Friday, August 29, 2014

PSA: Beyond Logic

In a recent Medscape article on the PSA debate the author states:

Cost is another issue. It is estimated that to prevent a single cancer death through screening and treatment costs more than $5 million. Could those dollars be better used to have a greater impact on society? Because although we may prevent a man from dying from prostate cancer, in many cases that doesn't mean that he is going to live a whole lot longer than he would have lived anyway. We have a net dilemma in trying to resolve these controversies. They are not going to be resolved tomorrow. Ultimately, we can hope that 2 things occur. One, going forward, it would be great if the gene tests that are in development turn out to be able to tell us which men need to be diagnosed and treated and which men can be spared. Two, we need to ensure that a similar fiasco does not occur. By that, I mean another screening test for early cancer that is not specific for that cancer being developed, without the right studies being done before it is used. We must avoid approving tests when we don't know for certain that they will be associated with more benefit than harm.

Let me now address each of these assertions:

1. Cost: This calculations makes a set of assumptions which in my opinion as discussed before herein are incorrect. We know the mortality rate of PCa and the costs associated with it. We also know that PSA velocity and % Free are excellent when combined with PSA. What we do not know is when we see a Gleason 6+ cancer whether it is aggressive or indolent. That is a genetic problem. Thus lacking such knowledge it is impossible to make a financial assertion of this type.

2. Genetic Tests: BRCA is a reasonable test for Breast cancer. The problem is that many PCa are not BRCA like, they may be methylation like and thus one needs to sample the actual cancer cells, not just one but many, and many individually to seek a stem cell as well. Not a simple problem.

3. Many tests lack great sp0ecificity. Welcome to testing. We cannot only use tests that  are perfect, medicine is never really like that. We never can give an answer to a patient who says "Doc, how long do I have?". No one patient is the same to all others.

Thus when we see statements like this we should take them with a grain of salt. We use the tools at hand and learn, many of the tools are poor, but they do work, somewhat. Perfection we leave to zealots.

Thursday, August 28, 2014

CATV and Monopolies

I read a piece in Ars Technical alleging that Comcast is taking measures to delimit competition.

The article states:

CenturyLink has accused Comcast of trying to prevent competition in cities and towns by making it difficult for the company to obtain reasonable franchise agreements from local authorities. CenturyLink made the claim yesterday in a filing that asks the Federal Communications Commission to block Comcast’s proposed acquisition of Time Warner Cable (TWC) or impose conditions that prevent Comcast from using its market power to harm competitors. Comcast has a different view on the matter, saying that CenturyLink shouldn’t be able to enter Comcast cities unless CenturyLink promises to build out its network to all residents. Without such conditions, poor people might not be offered service, Comcast argues.

Now that was the same game we saw when we tried to build Hanover, NH.  The incumbent had been Adelphia then bought by Comcast. Then things started, the town demanded almost 100% coverage and more. We wrote a paper discussing this at the time.

It was this added cost that made any entry prohibitive. As we saw it the town just did not comprehend the economics. All we had asked for was a equal and level playing field, the town apparently at the CATV's insistence demanded complete coverage. Frankly no CATV system does that, there are always dead zones due to reasonable economics.

As we have noted before, the merger, politically correct with the current administration, is unacceptable from any reasonable antitrust position in my opinion.

Not a Nice Application of Coase

As I had written yesterday, the poor bemoaning writer from the Times tried to apply Coase to seats on a plane.

Let us use a simple and well used example of Coase.

1. A railroad has a right of way across farm land. Let us assume that as a train goes across the land it sends off sparks.

2. The farmer has given a right of way to allow the tracks to be built but the right of way has no other conditions other then for say $1, and the railroad can then build the tracks and use them.

3. Now the farmer grows acres of corn and wheat. It is harvest time and the crops are dry but well developed and ready to be harvested.

4. A train comes along the tracks spitting out sparks. It sets the fields afire and the farmer looses all his crops.

How can this problem be dealt with.

For Coase there are two options:

1. The State, whatever that is could pass a law mandating how this is to be treated in all cases. The EPA and OSHA are examples of such agencies.

2. Assuming zero litigation costs, whenever such an occurrence happens the parties go to Court and litigate. Let the Courts decide. This is the Common Law approach.

Coase alleges that the second way is always cheaper. That is assuming zero litigation costs.

Now there is a third way in which one could have dealt with this; namely contractual. In the easement or right of way agreement there should be some negotiated and agreed to remedy for direct and indirect harms. A good attorney would have crafted such.

Now in the airline seat case there are, as I had indicated, two levels of rights; "property" right to a seat and a legal right not to be assaulted, which is a criminal issue not a civil one.

Now Mankiw appears to applaud their application to property rights but fails to understand, apparently, the right not to be physically harmed. This I find is common amongst Economists, a certain tunnel vision of self justifying assertions. The real issue here is not a property right, even in the Coasian sense, but the right not to be harmed, assaulted, by another party.

Now let me go back to Coase and the Farmer. Let us assume that the train set off sparks, the corn went afire but this time the farmer was in the field. He get burned to death, a criminal act perhaps, reckless indifference.  Here we have two distinct effects. One is a simple Coase quid pro quo. Sparks and burnt corn. If that were the case then the Farmer could have bought an insurance policy and factored the cost into the right of way. The no matter what both parties would be happy. That is a nice application of Coase. A fried Farmer now is a different story. That now requires, no demands, State intervention.

Let us then return to the airline seat. Yes, I could pay the inconsiderate character in front of me not to swing his seat back, if one were to agree to such an unencumbered property right. Yet there is a second set of issues here, my separated patella, the pain and resulting disability. I could then enter into an agreement with this character in the front seat not to file criminal charges. That is a second Coasian transaction. You see, there are two distinct actions and thus two distinct transactions.

Unfortunately that would not apply in the fried Farmer case, we hope.

Wednesday, August 27, 2014

Whose Rights

I just read a NY Times piece by some individual who apparently in my opinion believes that his right to smash someone's body and thus inflicting pain and harm for his personal comfort is a property right!

Let me pose the issue:

1. Assume that a passenger who is 6'3" is assigned to a seat in which his knees abut against the seat in front of him. Namely the passenger is tall, not obese, and the passenger consumes all of the space allotted to him. Specifically this passenger is using to the fullest his space. No more.

2. Assume we have in front of him a passenger who may or may not fills the space. Yet assume that this passenger desires to recline his seat to the fullest.

3. Now it is a physical impossibility to recline the seat without assaulting the passenger in the seat behind the front passenger. Yet he insists on his property right.

4. If we believe that each has a property right then the assault by the front passenger denies not only the back passenger property right but also inflicts harm. Namely deliberate bodily assault. Let us assume the rear passenger does not employ any means other than his body to inhibit the exercise of the assumed front passenger property right.

5. Then the rear passenger should have a right to file a criminal complaint against the front passenger for deliberate bodily harm, namely depressing the patella and inflicting pain.

Now the Times author in my opinion misrepresents the Coase Theorem. He states:

.... airline seats are an excellent case study for the Coase Theorem. This is an economic theory holding that it doesn’t matter very much who is initially given a property right; so long as you clearly define it and transaction costs are low, people will trade the right so that it ends up in the hands of whoever values it most. That is, I own the right to recline, and if my reclining bothers you, you can pay me to stop. We could (but don’t) have an alternative system in which the passenger sitting behind me owns the reclining rights. In that circumstance, if I really care about being allowed to recline, I could pay him to let me.

That would apply if and only if bodily harm were not inflicted. The act of so inflicting harm may very likely may possibly be criminal and this negates any Coasian solution.

However this piece in my opinion does clearly demonstrate the ego of those people who believe the world owes them and to hell with anyone else. It also perhaps represents the paper in which it was printed!

In fact in the old Salic law there are remedies for this type of assault. On the other hand perhaps we should be glad we no longer apply that law.

The CBO Report

The CBO issued its update on the economy report. What was of most interest was their projections on renormalization of interest rates while keeping inflation at arm's length. Worth a read.

Monday, August 25, 2014

Causes of Obesity

In almost all cases the cause of obesity is over eating. Simple. Now the over eating can be driven by many factors. Family situations are often a driver but that is complex. There are obese family members in the same household as those of normal weight. There is the phenomenon of ethnic groups who have lived for many generations on low caloric diets suddenly being exposed to "regular" diets and becoming obese. Two cases are of merit.

One is the Native American tribes in the Southwest. High obesity and high Type 2 Diabetes. There seems to be a lowered set point in metabolism that when presented with "normal" diets they seem to horde calories. The second is an interesting example, say the Irish after the famine and they come to the US and face a "normal" diet and thus have the same effect, obesity and in turn Type 2 Diabetes.

Now along comes another reason, somewhat suspicious. Namely racial and ethnic subtypes. In Eureka they state:

Many Americans need extraordinary willpower to avoid becoming obese – or to slim down if they already weigh too much. For members of minority groups, maintaining a healthy weight can be that much harder according to new research led by Luis Rivera, an experimental social psychologist at Rutgers University-Newark. Rivera says it is common for minorities in the United States to endure negative stereotypes, pervasive messages that suggest those groups are inferior, and that these attitudes can prevent people from doing what is needed to care for their health. "When you are exposed to negative stereotypes, you may gravitate more toward unhealthy foods as opposed to healthy foods," explains Rivera, whose study appears in this summer's edition of the Journal of Social Issues. "You may have a less positive attitude toward watching your carbs or cutting back on fast food, and toward working out and exercising." 

This seems to be based upon shaky ground. The same effects as seen in Native Americans and Irish Famine immigrants seem to be a better explanation. Immigrants from Hispanic lands in Central and South America come from low caloric diets and heavy manual labor. When the come here they face higher caloric intakes socially. Thus like the other cases one can see a set point difference, one lasting a few generations.

One may ask if this is akin to the methylation arguments seen in the Dutch Famine cases. It most likely is not attitude but a new set point.