Organ donation in the UK: the particular case of children

Children in need of transplants, particularly very young children, need appropriately sized organs, which can come from deceased donors of similar age. But there are obstacles, including family consent:

Despite removal of many obstacles, UK child organ donation rates remain low

"Despite the removal of many logistical/professional obstacles, and clear guidance from national bodies, UK child organ donation rates remain lower than in other comparable countries, say experts in a leading article published online in the Archives of Disease in Childhood.

"Many families of dying children are simply not even given the chance to consider the option, and potentially save another child's life, they argue.
...
"Family refusal remains a major obstacle to organ donation from children, emphasise the authors, but that is where trained staff are key, as they can ensure that "families are given the chance to consider donation, and that it is broached at the most appropriate time by the most appropriate person, and in the most appropriate way," say the authors.

"Immediate focus should be given to consent rates and supporting family decision-making, they urge."

Wild (and abandoned) horses are starving, because we love them too much

Chris Stewart, a horse-loving Republican congressman from Utah, writes in the NY Times:

The Hard Truth About the West’s Wild Horse Problem

"The federal government’s Wild Horse and Burro Program is broken, leaving thousands of animals to starve. The Bureau of Land Management says that the nearly 27 million acres it manages for wild horses and burros can sustain only about 27,000 animals. This year, the bureau estimates that there were more than 72,000 wild horses on the land, almost 50,000 too many and all fighting to survive.
...
"This isn’t just a horse management disaster, it’s a financial disaster too. In addition to the 72,000 horses it oversees on the range, the B.L.M. keeps about 45,000 horses that it has removed from the wild in corrals, off-range pastures and in sanctuaries. Over their lifetime, these horses will cost taxpayers roughly $1 billion overall, according to the B.L.M. That’s $1 billion we could otherwise spend on defense, education, job training or any other worthy cause.
...
"the bulk of the blame lies with shortsighted decision-making by misinformed but well-meaning members of Congress.

"Congress had once supported laws that allowed for proper management of these animals. Horses in excess of what the land could sustain were to be captured, put up for adoption, sold without restriction — including to slaughterhouses, which the B.L.M. does not do as a matter of policy — and as a last resort, humanely euthanized. The program wasn’t perfect, but the B.L.M. was able to keep the herds’ numbers in check while ensuring that the ranges were viable and healthy year after year.

"But since 2010, Congress has used annual appropriations acts to significantly restrict the ability of the B.L.M. to sell or euthanize horses. "
************

This is clearly not the situation intended by those who put in place the laws and regulations that prevent wild horse populations from being managed.  Maybe it's time to eat horsemeat, for the sake of the horses?  Not likely soon in the U.S.: see my previous posts on that...

Altruism is not a one-dimensional personality characteristic

It's important to remember that people are complex.

Teacher From Hudson Who Donated Kidney Busted For Drug Pushing
The kidney donation saved his father's life.

"A Hudson County high school teacher involved in a kidney exchange that saved his father's life was busted at his apartment with cocaine and pot for sale, authorities said."

Three stories of kidney donations (and one of a grinch that wants to limit them)

I regularly see stories about kidney donation and kidney exchange: they've become so common that they are hardly news. But they are still very moving.  For today, as some of you open your Christmas gifts, here are three recent ones.

The first, from the Toledo (Ohio) Blade features Mike Rees and the Alliance for Paired Donation, and a kidney transplant to a former Blade correspondent, from his daughter:  A daughter’s enduring gift

Here's one from the San Francisco Chronicle, about a police officer who decided to give a kidney to a stranger:
SF police officer’s kidney donation leads to lifesaving chain of events

And here's another story of a kidney exchange chain:
THE ULTIMATE GIFT: Three kidney patients meet their donors at Duke

If those stories make you feel good about donors, they should. And you can feel a little good about economics too, since it is through kidney exchange that many donations happen.

But maybe you should stop here for today, and hold on to that feeling of peace and good will.

Because I also have a less cheerful story, about a vigorous resistance to the idea that donors should be allowed to save the patients they love even if they don't have health insurance, perhaps because they live in a country in which health insurance doesn't cover transplantation.  I'm speaking about efforts to obstruct Global Kidney Exchange , which is a way of inviting such patient-donor pairs to participate in American kidney exchange, free of charge, with their care paid for by the savings to the American health care system that are achieved by transplanting a patient who would otherwise be on dialysis (which is more expensive). At the link above you can see my posts about how GKE works, how it has received support from the American Society of Transplant Surgeons, and how it has attracted statements of opposition, concerned that, because it is free of charge, it resembles organ trafficking.

A new statement of opposition, from the group that calls itself the Declaration of Istanbul Custodian Group, has appeard on their web site:
STATEMENT OF THE DECLARATION OF ISTANBUL CUSTODIAN GROUP CONCERNING ETHICAL OBJECTIONS TO THE PROPOSED GLOBAL KIDNEY EXCHANGE PROGRAM

It's an 8 page document (read it all at the link), but they summarize their position (on p2) this way:
"Although attractive at first glance, the GKEP proposal should be rejected for many reasons. It is deceptive; it creates major ethical problems, such as disproportionately helping the rich over the poor and undermining rather than advancing the welfare of kidney patients in LMICs; it amounts to international organ trafficking; and it will be difficult to administer in a way that actually prevents unethical and even illegal acts.  In the end, “reverse transplant tourism” differs from ordinary transplant tourism only with regards to the people who travel—organ recipients or organ donors—and not in the commercial nature of the organ “donation.”


So...I've written a lot about repugnant transactions (starting with this 2007 article), and repugnance to transactions involving body parts is something that has to be taken with the utmost seriousness.  In the coming year I'll devote some further effort to answering this and other objections with the seriousness that the subject demands.

But, today, in honor of the great Christmas festival of gift exchange, I'll just address this opposition to kidney exchange with these lines from Dr. Seuss's famous book How the Grinch Stole Christmas

"Every Who down in Whoville liked Christmas a lot.
But the Grinch who lived just North of Whoville did not!

The Grinch hated Christmas! The whole Christmas season!
Now, please don't ask why. No one quite knows the reason.

It could be, perhaps, that his shoes were too tight.
It could be his head wasn't screwed on just right.

But I think that the most likely reason of all
May have been that his heart was two sizes too small."

The riskiest job in medicine

 The November December Message from the ASTS President Jean Edmond refers to an auto accident involving the ambulance transporting a liver to be transplanted.

"Our donor team, two fellows, a surgical resident, and a medical student were involved in a high speed car crash coming back with a liver from Long Island. Fortunately, all were seat-belted and as they stood in a daze around the crushed ambulance, the first thing they worried about was getting the liver safely back to Cornell for the implant. This moment captures the selfless devotion of our young people as they carry out the lifesaving work that we all do every day."

Here's an article about that:

The Riskiest Job in Medicine: Transplant Surgeons and Organ Procurement Travel, by M. J. Englesbe, and R. M. Merion, in the American Journal of Transplantation,  Volume 9, Issue 10, October 2009, 2406–2415

Abstract

Transplant surgeons are exposed to workplace risk due to the urgent nature of travel related to organ procurement. A retrospective cohort study was completed using data from the Scientific Registry of Transplant Recipients and the National Transportation Safety Board. A web-based survey was administered to members of the American Society of Transplant Surgeons. The survey response rate was 38% (281/747). Involvement in ≥1 procurement-related travel accident was reported by 15% of respondents; surgeons reported 61 accidents and 11 fatalities. Air travel was used in 26% of procurements and was involved in 56% of accidents. The risk of fatality while traveling on an organ procurement flight was estimated to be 1000 times higher than scheduled commercial flight. Involvement in a ‘near miss accident’ was reported by 80.8%. Only 16% of respondents reported feeling ‘very safe’ while traveling. Procurement of organs by the geographically closest transplant center would have reduced the need for air travel (>100 nautical miles) for lung, heart, liver and pancreas procurement by 35%, 43%, 31% and 49%, respectively (p < 0.0001). These reductions were observed in each Organ Procurement and Transplantation Network region. Though these data have important limitations, they suggest that organ procurement travel is associated with significant risk. Improvements in organ procurement travel are needed.

Safe travels, all of you out there...

Auction design wins a national high school science prize

Market design may be expanding out into high schools...

Maryland and New York Students Capture $100,000 Scholarship Prizes in 2017 SIEMENS Competition in Math, Science and Technology


WASHINGTON, DC, December 5, 2017 – Four high school students, one from Bethesda, MD, and a team from Dix Hills and Melville, NY, were awarded grand prizes of $100,000 scholarships for their significant accomplishments in scientific research in the 2017 Siemens Competition in Math, Science & Technology. The Competition is the nation's premier science research competition for high school students and seeks to promote excellence by encouraging students to undertake individual or team research projects. For more information go to: www.siemens-foundation.org​

Andrew Komo, a senior at Montgomery Blair High School in Silver Spring, MD, won the $100,000 grand prize in the Individual category for developing a coded system that protects online auctions from threats, such as cheating and fraud."

HT: Scott Kominers

AEA interviews: the video

Going to the AEA to interview for a job?  Here's a video in which various already-employed economists reflect on the process of becoming employed...

Here's the webpage: Interviewing at AEA? Watch this first.  Laughs, Scares, and Wisdom from AEAs Past!

School choice among different kinds of schools

Chalkbeat on the changing face of school districts, and the role played by universal-enrollment school choice:

A ‘portfolio’ of schools? How a nationwide effort to disrupt urban school districts is gaining traction

"Several years ago, Indianapolis Public Schools looked like a lot of urban school districts. The vast majority of students attended traditional public schools, though enrollment was dwindling, and the district had an adversarial relationship with its small but growing number of charter schools.

"That’s no longer true. The district is actively turning over schools to charter operators, and it’s rolling out a common enrollment system for district and charter schools that could make it easier for charters to grow. Nearly half of the district’s students now attend charters or district schools with charter-like freedoms.

...

"A growing number of philanthropists, advocates, and policymakers say the way to improve schools is to upend the traditional school district. Usually pointing to the same cities as models — Indianapolis, along with Denver, New Orleans, and Washington D.C. — they want to see more charter schools and more district schools run like charter schools.

...

"Another piece of the portfolio playbook is supporting enrollment systems that allow families to easily choose among district and charter schools.

"Adding new schools and new choices can make things harder on parents, who must navigate several enrollment processes to make a choice and get assigned to a school. Common enrollment systems create a single place to navigate it all — while also ensuring that all parents are exposed to new schools, and making it especially clear to district leaders which schools are attracting the fewest students.

“In addition to efficiency for families, unified enrollment helps the system make better decisions about which schools to replicate, recruit, incubate, scale, and maximize and, perhaps, where to locate them,” according to an Education Cities report.

"Denver, New Orleans, and Washington D.C. all have common enrollment systems, and Indianapolis just adopted one. In Denver, the use of a streamlined system did in fact increase enrollment in charters among low-income students and English-language learners, though in New Orleans parents said it was actually harder to navigate initially."

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

U.S. laws on gestational surrogacy, state by state

The surrogacy agency & law firm Creative Family Connections LLC publishes a very informative interactive map (you can click on each state): 

STATE-BY-STATE INTERACTIVE MAP FOR COMMERCIAL SURROGACY

Here's a picture (green is where it's a go...)

“GREEN LIGHT” STATES

Surrogacy is permitted for all parents, pre-birth orders are granted throughout the state, and both parents will be named on the birth certificate. Go to the state page for more detailed information.

CA, CT, DC, DE, ME, NH, NV, RI

Surrogacy is permitted but results may be dependent on various factors or venue; OR only a post-birth parentage order is available. In some birth states additional post-birth legal procedure may be required. Click on any state on the map for more detailed information.

AL, AK, CO, FL, GA, HI, IL, KS, KY, MA, MD, MN, MO, MT, NC, ND, NM, OH, OK, OR, PA, SC, SD, TX, UT, VT, WI, WV

Note: The state where the baby is born must have a procedure to allow both parents to be named on the birth certificate without action in another state.

“YELLOW LIGHT” STATES

Proceed with caution. Surrogacy is practiced, but there are potential legal hurdles; or results may be inconsistent. Click on any state on the map for more detailed information.

AK, IA, ID, MS, MT, NE, TN, VA, WY

Proceed with caution. Surrogacy is practiced, but there are potential legal hurdles; or results may be inconsistent. Click on any state on the map for more detailed information.

AZ, IN

“RED LIGHT” STATES

STOP! Statute or published case law prohibits compensated surrogacy contracts, OR a birth certificate naming both parents cannot be obtained. Click on any state on the map for more detailed information.

LA, MI, NJ, NY, WA

Supervised injection facilities for opioids

From Statnews:
As a doctor, I was opposed to supervised injection facilities. Now I’m ready to give them a try  By Henry L. Dorkin (the president of the Massachusetts Medical Society).

"Over the last few years, I have watched with a blend of amazement and grave concern as an odd phenomenon has unfolded against the backdrop of our nation’s opioid crisis: Despite the clear need to battle this ongoing epidemic with all of the tools at our disposal, one evidence-proven option — supervised injection facilities — is being overlooked, and even disparaged.
...
"A supervised injection facility is a safe, clean space where individuals can inject drugs they already possess under the supervision of trained medical staff. The facilities also offer sterile injection equipment. The advantage is that medical expertise is immediately present in case an emergency occurs. At the same time, these on-site clinicians can facilitate pathways to treatment and rehabilitation from the chronic disease of opioid abuse disorder.
...
"As a physician and president of the Massachusetts Medical Society, I was initially inclined to oppose the concept of supervised injection facilities. How, I thought, could a health care professional, someone grounded in ethics and an oath to “do no harm,” stand by and watch as individuals inject street drugs into their veins?
...
"The concept of supervised injection facilities fits well with the overarching and proven public health philosophy of harm reduction: meeting patients where they are in their disease to eliminate existing barriers to rehabilitation.

With lives being lost each day from all segments of our society, dealing in theoretical solutions can be counterproductive. Fortunately, supervised injection facilities operating in other parts of the world have yielded substantial and evidence-backed reductions of death, disease, and expenditures.

"To better understand the utility of these facilities, the Massachusetts Medical Society created a task force to examine the evidence for and against supervised injection facilities. This group produced a report that reviewed all available data regarding the use of supervised injection facilities around the world.

"The report clearly showed that these facilities save lives. For example, after the Insite facility opened in Vancouver, British Columbia — the first supervised injection facility in North America — researchers reported a 35 percent decrease in the number of lethal overdoses in that area.

...

"Shortly after our medical society overwhelmingly voted to adopt a policy in support of a pilot supervised injection facility program in Massachusetts, the American Medical Association adopted a similar policy.

...

"As we continue to look for ways to increase access to recovery programs for those with opioid use disorder, we must remember that in order to get people into recovery, they must first stay alive."

More on the endorsement of Global Kidney Exchange by the ASTS

The October 2017 Message from the ASTS President Jean Edmond is now online, and I gather it would have been fun to be present at their discussion of GKE, prior to their decision to endorse it:

"We had several intense discussions during the Council meeting that highlighted the values of a strong and diverse Council. The intense ethical debate regarding the global kidney exchanges espoused by Mike Rees and Alvin Roth was addressed. Our ASTS culture prizes innovation and disruptive approaches to our challenges, and we therefore chose to support their work in a public statement with full recognition of the need to protect the vulnerable from exploitation."


Here's my earlier post on that: Monday, October 30, 2017, Global Kidney Exchange endorsed by the American Society of Transplant Surgeons

High frequency ticket buying, by scalper bots

Freakonomics asks Why Is the Live-Event Ticket Market So Screwed Up?

They talk to a bunch of good economists.  Here's Eric Budish on the subject of why it's odd that tickets are "underpriced," in the sense that it's profitable for software bots to buy them up before the humans can get in the act, and then resell them...

"BUDISH: That’s competition on — to an economist — a strange dimension: competition on speed rather than price; that’s the connection to my stuff on high-frequency trading. It’s competition, but it’s not a productive form of competition."

Read (or listen) to the whole thing at the link.

The legal market for marijuana in Uruguay

The Guardian has the story
How Uruguay made legal highs work
The South American country’s move to full legalisation of cannabis has so far proved a success, especially for its 17,391 users

"“On the street 25 grams of marijuana would cost you 3,000 pesos, that’s about $100 for something with probably a large amount of pesticide, seeds and stems,” says Luciano, a young buyer who is next in line. “But here the same amount would cost you only $30, and it comes in guaranteed, premium quality, thermosealed 5g packs.”

"In July this year, tiny Uruguay became the first country in the world to legalise the sale of marijuana across its entire territory.

"Only 12 of the country’s 1,100 pharmacies have signed up so far to supply the 17,391 government-registered consumers served by the system, which explains the long queues outside. The low price and slim profit margin partly explain their reticence. “But the main problem is that banks have threatened to close the accounts of pharmacies selling marijuana,” said one chemist who sells marijuana in Montevideo, but who did not want to reveal his name for fear of such bank intervention.

"Although sales of the drug have been legalised in various US states, they remain illegal at federal level, leading to a situation where most banks refuse to handle marijuana-related accounts anywhere in the world. Even now that sales in Uruguay have been completely legalised, the fear of running into trouble with the US federal authorities has become concrete.

...

"“The transformation of consumers has been astounding,” says Blasina. “They’ve gone from buying low-quality products from street dealers to becoming gourmet experts who compete with the crops at their clubs.”

Scott Kominers had a big market design class at Harvard this year

Scott may eventually educate a high percentage of market designers: here's a picture of his class this year.

Japan's health insurance will pay for overseas transplants

In Japan, the national insurance will now pay for some transplants done overseas, when they cannot be done at home. The discussion reflects concern that they may be accused of organ trafficking. (Thanks to Fuhito Kojima for the link...)

海外臓器移植、一部保険給付へ　１千万円程度　現在は全額自己負担

(Google translate: Overseas organ transplantation, partial insurance benefit To ten million yen now All costs self-burden)  http://www.sankei.com/politics/news/171212/plt1712120018-n1.html

"Katsuobu Kato Kunihiro Kato revealed a policy to pay part of expenses from public health insurance to patients who are going abroad and get organ transplants because they are not provided domestically at the Cabinet meeting after the Cabinet meeting on December 12 . Consider using "overseas medical care expense system" to reimburse overseas treatment expenses from medical insurance of subscribers. The relevant patient seems to be around ten people a year, mainly children.

　"Currently, all overseas organ transplant patients are borne entirely by themselves, and in the case of the heart, since it costs several hundred million yen, there are many cases where fund raising activities are carried out. There is also an international declaration that "Organs necessary for transplant surgery should be secured in the home country", and this policy can lead to promotion of transplantation and international criticism is also anticipated. Kato Atsushi said, "It is fundamental to implement organ transplants under the domestic regime and it will not change anything."

　"The subjects to be covered by insurance are limited to patients who satisfy certain criteria such as being registered in the Japan Organ Transplant Network and being in danger of maintaining life in the standby state. When applying for overseas medical expenses, it is also necessary to prove that it is an operation not applicable to organ trafficking."
**********

 I'm reminded of current controversies concerning global kidney exchange, which involves cross-border kidney exchange.

Tax credit for adopting a child

Philip Held draws my attention to this oped from the WSJ, by By Jedd Medefind (who is president of the Christian Alliance for Orphans, and formerly led the White House Office of Faith Based and Community Initiatives (2008-09)).

The Adoption Tax Credit Saves Money
The foster system costs over $25,000 a year for each child.

"The adoption tax credit, which provides up to $13,570 to aid families in adopting a child, has teetered on a razor’s edge in tax-reform negotiations. But the bills passed by the House and Senate both ultimately preserved it, and now the conference committee should follow suit. Eliminating the credit would harm children who need families, while hitting America in the pocketbook.

"There are more than 115,000 children in foster care today. About half of them will be adopted, but without the tax credit that number would drop significantly. The rest “age out” of foster care, likely without family for life.
...
"Families don’t adopt to get a tax credit. But the costs of going through the process—and then meeting the needs of a child coming from a hard place—can be a major barrier. After the adoption tax credit first became widely available in 1997, adoptions from foster care nearly doubled in three years.

"A drop in adoptions would mean fewer [children] finding families. It would also push government spending higher in many areas. Government’s replacement for parents—the foster system—costs taxpayers well over $25,000 a year for each child, according to a 2011 report by the National Council for Adoption. That doesn’t count spending on a huge number of other programs that chip in, including food stamps, Medicaid and Temporary Assistance for Needy Families."
***********


Here's the 2011 report.
"Comparing the per-child cost ofsubsidized adoption from fostercare with the cost of maintaininga child in foster care, one concludes that the child adoptedfrom foster care costs the publiconly 40 percent as much as thechild who remains in fostercare. The difference in cost perchild per year amounts to$15,480."
**************

I can't help seeing a strong analogy between

• adoption saving kids from foster care;
• kidney transplants saving patients from dialysis; and
• adoptive parents being analogous to kidney donors...

Ed Glaeser reviews Who Gets What and Why in the Journal of Economic Literature

Ed has written a generous review in the Journal of Economic Literature, of my book and of the field of market design. His review gave me an inkling of what it was like to read the book rather than to have written it*.

Glaeser, Edward L.. 2017. "A Review Essay on Alvin Roth's Who Gets What—And Why." Journal of Economic Literature, 55(4):1602-14.

Abstract: Alvin Roth’s Who Gets What—And Why provides a richly accessible introduction to his pioneering work on market design. Much of economics ignores the institutions that allocate goods, blithely assuming that the mythical Walrasian auctioneer will handle everything perfectly. But markets do fail and Roth details those failures, like the market for law clerks that unravels because clerks and judges commit to each other too quickly. Roth combines theory and pragmatic experience to show how the economist can engineer successful markets. He has even enabled welfare-improving trades in kidney exchanges, where law and social repugnance forbids cash payments.


*To put it another way, I'm reminded of Ralph Waldo Emerson's line "“Tis the good reader that makes the good book...," or maybe Samuel Johnson “A writer only begins a book. A reader finishes it.”

Wales' organ donation opt-out law has not increased donors--BBC

Here's the story from the BBC:
Wales' organ donation opt-out law has not increased donors

"Wales' opt-out system for organ donation has not increased the number of donors in the two years since it was introduced, a study has confirmed.

"Adults in Wales are presumed to have consented to organ donation unless they have opted out.

"The data was published in a Welsh Government report about the impact of the Human Transplantation (Wales) Act.

"In the 21 months before the law changed in December 2015 there were 101 deceased donors in Welsh hospitals. The data showed there were 104 in the same time period since the law change.

Every quarter NHS Blood and Transplant releases figures for organ donation for each county in the UK.

Mr Gething acknowledged the figures and added: "The report suggests this may be because there have been fewer eligible donors over the short period since the change in law.

"It's important to remember that it's too early to know what the true impact of the change will be, but I'm confident we have started to create a culture where organ donation is openly discussed."

HT: Frank McCormick

Different ways of being a bad apple

Readers of this blog may be familiar with the article by Judge Alex Kozinski about how he hires and interacts with law clerks, earlier than his competitors:
Confessions of a Bad Apple, The Yale Law Journal, Vol. 100, No. 6 (Apr., 1991), pp. 1707-1730

It began as follows:

I was sad to notice this Dec 8 Washington Post story which reports that Judge Kozinski is the latest public figure to face credible allegations, from six of his former clerks, of being a different sort of bad apple.

Prominent appeals court Judge Alex Kozinski accused of sexual misconduct

************
December 18 update from the Washington Post: Federal appeals judge announces immediate retirement amid probe of sexual misconduct allegations

The gray market for marijuana in Holland

The combination of a legal market and an illegal one makes for a gray market, which seems to be the situation of marijuana sellers in the Netherlands. (Not so different from legal marijuana sellers in some American states, who still run afoul of federal laws...)

The Guardian has the story:
Netherlands coffee shop case highlights 'paradox' of cannabis laws

"With 3,000 customers a day, a restaurant, ample parking and turnover of €26m (£23m) a year, Checkpoint cafe, the largest cannabis-selling coffee shop in the Netherlands, was a fabulous commercial success.

"That was until it was closed down in 2009 for testing to the limits what the Dutch describe as their gedogenbeleid (tolerance policy) under which prosecutors turn a blind eye to the breaking of certain laws, including in the business of selling cannabis.

"The latest and most likely final appeal hearing of criminal charges against the cafe’s owner, Meddie Willemsen, has highlighted what the president of a court in Den Bosch described as “paradoxes” in the Dutch approach to so-called soft drugs.

"Licensed coffee shops are allowed to sell cannabis from their premises, but can keep only 500g on site at any time. Production of the drug is illegal.

"When Checkpoint was at its peak, Willemsen, 66, was regularly keeping about 200kg of cannabis on his large premises in Terneuzen, near the Belgian border. The size of the enterprise could have led to fairly reasonable assumptions that those providing the drugs would be large criminal gangs.

"Prosecutors were informed by the court that while Checkpoint cafe was certainly criminal, local authorities had effectively aided it at times and turned a blind eye for long enough that punishment of the owner would be inappropriate.

"The court heard the illegal activity was necessary for a cafe of Checkpoint’s size. The president ruled: “That is punishable. But at the same time not to be avoided when you run a well-functioning coffee shop.”
...
"The president of the court in Den Bosch said the story of Checkpoint cafe highlighted the absurdity of the law in the Netherlands, where selling cannabis at the front of the shop is legal, under strict criteria, but production and sourcing of it at the back is illegal. “Here lies a task for the legislator,” the president said.

"In 2012, the Dutch government changed the law to criminalise sales by coffee shops to customers who cannot prove they live in the Netherlands. There is a dispensation for people in Amsterdam, on the grounds that the practice is part of the attraction for tourists visiting the city.

Hiring America's soldiers

The veterans' publication Task and Purpose has the story:
The Recruiters: Searching For The Next Generation Of Warfighters In A Divided America  By ADAM LINEHAN 

"Since the draft was ended in 1973, recruiting has become one of the most important jobs in the military. For the Army, it’s imperative. While the Marine Corps prides itself on being lean, mean, and agile, and the Navy and Air Force increasingly rely on unmanned vehicles and long-range munitions, the Army’s greatest contribution to the battlefield is, and always has been, people. Roughly 70% of the nearly 7,000 U.S. troops killed so far in Iraq and Afghanistan were Army soldiers. Most were recruited through centers like the one in East Orange.

"Headquartered in Fort Knox, Kentucky, U.S. Army Recruiting Command, or USAREC, manages the recruiting mission for the service’s active-duty and reserve components. It is a massive, ever-evolving operation involving approximately 12,500 military and civilian personnel spread across 1,400 recruiting centers in the United States and abroad, including in Europe and Guam. Roughly $4.6 billion of the Army’s $33.8 billion budget for fiscal year 2017 was allotted for recruiting and training new soldiers; $424 million of that was spent on bonuses alone. The Army also poured more than $289 million into television, radio, digital media, direct mail, and sports-related advertising campaigns. A lot of blood, sweat, and tears goes into keeping the ranks filled with qualified volunteers. The recruiting machine never stops.

"The biggest factor in recruiting success is the health of the economy. Typically, when the unemployment rate goes up, so does the number of Americans wanting to join the military. Nonetheless, the more economically stressed, socioeconomic classes tend to be underrepresented in the armed forces. Although people in low-income neighborhoods are generally more inclined than their wealthier compatriots to enlist, fewer and fewer have the qualifications to serve. Rising standards are part of the reason. But so are a host of societal problems that tend to hit disenfranchised populations especially hard, such as increasing obesity rates and a public education system that disadvantages low-income zip codes.

"Currently, only about 29% of Americans between the ages of 17–24 are eligible to serve. Disqualifiers include lack of a high-school diploma or GED; tattoos on the hand, face, or neck; a wide range of physical and mental-health problems; a history of illegal drug use, and a criminal record.
...
"Bryant believes the Army could keep its ranks filled by focusing on a handful of states, most of them south of the Mason-Dixon line, while paying extra attention to communities within those states that have formed around military installations. Current trends support this view: Of the newest crop of Army recruits, half came from just seven states; 79% had relatives who served. The military has become increasingly — some would even add dangerously — insular since the advent of the all-volunteer force. As the journalist Thomas E. Ricks noted in a 1997 article for The Atlantic titled The Widening Gap Between Military and Society, this trend toward homogeneity was likely accelerated by the closing of dozens of bases and installations following the end of the Cold War, which significantly reduced the military’s footprint in the West and Northeast. 

“You can kind of draw a smiley face from North Carolina around the southern United States halfway up California, and that’s where the majority of [military] post, camps, and stations are,” Snow said. “Youth who have more interaction with those in uniform tend to [be more likely to enlist].” Could the Army shutter its recruiting centers in the Northeast and still meet its quotas? Snow suspects it could. “But then we’re getting away from the very principles that we pride ourselves on, and that’s that we are a microcosm of society,” he added.  

Behavioral and Experimental Health Economics conference at Georgia State

Here's the announcement:
5th Workshop in Behavioral and Experimental Health Economics, Dec 7-8, 2017

General Information

Following the success of previous workshops in Oslo, Hamilton, Essen and Cologne, we are pleased to host the 5th Workshop on Behavioral and Experimental Health Economics in Atlanta. The workshop brings together economists who apply behavioral economics and experimental methods in health economics research to present and discuss their research papers. We also welcome researchers from related fields, such as Public Health, Epidemiology and Medicine. We welcome contributions on all topics within health economics using experimental methods and behavioral economics applications.

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Keynote

The primary keynote address will be given by Professor Judd Kessler from the Wharton School at the University of Pennsylvania: http://assets.wharton.upenn.edu/~juddk/. Judd received a B.A. in Economics from Harvard University in 2004, an M.Phil. in Economics from Cambridge University in 2005, and a Ph.D. in Business Economics from Harvard University in 2011. In his research he uses a combination of laboratory and field experiments to answer questions in Public Economics and market design. He investigates the economic and psychological forces that motivate individuals to contribute to public goods, with applications including organ donation, worker effort, and charitable giving. He also investigates market design innovations, placing particular emphasis on bringing market design from theory to practice, with applications including course allocation and priority systems for organ allocation. Judd’s research has appeared in general interest journals including the American Economic Review, the Quarterly Journal of Economics, and Management Science, as well as specialist journals such as Health Economics and American Journal of Transplantation, Annals of Internal Medicine, and the Journal of General Internal Medicine.

Same sex marriage is now legal in Australia

From the NY Times: Australia Makes Same-Sex Marriage Legal

"SYDNEY, Australia — Australia’s Parliament voted overwhelmingly to legalize same-sex marriage on Thursday, overcoming years of conservative resistance to enact change that the public had made clear that it wanted.

The final approval in the House of Representatives, with just four votes against the bill, came three weeks after a national referendum showed strong public support for gay marriage. The Senate passed the legislation last week.

“This belongs to us all,” Prime Minister Malcolm Turnbull, a longtime supporter of same-sex marriage who had previously failed to get it legalized, said on Thursday. “This is Australia: fair, diverse, loving and filled with respect. For every one of us this is a great day.”

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"A handful of lawmakers tried to add amendments that they said were meant to safeguard religious freedoms for opponents of same-sex marriage, but their efforts failed. Mr. Turnbull noted that nothing in the legislation requires ministers or other celebrants to oversee weddings of gay couples or threatens the charity status of religious groups that oppose same-sex marriage, two concerns the lawmakers had raised."