An interview in (not on) Clinical Orthopaedics and Related Research, largely about resident matching

 For those  readers of this blog who may have missed the May issue of Clinical Orthopaedics and Related Research, here's an interview by the editor

A Conversation with ... Alvin E. Roth PhD, Economist, Game Theorist, and Nobel Laureate Who Improved the Modern Residency Match  by Leopold, Seth S. MD, Clinical Orthopaedics and Related Research, Volume 479(5), May 2021, p 863-866   doi: 10.1097/CORR.0000000000001758

The interview includes this long answer to a short question about the resident Match:

Seth S. Leopold MD: Many readers will dispute the idea that the Match is resistant to strategic manipulation (“gaming the system”); why do you believe it is, and why do you think this perception persists?

Alvin E. Roth PhD: That question requires a somewhat complicated answer. The Match is built around an idea of how to organize a simple labor market, and that idea had to be adapted to the complex structure of the modern medical labor force. A simple labor market would be one in which graduating medical students each seek a single position, positions are well described in advance, and applicants and residency programs can each rank-order all of their possible matches; that is, applicants can rank programs and programs can rank applicants. That simple market can be modeled mathematically, and it can be shown that a deferred acceptance algorithm with applicants proposing makes it a dominant strategy for all applicants to submit rank-order lists corresponding to their true preferences. (A dominant strategy is one in which regardless of what rank-order lists others submit, no applicant can do better than to rank residency programs in order of his or her true preferences. For instance, your chance of getting your second-choice program if your first choice rejects you is exactly the same as if you had listed your second choice first.)

"That’s a theoretical answer about a market that is quite a bit simpler than the modern market for residencies. The deferred acceptance algorithm for that simple market was studied by Gale and Shapley [8], for which Shapley shared the 2012 Nobel Prize in Economics. (I had earlier shown that in a simple market, applicants can’t profitably manipulate their rank-order lists [16].)

"The actual modern market for residencies differs from that simple market in several ways. For one thing, not all applicants are seeking a single position. This can happen for several reasons, the most important of which is that couples can enter the Match looking for pairs of jobs; in 2020, for example, more than one thousand couples submitted rank-order lists consisting of pairs of jobs. There are also many more residency programs than an applicant can submit on a rank-order list, and many more applicants than programs can interview, so decisions have to be made beforehand that are more complicated than how to order the rank-order list. These complications may also add to confusion about the Match and about how the Match algorithm works.

"Computational studies of the Match nevertheless confirm that once interviews are over and an applicant has decided what programs to apply to, it is perfectly safe to submit a rank-order list that corresponds to the applicant’s true preferences [18]. To put it another way, there is no advantage to submitting a rank-order list that differs from an applicant’s preferences (and there is a danger in submitting a different rank-order list, because the Match will use the submitted list to make matches, in order).

"This fact doesn’t seem to have yet penetrated to everyone who participates in the Match [13]. For this reason, all those who advise medical students entering the Match should increase their advising efforts around this point.

"Note that the Match is only the final part of the transition to residency (or to fellowships). That transition starts with applications and interviews and includes various kinds of signals, like exam scores and transcripts and letters of reference. While the dominant-strategy property of the Match makes that part of the process strategically simple (that is, we can confidently advise students to submit rank-order lists in order of their true preferences), the other parts of the process (what rotations to take before applying, where to apply, how to conduct yourself at interviews) are not simple at all."

NRMP Position Statement On The (In)Feasibility Of An Early Match

 There has been some suggestion that dividing the resident match into early and late matches might be a way to address the congestion in applications and interviews that has bedeviled the transition from medical school to residency in recent years.  The NRMP now has a statement pointing out that there are serious problems with that idea.

NRMP Position Statement On The Feasibility Of An Early Match

"For the past eighteen months the National Resident Matching Program® (NRMP®) has been working closely with other national medical education organizations to examine the current state of the transition to residency. Conversations have focused on mitigating burdens for both applicants and programs in the selection and recruitment process and addressing uncertainty in the future of the interview cycle.

...

"Among the proposed solutions to current challenges in the transition to residency are calls for an early match. Specifically, NRMP has been asked to implement the Early Result and Acceptance Program (ERAP) pilot program proposed for Obstetrics and Gynecology, created through American Medical Association’s Reimagining Residency Grant, “Transforming the UME to GME Transition: Right Resident, Right Program, Ready Day One”. The stated goals of the ERAP pilot are to allow applicants to engage in strategic decision-making, reduce burden on programs while hypothesizing that the change will result in holistic review, and reduce necessary applications and interviews. ERAP calls for an early match to begin in September 2022 for the 2023 Match cycle. ERAP permits applicants to apply to a maximum of three programs in the early match with programs including up to 50% of their positions if they choose to participate. This statement outlines NRMP’s concerns about the structure of the ERAP pilot program, the lack of evidence supporting the proposed changes to the Match, the implications of an early match for the matching process, and preliminary findings of modeling an early match being conducted by experts in market design and the matching algorithm.

"The NRMP has reviewed the ERAP pilot program with consideration for whether changes to the matching process have the potential to inadvertently disadvantage Match participants. It is through that lens NRMP remains concerned with the following aspects of the ERAP pilot:

"Although voluntary, applicants may feel pressured to participate in an early match where up to half the available positions in a specialty may fill before the Main Residency Match® opens.

"There exists no mechanism for demonstrating how an early match will make visible less competitive applicants and those underrepresented in medicine, which is hypothesized in the project document.

"The proposed limit of three applications per applicant could force applicants to make compromises not present in the Match today. ...While the ERAP investigation team hypothesized that the application limit will increase holistic review by programs, there are no mandates to ensure that programs conduct holistic review nor are there restrictions on the number of applications programs may accept, interviews they may offer, or applicants they may rank. With no objective evidence to support the hypothesis, we cannot conclude that the proposed application limit would increase holistic review of applications.

"There exists no mechanism for safeguarding an applicant’s failure to match in the early match from programs as they enter the Main Residency Match, which could result in the applicant being viewed as less competitive.

"In addition to concerns about disadvantaging applicants, NRMP is mindful of possible behavior changes resulting from changes to the Match process that could affect Match outcomes for all Match participants.

• "The structure of an early match does not allow for mixed-specialty couples ranking or multispecialty individual ranking, which may cause applicants to reconsider their specialty choices, fundamentally changing their career path.
• "Programs may have insufficient information (e.g., clinical evaluations, MSPE, LORs) to evaluate applicants fully and fairly in the early match.
• Programs may see a surge in non-traditional applicants as the early match provides three opportunities to enter training through either the early match, the Main Residency Match, or SOAP®. This may result in an increased number of applications or applicants who may otherwise not select the specialty.
• Not matching in the early match is likely to increase the number of applications per individual in the Main Residency Match, as applicants enter a matching cycle with only half of the positions remaining available. This may increase stress, cost, and could adversely affect the wellness of applicants.

...

"it is important to first outline the core concepts of the match as a stable “market”. The Match was established in 1952, to solve a “congestion” problem in medical residencies involving applications, offers, and acceptances. In a May 2021 pre-submission working paper, Itai Ashlagi, Ph.D. and Alvin Roth, Ph.D. describe the consequences of congestion as “unraveling” where programs initially responded to congestion by making “exploding offers” that prevented applicants from considering many programs because they were pressed to accept an early offer, before knowing whether an offer from a more preferred program might be forthcoming if they waited. The authors note that NRMP’s matching process, in its current form, has four distinct properties that are relevant to managing the problems of congestion and unraveling and maintaining a stable matching market. Specifically, the NRMP matching process

"1. Is Uncongested: participants make all decisions (on Rank Order Lists) in advance, so there is no delay in processing offers, rejections, and acceptances, which is done by the computerized Roth-Peranson algorithm.

"2. Defers acceptances: preferences of applicants and programs are not finalized until all preferences have been considered, thereby producing stable matching: i.e., matching in which there are no “blocking pairs” of applicants and programs not matched to one another but who both would prefer to be.

"3. Promotes true preferences: it is safe for participants to state their true preferences when they submit their Rank Order Lists (ROLs).

"4. Establishes a “thick” market: most residency programs in most specialties participate in the NRMP Match, which also allows for multi-specialty applications and couple matching (including for mixed-specialty couples).

"The authors opine that an early match such as the proposed ERAP pilot followed by the Main Residency Match would not share three of the four important properties of the Match:

"1. An early match would dilute the thick market: not all positions would be available at the same time (and further, it would not allow applicants to express multi-specialty preferences, nor would it accommodate mixed-specialty couples).

"2. early match would introduce complicated strategic decisions into the formulation of ROLs: it would no longer be safe for participants to submit ROLs straightforwardly corresponding to their preferences.

"3. An early match would not produce a stable matching: there would be mutually disappointed blocking pairs of mismatched applicants and programs. This would also make it less safe to report ROLs that straightforwardly corresponded to preferences."

Trans as a gender identity

 New freedoms continue to be recognized.

It is not so long ago that sexual orientation and then same sex marriage were at the forefront of the cultural clash between individual rights and freedoms, and social repugnance.  Those battles aren't over, but the rights of individuals to love who they love have won important legal and cultural battles.

Lately, sexual identity is drawing increasing attention, with a growing recognition that some people's brains aren't wired the way their genitalia would suggest.  Two articles in the NY Times help (me at least) to understand some of the issues.

The first is written under a pseudonym by the mom of a transgender child, who notes that many people are trans starting as young children.  The second, by a trans man, argues that we should think of transgender a a gender identity of its own, not as a transition from one traditional gender to another. 

Where in the World Are All the Trans Children? Everywhere. By Marlo Mack

"I learned that while many transgender people do not transition until adolescence or adulthood, significant numbers of young children are aware of their gender identity from a very young age. Dr. Kristina Olson, a psychologist at Princeton University who studies gender development in children, says, “Research shows that there are a set of trans people who first identify with their gender by the toddler or preschool years and continue to do so throughout their lives.”

...

"But if transgender children are a global phenomenon, so are their struggles. Just as in the United States, parents who have spoken publicly are often harassed and threatened. (For safety reasons, I am not naming them.) Nearly all saw relationships with friends and family members disintegrate when their children came out as trans. Several families immigrated to countries that felt safer for their children. “When my daughter is older,” said one mother who left Mexico for the United States, “I’ll tell her the real reason we left.”

"These kinds of moves are likely to become more common, as courts and legislatures around the United States and in other countries chip away at transgender rights, restricting access to gender-affirming (and lifesaving) medical care for children like mine. On my social media feed, parents around the world are asking one another: Where can we go now? Where will my child be safe?

"It is not always easy to stay hopeful while raising a transgender child in a world that so rarely chooses to welcome her. I wonder what I would do if my own state passed a law making her medical care illegal. I worry about where she will be able to live and travel safely when she is older. I worry about the children who live in places where being transgender remains a crime.

"Yet I am hopeful, because I have witnessed the ferocious, protective love of parents around the world. And that is not a liberal Western fad."

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

What I Saw in My First 10 Years on Testosterone  By Thomas Page McBee

"I also wanted it known that despite the media fixation on a trite narrative about what it meant to be trans, I was not “a man trapped in a woman’s body or any cliché like that,” as I emailed my friends and family. I was a man and I was born trans, and I could hold both of those realities without an explanation that could be written on the back of a napkin.

“I will not become a different person,” I wrote in that email, defiantly and, as it turns out, correctly. “I am myself. I just want to feel more like me.”

The art of money laundering through the art market

 What looks like privacy to some looks like secrecy to others.

The NY Times has the story:

As Money Launderers Buy Dalís, U.S. Looks at Lifting the Veil on Art Sales. Secrecy has long been part of the art market’s mystique, but now lawmakers say they fear it fosters abuses and should be addressed.  By Graham Bowley

"Billions of dollars of art changes hands every year with little or no public scrutiny. Buyers typically have no idea where the work they are purchasing is coming from. Sellers are similarly in the dark about where a work is going. And none of the purchasing requires the filing of paperwork that would allow regulators to easily track art sales or profits, a distinct difference from the way the government can review the transfer of other substantial assets, like stocks or real estate.

...

"In January, Congress extended federal anti-money laundering regulations, designed to govern the banking industry, to antiquities dealers. The legislation required the Department of the Treasury to join with other agencies to study whether the stricter regulations should be imposed on the wider art market as well. The U.S. effort follows laws recently adopted in Europe, where dealers and auction houses must now determine the identity of their clients and check the source of their wealth.

“Secrecy, anonymity and a lack of regulation create an environment ripe for laundering money and evading sanctions,” the U.S. Senate’s Permanent Subcommittee on Investigations said in a report last July in support of increased scrutiny.

"To art world veterans, who associate anonymity with discretion, tradition and class, not duplicity, this siege on secrecy is an overreaction that will damage the market. They worry about alienating customers with probing questions when they say there is scant evidence of abuse.

...

"What is the origin of such secrecy? Experts say it likely dates to the earliest days of the art market in the 15th and 16th centuries when the Guilds of St. Luke, professional trade organizations, began to regulate the production and sale of art in Europe. Until then, art was not so much sold as commissioned by aristocratic or clerical patrons. But as a merchant class expanded, so did an art market, operating from workshops and public stalls in cities like Antwerp. To thwart competitors, it made sense to conceal the identity of one’s clients so they could not be stolen, or to keep secret what they charged one customer so they could charge another client a different price, incentives to guard information that persist today.

...

"Auction catalogs say works are from “a private collection,” often nothing more. Paintings are at times brought to market by representatives of owners whose identities are unknown, even to the galleries arranging the sale, experts and officials say. Purchasers use surrogates, too. 

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

Here's a related State Department report on how art sales have been used to circumvent U.S. sanctions on Russian oligarchs:

THE ART INDUSTRY AND U.S. POLICIES THAT UNDERMINE SANCTIONS.  STAFF REPORT, PERMANENT SUBCOMMITTEE ON INVESTIGATIONS, UNITED STATES SENATE

International (Stonybrook) Virtual Conference on Game Theory July 5 - 8, 2021

  The program this year looks unusually great. (If it doesn't show up well on mobile, click on the link instead...)  The event is hosted by Virtual Chair and will take place on the Gather.town platform.

International Conference on Game Theory

July 5 - 8, 2021

All times in Eastern Time (GMT -4)

Click on the talk title for more information.

Monday, July 05
09:30 - 10:00	Breakfast
10:00 - 10:30	Jon Kleinberg  (Cornell University) Algorithmic Monoculture and Social Welfare
10:30 - 11:00	Annie Liang  (Northwestern University) Data and Incentives
11:00 - 11:15	Break
11:15 - 11:45	Navin Kartik  (Columbia University) Improving Information from Manipulable Data
11:45 - 13:00	Poster Session
13:00 - 14:00	Robert Wilson  (Stanford University) Large Auctions
14:00 - 14:15	Break
14:15 - 14:45	Peter Cramton  (University of Cologne) Lessons from the 2021 Texas electricity crisis
14:45 - 15:15	Srihari Govindan  (University of Rochester) Toward an Axiomatic Theory of Stability
15:15 - 16:15	Reception for Robert Wilson

 

Tuesday, July 06
09:30 - 10:00	Breakfast
10:00 - 10:30	Michael Kearns  (University of Pennsylvania) Between Group and Individual Fairness for Machine Learning
10:30 - 11:00	Rediet Abebe  (University of California, Berkeley) TBA
11:00 - 11:15	Break
11:15 - 11:45	Jamie Morgenstern  (University of Washington) TBA
11:45 - 12:15	Irene Lo  (Stanford University) TBA
12:15 - 13:00	Meet the Speakers (Monday and Tuesday)
13:00 - 14:00	Jean Tirole  (Tolouse School of Economics) Safe Spaces: Shelters or Tribes?
14:00 - 14:15	Break
14:15 - 14:45	Éva Tardos  (Cornell University) The Virtue of Patience in Strategic Queueing Systems
14:45 - 15:15	Stephen Morris  (MIT) Conflation of Impressions: Market Thickness versus Efficiency

 

Wednesday, July 07
09:30 - 10:00	Breakfast
10:00 - 10:30	Maria-Florina Balcan  (Carnegie Mellon University) TBA
10:30 - 11:00	Benjamin Brooks  (University of Chicago) A Strong Minimax Theorem for Informationally-Robust Auction Design
11:00 - 11:15	Break
11:15 - 11:45	Daniela Saban  (Stanford University) TBA
11:45 - 13:00	Poster Session
13:00 - 13:30	Michael Jordan  (University of California, Berkeley) On Dynamics-Informed Blending of Machine Learning and Game Theory
13:30 - 14:00	Moshe Tennenholtz  (Technion--Israel Institute of Technology) Data Science with Game Theory Flavor
14:00 - 14:15	Break
14:15 - 14:45	Renato Paes Leme  (Google Research) Interactive Communication in Bilateral Trade
14:45 - 15:15	Constantinos Daskalakis  (MIT) TBA

 

Thursday, July 08
09:30 - 10:00	Breakfast
10:00 - 10:30	Marina Halac  (Yale University) Monitoring Teams
10:30 - 11:00	Eran Shmaya  (Stony Brook University) TBA
11:00 - 11:15	Break
11:15 - 11:45	Yiling Chen  (Harvard University) TBA
11:45 - 12:15	Tim Roughgarden  (Columbia University) Transaction Fee Mechanism Design
12:15 - 13:00	Meet the Speakers (Wednesday and Thursday)
13:00 - 14:00	Paul Milgrom  (Stanford University) Reprise of Nobel lecture (Auction Research Evolving: Theorems and Market Designs)
14:00 - 14:15	Break
14:15 - 14:45	Shengwu Li  (Harvard University) Investment Incentives in Near-Optimal Mechanisms
14:45 - 15:15	Susan Athey  (Stanford University) TBA
15:15 - 16:15	Reception for Paul Milgrom

Data for the people: Emily Oster in the NY Times

The NY Times writes about Emily Oster, who has pioneered a new way for an economist to be a public intellectual, by bringing to a general audience her skills at assembling and interpreting data on a wide variety of subjects, including parenting (is it ok to drink a glass of wine while pregnant?) and the Covid pandemic (how to decide when schools should reopen?)

She Fought to Reopen Schools, Becoming a Hero and a Villain. The economist Emily Oster offers loads of data-driven advice about children and Covid-19. Many parents live by her words. Others say she’s dangerous. By Dana Goldstein

"This steady stream of counterintuitive advice has made Dr. Oster a lodestar for a certain set of parents, generally college-educated, liberal and affluent. Many had first latched onto her data-driven child-rearing books. Her popularity grew during the pandemic, as she collected case counts of Covid-19 in schools and advanced her own strongly held views on the importance of returning to in-person learning.

"Some parents said, half-seriously, “Emily Oster is my C.D.C.”

"But others — teachers, epidemiologists and labor activists — criticized her, pointing out that she was not an infectious disease expert, nor did she have any deep personal or professional experience with public education. "

Evolutionary Models of Financial Markets in the PNAS

 Here's the relevant part (with links) of the PNAS Table of Contents for June 29, 2021; Vol. 118, No. 26 

Evolutionary Models of Financial Markets Special Feature

Introduction

Introduction to PNAS special issue on evolutionary models of financial markets

Simon A. Levin and Andrew W. Lo

Social Sciences — Economic Sciences

How market ecology explains market malfunction

Maarten P. Scholl, Anisoara Calinescu, and J. Doyne Farmer

Moonshots, investment booms, and selection bias in the transmission of cultural traits

David Hirshleifer and Joshua B. Plotkin

Social Sciences — Economic Sciences - Biological Sciences — Evolution

Evolution in pecunia

Rabah Amir, Igor V. Evstigneev, Thorsten Hens, Valeriya Potapova, and Klaus R. Schenk-Hoppé

The origin of cooperation

Nihal Koduri and Andrew W. Lo

Evolved attitudes to risk and the demand for equity

Arthur J. Robson and H. Allen Orr

Social Sciences — Economic Sciences - Physical Sciences — Statistics

High-frequency trading and networked markets

Federico Musciotto, Jyrki Piilo, and Rosario N. Mantegna

Perspectives

Social finance as cultural evolution, transmission bias, and market dynamics

Erol Akçay and David Hirshleifer

The landscape of innovation in bacteria, battleships, and beyond

Terence C. Burnham and Michael Travisano

Sunsetting as an adaptive strategy

Roberta Romano and Simon A. Levin

‘Harm Reduction’ Gains Federal Support.

 Another shot has been fired in the American war against drugs, this time in the battle between those who insist that drug abuse is everywhere and always a criminal problem, and those who think that even drug abusers might be entitled so some support in their personal fight against fatal overdosing.

The NY Times has the story.

Helping Drug Users Survive, Not Abstain: ‘Harm Reduction’ Gains Federal Support. By Abby Goodnough.

"Overdoses have surged during the pandemic. Now, for the first time, Congress has appropriated funds specifically for programs that distribute clean syringes and other supplies meant to protect users."

...

"Overdose deaths rose by nearly 30 percent over the 12-month period that ended in November, to more than 90,000, according to preliminary federal data released this month — suggesting 2020 blew past recent records for such deaths. The staggering increase during the pandemic has many contributing factors, including widespread job loss and eviction; diminished access to addiction treatment and medical care; and an illegal drug supply that became even more dangerous after the country essentially shut down.

...

"Now, with the nation reopening, the Biden administration is throwing support behind the contentious approach ... known as harm reduction. Instead of helping drug users achieve abstinence, the chief goal is to reduce their risk of dying or acquiring infectious diseases like H.I.V. by giving them sterile equipment, tools to check their drugs for fentanyl and other lethal substances, or even just a safe space to nap.

"Such programs have long come under attack for enabling drug use, but President Biden has made expanding harm-reduction efforts one of his drug policy priorities — the first president to do so. The American Rescue Act includes $30 million specifically for evidence-based harm reduction services, the first time Congress has appropriated funds specifically for that purpose. The funding, while modest, is a victory for the programs, both symbolically and practically, as they often run on shoestring budgets.

...

"Still, many elected officials and communities continue to resist equipping people with supplies for drug use, including the recent addition of test strips to check drugs for the presence of illicitly manufactured fentanyl, which shows up in most overdose deaths. Some also say that syringes from harm reduction programs end up littering neighborhoods or that the programs cause an increase in crime. Researchers dispute both claims.

"West Virginia just passed a law making it far more difficult for syringe service programs to operate, even though it is seeing a surge in H.I.V. cases driven by intravenous drug use. North Carolina’s legislature weighed a similar proposal this spring, and elected officials in Scott County, Ind., whose syringe exchange helped curb a major H.I.V. outbreak six years ago, voted this month to shut it down. Mike Jones, a commissioner there who voted to end the program, said at the time that he feared the syringes it distributed could be contributing to overdose deaths."

***********

Earlier post: 

Friday, May 14, 2021

Clean needle exchange faces renewed opposition in Indiana and elsewhere

Kidney exchange (including global kidney exchange), discussed at the European Society of Organ Transplantation meeting in Milan, Tuesday 29 June

 ESOT: The 20th Congress of the European Society of Organ Transplantation, meeting (by Zoom) in Milan, Italy (so the talks start at 9am pacific time, noon Eastern time in U.S., tomorrow)

Models of kidney exchange and chains

Tuesday 29 June 18:00 (CEST) 

18:00 – 18:12 Kidney exchange in UK Lisa Burnapp 

18:12 – 18:24 Kidney exchange in EU: where we are? Peter Biro

 18:24 – 18:36 Kidney exchange in US Michael Rees 

18:36 – 18:48 Ethical and legal issue in kidney exchange Frederike Ambagtsheer 

18:48– 19:00 Discussion Panellists 

19:00 Conclusions Nizam Mamode

Registration is free via https://us02web.zoom.us/webinar/register/WN_3sfBEFxnQleNoYezQvyjbg.

Can same sex couples adopt and foster children in need? It's complicated...

 When religion and non-discrimination contest with each other in court, the decisions sometimes rely on the details of the case:

The WSJ has the story:

Supreme Court Exempts Catholic Foster-Care Agency From Nondiscrimination Law. Catholic Social Services is entitled to city contract despite Philadelphia ordinance requiring contractors to treat same-sex couples equally, court rules  By Jess Bravin

"The Supreme Court unanimously ruled Thursday that a Catholic social-service agency was entitled to a Philadelphia contract even if its religious views prevented it from compliance with local policies forbidding discrimination against same-sex couples.

"The court’s decision, by Chief Justice John Roberts, was a narrow one, stopping short of fundamentally extending the accommodations for religious exercise that Catholic Social Services—and several conservative justices in concurring opinions—argued the Constitution required.

"The city of Philadelphia contracts with private agencies to screen foster parents for children in need. While a broad nondiscrimination policy is written into its contracts, Chief Justice Roberts observed that the agreements also authorize the city’s human-services department to grant exceptions.

"Catholic Social Services, which for decades has received city contracts, was entitled to such an exception, the chief justice wrote, because the city can grant them for secular reasons. The city’s interest in equal treatment for same-sex couples—and in caring for children in need—wasn’t impaired, the court found, because some 20 other agencies with foster-service contracts are available to work with married LGBT foster parents."

Covid and COVAX, lessons being learned for the next pandemic

 From the Lancet:

A beautiful idea: how COVAX has fallen short by Ann Danaiya Usher, June 19, 2021DOI:https://doi.org/10.1016/S0140-6736(21)01367-2

"At the pledging summit for COVAX on June 2, 2021, hosted by Japan, Gavi finally reached its US$8·3 billion ask for the procurement and delivery of vaccines for the 92 eligible low-income and middle-income countries (LMICs) this year. However, even with full financing, the COVAX roll-out has moved much more slowly than that in high-income countries (HICs). Speaker after speaker at the summit lamented the gross inequity in access to vaccines. “Today, ten countries have administered 75% of all COVID-19 vaccines, but, in poor countries, health workers and people with underlying conditions cannot access them. This is not only manifestly unjust, it is also self-defeating”, UN secretary general António Guterres told the gathering. “COVAX has delivered over 72 million doses to 125 countries. But that is far less than 172 million it should have delivered by now.” Of the 2·1 billion COVID-19 vaccine doses administered worldwide so far, COVAX has been responsible for less than 4%.

...

"COVAX, managed by Gavi, along with the Coalition for Epidemic Preparedness Innovations and WHO, was designed to stand on two legs: one for HICs, which would pay for their own vaccines, and the other for 92 lower-income countries, whose doses would be financed by donor aid.

"In the so-called self-financing leg of COVAX, HICs were asked to pay upfront by mid-September, 2020, for the option to buy vaccines for their own populations. The UK, for example, paid £71 million for 27 million doses from COVAX, and Canada paid CA$220 million for 15 million doses. Australia, New Zealand, Norway, and South Korea also bought vaccine options from COVAX as self-financing countries.

"In the other leg of COVAX, vaccines for lower-income countries would be financed with donor grants through an Advance Market Commitment (AMC). The poorest of the 92 countries would receive them at no cost. Team Europe (led by Germany) and the USA have together provided US$5 billion to the COVAX AMC, Japan has given US$1 billion, and the UK, US$735 million. Most of these funds have been pledged only in the past few months.

"The grand idea of COVAX was that the combination of these two funding streams—the self-financed part and the aid-financed AMC—would give the facility the means to invest in research and development of several promising vaccine candidates. Additionally, as a pooled procurement mechanism, COVAX would have the financial muscle as a buyer to drive down prices for all participants. Once any of the COVAX portfolio vaccines had successfully undergone clinical trials and proved themselves to be both safe and effective, both self-financing and AMC countries would be allocated vaccines at the same rate, proportional to their total population size.

...

"Everyone knew that rich countries would enter into bilateral vaccine deals, Yamey said. But it was hoped that they would also buy into COVAX as insurance in case some vaccine candidates did not prove successful. Most of them did not. In the end, “three dozen countries bypassed COVAX and made huge deals directly with manufacturers. They were very lucky that the vaccines worked out. And since they cleared the shelves, there were not enough doses left for COVAX”, he said.

...

"The report of the Independent Panel for Pandemic Preparedness and Response also pointed to the harm caused by the slow mobilisation of resources for COVAX: “Had COVAX had sufficient and readily available early funding it would have been better able to secure enough immediate supply to meet its aims”, it states.

...

"The original notion of a global vaccine hub more or less collapsed, and COVAX ended up using a traditional aid-financed approach, which has left lower-income countries wholly at the mercy of wealthy nations and profit-driven companies.

“It is still this model of seeing how much money you can bring in and then seeing what you can negotiate with industry based on that money”, said Elder. “The promise of COVAX from the beginning that it would be the most attractive buyer for industry because it represented the ‘global need’ obviously did not pan out.” For any future iterations of COVAX, Taylor has argued that since national leaders have a responsibility to protect their own populations, vaccine nationalism is inevitable and this should be integrated into the design from the start.

"Several global health experts point to the failure to recognise supply constraints as a major obstacle to global vaccination and emphasise diversifying and scaling up manufacturing from the beginning. This lack of recognition was a serious flaw in the COVAX design, said Gostin. “Supply shortages should have been anticipated and ramping up supplies should have been baked into the design of COVAX from the start.”

Blood donation, risk groups, and blood tests

 Before blood tests were developed for hepatitis virus and later for HIV, it made sense to screen potential blood donors by whether they were members of broad risk categories.  As tests have improved (and I think we still don't have those for prion based diseases like mad cow disease), it makes more sense to rely on testing, although risky behavior that might have recently resulted in infection, not yet detectable by blood tests, is still a screening factor.

All this is by way of saying that the current U.S. limitation on donation by homosexual men is out of date. Martha Gershun points me to this recent op-ed in the Baltimore Sun:

As a sexually active gay man, I can’t donate blood or tissue in America. That’s ridiculous | By GREG BRIGHTBILL

"My blood type is O negative, I am healthy, I can run a half-marathon, I do not smoke or use drugs, I only have two to three drinks a week, and I am in a committed relationship. Yet, due to homophobic stereotypes and outdated policies, gay men like myself  -- termed “MSM” or “men who have sex with men” -- cannot freely donate blood and soft tissue in America.

"According to the most recent Food and Drug Administration guidance, updated last year, MSMs must undertake a three-month deferral from male-to-male sexual activity before blood donation. Shockingly, that’s an improvement on the original full ban on blood donation implemented in 1985 (for any male who had a sexual encounter with another male after 1977) and the 2015 version of the policy, which required a 12-month deferral.

*********

In the UK, the guidelines have been changed, this month, to reflect the increased availability of testing. Here's the latest from the UK's NHS Blood and Transplant:

Landmark change to blood donation eligibility rules on today’s World Blood Donor Day  

"New eligibility rules that will allow more men who have sex with men to donate blood, platelets and plasma come into effect this week, marking an historic move to make blood donation more inclusive while keeping blood just as safe."

"From today (Monday) – World Blood Donor Day – the questions asked of everyone when they come to donate blood in England, Scotland and Wales will change. Eligibility will be based on individual circumstances surrounding health, travel and sexual behaviours evidenced to be at a higher risk of sexual infection.

"Donors will no longer be asked if they are a man who has had sex with another man, removing the element of assessment that is based on the previous population-based risks.

"Instead, any individual who attends to give blood - regardless of gender - will be asked if they have had sex and, if so, about recent sexual behaviours. Anyone who has had the same sexual partner for the last three months will be eligible to donate.

...

“We screen all donations for evidence of significant infections, which goes hand-in-hand with donor selection to maintain the safety of blood sent to hospitals. All donors will now be asked about sexual behaviours which might have increased their risk of infection, particularly recently acquired infections. This means some donors might not be eligible on the day but may be in the future."

...

"Under the changes people can donate if they have had the same sexual partner for the last three months, or if they have a new sexual partner with whom they have not had anal sex, and there is no known recent exposure to an STI or recent use of PrEP or PEP. This will mean more men who have sex with men will be eligible to donate.

"Anyone who has had anal sex with a new partner or with multiple partners in the last three months will be not be able to give blood right now but may be eligible in the future. Donors who have been recently treated for gonorrhoea will be deferred. Anyone who has ever received treatment for syphilis will not be able to give blood."

Health Applications Society Online Seminar Series (Inaugural seminar Friday June 25, on Kidney Exchange)

A new seminar series is being organized by the Health Applications Society of INFORMS.  I'll be giving the inaugural seminar tomorrow, June 25.

Here's the general announcement:

Health Applications Society Online Seminar Series

"Welcome to the HAS Online Seminar Series! This seminar series welcomes a broad range of healthcare modeling research topics such as healthcare operations, medical decision making, health policy, and health analytics. 

Please join our Google Group or subscribe to our Mailing List to receive the latest announcement on the upcoming seminars!

When: 1-2 pm ET (10-11 am PT) on 4th Friday of each month

Where: Zoom Webinar (Register Now!)   

Speaker: Dr. Alvin E. Roth, Stanford University

Seminar Title: Kidney Exchange: An Operations Perspective

Date and Time: June 25 (Friday), 2021, 1-2 pm ET (10-11 am PT)

Abstract: Many patients in need of a kidney transplant have a willing but incompatible (or poorly matched) living donor. Kidney exchange programs arrange exchanges among such patient-donor pairs, in cycles and chains of exchange, so each patient receives a compatible kidney. Kidney exchange has become a standard form of transplantation in the United States and a few other countries, in large part because of continued attention to the operational details that arose as obstacles were overcome and new obstacles became relevant. We review some of the key operational issues in the design of successful kidney exchange programs. Kidney exchange has yet to reach its full potential, and the paper further describes some open questions that we hope will continue to attract attention from researchers interested in the operational aspects of dynamic exchange.

Bio: Al Roth is the Craig and Susan McCaw Professor of Economics at Stanford, and the George Gund Professor Emeritus of Economics and Business Administration at Harvard. He and Lloyd Shapley shared the 2012 Nobel memorial prize in Economics "for the theory of stable allocations and the practice of market design.”  He received a Ph.D. in Operations Research from Stanford University in 1974.

Seminar Organizers and Advisory Board: This seminar series is organized by Sanjay Mehrotra (Northwestern University), Sait Tunc (Virginia Tech), Qiushi Chen (Pennsylvania State University).

The advisory board includes Ebru Bish (University of Alabama), Stephen Chick (INSEAD), and Mark Van Oyen (University of Michigan).

Special thanks to INFORMS Healthcare Application Society and all board members for their enormous support!"

Payments to college athletes, no longer so repugnant

 The longstanding debate over whether college athletes must remain unpaid to preserve their 'amateur' status is starting to reach some conclusions.  Expect more to follow. 

The NY Times has the story:

Supreme Court Backs Payments to Student-Athletes in N.C.A.A. Case. The N.C.A.A. argued that the payments were a threat to amateurism and that barring them did not violate the antitrust laws.  By Adam Liptak and Alan Blinder

"The Supreme Court unanimously ruled on Monday that the N.C.A.A. cannot bar relatively modest payments to student-athletes in a decision that questioned the association’s monopoly power at a time when the business model of college sports is under increasing pressure.

"The decision concerned only payments and other benefits related to education, but its logic suggested that the court may be open to a frontal challenge to the N.C.A.A.’s ban on paying athletes for their participation in sports that bring billions of dollars in revenue to American colleges and universities. In a concurring opinion, Justice Brett M. Kavanaugh seemed to invite such a challenge.

“Nowhere else in America can businesses get away with agreeing not to pay their workers a fair market rate on the theory that their product is defined by not paying their workers a fair market rate,” Justice Kavanaugh wrote. “And under ordinary principles of antitrust law, it is not evident why college sports should be any different. The N.C.A.A. is not above the law.”

"In a statement on Monday, the N.C.A.A. said the ruling “reaffirms the N.C.A.A.’s authority to adopt reasonable rules and repeatedly notes that the N.C.A.A. remains free to articulate what are and are not truly educational benefits.”

"Next week, student-athletes in at least six states are poised to be allowed to make money through endorsements — not because of action by the N.C.A.A., but because of state officials who grew tired of the industry’s decades-long efforts to limit the rights of players.

...

"Less than two weeks before some of the new laws are scheduled to take effect in Alabama, Florida, Georgia, Mississippi, New Mexico and Texas and allow athletes to make endorsements and make money from their social media presences, the N.C.A.A. has not agreed to extend similar rights to players nationwide. And in a setback last week for the association, senior members of Congress said that they did not expect to strike a deal for a federal standard before July 1."

*********

Several months ago, SCOTUSblog gave a nice summary of the issues (HT: Kim Krawiec):

Amid March Madness, antitrust dispute over college athlete compensation comes to the court   By Amy Howe

"What differentiates college sports from professional sports, the NCAA stresses, is that college sports are played by amateurs – who, by definition, are not paid to play. Having amateurs in college sports, the NCAA adds, promotes competition by giving consumers a choice between college sports and professional sports; that choice is only possible, the NCAA explains, because of the agreement among the NCAA and its members on eligibility and compensation for college athletes.

...

"As far as the athletes are concerned, the court’s inquiry is a straightforward one that boils down to whether the NCAA’s restrictions, imposed in the name of amateurism, create enough benefits for competition to offset the harm that they create. Whether those restrictions are necessary to preserve amateurism, the athletes reiterate, is irrelevant.

...

"A brief by historians derides the concept of amateurism in elite college sports as a “myth that is neither necessary to the activity nor fair to the students who participate.” To the contrary, the scholars note, “top-tier college sports” have flourished even as “amateurism” in the athletes playing those sports has decreased. What’s more, the historians continue, the NCAA’s efforts to rely on amateurism as the basis to shield its eligibility rules from antitrust scrutiny is “profoundly unfair,” as those rules often led to coaches and schools making millions from poor students."

Economists support Andreu Mas-Colell

 In El Pais (plus Google translate):

33 premios Nobel de Economía y otros 20 destacados economistas escriben en defensa de Andreu Mas-Colell. Los expertos internacionales muestran con un artículo conjunto su solidaridad con el profesor y exconsejero catalán investigado por el Tribunal de Cuentas

[33 Nobel Laureates in Economics and 20 other leading economists write in defense of Andreu Mas-Colell.  With a joint article, international experts show their solidarity with the professor and former Catalan councilor investigated by the Court of Auditors]

The letter ends with:

"We hope the situation clears up promptly. We also hope that, in the absence of specific charges against him, the Court of Auditors will avoid unwanted and unfair consequences for Professor Mas-Colell."

"The letter is signed by Philippe Aghion, George Akerlof *, Manuel Arellano, Orazio Attanasio, Robert Aumann *, Abhijit Banerjee *, Richard Blundell, Partha Dasgupta, Angus Deaton *, Eddie Dekel, Mathias Dewatripont, Peter Diamond *, Esther Duflo *, Eugene Fama *, Ernst Fehr, Drew Fudenberg, Jordi Galí, Pinelopi Goldberg, Jean-Michel Grandmont, Rachel Griffith, Lars Hansen *, Oliver Hart *, James Heckman *, Elhanan Helpman, Bengt Holmstrom *, Dale Jorgenson, Daniel Kahneman *, Mervyn King, Michael Kremer *, Finn Kydland *, Eric Maskin *, Daniel McFadden *, Robert Merton *, Paul Milgrom *, Stephen Morris, Roger Myerson *, Edmund Phelps *, Christopher Pissarides *, Paul Romer *, Alvin Roth *, Myron Scholes *, Amartya Sen *, Robert Shiller *, Christopher Sims *, Robert Solow *, Hugo Sonnenschein, Michael Spence *, Joseph Stiglitz *, Guido Tabellini, Richard Thaler *, Jean Tirole *, Robert Wilson * and Fabrizio Zilibotti.

"Names with an asterisk are Nobel laureates in economics."

***********

Some background here:

Tuesday, June 15, 2021

Crisis in Catalonia, and Andreu Mas-Colell

Matching patients with effective therapists improves mental health coutcomes

 A recent paper in JAMA Psychiatry reveals that matching patients to therapists who are effective at treating their particular issues improves mental health outcomes. (This may allow you to update your priors on either matching or therapy...)

Effect of Matching Therapists to Patients vs Assignment as Usual on Adult Psychotherapy Outcomes: A Randomized Clinical Trial  by Michael J. Constantino, PhD1; James F. Boswell, PhD2; Alice E. Coyne, MS1; et alThomas P. Swales, PhD3; David R. Kraus, PhD, JAMA Psychiatry. Published online June 9, 2021. doi:10.1001/jamapsychiatry.2021.1221

"Question  Can assigning patients to therapists with empirically determined strengths in treating the patients’ specific mental health problem(s) (ie, measurement-based matching) improve the outcomes of naturalistic psychotherapy compared with case assignment as usual?

"Findings  In this 2-arm, double-blind randomized clinical trial including 48 therapists and 218 outpatients, measurement-based matching promoted significantly greater reductions in patients’ general symptomatic and functional impairment, global psychological distress, and domain-specific impairment on patients’ most elevated presenting problem over 16 weeks post intake.

"Meaning  In this study, mental health care was enhanced by prospectively assigning patients to empirically good-fitting therapists, which requires minimal disruptions within a mental health care system."