Organ Donor Safety Exemptions

The following question was posted on the EA Policy Facebook page:

General idea: should exemptions be granted to certain safety laws if you sign up to be an organ donor?

Would such policies likely be a positive or negative for organ donation and safety compliance?

My response turned into a full blog post:

The biggest possible failure is that it discredits the idea of voluntary organ donation, resulting in less organ donation from other sources. I have no idea how big this effect might be.

Concrete examples help analysis, so I will consider this by looking at motorcycle helmet laws:

It is possible that telling people 'We will allow you to ride a motorcycle without a helmet if and only if you agree to become an organ donor, so we can harvest your organs after you crash and become brain-dead.' might shock them into wearing their helmet voluntarily, which seems like a simple good thing with no side effects aside from the possible organ donation discrediting.

Assuming that people are rational agents, some of whom experience large amounts of utility from riding without a helmet, we can expect the following:

1) People take the deal and ride without a helmet (good effect, social utility increases).
2) Motorcycle crashes decrease due to risk compensation (good effect).
3) The crashes that happen are more likely to cause death or brain injuries to motorcycle riders (bad effect).
4) More organs are available for use, both from the crash victims and people who take the deal and die from other causes (good effect).

I expect effects 3 and 4 to be the largest. More riders will die, or become disabled and require a lifetime of expensive medical care, and lives of people waiting for organ transplants will be saved.

Fatal motorcycle crashes tend to be an excellent source of donor organs, but I am fairly sure that most of them will cause a net decrease in QALYs, even the ones that result in many useful organs. Organ recipients tend to be old and unhealthy, so the organ does not give them that many QALYs. If the rider was young and healthy, they likely lose more QALYs than all the combined recipients of the organs would gain. If the rider was middle-aged and unhealthy, the organs are not likely to be as useful.

However, organ donation makes the QALY loss from those fatalities significantly less than most fatalities. (A nonfatal crash resulting in permanent disability will cause a larger QALY loss than a fatal crash.) If the rate of motorcycle crashes among people who take the deal is small enough, then the good effects of all of their organ donation will outweigh the bad effects of their crashes, and the policy is good.

I suspect that the crash rate is low enough that the policy of offering these exemptions is good. I think the breakeven would be something like ten new organ donors for every lethal or disabling crash, and I am almost sure that the lifetime risk of such a crash for motorcycle riders is significantly less than 10%.

Well-Being Analysis

This is a technical post, only of interest to people doing policy analysis. Much of it was originally written in response to a Facebook post related to Effective Altruism Policy Analytics, and I am reposting it here so it is in a more permanent place that I can link to.

One of the group members posted a link to the following paper:

Well-Being Analysis vs. Cost-Benefit Analysis

and asked me if we should consider using this method.

Briefly, well-being analysis is an attempt to measure the costs and benefits of a policy using a direct measure of human happiness or well-being, instead of using dollar values. My response was divided into two sections:

Well-being analysis in any form is not currently useful for people submitting policy comments:

1) Any comment that relied on a well-being analysis would likely be summarily dismissed. As the paper states, regulatory agencies are required by law to do cost-benefit analysis, and that is what they understand. They do not understand this new alien thing, have no way of judging its quality, and have no incentive to care about it.

2) The language of policy right now is monetary costs and benefits. We will influence policy by speaking the language currently used, and speaking it well. Lojban might be a better language than English, but it would be folly to submit comments in it.

3) There is a good chance that in 30 years, an overall framework like this will replace cost-benefit analysis and be required by law. This does not make it useful to us. 30 years ago, cost-benefit analysis was a bizarre fringe thing that nobody cared about and that would not affect policy in any way.

Well-bring analysis as presented in the paper has serious flaws:

4) Their example analysis dramatically undervalues monetary costs. They claim that "If that same individual's income decreased from $100,000 to $36,700, she would lose 0.11 WBUs" on a scale of 1 to 10. By comparison, "Unemployed individuals suffer a loss of 0.83 WBUs per year during the time that they remain unemployed." However, we know that people who have lost their jobs routinely choose to remain unemployed rather than settle for jobs that pay less than what they earned before.

4a) The data they use to determine well-being will systematically undervalue money, because they do a regression that separately counts the effects of money and health. Treating money and health as separate and exogenous is a grave error. Money and health are heavily correlated because money buys health. Most of what rich people do with their money is to rearrange their lives so they will be healthier and safer. When you take away money, health goes down. Their data on the 'well-being effect of income' is just the residual effect of money after 'correcting' for all the things that the money bought.

5) To a first approximation, the well-being analysis they present is just a way to ignore the compliance costs of any regulation that does not cause observable layoffs. Widespread use of this system in its current form would encourage a horde of very expensive regulations. Given how cheap it is for individuals to purchase lives with money, this is a huge problem. If 0.001% of the compliance costs of the EPA regulation they support would have otherwise gone to effective charities, the regulation has reduced well-being.

6) According to this analysis methodology in its current form, job losses dominate any consideration of economic efficiency, technological growth, or cheaper, better goods. Consistent use of it to analyze policies would result in support of policies that enforced stagnation on an economy, preventing almost any kind of innovation that had the potential to cause layoffs unless that innovation had an immediate and obvious health or safety benefit. Specifically, a "Ban computers" policy analyzed 40 years ago would probably score highly on a well-being analysis.

I do hope that, at some point in the future, all government actions will be evaluated on how they are expected to affect the well-being of all people, measured directly. Money is an imperfect measurement of how things affect well-being, because different people value money differently and a lot of important goods are hard to put money values on.

But right now, measuring things by their monetary impact, and the health and life impacts converted to their monetary values, is the best we can do. There is simply far more data available on money than there is on direct well-being measurements, and an imperfect system you can actually use is better than a theoretically ideal system that cannot be implemented.

Also, money is a much better measurement tool than most people realize. The money cost of doing a thing is a signal that includes a very good estimate of most of the resources consumed by that thing. Pollution and other externalities often make the money price of a thing an underestimate of its true cost, but in a competitive market it is rare for a money price to overestimate the cost of a thing. Whenever you think something should be cheap, but it costs a lot, that almost certainly means that you are missing something important. Regulators tend to miss important side effects and assume that things will be cheaper than they really are, because they only look sat narrow technical effects without considering larger impacts. Measuring the monetary impacts of a rule can correct for this.

However, as more research on well-being accumulates, and we get more data on how things affect quality of life, and we develop a better understanding of the complicated chains of causality that dominate all human interactions including the economy, we will probably move toward some kind of well-being analysis. The monetary costs and benefits will become a subset of the analysis. But it will likely take decades to get to that point.

Chen Guangcheng

Last evening, my girlfriend and I went to a book release event at the National Press Club. The author was Chen Guangcheng, the blind Chinese dissident who escaped house arrest three years ago. My girlfriend works with him at a policy think tank, and he had given her a signed book.

It was one of the most intense experiences I have had in a long time. I was confronted with a lot of thoughts and emotions.

Chen started by walking unsteadily to the podium, fumbling with braille notes, and giving a speech in broken English that included an excerpt from his book. As he described the effects of his imprisonment, he nearly broke down in tears and had to stop for almost a full minute.

On some level, he looked foolish or frail, but it was clear that we were seeing a great man afflicted by great trials. I found myself thinking how unfair it was that he lived in a world that, after all of his other problems, forced him to go through the hassle of learning a foreign language late in life just to continue doing his work and talking to people.

Later on, during the question and answer period, He spoke through a translator. I could tell from the way he spoke in Chinese that he was a good orator in his native language, speaking swiftly and confidently and with emotional resonance.

People tried to ask him questions about his real or percieved conflicts with people in the US. He deflected these in ways that were wise, but probably sounded a bit strange to most Americans.

While thinking about his life and the surrounding events, I realized several things about heroes. First, they will usually be difficult people. If they did not submit to armies of government thugs, there is no way they will submit to your assumptions and demands. They will do what they see is right, and your silly little social norms or strategic gamesmanship can be shoved where the sun does not shine.

Second, I was reminded of that I and many of my colleagues overvalue rational thought and analytical intelligence. A true hero is marked by insight and willpower, seeing what needs to be done and doing it. The media and academic world value a kind of cleverness and slickness that he did not have, but his presence reminded me that our culture often values and rewards the wrong virtues, and that we should remind ourselves about what the ancient thinkers like Aristote and Confucuious knew about virtue ethics.

Car Shoving

This morning, we had a very pretty snow; light powdery flakes that coat the trees and ground with a beautiful white dusting. It was the kind of snow that skiers love, the kind that anything will glide effortlessly over. About 9:00, I bundled up and went out for a walk to enjoy the scenery.

I quickly saw that what is good for skiing is terrible for driving. There were three pileups blocking the road outside my apartment. Nobody was getting anywhere. The rather steep hills had been turned into pure ice, and people were either sliding around or 'parked' at all kinds of angles on the side of the road. There were people attempting to drive around who should not have left their parking space, people who had no clue how to drive in snow and/or were driving crappy cars with bald tires. Some people had been stuck there since 6:30. It was a complete Charlie Foxtrot.

I joined a group of guys who were trying to clear up the mess near the entrance to the road. We told people coming in about the road conditions, trying to get them to turn around while they still could. For the cars on the road, we pushed them to get them started off the ice, and to help them steer around the other cars. Often this required telling people to put the car in neutral and coast backwards down the hill while we shoved the car away from the parked cars. Sometimes we were able to get a car out of the road and on its way, but for many of the ones near the bottom of the hill we had to just shove them off to the side to get them out of the road.

The de facto leader of the group was a charismatic young black guy who was clearly skilled, smart, aware of the situation, and knew how to handle winter conditions. Often he would offer to drive people's cars for them, using his skills to glide them down the hill and away from trouble. The thing that amazed me was the trouble he had getting people to listen to him. He would explain to people, repeatedly, that they had no chance of getting up the hill unless they had a 4-wheel drive and knew how to use it. He told them how he had personally seen 20 cars fail to make the hill. And people would repeatedly ignore him, try the hill, fail, get stuck or start sliding around, and have to rely on us to get them out of the road or back down the hill. Some people refused to cooperate, and we basically had to ignore them and route people around them.

We, and the other groups spontaneously forming at other parts of the road, did a decent job of clearing enough people out of the middle of the road to prevent it from getting completely stuck. But the situation was not really resolved until around 10:30, when the police came, parked their cars across the street to prevent anyone from entering it, and started ordering everyone to park legally on the curb or get off the road. I left then, after helping a couple last people on their way. Presumably the road has been cleared, plowed and salted by now.

At the start of my walk, I had been a bit chilly despite all the layers. But while moving cars, I was comfortable, even a bit warm toward then end. When I got back to my apartment around 11, I discovered that my t-shirt was completely soaked through with sweat. Right now, my thermostat claims that it is 46 degrees in my apartment, but I am sitting writing this in pajama bottoms and a (different) t-shirt, barely feeling cold at all.

So, the things I was reminded of this morning were:

1) People do not appreciate the usefulness of friction until it goes away.

2) Spontaneous social order can be a very helpful way of rapidly solving problems if enough people cooperate, and our society has amazing reserves of public-spiritedness.

3) In order to permanently fix things, you still need the men with uniforms and tasers on their hips, especially if there are people who will not cooperate with the spontaneous order.

4) Shoving cars around for an hour and a half is an excellent workout.

5) The human body is capable of amazing feats of thermoregulation if properly trained.

Media Musings

Recently, I rewatched Raiders of the Lost Ark and realized how dated and silly it is. Many flaws that I had never noticed before jumped out at me; as I watched the movie I kept thinking things like "I have personally filmed a better fight scene than this" and "Wait, they did not have rocket propelled grenades in 1936."

But the main thing that annoyed me was the sexist portrayal of Indy's friend Marion. She spends most of the movie whining and being useless, and the way that the story was written so she is always wearing cocktail dresses was nothing more than pointless fan service.

I was thinking "our society has definitely come a long way in the past 30 years". But then I watched Stardust, a 2007 movie of the same genre, and realized that it is even more sexist than the Indy movie.

All of the women in Stardust are either evil witches or easy fantasy girlfriends. None of them have any character at all; they are just cardboard villains for the hero to fight or they fall in love with men for no reason at all while being completely useless. At least Marion managed to machine-gun some Nazis while Indy was getting beaten up by the mechanic, and almost tricked her way out of captivity, but the star girl in Stardust does absolutely nothing interesting or heroic.

Compared to an Indy movie, Stardust and many modern movies like it are a reversion to simplistic and childish fairy tales, complete with the mindless wish-fulfillment and casual sexism of Medieval stories.

I realized that about 60% of all of the TV and movie time I have watched over the past two years was a Joss Whedon production. All of the characters in his works are interesting and real, especially the women. They are real people doing real or heroic things. The women in Stargate SG:1 and Farscape are portrayed almost as well. Those shows plus Whedon works are almost all the TV and movies I have watched in the past two years. This has distorted my perceptions of modern media. I was assuming that most stuff nowadays was similar, but it is not.

There is a media analysis tool known as the Bechdel Test. To pass the test:

1. It has to have at least two women in it,
2. who talk to each other,
3. about something besides a man.

Shockingly few movies can pass this test, and the percentage has not really gone up over time. Learning about it and thinking about it was one of the main things that made me realize how the media and stories that shape our culture seem to systematically exclude women.

It is not hard to pass the Bechdel Test and/or to have strong and competent female characters, as many of my favorite shows demonstrate. You don't have to be a media genius like Whedon to pull it off. Even if you are making a show that is a mindless heroic fantasy adventure, you can just randomly make some of the characters women. This is the approach taken by the Avengers cartoon. All of its female characters are basically just men with a different shape, but at least they are competent and heroic and are not defined by their romantic relationships with the male characters.

Confusing Social Norms

Last week, Tyler Cowen posted a link to the following article, and gave the link the title "Markets in Everything: educate your nanny". It describes people hiring professional chefs to teach their nannies how to cook better food for their children:

> Founded by two veterans of the private-chef world ..., marc&mark teaches nannies of affluent parents how to prepare healthful, organic meals that don't come frozen or under plastic wrap. "Some of these nannies already do the cooking in the family, but they're throwing chicken fingers in the oven, or worse, the microwave — they're doing the bare minimum," Mr. Leandro said.

http://www.nytimes.com/2013/11/14/fashion/chef-run-service-teaches-nannies-recipes-that-skip-the-microwave.html

The article did not really surprise me or cause much reaction in me. My thoughts were a mix of "This is interesting.", "I am glad that more people are learning how to cook good food.", and "It is kind of sad that the average person in our culture is so bad at cooking that this is necessary."

But apparently a lot of people got offended by the article:

"Pundits across the spectrum were enraged this week by a consulting firm that teaches nannies to cook quinoa"

http://blogs.the-american-interest.com/wrm/2013/11/16/people-thought-the-industrial-revolution-was-servile-too/

I would never have predicted that people would be upset about this, and I still do not really understand the reaction. A rich couple spends a good chunk of money to teach useful skills to their nanny, and people are reacting as if they had done something morally wrong.

This does not appear to be a case of envy. People do not seem to react as badly to other forms of conspicuous consumption, like living in big fancy houses in the best neighborhoods. I suppose that people are upset about the rich people ordering the nanny around and making her change. They seem to resent the 'abuse of power'.

But this makes no sense to me. The nanny was putting their child's health at risk by feeding the kid junk food. If people clearly do not know what they are doing, then you should teach them how to do things better. The only other alternative is to fire the unskilled person and try to hire someone better, which would be a lot worse for the people who do not know what they are doing.

The articles discussing the reaction to this news seem to assume that it is natural to be upset, and then go on to explain why people should not be upset. I need someone to explain to me exactly why people would get upset about this in the first place.

Lego in Asia

I have read two articles recently about the growing success of Lego in Asia. The Lego company is learning that they can make massive amounts of money by convincing Asian tiger moms that Legos will be good for their childrens' intellectual development:

Short overview from The Economist

Longer New Yorker article

I wish them great success in their venture; it will improve the world in many ways if millions of Asian children are allowed to play with Legos rather than being forced into piano lessons.

Learning about this development has had a surprisingly powerful effect on me, and it is interesting to analyze why. First, it is a reminder of how fascinating and interconnected the world is. Who would have guessed 50 years ago, or even 10 years ago, that a Danish toy company would be exporting its expensive and high-end products to millions of Chinese families?

But more importantly, it is a very powerful reminder of how rich and modern Asia has become. When I was growing up and learning about the world, about 20 years ago, I learned that Asia was a vast hive of farms and sweatshops full of people who lived in grinding poverty and an existence that was little better than medieval standards of living. This was mostly accurate.

I knew from an early age that Japan was a relatively rich and modern country, but I also knew that their culture was very different from that of American and European countries. Despite their wealth and prosperity, they were 'not like us' in a lot of important ways. And as other Asian countries got richer, they seemed to jump straight from medieval subsistence farming to Japanese-style computer-obsessed hyper-urbanization, skipping completely the comfortable semi-rural middle-class existence I grew up in. This was mostly accurate.

In short, the idea that any Asian child could have a childhood anything like mine never entered my mind. They all seemed to be either stuck in a miserable farming or sweatshop existence, or they were single children being pushed through a hyper-competitive educational system fanatically intent on memorization and conformity, and spending their free time plugged into electronic devices.

But now they are playing with Legos.

As a result of reading these articles, I am suddenly confronted with the fact that millions of children in former third-world countries will have a childhood a lot like mine: school, after-school academic activities, fun creative playtime, and parents who want them to be successful and well-rounded people. Because we now share a tangible and emotionally salient experience, these children have suddenly become much more real to me.

The amazing advancement of the standard of living in their countries has also become more real to me. A childhood once only available to the richest of the rich will now be the birthright of a substantial fraction of the world.