Removing financial disincentives to living organ donation: HRSA publishes Final Rule

 The Health Resources and Services Administration (HRSA), Health and Human Services Department (HHS) has published its Final Rule in the Federal Register

Removing Financial Disincentives to Living Organ Donation--A Rule by the Health and Human Services Department on 09/22/2020

"SUMMARY: This final rule amends the regulations implementing the National Organ Transplant Act of 1984, as amended (NOTA), to remove financial barriers to organ donation by expanding the scope of reimbursable expenses incurred by living organ donors to include lost wages, and child-care and elder-care expenses incurred by a caregiver. HHS is committed to reducing the number of individuals on the organ transplant waiting list by increasing the number of organs available for transplant. This final rule is associated with Section 8 of the Executive Order (E.O.) 13879 titled “Advancing American Kidney Health,” issued on July 10, 2019, which directed HHS to propose a regulation allowing living organ donors to be reimbursed for related lost wages, child-care expenses, and elder-care expenses through the Reimbursement of Travel and Subsistence Expenses Incurred toward Living Organ Donation program authorized under section 377 of the Public Health Service (PHS) Act, as amended."

...

"The National Living Donor Assistance Center (NLDAC) [4] operates the living organ donor reimbursement program funded by HRSA's Reimbursement of Travel and Subsistence Expenses Incurred toward Living Organ Donation grants program. Under the authority provided under section 377 of the PHS Act, as amended, the program is operated via cooperative agreement. The program's purpose is to help remove financial disincentives for living organ donations. In adherence to the authority outlined in the PHS Act, the program's Eligibility Guidelines currently provide that “qualifying expenses” include those incurred by the donor and his/her accompanying person(s) as part of: (1) Donor evaluation, (2) hospitalization for the living donor surgical procedure, and/or (3) medical or surgical follow-up, clinic visits, or hospitalization within two calendar years following the living donation procedure.

...

"Through this final rule, the Secretary determines that reimbursement for lost wages, and child-care and elder-care expenses incurred by a caregiver, is appropriate for living organ donors who incur such expenses toward their organ donation."

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The final rule authorizes the National Living Donor Assistance Center (NLDAC) to expand the category of expenses that it can reimburse, for those who meet its income and other conditions.

I'm on NLDAC's Advisory Board, and at the present time I haven't heard that NLDAC's budget will be increased to fund the expanded expenses it is now permitted to reimburse.

The unsharing economy: part time gig evicting people from their apartments

 Vice.com has the story:

Gig Economy Company Launches Uber, But for Evicting People--A company called Civvl says evicting people is the "FASTEST GROWING MONEY MAKING GIG DUE TO COVID-19."  By Ashwin Rodrigues

"In its Craigslist ads, posted across the country, Civvl explains the opportunity plainly: "There is plenty of work due to the dismal economy."

"Unemployment is at a record high and many cannot or simply are not paying rent and mortgages," the ads state. "We are being contracted by frustrated property owners and banks to secure foreclosed residential properties."

Civvl aims to marry the gig economy with the devastation of a pandemic, complete with signature gig startup language like "be your own boss," and "flexible hours," and "looking for self-motivated individuals with positive attitudes:" "FASTEST GROWING MONEY MAKING GIG DUE TO COVID-19," its website says. "Literally thousands of process servers are needed in the coming months due courts being backed up in judgements that needs to be served to defendants."

...

"The company, at first glance, appears to be some kind of _Nathan For You-_esque prank: siccing precarious gig jobs onto vulnerable people. But Civvl is connected to a larger—and real—gig economy company called OnQall, which describes itself as an app that provides "on-demand task services to non-urban communities beyond main city areas." OnQall is the developer behind other, more believable TaskRabbit-esque apps, like LawnFixr, CleanQwik, and MoveQwik. Given the fact that Civvl is advertising all over the country and that OnQall, though not popular, does exist, it seems as though Civvl actually is an attempt to simplify the process of evicting people who cannot pay their rent during a pandemic.

...

"There is a federal ban on evictions, declared by the CDC, but landlords are still attempting to press on. There is a penalty for violating the ban, which can include a combination of fines and jail time. Civvl did not respond to a question about how the company ensures evictions are legal, though based on the Terms of Service, it appears to pass all risk onto the companies using its platform, stating that it simply "provides lead generation to independent contractors," and does not actually carry out the work itself.  

HT: Sandro Ambuehl

The WHO proposal for allocating scarce vaccines: thinking of healthcare while dealing with politics by discussing ethics

From the Guardian:

'Landmark moment': 156 countries agree to Covid vaccine allocation deal--Covax plan will counter rising threat of ‘vaccine nationalism’, prioritising vulnerable healthcare systems and frontline workers  by Peter Beaumont

"A coalition of 156 countries has agreed a “landmark” deal to enable the rapid and equitable global distribution of any new coronavirus vaccines to 3% of participating countries’ populations, to protect vulnerable healthcare systems, frontline health workers and those in social care settings.

"The Covid-19 vaccine allocation plan – co-led by the World Health Organization and known as Covax – has been set up to ensure that the research, purchase and distribution of any new vaccine is shared equally between the world’s richest countries and those in the developing world.

"Sixty-four higher income economies have already joined Covax, which includes commitments from 35 economies as well as the European commission, which will procure doses on behalf of the 27 EU member states plus Norway and Iceland, with 38 more expected to join in the coming days.

...

"Recognising that the first useful vaccines to emerge may be in short supply, approved vaccines will initially be made available to a tightly targeted 3% of the population of participating countries, building over time to 20% of each country’s most vulnerable population.

...

"According to a document detailing the arrangement, under the scheme “all countries should gradually receive tranches [of vaccine] to cover each subset of their [initial] target groups … until they can cover 3% of the population”.

The document continues: “At this point of the pandemic, a reasonable scenario would be that, while the supply of Covid-19 vaccines remains very scarce, countries should focus initially on reducing mortality and protecting the health system.

“This … would enable, for example, the vaccination of frontline workers in health and social care settings in most countries … Additional tranches will follow gradually as more supply becomes available.”

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And this from the Washington Post:

World Health Organization unveils plan for distributing coronavirus vaccine, urges cooperation    By Emily Rauhala

"Under the plan, rich and poor countries pool money to provide manufacturers with volume guarantees for a slate of vaccine candidates. The idea is to discourage hoarding and focus on vaccinating high-risk people in every participating country first.

"So far, 64 higher-income countries have signed up, WHO officials said, but they added that 38 more are expected to do so in the coming days. Notably missing: Russia, China and the United States.

"China has not made an ann"ouncement either way. The White House said this month that the United States would not join, in part because the administration doesn’t want to work with the WHO, and will instead take a go-it-alone approach.

...

"The framework makes clear that each participating country can decide whom to vaccinate first, but it is based on the idea that doses for 3 percent of a country’s population could be used to vaccinate medical workers first and then other high-risk groups.

...

"“It seems like a compromise position,” said Thomas J. Bollyky, a senior fellow at the Council on Foreign Relations and the director of its global health program. “It’s not exactly what you would do if you were driven strictly by public health.”

"In a policy report this month for the journal Science, critics offered an alternate framework called the Fair Priority Model, which is critical of the country-based approach"

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Here's the Science article:

An ethical framework for global vaccine allocation, by Ezekiel J. Emanuel1, Govind Persad2, Adam Kern3, Allen Buchanan4, Cécile Fabre5, Daniel Halliday6, Joseph Heath7, Lisa Herzog8, R. J. Leland9, Ephrem T. Lemango10, Florencia Luna11, Matthew S. McCoy1, Ole F. Norheim12, Trygve Ottersen13, G. Owen Schaefer14, Kok-Chor Tan15, Christopher Heath Wellman16, Jonathan Wolff17, Henry S. Richardson18

"The Fair Priority Model is primarily addressed to three groups. One is the COVAX facility—led by Gavi, the World Health Organization (WHO), and the Coalition for Epidemic Preparedness Innovations (CEPI)—which intends to purchase vaccines for fair distribution across countries (5). A second group is vaccine producers. Thankfully, many producers have publicly committed to a “broad and equitable” international distribution of vaccine (2). The last group is national governments, some of whom have also publicly committed to a fair distribution (1).

...

"The Fair Priority Model proceeds in three phases, preventing more urgent harms earlier (see the Table). Phase 1 aims at reducing premature deaths and other irreversible direct and indirect health impacts. Phase 2 continues to address enduring health harms but additionally aims at reducing serious economic and social deprivations such as the closure of nonessential businesses and schools. Restoring these activities will lower unemployment, reduce poverty, and improve health. Finally, phase 3 aims at reducing community transmission, which in turn reduces spread among countries and permits the restoration of prepandemic freedoms and economic and social activities."

Unintended Consequences of Criminalizing Sex Work in East Java Indonesia, by Cameron, Seager, and Shah

 

Crimes Against Morality: Unintended Consequences of Criminalizing Sex Work

Lisa Cameron, Jennifer Seager, Manisha Shah

NBER Working Paper No. 27846 September 2020

 Abstract: We examine the impact of criminalizing sex work, exploiting an event in which local officials unexpectedly criminalized sex work in one district in East Java, Indonesia, but not in neighboring districts. We collect data from female sex workers and their clients before and after the change. We find that criminalization increases sexually transmitted infections among female sex workers by 58 percent, measured by biological tests. This is driven by decreased condom access and use. We also find evidence that criminalization decreases earnings among women who left sex work due to criminalization, and decreases their ability to meet their children's school expenses while increasing the likelihood that children begin working to supplement household income. While criminalization has the potential to improve population STI outcomes if the market shrinks permanently, we show that five years post-criminalization the market has rebounded and the probability of STI transmission within the general population is likely to have increased.

"Sex work is not directly addressed in Indonesian national law. As a result, sex work is widespread and largely tolerated throughout Indonesia, including East Java. However, a section of law titled “Crimes Against Morals” can be read to apply to sex work and has been used by local officials in some areas to close down sex worksites. On July 11, 2014, the Malang District government announced that on November 28, 2014, it would close all formal sex worksites within the district as a “birthday present” to Malang (Sukarelawati, 2014). The closures aligned with anniversary celebrations in Malang District and had religious overtones, being justified on the basis of sex work being banned by all religions (Tribunews.com, 2014).

Pandemic disruptions in the market for medical residents

 The coronavirus pandemic and associated lockdowns and limitations have stressed a number of labor markets, including the one for new physicians.  Here's an article from the Journal of Surgical Education that suggests that, in a world of online interviewing, the number of interviews might usefully be capped. They also recommend signalling...

The Case for Capping Residency Interviews

Helen Kang Morgan, MD,*,1 Abigail F. Winkel, MD,† Taylor Standiford, BS,‡ Rodrigo Muñoz, MD,§ Eric A. Strand, MD,║ David A. Marzano, MD,* Tony Ogburn, MD,¶ Carol A. Major, MD,# Susan Cox, MD,⁎⁎ and Maya M. Hammoud, MD, MBA

J Surg Educ. 2020 Sep 14, doi: 10.1016/j.jsurg.2020.08.033 [Epub ahead of print] PMCID: PMC7489264

"As a result of the COVID-19 pandemic, residency programs will make an abrupt shift to virtual interviews in the 2021 residency application cycle.1 ... Medical students, medical schools, and residency programs have needed to react to sudden developments such as cancelled clinical electives, delayed or cancelled United States Medical Licensing Exams (USMLE),2 significant limitations on visiting student elective and sub-internship rotations,3 and changes in Electronic Residency Application Service (ERAS) timelines.4 Given this context, applicants may opt to increase their total number of residency applications as well as interviews accepted and completed, especially since they will no longer be limited by travel and cost deterrents.5, 6, 7 Likewise, residency programs are no longer logistically restrained to configure an applicant's interview schedule on a single day, and will have the ability to schedule interviews throughout multiple days and during non-business hours. In-person interactions provided by traditional interview day experiences have historically weighed heavily in determining mutual compatibility8 , 9; thus, both stakeholder groups will be looking to raise their chances of finding a match, including potentially increasing the number of interviews.

This is particularly troublesome given the current state of residency application processes, "fraught with misaligned stakeholder incentives.10, 11, 12, 13, 14, 15 Although the ratio of positions per applicant is higher now than ever before, the number of applications per applicant have risen.16 , 17 These numbers have increased rapidly in certain specialties, with the mean number of applications per applicant in obstetrics and gynecology (OBGYN) rising from 28 in 2010 to 66 in 2019.18 The consequences of application inflation are numerous and include decreased abilities for residency programs to perform holistic review of applicants with increased reliance on metrics such as USMLE scores. Residency programs also need to devote significant faculty and administrative time for the interview processes.19 The consequence of application inflation that will be of crucial importance this application cycle is the growing awareness that a small percentage of applicants has been receiving a disproportionate percentage of interview offers.20 , 21 In the era of virtual interviews, if these applicants choose to schedule all of their interview offers, there is a real potential for detrimental downstream effects to other applicants. This may also lead to a greater number of unfilled residency spots, with a larger number of programs and applicants required to enter into the Supplemental Offer and Acceptance Program. Given the paucity of data to inform best practices, there is a pressing need to model the potential effects of current application processes and applicant strategies in this disrupted application cycle."

...

"All stakeholders urgently need equitable solutions that address both individual and systems-level problems for this coming application cycle and beyond.30 Capping the number of interviews that an applicant can schedule could remedy 1 pressing flaw in current application interview processes. Implementing caps at the interview scheduling stage is preferable to capping at the application stage given the multiple complexities that must be considered such as DO and IMG status, and overall competitiveness. In addition, exceptions may need to be made for individuals participating in the Couples Match. The potential legal implications of mandatory interview caps are in the infancy of exploration. Capping interviews would likely not violate anti-trust laws given that applicants would still have the choice of where they would like to interview, however these issues would need to be further investigated. New measures such as preference signaling mechanisms30, 31, 32 need to be urgently considered in order for programs to be able to prioritize whom to offer interviews. The use of “tokens” would enable applicants to be able to convey interest to a set number of programs; this has been well-described in graduate PhD economics education literature.33 It will be imperative for “fit” to not become a proxy for decisions guided by unconscious bias,34 but instead, for principles of equity and inclusion to guide change during this time of accelerated change."

HT: Marc Melcher

Filtering 'inappropriate' content is still a challenge for AI--human monitoring of YouTube

The Financial Times has the story:

YouTube reverts to human moderators in fight against misinformation--Video platform relied on machines after lockdown but found they over-censored borderline content

by Alex Barker and Hannah Murphy 

"Google’s YouTube has reverted to using more human moderators to vet harmful content after the machines it relied on during lockdown proved to be overzealous censors of its video platform.

"When some of YouTube’s 10,000-strong team filtering content were “put offline” by the pandemic, YouTube gave its machine systems greater autonomy to stop users seeing hate speech, violence or other forms of harmful content or misinformation.

"But Neal Mohan, YouTube’s chief product officer, told the Financial Times that one of the results of reducing human oversight was a jump in the number of videos removed, including a significant proportion that broke no rules." 

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Wired Magazine has a good backgrounder on the AI attempt to alter the recommender engine:

YouTube’s Plot to Silence Conspiracy Theories--From flat-earthers to QAnon to Covid quackery, the video giant is awash in misinformation. Can AI keep the lunatic fringe from going viral?

by Clive Thompson

Auctions and Market Design Friday Seminar Series, organized by INFORMS (starting Oct 2)

 The auctions and market design section of INFORMS (the Operations Research and Management Science organization) is initiating a new seminar series,  every other week on Fridays, starting Oct 2.  I'll start the series off with a talk on contemporary kidney exchange, and there are talks scheduled through December, see below.

Auctions and Market Design Online Seminar Series

About the Seminar

The aim of this interdisciplinary seminar is to discuss pioneering and impactful work in the broad area of market design. Theoretical, computational, and experimental work as well as field studies will be featured. A wide range of applications, ranging from online advertising and labor markets to networks and platforms, will be presented. The seminar features research talks and expository talks to highlight trends in the field.

Organization

The seminar is organized by Ozan Candogan (Chicago Booth), Vahideh Manshadi (Yale), and Fanyin Zheng (Columbia).

The seminar will be bi-weekly on Fridays at 1-2 pm ET (10-11 am PT).

Email List

If this seminar interests you and you would like to be notified of upcoming speakers, you can join our email list.

Schedule

October 02 - Alvin Roth (Stanford University)

Title: Kidney Exchange: an Operations Perspective

October 16 - John Birge (University of Chicago)

Title: Increasing Efficiency in Electricity Market Auctions

October 30 - Jon Kleinberg (Cornell University)

November 13 - Winners of the Michael H. Rothkopf Junior Researcher Paper Prize

December 04 - Asuman Ozdaglar (MIT)

December 18 - Matthew Jackson (Stanford University)