Lunch at the Labs

Various web links I found to be of interest recently.

• We Libertarians Were Really Wrong About School Vouchers

  Some studies suggest that voucher programs do modest good; others suggest that they do very little; and a few suggest that the impacts are actually negative. My overall takeaway from the literature is that voucher programs probably do a little bit of good. But the emphasis is on the word "little"; they are not a cure-all, or even much of a cure for anything. It was reasonable to think, in 1997, that voucher programs could change the world. Now we have two decades of evidence.
  ...
  But the quality of the pedagogy isn't the only thing that shapes student outcomes in schools. The peer group matters a great deal; families with higher socioeconomic status are better able to navigate the educational system, and they value education very highly, traits they pass on to their children. Those parents also work hard to improve the quality of the schools their children attend.

  The socioeconomic status of the students in a school is somewhat easier for parents to observe than the quality of the pedagogy. It's not then, all that surprising that when researchers sat down to analyze parental decision-making in New York City public school, peer group seemed to be what parents were looking at. And peer group matters a great deal.

• DeepMind's Go-playing AI doesn't need human help to beat us anymore

  The company's latest AlphaGo AI learned superhuman skills by playing itself over and over

  The original AlphaGo demonstrated superhuman Go-playing ability, but needed the expertise of human players to get there. Namely, it used a dataset of more than 100,000 Go games as a starting point for its own knowledge. AlphaGo Zero, by comparison, has only been programmed with the basic rules of Go. Everything else it learned from scratch. As described in a paper published in Nature today, Zero developed its Go skills by competing against itself. It started with random moves on the board, but every time it won, Zero updated its own system, and played itself again. And again. Millions of times over.
  ...
  After three days of self-play, Zero was strong enough to defeat the version of itself that beat 18-time world champion Lee Se-dol, winning handily -- 100 games to nil. After 40 days, it had a 90 percent win rate against the most advanced version of the original AlphaGo software. DeepMind says this makes it arguably the strongest Go player in history.

• This year's economics Nobel winner invented a tool that's both brilliant and undemocratic

  "Nudges" aren't good for democracy.

  The problem -- as Carnegie Mellon's Cosma Shalizi and I have discussed elsewhere -- is that government-by-nudging amounts to a kind of technocracy, which assumes that experts will know which choices are in the interests of ordinary people better than those people know themselves. This may be true under some circumstances, but it will not be true all of the time, or even most of the time, if there are no good opportunities for those ordinary people to voice their preferences.

• The New York Times: Promoting False Hope as Journalism

  Criticism of book The Other Side of Impossible promoting alternative medicine.

  We have already explored at length the problems with anecdotal evidence. Meadows' casual dismissal of these problems by stating that "an example of one" has meaning in terms of giving hope is itself a harmful deception. You could probably write a book filled with stories of people who played the lottery as the solution to their financial situation and won. You could cherry pick the winners, and then explore what they did to choose their winning numbers. a statistically negligible hope. Focus on the hope and the winners.
  ...
  Of course, only the most dramatic examples are going to make it into such a book. They are by definition not representative. There are also all the other problems with anecdotal evidence. We don't really know if the original diagnosis was accurate. We don't know which of the many treatments used were actually effective. We don't know that the outcome wasn't just the natural course of the illness or a spontaneous remission. There is also a lot of subjective judgement involved.

  The original New York Time article by Jane E. Brody is,
  Hitting a Medical Wall, and Turning to Unproven Treatments
  

  Also see this criticism of the original article from Respectful Insolence in Science Blogs,
  The New York Times publishes fake news false hope in the form of a credulous account of dubious alternative medicine testimonials
  

• Researchers have ditched the autism-vaccine hypothesis. Here's what they think actually causes it.

  Genes and the microbiome are some of the most promising leads.

  Of all the issues doctors have explored in children's health, none has been more exhaustively researched than the question of whether vaccines are linked to autism. After hundreds and hundreds of studies in thousands of children, "We can say with almost as much certainty than anybody could ever say that vaccines don't cause autism," Mayo Clinic autism researcher Dr. Sunil Mehta told me.
  ...
  "The bottom line is that when you add up all of the genetic risks, it looks like genetics can account for 50 percent of the risk for autism, which is very high," said David Amaral, an autism specialist at the UC Davis MIND Institute. To put that into context, compared to other common health problems -- like heart attacks, or cancer -- autism is much more genetic, with well over 100 genes now implicated.
  ...
  Exposure to infections and certain medicines during pregnancy may be linked to autism.
  ...
  The disorder seems to affect boys about four times more than girls.

• Meet the nocebo effect, the placebo effect's evil twin that makes you feel pain

  A fascinating new study finds patients report worse side effects when a drug costs more money.

  Doctors even see a placebo response in patients who are told they are on a placebo. And the more invasive, expensive, and drastic the placebo intervention, the greater the healing effect. Fake surgeries -- where doctors make some incisions but don't actually change anything -- make people feel better than placebo pills alone.
  ...
  But the placebo effect has an evil twin: the nocebo. It can kick in when negative expectations steer our experience of symptoms and create side effects where none should occur.

  This means, incredibly, that you can get side effects from a sugar pill. And sometimes these side effects are so severe that patients drop out of clinical trials, as a 2013 paper in Nature Reviews explains. A review of fibromyalgia drug trials revealed that 72 percent of people who left the trial did so because they felt severe side effects while on placebo.
  ...
  When patients are led to believe one drug is less expensive than another they're also less likely to report painful side effects.

Some links about the health care system and being healthy.

• Is Health Care a Right?

  Atul Gawande in The New Yorker

  It's a question that divides Americans, including those from my home town. But it's possible to find common ground.

  A right doesn't distinguish between the deserving and the undeserving, and, for many in my Ohio home town, that rankled.
  ...
  

  As he saw it, government existed to provide basic services like trash pickup, a sewer system, roadways, police and fire protection, schools, and health care. Do people have a right to trash pickup? It seemed odd to say so, and largely irrelevant. The key point was that these necessities can be provided only through collective effort and shared costs. When people get very different deals on these things, the pact breaks down. And that's what has happened with American health care.

  The reason goes back to a seemingly innocuous decision made during the Second World War, when a huge part of the workforce was sent off to fight. To keep labor costs from skyrocketing, the Roosevelt Administration imposed a wage freeze. Employers and unions wanted some flexibility, in order to attract desired employees, so the Administration permitted increases in health-insurance benefits, and made them tax-exempt. It didn't seem a big thing. But, ever since, we've been trying to figure out how to cover the vast portion of the country that doesn't have employer-provided health insurance: low-wage workers, children, retirees, the unemployed, small-business owners, the self-employed, the disabled. We've had to stitch together different rules and systems for each of these categories, and the result is an unholy, expensive mess that leaves millions unprotected.

• Single-payer isn't the only progressive option on health care

  There are several routes to universal coverage -- some more politically feasible than others.

  As we consider the most effective strategy for achieving universal coverage, progressives should keep two admonitions in mind. First, we must not conflate our foremost health care goal (universal coverage) with competing pathways toward achieving that goal
  ...
  America's unique history and politics make the successful promotion of a single-payer system an unlikely pathway to universal health coverage. There are three reasons. The first involves the inevitable strong and well-funded opposition of special-interest groups.
  ...
  The second political impediment is the potential backlash to the cost of single-payer, and how it will be financed.
  ...
  Finally, as both Democrats and Republicans have now learned, once people have health care coverage, they are sensitive about efforts that might take it away or potentially diminish its quality. Today, approximately half of the US population receives health coverage through the workplace. If that coverage is replaced with a single-payer system, workers will be vigilant about making sure the new coverage is at least as good as what they had before.
  
  Over time, there's no reason incrementalism can't get us all the way to 100 percent coverage. Single-payer isn't the only route to that goal. In the foreseeable future, the step-by-step approach is the strategy progressives should pursue.

  • Expanding Medicaid in 19 states
  • Providing coverage for immigrants
  • Fixing the so-called "family glitch"
  • Extending CHIP
  • Paying for quality, rather than quantity, of health care
  • Reducing prescription drug prices
  • Remedying anti-competitive health system market domination
  • Promoting a "public option"

• What Makes Singapore's Health Care So Cheap?

  And it spends far, far less than the United States does. Yet it achieves some outcomes Americans would find remarkable. Life expectancy at birth is two to three years longer than in Britain or the United States. Its infant mortality rate is among the lowest in the world, about half that of the United States, and just over half that of Britain, Australia, Canada and France. General mortality rates are impressive compared with pretty much all other countries as well.
  ...
  Americans tend to think that they have a highly privatized health system, but Singapore is arguably much more so. There, about two-thirds of health care spending is private, and about one-third is public. It's just about the opposite in the United States.
  ...
  In other words, Singapore discovered that, as we've seen many times before, the market sometimes fails in health care. When that happened in Singapore, government officials got more involved. They established the proportion of each type of ward hospitals had to provide, they kept them from focusing too much on profits, and they required approval to buy new, expensive technology.

• One-Fifth of Medical Care Is Unnecessary, Doctors Say

  Americans spend at least $3.2 trillion on health care each year. That's well beyond any other country in total and per capita. A great many factors feed the glut, but a primary contributor is overtreatment. Unnecessary tests and procedures account for at least $200 billion in spending every year.
  ...
  The most cited reason for overtreatment was "fear of malpractice." An astounding 84.7% of the responding physicians feared a lawsuit if they didn't exercise every treatment precaution. "Patient pressure/request" and "difficulty accessing prior medical records" were the next most common reasons, at 59% and 38.2% respectively.
  ...
  "Only 2-3% of patients harmed by negligence pursue litigation, of whom about half receive compensation. Paid claims have declined by nearly 50% in the last decade..." they wrote.

  Also see How drug companies make you buy more medicine than you need.

• Poor diet is a factor in one in five deaths, global disease study reveals

  Study compiling data from every country finds people are living longer but millions are eating wrong foods for their health.

  Diet is the second highest risk factor for early death after smoking. Other high risks are high blood glucose which can lead to diabetes, high blood pressure, high body mass index (BMI) which is a measure of obesity, and high total cholesterol. All of these can be related to eating the wrong foods, although there are also other causes.

• New Study Offers Support for Prostate Testing

  For men who are weighing the pros and cons of prostate cancer screening, a new study strengthens the evidence that testing can reduce deaths from this cancer, something two earlier large landmark clinical trials appeared to reach different conclusions about.
  ...
  "I personally believe that results from models are less convincing than data from actual clinical trials, so I doubt there's anything here that would move the needle on PSA screening," said Dr. Kenneth Lin, an associate professor of family medicine at Georgetown University Medical Center.