Alex Azar (Secretary of HH&S) writes about possible new kidney policies

In the New Hampshire Business Review, the Secretary of the U.S. Department of Health and Human Services writes about the recent executive order* concerning caring for kidney patients:

President is providing hope for kidney patients
August 29, 2019  Alex M. Azar

"To prevent kidney disease and provide more treatment options, we’re launching new ways for Medicare to pay for kidney care. For example, nephrologists will soon be able to receive bonuses for preventing the progress of kidney disease in their patients. We’ll give providers a financial stake in getting their patients healthy, as opposed to just paying them for performing more procedures.

"We have also proposed a Medicare initiative to give about half of America’s dialysis providers new incentives to provide patients with dialysis at home or even in their beds at night, rather than having them travel to dialysis centers. Today, only 6.1% of kidney patients in New Hampshire receive dialysis at home, an option that’s much more common in other countries.
...
"To provide more kidney transplants, we will be revising how kidneys are obtained from deceased organ donors, allowing better identification of kidneys for transplant. The executive order also calls for us to expand support for the generous living donors who choose to donate organs. Changing how we identify transplantable kidneys from deceased donors, by itself, could produce life-saving organs for an additional 17,000 Americans each year — including some of the 87 individuals currently waiting for a kidney in New Hampshire.
**************

*See earlier post:

Tuesday, July 16, 2019

President Trump's Executive Order on kidney care

HT: Frank McCormick

Predicting stable matches from the preferences of one side of the market: Haeringer and Iehlé in AEJ-Micro

Two-Sided Matching with (Almost) One-Sided Preferences
By Guillaume Haeringer and Vincent Iehlé
American Economic Journal: Microeconomics 2019, 11(3): 155–190.


Abstract: "In a two-sided matching context we show how we can predict  stable matchings  by  considering  only  one  side’s  preferences  and  the  mutually  acceptable  pairs  of  agents.  Our  methodology  consists  of  identifying  impossible  matches,  i.e.,  pairs  of  agents  that  can  never  be matched together in a stable matching of any problem consistent with  the  partial  data.  We  analyze  data  from  the  French  academic  job  market  for  mathematicians  and  show  that  the  match  of  about  45 percent of positions (and about 60 percent of candidates) does not depend on the preferences of the hired candidates, unobserved and submitted at the final stage of the market."


Haeringer and Iehlé present new theory and explore an interesting data set, described as follows:

"Market for Mathematicians
In 1998, a small group of young mathematicians set up a website, Opération Postes,  inviting  recruiting  committees  to  announce  the  lists  of  candidates  to  be  interviewed  as  well  as  the  rankings  of  candidates  that  will  be  submitted  to  the  clearinghouse (the ministry), as soon as these would be decided.19 The community of mathematicians was very responsive and the website quickly became a central tool  in  the  job  market.20  The  data  for  each  position  (interviewees  list  and  rank-ings) is usually uploaded by the the chairs of the recruiting committees themselves (and  if  not,  by  a  member  of  the  committee).  On  average,  about  90–95 percent  of  the  job  openings’  interview  lists  and  rankings  are  available.21  The  data  of  Opération  Postes  is  public,  although  not  in  a  format  that  makes  it  immediately  usable  for  any  analysis.  There  are  many  misspellings,  and  we  sometimes  found  confusions  between  the  married  and  maiden  names  of  some  female  candidates.  By  cross-referencing the data with other sources we were able to compose a clean dataset.22We  also  collected  for  each  year  the  assignment  of  candidates  to  departments.  This  assignment  is  computed  by  the  Ministry  of  Higher  Education  by  using  candidate’s  submitted  preference  lists  over  the  departments  and  the  rankings  of  candidates established by the recruiting committees."

Kidney donor athlete: Steve

Kidney donors have to be in excellent health, and the site Kidney Donor Athletes celebrates some exceptional donors, particularly as they return to their physically active lives after donating a kidney.

The recent entry Meet Kidney Donor Athlete, Steve!,  is inspiring on multiple levels. It is the story of the donor (and the people he met along the way) who started the chain at Virginia Mason hospital in Seattle, that I blogged about after hearing from the transplant nephologist Dr. Cyrus Cryst:

Monday, March 25, 2019

Followup on the latest Freakonomics kidney exchange chain

Here's how he describes his wife's reaction to his decision to become a non-directed donor:
"My wife said to me “This is the weirdest midlife crisis I have ever heard of.”  I told her, “You know, some guys buy Corvettes and have affairs.”  That quieted her down.  For a minute."

And here's a thought on where chains can go:
"I was elated to learn that the other donation would be to a Native Alaskan woman from Utqiagvik, Alaska, which is the northernmost town in the U.S.  Just think of how terrifying it must be to live in an Arctic village with a serious health problem.  Her odds of receiving a kidney were very small.  There is no way she could have gotten herself to Seattle in time to receive a deceased person’s kidney.  She does not live right around the corner.  And, having spent much of my working career sailing all over the Bering Sea and the Arctic Ocean, I have a deep emotional connection to Alaska.  It just felt right."
******

In separate correspondence, I learned that one of the hardships for Debbie, from Utqiagvik in Alaska, was that for some time after her transplant "it meant I couldn't eat raw whale muktak (outer skin and blubber of the whale ) which i love..."

Inter-caste marriage as a repugnant transaction in India: a hired hitman and a murdered groom

In the U.S. we've had long periods where the future of inter-racial and same-sex marriages were in doubt. In India, inter-caste marriage can still be dangerous.

Here's a story from the Washington Post, about a mixed-caste marriage, a hired hitman, and a murdered groom...

A young Indian couple married for love. Then the bride’s father hired assassins.
By Joanna Slater

"Hundreds of people attended the festivities on Aug. 17, 2018, but Amrutha’s parents were notably absent. Rao, her father, had already begun to plot Pranay’s murder, court documents say. The month before, he agreed to pay $150,000 to have his son-in-law killed, using a local political leader as an intermediary. Rao, 57, passed along a photo of the pair from their reception invitation to make it easier for the killers to identify Pranay, the documents allege."

Matching in Google's internal labor market

Bo Cowgill and Rembrand Koning have written a Harvard Business School case study called Matching Markets for Googlers

Abstract: "This case describes how Google designed and launched an internal matching market to assign individual workers with projects and managers. The case evaluates how marketplace design considerations—and several alternative staffing models—could affect the company’s goals and workers’ well-being. It discusses the details of implementation as well as the intended (and unintended) consequences of the internal match system. The case concludes with a debate about how the Chameleon marketplace could expand to include more Googlers and illustrates what to consider when thinking about launching new matching markets in organizations."

"Kuehn and her team launched the Chameleon program at the end of 2015 to optimize employees’ careers and Google’s business needs. Unlike most internal staffing paradigms, Chameleon did not rely on a central HR coordinator to assign the unit’s hundreds of individual contributors (ICs) to roles in its dozens of teams. Nor did Chameleon rely on self-initiated transfers, nor ad hoc, centrally planned reorganizations.

"Instead, under Chameleon, a staffing marketplace would open up three times during the year. At the start of each round, ICs would use Chameleon’s online platform to submit private rankings of the available roles. In turn, the ICs would be ranked by the manager responsible for each open role. The Chameleon platform would then turn these rankings into matches using a simple but robust marketplace algorithm, assigning ICs to roles for the next 6–18 months."
*******
Not a spoiler: It's a deferred acceptance algorithm...

A big role is played by a pseudonymous Googler who the case calls Bradford Preston, who was familiar with the market design literature and who "moved to a part-time role so that he could begin a PhD in economics."

There's much more, about getting this kind of internal marketplace adopted. And apparently new Googlers are called Nooglers.

Game theory post docs at the Technion

Ido Erev sends the following announcement

Post-Doc Positions
The Game Theory Group at the Technion is inviting applications for fully funded postdoctoral positions in Game Theory (broadly defined).

As a postdoc at our group, you will work with a varied team comprised of both leading researchers and young, highly motivated colleagues, all of whom are passionate about topics at the intersection of computer science, economics, operations research, and game theory. 

Requirements:  (1) A PhD degree obtained between October 1, 2015 and September 30, 2020. (2) Evidence of successful research accomplishments (discipline dependent; e.g., in CS, such evidence would usually be publications at top-tier conferences).

If you fit this profile and are passionate about an academic research career path, we would love to hear from you. Women are particularly encouraged to apply.

Applications will be considered on a rolling basis until positions are filled. The exact starting date is flexible/negotiable. Positions are for 1 year and are renewable for up to 3 years. There are no teaching duties (in some cases, compensation for performing additional teaching duties may be arranged). Further information is available online at: https://gametheory.net.technion.ac.il 

Applications should be addressed to GameTheory@technion.ac.il and should include:
1. a)    CV
2. b)    One representing research paper (possibly published)
3. c)    A short research statement (no more than 200 words)
4. d)    3 recommendation letters (please ask for these to be sent directly to GameTheory@technion.ac.il)

Typically post-doctoral scholarships range from $25,000 to $40,000 per year and carry no teaching duties. Note that scholarship income is not taxed in Israel and this may apply to non-residents through tax treaties. Also, the cost of living in Haifa is comparatively low. For example, the monthly rental of a one/two bedroom apartment in Haifa costs around $500-$800. For general information about doing a postdoc at the Technion, visit the Technion International School.
**********

My two cents: Haifa is a very agreeable city, and Ido Erev is one of the most exciting scientists I know...

Are we discarding too many deceased donor kidneys in the U.S.? A comparison from France, in JAMA

Here's a recent article from JAMA, that several people have brought to my attention over the last year as it has wended its way to publication:

Disparities in Acceptance of Deceased Donor Kidneys Between the United States and France and Estimated Effects of Increased US Acceptance
by
Olivier Aubert, MD, PhD1,2; Peter P. Reese, MD1,3,4; Benoit Audry, PhD5; Yassine Bouatou, MD, PhD1,6; Marc Raynaud, MSc1; Denis Viglietti, MD1,6; Christophe Legendre, MD1,2; Denis Glotz, MD, PhD1,6; Jean-Phillipe Empana, MD, PhD1; Xavier Jouven, MD, PhD1; Carmen Lefaucheur, MD, PhD1,6; Christian Jacquelinet, MD, PhD5,7; Alexandre Loupy, MD, PhD1,2

Abstract

Importance  Approximately 3500 donated kidneys are discarded in the United States each year, drawing concern from Medicare and advocacy groups.

Objective  To estimate the effects of more aggressive allograft acceptance practices on the donor pool and allograft survival for the population of US wait-listed kidney transplant candidates.

Design, Setting, and Participants  A nationwide study using validated registries from the United States and France comprising comprehensive cohorts of deceased donors with organs offered to kidney transplant centers between January 1, 2004, and December 31, 2014. Data were analyzed between September 1, 2018, and April 5, 2019.

Main Outcomes and Measures  The primary outcome was kidney allograft discard. The secondary outcome was allograft failure after transplantation. We used logistic regression to model organ acceptance and discard practices in both countries. We then quantified using computer simulation models the number of kidneys discarded in the United States that a more aggressive system would have instead used for transplantation. Finally, based on actual survival data, we quantified the additional years of allograft life that a redesigned US system would have saved.

Findings  In the United States, 156 089 kidneys were recovered from deceased donors between 2004 and 2014, of which 128 102 were transplanted, and 27 987 (17.9%) were discarded. In France, among the 29 984 kidneys recovered between 2004 and 2014, 27 252 were transplanted, and 2732 (9.1%, P < .001 vs United States) were discarded. The mean (SD) age of kidneys transplanted in the United States was 36.51 (17.02) years vs 50.91 (17.34) years in France (P < .001). Kidney quality showed little change in the United States over time (mean [SD] kidney donor risk index [KDRI], 1.30 [0.48] in 2004 vs 1.32 [0.46] in 2014), whereas a steadily rising KDRI in France reflected a temporal trend of more aggressive organ use (mean [SD] KDRI, 1.37 [0.47] in 2004 vs 1.74 [0.72] in 2014; P < .001). We applied the French-based allocation model to the population of US deceased donor kidneys and found that 17 435 (62%) of kidneys discarded in the United States would have instead been transplanted under the French system. We further determined that a redesigned system with more aggressive organ acceptance practices would generate an additional 132 445 allograft life-years in the United States over the 10-year observation period.

Conclusions and Relevance  Greater acceptance of kidneys from deceased donors who are older and have more comorbidities could provide major survival benefits to the population of US wait-listed patients.

The Iranian kidney market in Mashhad, by Mehdi Feizi and Tannaz Moeindarbari in Clinical Transplantation

Here's a new article in Clinical Transplantation:

Characteristics of kidney donors and recipients in Iranian kidney market: Evidence from Mashhad
Mehdi Feizi  Tannaz Moeindarbari
First published: 06 August 2019 https://doi.org/10.1111/ctr.13650

Abstract: The Iranian model of kidney transplantation is an example of a regulated living unrelated renal donation. In this paper, we collected and analyzed a unique dataset of 436 paired kidney donors and recipients, including their characteristics and the realized price of a kidney in Mashhad. As opposed to the global picture of kidney donation, we find that women are less likely to donate and more likely to receive a kidney. Moreover, the average price of a kidney amounts less than 2 years of work with the minimum level of wage.
***********

The article elicited a commentary by Gabe Danovitch, an eminent nephrologist at UCLA who speaks and writes frequently in opposition to compensation for donors:

COMMENTARY
Financial neutrality should replace the Iranian paid donor market
Gabriel Danovitch
First published: 16 July 2019 https://doi.org/10.1111/ctr.13665

He explains his opposition to markets in general this way: "the term “regulated market” is oxymoronic with respect to markets in general and specifically when it comes to human organs..."

(One wonders how the market for nephrologists works, and for medical specialists and subspecialists generally.  Someone should study that...)
**********

The article on Mashhad includes some very interesting description of the market there:

"Since the first live kidney transplant in Mashhad on 2 April 1985 until December 2017, more than 2500 people have had a kidney transplant in the Montaserie Organ Transplantation Hospital. It is operating as a center for dialysis and the only center in Mashhad and neighboring regions for transplantation of kidney, liver, and bone marrow. According to the latest reports, more than 7000 people from different age groups are now waiting for a kidney in Mashhad.

"In Mashhad, approximately 60 individuals refer to the IKF every week to sell their kidney. Of these donors, about 15 individuals are actively pursuing the process, while the rest are dissuaded due to various reasons. Out of these individuals, about one‐fifth are medically approved for kidney donation, after the 3 or 4 weeks of examinations.

"From the demand perspective, every end stage renal disease (ESRD) patient aged below 70 in Khorasan Razavi Province without having a willing related donor is referred through a nephrologist's letter to the IKF in Mashhad to enter the kidney waiting list according to their blood type. These patients can be entered in the waiting list of hospitals to receive a kidney from a deceased donor as well.

"From the supply perspective, each potential kidney donor, between 22 and 40 years old, should register at the IKF after undergoing the preliminary medical tests and bringing the notarized consent of him/herself and his/her family, including both parents for singles, only the spouse for married men, and the spouse and both parents for married women.
...
There are four different matching lines for each blood type, and the IKF usually pair each donor with a renal patient with the matching blood type in the waiting list based on a first come, first‐served basis. Nevertheless, this is not the only way of matching, and both sides can also publically advertise and find each other outside the IKF matching system. However, they have to register there and do the required paperwork and medical tests, as the transplantation centers only accept donors referred by the IKF, as a market maker.

"A renal patient should pledge in cash half the official price of a kidney to the IKF following the initial registration of the waiting list. Once a patient is matched to a donor and they both agree upon a price, the patient pays the remaining price of a kidney to the IKF via a cheque. After carrying out the transplantation, the IKF transfers all the amount of money received from the patient to the donor. However, the IKF neither receives any financial interest nor benefits from any monetary transactions, as it is a charity after all. Although there is no official ceil price, the IKF in Mashhad informally tries its best to convince and incentivize the donor not to ask a high price.
...
"Almost all kidney donors mostly face severe and urgent financial needs, for example, paying off debts (especially home rentals and blood money) and even living expenses, especially for single‐mother households. Thus, financial issues constitute the most frequent and primary motive for living unrelated donors in Iran.
...
"According to this law, compensated kidney donation in Iran is only possible between two individuals from the same nationality with the legal residence permits, especially refugees in Iran from Afghanistan.

"Since there is a large number of Afghan refugees in Mashhad, the IKF has formed a limited market for them. At the main kidney market for Iranians, donors do not have to wait to find a match, as there are always patients looking for a compatible kidney, especially those with a rare blood type such as AB. However, at the kidney market for Afghans, there is no patient in a queue to get a kidney and donors have to stay on the waiting list to find a suitable recipient.

"Moreover, for Afghan citizens, the amount of money a patient should pay to compensate a donor is determined not based on the official price of a kidney in Iran, but rather in a wholly agreed manner. In 2014, the total cost of kidney transplantation was about 6329 USD. While the government pays all kidney transplantation costs for Iranian patients and donors, Afghan renal patients should pay the hospital fees and other costs related to transplantation, which is estimated about 350 million IRR, almost 8650 USD, and reaches about 800 million IRR, almost 19 775 USD, with the cost of kidney purchase.
...
[Among Iranians] "Not only donors tend to be financially motivated for donation, but also recipients are not wealthy, as 47% of them are unemployed."

Drug wars and drug addiction, black markets and homelessness, in Seattle and elsewhere

This is the third of three posts on the twin problems of trying to reduce drug addiction and to reduce large-scale incarceration as the primary response to addiction.  

In my post yesterday, among the sentences I excerpted from Nicholas Kristof's NY Times column entitled Seattle Has Figured Out How to End the War on Drugs were these: "As I see it, the problem is that while Seattle has done an outstanding job halting the war on drugs, it hasn’t done well in financing the war on addiction. It closed the law enforcement toolbox without fully opening the public health toolbox."

Following his article, lots of the online comments pointed out that drug addiction, related crime, and homelessness has remained very visible in Seattle.  Some of the letters point to a video called “Seattle is Dying”.

Which brings me back to my post on Friday, which I titled

Clean needle exchange programs may be both helpful and harmful, which briefly reported on a recent NBER paper by Analisa Packham. on the effect of syringe exchange programs (SEPs). 

She concludes "I find that SEP openings decrease HIV diagnoses by up to 18.2 percent. However, I present new evidence that SEPs increase rates of opioid-related mortality and hospitalizations"

So... the headline to Kristof's piece is overly optimistic.  Drug addiction and its collateral damage are a giant problem, that we don't now how to solve.  It seems to me (in cases like this more generally) that experimentation is in order. We have a pretty good idea about some things that haven't worked very well, and we need to find policies that work better  Persistent black markets (which have survived decades of war on drugs) make clear that criminalizing markets needn't succeed in making them go away.  Nor does simply de-criminalizing them.

I anticipate that dealing with addictive drugs will be one of the important market design issues of the next decades.

Fighting addiction in Seattle, where incarceration isn't the treatment of choice

Here's Kristof in yesterday's NY Times:

Seattle Has Figured Out How to End the War on Drugs
While other cities are jailing drug users, Seattle has found another way.

"SEATTLE — On gritty streets where heroin, fentanyl and meth stride like Death Eaters, where for decades both drugs and the war on drugs have wrecked lives, the city of Seattle is pioneering a bold approach to narcotics that should be a model for America.

"Anyone caught here with a small amount of drugs — even heroin — isn’t typically prosecuted. Instead, that person is steered toward social services to get help.

"This model is becoming the consensus preference among public health experts in the U.S. and abroad. Still, it shocks many Americans to see no criminal penalty for using drugs illegally, so it takes courage and vision to adopt this approach: a partial retreat in the war on drugs coupled with a stepped-up campaign against addiction.

"The war on drugs has been one of America’s most grievous mistakes, resulting in as many citizens with arrest records as with college diplomas. At last count, an American was arrested for drug possession every 25 seconds, yet the mass incarceration this leads to has not turned the tide on narcotics.
...
"In effect, Seattle is decriminalizing the use of hard drugs. It is relying less on the criminal justice toolbox to deal with hard drugs and more on the public health toolbox.
...
"As I see it, the problem is that while Seattle has done an outstanding job halting the war on drugs, it hasn’t done well in financing the war on addiction. It closed the law enforcement toolbox without fully opening the public health toolbox.

"Local officials found that in a world of competing budget silos, money saved from jails can’t easily be reallocated to treatment. This is so even though researchers repeatedly find that drug treatment pays for itself by saving huge amounts of taxpayer money, not to mention lives. One study found that substance abuse treatment in California paid for itself seven times over in reduced crime and other savings.

Clean needle exchange programs may be both helpful and harmful

Here's a recent NBER working paper that looks at the effects of opening a place where intravenous drug users can get clean needles--it finds that this reduces blood borne disease, but may in fact increase drug use.

Are Syringe Exchange Programs Helpful or Harmful? New Evidence in the Wake of the Opioid Epidemic
by Analisa Packham
NBER Working Paper No. 26111,  July 2019

Abstract: "In light of the recent opioid crisis, many public health entities have called for an expansion in syringe exchange programs (SEPs), which provide access to sterile syringes and facilitate safe needle disposal for injection drug users. This paper investigates the effects of recent SEP openings on HIV diagnoses and drug-related overdoses in the wake of the opioid crisis. I find that SEP openings decrease HIV diagnoses by up to 18.2 percent. However, I present new evidence that SEPs increase rates of opioid-related mortality and hospitalizations, suggesting that needle exchanges alone may be less effective than other interventions at stimulating recovery."


"From an economic standpoint,SEPs have the potential to create large positive externalities by reducing the stock of used needles on the streets and preventing the spread of disease. Conversely, by providing clean needles to drug users, reducing the stigma of using drugs and/or creating a safe environment for networking with other users, SEPs may also generate untended consequences. In particular, lowering the cost of obtaining needles and other supplies incentivizes drug users to inject more frequently, potentially exacerbating rates of opioid misuse and abuse. 

"In this paper, I test the causal relationships between SEP openings and drug-related health and crime outcomes. Because no official national directory of SEPs exist, I construct a hand collected dataset on program locations and opening dates to identify areas exposed to SEPs within the last ten years. In particular, using health outcomes data from the CDC, I compare rates of HIV, drug- and opioid-related deaths, opioid-related overdoses, and drug-related crime in counties with SEP openings to other counties without SEPs before and after the initial year of implementation. I find that SEPs decrease the number of HIV cases in some areas, and that  this effect grows over time. However, estimates also indicate that SEP openings increase drug-related mortality. … Effects are largest in rural and high-poverty areas, suggesting that those with larger geographic or financial obstacles  to substance abuse treatment are most affected by such programs."

Black market in rosewood

National Geographic has the story on the trade in endangered rosewood, which pits forest rangers in Guatemala against Chinese furniture makers on the one hand and  impoverished villagers on the other, and makes clear why it is difficult to enforce bans that lack local support.

The fight to protect the world’s most trafficked wild commodity
Chinese demand for rosewood—trafficked more than ivory, rhino horn, and pangolin scales—is fueling a crisis in Guatemala's forests

"So coveted is rosewood that it’s now the world’s most trafficked wild product by value or volume—more than ivory, rhino horn, and pangolin scales combined. According to the Global Environment Facility, an international partnership among governments, civil society, and the private sector to support conservation, the illegal wild animal trade is worth between $5 billion and $20 billion a year; it’s often ranked as the world’s fourth most lucrative black market business after narcotics, human trafficking, and the weapons trade.

"According to Interpol, timber trafficking is valued at between $30 billion and $100 billion a year and accounts for 15 percent to 30 percent of the global timber trade. Sam Lawson, the director of Earthsight, a London-based nonprofit that investigates global environmental crime, estimates that the annual value of smuggled rosewood could exceed a billion dollars.
...
"The first time Guatemalan forest officials realized they had a rosewood problem was in 2011, according to documents submitted to the Convention on International Trade in Endangered Species of Wild Flora and Fauna (CITES), the body that regulates cross-border trade in wildlife, including rare timber. That’s when three shipping containers of the precious hardwood were discovered at Puerto Santo Tomas de Castilla, one of Guatemala’s two commercial shipping ports.
...
"The emergence of Guatemala's illegal rosewood trade has been driven largely by demand among China’s nouveau riche for traditional Ming and Qing dynasty-style rosewood furniture. Between 2009 and 2014, customs data analyzed by the Environmental Investigation Agency, a U.K.-based nonprofit, show a 14-fold increase in rosewood imports to China from around the world. This expansion coincided with (and contributed to) the decimation of preferred Southeast Asian rosewoods, which earlier had replaced depleted native rosewoods in southern China. Buyers searched for new sources, and Guatemala, which has at least four commercially desirable species, was one.

...

"CONAP’s Beltetón says “it’s terrible that [rosewood] is distributed in the poorest areas of Guatemala, and that that's where the trafficker goes, taking advantage of the poverty and ignorance of people who don't have other options.” He adds, “of course, the government also bears some responsibility”—for not providing state services and active law enforcement in the most contested and conflict-ridden areas, such as the Chiquibul Mayan Mountains Protected Area, where El Carrizal is located.

"On the evening of July 1, 2018, acting on an anonymous tip about the illegal transport of rosewood, three environmental police agents made the two-and-a-half hour drive from their post in La Libertad, Petén, to El Barillal, an unincorporated village neighboring El Carrizal.

"As they approached their destination, instead of encountering the suspect, they found themselves surrounded by at least 45 men, some armed, according to the report the police filed the next day. The report says the men prevented their vehicle from passing, threatened them, questioned them about their presence, detained them for over an hour, and fired their weapons, although no one was injured. In the end, the three policemen broke the standoff by returning to La Libertad empty-handed.

In the nine months since, the environmental police have not returned to El Barillal."

More chaos in the medical resident interviewing process

Not only do graduating medical students go on (too) many interviews for residency positions, but the process by which interviews are offered and accepted is chaotic. (I'm reminded of the process of offering and accepting actual positions in the 1940's, before a matching clearinghouse was first developed...)

Here's a paper from the August 2019 issue of the Journal of Graduate Medical Education, by three concerned doctors at Northwestern University, who describe the situation and then offer their own suggestions. (I admire the description, and am skeptical that the suggestions are radical enough to change the incentives responsible for the current congestion...)

A Challenge to Disrupt the Disruptive Process of Residency Interview Invitations
Matthew R. Klein, MD, MPH
Sandra M. Sanguino, MD, MPH
David H. Salzman, MD, MEd

"Residency programs may also contribute to the sense of urgency to secure an interview by offering
more invitations than available interview slots. The rise in the number of applications per
applicant, while certainly multifactorial, is facilitated in part by the ease of online interview scheduling...
...
"In the current environment, applicants who receive an interview invitation while they are in a situation where interruption is impossible—such as taking a clerkship examination, assisting in an operating room, performing a bedside procedure, participating in a difficult conversation with a patient or family, rounding on the wards, or simply being asleep as a result of time zone differences—are effectively penalized. A delay in response may result in the inability to schedule a favorable date or an increase in the cost to travel to an interview at a less convenient time, or it may preclude an interview altogether if all interview slots have been taken.
...
"We propose a 2-step process that we believe balances the need for residency programs to recruit
applicants and schedule interviews with the goal of preserving an environment that allows students to
maintain their commitment to their educational and patient care responsibilities. We recommend the
following process
Step 1: A program informs an applicant of an invitation for an interview. In that communication,
the program shares the interview dates and indicates the date and time when online interview
scheduling will become available. This allows medical students to plan in advance when they
need to be briefly excused from clinical or educational responsibilities to attend to interview
scheduling
Step 2: At the time indicated in the initial communication, and no earlier than the day after
that communication, the online interview scheduling system opens to applicants
...
"In an effort to further decrease pressure to reply immediately to an interview invitation, programs
should also ensure that the number of initial invitations does not exceed the number of interview
slots available. Additional interview offers from a wait-list could occur as needed based on unclaimed
interview slots or subsequent cancellations."

Black markets for academic work, not just for homework anymore

Inside Higher Ed lets you know where you can buy a Ph.D. dissertation...and Clarivate (which publishes the Web of Science) let's you know where you can buy co-authorship in an already accepted academic paper. And the WSJ reveals that some students complain to the Better Business Bureau about sub-par contract cheating services.

Ukraine hosts 46 firms selling ghost-written dissertations
In 2009, there were 16 firms that sold completed dissertations; in 2016, the number nearly tripled to 46 registered enterprises.
By Ararat L. Osipian

"An entire market emerged in Ukraine that offers ghost-written dissertations for a price. This market consists not only of individuals, but somewhat remarkably, also officially-registered firms. In 2009, there were 16 such firms; in 2016, the number nearly tripled with 46 registered enterprises that sell completed dissertations. Their clients lack time and knowledge, but certainly not money. Ukraine is a country with high levels of human capital but low average household incomes. This keeps dissertations reasonably priced and affordable to corrupt state bureaucrats and businesspersons. Highly educated academics earn additional income by producing dissertations for sale."
*************

Protecting the integrity of the scientific record from a new kind of academic misconduct
by VALENTIN BOGOROV

"At the Web of Science Group, we pride ourselves on protecting the integrity of the scholarly record. We are champions of high editorial standards and research practices, and our global team of in-house, publisher-independent editors are experts in their subjects.  So we are ever-vigilant to trends in unethical research practices, which pose a growing threat to legitimate scholarship worldwide.  Recently, we uncovered a new trend which we think is important to bring to light for wider discussion and action.

Our team in Russia received a tip from the local research community to a new form of publication fraud. The tip led to a website,  http://123mi.ru  set up by unscrupulous operators to serve as a virtual marketplace where authors can buy or sell authorship in academic manuscripts accepted for publication. This kind of peer-to-peer sharing, in “broad daylight” is not something we’ve seen before – so we conducted a quick analysis of the site, and its data, before taking swift action to alert our friends and colleagues in the scientific community.

...

"The geography of transactions covers primarily the post-Soviet area (Russia, Kazakhstan and Ukraine), but there are authorships sold outside of that region, notably to the United Arab Emirates, China and the UK."

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

And then there's homework...this from the WSJ

Schools Fight Websites That Sell Homework Help
Hundreds of sites claiming to offer tutoring services are often selling completed assignments to students
By Tawnell D. Hobbs, Aug. 12, 2019 

"The practice, sometimes called contract cheating by educators, was initially targeted at students in college but has since spread to include high-school students, according to a review of websites offering the service.
...
"A Wall Street Journal review of 100 websites offering tutoring help or writing services, or both, found they promise custom high-school and college work. Some websites offer to run work through anti-plagiarism programs to prove it is original.
...
"Seventeen states outlaw selling written work to another for academic credit, said Dr. Bertram Gallant, a board member of the International Center for Academic Integrity, a consortium of academic institutions and individuals focused on integrity in academic communities. But enforcement is difficult since the location of the sites can be hard to determine, she said.

Several sites reviewed by the Journal let students put the work out for bid. “Often, customers may have two or more writers bidding on their project, so before selecting a writer, customers can check the different writers’ ratings and reviews,” said Avery Morgan, spokesman for a site called EduBirdie that launched in 2015 and specializes in essay writing.
...
"Students unhappy with cheating websites cite missed deadlines and subpar work, according to complaints filed with the Better Business Bureau and online reviews. Some students also allege that tutors demanded more money than agreed upon and made threats."

Paternalism as a motivation for repugnance: Ambuehl, Bernheim and Ockenfels

When I talk about repugnant transactions, I mean transactions that some people would like to engage in, but others don't think they should be allowed to, even if those others don't suffer themselves when the transactions take place.  In this recent NBER working paper, Sandro Ambuehl (one of the leaders in the study of these things) teams up with Doug Bernheim and Axel Ockenfels to study paternalism, which is closely related and often a primary cause of a transaction being repugnant (e.g. you might not think I should chew tobacco, because you think it would be bad for me...)

PROJECTIVE PATERNALISM
by Sandro Ambuehl, B.Douglas Bernheim, and Axel Ockenfels
NBER Working Paper 26119 http://www.nber.org/papers/w26119

Abstract: "We study experimentally when, why, and how people intervene in others' choices. Choice Architects (CAs) construct opportunity sets containing bundles of time-indexed payments for Choosers. CAs frequently prevent impatient choices despite opportunities to provide advice, believing Choosers benefit. We consider several hypotheses concerning CAs' motives. A conventional behavioral welfarist acts as a correctly informed social planner; a mistakes-projective paternalist removes options she wishes she could reject when choosing for herself; an ideals-projective paternalist seeks to align others' choices with her own aspirations. Ideals-projective paternalism provides the best explanation for interventions in the laboratory and rationalizes support for actual paternalistic policies."

From the conclusion:

"This  paper  examines  when,  why,  and  how  people  intervene  in  others’  choices.   In  a  setting  involvingintertemporal tradeoffs, we find that Choice Architects frequently remove options that are attractive toimpatient decision makers.  Choice Architects believe their interventions benefit the Chooser, and are thusacting paternalistically.  How do Choice Architects judge what is good for others?  This is a difficult taskbecause, by definition, paternalists are hesitant to rely on the judgments implicit in Choosers’ decisions,and indeed may even question whether Choosers are aware of their own best interests.  Ideals-projectivepaternalism  emerges  from  our  empirical  analysis  as  the  key  organizing  principle.   An  ideals-projectivepaternalist acts as if she believes other share, or ought to share, the ideals to which she aspires for herself."
************

I think of paternalism as being one cause of a lot of repugnance to certain transactions, but certainly not the only cause. For example, I don't think that repugnance to same-sex marriage was intended to help those who wanted to marry...

Steve Leider celebrated for experimental economics

This cheerful email came in yesterday:

Dear ESA Colleagues,

We are pleased to announce that Stephen Leider has been selected as the 2019 recipient of the Vernon L. Smith Ascending Scholar Prize for his research on behavioral operations management.

This $50,000 prize is presented by the International Foundation for Research in Experimental Economics (IFREE).  You can learn more about IFREE, including its small grants program and workshops, at http://ifreeweb.org/.        

The Vernon L. Smith Ascending Scholar Prize is given to an exceptional scholar in the field of experimental economics whose work embodies IFREE’s mission to Promote Human Betterment through Experimental Economics to Improve the Understanding of Exchange Systems. Eligibility is limited to Assistant and Associate Professors (or equivalent). Dr. Leider was selected through a nomination process which identified many promising and highly-productive scholars in experimental economics who were then screened through peer review. Here is a link to the Prize announcement.

Please join us in congratulating Dr. Leider for his outstanding work and accomplishments!

Finally, mark your calendars, we will be sending out the call for nominations for next year's award in the Spring.

Jim Murphy & Cary Deck
IFREE Board Members

Here's a picture of Steve (wearing a tie) after his dissertation defense ten years ago:

Poll: majority of Canadians approve of paying plasma donors

New survey results from Peter Jaworski
Canadians think that pay-for-plasma is “morally appropriate.”

"A significant majority of Canadians (63%) believed that paying Canadians for plasma donations was “morally appropriate.”

By age, 18-34 year-olds were most likely to think that pay-for-plasma was “morally appropriate,” with 75% saying so. 70% of 35-54 year-olds, and 49% of those 55 or older thought pay-for-plasma was morally appropriate.

By region, 64% of Atlantic Canada, 69% in Quebec, 61% in Ontario, 70% in the Prairies, 65% in Alberta, and 56% in British Columbia held that opinion.

The provinces of Ontario (2014), Alberta (2017), and British Columbia (2018) have all recently banned pay-for-plasma citing moral objections as part of the motivation behind the prohibitions"

Waitlists in NYC school choice--early reflections on yesterday's initial announcements

Yesterday the New York City Department of Education announced a change in the school choice assignment process--I gather that after one round of deferred acceptance, they will do something else, involving interim assignments  and wait lists.  (The original design included a subsequent round of deferred acceptance, after disseminating to unmatched students a list of schools with vacancies, and eliciting new preference lists for this second round.)
The details of the new plan for the second round aren't yet clear (at least to me).

Here's the press release from the city:

Mayor de Blasio, Chancellor Carranza Announce Easier and More Transparent Middle and High School Admissions Process
August 15, 2019
Families will now have one form and one deadline for middle and high school admissions

"“We are changing the middle and high school application processes so families don’t have to go through the gauntlet just to get a placement. There will be one application round and one deadline to make everyone’s lives easier.”

“We’ve heard from families and educators that they want a simpler, more transparent, and more accessible system of school choice, and today we’re taking a step forward,” said Schools Chancellor Richard A. Carranza. “This common-sense change will make a real difference for families across the five boroughs, and improve our middle and high school choice process for years to come.”

The DOE is eliminating the second application rounds for middle and high school. The main round application process and timeline will remain the same, with middle and high school applications opening in October with a December deadline. Students will receive their offer in March. Families can still appeal for travel, safety, or medical hardships; if families have any hardship, they will be able to access in-person support at Family Welcome Centers, rather than wait to participate in a second process. The waitlists will open after offers are released and will be a simpler, clearer process for families, increasing:

• Transparency:  By knowing their waitlist position, families have a better understanding of their chances of getting into a preferred school option in the event that seats become available.
• Ease: This is a shorter process that requires less paperwork. Rather than having to complete a second application and wait weeks—often into May or June—for a second decision or offer, families will complete one process, receive one offer, and receive any additional offers based on waitlist position.
• Consistency:  Families will now have one admissions system at all grade levels, with the changes to the middle and high school process making it more similar to the elementary school admissions process. Currently the elementary school process has one round, and the middle and high school processes have two rounds with different names; now, families will not need to learn a different process each time a child applies to a new school—allowing them to focus on school options and not process."

************
From the WSJ:

New York City Introduces Wait Lists for Students Unhappy With School Placements
City’s complex school-choice system, in which students hope to be assigned to a top pick, has long been daunting for many families
By Leslie Brody

"In recent years, applicants who didn’t like their middle school assignments—given in spring for entry the next September—would have to go through an appeals process. High school applicants who didn’t like their offers would have to try a second round of applications and then appeal if need be.

"Under the new Department of Education system for fall 2020, students will be placed on wait lists for each school listed higher on their applications than the schools they were admitted to. They will be informed of their positions on wait lists and may be offered seats if they open up."

*******************
I got some emails about this. Here's my reply to a reporter...

"at this point I’m only an observer of NYC schools from a distance—I haven’t been involved in advising them for over a decade, and even then I worked only on the high school match, not anything involving middle schools.

So I don’t know anything about the current plans besides what I’ve read today ...

So I don’t have comments so much as questions.

1. How is the NYCDOE going to handle the timing of moving waitlists?  Many vacancies don’t become visible until just before (or just after) the official start of school, which means that there could be some complications right around that time, for families and schools.
2. How will students on multiple waitlists be dealt with?  Suppose a student waitlisted at multiple schools is admitted off one of them in the summer—if he or she accepts that new assignment, do his/her other waitlist positions remain?  
1. (If other waitlists have to be given up, this could be a complicated decision whether to accept a somewhat preferred school, or wait for an even more preferred one…  If other waitlist positions can be maintained, then the process may move slowly, as some students accept for one waitlisted position, and then a better one when it becomes available, and maybe another…)
3. How long will a student have to consider whether to accept a given waitlist position?

As with many questions of market design, the devil is in the details…"

and I added this in replies to followup emails asking for my thoughts on waitlists:

"I’ve always been cautious about waitlists, because some of the questions I asked you just don’t have good answers.  There’s a tension between wanting waitlists to move early and fast—to make planning easy for families and schools, and avoid disruption of the first week(s) of school, and wanting to give students the best chance at the schools they like best…"

"my colleagues and I never recommended waitlists to nyc, back at the turn of the century.:)
We thought it was important to reduce the number of “unmatched” students who had to be assigned to a school over which they  hadn’t had an opportunity to express preferences. This is why we had a second stage of the matching algorithm, in which lists of schools with still available places were disseminated to students unmatched in the first round, so that they could express preferences over these.

Another question about the new system is, how will such students now be assigned?  E.g. they might be assigned to the closest school to their home that has unfilled places.  In what order?  i.e. after some students are assigned this way, some schools will no longer have unfilled places, and students will have to be assigned to other schools.  The things I read today didn’t address that issue, but I gather that these interim assignments of unmatched students, which will turn out to be final assignments for students whose waitlists don’t move enough, will be made without having the students express preferences.

Another question about the waitlists: how will they be ordered?  According to the school priority/preferences that were used in the first round of matching?  Or perhaps unmatched students will be given preference? (that might sound attractive but I think it would be a bad idea, because it might make it seem desirable to be unmatched after the first round, which would interfere with eliciting student preferences altogether….)

My point is not to try to guess what design decisions have been made, but rather that there are lots of important decisions that have to be made to have a working system, and the initial announcements and news reports don’t reveal these. And they will have consequences.  So I hope that the system has been carefully designed."

European Job Market for Economists, 2019 (in Rotterdam, Dec. 18-19)

The European Economic Association has announced that a unified European job market will take place in Rotterdam December 18 and 19.

"The EEA is pleased to announce that the 2019 European Job Market for economists will take place on Wednesday, December 18 and Thursday December 19, in Rotterdam, Netherlands. The format will be the same as that of the inaugural 2018 European Job Market: it will take place immediately after the Econometric Society Winter Meetings and will feature, alongside job interviews, an educational session and an invited lecture by Thomas Piketty.

"The EEA has joined forces with the 2 main national associations in Europe who until now have organised their own job market – the Royal Economic Society (UK) and the Spanish Economic Association (SAE) – and there will be ONE consolidated Job Market in Europe from now on."

Here's the web site: European Job Market for Economists, 2019

How is the U.S. opt in system of organ donation doing compared to an opt out system? Alex Glazier and Tom Mone in JAMA

Alex Glazier and Tom Mone run, respectively, the big Organ Procurement Organizations (OPOs) in New England and Southern California.

Success of Opt-In Organ Donation Policy in the United States
Alexandra Glazier, JD, MP1; Thomas Mone, MS
JAMA. Published online August 8, 2019. doi:10.1001/jama.2019.9187

"Over the past 5 years, the United States has experienced a 30% increase in deceased organ donors, from 8269 in 2013 to 10 722 in 2018,1 although the number or organs available for transplant still does not meet the increasing need.
...
"The US practice of opt-in donation presents 2 opportunities for organ donation. The primary path to donation in the United States is through donor registries and is uniquely successful compared with other countries, with more than 152 million registered donors, representing 54% of the US adult population.2 A registered individual provides legally binding permission for donation at the time of death, and family does not have the right to override this decision. Current US practice is to proceed with a registered donation if medically suitable, even over family objection.3 The ability to move forward based on the donor’s affirmative decision is ethically supported and consistent with autonomy as a central principle in US health care decision-making. It is also in alignment with successfully maximizing opt-in policy and the UAGA state laws. The second path to donation in the United States is surrogate authorization of organ donation from an unregistered individual (ie, who has not registered as an organ donor) at the time of that individual’s death. The successful implementation of US opt-in is thus accomplished by a legal framework that is well-aligned with donation practices.
...
"Proponents of an opt-out system for the United States may have some misunderstandings about the performance and utility of the current opt-in US system. Requiring an affirmative donation decision through opt-in policies is also aligned with the US cultural emphasis on individual rights and autonomy principles that is not achieved in the opt-out international experience. As identified below, the US opt-in system donation rates routinely exceed those of the best performing opt-out international countries.
...
"In 2018, the US overall organ donation rate was 38.1 donors per 10 000 deaths, second among reporting countries only to Spain (which has an opt-out donation policy). Six individual US states had rates that were higher than Spain, and US states comprised 43 of the top 50 jurisdictions. Furthermore, in the opt-in jurisdictions, the mean donation rate was 27% higher than rates in opt-out jurisdictions (32.6 vs 25.6 donors per 10 000 deaths, respectively). The data demonstrate that opt-in policies in the United States are associated with higher organ donation rates than some countries with opt-out policies as the legal default.
...
"If the United States moved to a similar opt-out policy, the percentage of potential donors opting out combined with family objections would need to be quite small to realize any gains in donation performance. There is also the real potential for the donation rate to decline, as evidenced in Wales, which continues to have below-average international levels and most recently in the Netherlands, where an increasing number of people (currently 31%) have opted out.
...
"The United States has experienced significant growth in deceased organ donors and continues to have one of the best donation rates in the world. Nevertheless, the critical need for organ transplant is not met. International data suggest that the most effective donation authorization strategy for the United States is to build on the current opt-in system that demonstrably works and to increase the number of registered donors from today’s 54% to 75% or higher. Doing so would be an accomplishment that would increase available organs for donation and save thousands of lives.


HT: Alex Chan