Archive for the Category healthcare


All hail Donald Trump

People didn’t believe me when I said I’d praise Trump for the good things he did. Well now it’s time.  Here’s the WSJ:

Arya Majumder would have celebrated his 19th birthday last month. Instead he died of cancer in 2010, his condition exacerbated by a scarcity of bone-marrow donors. . . .

Other families may be spared the same life-upending sorrow because last week the Department of Health and Human Services withdrew a proposed Obama -era regulation that would have prohibited compensation for bone-marrow donation. About 11,000 ailing Americans are currently searching the national marrow registry, hoping to find a compatible donor. This year at least 3,000 people will die waiting for a transplant. Others, like Arya, must settle for an inexact match, which can cause lifelong health complications or prove fatal. . . .

The 1984 National Organ Transplant Act prohibited payment for organ donors, and bone marrow was included, though it regenerates like blood, eggs or plasma. Represented by the Institute for Justice in 2012, the mother of three girls suffering from a condition known as Fanconi anemi, which often impairs bone marrow function, won a lawsuit against the federal government to allow compensation.

But the Obama Administration then wrote new rules to recriminalize payment for marrow, and HHS sat on the pending regulation for four years, leaving sick patients and their families in limbo. The regulatory uncertainty deflated the interest of entrepreneurs seeking to invest in much-needed marrow-supply services, as well as of top-tier researchers who wanted to study the effectiveness of compensation.

Great news for utilitarians!

HT:  Frank McCormick


Wait, which tax are they repealing?

You really need a sense of humor to read the news these days.  Here’s Matt Yglesias, describing the Senate Majority leader:

Many more moderate House members, meanwhile, told themselves the real bill would be written by the Senate, which no doubt would be less harsh on Medicaid. Instead, McConnell opted to be harsher and has not softened it even slightly, even though he has hundreds of billions of dollars of flexibility.

Bizarrely, instead of addressing the issue, “McConnell has told several hesitant senators (including Portman and Sen. Shelley Moore Capito (R-W.Va.): The bill’s deepest Medicaid cuts are far into the future, and they’ll never go into effect anyway.”

McConnell made deep Medicaid cuts to please the GOP conservatives, knowing that none of this will ever go into effect.  Yglesias has a nice graph showing the recent changes:

So they had to rescind one of the tax increases, and they chose the tax on medical devices over the tax on saving and investment?  They chose to cut taxes on a massively subsidized industry instead of paring back taxes on savers who are already double taxed on the same income?  Is this the modern GOP, or the AMA?

I recall that back during the campaign some Republicans convinced themselves that Trump was a supply-sider, pointing to his “support” of a 25% top tax rate, ending the extra Obamacare taxes on capital, ending the AMT, ending the estate taxes, etc., etc.  A supply-side miracle bringing us 4% RGDP growth and tens of millions of jobs.

I can hardly wait!

PS.  If it’s monetary policy you want, it’s over at Econlog.

PPS.  So the Federal government will launch a $45 billion war on opioids.  What could go wrong?

Utility in the 21st century

Utility is one of those things we can’t measure, but we know it when we see it. The 20th century was about becoming “developed” (In North America, Europe, Australia and parts of East Asia). What will the 21st century be about? After all, going from one to two refrigerators is a much smaller jump than going from zero to one.

One possibility is drugs.  Will this 25-year old Malaysian woman end up being the most influential person in the 21st century?  (The Norman Borlaug of the 21st century.)


She is all of 25 and may have already made one of the most significant discoveries of our time.

Scientists in Australia this week took a quantum leap in the war on superbugs, developing a chain of star-shaped polymer molecules that can destroy antibiotic-resistant bacteria without hurting healthy cells. And the star of the show is 25-year-old Shu Lam, a Malaysian-Chinese PhD candidate at the University of Melbourne, who has developed the polymer chain in the course of her thesis research in antimicrobials and superbugs.

A polymer is a large molecule composed of several similar subunits bonded together. Polymers can be used to attack superbugs physically, unlike antibiotics that attempt to kill these bugs chemically and killing nearby healthy cells in the process.

“I’ve spent the past three and a half years researching polymers and looking at how they can be used to kill antibiotic resistant bacteria,” or superbugs, she told This Week in Asia, adding the star-shaped polymers work by tearing into the surface membrane of the bacteria, triggering the cell to kill itself. . . .

Her group is also examining the use of polymers as a drug carrier for cancer patients as well as the treatment of other diseases.

A key project at the moment is the synthetic transplant of cornea in the eye, which involves the use of polymers grown from the patient’s own cells in the lab to replace the damaged cornea.

The operation has already been tested multiple times successfully on sheep, and Qiao hopes to begin the first human trials in Melbourne within two years, working with the Melbourne Eye and Ear Hospital.

And from a bit more authoritative source (Science Daily):

The study, published today in Nature Microbiology, holds promise for a new treatment method against antibiotic-resistant bacteria (commonly known as superbugs).

The star-shaped structures, are short chains of proteins called ‘peptide polymers’, and were created by a team from the Melbourne School of Engineering.

The team included Professor Greg Qiao and PhD candidate Shu Lam, from the Department of Chemical and Biomolecular Engineering, as well as Associate Professor Neil O’Brien-Simpson and Professor Eric Reynolds from the Faculty of Medicine, Dentistry and Health Sciences and Bio21 Institute.

Professor Qiao said that currently the only treatment for infections caused by bacteria is antibiotics. However, over time bacteria mutate to protect themselves against antibiotics, making treatment no longer effective. These mutated bacteria are known as ‘superbugs’.

“It is estimated that the rise of superbugs will cause up to ten million deaths a year by 2050. In addition, there have only been one or two new antibiotics developed in the last 30 years,” he said.

OK, I know that preliminary research often looks promising in medicine, and that “more research is needed”—blah, blah, blah.

But even so, here’s a question for you infrastructure enthusiasts.  Which would do more for global utility in 2050, if you had to pick just one:

1.  Having the government spend $80 billion on a single (sort of) high-speed rail line from LA to the Bay Area?

2.  Funding 80 different research labs all over the world that are studying treatments for superbugs, at the tune of $1 billion each.

Another question:  Does it makes sense to go after China for “stealing” the idea behind an 80-year old Snow White film, based on a 200-year old European folktale, while constantly bashing the drug companies for high prices?

Lateral thinking

Over at Econlog a few weeks ago I did a post entitled “How I Think.”  I was reminded of that post when reading commenter theories on the poor health outcomes of American whites aged 45-54.  In the post, I said that when evaluating Alan Greenspan’s performance, you don’t want to focus on Greenspan; you want to focus on how other central bankers did during this period (about as well.)  When thinking about China’s growth prospects you don’t want to focus on everything you know about China (too complicated), but rather look at other East Asian countries.  And when deciding whether the gold inflows to Spain (1500-1650) were a resource curse that hurt long-term growth, you want to look at other Mediterranean regions that did not received big gold inflows.

Here’s the graph:

Screen Shot 2015-11-05 at 2.22.21 PMPeople were providing answers that seemed to miss the big picture. The graph shows two surprising results, the poor performance of middle-aged white health after 2000, and the excellent performance of Hispanic health after 2000.  In America, Hispanics tend to be disproportionately low income/working class, the group that has been hit hardest by recent economic trends. They were also especially likely (before ObamaCare) to lack health insurance.  And yet their health is significantly better than the health of French and German citizens, in the same age group.

I have no theories at all—I don’t even know if the data are accurate.  But if I was going to come up with a theory, I sure as hell would make sure it explained the sudden and massive divergence in White/Hispanic health outcomes.  If it didn’t, I’d have zero confidence that my theory was correct.

Paul Krugman has promised us an explanation in a future post.  Let’s see what he comes up with.

PS.  I don’t know about you, but to me that graph undercuts some of the recent anti-immigration hysteria.  If Hispanics are actually so inferior, so likely to degrade our precious “Anglo” civilization, how come they have such superior health outcomes?  In rich countries like America, don’t poor health outcomes often reflect poor lifestyle choices?  Just asking.

Update:  Commenter Mike Scally linked to an Andrew Gelman post that says the US data is biased about 5% upward due to compositional effects (the 45-54 age group is getting slightly older, due to boomers passing through).  So instead of rising slightly, US white (middle aged) death rates at a given age have been essentially flat. Of course other death rates fell about 30%, so there’s still a pretty big mystery.

Should soothsayers be regulated?

I have a new post at Econlog that is far more important that this throwaway effort.  I also recommend a recent post on China by David Beckworth, which I initially overlooked.  And excellent posts on the Fed by Tim Duy and Evan Soltas. But if you insist on continuing . . .

Scott Alexander is perturbed that 80% to 90% of doctors don’t know how to answer an extremely simple statistics question like this:

Ten out of every 1,000 women have breast cancer. Of these 10 women with breast cancer, 9 test positive. Of the 990 women without cancer, about 89 nevertheless test positive. A woman tests positive and wants to know whether she has breast cancer for sure, or at least what the chances are. What is the best answer?

(OK, technically 26% got it right, but it was multiple choice with 5 choices—you do the math.)  Nobody who’s taught in college should be surprised by this.  Unless you test students on material that they are told they’ll be tested on, and that they studied for the night before, most students basically can’t answer anything, even 8th grade level questions. Heck, I’d probably get some elementary stat questions wrong (although at least I can do the “story problems” like the one above) Alexander is concerned about the implications of this (here’s he’s referring to another question):

Good news! 42% of doctors can correctly answer a true-false question on p-values! That’s only 8% worse than a coin flip!

And this paragraph is your friendly reminder that six months after this study was published, the FDA decided it was unsafe for individuals to look at their own genome since they might misunderstand the risks involved. Instead, they must rely on their doctor. I am sure that statisticians and math professors making life-changing health or reproductive decisions feel perfectly confident being at the mercy of people whose statistics knowledge is worse than chance.

Obviously I agree.  But the FDA is model of rationality compared to the SEC.  At least with the FDA you can sort of understand the logic of the regulation.  If doctors actually knew what they theoretically should know, what they were taught in college, then they would have more expertise than the average person.  But not even that excuse is true for the regulation of stock pickers:

The Investment Advisers Act of 1940 is a United States federal law that was created to regulate the actions of those giving investment advice for compensation as means to protect the public.

The Act defines an “investment adviser” as anyone who, for compensation engages in the business of advising others about the value of securities or the advisability of investing in, purchasing, or selling securities.

So you go to your investment adviser for stock picking advice, not to some idiot like me. And that’s because your investment advisor is better able to pick the right stocks and mutual funds than I can.  Or at least that’s the theory.  In fact, they do worse than I’d do, in all but a few cases.  The rest of the post will exclude the tiny number of investment advisors that simply tell you to put everything into low cost index funds.

For the rest, the vast majority of regulated investment advisers, they either understand than indexed funds outperform managed accounts, and hence are dishonest, or they don’t understand and are incompetent.  So the SEC regulation virtually forces people like my mother to go to investment advisers who are either knaves or fools.

(On the other hand if doctors profit from needless cancer tests, then maybe medicine isn’t so different from the investment industry.  Maybe the doctors are just pretending not to understand statistics, as a cover.)

Progressives like to talk about the “science” of an issue (at least sometimes, not the science of gender differences, or GMO foods, or taxing capital income, or free trade, or that studies show that voucher schools are cheaper, but at least for global warming.) OK, the science of finance says that indexed funds outperform managed funds.  That stock pickers are no more helpful to investors than soothsayers. So if we force stock pickers to be regulated, why not do the same for palm readers, fortune tellers, soothsayers, tea leaf readers, and all the rest?  Alternatively, is the SEC going after unlicensed stock pickers any different from the leaders of Salem going after witches?  Aren’t both types of prosecution equally “anti-science”?