26 Comments

Another great article, David. Your curiosity and excitement comes through even in the written transcript of the interview. And thanks Bapu for encouraging me to be more curious about what natural experiments are hiding in plain sight.

Love the creativity. Another book to add to my ever growing reading list, but there are worse problems to have.

The random experiment framing makes me curious what it would be like to integrate this type of thinking into one of my courses. Effectively asking students to be attentive to what is around them and then leverage some mathematical skills and reasoning to try to pull an insight out that might be otherwise ignored.

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Another 'natural experiment' that I feel has been under-analyzed is Medicare. At age 65, everyone has good health insurance. At age 64, some people have poor health insurance, others have none. Rates of elective procedures like knee replacements spike at age 65, as you get those who have been putting it off. But non-elective procedures go up, too, suggesting people find ways to put just about everything off. If you look at mortality, it's worse to be 65 than 64, because the mortality rate always goes up with age. However, it goes up by less than 64 vs 63 or 66 vs 65. In other words, 64 year-olds die a bit more than they should, all else being equal. (Caveat: I looked into these things about 10-12 years ago and I no longer believe I have access to the data that would allow me to revisit it. Hopefully the Affordable Care Act would have attenuated this effect somewhat, but I know people in my daily life who have, for example, $10,000 annual deductibles and thus try to 'bundle' two or three procedures in the same year to save some money, so it has not gone away).

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Hey David, love your work esp Range. I originally found you from Peter Attias podcast. Btw have you read his book, Outlive?

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Fantastic conversation that I hope, before much longer, does stretch on for 40 more questions and answers. My wife covers the orthopedic device industry so she talks fairly regularly with surgeons, and we recently moved from the West side of Cleveland to the East side so now I talk fairly regularly with surgeons (and ER doctors, and other docs) just because they're around, and these are fascinating topics I would have never considered. Will definitely be reading the book this year. Thank you, Bapu, for your research and writing, and thank you, David, for your endless curiosity.

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Kudos for your question about behavioral similarities or differences related to Covid and children’s birthdays! I have two more questions. First, regarding the increased incidence of cardiac events in the geographic area around marathons, did the authors of the original article exclude mortality or other serious events among the marathon runners themselves? For example, most very large running events, unfortunately have one or more cardiac events, some resulting in mortality. In addition, there may be incidences of severe heat, illness or other problems that could then cause a cardiac event. Granted, one can hope these numbers are small, but they do occur, and it would be helpful to know whether they were included in that study or not. Second, regarding the opioid prescription discussion, at least one more natural experiment did occur in the US. In the not-so-distant past, physicians were instructed that we were under-prescribing pain medication, and should be more liberal in the treatment of pain, using opioid medications. More recently (this varies to some extent by state) a great deal of education has been required for license renewal that includes use of non-addictive medications such as acetaminophen or ibuprofen for pain rather than opioids. Any thoughts?

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I love the random correlations but still can decide how much causation to assign

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