Further thoughts on artificial hearts
A number of people emailed me or blogged (eg. here and here) on my post, Artificial heart won’t save lives. The number of transplants is constrained by the number of donated organs thus the main effect of the artificial heart, which is just a temporary stop-gap, is to redistribute organs. The artificial heart makes some people better off at the expense of other people who are made worse off. No one challenged this conclusion but it seemed to make some people uncomfortable. Two arguments were raised in opposition, both of which are weak.
First, the heart does allow some people to live a little bit longer – this is a benefit, but a few weeks of life while chained to a big machine doesn’t seem like a big breakthrough to me. Second, the artificial heart could allow for better matching. Theoretically true, but there are already many more patients on the waiting list than there are hearts available so the opportunity for better matching is negligible. Consider, that for a given heart there are now 3500 people on the waiting list to choose from – how much better is the match going to be if we add a few more people to this list?
I am not against artificial hearts (some people say I have one!) perhaps one day the technology will improve enough so that someone on an artificial heart can be taken off the list, but the issue is comparative. Suppose that we put the funds gong into artificial hearts into programs to increase organ donation. One donated organ is say good for 10 years of extra life. Average time on the artificial heat is 77 days and it is not clear how many of these days represent extra days of live. Let’s say very charitably that 50 days are extra then this means that one real heart is worth 73 times as much as an artificial heart (10*365/50) and that is before adjusting for quality of life.
Trade and child labor
Ben Muse’s economics blog continues to rise in my estimation. He reports on a recent study showing that child labor and trade are negatively correlated. The statistical result is the following: as a country’s measure of openness to trade increases by 1%, a measure of child labor is decreasing by 0.7%. Here is an earlier MR post on child labor.
Artificial heart won’t save lives
An FDA panel announced today that they would support approval of a new artificial heart. NPR and other media suggested that the new heart, which is designed only for temporary use and is not portable, would save lives by extending survival time until a transplant became available. But even if the artificial heart performs exactly as designed and even if it prolongs the lives of those who receive it, it won’t save lives overall.
The mathematics is simple; there are approximately 2200 hearts donated for transplant every year (data here). That means we can save 2200 lives a year and no more. All the artificial heart can do, therefore, is change who gets saved. Some people who previously died will live long enough to receive a transplant but this means there will be one less heart available for someone else on the waiting list. The artificial heart will make the waiting list longer but it will not save lives.
The only way we can truly save lives is to increase the number of organ donors. As readers of Marginal Revolution will know I have suggested financial compensation and organ donor clubs as the only realistic solutions.
Markets even in things you can’t imagine anyone would want
Read about restaurants where you do your own cooking, and no this is not just Korean barbecue. In some places you cook your own steak, at least they still wash the dishes for you.
The same article offers us some sad news:
Last fall, when almost 100,000 of the “surveyors” who contribute to the Zagat dining guides nationwide were asked what “irritates” them the most about dining out, 74% said service; only 6% said food.
And no, it’s not because they’re all dining at Matsuhisa.
That being said, I don’t think poor taste is the only culprit here. Often we blame the person we can see — the waiter — more than the person we can’t see, namely the chef. Economists have long understood the distinction between the seen and the unseen, let us not forget that the fallacy applies to other contexts as well.
Why has Russian health collapsed?
The health care collapse in the former Soviet Union is old news, less well known is the contrast between Russia and Poland:
…another Slavic nation with a traditional affection for vodka — Poland — is experiencing one of the greatest improvements in health ever known. The difference tells a story of how democracy has transformed the center of Europe in the past 15 years — and how it has failed in Russia.
Start with the figures. In the early 1980s life expectancies in Soviet Russia and Communist Poland were roughly similar, and both were starting to get worse. Cancer and cardiovascular disease were beginning a rapid rise, in lock step with their prime causes: smoking and alcoholism.
Two decades later, Poland’s life expectancy for men, at 70, has risen by four years since the collapse of communism and now is more than 10 years longer than that of Russian men. In Poland, cardiovascular disease has fallen by 20 percent in a decade, while in Russia, it has risen by 25 percent. Sudden deaths from accidents and other external causes have fallen 19 percent in Poland, while in Russia the rate has soared to an unprecedented level. Poland’s rate of HIV infection is one of the lowest in Europe; Russia has one of the world’s highest rates of new infection.
Polish researcher Witold Zatonski has an explanation for this difference:
…he has boiled his answer down to a simple slogan: “Democracy is healthier.” “It’s the only way to explain what has happened,” he said during a recent visit to Washington. “It turns out that the free-market economy and a free political debate correlate directly with good health in Eastern and Central Europe.”
I was incredulous when I first read this, apparently I was not the only one:
That conclusion used to be doubted by some of Zatonski’s colleagues, both in Poland and in the West. After all, democracy brought Poland freedom for cigarette and alcohol advertising, Western brands, and a parliament presumably susceptible to special interests. Tobacco companies spent $100 million a year on marketing to Poles in the 1990s.
Remarkably, though, all that money and influence have been outweighed by the other products of a free society, especially independent civic organizations and media that promote knowledge and open debate about health issues.
It is well known from happiness surveys (see the work of Bruno Frey) that people are happier in democracies, so maybe there is a link to health as well, even after adjusting for income.
What about the comparative statics?
In addition to Poland, the Czech Republic, Hungary and other newly democratic states have recorded dramatic gains in health. But Ukraine and Belarus, which have followed Russia’s political course of far more restricted freedom, have seen their health measures decline. The Baltic states of Latvia, Lithuania and Estonia, which were once republics of the Soviet Union, at first shared Russia’s downward spiral; but since 1995, as they have built Western-style democracy, they have reversed the trend and now follow Poland’s path.
Here is a comprehensive paper with data and cross-country comparisons. From this excellent piece I learned the following:
1. Health in Belarus has continued to decline. Since Belarus has stayed largely communist, the country may serve as a possible control for where Soviet health was headed before communism fell.
2. In Russia, many of the biggest negative health changes have come for the 18-34 group, not for the elderly.
3. In the CIS countries, injuries and violence account for a quarter of all deaths about men aged 25-64; this is six times higher than the death rate from Western Europe.
4. Homicide and suicide rates in CIS countries exceed those for the West by about 20 times.
5. In Russia, deaths from all external causes correlate closely with deaths from alcohol poisoning.
6. Men of low educational background have been to most vulnerable to bad health.
7. Russian life expectancy has declined but it actually improved during the 1994-8 period and has moved with economic crises.
Here is some additional information on mortality trends in Eastern Europe, here is another related link. Zatonski has a longer essay, which I do not currently have access to.
The bottom line: Here is what I used to think: “I blamed the Russian health collapse on the loss of relative status for the elderly. While market reforms have increased aggregate wealth, this has been mostly for the young. Older people have lost their grip on power, and suffered psychologically through their loss of international relative status as well. They lost the will to live and died early.”
Here is what I now think: “Russian young and middle-aged men have found few useful institutional supports during the transition. They’ve gone crazy with drinking and violence.” That being said, I don’t think we have sorted out the relative importance of economic and political factors.
Is Congress becoming worse?
In fundamental ways that have gone largely unrecognized, Congress has become less vigilant, less proud and protective of its own prerogatives, and less important to the conduct of American government than at any time in decades. “Congress has abdicated much of its responsibility,” Nebraska Sen. Chuck Hagel said in a recent conversation. “It could become an adjunct to the executive branch.”
Hagel is no disaffected Democrat frustrated by the imperious GOP leadership. He is a conservative Republican admired by colleagues in both parties for his thoughtfulness and independence. He admits that he is atypical in his concern for Congress’s constitutional role as a check on, and a balance to, the presidency and the judiciary. “Congress is the only thing that stands in the way between essentially a modern-day democratic dictator and a president who is accountable to the people,” he says.
Throughout American history, the status and influence of the three branches of government, and particularly of the executive branch and Congress, have risen and fallen like great historical tides. For long periods, most dramatically in the last third of the 19th century, Congress was dominant. Arguably this was also true in the last quarter of the 20th century, after Congress brought an end to the Vietnam War and forced Richard M. Nixon from office. Even in the ’90s, Congress played a key role in replacing Reagan-era budget deficits with the large surpluses George W. Bush inherited when he became president in 2001.
But Congress’s influence has waned in the past few years, perhaps since the unpopular and unsuccessful effort to remove Bill Clinton from office in 1998-99. Though it occasionally resists an executive-branch proposal, Congress today rarely initiates its own policies. Few members speak up for the institutional interests of Congress. “The idea that they have an independent institutional responsibility, that the institution itself is bigger than the individuals or the parties, doesn’t occur to the bulk of [members] for a nanosecond,” said an exasperated Norman Ornstein of the American Enterprise Institute, a longtime student of Congress.
It occurs to Rep. David Obey of Wisconsin, the ranking Democrat on the House Appropriations Committee. He said that the House has given up the meaningful exercise of its powers by largely forfeiting its oversight role and abandoning all discipline on the federal budget. “Which means that this administration is essentially walking around with a free hand . . . . If the Congress is turned into a jellyfish, there are no checks and there are no balances.” Jellyfish isn’t a bad image for the backbone Congress has shown in recent times.
Read the whole story, which is instructive and stimulating throughout.
My take: The blogosphere reflects an obsession with “the Bush administration,” but the failings of Congress are essential to understanding the last few years.
Smart prostitute with heart of gold
Earlier Tyler reported that lying is more common over the phone than with email. Further evidence comes from a surprising source. In a letter to New Scientist magazine Yvette Astre writes:
I have found a similar difference between phones and email in my business.
I am a prostitute, and to get clients I advertise in the local newspaper. Normal practice is to provide a phone number as an initial point of contact. Using my cellphone was getting rather expensive, as was advertising several days a week. I also work as a volunteer for several non-profit community organisations, and there I found many people preferred emails to the phone or postal services. So I decided to try an email address instead.
The difference really surprised me. With my phone number, guys would sometimes make bookings then not turn up. Others sounded very creepy. However, using email I have had only two cancellations, and in both cases I was paid in full for the time they booked with me.
Then again, prostitutes who read New Scientist and volunteer at non-profits? Johns who pay for services not rendered? Was this letter phoned in or emailed?
Markets in everything, the ongoing saga
St. Francis Episcopal Church in Stamford, Conn., in a bid to fill empty pews, has introduced a monthly Sunday service for pet owners who wish to take their dogs and cats (and presumably birds, ferrets, and boa constrictors) to the altar to receive the host or a special benediction. Other houses of worship around the country, the paper noted, are also offering everything from pet-friendly services and prayers for the animals to pet funerals and “bark mitzvahs.”
Here is Kasha’s Bark Mitzvah. By the way, “All of Beth Shir Shalom’s Bark Mitzvahs are held in the parking lot, to avoid any “accidents” in the sanctuary.”
Here is a photo of the Episcopal version of a pet-friendly service (no fear of accidents, apparently; see also the attached comments, such as “It looks like that black dog in the picture has some sort of mind control over that old lady. It gives me the creeps.”). Here is the full story, add your own commentary, you don’t want to hear “My Take” on this one.
Make your TV a work of art
That’s right, put a digital copy of a masterpiece as a screensaver on your TV:
An expensive new digital television is big, beautiful, flat and can hang on the wall. Some might even consider the set a piece of art.
RGB Labs charges for subscriptions to images such as The Luncheon of the Boating Party by Pierre Auguste Renoir.
So why not display Picasso, Renoir, Monet and other masters on the screen itself?
Three companies have recently formed to help consumers do just that…
[One of them] Chandler’s company, Dream City, has acquired licensing rights to more than 1,000 pieces of art, including masterpieces from Cézanne, Van Gogh and Picasso. He sells them in $14.95, 30-piece collections as screensavers. A Web site offers step-by-step instructions on how to connect a PC to the TV and run a slide-show loop on your big screen.
The core idea came from Bill Gates:
Microsoft (MSFT) Chairman Bill Gates has displayed art on wall-mounted PC screens at his home for years. That’s where Chandler got the idea for Dream City.
He put a frame around a monitor hooked to an old PC, hung it on the wall and showed family photographs and art.
“At parties, people just stood there, mesmerized,” Chandler says. “I realized there was a business there.”
Here is the whole story, which includes a Renoir image on a big TV screen.
My take: The idea is a promising start, but I am repelled by the idea of copies of classic paintings in my living room. Looking at lower quality reproductions would depress me. It would also make me wonder why I cannot find anything more personal, more current, and more alive to enjoy. I am keener on the idea of art created especially for this medium, let’s hope that is forthcoming.
Addendum: Michael Giesbrecht writes: “You’re in luck, Tyler! Literally hundreds, if not thousands, of pieces of art, created especially for this medium, are taken to market each year, and have been for quite some time. Check out netflix.com. In the common vernacular, the medium is referred to as a “movie”. Many of them look great displayed on wall-mounted digital television screens.” You can put up a static image from these movies quite easily. I love Renoir but on my screen I want Blade Runner.
Small business outsourcing can favor employment
Global giants aren’t the only companies cutting costs by shifting jobs overseas. Increasingly, small businesses are finding that “offshoring” jobs is a boon to their bottom line – and sometimes gives them room to create new jobs at home.
For example, when Rajeev Thadani wanted to expand Claimpower Inc., his medical-billing service in Fairlawn, N.J., he chose to outsource some of the work to India. But unlike most companies going this route, his business had just five other employees at the time.
Mr. Thadani, who runs the company with his wife, flew to his native Bombay in 2001 and hired four locals to help file insurance claims on behalf of New Jersey doctors. They use a software system that Mr. Thadani, a programmer by trade, developed specifically for the task.
Today, he employs 35 people [in India]…Now he’s taking steps to expand his business nationally, while planning to add staff in the U.S.
From The Wall Street Journal, Tuesday, March 16, Marketplace section.
This is comparative advantage in action, finding a cost advantage to create new and better jobs.
By the way, a new web site, BlameIndiaWatch details the scapegoating of India in the debate over trade and outsourcing. Here is their mission statement:
Blame India Watch is concerned with the increasing anti-Indian/anti-India sentiment among tech workers, as well as media coverage that focuses disproportionately on Indian workers or propagates anti-India(n) sentiment. What began a few years ago as IT grumbling about Indian-specific H-1B “Temporary Guest worker” and L-1 “Intracompany Transfer” workers and immigrants has now morphed into the outsourcing issue, and is now gaining international attention. We aim to highlight this scapegoating, encourage IT workers to put a stop it, and redirect the anger to where it belongs.
My take: I read about one Indian who said something like the following: “Hey, you lectured us for decades during the Cold War and Indian socialism. Aren’t we now doing exactly what you told us to?”
Unemployment in South Africa
More than 40 percent of the South African workforce is without a job and nearly 60 percent of those who are jobless have never worked. The NYTimes is correct that South Africa faces many problems including poorly educated workers, AIDS, and crime. But it is not true that South Africa is doing poorly “despite [it’s] sound economic policies.” In particular, if you read to the 22nd paragraph you find this buried lede:
In other developing countries, legions of unskilled workers have kept down labor costs. But South Africa’s leaders, vowing not to let their nation become the West’s sweatshop, heeded the demands of politically powerful labor unions for new protections and benefits. According to a study conducted in 2000 for the government’s finance department, South Africa’s wages are five times higher than Indonesia’s, even though its workers are only twice as productive.
To the great detriment of its people, South Africa’s leaders have been successful. South Africa is not the West’s sweatshop.
When is it rational to honor sunk costs?
Alex offers up some biography and describes his encounter with sunk costs. He asks the classic question: why honor a cost once it is sunk? Why not just go ahead and do what is best?
Brian at CrookedTimber writes the following, citing a paper by philosopher Thomas Kelly:
The main idea (roughly stated) is that since the value of an action is partially determined by what happens in the future…our current actions can be sometimes justified by the redemptive value they confer on past actions.
What does this mean concretely? Here is one example from Kelly:
One might prefer that, if others have made significant sacrifices in attempting to realize some valuable state of affairs S, then their sacrifices not be in vain. That is, one might prefer that these sacrifices causally contribute to the realization of some valuable state of affairs…Interestingly, one sometimes is in a position to determine, by one’s own actions, whether the past efforts of others will have been in vain. This is true, for example, when it is within one’s power to finish some valuable project in whose service others have labored, but which they are now not in a position to complete. Let us say that when one acts so as to prevent the past efforts of others from having been in vain one redeems those efforts.
In other words, you don’t want to admit that you shouldn’t have started your blog. And how about this?
Gilbert Harman…observes that, so strong is our desire to see our own past efforts play a role in bringing about valuable ends, we will often adopt new ends, carefully tailored, so that our past efforts can be seen as instrumentally valuable means to the achievement of these ends.
Let’s not forget the game-theoretic rationale for honoring sunk costs: You might honor sunk costs so that others do not perceive you as wasteful, or so that others perceive you as constant and reliable. Robert Nozick argued that we follow through on sunk costs as a kind of self-discipline, to prevent ourselves from initiating too many stupid undertakings in the future. If you self-signal that you will follow through on your commitments, you will be more careful in accepting commitments in the first place.
By the way, I have found that women honor sunk costs to a greater degree than do men. Furthermore women often do not like it when men announce that something is “only” a sunk cost.
The bottom line: Once your model of choice is at all complex, no one knows what a sunk cost means any more. So a theoretical scolding of those who honor “sunk costs” is not completely well-defined. That being said, there is still the empirical question of whether most people attach too much weight to previous plans and have a status quo bias. The experimental evidence suggests that we are more rigid than we need to be. The propensity to honor previous commitments may have efficiency properties, but we cannot discard this proclivity when we ought to.
Is overconfidence good for traders?
A little confidence is a good thing. But a lot of confidence may be even better — particularly if you’re a high-powered currency trader playing the international money markets.
Finance professor Carol Osler found that at least some of the wild and unexplained fluctuations in currency markets may simply be due to overconfident money traders. “Overconfidence can help you get ahead, but it can have serious ramifications, too,” says Osler, who teaches at the International Business School at Brandeis University.
Osler and her research colleague, psychologist Thomas Oberlechner of the University of Vienna, interviewed 416 currency market traders. They asked these wheeler-dealers to rate how successful they were as traders on a seven-point scale ranging from “much less successful” than other traders to “much more successful.” They also asked the traders’ bosses to rate the employees’ value to the firm, and then asked the traders to estimate what the exchange rate of five currencies would be in six months and in a year.
The first thing they learned is that — surprise! — most currency traders have outsize egos: Nearly three in four rated themselves as “better than average.” Even most traders working at less prestigious institutions thought they were better than most, Osler and Oberlechner reported in a paper they have presented at two European universities and at Harvard.
The distinct whiff of hubris was confirmed when they compared the traders’ self-evaluations with the supervisors’ ratings. More than half of the traders gave themselves a higher rating than their supervisors did, while few underestimated their value.
The researchers found that this self-confidence had no impact on a company’s bottom line. But it had a dramatic and positive impact on the careers of traders, increasing their chances of becoming a senior trader or chief dealer, when other factors such as age and trading success held constant.
Here is the link. Here is Carol Osler’s home page.
My take: I have mixed feelings about the core result. On one hand, competition is thick and you have to take chances to win special positions in life. This requires a certain amount of hubris. That being said, I worry about selection bias in the results. You only observe the ones who made it. Try asking the bankrupt currency traders, lying in the proverbial gutter, if cockiness was good for them. And let’s not forget about those in jail, or headed there.
Krugman vs the CEA
Paul Krugman goes beyond the bounds of decency and evidence when he accuses the Council of Economic Advisors of corruption. His evidence? The following graph (click to expand):
Krugman writes:
…wishful thinking on this scale is unprecedented. What you see in this chart is the signature of a corrupted policy process, in which political propaganda takes the place of professional analysis.
Now, the CEA has certainly made mistakes and can justifiably be accused of optimism (see Brad DeLong and passim) but Krugman’s chart is highly misleading. Here is the same data but over a slightly longer time-frame.

With this graph it becomes clear that the CEA has in essence been predicting a return to trend. Obviously, the CEA has been wrong, employment has not returned to trend, but that surely tells us more about the peculiar nature of this recession than it does about corruption at the CEA.
Has political progaganda taken the place of professional analysis? Indeed.
China fact of the day
China’s electricity consumption grew by 15 percent last year and 10.4 percent in 2002 – a spike in demand he said was equal to total power consumption in Brazil. “They are adding a middle-sized country every two years in terms of energy consumption,” he said.
Here is the full story. Here is an earlier installment of facts about China.