Legal and illegal sales of body parts

 U.S. law makes it illegal to sell deceased donor organs for transplant, i.e. to save a life, but it's otherwise legal to sell body parts or whole cadavers, for research, for instruction, etc.  Nevertheless, alongside the legal, regulated market, which requires consents and precautions, is an illegal black market which is occasionally prosecuted.  Here's a recent case, as reported in the NYT:

Funeral Home Operator Pleads Guilty in ‘Illegal Body Part Scheme’.  Megan Hess, who pleaded guilty to mail fraud, sold body parts without families’ consent... By Alex Traub

"The operator of a Colorado funeral home who was accused of stealing body parts and selling them to medical and scientific buyers, making hundreds of thousands of dollars in what the authorities called an “illegal body part scheme,” pleaded guilty to mail fraud on Tuesday, the Justice Department said.

...

"Here’s how prosecutors said the scheme worked: From about 2010 to 2018 Ms. Hess was in charge of Donor Services, a nonprofit “body broker service,” and Sunset Mesa Funeral Directors, which offered to arrange cremations, funerals and burials in the small western Colorado city of Montrose.

"Ms. Hess and her mother sometimes obtained consent from families to donate small tissue samples or tumors of their dead relative, according to an indictment in the case. On other occasions, their request was rejected, and sometimes, they never brought up the topic at all.

"In any case, the documents say, on hundreds of occasions the funeral home operators would sell heads, torsos, arms, legs or entire human bodies. Frequently, they delivered cremated remains to families with the suggestion they were the remains of their relative when, in fact, they were not, according to the indictment.

...

"The scheme included forging paperwork, such as signatures on authorization forms for donating body parts, and misleading buyers about the results of medical tests performed on the deceased, court documents said. Ms. Hess altered lab reports so that they said that people had tested negative for diseases like H.I.V. and hepatitis when they had actually tested positive, according to the authorities."

The Future of Living Donor Kidney Transplantation (videos)

On May 7, 2022 the University of Chicago hosted a Symposium on "The Future of Living Donor Kidney Transplantation: Evolving National Perspectives in Kidney Transplant "

Philip Held, one of the organizers, has provided the following guide, concluding with a link to an elegant Data Handbook that gives direct access to each talk.

 "A Symposium: The Future of Living Kidney Donor Transplantation

Earlier this year, we presented a virtual symposium on the Future of Living Kidney Donor Transplantation.  A primary focus was on the ethics of rewarding organ donors with an opening presentation by:

 ·       Janet Radcliffe Richards, a philosopher and ethicist from Oxford University.

 Other speakers and topics included:

 ·       Nobel Laureate Alvin Roth Ph.D. of Stanford University who laid out the case for paired kidney donation (aka kidney exchange), the only major technical improvement in transplantation in years.

 ·       Frank McCormick, Ph.D. presented recently published (Value in Health) research showing how the government can completely end the kidney shortage and save more than 40,000 kidney failure patients each year from premature death by rewarding living kidney donors. 

 The Symposium took place on May 7, 2022.  It was hosted by John Fung M.D. Ph.D. at the University of Chicago’s Transplantation and Transplant Institute and was funded by the National Kidney Donation Organization (NKDO) and WaitListZero.

 This Symposium presented a broad education on the subject of living kidney donation, and indeed was presented for Continuing Medical Education (CME) credits by the University of Chicago. 

 The audio-visual recording of the entire University of Chicago’s CME symposium is available, for free. Access is extremely easy and one can access any and all presentations with 3 simple clicks starting with 2 clicks here: Data Handbook."

 If you prefer you can binge on the sessions in order:

Session 1:  The Future of Living Kidney Donor Transplantation

Session 2:  The Future of Living Kidney Donor Transplantation

Session 3:  The Future of Living Kidney Donor Transplantation

My talk, called "Kidney Exchange (and Kidney Controversy)" is the first half hour of the video below of the second of three symposium sessions.

The first session of the symposium is below, starting with an intro by Philip Held, focusing on some of the inequalities that we see in dialysis and transplant, followed by the philosopher Janet Radcliffe-Richards (starting at minute 17:15), and then Sally Satel (at 59:30), and then a round table discussion starting at 1:12.

 

In the discussion I asked Dr. Radcliffe Richards (who has been a tireless advocate of thinking more clearly about the tradeoffs involved in preventing compensation of donors) what experience she could share about when and how she had been successful in convincing people to change their minds.  She replied "I don't regard myself as an expert in mind changing, except with people who are happy to follow arguments."

Session 3 is below, including talks by Martha Gerson, Thomas Peters, Arthur Matas, John Roberts,  and Josh Morrison.

These and other videos have been assembled by NKDO.

Allegations of organ trafficking for kidney transplants--in England and India

 From time to time there are stories of prosecutions for organ trafficking in connection with kidney transplants.

Here's a story developing in England. (Early reports were that the alleged donor/seller/victim was a child, but apparently he's not a minor):

From the BBC:

Ike Ekweremadu: Nigerian senator faces London organ-harvesting trial

"A prominent Nigerian senator and his wife who are accused of plotting to harvest a man's kidney in the UK will face trial at the Old Bailey.

"Ike Ekweremadu, 60, and Beatrice Nwanneka Ekweremadu, 55, are alleged to have transported a 21-year-old man from Nigeria to London.

"Prosecutors allege the couple planned to have his kidney removed so it could be given to their daughter.

...

"The alleged victim is said to have refused to consent to the procedure after undergoing tests at the Royal Free Hospital in Hampstead."

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Not long ago I participated in an online conversation including Professor Janet Radcliffe Richards, who recalls that her view that bans on kidney sales are ill-conceived arose from news in the 1980's about a case involving Turkish sellers (here's an LA Times story from then):

London Kidneys-for-Cash Scandal Prompts Action to Ban Sale of Organs BY ROBERT BARR JULY 16, 1989

"“The concept of organs being bought and sold for money is entirely unacceptable in a civilized society,” Health Minister Roger Freeman told a House of Commons committee during debate on proposed legislation outlawing organ sales. The bill is expected to pass Parliament later this month.

"Not all lawmakers agree.

“The bill will cause death where there could be life, and to prolong suffering where we could provide relief,” said Sir Michael McNair-Wilson, a Conservative Parliament member awaiting a kidney transplant.

...

"Neil Hamilton, who cast the only vote against the bill in committee, said he had pondered the dilemma facing one Turk who allegedly sold a kidney.

“His daughter was suffering from a medical problem which threatened her life, but it could not be solved in Turkey without money,” Hamilton said. “If he did not get the money for the operation, his daughter would die.”

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The situation in India is complex, since there is or was something of a long tradition of kidney sales, which are against the law, and are guarded against by authorization committees that have to approve each living donor transplant. Recently, kidney exchange has become legal in India, but the law only allows close family to be the intended donor in an incompatible patient-donor pair. Below is a report of a case where it's alleged that an attempted donor was paid, and also illegally claimed to be a family relation.

Here's the Hindustan Times story:

Ruby Hall Clinic kidney transplant ‘malpractices’ probe handed over to crime branch

"Earlier on Wednesday, police officials probing the case told Magisterial court that more cases of kidney transplants based on the relationship claims have been unearthed during the interrogation of agents Ravindra Rodge and Abhijit Gatane. Both have been arrested by the police. These two agents having donated their kidneys earlier and also played the role of middlemen in at least four kidney transplants where alleged malpractices were involved.

...

"The case pertains to a kidney swap procedure, also known as paired kidney exchange, between the Moshi man and the Kolhapur woman posing as his wife, and a mother-daughter duo from Baramati."

And here's the story in the Indian Express:

Two middlemen arrested in Pune kidney transplant malpractice case. The other accused in the case, including Ruby Hall Clinic doctors, the patient who received the kidney, and the unrelated donor who was passed off as his wife--are yet to be arrested.

"Police have arrested the two middlemen over the alleged malpractices in a kidney transplant conducted at Pune’s Ruby Hall Clinic in March in which an unrelated woman was allegedly presented as the organ receiver’s wife and promised Rs 15 lakh in return.

...

"Among the 15 people named in the FIR are the hospital’s managing trustee, Dr Purvez K Grant, deputy medical director Dr Rebecca John, legal advisor Manjusha Kulkarni, nephrologist Dr Abhay Sadre, urologists Dr Bhupat Bhati and Dr Himesh Gandhi and transplant coordinator Surekha Joshi. The police also booked the two middlemen, the patient—from Pimpri Chinchwad’s Moshi area—who received the kidney, his wife, their three family members, the woman from Kolhapur who was allegedly passed off as the patient’s wife to become the donor."

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Among the most vigorous opponents of paying kidney donors--e.g. among some of those who think it's a crime against humanity--there's also opposition to extending the scope of legal, ethical, unpaid kidney donation and transplantation, particularly in poor countries.  One reason for this is the intuition that more transplantation will cause more paid transplantation.  The cases reported above, although rare, help to support this view.

But a much stronger case can be made that it is the unavailability of transplants that causes exploitative black markets, and that increasing the availability of legal transplants will reduce the demand for illegal ones.

Kidney exchange debate in Brazil

 A discussion of kidney exchange in Brazil began with this letter to the editor, describing how kidney exchange (aka kidney paired donation) could increase transplantation in Brazil:

Bastos, J., Mankowski, M., Gentry, S., Massie, A., Levan, M., Bisi, C., Stopato,C., Freesz, T., Colares, V., Segev, D. and Ferreira, G., 2021. Kidney paired donation in Brazil-A single center perspective. Transplant International: Official Journal of the European Society for Organ Transplantation.

"Kidney paired donation (KPD) represents a strategy for increasing the number of LDKT, offering an incompatible donor/recipient pair, the chance to exchange with another pair in the same situation [4]. In Brazil, KPD is still prohibited by law. We designed a study to show mathematically how KPD could increase LDKT in a single center in Brazil.

Several comments followed in a forum.. The name of the forum is ""Kidney Paired Donation is necessary in Brazil."  But not everyone agrees with that headline.

In particular, a letter to the editor from Mario Abbud-Filho & Valter Duro Garcia concludes that there are too many poor people in Brazil to allow kidney exchange:

 "We do not condemn the KPD strategy, but we disagree that it should be proposed in the actual Latin American context, where such great socioeconomic disparities do exist and could fuel organ trafficking and commerce."

That letter drew this rejoinder, in favor of kidney exchange by Marcelo Perosa:

"We do not understand the rationale behind the claim that KPD could stimulate organ trafficking and trade if the LD of an eventual KPD swap would be submitted to the same steps and rigor currently used for unrelated LDKT to be approved.

"The acceptance of KPD is growing around the world. It brings a potential technological development with advanced algorithms and softwares, unites clinicians, surgeons, immunologists in fruitful discussions and analysis of match runs, expanding and exchanging knowledge among multidisciplinary teams that currently work separately. KPD still has the beauty of not dividing, but joining efforts among different centers since the more groups participating, the more patients in the database and more matches are found.

"The main goal of KPD was to increase the chance of KT among highly sensitized (HS) patients, preventing the onerous treatment of desensitization. For a country with more limited economic resources like Brazil, KPD makes perfect sense for always contemplating compatible, cheaper, and more successful transplants."

And a final summation from two of the authors of the original paper:

Bastos, Juliana, and Gustavo Ferreira. "Kidney Paired Donation in Brazil-It is time to talk about it." Transplant International: Official Journal of the European Society for Organ Transplantation (2021), 01 Oct 2021, 34(10):1757-1758 DOI: 10.1111/tri.14025 PMID: 34431143 

"The history of kidney transplantation in Brazil began in 1965 when the first related living donor transplant. Since then, Brazil has established a public programme and now has the most extensive public kidney transplantation system in the world. Brazil has established a regulated, standardized and ethical organ procurement system, created awareness of transplantation in physicians and the public, upgraded facilities and standardized medical care, and enforced legislation for transplantation.

"The Aguascalientes document establishes that KPD and altruistic donation are acceptable. Its final recommendations also say that the country must provide access to transplantation based on ethical considerations and protect the most vulnerable population for a healthy transplant system [4]. We are failing to do that when we have a system that does not contemplate highly sensitized recipients, as shown by a recent Brazilian analysis: highly sensitized patients (PRA > 98%) had lower transplant rates (3.7% vs. 31.2%) and higher mortality (HR: 1.09, P = 0.05) in the waitlist when compared to nonsensitized patients [1]."

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Earlier related posts:

aturday, February 12, 2022

First kidney exchange in Brazil

Sunday, December 26, 2021

A call for kidney exchange in Brazil, in the Brazilian Journal of Nephrology

Evidence based medical policy: compensation for donors, by Luke Semaru and Arthur Matas in the AJT

The American Journal of Transplantation has posted ahead of print a great article proposing clinical trials of a sensible system by which kidney donors might be compensated.  It's main point is that evidence might be useful...

 A Regulated System of Incentives for Living Kidney Donation: Clearing the Way for an Informed Assessment by Luke Semaru, and Arthur J. Matas

First published: 25 June 2022 https://doi.org/10.1111/ajt.17129

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ajt.17129

Abstract: "The kidney shortage continues to be a crisis for our patients. Despite numerous attempts to increase living and deceased donation, annually in the United States, thousands of candidates are removed from the kidney transplant waiting list because of either death or becoming too sick to transplant. To increase living donation, trials of a regulated system of incentives for living donation have been proposed. Such trials may show: 1) a significant increase in donation, and 2) that informed, incentivized donors, making an autonomous decision to donate, have the same medical and psychosocial outcomes as our conventional donors. Given the stakes, the proposal warrants careful consideration. However, to date, much discussion of the proposal has been unproductive. Objections commonly leveled against it: fail to engage with it; conflate it with underground, unregulated markets; speculate without evidence; and reason fallaciously, favoring rhetorical impact over logic. The present paper is a corrective. It identifies these common errors so they are not repeated, thus allowing space for an assessment of the proposal on its merits."

The article begins with some relevant history:

"The  concept  of  incentives  for  living  donation  arose  early  in  the  history  of  kidney  transplantation.  In  the 1960s, the framers of the Uniform Anatomical Gift Act noted “every  payment  is  not necessarily  unethical”,  but  “until  the  matter  of  payment becomes a  problem  of  some  dimensions,  the  matter  should  be  left  to  the  decency  of  intelligent  human  beings”.1  In  1983, the  matter  of payment  became a problem when,  in response to the organ shortage, a physician  (whose license had previously  been revoked) established a company to broker international  kidney sales. Impoverished  residents of low-income countries  were to be flown  to the United States to sell their kidneys at a nominal  price. This was met with general condemnation,  and in part, led to passage of the  National  Organ  Transplant  Act (NOTA,  Public Law 98-507) which made it a federal crime to “knowingly  acquire, receive or otherwise transfer any  human  organ for valuable consideration for use in human  transplantation...”.  At  the  same  time,  the  World  Medical  Association,  the  World  Health  Organization,   the  Council  of  Europe,  and  the  International  Council of the Transplantation  Society, among others, issued statements  of opposition to the sale of organs. "

...

"We are not tempted to conclude,  for example, that,  since in the 1920s Prohibition brought  about  an increase in political corruption  and organized crime, the sale of alcohol,  when  legal  and  regulated,  would  do  the  same.  For the same reason, we should not be tempted to conclude  that, since participants in unregulated  markets were swindled by outlaws, incentivized  donors in a regulated system will fare the same."

Medical assistance in dying: palliative care

A lot of the discussion of medical assistance in dying has focused on assisted suicide, but there is also the question of trying to die well by avoiding doomed heroic medical procedures at the end. Deborah James, an Englishwoman who chronicled how she dealt with her grim diagnosis, died recently, and is remembered in the British Press.

Here's a story, by a palliative care doc, from the London Sunday Times: 

How to have a ‘good death’ like Deborah James  by Dr Rachel Clarke

"As a palliative care doctor, I’m endlessly astounded by my patients’ capacity to savour their final days with a passion and intensity that can put the rest of us to shame. As time slips through their fingers, people find ways to be incandescent with life.

...

"I often ask patients: “What is the one thing you are most afraid of?” Invariably, the answer isn’t being dead per se, but the imagined horrors of the dying process. A conversation unfolds in which they learn that there are no upper limits on the doses of drugs we can give and that dying is rarely as dreadful as people fear. For the first time, they may start to feel a sense of control over their future.

"Practically speaking, planning ahead gives you the best chance of authoring how your life ends. Deborah, for example, died last week, aged 40, precisely on her terms — at her parents’ house, in the heart of her family, with domestic life quietly unspooling around her — by laying out her wishes clearly.

"Where would you like to be at the end — home, hospital or hospice? Who would you like to be with you when it happens? Sometimes patients regret being swept along by an impersonal medical machine that pushes endless rounds of gruelling treatment. Writing an advance care plan is the best way to ensure that what matters to you is placed centre stage. Appointing a legal power of attorney means that if you lose the capacity to make decisions for yourself, someone else can do so on your behalf.

"Consider asking to be referred to a palliative care team as early as possible. We can help with logistics such as finding carers, equipment, financial advice, “just in case” medications to store at home, and psychological support for adults and children."

Texas inmate asks to delay execution for kidney donation

 For all you practical ethicists out there, here's a story by the AP that has divided my email correspondents:

Texas inmate asks to delay execution for kidney donation By JUAN A. LOZANO

"A Texas inmate who is set to be put to death in less than two weeks asked that his execution be delayed so he can donate a kidney.

...

"In a letter sent Wednesday, Gonzales’ lawyers, Thea Posel and Raoul Schonemann, asked Republican Gov. Greg Abbott to grant a 30-day reprieve so the inmate can be considered a living donor “to someone who is in urgent need of a kidney transplant.”

...

"Gonzales’ attorneys say he’s been determined to be an “excellent candidate” for donation after being evaluated by the transplant team at the University of Texas Medical Branch in Galveston. The evaluation found Gonzales has a rare blood type, meaning his donation could benefit someone who might have difficulty finding a match.

“Virtually all that remains is the surgery to remove Ramiro’s kidney. UTMB has confirmed that the procedure could be completed within a month,” Posel and Schonemann wrote to Abbott.

"Texas Department of Criminal Justice policies allow inmates to make organ and tissue donations. Agency spokeswoman Amanda Hernandez said Gonzales was deemed ineligible after making a request to be a donor earlier this year. She did not give a reason, but Gonzales’ lawyers said in their letter that the agency objected because of the pending execution date.

...

"In a report, the United Network for Organ Sharing, a nonprofit that serves as the nation’s transplant system under contract with the federal government, listed various ethical concerns about organ donations from condemned prisoners. They include whether such donations could be tied to prisoners receiving preferential treatment or that such organs could be morally compromised because of their ties to the death penalty."

HT: Frank McCormick

Prospects for improving kidney exchange in France

A recent article in Néphrologie & Thérapeutique simulates how kidney exchange in France could possibly be made substantially more effective, following liberalizations in the law. (The article is in French, but also has an English abstract.) A promising feature is that the article is a collaboration between physicians and market design economists.

Perspectives pour une évolution du programme de don croisé de reins en France

Perspectives for future development of the kidney paired donation programme in France by Julien Combe, Victor Hiller, Olivier Tercieux,  Benoît Audry, Jules Baudet, Géraldine   Malaquin, François Kerbaul, Corinne Antoine, Marie-Alice Macher, Christian Jacquelinet, Olivier Bastien, and Myriam Pastural

Abstract: "Almost one third of kidney donation candidates are incompatible (HLA and/or ABO) with their directed recipient. Kidney paired donation allows potential donors to be exchanged and gives access to a compatible kidney transplant. The Bioethics Law of 2011 authorised kidney paired donation in France with reciprocity between 2 incompatible “donor-recipient” pairs. A limited number of transplants have been performed due to a too restricted authorization compared to other European practices. This study presents the perspectives of the new Bioethics Law, enacted in 2021, which increases the authorised practices for kidney paired donation in France. The two simulated evolutions are the increase of the number of pairs involved in a kidney paired donation to 6 (against 2 currently) and the use of a deceased donor as a substitution to one of living donor. Different scenarios are simulated using data from the Agence de la Biomedecine; incompatible pairs registered in the kidney paired donation programme in France between December 2013 and February 2018 (78 incompatible pairs), incompatible transplants performed during the same period (476 incompatible pairs) and characteristics of deceased donors as well as proposals made over this period. Increasing the number of pairs has a limited effect on the number of transplants, which increases from 18 (23% of recipients) in the current system to 25 (32% of recipients) when 6 pairs can be involved. The use of a deceased donor significantly increases the number of transplants to 41 (52% of recipients). This study makes it possible to evaluate the increase in possibilities of kidney transplants by kidney paired donation following the new bioethics law. A working group and an information campaign for professionals and patients will be necessary for its implementation."

While the paper focuses on the situation in France, it's opening lines could have been written anywhere:

"La France, comme l’ensemble des pays du monde, souffre d’une pénurie de greffons rénaux de sorte que le nombre de malades en attente d’une greffe de rein ne cesse de croître." [France, like all countries in the world, suffers from a shortage of kidney transplants so that the number of patients waiting for a kidney transplant continues to grow."

Here's hoping that the authors will succeed in their plans to use deceased-donor initiated chains to save more lives in France.

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Earlier related posts:

Sunday, April 3, 2022

Kidney Paired Donation Chains Initiated by Deceased Donors

Monday, November 22, 2021

A naturally occurring deceased-donor-initiated kidney exchange chain, by Maghen and Veale

Sunday, August 23, 2020

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

Tuesday, August 7, 2018

Deceased donor chains: Market design language is entering transplantation

Monday, April 11, 2016

Using deceased donor kidneys to start living donor kidney exchange chains

 

FDA Contemplating Clinical Trials of Pig-Organ Transplants (WSJ)

The WSJ has the story:

FDA Planning to Allow Clinical Trials of Pig-Organ Transplants. Move could be an important step in effort to ease the shortage of human donor organs.  By Amy Dockser Marcus and Liz Essley Whyte

"The Food and Drug Administration is devising plans to allow clinical trials testing the transplantation of pig organs into humans, a person familiar with the matter said.

"If the agency follows through, the trials could be a key step in an effort to ease the deadly shortage of human donor organs. The planning comes in the wake of a handful of experimental surgeries involving the transplantation of pig organs into a critically ill man and in brain-dead patients.

"It is unclear when the trials would begin, the person said, adding that proposals from researchers would be handled case by case."

Coordinating the timing of the market for new Economics Ph.D.s: guidance from the AEA

 Here's an email broadcast by the American Economic Association, aimed to promote market thickness by avoiding unraveling and dealing with congestion:

AEA Guidance on Timeline for 2022-23 Economics Job Cycle

 July 1, 2022

To: Members of the American Economic Association
From: Peter L. Rousseau, Secretary-Treasurer
Subject: AEA Guidance on Timeline for 2022-23 Economics Job Cycle

The AEA Executive Committee, in conjunction with its Committee on the Job Market, recognizes that it is to the benefit of the profession if the job market for economists is thick, with many employers and job candidates participating in the same stages at the same time.  Moreover, the AEA's goals of diversity, equity, and inclusion are fostered by having a timeline that remains widely known and accepted, ensuring that candidates can correctly anticipate when each stage will occur. With these goals in mind, and in light of inquiries from both students and departments about how to proceed, the AEA asks that departments and other employers consider the following timeline for initial interviews and “flyouts” in the upcoming job cycle (2022-23).  

Interview invitations
The AEA suggests that employers wait to extend interview invitations until the day after job market signals are transmitted to employers.

Rationale: the AEA created the signaling mechanism to reduce the problem of asymmetric information and allow job candidates to credibly signal their interest to two employers. The AEA asks that employers wait to extend interview invitations until those signals have been transmitted, and to use that information to finalize their set of candidates to interview. This helps the job market in several ways: it reduces the problem of imperfect information, it helps ensure a thick market at each stage, and it promotes the AEA’s goals of diversity, equity, and inclusion. Job candidates from historically under-represented groups may lack informal networks and thus may especially rely on the signals to convey their interest. Waiting to review the signals before issuing invitations promotes a fairer, more equitable process.

We also ask that all employers indicate on EconTrack when they have extended interview invitations; this allows candidates to learn about the status of searches without visiting websites posting crowd-sourced information and potentially inappropriate other content.

Interviews
The AEA recommends that employers conduct initial interviews starting on Monday, January 2, 2023, and strongly recommends that all interviews take place virtually (e.g. by Zoom). We suggest that interviews not take place during the AEA meeting itself (January 6-8, 2023).

Rationale: In the past, interviews were conducted in person at the AEA/ASSA meetings. This promoted thickness of the market, because most candidates and employers were present at the in-person meetings, but had the disadvantage of precluding both job candidates and interviewers from fully participating in AEA/ASSA sessions. 

Interviews should now be conducted virtually to prevent risk of exposure to COVID, and to promote equity among the candidates. Informal feedback to the AEA committee on the job market indicated that the benefits of virtual first-round interviews (e.g. low monetary cost, zero cost in travel time, convenience) outweighed the limitations (e.g. less rich interaction).

We recommend that employers wait until January 2 to interview candidates because job candidates may have teaching or TA responsibilities in December. Moreover, having a clear start date for interviews will help candidates to have accurate expectations of the timing of the stages of the market. An unraveling of the market works against the AEA’s goal of having a thick market at each stage and also works against candidates having uniform expectations of the timing of each stage of the market.

We ask that interviews NOT take place during the AEA/ASSA meetings (January 6-8, 2023) in order to allow job candidates and interviewers to participate in the conference.

Flyouts and offers
Flyouts and offers have historically happened at times appropriate for the employer, and the AEA sees no reason to suggest otherwise.  We ask that all employers indicate on EconTrack when they have extended flyout invitations and closed their searches. Unlike with interviews, the AEA does not take a position on whether flyouts should be virtual or in-person.

Job market institutions and mechanisms
Please keep in mind the various job market institutions and mechanisms created by the AEA to improve the job market:

·       The JOE Network includes a database of job openings for economists.

o   Employers may sign up here: https://www.aeaweb.org/joe/employer.

o   Job candidates may search the database here: https://www.aeaweb.org/joe/listings.

o   The JOE Network has an electronic clearinghouse for job candidates to submit job applications. Job candidates may register here: https://www.aeaweb.org/joe/candidate.

·       The AEA Committee on the Job Market releases data and guidance on the job market here: https://www.aeaweb.org/joe/communications.

·       EconTrack: a board on which employers can indicate when they have extended interview and flyout invitations, and closed their search: https://www.aeaweb.org/econtrack.

Thank you for helping to ensure a transparent and equitable job market for new Ph.D. economists.  

Mark Braverman wins Abacus Medal (formerly Nevanlinna Prize)

 Mark Braverman, a computer scientist whose work touches on mechanism design, has won the Abacus Medal of the International Mathematical Union.

Here are some links: citation, video, write-up, CV/publications, proceedings, interview, Plus magazine! article

Readers of this blog may be interested in these papers:

Optimization-friendly generic mechanisms without money

Mark Braverman

"The goal of this paper is to develop a generic framework for converting modern optimization algorithms into mechanisms where inputs come from self-interested agents. We focus on aggregating preferences from n players in a context without money. Special cases of this setting include voting, allocation of items by lottery, and matching. Our key technical contribution is a new meta-algorithm we call \apex (Adaptive Pricing Equalizing Externalities). The framework is sufficiently general to be combined with any optimization algorithm that is based on local search. We outline an agenda for studying the algorithm's properties and its applications. As a special case of applying the framework to the problem of one-sided assignment with lotteries, we obtain a strengthening of the 1979 result by Hylland and Zeckhauser on allocation via a competitive equilibrium from equal incomes (CEEI). The [HZ79] result posits that there is a (fractional) allocation and a set of item prices such that the allocation is a competitive equilibrium given prices. We further show that there is always a reweighing of the players' utility values such that running unit-demand VCG with reweighed utilities leads to a HZ-equilibrium prices. Interestingly, not all HZ competitive equilibria come from VCG prices. As part of our proof, we re-prove the [HZ79] result using only Brouwer's fixed point theorem (and not the more general Kakutani's theorem). This may be of independent interest."

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Clearing Matching Markets Efficiently: Informative Signals and Match Recommendations by Itai Ashlagi , Mark Braverman, Yash Kanoria , Peng Shi , Management Science, 2020, 66(5), pp.2163-2193.  https://doi.org/10.1287/mnsc.2018.3265

Abstract: "We study how to reduce congestion in two-sided matching markets with private preferences. We measure congestion by the number of bits of information that agents must (i) learn about their own preferences, and (ii) communicate with others before obtaining their final match. Previous results suggest that a high level of congestion is inevitable under arbitrary preferences before the market can clear with a stable matching. We show that when the unobservable component of agent preferences satisfies certain natural assumptions, it is possible to recommend potential matches and encourage informative signals such that the market reaches a stable matching with a low level of congestion. Moreover, under our proposed approach, agents have negligible incentive to leave the marketplace or to look beyond the set of recommended partners. The intuitive idea is to only recommend partners with whom there is a nonnegligible chance that the agent will both like them and be liked by them. The recommendations are based on both the observable component of preferences and signals sent by agents on the other side that indicate interest."

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Update: from Quanta.

The Scientist Who Developed a New Way to Understand Communication. Mark Braverman has spent his career translating thorny problems into the language of information complexity.  by Stephen Ornes

"While Braverman continues to guide the theory as his former students and postdocs push it forward, the bulk of his work is done. Now his interests are more focused on a new field called mechanism design, which uses the mathematical approaches of economics and game theory. "

Cops and comedy: repugnant speech

 The Guardian has a story about comedians who have been accused or charged with violating laws because of their acts. Recent cases involve jokes that are adjacent to pornography or hate speech, but the article reminds us that comedy and free speech have sometimes come into conflict for a long time.

Arrest that joke! A history of gags so offensive that punters called the cops  by Brian Logan

"Comedy’s defining brushes with the law, in the 1960s and 70s, also concerned indecency. Standup’s self-image has deep roots in the prosecutions of the American comics Lenny Bruce and George Carlin. Fifties hepcat and standup trailblazer Bruce was repeatedly arrested and tried for obscenity – or, in the words of his prosecutor during a 1964 trial, for his “nauseating word pictures interspersed with all the three- and four-letter words and more acrid 10- and 12-letter ones, spewed directly at the audience”. Bruce was found guilty and died – of a drugs overdose – while on parole pending his appeal.

"Carlin’s later Seven Words You Can Never Say on Television riff led to a legal fight between the Federal Communications Commission and a radio broadcaster that aired the routine – a case that went to the Supreme Court. “FCC v Pacifica,” wrote Carlin in his autobiography, “became a standard case to teach in communications classes and law schools. I take perverse pride in that. I’m actually a footnote to the judicial history of America.” The court ruled he was being indecent, but not obscene."

American data privacy, post Roe

 As we plunge ahead into the post-Roe era, American laws about abortion are going to be very divided. Some states will seek to criminalize not only surgical abortions, but the use of pharmaceuticals as well (and, if Justice Thomas gets his wish, perhaps contraceptives of all sorts, as well as day-after pills).*

Some states may seek to prosecute their residents who seek treatment out of state, or who order mail order pharmaceuticals. Doing so will leave a data trail, in searches on the web, emails, and geo-location data.  How private will those data be?

This is going to be an issue for tech companies, prosecutors, and legislators at both state and federal levels.  E.g. can prosecutors access and use your geo-location data to determine if you visited a clinic?  Your web searches to see if you looked for one? Your emails or pharmacy data to see if you ordered drugs?  Your medical data of other sorts?

*Here is the Supreme Court Opinion, written by Justice Alito followed by the other opinions. Justice Thomas' concurring opinion begins on p. 117 of the pdf, after Appendix A to the majority opinion which ends on numbered page 108 (but the numbering restarts at 1 for Justice Thomas' opinion).  DOBBS, STATE HEALTH OFFICER OF THE MISSISSIPPI DEPARTMENT OF HEALTH, ET AL. v. JACKSON WOMEN’S HEALTH ORGANIZATION ET AL. 

Here are some thoughts on various aspects of the emerging situation.

From STAT:

HIPAA won’t protect you if prosecutors want your reproductive health records  by By Eric Boodman , Tara Bannow , Bob Herman  and Casey Ross

"With Roe v. Wade now overturned, patients are wondering whether federal laws will shield their reproductive health data from state law enforcement, or legal action more broadly. The answer, currently, is no.

"If there’s a warrant, court order, or subpoena for the release of those medical records, then a clinic is required to hand them over. 

...

"As far as health records go, the most salient law is HIPAA — the Health Insurance Portability and Accountability Act. It’s possible that federal officials could try to tweak it, so records of reproductive care or abortion receive extra protection, but legal experts say that’s unlikely to stand up in the courts in a time when many judges tend to be unfriendly to executive action.

...

"In states that ban abortion, simply the suspicion that a patient had an abortion would be enough to allow law enforcement to poke around in their medical records under the guise of identifying or locating a suspect, said Isabelle Bibet-Kalinyak, a member of Brach Eichler’s health care law practice. “They would still need to have probable cause,” she said."

***

Health tech companies are scrambling to close data privacy gaps after abortion ruling By Katie Palmer  and Casey Ross July 2

"STAT reached out to two dozen companies that interact with user data about menstrual cycles, fertility, pregnancy, and abortion, asking about their current data practices and plans to adapt. The picture that emerged is one of companies scrambling to transform — building out legal teams, racing to design new privacy-protecting products, and aiming to communicate more clearly about how they handle data and provide care in the face of swirling distrust of digital health tools.

"Period-tracking apps have been the target of some of the loudest calls for privacy protections, and the most visible corporate response. At least two period-tracking apps are now developing anonymous versions: Natural Cycles, whose product is cleared by the Food and Drug Administration as a form of birth control, said it’s had calls to trade insights with Flo, which is also building an anonymous version of its app."

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From the Guardian:

Tech firms under pressure to safeguard user data as abortion prosecutions loom. Private information collected and retained by companies could be weaponized to prosecute abortion seekers and providers by Kari Paul

"Such data has already been used to prosecute people for miscarriages and pregnancy termination in states with strict abortion laws, including one case in which a woman’s online search for abortion pills was brought against her in court. 

...

"Smaller companies are also being targeted with questions over their data practices, as frantic calls to delete period tracking apps went viral following the supreme court decision. Some of those companies, unlike the tech giants, have taken public stands.

“At this fraught moment, we hear the anger and the anxiety coming from our US community,” period tracking app Clue said in a statement. “We remain committed to protecting your reproductive health data.”

"Digital rights advocacy group the Electronic Frontier Foundation (EFF) has advised companies in the tech world to pre-emptively prepare for a future in which they are served with subpoenas and warrants seeking user data to prosecute abortion seekers and providers.

"It recommends companies allow pseudonymous or anonymous access, stop behavioral tracking, and retain as little data as possible. It also advocated for end-to-end encryption by default and refrain from collecting any location information."

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From the NYT:

When Brazil Banned Abortion Pills, Women Turned to Drug Traffickers. With Roe v. Wade overturned, states banning abortion are looking to prevent the distribution of abortion medication. Brazil shows the possible consequences.  By Stephanie Nolen

"The trajectory of access to abortion pills in Brazil may offer insight into how medication abortion can become out of reach and what can happen when it does.

"While surgical abortion was the original target of Brazil’s abortion ban, the proscription expanded after medication abortion became more common, leading to the situation today where drug traffickers control most access to the pills. Women who procure them have no guarantee of the safety or authenticity of what they are taking, and if they have complications, they fear seeking help.

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From the Guardian

Google will delete location history data for abortion clinic visits. The company said that sensitive places including fertility centers, clinics and addiction treatment facilities will be erased

"Alphabet will delete location data showing when users visit an abortion clinic, the online search company said on Friday, after concern that a digital trail could inform law enforcement if an individual terminates a pregnancy illegally.

...

"Effective in the coming weeks, for those who do use location history, entries showing sensitive places including fertility centers, abortion clinics and addiction treatment facilities will be deleted soon after a visit."

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And while we await further developments here, the Times has an article about growing surveillance in China:

‘An Invisible Cage’: How China Is Policing the Future By Paul Mozur, Muyi Xiao and John Liu, June 25, 2022

It begins "The more than 1.4 billion people living in China are constantly watched. They are recorded by police cameras that are everywhere, on street corners and subway ceilings, in hotel lobbies and apartment buildings. Their phones are tracked, their purchases are monitored, and their online chats are censored..."

Pregnancy in Poland, a database and anti-abortion laws

 The Lancet recently reported on new pregnancy data being collected in Poland, and controversy on whether and how it might be used in enforcing Poland's very stringent anti-abortion laws.

Poland to introduce controversial pregnancy register, by Ed Holt, Lancet,  VOLUME 399, ISSUE 10343, P2256, JUNE 18, 2022  DOI:https://doi.org/10.1016/S0140-6736(22)01097-2

"A new legal provision in Poland requiring doctors to collect records on all pregnancies has been condemned by critics who fear it could create a pregnancy register to monitor whether women give birth, or track those who go abroad for abortions.

Poland has some of Europe's strictest abortion laws, with terminations allowed in only two instances—if the woman's health or life is at risk and if the pregnancy is the result of either rape or incest. Until last year, abortions had also been allowed when the fetus had congenital defects. Most legal terminations in Poland were carried out under this exemption. But this provision was removed by a constitutional court ruling following a challenge by members of the ruling right-wing Law and Justice party, which some rights activists accuse of systematic suppression of women's rights.

Rights groups and opposition Members of Parliament (MPs) say that, in light of the tightened abortion legislation, they worry that the collected pregnancy data could be used by police and prosecutors in an unprecedented state surveillance campaign against women. “A pregnancy register in a country with an almost complete ban on abortion is terrifying”, Agnieszka Dziemianowicz-BĄk, an MP for the New Left party, said. 

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Here's a recent NY Times story on the implementation of Polish anti-abortion law:

Poland Shows the Risks for Women When Abortion Is Banned. Poland’s abortion ban has had many unintended consequences. One is that doctors are sometimes afraid to remove fetuses or administer cancer treatment to save women’s lives.  By Katrin Bennhold and Monika Pronczuk, Updated June 16, 2022

"Today, Poland and Malta, both staunchly Catholic, are the only European Union countries where abortions are effectively outlawed.

"The consequences in Poland have been far-reaching: Abortion-rights activists have been threatened with prison for handing out abortion pills. The number of Polish women traveling abroad to get abortions, already in the thousands, has swelled further. A black market of abortion pills — some fake and many overpriced — is thriving.

"Technically, the law still allows abortions if there is a serious risk to a woman’s health and life. But critics say it fails to provide necessary clarity, paralyzing doctors."

SCOTUS on dialysis and DaVita

 The Supreme Court delivered a number of decisions recently, and the news coverage has rightly focused on the decisions that will increase guns and decrease abortions.  

But another decision has implications for how dialysis is financed for patients with kidney failure. It's going to take some time for all the adjustments that will now start to be made to determine what this means for the financing of kidney care.

Briefly, all kidney failure patients are eligible for Medicare coverage for dialysis, but private insurers covered the first 30 months (and pay much more than Medicare rates).  The case concerns a health insurance program that sought not to pay those rates, and in the case of MARIETTA MEMORIAL HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN ET AL. v. DAVITA INC. ET AL.  the Supreme Court ruled in favor of the health plan.

Here's the story from Reuters:

U.S. Supreme Court rules against DaVita over dialysis coverage  By Nate Raymon

"June 21 (Reuters) - The U.S. Supreme Court on Tuesday rejected dialysis provider DaVita Inc's (DVA.N) claims that an Ohio hospital's employee health plan discriminates against patients with end-stage kidney disease by reimbursing them at low rates in hopes they would switch to Medicare.

"In a 7-2 decision authored by conservative Justice Brett Kavanaugh, the court ruled that Marietta Memorial Hospital's employee health plan did not violate federal law by limiting benefits for outpatient dialysis because it did so without regard to whether patients had end-stage renal disease. A lower court had ruled in favor of Denver-based DaVita.Following the ruling, shares of DaVita, one of the nation's two largest dialysis providers, closed 15% lower. Shares of German rival Fresenius Medical Care (FMEG.DE) dropped 9%."

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Here's a blog from the law firm that won the case, Vorys, Sater, Seymour and Pease LLP :

6/21/22 Vorys Wins 7-2 at U.S. Supreme Court in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc 

"On June 21, 2022, the U.S. Supreme Court released its decision in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc. siding with petitioners (our side) and our client Marietta Memorial Hospital, its employee group health plan and health plan third-party administrator, for which Vorys argued the case.  The Court found that the group health plan does not impermissibly “‘differentiate in the benefits it provides’ to individuals with end-stage renal disease or ‘take into account’ whether an individual is entitled to or eligible for Medicare.”  The Supreme Court decision overturned a split decision by the U. S. Court of Appeals for the Sixth Circuit.

...

"The case began on December 19, 2018, when DaVita, a commercial dialysis provider, sued Marietta Memorial Hospital, a small community hospital located in Marietta, Ohio; the Hospital’s medical plan, the Marietta Memorial Hospital Employee Health Benefit Plan; and the Hospital’s third-party administrator, Medical Benefits Mutual Life Insurance Company, in the United States District Court for the Southern District of Ohio.  DaVita, a large, for-profit dialysis provider, alleged violations of the Medicare Secondary Payer Act (MSPA) and Employee Retirement Income Security Act (ERISA).  The Defendants, represented by Vorys, filed a motion to dismiss, which the District Court granted. 

"DaVita appealed to the United States Court of Appeals for the Sixth Circuit, which disagreed with the District Court decision.  Marietta appealed the district court decision to the U.S. Supreme Court. 

"On November 5, 2021, the U.S. Supreme Court granted a writ of certiorari, agreeing to hear the case.   In recognition of the importance of the case, the office of the Solicitor General of the United States filed an amicus brief, joined in the oral argument and urged the U.S. Supreme Court to rule in favor of the Marietta Memorial Hospital, its group health plan and the third-party administrator.  Oral arguments took place on March 1, 2022."

Scott Cunningham's Mixtape Podcast Interview with Alvin Roth

 Here's Scott Cunningham's Mixtape Podcast Interview with Alvin Roth... "We discuss Gale and Shapley, Roth and Sotomayor, game theory and more"

You can listen to our conversation at the link above.  He drew me out about some things I hadn't thought of in a while, such as my varied relationships with Gale, Shapley and Bob Wilson, and how my ideas about matching markets developed over the course of my career (which started in Operations Research and then morphed into Economics...)

He also reveals the manner in which he was the perfect reader of my 1990 book Two-Sided Matching with Marilda Sotomayor. 

His site is multi-media, if you scroll down you'll find a video (the one below in on YouTube), and if you keep scrolling down you'll find an essay he wrote called "Paying it Forward..." which recounts more about what our book meant to him and some of our subsequent interactions over the years. And below that is his Transcript of [our] podcast interview, for those who prefer to read rather than listen or watch.

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I've had occasion to blog about Scott:

Friday, February 16, 2018

Sex work, Craigslist, and the law; podcast with Scott Cunningham

Here's a link to an interview with Scott Cunningham, whose work on sex work I've blogged about before. There's a surprising amount of discussion about causal inference and differences in differences. (I always suspected that econometrics was sexy, but this is the first time I’ve heard a podcast about that.)

Wednesday, August 30, 2017

The accidental experiment with legal prostitution in Rhode Island

A scholarly paper and an easy to read-or-listen-to NPR report recount the period in which indoor prostitution was legal in Rhode Island.

Tuesday, September 14, 2010

The Craigslist market for erotic/adult services

Same sex marriage in Colorado: then and now

In 1975, as the county clerk of Boulder County, Cela Rorex issued several marriage licenses to same sex couples, before the State Attorney General ruled against them.  When she died earlier this month, she was remembered by the current Colorado governor, and his husband.

Clela Rorex, Clerk Who Broke a Gay-Marriage Barrier, Dies at 78. In 1975 she issued a gay couple a license to marry in Colorado, becoming a hero to some and an object of hate for others.  By Neil Genzlinger

"Colorado’s governor, Jared Polis, who is gay, was among those paying tribute to Ms. Rorex.

“So many families, including First Gentleman Marlon Reis and I, are grateful for the visionary leadership of Clela Rorex,” he wrote on Facebook, calling her a woman “ahead of her time.”

Medical aid in dying in Italy--a first

 The NYT has the story:

Man Paralyzed 12 Years Ago Becomes Italy’s First Assisted Suicide  By Elisabetta Povoledo

"Paralyzed 12 years ago in a traffic accident, “Mario” faced a series of legal, bureaucratic and financial hurdles in his pursuit of death

"On Thursday, “Mario,” identified for the first time by his real name, Federico Carboni, ended his life, becoming Italy’s first legal assisted suicide, in his home in the central Italian port town of Senigallia.

"Mr. Carboni, an unmarried truck driver, was surrounded by his family, friends, and people who had helped him to achieve his goal, including officials with the Luca Coscioni Association, a right-to-die advocacy group that assisted Mr. Carboni during the past 18 months and announced his death.

...

"An Italian court ruling has declared assisted suicide permissible in Italy under certain limited circumstances, but there is no legislation enshrining the practice, which for Mr. Carboni, led to delays.

...

"In a landmark ruling in 2019, Italy’s Constitutional Court said that assisted suicide could not be considered a crime as long as certain conditions were met.

...

"The Constitutional Court ruled that in some cases assisting someone could not be considered a crime as long as the person requesting aid met certain conditions: they had to have full mental capacity and suffer from an incurable disease that caused severe and intolerable physical or psychological distress. They also had to be kept alive by life-sustaining treatments.

...

"The Roman Catholic Church is firmly opposed to assisted suicide and euthanasia, which it has called “intrinsically evil” acts “in every situation or circumstance.”