Monday, August 20, 2018

Medically assisted death debated in Australia

A bill is under consideration in Australia regarding medically assisted suicide, aka death with dignity.  (The politics are complicated by the fact that Australia has both states and territories.) Here's the story from the Guardian:

David Leyonhjelm confident voluntary euthanasia bill will pass Senate
Liberal Democrat pressures Malcolm Turnbull to permit vote in lower house

"The bill to allow the Northern Territory and Australian Capital Territory to legislate for euthanasia – reversing a ban imposed by the commonwealth in 1997 – has support from at least 18 Labor senators, the nine Greens, eight crossbench senators and a small but growing group of Coalition senators. It needs 39 to pass the Senate.
"“Australians with a terminal illness should have a right to die with dignity, ideally with effective palliative care, but with sufficient safeguards, that right, in extreme cases, should also extend to voluntary euthanasia.”

An earlier, related post:

Friday, May 4, 2018

Saturday, August 18, 2018

Diversity isn't just about role models: Alsan, Garrick and Graziani on black male doctors and patients

Medical compliance--following the doctor's "orders,"--is a big issue in medical care, and here's an article that reports a novel field experiment suggesting that black male doctors treating black men may have more success than non-black docs.

Does Diversity Matter for Health? Experimental Evidence from Oakland
Marcella Alsan, Owen Garrick, Grant C. Graziani
NBER Working Paper No. 24787

"We study the effect of diversity in the physician workforce on the demand for preventive care among African-American men. Black men have the lowest life expectancy of any major demographic group in the U.S., and much of the disadvantage is due to chronic diseases which are amenable to primary and secondary prevention. In a field experiment in Oakland, California, we randomize black men to black or non-black male medical doctors and to incentives for one of the five offered preventives — the flu vaccine. We use a two-stage design, measuring decisions about cardiovascular screening and the flu vaccine before (ex ante) and after (ex post) meeting their assigned doctor. Black men select a similar number of preventives in the ex-ante stage, but are much more likely to select every preventive service, particularly invasive services, once meeting with a doctor who is the same race. The effects are most pronounced for men who mistrust the medical system and for those who experienced greater hassle costs associated with their visit. Subjects are more likely to talk with a black doctor about their health problems and black doctors are more likely to write additional notes about the subjects. The results are most consistent with better patient-doctor communication during the encounter rather than differential quality of doctors or discrimination. Our findings suggest black doctors could help reduce cardiovascular mortality by 16 deaths per 100,000 per year — leading to a 19% reduction in the black-white male gap in cardiovascular mortality.

While there's no substitute for the kind of serious science reported in the paper above, below is a very believable anecdotal account in an interview published in Stat that suggests that companies seeking to solve medical problems afflicting women may have more success with venture capital firms that have women partners:

A women’s health startup tried to drum up interest for a much-needed drug. Many men didn’t get it

Friday, August 17, 2018

Kidney exchange on NPR

Two friends told me that they'd heard me on NPR yesterday, and so I searched and found this program on kidney exchange. (At the link below you can read the transcript, and also see a 9 minute video that apparently played on tv.) They interview patients, donors, and kidney docs, and feature two economists, me and Nikhil Agarwal.  (My part seems to be pieced together from footage from a talk I gave at a Google conference, and a video made by the National Academy of Sciences, but it looks like they actually interviewed Nikhil...)

The economic principle that powers this kidney donor market
Aug 16, 2018 6:20 PM EDT

I can't figure out how to embed the video in this post, but here's a picture that's just a screen shot, not a link:

Thursday, August 16, 2018

An open marketplace for reinsurance

Tremor Technologies Inc. has announced its new online marketplace for reinsurance.  Here's the press release:

Tremor Technologies, Inc., a venture-backed startup based in Greenwich, CT, has announced that its programmatic risk placement marketplace is fully operational with significant buyers and sellers of reinsurance protection in place.

And here's an article with a little more detail:

Tremor opens programmatic marketplace for reinsurance risk placement
by ARTEMIS on AUGUST 14, 2018

"The company has venture capital backing and has been developing its technology platform and building a team of marketplace design experts* for two years now, with the resulting smart market now available.
"Peter Cramton, Tremor’s Chief Economist and a recognised international expert on auction theory and practice, as well as market design, commented, “We maximize value for both sides of the market and then fairly share that value among participants with competitive clearing prices.”

*full disclosure--I'm on Tremor's advisory board.

Wednesday, August 15, 2018

Why aren't clearinghouses used in college admissions?

I recently had an email from  Professor Deepak Hegde, at NYU's Stern School who asked me a question that led to the following exchange (edited for brevity and reproduced with his permission):

"Why are admission decisions in a broader set of settings (e.g., Phd applicants-programs, MBA applicants-to-business schools and so on)  not cleared through matching programs as is done with medical schools and residency applicants (or in some cases public schools matching)?   Are there a general set of conditions that one could develop to understand the contexts in which the matching algorithm that have helped advance could be implemented effectively?"

I replied as follows:

"I certainly don’t have a complete answer, but one obvious piece is that setting up a centralized clearinghouse for a whole market involves getting a lot of parties to coordinate and cooperate.  So I would guess that MBA admissions have a better chance of getting organized than, say Ph.D. admissions, since MBA programs are more alike one another than are Ph.D. programs (e.g. in Physics and Philosophy, or Chemistry and Chinese).

"And since wide scale cooperation is hard, I think it mostly happens in market in which people are very dis-satisfied with the existing system, and not just somewhat irritated.

"Is it your sense that MBA admissions is in a crisis of some sort?"

His reply: "In my assessment ... MBA admissions is not facing such a crisis, yet."

So...I think the MBA Match isn't something we'll hear about in the near future.

Tuesday, August 14, 2018

Dealing with shortages of deceased donors in a future with fewer automobile accidents

Sometimes you find out that someone has already worried about something that you haven't even thought of worrying about.  I worry about some aspects of transplantation, and I sometimes think about driverless cars, but here's an article about a worry that is nowhere near the top of my list.  However the short article below (it's a comment on another article) raises some interesting points about how society may want to rethink increasing organ donation as we see (I hope) ever fewer deaths from automobile accidents:

How Do You Donate Life When People Are Not Dying: Transplants in the Age of Autonomous Vehicles

Zoe Corin, Roee Furman, Shira Lifshitz, Ophir Samuelov & Dov Greenbaum (2018) , The American Journal of Bioethics, 18:7, 27-29, DOI: 10.1080/15265161.2018.1478024

"While there are differences of opinion as to when autonomous or self-driving cars will actually invade our roads—some car manufacturers are predicting consumer-ready self-driving cars as early as 2021—there is broad consensus that their inevitability is assured. And while there are clear positive social consequences that will result from self-driving cars and trucks, there are also a number of often less appreciated negative externalities. Balanced against the saved lives, minimized commutes, reduction in pollution, and general decrease in daily stress are the driving-related job losses and the reality that there will be fewer organ donors."
"There are no quick fixes, and current laws already place significant restrictions on the organ acquisition process. Buying and selling organs is nearly universally objectionable, unethical, and illegal (Ludin 2008). Some countries even ban any benefit, or any form of valuable consideration whatsoever, in exchange for an organ (Caulfield et al. 2014
Caulfield, T.E. NelsonB. Goldfeldt, and S.Klarenbach2014Incentives and organ donation: what’s (really) legal in Canada?Canadian Journal of Kidney Health and Disease 1: 7.[Crossref][PubMed], [Google Scholar]). Some jurisdictions go even beyond this altruistic-only donor requirement, and allow live donations only among blood relatives (India 1994Government of India. 1994. Transplantation of Human Organs Act, 1994.http://wwwmedindianet/tho/thobill1asp. [Google Scholar]).
"However, even these universal attitudes have some specific exceptions: In many countries, blood donors are paid, and sperm and egg donors can receive thousands of dollars in remuneration. But just because a handful of tissue donations have been commodified (albeit sometimes obfuscated as gifts with financial consideration), it is not clear that this cash for contribution system will expand anytime soon to include other types of living donations, such as liver lobes or kidneys. To wit: While New York sperm donors can make more than a thousand dollars a month (Lewinnov 2016
Lewinnov, T201610 things to know about being a sperm donor, New York Times, Nov. 3 2016. [Google Scholar]), surrogacy contracts are still void and unenforceable by law (New York 2014New York. 2014. N.Y. Dom. REL. Law §§ 121-124 Surrogate Parenting Contracts Organ Donation and Recovery Improvement Act (2004). [Google Scholar]).
Nevertheless, in light of the need for organs, a number of jurisdictions have tried to indirectly incentivize donation, either through financial or non-financial mechanisms. Such incentives include paying for funeral costs of non-living donors, or for the out-of-pocket expenses directly associated with transplantation (US 2004)."