I'm Fired!

My fantasy football team, following an almost miracle season, has regressed back to the mean this year. I am currently 2-4 and have the lowest point total of the 12 teams in our annual league. I attribute a lot of this to injuries: the three starting wide receivers I drafted are all out (two indefinitely and one for the year), as well as two of my defensive players. Furthermore, the league draft having been before the end of preseason, I found myself with two QBs with strong training-camp buzzes that turned out to be unusually poor forecasts. All in all, an idiosyncratic mess.

But, I look at my lifetime record (I average about a 6th place finish out of 12 teams) and realized that there is likely a persistent component to my lack of titles and general mediocrity. I also noticed that Yahoo! Fantasy Football has a new feature where people can co-manage a single fantasy team.

Given all this, I've decided to fire myself as the general manager of my team, and outsource the responsibilities of drafting and early season waiver-wire moves to someone else. I will still retain final authority over decision-making and retain the capacity to make some moves myself, but all of this will be in a much reduced role.

My firing of myself is effective immediately. I am currently looking for someone with at least five years of fantasy football experience (from competitive leagues, with a successful track record) to take over the GM role of the team. Let me know if you are interested.

Random Thoughts from Cape Town

I have about two days left here in Cape Town and decided that this would be an appropriate time to reflect on what has been a great experience. I came here with the intention of finishing off one paper, and starting the second. As was the case with my last trip here, I leave the region with some great experiences and some new puzzles to ponder. Here are a collection of random thoughts I have (too tired to string these together in the usual thematic piece). Enjoy.

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On the plane ride over, I saw this great movie called The Visitor. It's about a tenured widower academic (a development economist!) who is going through the motions in life, until he meets an illegal immigrant who he eventually shares his apartment with and starts learning the African drums from. The immigrant chap is eventually arrested and detained, and the academic works hard to get him out, forming life changing relationships with the drummer and the drummer's wife and mother in the process. It is an uplifting, sad and thoughtful movie, all at once, and perhaps one of the best movies I've seen in the last few months. Furthermore, Richard Jenkins, who plays the academic, gives an incredible performance and should win awards for this.

Highly recommended.

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I absolutely love the University of Cape Town. Aside being located on the side of Table Mountain (and thus offering incredible views of both the mountain side and the city below), UCT is one of the best academic institutions on the continent, and the research that is going on here is really interesting. You often get a good grip on the quality of the research in an institution from the comments you get during a seminar. At my seminar, the feedback was ridiculously sharp and useful - definitely one of the best academic experiences of my young research career.

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Speaking of UCT, I got a chance to revisit the owner of the Chinese food stall here, who made an appearance in one of my earlier posts on incentives to induce environmentally friendly behavior. The gentleman is still offering his R0.50 discount to those who bring their own plates or containers for food, though, he noted sadly, few people take him up on that these days. He seemed quite distraught to keep having to dole out styrofoam containers. I told him that it might be time to up the incentive, to which he laughed in response.

I don't think he is going to take me up on this.

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One of the best ways to spend a day in Cape Town is to hike up Table Mountain and/or Lion's Head. Both offer stunning vistas of the city and surrounding suburbs. My body continues to revolt after the two hikes I've done here, but spending a day out in the sun, walking and climbing on paths surrounded by spring colors and geckos was pretty mind blowing.

Also mind blowing are Chandini restaurant in Woodstock (amazing Indian food), the Royale Eatery (at least 15 options for vegetarian burgers) and the High Life (Hare Krishna) food stall at UCT.

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Of course, the trip wasn't all fun and games - at least in the recreational sense. My colleague and I spent most of our time working (fun and games, though of a different sort, in my book), and are onto some new research questions. In particular, we are going to look at links between economic vulnerability and shocks and risky sexual behaviors. More on that in a later post...

All in all, this has been a great trip: productive, fun, and thought-provoking. And it's been great also to create partnerships that could spur projects and travel opportunities in the future.

Circumcision, HAART and Behavior

Male circumcision is a hot topic among academics and policy-makers alike. A recent randomized controlled clinical trial suggests that the decrease in transmission rates from circumcision could rival those from putative AIDS vaccines (around a 60% in the odds of contracting HIV).

This is quite impressive, but, as my colleague Brendan here in Cape Town suggests, the public health benefits of a wide-scale circumcision program will likely be smaller than what is seen in clinical trials. The argument is that people will be encouraged to take up circumcision because it will lower their risk of contracting the disease. Men may who choose to get circumcised may then engage in more risky sexual behavior thereafter as a response to lower perceived risks, thus undoing some of the benefits of circumcision seen in the clinical evidence. The take home point is that policymakers should be careful when extrapolating from randomized clinical trials, and that behavioral responses to new public health policies may alter (sometimes radically) the efficacy of new interventions.

On a related note: an interesting piece from 2006 in the Quarterly Journal of Economics examines the effects of the development and roll-out of HAART on HIV incidence rates. The authors find that people on HAART take up more sexual partners as a result of being healthier. While the infectiousness of those on HAART is lower from those who are not treated, the authors contend that this phenomenon increases the risk of an HIV- individual contracting the disease: more HIV+ are engaged in sexual activity. They go on to argue that HAART may lower the welfare for those who are not infected with the virus. (Technical note: to establish causality, the authors use state-level differences in Medicaid generosity towards HAART to predict HAART use, and then use that predicted value in their models for risky behaviors).

It's About Time

As of this past Wednesday, Medicare has stopped paying for procedures they deem to be the result of medical errors (great piece on it here). This was a long time coming. The hullabaloo around medical errors is now about a decade old, and several large private insurers in the interim realized the folly in paying doctors and hospitals to make mistakes. Glad to see the Feds followed suit.

I have a few questions though. This policy will only be effective if errors can be identified and there aren't other means the game the system. The new Medicare policy appears to hold up on the first ground (they have a list of specific things they won't pay for), but it is not clear to me that doctors or hospitals couldn't a) pass the costs on the patients or b) use different codes to procure payment. The linked article suggests that Medicare has a way around (a). I'd love to hear about it if any of you have more information.

This policy is a good idea from the standpoint that there are welfare losses due to medical errors and that people should never be paid for doing something wrong. On the flip side, my sense is that the impact of this policy on health care costs will be minimal, at best. The importance of medical errors as a money drain has long been overstated. It's nice to see the aforementioned popular press article get this point right.

Incentives and HIV/AIDS

I'm now in Cape Town, South Africa, finishing off some research with my colleague Brendan Maughan-Brown and starting some fresh work, as well. It's definitely great to be back here, and away from the dissertation and financial crisis (kind of - the South African market went tumbling after the failure of the bailout, and my e-trade account looks destitute), if at least for a few days.

More so than usual, incentives and behavior have been front and center in my mind. Not surprising, as these topics figure centrally in a paper Brendan and I just presented and submitted for publication (see here for an earlier post on the topic). Some background: HIV/AIDS is a big problem in South Africa, with perhaps as much as 20% of the working age population afflicted by the disease. South African public policy towards the disease involves two main components: government provided antiretrovirals and disability grants. The latter is the focus of our work.

Disability grants are very large transfers given to poor individuals who are too sick to work. Once these individuals become healthy again, the grant is revoked. However, the problem in South Africa is that high rates of unemployment (up to 40% in some areas) make it likely that many individuals will not be able to find jobs post losing their grants. A fair amount of scholars and policy-wonks worry that this may create a perverse incentive for individuals to forego or modulate their antiretroviral treatment in order to remain eligible for grants.

We decided to investigate this issue by using some interesting data on individuals with HIV/AIDS taking treatment who were followed during the period 2004-2007. Our main finding is that, while losing a disability grant is associated with drops in individual and household income, people do not get sicker and continue to adhere to treatment. We find that households appear to use other strategies to cope with the loss of a grant, including transferring young children (dependents) to other households. In all of our models, we try to account for a host of factors that might bias our results (individuals on disability grants might be worse off because they need to meet a means test, or better off because they are good at pro-actively getting what they want or obtaining social transfers; the causality between the outcomes and disability grant receipt might run the other way, etc).

I'm not too surprised by these findings. It seems a bit much to think that someone who has been AIDS-sick would want to go through that again under any circumstances. In the words of a University of Cape Town researcher who attended the seminar Brendan and I gave: "being poor is better than being dead."

Another interesting thing we found was that individuals were receiving disability grants long after their eligibility should have been up (people on highly active antiretrovirals get better within six to nine months). This, along some other interesting evidence, leads us to believe that people are really good at gaming the social security system. So perhaps this is another reason why people aren't responding to the perverse incentive: there are other ways to survive (that confer far less risk and disutility), including taking advantage of a broken system.

Drop me a line if you have any questions about our work: I'm really excited about this project and the several extensions we have planned, and would certainly love to discuss.

Useful Links Re: Financial Crisis

The financial/credit crisis and our recent economic woes looms large in everyone's mind these days. Even in my counter-cyclical student bubble haven, there are daily reminders (both on the news and in the flesh) of people who have been hurt by the recent economic downturn (much more trivially, my own paltry investments have taken a huge hit these last 10 days, to the point where I've stopped logging into E-trade to view the carnage). All of this has deepened my resolve to try and understand how this crisis originated, how it can be prevented in the future, and what our country's economic prospects are for the next year or two.

My usual source for this kind of knowledge is The Economist. Lately though, I've found the stuff on the financial crisis to be a bit incomprehensible (is it just me or are they being a bit too jargony?). Thus, after a steady dose of the Englishmen, I felt up-to-date on all the news (like which bank went down most recently), but the hows and whys were still unclear.

Today, I did some browsing and found three pieces that really helped me gain a conceptual understanding about the financial system and what went wrong. The links are provided below. The first two couch the crisis in the form of hokey stories. It might seem a bit Mickey Mouse, but the insights are powerful and the analogies accessible. I would classify these as must reads for anyone who wants to understand what is going on without having to decipher all the usual Wall Street gibberish. The third is a guest post on the Freakonomics blog: also very good, and goes through the key questions and players and also provides some insights into what might happen in the future.

Finally, if any of you have found other sources/websites that explain the crisis in easy-to-understand terms, please post a link in the comments. Thanks in advance.

Links:
1. Interfluidity blog: Credit Crisis for Kindergarteners
2. CNN.com: Glenn Beck
3. Freakonomics: Diamond and Kashyap on the Recent Financial Upheavals

The Dubious Legacy of Candy Cigarettes?

I remember getting my first candy cigarette from a classmate at school when I was eight years old. I had no idea what it was, but it seemed pretty exciting and, despite my unusually high discount rate when it comes to candy (ask anyone in my family), I ended up saving it for when I got home.

This turned out to be a huge mistake. My mom saw me "smoking" and completely flipped out. From then on candy cigarettes were banned from my house (and, to this day, my mom gets mad if my sister and I pretend carrot sticks or pens to be cigarettes or cigars). Later, enough mothers were upset by the whole idea that candy cigarettes were banned from my elementary school, as well.

What worried moms across the country was the possibility that smoking candy cigarettes would induce children to take up the real thing a few years later. Is there good evidence that candy cigarette use has a causal effect on later smoking? I trolled around the internet and found some interesting links off the candy cigarettes Wikipedia page. As it turns out, there IS a study on the association between candy cigarette and nicotinic cigarette use (see here for a summary and here for the actual piece). Here are the findings (lifted from the abstract):

26.4% of respondents reported current smoking and 29.4% reported former smoking. Candy cigarette use was reported by 88% of both current and former smokers and 78% of never smokers (p ≤ 0.001). Logistic regression showed that the odds of smoking for those who used candy cigarettes was 1.98 (95% CI: 1.77, 2.21) for ever (current plus former) smokers and 1.83 (1.59, 2.10) for current smokers, compared to those who had not used candy cigarettes. Odds for current and ever smoking increased with increasing candy cigarette use.

The main issue here, of course, is whether the link between candy cigarettes and smoking is causal. For example, if individuals who really want to fit in use candy cigarettes to appear "cool" and later smoke for the same sense of social acceptance, one would see an association between the two behaviors, but this association certainly would not be causal. Even so, the results are pretty intriguing and worthy of further exploration.

Health Policy Seminar Series at Yale

If you are a Yale student or someone who happens to be visiting on a Monday between noon and 1:30 PM, be sure to check out this semester's Division of Health Policy and Administration's seminar series. The bill looks fantastic and represents a good mix of economics, health services research and management. It also features me, bringing up the tail end with a talk on a subject that is as of yet unknown (you'll hear more about it what I am doing in the next few weeks).

Hope to see you here!

Public Nutrition Programs and Child Health

Two interesting working papers this week on the effect of major U.S. nutrition programs and child health. The first, by Douglas Almond and coauthors, examines the effect of the Food Stamp Program (FSP) on birth outcomes. Using variation in the roll-out of the program (Food Stamps became operative in different counties at different times during the 60s and 70s) to identify causal effects, the authors find that women exposed to the policy for three months or more of their pregnancy gave birth to heavier babies.

Daniel Millimet and coauthors study the School Breakfast Program (SBP) and the National School Lunch Program (NLSP), looking at the link between school feeding and childhood obesity. The authors find that the SBP works against the rising tide of childhood obesity while NSLP exacerbates it. Unfortunately, they offer little intuition for these opposing findings, especially when the two programs have similar inclusion criteria (i.e., they target poor students). One possibility might be the scope of the program: the NSLP serves twice as many students as the SBP. Another is the nutritional content of the meal: lunch is higher in calories (though similar in "healthiness").

Besides discussing issues of intrinsic interest to public health, these two papers are also noteworthy in their rigor in pursuing causal effects. The Millimet, et al study, in particular, uses a methodology where, recognizing that kids who enroll in SBP and NSLP are likely different than those who do not, they study the sensitivity of their results to different degrees of selection bias. Basically, the authors define a parameter for non-random selection into the program, and dial the level of this parameter up and down to see how their econometric results change. Very clever stuff. It's nice to see that, lacking experimental or even quasi-experimental program variation, such as that exploited in the Almond paper, it is still possible to say something about causality. The selection correction method utilized by Millimet, et al is simple and intuitive: I hope it finds it way into medical journals soon!

Anyone Interesting in Working on a Small Project?

"Guess who's back, back again..."

That's right. I'm back to blogging after several weeks off - August turned out to be an exceptionally busy month (more on that in the next few days). It's great to come back to this space and resume writing about health economics and other topics of interest.

To start off September, I'd like to use this post to solicit help on a small project I am starting. Basically, I want to look at published studies of industry sponsorship bias in drug trials (a very hot topic: see here, from the recent issue of JAMA) and understand what we can learn with the existing statistical evidence, and need a research assistant to do some data collection and extraction. You will also be able to help out in designing the analysis. Here is what you get in return: authorship if the work gets published, and experience on what should be an interesting, fun, non-trivial and short project.

If you are interested in learning more, write me at this e-mail address.

Finally, I realize I'm being especially vague here about what the project is actually about. This is because I recently had a bad experience getting scooped and do not want to go through that again. However, you can trust me on the fact that this will, indeed, be interesting!