“What is wrong with physicians?” (from the comments)

My top candidates:

1. Loss of locus of control. People go into medicine to save lives. They believe that they will use their demonstrated intelligence and skills to make a difference. Unfortunately, modern medicine is ever more about turning physicians into box checkers. CPT codes, checklists, facility mandates, perpetual boards … a physician quickly loses control of their working day unless they are weird freaks who do extensively more work to retain control. And beyond that the average physician becomes enculturated to this much earlier. Which medical school you get into is largely a function of where you grew up, went to undergrad, and exactly how well you did on a test that everyone aces with a side of barely legal implicit racial quotas. Your residency is determined by where you went to medical school, where you went to medical school, where/what the top candidates want, and how well you did on a test that everyone aces with a side of barely legal implicit racial quotas. You spend a decade where your locus of control in life is minimal. Then you hit the real world and rather than being set free, you get hit by unending paperwork and yet a thousandth petty demand on your time. If you do research it is not uncommon to spend multiplicatively more time on compliance paperwork. If you head out to make money, you will find that your charge capture is more relevant than the quality of care you provide by an order of magnitude. All of this is a textbook case of loss of locus of control that we know is highly correlated with drug use and depression.

2. There is a wild disconnect between “being a physician” as understood by the public and what you actually live. The public thinks this is still the 1980s when you could pay for medical school working a summer job, residency was three years, and salaries were higher in real terms than they are today. Instead, physicians spend much closer to fifteen years going through training as the needed resume padding has grown at every step along the way. This means that they live longer at resident salaries which are close to US median, but typically are located in high population areas with expensive housing costs. And being a resident physician is not cheap. You have high commuting costs because the regs allow your boss to work you 24 out of 28 days. You can, and will, have weeks with over 100 hours of actual patient care. And again, remember that something like half of residencies are in violation of these rules. And all of this is while nursing a second mortage in undischargable medical school debt. Everyone will think you are rich and that you take fine vacations to Europe and the you will drive a flashy care. And maybe you will, but it will not be until after you are 40 and often 45 that the full physician lifestyle of the movies really comes into play.

3. And then we have the stakes. At every step in a physicians formative adult years you face massive ultra-high stakes events that we know are bad for mental health. College admissions (where you will hit a ceiling for medical schools if you get in too low), MCAT and medical school admissions (which will drastically lower your access to certain specialties if you end up having to go DO), Step and the Match (where you will spend five figures to beg for interviews, the folks on the other side will be unable to differentiate you from the thousands of other applicants, and when you get the interview the only thing of meaning that will come forth is if they like you and if you grew up nearby). Then you have boards and your first job. All of these are massively high stakes and they all require performing quite well relative to your peers. This sort of setup is known in experimental animals and people to lead to depression, anxiety disorders, and drug use.

3. Then we have the punctuated nature of the physician’s life. Going back to medical school, you routinely have long weeks with minimal time to enjoy because studying is rampant. Your entire career can theoretically hang on if you memorized which ultra-rare cancer is caused by which mutation in which gene – even if you want to be a psychiatrist. When you have time “off” this may be the only time you get and there is a very strong tendency toward binges and bacchanals. This will continue to residency where you might have one free weekend in a month (the others being taken up with working and studying), which again lends itself toward binging. And it may continue from there with horrid call schedules and long weeks punctuated by long vacations.

4. The stakes never get lower. You go through with your career riding on high stakes tests and your studying time never being accounted for in your official duties. Boards are now never ending and you face ever more theoretically threatening liability for your decisions.

5. And then there is the obvious stuff. Day in, day out you meet people at their worst. And all your coworkers are doing the same. People cry, threaten, swear, and otherwise abuse you. And nobody wants to get mad at somebody who was just paralyzed from the waist down. Likewise, you can only become so inured to death and dying, we are a social species with extremely large portions of our brains dedicated to feeling empathy for others, physicians see the 5% of humanity who is most obviously suffering as their modal patient.

6. Lastly, whatever you think about physician renumeration, it becomes painfully evident that the golden days were decades ago and there is a small army looking for ways to reduce your renumeration. It will fall disproportionately on you even when the major growth in medical expenses has been nursing, administration, and other warm bodies. Whatever you got paid for a highly taxing job last year, there will be a thousand signs that people think you should do it again for less. People who believe wholeheartedly in the stickiness of wages for reasons of morale and who hold that pay cuts are sufficiently difficult that we need to order international finance around inflation and obviating the need for explicit wage reductions will turn around and concoct wild schemes that explicitly reduce your income in real and nominal terms and question your character should your professional organization (to which you don’t belong) object. All, of course, while the administrators who are generally incompetent at understanding medical practice rake in an ever larger share of the money.

Some of this is US specific, but we have set up medicine to be highly backloaded with its rewards for physicians. We have risen the profession to a vocation and made it a truly arduous task to get through. And at every step along the way physicians have not had access to healthy coping mechanisms and repeated psychic injuries of the sort known to cause or exacerbate these conditions. Major life protective events (e.g. marriage, children, home ownership) are routinely delayed and disrupted by the demands of the training. Why again are we surprised that physicians come out bruised, batter, and willing to take the short term fix for some relief?

That is all from Sure.

The London Blitz and the NIMBYs

NIMBYs can be so bad that they make the London Blitz look good:

We exploit locally exogenous variation from the Blitz bombings to quantify the effect of redevelopment frictions and identify agglomeration economies at a micro-geographic scale. Employing rich location and office rental transaction data, we estimate reduced-form analyses and a spatial general equilibrium model. Our analyses demonstrate that more heavily bombed areas exhibit taller buildings today, and that agglomeration elasticities in London are large, approaching 0.2. Counterfactual simulations show that if the Blitz had not occurred, the concomitant reduction in agglomeration economies arising from the loss of higher-density redevelopment would cause London’s present-day gross domestic product to drop by some 10% (or £50 billion).

Here is the full paper by Gerard H Dericks and Hans R A Koster, via tekl.

Josh Angrist’s Nobel Prize Lecture

The Nobel prize lectures were online this year which gave Josh Angrist and MRU an opportunity to produce a Nobel prize lecture unlike any ever before! Josh gives a commanding yet down-to-earth talk with lots of graphics, animations and even a few guitar riffs! Indeed, Josh’s Nobel Prize lecture includes a clip from his MRU videos. Future Nobel laureates take note!

I’m also very happy that Josh focused much of his lecture on his very important work on charter schools. Watch for the stunning graph showing how Boston charter schools close the black-white achievement gap.

Josh’s work with MRU has really paid off on camera! Congrats Josh!

David Card gives a more traditional but very good lecture. Guido Imbens lecture is excellent and nicely complements Josh’s lecture and also includes some great graphics. Nobel lectures will never be the same.

Israel fact of the day

The prevalence of consanguineous marriage among the Arab population in Israel increased significantly from 36.3% to 41.6% in the decade from 2007 to 2017. First-cousin and closer marriages constituted about 50% of total consanguineous marriages in the two periods surveyed. Consanguinity was found to be significantly related to religion and place of residence. Thus, the prevalence of consanguineous marriage remains high among the Arab population in Israel, similar to other Arab societies.

Here is the research paper, via the excellent Kevin Lewis.

The Cultural Origins of the Demographic Transition in France

Is it a story of early secularization?:

This research shows that secularization accounts for the early decline in fertility in eighteenth-century France. The demographic transition, a turning point in history and an essential condition for development, took hold in France first, before the French Revolution and more than a century earlier than in any other country. Why it happened so early is, according to Robert Darnton, one of the “big questions of history” because it challenges historical and economic interpretations and because of data limitations at the time. I comprehensively document the decline in fertility and its timing using a novel crowdsourced genealogical dataset. Then, I document an important process of secularization at the time. Using census data available in the nineteenth century, I show a strong association between secularization and the timing of the transition. Finally, I leverage the genealogies to account for unobserved pre-existing, geographic, and institutional differences by studying individuals before and after the onset of the transition and exploiting the choices of second-generation migrants.

Here is the paper by Guillaume Blanc, a job market candidate at Brown University.  Here is his home page.  Via Matt.

And now it is over…

With both the Beatles and chess peaking this year in terms of media coverage, at times I have felt like I am thirteen years old again.  But now the WCC match is over, and Magnus Carlsen has solidified his claim to GOAT.  Carlsen has now won five such matches, and he has always won when he has needed to.  Since he broke through the 2800 rating point, he has never fallen below it, not once.  As a study in “management,” he is most of all a study in consistency.  Nepo played even with him for five games, but then fell apart.  Carlsen does not fall apart.  Karjakin and Caruana played even with him for a whole match, but when the pressure was on in the rapid tiebreaks guess who was reaching new peaks?

I suspect this last match means the death of the slow classical format for the world championship.  The last three matches have been deadly dull.  You can cite particular reasons for the lack of excitement, but the fundamental problem is that the players are too good and a very well played chess game is a clear draw.  It is hard to see how that gets reversed.  On top of that the match format encourages risk-aversion and openings such as the Petroff for Black.  There is too much advance openings preparation.

A Carlsen-Firouzja rapid match is what I wish to see, and somehow I expect the market will oblige.  To have a repeat of what we just witnessed — even if the challenger shows up as the inspired player — just isn’t going to cut it.  The cost is that we may not have a well-defined world champion by the time the next cycle moves toward its climax.

So, as of today, I predict that chess fundamentally has changed and won’t go back.  No more Capablanca vs. Alekhine or Fischer vs. Spassky at slow speed.  That’s just going to mean too many drawish opening choices.

Addendum: Please put aside your barbaric talk about Fischer Random 960.  It obliterates the ability of the viewer to make sense of the board, so why bother?  The rapid matches sponsored by Carlsen and others already have shown there are simpler, more viewer-friendly, and more intuitive ways to restore excitement to the games.

Air pollution and the history of economic growth

I have not had the chance to read this through, but here goes:

Documenting environmental pollution damage affects the magnitude of aggregate output, net of pollution damage, and the contribution to national product across economic sectors. For example, air pollution damage from the production side of the economy amounted to over 5 percent of gross domestic product (GDP) in 2002…

I have presented estimates of these effects in the US economy between 1957 and 2016. This period featured the passage of the Clean Air Act (CAA) in 1970 and its subsequent implementation through the 1970s, as well as several business cycles. This research suggests that pollution damage began to decrease just after the CAA was enacted, and the orientation between GDP growth and that of the adjusted measure, or environmentally adjusted value added (EVA), switched.

That is from Nicholas J. Muller, all a bit awkwardly worded.  Jeremy Horpedahl is more to the point:

If we use the standard measure of GDP, growth indeed slowed down after 1970. If instead we augment GDP for environmental damages, the period after 1970 was actually faster! The adjustment both slows down growth from 1957-1970, and speeds up growth after 1970.

Worth a ponder.

Friday assorted links

1. Stubborn Attachments and the veil of ignorance.

2. “Interestingly, our results are completely moderated in U.S. counties that forbid alcohol sales, which suggests that alcohol is a necessary channel through which exposure to violent video games contributes to crime.”  Link here.

3. Real wages are down since the pandemic.

4. Are Hispanic voters now evenly split across the parties? (WSJ)

5. Gopher, and language modeling at scale.  And a broader and useful thread on what is new behind all this.

6. Segregating unvaccinated students?

The best guitar music from 2021

Two new boxed sets are not only among the best releases of the year, they are some of the best guitar recordings of all time.  The first is Doc Watson: Life’s Work A Retrospective, four CDs of wonder and much better than any other Watson collection.

The second is Bola Sete, Samba in Seattle: Live at the Penthouse 1966-1968.  Sete has remained a largely obscure figure, with his reputation kept alive by a few cryptic John Fahey comments over the years.  His LPs have been hard to find, and they did not always reflect the full quality of his playing.  His best YouTube clips would come and go.  This boxed set shows Sete to be one of the best acoustic guitarists of the 20th century.  He is rooted in Brazilian bossa nova, but can play everything including Duke Ellington and Villa-Lobos.  Here is Ted Gioia’s appreciation of Sete.

In terms of original contribution and historical import, this has to be the release of the year in any field of music.

I’ll be getting you some classical music recommendations soon.

What is the profile of leading development economists on the PhD job market?

From David McKenzie at the World Bank, here is one excerpt:

Data from big middle-income countries, and English-speaking Africa were most common, with no papers on the Middle East and North Africa, and very little study of the poorest places: In both samples, India, Brazil, and Colombia (and the U.S.!) were the most common countries studied, with a smattering of papers from East Asia, other South Asian countries, and Latin America, and one from Russia with nothing else on Eastern Europe and Central Asia. Of the World’s 25 poorest countries, only one (Mozambique) was the subject of study; of the five countries that contain half the World’s poor, there were papers on India and Bangladesh, but none on Nigeria, DRC or Ethiopia.

Here is another:

RCTs have far from overtaken development, difference-in-differences is the most popular identification method, yes, people still do IV, and no, no one does PSM on the job market: The pandemic may have reduced the ability of people to do some field experiments, but this year at least, only 20% of the top school sample, and only 6% of the World Bank sample were doing RCTs. More than one quarter in both cases were using difference-in-differences. RDD and IVs were used in about 10% of the papers each, and structural models were common in the World Bank sample (which has more trade and macro papers). None of the papers used propensity score matching.

The blog post is interesting throughout.  Via the excellent Samir Varma.

One scenario for Omicron

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

How will institutions react to a proliferation of cases?

Imagine that a significant percentage of students in a school test positive, but no one is seriously ill. Will that school feel compelled to shut down and move to remote learning?

One possibility is that administrators will realize that virtually everyone is going to catch omicron anyway, articulate that reality to their constituencies, and plough ahead with face-to-face instruction. An alternate scenario is that the mere mention of Covid will prove so scary that closure will be inevitable. After all, how much will be known a month or two from now about the prospects of getting Long Covid from omicron? I am expecting a lot of school closures.

Another habit that will be hard to break is tracking the severity of the virus by counting cases. Until now, cases have been pretty good predictors of subsequent hospitalizations and then deaths. If cases become more detached from bad outcomes, will institutions and authorities be able to respond rapidly to that new reality? By the time they adjust, if they do, omicron might have come and gone.

To those who are inclined to worry, it will be scary how quickly omicron cases accumulate. It might feel as if the apocalypse has arrived, even if a lot of that short-term case activity is simply an acceleration of illness rather than an increase in the year’s total. (How scared would we get if most of the year’s murders happened in the first six or eight weeks of the year?) In any case, hospitals will have to be ready. But it is likely that a lot of health-care professionals might test positive early next year as well.

There is much more at the link.

The Rise and Decline and Rise Again of Mancur Olson

Mancur Olson’s The Rise and Decline of Nations is one of my favorite books and a classic of public choice. Olson may well have won the Nobel prize had he not died young. He summarized his book in nine implications of which I will present four:

2. Stable societies with unchanged boundaries tend to accumulate more collusions and organizations for collective action over time. The longer the country is stable, the more distributional coalitions they’re going to have.

6. Distributional coalitions make decisions more slowly than the individuals and firms of which they are comprised, tend to have crowded agendas and bargaining tables, and more often fix prices than quantities. Since there is so much bargaining, lobbying, and other interactions that need to occur among groups, the process moves more slowly in reaching a conclusion. In collusive groups, prices are easier to fix than quantities because it is easier to monitor whether other industries are selling at a different price, while it may be difficult to monitor the actual quantities they are producing.

7. Distributional coalitions slow down a society’s capacity to adopt new technologies and to reallocate resources in response to changing conditions, and thereby reduce the rate of economic growth. Since it is difficult to make decisions, and since many groups have an interest in the status quo, it will be more difficult to adopt new technologies, create new industries, and generally adapt to changing environments.

9. The accumulation of distributional coalitions increases the complexity of regulation, the role of government, and the complexity of understandings, and changes the direction of social evolution. As the number of distributional coalitions grows, it will make policy-making increasingly difficult, and social evolution will focus more on distributing wealth among groups than on economic efficiency and growth.

Olson’s book has become less well known over the years but you can gauge it’s continued relevance from this excellent thread by Ezra Klein which gets at some of the consequences of the forces Olson explained:

A key failure of liberalism in this era is the inability to build in a way that inspires confidence in more building. Infrastructure comes in overbudget and late, if it comes in at all. There aren’t enough homes, enough rapid tests, even enough good government web sites. I’ve covered a lot of these processes, and it’s important to say: Most decisions along the way make individual sense, even if they lead to collective failure.

If the problem here was idiots and crooks, it’d be easy to solve. Sadly, it’s (usually) not. Take the parklets. There are fire safety concerns. SFMTA is losing revenue. Some pose disability access issues. It’s not crazy to try and take everyone’s concerns into account. But you end up with an outcome everyone kind of hates.

I’ve seen this happen again and again. Every time I look into it, I talk to well-meaning people able to give rational accounts of their decisions.

It usually comes down to risk. If you do X, Y might happen, and even if Y is unlikely, you really don’t want to be blamed for it. But what you see, eventually, is that our mechanisms of governance have become so risk averse that they are now running *tremendous* risks because of the problems they cannot, or will not, solve. And you can say: Who cares? It’s just parklets/HeathCare.gov/rapid tests/high-speed rail/housing/etc.

But it all adds up.

There’s both a political and a substantive problem here.

The political problem is if people keep watching the government fail to build things well, they won’t believe the government can build things well. So they won’t trust it to build. And they won’t even be wrong. The substantive problem, of course, is that we need government to build things, and solve big problems.

If it’s so hard to build parklets, how do you think think that multi-trillion dollar, breakneck investment in energy infrastructure is going to go?
This isn’t a problem that just afflicts liberal governance, of course.

All these problems were present federally under Trump and Bush. They are present under Republican governors and mayors. But it’s a bigger problem for liberalism because liberalism has bigger public ambitions, and it requires trust in the government to succeed. I’m going to be working a lot over the next year on the idea of supply-side progressivism, and this is an important part.

How to read canonical Western literature

From a reader:

You should do a post on tips for reading canonical Western literature.  Especially on whether, and to what extent, one ought to read secondary stuff like criticism, biographies, histories alongside.  Also, to reread, or to read another canonical work for the first time instead.  Tips for the average interested reader…

For your consideration, feel free to ask me anything you’ve ever wanted to know about Kosrae (one of the four states that make up the great Federated States of Micronesia!)

I am hardly the expert here, and I don’t pretend these techniques will work for you, but here are my pointers:

1. Assume from the beginning that you will need to read the work more than once, or at least read significant portions of the work more than once.  Furthermore, these multiple readings should be done back-to-back (and also over many years, btw, after all this is the canonical).  So your first reading should not in every way be super-careful, as you don’t yet know what to look for.  Treat the first reading as a warm-up for the second reading to follow.

2. The first fifty pages very often should be read twice, in a single sitting if possible, even on your “first reading.”

3. Assemble three to five guides to the main book you are reading, or significant fairly general contributions to the secondary literature.  Consult those works throughout, and imbibe an especially large dose of them between your first and second readings of the classic itself.  But you shouldn’t necessarily read those books straight through, or finish them.  They are to be pillaged for both conceptual structure and particular insights, not to be reified as books in their own right.

4. Always be asking yourself how the classic work you are reading is engaging with other classic works you might know or know of.  Starting with the Bible, but not ending there.

5. Find people to talk to about the book.

6. Read Western canonical literature.  This is actually the most important item on the list.

p.s. Don’t forget the small groups and mentors!

Addendum: Nathan Meyvis comments.