An unusual Argentine presidential candidate supports a monetary market for kidneys

 The right-wing Argentine politician,  Javier Milei, who describes himself as an anarcho-capitalist (but who the Washington Post thinks has a chance of becoming Argentina's next president, supports the sale of kidneys for transplantation. (The Buenos Aires Times describes him in general as an "outspoken provocateur.") While the election is only in 2023, this is the first time I have heard of this issue entering any sort of political campaign.

Here's the story in La Nacion, with some excerpts in rough translation by Google:

Javier Milei se manifestó a favor de la venta de órganos tras apoyar la compra libre de armas y denunciar a periodistas: “Es un mercado más”  2 de junio de 2022

"Javier Milei spoke out in favor of the sale of organs after supporting the free purchase of weapons and denouncing journalists: “It is one more market”

"In a week full of controversy for having denounced journalists and supported the free purchase of arms , the national deputy Javier Milei expressed another controversial opinion this morning: he declared himself in favor of the sale of organs . “It is one more market,” said the libertarian, who has already declared himself a presidential candidate for 2023.

"Asked about his position regarding this practice prohibited by law in Argentina, Milei said: “It is one more market and you could think of it as a market. The problem is why everything has to be regulated by the State.

...

"Later, he said that "there is probably something" that leads someone to decide to market their organs and under the assumption that this reason could be, for example, poverty, Milei indicated: "Then we are going to put it in other terms: if not you end up buying that organ, you end up starving and you don't even have a life."

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HT: Julio Elias

Transplant science, transplant politics , and public perception--the case of living-donor livers

 Liver transplants from living donors are on the increase in the U.S., so liver transplants are coming to more closely resemble kidney transplants.  Apparently that comes with some of the politics that I've witnessed involving kidney transplants. At least that's what the article below, by a very large and distinguished set of American authors, seems to be dealing with, in this critique of a paper published in a European journal. (It's unusual to see a question about scientific integrity highlighted in the title of an academic paper...). Apparently the title of the paper being criticized received news coverage unfavorable to transplantation, and not justified by the data being reported.

Emamaullee, J., Heimbach, J.K., Olthoff, K.M., Pomfret, E.A., Roberts, J.P., Selzner, N. and NALLDIG Consortium, 2022. Assessment of long‐term outcomes post living liver donation highlights the importance of scientific integrity when presenting transplant registry data. American Journal of Transplantation, online early,  First published: 30 March 2022 https://doi.org/10.1111/ajt.17045

"Abstract: Living donor liver transplantation has expanded in recent years, particularly in North America. As experience with this procedure has matured over the last 25 years, centers are increasingly faced with potential living donors who are more medically complex. As donors move through the evaluation process, completing the informed consent process continues to be challenged by a paucity of granular data demonstrating long-term outcomes and overall safety specifically in the otherwise ‘healthy’ living liver donor population. Two recently published studies examined long-term outcomes post-living liver donation using Korean registry data and reported similar results, with excellent overall survival when compared to appropriately matched controls. However, the authors of these studies were presented differently, with one reporting an alarmist view based on one aspect of a suboptimal analysis approach using an inappropriate comparator group. Herein, the North American Living Liver Donor Innovation Group (NALLDIG) consortium discusses these two studies and their potential impact on living liver donation in North America, ultimately highlighting the importance of scientific integrity in data presentation and dissemination when using transplant registry data."

"Recently, in the Journal of Hepatology, Choi and colleagues published a noteworthy study of long-term outcomes of Korean living liver donors, titled “Outcomes of living liver donors are worse than those of matched healthy controls.”

...

"Although careful examination of long-term outcomes for living liver donors is essential, and the South Korean population is an excellent population in which to conduct these analyses given the relative frequency of living donor liver transplantation, the current study suffers from a serious design flaw which makes interpretation of the data very challenging, as highlighted in detail in the letter to the editor from the Toronto group.4 Indeed, the Control Group I “heathy population” is actually healthier than the living liver donors given that “the proportion of individuals with Charlson Comorbidity Index ≥1, diabetes, hypertension, or depression in the living liver donor group was higher than that in the matched healthy group (Control Group I).” They then use this heavily weighted (10:1 match) heathier group to demonstrate, unsurprisingly, a subtle but statistically worse outcome in the living liver donor group, hence the title of the paper. 

...

"Unfortunately, both the manuscript title, “Outcomes of living liver donors are worse than those of matched healthy controls” and the lay summary, which is intended for the public at large are highly misleading, given this lack of a matched control group. This leads to confusion and uncertainty not only for those within the medical community but also for prior donors as well as for future potential living donors and their recipients. One may wonder whether these choices were made to drive the sensationalism of the media on this topic particularly in some European countries where practice of LDLT is no longer pursued for a variety of reasons including overall skepticism that the procedure is truly safe for living donors.

...

"Journal editorial boards bear the responsibility of arranging high-quality, expert peer review. The dramatic increase in the volume of manuscripts submissions during COVID-19 pandemic has strained many editorial board members and reviewers, likely resulting in publication of studies of variable rigor.16 In parallel, careful assessment of statistical techniques and interpretation of analyses has become an integral part of the review process. Many journals now employ full-time statistical editors, which has enabled identification of serious flaws in experimental design including insufficient study power, missing data, or inappropriate use of statistical tests or models.17 Editors must also critically assess the power of a provocative manuscript title, as initially it may grab the reader's attention and can bias the reader's interpretation and impression. Journals also must be willing to publish studies even when results are disappointing and/or controversial. The transplant community should continue to carefully assess and respond to any work that may dampen enthusiasm for living donation or living donor liver transplantation."

Practical market design and public policy

 Market designers who want to influence practice have some things in common with makers of public policy. Here are some reflections, in Nature, by Chen Chien-jen, a distinguished epidemiologist who recently finished a term as Vice President of Taiwan.

Taiwan’s pandemic vice-president — from lab bench to public office and back. Successful policy and preparedness require more diverse evidence than researchers often encounter. by Chen Chien-jen

"The first lesson: scientific training teaches us to seek out all the variables that might affect a system. My work as a minister taught me to expand that list of variables far beyond what is typical. Budgets, laws, staffing levels and more enter the picture. So do values and priorities.

...

"The second lesson: science is never enough to bring about a thriving society. That takes trust, robust institutions and social cohesion. 

...

"The third lesson: infectious and toxic agents have impacts that last for decades, so long-range investments in scientific infrastructure pay off. But action must be quick.

...

"For treatments to be effective, patients must receive them, which depends on where they are offered, what patients have to pay and what makes them inconvenient and uncomfortable."

Radical content on YouTube, in PNAS

 Here's a paper in PNAS which finds that YouTube viewing of politically radical content reflects viewers' other web behavior, rather than being driven by the YouTube recommender system.

Examining the consumption of radical content on YouTube by Homa Hosseinmardi,  Amir Ghasemian,   Aaron Clauset,   Markus Mobius,   eDavid M. Rothschild, and   Duncan J. Watts. 

PNAS August 10, 2021 118 (32) e2101967118; https://doi.org/10.1073/pnas.2101967118

Abstract: Although it is under-studied relative to other social media platforms, YouTube is arguably the largest and most engaging online media consumption platform in the world. Recently, YouTube’s scale has fueled concerns that YouTube users are being radicalized via a combination of biased recommendations and ostensibly apolitical “anti-woke” channels, both of which have been claimed to direct attention to radical political content. Here we test this hypothesis using a representative panel of more than 300,000 Americans and their individual-level browsing behavior, on and off YouTube, from January 2016 through December 2019. Using a labeled set of political news channels, we find that news consumption on YouTube is dominated by mainstream and largely centrist sources. Consumers of far-right content, while more engaged than average, represent a small and stable percentage of news consumers. However, consumption of “anti-woke” content, defined in terms of its opposition to progressive intellectual and political agendas, grew steadily in popularity and is correlated with consumption of far-right content off-platform. We find no evidence that engagement with far-right content is caused by YouTube recommendations systematically, nor do we find clear evidence that anti-woke channels serve as a gateway to the far right. Rather, consumption of political content on YouTube appears to reflect individual preferences that extend across the web as a whole.

"Our data are drawn from Nielsen’s nationally representative desktop web panel, spanning January 2016 through December 2019 (SI Appendix, section B), which records individuals’ visits to specific URLs. We use the subset of N = 309,813 panelists who have at least one recorded YouTube pageview. Parsing the recorded URLs, we found a total of 21,385,962 watched-video pageviews (Table 1). We quantify the user’s attention by the duration of in-focus visit to each video in total minutes (32)."

Economists support Andreu Mas-Colell

 In El Pais (plus Google translate):

33 premios Nobel de Economía y otros 20 destacados economistas escriben en defensa de Andreu Mas-Colell. Los expertos internacionales muestran con un artículo conjunto su solidaridad con el profesor y exconsejero catalán investigado por el Tribunal de Cuentas

[33 Nobel Laureates in Economics and 20 other leading economists write in defense of Andreu Mas-Colell.  With a joint article, international experts show their solidarity with the professor and former Catalan councilor investigated by the Court of Auditors]

The letter ends with:

"We hope the situation clears up promptly. We also hope that, in the absence of specific charges against him, the Court of Auditors will avoid unwanted and unfair consequences for Professor Mas-Colell."

"The letter is signed by Philippe Aghion, George Akerlof *, Manuel Arellano, Orazio Attanasio, Robert Aumann *, Abhijit Banerjee *, Richard Blundell, Partha Dasgupta, Angus Deaton *, Eddie Dekel, Mathias Dewatripont, Peter Diamond *, Esther Duflo *, Eugene Fama *, Ernst Fehr, Drew Fudenberg, Jordi Galí, Pinelopi Goldberg, Jean-Michel Grandmont, Rachel Griffith, Lars Hansen *, Oliver Hart *, James Heckman *, Elhanan Helpman, Bengt Holmstrom *, Dale Jorgenson, Daniel Kahneman *, Mervyn King, Michael Kremer *, Finn Kydland *, Eric Maskin *, Daniel McFadden *, Robert Merton *, Paul Milgrom *, Stephen Morris, Roger Myerson *, Edmund Phelps *, Christopher Pissarides *, Paul Romer *, Alvin Roth *, Myron Scholes *, Amartya Sen *, Robert Shiller *, Christopher Sims *, Robert Solow *, Hugo Sonnenschein, Michael Spence *, Joseph Stiglitz *, Guido Tabellini, Richard Thaler *, Jean Tirole *, Robert Wilson * and Fabrizio Zilibotti.

"Names with an asterisk are Nobel laureates in economics."

***********

Some background here:

Tuesday, June 15, 2021

Crisis in Catalonia, and Andreu Mas-Colell

Crisis in Catalonia, and Andreu Mas-Colell

 Catalonia's crisis has been in the news again, with different parts of the Spanish government taking different views about reconciliation.  Here's one story, from the Guardian:

Spanish right rallies against plans to pardon Catalan separatists.  Protest at Plaza de Colón in Madrid draws 25,000 people, including leaders of three rightwing parties. by Sam Jones

But outside of any news stories I've seen, there is a set of administrative actions that threaten a variety of Catalan people who have had public service jobs, including a number of economists, among them one of the world's leading economic theorists, Andreu Mas-Colell.

On twitter, his son, the economist Alex Mas, tells some of the alarming story: https://twitter.com/AlexMasPton/status/1404438475408035845

Alex Mas @AlexMasPton

"Normally I would not be posting personal developments on this website, but in this case I have a pressing concern. My dad, Spanish economist Andreu Mas-Colell, is dealing with an incredibly difficult and unjust situation.  1/

"In two weeks my parents home, his pension and his bank account may be seized by state authorities, without due process. This has to do with events in Catalonia over the last few years. That’s a lot to digest, so let me give some background.

"Following the global financial crisis my dad was called on to head the department in charge of finance and the budget in the government of Catalonia to help in the recovery from one of the worst recessions in history.

"He left his comfortable position as Secretary General of the European Research Council to take on this challenge. This was not surprising. He has been committed to public service from well before leaving Harvard in 1995 to help establish a new university in Barcelona.

"After my dad retired from public service in 2015, a new government formed. Catalonia then underwent a period of turmoil precipitated by a referendum for independence in October 2017.

...

"My dad did not have anything to do with the organization of the referendum, or the events that transpired. He has been living a retired life for years. And now, a full six year after retirement, he has been targeted for severe financial punishment.

"Last month, a politicized, non-judicial “tribunal” of controllers (“Tribunal de Cuentas”) made personally responsible 39 former government officials for the bulk of the expenses (back to 2011) of an entire section of the Catalan government: that concerned with foreign relations.

"The claim is that the Catalan government used public funds to promote Catalan independence, and specifically the 2017 referendum, abroad.

"What's my dad’s connection? The 18,000+ page document of accusations he was sent, and given ten days to respond to in writing (his only chance to defend himself in all this), does not specify.

"Though not stated, he seems to be targeted because he was, in the last resort, responsible for implementing the budgets voted on by parliament. It appears that for that he is now being held personally liable for a total amount that may add up to tens of millions of dollars.

"In what I understand is highly unusual, a member of the tribunal issued a written dissent against the decision. She says that the tribunal was not impartial, the decision was based on unproven allegations and contains exaggerations.

...

 "There will be no trial. There is simply a penalty that is handed down. The appeals will take years and can reach the EU Courts of Human Rights, but the neat trick is that in the meantime the accused will have to put up a guarantee for the full amount requested.

"Because the penalty could far exceed the combined net worth of all targeted individuals, they could have *all* of their personal property, assets and income seized. It will be complete and arbitrary expropriation. Without due process.

"This administrative body has taken this action in past cases.

...

"The penalties will be levied on June 29, coincidentally the day of his 77th birthday. Before then the best thing we can do is raise awareness. If you are able, I would be grateful if you can share what is going on with others, on social media or simply in real life. Thank you."

***********

Here's a related story, for which Google Translate works reasonably well:

https://www.lavanguardia.com/politica/20210512/7449503/consejera-tribunal-cuentas-cree-informe-diplocat-imparcial.html

***********

Professor Dora Costa has started a petition of support on Change.org, here http://chng.it/NkLRKvszpF

Electricity supply and electricity politics in Texas--an interview with Peter Cramton

 The veteran market designer Peter Cramton was among the members of the Board of Directors of the Electric Reliability Council of Texas (ERCOT) who live outside of Texas and were asked to resign last week, following the winter storm that left many Texans without power, or with unexpected, very high electricity bills. ERCOT is the independent system operator, charged with running the network minute to minute.  

He's interviewed by Texas Public Radio:

Former ERCOT Board Member Says ‘Toxic Politics’ Spurred Resignations After Texas Grid Failure  Texas Public Radio | By Dominic Anthony Walsh

"Peter Cramton is an economics professor at the University of Cologne and the University of Maryland. He has expertise and experience in complex market designs, including electricity and radio spectrum markets. He served as an “independent director” on the board of the Electric Reliability Council of Texas (ERCOT) from 2015 until last week.

"At his final board meeting, he said, “ERCOT was flying a 747. It had not one, but two engines experience catastrophic failure. (ERCOT) then flew the damaged plane for 103 hours before safely landing in the Hudson. In my mind, the men and women in the ERCOT control room are heroes.”

Here are some bits of the interview:

Dominic Walsh: Could you help me understand your role as an “independent director?” And does it make sense for some of the independent directors to live out of state? There's a lot of controversy around that.

Peter Cramton: What’s unusual is that we have a hybrid board that consists of “affiliated directors” that are affiliated with a particular stakeholder group. There's complete transparency on that, who they're affiliated with. And it is completely balanced. There are four affiliated directors representing the supply side, and there are four affiliated directors representing the demand side. So those are the two sides of almost every market — supply and demand, production and consumption — and there is a perfect balance. Then there's the “independent directors.” There's five independent directors, and the independent directors can have no association with either side of the market. The challenge with independent directors is: It's hard to find people that have the technical expertise, and (are) independent of the market participants. Now, here's the problem: So, one natural thing is you could say, "Well, you know, it's important that the directors live in Texas." Well, then you’d just be imposing another constraint. So, if we say, "OK, now you have to be independent from all market participants. You have to live in Texas. And you have to be an expert in a highly technical industry…" The reality is it's going to be very difficult to find people that fill all of these.

Walsh: So far, you've described a bunch of advocates for various sectors, and a bunch of experts. It sounds slightly more technocratic than democratic. So, where is the accountability to the public — the democratic element of the board?

Cramton: Absolutely. So, it's critically important. And that is the Public Utility Commission of Texas. So, there's a Public Utility Commission that consists of three commissioners, and they provide that oversight. And in fact, that oversight is incredibly important. So, for example, it's the Public Utility Commission that is responsible for the more delicate decisions that are made in the market. And the Public Utility Commission has oversight over all the market rules. What about a renegade Public Utility Commission? You know, who's watching them? Well, who's watching them: that's the legislature and the governor. The commissioners serve largely for the governor and legislature. And if they're doing something that the governor, the legislature does not like, then the governor and legislature can take action to replace the commissioners or whatever other action they want. So that's the continued hierarchy in this governance structure, and that's all within Texas.

Walsh: Why did you resign? It sounds like you're a big fan of ERCOT and their mission. It sounds like you think ERCOT performed well throughout this. Why did you and other members of the board ultimately resign?

Crampton: We resigned, in short, because the politics are toxic right now. The governor and legislature suggested that we resign. And we basically took him up on that. And so that is the reason that we resigned. So, I think the best way to put it is: We were on the boat. And we were — we didn't leave the sinking ship. We were thrown off the boat. But we're all good swimmers, so I'm sure we'll all do just fine. And quite frankly, because of the toxic politics, we're not the ones that are — for me, I'm a professor. I'm an expert in electricity market design. And I'm not an expert in delicate politics.

***************

Here's a story from the Texas Monthly on the Texas power grid that also discusses some of the political players:

The Texas Blackout Is the Story of a Disaster Foretold.  Those in charge of Texas’s deregulated power sector were warned again and again that the electric grid was vulnerable.  by Jeffrey Ball

Senate Finance Committee subpoenas UNOS

 There's a new sheriff in town in Washington, and Congress is taking note by investigating UNOS, the United Network for Organ Sharing, which is in charge of administering the allocation of deceased organs for transplant.

The United States Senate Committee on Finance yesterday issued the following announcement:

Grassley, Wyden Subpoena the United Network for Organ Sharing as part of Continued Investigation into U.S. Organ Transplant System

Washington – Senate Finance Committee leaders Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) yesterday issued a subpoena to the United Network for Organ Sharing (UNOS), compelling production of documents related to the committee’s investigation of organ procurement organizations (OPOs), and potential false claims submitted to government benefit programs. The Committee determined that issuing a subpoena was necessary in order to receive full and complete production from UNOS.

 

Senators Grassley and Wyden issued the following joint statement:

 “We have serious concerns related to UNOS’ role in overseeing our nation’s OPOs, which have been severely underperforming for decades. Our review has shed light on the improper use of Medicare funds, conflicts of interest and gaps in oversight. UNOS has served as the federal government’s contractor, without competition, since 1986, and is responsible for overseeing the Organ Procurement and Transplantation Network established by Congress. UNOS has indicated they will comply with the subpoena and we look forward to continuing our inquiry.”

 "Senate Finance Committee members began inquiries into organ procurement organizations and UNOS, nearly a year ago. Reports have also detailed various gaps and conflicts in UNOS management of the organ donation system, resulting in a failure to properly ensure an effective system operating on behalf of patients across the country.

 "In November 2020, the Department of Health and Human Services (HHS) issued a Final Rule to impose new transparency guidelines on OPOs. Racial equity experts have lauded these OPO reforms, highlighting that OPOs often provide substandard care to patients of color. And given expert projections that COVID-19 may severely increase the demand for kidney transplants in the coming years, it is more important than ever to ensure the OPO system is functioning effectively and in patients’ interests. 

Forbes interviews Jennifer Erickson on organ donation

 I met Jennifer Erickson when she was at the White House Office of Science and Technology Policy during the Obama administration, and helped organize the White House Organ Summit in 2016.

Here's a story about her in Forbes:

Why Ending The Organ Donation Waitlist Can Save Countless Lives And Billions Of Dollars  by Rob Dube

“You have no budget,” Jennifer’s boss told her. “What you do have is your desk, a phone, and a period of time where people will take your call. You’re here to hustle. You’re here to make something happen for people around the country.

...

"After speaking with experts, Jennifer chose to focus on ending the waitlist for organ transplants. She was drawn in by the enormous problems within the United States’ current organ donation system. The U.S. has the research, resources, and expertise. Yet, “tens of thousands of organs go unrecovered every year!” says Jennifer. “That’s nuts!”

...

"Once the research was compiled, Jennifer found startling information. She uncovered “really troubling issues with inequality,” Jennifer says. Too often, low-income citizens and people of color were left out-of-loop both as donors and recipients. “Research shows that Black families are less likely to be approached about organ donation, and talked to less about it when they actually are.” 

"And although saving lives is always at the forefront of her mind, Jennifer learned how much money the U.S. could save by ending the organ transplant waitlist. “For every patient who gets a kidney transplant,” Jennifer says, “We save a quarter of a million dollars. 

"Most people care more about saving lives—but what an opportunity to save tens of billions a year while helping Americans at the same time. It’s huge, exciting, and we have every reason to get it right.”

"The conversation with Jennifer Erickson continues on the Leading with Genuine Care podcast. "

HT: Frank McCormick

**********

Related post:

Monday, January 13, 2020

The organization of organ donation: Jennifer Erikson and Abe Sutton call for an Office of Organ Policy

Why I have signed election day letters

 I am a reluctant letter signer, but this election season I have signed two open letters.  My reluctance stems in part from the fact that, when I am one among many who sign a letter, I'm often prominently mentioned in the resulting news stories, even though my expertise on the subject of the letter is no more than the other signers.

But, we are entering on an important election, and I'm a concerned citizen.  So, I let myself be counted (even if over-counted), and when asked to explain, I sometimes feel moved to respond.

Here's the latest, from Business Insider:

More than 1,000 economists have now signed letter urging voters to reject 'reckless and selfish' Trump on Election Day. Alvin Roth, a Nobel winner, tells us why he's among them.

by Kate Duffy.

"As of Friday, 1,027 prominent economists from major institutions across America, including numerous Nobel winners, had signed the open letter, which is being updated until Election Day.

"The number of signatures has increased by more than 300 since last Friday, when it was first created.

"Alvin Roth, who shared the Nobel Memorial Prize in Economic Sciences in 2012, told Business Insider he signed the letter because he was "concerned that some voters might believe President Trump's essentially false claims that his careless stewardship has been good for the US economy."

"Roth said: "That certainly isn't the view of those who study these things. Letters like this may also help many people know that they are not the only ones to notice that the current president is trying to keep us divided and misinformed." He added that "democracy depends on reliable information, and the letter was meant to provide some of that."

...

"Roth, an economics professor at Stanford University, believes the re-election of Trump could severely damage the US economy. ...economic progress in the US is made through working with trading partners, he said.  

"But "President Trump prefers trade wars, with government subsidies to help staunch the bleeding in those parts of the economy that are harmed," such as the damage to American overseas agricultural markets, Roth added.

"Roth said that if Biden were elected as president, he would most likely appoint advisors who have knowledge in their areas of responsibility, and could therefore "restore America's relations with our allies and trading partners."

"Biden's tax and economic policies will not aim to benefit only the wealthiest Americans and political supporters, according to Roth, who emphasized how divided the country he believes the country is."

*******************

Related posts:

Monday, October 26, 2020

Vote! Here's another open letter, this one from business school professors

 Open letters are in season, and I've signed another one.  You can too, at the link.

It’s Time for America’s Business Leaders to Speak Out Against the Threat Trump Poses to Our Republic

Thursday, October 22, 2020

Open letter by economists opposing re-election of current U.S. president

 Open Letter: 690 Economists Oppose Trump's Re-Election

Don't forget to vote.

Vote! Here's another open letter, this one from business school professors

 Open letters are in season, and I've signed another one.  You can too, at the link.

It’s Time for America’s Business Leaders to Speak Out Against the Threat Trump Poses to Our Republic

An Open Letter & Call for Action - Signed by Business School Professors from Across America
Click here to add your name.

*************

Related recent post

Thursday, October 22, 2020

Open letter by economists opposing re-election of current U.S. president

 Open Letter: 690 Economists Oppose Trump's Re-Election (850 last time I checked)

Open letter by economists opposing re-election of current U.S. president

 Open Letter: 690 Economists Oppose Trump's Re-Election

Don't forget to vote.

********

update: 932 economists the last time I checked.

How King Uzziah became corrupt and was stricken with Covid and quarantined (II Chronicles 26)

Chronicles II chapter 26 describes how King Uzziah became corrupt and power hungry, so that the Lord infected him with the untranslatable disease that the Chronicler called "zaraath," which required him to be quarantined for the rest of his life.

Here it is, starting from verse 16.
 

And when he became strong, his heart became haughty until he became corrupt, and he trespassed against the Lord his God, and he came into the Temple of the Lord to burn incense on the altar of incense.		טזוּכְחֶזְקָת֗וֹ גָּבַ֚הּ לִבּוֹ֙ עַד־לְהַשְׁחִ֔ית וַיִּמְעַ֖ל בַּֽיהֹוָ֣ה אֱלֹהָ֑יו וַיָּבֹא֙ אֶל־הֵיכַ֣ל יְהֹוָ֔ה לְהַקְטִ֖יר עַל־מִזְבַּ֥ח הַקְּטֹֽרֶת:
17And Azariah the priest came after him, and ,with him were priests of the Lord, eighty mighty men.		יזוַיָּבֹ֥א אַֽחֲרָ֖יו עֲזַרְיָ֣הוּ הַכֹּהֵ֑ן וְעִמּ֞וֹ כֹּֽהֲנִ֧ים| לַֽיהֹוָ֛ה שְׁמוֹנִ֖ים בְּנֵי־חָֽיִל:
18And they stood beside Uzziah the king and said to him, "It is not for you, Uzziah, to burn incense to the Lord, but for the priests, sons of Aaron, who are consecrated to burn [incense]. Leave the Sanctuary, for you have trespassed, and it will not be glory for you from the Lord God."		יחוַיַּֽעַמְד֞וּ עַל־עֻזִּיָּ֣הוּ הַמֶּ֗לֶךְ וַיֹּ֚אמְרוּ לוֹ֙ לֹֽא־לְךָ֣ עֻזִּיָּ֗הוּ לְהַקְטִיר֙ לַֽיהֹוָ֔ה כִּ֣י לַכֹּֽהֲנִ֧ים בְּנֵי־אַֽהֲרֹ֛ן הַֽמְקֻדָּשִׁ֖ים לְהַקְטִ֑יר צֵ֚א מִן־הַמִּקְדָּשׁ֙ כִּ֣י מָעַ֔לְתָּ וְלֹֽא־לְךָ֥ לְכָב֖וֹד מֵֽיְהֹוָ֥ה אֱלֹהִֽים:
19And Uzziah became furious, and in his hand was a censer to burn, and in his fury with the priests, the zaraath shone upon his forehead before the priests in the House of the Lord, over the altar of incense.		יטוַיִּזְעַף֙ עֻזִּיָּ֔הוּ וּבְיָד֥וֹ מִקְטֶ֖רֶת לְהַקְטִ֑יר וּבְזַעְפּ֣וֹ עִם־הַכֹּֽהֲנִ֗ים וְ֠הַצָּרַעַת זָֽרְחָ֨ה בְמִצְח֜וֹ לִפְנֵ֚י הַכֹּֽהֲנִים֙ בְּבֵ֣ית יְהֹוָ֔ה מֵעַ֖ל לְמִזְבַּ֥ח הַקְּטֹֽרֶת:
20And Azariah, the chief priest, and all the priests, turned to him, and behold he was stricken with zaraath on his forehead; so they rushed him out of there, and he too hastened to leave, for the Lord had smitten him.		כוַיִּ֣פֶן אֵלָ֡יו עֲזַרְיָהוּ֩ כֹהֵ֨ן הָרֹ֜אשׁ וְכָל־הַכֹּֽהֲנִ֗ים וְהִנֵּה־ה֚וּא מְצֹרָע֙ בְּמִצְח֔וֹ וַיַּבְהִל֖וּהוּ מִשָּׁ֑ם וְגַם־הוּא֙ נִדְחַ֣ף לָצֵ֔את כִּ֥י נִגְּע֖וֹ יְהֹוָֽה:
21And King Uzziah was stricken with zaraath until the day of his death, and he lived in a house of retirement, for it had been decreed from the House of the Lord,

HT: Aviya Kushner in the Forward

Becky Morton, RIP

 Becky Morton has passed away after a short illness. She was a pioneer in bringing experimental methods to political science, as an individual investigator, an editor and journal founder, textbook writer, and as an institution builder, who made NYU Abu Dhabi a center of experimental work.

Here's the announcement from NYU:

Mourning the Passing of Rebecca Morton September 27, 2020

"She was an extraordinary academic leader for the development of research and teaching in the social sciences at NYUAD, serving as Associate Dean of Faculty Affairs and Development, Program Head of Political Science, and Global Network Professor of Politics and Economics. Becky was the founding Director of the Social Science Experimental Laboratory at NYUAD, one of her proudest creations. Her unfailing commitment to nurturing early career scholars was epitomized in the postdoctoral program in the social science division, which she led as director until the beginning of fall. Becky’s intellectual engagement with colleagues, students, and our postdoctoral fellows helped forge a lively and successful research community in social science.

"Becky Morton was an outstanding scholar whose work ranged across economics and political science. Committed to interdisciplinary inquiry, she was the author and co-author of four books and numerous articles in prominent economics and political science journals, such as the American Economic Review, American Journal of Political Science, American Political Science Review, Journal of Law and Economics, Journal of Politics, and Review of Economic Studies."

*******

Here's one of her books:

Experimental Political Science and the Study of Causality: From Nature to the Lab"         By Rebecca B. Morton, Kenneth C. Williams

Here's her editor's introduction to the first issue of the Journal of Experimental Political Science, in 

Welcome to JEPS!,  Journal of Experimental Political Science,Volume 1, Issue 1, Spring 2014 , pp. 1-5, by Rebecca B. Morton  Joshua A. Tucker

In short, she was a force for experiments in political science, despite having a Ph.D. in Economics (and, as I recall, drinking Coke for breakfast).

A modest proposal for the design of presidential debates

 1. Turn off the microphone of whoever isn't supposed to be speaking.

Politics and medicine, at Stanford and in Washington--an open letter from Stanford docs about corona virus policies

 Politics and medicine can combine poorly, particularly in a politicized pandemic.

Here's an open letter from over a hundred faculty at Stanford's Medical school, disowning the positions about pandemic policies taken by one of their former colleagues, now in Washington, by way of Fox News. (Here's the letter in full; to see the signatories click on the link...)

An Open Letter from Stanford Doctors [Update: the letter has been taken down from the Stanford medicine website, but here is another copy...]

"As infectious diseases physicians and researchers, microbiologists and immunologists, epidemiologists and health policy leaders, we stand united in efforts to develop and promote science-based solutions that advance human health and prevent suffering from the coronavirus pandemic. In this pursuit, we share a commitment to a basic principle derived from the Hippocratic Oath: Primum Non Nocere (First, Do No Harm).

"To prevent harm to the public’s health, we also have both a moral and an ethical responsibility to call attention to the falsehoods and misrepresentations of science recently fostered by Dr. Scott Atlas, a former Stanford Medical School colleague and current senior fellow at the Hoover Institute at Stanford University. Many of his opinions and statements run counter to established science and, by doing so, undermine public-health authorities and the credible science that guides effective public health policy. The preponderance of data, accrued from around the world, currently supports each of the following statements:

●  The use of face masks, social distancing, handwashing and hygiene have been shown to substantially reduce the spread of Covid-19. Crowded indoor spaces are settings that significantly increase the risk of community spread of SARS-CoV-2.

●  Transmission of SARS-CoV-2 frequently occurs from asymptomatic people, including children and young adults, to family members and others. Therefore, testing asymptomatic individuals, especially those with probable Covid-19 exposure is important to break the chain of ongoing transmission.

●  Children of all ages can be infected with SARS-CoV-2. While infection is less common in children than in adults, serious short-term and long-term consequences of Covid-19 are increasingly described in children and young people.

●  The pandemic will be controlled when a large proportion of a population has developed immunity (referred to as herd immunity) and that the safest path to herd immunity is through deployment of rigorously evaluated, effective vaccines that have been approved by regulatory agencies.

●  In contrast, encouraging herd immunity through unchecked community transmission is not a safe public health strategy. In fact, this approach would do the opposite, causing a significant increase in preventable cases, suffering and deaths, especially among vulnerable populations, such as older individuals and essential workers.

"Commitment to science-based decision-making is a fundamental obligation of public health policy. The rates of SARS-CoV-2 infection in the US, with consequent morbidity and mortality, are among the highest in the world. The policy response to this pandemic must reinforce the science, including that evidence-based prevention and the safe development, testing and delivery of efficacious therapies and preventive measures, including vaccines, represent the safest path forward. Failure to follow the science -- or deliberately misrepresenting the science – will lead to immense avoidable harm.

"We believe that social and economic activity can reopen safely, if we follow policies that are consistent with science. In fact, the countries that have reopened businesses and schools safely are those that have implemented the science-based strategies outlined above.

"As Stanford faculty with expertise in infectious diseases, epidemiology and health policy, our signatures support this statement with the hope that our voices affirm scientific, medical and public health approaches that promote the safety of our communities and nation."

*******

Here's a recent NY Times story on Dr. Atlas, a radiologist:

A New Coronavirus Adviser Roils the White House With Unorthodox Ideas

Dr. Scott Atlas arrived at the White House as a coronavirus contrarian, questioning controls like masks. He has angered top health officials while pushing a suite of disputed policy prescriptions.

By Noah Weiland, Sheryl Gay Stolberg, Michael D. Shear and Jim Tankersley,  Sept. 2, 2020

"Before joining the task force, Dr. Atlas pitched his ideas as a health commentator on Fox News, which is in part how he attracted Mr. Trump’s attention. His arrival at the White House has coincided with less visible roles for Dr. Birx and Dr. Fauci, the director of the National Institute for Allergy and Infectious Diseases."

**********

Of course, medicine isn't the only kind of science that has been caught up in Washington lately. (I write this from smoky California, where climate change seems quite real).

Nor is it the only part of medicine that has been caught up in politics around the world: I'm reminded of yesterday's post about the politics of global health care.  Science seems to be slowly gaining on politics there, and so I'm hopeful that's a general trend, although sometimes slow and uneven, with a high ratio of heat to light.

Global Kidney Exchange supported by the European Society of Transplantation's committee on Ethical, Legal, and Psychosocial Aspects of Transplantation .

Quite some time ago, the European Society for Organ Transplantation (ESOT) charged its committee on Ethical, Legal, and Psychosocial Aspects of Transplantation (ELPAT) with the task of evaluating those aspects of global kidney exchange (GKE). GKE had been greeted in some quarters with a number of dramatic accusations (e.g. that it was a form of organ trafficking), and the ELPAT committee tried to consider each of them.  Interestingly, the committee included members who I surmise started with a wide range of views, from cautious support to active hostility to GKE.

The final report, just published in Transplant International,  (which is the official journal of ESOT) is one that I think the committee can be proud of.  While you can tell that some committee members retain reservations about GKE, they nevertheless all agreed on a report that finds all of the principal objections raised against GKE to be unfounded.  Together with the even more clearly stated support for GKE in the Lancet, I think that this may mark a turning point: it certainly marks that GKE is receiving growing (and well deserved) support. 

Global Kidney Exchange: opportunity or exploitation? An ELPAT/ESOT appraisal
Frederike Ambagtsheer  Bernadette Haase‐Kromwijk  Frank J. M. F. Dor  Greg Moorlock  Franco Citterio  Thierry Berney  Emma K. Massey
Transplant International, September 2020, 33, 9, 989-998.    

https://onlinelibrary.wiley.com/doi/full/10.1111/tri.13630       Here's the pdf

"Summary: This paper addresses ethical, legal, and psychosocial aspects of Global Kidney Exchange (GKE). Concerns have been raised that GKE violates the nonpayment principle, exploits donors in low‐ and middle‐income countries, and detracts from the aim of self‐sufficiency. We review the arguments for and against GKE. We argue that while some concerns about GKE are justified based on the available evidence, others are speculative and do not apply exclusively to GKE but to living donation more generally. We posit that concerns can be mitigated by implementing safeguards, by developing minimum quality criteria and by establishing an international committee that independently monitors and evaluates GKE’s procedures and outcomes. Several questions remain however that warrant further clarification. What are the experiences and views of recipients and donors participating in GKE? Who manages the escrow funds that have been put in place for donor and recipients? What procedures and safeguards have been put in place to prevent corruption of these funds? What are the inclusion criteria for participating GKE centers? GKE provides opportunity to promote access to donation and transplantation but can only be conducted with the appropriate safeguards. Patients’ and donors’ voices are missing in this debate." 

Here's their introduction:

"In 2017, Rees et al. [1] introduced “Global Kidney Exchange” (GKE), an international kidney exchange program that facilitates cross‐border exchanges between immunologically incompatible donor–recipient pairs in high‐income countries (HIC) and biologically compatible but financially impoverished donor–recipient pairs in low‐ to middle‐income countries (LMIC). GKE aims to overcome immunologic barriers in the developed world and poverty barriers in the developing world. The underlying rationale is that financial barriers prevent transplantation much more frequently than organ scarcity. The number of patients dying annually worldwide from end‐stage kidney disease due to inadequate financial resources far exceeds the number of patients in developed countries placed on kidney transplantation waitlists [1-3]. GKE has the potential to expand the genetic diversity of the donor pool which may help to transplant difficult‐to‐transplant, highly immunized patients [1]."

As they debunk the main arguments that have been made against GKE, I thought that some of these remarks were among the most interesting:

"Removing financial barriers to organ donation is an internationally agreed objective, enshrined, among others, in the World Health Organization’s (WHO) Guiding Principles on Human Cell, Tissue and Organ Transplantation and in the CoE Convention [13, 15]. These organizations highlight that prohibition of organ payments does not preclude reimbursing expenses incurred by the donor, including the costs of medical procedures [13, 17]. Given that countries’ legislation vary in their approach to what constitutes illicit payment versus legitimate reimbursement, it is doubtful whether GKE violates the nonpayment principle under all circumstances. For example, the University of Minnesota’s legal team vetted GKE and agreed to proceed. Other hospital legal teams have followed suit [1]."

...

"“[e]xploitation occurs when someone takes advantage of a vulnerability in another person for their own benefit, creating a disparity in the benefits gained by the two parties” [9]. It is hard to see, however, that this description of exploitation can be readily applied to GKE. Primarily, it is not clear that there is a significant disparity in benefits between recipients. Each patient receives a kidney transplant, and as Minerva et al point out, benefits are arguably greater for LMIC recipients, who get the additional benefit of their follow‐up care being paid for [33]. The same is true for the donors, who each obtain the desired benefit of their intended beneficiary receiving a transplant. Rather than there being a morally troubling disparity in benefit, GKE appears to offer either roughly equal benefit, or greater benefit for those who are allegedly exploited."

"It is also unconvincing to consider GKE exploitative on other grounds. Rather than failing to protect the vulnerable, it seems that GKE addresses specific vulnerabilities by offering protection to those who are (i) vulnerable to death from kidney failure or (ii) vulnerable to losing a loved one due to kidney failure. It is similarly unconvincing to suggest that GKE treats people merely as a means to an end. Instead, one can see that participants in LMIC are respected as individuals, with measures put in place to protect their welfare and to ensure that their participation is voluntary."

...

The claim that donors and recipients in LMIC are too poor or vulnerable to voluntarily engage in GKE is also debatable and could be seen as paternalistic. First of all, the risk that voluntariness is undermined does not apply specifically to GKE or to LMIC alone, but applies to living donation more generally [35].

...

"The proclamation that countries have to be self‐sufficient was first declared by the 2008 DoI and the WHO [73, 74] and has rapidly gained momentum since [75-77]. The argument to ban GKE because of the need to achieve self‐sufficiency raises various implications however. First of all, it implies that the need for countries to become self‐sufficient is more important than the lives that can be immediately saved through GKE. Is achievement of self‐sufficiency so important that it overrides life‐saving alternatives? Who has the authority to decide which approach should get priority? Why is it required that countries become self‐sufficient in organ donation and transplantation, while it is universally accepted for countries to rely on global exchanges of all other types of goods and services?

 ***********************

The ESOT/ELPAT committee apparently operated under rules that prevented them from investigating some claims that required evidence, so they included some questions for us in their paper, which we answer in the comment that appeared in the same issue of TI. (For example, there was some confusion about what escrow meant in connection with the money provided for the foreign donor and recipient's medical expenses after their return home...)

In any event, the large number of co-authors to our comment (21!) is another expression of the broad and international support that GKE is achieving.

Global Kidney Exchange Should Expand Wisely
Alvin E. Roth  Ignazio R. Marino  Obi Ekwenna  Ty B. Dunn  Siegfredo R. Paloyo  Miguel Tan  Ricardo Correa‐Rotter  Christian S. Kuhr  Christopher L. Marsh  Jorge Ortiz  Giuliano Testa  Puneet Sindhwani  Dorry L. Segev  Jeffrey Rogers  Jeffrey D. Punch  Rachel C. Forbes  Michael A. Zimmerman  Matthew J. Ellis  Aparna Rege  Laura Basagoitia  Kimberly D. Krawiec  Michael A. Rees 

Transplant International, September 2020, 33, 9,  985-988. https://onlinelibrary.wiley.com/doi/full/10.1111/tri.13656   Here's a link to the pdf 

Here's the full first paragraph:

"We read with great interest and appreciation the careful consideration and analysis by Ambagtsheer et al. of the most critical ethical objections to Global Kidney Exchange (GKE). Ambagtsheer et al. conclude that implementation of GKE is a means to increase access to transplantation ethically and effectively.1,2 These conclusions by their European Society of Transplantation (ESOT) committee on Ethical, Legal and Psychological Aspects of Transplantation (ELPAT) represent a step forward toward a greater understanding and an open, honest debate about GKE. Taken together with the strong endorsement of GKE by Minerva et al. in Lancet  and the positive position statement of the American Society of Transplant Surgeons (ASTS), Ambagtsheer et al. successfully dispel previously raised doubts 5-13 to which we have previously responded .2,14-17"

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Here are all my posts on global kidney exchange (GKE)