Comment on the proposed federal regulation limiting bone marrow compensation

I've written earlier about the proposed regulations that would reverse the effect of the 9th circuit court of appeals decision to allow some bone marrow donors to be compensated. The opportunity to comment on the proposed regulation closed Monday at midnight Eastern time. (Here are all the comments.) Below is a comment on the proposed regulations, signed by a number of economists, myself included. Note point 2 in particular, which points out that the regulation would cut off research on the effect of incentives.

December 2, 2013

Shelley Grant, MHSA, Branch Chief,
Blood Stem Cell Transplantation Program, Division of Transplantation Healthcare Systems Bureau,  Health Resources and Services Administration 5600 Fishers Lane, Room 12C–06, Rockville, Maryland 20857


Comment on Change to the Definition of ‘‘Human Organ’’ Under Section 301 of the National Organ Transplant Act of 1984. Health Resources and Services Administration, HHS. RIN 0906–AB02.

We are academic economists who study how incentives and other mechanisms affect individual behavior and whose research is concerned with improving public welfare. We are writing in opposition to the proposed rule changes by the Department of Health and Human Services (HHS) that would ban compensation for bone marrow donations. The reasons we oppose the proposed rule change are that it ignores the most critical benefits of offering economic incentives (point 1 below) and prevents the ability to properly assess and improve the benefits of offering incentives (points 2 and 3 below) despite the HHS proposed regulation explicitly stating (Section III. Impact Analysis) “Economic and Regulatory Impact Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives” (Italics added). The HHS document also states that “The provisions of this rule will not affect the following elements of family well-being: Family safety, … parental rights in the education, nurture, and supervision of their children,” and this regulation could prevent parents such as the lead plaintiff in Flynn v. Holder from obtaining bone marrow transplants for their children.1

1. The proposed regulation entirely ignores potential benefits to bone marrow recipients. The motivation for the ban focuses entirely on concerns for potential donors and gives no weight to the consideration of the patients in need of a bone marrow transplant. There are many patients whose health conditions worsen each year waiting unsuccessfully for a matched bone marrow donation. Depending on the patient's race, there is between an 8 and 50 percent chance that there will be no match in the existing registry. As a result, hundreds of patients die each year due to an
inadequate supply of donors.2 Economic incentives have the potential to motivate more bone marrow donations thereby saving and prolonging the lives of potentially thousands of patients. Indeed, the benefit-cost of adding one potential donor to the registry indicates enormous positive value, between 5 and 7 times the benefit to the cost.3 By entirely ignoring these potential benefits, the proposed regulation fails to accurately present the welfare consequences of the ban.

2. The proposed ban will prevent the most policy relevant academic research that is critically needed to determine whether and how economic incentives can be used to save lives. Alternative research methods that do not directly examine actual incentives for actual bone marrow donations (e.g., surveys), or uncontrolled studies that do not appropriately account for confounding factors (i.e., differences in incentivized and non-incentivized populations), will produce unreliable policy evidence. Recent work, consisting mainly of Randomized Controlled Studies (RCTs) examining economic incentives to motivate blood donations, shows positive results when evaluating actual incentives for actual blood donations in natural contexts. This robust evidence contrasts with earlier results using alternative methods not examining actual incentives and donations.4 This is not just an academic point; empirical evidence obtained with rigorous methods should be used to inform policy. This rigor should apply in general, but it is especially critical in the context of bone marrow donations where thousands of lives are at stake every year and where adopting a ban without appropriate evidence could have disastrous  consequences.

3. The ban will eliminate the opportunity to offer any form of economic incentive, not just cash payments. The policy would thus prevent even non-cash rewards that have been shown to significantly increase blood donations with no harm to the quality of the blood supply.5 The proposed change will thus prevent many potential types and sizes of incentives that could be effective. Appropriately designed research could shed light on whether different types of incentives and incentive amounts would have different effects on donations, but the proposed regulation would make this type of research illegal.

In addition to inappropriately assessing the cost-benefit analyses, we oppose the ban for the
following two reasons. First, allowing for the compensation of bone marrow donors does not mean
that donors have to accept the compensation. When offered, donors could still choose to not accept the incentive or could even donate it to charity. Second, donating bone marrow through the
apheresis process and donating whole blood or plasma share a critical characteristic: donors
provide renewable material that is extracted with minimal risk and that their body regenerates
quickly. The US government has never prevented compensation for these other blood products despite deliberations,6 thus from this renewable material perspective there is no reason to have different policies for these types of donations.

In summary, the proposed regulation ignores the potential beneficial effects that offering compensation to bone marrow donations will have on the well-being of patients who need a transplant but are unable to find a match in an uncompensated-only donation system. This implies that “all costs and benefits of available regulatory alternatives” have not been assessed. Moreover, it makes it illegal to conduct the very research that would be critically necessary to establish the effects that incentives can have on donations. For these reasons, we oppose this regulation proposed by HHS that would ban all forms of compensating bone marrow donors.

Signed,
Theodore Bergstrom, University of California at S. Barbara Stefano DellaVigna, University of
California at Berkeley Julio J. Elias, Universidad del CEMA, Argentina
Rodney Garratt, University of California at S. Barbara
Michael Gibbs, University of Chicago Judd Kessler, University of Pennsylvania Nicola Lacetera,
University of Toronto Stephen Leider, University of Michigan John List, University of Chicago
Mario Macis, Johns Hopkins University
Daniel McFadden, University of California at Berkeley Matthew Rabin, University of California at
Berkeley Alvin Roth, Stanford University
Damien Sheehan-Connor, Wesleyan University
Robert Slonim, University of Sydney
Alex Tabarrok, George Mason University



Footnotes:
1 The lead plaintiff, Doreen Flynn, has three daughters afflicted with Fanconi anemia who may need
multiple bone marrow transplants during their teen years.
2 Bergstrom, Garratt, and Sheehan-Connor 2009, Tables 2 and 4.
3 Ibid, Table 7.
4 Lacetera, Macis and Slonim 2013.
5 Ibid.
6 Starr, 1998.


References
Bergstrom, T., Garratt, R., Sheehan-Connor, D. 2009. One chance in a million: altruism and the bone marrow registry. American Economic Review 99, 1309–1334.
Lacetera, N., Macis, M., Slonim, R. 2013. Economic rewards to motivate blood donations. Science 340: 6135, 927–928.
Starr, D. 1998. Blood: An epic history of medicine and commerce. Imperial College, London.

First heart transplant: Dec. 3 1967

Here's the story: First heart transplant: Dec. 3 1967

"Shortly after midnight, Dr. Christiaan Barnard, heading a team of 20 doctors, removes the heart from the body of a young woman named Denise Darvall--who had been hit by a car--and places it into a 53-year-old grocer, Louis Washkansky, who was dying of heart disease.

Barnard would later say that he wasn't sure the surgery was successful until five hours later, when he electrically shocked the transplanted heart and it started beating. Washkansky was soon able to speak and even walk a bit, but died only 18 days after the operation when he developed double pneumonia--a consequence of having his immune system suppressed so that his body wouldn't reject the new organ.

A month later, Barnard repeated the procedure on a 58-year-old dentist named Philip Blaiberg, giving him the heart of a young black man, Clive Haupt, who had died of a stroke--a very controversial decision in racially segregated South Africa,  Blaiberg was kept in a sealed suite of hospital rooms for more than two months and was not given steroids--treatment that had weakened Washkansky. He managed to live for 19 months.

Other doctors had performed heart transplants on animals, but none had been willing to do the surgery on humans, in part because of legal issues, particularly in the United States, where district attorneys had threatened to prosecute doctors who took organs from people who were brain dead, but had not yet died.

Barnard's surgery, however, made it more acceptable to use organs from brain-dead patients. He had been able to take advantage of the absence of legal restraints in South Africa; in fact, he had gone ahead with the operation without seeking permission of his hospital's executives. He only told them about it afterwards. "

Compensation for donors: it's not just kidneys

I'll be speaking later this year about deceased donation at a conference of the International Society for Heart & Lung Transplantation. When I went to their website to arrange some hotel details, I saw this announcement about the Society's position that "the sale of organs from both live and deceased donors is unethical and violates the Universal Declaration of Human Rights."

NEW: ISHLT Position on the Trafficking of Donor Organs
"Tales from the Organ Trade” and similar documentaries are reminders that organ trafficking remains an important international problem. In line with the previously stated ISHLT position and in concert with other national and international transplantation societies, the ISHLT strongly and emphatically endorses the Declaration of Istanbul which seeks to abolish the illegal and immoral trade in donor organs which is supported in part by so called “transplant tourism”. As a corollary of which,  the Society values and supports every effort to improve the availability of donor organs by legitimate process thereby providing community access to these life sustaining therapies.


They link to their 2007 position statement, reproduced here:

International Society for Heart and Lung Transplantation
Statement on Transplant Ethics
Approved April 2007

Thoracic organ transplantation improves the length and quality of life of patients with severe
heart or lung disease. It is a societal endeavour bound by ethical principles. The donation of
organs from a deceased patient must always be made freely and without coercion. The gift
of an organ by a live donor, such as a pulmonary lobe transplant, must be made in the same
fashion and with informed consent. To ensure that these principles are adhered to, the
transplant process must be transparent, legally regulated and open to both national and
international scrutiny.

The ISHLT endorses the view of the World Medical Association that the sale of organs from
both live and deceased donors is unethical and violates the Universal Declaration of Human
Rights.

Obtaining organs for transplantation from the bodies of executed prisoners contravenes the
principle of voluntary donation. A condemned prisoner and his relatives cannot consent
freely. Furthermore, such practices provide a perverse incentive to increase the number of
executions and it lays the judicial process open to corruption.

ISHLT members should discourage patients from seeking transplantation in countries where
transplantation is not open to external scrutiny and the ethical standards of the ISHLT
cannot be assured, regardless of whether payment for organs is involved. ISHLT members
should work with their own governments to ensure that such ‘transplant tourism’ that
contravenes these ethical principles is made illegal.

Members of the ISHLT should not participate in or support the transplantation of organs
from prisoners or the sale of organs for transplantation. Any ISHLT member who has been
found to have contravened this ethical principle may have their rights and privileges as a
member suspended or removed by the ISHLT Board.

Individuals submitting data about clinical transplantation, or the use of human tissue, for
presentation at any of the ISHLT’s meetings, to the Society’s Registry or for publication in
the Journal of Heart and Lung Transplantation will be asked to sign a personal statement
confirming that the principles of both the Declaration of Helsinki formulated by the World
Medical Association and of this ethical statement by the ISHLT have been adhered to.

References
Rothman DJ, Rose E, Awaya T, Cohen B, Daar A, Dzemeshkevich SL, Lee CJ, Munro R,
Reyes H, Rothman SM, Schoen KF, Scheper-Hughes N, Shapira Z, Smit H. The Bellagio Task
Force report on transplantation, bodily integrity, and the International Traffic in Organs.
Transplant Proceedings 1997; 29: 2739-45. Also available at the International Committee of
the Red Cross web-site:
http://www.icrc.org/Web/Eng/siteeng0.nsf/iwpList302/87DC95FCA3C3D63EC1256B66005B3
F6C (accessed 1st May 2007)
Declaration of Helsinki. http://www.wma.net/e/policy/pdf/17c.pdf (accessed 1st May 2007)

Horse meat served in an Israeli restaurant, with subsequent apologies

Here's the story from Haaretz: Psst! That's horse you're eating, Tel Aviv waiter admits
Turkiz serves horse regularly but didn't mention it in the dish description; waiter tells the couple what the menu didn't.

apparently the restaurant has horse meat on its menu, but left it out of the description of at least one dish.

(Many Israelis may share the American repugnance for eating horse, but an additional complication there is that horses don't have split hooves nor chew their cud and so are not kosher.  Apparently the sale of horse meat for human consumption is legal there, unlike here in California...)

HT: Ran Shorrer

An investigative journalist at the Telegraph is offered a kidney for sale

Britons being sold illegal kidneys for surgery in Sri Lanka
Patients awaiting kidney transplants in the UK are being offered illegal organs which are then used in operations at a Ski Lankan hospital

George Dantzig's math library is available for "private treaty sale"

Here is the sale site, and here is Michael Trick's blog post on the sale, Own a Ton of Operations Research History.

That post ends with this observation: " I suspect in the future, there will be far fewer libraries from great researchers.  I know that my own “library” is really nothing more than the hard drive on whatever computer I am using."

High pay isn't repugnant in Switzerland after all, at least not to 65%

Here's the story from Bloomberg: Swiss Voters Reject Strict CEO Pay Limits in Referendum

"Swiss voters rejected a proposal to limit executives’ pay to 12 times that of junior employees yesterday, a measure that would have gone further than any other developed nation.
The measure was opposed by 65 percent of voters, the government in Bern said yesterday.
...
"“It’s a big relief,” Valentin Vogt, president of the Swiss Employers’ Association, said in an interview on Swiss national television SRF. “It’s a signal that it’s not up to the state to have a say in pay.”
Switzerland is the home to at least five of Europe’s 20 best-paid chief executive officers. Opposition to excessive pay has stiffened among the traditionally pro-business Swiss following the government bailout of UBS AG (UBSN), Switzerland’s biggest bank, in 2008 and a plan -- later scrapped -- by Novartis AG (NOVN) to pay outgoing Chairman Daniel Vasella as much as $78 million.
In March, Swiss voters approved the so-called fat-cat initiative that gave company shareholders a binding vote on managers’ pay and blocked golden handshakes and severance packages."
*******************

But sometimes high pay strikes some people as repugnant, and it's not just hedge fund managers: take a look at this story from the NY Daily News.

Top 16 NYC charter school executives earn more than Chancellor Dennis Walcott

What happens when Big Data meets human resources?

That's the question asked by this recent article in the Atlantic by Don Peck, which focuses on using nontraditional data to match workers to jobs, either for hiring new workers or for assigning workers to tasks within a firm.

One of the companies they mention (and one I'm interested in) is Knack, which has created video games which generate apparently useful kinds of data about individuals.

In general, there's a question of what should the inputs be for a matching algorithm, and for many purposes economists have focused on preferences, but 'big data' offers some possibilities for informing preferences and identifying good matches.

(See an earlier related post with links to other articles here: New sources of data for selecting who to hire )

School choice in New Orleans: schools have big strategy sets

In New Orleans (as in New York City), some schools have big strategy sets. The Times-Picayune reports: Two New Orleans high schools said they were 'full' -- then enrolled more students


"the data raises troubling questions about whether these two schools are truly "open admission" campuses or are secretly cherry-picking students. "I think it's a fact that school leaders of certain schools are deciding who gets a seat, and I don't think that's serving students well," said Caroline Roemer Shirley, head of the Louisiana Association of Public Charter Schools.

McMain Principal Bridgette Frick admitted taking in more freshmen after officially declaring the class full. She said she let in students who came to sign up at the school in July, after McMain was freed from OneApp.

So, too, did McDonogh 35 Principal Gerald DeBose. He said the school independently boosted ninth-grade enrollment beyond its initial number to offset an unexpected loss of students in 10th and 11th grade.

The Orleans Parish School Board allowed the schools to fill any open seats on their own over the summer. However, Recovery School District data show they were overenrolled well before then."

...

"In most parts of the country, charters run their own application lotteries. But suspicions arose in New Orleans that the lack of oversight left room for individual schools to prioritize some applicants over others, even though almost all are "open admission," meaning they have no stated entry requirements. 

...

"The state Recovery School District introduced OneApp in 2012 to address these and other issues. It applies to all New Orleans public schools in both the state-run district and about half of those overseen by the separate Orleans Parish School Board. The exceptions, for now, are Orleans Parish School Board charters that choose not to participate until their charters come up for renewal.

Celebrate Marilda Sotomayor at her 70th birthday conference in Brazil, July 25-31, 2014

Here's the conference website, which says in part:

It is a great pleasure to invite you to participate in the SÃO PAULO SCHOOL OF ADVANCED SCIENCES ON GAME THEORY – INTERNATIONAL WORKSHOP ON GAME THEORY AND ECONOMIC APPLICATIONS OF THE GAME THEORY SOCIETY, to celebrate the 70th birthday of Marilda Sotomayor. It will be held at the University of São Paulo, from July 25 to July 31, 2014.

The workshop will offer the participants the opportunity to interact with some of the most productive researchers in Game Theory. The week-long event will consist of mini-courses, conferences and contributed papers sessions, which will be complemented with a round table for discussions on themes of interest of the participants. The courses will start at the introductory level and will reach the frontiers of current research.

...

Mini-Courses

• MARKET DESIGN - ALVIN ROTH (University Stanford)
• SOCIAL CHOICE AND FAIR DIVISION - HERVÉ MOULIN (University of Glasgow)
• INFORMATION THEORY - DAVID PEREZ-CASTRILLO (University Autonoma de Barcelona)
• COOPERATIVE GAMES - ROBERTO SERRANO (Brown University)
• STOCHASTIC GAMES: ALGORITHMS AND EXISTENCE - T. E. S. RAGHAVAN (University Chicago)
• INTRODUCTION TO AUCTION THEORY - Vijay Krishna (Pennsylvania State Univ.)
  • CLUBS, COALITIONS AND NETWORKS - Myrna Wooders (Vanderbilt Univ.)

All the courses will be ministered in parallel, except for “Market Design”.

Plenary Lecturers

• AUMANN, ROBERT: Hebrew University of Jerusalem, Israel and State University of New York at Stony Brook, USA.
• HART, SERGIU: Hebrew University of Jerusalem, Israel.
• MASKIN, ERIC: Princeton University, USA
• NASH, JOHN: Princeton University, USA
• ROTH, ALVIN: Stanford University, USA.
• SCHMEIDLER, DAVID: Interdisciplinary Center in Herzliya, Israel.
• SOTOMAYOR, MARILDA: Universidade de São Paulo, Brazil.

N.Y.C. turns to open data to help with high school choice

Here's an encouraging development: New York City is making data available to third party app developers to help families compare schools:  N.Y.C. turns to open data to help with high school choice

Deceased donor registration versus transplantation in Malaysia

The National News Agency of Malaysia (BERNAMA) has the following disheartening report on the difference between deceased organ donor registration and subsequent transplantation:

Sarawak News

---

November 16, 2013 19:10 PM

Organ Transfer Conducted From Only 435 Of 237,395 Registered Organ Donors - Lee Lam Thye

SIBU, 16 Nov (Bernama)- The Organ Donation Public Awareness Action Committee revealed that only 435 of the 237,395 registered organ donors had donated their organs after their death so far.

Its chairman, Tan Sri Lee Lam Thye, said the number was very small compared with the number of those who had registered to donate their organs upon their death.

He attributed this to, among others, the family members or next-of kin of the registered organ donors not allowing the organ transfer to be conducted when the former died.

"This happens because the registered donors did not inform their family members of their pledge to donate their organs upon their death.

"Hence, we advised those who have pledged to donate their organs upon their death to inform their family members of their decision," he told a media conference after an organ donation campaign here Saturday.

Eating horsemeat is good for horses, says Britain's Princess Anne

The Telegraph has the story (and a video):
Princess Anne: why Britain should consider eating horsemeat
"The Princess Royal, who is President of World Horse Welfare, says that Britain should consider eating horsemeat because it would improve standards of care for the animals"

 "Princess Anne was speaking at the World Horse Welfare Organisation annual meeting when she made the comments:
"Our attitudes to the horsemeat trade may have to change" she said, because those in the trade "value their horses and look after them well" and therefore "should we be considering a real market for horsemeat and would that reduce the number of welfare case?
"I think this need a debate," the Princess Royal added."

D.C.plans a single school choice system that includes both traditional and charter schools

Here's the story from the Washington Post:
D.C. rolls out unified enrollment lottery for traditional, charter schools

The story even includes a link to IIPSC.

And here's a link to the DC school choice site, My School DC

Seminar on modern matching, by Scott Kominers

If you are at loose ends in Cambridge MA this noon...

Scott Kominers: "Theory, Practice, and Engineering in (Generalized) Matching Market Design"

Date: Wednesday, November 20, 2013
Time: 12:00pm – 1:30pm
Place: Maxwell Dworkin 119

Speaker: Scott Kominers, Harvard Society of Fellows, Harvard Program for Evolutionary Dynamics, and Harvard CRCS

Title: Theory, Practice, and Engineering in (Generalized) Matching Market Design

Abstract:
In recent years, matching theory has been widely applied in the design of centralized labor markets and school choice programs. At the same time, new theoretical discoveries have shown how to generalize matching algorithms to incorporate contract negotiation and complex market structures. I will survey the history of matching, from the marriage problem, through "marriage with dowries," to generalized matching with contracts. Then, I will discuss applications of generalized matching algorithms to the design of affirmative action and cadet--branch matching systems. I will conclude by showing how these results have recently contributed to the elimination of "walk-zones" in the Boston public schools match.

Bio:Scott Duke Kominers is a Junior Fellow at the Harvard Society of Fellows, a Research Scientist at the Harvard Program for Evolutionary Dynamics, and an Associate of the Harvard Center for Research on Computation and Society. From 2011-2013, he was the inaugural Research Scholar at the Becker Friedman Institute for Research in Economics at the University of Chicago.

Kominers received his A.B. in Mathematics and Ph.D. in Business Economics from Harvard University, in 2009 and 2011, respectively. His research focuses on market design and its interactions with law and computer science. His specific research interests include matching theory, mechanism design, law and economics, privacy, and quadratic form representation theory.

Location: 

Maxwell Dworkin 119

More on the law and politics of compensating bone marrow donors

The legal battle is shaping up over the decision of the department of Health and Human Services to circumvent the decision of the ninth circuit court of appeals that it is legal to compensate bone marrow donors.  The Institute for Justice, which was a successful litigant in the court ruling, has outlined their current thoughts here:
Federal Officials Move to Block Life-Saving Research
HHS’ Proposed Rules Would Undo Court Ruling Legalizing Bone Marrow Compensation

They say in part:
"The proposed regulation would ban marrow compensation just when empirical research has begun into the effects of compensating donors.  A team of economists—Nicola Lacetera of the University of Toronto, Mario Macis of Johns Hopkins University, and Robert Slonim of the University of Sydney—were in the process of finalizing a research proposal that would have investigated the effects of donor compensation when they learned of the new rule.

“These new regulations make it impossible for researchers to obtain the necessary evidence to inform policy.  Our proposed studies would be made illegal by these new provisions,” explained Macis, who, along with Lacetera and Slonim, has published some of the leading work showing that economic incentives can be effectively used to increase blood donations without affecting blood supply safety.  “Properly designed compensation for bone marrow donors could similarly lead to significant increases in donations, thus giving potentially hundreds or thousands of people in need of a transplant every year a greater chance of survival.  At a minimum, the federal government should not make it illegal for researchers to find out whether incentives can help address the shortage of bone marrow donors.”

“I don’t think that anybody should go to jail just for trying to save somebody’s life,” added Doreen Flynn, who has three children with Fanconi anemia, a blood disease that frequently requires a bone marrow transplant and who was the lead plaintiff in the original lawsuit.  “If paying donors results in more marrow donations, we should pay them.  And it shouldn’t be a crime to investigate it.”
“We know what doesn’t work,” said Robert McNamara, also a senior attorney with the Institute and co-lead counsel in the case.  “We have 30 years of experience with an altruism-only marrow-donor program, and we know that has not succeeded in recruiting enough donors.  The only question is whether offering compensation can achieve better results.  We will not allow the federal government to make it a felony to find out the answer.  Hopefully, we will do that by persuading the government not to adopt this rule, but if we have to, we will sue them again.  And we will win—again.”

The proposed regulation is currently open for a period of public comment through December 2, 2013.  Individuals who have been impacted by blood-borne cancer or bone marrow donations are encouraged to leave comments on the Department of Health and Human Services’ website:  http://www.regulations.gov/#!submitComment;D=HRSA_FRDOC_0001-0115."
****************

You can follow some of the story in my earlier posts on bone marrow and compensation.

AEA Registry for Randomized Control Trials

This just in...

Dear AEA member:

The AEA has launched a new site to register randomized control trials (RCTs). The AEA encourages all investigators to register new and existing RCTs. Registration is entirely voluntary and is not currently linked to or required for submission and publication in the AEA journals.

The site is available at https://www.socialscienceregistry.org

On this site, you can register your forthcoming, ongoing, or even completed RCTs, with as little or as many details as you wish. The site will also permit you to store and make publicly-available additional information on your RCTs (reports, articles, data, and code). We believe that this will prove to be a very valuable resource for investigators to share their work and the site will be widely used by those who wish to find out about on-going and completed studies.

The registry is characterized by:

1) Simplicity and flexibility: Registering a trial is straightforward with only a minimal number of required fields. There is considerable flexibility to provide additional material at the time of registration or at any point in the life of the study. Materials can also be hidden from public view until completion of the study, or be made accessible only with the permission of the PI.

2) Adjustability and memory: Any registry entry can be amended by the PI at any point, but the registry keeps track of all versions.

3) Ability to work as a research portal for your RCTs: The registry can serve as an access point for collaborators, other scholars, students, and the general public providing links to data sets, survey instruments, experimental findings, and experimental protocols.

To register a trial, the PI simply needs to enter the following information: PI name, project title, study location, project status, keyword(s), abstract, trial start and end dates, intervention start and end dates, proposed outcome(s), experimental design, whether the treatment is clustered, planned number of clusters, planned number of observations, and IRB information. Optional fields allowing the PI to customize and enhance the information made available include details on sponsors and partners, survey instruments, an analysis plan, and other supporting documents. Help is available if the PI encounters any problem.

The AEA registry system will provide the PI with reminders to update the registration of an RCT at appropriate points in the trial's lifecycle. For example, the submitted end date will trigger an email asking the PI to enter post-trial information. If the trial has been extended, the PI can update the trial with the new end date.

We encourage you to explore the registry and to register your RCTs.

The committee on the registry for social experiments
Larry Katz (chair)
Esther Duflo
Pinelopi Goldberg
Duncan Thomas

Ohio execution stay for Ronald Phillips for possible organ donations

This will complicate my discussions in China...

Ohio execution stay for Ronald Phillips for possible organ donations

November 14, 2013 (COLUMBUS, Ohio) -- Ohio's governor delayed the execution of a condemned child killer to consider the inmate's unprecedented organ donation request, acknowledging that it's ''uncharted territory'' but expressing hope that the man might help save a life before losing his own.

Ronald Phillips, 40, was scheduled to be put to death Thursday with a lethal injection of a two-drug combination not yet tried in the U.S., but Gov. John Kasich issued a stay of execution Wednesday. The execution date has been reset for July 2.

"I realize this is a bit of uncharted territory for Ohio, but if another life can be saved by his willingness to donate his organs and tissues then we should allow for that to happen," Kasich said in a statement. He said he wanted to allow time for medical experts to study whether Phillips could donate non-vital organs, such as a kidney, before being executed.

Related Content

STORY: Organ-donor request delays Ohio killer's execution

Phillips, who was sentenced for raping and killing a 3-year-old girl in Akron in 1993, asked this week to donate a kidney to his mother and his heart to his sister. His attorney said it was an attempt to do good, not a delay tactic.

Ohio's prison medical policy accommodates organ donations, but prison officials rejected the request, saying it came too late to work out logistics and security concerns.

Kasich said Phillips' crime was heinous but his willingness to donate organs and tissue could save another life and the state should try to accommodate that.

Some 3,500 people in Ohio and more than 120,000 nationally are awaiting organ donations, said Marilyn Pongonis, a spokeswoman for the Lifeline of Ohio organ donation program.

If Phillips is a viable donor for his mother, who has kidney disease and is on dialysis, or for others awaiting live transplants of non-vital organs, the stay would allow time for those procedures to be performed, Kasich said.

Phillips' sister suffers from a heart ailment and he also wants to donate his heart to her.

Richard Dieter, executive director of the Death Penalty Information Center, said a Delaware death row inmate was permitted in 1995 to donate a kidney to his mother while in prison, though he was not facing imminent execution like Phillips.

"This step by the governor puts it into a more normal discussion of (how) an inmate, without any security problems, can help save another person and is that the right thing to do," he said. "With 24 hours to go before an operation had to be carried out, it definitely gets in the way of that process."

Vital organ donations raise larger ethical issues and have not been allowed during U.S. executions but have occurred in China, Deiter said.

Dieter, whose group opposes the death penalty, added: "If the whole idea is to save a life, there's one life to be saved simply by not executing the person at all."

Phillips made his request after the governor denied him mercy and Phillips had exhausted his other legal options. The state had left it up to Phillips' family whether the organs would be harvested after his death.

HT: Bernadette Keller

Saudi comedians mock the ban on women drivers with a video song

The NY Times has the story

"Their video, a play on the Bob Marley classic “No Woman, No Cry,” has gone viral, receiving more than 6.5 million views on YouTube since it was posted on Saturday. The catchy a cappella tune mocks the country’s restrictions, as well as the assertion by one Saudi cleric that driving would harm women’s ovaries."

Repugnant transaction watch: Saudi women drivers

The NY Times has the latest on a demonstration by Saudi women who wish to be allowed to drive in the Kingdom, and the reaction it has drawn: Saudi Women Rise Up, Quietly, and Slide Into the Driver’s Seat

"The public call for women nationwide to drive on Saturday was the latest push in a decades-old effort by a small group of activists to exercise what they see as a fundamental human right. Saudi Arabia, a hereditary monarchy, is the only country in the world where women are not allowed to drive."

Is the Common App still doing what it was designed to do?

The letters to the editor of the NY Times, following a recent article on the Common App and its troubles, include one (the second letter) from one of the founders of the Common App. It says in part:

"The unavoidable standardization of the Common Application, not to mention the online debacle for students trying to use it this year, causes serious questions regarding its service to both the candidate and the college.

As co-founder of the Common Application some 40 years ago (with Jack Osander of Princeton and Fred Jewett of Harvard), I sense that the Common App’s time is up. The sole original goal of the Common Application was to make applying to highly selective colleges easier for nontraditional, less advantaged but deserving students. Clearly, it worked early on.

Now it seems that the ease of applying via the Common App has transferred from the poorest to the most affluent students, whose families have no problem paying a dozen or more application fees — the more apps, the better the chance of admission somewhere special. This phenomenon also creates thousands more “ghost applications” (from students unlikely to enroll) for the colleges."

HT: Eric Budish

Earlier posts on the common app.

Is published economics research credible?

Not so much, is the answer given in the article below by Doucouliago and Ioannidis in the December issue of J of Economic Surveys (see, even the date isn't credible:). John Ioannidis is quite well known for his critiques of the reliability of published medical research.

Ioannidis, J. and Doucouliagos, C. (2013), WHAT'S TO KNOW ABOUT THE CREDIBILITY OF EMPIRICAL ECONOMICS?. Journal of Economic Surveys, 27: 997–1004. doi: 10.1111/joes.12032

Abstract
The scientific credibility of economics is itself a scientific question that can be addressed with both theoretical speculations and empirical data. In this review, we examine the major parameters that are expected to affect the credibility of empirical economics: sample size, magnitude of pursued effects, number and pre-selection of tested relationships, flexibility and lack of standardization in designs, definitions, outcomes and analyses, financial and other interests and prejudices, and the multiplicity and fragmentation of efforts. We summarize and discuss the empirical evidence on the lack of a robust reproducibility culture in economics and business research, the prevalence of potential publication and other selective reporting biases, and other failures and biases in the market of scientific information. Overall, the credibility of the economics literature is likely to be modest or even low.
...

4. Conclusions: Unanswered Questions and Possibilities for Improvement
Despite the aforementioned empirical evidence, much remains unknown. How credible is economics research in different subfields? Is credibility rising or falling over time? How can this market be improved? What is the impact of corporate and institutional interests, journals, funding agencies, and other stakeholders and how can we utilize this potential impact to improve the credibility of economics?

However some paths forward seem clear: strengthen the reproducibility culture with emphasis on independent replication; conduct larger, better studies; promote collaborative efforts rather than siloed, one-investigator research; and reduce biases and conflicts. The exact interventions, which might achieve these changes are not clear, and perhaps there is room for conducting experimental studies on different potential interventions. Progress may be difficult to achieve unless the rewards and incentives system of conducting and publishing research is modified. Little progress is likely if investigators get rewarded and promoted for publishing significant results and for perpetuating theories and claims even when they are wrong. Conversely, one might expect better outcomes, if replication research is encouraged, reproducibility is rewarded, and/or irreproducibility is penalized.


Answering these questions requires more meta-research (i.e. empirical research on research). Empirical studies that have been performed in other scientific disciplines may be extrapolated and conducted in economics. Tests for bias may also be adapted for economics and embraced by leading journals. Of course, meta-research is also susceptible to bias and errors of its own. The extent of bias and possible errors needs to be evaluated also for emerging meta-research tools. Nonetheless, tests for small-study effects and publication or selective reporting biases need to be applied increasingly, further developed and evaluated (Stanley and Doucouliagos, 2012).
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See also
Why Most Published Research Findings Are False
John P. A. Ioannidis
Published: Aug 30, 2005DOI: 10.1371/journal.pmed.0020124

Minimum age of marriage

Israel has raised the legal minimum age of marriage to 18, but this is unlikely to prevent the early marriages which circumvented the prior minimum age of 17...

17-year-old wives: Law passed too late for us

Several groups of ultra-Orthodox Jews, Israeli-Arabs conduct underage marriages, say new law, to raise minimum age for marriage, will not make great difference. With 11,000 underage marriages a year, will law change current custom?

"A new law passed by the Knesset on Monday that permits marriage starting from the age of 18 is not impressing Hasidic members of the haredi public and several groups with the Israeli-Arab sector in which underage marriage is quite common. In many such communities, there are couples who tie the knot before their 17th birthday – the minimum age before the new law.

According to figures from the Central Bureau of Statistics, 11,747 girls under the age of 18 were married in Israel during 2011. From 2000 to 2009, 19,863 girls married at the age of 18; 15,020 girls said their vows by their 17th birthday; and 2,548 girls up to the age of 16 committed to their partner for the rest of their lives.

According to Hasidic custom, the sons of distinguished rebbis marry even earlier in order to minimize the time frame between puberty and their wedding, and to prevent young males from inappropriate thoughts or worse – sinful deeds.

The legislation is not expected to raise the minimum age for marriage in those communities, as they already ignore the existing law. The ceremony at underage marriages in these communities is conducted privately by rabbis who do not report the event to the authorities. The registration for the wedding is completed at a later date, when both the bride and the groom reach the legal age."

MIT news on the couples match for doctors

MIT news does a good job of science reporting (and of celebrating Parag Pathak)...

Doctor, doctor: Why the job market for married couples in medicine works well

New study in the growing ‘market design’ field of economics explains how a job-market algorithm helps land couples in the same locations.

Formerly repugnant transaction watch: Ilinois looks to be number 15 to recognize same sex marriage

Illinois House Votes to Allow Same-Sex Marriages

"SPRINGFIELD, Ill. — A historic vote Tuesday in the Illinois House positioned that state to become the largest in the heartland to legalize gay marriage, following months of arduous lobbying efforts by both sides in President Barack Obama's home state.

Fourteen states plus Washington D.C., allow same-sex marriage. Most recently, New Jersey, Minnesota and Rhode Island have legalized it.

The road to the Illinois vote was long with stalled attempts earlier this year, something that frustrated activists in the state where Democrats lead the House, Senate and governor's office. Chicago Democratic Rep. Greg Harris, who is the sponsor of the bill, decided not to bring the bill for a vote in May because he said he simply didn't have the support.

Then the U.S. Supreme Court ruled to strike down a provision of the federal Defense of Marriage Act, something he said resonated with lawmakers. Backers also launched a furious campaign, hiring a lobbyist from the state's largest union, the former head of the Illinois Republican Party and field organizers spanning the state.

"To treat all our citizens equally in the eyes of the law we must change this," Harris said on the floor. "Families have been kept apart."

Debate lasted more than two hours, and the final roll call was met with hearty cheers and applause. Supporters' speeches echoed themes of equality and civil rights with mentions of Obama, Martin Luther King Jr. and Matthew Shepard, a gay college student whose 1998 death sparked numerous hate crime bills.

Polls show support for gay marriage has surged since 1996, when Gallup found that 27 percent of Americans backed it. Now Gallup finds the majority support giving gay and lesbian couples the right to marry."

Congestion in the market for law internships in Israel

Aviad Heifetz points me to an article in the Haaretz magazine, on law clerks (in Hebrew, but Google Translate makes it clear enough that they are talking about congestion (apparently after a period of unraveling): http://www.themarker.com/law/1.2151631

"The new rules stipulate that law firms will not be able to interview candidates to specialize before 15 March in the third year of undergraduate law students.

In March the new rules came into effect and the change was felt immediately. That day open all major law firms in the competition for employment outstanding students. Race interviews lasted for a few intense days. Although March 15 falls on a Friday this year many offices were assembly-line interviews and ambitious students frantically moved from office to office.

Headhunters

Here's a paper (forthcoming in Organization Science) on headhunters of the modern variety, and who they hunt:

Who Says Yes When the Headhunter Calls? Understanding Executive Job Search Behavior

Peter Cappelli, Monika Hamori

NBER Working Paper No. 19295
Issued in August 2013
NBER Program(s):   LS 

We examine an aspect of job search in the important context of executive-level jobs using a unique data set from a prominent executive search firm. Specifically, we observe whether or not executives pursue offers to be considered for a position at other companies. The fact that the initial call from the search firm, which we observe, is an exogenous event for the executive makes the context particularly useful. We use insights from the Multi-Arm Bandit problem to analyze the individual’s decision as it emphasizes assessments of future prospects in the decision process, which are particularly relevant for executive careers. More than half the executives we observe were willing to be a candidate for a job elsewhere. Executives are more likely to search where their current roles are less certain and where their career experience has been broader. Search is more likely even for broader experience within the same employer. In the latter case, the array of likely opportunities is also broader, making search more useful.

In France: are buyers as well as sellers of prostitution criminals?

343 French sign 'Don't Touch My Whore' petition

Feminist wrath as Dominique Strauss-Kahn's lawyer joins "manifesto of the 343 b-------" in petition against plans to criminalise clients of prostitutes

HT: Ron Shorrer

Swap clothes on swapdom.com

Swapdom is a site for trading clothes.

It came to my attention through this blog post:  Swapping clothes instead of kidneys

Financial Incentives for Living Kidney Donation: Ethics and Evidence

That's the title of a recent letter by Matthew B. Allen and Peter P. Reese at Penn, motivated by an article suggesting that payment to donors could be welfare improving,

1. Barnieh L, 
2. Gill JS, 
3. Klarenbach S, 
4. Manns BJ

: The cost-effectiveness of using payment to increase living donor kidneys for transplantation. Clin J Am Soc Nephrol   2013

Allen and Reese (may be gated) review arguments pro and con, and conclude:

Given the promise of a cost-effective strategy provided by Barnieh’s group—and a lack of empirical evidence that ethical concerns about incentivizing live donors would manifest—we propose a research agenda and necessary elements for a limited trial of incentives. First, using modeling, researchers should examine the comparative effectiveness of different incentive strategies, such as reimbursement for lost wages and expenses or provision of insurance. Expense reimbursement is a promising alternative to fixed payment. Estimates of donor financial burden range from $907 to $3089, and compensation would help ensure that donors do not suffer financially from donation (8). Because potential donors would not stand to benefit financially, expense reimbursement could ease concerns about undue and unjust inducement, but it might also fail to generate a meaningful increase in the supply of organs (5). Moreover, in contrast with fixed payment for donation, expense reimbursement is legal in the United States (1).

Second, a limited, real-world trial of regulated incentives should be conducted. Ideally, the effect of a direct payment intervention could be contrasted with expense reimbursement and usual care. A geographically limited trial should assess (1) the effect of different payment models on the number of donors (to assess the program’s benefits), (2) the socioeconomic and general health status of potential and actual donors (to assess unjust inducement), and (3) donor comprehension of risks and evidence of donor coercion (to assess undue inducement). If incentives are provided for only a subset of donors, evidence of crowding out should also be assessed. The trial should measure psychological, financial, and physical outcomes after donation. Existing protections for potential live donors will be necessary, such as use of independent donor advocates, separation of donor and recipient evaluation teams, and ability to opt-out from donation with dignity at any time (5). Additional protections may also be needed, such as a “cooling off” period between evaluation and donation to allow transplant teams multiple opportunities to assess donor motives and comprehension.

The barriers to conducting such a trial are significant. In the United States, these barriers include the National Organ Transplant Act (1). Removing the legal prohibition on payment for donation would require persistent advocacy by diverse stakeholders. So far, surveys suggest a lack of consensus for organ markets among the general public, and a minority of transplant surgeons support paying for living donation (9,10).

Current trends regarding the use of financial incentives in medicine suggest that the time is ripe for new consideration of payments for living kidney donation. The last decade has witnessed rising interest in behavioral economics and well-designed clinical trials using financial incentives to change diverse health behaviors, including smoking and weight loss (11–13). In the meantime, this work by Barnieh et al. may allow advocates to make a financial case for incentives in the realm of living kidney donation. Reassurance about the ethical concerns, however, can come only through empirical evidence from actual experience.

Preferences for randomness in German university admissions

Here's a paper that pushed a lot of my buttons: theory, experiments, and institutional detail on university admissions to study medicine (and some other disciplines) in Germany: Flipping a Coin: Theory and Evidence, by Nadja Dwenger, Dorothea Kubler, and Georg Weizsacker

Abstract: We investigate the possibility that a decision-maker prefers to avoid making a decision and instead delegates it to an external device, e.g., a coin flip. In a series of experiments our participants often choose stochastically dominated lottery between outcomes, contradicting most theories of choice such as expected utility. A large data set on university applications in Germany shows a choice pattern that is consistent with a preference for randomization, entailing substantial allocative consequences. The findings are consistent with our theory of responsibility aversion.

Here's some of the institutional description:

"Admissions to German undergraduate university programs in the medical subjects are centrally administered by a clearinghouse. The clearinghouse assigns applicants according to the following three procedures that are implemented in a sequential order:

(1) Procedure A admits students who are top of the class to up to 20% of seats.

(2) Procedure W admits students with long waiting times to up to 20% of seats.

(3) Procedure U represents admission by universities according to their own criteria to the

remaining (at least 60% of) seats.

For each of the three procedures, applicants are asked to submit a preference ranking of universities, which may either be identical or di fferent across procedures. All rank-order lists are submitted at the same moment in time. The central clearinghouse employs the three procedures in a strictly sequential order: all applicants who are matched in procedure A are firmly assigned a seat at their matched university and do not take part in subsequent procedures. All remaining applicants enter procedure W. Likewise, after procedure W, all applicants who are still unmatched enter procedure U. The fact that applicants can submit three (potentially different) rank-order lists of universities, each of which may be relevant, is a unique property of the German mechanism and makes it suitable for our analysis."

Procedure A is apparently an immediate-acceptance ("Boston") algorithm that takes only the preferences of the students as inputs, while procedure U is a university-proposing deferred acceptance algorithm.  While there are strategic reasons for students to submit different preferences in A and U, the authors argue that these can be identified and removed from the data, and that there remain students who order their choices differently in the two procedures, in the manner of experimental subjects who display a preference for introducing some randomness into their assignment.

Georg W. further writes to me as follows:
"Arguably the most important and most interesting strategic motives in the German application system appear because of the multi-stage nature of the mechansim: Applicants need to be careful that they are not matched in the first stage of the mechanism, in cases where they plausibly have a chance to get a better match on subsequent stages."

Nalini Ambady, RIP

Stanford psychology professor Nalini Ambady passed away after a long search for a matching bone marrow donor:
Nalini Ambady, Stanford psychology professor, dies at 54
"A distinguished social psychologist, Ambady was well known for her research that showed that people can form accurate first impressions about others based only on seconds-long observations of their nonverbal behavior."

"Nalini Ambady, a Stanford professor of psychology, died Oct. 28 after a long battle with leukemia. Her passing followed a yearlong, worldwide effort by family, friends and students to find a bone marrow donor match."
**************

Professor Ambady's students and friends organized an active campaign to help her find a bone marrow donor, which you can follow here: http://ambadylab.stanford.edu/helpnalininow/

Here's a story from New Delhi TV (NDTV) that in passing emphasizes how the inability to compensate donors can make the search tragically difficult (emphasis added): Professor Nalini Ambady's death highlights lack of awareness on bone marrow transplants in India

"Because of genetic markers, a person is likely to find a match from one's own ethnic gene pool. In Ms Ambady's case her match would most likely have been from someone from her birthplace - Kerala.

"For the past six months, the Ambady family has been carrying out drives in India to encourage people to sign up for the bone marrow registry in the hopes of finding her a potential match.

"But in a country of 1.2 billion, only about 45,000 people have signed up to be bone-marrow donors. In comparison, there are over 10 million donors on the United States' National Marrow Donor Program.

"This is despite the fact that becoming a bone marrow donor is simple. All it takes is a swab test-rubbing an ear bud on the inside of one's cheek. An actual transplant is as painless as donating blood. Still, because of ignorance, lack of awareness, cultural taboos or psychological fears Indian's don't sign up to become donors.

"Ms Ambady found at least six potential matches from India. But they all dropped out. According to a childhood friend Ann Ninan, "It was heart breaking for the family."

"Ms Ambadi's family will not be able to celebrate this Diwali with her but during this festive season let's all sign up as donors. It's a few minutes of your time but it could save someone's life."
***************

My colleague Muriel Niederle, who took a class from Professor Ambady at Harvard, reflects on her passing here.

See some of my other posts on bone marrow donation, and the ongoing political/legislative/legal disputes concerning whether bone marrow donors can be compensated, or whether this should be forbidden as a repugnant transaction. (Long story short: The conventional interpretation that paying bone marrow donors was outlawed by the National Organ Transplant Act was upset by a decision of the 9th Circuit Court of Appeals, but the Department of Health and Human Services is taking steps to change the relevant regulations so that it will continue to be illegal despite the court ruling.)

The law and politics of bone marrow and compensation for donors

The Department of Health and Human Services is proposing new regulations that would put bone marrow more clearly into the class of organs for which payment is forbidden by the National Organ Transplant Act of 1984. This is in response to the decision by the Ninth Circuit to make compensation legal for bone marrow donations made through the harvesting of blood stem cells directly from the blood.

Here's the relevant page from the Federal Register: Federal Register/ Vol. 78, No. 191 / Wednesday, October 2, 2013 / Proposed Rules

Here are my earlier posts on the courts and compensation for bone marrow donation.

Since I'm not licensed to practice law in North Carolina or anywhere else, I wrote to Kim Krawiec to ask whether HHS could simply overrule the Ninth Circuit with a regulation, or whether Congress would have to get involved.

Here is Kim's reply:
"... new legislation is probably not needed to overturn the 9th circuit ruling -- that is certainly the position of HHS.  Here is the relevant language from NOTA (with emphasis mine): (1) The term “human organ” means the human (including fetal) kidney, liver, heart, lung, pancreas, bone marrow, cornea, eye, bone, and skin or any subpart thereof and any other human organ (or any subpart thereof, including that derived from a fetus) specified by the Secretary of Health and Human Services by regulation.  

The only question would be whether HHS exceeded its authority in some way through this change. I'm sorry to say that such a claim would be an uphill battle.  One might imagine, for example, a claim that the statute only permits the addition of "organs" and HSCs drawn from peripheral blood are not an organ (as the 9th Circuit concluded).  But courts are extremely deferential to agencies on these questions of interpretation (the term is "Chevron deference", named after a Supreme Court case establishing the standard). Courts are very reluctant to overturn agency interpretations of this sort and defer to the agency interpretation unless it is unreasonable.  Hopefully the interpretation (assuming the proposed reg is enacted) will be challenged, but I think this one will be a tougher fight than the first case."

HT: Bob Slonim

A new NBER paper makes use of some of the random elements of the New York City high school assignment algorithm to understand the effect of small schools:

Small High Schools and Student Achievement: Lottery-Based Evidence from New York City

Atila Abdulkadiroğlu, Weiwei Hu, Parag A. Pathak

NBER Working Paper No. 19576
Issued in October 2013
NBER Program(s):   ED   LS   PE 

One of the most wide-ranging reforms in public education in the last decade has been the reorganization of large comprehensive high schools into small schools with roughly 100 students per grade. We use assignment lotteries embedded in New York City's high school match to estimate the effects of attendance at a new small high school on student achievement. More than 150 unselective small high schools created between 2002 and 2008 have enhanced autonomy, but operate within-district with traditional public school teachers, principals, and collectively-bargained work rules. Lottery estimates show positive score gains in Mathematics, English, Science, and History, more credit accumulation, and higher graduation rates. Small school attendance causes a substantial increase in college enrollment, with a marked shift to CUNY institutions. Students are also less likely to require remediation in reading and writing when at college. Detailed school surveys indicate that students at small schools are more engaged and closely monitored, despite fewer course offerings and activities. Teachers report greater feedback, increased safety, and improved collaboration. The results show that school size is an important factor in education production and highlight the potential for within-district reform strategies to substantially improve student achievement.

A Finnish team takes top honors at 2013 North American wife carrying championship

Sometimes when I talk about dwarf tossing (which is illegal in many places), I also talk about wife carrying, which is not.  Here's the latest from the North American championships: Results from the 2013 North American Wife Carrying Championship

It includes a video of the competition