Grow hair and prevent cancer

I’ve become quite a fan of the NPR Health Blog “Shots.”  This entry today about finasteride (Propecia)  caught my attention:

A generic drug called finasteride reduces the risk of prostate cancer by 25 percent, according to a 2003 study of 18,000 men.

But doctors apparently don’t believe it, misunderstand the findings, or just don’t know about it…

When researchers asked them why, half said they didn’t know the drug could prevent prostate cancer. And more than half said they were worried that men taking finasteride had a higher risk of developing more aggressive tumors.

That second concern arises from the first results of that 2003 study, called the Prostate Cancer Prevention Trial. It seemed to show that finasteride, which blocks the cancer-stimulating effects of testosterone, lowered the overall rate of prostate cancer by 25 percent but increased the risk of more dangerous tumors by 27 percent.

But in 2008, the researchers refuted from that finding, after looking more closely at the data along with biopsies of the tumors that occurred during the study. The new analysis showed finasteride didn’t really raise the risk of high-grade tumors, it just makes tests for tumor grade more sensitive.

Couple of things.  It’s hard for doctors to keep up on all the latest information (though they really should do a better job of it).  In this case, not keeping up may very well be costing men their lives, or at least other unpleasant consequences of prostate cancer.  All the more reason patients really need to learn all they can do be the best advocates for themselves.  If you ever have a doctor who resents you educating yourself on-line (what are you supposed to do, go to a medical school library?) you should find another doctor.  Also, wow, Propecia, like a wonder drug.  There’s got to be some downside to this (actually, here they are, and they really are minimal– that is unless you’re part of the extra .5% with erectile dysfunction or decreased libido).

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Hot Professors

Somewhat amusing and silly article in the Chronicle of Higher Education about the “burdens” faced by professors who are too attractive.

But in academe, being hot has a downside: Professors who are considered too good-looking can be cast by their peers as lightweights, known less for their productivity than for their pulchritude.

“You have to be acceptable-looking, but being gorgeous can be a problem,” says Judith Waters, a professor of psychology at Fairleigh Dickinson University who does research on beauty and success. “If you look as if you spend more time in the beauty parlor than in the library, that’s going to be a problem.”

Cari B. Cannon, who heads the department of behavioral sciences at Santiago Canyon College, agrees. “Any idea that you might put any effort into how you look means you are not putting effort into reading the latest journal article,” she says. Ms. Cannon was No. 5 on a list of the 50 “hottest” professors compiled last academic year by the online teaching-evaluation site RateMyProfessors, which lets students award “chili peppers” to faculty members.

Well, I have now figured out my low evaluations from the Spring– I was clearly just too hot.  As you can see, I actually qualify for the coveted ratemyprofessor.com chili pepper.  Now, I’m validated.  I don’t actually put a lot of stock in that.  More important to me than actually having a chili pepper, is that I do, and neither Boettcher nor Cobb have one.

Less crime; less punishment

Blogging over at the Atlantic this week, Mark Kleiman summarizes his amazing book, When Brute Force Fails in a single blog post.  This is definitely one of the 1-2 best books I’ve ever assigned for a course and really structured my approach to Criminal Justice Policy last spring.  Anyway, here’s the crux:

There are two central principles of smart punishment:

1.)  For actual human beings as opposed to economically rational expected-utility maximizers, certainty and swiftness of punishment matter a lot more than severity, in part because of behavioral economics and in part because a system that is certain and swift can also be fair, which randomized draconianism isn’t, and people are more willing to adjust their behavior if they think the system that’s pressing on them is reasonably fair. Moreover, severity is the enemy of certainty and swiftness, because severe punishments chew up scarce capacity and require a lot of time-consuming due process. That’s textbook criminology going back to Beccaria, but putting it into practice is tricky.

2.) The more effective a deterrent threat is, the less often is has to be acted on. Because the risk of punishment faced by an offender depends not only on the capacity of the authorities to punish but also on the rate of offending, there is a natural positive feedback in offending rates.  More offending means less risk for each offender; that’s the logical structure of a riot.  By the same token, as violation rates fall the risk of being punished for those who do offend rises.   That creates the possibility of “tipping” effects, situations which have both high-violation and low-violation equilibria.  In such a “tipping” situation, even a temporary increase in enforcement can lead to a lasting decrease in violation rates, and – this is the key point—that decrease can be sustained even after the additional enforcement resources are withdrawn.

Principle #2 leads to a strategic proposal:  when there’s not enough capacity to deter every possible violator of every rule—as there generally isn’t—then it makes sense to concentrate threats on some subset of offenses or offenders or areas, “tip” that subset to the low-offending equilibrium, and then move on. Because enforcement is costly and enforcement capacity is scarce, enforcers and potential violators actually share a common interest in having actual punishment not happen; therefore, authorities ought in general to “telegraph their punches,” issuing specific warnings to specific people in order to reduce the cost of the transition from high to low offending. And Principle #1 means that, if you can deliver on the threat of punishment quickly and reliably, you don’t need to threaten years in prison to change behavior—days in jail can be perfectly adequate.

I don’t think there’s anything particularly “liberal” about the idea of trying to have both less crime and less punishment and to use criminal justice resources more efficiently, but sadly, it seems I’m wrong on the score.  I was lambasted by several of my students in the class for “liberal indocrination” much more so than in most classes.  Frustrating, as in many ways, this strikes me as the least ideological class I teach.  Sad, if to be politically conservative means you simply want more punishment regardless of whether it is a efficient or rational approach to policy.

Death panels

Atul Gawande had a terrific article (seriously, this is one of those articles you should take the time to click through and read.  People will be talking about this one for a long time, much like Gawande’s classic article on Medicare spending)in the New Yorker recently about how incredibly poorly we deal with end-of-life issues.  Short version: we should make way more use of Hospice.  People generally survive just as long and have a much higher quality of life in the process.  Unfortunately, the current incentive for doctors is always to treat, treat, treat, even when it doesn’t make sense.  If you’re more the auditory type, I strongly suggest you listen to his interview on Fresh Air.

It was hard for me to keep focus reading the article and listening to the interview because this really hits close to home.  My mom finally got into Hospice in the last month of her life, but I think the last months would have been so much better if she had made the decision to go into Hospice earlier.  Much of that was her, of course, but a lot of it was also a medical culture that really does not want to accept death as an option, even if it ruins quality of life in the process (without actually extending it, either).

One of the things that got me so mad was when Gawande discussed the fact that doctors are reimbursed for taking the time to order Chemo, but not to sit down with a patient and family and thoroughly discuss end-of-life issues.  That can be hugely helpful, but it is time consuming and, currently, doctors are given little incentive to do so.  That was going to change in the original health care legislation, which had a provision to actually reimburse doctors for these discussions.  Alas, Sarah Palin went on to label these “Death Panels” and Democrats cravenly dropped this from the final legislation.  The actual end result is that more people will suffer needlessly at the end of life and fail to have the benefits of hospice.  That’s some real damage courtesy of Sarah Palin.

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