Tag Archives: Medicine

Brin Says Cryonics Selfish

By Robin Hanson · January 15, 2012 7:20 pm · Comments (49)

Like Tyler, sf author David Brin says cryonics is selfish:

A majority of citizens today perceive cryonics enthusiasts as kooky. … I share some of this skepticism. … Wouldn’t any reasonable person — one worthy of revival — dedicate a lifetime’s accumulated resources to helping their children and posterity, instead of splurging it all on a chancy, self-important gamble for personal immortality?

Consider:

“Median total [US Medicare] expenditures in the last 6 months of life [in '00 to '06] were $22,407.” (More)
“Out-of-pocket medical expenditures … for the years 1998-2006 … in the last year of life is estimated to be $11,618 on average.” (more)

Since US medical spending has more than doubled since then, we must now spend over $50K per person on the last six months of life. And this spending seems to, if anything, reduce lifespan. In contrast, a ~$40K (30 + 10) cryonics procedure gives a chance of a whole new life, and increases the chance of others gaining the same benefit at a lower cost. So why don’t Cowen or Brin first complain about selfish end-of-life care?

Brin continues:

Some people who sign up for storage believe their bank accounts alone — set up to earn dividends until some future era — will suffice to make them worthy of being thawed, repaired, and given full corporeal citizenship in a coming age of wonders. Somehow, I wouldn’t give that bet anything like sure odds, no matter how many technological barriers future people overcome.

Let me get this straight. People who suffer ridicule and fierce conformity pressures to pay to take a chance to avoid death and help others avoid death, who actually end up being right, and who in addition save money that gets invested in the world economy to help it to grow faster and larger, in order to generously pay future folks to revive them, do not deserve to be revived?! Even if they are quite willing to work to pay their way upon revival? Future folk should instead steal their money and refuse to revive them?! Why doesn’t Brin suggest that we today kill old folks a few weeks early to save thousands in medical costs? How exactly are they deserving yet cryonics patients not?

Btw, a second person has finally taken their cryonics hour. Any more takers?

GD Star Rating
loading...
Tagged as: ,

All In Their Heads

By Robin Hanson · January 7, 2012 9:30 am · Comments (10)

A randomized insurance experiment found that on average people who thought they had a higher health risk bought more insurance. But they didn’t actually have higher risk:

[In] a large-scale randomized field experiment in Mexico … [in '04 on] a voluntary health insurance option [=SP] … ‘high risk’ agents are, ceteris paribus, more likely to opt into SP—although the insured are not more ‘risky’ on average. That is, despite the absence of a positive raw correlation between agents’ insurance status and proxies of risk, this paper presents evidence of the systematic selection predicted by theory. In particular, individuals who rated their health as “bad or very bad” before SP became available are 6.9 percentage points more likely to sign up for SP than those in “good or very good” health (compared to an overall treatment effect of 29 percentage points).

Curiously, however, agents in the experiment sort only on pre-period medical expenditures and subjective well-being. There appears to be no selection on objective measures of health—possibly because individuals are less aware of the latter. … [Regarding] preventive care decline with insurance coverage, the effect of SP on the utilization of these services is negative and non-trivial in size. Given the positive price effect, such a decline is likely due to ex ante moral hazard. (more)

This supports the idea that medicine is less about health than health-related feelings. If medicine were more about the reassurance that comes from being taken care of medically (because medicine is a standard way for others to show that they care about us), it makes sense that we want more insurance when we feel more vulnerable to illness, but that sense of vulnerability would  have a lot more to do with the social assurances we desire than our state of health.

GD Star Rating
loading...
Tagged as: ,

Why Work Hour Limits?

By Robin Hanson · December 26, 2011 9:30 am · Comments (84)

Many laws discourage and limit work hours. Laws require holidays and vacations, limit hours per day and week, and require extra payment for work over these limits. And of course income taxes discourage work more generally. The standard economic explanation for these limits is to prevent inefficient signaling. People motivated to gain relative status, to show their extra dedication to success, and to appear more able, work extra hours, for a net social loss. Work hour limits can reduce such losses. (Academic articles here, here, here, here, here.)

This argument makes some sense, but it would make a lot more sense if we set broader and more consistent limits. Yet we don’t at all limit housework, and place few limits on self-employed work. Furthermore, high status occupations are especially exempt. Doctors, lawyers, managers, financiers, artists, writers, athletes, academics, and software engineers often work crazy hours. Yet the signaling argument would seem to apply nearly as well if not better to such high status work. Why are we so selective in our limits?

One explanation is a battle for relative status between professions and activities. Areas where work hours are limited produce less, and so look less impressive. Ambitious folks who want to show their high abilities then choose other areas, leading to an equilibrium were observers reasonably less respect folks who work in limited areas. On this story, work hour limits were set in manufacturing and manual labor in order to reduce the status of such activities.

A second related explanation is that each society is eager to look good to other societies. So each society prefers to encourage, not discourage, activities that are especially visible to outsiders. When outsiders evaluate societies more on the basis of their athletes than their shop technicians, societies naturally subsidize the former relative to the latter.

Another third explanation is that voters support limits on work hours in some jobs mainly as a way to defy and “stick it to” employers, who are seen as evil and in need of taking down. Firms who employ low status workers may themselves seem lower status and “exploitive,” and thus more acceptable targets of ire. Work hour limits serve as a quantity limit which raises wages and thus employer expenses. Any reduction of signaling losses is nice, but mainly a side effect.

GD Star Rating
loading...
Tagged as: , , , , , ,

Why Boom Times Kill

By Robin Hanson · December 19, 2011 1:30 pm · Comments (36)

It seems that the puzzle of why death rates rise in good economic times is nearly solved. There’s an effect of increased driving deaths from increased driving, but the main effect is that in good times nursing homes have to compete more for minimum wage nursing assistants. Apparently a one percentage point cut in the unemployment rate leads to three percent fewer nursing assistants, which increases the national death rate by a half percent (which cuts about three weeks of life per person):

We find that most of the additional deaths that occur during times of economic growth are among the elderly, particularly elderly women. … Cyclicality is especially strong for deaths occurring in nursing homes, and is stronger in states where a higher fraction of the elderly reside in nursing homes. … Staffing in skilled nursing facilities moves counter-cyclically.

A typical estimate suggests that a one-percentage point increase in a state’s unemployment rate leads to a 0.54% reduction in that state’s mortality rate. … Deaths by motor vehicle accidents are associated with the largest coefficient estimate. … It is likely that motor vehicle deaths fluctuate because people drive more during strong economic times. …

Approximately 80 percent of the averted respiratory deaths are among those over age 60. … Virtually all of the additional cardiovascular deaths are among those over age 65. … The correlation between changes in hospital employment and changes in aggregate employment is strongly negative (-0.90). … Nursing homes experience especially severe shortages of nursing aides when the economy is strong. … Between 70 to 90% of home health care agencies and nursing homes indicate shortages of direct care workers. …
Nursing home deaths are associated with an estimated [unemployment rate] coefficient that is an order of magnitude larger than the coefficient that is estimated among deaths taking place elsewhere. …

A one percentage point increase in the unemployment rate raises total full-time employment at skilled nursing facilities by approximately three percent. There is no statistically significant increase in the number of physicians, but there are significant increases in nurses, certified aides, and other occupations. (more)

A quick calculation says the US paid ~$13 billion for nursing assistant salaries in 2004, less than one percent of US medical spending (source). By cutting nursing assistants 3% when unemployment falls by 1% (and cutting three weeks off US lifespan), we save ~$400 million a year, or one part in 5000 of US medical spending.

Given how cheap they are, it seems inexcusable that we don’t raise wages on nursing assistants in boom times, to keep nursing homes fully staffed. Might this be due to a fixed government price that refuses to adapt to the business cycle?

Added 23Dec: See the comment here suggesting that med understaffing is chronic and makes a big difference.

GD Star Rating
loading...
Tagged as:

Japan’s Fat Tax

By Robin Hanson · November 26, 2011 8:00 am · Comments (28)

This has been going on for three years, yet I just learned of it:

In 2008, Japan’s Ministry of Health passed the ‘metabo’ law and declared war against obesity. …

Japanese people are normally envied for their lean physiques. In fact, the OECD ranks them, with only 3% population obesity, one of the least obese developed countries. … Comparing the time periods 1976-1980 and 1996-2000, prevalence of obese boys and girls increased from 6.1% and 7.1% to 11.1% and 10.2%. …

The law mandates that local governments and employers add a waist measurement test to the annual mandatory check up of 40-75 year olds. For men and women who fail the test and exceed the maximum allowed waist length of 33.5 and 35.4 inches, they are required to attend a combination of counseling sessions, monitoring through phone and email correspondence, and motivational support. …

Employers or local government … are required to ensure a minimum of 65% participation, with an overall goal to cut the country’s obesity rates by 25% by year 2015. Failure to meet these goals results in fines of almost 10% of current health payments. (more)

Even before Japanese lawmakers set the waistline limits last year, the International Diabetes Federation (IDF) amended its recommended guidelines for the Japanese. The new IDF standard is 90 centimeters (35.4 inches) for men and 80 centimeters (31.5 inches) for women. But the Japanese government has yet to modify its limits. (more; HT Melanie Meng Xue)

Two interesting patterns:

  1. Japanese waist limits are stricter on men, yet since men are taller health-based rules would be stricter on women.
  2. The thinnest rich nation (Japan) passed a big law to make itself thinner just as the biggest medical spending nation (USA) debated a big law (Obamacare) ensuring it would spend more on medicine.

My tentative explanations:

  1. Most societies find it easier to disrespect/mistreat/etc. low status men than low status women.
  2. National policy is more about reaffirming and supporting symbols of national pride than about addressing national needs. The USA is proud of its medicine and Japan is proud of its thinness.

Note that that if you want to regulate health it makes far more sense to regulate weight than medicine, since weight is far more related to health than medicine.

GD Star Rating
loading...
Tagged as: , , , ,

Forget Salt

By Robin Hanson · November 15, 2011 3:40 pm · Comments (20)

From May:

A new JAMA study finds a strong correlation: the third of folks who eat the least salt die over three times as often as the third of folks who eat the most salt. (more)

Now:

[A] new analysis … conducted …. for the Cochrane Collaboration … analyzed 167 studies conducted between 1950 and 2011 that compared people who consumed low-sodium versus high-sodium diets. Low-sodium diets did cut blood pressure levels in people with high and normal blood pressure. … But it also significantly increased other risk factors for heart disease, such as cholesterol levels, triglycerides, adrenaline and renin, the researchers reported in the American Journal of Hypertension. “These results do not support that sodium reduction may have net beneficial effects in a population of Caucasians.” (more; study)

The official response is no change in official advice:

U.S. health officials recommend that adults get no more than 2,300 mg of sodium daily. … ”We eat a lot of sodium — way too much — and I don’t think it’s going to hurt anybody to lower sodium in the current American diet,” Penny Kris-Etherton, a spokesperson for the American Heart Association [said]. (more)

GD Star Rating
loading...
Tagged as:

In Time Economics

By Robin Hanson · October 30, 2011 8:00 pm · Comments (37)

Many praise the new movie In Time for its intriguing premise:

Time is money: Everyone is genetically engineered to stop aging at 25; … after that, people will live for only one more year unless they can gain access to more hours, days, weeks, etc. (more)

In its tone, the movie comes across as shrill class hatred, like They Live. Lazy snobbish aristocrats with inherited wealth live forever young, and conspire to “manipulate” prices so the poor die fast, to keep them motivated to work. Boo mean rich folks, rah poor rebels. Though some think it didn’t hit hard enough:

For a real dose of revolutionary fervor, you’d do better to head down to Occupy Wall Street. (more)

But if you study the movie a little closer, its moral looks rather different.

First, the “time is money” angle can be misleading, leading folks to think in nominal price terms. In real prices, the scenario is equivalent to:

  1. Physical immortality, with no body/mind aging, has been achieved.
  2. Everyone must periodically pay a head tax to the government. Each person pays their tax into a personal tax account, which the government continually drains.
  3. Everyone has a built-in bomb, which automatically kills them if their personal tax account ever gets empty. Most people die either from tax bombs or from murder by thieves, which authorities tolerate.
  4. If a situation arises where most people can reliably pay their taxes, authorities raise prices on widely-needed commodities until enough people die from tax bombs. In the movie, commodity prices are raised via “manipulation,” but that can’t work reliably unless authorities in effect raise taxes on those commodities.
  5. [Added 1p:] The government gives the tax revenue, and more, to favorites.

Now first of all it is extremely expensive to kill off most of your working class, just to motivate them to work. Surely they’d be motivated plenty just to eat and pay rent.

More important, this society’s main problem is being over-taxed, via a severely regressive tax system, with poor law enforcement aside from very well enforced and extreme penalties for failure to pay taxes. How can the outcome of such a terrible tax system be a critique of wealth inequality in our society, where the rich work hard, taxes are progressive, the poor pay few taxes, and penalties for non-payment of taxes are mild?

Yes, once physical immortality is possible, then how long any one person actually lives must depend on their ability to afford rent, food, etc. But this would be true no matter what the tax or economic system.

Added 10a: The main event that drives the plot is when a government detective, apparently without due process, takes all but a few hours from our hero’s tax account. Again, government, and those who profit from it, are the villains in this movie.

GD Star Rating
loading...
Tagged as: , ,

Beware Mind Drugs

By Robin Hanson · September 19, 2011 10:50 am · Comments (16)

One in eight Americans take prescribed mind drugs, which probably hurt on average (vs. talking cures):

I first took a close look at treatments for mental illness 15 years ago while researching an article for Scientific American. At the time, sales of a new class of antidepressants, … SSRI’s, were booming. … Clinical trials told a different story. SSRI’s are no more effective than two older classes of antidepressants. … Antidepressants as a whole were not more effective than so-called talking cures. … According to some investigators, treatments for depression and other common ailments work—if they do work—by harnessing the placebo effect. …

In retrospect, my critique of modern psychiatry was probably too mild. According to Anatomy of an Epidemic … by … Robert Whitaker, psychiatry has not only failed to progress but may now be harming many of those it purports to help. …

As recently as the 1950s, Whitaker contends, the four major mental disorders—depression, anxiety disorder, bipolar disorder, and schizophrenia—often manifested as episodic and “self limiting”; that is, most people simply got better over time. Severe, chronic mental illness was viewed as relatively rare. But over the past few decades the proportion of Americans diagnosed with mental illness has skyrocketed. … One in eight Americans, including children and even toddlers, is now taking a psychotropic medication. …

Whitaker compiles anecdotal and clinical evidence that when patients stop taking SSRI’s, they often experience depression more severe than what drove them to seek treatment. A multination report by the World Health Organization in 1998 associated long-term antidepressant usage with a higher rather than a lower risk of long-term depression. …

Before the introduction of Thorazine in the 1950s, Whitaker asserts, almost two-thirds of the patients hospitalized for an initial episode of schizophrenia were released within a year, and most of this group did not require subsequent hospitalization. Over the past half-century, the rate of schizophrenia-related disability has grown by a factor of four, and schizophrenia has come to be seen as a largely chronic, degenerative disease. A decades-long study by the World Health Organization found that schizophrenic patients fared better in poor nations, such as Nigeria and India, where antipsychotics are sparingly prescribed. …

Beginning in the 1970s, Harrow tracked a group of 64 newly diagnosed schizophrenics. Forty percent of the nonmedicated patients recovered—meaning that they could become self-supporting—versus 5 percent of those who were medicated. … Electroconvulsive therapy … fell out of favor in the 1970s, in part because of its negative portrayal in the 1975 film One Flew Over the Cuckoo’s Nest, and yet about 100,000 Americans a year still receive ECT. … virtually everyone who receives electroconvulsive therapy relapses within a year without further treatment. (more)

Added 1p: I’ve blogged before on antidepressants as placebos.

Added 21Sept: Yvian has convinced me to doubt the claim above I had found most interesting, that schizophrenia changed from a temporary to a chronic condition. So now I doubt this author in general as a source.

GD Star Rating
loading...
Tagged as:

Downturn Cuts Exercise

By Robin Hanson · September 16, 2011 8:00 am · Comments (26)

It turns out that death rates fall during recessions. I posted in January on how some had speculated that people eat better during recessions, but in fact people seem to eat worse food. Now I can report that people also get less exercise during recessions:

Recreational exercise tends to increase as employment decreases. In addition, we also find that individuals substitute into television watching, sleeping, childcare, and housework. However, this increase in exercise as well as other activities does not compensate for the decrease in work-related exertion due to job-loss. Thus total physical exertion, which prior studies have not analyzed, declines. These behavioral effects are strongest among low-educated males. (more)

The healthy-recession puzzle deepens.

GD Star Rating
loading...
Tagged as: , ,

Are Nations Tribes?

By Robin Hanson · September 15, 2011 9:10 am · Comments (71)

Ezra Klein:

During Monday’s debate, CNN’s Wolf Blitzer asked whether an uninsured 30-year-old who had chosen to go without insurance should be left to die if he falls unexpectedly ill. Ron Paul dodged the question. … If you collapse on a street, an ambulance will rush you to a hospital. If you get into a car accident, you’ll wake up in intensive care. … Whether you get billed or your family gets billed or society gets billed, someone will pay the bill. … Even the hardest of libertarians has always understood that there are places where your person ends and mine begins. Generally, we think of this in terms of violent intrusion or property transgressions. But in health care, it has to do with compassion. We are a decent society, and we do not want to look in people’s pockets for an insurance card when they fall to the floor with chest pains.

But a great many ill, collapsed, etc. folks in the world are largely left to die, at least if curing them costs anything like a US hospital stay. Ezra argues above for “decent” national care, not global care. And even libertarians wouldn’t leave family members to die. So everyone agrees that we heroically help some, and leave others to die. We only disagree on who falls into which category.

I see key similarities between this and many responses to my recent posts, such as on 9/11, alien elites, or immigration. Such as: How can I not see that 9/11 deaths matter far more than most deaths, because this was them attacking our way of life? Or that alien elites secretly running our society, even running it well, must be exterminated though that would be unreasonable for human elites? Or that the richest big US county, Fairfax County, shouldn’t restrict immigration from poorer counties because we US folks are similar enough to each other?

Humans clearly evolved quite different mental modes for thinking about how to treat folks with our our local tribe, vs. how to treat distant strangers. Libertarians largely accept the usual ideas about how to treat both groups. Where they disagree is who counts as a stranger.

Libertarians limit “my tribe” to close family and small chosen communities, much as did our forager ancestors, who were free to change bands at any time. Farmer culture taught farmers to think of distant strangers as “my tribe”, as long as “our elites” said so, or if “we” fought wars together. And nation-states have worked hard over the last few centuries to transfer this feeling to nations. Libertarians mostly just don’t accept this. And though I’m not strictly libertarian, on this I agree – it is far from obvious that nations must be our tribes.

Now people usually try to be nicer to their tribe than to distant strangers. From this one might conclude that libertarians, who see more folks as strangers, are not as nice people. But not only are folks who see their tribe as smaller usually nicer to such insiders, libertarians also tend to be more accepting of mutually beneficial interactions with strangers. And economists make a pretty strong case that libertarian policies such as free immigration would greatly improve overall welfare.

As with Ezra’s comments above, most critiques of libertarian policy seem to miss this central point, by invoking standard ways to classify folks into “us” and “them.” To criticize libertarians effectively, you need to make clear why exactly “we” are a nation, rather than the entire world, or close family and friends. Alas, few critics even try to argue this point.

GD Star Rating
loading...
Tagged as: , , ,