Clearinghouses are hard to organize in a hurry: volunteer medical workers in NYC

Many healthcare workers are willing and able to come to New York to help with the shortages that Covid-19 has created there.  But existing staffing marketplaces seem to be the avenue by which many of them are in fact matched.

The NY Times has the story:

Volunteers Rushed to Help New York Hospitals. They Found a Bottleneck.
When New York called for volunteers to help fight the coronavirus, 90,000 people responded. The hard part? Getting them into hospitals.

"Ms. Strickland, a former pediatric intensive care unit nurse in High Point, N.C., spent hours trying to submit her volunteer application online, and then emailed city and state representatives. She never heard back.

"Frustrated, she reached out directly to Mount Sinai Queens hospital in New York City. A manager told her to use a private recruiting agency, which the hospital had used for years to bring in temporary staff.

"Within two days, Ms. Strickland, 47, received her assignment. She started this week in the hospital’s emergency department, making about $3,800 a week for three 12-hour shifts instead of doing it for free, as she had initially wanted.
...
"As of Wednesday, more than 90,000 retired and active health care workers had signed up online to volunteer at the epicenter of the pandemic, including 25,000 from outside New York, the governor’s office said.
...
"New York City hospitals have only deployed 908 volunteers as of Wednesday, according to city health officials.

"The urgent need for medical personnel is colliding head-on with the immovable bureaucracy of hospital regulations
...
"State officials said the volunteer portal, which was built from scratch, was initially overwhelmed by the response, but has since connected about 10,000 volunteers to hospitals in New York State within two weeks.
...
"The challenge of screening so many medical workers has opened an opportunity for the dozens of established private agencies that place temporary nurses and doctors at hospitals nationwide
...
"The staffing agencies, an $18 billion industry, say that unlike the state, they already have the technology and infrastructure in place to quickly check credentials for health professionals. In normal times, hospitals hire them to fill short-term staffing needs, such as during a regular flu season.

“As great as it is that the state is trying to help, it’s a very complex process to staff a clinician,” said Alexi Nazem, chief executive of Nomad Health, a health recruiting agency based in New York. “There are dozens of documents to verify. Our company has spent years building those systems.”
...
"New York City’s public hospitals had used private recruiters to bring in about 3,600 new medical workers as of late last week and were seeking to hire 3,600 more, according to the mayor and a city spokesman.

"One of those recruiting agencies, NuWest Group, began contracting with the city less than two weeks ago. Since then, the agency has secured hundreds of nurses and respiratory therapists for city hospitals, with some positions paying more than $10,000 a week, a spokeswoman for the agency said.

"Agencies, who negotiate the rates with hospitals, say that without the high pay, there would not be enough qualified clinicians willing to take jobs at the front lines
...
"Hospital staff members say they are grateful for any reinforcements, but some residents and nurses have expressed frustration over the pay disparities."

Medical triage for Covid-19: if/when it comes to that, how should it be organized?

So far I haven't heard of any actual medical triage in the U.S. in which life-saving treatment for Covid-19 is rationed.  There has been a good deal of discussion of how to avoid this, and of the short supply of masks, gowns, sedatives for intubation, and health care personnel.  Much of that discussion  has focused on reallocating scarce resources to where they are needed (from where they are not so scarce (e.g. California Ventilators En Route to New York, Other States), so that rationing of e.g. ventilators doesn't become necessary.  But if the infection curve doesn't flatten enough, triage may well be coming, at least in some places. (Here's an up to date account of a hard hit rural hospital near New Orleans that hasn't yet had to triage, but might be getting close if nearby hospitals were to stop taking transfers of patients.)  

Already in Italy there was a period (maybe still) when patients over age 70 (and later over 65) were not being given ventilators because of an actual shortage of ventilators compared to the number of patients who needed them. So it makes sense that, along with the discussion of how to prevent the need for triage, there is an ongoing discussion of how to manage it, if  there comes a time and place where there aren't enough vents to go around. (I have already heard a somewhat related discussion in the U.S. about whether patients on vents should be resuscitated--given the small chance of recovery, and the exposure of health care workers to Covid-19 during a resuscitation attempt.)

As in discussions of repugnant transactions, discussing allocation of scarce resources provokes lots of debate about who should get what, and what kind of distinctions should and should not be made. 

Here are longish excerpts from several interesting contemporary accounts:

Here's an article in the March 23 New England Journal of Medicine:

Fair Allocation of Scarce Medical Resources in the Time of Covid-19

by Ezekiel J. Emanuel, M.D., Ph.D., Govind Persad, J.D., Ph.D., Ross Upshur, M.D., Beatriz Thome, M.D., M.P.H., Ph.D., Michael Parker, Ph.D., Aaron Glickman, B.A., Cathy Zhang, B.A., Connor Boyle, B.A., Maxwell Smith, Ph.D., and James P. Phillips, M.D.

"Rationing is already here. In the United States, perhaps the earliest example was the near-immediate recognition that there were not enough high-filtration N-95 masks for health care workers, prompting contingency guidance on how to reuse masks designed for single use.2 Physicians in Italy have proposed directing crucial resources such as intensive care beds and ventilators to patients who can benefit most from treatment.3,4 Daegu, South Korea — home to most of that country’s Covid-19 cases — faced a hospital bed shortage, with some patients dying at home while awaiting admission.5 In the United Kingdom, protective gear requirements for health workers have been downgraded, causing condemnation among providers.6 The rapidly growing imbalance between supply and demand for medical resources in many countries presents an inherently normative question: How can medical resources be allocated fairly during a Covid-19 pandemic?

...

"According to the American Hospital Association, there were 5198 community hospitals and 209 federal hospitals in the United States in 2018. In the community hospitals, there were 792,417 beds, with 3532 emergency departments and 96,500 ICU beds, of which 23,000 were neonatal and 5100 pediatric, leaving just under 68,400 ICU beds of all types for the adult population.12 Other estimates of ICU bed capacity, which try to account for purported undercounting in the American Hospital Association data, show a total of 85,000 adult ICU beds of all types.13

"There are approximately 62,000 full-featured ventilators (the type needed to adequately treat the most severe complications of Covid-19) available in the United States.14 Approximately 10,000 to 20,000 more are estimated to be on call in our Strategic National Stockpile,15 and 98,000 ventilators that are not full-featured but can provide basic function in an emergency during crisis standards of care also exist.14 Supply limitations constrain the rapid production of more ventilators; manufacturers are unsure of how many they can make in the next year.16 However, in the Covid-19 pandemic, the limiting factor for ventilator use will most likely not be ventilators but healthy respiratory therapists and trained critical care staff to operate them safely over three shifts every day. In 2018, community hospitals employed about 76,000 full-time respiratory therapists,12 and there are about 512,000 critical care nurses — of which ICU nurses are a subset.17 California law requires one respiratory therapist for every four ventilated patients; thus, this number of respiratory therapists could care for a maximum of 100,000 patients daily (25,000 respiratory therapists per shift).

...

"Previous proposals for allocation of resources in pandemics and other settings of absolute scarcity, including our own prior research and analysis, converge on four fundamental values: maximizing the benefits produced by scarce resources, treating people equally, promoting and rewarding instrumental value, and giving priority to the worst off.24-29 Consensus exists that an individual person’s wealth should not determine who lives or dies.24-33 Although medical treatment in the United States outside pandemic contexts is often restricted to those able to pay, no proposal endorses ability-to-pay allocation in a pandemic.24-33

...

"These ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients."

**********

Here's a Washington Post story with a good summary of much of the discussion and disagreement about how different patients (and groups of patients) might be prioritized if ventilators have to be rationed:

Who gets a shot at life if hospitals run short of ventilators?

States, hospitals scramble to set guidelines that could prioritize pregnant women, health-care workers — and even some politicians

By Ariana Eunjung Cha and Laurie McGinley April 7, 2020 

"Pregnant women would get extra priority “points” in most if not all plans, U.S. hospital officials and ethicists say. This is not controversial. There also has been some discussion about whether high-ranking politicians, police and other leaders should be considered critical workers at a time when the country is facing an unprecedented threat.

...

"Catholic groups have called on hospitals to treat pregnant women as two lives instead of one. AARP, formerly the American Association of Retired Persons, has decried age cutoffs for ventilator access in some plans. Last month, the Arc, a disability rights group, filed multiple complaints with the Department of Health and Human Services objecting to plans that disadvantage those with “severe or profound mental retardation” or dementia.

...

"Bioethicist Brendan Parent, who served on a New York state task force that developed a highly regarded framework for rationing, sees hospitals and states following two paths.

"One group takes a utilitarian view of doing “the greatest good for the greatest number,” giving preference to those with the best chance of surviving the longest. Others are more focused on ensuring social justice and ensuring vulnerable groups have an equal chance.

...

"UCLA’s plan goes to great lengths to avoid possible discrimination, stating that medical teams may not consider a long list of criteria for ventilator allocation including gender, disability, race, immigration status, personal relationship with hospital staff or “VIP status” — an important reminder given the medical center’s proximity to Hollywood.

...

"In UCLA’s plan, front-line health-care workers and administrators may be given priority access to lifesaving treatment, when their return to work means more people are likely to survive the crisis. If all the allocation criteria are applied and there’s still a shortage of medical resources, then care should be allocated on the basis of a lottery, the document says.

...

"One of the most striking differences among plans is how they deal with the elderly and disabled. Some have strict age cutoffs, or explicit criteria that disadvantage those with certain conditions.

...

"Using life expectancy or remaining life years can also be problematic for those with disabilities, civil rights groups say. The typical life expectancy for a person with Down syndrome, for example, is 60 years, as compared to about 78 years for someone without the condition.

...

"Inova’s Motew said ethical principles allow for prioritizing “some individuals who provide more lifesaving opportunities if they could live” — and that this could include “government leaders.” He compared it to military medicine, in which those who are in a position to go back to help win the war are treated first."

***********
And here are some thoughts on what we might learn about medical triage from considerations that come up in allocating school places among different populations for whom some positions are reserved.  The idea is that different groups of patients would have places reserved for them, through the kind of political process that reserves places in schools for different demographic groups, with priorities within groups, and ordering of reservations among groups. Once those issues are settled by some political process, the problem starts to look like school choice with affirmative action, and in the model proposed by these authors (who are well acquainted with school choice), deferred acceptance algorithms emerge:

Triage Protocol Design for Ventilator Rationing in a Pandemic:
A Proposal to Integrate Multiple Ethical Values through Reserves
Parag A. Pathak, Tayfun Sonmez, M. Utku Unver, M. Bumin Yenmez
April 2020

Abstract: In the wake of the Covid-19 pandemic, the rationing of medical resources has become a critical issue. Nearly all existing triage protocols are based on a priority point system, in which an explicit formula specifies the order in which the total supply of a particular resource, such as a ventilator, is to be rationed for eligible patients. A priority point system generates the same priority ranking to ration all the units. Triage protocols in some states (e.g. Michigan) prioritize frontline health workers giving heavier weight to the ethical principle of instrumental valuation. Others (e.g. New York) do not, reasoning that if medical workers obtain high enough priority, there is a risk that they obtain all units and none remain for the general community. This debate is particularly pressing given substantial Covid-19 related health risks for frontline medical workers. In this paper, we propose that medical resources be rationed through a reserve system. In a reserve system, ventilators are placed into multiple categories. Priorities guiding allocation of units can reflect different ethical values between these categories. For example, while a reserve category for essential personnel can emphasize the reciprocity and instrumental value, a reserve category for general community can give higher weight to the values of utility and distributive justice. A reserve system provides additional flexibility over a priority point system because it does not dictate a single priority order for the allocation of all units. It offers a middle-ground approach that balances competing objectives. However, this flexibility requires careful attention to implementation, most notably the processing order of reserve categories, given that transparency is essential for triage protocol design. In this paper, we describe our mathematical model of a reserve system, characterize its potential outcomes, and examine distributional implications of particular reserve systems. We also discuss several practical considerations with triage protocol design.

And from the conclusion:

"In our formal analysis, we characterize the entire class of reservation policies that satisfy three minimal principles though implementation of the deferred-acceptance algorithm. As such, we also provide a full characterization of affirmative action policies."
************

There are of course other models of triage than school choice. In transplantation, there's a shortage of both deceased and living donors, to the extent that many people who need transplants will never get them. The allocation of deceased donor organs is handled not entirely differently than generalized school choice of a particularly dynamic sort (potential recipients of a deceased donor kidney that suddenly becomes available are categorized into groups, not just by blood and tissue types which have immediate feasibility implications, but also by age and by how difficult it will be to find them a feasible match, and prioritized within groups mostly by waiting time and health status, differently for different organs).  Living donors (almost all are donating a kidney) are much less regulated, and through kidney exchange are mostly allocated through an exchange system that is fairly blind to group membership, although the statistics that are collected pay attention to people in a variety of categories.  The point of kidney exchange of course is not just to allocate scarce resources, but to make them less scarce.  That is a goal to think about whenever triage becomes necessary, or starts to look like it might.

Plasma donation, "convalescent plasma" and Covid-19 antibodies

Blood plasma is a big source of antibodies for people who don't make their own, and in these days of Covid-19 pandemic, antibodies are again in the news. As the number of recovering patients grows, can the antibodies they produce be of help in stemming the spread of the disease, or in curbing its intensity?

Here's a just published report of a quite preliminary study from China, in the PNAS:

Effectiveness of convalescent plasma therapy in severe COVID-19 patients
by Kai Duan, ... Xiaoming Yang (46 authors)
PNAS first published April 6, 2020 https://doi.org/10.1073/pnas.2004168117
Contributed by Zhu Chen, March 18, 2020 (sent for review March 5, 2020; reviewed by W. Ian Lipkin and Fusheng Wang)


"Significance: COVID-19 is currently a big threat to global health. However, no specific antiviral agents are available for its treatment. In this work, we explore the feasibility of convalescent plasma (CP) transfusion to rescue severe patients. The results from 10 severe adult cases showed that one dose (200 mL) of CP was well tolerated and could significantly increase or maintain the neutralizing antibodies at a high level, leading to disappearance of viremia in 7 d. Meanwhile, clinical symptoms and paraclinical criteria rapidly improved within 3 d. Radiological examination showed varying degrees of absorption of lung lesions within 7 d. These results indicate that CP can serve as a promising rescue option for severe COVID-19, while the randomized trial is warranted."
**********

Here's a story from the WSJ:

Coronavirus Survivors Keep Up the Fight, Donate Blood Plasma to Others
National Covid-19 project seeks volunteers to aid the seriously ill; ‘I feel obligated to help’
By Amy Dockser Marcus

"The Mount Sinai Hospital in New York, where Mr. Sherman volunteered to donate plasma, is one of 34 institutions around the country participating in the National Covid-19 Convalescent Plasma Project, which is seeking blood-plasma donations from recovered patients who have a confirmed Covid-positive test and are at least 21 days out from the onset of symptoms.
...
“The biggest problem is not the lack of donors,” said Arturo Casadevall, a professor at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, and one of the organizers of the national project. “It is the logistics of figuring out how people who want to participate can actually donate.”

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

And here's a plasma industry press release:

Global Plasma Leaders Collaborate to Accelerate Development of Potential COVID-19 Hyperimmune Therapy

"Osaka, JAPAN, and King of Prussia, PA, USA – April 6, 2020 –  Biotest, BPL, LFB, and Octapharma have joined an alliance formed by CSL Behring (ASX:CSL/USOTC:CSLLY) and Takeda Pharmaceutical Company Limited (TSE:4502/NYSE:TAK) to develop a potential plasma-derived therapy for treating COVID-19. The alliance will begin immediately with the investigational development of one, unbranded anti-SARS-CoV-2 polyclonal hyperimmune immunoglobulin medicine with the potential to treat individuals with serious complications from COVID-19.
...
"Developing a hyperimmune will require plasma donation from many individuals who have fully recovered from COVID-19, and whose blood contains antibodies that can fight the novel coronavirus. Once collected, the “convalescent” plasma would then be transported to manufacturing facilities where it undergoes proprietary processing, including effective virus inactivation and removal processes, and then is purified into the product."

********
My other posts on plasma, mostly focused on repugnance to compensation for donors. Here's one that explains some of the underlying medical issues:

Thursday, July 11, 2019

Plasma shortage alert from the IDF--the Immune Deficiency Foundation

Allocating and reallocating scarce medical supplies

An op-ed in USA today points out that shortages of critical hospital supplies are occurring and will continue to occur at different times in different states, allowing for increased efficiencies in sharing (which is hampered by a vacuum in leadership at the Federal level).

One of the authors, Dr. Deborah Proctor, is in fact an experienced market designer, who led the (re-)adoption of a fellowship match for gastroenterology fellows.*

National redistribution of hospital supplies could save lives
Taking supplies from less stressed hospitals and sharing them with overwhelmed ones, we could maximize the use of equipment and save more lives.
Diane R. M. Somlo, Dr. Howard P. Forman and Dr. Deborah D. Proctor

"Since we now know more about the predicted peaks in COVID-19 across the U.S., we can see that peak demand will likely occur at different times in different states and cities, starting in early April and extending through May. While some hospitals are already starting to drown, other hospitals that are further from their peak demand have stockpiles of unused equipment lying in wait. 

"What if there was a nation-wide system that allowed hospitals that have equipment but have lower present and predicted demand to lend some reusable (ventilator) and non-reusable equipment (PPE, testing kits) to hospitals that are currently being overwhelmed? Then, as demand in one area rises and the other falls, freed up ventilators could be re-distributed, and manufacturers will have had more time to generate non-reusable equipment for hospitals that lent their equipment. By taking from stockpiles of less stressed hospitals and sharing it with currently overwhelmed ones, we could maximize the use of our national inventory of equipment and save more lives.
...
" redistribution approaches in other settings have enabled vast functional expansions of limited supplies, including kidney transplants and donated food for food pantries across the U.S. Bottom line: Redistribution has the potential to improve the trajectory of COVID-19 mortality in the U.S. Our country is already on track to employ these measures at a state level or voluntarily, so delaying set up of cross-state exchange only means missing out on the maximal benefit of redistribution. In fact, as of this writing, New York’s Governor Andrew Cuomo has just signed an executive order enabling redistribution of medical supplies to struggling hospitals within New York state and Oregon has sent ventilators to New York.

"In these coming trying times, our healthcare system is facing an unprecedented, deadly burden, and we need to make supplies available where they are needed most —independent of state lines. Now is the time to start making the changes, to call on the federal government, national leaders, and private partnerships to coordinate our efforts as a nation, so we can provide the best care possible with our limited supplies. Lives depend on it."

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

* Niederle, Muriel, Deborah D. Proctor and Alvin E. Roth, ''The Gastroenterology Fellowship Match: The First Two Years,'' Gastroenterology , 135, 2 (August), 344-346, 2008.

Transplantation slows in Canada, too...

Ventilators in short supply may be part of the problem (since most deceased donations involve ventilators), but there's also a general risk aversion at play...

Donated organs not being used as hospitals scale back transplants for COVID-19

"OTTAWA — Transplant centres across the country have massively scaled back organ transplants as hospitals try to make sure they are able to accommodate COVID-19 cases.

"Living-donor surgeries have largely shut down across the country, and deceased-donor transplants are happening only when the case is urgent.

"Dr. Atul Humar, past president of the Canadian Society of Transplantation, said that means many organs are not going to good use.

“There’s some donors, deceased organ donors, and we’re not sending teams to procure those organs,” said Humar, who is also the director of the transplant program at Toronto General Hospital.

“It’s quite tragic.”

"Patients who go through certain types of organ donation often require time in the intensive care unit on a ventilator — resources desperately needed by patients with serious cases of COVID-19.

"At Humar’s hospital, organ transplant surgeries have decreased by about 80 per cent, though the numbers vary from province to province."

Eating cats and dogs banned in Shenzhen

The distinction between pets and pet food just became a little clearer in Shenzhen.

The BBC has the story:

Shenzhen becomes first Chinese city to ban eating cats and dogs  

"The new law will come into force on 1 May.

"Thirty million dogs a year are killed across Asia for meat, says Humane Society International (HSI).

"However, the practice of eating dog meat in China is not that common - the majority of Chinese people have never done so and say they don't want to.

"Dogs and cats as pets have established a much closer relationship with humans than all other animals, and banning the consumption of dogs and cats and other pets is a common practice in developed countries and in Hong Kong and Taiwan," the Shenzhen city government said, according to a Reuters report."

Sheltering in place (or maybe someplace else), repugnantly

Many fewer things would be regarded as repugnant were it not for underlying inequality. So it shouldn't surprise us to see new repugnances emerge as  we are all--rich and poor and in between-- asked to shelter in place to halt the spread of the COVID-19 corona virus.

Here's an example from the Guardian:

Coronavirus retreat for wealthy to wait out pandemic cancelled

The Harbor offered a two-month retreat in a villa where guests could ‘meet and mingle and collaborate – no facemask required’

"A luxurious southern California retreat for wealthy participants to wait out the coronavirus pandemic has folded before the program could even open its doors.

"As millions of Americans face strict social distancing orders amid the pandemic, the “Harbor” proposed the opposite for those who could afford it: a two-month retreat in an exclusive villa where guests could “meet, mingle and collaborate with some of the brightest, forward-thinking individuals – no facemask required”.

*********

Frankly, it sounded like a cruise ship to me...

Choosing who to interview in the sports medicine fellowship match

Little is known about what goes on between application to fellowship (or residency) programs, and rank-ordering for the relevant medical Match.  Here's an attempt at looking into the black box of choosing who to interview, and combining interview information with other information to determine rank order lists:

Factors Used by Program Directors in the Orthopedic Sports Medicine Fellowship Match
Travis Menge, Ashley Nord, Kendall Hamilton, Monica LaPointe and Peter J.L. Jebson
Journal of Surgery [Jurnalul de chirurgie], Volume 16:2, 2020

Abstract
Background: Obtaining an orthopedic sports medicine fellowship position is becoming more difficult, as the number of residents seeking post-graduate training continues to increase.
Objective: To identify factors that orthopedic surgery sports medicine fellowship program directors deem valuable in selecting applicants.
Methods: A web-based questionnaire was sent to all ACGME accredited sports medicine fellowship program directors in the United States in 2016. The questionnaire was designed to identify the most important criteria in selecting applicants for an interview, and ranking candidates to match into their program.
Results: Thirty-five of ninety-one program directors responded. The criteria for offering an applicant an interview were quality of recommendation letter, technical competence, and residency program reputation. Letters of recommendation that held the highest value were from the chief of sports medicine and another sports medicine surgeon in the department. The most important features of the interview were the applicant’s ability to articulate thoughts, the maturity of the applicant, and the ability of the applicant to listen well. The attributes deemed most important in high ranking a candidate included the applicant’s commitment to hard work, quality of the interview, and quality of letters of recommendation.

Bikes and guns while sheltering in place in Santa Clara County (bikes are essential, guns are not)

From the Santa Clara County Department of Public Health, a new shelter in place order that defines, among other things, "essential businesses" which are those that can keep operating from their traditional premises (as opposed to only making home deliveries):


Coronavirus Frequently Asked Questions
MARCH 31, 2020 SUPERSEDING SHELTER-IN-PLACE ORDER 

"This new Order requires that most people continue sheltering in their place of residence until May 3, 2020.  This new Order replaces the prior Shelter-in-Place Order, which was set to expire on April 7, 2020.  It also adds to the list of restrictions to slow the spread of the COVID-19 disease.

"You are still allowed to participate in “essential activities” or to work for an “essential business” if it is not possible for you to work from home."

There follows a long list of essential businesses, and a long set of Q's and A's to guide the perplexed.

Among the Essential businesses:

"Bicycle repair and supply shops"
********************

and there's this Q&A:

"Can gun shops selling firearms and ammunition continue to keep their storefronts open? 

"No.  Gun shops are not essential businesses under the Order.  The Order allows delivery of inventory directly to customers at their residences in compliance with applicable laws and regulations, but gun shops may not make sales from their storefronts. "
*********
I imagine the situation is different in Texas.

Expect a case to reach the Supreme Court in a few years...

Headlines that could be dated April 1

Something was in the air this year: many headlines in serious outlets struck me as appropriate for April Fools Day.

Non-political ones come first:

Coffee beans not vital for human survival, Switzerland decides

Dairy Queen burgers are not made of human flesh, county coroner is forced to confirm

The Ohio State University wants to trademark its favorite word: ‘The’

"officials filed Application No. 88571984 with the U.S. Patent and Trademark Office last week, seeking a trademark for the word “THE” to use it on items including T-shirts, caps and hats."



Bodyguard to Saudi king reportedly shot dead by friend
...with friends like these...

A Prisoner Who Briefly Died Argues That He’s Served His Life Sentence

A court in Iowa found that a murderer who was revived “is either still alive, in which case he must remain in prison, or he is actually dead, in which case this appeal is moot.”

Investors who lost $190m demand exhumation of cryptocurrency mogul
Canadian company founder took crucial password to the grave

Are vegetables vegan?

Wisconsin town to legalize snowball fights after 50-year ban

Judge blocks California’s alligator ban after Louisiana sues

Why is Gwyneth Paltrow selling a candle that smells like her vagina?

‘Mad’ Mike Hughes, who vowed to prove the flat-Earth theory, dies in homemade-rocket disaster

Alabama bill may lift yoga ban in public schools but prohibit 'namaste' greeting

Nevada Brothels Requiring Customers To Wear Masks

Astrophysicist gets magnets stuck up nose while inventing coronavirus device

Turkmenistan Has Banned Use Of The Word 'Coronavirus'


And a special section of (American) politics, if you can call it that:

Donald Trump’s interest in buying Greenland stuns Denmark
‘Greenland is not for sale, and can’t be sold,’ says island’s government

Trump cancels Denmark trip after PM says Greenland is not for sale
President says he is postponing meeting with Mette Frederiksen because she was not interested in discussing transaction

Trump blasts report claiming he wanted to nuke hurricanes

Trump border wall between US and Mexico blows over in high winds

Trump’s border wall, vulnerable to flash floods, needs large storm gates left open for months

Sarah Palin stuns TV viewers by rapping Baby Got Back dressed as a bear

Complacency, Not Panic, Is the Real Danger: Ido Erev in the NYT

A timely article points out that many of us are more likely to underestimate dangers (like corona virus) than overestimate them.

Complacency, Not Panic, Is the Real Danger
Only a small minority of people panic under threat, research shows. Far more don’t take the threat seriously enough.

How to efficiently (re)distribute ventilators (and masks, gowns, test kits...)?

How to allocate scarce medical goods, when all signals indicate shortages of everything, everywhere (but some needs are more immediate and urgent than others)?

Market mechanisms that work well when the situation evolves slowly are struggling under big swings in demand and supply.

I've received many emails on this and related subjects in the last week. (If the predictions of future need were precise, things would be easier...).  Here are two thoughts on providing market-wide information that isn't emerging naturally from the functioning of existing markets.

From the WSJ:

Manufacturers Seek U.S. Help in Deciding Where to Ship Scarce Medical Goods
To address coronavirus-related shortages, companies want the federal government to provide strategic guidance
By Rebecca Ballhaus and Andrew Restuccia, March 29, 2020

"Producers and distributors of medical supplies across the country are raising red flags about what they say is a lack of guidance from the federal government about where to send their products, as hospitals compete for desperately needed masks and ventilators to combat the spread of the novel coronavirus.
...
"Company executives say they are ill-equipped to make decisions about which hospitals and states should first receive their medical supplies and are calling on the government to step in.

“It’s really the allocation piece that’s most important to us right now because we just cannot and never will have a window into what the most urgent need is,” said Scott Whitaker, chief executive of the Advanced Medical Technology Association, a trade association that represents producers of medical devices.

"Charlie Mills, chief executive of Medline Industries Inc., a large privately held manufacturer and distributor of medical supplies, said as the company works to ramp up its production of supplies, it is being inundated with orders. He said he would welcome the government having a “strong say” in how to respond.

“All of our customers are wanting more,” Mr. Mills said. “The federal government might be in a better position to decide where it would go.”
**************

And here's an op-ed in The Hill by Loertscher and Marx:

A national ventilator exchange could address critical shortages
BY SIMON LOERTSCHER AND LESLIE M. MARX

"With elective procedures on hold indefinitely, we know there are ventilators sitting unused across the country right now — we just don’t know where and how many, so we need a nationwide registry. Every hospital in the country can document the quantity, makes and models of their machines, how many are available to treat COVID-19, and which are reserved to treat other conditions.

"There is ample evidence, for example, from reallocating land or spectrum licenses, that such registries improve the efficiency and volume of transactions.
...
"Of course, if there are not enough ventilators to go around, we face terrible ethical dilemmas, either with or without a rental market. But if we have enough, and they are just in the wrong places, then a short-term rental market is exactly the thing that could get us out of such dilemmas.

"For this model to be effective, it’s imperative to act now. If our government moves quickly to pool our resources and combine the best ideas of health care professionals, market design economists, and logistics specialists, we could do a lot of good in this time of unprecedented challenges."

Family legacies in Operations Research (and related fields)

ORMS Today has an article on multi-generations of operations researchers, broadly defined.

Like father, like son and daughter
All in the family tree: INFORMS rich with O.R. legacies

I know only some of the folks they interviewed: here's the full list.

The Wikums
Erick and his son Anders

The Weintraubs
Andres and his son Gabriel 

The Weins
Lawrence, his son Alex and daughter Nicole

The Roths
Al and his son Aaron

The Elmaghrabys
Wedad and her father Salah

The Bixbys
Robert and his daughter Ann

The Armacosts
Robert and his son Andrew

The Camms
Jeff and his daughter Allison

The Hilliers
Fred and his son Mark (and almost his granddaughter Sarah)

Repugnant Behavior, a conference in Montpellier in February 2021

Here's the announcement and call for papers:

WINIR Workshop on

Repugnant Behaviours

24-25 February 2021

University of Montpellier, Montpellier, France

Organiser: Alain Marciano

"Formally introduced in economics by Nobel laureate Alvin Roth, the concept of "repugnance" arises in the debate among philosophers (e.g., Elizabeth Anderson, Michael Sandel, Debra Satz) and other social scientists (e.g., Kristie Blevins, Amitai Etzioni, Kimberly Krawiec, Amartya Sen, Philip Tetlock) about how and why moral concerns, taboos and sacred values place, or ought to place, limits on market transactions. (A set of representative references is provided in the call for papers.)

Important dates

15 June 2020 – Abstract submission deadline

15 July 2020 – Notification of acceptance

15 December 2020 – Full paper submission deadline

Keynote speaker

Kimberly D. Krawiec

Kathrine Robinson Everett Professor of Law

Duke Law School, USA

REFERENCES

Anderson, E. (1990) “The Ethical Limitations of the Market” Economics and Philosophy 6(2): 179-205.

Anderson, E. (1993) Value in Ethics and Economics (Cambridge, MA: Harvard University Press).

Blevins, B., Ramirez, R. & Wight, J. B. (2010) “Ethics in the Mayan Marketplace” in M. D. White (ed.) Accepting the Invisible Hand: Market-Based Approaches to Solving Social-Economic Problems (New York: Palgrave Macmillan).

Cook, P J. & Krawiec, K. D. (2018) “If We Allow Football Players and Boxers to Be Paid for Entertaining the Public, Why Don’t We Allow Kidney Donors to Be Paid for Saving Lives?” Law and Contemporary Problems 81(3): 9-35.

Elias, J. J., Lacetera, N. & Macis, M. (2015) “Sacred Values? The Effect of Information on Attitudes toward Payments for Human Organs” American Economic Review 105(5): 361-365.

Elias, J. J., Lacetera, N. & Macis, M. (2016) “Efficiency-Morality Trade-Offs In Repugnant Transactions: A Choice Experiment” NBER, Working Paper No 22632.

Etzioni, A. (1986) “The Case for a Multiple-Preference Conception” Economics and Philosophy 2: 159-183.

Etzioni, A. (1988) The Moral Dimension: Toward a New Economics (New York: Free Press).

Healy, K. & Krawiec, K. D. (2017) “Repugnance Management and Transactions in the Body” American Economic Review 107(5): 86-90.

Held, P. J., McCormick, F., Ojo, A & Roberts, J. P. (2016) “A Cost‐Benefit Analysis of Government Compensation of Kidney Donors” American Journal of Transplantation 16(3): 877–885.

Kass L. R. (1997) “The Wisdom of Repugnance: Why We Should Ban the Cloning of Humans” New Republic 216(22):17-26.

Kekes J. (1998) A Case for Conservatism (Ithaca, NY: Cornell University Press).

Khalil, E. L. & Marciano, A. (2018) “A Theory of Tasteful and Distasteful Transactions” Kyklos 71(1): 110-131.

Krawiec, K. D. (2015) “Markets, Morals and Limits in the Exchange of Human Eggs” Georgetown Journal of Law & Public Policy 13(1): 349-365.

Krawiec, K. D. (2016) “Lessons from Law About Incomplete Commodification in the Egg Market” Journal of Applied Philosophy 33(2): 160-177.

Krawiec, K. D., Liu, W. & Melcher, M. (2017) “Contract Development in a Matching Market: The Case of Kidney Exchange” Law and Contemporary Problems 80(1): 11-35.

Kray, L. J., George, L. G., Liljenquist, K. A., Galinsky, A. D., Tetlock, P. E. & Roese, N. J. (2010) “From What Might Have Been to What Must Have Been: Counterfactual Thinking Creates Meaning” Journal of Personality and Social Psychology 98(1): 106-118.

Leider, S. & Roth, A. E. (2010) “Kidneys for Sale: Who Disapproves, and Why?” American Journal of Transplantation 10(5): 1221-1227.

McGraw, P. & Tetlock, P. E. (2005) “Taboo Trade-Offs, Relational Framing And The Acceptability Of Exchanges” Journal of Consumer Psychology 15(1): 35-38.

McGraw, P., Schwartz, J. & Tetlock, P. E. (2012) “From the Commercial to the Communal: Reframing Taboo Trade-Offs in Religious and Pharmaceutical Marketing” Journal of Consumer Research 39(1): 157-173.

Roth, A. E. (2007) “Repugnance as a Constraint on Markets” Journal of Economic Perspectives 21(3): 37-58.

Sandel, M. J. (2012) What Money Can't Buy: The Moral Limits of Markets (New York: Farrar, Straus & Giroux).

Sandel, M. J. (2013) “Market Reasoning as Moral Reasoning: Why Economists Should Re-Engage With Political Philosophy” Journal of Economic Perspectives 27(4): 121-140.

Satz, D. (1995) “Markets in Women's Sexual Labor” Ethics 106(1): 63-85.

Satz, D. (2008) “The Moral Limits of Markets: The Case of Human Kidneys” Proceedings of the Aristotelian Society 108(1/pt3): 269-288.

Satz, D. (2012) Why Some Things Should Not Be For Sale: The Moral Limits of Markets (New York: Oxford University Press).

Schoemaker, P. & Tetlock, P.E. (2011) “Taboo Scenarios: How To Think about The Unthinkable” California Management Review 54(2): 5-24.

Sen, A. (1987) On Ethics and Economics (Oxford: Blackwell).

Sheehan, M. (2016) “The Role of Emotion in Ethics and Bioethics: Dealing with Repugnance and Disgust” Journal of Medical Ethics 42(1): 1-2

Death with dignity, in Germany

Medically assisted suicide, controversial everywhere, has come to Germany.

The Lancet reports:
Germany overturns ban on assisted suicide
Rob Hyde
Published:March 07, 2020DOI:https://doi.org/10.1016/S0140-6736(20)30533-X

"Germany's supreme court has lifted a ban on professionally assisted suicide in a landmark ruling. ...

"Following a campaign by doctors and terminally ill patients, Germany's supreme court has lifted a law which outlawed the provision of assisted-suicide services. These services could range from signing a prescription for a lethal overdose of sedatives, to providing consultation to terminally ill patients on how they could travel outside of Germany to end their lives legally.

"Speaking from Germany's Federal Constitutional Court in Karlsruhe, Judge Andreas Voßkuhle said the 2015 law—paragraph 217 of the German Criminal Code—did not allow a person either “the right to a self-determined death” or “the freedom to take one's life and seek help doing so”. This law, he said, therefore violated the German constitution, and was now void.

"The association Sterbehilfe Deutschland e.V. (Assisted Suicide Germany) was among those campaigning against paragraph 217. Roger Kusch, head of the organisation and Hamburg's former senator for justice, said that the ruling by the supreme court marked “…a wonderful day for our association, for the association members and also for all interested citizens.” He said the ruling meant that no-one now has to suffer the pressure “…from churches and from other people, who believe they have to influence the entire population and the whole of society.”

"Others, however, are less jubilant. Frank Ulrich Montgomery is president of the Standing Committee of European Doctors, which represents national medical associations across Europe. He fears that the supreme court's ruling will mean the principle of doctors preserving life could be rendered obsolete.
...
"“Euthanasia” comes from the Greek word euthanatos (which means easy death), and means taking steps to end an individual's life to relieve suffering. In a medical context, euthanasia refers to a doctor using painless means to end a person's life, providing the patient and the patient's family agree. Assisted suicide, by contrast, refers to when a person is helped to kill themselves. Switzerland has eight right-to-die clinics and is the European country most often associated with euthanasia. However, euthanasia and assisted suicide are legal not only in Switzerland, but also in Belgium, Luxembourg, and the Netherlands, although each country varies on how it defines both terms. In Germany, the issue of the state legalising euthanasia is highly sensitive, especially given that the Nazis used the same term to describe the murder of hundreds of thousands of disabled people."

NSF report on Doctorate Recipients in the Social, Behavioral, and Economic Sciences (SBE): 2017

Here's the Doctorate Recipients in the Social, Behavioral, and Economic Sciences (SBE): 2017
NSF 20-310   |   March 16, 2020

There were almost 1,000 more doctorates awarded in Psychology in 2017 than the total in Economics plus Political Science plus Sociology.

I was surprised to note that the gender ratio of Economics doctorates is less extreme than that of Psychology doctorates, although in the opposite direction, and that Poli Sci doctorates are more evenly distributed between women and men (and the gender imbalance in Sociology is very close to Economics, also in the opposite direction.)


Here's a figure and a table from the pdf file.

Litigation financing revisited

It looks like litigation financing--i.e. the financing of legal suits for a share of the proceeds--is here to stay, and the New York City Bar Association is trying to come to terms with it.   Here is their

REPORT TO THE PRESIDENT
BY THE NEW YORK CITY BAR ASSOCIATION
WORKING GROUP ON LITIGATION FUNDING

"Maintenance is defined as “helping another prosecute a suit,”18 and champerty is defined as “maintaining a suit in return for a financial interest in the outcome.”19 Prohibitions against maintenance and champerty arose in medieval England.20
...
"Many U.S. states are beginning to relax prohibitions on maintenance and champerty.  Twenty-eight jurisdictions permit maintenance with varying limitations,31 and sixteen explicitly allow champerty.32 However, other states have refused to “abandon the champerty doctrine ...

"New York’s prohibition of champerty remains in force, although its breadth is uncertain.
**************
Earlier:
Sunday, November 8, 2015

More on (third party) litigation financing, including a medieval word, "champerty"

Saturday, July 13, 2019

Litigation financing is no longer so repugnant

Celebrating Hervé Moulin's 70th Birthday, in Mexico City, in June (maybe)

Not many scholars are as worthy of celebration as Hervé Moulin, so I was glad to see this announcement (from before corona virus achieved pandemic status...)

Workshop on Fairness, Incentives and Algorithms in Celebration of Hervé Moulin 70th Birthday  June 22-23, 2020, CIDE, Mexico City, Mexico

"Topics addressed in this interdisciplinary workshop include, but are not limited to: Fair division, Cost-sharing, Computational Social Choice, Mechanism design on Networks, Price of Anarchy, Matching.

"Program Committee

Anna Bogomolnaia (Glasgow) Justin Leroux (HEC Montreal)

Local committee

Isabel Melguizo (CIDE)

Ruben Juarez (Hawaii) Hervé Moulin (Glasgow)

Antonio Jiménez (CIDE)

Rajnish Kumar (Belfast) Alison Watts (SIU)"


The Moulin celebration was originally planned to coordinate with the 15th Meeting of the Societyfor Social Choice and Welfare [June 24-7], which has now been postponed due to corona virus.  Birthday's are harder to postpone, but there's no telling about celebrations in these complicated times.

Foie gras and NY farm workers

The NY Times ran this story:

A Luxury Dish Is Banned, and a Rural County Reels
The ban protects animals and slaps wealthy gourmands. But upstate, hundreds of low-wage immigrant laborers are bracing for the impact.
By John Leland, Photographs by Desiree Rios

"Last October, when the New York City Council passed a ban on foie gras as inhumane, Mayor Bill de Blasio called foie gras “a luxury item that the vast majority of us would never be able to afford.”
...
"But two hours northwest of the city, in one of New York’s poorest counties, foie gras plays a much different role. There it is not a luxury splurge but a domino in a fragile local economy. Almost all of the foie gras produced in the United States comes from two duck farms in Sullivan County, where about 400 workers, mostly immigrants from Mexico and Central America, rely on it for their livelihood.

"Locals say that New York City’s ban, which is scheduled to go into effect in 2022, threatens all the businesses connected with the two farms, from the neighboring farms that supply feed for the ducks to the machine shops that repair agricultural equipment, from the small truckers to the local markets and restaurants that cater to the Spanish-speaking workers.
...
"Hudson Valley Foie Gras, the larger of the two farms, is a sprawling artifact of an earlier disruption, on the site of three former egg farms, which closed when the advent of interstate highways made it cheaper for city stores to get eggs from industrial farms elsewhere.
...
"Opponents of foie gras call the force-feeding process cruel. It’s already banned in India, Israel and Britain. Whole Foods stopped selling the product in 1997, and Postmates stopped delivering it in 2018. The American Veterinary Medical Association takes a neutral position, citing a lack of evidence that birds are harmed by the process, though many veterinarians disagree.
...
"Already hurting from a ban in California, which they say cut their sales by 20 percent, Hudson Valley hired a politically connected lobbying firm, Bolton-St. Johns, and a publicity firm, Millennial Strategies, which represents Lyft, Juul and Starbucks. 

School choice without the assumption of full-information equilibrium by Kapor, Neilson and Zimmerman

Forthcoming in the AER:

Heterogeneous Beliefs and School Choice Mechanisms By Adam J. Kapor and Christopher A. Neilson and Seth D. Zimmerman

Abstract: This paper studies how welfare outcomes in centralized school choice depend on the assignment mechanism when participants are not fully informed. Using a survey of school choice participants in a strategic setting, we show that beliefs about admissions chances differ from rational expectations values and predict choice behavior. To quantify the welfare costs of belief errors, we estimate a model of school choice that incorporates subjective beliefs. We evaluate the equilibrium effects of switching to a strategy-proof deferred acceptance algorithm, and of improving households’ belief accuracy. We find that a switch to truthful reporting in the DA mechanism offers welfare improvements over the baseline given the belief errors we observe in the data, but that an analyst who assumed families had accurate beliefs would have reached the opposite conclusion.
**********

see my earlier post:

Monday, January 28, 2019

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

The Power of Experiments by Mike Luca and Max Bazerman

New this month from MIT Press, a history and guide to experiments in (mostly) online businesses:

The Power of Experiments

Decision Making in a Data-Driven World

By Michael Luca and Max H. Bazerman

"How organizations—including Google, StubHub, Airbnb, and Facebook—learn from experiments in a data-driven world."

My blurb says: "Luca and Bazerman's The Power of Experiments will open your eyes about how to distill information from data."

Hal Varian's blurb says: "One of the great things about e-commerce is that it is far easier to run experiments online than offline. As more and more companies move online, they need to learn how to use this powerful tool. This book shows how to take advantage of experiments and how this will revolutionize business, both online and off."

Susan Athey's says: "This accessible and engaging book provides an excellent introduction to a subject that every young person entering the business world today should understand—experimentation. The case studies draw the reader into the challenges that arise in practice, highlighting issues ranging from bias to ethics to unintended consequences."

And the draft I read was fun and easy to read.  This might be the book to spend time with while you're sheltering in place.

NRMP Match Day (and corona virus precautions)

Today, Friday, is Match Day, the day when new American medical school graduates and others find out the residency programs to which they have been matched by the National Resident Matching Program (NRMP).

In a usual Match Day, the graduates of most American med schools would gather together, to learn all together where they would be heading later this summer.  However this year, many of us are working from home, with large gatherings discouraged if not banned, to prevent the spread of corona virus.

The AAMC put out this announcement earlier this week:

The Match®: 10 things to know as the day draws nigh
...

"A two-stage reveal: On Monday, students learned if they have been matched to a residency via emails that were sent out at 11 a.m. ET. On Friday, they learn specifically where their residencies will be during the Match Day ceremonies (either in-person or online), which start at noon ET across the country, or by emails from the National Resident Matching Program® that go out at 1 p.m. ET. Students can also learn about both results through a mobile device.

"Coronavirus impact: Many schools have made or are weighing changes to Match Day celebrations as the status of the virus outbreak changes in various regions of the country."