Wednesday, August 08, 2012

The Economic Approach to Thinking About Diabetes

In the late 1990s, I published three papers about the economics of diabetes.  These are not my best known papers but you can judge whether they are good.  Here is paper #1,  paper #2 and paper #3.

Here is the abstract for paper #3 called " Diabetic Risk Taking: The Role of Information, Education and Medication"

Diet adherence is a key determinant in minimizing the risk of diabetic health complications. Diabetics who ignore their doctor's advice, concerning diet, smoking and exercise, are taking a gamble. Food product innovation, improved understanding about the benefits of tight diabetic compliance, and increased information dissemination all provide incentives for diabetics to modify their behavior. This paper uses repeated cross-sections of the NHANES from 1971-1994 to document that diabetics are making better choices over time relative to earlier cohorts and relative to non-diabetics. They smoke less than their non-diabetic counterparts. Their consumption of cholesterol has fallen sharply and they are reducing their alcohol and sweets consumption. New medications have played an important role in improving diabetic quality of life. This paper studies whether access to improved diabetic medicine has created offsetting incentives such that diet compliance falls. I find little evidence that the more medicated display worse health habits. 

I haven't thought much about these issues but a piece in today's NY Times made me revisit these issues.  In this blog entry , the NY Times reports about a new JAMA paper reporting that heavy diabetics who are diagnosed with Type II diabetes face a lower death probability than thin diabetics diagnosed with the same disease.  The amazing thing is that the blog post focuses on baseline health differences between thin and heavy people.

"The researchers could not explain why having a greater body mass index, or B.M.I., might protect someone with diabetes. But they did point out that some doctors may be prone to treating thin diabetics differently from their obese counterparts, and may be less likely to push them to make diet and exercise changes that could improve their survival."

My past research suggests that the causal explanation for the facts is that heavy diabetics are more likely to change their personal habits at diagnosis than thin diabetics who think they are "healthy".  There is a differential diagnosis effect on the behavior of diabetics at diagnosis and the diagnosis is more of a "wake up call" for heavy diabetics.  Note that the article makes the doctor the prime agent here.  Basic economics tells us that the diabetic is the important person here and her behavioral change is the key issue here.  What is "salient" news?  My claim is that the "thin" are lulled into thinking they are healthy at diagnosis and do not change their game.  This is testable!