Forbes Health Forum in Mexico City, May 23

I'm travelling to Mexico today, to speak about kidney exchange at a health forum sponsored by Forbes, and to meet with colleagues at Pro-Renal, the new kidney exchange program there.

Here's a brief news story:
Alvin E. Roth, el Nobel de Economía que ha salvado miles de vidas
No es médico, pero el doctor Roth ha ayudado a miles de personas a recibir un trasplante de riñón, lo que le valió un Nobel en 2012.

And here's the conference program:

FORO FORBES SALUD
May 23,
HACIENDA DE LOS MORALES, CDMX

Agenda (via Google translate)

08:30 HRS. WELCOME

MANAGING TEAM OF FORBES MEDIA LATAM

08:40 HRS. FORBES HEALTH FORUM RECOGNITION

ALFREDO QUIÑONES-HINOJOSA , "DOCTOR Q", MD, FAANS, FACS. WILLIAM J. AND CHARLES H. MAYO PROFESSOR | CHAIR, NEUROLOGIC SURGERY

Dr. Alfredo Quiñones is an example to follow. His history as a migrant in the United States is a reflection of tenacity, dedication, inspiration. He is currently one of the most recognized doctors in the United States for his contributions to neurosurgery. And it's Mexican.

09:00 HRS. INAUGURAL DISCOURSE

TBD

An economic-financial diagnosis of the sector and the challenges it faces such as increased investment in health services.

09:30 HRS. CONFERENCE.

"THE ECONOMY CURES THE HUMANS"

ALVIN E. ROTH , NOBEL PRIZE OF ECONOMY 2012

The work of Dr. Roth has allowed the realization of more than 4 thousand kidney transplants in the United States. This economist developed a "Algorithm of Compatibility" based on technology, big data and the economy applied to health that is solving two of the main public health problems in the world: chronic renal failure and incompatibility between couples of donors and recipients of transplants.

10:00 HRS. RECESS | EXPO | NETWORKING OPPORTUNITY 

10:30 HRS. PANEL. 1

"HEALTHY SOCIETY = HEALTHY ECONOMY"

Investing in health can mean big business, but above all the best practice to build a better future. The principle is basic: if we have healthy Mexicans, companies and the public sector would register a better performance and, consequently, economic activity would register better numbers. How to face costs, have the necessary infrastructure, treat chronic degenerative diseases and maintain a decent level of quality of life?

DR. DAVID KERSHENOBICH STALNIKOWITZ , DIRECTOR GENERAL OF THE NATIONAL INSTITUTE OF MEDICAL SCIENCES AND NUTRITION SALVADOR ZUBIRÁN

ÁNGELES DE GYVES , CEO OF THE CORPORATE HEALTH AND WELFARE COUNCIL

11:00 HRS. PANEL. 2

"THE DIGITAL WORLD IN HEALTH"

The patient has changed and that forces companies in the sector to adapt to the new circumstances. The digital revolution is largely responsible for this transformation. How to understand the new consumption habits? How to transmit the information to customers? This table will be aimed at understanding and applying the best techniques to know the voice of the e-patient.

JENNIFER BARBA , FOUNDER AND CEO OF FRAME CONSULTING

ALEJANDRO PAOLINI , MANAGING DIRECTOR OF SIEMENS HEALTHINEERS MESOAMÉRICA AND MEXICO

HÉCTOR VALLE MESTO , EXECUTIVE PRESIDENT OF THE MEXICAN FOUNDATION FOR HEALTH, AC

JORGE RUIZ ESCAMILLA

11:30 HRS. PANEL. 3

"HACKING HEALTH"

New forms emerge as a muscle for efficient use and maximization of resources, patient management and electronic records. Along with this, home care, mobile applications and regulatory challenges begin to be promoted. Also, the best practices of IT companies. This space will serve to know the best strategies that allow the Health Sector to capitalize on the new trends.

MARTHA GONZÁLEZ , DIRECTOR OF IBM WATSON & amp; CLOUD PLATFORM

JAVIER CORDERO , PRESIDENT OF ORACLE MEXICO

FERNANDO OLIVEROS , CEO OF MEDTRONIC

GABRIEL LOOR MD., FACC , SURGICAL DIRECTOR, LUNG TRANSPLANT PROGRAM BAYLOR AT ST. LUKE'S MEDICAL CENTER

MODERATOR : ARMANDO SANDERS , CO-FOUNDER OF GENO +

12:00 HRS. PANEL. 4

"HEALTH AS A BUSINESS AND INVESTMENT"

Health is a good investment. The Mexican Pharmaceutical Industry as a contributor to the productive capacity of the country. Multinational and Mexican companies will share their success stories and strategies to adapt to market conditions.

RODRIGO PUGA , CEO OF PFIZER MEXICO

ANA LONGORIA , CEO OF NOVARTIS MEXICO

RAFAEL GUAL , DIRECTOR GENERAL OF CANIFARMA

VLADIMIRO DE LA MORA , PRESIDENT OF GE MEXICO

MODERATOR : JUANA RAMÍREZ , FOUNDER AND PRESIDENT OF SOHIN

12:30 HRS. CONFERENCE.

"EXPONENTIAL HEALTH", ACCORDING TO SINGULARITY UNIVERSITY

RAYMOND MCCAULEY , CHAIR OF THE BIOTECH TRACK OF SINGULARITY UNIVERSITY

13:00 HRS. TIME FOR FOOD

14:30 HRS. PANEL. 5

"THE NEW FINANCING"

Pharmaeconomics, changing the health dialogue. Going from asking for "budget" and "demonstrating that health brings productivity". This space has a clear objective: to understand public finances and the impact it has on the country's fiscal balance. What are the new financing models? Topics such as investment in infrastructure, private equity and health financing models will be put on the table.

PATRICK DEVLYN , PRESIDENT OF THE CCE HEALTH COMMISSION

PABLO ESCANDÓN , PRESIDENT AND DIRECTOR GENERAL OF GRUPO NADRO

FRÈDÈRIC GARCÍA , PRESIDENT OF THE EXECUTIVE BOARD OF GLOBAL COMPANIES (CEEG)

FÁTIMA MASSE , CONSULTANT IN URBAN URBAN DEVELOPMENT

ANTONIO CHEMOR RUIZ , NATIONAL COMMISSIONER OF SOCIAL PROTECTION IN HEALTH / PEOPLE'S INSURANCE

MODERATOR : GUSTAVO CANTÚ , CEO OF SEGUROS MONTERREY NEW YORK LIFE

15:00 HRS. PANEL. 6

"THE END OF THE TRADITIONAL DISTRIBUTION"

New disruptive models of distribution and access to primary health care. The customer service in the last chain of the process in the distribution of the drug is being transformed.

MAX LEONARDO , ATTORNEY GENERAL OF PHARMACIES OF SAVINGS

RICARDO MARTÍ , DIRECTOR OF WALMART FARMACIAS

15:30 HRS. CONFERENCE.

"BENEFITS OF AEROSPACE MEDICINE ON EARTH"

EMMANUEL URQUIETA, MD, MS , SENIOR RESEARCH PORTFOLIO MANAGER OF THE TRANSLATIONAL RESEARCH INSTITUTE FOR SPACE HEALTH

16:00 HRS. HEALTH VIEWED BY THE NEXT SEXENIUM

The political times are already here and, under this environment, this table will convene the links of the candidates to the Presidency of the Republic to share with the audience the great tasks that would be carried out in the next six years.

JORGE ALCOCER VARELA , REPRESENTATIVE OF ANDRÉS MANUEL LÓPEZ OBRADOR, PRESIDENTIAL CANDIDATE FOR THE COALITION TOGETHER WE WILL HISTORY

16:30 HRS. CLOSING

***********

And here's an article in the Mexican edition of Forbes describing some of the health problems faced in Mexico:

La biotecnología puede ser una cura para muchos males en México
México está enfermo: Cada año unas 100 mil personas mueren a causa de diabetes, 80 mil por infartos y 80 mil por tumores, sin embargo, la tecnología podría estar cerca de cambiar las reglas del juego. Este tema y otros se tocarán en el Foro Forbes de Salud.

Google translate:
"Biotechnology can be a cure for many ills in Mexico
Mexico is sick: Every year about 100 thousand people die from diabetes, 80 thousand from heart attacks and 80 thousand from tumors, however, technology could be close to changing the rules of the game. This theme and others will be played at the Forbes Health Forum."

Safe injection sites in New York City? Learning from Canada...

The NY Times has two recent stories, one perhaps a reaction to the other.  First this:
De Blasio Moves to Bring Safe Injection Sites to New York City

"Mayor Bill de Blasio is championing a plan that would make New York City a pioneer in creating supervised injection sites for illegal drug users, part of a novel but contentious strategy to combat the epidemic of fatal overdoses caused by the use of heroin and other opioids.

"Safe injection sites have been considered successful in cities in Canadaand Europe, but do not yet exist in the United States. Leaders in San Francisco, Philadelphia and Seattle have declared their intention to create supervised sites, although none have yet done so because of daunting obstacles. Among them: The sites would seem to violate federal law.

"The endorsement of the strategy by New York, the largest city in the country, which last year saw 1,441 overdose deaths, may give the movement behind it impetus.

"For the sites to open, New York City must still clear some significant hurdles. At minimum, the plan calls for the support of several district attorneys, and, more critically, the State Department of Health, which answers to Gov. Andrew M. Cuomo. The city sent a letter on Thursday to the state, asserting its intention to open four injection centers.

 ...
"The most serious obstacle to the safe injection sites may be the federal government. A section of federal law known as the crack house statute makes it illegal to own, rent or operate a location for the purpose of unlawfully using a controlled substance.

The enforcement of the statute in the case of safe injection sites, however, would be up to the discretion of federal authorities. While it is unclear how the Trump Justice Department will respond to the city’s proposal, the attorney general, Jeff Sessions, has taken a hard line on drug policy.

“We don’t believe a president who has routinely voiced concern about the national opioid epidemic will use finite federal law enforcement resources to prevent New York City from saving lives,” Eric F. Phillips, the mayor’s press secretary, said in a written statement.

Advocates for the sites point out that needle exchanges were considered illegal when they began, and they are now commonplace; in 2015, for example, when Mike Pence was governor of Indiana, he put aside his moral opposition to needle exchanges and allowed a program to stem the flood of H.I.V. cases."

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

And, today, this:

Opioid Crisis Compels New York to Look North for Answers
Supervised injection sites for heroin users have prevented overdose deaths in Canada. But is New York City ready for the scenes that come with them?

"As Mayor Bill de Blasio has come out in support of supervised injection centers in New York, his stance has been shaped by Canada’s lead.

The country has been a pioneer; its first supervised injection facility, where heroin can be used under supervision, opened in Vancouver in 2003. A decade of political and legal wrangling followed, culminating with the Canadian Supreme Court ruling in favor of the approach in 2011."

A quick look back at the politics of electricity markets

This, from the RTO Insider, which bills itself as "Your Eyes and Ears on the Organized Electric Markets."

Former FERC Chairs Reminisce, Sound Off at EBA

"The Energy Bar Association closed its annual meeting last week with a panel discussion with five former FERC chairs whose terms collectively spanned two decades. The former chairs offered entertaining anecdotes about the past while expressing pride over the growth of competitive markets — and frustration over forces they said threaten them."

Afshin Nikzad defends (x2)

Defense 2, (Offense 0).
Afshin Nikzad defended twice in eight days, to qualify for two Ph.D.s, one from Management Science and Engineering, in Operations Research, and one from Economics (in economics:).  Here are photos from his Economics defense.

Afshin Nikzad and some of his admirers: Philip Strack, Fuhito Kojima, Daniela Saban, Niloufar Salehi, Al Roth, Afshin, Paul Milgrom, and Itai Ashlagi

The papers he presented for his Economics defense were
Thickness and Competition in Ride-sharing Markets 
and 
Financing Transplant Costs of the Poor: A Dynamic Model of Global Kidney Exchange 

The papers he presented for his MS&E defense were 
Approximate Random Allocation Mechanisms 
and
What matters in tie-breaking rules? How competition guides design 


Welcome to the club(s), Afshin

Eric Budish on (expensive) blockchain technology

The Economic Limits of the Blockchain
by Eric Budish
May 3, 2018

Abstract: The amount of computational power devoted to blockchains such as Bitcoin’s must simultaneously satisfy two conditions in equilibrium: (1) a zero-profit condition among miners,who engage in a rent-seeking competition for the prize associated with adding the next block to the chain; and (2) an incentive compatibility condition on the system’s vulnerability to a“majority attack”, namely that the computational costs of such an attack must exceed the benefits. Together, these two equations imply that (3) the recurring, “flow”, payments to miners for running the blockchain must be large relative to the one-off, “stock”, benefits of attacking it. The constraint is softer (i.e., stock versus stock) if both (i) the mining technology used to run the blockchain is both scarce and non-repurposable, and (ii) any majority attack is a “sabotage” in that it causes a collapse in the economic value of the blockchain; however, reliance on non-repurposable technology for security and vulnerability to sabotage each raise their own concerns, and point to specific collapse scenarios. Overall the results place potentially serious economic constraints on the applicability of the Nakamoto (2008) blockchain innovation. The anonymous, decentralized trust enabled by the blockchain, while ingenious, is expensive.

Liver exchange in the U.S.?

 From  Liver Transplantation 24 677–686 2018 

Liver paired exchange: Can the liver emulate the kidney?
Ashish Mishra  Alexis Lo  Grace S. Lee  Benjamin Samstein  Peter S. Yoo Matthew H. Levine  David S. Goldberg  Abraham Shaked  Kim M. Olthoff Peter L. Abt

Abstract: Kidney paired exchange (KPE) constitutes 12% of all living donor kidney transplantations (LDKTs) in the United States. The success of KPE programs has prompted many in the liver transplant community to consider the possibility of liver paired exchange (LPE). Though the idea seems promising, the application has been limited to a handful of centers in Asia. In this article, we consider the indications, logistical issues, and ethics for establishing a LPE program in the United States with reference to the principles and advances developed from experience with KPE. 

...

"The potential number of donor and recipient pairs that might be suitable for LPE in the United States is unknown and is dependent on numerous factors. However, the Asan Medical Center experience from South Korea provides some perspective; among 2182 LDLT patients, 26 involved LPE.3 In the United States, most donors selected for LPE will likely be those where the donor is appropriate to donate with regard to the usual anatomical, medical, and psychosocial dimensions, but for 1 reason or another not appropriate for his or her intended recipient. Centers that evaluate living liver donors follow a stepwise approach to determining eligibility for donation. Some donors are rejected early in the evaluation process for obesity or other comorbidities, age, or being psychosocially unfit to proceed with donation.16, 17 Those who pass the initial screening process are assessed further for blood type, liver volumes, and other anatomical considerations, as well as general medical and psychosocial concerns. The donors who are rejected at this stage in the evaluation are the ones who could be considered for LPE. It is estimated that 3.5%‐17.0% of donors are rejected for ABOi, 4.1%‐14.0% for inadequate hepatic mass to support the recipient, and 1.5%‐6.0% due to vascular or biliary anatomic variations.17-20 There is considerable variation of these estimates based on the order of tests and the screening processes used to evaluate potential donors based on transplant center‐specific donor criteria. These barriers to donation represent opportunities for a variety of exchanges between donor and recipient pairs, such that the total number of lives saved through LDLT could be increased."
...

Examples of Potential LPE

In the following section, we provide some examples of potential LPE. If the history of KPE serves as a guide for the trajectory of LPE, the number of pairs involved, the indications for participation, and the complexity of exchanges are likely to increase (Fig. 2).

1. Two‐way swap: ABOi pair and a pair where the estimated weight of the donor lobe is inadequate for the intended recipient (Fig. 2A).
2. Three‐way swap: ABO compatible pair where the remnant volume is too small for the donor; ABOi donor to small child where the left lateral segment (LLS) is also too large for the child; and an ABOi pair (Fig. 2B).
3. Nondirected donor starts a chain (Fig. 2C).
4. Patient with familial amyloid polyneuropathy (FAP) receives a deceased donor organ or LDLT and starts a chain with a domino liver (Fig. 2D).

"Economics that works" in Bloomberg, celebrates Parag Pathak as a reply to some critics of economics

A Top Econ Prize for a Theory That Works
This economist figured out a better way to assign students to public schools.
By Noah Smith, May 15

Here are the opening lines:

"What do people think economic theorists do? The pundits who regularly criticize the profession, particularly in the pages of British magazines, seem to think that they spend all their time making abstruse, unrealistic theories about how free markets are the best of all possible worlds. And it's true that there are still a few economists out there who are essentially doing that. But a lot of theorists are doing something much more humble and practical work on small-bore theories that can be immediately applied to make the real world a little more efficient.

Parag Pathak is a theorist of this latter type. "

And here are the closing lines (what's in between is well worth reading too:)

"In an age when bashing economics is in vogue, the critics should pay attention to researchers like Pathak. Their theories are not as grandiose as the macroeconomic ideas that appear in the press — but they really work, and every day they improve people’s lives."

Dick Thaler reflects on nuts to nudges--The economist as story teller

Some Thaler stories, from the horse's mouth

Behavioral economics from nuts to ‘nudges’
A bowl of cashews led to a research breakthrough
by Richard H. Thaler

"People think in stories, or at least I do. My research in the field now known as behavioral economics started from real-life stories I observed while I was a graduate student at the University of Rochester. Economists often sneer at anecdotal data, and I had less than that—a collection of anecdotes without a hint of data. Yet each story captured something about human behavior that seemed inconsistent with the economic theory I was struggling to master in graduate school. Here are a few examples:..."

Kidney Exchange in India: current conditions and recommendations for the future

The Indian Society of Organ Transplantation has published guidelines for expanding kidney exchange in India:

Kute VB, Agarwal SK, Sahay M, Kumar A, Rathi M, Prasad N, Sharma RK, Gupta KL, Shroff S, Saxena SK, Shah PR, Modi PR, Billa V, Tripathi LK, Raju S, Bhadauria DS, Jeloka TK, Agarwal D, Krishna A, Perumalla R, Jain M, Guleria S, Rees MA. Kidney-paired donation to increase living donor kidney transplantation in India: Guidelines of Indian Society of Organ Transplantation – 2017. Indian J Nephrol 2018;28:1-9

Here's the summary of their recommendations:

"Evidence-based recommendations, suggestions, and expert consensus statements in this document aim to expand KPD and may serve as a model for other developing countries. For these guidelines, all reference articles in the English literature related to KPD transplantation in India from MEDLINE (PubMed from 2000 to 2017) database were included and reviewed.

We recommend that each potential DRP should be educated, encouraged, and counseled about KPD transplant in an easy-to-understand format as early as possible in the process of chronic kidney disease (CKD) care.

We recommend that all the transplant team members including transplant coordinator in addition to other regular training should also be trained for counseling about risk, benefits of KPD, nonexchange options, consent process, financial screening of DRP, data entry-related issues of KPD, and overall support for KPD.

We recommend that a standard written informed consent should be obtained from each DRP. We suggest that DRP should be given information about expected waiting time before transplantation, and every attempt should be made to reduce waiting time, particularly for hard-to-match pairs with the innovative ways in KPD matching.

We suggest that easy-to-match pairs (A donor and B recipient and vice versa) and sensitized pairs should be encouraged for KPD over ABO-incompatible kidney transplantation (ABOiKT) and desensitization protocol.

We recommend that all types of KPD should be practiced only after legal permission as per the existing transplant law.

We suggest that three-way exchange has optimum quality and quantity of matching.

We suggest that potential KPD transplant centers should study the key elements of success of other successful KPD program.

We suggest that computerized algorithms should be encouraged over manual allocation.

We recommend that all patients should be screened for pretransplant immunological risk, occult infections, and other risk factors to prevent and reduce posttransplant unequal outcome due to patient-related factors.

We suggest that the age difference between KPD donors should not be the key issue in allocation and better immunological match may counteract the effect of higher donor–recipient age difference.

We recommend that participating transplant teams should make the decision by consensus about kidney donor travel versus kidney transport as per local resources and logistics, though donor travel rather than kidney transport is likely to be simple.

We suggest that transplant surgery should be performed at the place where patient is evaluated, admitted, and willing to do posttransplant follow-up and simultaneous rather than sequential surgery should be preferred.

We recommend that the formation of KPD registry is one of the principal strategies to improve the quality of matching and number of KPD.

We suggest that DRP needs to be cognizant of transcultural, language, and legal barriers in national program when patients and their donors may belong to different regions or states of India."


And here's the introductory summary of the background in India:

The Indian CKD registry in 2010 reported that at the time of enrolment in registry, 61% of end-stage renal disease (ESRD) patients were not on any form of renal replacement therapy (RRT), while 32% were on hemodialysis, 5% on peritoneal dialysis, and only 2% were being worked up for kidney transplantation.^[1] There is a gross disparity between supply and demand of the transplant organs across the world, including India. All efforts are to be made to increase the supply of quality organs to the waiting transplant recipients. KPD is one such process for increasing supply of organs to patients waiting for transplant. ABO-compatible living donor kidney transplant (LDKT) is the ideal and cost-effective RRT modality for ESRD patients in resource-limited developing country such as India, where morbidity and mortality on long-term dialysis is unacceptably high. Access to RRT is mainly prevented by paucity of facilities and affordability. Up to 80% of kidney donors are living donors, while DDKT programs are still evolving in most parts of India.

KPD transplant enables two incompatible DRP to receive more compatible kidneys. In this, a living kidney donor who is otherwise incompatible with the recipient exchanges kidneys with another DRP. KPD can be performed at any transplant center that is doing kidney transplantation without the need of extra facilities as required for ABOiKT and transplant with desensitization protocol.

Too many traffic jams: an interview with Stanford's Mike Ostrovsky (and a paper by Ostrovsky and Schwarz)

Mike Ostrovsky at Stanford GSB is interviewed on technology and traffic:
An End to Traffic Jams? It Might Not Be a Dream

And here's the paper on which the interview is based:

Carpooling and the Economics of Self-Driving Cars
Michael Ostrovsky and Michael Schwarz
February 12, 2018

Abstract: We study the interplay between autonomous transportation, carpooling, and road pricing.We discuss how improvements in these technologies, and interactions among them, will affect transportation markets. Our main results show how to achieve socially efficient outcomes in such markets, taking into account the costs of driving, road capacity, and commuter preferences.  An important  component  of  the  efficient  outcome  is  the  socially  optimal  matching  of  carpooling riders.  Our approach shows how to set road prices and how to share the costs of driving and tolls among carpooling riders in a way that implements the efficient outcome

The Alliance for Paired Donation celebrates it's 10th anniversary

Celebrating 10 Years of Paired Kidney Donations in Toledo, Ohio.

"The Alliance for Paired Kidney Donation is celebrating 10 years of helping to save lives. A gala will be held this Saturday, May 12th, 2018 at the Renaissance Hotel in Downtown, Toledo, 444 N. Summit Street. The event kicks off with a cocktail hour from 6-7 with dinner and dancing to follow.

"There will be many kidney donors and kidney transplant recipients at the event to celebrate the chain of life saving donations provided through the Alliance for Paired Kidney Donation."

Technology, diversity and money in modern pornography

The fashion section of the NY Times recently ran a story on how technology such as webcams has democratized the pornography industry, in part by allowing people to produce their own material:
‘Who Gets to Be Sexy?’
Technology has made it possible for just about anyone to shoot, direct and star in their own porn films. Women are leading the new guard.

The url is as informative as the headline:
https://www.nytimes.com/2018/05/05/style/porn-women-nonbinary-queer.html

Given the concern about how monetary payments interact with various kinds of  transactions to make them repugnant (e.g. money is what turns sex into prostitution), I was struck by this quote, about money's coercive power:

"It’s harder and harder to argue that porn performers are desperate people lured in by easy cash and coerced into submission. There’s just too little money in it — and women have to work too creatively to make it — for that to stand."

The article--in the fashion section of the newspaper no less--is itself a signal of changing views about pornography as a repugnant market.

Swaying minds about marketplaces, technology summit

I'll be trying to sway minds in tech today at the
Sway Minds Technology Summit 2018.  I'll be giving a very brief talk on matching markets, and then participating in a panel on marketplaces...

How many transplants could a transplant surgeon do if ...?

The  Indy Star carried this story about Dr. William Goggins at Indiana University, on the occasion of his 2000th kidney transplant (which happened to be through kidney exchange):

1 doctor, 2,000+ kidney transplants. If surgeons kept stats, he’d be LeBron James

"Goggins stands out, having notched more kidney transplants than some transplant programs as a whole. Last year Lutheran Hospital of Fort Wayne did 13 transplants, St. Vincent Hospital about 50. Goggins might do 10 to 12 in a week.
...
"To Goggins, there's nothing more interesting than kidney transplants. And the more complicated the surgery, the better.
...
"A typical kidney transplant will take Goggins from two to three hours, although more complicated procedures may go longer. It's demanding, physical work that requires bending over, delving deep into a patient's abdominal cavity, and doing the painstaking job of sewing the donor kidney into the recipient.
...
"[Patient 2000's] kidney came earlier this year, as part of what's known as a paired kidney exchange. How that worked: A friend of hers donated a kidney on her behalf; the organ went to another donor who was a match. Then, Brophy was matched with a kidney from a different donor.
...
“You put in a good kidney, you do a nice operation, and they get healthy very quickly and they’re like a new person within 24, 48 hours and it’s just, an awesome experience,” Goggins said.       
...
"At one point, he recalled, he performed 365 transplants over two years, each one taking two to three hours. That adds up to every other day for two years straight.
...
"patients over 60 are the fastest-growing group of kidney transplant patients, Goggins says. Studies have shown that people in this age range with a life expectancy of five to 10 years will do better with a kidney transplant than they would staying on dialysis.
...

Surgeons get up early: Grand Rounds at Stanford

Today, shortly after dawn, I'll be speaking at the Department of Surgery, on matching.  Come if you're up...

I am slandered (or at least misunderstood) by The Economist for writing about repugnant transactions

You would think that writers for a magazine/newspaper called The Economist would read some economics before writing about it.

Yet here, in a piece on what economists do
Economists focus too little on what people really care about
The fourth in our series on the profession’s shortcomings,
is this:

"Indeed, economists often work on the basis that tangible costs and benefits outweigh subjective values. Alvin Roth, for example, suggests that moral qualms about “repugnant transactions” (such as trading in human organs) should be swept aside in order to realise the welfare gains that a market in organs would generate. Perhaps so, but to draw that conclusion while dismissing such concerns, rather than treating them as principles which might also contribute to human well-being, is inappropriate. "

I don't think I dismiss such concerns when I write about them, e.g. here:
Repugnance as a Constraint on Markets
Alvin E. Roth, JOURNAL OF ECONOMIC PERSPECTIVES, VOL. 21, NO. 3, SUMMER 2007, (pp. 37-58)

But reading is hard, and deadlines are short.

For those who prefer to listen, I'll be speaking about repugnance with my colleague, the eminent philosopher Debra Satz, on Philosophy Talk Radio on  Sunday, June 3, at 11am (pacific) on KALW 91.7 FM Local Public Radio, San Francisco.  (I believe there will be a podcast of the show available afterwards...)
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Update: now that I think of it, repugnance is one of the parts of economics The Economist has trouble with.  Here's an earlier blog post, in which I remarked "It's nice to be quoted, not so nice to be misunderstood."...

Friday, March 2, 2018

The Economist discusses repugnant transactions

******
Further update: Economists and economic journalists might have different ideas about this sort of thing, so I was gratified by this expression of support from Tim Harford, one of this generation's most distinguished economic journalists:

I choked on my coffee when I read that line in The Economist. I think they owe Al an apology. It seemed a strange claim.

Laboratory grown meat: coming ...soon?

For omnivores concerned about cruelty in the food supply, laboratory grown meat offers an attractive possibility.  It's being explored in many places: here's an optimistic recent story that caught my eye on an Israeli Lab Meat Startup.

"Future Meat Technologies is developing a manufacturing platform for the production of meat products directly from animal cells. By the end of 2018, Future Meats intends to have a dish based on its cultured chicken meat served at a Jerusalem chef restaurant, the company’s chief scientist Yaakov Nahmias said in an interview with Calcalist Wednesday. The company is set to launch its first line of meat products by 2020, he said.

"Founded in February, Future Meat Technologies sprung from research conducted at the Hebrew University of Jerusalem by a team led by Mr. Nahmias. The technology is licensed to the company by the university's knowledge transfer company Yissum Research Development.


"Companies producing lab-cultured meat state that in addition to eliminating the need to raise animals for slaughter, lab-grown meat products reduce exposure to food-borne illnesses and reduce pollution and water consumption.


"The world’s first cultured beef hamburger was grown at a Maastricht University lab in 2013 by Mosa Meat, a Maastricht, the Netherlands-based company backed by Google co-founder Sergey Brin. Other companies have since attempted to create meat from single cells.


"New York-based early-stage biotechnology startup Finless Foods Inc. is aiming to develop and mass manufacture lab-cultured alternatives to conventionally-caught and commercially-farmed seafood. San Francisco-based Memphis Meats produces beef, chicken, and duck products by culturing animal cells, and released the world’s first cultured meatball in February 2016 and the world’s first cultured poultry in March 2017.

...
"The first lab-grown burger, produced in 2013, cost about $2.3 million per kilogram. The price of cultured meat production has since plummeted. Production costs for Future Meats currently stand at $500 per kilo, and the company aims to reach a $5 per kilo cost by 2020, Mr. Nahmias said."

Illegal trade in wildlife--photographic art recording a black market

The WSJ has a story about a photographer who has created still-life photos from animal remains confiscated  by Canadian customs agents.

‘The illegal trade of wildlife is one of the great disgraces of humanity

"To create “Trafficked,” Fitzgerald holed up for days with the Wildlife Enforcement Branch of the Canadian government in a locked area containing cases of confiscated specimens from the illegal wildlife trade. She created all of the images using the laborious 19th century wet collodion process that involves exposing chemically treated photographic plates and then developing them in a darkroom. What resulted is a poetically compelling look at the evidence of human beings’ sometimes illegal, often abusive, relationship in wildlife trading."

Death with dignity: David Goodall flies from Australia to Switzerland

The Australian has the story:
Professor David Goodall, 104, prepares to die in Switzerland

"Australia’s oldest working scientist and prominent euthanasia campaigner David Goodall will access a Swiss voluntary euthanasia scheme weeks after securing a fast-tracked appointment with a Basel-based agency which assists people to die.

"The botanist, ecologist and Emeritus Professor who celebrated his 104th Birthday in April, received news last week that he had secured an appointment with pro-euthanasia group Life Circle and assisted dying expert Dr Erika Preisig in Basel for early May.

"Dr Goodall is not terminally ill but has poor eyesight and declining mobility. In evidence submitted to a Western Australian parliamentary inquiry on end of life options, he said that his quality of life had deteriorated and he wanted to access an assisted dying program.

"Dr Goodall is now at the centre of a crowd-funding push organised by local pro-euthanasia group Exit International to raise $15,000 to upgrade his fares to business class so he can travel to Basel in relative comfort.

"The campaign has already exceeded the $15,000 target and volunteers running the campaign have told The Australian his seats have now been upgraded and tickets booked."
********

Here's the Washington Post story:
A scientist just turned 104. His birthday wish is to die.

"“I greatly regret having reached that age. I would much prefer to be 20 or 30 years younger,” he told the Australian Broadcasting Corp. When asked whether he had a nice birthday, he told the news organization: “No, I’m not happy. I want to die. ... It’s not sad, particularly. What is sad is if one is prevented.”

“My feeling is that an old person like myself should have full citizenship rights, including the right of assisted suicide,” the 104-year-old added.
...
"For the past two decades, Goodall has been a member of Exit International, a nonprofit organization based in Australia that advocates for the legalization of euthanasia, according to the group’s website.
...
"In most countries, euthanasia and physician-assisted suicide are illegal. However, a handful of nations — including Belgium, Luxembourg and the Netherlands — have legalized one or both of the practices, according to the nonprofit group ProCon.org. For years, Australia has banned such practices, but in November, the state of Victoria became the first to pass a euthanasia bill, which, by summer 2019, will allow terminally ill patients to end their lives.
...
"In the United States, only six states — California, Colorado, Hawaii, Oregon, Vermont and Washington state — and Washington, D.C., have death-with-dignity laws for terminally ill patients.

"Goodall does not have a terminal illness.
...

"The Australian Broadcasting Corp. reported [in 2016] that after nearly two decades on the campus, Goodall was told to leave amid concerns about his well-being. The incident gained international media attention, with Goodall, then 102, calling it ageism in the workplace.

“It’s depressed me; it shows the effect of age. The question would not have arisen if I were not an old man,” he told the news organization at the time.

"University officials later reversed their decision.

"But Goodall said his health is declining.

"He told the Australian Broadcasting Corp. that several months ago he fell down in his apartment in Perth and, for two days, he lay on the floor until his housekeeper found him.
...
"Goodall said he believes it is time for him to die, but his country’s new legislation is of no use to him because it applies only to those who are terminally ill."
*********

And he's on his way:
David Goodall en route to Europe after emotional goodbye with family
AT THE age of 104, professor David Goodall has said goodbye to his family before boarding a flight to Europe to end his life.   AAP MAY 4, 2018

Tariffs and trade wars still seem like a bad idea: open letter to the President

The National Taxpayers Union has organized the following letter, signed by more than 1100 economists, of whom I am one. It is mainly a copy of a 1930 letter, signed by1,028 economists, urging Congress to reject the protectionist Smoot-Hawley Tariff Act.

Here's the beginning:

"May 3, 2018

Open letter to President Trump and Congress: 

"In 1930, 1,028 economists urged Congress to reject the protectionist Smoot-Hawley Tariff Act. Today, Americans face a host of new protectionist activity, including threats to withdraw from trade agreements, misguided calls for new tariffs in response to trade imbalances, and the imposition of tariffs on washing machines, solar components, and even steel and aluminum used by U.S. manufacturers. Congress did not take economists’ advice in 1930, and Americans across the country paid the price. The undersigned economists and teachers of economics strongly urge you not to repeat that mistake. Much has changed since 1930 -- for example, trade is now significantly more important to our economy -- but the fundamental economic principles as explained at the time have not: [note -- the following text is taken from the 1930 letter]"

*******
Here's a link to the pdf file of the letter.

Abelard and Heloise and sexual harassment in the Academy...

At the same time as some sexual repugnances are diminishing (e.g. same sex marriage), other kinds of sexual liaisons, such as those between college faculty and undergraduate students  now meet with increased disapproval and regulation.  A recent article in the Boston Review tries to put that in historical perspective:

The Erotics of Mentorship, by Marta Figlerowicz and Ayesha Ramachandran

"In twelfth-century France, the prominent logician and theologian Abelard and his pupil Heloise famously struggle, in a series of letters, to determine whether the bond between them is intellectual or romantic."
**********

Here's Wikipedia on Abelard, and on Heloise. I hadn't remembered the details of their affair, but the outcome was quite drastic for both of them. Abelard continued to teach for much of his life, which wasn't so easy.

See my earlier post

Sunday, April 25, 2010

Faculty-student liasons repugnant at Yale

From the Yale alumni magazine: University bans faculty-student sex 

College admissions and (versus) antitrust law, in the Atlantic. Legal status of a medical style match?

The Atlantic has an article on college admissions, saying it could be made to work better if only (and only if) colleges were exempted from antitrust law.

The Best Ways to Fix College Admissions Are Probably Illegal:
Cooperation among selective schools would make students’ lives easier. It would also likely run afoul of federal antitrust law.
by JEFFREY SELINGO

The article provides an interesting summary of ideas being floated to reform college admissions: e.g. a medical residency style match, or a lottery, or a coordinated reduction in merit scholarships. (Those don't all address the same issues, of course.)

Regarding antitrust, I'm no lawyer, and the DOJ has clearly shown an anti-trust interest in some aspects of college admissions, particularly including early decision admissions, but the article doesn't offer deep insight into which aspects of college admissions, or college admissions reform, might or might not be defensible without legislative relief.

Regarding a college admissions process that might resemble the medical match, the article says
"Those who follow admissions closely tend to think that such a system would ease the pressures on students, parents, and schools. But, alas, antitrust law prohibits it—it would produce a level of cooperation that the federal government would likely find unacceptable. (The medical-residency match program is legal because Congress granted it an antitrust exemption about 15 years ago.)"

But the relevant law exempting the medical match from being a per se violation of the antitrust laws is section 207 added in conference to the Pension Funding Equity Act of 2004 Public Law 108-218.  The legislative language is preceded by a Congressional Finding, which states in part:
Congressional finding:
"(E) Antitrust lawsuits challenging the matching process, regardless of their merit or lack thereof, have the potential to undermine this highly efficient, pro-competitive, and long-standing process. "

The Congressional finding also praises the medical match for solving the unravelling of medical appointments to very early dates.

So, particularly if early admissions turns out to have anti-trust difficulties, to my non-lawyerly eyes the Congressional language suggests that Congress and the courts might continue to find that medical style matches are not violations of antitrust laws, even in new applications like college admissions (and of course school choice, which may include private charter schools as well as municipal schools).
*********

I ran this by my favorite law professor Kim Krawiec, who confirms that I'm no lawyer and writes
"Hi Al — with the caveat that I’m not an antitrust specialist, I think that your conclusion could be right, but I wouldn’t rely too much on section 207 as evidence. My read of section 207 is that it’s application is quite clearly limited to medical residency matches. So I don’t think the language there would have any particular sway with courts weighing the legality of matches in other settings. Nonetheless, restraints on trade are not always illegal under antitrust law, even without an explicit exemption. Specifically, courts may consider procompetitive and (rarely) social welfare justifications in favor of restraints on trade. The hurdle is pretty high, especially for social welfare arguments, but they’re more likely to be entertained in educational settings than elsewhere, I think. A case on point is U.S. v. Brown https://law.justia.com/cases/federal/appellate-courts/F3/5/658/626013/

"The case may be an outlier in some ways, since it involves diversity in admissions, but I find this language instructive:

 It may be that institutions of higher education "require that a particular practice, which could properly be viewed as a violation of the Sherman Act in another context, be treated differently." Goldfarb v. Virginia, 421 U.S. 773, 788 n. 17, 95 S. Ct. 2004, 2013 n. 17, 44 L. Ed. 2d 572 (1975). 

It is most desirable that schools achieve equality of educational access and opportunity in order that more people enjoy the benefits of a worthy higher education. There is no doubt, too, that enhancing the quality of our educational system redounds to the general good. To the extent that higher education endeavors to foster vitality of the mind, to promote free exchange between bodies of thought and truths, and better communication among a broad spectrum of individuals, as well as prepares individuals for the intellectual demands of responsible citizenship, it is a common good that should be extended to as wide a range of individuals from as broad a range of socio-economic backgrounds as possible. It is with this in mind that the Overlap Agreement should be submitted to the rule of reason scrutiny under the Sherman Act.

"So, the fact that Congress once concluded that the benefits of matching outweighed any antitrust concerns bodes well, I think, in the sense that it is always easier to convince Congress to extend a successful practice to a new area than to convince them to adopt an entirely new method that has no track record. But, I don’t think that a court would be comfortable extending the 108-218 exemption to other settings w/o congressional approval.  "

************************
HT: Muriel Niederle

Deferred rejection: longer college admission wait lists

College waiting lists are a bit of a misnomer--they aren't ordered lists, they are more like waiting pools from which candidates can be drawn if the yield from regular admissions falls short.

The WSJ has the story:
College Wait Lists Are Ballooning as Schools Struggle to Predict Enrollment
The chance of getting off the wait list has plummeted at many schools as the pool has expanded

"As hundreds of thousands of high-school seniors face a May 1 deadline to put down deposits at their college of choice, many still face uncertainty over where they will end up. Their futures are clouded by the schools’ use of wait lists to make sure they have the right number, and type, of students come fall.

"The University of Virginia increased the number of applicants invited onto wait lists by 68% between 2015 and 2017. At Lehigh University, that figure rose by 54%. And at Ohio State University, it more than tripled.
...
"[Carnegie Mellon University], with a target of 1,550 freshmen, offered wait-list spots to just over 5,000 applicants this year.

"“You can take stock and ‘fix’ or refine the class by gender, income, geography, major or other variables,” said Jon Reider, director of college counseling at San Francisco University High School. “A large waiting list gives you greater flexibility in filling these gaps.”

"This year, applications to Carnegie Mellon rose 19%. With more students accepting its offers of admission, it couldn’t risk over-enrolling. The school admitted 500 fewer students and expects to go to some of its wait lists to make sure each undergraduate program meets enrollment goals, and that there is a good mix of students, including enough aspiring English majors or kids from South Dakota. The school can also take into account the financial situations of wait-listed candidates."

Kidney exchange amendment proposed for Hong Kong organ donation law

A bill introduced in Hong Kong clarifies that kidney exchange doesn't count as (forbidden) "inducement" to donate an organ under the law. (In this respect the bill seems to parallel the Norwood Act which amended the U.S. National Organ Transplant Act for the same reason.)  The bill excludes exchange of different organs (about which I recently blogged here.)

Human Organ Transplant (Amendment) Bill 2018 gazetted

"Hong Kong (HKSAR) -      The Government published in the Gazette today (April 27) the Human Organ Transplant (Amendment) Bill 2018, which seeks to allow for paired/pooled organ donation arrangements in Hong Kong.

     A spokesman for the Food and Health Bureau said, "Living donation offers an alternative for individuals awaiting transplantation from a deceased donor and increases the existing organ supply. There are however cases where the patient who needs an organ transplant has a living related donor who is willing but unable to donate because of an incompatible blood type or tissue type. One option would be paired donation."

     Under a paired donation arrangement, both medically approved incompatible donor-patient pairs donate organs to the other pair so that the patients in both pairs receive compatible organs.

Currently, as stipulated in section 5D(1)(c) of the Human Organ Transplant Ordinance (Cap 465) (HOTO), the donor has to give his consent to the proposed organ removal without coercion or the offer of inducement before any organ transplant between living persons can take place. Under a paired or pooled organ donation, a donor is willing to donate his/her organ to a stranger in exchange for another donor donating his/her organ to the first donor's originally intended recipient. While the term "inducement" is not specifically defined, the Government intends to amend HOTO to clear any legal ambiguity as to whether a paired organ donation involves "inducement".

     "The Hospital Authority is proposing a pilot Paired Kidney Donation Programme, participation in which will be voluntary.

The donor from the first incompatible donor-recipient pair ('dyad' as defined under the Amendment Bill) would donate to the recipient of the second dyad, and the donor from the second dyad would donate to the recipient of the first dyad," the spokesman said.

     The Amendment Bill will be introduced into the Legislative Council for scrutiny on May 9."
*********
Here's the bill: Human Organ Transplant (Amendment) Ordinance 2018.
"A bill to Amend the Human Organ Transplant Ordinance to provide that a donor is not to be regarded as having given consent to a proposed organ removal with the offer of inducement only because the consent has been given in consideration of a proposed organ transplant into a person chosen by the donor under a donation arrangement."

And here's the Legislative Council Brief.
Interestingly, it contains the following stipulation:
"6. In order to better describe the paired and pooled donation arrangements, we intend to introduce a new concept of a dyad, which is a group of two persons consisting of a donor and a beneficiary. The definitions for paired and pooled donation arrangements are also expressly set out. To avoid any impression or possibility that different types of organs could be exchanged under such
arrangements, organs to be removed and transplanted under the arrangements are restricted to be of the same kind and every removal and transplant is to be carried out by a registered medical practitioner in Hong Kong."

Ticket scalping in Hong Kong

I don't know how big of an issue it is, but this story on ticket scalping was prominently displayed in the South China Morning Post the other day:

 Touts snap up tickets as Hong Kong fans queue overnight for chance to see Dayo Wong.  Scalpers operating in city despite leader’s promise to crack down on practice, which leaves fans facing exorbitant fees

"The promise by Hong Kong’s leader to clamp down on the black market for show tickets appears to have done little to deter the city’s ticket touts."