Commercial surrogacy to be legalized in New York?

Some stories on the current proposals and the controversy involved.

From the NY Post:

Cuomo proposes law to end ban on surrogate moms

"Gov. Cuomo is proposing a new law that will lift the ban on surrogacy contracts — enabling New Yorkers for the first time to pay a woman to have a baby for them through in-vitro fertilization.

The ban has been in place since 1992.

“New York’s antiquated laws frankly are discriminatory against all couples struggling with fertility, same sex or otherwise” Cuomo said in a statement to The Post."

***********

From the National Catholic Register:

Cuomo Proposal Would Lift New York’s Ban on Surrogacy Contracts --Under current law, surrogacy contracts in the state are punishable by a fine of up to $10,000 or by a felony charge.

"Just days after expanding legal abortion up to the point of birth, New York Gov. Andrew Cuomo is proposing a law that would lift the ban on surrogacy contracts in the state of New York.

If passed, the law would allow New Yorkers to pay a woman to carry to term a child conceived through in vitro fertilization. It would not allow a surrogate mother to use her own eggs (and therefore be related biologically to the child).
...
"Cuomo’s proposal, called the Child-Parent Security Act, is included in the governor’s executive budget plan for the state and is something his administration has been considering since at least 2015, according to the Post.  
When Cuomo first floated the idea, Jennifer Lahl of The Center for Bioethics and Culture Network, slammed surrogacy for treating women “like breeding animals.”
“We try to get a mother and a baby to bond,” Lahl told the Post in 2015. “We’re against ripping the baby from the mother the moment he leaves the womb. It’s not good for the child.”
Surrogacy laws vary widely throughout the United States. Besides New York, only three other states explicitly ban all surrogacy contracts: Nebraska, Michigan, and Arizona. Many other states have restrictions on surrogacy agreements and treat the surrogacy process similarly to adoption, requiring court appearances, home studies and a window for the birth mother to change her mind after the baby is born.
Surrogate mothers are typically paid between $30,000 and $50,000 for carrying a child to term, depending upon the state and the contract.  
...
"Kathleen Gallagher, the New York Catholic Conference director of pro-life activities, told the Post that she found the New York proposal “appalling.”
“This is the buying and selling of children and the exploitation of women. There are going to be poor women exploited by wealthy couples,” she said.
The Catholic Church denounced the practice of surrogacy in the 1987 document Donum Vitae, in which the Vatican stated that surrogacy “represents an objective failure to meet the obligations of maternal love,” calling it a “detriment” to the family and the dignity of the human person by divorcing the “physical, psychological and moral elements which constitute those families.”

Matching story for Valentine's day--BBC

Valentine's Day sparks a demand not just for love, but also for stories about marriage as a matching market.  This year I was among those interviewed by the BBC.  Below are two links:  you can listen to the interviews, or read a summary.

First, the interviews: They go for 18 minutes, and are easy listening.  I'm interviewed third, beginning just before minute 10 and going to about minute 14.   (I didn't see a way to embed it) :

Rational Partner Choice: "Should your head trump your heart when seeking lifelong love? We ask an economist, a romantic novelist and a hyper-rationalist businessman this Valentine's Day challenge."

(There actually are 4 interviews, the fourth is with the wife of the businessman, Ed Conard: they've been happily married for 20 years.)
************

The written summary has me as the middle of three views on the subject (the headline below reflects the first of the views they considered, with marriage modeled as an optimal stopping problem).

Forget love: This is how to find your perfect partner  By Justin Rowlatt

Here's what they say about their conversation with me:

"Mr Conard's approach to choosing a wife is a well-established method for buying things like a new place to live but, says Nobel Prize winning economist Alvin Roth, spouses aren't like houses: marriage is a market without prices.
...
"He agrees that it is important to meet quite a few possible partners before you take the plunge - "don't marry the first person you meet", he warns.

"You've also got to have realistic expectations: "the first thing a matrimonial agency has to do is persuade clients they aren't a 10."

"But, he says, you can do too much calibrating and evaluating. Choosing a partner is a two-way thing: it is only when you are serious about marriage that potential partners will take you seriously.

"Part of being well matched is the history you share and this starts when you first meet", Prof Roth says, "so investing in that history improves the quality of that match."
***************
And here are my Valentine's Day blog posts to date.

Market design through machine learning: David Parkes

If I were in Boston I'd go to hear David Parkes speak today about

Optimal Economic Design through Deep Learning

Abstract: Designing an auction that maximizes expected revenue is a major open problem in economics. Despite significant effort, only the single-item case is fully understood. We ask whether the tools of deep learning can be used to make progress. We show that multi-layer neural networks can learn essentially optimal auction designs for the few problems that have been solved analytically, and can be used to design auctions for poorly understood problems, including settings with multiple items and budget constraints. I will also overview applications to other problems of optimal economic design, and discuss the broader implications of this work. Joint work with Paul Duetting (London School of Economics), Zhe Feng (Harvard University), Noah Golowich (Harvard University), Harikrishna Narasimhan (Harvard -> Google), and Sai Srivatsa (Harvard University). Working paper: https://arxiv.org/abs/1706.03459

The new market for (and marketing of) nicotine--Robert Jackler (followed by the CDC)

My colleague Rob Jackler has been investigating the marketing of nicotine delivered through (non-burning) e-cigarettes, which deliver nicotine without combustion products, by "vaping." Apparently nicotine is highly addictive, and the marketing is taking aim at very young people, including  "stealth" delivery systems designed to camouflage the act of vaping.

Here's a Stanford Medicine interview, published yesterday:
Robert Jackler says Juul spurs 'nicotine arms race'


Here's a figure from the paper "Nicotine arms race: JUUL and the high-nicotine product market, " by Robert K Jackler, Divya Ramamurthi, in the Journal Tobacco Control.

 And here's a figure from the article
"JUUL and other stealth vaporisers: hiding the habit from parents and teachers," by Divya Ramamurthi, Cindy Chau, Robert K Jackler, in Tobacco Control

*****
In related news, also published yesterday, here's a press release from the Center for Disease Control (CDC):
4.9 million middle and high school students used tobacco products in 2018

"About 4.9 million middle and high school students were current users (used in the past 30 days) of some type of tobacco product in 2018, up from 3.6 million in 2017. This increase—driven by a surge in e-cigarette use—erased past progress in reducing youth tobacco product use, according to a new Vital Signs report published by the Centers for Disease Control and Prevention (CDC).
...
"More than 1 in 4 (27.1%) high school students and about 1 in 14 (7.2%) middle school students currently used a tobacco product in 2018. For the fifth year in a row, e-cigarettes (20.8%) were the most commonly used tobacco product among high schoolers...
...
"This Vital Signs report is based on data from the 2011–2018 National Youth Tobacco Surveys analyzed by CDC, the Food and Drug Administration (FDA), and the National Cancer Institute (NCI)."

Here's a figure from the Vital Signs report:

Computational and Experimental Economics Conference in Barcelona

Here's the call for papers, by Feb 28:
Computational and Experimental Economics

The workshop will run for 2 days and will take place on June 10-11, 2019 in Barcelona. In this two days’ workshop we want to bring together researchers working in two quite separate fields, computational economics and experimental economics, which yet have seen a steady increase of fruitful interaction in the recent years ( see e.g. The Handbook of Computational Economics, Heterogenous Agents, Edited by Cars Hommes, Blake LeBaron, Volume 4, 2018, Elsevier.).

Topics include the understanding of the emergent dynamic properties of economic models, some of which are too complex to solve analytically. However, human behavior can often be captured by relatively simple heuristics. While computational economics departs from simulations to derive their models, experimental economics uses human behavior and then often simulation techniques to develop descriptive models of such behavior. Such models include Agent Based Modeling (ABM), models of learning based on genetic algorithm, Reinforcement models, and other learning or cognitive models.

Keynote Speakers

• Yan Chen (University of Michigan)
• Herbert Dawid (University of Bielefeld)

Workshop organizers

• Jasmina Arifovic (Simon Fraser University)
• Domenico Delli Gatti (Università Cattolica del Sacro Cuore)
• John Ledyard (Caltech)
• Rosemarie Nagel (ICREA-UPF and Barcelona GSE)

Digital Economy and Inclusive Growth--report from the Luohan Academy

Here's an initial report from the Luohan Academy:

 Digital Technology and Inclusive Growth--Executive Summary

From the mission statement:
"Social scientists in general, including economists, must therefore collaborate to help societies adapt smoothly and fairly to the digital revolution. Two important objectives of the academic community are first, to understand business models and market structures that enable growth and progress, and second, to identify the impact of digitization on individual and social welfare. So far the rapidly increasing scale of digitization has not been followed by a corresponding increase in theoretically grounded empirical research on the rationales,  consequences, and policies of digitization. A well-organized research community could greatly facilitate and speed up such research efforts."

And, as the report makes clear, China is a good place to study ecommerce:

Stanford GSB celebrates Mohammad Akbarpour

Mohammad Akbarpour: Humanizing Math for the Greater Good
"The Stanford GSB economist discusses his groundbreaking research into kidney exchanges, wealth inequality, and “anything that wakes me up at night.”
...
"In 2012, ...He and four of his close friends, who had all attended high school, college, or graduate school together, were feeling unsatisfied with their influence beyond Stanford’s manicured campus. Then Salman Khan, the founder of Khan Academy, presented at Stanford GSB.

"After watching Khan’s talk, Akbarpour and his friends built KelaseDars, also known as KhanacademyFarsi, to which Akbarpour has now contributed more than 280 videos on subjects ranging from high school Newtonian physics to college-level game theory. The website as a whole has delivered more than 5 million free lessons to Farsi speakers who would otherwise not have access to a high-quality education. Many of them live in Afghanistan and Iran.
...
"It was hectic and hard, “but it was a beautiful experience with a magnificent team,” Akbarpour says. “KelaseDars is the most meaningful thing I’ve done with my life.”

And here:

Kidney matching podcast: Jeremiah Johnson interviews me and Josh Morrison

On the Neoliberal Podcast (49 minutes):
Kidney Matching featuring Dr Alvin Roth & Josh Morrison

Josh Morrison, who donated one of his kidneys as a non-directed donor, is a founder of Waitlist Zero.
*******

The audio connection seemed to change my voice a bit: here's an unusual comment, forwarded to me by a twitter-literate colleague:

Replying to @ne0liberal @JoshMorrison @waitlistzero

Dr Roth has the velvetiest voice I’ve ever heard

(if you find voices entertaining, you can compare it to the audio in yesterday's post, where I thought I sounded more like myself.)

Kidney exchange chains and altruistic kidney donation on PBS newshour

PBS economics correspondent Paul Solman interviews non-directed kidney donors, and kidney exchange patients, and me, in yesterday's PBS newshour.

Here's a link to video of the 10 minute segment on kidneys, including a transcript.
How an economist’s idea to create kidney transplant chains has saved lives

and here's the video itself:

The show talks about how a single altruistic donor can initiate a long chain of kidney transplants that helps many people.

The kidney exchange organization that started non-simultaneous non-directed donor chains is the Alliance for Paired Donation, run by Mike Rees, and I think that they still organize the longest chains, i.e. the ones with the highest average number of transplants.  

The very first long chain was reported in this article in the New England Journal of Medicine:

Rees, Michael A., Jonathan E. Kopke, Ronald P. Pelletier, Dorry L. Segev, Matthew E. Rutter, Alfredo J. Fabrega, Jeffrey Rogers, Oleh G. Pankewycz, Janet Hiller, Alvin E. Roth, Tuomas Sandholm, Utku Ünver, and Robert A. Montgomery, “A Non-Simultaneous Extended Altruistic Donor Chain,” New England Journal of Medicine, 360;11, March 12, 2009

Here's the full hour-long newshour: kidneys are from about minute 34:46 to minute 44:38 on the video below.

Michel Balinski (1933-2019)

Michel Balinski, perhaps best known for his work on the design of voting systems*, has passed away.
Here's the announcement:

"INFORMS is saddened to share the passing of Michel Balinski, a long-time INFORMS member and a major figure in operations research, mathematics, economics, and political science. Balinski is best known for bringing O.R. methodology to bear on the electoral process, for which he is recognized as the inventor of several fair voting and representation systems. We invite you to share remembrances, photos, and other thoughts on this post, and to learn more about Michel Balinski's incredible career and contributions to the field. His full biography is available under INFORMS History of O.R. and Excellence on INFORMS.org."

*See e.g.
Fair Representation: Meeting the Ideal of One Man, One Vote  
By Michel L. Balinski, H. Peyton Young

Philly and Feds at odds over reducing opioid overdoses

Here's the story from NPR:

U.S. Prosecutors Sue To Stop Nation's First Supervised Injection Site For Opioids

"After months of threats, federal prosecutors in Philadelphia launched a legal challenge on Wednesday against the nonprofit Safehouse, which is hoping to open what could be the nation's first site where people with opioid addiction can use drugs under medical supervision.

"The civil lawsuit, which is jointly being pursued by Pennsylvania-based prosecutors and the Department of Justice in Washington, is the first time the federal government has intervened in the hotly debated issue of supervised injection sites. The lawsuit could become an important legal test case as about a dozen cities across the country consider similar proposals.
...
"The provision of the law in question is widely known as the crack house statute. It makes it illegal to maintain a space for the purpose of making, storing, distributing or using an illegal drug. Safehouse would not make or provide opioids to users. But it would allow people to bring in their own drugs, to use while being monitored by medical staff."

Transplant statistics (through 2016) from the 2018 USRDS annual data report

The United States Renal Data System. 2018 USRDS annual data report  has come out. It seems to cover data through 2016.  Here are the bullet points on transplantation.

Chapter 6: Transplantation

• In 2016, 20,161 kidney transplants were performed in the United States (19,301 were kidney-alone; Figure 6.6).
• Fewer than a third (28%) of kidneys transplanted in 2016 were from living donors (Figure 6.6).
• From 2015 to 2016, the cumulative number of recipients with a functioning kidney transplant increased by 3.4%, from 208,032 to a total of 215,061 (Figure 6.7).
• On December 31, 2016, the kidney transplant waiting list had 81,418 candidates on dialysis, 51,238 (62.9%) of whom were active. Eighty-five percent of all candidates were awaiting their first transplant (Figure 6.1).
• Among Candidates newly wait-listed for either a first or repeat kidney-alone transplant (living or deceased-donor) during 2011, the median waiting time to transplant was 4.0 years (Figure 6.4). This waiting time varied greatly by region of the country, from a low of 1.4 years in Nebraska to a high of 5.1 years in Georgia (Reference Table E.2.2).
• Unadjusted rates of kidney transplantation among dialysis patients had been declining since at least 2006 for candidates for both living and deceased donors. These appear to have stabilized as of 2013, at about 2.5 per 100 dialysis patient-years for recipients from deceased donors and about 1.0 per 100 dialysis patient-years for recipients from living donors (Figure 6.8).
• The number of deceased kidney donors, aged 1-74 years, with at least one kidney retrieved increased by 62.7%, from 5,981 in 2001 to 9,732 in 2016 (Figure 6.19.a).
• The rate of kidney donation from deceased Blacks/African Americans nearly doubled from 2002 to 2016, from 4.5 to 7.9 donations per 1,000 deaths (Figure 6.21.b). This rate overtook that of Whites in 2009. Asians consistently had the highest rate of deceased kidney donation during this time, at about 9 per 1,000 deaths.
• Since 1999, Whites have had the highest rate of living kidney donation, although this has been in decline along with all other races except Asians, who as of 2016 showed rates of living donation essentially equivalent to Whites (Figure 6.16.b).
• Eighteen percent of kidneys recovered from deceased donors were discarded in 2016; this rate has increased slightly since 2010.
• The number of kidney paired donation transplants has risen sharply since 2005, with 642 performed in 2016, which represented 11% of living-donor transplants that year. The rate plateaued during 2012-2014 but increased again in 2016 (Figure 6.18).*
• Since 1999, the probabilities of graft survival have improved among recipients of both living and deceased-donor kidney transplants, over both the short-term (one-year survival) and long-term (five and ten-year survival) (Figure 6.25).
• In 2015, the probabilities of one-year graft survival were 93% for deceased and 98% for living-donor kidney transplant recipients (Figure 6.25).
• In 2015, the probabilities of patient survival within one-year post-transplant were 96% and 99% of deceased- and living-donor kidney transplant recipients (Figure 2.6).
• The one-year graft-survival and patient-survival advantages experienced by living-donor transplant recipients persisted at five and ten years post-transplant (Figures 6.25 and 6.26).

*

Repugnance in Spain: surrogacy and prostitution

I've relatively recently started to pay attention to repugnance in Spain, here are some useful older links.

From El Pais:
Spain struggles with surrogate pregnancy issue
Practice is illegal here but debate rages over whether surrogacy is a right or a form of exploitation


From la Asociación por la Gestación Subrogada en España
Sobre la Gestación Subrogada

GT "In our country the surrogate pregnancy is illegal: Article 10 of Law 14/2006, of May 26, on Techniques of Assisted Human Reproduction establishes that the contract by which gestation is agreed, with or without price, in charge of a woman who renounces maternal filiation in favor of the contracting party or third party is null and void. 

"However, the Instruction of October 5, 2010 of the General Directorate of Registries and Notaries has left without effective content the prohibition of surrogate pregnancy by contemplating the registration in the Civil Registry of children of this technique provided that the procedure has been carried out in a country where this technique is regulated, that one of the parents is Spanish and that there is a court order that guarantees, among other aspects, the rights of the pregnant woman. The name of this woman will not appear in the annotation made in our records.

"This creates an important discrimination between those Spaniards who can afford treatment outside our borders and those who can not."


From Bright Magazine;
Decriminalizing Sex Work in Spain Made It Safer For Women — and Traffickers
Thirty years ago, most sex workers were Spanish. Today almost 90 percent are immigrants, most under the control of organized crime networks.

Kidney exchange in Israel using Itai Ashlagi's software

My colleague Itai Ashlagi has been inventing, building, distributing and updating state of the art kidney exchange software ever since he came to Harvard, some years ago. Since then he's been at MIT, and now Stanford, but this recent article from the Jewish Telegraphic Agency about how his software is propagating in Israel still thinks he's at Harvard:

New program finds donors for complicated kidney transplant patients

"JERUSALEM (JTA) — Kidney transplant patients who have had a hard time finding a match will have another opportunity through a new unit at an Israeli hospital.

"Kidney transplant patients who suffer from high levels of antibodies due to previous transplants or blood donations can go for many years without finding a suitable donor. A new and advanced software program can be used to cross-check through advanced information systems from hospitals in Israel and around the world.

"The program, developed by Professor Itai Ashlagi of Harvard University, was donated to the Matnat Chaim organization and will be operated out of Beilinson Hospital’s Department of Transplantation in Petach Tikvah, in central Israel."

Kim Krawiec on repugnance, and global kidney exchange

Kim Krawiec talks about podcasts, and then about repugnance with some of her old podcast pals at Oral Argument.  They talk about global kidney exchange (the short title they propose to her is "more kidneys, more better," around minute 5:30 when the substantive discussion starts).

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


Kim blogs about this herself over at the Faculty Lounge:
Repugnance, Global Kidney Exchange, and Drinking Our Own Spit: An Oral Argument Reunion

Medically assisted death

The Guardian and the BBC bring us up to date on death with dignity in the Netherlands.

Here are some excerpts from the Guardian's long read:

Death on demand: has euthanasia gone too far?
Countries around the world are making it easier to choose the time and manner of your death. But doctors in the world’s euthanasia capital are starting to worry about the consequences
By Christopher de Bellaigue

"Keizer is one of around 60 physicians on the books of the Levenseindekliniek, or End of Life Clinic, which matches doctors willing to perform euthanasia with patients seeking an end to their lives, and which was responsible for the euthanasia of some 750 people in 2017. For Keizer, who was a philosopher before studying medicine, the advent of widespread access to euthanasia represents a new era. “For the first time in history,” he told me, “we have developed a space where people move towards death while we are touching them and they are in our midst. That’s completely different from killing yourself when your wife’s out shopping and the kids are at school and you hang yourself in the library – which is the most horrible way of doing it, because the wound never heals.
...
"Euthanasia has been legal in the Netherlands for long enough to show what can happen after the practice beds in.
...
"In 2002, the parliament in the Hague legalised euthanasia for patients experiencing “unbearable suffering with no prospect of improvement”. Since then, euthanasia and its close relation, assisted dying, in which one person facilitates the suicide of another, have been embraced by Belgium and Canada, while public opinion in many countries where it isn’t on the national statute, such as Britain, the US and New Zealand, has swung heavily in favour.

"The momentum of euthanasia appears unstoppable; after Colombia, in 2015, and the Australian state of Victoria, in 2017, Spain may be the next big jurisdiction to legalise physician-assisted death, while one in six Americans (the majority of them in California) live in states where it is legal. In Switzerland, which has the world’s oldest assisted dying laws, foreigners are also able to obtain euthanasia.
...
"Euthanasia is counted as a basic health service, covered by the monthly premium that every citizen pays to his or her insurance company. But doctors are within their rights not to carry it out. Unique among medical procedures, a successful euthanasia isn’t something you can assess with your patient after the event. A small minority of doctors refuse to perform it for this reason, and others because of religious qualms. Some simply cannot get their heads around the idea that they must kill people they came into medicine in order to save.
...
"At any meeting organised by the NVVE [Dutch Voluntary Euthanasia Society], you will look in vain for poor people, pious Christians or members of the Netherlands’ sizeable Muslim minority. Borne along by the ultra-rational spirit of Dutch libertarianism (the spirit that made the Netherlands a pioneer in reforming laws on drugs, sex and pornography), the Dutch euthanasia scene also exudes a strong whiff of upper-middle class entitlement.

"Over coffee I was introduced to Steven Pleiter, the director of the Levenseindekliniek. We went outside and basked in the early October sun as he described the “shift in mindset” he is trying to achieve. Choosing his words with care, Pleiter said he hoped that in future doctors will feel more confident accommodating demands for “the most complex varieties of euthanasia, like psychiatric illnesses and dementia” – not through a change in the law, he added, but through a kind of “acceptance … that grows and grows over the years”. When I asked him if he understood the scruples of those doctors who refuse to perform euthanasia because they entered their profession in order to save lives, he replied: “If the situation is unbearable and there is no prospect of improvement, and euthanasia is an option, it would be almost unethical [of a doctor] not to help that person.”
...
"Even those who have grave worries about the slippery slope concede that consensual euthanasia for terminal illness can be a beautiful thing, and that the principle of death at a time of one’s choosing can fit into a framework of care. The question for any country contemplating euthanasia legislation is whether the practice must inevitably expand – in which case, as Agnes van der Heide recognises, death will eventually “get a different meaning, be appreciated differently”. In the Netherlands many people would argue that – for all the current wobbles – that process is now irreversible."
*******

And here's a link and a figure from the BBC story, which concentrates on the difficult case of dementia--difficult because even the clearest directive from a patient with early stage dementia who wants to end his or her life as the disease progresses can often not be confirmed by the patient once dementia is fully established.

Wanting to die at 'five to midnight' - before dementia takes over

Colleges harvest signals of interest in more ways

Congested markets--those in which there are more potential transactions than can be easily processed--promote signaling, and the search for signals, about which transactions to pursue.  College admissions is a famously congested market, particularly since it became easy for students to submit many applications. So all but the most elite colleges have long searched for signals of "demonstrated interest."  The WSJ has an update on how technology is changing that search.

The Data Colleges Collect on Applicants
To determine ‘demonstrated interest,’ some schools are tracking how quickly prospective students open email and whether they click links  By Douglas Belkin

"Enrollment officers at schools including Seton Hall University, Quinnipiac College and Dickinson College know down to the second when prospective students opened an email from the school, how long they spent reading it and whether they clicked through to any links. Boston University knows if prospective students RSVP’d online to an event—and then didn’t show.
...
"At Seton Hall University, in South Orange, N.J., students receive a score between 1 and 100 that reflects their demonstrated interest, said Alyssa McCloud, vice president of enrollment management. The score includes about 80 variables including how long they spent on the school’s website, whether they opened emails and at what point in high school they started looking on the website (the earlier the better).
...
"In 2017, 37% of 493 schools surveyed by the National Association of College Admission Counseling said they consider demonstrated interest to be of moderate importance—on par with teacher recommendations, class rank and extracurricular activities. It carried less weight than grades, class rigor or board scores.
...
"Colleges also have low-tech means to help determine demonstrated interest. Last year, one third of students who applied to American University either visited its Washington, D.C., campus or attended an information session about the school, said Andrea Felder, assistant vice provost for undergraduate admissions. Two thirds of those admitted took part in either the campus tour or offsite information session.
...
"Mary Hinton, a senior at Dickinson College, benefited from demonstrated interested without knowing it. After she toured Dickinson in high school, she sent a thank-you note to her tour guide, at her mother’s suggestion.

Now a tour-guide herself, Ms. Hinton has learned those notes are forwarded from tour guides to admissions officers. Her advice to prospective students about thank-you notes: “Write them. It just takes a minute and it can make a difference.”

Understanding and misunderstanding algorithmic bias

Adventures in Computation explains a recent political discussion:

Algorithmic Unfairness Without Any Bias Baked In
"Discussion of (un)fairness in machine learning hit mainstream political discourse this week, when Representative Alexandria Ocasio-Cortez discussed the possibility of algorithmic bias, and was clumsily "called out" by Ryan Saavedra on twitter.
...
"Bias in the data is certainly a problem, especially when labels are gathered by human beings. But its far from being the only problem. In this post, I want to walk through a very simple example in which the algorithm designer is being entirely reasonable, there are no human beings injecting bias into the labels, and yet the resulting outcome is "unfair".

Kidney exchange in Germany? It will need an amendment to the Transplantation Act

Axel Ockenfels points out that the Frankfurter Allgemeine Sonntagszeitung has a recent piece on "Tauschen wir die Nieren?" ("Do we exchange kidneys?"). I can't find it online, but here's a picture:

Google translate renders the opening paragraphs as follows:

"Patients wait a long time for donor organs. That can be changed - with a proposal that has received the Nobel Prize.
Organ donation is literally a matter of life and death. Anyone who receives the urgently needed organ in good time lives on. In Germany, however, many are waiting for the necessary transplantation - often for years. At the same time, the number of organ donations is falling. So how can the number of donated organs be increased so that affected people can live? That's a tricky question, because too many answers tend to limit the voluntary nature of the donation. On Wednesday, the topic is on the agenda of German politics, when the Health Committee of the Bundestag deals with the amendment of the Transplantation Act.
The economists Dorothea Kübler and Axel Ockenfels advise the politicians to take a look at living donations. Kidneys or parts of the liver can also be donated by living people - and this is much less common in Germany than in other countries. The proposal goes in the direction of the FDP parliamentary group around the chairman Christian Lindner, who are pushing for more living donations. In a motion for the health committee on Wednesday, the FDP is proposing to allow the cross-donation of two couples and an anonymous live donation to an organ pool. "

Repugnant markets and black markets -- interview

Here's a short interview on repugnant markets, in Stanford's engineering magazine:

Repugnant markets spur thinking about how to engineer complex systems
"​When some people want to engage in economic activity that others seek to ban, society faces tough choices in designing the right market incentives — or disincentives."
By ​Edmund L. Andrews

"when is it effective to outlaw an activity, and when does that simply foster a black market? At what point does it make more sense to focus on harm reduction than prevention?

"Roth expanded on these ideas in a recent interview..."

Another link is here.

School choice in New Haven: studied by Kapor, Neilson and Zimmerman and switching from immediate to deferred acceptance

The New Haven Independent reports on efforts to change school choice there:
Profs Tapped To Fix School-Choice Lottery

"Would knowing the exact odds make any difference in the parents’s choices? If they’d been warned about their slim chances, would they be more likely to swap in a backup? If they still went ahead with a big gamble, should the lottery administrators take that as a signal of how deeply they care about their picks?

"The school district has tapped three academics to study those very questions in an effort to make the lottery process more transparent, simple and equitable this year.

"At its Monday night meeting on Meadow Street, the Board of Education’s Finance & Operations Committee recommended approving a non-financial agreement with three assistant professors —  Princeton’s Adam Kapor and Christopher Neilson and University of Chicago’s Seth Zimmerman —  to recommend how the district could do a better job marketing and communicating about a revamped enrollment process.

"As part of the agreement, New Haven will change the algorithm that it uses to assign students in 2019-20. Modeled on applications in New York, Chicago and Boston, the new model will ideally reward students for listing the schools that they’d like to attend rather than for gaming the system."

The project started with a study of the system's current, immediate acceptance algorithm

"In the paper, which was published in the American Economic Review in 2016, Kapor, Neilson and Zimmerman said that there’s currently more uninformed parents making mistakes than sophisticated gamblers making savvy bets. They concluded that “offering some means to learn about admissions probabilities for different portfolios” would likely be “welfare-improving.”

"Figuring out exactly what that will look like is the subject of Kapor, Neilson and Zimmerman’s next experiment.

As part of the memorandum of understanding that the Finance & Operations Committee reviewed on Monday, the academics agreed to provide a data analyst who will assist the Choice & Enrollment Office in-house at no charge for the next two years. With additional surveys and data analysis, they’ll review how the revamped lottery changes placement outcomes, family satisfaction and student achievement."

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

For more on the investigators, see https://sites.google.com/site/adamkapor/research
http://wws.princeton.edu/sites/default/files/person/cvfiles/CNeilson_vita_extended_Princeton_2018_08_01.pdf
https://sites.google.com/site/sethdavidzimmerman/research

Black market kidney transplants to UK patients? An inflammatory article in the Daily Mail

There seems to be good evidence that kidneys for transplantation are bought and sold in some parts of the world. However I'm not aware of any good data on how much of this trade involves people from wealthy countries, as opposed to internal commerce in less well resourced countries.

 Here's a scare headline from the British tabloid newspaper the Daily Mail:
REVEALED: Hundreds of Britons who buy KIDNEYS on the black market from overseas traffickers charging £30,000 in a bid to avoid NHS waiting lists are coming back with deadly diseases such as HIV and hepatitis

It turns out that the "hundreds"  in the National Health Service data are 400, over a period of 16 years, which averages out to 25 Britons a year.

"Around three million Britons have chronic kidney disease, with the biggest causes uncontrolled diabetes and high blood pressure. It contributes to 45,000 early deaths every year.

NHS figures show almost 400 UK residents have received follow-up support after a transplant abroad over the past 16 years. But medics say the true number is likely to be higher because most are advised by brokers not to tell the NHS what they have done."

I don't know what kinds of health data the NHS collect, but in principle it would be easy to track all patients who return to the UK with a transplant from overseas, because such patients immediately need to get prescriptions for daily immunosuppressive drugs. (However I don't think we track these data in a centralized way in the U.S.)


HT Frank McCormick
***********
Here some of what I've gleaned in the past:

Monday, December 17, 2018 

Australia's parliament reports on organ trafficking

Australia's parliament has published a report on organ trafficking in Australia. They didn't find much trafficking there, but recommend that data be more vigorously collected. They report that only one case of (attempted) paid organ donation has come to the attention of the authorities, but that it was successfully prevented, and the intended recipient died. The report ends with a case study of an anatomical exhibit using human cadavers.

Wednesday, October 4, 2017 

Kidney black markets are persistent

Black markets in kidneys--like those for narcotic drugs--have resisted attempts to abolish them.

Sunday, September 17, 2017

Yemenis selling kidneys in Egypt: Al Jazeera

Al Jazeera has the (nuanced) story:
Desperate Yemenis sell organs to survive

Sunday, January 15, 2017

Egypt arrests 'organ trafficking ring'

The BBC has the story: Egypt arrests 'organ trafficking ring'
Egyptian authorities have arrested doctors, nurses and professors suspected of being involved in an international organ trafficking ring.

Black markets for kidney transplants--arrests in Israel

A late December story of black markets and law enforcement from the Times of Israel:
2 charged with running international organ traffic ring. Patients allegedly paid $180,000 for a kidney; illegal transplants carried out in Turkey, Bulgaria, Thailand, Philippines

"In the last two years, the ring reportedly arranged for 14 transplants in four countries; Turkey, Bulgaria, Thailand and Philippines"

Saturday, October 8, 2016

More on kidney black markets in India

Top Indian Hospital Complicit In Lucrative Black Market for Human Organs

Friday, August 19, 2016

Interview with a kidney buyer and seller in Syria

Here's an interview with a displaced person in Syria (an internal refugee) and the Syrian woman to whom he sold his kidney:
The woman in need of a kidney and the man willing to sell one to her: ‘I’m at the end of the line’

Tuesday, June 21, 2016

Kidney black market arrests at Apollo hospital in Delhi

Wednesday, June 8, 2016

On Patients Who Purchase Organ Transplants Abroad--Many or few?

An article in the American Journal of Transplantation:
On Patients Who Purchase Organ Transplants Abroad
by F. Ambagtsheer,*, J. de Jong,W. M. Bramer and W. Weimar

"We conclude that the scientific literature does not reflect a large number of patients buying organs. Organ purchases were more often assumed than determined. A reporting code for transplant professionals to report organ trafficking networks is a potential strategy to collect and quantify cases."

Universal health coverage under siege from both the right and the left, in the U.S. and Mexico

Here's a commentary in The Lancet, comparing attacks on the Affordable Care Act in the U.S. and on Seguro Popular in Mexico.

A dark day for universal health coverage, by Julio Frenk, Octavio Gómez-Dantés, and Felicia Marie Knaul

"Dec 14, 2018, was a dark day for universal health coverage (UHC). To begin with, a federal judge in Texas, USA, ruled that the Affordable Care Act (ACA) is unconstitutional.1 That same day, the new President of Mexico, Andrés Manuel López Obrador, announced his intention to abolish the country's largest public insurance programme, known as Seguro Popular (People's Health Insurance).2 The ACA and Seguro Popular have extended health coverage to millions of previously uninsured families, most of them among the poorest in their respective countries. Signed into law in 2010, the ACA roughly halved the number of uninsured, from 46·5 million then to 26·7 million in 2016, towards the end of the Obama administration.3,  4 Following legislative approval, Seguro Popular began full-scale implementation in Mexico in 2004. Public expenditure increased to finance coverage for non-salaried workers and their families, approximately half of Mexico's total population, who were excluded from employment-based social insurance. By 2018, 53 million beneficiaries had access to 290 essential and 65 high-cost interventions.
...
"The challenge to the ACA has been headed by the right wing of the US Republican Party, whereas the attack to Seguro Popular comes mostly from the far left factions of the President's Morena party. This is an example of the way in which opposing political extremes can converge in their attack against centrist positions.
...
"Seguro Popular is one of the most thoroughly evaluated programmes in the world. A 2006 Lancet Series set out the evidence base for the design of this innovative initiative.7,  8 A comprehensive review9 published 8 years into implementation identified a large body of peer-reviewed articles, including one of the few randomised assessments of a large-scale social intervention.10 The evidence strongly points to major benefits of Seguro Popular in terms of financial protection and effective coverage,11 without labour market distortion.12 In a recent cover article on UHC, The Economist featured Seguro Popular among the most successful efforts in low-income and middle-income countries, noting how “studies suggest that Seguro Popular has drastically reduced the number of Mexicans facing catastrophic health costs and reduced infant mortality”

Kidney transport: a Tesla and a flat tire

Transporting kidneys can be surprisingly informal.  Here's an account of a Tesla, a flat tire, and hitching a ride.

Good Samaritan drives stranded surgeon, donor kidney to Pa. hospital

"Dr. Martin Wijkstrom had two jobs to perform Wednesday evening: Drive a donor kidney from Pittsburgh to Erie, Pa., then implant the organ in a patient at UPMC Hamot.
...
“I had already picked up the kidney at a Pittsburgh hospital and had just charged my Tesla in Cranberry Township,” said Wijkstrom, a UPMC transplant surgeon. “I was driving to get back on (Interstate 79) to go to Erie when I struck a pothole.”

"The pothole caused one of Wijkstrom’s tires to go flat. He was stuck in the Cranberry Mall parking lot with a donor kidney, 108 miles from the hospital where a patient waited to receive it.

"His Tesla didn’t carry a spare tire. Though the kidney was secured in a refrigerated container in Wijkstrom’s trunk, the surgeon had about 12 hours to implant the organ for the best chances of success.

“It wasn’t an emergency situation but we needed to put the kidney into the patient as soon as possible,” said Wijkstrom, who said he had transported kidneys in his car three or four previous times.
...
"Brad Dostlik was driving his Nissan Sentra near the mall, listening to his portable police scanner.
He heard a dispatcher send police to the surgeon’s car and notify them about the kidney. Dostlik, who was headed to the nearby Field & Stream store, decided to see if he could help.
...
“He asked if I could take him to Erie,” Dostlik said. “I had a full tank of gas, so why not?”
...
“I learned a lot of stuff during the trip,” Dostlik said. “I don’t think I could do what he does.”
...
"The two men shook hands and the surgeon walked into the hospital with the donor organ, just 40 minutes later than expected.

“The surgery was uneventful,” Wijkstrom said. “The patient is doing well, his kidney is making some urine already.”

Kosher and halal slaughtering banned in Belgium

The coalition of liberal animal rights activists and European anti-Semites and Islamophobes doesn't make the new laws easy to parse:

Belgium Bans Religious Slaughtering Practices, Drawing Praise and Protest

"BRUSSELS — A Belgian ban on the Muslim and Jewish ways of ritually slaughtering animals went into effect on New Year’s Day, part of a clash across Europe over the balance between animal welfare and religious freedom.

"With both animal rights advocates and right-wing nationalists pushing to ban ritual slaughter, religious minorities in Belgium and other countries fear that they are the targets of bigotry under the guise of animal protection.
...
"Laws across Europe and European Union regulations require that animals be rendered insensible to pain before slaughter, to make the process more humane. For larger animals, stunning before slaughter usually means using a “captive bolt” device that fires a metal rod into the brain; for poultry it usually means an electric shock.
...
"But slaughter by Muslim halal and Jewish kosher rules requires that an animal be in perfect health — which religious authorities say rules out stunning it first — and be killed with a single cut to the neck that severs critical blood vessels. The animal loses consciousness in seconds, and advocates say it may cause less suffering than other methods, not more.

"Most countries and the European Union allow religious exceptions to the stunning requirement, though in some places — like the Netherlands, where a new law took effect last year, and Germany — the exceptions are very narrow. Belgium is joining Sweden, Norway, Iceland, Denmark and Slovenia among the nations that do not provide for any exceptions.
...
"The idea for the ban was first proposed by Ben Weyts, a right-wing Flemish nationalist and the minister in the Flanders government who is responsible for animal welfare. Mr. Weyts was heavily criticized in 2014 for attending the 90th birthday of Bob Maes, who had collaborated with the Nazi occupation of Belgium in World War II and later became a far-right politician."

Bounty hunters, licensing, and cellphone location data

The Seattle Times has a disturbing article about a little-regulated private enterprise part of the criminal justice system in many American states--the bounty hunters who work with bail bondsmen:

Lax Washington oversight of bounty hunters sets stage for mayhem, tragedy
(The url gives an alternative headline: https://www.seattletimes.com/seattle-news/times-watchdog/high-adrenaline-bounty-hunter-industry-operates-with-little-oversight-despite-concerns-over-training-tactics/ .)

"Formally known as bail-bond recovery agents, bounty hunters frequently carry firearms and have the right to forcibly enter homes and apprehend people who jump bail.

"Yet getting a license is relatively easy, and hardly anyone is turned away — even if they have a history of violence, a Seattle Times investigation has found.
...
"The lax requirements for bounty hunters are at odds with the weapons and tactics the agents are allowed to use. To get a license, an applicant must take 32 hours of training, which can include self-study, and must pass a 50-question, multiple-choice exam. The state has no formalized curriculum or certification process for instructors. Only the person teaching the firearms portion of the training is required to be certified through the state.

"By comparison, to get a license to perform manicures and style hair, a cosmetologist must receive 1,600 hours of training from a state-approved and licensed instructor."
***********

Furthermore:
I Gave a Bounty Hunter $300. Then He Located Our Phone
T-Mobile, Sprint, and AT&T are selling access to their customers’ location data, and that data is ending up in the hands of bounty hunters and others not authorized to possess it, letting them track most phones in the country.

and
Ajit Pai Refuses to Brief Congress About Why Bounty Hunters Can Buy Cell Phone Location Data
The Chairman's staff said the selling of location data is not a 'threat to the safety of human life or property that the FCC will address during the Trump shutdown.'

National Kidney Foundation (NKF) statement

A January press release from the NKF :

NKF Statement: A Path Forward for Increasing Kidney Transplantation

"Nearly 680,000 Americans have irreversible kidney failure, or end-stage renal disease (ESRD), and need dialysis or a kidney transplant. More than 475,000 ESRD patients receive dialysis at least three times per week to replace kidney function.  Nearly 100,000 Americans are on the waitlist for a kidney transplant right now.  Depending on where a patient lives, the average wait time for a kidney transplant can be upwards of three to seven years.  

The National Kidney Foundation is calling on Congress and the Administration to make organ transplantation a top priority and has identified several critical areas to be addressed from a legislative and regulatory standpoint. These priorities will create a strategic and effective path forward towards increasing the number of kidney transplants and decreasing the number of patients who die waiting.

1. Living Donation

a. Expand financial assistance offered to living organ donors to cover all expenses related to organ donation including lost wages; travel expenses including transportation, lodging and food; child care or dependent care expenses incurred during the donor’s recovery; living donor medical care and follow-up care for donation; paperwork or legal costs related to the donation; and other expenses related to the donation.

..."

More at the link...

HT: Frank McCormick

Pharma pricing, and the secondary market for diabetes test strips

The NY Times has the story on the gray market for diabetes test strips:

The Strange Marketplace for Diabetes Test Strips

"Test strips are a multi-billion-dollar industry. A 2012 study found that among insulin-dependent patients who monitor their blood sugar, strips accounted for nearly one-quarter of pharmacy costs. Today, four manufacturers account for half of global sales.

"In a retail pharmacy, name-brand strips command high prices. But like most goods and services in American health care, that number doesn’t reflect what most people pay.

"The sticker price is the result of behind-the-scenes negotiations between the strips’ manufacturer and insurers. Manufacturers set a high list price and then negotiate to become an insurer’s preferred supplier by offering a hefty rebate.
...
"For a patient testing their blood many times a day, paying for strips out-of-pocket could add up to thousands of dollars a year. Small wonder, then, that a gray market thrives. The middlemen buy extras from people who obtained strips through insurance, at little cost to themselves, and then resell to the less fortunate.

"That was the opportunity that caught Chad Langley’s eye. He and his twin brother launched the website Teststripz.com to solicit test strips from the public for resale. Today they buy strips from roughly 8,000 people; their third-floor office in Reading, Mass., receives around 100 deliveries a day.

"The amount the Langleys pay depends on the brand, expiration date and condition, but the profit margins are reliably high. For example, the brothers will pay $35 plus shipping for a 100-count box of the popular brand Freestyle Lite in mint condition.

"The Langleys sell the box for $60. CVS, by contrast, retails the strips for $164.
...
"While some resellers use websites like Amazon or eBay to market strips directly to consumers, the biggest profits are in returning them to retail pharmacies, which sell them as new and bill the customer’s insurance the full price.
...
“Test strips are basically printed, like in a printing press,” said David Kliff, who publishes a newsletter on diabetes. “It’s not brain surgery.”

"He estimated the typical test strip costs less than a dime to make."

Surrogacy as viewed from Spain (where it is illegal)

Not late-breaking news, but here are some El Pais reports that reflect the ongoing situation in Spain:

Spain struggles with surrogate pregnancy issue
Practice is illegal here but debate rages over whether surrogacy is a right or a form of exploitation

"The Swiss-based International Social Security Association estimates that every year, surrogate mothers give birth to around 20,000 children worldwide. Agencies and parents estimate that between 800 and 1,000 go on to live with Spanish parents, but there are no official figures. There are numbers, however, for international adoptions undertaken by Spaniards, and these have fallen from 5,541 in 2004 to 799 in 2015.

"Yet if the estimates are correct, international surrogacy has overtaken international adoption in popularity. Instead of the international adoption process, which can take up to eight years, it seems that those wanting to be parents are more frequently opting for the quicker route, and paying between €45,000 and € 60,000 in the Ukraine or Russia or up to €120,000 in California – one of 14 American states where the practice is legal.

"Every country has different legislation. Ukraine, for example, only allows heterosexual couples to use surrogates. In Canada, the United Kingdom and Portugal, surrogacy is only allowed in the altruistic sense, meaning the surrogate mother receives no direct economic benefit. And the latter two countries only let nationals use surrogacy. India, a former worldwide power in surrogacy, has vetoed it for foreign couples, and is on the verge of making it illegal for economic profit. Mexico too, particularly the State of Tabasco, has recently restricted surrogacy laws.
...
"“The best solution to avoid abuses is to legislate it. It’s like organ transplants – regulating the legal practice gets rid of organ trafficking,” says Pedro Fuentes, president of a pro-surrogacy parental association that brings together around 400 families, Son Nuestros Hijos. Fuentes is a gynecologist and alongside his husband, he is also the father of a six-year-old boy who was born in California to a surrogate mother. He gets emotional when he tells the story of how he met the surrogate mother and the warm relationship they developed. He said that her own ethics also guided the process, as she had decided to use her body as a surrogate to help a gay couple.

"The association itself has a code of ethics and recommends not trusting “agencies that don’t let you meet the mother, which guarantee results, and which offer package deals saying you won’t have to worry about anything.” Also, they suggest that parents work with a woman who has already given birth. The association certainly makes the case for altruism but it is also open to economic compensation.
...
"The association asks: “When is a women being exploited? When you pay her or when you don’t?”
**********

Also,
The dark side of Ukraine’s surrogacy boom
Lack of oversight, lax regulations and a failing economy have made the eastern European country one of the most popular destinations to find a surrogate mother
*******

And here's a story from 2014 with background on the Spanish supreme court's decision not to recognize the child of Spanish parents borne by a California surrogate:
Are you my mother? The Spanish Supreme Court and surrogacy tourism

"The majority of the judges, however, contend that the “best interests” criterion is not the sole factor to be taken into account. Judges should also ponder the State’s interest in preventing the commodification of children and motherhood. But more strikingly, the Supreme Court argues that it is not obvious that it goes in the best interests of the twins to be legally declared as the sons of Ramón and César and not of the surrogate mother. It is striking, in my view, to argue along those lines when the surrogate mother is a woman who has relinquished her motherhood and the intending parents are not only willing to be the parents, but, most importantly, are the “social” fathers."



HT: Stephanie Wang