Health

Life Expectancy and the Business Cycle

Posted by Peter on October 18, 2009
Posted in: Health, Idea Futures.

I once proposed using life expectancy as the primary indicator of what society should try to maximize.

Recently there have been reports that life expectancy is negatively correlated with standard measures of economic growth. I accept the conclusion that depressions and recessions are less harmful than is commonly believed, but I want to point out the dangers of looking at only the life expectancy in the same year as an event that influences life expectancy. Depressions may have harmful effects that take a decade to show up in life expectancy figures (e.g. long-term wealth effects, effects on willingness to wage war, etc). So I’d like to see how life expectancy averaged over the ensuing 10 or 15 years correlates with a year’s gdp change.

Human Enhancement

Posted by Peter on July 10, 2009
Posted in: Book Reviews, Health, Humor, Science and Technology. Tagged: , , , , .

Book review: Human Enhancement, edited by Julian Savulescu and Nick Bostrom.

This book starts out with relatively uninteresting articles and only the last quarter of so of it is worth reading.

Because I agree with most of the arguments for enhancement, I skipped some of the pro-enhancement arguments and tried to read the anti-enhancement arguments carefully. They mostly boil down to the claim that people’s preference for natural things is sufficient to justify broad prohibitions on enhancing human bodies and human nature. That isn’t enough of an argument to deserve as much discussion as it gets.

A few of the concerns discussed by advocates of enhancement are worth more thought. The question of whether unenhanced humans would retain political equality and rights enables us to imagine dystopian results of enhancement. Daniel Walker provides a partly correct analysis of conditions under which enhanced beings ought to paternalistically restrict the choices and political power of the unenhanced. But he’s overly complacent about assuming the paternalists will have the interests of the unenhanced at heart. The biggest problem with paternalism to date is that it’s done by people who are less thoughtful about the interests of the people they’re controlling than they are about finding ways to serve their own self-interest. It is possible that enhanced beings will be perfect altruists, but it is far from being a natural consequence of enhancement.

The final chapter points out the risks of being overconfident of our ability to improve on nature. They describe questions we should ask about why evolution would have produced a result that is different from what we want. One example that they give suggests they remain overconfident – they repeat a standard claim about the human appendix being a result of evolution getting stuck in a local optimum. Recent evidence suggests that the appendix performs a valuable function in recovery from diarrhea (still a major cause of death in places) and harm from appendicitis seems rare outside of industrialized nations (maybe due to differences in dietary fiber?).

The most new and provocative ideas in the book have little to do with the medical enhancements that the title evokes. Robin Hanson’s call for mechanisms to make people more truthful probably won’t gather much support, as people are clever about finding objections to any specific method that would be effective. Still, asking the question the way he does may encourage some people to think more clearly about their goals.

Nick Bostrom and Anders Sandberg describe an interesting (original?) hypothesis about why placebos (sometimes) work. It involves signaling that there is relatively little need to conserve the body’s resources for fighting future injuries and diseases. Could this understanding lead to insights about how to more directly and reliably trigger this effect? More effective placebos have been proposed as jokes. Why is it so unusual to ask about serious research into this subject?

Ending Aging

Posted by Peter on July 31, 2008
Posted in: Book Reviews, Health. Tagged: .

Book review: Ending Aging: The Rejuvenation Breakthroughs That Could Reverse Human Aging in Our Lifetime by Aubrey de Grey and Michael Rae.
This book makes a strong argument that the most important medical need in developed countries is to cure the damage associated with aging, rather than to combat the diseases which become serious as a result of that damage. It outlines a set of solutions which, if they can be implemented, look like they would add at least a decade or two to healthy lifespans.
All of the solutions look like they have a reasonable chance of being implemented within 20 years. But the probability of all of them working within that time is a good deal lower than the probability of any one solution working, and there’s no obvious way to analyze whether we can get significant health benefits without implementing all of the solutions.
The authors seem somewhat overconfident about most aspects of their proposed solutions, but that doesn’t affect the substance if their arguments very much. Even a small chance of postponing death and disability is worth a good deal of effort.
The parts of the solutions that appear hardest are the ones that rely on techniques similar to what are already being attempted by mainstream scientists (genetic engineering to add and delete genes from most cells in the body, massive use of stem cells, and moving enzymes across the blood-brain barrier). My impressions about the effort that has been put into these techniques and the results that have been produced so far suggest that at least one of these is likely to take much longer than the book asks us to hope for. The book gives one clear example of important research not living up to the hype surrounding it when it gives arguments that most cancer research is directed toward modestly postponing cancer rather than providing a full solution to cancer. I see no obvious way for a layman to tell whether the authors are relying on similarly overhyped research.
So even though the book gives convincing arguments that the goals of medical research ought to be reframed to focus on aging as the primary threat to be solved, it’s far from conclusive about whether that should imply a large change in actual research. It may be that the hardest and most valuable tasks are the ones that are already being worked on. Or it may be that one of the critical tasks is sufficiently hard that the most important need is to invent tools that are substantially more sophisticated than what’s used in existing research (i.e. that we most need something more radical that what’s proposed in the book, such as nanomedicine).

Reasonable Rx

Posted by Peter on July 4, 2008
Posted in: Book Reviews, Health. Tagged: , .

Book review: Reasonable Rx: Solving the Drug Price Crisis by Stan Finkelstein and Peter Temin.
This book provides a mediocre analysis of what is wrong with drug prices, and presents a solution that is probably a nontrivial improvement on the status quo, but isn’t the most thoughtful solution I’ve seen.
The most important complaint of the book boils down to the fact that knowledge about drug safety and effectiveness is a public good, and the current method of rewarding drug companies for producing that knowledge is mediocre (although the book presents it less clearly than that and seems as interested in blaming drug companies’ lack of altruism as it is in analyzing the incentives).
For example, it is sometimes possible to identify biomarkers which indicate that a drug will be ineffective in a patient, but that would often reduce sales of the drug.
They complain that the current focus on producing a few very profitable drugs is an obstacle to creating personalized treatments. But they do little more than imply that drug companies are misjudging the available opportunities, without presenting any clear evidence that the authors’ have better judgment about what’s feasible.
Their proposed changes to the drug industry involve separating drug development and drug marketing/manufacturing into two different sets of companies, and using a combination of subsidies and contractual price controls (negotiated by a government sponsored nonprofit) to lower the prices of drugs.
They didn’t convince me that splitting drug companies will produce any significant benefits, although I also don’t see it producing harm.
The subsidies and price controls are likely to help mitigate some of the problems created by the patent system. Their attempts to show that this solution is better than Kremer’s patent buyout proposal suggest they don’t understand how much harm patent monopolies cause. Their subsidy mechanism isn’t clearly tied to benefits (unlike proposals for prizes based on Quality Adjusted Life Years). They claim drug prize proposals set arbitrary values for drugs and that their auction system produces a less arbitrary market price, but the subsidy part of their part of their system is at least as arbitrary, and their market based prices reflect the value of an arbitrary patent duration.
Their claim that Medicare savings will pay for their subsidies seems deceptive. When estimating the Medicare savings, they appear to rely on an assumption that prices of existing drugs will drop by a large amount. Yet when estimating the subsidy costs, they appear to count only the costs of subsidizing newly introduced drugs.
They are too quick to complain about drug companies medicalizing conditions that are mere inconveniences. E.g. they say Flomax does nothing more important than reduce sleep disturbances. This ignores the evidence that sleep disturbances cause significant health problems.
The chapter “Are Drug Companies Risky?” is pointless because it only evaluates the most successful companies (i.e. those whose gambles have already paid off).

Counting Sheep

Posted by Peter on June 4, 2008
Posted in: Book Reviews, Health, Miscellaneous. Tagged: , , .

Book review: Counting Sheep: The Science and Pleasures of Sleep and Dreams by Paul Martin.
This book makes convincing claims that most people give too little thought to an activity that occupies a large fraction of our life.
It has lots of little pieces of information which can be read as independent essays. Here are some claims I found interesting:

  • “sleepiness is responsible for far more deaths on the roads than alcohol or drugs”.
  • Tired people rate their abilities higher than people who slept well do.
  • Poor sleep contributes to poor health a good deal more than medical diagnoses suggest, but hospitals are designed in ways that hinder patients’ sleep.
  • Idle time was apparently a status symbol up to a century ago, now being busy is a status symbol. This should have economic implications that someone ought to explore in depth.
  • People in a vegetative state have REM sleep. This sounds like cause to re-evaluate the label we apply to that state.

While the book has many references, it doesn’t connect specific claims to references, and I’m sometimes left wondering why I should believe a claim. How can boredom be a modern concept? When he says “no person has ever gone completely without sleep for more than a few days”, how does he know he can dismiss people who claim to have not slept for years?

Drug Prizes instead of Patent Exclusivity

Posted by Peter on October 31, 2007
Posted in: Health, U.S. Politics. Tagged: , .

Bernie Sanders has introduced a bill to replace patent monopoly protection for drugs with awards based in part on Quality Adjusted Life Years added by the drugs.
This would eliminate the harm due to monopoly pricing. It might also cause some research to be redirected from “me-too” drugs to more innovative drugs. But I suspect that it’s common enough for what initially looks like a “me-too” drug to end up having valuable advantages that such an effect will be minor.
It would probably be a bigger help to people in developing nations than all the government spending misleadingly labeled as foreign aid.
Because politics will ensure that the idea is implemented suboptimally, I would prefer that something similar (e.g. patent buyouts) be implemented by a more responsible institution such as the Gates Foundation. But the patent system has enough problems that even this imperfectly written bill might improve on the status quo.
One strange effect of political reality is that the rewards are apportioned according to either benefits to U.S. patients or world patients, and the bill provides an awfully vague description of which rule will apply to which drug.
The bill allocates 10% of the rewards to orphan drugs, presumably because the lives of people with those diseases are worth more than those with common diseases.
The bill claims generics cost 85% less than patented drugs, but gets that figure from comparing overall generic prices with overall patented prices. If the cost of manufacturing drugs differs for old and new drugs, that will be misleading. The estimates I’ve found for same-drug price declines after generic competition starts suggest the price decline is more like 30% to 50%. So the bill’s claim that it can be financed by the reduced Federal government drug spending appear to be fiction.
Besides, if it were self-financing that way, wouldn’t it indicate a big reduction in the rewards to drug development? I want to see a good analysis of why $80 billion a year is adequate to substitute for patent exclusivity. My crude attempts at analyzing it suggests it’s too low, but not by a large amount.
(HT Alex Tabarrok)

Cuban Health

Posted by Peter on October 16, 2007
Posted in: Health. Tagged: .

A recent report makes surprising claims about the causes of the apparently impressive Cuban life expectancy data.
It says that shortages of cars, food, and reduced cigarette use had effects that were on balance healthy (I don’t see anything specific about whether a cigarette shortage caused the decline in smoking).
I had thought that there was strong evidence for the claim that increased wealth reliably correlated with increased health. It looks like I ought to examine the evidence on that subject more carefully.

Life expectancy national variations

Posted by Peter on September 27, 2007
Posted in: Health. Tagged: , .

Political Calculations has a post with an interesting table of life expectancy in OECD countries. In addition to the standard life expectancy numbers, there is an additional set that is standardized to eliminate differences in a category of deaths that is roughly described as accidents and homicide (those least likely to be connected to healthcare problems).
I haven’t found an online explanation of how they were standardized (it’s apparently explained in the book The Business of Health: The Role of Competition, Markets, and Regulation by Robert Ohsfeldt and John Schneider, which I haven’t checked), and I can’t evaluate the extent to which their desire to promote the U.S. medical system has biased their methods.
What surprised me most was that it implies that the differences in what we normally think of as health and healthcare explain a surprisingly small part of the difference between national life expectancies. The actual life expectancy shows a difference of 3.6 years between the highest (Japan) and lowest (Denmark), but the standardized life expectancy shows a difference of 1.2 years between the highest (U.S.) and the lowest (U.K.).
This implies that national difference in traffic accidents, homicides, and some similar (poorly identified) causes of death are a good deal more important than the following differences: healthcare systems, diet, serious vitamin D deficiencies (which I expect to vary by latitude), FDA rules, and litigation of medical outcomes.

On a loosely related note, the book A Farewell to Alms mentions a report that 16th century Japan had an unusual absence of disease (but no indication whether it’s possible to get any quantitative evidence of this). This made me think of the alleged high Cuban life expectancy. Could relatively isolated islands be healthier due to lower influx of disease? Not that this would make isolation nice, especially since it might mean increased vulnerability to disease when contact with the outside increases.

Mindless Eating

Posted by Peter on April 30, 2007
Posted in: Book Reviews, Health. Tagged: , , .

Book review: Mindless Eating: Why We Eat More Than We Think by Brian Wansink.
This well-written book might help a few people lose a significant amount of weight, and many to lose a tiny bit.
Some of his advice seems to demand as much willpower for me as a typical diet (e.g. eat slowly), but he gives many small suggestions and advises us to pick and choose the most appropriate ones. There’s enough variety and novelty among his suggestions that most people are likely to find at least one feasible method to lose a few pounds.
A large fraction of his suggestions require none of the willpower that a typical diet requires, but will be rejected by most people because their ego will cause them to insist that only people less rational than them are making the kind of mistakes that the book’s suggestions will fix.
Most of the book’s claims seem to be backed up by careful research. But I couldn’t find any research to back up the claim that approaches which cause people to eat 100 calories per day less for days will cause people to lose 10 pounds in ten months. He presents evidence that such a diet doesn’t need to make people feel deprived over the short time periods they’ve been studied. But there’s been speculation among critics of diet books that our bodies have a natural “set point” weight, and diets which work for a while have no long-term effect because lower body weights cause increased desire to return to the set point. This book offers only weak anecdotal evidence against that possibility.
But even if it fails as a diet book, it may help you understand how the taste of your food is affected by factors other than the food itself.