The econometrics of deceased kidney donation

Two papers have made me think about the power of econometric methods applied to studies of medical issues related to matching deceased donor kidneys to patients.

I recently heard Chuck Manski give a seminar on this paper published last year in PNAS:

One thing I took away from it is that proportional hazard (Cox) models are very popular in the medical literature, but they assume that effects (e.g. rejection of a graft) are proportional to time, and there are immunological processes that don't in fact have a constant hazard rate, but build up over time, so that isn't a good model for those things.

Predicting kidney transplant outcomes with partial knowledge of HLA mismatch

Charles F. Manski,  Anat R. Tambur, and Michael Gmeiner, PNAS October 8, 2019 116 (41) 20339-20345

"Abstract: We consider prediction of graft survival when a kidney from a deceased donor is transplanted into a recipient, with a focus on the variation of survival with degree of human leukocyte antigen (HLA) mismatch. Previous studies have used data from the Scientific Registry of Transplant Recipients (SRTR) to predict survival conditional on partial characterization of HLA mismatch. Whereas earlier studies assumed proportional hazards models, we used nonparametric regression methods. These do not make the unrealistic assumption that relative risks are invariant as a function of time since transplant, and hence should be more accurate. To refine the predictions possible with partial knowledge of HLA mismatch, it has been suggested that HaploStats statistics on the frequencies of haplotypes within specified ethnic/national populations be used to impute complete HLA types. We counsel against this, showing that it cannot improve predictions on average and sometimes yields suboptimal transplant decisions. We show that the HaploStats frequency statistics are nevertheless useful when combined appropriately with the SRTR data. Analysis of the ecological inference problem shows that informative bounds on graft survival probabilities conditional on refined HLA typing are achievable by combining SRTR and HaploStats data with immunological knowledge of the relative effects of mismatch at different HLA loci."

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And here's a recent working paper that says that if we want to maximize life years added by transplant, more organs should go more quickly to healthier patients:

Choices and Outcomes in Assignment Mechanisms: The Allocation of Deceased Donor Kidneys

Nikhil Agarwal, Charles Hodgson, Paulo Somaini, August 17, 2020

"Abstract: While the mechanism design paradigm emphasizes notions of efficiency based on agent preferences, policymakers often focus on alternative objectives. School districts emphasize educational achievement; and transplantation communities focus on patient survival. However, it is unclear whether choice-based mechanisms perform well when assessed using these outcomes. This paper evaluates the assignment mechanism for allocating deceased donor kidneys on the basis of the additional patient life-years from transplantion (LYFT). We examine the role of choice in increasing LYFT and compare equilibrium assignments to benchmarks that remove choice. Our approach combines a model of choice and outcomes in order to study how selection induced in the mechanism produces the outcome of

interest, LYFT. We show how to identify and estimate the model using quasi-experimental variation resulting from the mechanism. The estimates suggest that the design in use selects patients with better survival prospects after a transplant and matches them well. It results in an average LYFT of 7.97, which is 0.88 years higher than a random assignment. However, there is scope for increasing the aggregate LYFT to 12.07. While some of this increase can be achieved by assigning transplanted patients to different donors, realizing the majority requires transplanting relatively healthy patients, who would have longer life-expectancy even without a transplant. Therefore, a policymaker faces a dilemma between transplanting patients that are sicker and those for whom life will be extended the longest."

Profile of Amy Finkelstein in the PNAS

 Profile of Amy N. Finkelstein by Jennifer Viegas

"“It is a very exciting time to be an economist,” says Amy Finkelstein, a professor of economics at the Massachusetts Institute of Technology (MIT) who was elected to the National Academy of Sciences in 2018. “Economics has become a rigorous science, combining theory and data to better understand how the world works and how to improve it.” Focusing on the healthcare sector in the United States, Finkelstein integrates economic models, empirical methods, and data to find solutions for problems facing health insurance markets and healthcare delivery systems. Her research carries implications for healthcare policy. Finkelstein’s Inaugural Article (1) reports that a nationwide Medicare reform influenced the treatment of patients who were covered by other kinds of health insurance. The findings suggest that such broad effects should be taken into account when formulating future healthcare policies.

"Three Generations of Women with Doctorates

"Finkelstein was born in New York City in 1973 to biologist parents, who both earned doctorates at The Rockefeller University. In 1940, her mother immigrated to the United States from Poland, where her maternal grandmother had received a doctorate in comparative literature at the University of Warsaw. Finkelstein says, “It is remarkable that a Jewish woman in the 1920s was able to earn a doctorate in Eastern Europe.” The Finkelstein family papers documenting their lives are archived at the US Holocaust Memorial Museum in Washington, DC."

Poets and Quants celebrates Professor Övül Sezer

Two days ago I received a note of encouragement by email from Övül Sezer, a former student in my Harvard class on experimental economics, which she spoke about while being celebrated by Poets and Quants.

2020 Best 40 Under 40 Professors: Övül Sezer, University of North Carolina at Chapel Hill Kenan-Flagler Business School

 BY: NATHAN ALLEN

Here's that Q&A from her interview:

"Professor I most admire and why:

"There have been so many professors who inspired me and influenced me in several ways and I am so grateful for all the things I learned from them. But one class that I took in college changed the course of my path. Back in college, I was studying math, spending a lot of time on equations and mathematical proofs. In a very serendipitous way, I ended up trying to take a graduate-level economics class, called “Experimental Economics” because I wanted to take a class where I didn’t have to do any weekly “problem set” but it still counted as credit. To be able to take the class as an undergrad, I needed the professor’s permission. The professor teaching the course happened to be Al Roth, who allowed me to the class and introduced me to the love of experiments. Through him, I started learning a lot about experiments, and how we can take our very own observations about life and test them. This was the first time I fell in love with experimental science, and this is where I am today. In addition to being a great professor, Al Roth is also a very thoughtful and a kind person. I feel tremendously grateful to have taken that class."

Surrogacy in the time of covid travel restrictions

 The NY Times has the story:

Mothers, Babies Stranded in Ukraine Surrogacy Industry--Virus travel bans are wreaking havoc on surrogacy agencies that help same-sex couples build families  By Maria Varenikova

"In one of the more bizarre consequences of coronavirus travel restrictions, biological parents, babies and surrogate mothers have become scattered and sometimes stranded in multiple countries for months this year.

"Ukraine, with its relatively permissive reproductive health laws and an abundance of willing mothers among a poor population, is a hub of the international business, executives in the industry and women’s rights advocates say.

"But Ukrainian law bans surrogacy for same-sex couples or for clients who wish to select the sex of the child. In response, a branch of the Ukrainian industry began moving women to other jurisdictions for impregnation and birth, often to legal gray zones like the largely unrecognized, Turkish-backed, splinter state of Northern Cyprus.

...

"The women travel to have an embryo implanted, return to Ukraine for seven months of pregnancy, then travel again to give birth.

"Virus travel restrictions drew attention earlier this year for blocking heterosexual parents from retrieving their babies inside Ukraine. At one point, 79 babies were stacked up in Kyiv, cared for by nurses, in cribs at a hotel.

...

"It is a very common illegal business in such countries as Northern Cyprus, Transnistria, Abkhazia and other unrecognized statelets, said Sergii Antonov, a lawyer and authority on reproductive law in Ukraine.

"In Northern Cyprus, the Ukrainian mothers give birth without a legal surrogacy contract. Instead, they renounce custody after birth, which allows the genetic parents to adopt the children. It is a legal process that can stretch for several weeks.

"In February and March, 14 Ukrainian mothers, fearful of being stranded by virus travel bans, left Northern Cyprus after giving birth but before completing the transfer to the genetic parents, leaving behind a crop of babies in legal limbo.

School choice with common preferences and incomplete information admits a winner's curse, by Kloosterman and Troyan

 Suppose that schools have an intrinsic quality that would affect the preferences of all students if they knew it, but some students are better informed than others. Then, for uninformed students, there can be a kind of winner's curse associated with being accepted to a school: the fact that it had seats available suggests that it might not be high quality.  Kloosterman and Troyan propose mitigating this by giving each student a secure school for which he/she has high enough priority to be admitted regardless of others' preferences: " a secure school is one with enough seats for j and every student who has higher priority than j. "  When all students have the same ordinal preferences at every state of the world, then the deferred acceptance algorithm with students proposing continues to make it a dominant strategy for informed students to state their true preferences, and there is an equilibrium that avoids the winners curse in which each uninformed student lists their secure school as their first choice.

School choice with asymmetric information: Priority design and the curse of acceptance

by Andrew Kloosterman and Peter Troyan 

Theoretical Economics, Volume 15, Issue 3, July 2020, Pages: 1095-1133

Abstract: We generalize standard school choice models to allow for interdependent preferences and differentially informed students. We show that, in general, the commonly used deferred acceptance mechanism is no longer strategy‐proof, the outcome is not stable, and may make less informed students worse off. We attribute these results to a curse of acceptance. However, we also show that if priorities are designed appropriately, positive results are recovered: equilibrium strategies are simple, the outcome is stable, and less informed students are protected from the curse of acceptance. Our results have implications for the current debate over priority design in school choice.

...

"How do secure schools help the uninformed? The problem for them is the curse of acceptance, and a secure school allows for them to have a default option that they can get in every state. Hence, the curse is entirely eliminated by allowing them to expect to get average utility, rather than always being left with the worst schools in every state. Theorem 1 formalizes this intuition to all markets in the common ordinal preferences model."

Information from the AEA on this year's new Ph.D. job market

Here's an announcement that came by email from the American Economic Association:

Webinar on the new Ph.D. Job Market, hosted by the AEA ad hoc Committee on the Job Market

August 25, 2020 To: Members of the American Economic Association From: Peter L. Rousseau, Secretary-Treasurer The AEA's ad hoc Committee on the Job Market will host a webinar on the job market for new Ph.D. economists on Wednesday, September 2, from 3:00 – 4:30 p.m. ET.  The purpose of the webinar is to share information about the structure and timeline of the job market for new Economics Ph.D.s, and is intended to help job market candidates in 2020-21 as well as their advisors and placement committees. A pre-recorded video is available at https://www.aeaweb.org/joe/communications which provides information on the Economics Ph.D. job market, such as timelines, institutions, and general advice. The live 90 minute webinar will then be devoted to Q&A on either the material in the presentation or any other questions about the job market that participants may have.  Those answering questions at the webinar include the following: Aditya Aladangady, Board of Governors of the Federal Reserve John Cawley, Cornell University Matthew Gentzkow, Stanford University Brooke Helppie-McFall, University of Michigan Elisabeth "Bitsy" Perlman, U.S. Census Bureau Peter Rousseau, Vanderbilt University and Secretary-Treasurer of the AEA Max Schmeiser, Head of Data Science at Twitter Wendy Stock, Montana State University Omari Swinton, Chair of the Economics Department at Howard University The pre-recorded video and the link to the live webinar will be available from the committee's webpage: https://www.aeaweb.org/joe/communications. This webinar is free and available to all.  Feel free to share with others.  *********** The communications page includes the following: Webinar on the Economics Ph.D. Job Market Part I (Asynchronous): Recorded video providing information on the job market timeline, institutions, etc. Part II (Synchronous): Live Q&A on Wednesday, Sept 2, 3:00 – 4:30 pm EDT (Link coming soon) AEA Guidance on Timeline for the 2020-21 Economics Job Cycle (August 20, 2020) Memo on the Impact of the 2008-09 Financial Crisis on the Demand for Ph.D. Economists (August 11, 2020) Memo on trends in Job Listings on JOE Network (July 14, 2020)

Surrogacy and citizenship in the U.S.

 Some rules seem clear: anyone born in the U.S. is an American citizen, as is any child of an American parent.  But in these partisan times, even clear rules are subject to argument, and questionable distinctions can be brought up to litigate old repugnances.

ABC has the story:

State Dept. fighting to deny US citizenship to gay couple's child: A federal judge ruled in June that the agency had to grant citizenship.  By Conor Finnegan

"The State Department is appealing a federal judge's decision that it must recognize the U.S. citizenship of a young girl born via surrogate to a gay couple -- prolonging one of many legal fights over its controversial policy that was deemed unconstitutional in June.

"Roee Kiviti and Adiel Kiviti of Chevy Chase, Maryland, are legally married and both U.S. citizens. Their daughter Kessem was born in Canada via a surrogate, so the State Department has argued in federal court that she is "born out of wedlock" and not entitled to birthright citizenship.

...

"The Kiviti's are not the only family in a legal battle with the department on this issue.

"According to Immigration Equality, Derek Mize and Jonathan Gregg, a gay couple in Atlanta, are also awaiting a ruling by a federal judge over their daughter Simone's citizenship.

"The group also represents Allison Stefania and Lucas Zaccari -- a lesbian couple fighting for their daughter's citizenship. She was born to Lucas, an Italian citizen, via in vitro fertilization, so the State Department ruled she was born out of wedlock to a non-U.S. citizen, disregarding Allison's U.S. citizenship and their marriage. The couple is also awaiting a decision."

HT: Kim Krawiec

The Canadian Resident Matching Service: a history

 Here's a brief history of the Canadian medical residency match:

Gallinger J, Ouellette M, Peters E, Turriff L. CaRMS at 50: Making the match for medical education [Les 50 ans du CaRMS: jumelage pour l’éducation médicale]. Can Med Educ J. 2020;11(3):e133-e140. Published 2020 Jul 15. doi:10.36834/cmej.69786

Abstract: "Entry into postgraduate medical training in Canada is facilitated through a national application and matching system which establishes matches between applicants and training programs based on each party’s stated preferences.

"Health human resource planning in Canada involves many factors, influences, and decisions. The complexity of the system is due, in part, to the fact that much of the decision making is dispersed among provincial, territorial, regional, and federal jurisdictions, making a collaborative national approach a challenge. The national postgraduate application and matching system is one of the few aspects of the health human resources continuum that is truly pan-Canadian.

"This article examines the evolution of the application and matching system over the past half century, the values that underpin it, and CaRMS' role in the process."

More on Deceased donors as non‐directed donors in kidney exchange chains

I anticipate that we  will be reading more in the future about kidney exchange chains started by a deceased donor kidney.  In the meantime, here are two recent papers:

From the American Journal of Transplantation:

Deceased donors as non‐directed donors in kidney paired donation

W. Wang 

 

M.A. Rees 

 

A.B. Leichtman 

 

P. X‐K. Song 

 

M. Bray 

 

V.B. Ashby 

 

T. Shearon 

 

A Whiteman 

 

J.D. Kalbfleisch

First published: 16 August 2020

 

https://doi.org/10.1111/ajt.16268

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ajt.16268

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Abstract

As proof of concept, we simulate a revised kidney allocation system that includes deceased donor (DD) kidneys as chain‐initiating kidneys (DD‐CIK) in a kidney paired donation pool (KPDP), and estimate potential increases in number of transplants. We consider chains of length 2 in which the DD‐CIK gives to a candidate in the KPDP, and that candidate’s incompatible donor donates to the deceased donor (DD) waitlist. In simulations, we vary initial pool size, arrival rates of candidate/donor pairs and (living) non‐directed donors (NDDs), and delay time from entry to the KPDP until a candidate is eligible to receive a DD‐CIK. Using data on candidate/donor pairs and NDDs from the Alliance for Paired Kidney Donation, and the actual DDs from the Scientific Registry of Transplant Recipients (SRTR) data, simulations extend over two years. With an initial pool of 400, respective candidate and NDD arrival rates of two per day and 3 per month, and delay times for access to DD‐CIK of 6 months or less, including DD‐CIKs increases the number of transplants by at least 447 over two years, and greatly reduces waiting times of KPDP candidates. Potential effects on waitlist candidates are discussed as are policy and ethical issues.

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And from Transplant International: 

Kidney exchange strategies: New aspects and applications with a focus on deceased‐donor‐initiated chains

Lucrezia Furian  Antonio Nicolò  Caterina Di Bella  Massimo Cardillo  Emanuele Cozzi  Paolo Rigotti

First published: 09 August 2020 https://doi.org/10.1111/tri.13712

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/tri.13712

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Abstract: "Kidney paired donation (KPD) is a valuable way to overcome immunological incompatibility in the context of living donation, and several strategies have been implemented to boost its development. In this article, we reviewed the current state of the art in this field, with a particular focus on advanced KPD strategies, including the most recent idea of initiating living donor (LD) transplantation chains with a deceased‐donor (DD) kidney, first applied successfully in 2018. Since then, Italy has been running a national program in which a chain‐initiating kidney is selected from a DD pool and allocated to a recipient with an incompatible LD, and the LD’s kidney is transplanted into a patient on the waiting list (WL).

"At this stage, since the ethical and logistic issues have been managed appropriately, KPD starting with a DD has proved to be a feasible strategy. It enables transplants in recipients of incompatible pairs without the need for desensitizing and also benefits patients on the WL who are allocated chain‐ending kidneys from LDs (prioritizing sensitized patients and those on the WL for longer)."

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Previous posts:

Monday, October 14, 2019  A kidney exchange chain initiated by a deceased donor, in Italy

Tuesday, September 5, 2017 UNOS proposal: Allowing Deceased Donor-Initiated Kidney Paired Donation (KPD) Chains

Monday, April 11, 2016 Using deceased donor kidneys to start living donor kidney exchange chains

 

Utilization of Deceased Donor Kidneys to Initiate Living Donor Chains

1. M. L. Melcher¹, 
 
2. J. P. Roberts^2,*, 
 
3. A. B. Leichtman³, 
 
4. A. E. Roth⁴ and
 
5. M. A. Rees

 

Organs for sale

 Given the heated discussions and intense repugnance that often accompany questions concerning compensation for organs, you might be surprised to find an American Organ Clearing House  that has a section devoted to Organs for Sale.  

The site appears to get a lot of support from religious institutions

Needless to say, although money plays an important role, this kind of commerce still involves a good deal of matching.

"There is more to placing a pipe organ than checking physical dimensions. We will work with you to choose an instrument appropriate for the acoustics, liturgy, and other activities of your church."

Brain death (death by neurological criteria)

 Defining human life is hard, but defining death used to be easy: no heartbeat or respiration.  That changed with modern technology--e.g. a patient in the midst of a heart transplant may have no heart, but may have a long life ahead.

And of course, if we are who we think we are, it is brain death that matters most: loss of heartbeat and respiration kills our brains, our selves. But defining brain death is not so easy, especially for a patient on a ventilator who may have a pulse and be visibly breathing.

A recent discussion in JAMA seeks to standardize definitions of brain death, which are of more than academic interest, because deceased donor organ transplantation mostly goes on after brain death but while the organs are still receiving oxygen from (artificially maintained) heartbeat and respiration. 

Greer DM, Shemie SD, Lewis A, et al. Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. JAMA. Published online August 03, 2020. doi:10.1001/jama.2020.11586

"The concepts of life and death have always been complicated, but ever more so as medical and technological advances continue to extend the limits to saving life and prolonging physiological function. For previous generations, cardiorespiratory death was the sole clinical definition of death, often without any standard criteria, leading to the risk of misdiagnosis. As resuscitation techniques and mechanical ventilation developed, a new definition of death was needed.

"The idea of brain death/death by neurologic criteria (BD/DNC) was first recognized in 1959 as “coma depassé”1 and subsequently described as “brain death” with the first published clinical definition in 1968, commonly known as the Harvard Brain Death Criteria.2 Since then, many other guidelines and protocols have been published, adopted, and revised throughout the world with general acceptance of the concept of BD/DNC among medical groups, major religions, and governments.3

'However, there continues to be confusion and dilemmas that arise regarding BD/DNC. The wide variance in practice reflects this confusion and numerous other challenges. Inconsistencies in concept, criteria, practice, and documentation exist internationally and within countries.3,4 Difficulties in conducting randomized clinical trials and large-scale studies on BD/DNC have resulted in a lack of robust data from which to develop evidence-based recommendations. Challenges to the validity of BD/DNC continue to promote controversy. These factors initiated this project to harmonize practice and improve the rigor of BD/DNC determination."

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Here's an earlier take, with a more philosophical slant:

Sarbey, Ben. “Definitions of death: brain death and what matters in a person.” Journal of law and the biosciences vol. 3,3 743-752. 20 Nov. 2016, doi:10.1093/jlb/lsw054

Here are the concluding sentences:

"The neurological criteria for death represent a remarkable advance in our ways of responding to changes in death and dying. However, as medical technology and life extension techniques develop, we must also develop increasingly precise notions of what aspects of our neurological lives are the most important. While the current total brain death standard currently suffices in the vast majority of cases, the standard does not fully line up with what we value in persons. Should we retain the current brain death standard despite its mismatch with our values and despite negative consequences in determining death and in organ donation? Technological advances seem as if they will inevitably make this question inescapable."

Opioid deaths in Canada during the pandemic, and what to do about it.

 Canada has a different political culture than the U.S., and attitudes towards drug abuse are one place in which that shows through clearly.

The Washington Post has the story--drug overdoses have risen during the pandemic:

Canada’s other health crisis: As overdoses surge, officials call on government to decriminalize illicit drugs

By Amanda Coletta

"a growing chorus, including top public health officials, the premier of British Columbia and the nation’s police chiefs, is calling on Prime Minister Justin Trudeau to decriminalize the possession of illicit drugs for personal use.

...

"British Columbia, the epicenter of the crisis, recorded its deadliest month in May — and then surpassed it in June. Nearly four times as many people in the province have died of a suspected overdose this year as have died of the coronavirus.

...

"Border closures have disrupted drug markets, making the street supply more unpredictable and toxic. Authorities have urged people to stay at home, pushing some to use drugs alone, without anyone nearby to help when dosages go wrong. Some supervised consumption sites and treatment centers have reduced operations, cutting people off from support networks.

...

"For the pandemic, officials have marshaled extraordinary financial resources and provided daily updates. Lawmakers have stood side-by-side with public health officials, largely deferring to their advice.

"But they’ve not always backed the remedies those same officials have offered to fight overdoses.

...

"“The most important thing we can do is make it okay for people to talk about their drug use and to seek assistance for it,” Henry said. “Labeling somebody a criminal is one of those major barriers that keeps people hiding and afraid and ashamed.”

... 

"That followed an extraordinary endorsement from the Canadian Association of Chiefs of Police, which said police resources would be better spent on cracking down on drug trafficking, illegal production and importation than on pursuing users.

"The chiefs said that arresting people for simple possession has been “ineffective” and that police should instead direct users to ­social services and health care, which could reduce recidivism and ancillary crimes."

The ethics (and some economics) of paying participants in Human Infection Challenge Studies, for a coronavirus vaccine

 

Here's a paper (that is perhaps not too long when you divide by the number of authors) seeking to provide some background for payment decisions in connection with  human infection studies (i.e. challenge trials) of covid-19 vaccines.

Lynch, Holly Fernandez and Darton, Thomas and Largent, Emily and Levy, Jae and McCormick, Frank and Ogbogu, Ubaka and Payne, Ruth and Roth, Alvin E. and Jefferson Shah, Akilah and Smiley, Thomas, Ethical Payment to Participants in Human Infection Challenge Studies, with a Focus on SARS-CoV-2: Report and Recommendations (August 14, 2020).  

Abstract: To prepare for potential human infection challenge studies (HICS) involving SARS-CoV-2, this report offers an expert analysis of ethical approaches to paying research participants in these studies, as well as HICS more broadly. The report first provides an overarching ethical framework for research payment that divides payment into reimbursement, compensation, and incentive, focusing on fairness and promoting adequate recruitment and retention as counterweights to ethical concerns about undue inducement. It then describes variables relevant to applying this framework to any type of study, including the prospect of direct medical benefit, early participant withdrawal, study setting and location, pandemic circumstances, study budget, and participant perspectives. We conclude that there is no need for a unique payment framework specific to HICS or SARS-CoV-2 HICS, but that there may be features of particular relevance to ethical payment for these studies. Participants have varied motivations for enrolling in HICS, including financial considerations, altruism, and other interests, but undue inducement does not seem to be a significant problem based on available evidence. Payment in these studies should reflect the nature of participant confinement, anticipated discomfort from induced infection, risks and uncertainty, participant motivations, and the need to recruit from certain populations, as relevant. Where HICS involve significant risks and highly contingent social value, special review confirming the ethical permissibility of these studies can help promote confidence in the ethical permissibility of offers of payment to participate in them. We do not propose specific payment amounts for potential SARS-CoV-2 HICS, as these will be highly variable based on the relevant factors described in the report. Instead, we note that it is reasonable to start from payments offered in other similar studies, while adopting a systematic approach based on the ethical framework herein, as reflected in a pragmatic payment worksheet describing goals, coverage, factors to consider, and potential benchmarks.

Organizing tests of drugs to treat, and vaccines to prevent, coronavirus

 Here's a story on some of the difficulties in drug testing: among the difficulties are that positive test results for infection are taking too long after testing to allow prompt treatment...

Clinical Trials of Coronavirus Drugs Are Taking Longer Than Expected  By Katie Thomas

Aug. 14, 2020

"Antibody trials sponsored by Regeneron and Eli Lilly are off to a slow start because of a dearth of tests, overwhelmed hospitals and reluctant patients."

...

"While much of the world’s focus has been on the race to create a coronavirus vaccine, new drugs could also help curb the pandemic by making the disease less deadly. Because drugs are typically tested in sick patients in smaller clinical trials, they can also be developed more quickly than vaccines.

...

"The fast-moving disease has presented opportunities and challenges for the researchers testing antibodies. As the number of infections mounted in states like Florida, Texas and Arizona, there was no shortage of patients who would be eligible for trials. But at the same time, the outbreaks overwhelmed the very hospitals that would be overseeing the studies.

...

"“That doesn’t happen when you’re setting up diabetes trials or cancer trials,” he said. “We’ve had investigators say: ‘Look, I’d love to do research, but I don’t have time to set up a new trial. I’ve got an I.C.U. full of patients.’”

...

"Both the Regeneron and Eli Lilly trials require giving the drug within three days of taking a positive test.

"But with turnaround times in some areas lagging for five days or more, keeping within those time frames has proved difficult."

**********

With conventional (non-challenge) vaccine trials, having a high level of infection is important, to allow the effectiveness of vaccine candidates to be tested.  So, Brazil (and the U.S.):

 Coronavirus Crisis Has Made Brazil an Ideal Vaccine Laboratory  By Manuela Andreoni and Ernesto Londoño  Aug. 15, 2020

"Widespread contagion, a deep bench of scientists and a robust vaccine-making infrastructure have made Brazil an important player in the quest to find a vaccine."

...

"Some 5,000 Brazilians have also been recruited to support a vaccine trial conducted by AstraZeneca, a British-Swedish pharmaceutical company in partnership with Oxford University. An additional 1,000 volunteers in Brazil were recruited to test a vaccine developed by New York-based Pfizer.

"Researchers need countries with large enough outbreaks to assess whether a vaccine will work. Some volunteers are given the potential vaccine while others are given a placebo, but they have to be in a place where enough virus is circulating to test the vaccine’s efficacy.

"Brazil, where the virus has infected more than three million people, has clear conditions for these trials. And it will be the only country other than the United States to be playing a major role in three of the leading studies as an unparalleled quest for a vaccine has led to unusually fast regulatory approvals and hastily brokered partnerships."

College admissions in the UK during the pandemic: exams replaced by teacher assessments, algorithms, appeals and disorder

Many exams around the world have been cancelled because of corona virus. For college admissions, which operates on a strict schedule (despite the facts that college is going remote in many places), exam scores have been estimated by teachers and/or algorithms. (That is to say, exams, which are noisy measures of aptitude and accomplishment, are being replaced by noisy predictions of exam performance...)

Wired summarizes the situation in the UK, where exam results are especially salient, since universities issue acceptances conditional on grades:

An Algorithm Determined UK Students' Grades. Chaos Ensued  by Amit Katwala

"This year's A-Levels, the high-stakes exams taken in high school, were canceled due to the pandemic. The alternative only exacerbated existing inequities."

...

"The coronavirus pandemic means exams were canceled and replaced with teacher assessments and algorithms. It has created chaos.

"In Scotland, the government was forced to completely change tack after tens of thousands of students were downgraded by an algorithm that changed grades based on a school’s previous performance and other factors. Anticipating similar scenes for today’s A-level results, the government in England has introduced what it’s calling a ‘triple lock’—whereby, via stages of appeals, students will effectively get to choose their grade from a teacher assessment, their mock exam results, or a resit to be taken in the autumn.

*********

So, chaos ensued. The Guardian gives us a taste:

Ofqual 'blindsided' government by revoking A-level appeals process: Move by regulator could leave thousands of students without university places by Richard Adams and Heather Stewart

"The government’s attempts to fix this summer’s broken A-level and GCSE results have been thrown into chaos after the exam regulator Ofqual revoked the appeals process for schools and students that it had published only a few hours earlier.

"The move, which was caused by internal disagreements over the appeals process, could leave thousands of A-level candidates in limbo, including those trying to secure places at universities this autumn by overturning the grades awarded to them by Ofqual’s algorithm.

"The guidance was revoked late on Saturday night, less than eight hours after it was published, leaving school leaders and exam boards bewildered.

"Insiders said Ofqual had “blindsided” the Department for Education, after ministers had endorsed the guidance just two hours earlier.

...

"The controversy is set to deepen on Thursday when GCSE results are published for more than 600,000 year 11 pupils in England. As many as 2m assessments submitted by teachers could be downgraded by Ofqual’s model, which relies on a school’s past performance and each pupil’s previous results from primary school.

"Analysis published by the Observer found that 97% of GCSE results will be allocated solely by Ofqual’s algorithm rather than teacher-assessed grades submitted by schools and colleges. Teacher rankings of pupils will be used to distribute grades within each school."

*********

Also from the Guardian:

A-levels row: Oxford college to honour all offers despite results: Worcester College move comes as thousands of Oxbridge alumni call on others to follow suit.  by Aaron Walawalkar

"An Oxford college said it will accept all students with offers regardless of their A-level results, as thousands of Oxbridge alumni call on others to show equal “kindness and generosity” to downgraded pupils.

...

"It comes after Oxbridge applicants who received lower grades than expected on Thursday were told they may have to wait a year before they can start degree courses after successfully appealing against their results.

"About 39% of A-level results were downgraded by the exam regulator Ofqual’s algorithm, with disadvantaged pupils worst affected.

"Ashe told BBC Radio 4: “For us, at a very simple level, it was clear to us before results came out that these students were not going to have sat exams and therefore we took the view that there wasn’t going to be any new information there that could justify rejecting someone to whom we’d made an offer."

4th Workshop on Mechanism Design for Social Good, August 17-19, 2020 (MD4SG )'20

 This week: 

4th Workshop on Mechanism Design for Social Good, August 17-19, 2020 (MD4SG '20)

"The fourth workshop on Mechanism Design for Social Good (MD4SG '20) will be held online on August 17-19, 2020. The goal of the workshop is to highlight work where techniques from algorithms, optimization, and mechanism design, along with insights from other disciplines, have the potential to improve access to opportunity for historically underserved and marginalized communities. The workshop will feature keynote presentations, contributed talks, problem pitches and demos, a poster session, and a panel discussion, with a focus on bridging research and policy. To this end, participants will include researchers as well as practitioners in various government and non-government organizations and industry."

Here's the program:

Monday, August 17

 Time Event Authors

10:00-10:15 EST Opening Remarks Program Chairs: Faidra Monachou and Francisco Marmolejo-Cossío

10:15-11:00 EST Keynote: Maximizing the Social Good: Markets without Money Nicole Immorlica

11:00-11:45 EST Session 1: Education Policy and Diversity

11:00-11:15 EST Top Percent Policies and the Return to Postsecondary Selectivity Zachary Bleemer

11:15-11:25 EST Unequal Assignment to Public Schools and the Limits of School Choice Mariana Laverde

11:25-11:35 EST Who Gets Placed Where and Why? An Empirical Framework for Foster Care Placement Alejandro Robinson Cortes

11:35-11:45 EST Explainability in Matching Mechanisms with Diversity Goals: A Case Study of Ethiopian Universities Basiliyos Betru, Meareg Hailemariam and Rediet Abebe

11:45-12:00 EST Short Break

12:00-12:45 EST Keynote Anjana Rajan

12:45-13:30 EST Session 2: Technology, Law and Policy

12:45-13:00 EST Feminicide & Machine Learning: Detecting Gender-based Violence to Strengthen Civil Sector Activism Catherine D'Ignazio, Helena Suarez Val, Silvana Fumega, Harini Suresh, Isadora Cruxen, Wonyoung So, Maria De Los Angeles Martinez and Mariel Garcia-Montes

13:00-13:10 EST The Gender Panopticon: AI, Gender, and Design Justice Sonia Katyal

13:10-13:20 EST Privacy as Privilege Rebecca Wexler

13:20-13:30 EST "Computer says no!": Unpacking the Human in the Loop Requirement in the Context of Welfare Fraud Doaa Abu Elyounes

13:30-14:00 EST Long Break

14:00-15:00 EST Session 3: Labor Markets

14:00-14:15 EST The Role of Referrals in Inequality, Immobility, and Inefficiency in Labor Markets Lukas Bolte, Nicole Immorlica and Matthew Jackson

14:15-14:30 EST All Things Equal? Social Networks as a Mechanism for Discrimination Chika Okafor

14:30-14:40 EST Outside Options, Bargaining, and Wages: Evidence from Coworker Networks Sydnee Caldwell and Nikolaj Harmon

14:40-14:50 EST The Geography of Unemployment Adrien Bilal

14:50-15:00 EST Location Sorting and Endogenous Amenities: Evidence from Amsterdam Milena Almagro and Tomas Dominguez-Iino

15:00-16:00 EST Poster Session

16:00-17:00 EST Networking Session 

Tuesday, August 18

Time Event Authors

10:00-10:45 EST Keynote: Tech in Support of Caregiving: Innovation Opportunities and Ecosystem Challenges Deborah Estrin

10:45-11:20 EST Session 1: Environment, Agriculture and Food Consumption

10:45-11:00 EST Improving Farmers' Income on Online Agri-platforms: Theory and Field Implementation of a Two-stage Auction Retsef Levi, Manoj Rajan, Somya Singhvi and Yanchong Zheng

11:00-11:10 EST Optimal Interventions for Increasing Healthy Food Consumption Among Low-Income Populations Elisabeth Paulson, Retsef Levi and Georgia Perakis

11:10-11:20 EST Simple and Approximately Optimal Contracts for Payment for Ecosystem Services Wanyi Li, Irene Lo and Itai Ashlagi

11:20-12:00 EST Long Break

12:00-12:45 EST Keynote Natalia Aríza Ramirez

12:45-13:25 EST Session 2: Education in Practice

12:45-13:00 EST School Choice in Chile Natalie Epstein, Jose Correa, Rafael Epstein, Juan Escobar, Ignacio Rios, Nicolas Aramayo, Bastian Bahamondes, Carlos Bonet, Martin Castillo Quintana, Andrés Cristi, Boris Epstein and Felipe Subiabre

13:00-13:15 EST Competition under Social Interactions and the Design of Education Policies Claudia Allende

13:15-13:25 EST From Pipeline to Pipelines: How Multiple Definitions of CS Education Distort CS Enrollment Data Stephanie Tena-Meza, Aj Alvero and Miroslav Suzara

13:25-14:00 EST Long Break

14:00-15:00 EST Panel Discussion (in Spanish, with live captioning) Natalia Aríza Ramirez, José R. Correa, Rafael Obregón

15:00-16:00 EST Session 3: Healthcare

15:00-15:15 EST Large-scale clinical trial of an AI-augmented intervention for HIV prevention in youth experiencing homelessness Bryan Wilder, Laura Onasch-Vera, Graham Diguiseppi, Robin Petering, Chyna Hill, Amulya Yadav, Eric Rice and Milind Tambe

15:15-15:30 EST Heterogeneous Donor Circles for Fair Liver Transplant Allocation Shubham Akshat, Sommer Gentry and S. Raghavan

15:30-15:40 EST Predicting no-show appointments in a pediatric hospital in Chile using machine learning Hector Ramirez, Fabian Villena Rodriguez, Jocelyn Dunstan, Victor Riquelme, Juan Pablo Hoyos, Javier Madariaga and Juan Peypouquet

15:40-15:50 EST Socioeconomic Network Heterogeneity and Pandemic Policy Response Mohammad Akbarpour, Cody Cook, Aude Marzuoli, Simon Mongey, Abhishek Nagaraj, Matteo Saccarola, Pietro Tebaldi, Shoshana Vasserman and Hanbin Yang

15:50-16:00 EST The Consequences of Medicare Pricing: An Explanation of Treatment Choice Elena Falcettoni

16:00-17:00 EST Networking Session 

Wednesday, August 19

Time Event Authors

10:00-10:45 EST Keynote Stephanie Dinkins

10:45-11:30 Session 1: Fairness and Inequality

10:45-11:00 EST Measuring Non-Expert Comprehension of Machine Learning Fairness Metrics Debjani Saha, Candice Schumann, Duncan C. McElfresh, John P. Dickerson, Michelle L. Mazurek and Michael Carl Tschantz

11:00-11:10 EST Pipeline Interventions Eshwar Ram Arunachaleswaran, Sampath Kannan, Aaron Roth and Juba Ziani

11:10-11:20 EST Pricing with Fairness Maxime Cohen, Adam Elmachtoub and Xiao Lei

11:20-11:30 EST Public Transit Access and Income Segregation Prottoy Akbar

11:30-12:30 EST Poster Session

12:30-13:15 EST Session 2: Algorithms for Policy and Governance

12:30-12:45 EST Modeling Assumptions Clash with the Real World: Configuring Student Assignment Algorithms to Serve Community Needs Samantha Robertson, Tonya Nguyen and Niloufar Salehi

12:45-12:55 EST The AI Economist: Improving Equality and Productivity with AI-Driven Tax Policies Stephan Zheng, Alex Trott, Sunil Srinivasa, Nikhil Naik, Melvin Gruesbeck, David Parkes and Richard Socher

12:55-13:05 EST (Machine) Learning what Governments Value Daniel Bjorkegren, Joshua Blumenstock and Samsun Knight

13:05-13:15 EST Economic Method, Digital Platform: When Mechanism Design Moves Online Salome Viljoen, Jake Goldenfein and Lee McGuigan

13:15-13:45 EST Long Break

13:45-14:30 EST Session 3: Online Platforms and Civic Participation

13:30-13:45 EST Advertising for Demographically Fair Outcomes Lodewijk Gelauff, Ashish Goel, Kamesh Munagala and Sravya Yandamuri

13:45-13:55 EST Neutralizing Self-Selection Bias in Sampling for Sortition Bailey Flanigan, Paul Gölz, Anupam Gupta and Ariel Procaccia

13:55-14:05 EST Auditing Digital Platforms for Discrimination in Economic Opportunity Advertising Sara Kingsley, Clara Wang, Alexandra Mikhalenko, Proteeti Sinha and Chinmay Kulkarni

14:05-14:15 EST Online Policies for Efficient Volunteer Crowdsourcing Vahideh Manshadi and Scott Rodilitz

14:15-14:30 EST Short Break

14:30-15:10 EST Session 4: Information

14:30-14:40 EST Information Design for Congested Social Services: Optimal Need-Based Persuasion Jerry Anunrojwong, Krishnamurthy Iyer and Vahideh Manshadi

14:40-14:50 EST How to get-toilet-paper.com? Provision of Information as a Public Good Robizon Khubulashvili, Mallory Avery, Kristi Bushman, Alexandros Labrinidis, Sera Linardi and Konstantinos Pelechrinis

14:50-15:00 EST Responsible Sourcing: The First Step Is the Hardest Pia Ramchandrani, Hamsa Bastani and Ken Moon

15:00-15:10 EST Anticipation and Consumption Neil Thakral and Linh To

15:10-15:30 EST Closing Remarks & Award Announcements Faidra Monachou and Francisco Marmolejo-Cossío

15:30-17:00 EST Networking Session 

The full program of the workshop will take place on August 17-19, 2020, on Gather.town and Zoom. Please register at this link to attend the talks and other events

Social distancing during the plague

 The Washington Post has the story (as a tourist destination...)

Restaurants in Italy are reopening ancient ‘wine windows’ used during the plague

The coronavirus pandemic has inspired a comeback for the socially distant invention.

By Natalie B. Compton Add to list

"In the 1300s, Europeans lived in fear of the plague claiming lives across the continent. In 2020, Europeans face the threat of the coronavirus, a pandemic that has killed more than 728,000 worldwide.

..."Between the wrath of the Black Death in the 1300s and the Italian Plague in the 1600s, wine merchants in the Italian region of Tuscany built “wine windows” to protect buyers and sellers from coming into close contact."

"The socially distant precaution was ahead of its time."

Should residency program rank order lists be kept confidential from the Dean?

Here's the report of a survey of residency program directors in radiology. One issue, not confined to radiology, is the confidentiality of their rank order list for the resident match--confidentiality from their own administrative hierarchy.  The problem with having to show your rank order list to your dean is that it interferes with program directors' incentives to rank candidates in order of true preferences:   Thirty-seven percent felt pressure to match applicants from the top of the rank list in order to improve the perceived “success” in the match."  That is, some of these programs are refraining from ranking the most desirable applicants they interviewed because they worry these people will match to other programs.  This will make their program look bad to the dean (who will ask "how come you have to go so far down on your list?")

“What Program Directors Think” V: Results of the 2019 Spring Survey of the Association of Program Directors in Radiology (APDR) Academic Radiology,  8 August 2020, In Press, Corrected Proof

by Anna Rozenshtein MD, MPH1 Brent D. Griffith MD2 Priscilla J.Slanetz MD, MPH3 Carolynn M.DeBenedectis MD4 Jennifer E.Gould MD Jennifer R.Kohr MD6 Tan-Lucien Mohammed MD, MS7Angelisa M.PaladinMD8Paul J.Rochon MD9 Monica Sheth MD10Ernest F.Wiggins III MD11 Jonathan O.Swanson MD12   Academic Radiology Available online 8 August 2020, In Press, Corrected Proof 

"The Association of Program Directors in Radiology (APDR) surveys its membership annually on hot topics and new developments in radiology residency training. Here we report the results of that annual survey.

...

"Radiology Residency Match: Forty-nine percent of respondents reported that the final rank list is known only to the program administration (PD/APD) and the selection committee, while 27% disclosed the rank list to the department administration and 24% to the institution. Thirty-seven percent felt pressure to match applicants from the top of the rank list in order to improve the perceived “success” in the match."

Gender distribution of medical residents

 Surgeons are still less likely to be women (particularly orthopedic surgeons):

Bennett CL, Baker O, Rangel EL, Marsh RH. The Gender Gap in Surgical Residencies. JAMA Surg. Published online July 29, 2020. doi:10.1001/jamasurg.2020.2171

HT: Irene Wapnir

The end of the beginning of the gig economy? Uber, Lyft and California AB5

 The San Francisco Chronicle has the latest news on the most concrete step yet to require Uber and Lyft to shift from a contractor-driver business model to one of driver employees...

Judge says California Uber, Lyft drivers should be employees

by Carolyn Said 

"A San Francisco Superior Court judge on Monday granted California’s request for a preliminary injunction to make the state’s Uber and Lyft drivers into employees. The 34-page order was scathing about the ride-hailing companies’ “prolonged and brazen refusal to comply with California law,” namely AB5, the new gig-work law that makes it harder for companies to claim that workers are independent contractors.

...

"However, it is likely to have little immediate impact.

"Judge Ethan Schulman stayed his injunction for 10 days. The companies will appeal it and seek a longer stay before the 10 days are up. An appeals court likely would hear their emergency motion quickly. Uber said it expects to be granted the longer-term delay and does not anticipate any near-term changes to its business. No matter what, it could not hire tens of thousands of drivers in a matter of days, it said.

...

"AB5 established an ABC test that says workers are employees unless A) they are free from a hiring entity’s control, B) perform work outside the hiring entity’s usual business, and C) have an independent business doing that kind of work.

...

"Along with other gig companies, Uber and Lyft are pursuing a $110 million November ballot measure, Proposition 22, asking California voters to keep drivers as freelancers who are entitled to some earnings guarantees and benefits. DoorDash, Instacart and Postmates, the other Prop. 22 backers, are not named in the California lawsuit but presumably would be affected by whatever precedent it sets. (Uber has purchased Postmates in a deal that will close next year.)"

Transplanting two kidneys from older deceased donors to reduce discards

Here's a venerable but newly fashionable idea in transplantation, particularly for deceased donors whose (individual) kidneys have already been rejected when offered.  Transplant both kidneys into the same recipient, to reduce the risk.

Here's a paper from January:

Lee, K.W., Park, J.B., Cha, S.R. et al. Dual kidney transplantation offers a safe and effective way to use kidneys from deceased donors older than 70 years. BMC Nephrol 21, 3 (2020). https://doi.org/10.1186/s12882-019-1664-8

And here's a very recent news article talking about a different, larger study:

July 30, 2020

Using older donor kidneys for dual transplant may present safe way to reduce discard rate

By Melissa J. Webb

"Using data from the United Kingdom Transplant Registry, they identified 7,841 kidneys procured from deceased donors aged 60 years or older, finding that 17% of these were discarded.

Considering the remaining kidneys used for transplant (356 for dual; 5,032 for single), the researchers determined that both donors and recipients of dual transplants were older (median, 73 years vs. 66 years and 64 years vs. 61 years, respectively). Donors of kidneys used in dual transplantation also had higher United States Kidney Donor Risk Indices (2.48 vs 1.98 for those used in single transplants).

After adjusting for confounders, the researchers observed similar 5-year graft survival between dual and single transplants (HR = 0.81), as well as a higher median eGFR at 12 months for recipients of dual transplants (40 mL/min/1.73m2 vs. 36 mL/min/1.73m2)."