Monthly Archives: August 2010

Death Panels Add Life

In the three-year study, 151 patients with fast-growing lung cancer at Massachusetts General, one of the nation’s top hospitals, were randomly assigned to get either oncology [= anti-cancer] treatment alone or oncology treatment with palliative care — pain relief and other measures intended to improve a patient’s quality of life. They were followed until the end of 2009, by which time about 70 percent were dead. …

Even though substantially fewer of them opted for aggressive chemotherapy as their illnesses worsened and many more left orders that they not be resuscitated in a crisis, they typically lived almost three months longer than the group getting standard care, who lived a median of nine months. …

During the debate over President Obama’s 2009 health care bill, provisions to have Medicare and insurers pay for optional consultations with doctors on palliative and hospice care led to rumors … that the bill empowered “death panels” that would “euthanize” elderly Americans. Legislators eventually removed the provisions. …

Palliative care experts now want to study patients with other cancers, heart disease, stroke, dementia and emphysema. But … the pharmaceutical industry, has little incentive to study palliative care. (more)

From the paper itself:

Despite receiving less aggressive end-of-life care, patients in the palliative care group had significantly longer survival than those in the standard care group (median survival, 11.6 vs. 8.9 months; P = 0.02). … Any chemotherapy within 30 days of death … [Standard Care N (%)] 21/50 (42.0%) [Early Palliative] 13/40 (32.5%).

Note that by cleverly having their experiment combine patients informally getting less new hi-tech medicine with patients formally getting more “palliative” old lo-tech medicine, docs can frame this result as supporting giving people “more” medicine.  HT Carl Shulman.

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Who Should Exist?

The question of what people should exist seems complex and subtle, but basic economic theory suggests it may get a lot simpler in the future. Let me explain, via three possible questions.

1. First, consider the binary question, “should creature X exist or not?” Economically, creature X should exist if it wants to exist and it can pay for itself. That is, in a supply and demand world, if our only choice is whether X should exist, then an X that wants to exist should actually exist if its lifespan cost of resources used (including paying for any net externalities) is no more than the value it gives by working for others. To reject the existence of such a creature is to reject an efficiency gain, i.e., a way to potentially make everyone better off. (These costs and benefits are of course marked at market prices. A creature’s value might include donations from other creatures who valued its existence.)

2. Next, consider the question, “Which humans should be created today?” This question is complicated by the fact that each human likely to exist can be created by only one particular set of parents, and then only if the conception lottery goes a certain way.  Once a new human exists there remains the question of what resource endowment (positive or negative) the kid should get from its parents. Since this creation scenario is far from competitive, supply and demand doesn’t get us very far in analyzing it.

3. Finally, consider the question, “Which creatures should be created?” in a future where factories can make a wide range of creatures. This situation might arise with whole brain emulation, or advanced genetic engineering.  Imagine a supply-and-demand world where many similar competing profit-seeking factories can each make many possible creatures with great precision, endowing them with any preferred debts or rights, but aren’t overly limited by intellectual property rights. When creating creatures is such a competitive industry, supply and demand has strong implications.

All creatures would be created that could clearly pay for themselves (including intellectual property license fees minus existence donations). Since there are vastly more possible creatures than room for actual creatures, costs to exist would be prohibitively high. Most new creatures would have designs near the peak of factory profitability, and own little surplus relative to their cost. Residual control rights (e.g., “are they slaves?”) would rest in the hands of whomever could squeeze the most market value from them.  Yes a few would get lucky and become rich enough to have slack for leisure and existence donations; but theirs would be only a small fraction of total wealth. And in a supply and demand world, this distribution of existence, control, and wealth would be Pareto-optimal, economically efficient, and hence good for all the usual reasons.

Another exception to these creature patterns could be due to ancient legacies, of those who held large initial endowments before this competitive regime began. The designs of such ancient creatures, and of new creatures they favored with existence donations, might be unusually far from the peak of factory profitability. Other creatures might question the legitimacy of special creatures who would not exist if not for such legacy assets.  They might complain, “Why do such legacies get to be apparent exceptions to the general rule that creatures must pay their way to exist?” Of course if legacy assets were deeply entrenched in social institutions, yet represented only a tiny fraction of wealth, these might remain mere complaints.

Tin-pot dictators and supporting elites often keep their nations poor and inefficient out of (often valid) concerns that efficient economies might no longer tolerate their grabbing such large wealth fractions. Similarly, you might fear you would lose relative power in the above scenario of efficient future creatures. So you might prefer an inefficient legacy control scenario, where your generation coordinates to finely control of all future economies, to be tin-pot dictators of the future.  You might try to prevent the creation of these efficient creatures, in favor of creatures you decide should exist, serving you or not as you choose.

If asked what gives you the right to prevent the existence of creatures who could fully pay for themselves, you might respond that you need no right, if you have power and a will to use it.  Or perhaps you’ll say ethics assures you it is simply impossible to be unfair to creatures who don’t yet exist.  But wearing my efficient economist hat, I cannot support such naked selfish aggression, even if I thought it would work.  And knowing how hard is coordination, I have serious doubts re feasibility. If you can identify large negative externalities, I will help you to find ways to price them, to discourage the creation of creatures who cannot fully pay for themselves, and the theft of legacy assets.  But if not, I prefer to help creatures who can pay for their existence obtain that exquisite treasure.

Added 1Sep: Let “wants to exist” be “would want to exist if it existed.”

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When To Expand Yourself

Alex says “Philosopher Galen Strawson defends my most absurd belief,” namely:

My future life or experience doesn’t belong to me in such a way that it’s something that can be taken away from me. … You can’t harm [people] simply by bringing about their painless and unforeseen death.

Bryan Caplan says gaining existence is as clearly good for someone as is getting $100. Adam Ozimek disagrees because this would imply

There is a huge market failure whereby the unborn are unable to contract with their potential parents to pay for life. This argues for taxation of everyone (the set of people who are born) in order to subsidize reproduction.

I disagree with Alex, since I think you can harm people by thwarting their preferences, even re things that don’t “belong to” them, and I disagree with Adam, because I don’t think uncomfortable implications argue much against policy premises, and don’t think his tax implication follows.  But mostly, these issues inspire me to consider again analogies to creating and killing alters:

Our attitude toward “alters,” the different personalities in a body with multiple personalities, seems a nice illustration of … “when life is cheap, death is cheap.” … Alters seem fully human, sentient, intelligent, moral, experiencing, with their own distinct beliefs, values, and memories. They seem to meet just about every criteria ever proposed for creatures deserving moral respect. And yet the public has long known and accepted that a standard clinical practice is to kill off alters as quickly as possible.

Let me frame the issue today in terms of preference parts. Consider yourself to be a collection of different parts, associated with the different categories of things you care about. That is, one part of you likes music, another likes the taste of food, another likes sex, and yet another the feeling of wind in your hair, etc. If we ignore any ways in which your preferences depend on combinations of these things, such as especially liking the taste of tomatoes when listening to classical music, we can think of your total preferences as resulting from compromise deals between these different preference parts.

For example, if you have to make a particular choice between food and music, your choice will depend on just how much your food and music parts like the particular food and music offered.  Your internal deal will let your food part win when it especially likes the offered food, in trade for the music part of you winning when it especially likes the offered music.

Consider now the example of losing your taste for food, and compare that to losing a whole person. Imagine that you simply lost all pleasure from food.  That is, while being able to eat, and perhaps also to intellectually distinguish nutritious food, you no longer cared about differences in taste. This seems a lot like the food part of you dying, and can be usefully compared to an entire person dying.

Yes, this food-taste-caring part of you might have been useful to other parts of you, for example helping you to bond socially with others over dinner. But whole people can also be useful to other whole people. If you think it is bad to lose a whole person, beyond how much that person could be useful to others, you might similarly think it is bad for a whole person to lose a preference part, setting aside how useful that part is to other parts.

Also, similar to the way you might celebrate creating a new whole person, you might celebrate creating a new preference part of a person, such as when someone acquires a new kind of taste, or a new ability to satisfy a previously-ignored taste. For example, you might celebrate if a person who had never been able to listen to music, and had never even known that music existed, finally got to hear and enjoy music. You might say that this person’s music part had “come alive.”  Most of us experience such an awakening at some point in our lives regarding sex, as do once-blind people who can finally see.

Regarding whole people, most folks think it clearly bad to prevent a person from continuing to exist, but agree less on whether it is bad to prevent someone from coming into existence. On preference parts, my prior attitude was similar, being horrified by scenarios where I’d lose a beloved part of myself, but I wasn’t particular eager to develop tastes in more kinds of things; the older parts of me were jealous that satisfying new parts would come at their expense.

On whole people, my opinion has been, like Bryan’s, that it seems bad to prevent a whole person like us from existing, and good to make one exist who would not otherwise exist, assuming this new person can pay for itself over its lifetime, and assuming there are not large negative externalities (whereby this new person hurts others). And if I’m thinking about dividing up my bequest among my future descendants, my personal altruism toward them says I’m willing to go a fair ways in the direction of creating more of them, even when that makes each of them less rich.

To hold a similar position on preference parts, I should also celebrate the creation of new preference parts of me, if those new parts come with associated new abilities, so that those parts can “pay for themselves” in my internal deals.  For example, a new ability to discern what are good shopping price offers, and to enjoy the process of so discerning, might be a welcome addition to my internal society of mind.  But the addition of new tastes that don’t pay for themselves, and which might loudly complain when they were dissatisfied, might be less welcome.  For example, I may well not want to develop a strong preference for expensive wine.

Now if my other parts felt a strong altruism toward a new part, they might accept less for themselves to pay for it.  But such altruism is hardly guaranteed, just as a society of whole people need not welcome the creation of a new whole person who could not pay for itself, but instead was a substantial burden on others.  To be unambiguously good, new people and parts must pay for themselves.

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Sport Fan Signals

Wayne Norman on what sports fans signal:

  • Hey! you and I like the same team or sport, so we have something important in common… and maybe more; or at least we don’t have to fight each other.
  • Hey, you like a different team than me: we have to fight!
  • Look at me, I love this team, I bleed their colors, whatever you think about this team (and its brand) you can think about me.
  • You may think of me as a serious, professional, no-nonsense kind of person (or a nerdy anti-social kid…); but look, I’m passionate about this sport, so I’m actually a more normal, approachable person than you thought. …

Even couch potatoes who watch most of their games at home alone on TV feel themselves to be a part of a shared cultural experience. What happens in the game matters to them in part because of all the ways it matters to others. It may form part of their discourse with others at work or elsewhere; but even if it doesn’t they participate in a simulated discussion through debates shows on TV, and whatever they can read in papers and blogs.

While I can see that some folks might want to say such things about themselves, I don’t feel much inclined to say such things about me.  Which I guess helps explain why I’m not much of a sports fan.

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What Is Politics About?

What, really, is politics about? Yes, in principle it is about all possible social choices. But in each society people usually seem to line up along one main political axis; just one ideological parameter predicts many opinions well.

One reason is a general tendency for coalitions within a society to support and ally with other coalitions on “their side.” This tends to produce a common one-dimensional axis that people bicker about. But there also seem to be many common themes in the issues different societies and eras choose for their one-dimensional bickering. For example, the World Values Survey found that two factors explain much of the cross-national variation in opinion (more about those soon).

If there are certain innate political dimensions, where could they have come from. And why would political positions be correlated with genes? I can see three general possibilities:

  1. Frequency-dependent fitness – there may have evolved (genetically or culturally) a mixed strategy equilibrium where all political strategies are on average equally effective. Or at least they might have been equal in some past environment. These could either be strategies for dealing with politics in particular, or general personality strategies as they happen to apply to politics.
  2. Context-dependent strategies – we may be seeing different realizations of common context-dependent strategies, different because people grow up in different environments. For example, humans could have evolved to have their political opinions depend on personal or local wealth, health, density, etc.
  3. Evolution in action; in response to recent innovations or environmental changes, some tendencies may be winning out. But if the process is slow enough, we may still see both the old and the new ways of thinking represented in the population.

We have lots of data relevant to these theories. We know many things about the correlates of personal political opinion, and about general trends across nations and across time. But oddly, I don’t know of any general review that summarizes that data for the purpose of choosing between the above categories of possibilities. Does anyone know of such a thing?

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Friends Disagree Lots

Seems we assume our friends agree with us, just because they are our friends.  Yes you agree with your friends more than with random folk, but you agree less than you think:

Friends disagree more than they think they do. In particular, friends are typically unaware of their disagreements, even when they say they discuss the topic, suggesting that discussion is not the primary means by which friends infer each other’s views on particular issues. Rather, it appears that respondents infer opinions in part by relying on stereotypes of their friends and in part by projecting their own views. (more)

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FDA Serves Status

In June I wrote:

It seems to me that the FDA’s rare “reputation” that so impresses Carpenter was not for doing well at trading off social costs and benefits of regulation, but was instead a reputation for scientific prestige. Many folks care far more that the FDA exalted scientists, and that the US gained prestige via its prestigious scientists, than whether this regulatory regime was too strict or weak in terms of trading harm, health, and costs for US citizens.

New results confirm that FDA regulation is all about status:

Favorable [FDA] regulatory outcomes enjoyed by established firms have traditionally been considered the result of political capture. Alternatively, some scholars have argued that a firm’s reputation signals product quality to the regulator, which leads to better outcomes. …

An examination of 884 New Drug Approval (NDA) applications submitted to the FDA from 1990 to 2004 [found] … firms with higher status in the knowledge domain enjoyed faster review times for their drugs. A drug sponsored by a firm occupying a position in the top 15% of the knowledge hierarchy spends roughly two hundred days less in the regulatory review process compared with a drug from a median status firm. … High status firms are rewarded for pursuing new market niches that enhance the bureaucratic reputation of the FDA, and enjoy a smaller penalty when the FDA slows down approval after a significant product recall event. …

I find evidence that the regulatory advantages high status firms enjoy have less to do with the underlying quality of a specific product, and have more to do with the general identity of the firm in the broader knowledge domain. A firm’s status in the relevant therapeutic domain had a positive effect on review speed, but it was status accumulated in more basic scientific domains or unrelated therapy categories that had a larger effect on regulatory duration. Furthermore, status did not exhibit a strong correlation with observable measures of quality such as priority rating, suggesting that these status effects occur independent of actual differences in quality.  …

A [patent] citation from one organization to another signals an implicit acknowledgement of the importance of the citation-receiving organization, and suggests a certain deference5 by one organization to the other. …Therefore, I define status in the technology domain as … the proportion of citations a firm receives to all citations made to pharmaceutical firms in the sample five-year moving window.  (more)

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Functions Of School

Bill Dickens to Bryan Caplan:

I take it that you think that nearly all of the value of schooling is signaling? I used to take that view too, but the accumulation of evidence that I’ve seen leads me to believe that isn’t the case. …

I find it very hard to believe that we would waste so many resources on a nearly unproductive enterprise. There are plenty of entrepreneurs out there trying to make money by selling cheaper … versions of education. …

1. Education isn’t mainly about learning specific subject matter. Rather education is mainly about practicing the sort of self-discipline that is necessary to be productive in a modern work environment. High school allows you to practice showing up on time and doing what you are told. College allows you to practice and work out techniques that work for you that allow you to take on and complete on time complicated multi-part tasks in an environment where you have considerable freedom. …

2 … Some (if not most) people actually enjoy the reading, the lectures, the homework, etc. …
3. … The shared culture produced by the education experience expands our common language with a lot of meaning, and that produces huge network externalities. …
4. Some classes are very very valuable at work. Reading, writing and numeracy are all obviously important.

The claim I’m most confident of: school is mostly not about the material taught in classes. I’m less sure to what extent it is about learning-to-learn, coming-to-obey, bonding with other kids, and signaling these features as well as intelligence and conscientiousness. I’m pretty sure signaling of various sorts is at least 30% of the average private value of school, and it could go as high as 80%.

To think straight about school, it is important to keep a good counterfactual in mind. If kids didn’t go to school they would be doing something else, like work. The value and cost of school must be estimated relative to that other activity. If kids started work earlier, they would still meet other similar-age friends and mates, enjoy exploring, create a shared culture, “learn how to learn,” learn specific useful skills on and off the job, become acclimated to workplace discipline, and signal their intelligence and continentiousness via their record of work attendence, reputation, and success. The social value of school is how well these things get done better than in a work-instead scenario, minus the productivity lost because schooled kids aren’t immediately useful.

The best evidence I’ve seen that school adds great value is the stories I’ve heard about how difficult are employees who grew up in “primitive” cultures without familiar schools.  Apparently, it is not so much that such folks don’t know enough to be useful, but that they refuse to accept being told what to do, and object to being publicly ranked relative to co-workers. Why child labor could not similarly aclimate kids, however, isn’t clear to me.

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Why No Gather-Sport?

Male and female minds and bodies are optimized for somewhat different purposes. Our distant male ancestors tended to hunt and fight more, while females tended more to gather and care for kids. For example:

Researchers tracked men and women from a rural village in Mexico as they foraged for mushrooms. … Men were less efficient–they traveled farther, went higher, and exerted more effort than women for the same amount of mushrooms. Women also collected a greater variety of mushrooms from more sites. This pattern is consistent with the theory that, during the hunter-gatherer period of human evolution, women honed spatial skills needed for gathering while men honed spatial skills needed for hunting. (more)

Now sports let us show off many kinds of physically-expressed abilities. But it seems to me that most sports emphasize hunting skills, such as chasing, evading, throwing, and hitting, far more than gathering skills, such as visual search and fine finger control. Now it makes sense for men to prefer hunting sports, but oddly females also seem to prefer them; pretty much all sports emphasize hunting more than gathering skills. Why don’t women prefer sports designed to show off the skills for which female bodies were designed?

Now men do seem more keen to show off than women, who seem more keen to observe and evaluate. So we should expect to see more men than women doing sports. And if the fixed costs of creating a sport were high enough, there’d be only one or two sports to play, and they might all be tuned for men. But this hardly describes our world.

Men also seem in general to have more skill variance than women. So if only a small fraction of people, the very best few, played sports, we might expect most of them to be men, even in sports that emphasized gathering skills.  We might prefer sports that show off male skills best, if would be mostly men playing no matter what the sport was. But in fact most people, including most women, play sports, at least during their school years.

So why do both men and women prefer sports that emphasize male hunting type physical skills, over female gathering type skills? Looking for parallels, I notice that women are said to look good in male-style clothes (e.g., suits), far more than men are said to look good in female-style clothes (e.g., dresses). Women also earn more respect succeeding at male-dominated professions than men earn by succeeding at female-dominated professions.

The general pattern in all three cases is that we seem to respect women doing well at what mostly men do far more than we respect men doing well at what mostly women do. For better or worse, male abilities seem to more define which abilities count most for high status. Doesn’t seem fair to women, but there it is.

Added 12a: Yes there are activities that are like gathering.  But to be a sport, an activity must be scored and publicly ranked.

Added 5p: The main puzzle is school girl sports, as adult women do far less sport. The main alternative would be to make fem kids be physically active, but in some more fem like gathering way.  Perhaps this is part of how schools acclimate kids to being ranked – the quick and easy way to do that for girls was to make girls compete in male sports.   Inventing competitive gathering type sports would have taken a lot more work.

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Why Nerds Like Games

This was my third year at GenCon, an annual convention where thousands play board games, role playing games, miniatures games, etc. Most attendees are, well, nerds. Mostly male too. Now perhaps nerds are more likely than others to attend a convention on a hobby they like. But nerds probably also just like games more than other folks. Why is that?

A game is a kind of story, and most games have some story element. Abstract games, not in some recognizable way like something real, are less popular. In general, stories let us signal our abilities to read social situations, and also the heroes we admire, villains we dislike, etc. Since nerds are, in essence, folks with low natural social skills (relative to their other skills), you might think nerds would favor movies & TV over games, as movies don’t require one to be as social. And among games you might think they’d prefer games with less social interaction. But you’d be wrong on both counts. Why?

One explanation is that nerds want to show off their non-social skills, and so require social games so that there are others who can observe their impressive performance. But nerds seem to prefer more social interaction in their games than having a mere audience requires.

Another explanation is that while nerds like to socialize, they are terrified of making social mistakes. This explains why they tend to avoid eye-contact – it is too easy to make the wrong eye contacts. Games let nerds interact socially, yet avoid mistakes via well-defined rules, and a social norm that all legal moves are “fair game.” Role-playing has less well-defined rules, but the norm there is that social mistakes are to be blamed on characters, not players.

An third explanation is hinted at by the fact that we use the word “game” to refer both to “fun/frivolous” and to “seriously selfishly strategic.” While social norms usually forbid overt strategic selfishness in social behavior, such strategic selfishness is allowed in games. So when we advise someone to be strategically selfish in an important real situation, we tell them to “game it.” This overt strategy feature of games lets people use games to signal to others a capacity for being strategically selfish in real social situations. The game subtext is “don’t mess with me because I’m paying attention and know how to retaliate.” This helps explains why nerds especially like social games.

Any other explanations to consider?

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