Montréal citation:
Ms. Dawson is autistic and has never attended university as a student. In the early 2000s, faced with the devastating effects of human rights violation based on her diagnosis, she started learning about autism science, ethics, and law.
Since 2004, she has been affiliated with the Université de Montréal’s autism research group. Despite her lack of formal education and the precariousness of her situation, she has collaborated widely with academics here at home and around the world, and made original contributions to autism research in scientific journals, encyclopedias, scholarly books, and conference presentations. She has also used social media to promote better standards in autism research.
Her work has contributed to the advancement of knowledge in several areas, including perception, cognition, learning, and intelligence in autism. She has documented the poverty of scientific and ethical standards in autism intervention research, and the resulting harm to autistic people. Contrary to long-entrenched views, she believes that autistics deserve the same basic rights as the rest of humanity. She also believes that in research, as elsewhere, autistic and non-autistic people should work together as equals.
So what should I ask her?
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.
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.
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.
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.
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.
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.