Dying for Drugs

Kerry's outstanding piece on access to experimental drugs from the August/September issue of Reason is now available online. I think the thing that sets this article apart from typical libertarian FDA hit pieces is the way it so evenhandedly explains the rationale for excluding some dying patients from clinical trials. There is no ideological table pounding. I really understand why the system works the way it does in a way I never did before. It is moving without being sentimental. And, overall, completely devastating.

If Warheads Were Dessert, Arms Races Would be Delicious

David Brooks once wrote a column based on an astonishing sociological insight seldom noted by teenagers to the effect that not conforming is just another way of conforming when you do it in the way everyone else is doing it, say, by getting a tatttoo. Opting out is hard! Robert Frank noted this dynamic with the bygone multiple piercing fad in What Price the Moral High Ground. As whatever it is that having a piercing signals gets diluted by widespread adoption, you need more more bangles in holes to get the signaling job done. Frank says something about this costly race subsiding as norms against “bodily mutilation” kick in. That sounds wrong. What kicks in, I think, is a kind of signaling backfire — the “trying too hard” phenomenon. If you're out toward the right tail of the piercing distribution, you can attempt a kind of counter-signaling: “I'm not in fact trying too hard; I look this way because I seriously don't give a f*ck what you think,” but it takes a very special person to make this work. People who invested in the signal early, before it got noisy, generally just drop it and search for something else. 

But let's back up a second. Frank is right that it seems like there is a kind of waste here. If some kind of truce could be established in the form of a norm that that three, but no more than three, piercings is maximally edgy, people could signal precisely the degree of edginess desired without fear of signal dilution and the costs of an escalating arms race. But in cases where the goal is to signal willingness to deviate from widespread social norms, it seems that additional widespread social norms regulating the pursuit of this goal can't possibly be stable.

This obviously relates to the paradox of the avant garde, which I spent way too much time thinking about when I was an art student back when giants like Kurt Cobain walked the Earth. Each new shocking work intended to jar the bourgeousie out of their dull complacency only further desensitizes the burghers and hausfraus until even churchgoers and patriots become well-nigh unshockable and the game is used up. So, like a guy who affiliates with a community of tattoo afficianados among whom it doesn't look like he's trying too hard (and who provide an explanation), artists shift their frame of reference and create “the art world” and try to impress and dismay the denizens of that world — other artists, critics, collectors, hangers-on — with other kinds of limit-pushing. At some point, it seems, it became radical to paint figurative pictures in a traditional style and bisect sharks. It never ends! Think of the waste!

So how could a “truce” norm possibly work in this context? It couldn't, unless there is a prior implicit agreement to refuse to confer status upon those who satisfy, entertain, and stimulate with paradigm-shifting novelty, which is not forthcoming. Therefore, artists continue to angle for attention and praise by producing interesting things. Positional arms races do seem to exhaust lines of creation. Each envelope-pushing success imposes costs on competitors. These days Piss Christs and dung-smeared madonnas need media blitzkriegs to invent a minor hubbub. Blank canvases get no blanker, empty rooms no emptier, etc. But as long as there is prestige (money, too) to be won, the aesthetic search pushes into neglected corners and fresh frontiers. Like oil companies with ingenious new extraction techniques, artists unsuited to blazing new trails return to fields that had seemed tapped out, but weren't. The fecundity of these races is precisely in their norm-defying trucelessness.

Entrepreneurship, I think, is a lot like that.  Or, rather, that's an example of entrepreneurship at work. Something like this dynamic is behind a great deal of economic discovery in addition to artistic innovation. The supply of human creativity is too low. And status-seeking is probably a greater spur to creativity than even wealth-seeking. We need it. One argument against both taxes and certain social norms intended to limit positional competition is that they further reduce already undersupplied creativity. Of course, positional competition along certain dimensions — for political power, say — can be incredibly destructive and we'd be doomed without robust norms tighly regulating it.  But we should be careful about what exactly we are taxing, socially and fiscally. 

Why Wait?

Matt writes:

Back in December I called my primary care physician's office to schedule an appointment. I got one in mid-March. Such is life.

Dude! What are you doing? Medics USA on the corner of 17th and P Streets NW. The office will not be featured in Architectural Digest, but the doctors have presciption pads. I've always gotten in the same or next day. (202) 483-4400. You're welcome.

Also, when a restaurant has an hour wait for a table, I just go somewhere else.

The Paid Vacation Laffer Curve

Yglesias makes a perfectly sound point in this post about paid vacation:

A paid vacation is a kind of accounting fiction — you continue to draw a paycheck (and health care benefits, etc.) even while you're on vacation. But nobody's going to pay you to go on vacation. You're paid for the work that you actually do.The money you get on your vacation days is part of your payment for the work you do on the other days. Over the long run, if the government mandates a certain number of paid vacation days, then positions that currently offer fewer vacation days [than] that will become less lucrative.

Things like this assure us that Matt isn't economically illiterate. But to some of his commentators, economic literacy amounts to treason. Witness Bloix:

At one point, Matt was an intelligent moderate liberal. All of sudden, he's a wingnut spouting moronic right-wing talking points.

Incredible! Bloix, like a number of other commenters, seem peeved that Matt did not mention that productivity and wages could go up, due to happier, better-rested workers. And even if productivity did go down, wages could be kept constant by cutting executive pay, or shafting shareholders. Why are you such a wingnut, Matt!?

I like the point about highly tanned, highly productive workers, since it strikes me that it turns on something very like the logic of the so-called Laffer Curve. At the “no vacation” limit, you don't get zero productivity, but the workers may be worn down, demoralized, listless, and perhaps even spitefully sluggish. At the “permanent vacation” limit, you do get zero productivity, since no one is ever at work. Somewhere in between is the productvity sweet spot. I suppose it is easy to imagine that we are currently at a point where more vacation would give us enough extra productivity to compensate for the time off. More productivity from less working! Like more revenue from lower taxes! Damn right-wing talking points.

Now, since companies obviously have no incentive to hit the productivity sweet spot, since companies don't like making money, we may indeed need the government to step in here and make sure we all get the vacations our employers would give us if they had any reason to try to get us to really put our shoulders into it. Naturally we can be sure the government will find the optimal vacation sweet spot. You can't buy bombs with taxes on unrealized profits!

Whetever you do, don't tell the Chinese about weekends off!