April 2009

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Economics 2.0: Are more experienced Heart Surgeons better?

April 23, 2009 in Quality, Specialists | No comments

According Economics 2.0′s review of Huckman and Pisano (2006):

WIth each additional operation the surgeon preforms in a clinic, the mortality factor of his or her patients there drops by 0.018 percentage points.  When that doctor performs an operation in another clinic during the same three-month period, patients’ death rates decline by only 0.001.  

Few heart surgeons are employed directly by hospitals.  Most cardiac surgeons work as independent contractors who operate on their patients in a variety of hospitals. It seems that when cardiac surgeons are more comfortable with their surroundings and have more established relationships with the nurses, anesthesiologists, and other support staff in the hospital, performance improves. The authors claim the following:

“The quality of a surgeon’s performance at a given hospital improves significantly with increases in his or her recent procedure volume at that hospital but does not significantly improve with increases in his or her volume at other hospitals. Our findings suggest that surgeon performance is not fully portable across hospitals (i.e., some portion of performance is firm specific). Further, we provide preliminary evidence suggesting that this result may be driven by the familiarity that a surgeon develops with the assets of a given organization.

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Economics 2.0: How to do a colonoscopy

April 22, 2009 in Economics - General | No comments

Clinical trials often examine the effectiveness of a treatment outside of real world contexts.  For instance, if a medicine is very effective, but has severe side effects, this likely will reduce adherence and can make the medicine less effective in the real world.  The Economics 2.0 book looks at when individuals are most satisfied with a colonoscopy:

“[An] experimental was conducted with colonoscopies at a time when sedation was not yet customary.  With half of the patients, the doctor left the instrument inside the colon at the end of the examination for one extra minute, without moving it.  This was unpleasant, but much less painful than the colonoscopy itself.  It turned out that patients who had this done to them later recalled the overall examination as less unpleasant than other test subjects who had the instrument removed earlier.  Also, they were more likely to show up for follow-up examinations.“

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Cavalcade of Risk #76

April 22, 2009 in Carnivals | No comments

The latest edition of the Cavalcade of Risk is up at My Wealth Builder.  My favorites are:

  • InsureBlog: Will DNA tests replace the Pap smear?  A Bill and Melinda Gates study shows that a DNA test for cervical cancer outpreforms all other tests including the Pap smear. 
  • Colorado Health Insurance Insider: Discusses the risk involved with having a Cesarean-section. 

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Chagas Disease

April 21, 2009 in Contagious Disease | No comments

In Bolivia, up to 70% of children in rural areas have Chagas.

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Economics 2.0: Status matters more than money

April 21, 2009 in Economics - General | 2 comments

Here’s another excerpt from the Economics 2.0 book.

“Scientists Sara Solnick and David Hemenway…questioned students in what kind of world they would rather live–one where they earned $50,000 and everyone else half as much, or alternatively, $100,000 while everybody else would make twice as much.  The majority chose the first option, even though they would have cleared improved their lot by picking the second.”

…paved with Green intentions

April 20, 2009 in Economics - General | No comments

Biofuels may not be all they are cracked up to be.  The Economist reports (“Biofools“) that biofuels may actually hurt the environment more than traditional energy sources.   

The International Council for Science (ICSU)…report concludes that, so far, the production of biofuels has aggravated rather than ameliorated global warming. In particular, it supports some controversial findings published in 2007 by Paul Crutzen of the Max Planck Institute for Chemistry in Mainz, Germany. Dr Crutzen concluded that most analyses had underestimated the importance to global warming of a gas called nitrous oxide (N2O) by a factor of between three and five. The amount of this gas released by farming biofuel crops such as maize and rape probably negates by itself any advantage offered by reduced emissions of CO2.

Although N2O is not common in the Earth’s atmosphere, it is a more potent greenhouse gas than CO2 and it hangs around longer. The upshot is that, over the course of a century, its ability to warm the planet is almost 300 times that of an equivalent mass of CO2. 

On my commute to campus this morning, I used the UCSD shuttle.  This shuttle service now uses buses fueled by biodiesel.  One drawback of using biodiesel, however, is that the engines are prone to overheat.  When today’s temperature hit 95 degrees in San Diego, sure enough the bus broke down and was not able to make the 25 minute journey to campus.  

Biofuels may not be the fuel of the future after all.

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Nature vs. Nuture: Yemeni edition

April 20, 2009 in Uncategorized | No comments

Experiment: Airlift 50,000 Yemini Jews to Israel and randomly place them with Israeli families.

Finding: Nuture matters.  ”We find that children who were placed in a good environment (a home with good sanitary conditions, in a city, and outside of an ethnic enclave) were more likely to achieve positive long-term outcomes. They were more likely to obtain higher education, marry at an older age, have fewer children, work at age 55, be more assimilated into Israeli society, be less religious, and have more worldly tastes in music and food…We find weaker and somewhat mixed effects on health outcomes…”

H.T.: Marginal Revolution

  • On a side note: Malawach is a very tasty traditional dish among Yemini Jews.  With the Yemini airlift, it’s become a favorite comfort food in Israel.  I sampled this dish in a Yemini restaurant in L.A.  

Economics 2.0: Does paying parents to be on time increase punctuality?

April 20, 2009 in Uncategorized | 1 comment

I recently read an interesting book titled Economics 2.0.  The book has a Freakonomics pedigree, but reads more like a newspaper or a blog. The benefit of this format is that the authors are able to review a wide variety of economic studies. The downside is there isn’t any real thesis. The book is basically just: “here are summaries of some interesting economic research.” Many of the papers reviewed, however, are interesting and this week I will recount some of the sections that peaked my interest.

Does paying parents to be on time increase punctuality?

Economists generally believe that when you pay someone more to do an activity, they will respond by doing more of the activity.  This may not always be the case.  

Uri Gneezy and Aldo Rustichini (2000) ask the following question: What will happen when a kindergarten charges parents a fee for being late picking up their children?  Generally economists would predict a decrease in tardiness.  However, when Gneezy and Rustichini conducted this experiment in Israeli daycare centers, they found that the late fee actually increased tardiness! After the fine was removed, punctuality did not revert to earlier levels.

The authors argue that charging a price broke a social covenant to be on time to pick up your kid.  Because the late fee put a price on tardiness, it became a market transaction and thus was viewed as an acceptable behavior.  ”A powerful, intrinsic motive was crowded out by a weaker, extrinsic one.”

Physician Prescribing Behavior for NSAIDs

April 17, 2009 in Pharmaceuticals | 1 comment

What determines which NSAIDs physicians prescribe? According to the Naik et al. (2009) the following six factors are the most important:

  1. Direct Marketing by Pharmaceutical Reps.
  2. Patient requests for medication, often driven by direct-to-consumer pharmaceutical advertising.
  3. Habits formed during medical school. Often, these habits are influenced by drug rep visits while the physician was in medical school.
  4. Journals, electronic peer-reviewed literature, and professional meetings.
  5. Local physician expert opinion and practice guidelines.
  6. The physician’s own experience prescribing drugs to patients.

Although many physicians believe that academic journals and peer-reviewed literature provide the highest quality advice, few doctors actually follow this advice. Instead, many physicians rely on their “…relationships with local physician experts [in order to] provide interpretation and context to new clinical evidence, practice guidelines, and pharmaceutical marketing related to NSAID prescribing behaviors.”

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Assorted Links

April 16, 2009 in Miscellaneous | 1 comment

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