Medical Forum / Diseases and Disorders / AIDS / January 2007
The Future of Economics Isn't So Dismal
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Alex - 14 Jan 2007 02:08 GMT " Any attack on AIDS should therefore include an attack on poverty. "
http://www.nytimes.com/2007/01/10/business/10leonhardt.html?_r=1&oref=slogin
The Future of Economics Isn't So Dismal
By DAVID LEONHARDT Chicago
On a summer day a few years ago, a recent college graduate named Emily Oster was talking to her boyfriend about the research that was, and wasn't, being done on the spread of AIDS. She was an aspiring economist at the time, getting ready to go to graduate school, and she was struck by the fact that her field had little to say about why some countries had such high H.I.V. rates.
To most people, that may not sound like a question an economist needs to be asking. It's more the domain of epidemiologists or public health workers, and they were already doing good work on it. But economists have been acting a lot like intellectual imperialists in the last decade or so. They have been using their tools - mainly the analysis of enormous piles of data to tease out cause and effect - to examine everything from politics to French wine vintages. As the daughter of two economists, Ms. Oster probably understood this better than most 22-year-olds. Her father, Ray Fair, invented a semi-famous economic formula that has an impressive track record of predicting presidential elections. Her mother, Sharon Oster, studies business strategy.
So during her time as a Ph.D. student at Harvard, the younger Ms. Oster took on AIDS in Africa. Her most provocative finding was that Africans didn't really behave so differently from people in countries with much lower H.I.V. rates. They did not have many more sexual partners than Americans on average. And, like Americans, Africans had cut back on unsafe sex in response to AIDS - or at least relatively well-off, healthy Africans had. Poorer Africans, who of course make up the continent's overwhelming majority, had made fewer changes. They had less of an incentive to practice safe sex, Ms. Oster concluded, because many of them could not expect to reach old age, whether or not they contracted H.I.V. Any attack on AIDS should therefore include an attack on poverty. "This is not the kind of thing epidemiologists would do. It's not the way they would have framed it," Ms. Oster, now 26, said. "It's an idea only an economist would love."
Whatever you think of her conclusions, there's no denying that her subject is more interesting - and, yes, more important - than the esoteric fiscal and monetary models that once dominated economics. Ms. Oster is studying death, not taxes. Last weekend, hundreds of economists gathered in Chicago for their annual conference, where they interviewed one another for job openings, presented new research papers and had the occasional glass of wine. This was my sixth such conference, and I have often been stunned by how much of the research here, like Ms. Oster's work, would interest non-economists. As "The Soulful Science," a new book by Diane Coyle, puts it, there has been a "remarkable creative renaissance in how economics is addressing the most fundamental questions - and how it is starting to help solve problems." The reams of data that computers can now crunch have ushered the field into a new golden age, Ms. Coyle writes, yet most of its accomplishments are not widely known.
So before this year's conference, I did an informal poll of about 20 senior economists around the country and asked a single question: who are the young (untenured) economists doing work that is both highly respected among experts and relevant to the rest of us? Who, in other words, is the future of economics? Thirteen names came up more than once, and I'm sure a scientific survey would have produced a longer list. As it is, though, the list is incredibly diverse. It includes Justin Wolfers, who once worked for an Australian bookie and is now an expert on online prediction markets , and Raj Chetty, who grew up in both India and Milwaukee and studies antipoverty policy.
Ms. Oster is on the list, and so is the boyfriend with whom she first discussed her AIDS ideas: Jesse Shapiro, now her husband. He has done innovative work on, among other things, the benefits of television for some toddlers. The two of them are the inaugural fellows at a University of Chicago research center run by Gary Becker (a Nobel laureate), Steven Levitt (co-author of "Freaknomoics") and Kevin Murphy (winner of a MacArthur genius award). In fact, the least diverse aspect of the list of 13 - the full roster appears above - may be the way that its members have chosen their mates. Six of them are married to another person in the group. In the end, this new era of economics matters because it has a chance to influence the world that is its subject matter. Ms. Oster, for example, has presented her work to the President's Commission on AIDS and others, and her findings seem to be one small part of the recent push for better H.I.V. prevention measures.
In Massachusetts, a 41-year-old economist named Jonathan Gruber helped design the new state program to provide health insurance for every resident, which is a model for the California plan announced on Monday. The new federal pension law, meanwhile, encourages employers to sign up workers automatically for 401(k) plans largely because academic research has shown just how costly procrastination is.
For all this success, though, there are still two big obstacles holding back the economics revolution. The first is that the field remains too narrow in its approach. As David Colander, an economist at Middlebury College, notes, researchers are rewarded - with job offers, endowed chairs and prizes - for finding statistically significant patterns that can be published in prestigious journals. They're generally not rewarded for collaborating with experts in other fields to put those patterns into better context. As a result, there is too much "cleverness for cleverness's sake," Mr. Colander says, and not enough "judgment and wisdom."
The second obstacle is that when economists do uncover a nugget of true wisdom, they're often hesitant to follow it to its natural conclusion and to become principled advocates for better policy. Theirs is not to judge, they insist, only to report what they find. Otherwise, they may risk their reputation for impartial research. Which is a fair point. But it's a risk worth taking, because the alternative is frankly much worse. When David Hume, the philosopher and friend of Adam Smith, called for the establishment of a "science of human nature" in the 18th century, he helped invent modern economics. The new generation of researchers will probably come closer to realizing his vision, and to making economics a true science, than any of their predecessors. But think about what scientists do when they uncover a problem: they try to solve it. To do otherwise is to let an impressive piece of research turn into a scientifically rigorous piece of trivia.
E-mail: leonhardt@nytimes.com
eponymous cowherd - 14 Jan 2007 04:52 GMT > " Any attack on AIDS should therefore include an attack on poverty. " The richest countries in Africa have the highest AIDS rates: Namibia, SA, Bots, Lesotho, Swazi. These countries lead in per capita income and AIDS.
They also lead in the number of men who spend much of their time away from their wives while working in the mines ...
Alex - 14 Jan 2007 20:47 GMT > > " Any attack on AIDS should therefore include an attack on poverty. " > [quoted text clipped - 3 lines] > They also lead in the number of men who spend much of their time away from their > wives while working in the mines ... They're also at or near the tropic of capricorn.
Look, even if you believe in the HIV/AIDS paradigm, even if you believe that there is an HIV epidemic in Africa, you still have to believe that people who are poor, drinking bad water, malnourished and don't have the money to get treatment for other diseases, will be helped by avoiding these factors that are at least aggravating their HIV/AIDS.
It makes no sense to go into communities where people drink contaminated water and don't have three meals a day, and then start handing out antiretrovirals.
However, what is obvious and pointed out in this article, is that sexual habits in Africa are no different from those in the West. Which is another excuse that is claimed as a 'reason' why there is a heterosexual HIV epidemic in Africa, but nowhere else.
Alex
GMCarter - 15 Jan 2007 10:27 GMT snip
>It makes no sense to go into communities where people drink contaminated >water and don't have three meals a day, and then start handing out antiretrovirals. It DOES make sense to hand out ARV. And OI drugs. But you are absolutely correct that these issues of clean water and food are critical and paramount.
It is indeed something we do agree on and perhaps if we could pressure governments to actually spend resources on assuring access to food--and that goes from local sustainable farming rooted in FAIR trade all the way to the US and European governments tarriff protections--this can make a huge difference.
A rather horrible article that reveals the grisly side of Gates for example was recently published in the LA Times underscoring that their funds are invested in companies that turn people's lives into sh.t.
George M. Carter
Moira de Swardt - 15 Jan 2007 15:07 GMT "GMCarter" <fiar@verizon.net> wrote in message
> On Sun, 14 Jan 2007 21:44:13 -0000, "Alex"
> snip > >It makes no sense to go into communities where people drink contaminated > >water and don't have three meals a day, and then start handing out antiretrovirals.
> It DOES make sense to hand out ARV. And OI drugs. But you are > absolutely correct that these issues of clean water and food are > critical and paramount. In South Africa there is no problem with clean water and ARVs. In places where one can access the ARVs, there is clean water. In places where the water is a problem, so too is access to clinics for ARVs.
There is, however, a problem with adequate diets. Many of the people who are HIV positive and receiving ARVs and OI drugs from the hospital in Johannesburg are also receiving food supplements from the same hospital. One of the nutritionists at the hospital is a friend and she advises that they hand out "E-Pap", a fortified porridge to each person in this particular programme per month. She's concerned that the amount needed per person, which is all they're given, is actually shared with other people.
My church has a programme where we have a DOTS system for TB. We have five people at any time who themselves are taking, or have recently been taking, TB meds. We hand them 30 eggs per week, and money for bread or bread (together with other food parcel items as and when we receive generous donations of food past it's "sell by" date, but not yet past it's "best before" date from an upmarket local store). They then each monitor five people on TB drugs. When the people get their drugs they also get an egg sandwich and coffee, tea or milk etc. to help with the nausea which the medication can cause (and, where available, something to take home). One of these five people will become the next monitor when the present monitor is finished with his or her course. It works very well. One of wealthy people of the parish donates the money for the eggs. We have restricted it to five sites because we believe that if every religious group was doing the same, all the people with TB in our city would have regular meals while they're on TB medication.
As you know TB is an OI which hits at about a CD4 count of 350 and most people in South Africa who live in crowded conditions and who have a sufficiently lowered CD4 count will get TB. It is a suitable training for the later discipline of taking ARVs (handed out at a CD4 count of 200 or less) and it enables someone to note who is *really* going to need food assistance later.
It is very difficult for well fed people to understand the concept of the need for food security.
-- Moira de Swardt posting from Johannesburg, South Africa Remove the dot in my address to find me at home.
GMCarter - 15 Jan 2007 20:39 GMT snip...
>In South Africa there is no problem with clean water and ARVs. In >places where one can access the ARVs, there is clean water. In >places where the water is a problem, so too is access to clinics for >ARVs. Moira--what a marvelous and refreshing relief to read something so genuine and good. Thank you. It seems it's been so long that there has been anything positive on these lists (and for which I take as much blame as anyone).
Malnutrition was picked as one of MSF's top 10 neglected crises and they advocate additional strategies: http://www.doctorswithoutborders.org/news/malnutrition/malnutrition.htm
I wonder if there are things besides E-Pap that can be done. A friend runs a program in Harare that has been doing terrific work in assuring access to nutrition and the like; they're also very big on local gardens etc. (And the situation there is pretty grim, due to the political problems, inflation, etc.)
I've been thinking a lot about how there can be more systematic, "bottom-up" approaches like this where the local problems are identified and addressed at a community level. Yours is one example of such a practical approach. Combining DOTS with nutrition is brilliant.
The idea is to figure out the ratio of sustainable economic development locally to what the current need for outside assistance or other aid resources is. And gradually shifting the ratio to more of the latter and less of the former. For example, the outside assistance is donation of the eggs. Could a microcredit program help some local entrepreneurs to have chicken farms that they can make some money from the eggs and meat which then reduces the need for donations?
That kind of thing. At least South Africa does have some degree of resources it could put toward these type of programs (as opposed to some other countries where the situation is much more horrific, even might one note a place like Lesotho.)
Also--how much cow or other animal milk is used by locals? A very inexpensive protein source that can be fortified with vitamins is whey proteins. Very inexpensive product and add some variety to things like the E-Pap.
George M. Carter
GMCarter - 16 Jan 2007 00:23 GMT >snip... snip
>The idea is to figure out the ratio of sustainable economic >development locally to what the current need for outside assistance or >other aid resources is. And gradually shifting the ratio to more of >the latter and less of the former. Oops. I meant tother way round. Decreasing, as and if possible, the need for donated aid, while improving local programs to alleviate poverty/etc.
George M. Carter
Death - 16 Jan 2007 01:20 GMT "GMCarter" <fiar@verizon.net> wrote in message
> Oops. I meant tother way round. I know pervert.
Death - 16 Jan 2007 01:19 GMT "GMCarter" <fiar@verizon.net> wrote in message
> Moira--what a marvelous and refreshing relief to read something so > genuine and good. Thank you. It seems it's been so long that there has > been anything positive on these lists (and for which I take as much > blame as anyone). LOL, then you take no blame if you wait on me. Being hungry does not cause aids or TB.
Does being hungry make aids or TB worse? You bet. Being wet and cold makes aids and TB worse.
Alex - 17 Jan 2007 20:15 GMT > "GMCarter" <fiar@verizon.net> wrote in message > > On Sun, 14 Jan 2007 21:44:13 -0000, "Alex" [quoted text clipped - 11 lines] > In South Africa there is no problem with clean water and ARVs. In > places where one can access the ARVs, there is clean water. Oh, ok. So that would make the usual drinking of contaminated water ok. They may drink clean water in the clinic, but when they go home...
And let's forget about those three meals per day too.
And decent living quarters.
Alex
alexkew@lycos.co.uk - 15 Jan 2007 00:32 GMT I use Alex in soc.culture.singapore/malaysia/china/taiwan/hongkong etc. I use my e-mail at lycos for posts here and the west.
It is the moral issue not economic issue is at stake. If laws are enacted to punish sex before marriage, I think Aids can be reduced tremendrously in Africa. You might call this something like the Islamic laws but it is the only fast method to eradicate Aids.
> " Any attack on AIDS should therefore include an attack on poverty. " > [quoted text clipped - 107 lines] > > E-mail: leonhardt@nytimes.com FreeSpirit_uk - 15 Jan 2007 09:52 GMT >I use Alex in soc.culture.singapore/malaysia/china/taiwan/hongkong etc. > I use my e-mail at lycos for posts here and the west. [quoted text clipped - 3 lines] > tremendrously in Africa. You might call this something like the Islamic > laws but it is the only fast method to eradicate Aids. Spoken like a true Singaporean. How do you propose to enforce these laws? And what do you think would the most fitting punishment for transgressors of such laws?
<snipped>
Alex - 17 Jan 2007 20:03 GMT > I use Alex in soc.culture.singapore/malaysia/china/taiwan/hongkong etc. > I use my e-mail at lycos for posts here and the west. > > It is the moral issue not economic issue is at stake. If laws are > enacted to punish sex before marriage, I think Aids can be reduced > tremendrously in Africa. There is no AIDS in Africa.
And if laws could be enacted to punish sex before marriage, they would have been enacted in the UK by now. :)
Alex
Moira de Swardt - 18 Jan 2007 04:16 GMT "Alex" <avdeelen.REMOFETHIS1@wanadoo.nl> wrote in message
> There is no AIDS in Africa. Why don't you come to Africa so that you can tell that to the people who have buried their children, their parents and their spouses and are getting sicker every day? I'm sure that will comfort them.
-- Moira de Swardt posting from Johannesburg, South Africa Remove the dot in my address to find me at home.
Death - 18 Jan 2007 16:42 GMT "Alex" <avdeelen.REMOFETHIS1@wanadoo.nl> wrote in message
> There is no AIDS in Africa. What is it exactly that you are selling Alex?
One day you claim aids is caused by poverty and now you say there is no aids in Africa.
Moira de Swardt - 18 Jan 2007 21:19 GMT " Death" <Death@yourdoor.net> wrote in message
> "Alex" <avdeelen.REMOFETHIS1@wanadoo.nl> wrote in message
> > There is no AIDS in Africa.
> What is it exactly that you are selling Alex?
> One day you claim aids is caused by poverty > and now you say there is no aids in Africa. Alex is too, how should I put this charitably, ... *reactive*... to actually know *what* he thinks.
-- Moira de Swardt posting from Johannesburg, South Africa Remove the dot in my address to find me at home.
Death - 19 Jan 2007 15:46 GMT "Moira de Swardt" <moira.ds@wol.co.za> wrote in message
> Alex is too, how should I put this charitably, ... *reactive*... to > actually know *what* he thinks. Here is something I found that you may want to read :
By Ian Sample Science Correspondent The Guardian - UK 1-19-7
Scientists have unravelled the workings of a deadly superbug that attacks healthy young people and can kill within 24 hours.
PVL-producing MRSA, a highly-virulent strain of the drug-resistant superbug, methicillin-resistant staphylococcus aureus, has spread around the world and caused deaths in the UK, Europe, the US and Australia. PVL or panton-valentine leukocidin toxin destroys white blood cells and usually causes boils and other skin complaints. But if it infects open wounds it can cause necrotising pneumonia, a disease that rapidly destroys lung tissue and is lethal in 75% of cases.
Thousands of infections have been recorded across the US, but scientists believe the number is likely to rise in Britain.
In 2004 the bug claimed the life of Richard Campbell-Smith, a fit 18-year-old Royal Marine, who died three days after scratching his legs on gorse during a training exercise in Devon. In December an outbreak at Norfolk and Norwich University hospital killed a baby and infected five others. According to the Health Protection Agency there were 106 cases of PVL-MRSA in England and Wales in 2005 and one confirmed death from necrotising pneumonia caused by the infection.
Scientists at the University of Texas in Houston and Lyon University in France conducted experiments into PVL to work out why it was so lethal. They took two batches of normal staphylococcus aureus bacteria and modified one of them to produce the PVL toxin.
The researchers exposed mice to the different groups of bacteria, to see if they developed lung infections. Animals that inhaled the normal staphylococcus were unaffected, but those that inhaled the PVL-producing staphylococcus quickly developed necrotising pneumonia, with some dying within 48 hours. Further tests on the PVL-producing bacteria showed they also produced higher levels of proteins that caused massive inflammation and made the bacteria more "sticky", helping microbes cling to people's skin and making it more easy to spread.
The study appears in Science Express, an online journal.
Gabriela Bowden, who lead the study, said: "We've shown that not only is PVL responsible for causing necrotising pneumonia, but it somehow also causes over-production of these other proteins which cause damage and help the infection spread. We now have targets to go for. We can see if we can block the activity of PVL with antibodies, for example," she added.
Mark Enright, a microbiologist at Imperial College, London, said the new PVL-MRSA strain probably evolved from a strain that first surfaced in the 1950s. The bug produced PVL toxin, but had yet to develop drug resistance. "Now it's developed resistance, it has come back. We are in the early stages of an epidemic, but this is moving very fast," he said. A fear held by many health officials is that the PVL strain will become rife in hospitals, where it could inflict a much greater death toll than the existing MRSA superbugs.
Marina Morgan, consultant medical microbiologist at Royal Devon and Exeter hospital, said PVL-MRSA was a particular threat because it was spreading outside hospitals, where doctors were not familiar with it. "A lot of patients die because it is unexpected. A doctor will probably prescribe a standard antibiotic that won't kill it, so it has time to get worse. The bottom line is it's coming and it's going to spread."
PVL-MRSA can only be tackled with treatments that attack the bacteria on three fronts. The drugs must kill the bacteria, destroy their ability to make PVL toxins, and mop up the toxins already released into the bloodstream.
Patricia A. Doyle DVM, PhD Bus Admin, Tropical Agricultural Economics Univ of West Indies
Please visit my "Emerging Diseases" message board at: http://www.emergingdisease.org/phpbb/index.php Also my new website: http://drpdoyle.tripod.com/ Zhan le Devlesa tai sastimasa Go with God and in Good Health
http://www.guardian.co.uk/medicine/story/0,,1994012,00.html?gusrc=rss&feed=11
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