Thursday, July 29, 2021

Uterus transplants considered in Japan

 Here's the story from the Asahi Shimbun, including some background. For the time being, only living-donor organs seem to be allowed under Japanese law:

Medical group allows for uterus transplants to give birth

"A Japanese Association of Medical Sciences committee released a report on July 14 clearing the way for uterus transplants, a rare procedure that faces obstacles. 

...

"The biggest issue facing the committee was that the transplant objective would be to allow the woman to give birth.

"That differs greatly from other transplants in which the main objective is to save the recipient’s life. In addition, committee members had to consider allowing a transplant operation that held major health risks for both the donor and recipient.

"According to a report, there have been 85 cases of uterus transplants in 16 nations overseas as of March and 40 have led to the delivery of a baby.

"In many of those cases, an in-vitro fertilized embryo is placed in the transplanted uterus. But the uterus is removed after childbirth because of the need to continue using immunosuppressant agents to prevent the body from rejecting the transplanted organ.

"In Japan, there are an estimated 60,000 to 70,000 women between the ages of 20 and 50 who were born without uteruses or have had their uteruses surgically removed due to tumors or other causes.

...

"There are also legal hurdles that have to be cleared.

"Japan’s organ transplant law does not include uteruses as an organ that can be removed for transplantation from a brain-dead individual.

"For that reason, the report allowed for transplants from live donors in only a very few cases to conduct clinical research.

"The report also called for revising the organ transplant law to allow for uterus transplants from brain-dead women.

"But even if the law was revised, organ donations from brain-dead individuals are still not widespread in Japan, meaning it would be almost impossible to plan for a uterus transplant operation.

"Experts were divided in their views about the latest report.

"Nobuhiko Suganuma, a professor of reproductive medicine at Nagoya University of Arts and Sciences who heads the Japan Society for Uterus Transplantation, said providing an alternative for women who want to give birth was a positive development.

"But Yukiko Saito, an associate professor of medical ethics at Kitasato University, raised concerns about approving an available technology just because there may be people who want to utilize it."

Wednesday, July 28, 2021

Redistribution through markets, in Econometrica, by Dworczak, Kominers, and Akbarpour

 Market designs involving taxes, or rationing, in the latest Econometrica, Vol. 89, No. 4 (July, 2021), 1665–1698:

REDISTRIBUTION THROUGH MARKETS by PIOTR DWORCZAK, SCOTT DUKE KOMINERS,  and MOHAMMAD AKBARPOUR

Abstract: "Policymakers frequently use price regulations as a response to inequality in the markets they control. In this paper, we examine the optimal structure of such policies from the perspective of mechanism design. We study a buyer-seller market in which agents have private information about both their valuations for an indivisible object and their marginal utilities for money. The planner seeks a mechanism that maximizes agents’ total utilities, subject to incentive and market-clearing constraints. We uncover the constrained Pareto frontier by identifying the optimal trade-off between allocative efficiency and redistribution. We find that competitive-equilibrium allocation is not always optimal. Instead, when there is inequality across sides of the market, the optimal design uses a tax-like mechanism, introducing a wedge between the buyer and seller prices, and redistributing the resulting surplus to the poorer side of the market via lump-sum payments. When there is significant same-side inequality that can be uncovered by market behavior, it may be optimal to impose price controls even though doing so induces rationing."

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" the classic idea that competitive-equilibrium pricing maximizes welfare relies on an implicit assumption that the designer places the same welfare weight on all agents in the market. Thus, the standard economic intuitions in support of competitive equilibrium pricing become unreliable as the dispersion of wealth in a society expands."

Tuesday, July 27, 2021

Emergency decision making and medical ethics for breakfast

 Saturday morning breakfast cereal (SMBC) has hidden a message for us here:



Monday, July 26, 2021

Does legal marijuana lead to the use of more dangerous drugs, or increase crime?

 It appears that the short answer is "No," according to this recent NBER working paper

Is Recreational Marijuana a Gateway to Harder Drug Use and Crime?  by Joseph J. Sabia, Dhaval M. Dave, Fawaz Alotaibi & Daniel I. Rees

WORKING PAPER 29038, DOI 10.3386/w29038,  July 2021

Recreational marijuana laws (RMLs), which legalize the possession of small quantities of marijuana for recreational use, have been adopted by 18 states and the District of Columbia. Opponents argue that RML-induced increases in marijuana consumption will serve as a “gateway” to harder drug use and crime. Using data covering the period 2000-2019 from a variety of national sources (the National Survey of Drug Use and Health, the Uniform Crime Reports, the National Vital Statistics System, and the Treatment Episode Data Set) this study is the first to comprehensively examine the effects of legalizing recreational marijuana on hard drug use, arrests, drug overdose deaths, suicides, and treatment admissions. Our analyses show that RMLs increase adult marijuana use and reduce drug-related arrests over an average post-legalization window of three to four years. There is little evidence to suggest that RML-induced increases in marijuana consumption encourage the use of harder substances or violent criminal activity.

Sunday, July 25, 2021

U.S, drug overdose deaths at 93,000 in 2020

Fentanyl infused opioids are epidemic on the street. Here's the story from the Washington Post:

Drug overdose deaths soared to a record 93,000 last year By Lenny Bernstein  and Joel Achenbach

 The death toll jumped by more than 21,000, or nearly 30 percent, from 2019, according to provisional data released by the National Center for Health Statistics, eclipsing the record set that year.

...

"The estimated number of overdose deaths reached 93,331 in 2020, according to the new data. Annual final numbers usually differ little from the provisional figures released Wednesday. More than 900,000 people have died of overdoses since the U.S. drug epidemic began about 1999, according to the Centers for Disease Control and Prevention. The National Center for Health Statistics is part of the CDC.

"Opioids, primarily illegal fentanyl, continued to drive the death toll, as they have for years. Overdose deaths involving opioids reached 69,710 in 2020, up from 50,963 in 2019, according to the data. Deaths from methamphetamine and cocaine also rose.Nora Volkow, head of the National Institute on Drug Abuse, said in an interview that fentanyl has so thoroughly infiltrated the illegal drug supply that 70 percent of cocaine overdose deaths and 50 percent of methamphetamine overdose deaths also involved fentanyl."

Saturday, July 24, 2021

Marketplace for supplies to produce vaccines: COVAX

 Scott Kominers sends me the following link, of a marketplace intended to notify vaccine makers of supplies that may be available:

The COVAX Marketplace

"The COVAX Marketplace aims to accelerate the global production of COVID-19 vaccine doses for COVAX by matching existing suppliers of critical inputs with vaccine manufacturers who urgently need them to produce vaccines for fair and equitable distribution through COVAX

...

"The COVAX Marketplace is a key deliverable of the COVAX Manufacturing Task Force. It aims to respond quickly to immediate market needs and bottlenecks and improve the free flow of critical COVID-19 vaccine supplies by:

Providing suppliers with a platform to allocate and reallocate unused materials.

– Mobilising idle stock from vaccines and candidates that fail prior to gaining regulatory approval – as well as from those that might scale down their production in the future.

– Mobilising potential surplus stock from manufacturers with non-vaccine activities.

...

"The initial version of the Marketplace will include COVAX vaccine manufacturers and suppliers of the key materials that have been identified as being most urgently needed.

"Participants in the COVAX Marketplace will be able to offer and request any materials required for vaccine production through the Marketplace, but it will initially focus on six categories of supplies that have been identified as critical: bioreactor bags, single use assemblies, cell culture media, filters, lipids, vials, and stoppers.

...

"Matches negotiate and conclude the transaction between themselves, independently of the Marketplace. Pairs notify CEPI on successful closure."

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Other posts on supply chains.


Friday, July 23, 2021

Matching Foreign Service officers to positions: the labor market at the State Department

 Many public servants became discouraged during the Trump administration, and those who serve in U.S. Embassies and consulates, and at the State Department in Washington, are no exception.  But the demands of overseas assignments make their internal labor market a matching market with many specific requirements.

Here's a new report:

Retention Issues at the State Department

"In a new report published by the Institute for the Study of Diplomacy, Constanza Castro Zúñiga, Mojib Ghaznawi, and Caroline Kim highlight the retention crisis at the State Department. The Harvard Kennedy School Master in Public Policy (MPP) graduates surveyed 2,853 Foreign Service Officers (FSOs) and Foreign Service Specialists (FSSs) on their experiences at State.

"Their report finds that “31.42% (797) of current officers surveyed are seriously considering leaving the Foreign Service and are actively exploring their options. Of these officers, 31.27% (247) plan to leave in the next year and 56.58% (447) plan to leave in the next five years. This indicates a clear discontent within the Foreign Service that will increase attrition above the Department’s historical averages” (p.11).

"The authors conclude that “FSOs and FSSs feel lost in a workplace that lacks accountability and transparency, to the point where our data suggests a coming exodus on the horizon. While it is impossible to design the perfect system, the Department can strive to create a Foreign Service that feels fair, equitable, and inclusive. However, that can only happen if the Department understands what is driving people away. By surveying over one-fifth of the State Department’s officer corps, we discovered the four biggest drivers that motivate members to leave the Department. By targeting structural and cultural changes to address families, assignments, promotions, and bias, the Department can begin a proactive approach to address retention. However, this will require leadership to listen from the bottom-up and implement from the topdown. If the State Department can begin implementing the recommendations that we have suggested here, it will be on its way to having a Foreign Service that is truly talented and representative” (p. 41).

"Recommendations include extension of Leave Without Pay (LWOP) for Department employees; updated and more flexible remote work policies; a centralized preference matching system to streamline, standardize, and increase transparency in the assignments process; and that the State Department should consider conducting an annual Organizational Climate Survey."

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The report itself is here:  https://georgetown.app.box.com/s/vu5gk9qfh6vd0uc6feagqu1u6o7mmawc 


Here's part of the discussion of the matching market: 

"The  current  assignments  process  at  State  is  broken.  Bidders  and  hiring  managers  waste  considerable  time and energy under the current system trying to extract commitments from each other. Rules related to  bidding  prevent  commitments  and  formal  offers  before  imposed  deadlines,  relying  on  informal “handshakes”  of  mutual  interest.  Pressure  on  both  sides  to  secure  desirable  positions  or  candidates  leads to suboptimal outcomes in a process that is growing increasingly non-transparent, stressful, time-consuming, and inequitable.

...

" The Bureau of Global Talent Management’s Office of Career Development and Assignments (GTM/CDA) is collaborating with the National Resident Matching Program (NRMP)58 to design, execute, and evaluate a pilot use of a preference-matching algorithm in bidding and assignments. NRMP will adapt its ranking process to account for CDA bidding rules on eligibility.  NRMP will provide a software platform for collecting rank ordered preferences from bidders, hiring-managers, and bureaus.  CDA  and  NRMP  will  develop  training  and  communication  materials  for  bidders,  hiring  managers, and bureau decision-makers on the use of the algorithm during one or more regular bidding cycles, as well as provide customer support on using NRMP’s proprietary software. Using the collected preferences, NRMP will run the algorithm to produce matches for bureaus to use as the basis for handshake offers for assignments."