Friday, May 31, 2024

Organs, tissues, and medical devices are regulated very differently

 Here's an article in JAMA by a Michigan doctor and his Congresswoman, on the lack of regulation for some substances of human origin.

Urgent Need for Regulatory Oversight of Human Cells, Tissues, and Cellular and Tissue–Based Products, by Robert P. Dickson, MD; Deborah A. Dingell, MS, JAMA. 2024;331(20):1703-1704. doi:10.1001/jama.2024.6834

" In 2021, an outbreak of M tuberculosis occurred in the US when contaminated bone graft material was implanted into 113 patients, 77% of whom developed clinically apparent tuberculosis.

...

[Again in 2023] "the Centers for Disease Control and Prevention (CDC) had identified additional tuberculosis-infected patients who had received implants of the same product, harvested from the same donor. At final count, 36 patients in 7 states had undergone implantation of bone graft tissue contaminated with M tuberculosis.

...

"Given the rigorous safety testing required of most medical therapies, how could 2 lethal outbreaks of tuberculosis occur in as many years, arising from the same product, distributed by the same company?

"The answer lies in the FDA’s designation of this product as a human cells, tissues, and cellular and tissue–based product (HCT/P) (Table). This class of therapies, which includes bone grafts, skin grafts, and stem cells, is not subject to the same regulatory standards as pharmaceuticals, biological products (such as blood products and monoclonal antibodies), or organ transplants. This designation has profound regulatory and clinical consequences



Thursday, May 30, 2024

Sigecom Test of Time Award 2024 for AdWords and generalized online matching by Mehta, Saberi, Vazirani, and Vazirani

 The SIGecom Test of Time Award recognizes the author or authors of an influential paper or series of papers published between ten and twenty-five years ago that has significantly impacted research or applications exemplifying the interplay of economics and computation. More details and nomination procedure…

The Test of Time Award Winners for 2024 are Aranyak MehtaAmin SaberiUmesh Vazirani, and Vijay Vazirani  

They are cited for "introducing and solving a model of online matching with budgets that has seen many practical applications to online markets and broad and continuing impact in the literature."

in their paper

AdWords and generalized online matching, Journal of the ACM 54(5), 2007, Article 22

Abstract: How does a search engine company decide what ads to display with each query so as to maximize its revenue? This turns out to be a generalization of the online bipartite matching problem. We introduce the notion of a trade-off revealing LP and use it to derive an optimal algorithm achieving a competitive ratio of 1−1/e for this problem.

From the introduction:

"Internet search engine companies, such as Google, Yahoo and MSN, have revolutionized not only the use of the Internet by individuals but also the way businesses advertise to consumers. Typical search engine queries are short and reveal a great deal of information about user preferences. This gives search engine companies a unique opportunity to display highly targeted ads to the user.

"The online advertising mechanisms used by search engines, including Google’s AdWords, are essentially large auctions where businesses place bids for individual keywords, together with limits specifying their maximum daily budget. The search engine company earns revenue when it displays their ads in response to a relevant search query (if the user actually clicks on the ad). Indeed, most of the revenues of search engine companies are derived in this manner [Battelle 2005]. One factor in their dramatic success is that, unlike conventional advertising, search engine companies are able to cater to low-budget advertisers (who occupy the fat tail of the power law distribution governing advertising budgets of companies and organizations).

"The following computational problem, which we call the adwords problem, is a formalization of a question posed to us by M. Henzinger: There are (private communication, 2004). N bidders, each with a specified daily budget bi . Q is a set of query words. Each bidder i specifies a bid ciq for query word q ∈ Q. A sequence q1q2 · · · q M of query words q j ∈ Q arrive online during the day, and each query q j must be assigned to some bidder i (for a revenue of ciq j ). The objective is to maximize the total revenue at the end of the day while respecting the daily budgets of the bidders.

"In this article, we present a deterministic algorithm achieving a competitive ratio of 1 − 1/e for this problem, under the assumption that bids are small compared to budgets."

###########

Last year's award:

Monday, April 3, 2023

Test of Time Award 2023 to Immorlica & Mahdian, and Ashlagi, Kanoria & Leshno

#######

"Past and Present Members of the Test of Time Award Committee: Yeon-Koo Che, Yiling Chen, Nikhil Devanur, Joan Feigenbaum, Jason Hartline, Bobby Kleinberg, Paul Milgrom, Noam Nisan, Asu Ozdaglar, David Parkes, David Pennock, Alvin Roth, Tim Roughgarden, Larry Samuelson, Tuomas Sandholm, Yoav Shoham, Éva Tardos, Moshe Tennenholtz"


Wednesday, May 29, 2024

Marijuana policy and use in the U.S., 1979-2022, by Jonathan Caulkins, in Addiction

 Here's a paper forthcoming in the journal Addiction:

Changes in self-reported cannabis use in the United States from 1979 to 2022, by Jonathan P. Caulkins, published online 22 May 2024, https://doi.org/10.1111/add.16519 

"Abstract

Background and aims: Multiple countries are considering revising cannabis policies. This study aimed to measure long-term trends in cannabis use in the United States and compare them with alcohol use.

Design and setting: Secondary analysis of United States general population survey data.

Participants: The national surveys had a total of 1 641 041 participants across 27 surveys from 1979 to 2022.

Measurements: Rates of use reported to the US National Survey on Drug Use and Health and its predecessors are described, as are trends in days of use reported. Four milepost years are contrasted: 1979 (first available data and end of relatively liberal policies of the 1970s), 1992 (end of 12 years of conservative Reagan-Bush era policies), 2008 (last year before the Justice Department signaled explicit federal non-interference with state-level legalizations) and 2022 (most recent data available).

Findings: Reported cannabis use declined to a nadir in 1992, with partial recovery through 2008, and substantial increases since then, particularly for measures of more intensive use. Between 2008 and 2022, the per capita rate of reporting past-year use increased by 120%, and days of use reported per capita increased by 218% (in absolute terms from the annual equivalent of 2.3 to 8.1 billion days per year). From 1992 to 2022, there was a 15-fold increase in the per capita rate of reporting daily or near daily use. Whereas the 1992 survey recorded 10 times as many daily or near daily alcohol as cannabis users (8.9 vs. 0.9 M), the 2022 survey, for the first time, recorded more daily and near daily users of cannabis than alcohol (17.7 vs. 14.7 M). Far more people drink, but high-frequency drinking is less common. In 2022, the median drinker reported drinking on 4–5 days in the past month, versus 15–16 days in the past month for cannabis. In 2022, past-month cannabis consumers were almost four times as likely to report daily or near daily use (42.3% vs. 10.9%) and 7.4 times more likely to report daily use (28.2% vs. 3.8%).

ConclusionsLong-term trends in cannabis use in the United States parallel corresponding changes in cannabis policy, with declines during periods of greater restriction and growth during periods of policy liberalization. A growing share of cannabis consumers report daily or near daily use, and their numbers now exceed the number of daily and near daily drinkers."

Daily and Near Daily (DND) use

...

"That is still not as high as for cigarettes. The 2022 NSDUH survey finds that 58.7% of PM ["Past Month"] cigarette smokers smoked ‘daily’—defined as ‘smoked one or more packs of cigarettes per day’ [8]. Therefore, there are more daily cigarette smokers than DND PM marijuana users (24.1 vs 17.7 million). 3 Still, patterns of marijuana consumption have shifted from being like alcohol to being closer to cigarette use. It is also no longer a young person's drug. In 2022, people 35 and older accounted for (slightly) more days of use than did those under the age of 35."

Tuesday, May 28, 2024

Gonzalo Arrieta defends his dissertation

Gonzalo Arrieta defended his dissertation last week.



Here's his job market paper:

Procedural Decision-Making In The Face OfComplexity by Gonzalo Arrieta and Kirby Nielsen

Abstract: A large body of work documents that complexity affects individuals’ choices, but the literature has remained mostly agnostic about why. We provide direct evidence that individuals use different choice processes for complex and simple decisions. We hypothesize that individuals resort to “procedures”—cognitively simpler choice processes that we characterize as being easier to describe to another person—as the complexity of the decision environment increases. We test our hypothesis using two experiments, one with choices over lotteries and one with choices over charities. We exogenously vary the complexity of the decision environment and measure the describability of choice processes by how well another individual can replicate the decision-maker’s choices given the decision-maker’s description of how they chose. We find strong support for our hypothesis: Both of our experiments show that individuals’ choice processes are more describable in complex choice environments, which we interpret as evidence that decision-making becomes more procedural as complexity increases. We show that procedural decision-makers choose more consistently and exhibit fewer dominance violations, though we remain agnostic about the causal effect of procedures on decision quality. Additional secondary evidence suggests that procedural decision-making is a choice simplification that reduces the cognitive costs of decision-making."

##########
Another of his papers is a really creative investigation of human welfare:

Abstract: The dominant approach to welfare is based on revealed preferences and thus is restricted to settings where the individual knows their preferences have been fulfilled. We use a choosing-for-others framework to experimentally study welfare when what the individual believes to be true differs from what is actually true. About 42% of participants see welfare as independent of beliefs; 22% see welfare as only depending on beliefs; and 29% see a lower, but still positive, welfare effect when beliefs are fixed. Furthermore, the average participant values accurate beliefs. Our results suggest most people support the idea that welfare goes beyond awareness, which can inform media regulation, informational policies, and government communication.

 

Here's a figure from the instructions about the creation of "real" and "fake" inscribed copies of books. A third party judged the welfare to the recipient

"Our altruistically revealed preference paradigm consists of asking surrogate participants to trade off a monetary bonus given to the Receiver, and the Receiver getting the books with the original notes over those with the fake notes. The bonus amount is a surprise to the Receiver to minimize concerns that they use it to deduce which books they got (i.e., to maintain obliviousness). Our three requirements allow us to interpret the bonus amount that leaves participants indifferent between giving the original and fake notes as a measure of the change in the Receiver’s welfare. As a benchmark, we also elicit the welfare effect when the Receiver does learn which notes they get."
********
Welcome to the club, Gonzalo.



Monday, May 27, 2024

Matching for love or profit at Stanford

 Looking for a date, a marriage, a business partner?  Stanford might have the right app for you.

Here's the story from the Stanford Daily

Match, Marry, Capitalize? A catalog of Stanford’s matchmaking services, By Oriana Riley

"Here’s how matchmakers have attempted to help the Stanford community find love, friendships and business partners. 

Marriage Pact 

Perhaps the most famous Stanford matchmaking service, Marriage Pact, originated as a final project for a Stanford economics project. The annual service, which uses a survey to match compatible individuals for friendships and romantic relationships, has expanded to 88 campuses and more than 400,000 people.

...

"Founder Pact 

"Founder Pact presented an opportunity for students to try their hand not at love, but entrepreneurship. Founder Pact, created by the Business Association of Stanford Entrepreneurial Students (BASES), aimed to match entrepreneurs to realize their business ideas together. 

"The Founder Pact form, however, is now closed. 

"Wing

"A baby bird on the Stanford dating scene is Wing, announced to Stanford students via email on April 18. According to the email, Wing is built on the idea of “set[ting] up your friends.” 

Sunday, May 26, 2024

Recent papers on matching: May GEB

 The May issue of Games and Economic Behavior has several papers on matching that caught my eye:

Games and Economic Behavior, Volume 145, May 2024

Strong core and Pareto-optimality in the multiple partners matching problem under lexicographic preference domains, by Péter Biró and Gergely Csáji

Abstract: We study strong core and Pareto-optimal solutions for multiple partners matching problem under lexicographic preference domains from a computational point of view. The restriction to the two-sided case is called stable many-to-many matching problem and the general one-sided case is called stable fixtures problem. We provide an example to show that the strong core can be empty even for many-to-many problems, and that deciding the non-emptiness of the strong core is NP-hard. On the positive side, we give efficient algorithms for finding a near feasible strong core solution and for finding a fractional matching in the strong core of fractional matchings. In contrast with the NP-hardness result for the stable fixtures problem, we show that finding a maximum size matching that is Pareto-optimal can be done efficiently for many-to-many problems. Finally, we show that for reverse-lexicographic preferences the strong core is always non-empty in the many-to-many case.


Bayesian stable states, by Yi-Chun Chen and Gaoji Hu 

Abstract: This paper extends the Bayesian stability notion of Liu (2020) to define the Bayesian stability of a market state, which consists of a matching outcome and an information structure. The information structure can be arbitrarily heterogeneous and can accommodate learning among agents. We first establish that a Bayesian stable matching function of Liu (2020) can be recast as Bayesian stable market states with homogeneous information. We then illustrate the usefulness of such an extension by (i) refining Liu's Bayesian efficiency notion to define the Bayesian efficiency of a market state and (ii) generalizing his result—that Bayesian stable matching functions are Bayesian efficient—to an analogous one for market states. More importantly, we show that (iii) a decentralized matching process converges to a Bayesian stable market state and thereby offer a decentralized foundation for Liu's Bayesian stable matching function.


Efficient matching under general constraints  by Kenzo Imamura, Yasushi Kawase

Abstract: We study indivisible goods allocation problems under constraints and provide algorithms to check whether a given matching is Pareto efficient. We first show that the serial dictatorship algorithm can be used to check Pareto efficiency if the constraints are matroid. To prove this, we develop a generalized top trading cycles algorithm. Moreover, we show that the matroid structure is necessary for obtaining all Pareto efficient matchings by the serial dictatorship algorithm. Second, we provide an extension of the serial dictatorship algorithm to check Pareto efficiency under general constraints. As an application of our results to prioritized allocations, we discuss Pareto improving the deferred acceptance algorithm.


Saturday, May 25, 2024

Size is important in liver exchange

 Liver exchange has a lot in common with kidney exchange, in the sense that the issues involved in forming cycles and chains once you know which donors are compatible with which patients are very similar.  But a big difference is what constitutes a compatible donor: for livers, size (of the donor, and the donor liver) is very important, sensitively so.

Here's a paper forthcoming in the American Journal of Transplantation, by a team of transplant physicians and economists (with kidney exchange experience), on the importance of size.

"Enhanced Role of Multi-Pair Donor Swaps in Response to Size Incompatibility: The First Two 5-Way and the First 6-Way Liver Paired Exchanges" by Sezai Yilmaz, MD, FACS, Tayfun Sönmez, PhD, M. Utku Ünver, PhD, Volkan Ince, MD, Sami Akbulut, MD, PhD, FACS, Kemal Baris Sarici, MD, and Burak Isik, MD, American Journal of Transplantation, Brief communication, in press.

Abstract: A significant portion of liver transplantations in many countries is conducted via living-donor liver transplantation (LDLT). However, numerous potential donors are unable to donate to their intended recipients due to factors such as blood-type incompatibility or size incompatibility. Despite this, an incompatible donor for one recipient may still be a viable donor for another patient. In recent decades, several transplant centers have introduced liver paired exchange (LPE) programs, facilitating donor exchanges between patients and their incompatible donors, thereby enabling compatible transplants. Initially, LPE programs in Asia primarily involved ABO-i pairs, resulting in 2-way exchanges mainly between blood-type A and B recipients and donors. This practice has led to a modest 1-2% increase in LDLTs at some centers. Incorporating size incompatibility alongside blood-type incompatibility further enhances the efficacy and significance of multiple-pair LPEs. Launched in July 2022, a single-center LPE program established at Inönü University Liver Transplant Institute in Malatya, Türkiye, has conducted thirteen 2-way, nine 3-way, four 4-way, two 5-way, and one 6-way LPEs until February 2024. In 2023 alone, this program facilitated 64 LDLTs, constituting 27.7% of the total 231 LDLTs performed. This paper presents the world's first two 5-way LPEs and the first 6-way LPE.

*********

Another (not entirely unrelated) domain in which size is important, and exchange involves many pairs, involves the exchange of shells among hermit crabs. See these earlier posts (which included this short video):

xx

Saturday, July 21, 2012

Friday, May 24, 2024

NRMP Board of Directors (2020-2024), and a 40th anniversary

 This bit of glass marks the end of my term on the National Resident Matching Program (NRMP) Board of Directors.



One of the issues that consumed a lot of attention during my term is discussed in this post:

Friday, April 21, 2023

Transition from medical school to residency: defending the parts that work well (namely the NRMP Resident Match)




And here are all my posts about residents and fellowsgoing back to the beginning of this blog in 2008. (It's been interesting watching medical specialties begin to develop signaling in ways  reminiscent of signaling in the Economics job market, to deal with congestion of interviews and applications.*)

My first paper dealing explicitly with The Match suddenly seems to have been published 40 years ago:
Roth, A.E. "The Evolution of the Labor Market for Medical Interns and Residents: A Case Study in Game Theory", Journal of Political Economy, Vol. 92, 1984, 991‑1016. http://web.stanford.edu/~alroth/papers/evolut.pdf 

And the main report (with Elliott Peranson) of our redesign of The Match is now a quarter of a century old:
Roth, A.E. and E. Peranson, "The Redesign of the Matching Market for American Physicians: Some Engineering Aspects of Economic Design,” American Economic Review, 89, 4, September, 1999, 748-780. https://www.aeaweb.org/articles?id=10.1257/aer.89.4.748

*See yesterday's post for some discussion of market design interventions in job markets.

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


Thursday, May 16, 2024

Increasing the supply of transplantable organs, in the long term, and sooner.

 Here's an article on the website of The American Council on Science and Health, on technologies that might eventually replace the need for human organ transplants, and on policies to increase their supply while still needed.

We Urgently Need More Organs For Transplantation. Science And Policy Can Come To The Rescue. By Henry I. Miller, MS, MD and Sally Satel, MD

"Both scientific and policy advancements could provide desperately needed organs for transplantation. For example, there have been some promising early studies using kidneys from pigs genetically engineered to prevent rejection, but a policy change – paying human donors for donating organs – could be implemented immediately and would be a game changer.

...

"[A] sector of medicine that desperately needs breakthroughs is the transplantation of solid organs, which are in severely short supply. Currently, more than 100,000 Americans are waiting for transplants, and due to a shortage of hearts, lungs, livers, and kidneys, at least 17 die each day. Donor organs — from a living person or cadaver — must match the rejection recipient’s tissue type and size; they are often not perfect. By one estimate, approximately half of transplanted organs are rejected by recipients’ bodies within 10-12 years, despite a constantly expanding understanding of what causes rejection. Another obstacle is that the organ procurement system in the U.S. is inefficient, inconsistent, and unaccountable – in short, a mess that causes preventable deaths.

"We are making progress, but too slowly. Two new high-tech approaches to providing organs for transplantation might ultimately both eliminate the need for organ donors and reduce the risk of tissue rejection. And there is also a low-tech approach that would require only a tweak in healthcare policy.

"Organs produced by 3D bioprinting"

...

"Organs from genetically modified pigs"


...

"The low-tech policy approach

"Although friends and relatives and even the occasional “good Samaritan” donor can donate kidneys, they must be given without compensation. Under section 301(a) of the National Organ Transplant Act of 1984 (NOTA), it is a federal crime for “any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce.”  Therefore, we propose a federal tax credit for living donors willing to save the life of a stranger. The value of the reward should be between $50,000 and $100,000, which physicians and others who endorse donor compensation believe would be sufficient to address the organ shortage. An economic analysis published in 2022 estimated that a reward of $77,000 could encourage sufficient donations to save 47,000 patients annually.

"The credit would be universally available—refundable in cash for people who do not owe income tax, not phased out at high-income levels, and available under the alternative minimum tax. NOTA’s restriction on payments by organ recipients and other private individuals and organizations would not change—it would still be illegal for recipients to buy organs.

"A qualified organ donation would be subject to stringent safeguards. As all donors are now, prospective compensated donors would be carefully screened for physical and emotional health. A minimum six-month waiting period before the donation would filter out impulsive donors and donations by financially desperate individuals seeking instant cash.

"In addition to saving lives, the credit would save the government money, perhaps as much as $14 billion per year, by reducing expenditures on dialysis. Thus, donors would receive financial compensation from the government for contributing to the public good and bearing the risk of a surgical operation to remove the organ.

"This would be a compassionate and pragmatic policy. Moreover, it could be implemented immediately, rapidly clearing much of the backlog of Americans waiting for organs in advance of the longer-term high-tech approaches.

"The organ shortage kills thousands of Americans every year. We must do all we can to alleviate it now."


HT: Frank McCormick

Wednesday, May 15, 2024

Interviews with school choice stakeholders

 Here's a paper about school choice in New Orleans, organized around interviews with New Orleans "Experts and Administrators" on the one hand and "Activists and Educators" on the other. 

Akchurin, Maria, and Gabriel Chouhy. "Designing Better Access to Education? Unified Enrollment, School Choice, and the Limits of Algorithmic Fairness in New Orleans School Admissions." Qualitative Sociology (2024): 1-43.

Abstract: "Economic sociologists have long recognized that markets have moral dimensions, but we know less about how everyday moral categories like fairness are reconciled with competing market principles like efficiency, especially in novel settings combining market design and algorithmic technologies. Here we explore this tension in the context of education, examining the use of algorithms alongside school choice policies. In US urban school districts, market design economists and computer scientists have applied matching algorithms to build unified enrollment (UE) systems. Despite promising to make school choice both fair and efficient, these algorithms have become contested. Why is it that algorithmic technologies intended to simplify enrollment and create a fairer application process can instead contribute to the perception they are reproducing inequality? Analyzing narratives about the UE system in New Orleans, Louisiana, USA, we show that experts designing and implementing algorithm-based enrollment understand fairness differently from the education activists and families who use and question these systems. Whereas the former interpret fairness in narrow, procedural, and ahistorical terms, the latter tend to evaluate fairness with consequentialist reasoning, using broader conceptions of justice rooted in addressing socioeconomic and racial inequality in Louisiana, and unfulfilled promises of universal access to quality schools. Considering the diffusion of “economic styles of reasoning” across local public education bureaucracies, we reveal how school choice algorithms risk becoming imbued with incommensurable meanings about fairness and justice, compromising public trust and legitimacy. The study is based on thirty interviews with key stakeholders in the school district’s education policy field, government documents, and local media sources."


"Designing and implementing algorithm-based UE systems entails complex moral and political considerations, including questions about how to operationalize what is fair when giving priority to some students over others. The designers and supporters of these systems argue that, by automating and randomizing assignments to oversubscribed schools, UE algorithms are not only efficient, but also impartial and, therefore, value-neutral. Yet as policy instruments, their use is explicitly predicated on normative grounds: centralized enrollment platforms seek to make choice more transparent and fair, which in practice means weakening the influence of social privileges in access to educational opportunities. But even if UE systems constitute powerful technologies that deliver simple and efficient enrollment across the board, providing greater access to school choice, is it possible that they still end up eroding public trust and contributing to the perception they are reproducing inequality? And if so, why?

,,,

"We argue that a crucial reason why technically irreproachable policy instruments like UE algorithms may fall short of eliciting sufficient moral consensus and become enmeshed in political disputes is that core values like fairness are defined and interpreted differently across the contexts where such instruments are created and used.

...

"We examine the multivalent meanings of algorithmic fairness through a study of OneApp, the unified enrollment system developed more than a decade ago in New Orleans, Louisiana (NOLA).Footnote1 Well-known as a national exemplar of market-based school reform, New Orleans is unique in that all the city’s public-school students now attend charter schools, a radical experiment widely celebrated by the school reform movement that has nevertheless elicited heated debate. Our study shows that a paradigmatic clash has emerged between how fairness in the enrollment process is understood “from above” and “from below.” Fairness tends to be interpreted in narrow, procedural, and ahistorical terms by education experts who design and shepherd UE through implementation, even if many do imbue UE with the normative purpose of limiting the influence of social privilege in access to school choice. By contrast, education activists tend to evaluate fairness with consequentialist reasoning and in terms of broader conceptions of justice rooted in addressing the history of socioeconomic and racial inequality in New Orleans, and the unfulfilled promise of access to quality schools for all. From a top-down perspective, then, UE algorithms are seen as a positive step towards making the school system a more equitable marketplace. In this view, an algorithm-based enrollment system plays a critical role in the democratization of choice. Seen from below by those left out, however, the same algorithms legitimize an inherently unjust market system where chance still determines (unequal) access to educational opportunity. Moreover, the fact that parents need to participate in an algorithmic process instead of directly enrolling their kids in a good-quality neighborhood school signals the absence of real equity.

...

"promoting choice options such as charter schools has yielded benefits to both students who enroll in them and—via competitive effects—those who attend schools nearby (Berends 2015; Jabbar et al. 2022) in some (but not all) cases. On the other hand, researchers have also warned that choice policies can exacerbate existing inequalities, insofar as access to valued information, social networks, and resources are crucial for capitalizing on the new opportunities that become available in a more competitive marketplace

...

“market design” is perhaps the specialization area that most enthusiastically embodies the “performative” aspect of economics practice—the idea that economists not only describe markets but also perform them through sociotechnical devices (Caliskan and Callon 2009; Callon 1998; MacKenzie and Millo 2003).  ... For too long, the design of “fair”, “efficient”, and “transparent” UE algorithms has remained a technical matter in the hands of experts, not an object of study worth analyzing from sociological, political, or even philosophical standpoints.

...

"Interviews consisted of a semi-structured component following an interview guide and a component relying on vignettes designed to compare how our interviewees conceptualize fairness across the same four scenarios. After the first part of the interview, we typically took turns reading vignettes aloud and asking the same set of follow-up questions to our respondents. For example, the first scenario describes Malcolm, a hypothetical student whose family uses OneApp to apply to elementary school and he gets his fifth-choice school, which is rated a C. We then ask respondents to evaluate whether Malcolm has been treated fairly, gradually adding new information about his socioeconomic status, racial background, and disability status.

...

"In this study, we do not rely on statistical sampling logic and do not seek to make generalizable claims about perceptions of fairness regarding OneApp among all administrators or all NOLA families using this UE system. Instead, we aim to show how studying an algorithmic tool reveals how experts and community leaders embedded in the same education policy field have different ways of conceptualizing and talking about fairness. 

...

"For instance, when we described the experience of a hypothetical student, Malcolm, whose parents used OneApp to apply to elementary school last year, many respondents rejected the notion of procedural fairness outright. In the scenario, Malcolm and his family had secured a spot in a school with the letter grade C that was their fifth preference. When we asked our respondents whether Malcolm had been treated fairly, one respondent from an education justice organization replied, “No, I don’t think it’s fair and it makes me wonder what is a better way because [the explanation we hear is], ‘We need more quality seats.’ I’m like, ‘Oh really? How are we going to get there?’ Because we want more quality seats” 

#########

The article goes on to point out that the school district hasn't published the algorithm code or flow charts, which adds to suspicions of unfairness.  My inclination is that such things should be in the public domain, which might help the discussion focus on the very different issues of how schools are assigned, and why not all schools are first rate.