Category: Labor Economics

For Some Cancers, Less Aggressive Therapies Can Be Equally Effective, With Fewer Damaging Side-Effects

(p. A1) Doctors are coalescing around the ironic idea that for some cancer treatment, less can be better.

Some patients with cervical and pancreatic cancer can do as well with less invasive surgery, according to research presented at the American Society of Clinical Oncology conference in Chicago over the weekend. Other studies at the annual meeting showed some patients with rectal cancer or Hodgkin lymphoma can safely get less radiation.

The findings expand a body of evidence doctors are using to design treatment plans that aim to reduce side effects and costs. They call the strategy de-escalation: cutting back on some therapies to improve a patient’s quality of life without hurting their odds of survival.

Newer treatments and tests are extending patients’ lives and moving cancer care away from a blunt, one-size-fits-all approach. On the strength of studies like those presented in Chicago, doctors are getting better at determining who needs the most aggressive care and who can get away with less treatment and less collateral damage.

. . .

(p. A7) In another study presented at the conference of some 1,200 patients with rectal cancer that had spread to nearby tissue or lymph nodes, about half got standard chemotherapy and radiation before surgery. The others got more aggressive chemotherapy but no radiation, unless their tumors failed to shrink by at least 20%. About 10% of those patients needed the radiation, according to the study, which was published in the New England Journal of Medicine and the Journal of Clinical Oncology.

At five years, results from the protocols were similar, suggesting that many rectal cancer patients can safely skip radiation that increases risks of pelvic fractures, bowel and sexual dysfunction and infertility, researchers said.

“We can spare select patients,” said Dr. Pamela Kunz, director of the Center for Gastrointestinal Cancers at Yale Cancer Center. “This trial is really less is more.”

The patients who avoided radiation by undergoing more aggressive chemotherapy experienced more, different shorter-term side effects including appetite loss, fatigue and nervous-system damage. Some patients might still opt to get the radiation, researchers said.

. . .

The Food and Drug Administration this year released draft guidance to cancer-drug developers on how to determine the best dose for new therapies. Doses were traditionally set at the highest tolerable amount, since the drugs were less precise and patients needed them quickly.

For the full story, see:

Brianna Abbott. “Cancer Doctors Rethink Aggressive Treatments.” The Wall Street Journal (Tuesday, June 6, 2023): A1 & A7.

(Note: ellipses added.)

(Note: the online version of the story was updated June 5, 2023, and has the same title as the print version. The wording in the last sentence quoted above follows the more nuanced online version of the sentence.)

The Enemies of Horatio Alger “Are Out to Get the American Dream”

(p. A13) Of all the institutions for investigative journalists to put under the microscope, the Horatio Alger Association of Distinguished Americans sure is a strange target.

The charity says it has awarded more than $245 million in college scholarships to 35,000 students since 1984. Its 300 or so members cross the political, cultural and business-success spectrum and include Michael Bloomberg and Oprah Winfrey.

So what explains the recent onslaught of critical press coverage? The New York Times has put eight reporters on the case and devoted two 4,000-word Sunday front-page pieces in the past two months to the Horatio Alger Association and its members. ProPublica, which styles itself “an independent, nonprofit newsroom that produces investigative journalism with moral force,” produced a 5,000-word article that credited four reporters.

The journalists and the advocates they quote say it’s a matter of judicial ethics, highlighting Justice Clarence Thomas’s role as an honorary board member of the Horatio Alger Association and his friendships with the association’s members, some of whom are prosperous.

. . .

The venom directed at the Horatio Alger Association, though, isn’t only about Justice Thomas and the court. The association’s critics are out to get the American dream.

The association’s website explains that its mission is to “educate all youth about the limitless possibilities that are available through the American free-enterprise system.” The group was founded to dispel the myth “that the American dream was no longer attainable.” Its members are “role models whose experiences exemplify that opportunities for a successful life are available to all individuals who are dedicated to the principles of integrity, hard work, perseverance and compassion for others.”

For the full commentary, see:

Ira Stoll. “Why the Left Hates Horatio Alger.” The Wall Street Journal (Saturday, Aug. 12, 2023): A13.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date August 11, 2023, and has the same title as the print version.)

With Repetitions Surgeons Gain Informal Knowledge, Such as “Muscle Memory”

(p. C6) Imagine you’ve been admitted to the hospital and you’re meeting the physician taking care of you for the first time. Who are you hoping walks through that door? Would you rather they be in their 50s with a good amount of gray hair, or in their 30s, just a few years out of residency?

In a study published in 2017, one of us (Dr. Jena) and colleagues set out to shed some light on the role of age when it came to internists who treat patients in hospitals. These physicians, called hospitalists, provide the majority of care for elderly patients hospitalized in the U.S. with some of the most common acute illnesses, such as serious infections, organ failure and cardiac problems.

. . .

. . ., the results suggested if the over-60 doctors took care of 1,000 patients, 13 patients who died in their care would have survived had they been cared for by the under-40 doctors. We repeated the analysis using 60- and 90-day mortality rates, in case longer term outcomes might have been different, but again, the pattern persisted: Younger doctors had better outcomes than their more experienced peers.

. . .

Younger doctors possess clinical knowledge that is more current. If older doctors haven’t kept up with the latest advances in research and technology, or if they aren’t following the latest guidelines, their care may not be as good as that of their younger peers.

. . .

. . ., a separate study by Dr. Jena and colleagues looked at about 900,000 Medicare patients who underwent common non-elective major surgeries (for example, emergency hip fracture repair or gall bladder surgery) performed by about 46,000 surgeons of varying age.

. . .

The results showed that unlike hospitalists, surgeons got better with age. Their patient mortality rates had modest but significant declines as they got older: mortality was 6.6% for surgeons under 40, 6.5% for surgeons age 40-49, 6.4% for surgeons age 50-59, and 6.3% for surgeons over age 60.

Clearly something different was happening here. It may be that for hospitalists, the benefit of steadily increasing experience starts to be outweighed by their waning knowledge of the most up-to-date care. It’s different for surgeons, though, who hone many of their skills in the OR. Surgeons build muscle memory through repetition, working in confined spaces with complex anatomy. They learn to anticipate technical problems before they happen and plan around them based on prior experience. Over time, they build greater technical skills across a wider variety of scenarios, learn how to best avoid complications, and choose better surgical strategies.

What does this mean for all of us as patients when we meet a new doctor? Taking studies of hospitalists and surgeons together, it’s clear that a doctor’s age isn’t something that can be dismissed out of hand—age does matter—but nor can it be considered in isolation. If we’re concerned about the quality of care we’re receiving, the questions worth asking aren’t “How old are you?” or even “How many years of experience do you have?” but rather “Do you have a lot of experience caring for patients in my situation?” or “What do you do to stay current with the research?”

For the full essay, see:

Anupam B. Jena and Christopher Worsham. “Do Younger or Older Doctors Get Better Results?” The Wall Street Journal (Saturday, July 8, 2023): C6.

(Note: ellipses added.)

(Note: the online version of the essay was updated July 8, 2023, and has the same title as the print version.)

The essay quoted above is adapted from the book:

Jena, Anupam B., and Christopher M. Worsham. Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health. New York: Doubleday, 2023.

Socialist Alexandria Ocasio-Cortez (AOC) Rallied with Poor Hispanic Entrepreneurs Who Were Shut Down by Government Regulators

(p. A21) Until last week, Corona Plaza in Queens was bustling: taqueros flipping fresh tortillas and vendors hawking Central American crafts over a soundtrack of cumbia and train traffic. There were produce stands, live bands and surging crowds, all in a public square that was named one of the 100 best places to eat in the city.

But last Thursday [Aug. 3, 2023] and Friday [Aug. 4, 2023], sanitation workers swept through the plaza, removing several stalls and threatening to penalize vendors who did not have a city permit to operate — nearly all of the more than 80 who regularly work there. In the days since, the grilled-meat stands and jugs of agua fresca have been replaced with protest signs.

It was the latest escalation in the city’s tense relationship with the plaza merchants — most of them immigrant women, many of them undocumented — who have helped revive one of the New York neighborhoods hit hardest by the coronavirus pandemic.

. . .

The City Council passed a law in 2021 mandating the release of another 445 food vendor permits every year for a decade, but the rollout has been slow.

There are 10,195 food vendors on the waiting list, according to a spokeswoman for the Department of Health and Mental Hygiene, which manages the applications. The agency has issued just 104 of the new licenses so far, and only four of the recipients have completed all the steps needed to sell food legally.

Ms. Calle is one of the few vendors at the plaza who has a permit — but only because she rents it from a third party for $16,000 a year, a prohibited but widespread practice.

Even so, Ms. Calle decided to close her stall this week, in solidarity with her neighbors.

“I know how hard it is” for new vendors, she said in Spanish, recounting how she had been arrested four times in 23 years for various permitting violations.

While few merchants at the plaza own the hard-to-obtain permits, most of them, including Ms. Calle, pay taxes on sales, and hold a license that certifies they have taken a food safety course.

At the rally at the plaza on Wednesday [Aug. 2, 2023], the dispersed merchants were joined by elected officials including Representative Alexandria Ocasio-Cortez and Donovan Richards, the Queens borough president, . . .

. . .

Nearly 4,000 people, most of them locals, have signed a petition in support of the vendors.

The plaza, once an underused service road near 103rd Street and Roosevelt Avenue, was redesigned in 2012 as a public square.

When the pandemic hit the surrounding neighborhood of Corona — harder than almost anywhere else in the United States — the plaza became an economic and cultural hub for recovering workers, said Carina Kaufman-Gutierrez, the deputy director of the Street Vendor Project.

For the full story, see:

Stefanos Chen and Raúl Vilchis. “Their Food Is Hailed; They Want the Right to Sell It.” The New York Times, First Section (Sunday, August 6, 2023): A21.

(Note: ellipses, and bracketed dates, added.)

(Note: the online version of the story has the date Aug. 5, 2023, and has the title “They Make Some of New York’s Best Food. They Want the Right to Sell It.” Where there are minor differences in wording between the print and online versions, the passages quoted above make use of the online wording.)

Disenchanted Young Chinese Are “Lying Flat” or Joining the Bureaucracy

(p. A1) HEFEI, China—More than one in five young people in China are jobless. The government casts much of the blame on the job seekers themselves, insisting that their expectations have gotten too high.

. . .

The government’s guidance is ringing hollow with many young people. Growing up in a period of rising prosperity, they were told that China was strong, the West was declining and endless opportunities awaited them. Now, with the urban youth unemployment rate hitting a record of 21.3% in June, their employment frustrations are posing a new challenge to Xi and his vision for a more powerful China.

For the estimated 11.6 million college graduates in 2023, having heeded calls by the state to study hard, the prospect of resorting to the physical labor that many of their parents performed is distinctly unappealing.

. . .

(p. A10) The problem isn’t that jobs don’t exist in China. They do. With its shrinking population, China needs workers as much as ever. It is that China’s weakened economy isn’t producing enough of the high-skill, high-wage jobs that many college students have come to expect.

This is especially so after Xi’s targeting of the private sector in recent years with regulatory crackdowns on technology and other companies.

Disenchanted, many young people are opting out of the job market entirely, or “lying flat,” as many of them call it. Chinese media has recently featured articles about young “drifters” who live hand-to-mouth and pick up odd jobs as they roam the country.

Many of those who still want to work have soured on the private sector, with surging numbers of people sitting for the country’s civil-service exam for a chance at a low-paid, but stable, role in China’s bureaucracy.

For the full story, see:

Brian Spegele. “Unemployed Youth Cast Pall Over China’s Economy.” The Wall Street Journal (Thursday, July 27, 2023): A1 & A10.

(Note: ellipses added.)

(Note: the online version of the story has the date July 26, 2023, and has the title “How Bad Is China’s Economy? Millions of Young People Are Unemployed and Disillusioned.”)

Average Wages in Boom Towns Would Rise “Astounding” $8,775 If Zoning Laws Eased

(p. A13) Though some might expect areas populated by conservatives to be the most exclusionary, it is areas where highly educated liberals live that engage in the worst forms of economically exclusionary housing policy. Researchers writing in the Journal of Experimental Social Psychology in 2018 found that highly educated Americans have comparatively tolerant racial attitudes but hold “negative attitudes toward the less educated.” Americans with different levels of education all have biases, they wrote, but “the targets of prejudice are different.”

Exclusionary housing practices are a linchpin in the architecture of educational inequality in America. Because 73% of American school children attend neighborhood public schools, where you live typically determines the quality of schooling. Most people who are concerned about improving education naturally focus attention on what school boards and state education officials do, but it’s at least as important to focus on what the local and state officials running housing policy are up to.

For sixty years, researchers have found that the economic segregation of students. which is driven by housing policy, shapes educational opportunity even more powerfully than per pupil spending. In Montgomery County Maryland, for example, county officials pursued two strategies for raising the achievement of low-income students. In one program, starting in 2000, the school board spent $2,000 extra per pupil in high-poverty schools. In another, begun decades earlier, the county council enacted an “inclusionary zoning” law that to this day requires builders to set aside a portion of new developments for low-income families. Over time, as Heather Schwartz of RAND found in a 2010 study, what the housing authority did for students cut the math achievement gap between low-income and middle-class students in half, while the school board’s program had much less impact.

Zoning-induced housing costs also prevent workers from moving to places where they can make the highest wages, which is typically in coastal cities. Research shows that this barrier to mobility gravely damages American economic productivity, to say nothing of the aspirations of individuals and families. A 2018 study by Edward Glaeser and Joseph Gyourko, for example, found that “restrictive residential land-use regulation” had a price tag of “at least 2% of national output,” or about $400 billion. A 2019 study by Chang-Tai Hsieh and Enrico Moretti, found that if three high-productivity cities—New York, San Jose and San Francisco—relaxed restrictions on housing supply, more workers could move to them, and average wages nationally would rise an astounding $8,775.

When people do move to higher-wage regions, exclusionary zoning laws often force them to live in the far reaches of metropolitan areas. This means longer commutes, which are associated with higher blood pressure and divorce rates, and more miles on the road, which is bad for the environment.

For the full essay, see:

Richard D. Kahlenberg. “Only Zoning Reform Can Solve America’s Housing Crisis.” The Wall Street Journal (Saturday, June 24, 2023): A13.

(Note: the online version of the essay has the date June 22, 2023, and has the same title as the print version. The sentences in the penultimate paragraph quoted above (mentioning 2018 and 2019 papers) appear in the online, but not in the print, version of the essay.)

The essay quoted above is adapted from the book:

Kahlenberg, Richard D. Excluded: How Snob Zoning, Nimbyism, and Class Bias Build the Walls We Don’t. New York: PublicAffairs, 2023.

The Talented, Wealthy, Ambitious, and Hardworking Vote with Their Feet Against Communist China

(p. B12) Is China reopening to the world or turning inward again?

Many would argue the latter, but in one important way, the country is still going global: Residents appear to be leaving at a faster clip than they have in years, including a significant number of the wealthy and well-educated the nation needs to keep modernizing and investing.

. . .

Rebounding emigration is also striking in the context of a declining overall birthrate, and suggests that Beijing must do far more to convince talent, both domestic and foreign, that China is a good place to put down roots if it wants to avoid a steeper growth slowdown in the years ahead.

. . .

Rising net emigration also mirrors much smaller influxes of foreign talent in recent years—another trend that threatens to slow China’s climb up the technological ladder. Foreign residents of Shanghai and Beijing numbered just 163,954 and 62,812 in 2020, according to official data, down 21% and 42%, respectively, since 2010. The pandemic is clearly a major factor. But given the well-publicized rising tensions between China and the West, slowing growth and the rising risks of detention and investigation for what used to be considered routine business by foreigners in China, a portion of that decrease seems very likely to persist.

For much of the new millennium, China has been a place where the ambitious, hardworking and lucky could often get ahead. But in today’s China—more focused on security and control, less on growth—it is no longer clear how true that really is.

Some people, at least, seem to be voting with their feet.

For the full commentary, see:

Nathaniel Taplin. “HEARD ON THE STREET; China’s Brain Drain Threatens Its Future.” The Wall Street Journal (Thursday, July 6, 2023): B12.

(Note: ellipses added.)

(Note: the online version of the commentary has the date July 5, 2023, and has the same title as the print version.)

Affirmative Action Quotas Forced Admission of the Academically Unqualified

(p. A13) As Richard Sander and Stuart Taylor Jr. demonstrated in “Mismatch,” their 2012 book on affirmative action, there are very few black students in the top academic cohorts from which highly selective colleges draw most of their students. Black high-school seniors are one-tenth as likely to be in the top tenth of college applicants nationwide as nonblack applicants. The average black SAT score in 2022 was 926 on a 1600 point scale. The average Asian score was 1229 and the average white score was 1098.

. . .

Harvard’s own research in 2013 showed that the black share of its undergraduate population would drop from 10% to less than 1% if it admitted students according to academic skills only. Harvard has the pick of the black U.S. high-school population, but even it can’t fill its desired quota without double standards.

. . .

The result isn’t a benefit to these students but a burden. Research shows they are more likely to end up in the bottom of their classes, if not to drop out of college and professional education entirely. This academic mismatch doesn’t dispel racial stereotypes; it reinforces them.

For the full commentary, see:

Heather Mac Donald. “Racial Preferences Bred 50 Years of ‘Mismatch’.” The Wall Street Journal (Wednesday, July 11, 2023): A13.

(Note: ellipses added.)

(Note: the online version of the commentary was updated July 10, 2023, and has the title “Affirmative Action Bred 50 Years of ‘Mismatch’.”)

The affirmative action book cited in the passage quoted above is:

Sander, Richard, and Stuart Taylor, Jr. Mismatch: How Affirmative Action Hurts Students It’s Intended to Help, and Why Universities Won’t Admit It. New York: Basic Books, 2012.

“Harvard’s own research” from 2013 mentioned above was reported in Slate in 2018:

Mak, Aaron. “Admitting Bias; Harvard Had Proof Its Admissions Process Was Hurting Asian Americans. How Will Its Dean Explain Why He Did Nothing About It?” slate.com, Oct. 15, 2018.

United Airlines CEO Gave Up on Flying United Airlines

United Airlines had major flight cancellations on Sun., June 25, 2023, on the day we were to fly United through O’Hare airport on our way to a European trip. Stress, exhaustion, chaos. United Airlines chaos continued for days. My brain has not yet totally processed the story quoted below. My gut, on the other hand, wants the CEO of United Airlines to be fired.

(p. B11) United Airlines Chief Executive Scott Kirby apologized for taking a private jet from Teterboro Airport in New Jersey to Denver this week as his airline grappled with widespread weather disruptions.

“Taking a private jet was the wrong decision because it was insensitive to our customers who were waiting to get home,” Kirby said in a statement Friday. “I sincerely apologize to our customers and our team members who have been working around-the-clock for several days—often through severe weather—to take care of our customers.”

A United spokeswoman said Kirby took the flight Wednesday because he was unable to secure a seat on a commercial flight. The company didn’t pay for the private flight, she said.

Wednesday was a hectic day for United: The carrier canceled over 750 mainline flights, according to FlightAware, over a quarter of what it had scheduled. The night before, a long stretch of bad storms in New York led to logjams at the area’s airports, including United’s Newark hub.

Some travelers over the past week have been stranded for days while waiting for space on flights home, in some cases sleeping in the airport. Travelers said they spent hours waiting in line for assistance or to be reunited with checked bags.

For the full story, see:

Alison Sider. “United CEO Apologizes for Flying on Private Jet Amid Airline’s Cancellations.” The Wall Street Journal (Saturday, July 1, 2023): B11.

(Note: the online version of the story was updated June 30, 2023, and has the title “United Airlines CEO Apologizes for Taking Private Jet During Flight Disruptions.”)

Portland Feels “Unsafe” and “There’s Trash Everywhere”

(p. A3) PORTLAND, Ore.—Mark Rogers has made a list of things he misses about Portland—its vegan restaurants, Powell’s bookstore, public transit—and the things he doesn’t—having his things stolen, stepping in human excrement, extreme politics.

The 44-year-old artist moved across the country to Fort Wayne, Ind., last year.

“I don’t want to talk trash about my home city even though there’s trash everywhere,” Rogers said.

. . .

Andrea Lamprecht, 50, a cardiac nurse, said she was chased by a homeless man while out on a jog in her Alameda neighborhood on the east side of Portland, where the median home price hovers around $1 million.

She and her husband, Derek Lamprecht, an orthopedic surgeon, had raised their children in Portland. The chasing incident contributed to the couple’s decision to move to a quiet rural area about 10 miles outside the city in 2021. “It never felt unsafe before,” said Derek Lamprecht. “The character of the city changed.”

For the full story, see:

Zusha Elinson. “Disenchanted Portland Residents Leave the City.” The Wall Street Journal (Thursday, June 29, 2023): A3.

(Note: ellipsis added.)

(Note: the online version of the story has the date June 28, 2023, and has the title “Portland Is Losing Its Residents.”)

Engerman, with Fogel, Courageously Asked Politically Incorrect Questions about Slavery

(p. D8) Stanley Engerman, one of the authors of a deeply researched book that, wading into the fraught history of American slavery, argued that it was a rational, viable economic system and that enslaved Black people were more efficient workers than free white people in the North, died on May 11 [2023] in Watertown, Mass.

. . .

In their two-volume “Time on the Cross: The Economics of American Negro Slavery” (1974), Professor Engerman and Prof. Robert W. Fogel used data analysis to challenge what they called common characterizations of slavery, including that it was unprofitable, inefficient and pervasively abusive.

They said they were not defending slavery. “If any aspect of the American past evokes a sense of shame,” they wrote, it’s the system of slavery.” But much of the accepted wisdom about it, they said, was distorted, or just plain wrong.

“Slave agriculture was not inefficient compared with free agriculture,” they wrote. “Economies of large-scale operation, effective management and intensive utilization of labor made Southern slave agriculture 35 percent more efficient than the Northern system of family farming.”

They insisted that the typical slave “was not lazy, inept and unproductive” but rather “was harder working and more efficient than his white counterpart.” They contended that the destruction of the Black family through slave breeding and sexual exploitation was a myth, and that it was in the economic interest of plantation owners to encourage the stability of enslaved families.

They also wrote that some slaves received positive incentives, such as being elevated to overseers of work gangs, to increase their productivity.

The book attracted a lot of attention, including a rave review by the economist Peter Passell in The New York Times. “If a more important book about American history has been published in the last decade, I don’t know about it,” he wrote. He described the work as a corrective, “a jarring attack on the methods and conclusions of traditional scholarship” on slavery.

. . .

. . . the Marxist historian Eugene D. Genovese, whose own book about slavery, “Roll, Jordan Roll: The World the Slave Made,” was also published in 1974, called “Time on the Cross” an “important work” that had “broken open a lot of questions about issues that were swept under the rug before.”

For the full obituary, see:

Richard Sandomir. “Stanley Engerman, 87, Scholar Who Disputed Views on Slavery, Dies.” The New York Times (Monday, May 29, 2023): D8.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the commentary was updated May 30, 2023, and has the title “Stanley Engerman, Revisionist Scholar of Slavery, Dies at 87.”)

The book praised in the obituary quoted above is:

Fogel, Robert William, and Stanley L. Engerman. Time on the Cross: The Economics of American Negro Slavery. Boston: Little, Brown and Company, 1974.