Thursday, May 23, 2024

Social Media and Job Market Success: A Field Experiment on Twitter, by Qiu, Chen, Cohn, and Roth

 Here's a new working paper on SSRN:

Social Media and Job Market Success: A Field Experiment on Twitter, by Jingyi Qiu, Yan Chen, Alain Cohn, and Alvin E. Roth, May 20, 2024

"Abstract: We conducted a field experiment on Twitter to examine the impact of social media promotion on job market outcomes in economics. Half of the 519 job market papers tweeted from our research account were randomly assigned to be quote-tweeted by prominent economists. Papers assigned to be quote-tweeted received 442% more views and 303% more likes. Moreover, candidates in the treatment group received one additional flyout, with women receiving 0.9 more job offers. These findings suggest that social media promotion can improve the visibility and success of job market candidates, especially for underrepresented groups in economics such as women."


I gather that our paper has gone somewhat viral on twitter, with discussion about whether field experiments on job markets are ethical.  That's not a bad discussion to have, and of course we discussed that in the course of planning this experiment. (A similar discussion can and should be be had about any intervention in a market, not just an experiment.*)

Here is what we had to say about that in the paper.

"Despite the positive outcomes, one might question the ethics of our intervention, which randomly promotes a subset of JMPs on social media. However, we observe that senior economists naturally promote their own students and coauthors on Twitter. In comparison, we tweeted every JMP in our sample from our dedicated research account. Furthermore, while 80% of the influencers in our sample come from top 30 institutions, they quote-tweeted JMPs from a broader spectrum of academic institutions, thus allocating attention more equitably. Given that 92% of the JMCs in both the treatment and control groups accepted a job, it is unlikely that our treatment displaced those in the control group. The current focus on diversity, equity, and inclusion suggests that highlighting suitable candidates could potentially expand the number of job openings, making the job market for economists not entirely zero-sum. Lastly, the differential benefit of our treatment for women contributes to fostering a more inclusive economics profession. In summary, we argue that the knowledge gained from our experiment outweighs the potential cost."


*I've been involved in several operational (i.e. not experimental) interventions in job markets, including  the job market for new Econ Ph.D.s (e.g. signaling and the scramble):  see 

 Coles, Peter, John H. Cawley, Phillip B. Levine, Muriel Niederle, Alvin E. Roth, and John J. Siegfried, “The Job Market for New Economists: A Market Design Perspective,” Journal of Economic Perspectives, 24,4, Fall 2010, 187-206.  https://www.aeaweb.org/articles?id=10.1257/jep.24.4.187


Wednesday, May 22, 2024

Gaming the health care system; David Cutler's concerns

 The eminent Harvard health economist  David Cutler is worried by, among other things, the takeover of many healthcare facilities by private equity

Financial Games in Health Care—Doing Well Without Doing Good, by David M. Cutler, , JAMA Health Forum. 2024;5(5):e241591. doi:10.1001/jamahealthforum.2024.1591

"One form of gaming is asset looting—businesses taking money out of health care and then extorting state governments to replenish the funds. In an earlier publication,1 Song and I discussed how this works. Typically, a private equity firm owning a hospital sells the land the hospital is on and agrees to lease it back to the hospital at a high interest rate. The money from the sale is paid out to private equity investors; the hospital is saddled with the debt. If the hospital cannot repay the loan, the private equity firm threatens to close the facility unless the government covers the debt. Quality suffers during this process. Quality indicators at hospitals and nursing homes bought by private equity firms worsened after these changes in ownership.

...

"A third gaming strategy involves “coding intensity” and “upcoding,” which is coding and billing for more complex (and thus more expensive) care. These practices seek to maximize risk-adjusted reimbursements based on diagnostic codes. With coding intensity, the insurer codes all diagnoses ever received by an individual so that disease-based reimbursement is higher. Medicare pays private plans based on the health risks of their enrollees (measured by reported diagnoses). Thus, private insurers participating in Medicare Advantage spend enormous sums to find and code additional diagnoses. Estimates are that coding intensity will cost Medicare $50 billion in 2024.6

...

However, addressing coding practices is challenging because it may encourage risk selection. If payments for care provided to a patient are less than the costs incurred for that patient, insurers and clinicians may seek to treat only profitable patients and drive away the unprofitable ones. There are countless ways to do this. At the plan level, leaving prestigious hospitals out of a network and putting expensive medications in high cost-sharing tiers will drive away sicker patients.9,10 Clinicians engage in risk selection as well. Widespread nonparticipation in Medicaid is evidence of the consequences when profitability varies with patient insurance status.

Because setting optimal health care reimbursement is difficult, less scrupulous clinicians and insurers will always have incentives to cut corners. Recently, it seems that the norms preventing this tendency are fraying. Thus, policymakers need to deter the idea that doing well can come at the expense of doing good. Whenever possible, malfeasance must be prevented in advance and punished when it occurs. Such a strategy will require willpower on the part of policymakers, not just tough words."


Tuesday, May 21, 2024

Britain's Infected Blood Inquiry Report: Prime Minister's apology, and the benefits and perils of hindsight

 After the publication  yesterday of Britain's Infected Blood Inquiry Report, the UK's Prime Minister apologized to the nation. Here's the BBC story:

PM apologises after infected blood scandal cover-up  By Nick Triggle and Jim Reed, BBC News

"Prime Minister Rishi Sunak says he is truly sorry for the failures over the infected blood scandal, calling it a decades-long moral failure.

"He was responding to the public inquiry's report into the scandal, which has seen 30,000 people infected from contaminated blood treatments.

"It found authorities covered up the scandal and exposed victims to unacceptable risks.

"Mr Sunak described it as a "day of shame for the British state".

...

""Today's report shows a decades-long moral failure at the heart of our national life. I want to make a wholehearted and unequivocal apology."

"He said the attitude of denial was hard to comprehend and was to "our eternal shame".

...

Labour leader Sir Keir Starmer apologised too, describing it as one of the "gravest injustices" the country had seen and saying victims had "suffered unspeakably".

***********

I've now had the opportunity to read some of the (2000 page) report, and it leaves me in two minds.  On the one hand, as summarized in various news stories about the report, it deals with a long history during which British clinicians could have responded faster to growing evidence about hepatitis and HIV in the blood supply, and the various British governing coalitions could certainly have acknowledged earlier and more fully that people had been infected.

On the other hand, some of the harms to people who were infected by blood-borne pathogens are clearer in hindsight than they were at the times that they began to occur.

The cases of hemophila patients (many of them children, many of them at Treloar's, a school for disabled children including many with severe hemophilia) are particularly jarring.  Many of those children are no longer living, having been infected with HIV in the  1980's, before it was positively identified as the cause of AIDS (but after there was evidence that something in the blood carried the infection). The clotting factors (extracted from plasma pooled from many donors) that were being explored to treat hemophilia patients, are  (today standard treatments for hemophilia, but in the period covered by the report they were subjects of research, and were, tragically, infected with HIV, and hepatitis C before it's virus had been identified.

Here's a passage (from Vol. 1, p23) of the report that crystallizes why I think it's easier to assess blame in hindsight than it was at the time: (NANBH stands for non-A non-B Hepatitis, as Hep C was still something of a mystery.)

"By 1978 there were a number of reports showing that NANBH was linked to persistent liver damage. Amongst them was a paper published in September 1978 in The Lancet, authored by Dr Eric Preston and colleagues in Sheffield. In his oral evidence to the Inquiry, Dr Mark Winter said that this paper “blew out of the water instantly the idea that this [NANB hepatitis] was nothing to worry about because their study showed, as did other studies, that most of these patients had very significant chronic liver disease”. He thought doctors had been unwilling to think that NANBH might be a problem, because factor concentrate had brought “such spectacular benefits”: it was this reluctance to face the facts described in scientific journals that had prevented earlier acceptance of the seriousness of the problem."

The report also dwells on the difficulties that the UK faced in becoming self-sufficient in non-commercial plasma and clotting factor from domestic sources.  But self sufficiency is a world-wide problem today in states that depend on unpaid domestic donors. So it's not clear how culpable the British blood services should be considered on that account.

And it's a complicated question, because some of the U.S. commercial suppliers started heat treating their plasma to effectively destroy many pathogens, before this became common in the U.K.

The report states (Vol 1, p49)
"Some clinicians were reluctant to embrace commercial heat-treated products. There was as yet little direct evidence of how reliable the claims about commercial heat-treated products were in practice. Although there was no evidence of side-effects after a year of use in the US, heat-treated commercial products were not licensed for use in the UK until early in 1985. It is not difficult to see why clinicians may have preferred to wait for domestic product rather than change their treatment practices. Further, commercial products were believed to be more likely to carry hepatitis than domestic ones. Understandable though this reluctance may have been, it did not excuse continued use of unheated products beyond a short period into 1985."

So, British physicians were caught between desire for domestic plasma (from unpaid donors, which they believed was safer), and reluctance to use U.S. commercial plasma as it became the safer alternative.  And British plasma processors waited until 1985 to start producing their own heat treated plasma products. The results were tragic, but (unlike some of the later delays and evasions that the report spells out) I don't see that there is in every instance a clear case of blame.

The chair of the Infected Blood Inquiry is Sir Brian Langstaff , "a former judge of the High Court of England and Wales."  Judges have experience at hearing evidence, and may have some professional inclination to explain events in terms of guilt.  Not that there isn't plenty to apologize for.
#######


Monday, May 20, 2024

Britain's Infected Blood Inquiry Report published today

 The UK commissioned a report on infections in its blood supply in the 1970's and 80's, and on the government's belated responses during and afterwards, as some 3,000 people died from HIV and other infections.  It's a long and complicated report, which came out today, and is available at

Infected Blood Inquiry Report

I've started to read it, and hope have more to say in a few days.  (It condemns many past decisions about maintaining the blood supply, providing medical care, and then failing to acknowledge past harms, which the current report is particularly aimed at addressing.)

In the meantime, here are some news reports.

From the BBC:

NHS and government covered up infected blood scandal By Nick Triggle and Jim Reed, BBC News

From the NYT:

Report Finds ‘Catalog of Failures’ in U.K. Contaminated Blood Scandal - A six-year inquiry found that the deaths of about 3,000 people and the infection of tens of thousands of others could have mostly been avoided.  By Aurelien Breeden  May 20, 2024


The labor market for OnlyFans chatters

 Here's a story by a professional writer and journalist, who appears to be a middle-aged dad, about his efforts to find and then master a job impersonating a 20-something female sex performer chatting with her fans on the website OnlyFans.

Wired has the story:

.I Went Undercover as a Secret OnlyFans Chatter. It Wasn’t Pretty. Your online influencer girlfriend is actually a rotating cast of low-wage workers. I became one of them. by BRENDAN I. KOERNER

"Like many of OnlyFans’ top earners, she had hired a management agency to help keep up with her customers’ demands for personal attention. “The chat specialists they give you, that was a huge deal for me,” she said. The agency provided a team of contractors whose sole job is to masquerade as the creator while swapping DMs with her subscribers. These textual conversations are meant to be the main way that OnlyFans users can interact with the models they adore.

"The existence of professional OnlyFans chatters wouldn’t have surprised me so much if I’d given just a few moments’ thought to the mathematical realities of the platform. OnlyFans has thrived by promising its reported 190 million users that they can have direct access to an estimated 2.1 million creators. It’s impossible for even a modestly popular creator to cope with the avalanche of messages they receive each day. The $5.6 billion industry has solved this logistical conundrum by entrusting its chat duties to a hidden proletariat, a mass of freelancers who sustain the illusion that OnlyFans’ creators are always eager to engage—sexually and otherwise—with paying customers.

...

"Gradually I realized that my best shot at understanding how chatters operate would be to join their ranks. As an English major who’s been fortunate enough to make a living with words for more than 20 years, I naively assumed I was qualified to land a gig. And as a writer, I was curious to learn what kind of artistry the job would require—what it takes to ensure that OnlyFans users never doubt they’re really interacting with the objects of their desire.

"AS I EMBARKED on my job hunt, I asked the owner of a top-tier OnlyFans agency for tips on how to make myself an appealing candidate. He was pessimistic about my odds of getting hired, mainly because I’m American. He said agencies tend to favor contractors who reside in lower-wage countries. That insight was borne out as I poked around the online communities where chatters find help-wanted ads; though the vast majority of OnlyFans users live in the US, the bulk of my competitors were based in places like the Philippines and Venezuela. Judging by their posts on the r/OnlyFansChatter subreddit and in an invite-only Facebook group, these workers are relatively well-educated, with university-level English and ace typing skills that some developed in high-pressure call centers. They also put up with all manner of abuses: OnlyFans agencies are notorious for stiffing their freelancers, forcing them to work 70-hour weeks, and summarily firing them if they miss a shift due to a power outage."


Sunday, May 19, 2024

IVF for sex selection: legal in the U.S

Slate has the story:

The Parents Who Want Daughters—and Daughters Only. Sex selection with IVF is banned in much of the world. Not in the U.S. by Emi Nietfeld

"Sex selection was once controversial in the U.S. and is banned in almost every other country. Many Americans unaware of the process still assume that it’s that way. In reality, it has now become a standard part of IVF here. For some, the option to sex select is a perk of an otherwise exacting process. For others, it’s the whole point of doing IVF in the first place.

...

"Still, “the very act of sex selection is sexist,” argues Arianne Shahvisi, a professor of philosophy at Brighton and Sussex Medical School in the U.K., where elective sex selection is illegal.

...

"It’s not just the U.K. Virtually all the industrialized world—including Canada, Australia, and every European country besides Cyprus—bans sex selection except in rare medical cases. Most nations prohibit the practice on the grounds that it promotes sexism and that the children born from it may be harmed by gendered expectations. Widespread preference for a certain sex can also skew the population—as in India and China, where abortion and infanticide of girls have resulted in tens of millions more men than women. 

...

"In 1994 the American Society for Reproductive Medicine, the nonprofit that provides the industry’s professional guidelines, condemned sex selection for nonmedical reasons. Yet with no enforcement power, the guidelines remained just that. Unlike in most peer nations, IVF in America is mostly privately paid and weakly regulated. Instead, market forces dominate. By 2018, despite the ASRM’s recommendation that they not offer sex selection, 75 percent of clinics continued to provide the service. Since then, the ASRM’s ethics committee has updated its position to a neutral stance."

Saturday, May 18, 2024

Top Trading Cycles (TTC) is characterized by strategy proofness and individual rationality on a large set, by Özgün Ekici

 Here's a very nice result about TTC:

 Pair-efficient reallocation of indivisible objects, by Özgün Ekici, Theoretical Economics 19 (2024), 551–564

Abstract: We revisit the classical object reallocation problem under strict preferences. When attention is constrained to the set of Pareto-efficient rules, it is known that top trading cycles (TTC) is the only rule that is strategyproof and individually-rational. We relax this constraint and consider pair-efficiency. A rule is pair-efficient if it never induces an allocation at which a pair of agents gain from trading their assigned objects. Remarkably, even in the larger set of pair-efficient rules, we find that TTC is still the only rule that is strategyproof and individually-rational. Our characterization result gives strong support to the use of TTC in object reallocation problems.

Friday, May 17, 2024

Sperm donation from Denmark to the UK and elsewhere

 The Daily Mail has the story:

'They invaded us once by boat and now they're doing it with sperm!' Why hundreds of British women are giving birth to 'Viking babies' conceived with Danish donors

"These are the main Danish export products - beer, Lego and sperm!"'

"So why are so many British women going Danish? According to Dr Alan Pacey, a fertility expert at the University of Sheffield, one of the reasons is a shortage of homegrown sperm.

'We don't have enough donors in the UK to meet the national need,' he explains. 'We don't have the clinic infrastructure sufficient to recruit enough donors - even when men want to donate.

...

"'The NHS is used to treating patients and you get a fee for treating patients. You don't get a fee for screening a donor that you may not ultimately accept.'

"Compounding the problem for British clinics is the 2005 law that forces men to waive their anonymity, meaning sperm donors face the prospect of offspring turning up on their doorstep once they reach the age of 18.

"Nevertheless, although Danish clinics, among them the world's largest sperm bank, Cryos, cannot sell semen from anonymous donors to British women, business is booming thanks to the huge numbers of local men happy to sign up anyway.

...

"Experts such as Laura Witjens, CEO of the National Gamete Donation Trust, say the excellent customer service deployed by Copenhagen's sperm banks has also contributed to the Viking baby boom.

'It's much easier for a British clinic to order sperm from Denmark which is Fed-exed the next day than to try and recruit their own donors and all the hassle that goes with them,' says Witjens.

'The Danish model is customer service driven. It knows how to deal well with customers, it has a good website, and that's what we could do in the UK as well - it's not rocket science.'


HT: Mario Macis