Languages and future-oriented economic behavior-Experimental evidence for causal effects.

Studies have shown that the use of languages which grammatically associate the future and the present tends to correlate with more future-oriented behavior. We take an experimental approach to go beyond correlation. We asked bilingual research participants, people fluent in two languages (12 language pairs) which differ in the way they encode time, to make a set of future-oriented economic decisions. We find that participants addressed in a language in which the present and the future are marked more distinctly tended to value future events less than participants addressed in a language in which the present and the future are similarly marked. In an additional experiment, bilingual research participants (seven language pairs) were asked to choose whether they wish to complete a more enjoyable task first or later (delayed gratification). When addressed in a language in which the present and the future are marked more distinctly, participants tended to prefer immediate gratification more than when addressed in a language in which the present and the future are marked less distinctly. We shed light on the mechanism in a within-person experiment in which bilingual research participants (nine language pairs) were asked to spatially mark the distance between the present and the future. When participants were addressed in a language in which the present and the future are marked more distinctly, they tended to express more precise temporal beliefs compared with when addressed in a language in which the present and the future are marked less distinctly.

Cost Benefit Analysis of Limited Reopening Relative to a Herd Immunity Strategy or Shelter in Place for SARS-CoV-2 in the United States.

Background: Fierce debate about the health and financial tradeoffs presented by different COVID-19 pandemic mitigation strategies highlights the need for rigorous quantitative evaluation of policy options. Objective: To quantify the economic value of the costs and benefits of a policy of continued limited reopening with social distancing relative to alternative COVID-19 response strategies in the United States. Design: We estimate the number and value of quality-adjusted life-years (QALY) gained from mortality averted, with a value of $125,000 per QALY, and compare these benefits to the associated costs in terms of plausible effects on US GDP under a policy of continued limited reopening with social distancing relative to a policy of full reopening toward herd immunity. Using the same QALY value assumptions, we further evaluate cost-effectiveness of a return to Shelter-in-Place relative to a policy of limited reopening. Setting: United States. Measurements: QALY and cost as percent of GDP of limited reopening with continued social distancing relative to a strategy of full reopening aimed at achieving herd immunity; a limited reopening "budget" measured in the number of months before this strategy fails to demonstrate cost-effectiveness relative to a full reopening; a shelter-in-place "threshold" measured in the number of lives saved at which a month of sheltering in place demonstrates cost effectiveness relative to the limited reopening strategy. Results: QALY benefits from mortality averted by continued social distancing and limited reopening relative to a policy of full reopening exceed projected GDP costs if an effective vaccine or therapeutic can be developed within 11.1 months from late May 2020. White House vaccine projections fall within this date, supporting a partial reopening strategy. One month of shelter-in-place restrictions provides QALY benefits from averted mortality that exceed the associated GDP costs relative to limited reopening if the restrictions prevent at least 154,586 additional COVID-19 deaths over the course of the pandemic. Current models of disease progression suggest that limited reopening will not cause this many additional deaths, again supporting a limited reopening strategy. Limitation: Limited horizon of COVID-19 mortality projections; infection fatality ratio stable across strategies, ignoring both the potential for ICU overload to increase mortality and the deployment of partially effective therapeutics to decrease mortality; effect on GDP modeled as constant within a given phase of the pandemic; accounts for age and sex distribution of QALYs, but not effect of comorbidities; only considers impact from QALY lost due to mortality and from changes in GDP, excluding numerous other considerations, such as non-fatal COVID-19 morbidity, reduced quality of life caused by prolonged social distancing, or educational regression associated with prolonged school closures and restrictions. Conclusions: A limited reopening to achieve partial mitigation of COVID-19 is cost effective relative to a full reopening if an effective therapeutic or vaccine can be deployed within 11.1 months of late May 2020. One additional month of shelter-in-place restrictions should only be imposed if it saves at least 154,586 lives per month before the development of an effective therapeutic or vaccine relative to limited reopening.

A lottery test of the effect of dispensaries on emergency room visits in Arizona.

In August 2012, the Arizona Department of Health Services conducted a lottery to allocate licenses for the state's first medical marijuana dispensaries. The lottery randomly selected an applicant within each of 69 contested Community Health Analysis Areas to open a dispensary. By comparing 36 zip codes with winning applications to 48 zip codes with losing applications and weighting using propensity scores based on the true probability of winning, we estimate the causal effect of the allocation of a dispensary on the emergency room visits of residents of that zip code. Outcomes of interest are emergency room visits for acute symptoms caused by cannabis, opioids, alcohol, and cocaine. Using emergency room discharge data from 2010 to 2016, we find evidence of an increase in visits for acute cannabis-related causes for the winning set of zip codes and weak evidence of an increase in visits for opioid-related causes. The results indicate that in the four years following the lottery, emergency room visits for acute cannabis causes rose by approximately 45% in allocated zip codes relative to non-allocated zip codes. Because of the high likelihood of spillovers to neighboring zip codes, these effects are likely underestimates.

Your Liberty or Your Gun? A Survey of Psychiatrist Understanding of Mental Health Prohibitors.

This first-of-its-kind national survey of 485 psychiatrists in nine states and the District of Columbia (DC) finds substantial evidence of clinicians being uninformed, misinformed, and misinforming patients of their gun rights regarding involuntary commitments and voluntary inpatient admissions. A significant percentage of psychiatrists (36.9%) did not understand that an involuntary civil commitment triggered the loss of gun rights, and the majority of psychiatrists in states with prohibitors on voluntary admissions (57%) and emergency holds (56%) were unaware that patients would lose gun rights upon voluntary admission or temporary commitment. Moreover, the survey found evidence that psychiatrists may use gun rights to negotiate "voluntary" commitments with patients: 15.9% of respondents reported telling patients they could preserve their gun rights by permitting themselves to be voluntarily admitted for treatment, in lieu of being involuntarily committed. The results raise questions of whether psychiatrists obtained full informed consent for voluntary patient admissions, and suggest that some medical providers in states with voluntary admission prohibitor laws may unwittingly deprive their patients of a constitutional right. The study calls into question the fairness of state prohibitor laws as policy, and - at minimum - indicates an urgent need for psychiatrist training on their state gun laws.

Guests with Guns: Public Support for "No Carry" Defaults on Private Land.

A nationally representative survey of 2000 American adults shows broad support for prohibiting gun-possession on private land without the landowner's explicit permission. Many states have laws which permit concealed weapon carry unless explicitly prohibited by the landowner, but our survey suggests statistically-significant majorities would prefer "no carry" defaults with regard to homeowners, employers, and retailers. While respondents who are Republican, male, or gun owners are more likely to support "carry" defaults, we find that the majoritarian rejection of "carry" defaults does not tend to vary by region or state. However, our survey does find majority support for a default right to possess guns in rented property and on an employer's parking lot. Respondents across all contexts also report substantial ignorance or misinformation about the law. Landowners who don't know or mistakenly believe that concealed carry is, by default, prohibited on their land may be less able to protect themselves by explicitly prohibiting such third-party possession.

The Walmart Effect: Testing Private Interventions to Reduce Gun Suicide.

This article tests the impact of Walmart's corporate decisions to end the sale of handguns at its stores in 1994 and to discontinue the sale of all firearms at approximately 59% of its stores in 2006 before resuming firearms sales at some of those stores in 2011. Using a difference-in-differences framework, we find that that from 1994 to 2005 counties with Walmarts robustly experienced a reduction in the suicide rate and experienced no change in the homicide rate. These models suggest that Walmart's policy change caused a 3.3 to 7.5% reduction in the suicide rate within affected counties, which represents an estimated 5,104 to 11,970 lives saved over the studied period (425-998 per year). In contrast, Walmart's 2006 and 2011 decisions to discontinue and subsequently resume the sale of rifles and shotguns in many of its stores was not associated with a robustly measured effect on homicide or suicide rates. We do find evidence that Walmart's 2006 decision to reduce the number of its stores that sold firearms caused a statistically significant reduction in the suicide rate for counties in which Walmart did not subsequently resume firearms sales.

The Impact of Prescription Drug Monitoring Programs on U.S. Opioid Prescriptions.

This paper seeks to understand the treatment effect of Prescription Drug Monitoring Programs (PDMPs) on opioid prescription rates. Using county-level panel data on all opioid prescriptions in the U.S. between 2006 and 2015, we investigate whether state interventions like PDMPs have heterogeneous treatment effects at the sub-state level, based on regional and temporal variations in policy design, extent of urbanization, race, and income. Our models comprehensively control for a set of county and time fixed effects, countyspecific and time-varying demographic controls, potentially endogenous time-series trends in prescription rates, and other state-level opioid interventions such as Naloxone Access and Good Samaritan laws, Medicaid expansion, and the provision of Methadone Assistance Treatment. We find that PDMPs are only effective in reducing prescription rates if they obligate doctors to check for patients' history prior to filling out a prescription, but the frequency at which a state requires its PDMP to be updated is irrelevant to its effectiveness. Moreover, the significant treatment effects of PDMPs are almost exclusively driven by urban and predominantly white counties, with the relatively more affluent regions showing greater responsiveness than their less affluent counterparts.

Effect of perineal self-acupressure on constipation: a randomized controlled trial.

BACKGROUND: The efficacy of perineal self-acupressure in treating constipation is uncertain. OBJECTIVE: We aimed to evaluate whether perineal self-acupressure would improve patient reports of quality of life and bowel function at 4 weeks after training. DESIGN: A randomized, parallel group trial was conducted. SETTING: The study took place at the UCLA Department of Medicine. PATIENTS: One hundred adult patients who met Rome III criteria for functional constipation participated. INTERVENTION: The control group received information about standard constipation treatment options, while the treatment group received training in perineal self-acupressure plus standard treatment options. MEASUREMENTS: Primary outcome was the Patient Assessment of Constipation Quality of Life (PAC-QOL). Secondary outcomes included patient assessments of bowel function (as measured by a modified Bowel Function Index (BFI)), and health and well-being (as measured by the SF-12v2). RESULTS: The mean PAC-QOL was improved by 0.76 in the treatment group and by 0.17 in the control group (treatment-effect difference, 0.59 [95 % CI, 0.37 to 0.81]; p < 0.01). The mean modified BFI was improved by 18.1 in the treatment group and by 4.2 in the control group (treatment-effect difference, 13.8 [95 % CI, 5.1 to 22.5]; p < 0.01). The mean SF-12v2 Physical Component Score was improved by 2.69 in the treatment group and reduced by 0.36 in the control group (treatment-effect difference, 3.05, [95 % CI, 0.85 to 5.25]; p < 0.01); and the mean SF-12v2 Mental Component Score was improved by 3.12 in the treatment group and improved by 0.30 in the control group (treatment-effect difference, 2.82, [95 % CI, -0.10 to 5.74]; p < 0.07). LIMITATION: The trial was not blinded. CONCLUSION: Among patients with constipation, perineal self-acupressure improves self-reported assessments of quality of life, bowel function, and health and well-being relative to providing standard constipation treatment options alone.

Three tests for measuring unjustified disparate impacts in organ transplantation: the problem of "included variable" bias.

Civil rights statutes often prohibit two distinct types of discrimination, referred to as "disparate treatment" and "disparate impact." Disparate treatment is race-contingent decision making. But even decision making that is not affected by people's race may still produce an unjustified disparate impact. For example, a race-neutral transplantation preference for allografts with partial antigen matches might produce an unjustified disparate impact on African Americans with end-stage renal disease. The transplantation preference might make it harder for African Americans to receive a transplant without significantly increasing the chance of transplant survival. Because disparate impact and disparate treatment claims have distinct elements, they require distinct methods of statistical testing. This article analyzes three different ways of testing unjustified disparate impacts in organ transplantation, which I will call the traditional test, the omitted variable test, and the outcome test. Each of these methods of testing for disparate impact are attuned to the problem of "included variable" bias. Controlling statistically for nonracial variables may actually bias the analysis and mask the existence of unjustified disparate impacts.