Tuesday assorted links

How Much Did Physicians Drive the Opioid Crisis?

It’s well known that the opioid crisis started with prescription abuse but how much abuse was driven by patients who fooled their physicians and how much was driven by physicians who responded to monetary incentives with a nod and a wink? Molly Schnell provides some evidence which even a hard headed rationalist like myself found startling.

In August of 2010, Purdue Pharma replaced old OxyContin with a new, anti-abuse version of OxyContin. The new version was just as good at reducing pain as the old but it was more difficult to turn it into an injectable to produce a high. If physicians are altruists who balance treating their patient’s pain against their fear of patient addiction and downstream abuse then they should increase their prescriptions of new Oxy. From the point of view of health, the new Oxy is simply a better drug and with less abuse to worry about altruistic physicians should be more willing on the margin to prescribe Oxy to reduce pain. So what happened? Prescriptions for Oxy fell immediately and dramatically when the better version was released.

Now, to be fair to the physicians, patients who wanted to abuse Oxy stopped demanding it after the new version was released and physicians might not have realized how many of their prescriptions were being abused or sold on the secondary market. The aggregate data, which is a combination of supply and demand shifts, can mask individual physician behavior. Schnell, however, has data on the prescribing behavior of about 100,000 individual physicians who prescribed opioids.

Schnell finds that nearly a third of physicians behaved exactly as the altruism theory predicts. Namely, when new Oxy was released these altruistic physicians increased their prescriptions of Oxy and they maintained or reduced their prescriptions of other opioids. In fact, the median altruistic physician doubled their prescriptions of the new and improved Oxy. But almost 40% of physicians in Schnell’s sample behaved in a decidedly non-altruistic manner. Beginning in August of 2010, these non-altruistic physicians halved their prescriptions of new and improved Oxy and increased their prescriptions of other opioids. It’s difficult to see how attentive and altruistic physicians could decrease their demand for a better drug.

Schnell also finds that some parts of the country had fewer altruistic physicians and the consequences are evident in mortality statistics:

…. these differences in physician altruism across commuting zones translate into significant differences in mortality across locations…a one standard deviation increase in low-altruism physicians is associated with a 0.33 standard deviation increase in deaths involving drugs per capita. While this association is reduced conditional on observable commuting zone characteristics (including race, age, education, and income profiles), a significant and large association between the share of low-altruism physicians and drug-related mortality remains. Furthermore…this relationship persists even conditional on the number of opioid prescriptions, suggesting that the association is driven by the allocation of prescriptions introduced by low-altruism physicians rather than simply the quantity.

The less-altruistic physicians increased prescriptions for other opioids after new Oxy was introduced but perhaps even this was better than the non-prescription alternatives like heroin and street fentanyl. Indeed, Alpert, Powell and Pacula show that the introduction of improved Oxy led to more deaths because people switched to more dangerous, illegal alternatives. So was it a bad idea to introduce a better drug? Maybe, but if new Oxy had been introduced earlier perhaps fewer people would have been addicted, leading to less demand for illegal markets later. Thus, static and dynamic effects may differ. The economics of dual use goods is complicated.

Do minimum wage hikes get rid of bad restaurants?

We study the impact of the minimum wage on firm exit in the restaurant industry, exploiting recent changes in the minimum wage at the city level. We find that the impact of the minimum wage depends on whether a restaurant was already close to the margin of exit. Restaurants with lower ratings are closer to the margin of exit on average, and are disproportionately driven out of business by increases to the minimum wage. Our point estimates suggest that a one dollar increase in the minimum wage leads to a 10 percent increase in the likelihood of exit for a 3.5-star restaurant (which is the median rating on Yelp), but has no discernible impact for a 5-star restaurant (on a 1 to 5 star scale). We expand the analysis to look at prices using data from delivery orders, and find that lower rated restaurants also increase prices in response to minimum wage increases. Our analysis also highlights how digital data can be used to shed new light on labor policy and the economy.

That is from a new NBER working paper by Dara Lee Luca and Michael Luca.  Obviously this will not be good for jobs, yet part of me believes that creative destruction in the restaurant sector is undersupplied…

The politics of CEOs

We find that more than 57% of CEOs are Republicans [defined by 2/3 or more campaign contributions to Republicans], 19% are Democrats…and the rest are Neutral [do not contribute 2/3 of their campaign spending to either of the two major parties].  Therefore, Republican CEOs are more than three times as Democratic CEOs.  Furthermore, Republican CEOs lead companies with almost twice the asset value of companies led by Democratic CEOs.

That is from 2000-2017, across the S&P 1500.  And:

We show that the median CEO directs 75% of his or her total contributions to Republicans.


We find that companies led by Republican CEOs are less transparent to their investors on whether how, and how much they spend on politics.

The most Republican-leaning sectors are energy (89.1%), manufacturing, and chemicals.  Business equipment and telecoms are the least-leaning R to D sectors for their CEOs, though still Republican by clear margins.  In the Northeast and West the number of Democratic CEOS has almost caught up to the Republicans.  As for female CEOs, they lean Republican 34.3% to Democratic 32.3%, a small margin but still more Republican donors.

That is all from a new paper The Politics of CEOs, by Alma Cohen, Moshe Hazan, Roberto Tallarita, and David Weiss, NBER link here.

Monday assorted links

Algiers fact of the day

There has not been a single property transaction in the Casbah in 40 years, said Mr. Ben Meriem, the head of the Paris institute. “No buyers, no sellers — for 30 percent of the buildings, we don’t even know who the owners are.”

Among the disused buildings, said Mr. Mebtouche, “eighty percent are owners who have abandoned their properties,” unable to pay for renovations.

Here is the longer NYT story by Adam Nossiter.  An excellent piece, though I would like to know more about the underlying regulations and incentives.

The Facebook cryptocurrency

Kroszner and I wrote about related possibilities in our 1994 book Explorations in the New Monetary Economics.  Here is a not very informative WSJ article.  Here is Ben Thompson speculating from his email newsletter:

This, then, is what I suspect is the overall motivation for Facebook’s efforts: having its own currency will allow for transactions on Facebook’s terms, not the credit card companies, which should, in turn, allow for both more kinds and more total transactions. Consider a Facebook currency on a theoretical level: if there were no fees attached to a transaction, micropayments suddenly become much more viable; peer-to-peer payments are simple — for both users and Facebook — as clicking a button; tipping models actually make sense.

None of these benefits are new to be sure, the question, though — and this is always the question generally, but with payments especially — is how you get from here-to-there. Remember, payments is a multi-sided network: users have to be one board, merchants need to be on board, and there has to be some sort of liquidity in the market. From a user perspective, how do you get them to buy into the network? Then consider merchants: how do you prevent them from taking money out of the market, killing liquidity?

In fact, Facebook is well-equipped on both fronts, particularly the merchant side: remember, merchants are the most likely culprits when it comes to killing liquidity in a market. They are going to transfer a cryptocurrency to fiat as soon as possible. Merchants, though, are also paying Facebook a lot of money for ads: that is, they are already putting money into the system. To that end, it is easy to see Facebook giving a discount to merchants willing to leave their money in the system and simply buy advertising using their Facebook tokens.

Users are trickier: certainly Facebook will push things like peer-to-peer payments to get users to connect up their bank accounts or debit cards to Facebook’s network, but I also suspect this is where the rumors about Facebook paying for ad-viewing comes in. This is not, in my estimation, some sort of genuine acknowledgment that user attention is worth compensating directly, but rather a plausible way to seed user accounts such that they are motivated to use Facebook’s currency; ideally, at least for Facebook, there will end up being lots of ways to use that currency.

…I don’t think that Facebook wants to impose any fees at all: thinks about it — what could possibly be more valuable to an advertising-based business than knowing exactly what customers are spending their money on?

You have to pay for Ben, but it is worth doing so, you can subscribe here.

Intelligence predicts cooperativeness better than conscientiousness does

We study how intelligence and personality affect the outcomes of groups, focusing on repeated interactions that provide the opportunity for profitable cooperation. Our experimental method creates two groups of subjects who have different levels of certain traits, such as higher or lower levels of Intelligence, Conscientiousness, and Agreeableness, but who are very similar otherwise. Intelligence has a large and positive long-run effect on cooperative behavior. The effect is strong when at the equilibrium of the repeated game there is a trade-off between short-run gains and long-run losses. Conscientiousness and Agreeableness have a natural, significant but transitory effect on cooperation rates.

That is by Eugenio Proto, Aldo Rustichini, and Andis Sofianos, forthcoming in the JPE.  Note that agreeable people do cooperate more at first, but they don’t have the strategic ability and consistency of the higher IQ individuals in these games.  Conscientiousness has multiple features, one of which is caution, and that deters cooperation, since the cautious are afraid of being taken advantage of.  So, at least in these settings, high IQ really is the better predictor of cooperativeness, especially over longer-term horizons.

Money lending and the origins of anti-Semitism

We study the role of economic incentives in shaping the coexistence of Jews, Catholics, and Protestants, using novel data from Germany for 1,000+ cities. The Catholic usury ban and higher literacy rates gave Jews a specific advantage in the moneylending sector. Following the Protestant Reformation (1517), the Jews lost these advantages in regions that became Protestant. We show (i) a change in the geography of anti-Semitism with persecutions of Jews and anti-Jewish publications becoming more common in Protestant areas relative to Catholic areas; (ii) a more pronounced change in cities where Jews had already established themselves as moneylenders. These findings are consistent with the interpretation that, following the Protestant Reformation, Jews living in Protestant regions were exposed to competition with the Christian majority, especially in moneylending, leading to an increase in anti-Semitism.

That is from a new AER piece by Sascha O. Becker and Luigi Pascali.

Big business isn’t big politics

That is my recent essay, adapted in Foreign Policy, from my new book Big Business: Love Letter to an American Anti-Hero.  Here is the opening:

The basic view that big business is pulling the strings in Washington is one of the major myths of our time. Most American political decisions are not in fact shaped by big business, even though business does control numerous pieces of specialist legislation. Even in 2019, big business is hardly dominating the agenda. U.S. corporate leaders often promote ideas of fiscal responsibility, free trade, robust trade agreements, predictable government, multilateral foreign policy, higher immigration, and a certain degree of political correctness in government—all ideas that are ailing rather badly right now.

To be sure, there is plenty of crony capitalism in the United States today. For instance, the Export-Import Bank subsidizes U.S. exports with guaranteed loans or low-interest loans. The biggest American beneficiary is Boeing, by far, and the biggest foreign beneficiaries are large and sometimes state-owned companies, such as Pemex, the national fossil fuel company of the Mexican government. The Small Business Administration subsidizes small business start-ups, the procurement cycle for defense caters to corporate interests, and the sugar and dairy lobbies still pull in outrageous subsidies and price protection programs, mostly at the expense of ordinary American consumers, including low-income consumers.

…overall, lobbyists are not running the show. The average big company has only 3.4 lobbyists in Washington, and for medium-size companies that number is only 1.42. For major companies, the average is 13.9, and the vast majority of companies spend less than $250,000 a year on lobbying. Furthermore, a systematic study shows that business lobbying does not increase the chance of favorable legislation being passed for that business, nor do those businesses receive more government contracts; contributions to political action committees are ineffective too.

If you are looking for a villain, it is perhaps best to focus on how corporations sometimes help poorly staffed legislators evaluate and draft legislation. But again, national policy isn’t exactly geared to making businesses, and particularly big business, entirely happy.

References and further support are available in the book,

Is day care bad for kids, especially well-off kids?

Exploiting admission thresholds to the Bologna daycare system, we show using RDD that one additional daycare month at age 0–2 reduces IQ by 0.5% (4.7% of a s.d.) at age8–14 in a relatively affluent population. The magnitude of this negative effect increases with family income. Similar negative impacts are found for personality traits. These findings are consistent with the hypothesis from psychology that children in daycare experience fewer one-to-one interactions with adults, with negative effects in families where such interactions are of higher quality. We embed this hypothesis in a model that lends structure to our RDD.

Here is the forthcoming JPE article by Margherita Fort, Andrea Ichino and Giulio Zanella.  And here are various ungated versions.  (Do any of you have the links handy for other papers with similar results?  They do exist.)

Quick quiz, we should:

a. Subsidize day care heavily

b. Not subsidize day care, or

c. Wait and see until more evidence is in.

Who is passing and failing this quiz?  How about you?

Which countries are best for creating and encouraging women chess players?

Via David Smerdon, here is the picture:

To oversimplify only a wee bit, it is the countries with less gender equality which have more female chess players, relative to male chess players.  Here is some description:

Denmark is the worst country in our list of participation, with only one female player to roughly 50 males, while the rest of Scandinavia as well as most of western Europe also languish at the bottom.

On the other hand, some of the best countries show evidence of the effect of female role models, and would be no surprise to players familiar with women’s chess history. Georgia (ranked 5th) and China (ranked 4th) both featured multiple women’s World Champions. There are also some high rates from a few unexpected sources: Vietnam (1st), the United Arab Emirates (2nd), Indonesia (8th), and even Kenya (12th) really buck the trend. Interestingly, a lot of the best countries for female chess players are in Asia. Besides Vietnam, there are five other countries in the best ten, and if I am a little more lenient with the chess population cut-offs, Mongolia and Tajikistan would also be in there.

Here is one cited hypothesis:

Could it be that, deep down, women just don’t like chess as much as men?

I consider that to be possible, but unconfirmed.  In any case, the lesson is that gender imbalance in a particular field can be correlated with greater equality of opportunity overall.

Saturday assorted links

1. “Employing a comprehensive dataset on the incidence of hate crime across Germany, we first demonstrate that hate crime rises where men face disadvantages in local mating markets. Next, we deploy an original four-wave panel survey to confirm that support for hate crime increases when men fear that the inflow of refugees makes it more difficult to find female partners. Mate competition concerns remain a robust predictor even when controlling for anti-refugee views, perceived job competition, general frustration, and aggressiveness. We conclude that a more complete understanding of hate crime must incorporate mating markets and mate competition.”  Link here.

2. Bryan Caplan on *Big Business* and crony capitalism.

3. Iceland fact of the day: “Sixty-four percent of students are women, the highest percentage of any European nation.”

4. How to get to ngdp targeting.

5. I’ve read so many bad or even absymal critiques of Facebook, but Bret Stephens (NYT) wrote a good one.