Blood use in the U.S., in JAMA

 Here are a collection of articles, some of which suggest that we may in the not so distant future face a shortage of whole blood in the U.S., the need for which is so far filled by uncompensated donors (unlike the need for plasma, which is presently filled by compensated donors...).  One issue is that apparently ambulance companies aren't easily compensated for beginning transfusion on the way to the hospital, which could save lives.

Original Investigation Caring for the Critically Ill Patient Red Blood Cell Transfusion in the Intensive Care Unit Senta Jorinde Raasveld, MD; Sanne de Bruin, MD, PhD; Merijn C. Reuland, MD; et al. "RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices." Editorial: Precision in Transfusion Medicine ; Matthew D. Neal, MD; Beverley J. Hunt, MD "blood transfusion practice has come a long way, but further efforts toward precision medicine are required to ensure that patients receive the most effective components. These products should be matched to patients as individuals who have unique antigens and a variable host response, and how to use the appropriate blood components in different clinical settings must be understood." Caring for the Critically Ill Patient Small-Volume Blood Collection Tubes to Reduce Transfusions in Intensive Care: The STRATUS Randomized Clinical Trial Deborah M. Siegal, MD; Emilie P. Belley-Côté, MD, PhD; Shun Fu Lee, PhD; et al. Caring for the Critically Ill Patient Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial Jan O. Jansen, PhD; Jemma Hudson, PhD; Claire Cochran, MSc; et al. Editorial: Contemporary Adjuncts to Hemorrhage Control ; Samuel A. Tisherman, MD; Megan L. Brenner, MD Caring for the Critically Ill Patient Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial Ross Davenport, PhD; Nicola Curry, MD; Erin E. Fox, PhD; et al. Editorial: Contemporary Adjuncts to Hemorrhage Control; Samuel A. Tisherman, MD; Megan L. Brenner, MD Special Communication Red Blood Cell Transfusion: 2023 AABB International Guidelines Jeffrey L. Carson, MD; Simon J. Stanworth, MD, DPhil; Gordon Guyatt, MD; et al. Earn CME credit Viewpoint From Product to Patient—Transfusion and Patient Blood Management Matthew A. Warner, MD; Linda Shore-Lesserson, MD; Carolyn Burns, MD "Recent years have also exposed vulnerabilities in blood inventories. As the most prominent example, the COVID-19 pandemic led to cancellations of many community-based and mobile blood collections, culminating in the declaration of a national blood crisis by the American Red Cross for the first time in history. In response, the American Medical Association, in partnership with the American Hospital Association and American Nurses Association, issued a joint statement in January 2022 describing the worst blood shortage in more than a decade and urging blood donation from all eligible persons. Not long after, the AABB, in collaboration with 17 leading US health care and blood collection organizations, launched the Alliance for a Strong Blood Supply to track and coordinate information and public communications about blood inventories and explore mechanisms to improve blood supply resilience." The Bloody Transfusion Problem John B. Holcomb, MD; William K. Hoots, MD; Travis M. Polk, MD "Preventable death after injury is a national crisis. Worldwide, injury accounts for more deaths than malaria, tuberculosis, and HIV combined and is increasing.1 Trauma is largely a condition of young people and is the leading cause of life-years lost between 1 and 75 years of age, and costs to the US are estimated at $4.2 trillion a year.2 As is always the case, lessons learned on recent battlefields have improved civilian care, and the most impactful intervention has been the increased use of blood products as a primary resuscitation fluid. "During the past decade several large, prospective, multicenter, randomized, federally funded studies have improved outcomes and changed practice.3,4 Transfusing blood as early as possible to patients with hemorrhagic shock saves lives, and fewer patients die from exsanguination when receiving a balanced transfusion of platelets, red blood cells, and plasma or whole blood. This is true in the hospital but is especially so in the prehospital setting, where blood products decrease mortality from 33% to 23%.4 When all indicated blood products are available and given early, deaths due to hemorrhage decrease and care is cost-effective. However, of the 2045 hospitals to which the American Red Cross supplied blood components in 2019, 33% did not routinely have platelets ready to transfuse to bleeding patients, and more than 78% of those hospitals are in a rural setting.4 Emergency medical services (EMS) agencies and hospitals that do not have all blood products immediately available cannot provide optimal care. Unfortunately, the blood products required to save lives are not uniformly available to all persons, and implementation of these proven lifesaving interventions is uneven, largely because of supply and policy reasons. "To remedy this disparity, we believe there are 3 significant hurdles to overcome: (1) enabling a reliable strategy for insuring an adequate blood product supply by developing new shelf-stable blood products and by providing greater financial support for donor blood collection and processing; (2) insuring adequate reimbursement for current and new blood products in the hospital setting and removing the limitation of prehospital provider scope of practice and ability to bill for all blood products; and (3) sustaining consistent and appropriate research funding for trauma studies of hemorrhagic shock in both pediatric and adult populations.  ... "Blood collection and processing centers are operating at a loss because remuneration has not kept pace with ever-increasing costs of regulatory required infectious disease testing. ... "More than 55 000 additional donors will be required for just the prehospital blood program implementation.6 Increasing the blood supply will require novel solutions combining remuneration for donors, increased reimbursement for blood collection centers, modern efforts to recruit younger donors, and streamlined regulatory and financial reimbursement pathways for new blood products that are shelf stable at room temperature for years. ... "scope of practice, reimbursement barriers, and the inability to bill for transfusions provided in air or ground ambulances are significant obstacles to the widespread availability of prehospital blood programs." Redefining Blood Donation—Path to Inclusivity and Safety Pampee P. Young, MD, PhD; Paula Saa, PhD Video: Gay and Bisexual Men Can Now Donate Blood—Why This Matters "The journey to establish equitable blood donation policies can be likened to the myth of Theseus navigating the Labyrinth. Just as Theseus ventured into the complex maze to save Athenians from the Minotaur, the blood industry has been navigating the intricacies of research, regulation, and public sentiments to secure a safe blood supply and equitable policies. With the advancements in testing and the changing policies as our guiding thread, we are dedicated to ensuring fairness, equality, and safety, led by evidence and a deep commitment to humanity." Editorial Precision in Transfusion Medicine Matthew D. Neal, MD; Beverley J. Hunt, MD Contemporary Adjuncts to Hemorrhage Control Samuel A. Tisherman, MD; Megan L. Brenner, MD Medical News & Perspectives Could Universal Donor Blood Be Made in the Laboratory? Bridget M. Kuehn "In the face of chronic national and international blood supply shortages, scientists are renewing efforts to achieve the holy grail of transfusion—laboratory-made universal donor blood." JAMA Revisited The Status of Blood Transfusion "Originally Published September 29, 1923 | JAMA. 1923;81(13):1114- 1115." JAMA Patient Page Blood Donation Kristin Walter, MD, MS Video: Gay and Bisexual Men Can Now Donate Blood—Why This Matters Video Gay and Bisexual Men Can Now Donate Blood—Why This Matters

Peter Singer on brain death

 Here's Peter Singer's op-ed in the Washington Post on the debate over brain death, presently used to decide when deceased donor organs can be used for transplantation:

What is the line between life and death? Here’s my answer.  By Peter Singer  October 17, 2023 

"When it is justifiable to end a human life?

"Here’s my answer: When consciousness has gone, never to return. Other bioethicists have different views. No surprise there. But on this we should all agree: These differences need to be hammered out in public, not behind closed doors by a body that few people have heard of.

"The last effort to define death in the United States was in 1980, and at that time there was remarkable consensus on a decision so consequential. Then, the commission proposed a new Uniform Determination of Death Act establishing that in addition to the traditional determination of death by the heart ceasing to beat, a person is dead when their whole brain has irreversibly ceased to function. All 50 states and D.C. adopted the act’s central proposition — which is staggering, really, given today’s battles over when life begins."

############

Earlier:

Sunday, October 8, 2023

Dead or alive? Debates about defining brain death and circulatory death in the medical literature

Sunday, May 21, 2023

Defining death for deceased organ donation

Thursday, April 13, 2023

Brain Death

Friday, August 21, 2020

Brain death (death by neurological criteria)

The international market for squid (and how squid came to be calamari...)

China's fishing fleet plays a giant role in the international market for squid. The New Yorker has the story:

THE CRIMES BEHIND THE SEAFOOD YOU EAT.  China has invested heavily in an armada of far-flung fishing vessels, in part to extend its global influence. This maritime expansion has come at grave human cost.  By Ian Urbin in collaboration with the Outlaw Ocean Project.

"In the past few decades, partly in an effort to project its influence abroad, China has dramatically expanded its distant-water fishing fleet. Chinese firms now own or operate terminals in ninety-five foreign ports. China estimates that it has twenty-seven hundred distant-water fishing ships, though this figure does not include vessels in contested waters; public records and satellite imaging suggest that the fleet may be closer to sixty-five hundred ships. (The U.S. and the E.U., by contrast, have fewer than three hundred distant-water fishing vessels each.) 

...

" The country is largely unresponsive to international laws, and its fleet is the worst perpetrator of illegal fishing in the world, helping drive species to the brink of extinction. Its ships are also rife with labor trafficking, debt bondage, violence, criminal neglect, and death. “The human-rights abuses on these ships are happening on an industrial and global scale,” Steve Trent, the C.E.O. of the Environmental Justice Foundation, said.

...

"Vessels can now stay at sea for more than two years without returning to land. As a result, global seafood consumption has risen fivefold.

"Squid fishing, or jigging, in particular, has grown with American appetites. Until the early seventies, Americans consumed squid in tiny amounts, mostly at niche restaurants on the coasts. But as overfishing depleted fish stocks the federal government encouraged fishermen to shift their focus to squid, whose stocks were still robust. In 1974, a business-school student named Paul Kalikstein published a master’s thesis asserting that Americans would prefer squid if it were breaded and fried. Promoters suggested calling it “calamari,” the Italian word, which made it sound more like a gourmet dish. (“Squid” is thought to be a sailors’ variant of “squirt,” a reference to squid ink.) By the nineties, chain restaurants across the Midwest were serving squid. Today, Americans eat a hundred thousand tons a year.

...

"China has invested heavily in its fleet. The country now catches more than five billion pounds of seafood a year through distant-water fishing, the biggest portion of it squid. China’s seafood industry, which is estimated to be worth more than thirty-five billion dollars, accounts for a fifth of the international trade, and has helped create fifteen million jobs. The Chinese state owns much of the industry—including some twenty per cent of its squid ships—and oversees the rest through the Overseas Fisheries Association. Today, the nation consumes more than a third of the world’s fish."

Refugee resettlement and the top trading cycles algorithm, by Farajzadeh, Killea, Teytelboym, and Trapp

 Here's a recent paper that (among other things) considers using the top trading cycles algorithm for matching refugees to sponsors (under a special program for Ukraine), to satisfy the location preferences of refugees.

Optimizing Sponsored Humanitarian Parole by Fatemeh Farajzadeh, Ryan B. Killea, Alexander Teytelboym, Andrew C. Trapp, working paper, 2023

Abstract: The United States has introduced a special humanitarian parole process for Ukrainian citizens in response to Russia’s 2022 invasion of Ukraine. To qualify for parole, Ukrainian applicants must have a sponsor in the United States. In collaboration with HIAS, a refugee resettlement agency involved in the parole process, we deployed RUTH (Refugees Uniting Through HIAS), a novel algorithmic matching system that is driven by the relocation preferences of refugees and the priorities of US sponsors. RUTH adapts Thakral [2016] Multiple-Waitlist Procedure (MWP) that combines the main First-In/First-Out (FIFO) queue with location specific FIFO queues in order to effectively manage the preferences of refugees and the supply of community sponsors. In addition to refugee preferences and sponsor priorities, RUTH incorporates various feasibility considerations such as community capacity, religious, and medical needs. The adapted mechanism is envy-free, efficient and strategy-proof for refugees. Our analysis reveals that refugee preferences over locations are diverse, even controlling for observables, by demonstrating the difficulty of solving a much simpler problem than modeling preferences directly from observables. We use our data for two counterfactual simulations. First, we consider the effects of increased waiting times for refugees on the quality of their matches. We find that with a periodic Top Trading Cycles algorithm, increasing period length from 24 days to 80 days, improves average rank of a refugee’s match from 3.20 to 2.44. On the other hand, using the available preference data RUTH achieved an average rank of 4.07 with a waiting time of 20 days. Second, we estimate the arrival rates of sponsors in each location that would be consistent with a long-run steady state. We find that more desirable locations (in terms of refugee preferences) require the highest arrival rates suggesting that preferences might be a useful indicator for investments in sponsorship capacity. Our study highlights the potential for preference-based algorithms such as RUTH to improve the efficiency and fairness of other rapidly-deployed humanitarian parole processes.

#######

Earlier:

Sunday, December 18, 2022

Resettling refugees using preferences of refugees and hosts

Hamas, Gaza and American universities: more letters, and two speeches

 First, letters from the President of the Hebrew University to his counterparts at Harvard and Stanford:

“You Have Failed Us” Letters by Hebrew University Leadership to the Presidents of Harvard University and Stanford University

The leadership of the Hebrew University in a strongly-worded, unequivocal response letter to the presidents of Harvard and Stanford universities, following their weak condemnation of Hamas: “You have failed us, not only as Israelis, who are subject to the imminent threat of being subject to genocide, but also as leaders of an academic institution, who expect their colleagues to present higher moral standards and more courage.”

In a strongly-worded, unequivocal response letter jointly signed by Prof. Asher Cohen, President of the Hebrew University, Prof. Tamir Sheafer, Rector of the Hebrew University, and Prof. Barak Medina, was dispatched to the Presidents of Harvard and Stanford Universities. This letter comes in the wake of what the Hebrew University officials perceive as shockingly feeble condemnations from these revered institutions in response to Hamas’ recent barbaric assault on Israel and the grievous loss of life among the southern residents.

In their letter addressed to the Presidents of Harvard and Stanford, the senior officials of the Hebrew University made it unequivocally clear that there is no room for “balance” or justification when it comes to such a heinous assault by Hamas on Israel. They expressed their deep disappointment in the messages emanating from these universities under their leadership, deeming them to fall far short of the minimum standards expected of moral leadership, courage, and a commitment to truth.

The response letter proceeds to recount the distressing sequence of events that transpired in the southern region of the country, beginning on October 7, 2023, highlighting the war crimes and atrocities committed by Hamas against innocent civilians. It concludes with the stern statement, “you have failed us, not only as Israelis, who are subject to the imminent threat of being subject to genocide, but also as leaders of an academic institution, who expect their colleagues to present higher moral standards, and more courage.”

To read the full letters: https://en.huji.ac.il/news/letters-presidents-harvard-university-and-stanford-university

Letter to Harvard University

Letter to Stanford University

############

And here's a statement from some Yale faculty condemning Hamas but worrying about what comes next in Gaza:

Statement of Concerned Yale Faculty Regarding Crimes Against Humanity in Israel-Palestine

#########

Earlier:

Thursday, October 12, 2023

Thinking locally about Hamas, and murderous antisemitism, on college campuses

###########

I've spent my adult life in and around universities, and in many ways and at many times universities have been at the forefront of progress.  But for right now, as we brace ourselves for what may be coming, I'll let two elected political leaders, the Mayor of New York and the President of the United States, have the last words:

 

Ariel Pakes celebrated at the Nemmers Prize conference

 Ariel Pakes could certainly also win the prize for being loved by his students and colleagues: 

CONFERENCE IN HONOR OF ARIEL PAKES

Fentanyl

 The NY Times has the story:

Some Key Facts About Fentanyl. It’s lowering American life expectancy and influencing the nation’s politics. By Josh Katz, Margot Sanger-Katz and Eileen Sullivan

"Overdose deaths have been increasing in the United States for decades, but the introduction of fentanyls has led to a staggering rise, accounting for the vast majority of overdose deaths in recent years.

"Around 77,000 Americans died from overdoses involving synthetic opioids like fentanyl in the 12-month period ending in April of this year, according to provisional estimates from the Centers for Disease Control and Prevention. In 2022, the most recent year with complete data, this number was around 74,000. Those three wars  [Vietnam, Iraq and Afghanistan] killed a little over 65,000 Americans combined.

"For comparison, around 55,000 Americans died in 1972 from car crashes, the year with the most such deaths. Around 49,000 died from guns in 2021 (including suicide), the year with the most such deaths.

"Fentanyl alone has become a leading cause of U.S. deaths. It was responsible for a third of deaths among Americans 25 to 34 in 2022, according to a New York Times analysis of C.D.C. mortality data.

...

"Most of the fentanyl sold in the United States is coming from Mexico, where drug cartels synthesize the drugs from precursor chemicals believed to come from factories in China. Some fentanyls are also shipped directly from China into the United States."

Thinking locally about Hamas, and murderous antisemitism, on college campuses

 How should universities deal with controversy in the midst of horrors?

Both Harvard and Stanford are having troubles with talking about Israel and Hamas.  Below are two news articles, and a letter...

Here's the NY Times, on Harvard:

At Harvard, a Battle Over What Should Be Said About the Hamas Attacks. After a student group blamed Israel for the violence, Lawrence Summers, a former university president, condemned the leadership for not speaking up.  By Anemona Hartocollis, Stephanie Saul and Vimal Patel

#######

And here's the SF Chronicle on Stanford and Berkeley:

Stanford, UC Berkeley respond to Israel-Hamas war amid campus debates by Nanette Asimov

"Rather than condemn the brutal invasion by Hamas into Israel, some student groups at universities across the country are turning the message around, using posters, social media posts and statements in campus newspapers to criticize Israel for its historic hard line against Palestinians.

"And some prominent universities have let them.

"On Wednesday, dozens of faculty members, including three Nobel laureates, sent a letter to Stanford leaders condemning the university’s mild response to the crisis and to pro-invasion sentiments expressed on campus.

"The letter to interim President Richard Saller and Provost Jenny Martinez chastised Stanford not only for referring to the murder of at least 1,200 Israelis and more than 100 people taken hostage merely as the “Middle East conflict,” but also for failing to remove “extremely offensive banners” on campus calling for the abolition of Israel, and for standing by as Jewish students were targeted online after the invasion by Hamas.

“This situation calls for a clear condemnation of terrorism and a strong stance in support of basic human rights and dignity,” says the letter signed by faculty across many disciplines and by three Nobelists: Michael Levitt, who won for chemistry, and the economists Paul Milgrom and Alvin Roth.

##########

Here's the Stanford letter:

Dear President Saller and Provost Martinez,

 We, members of the Stanford community — faculty, staff, students, and alumni — feel the obligation to share our thoughts on the university's response to the recent events in Israel and Gaza. 

 Many members of the Israeli and Jewish communities on campus are experiencing the hardest, most stressful days of their lifetime. Many Stanford faculty members and students have been reaching out to their Jewish and Israeli friends and colleagues, to extend their sympathy and support. These past few days have been terrifying and incredibly painful for us all, and this acknowledgment is heartwarming and greatly appreciated.

 With that said, we must respectfully convey our concerns regarding the wording used in the messages sent by Stanford University as an institution, which, unintentionally, downplays the horrific gravity of the situation. Furthermore, over the last few days extremely offensive banners, calling to abolish Israel “by all means necessary”, have been on display in various spots on campus. Jewish, Israeli, and Zionist students at Stanford are being targeted both on campus and on Stanford-affiliated platforms. We are aware of some messages published by various University officials. However, the University has yet to take appropriate action against what is happening. 

 Since Saturday morning, Hamas has murdered more than 1,200 Israelis, many of them women, children, and elderly Holocaust survivors, in their homes and on the streets. Over one hundred more have been brutally kidnapped and taken hostage. These include young women paraded naked through the streets, toddlers ruthlessly snatched away from their parents, and elderly people in wheelchairs. The murdered and kidnapped are not just Israelis, they are also citizens of the United States, Brazil, Argentina, Nepal, Thailand, and Germany. These are not a result of “the Middle East conflict”, as stated in the University's message from earlier today. Rather, it is the result of a horrific, inhumane, terror attack by Hamas that has shaken the international and Jewish communities in a way we have not experienced since the darkest days of the previous century.

 While there may be an instinct to chalk this up to just another skirmish in the Israel-Palestinian conflict, it is imperative that all of us are able to understand the gravity of these acts and call out terrorism. Phrasing these acts as “the Middle East conflict” inadvertently suggests a moral equivalence between the actions of terrorists and of those trying to protect innocent lives.

 We believe that in an academic institution like Stanford, where critical thinking and accurate representation of events are paramount, it is essential to be mindful of the language we use. This situation calls for a clear condemnation of terrorism and a strong stance in support of basic human rights and dignity. Let us be clear, we are not demanding support of the Israeli government's policies vis a vis Gaza or the occupation, and in fact, many of us are ardent activists against these policies. Rather, as a bastion of critical and nuanced thinking, Stanford should be able to hold any and all of these positions while also unequivocally calling out unequivocal evil, as President Biden did earlier today. The Israel-Palestine conflict is complex and nuanced. Condemnation of the murder, rape, and kidnapping of innocent civilians should not be.

     We believe that Stanford should immediately take action: it must voice its unambiguous condemnation of the horrifying actions taken by Hamas these past days. It must reach out to Israeli and Jewish students on campus and voice a clear message of support in these dire times. The university must act, firmly and immediately, to prevent hate speech, including antisemitic voices on campus, which, unfortunately, has already seen troubling instances of antisemitism in recent years. The university must ensure the safety of our Stanford community, which includes our Jewish and Israeli members. The lack of appropriate response is deeply troubling to us, as faculty, staff, students, and alumni of this university. Stanford’s failure to act appropriately is unacceptable.

 Thank you for your attention to this matter, as well as for reaching out and offering us your support. We hope we can continue to engage in thoughtful dialogue. 

 Sincerely,

 Michael Levitt, Robert W. and Vivian K. Cahill Professor in Cancer Research, Department of Structural Biology, Nobel Prize Laureate 

 Paul Milgrom, Leonard and Shirley Ely Professor, Department of Economics, Nobel Prize Laureate 

 Alvin Roth, Craig and Susan McCaw Professor, Department of Economics, Nobel Prize Laureate 

 Anat Admati, George G.C. Parker Professor of Finance and Economics, GSB

 Lior Almagorl, esearch scientist (staff), Department of Structural Biology

 Itai Ashlagi, Professor of Management Science and Engineering

 Laren Becker, Assistant Professor of Medicine, Stanford SOM

 Gill Bejerano, Professor Computer Science and Developmental Biology

  ...

and dozens more signers, in alphabetical order...

Ran Abramitzky interviews me on market design (followed by a good Q&A with Stanford freshmen)

Here's the video recording of our conversation

 

Econometric Society Fellows (2023), procedures, and some thoughts on prizes in general

The Econometric Society has announced its newest class of Fellows. I don't know them all, but I bet they all deserve that distinction, because it isn't easy to be recognized as a Fellow.  More on that after celebrating and congratulating these jolly good Fellows:

The Society is pleased to announce the election of 29 new Fellows of the Econometric Society.

1. Nava Ashraf, London School of Economics
2. Steve Bond, University of Oxford
3. Tilman Börgers, University of Michigan
4. Robin Burgess, London School of Economics
5. Gabriel Carroll, University of Toronto
6. Yongsung Chang, Seoul National University/Bank of Korea
7. Dean Corbae, University of Wisconsin – Madison
8. Mariacristina De Nardi, University of Minnesota
9. Ben Golub, Northwestern University
10. Christian Hellwig, Toulouse School of Economics
11. Michael Jansson, University of California, Berkeley
12. Steven Koch, University of Pretoria
13. Thierry Mayer, Sciences Po
14. Hyungsik Roger Moon, University of Southern California/Yonsei University
15. Georg Nöldeke, University of Basel
16. Emanuel Ornelas, Sao Paulo School of Economics – FGV
17. Pietro Ortoleva, Princeton University
18. Sven Rady, University of Bonn
19. Gil Riella, School of Public Policy & Government - FGV
20. Uta Schönberg, University of Hong Kong/UCL
21. Katsumi Shimotsu, University of Tokyo
22. Marciano Siniscalchi, Northwestern University
23. Vasiliki Skreta, University of Austin, Texas/UCL
24. Zheng Song, Chinese University of Hong Kong
25. Yves Sprumont, Deakin University
26. Abderrahim Taamouti, University of Liverpool Management School
27. Pierre-Olivier Weill, University of California, Los Angeles
28. Wei Xiong, Princeton University
29. Motohiro Yogo, Princeton University

The 2023 FNC consisted of Gabrielle Demange (Chair) Irene Brambilla, Richard Holden, Dilip Mookherjee, Whitney Newey, Michele Terlit, and Yaw Nyarko.

*********

The great thing about prizes and other recognitions is that they celebrate the accomplishments of the accomplished.  The complicated thing about them is that they inevitably leave out many whose accomplishments are deserving of similar celebration.

What makes the Econometric Society Fellows such an interesting recognition is that its procedures are transparent: it's a nomination process followed by an election, and the electorate is the collection of existing Fellows.  I participate each year by nominating several Fellows, and then voting for quite a few more. 

One flaw in such a system could be that the existing fellows, who initiate many of the nominations, might find it easier to think of people close to them in some sense than to think of equally deserving candidates who aren't so close.  The Fellows Nominating Committee (FNC) is an attempt to address this: their job includes nominating deserving candidates  who seem likely to have been overlooked, perhaps because they are from parts of the world that seem underrepresented among the existing Fellows.

Each year the number of nominees is a multiple of the number of elected Fellows (if memory serves only around a fifth of the nominees have been elected in recent years). The rules of the election since 2020 are that the threshold to get elected is to be included in 25% of the votes cast (and a single "vote"  if I understand correctly is a list submitted by a Fellow that can contain as many of the nominated candidates as he or she wishes to vote for).  I say "since 2020" because it is the sense of many of the past and present officers of the Society that we elect too few Fellows each year, and so the threshold has been dropping in an effort to elect more fellows.  But the equilibrium response of the voters seems to be to vote for a smaller proportion of the nominees, so that the number of new fellows doesn't seem to be increasing at the hoped for rate.

I don't know of a good model to explain all this, but it might  include some notion that the value of being a Fellow (or of receiving other recognition) is a non-monotone function of its scarcity.  If we elect too many new Fellows, this might eventually diminish the value (to existing Fellows) of being a Fellow.  But (less obviously), if we elect too few Fellows the same thing could happen, if being a Fellow stops being something that people aspire to or even have heard of.  

My sense is that being a member of the National Academies is less important among economists than in many sciences precisely because too few economists are elected, so that it comes to seem like a random recognition rather than one that recognizes success as economists define it. One of the reasons that the economics Nobel, awarded yesterday with much fanfare to Claudia Goldin, is so widely applauded, not just in the disciplines in which Nobels are awarded but among the general public as well,  is that Nobels are awarded every year in several disciplines, so that they manage to be both a scarce distinction and a familiar one. (Exceptions that test this rule are the Clark medal, awarded each year by the American Economic Association to an economist younger than 40, which has high prestige among American economists even though so few are well recognized enough at that age to be serious contenders, and the Fields medals of the International Mathematical Union, also awarded to up to four scholars under 40, every four years.)

But nothing is perfect. Congratulations again to the new Fellows, who have received the carefully considered and frugally awarded applause of their peers. 

Claudia Goldin wins the 2023 Nobel Prize in Economics

 The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 2023 was awarded  today to the indefatigable

Claudia Goldin "for having advanced our understanding of women’s labour market outcomes"

Here's her latest NBER working paper, which appeared yesterday:

Why Women Won

Claudia Goldin

WORKING PAPER 31762, DOI 10.3386/w31762, October 2023

Abstract: How, when, and why did women in the US obtain legal rights equal to men’s regarding the workplace, marriage, family, Social Security, criminal justice, credit markets, and other parts of the economy and society, decades after they gained the right to vote? The story begins with the civil rights movement and the somewhat fortuitous nature of the early and key women’s rights legislation. The women’s movement formed and pressed for further rights. Of the 155 critical moments in women’s rights history I’ve compiled from 1905 to 2023, 45% occurred between 1963 and 1973. The greatly increased employment of women, the formation of women’s rights associations, the belief that women’s votes mattered, and the unstinting efforts of various members of Congress were behind the advances. But women soon became splintered by marital status, employment, region, and religion far more than men. A substantial group of women emerged in the 1970s to oppose various rights for women, just as they did during the suffrage movement. They remain a potent force today.

 Here's the concluding paragraph:

"Women won some of their most important workplace rights in the 1960s because of a set of fortuitous events. They continued to win in the early 1970s because of a movement that gave them influence. They won yet more because groups that were supportive of their cause—college graduates, single women, Black women—expanded relative to others. They won when they had the political clout to get men, especially those in Congress and the White House, to see that women’s rights were as valid as civil rights. Yet, women’s rights had setbacks when, in light of many gains, women abandoned the movement. Women’s rights has had a truly “strange career.”

Dead or alive? Debates about defining brain death and circulatory death in the medical literature

Before the invention of ventilator technology, circulatory death ('cardiorespiratory death') and brain death ('neurological death') were essentially the same thing, because one inevitably caused the other, very quickly.  But now that circulation can be maintained after the brain has gone irreversibly/permanently silent, we can make distinctions.  And some of those distinctions depend on the distinction between irreversibly and permanently.  This post starts with a position statement, but then features the underlying debate, and in fact two of the dueling papers take opposite stands on 'irreversible' and 'permanent.'. (The difference is that e.g. heart stoppage might be possibly reversible, but a 'do not resuscitate' order would mean that it was nevertheless permanent.) 

But before the debate, here's a position paper

Standards and Ethics Issues in the Determination of Death: A Position Paper From the American College of Physicians by  DeCamp, Matthew, Kenneth Prager, and American College of Physicians Ethics, Professionalism and Human Rights Committee, Annals of Internal Medicine (2023).

"Abstract: The determination of a patient’s death is of considerable medical and ethical significance. Death is a biological concept with social implications. Acting with honesty, transparency, respect, and integrity is critical to trust in the patient–physician relationship, and the profession, in life and in death. Over time, cases about the determination of death have raised questions that need to be addressed. This American College of Physicians position paper addresses current controversies and supports a clarification to the Uniform Determination of Death Act; maintaining the 2 current independent standards of determining death, cardiorespiratory and neurologic; retaining the whole brain death standard; aligning medical testing with the standards; keeping issues about the determination of death separate from organ transplantation; reaffirming the importance and role of the dead donor rule; and engaging in educational efforts for health professionals, patients, and the public on these issues. Physicians should advocate for policies and practices on the determination of death that are consistent with the profession’s fundamental and timeless commitment to individual patients and the public."

...

"Scientific advances motivate revisiting foundational concepts, including those around death and dying. Decades ago, advanced cardiorespiratory support—because of its ability to maintain cardiac and respiratory functions in individuals whose brain function was thought to have ceased—contributed to the development of brain death as a concept. Studies now show restoration of cellular and molecular activity in whole pig brains (without restoration of brain functions) 4 hours postmortem using an ex vivo perfusion system called “BrainEx” (15, 16). Today, a controversial protocol known as thoracoabdominal normothermic regional perfusion with controlled donation after circulatory determination of death can result in the resuscitation of the asystolic heart to restore circulation after what was a determination of circulatory death—to increase organ availability for transplant—but this invalidates the determination of death and breaches ethical boundaries (17, 18). Moreover, there has been ongoing advancement in ancillary tests, such as electroencephalograms, magnetic resonance angiography, single-photon emission computed tomography, hypothalamic testing (19), computed tomography angiography, computed tomography perfusion (20), and others. Results of these methods of testing can raise questions about the accuracy of clinical determinations of death.

...

"Position 1

ACP supports revising the Uniform Determination of Death Act (UDDA) to replace the word “irreversible” with “permanent” in the first clause to read, “An individual who has sustained either (1) permanent cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.”

"The UDDA (21) currently states, “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.”

############

And here's a whole series of position papers in the journal Neurology: 

The Uniform Determination of Death Act (UDDA) Revision Series

This series aims to educate the neurology community about the most important brain death controversies the US Uniform Law Commission must consider in rewriting the UDDA.

Challenges to Brain Death in Revising the Uniform Determination of Death Act: The UDDA Revision Series
James L. Bernat

What Is the Ideal Brain Criterion of Death? Clinical and Practical Considerations: The UDDA Revision Series
Nathaniel M. Robbins

What Is the Ideal Brain Criterion of Death? Nonclinical Considerations: The UDDA Revision Series
Michael A. Rubin

Must Hypothalamic Neurosecretory Function Cease for Brain Death Determination? Yes: The UDDA Revision Series
Michael Nair-Collins

Must Hypothalamic Neurosecretory Function Cease for Brain Death Determination? No: The UDDA Revision Series
Panayiotis Nicolaou Varelas

Should the Criterion for Brain Death Require Irreversible or Permanent Cessation of Function? Irreversible: The UDDA Revision Series
Ari R. Joffe

Should the Criterion for Brain Death Require Irreversible or Permanent Cessation of Function? Permanent: The UDDA Revision Series
Andrew McGee, Dale Gardiner

Should the Brain Death Exam With Apnea Test Require Surrogate Informed Consent? Yes: The UDDA Revision Series
Ivor David Berkowitz, Jeremy Garrett

Should the Brain Death Exam With Apnea Test Require Surrogate Informed Consent? No: The UDDA Revision Series
David Greer

Potential Threats and Impediments to the Clinical Practice of Brain Death Determination: The UDDA Revision Series
Ariane Lewis, Matthew P Kirschen

Rethinking Brain Death—Why “Dead Enough” Is Not Good Enough: The UDDA Revision Series
Daniel P. Sulmasy, Christopher DeCock

Nicotine in New Zealand, banned for the future generation.

 In New Zealand, the incidence of smoking is down, but not so much among the Maori. And now there's a law that cuts nicotine content of cigarettes, and (get this) "bans the next generation of New Zealanders — anyone born after 2008 or currently 14 years old or younger — from ever buying cigarettes in the country. " (That's going to be a complicated age restriction to administer in, say, 10 years from now...)

NPR has the story:

It's one of the world's toughest anti-smoking laws. The Māori see a major flaw  by Simar Bajaj

"In 2011, New Zealand set one of the most audacious public health targets in the world: to slash its cigarette smoking rate to 5% by 2025.

"The rate was 18% at the time. Fast forwarding over a decade later, the country seems on track to reach this goal ahead of the 2025 target — but only for its European and Asian populations. Māori, on the other hand, had the country's highest smoking rate at 20% in 2021, and they are expected to reach the 5% goal only 40 years later in 2061 per government modeling.

...

"Every year, 4,000 Māori die in New Zealand, and cigarettes are responsible for nearly a quarter of these deaths, according to an estimate in The New Zealand Medical Journal. The study also found that smoking explains a third of the seven-year life expectancy gap between Māori and other New Zealanders.

...

"Last December, in an all-hands-on-deck effort to get Māori across the 2025 finish line, New Zealand passed one of the strongest anti-tobacco laws in global history.

"Specifically, the legislation limits the amount of nicotine in cigarettes to non-addictive levels and reduces the number of retailers allowed to sell cigarettes from 600 currently to 60 by July 2024.

"Most remarkably, the law bans the next generation of New Zealanders — anyone born after 2008 or currently 14 years old or younger — from ever buying cigarettes in the country. "The denicotinization and retail reduction are important for us to get to the lower than 5% smoking rate," says New Zealand's Health Minister Ayesha Verrall, "and then the smoke-free generation policy is to keep us there."

...

"Fears that the crackdown on smoking will backfire

"Tobacco regulation is like a game of whack-a-mole: Knock a product out of one market, and it'll usually pop up in another possibly illegal transaction. In 2019, illicit tobacco represented almost 12% of New Zealand's consumption, and this new legislation may further relegate tobacco to the black market, according to Māori physician and Parliament member Shane Reti, who has tribal affiliations to Ngā Puhi, Ngāti Wai, Ngāti Hine and Ngāti Kura. What he's particularly concerned about is that, given high rates of tobacco addiction in his community, this expanded black market will disproportionately impact Māori via more dangerous cigarettes and police crackdowns.

...

"The risk of such smuggled tobacco, Reti points out, is that it would exist wholly outside New Zealand's safety regulations. As such, he posits that these cigarettes would be more addictive and toxic for Māori who continue to smoke, with higher levels of nicotine and heavy metals like lead. (It is presently illegal to import tobacco into New Zealand without a permit.)

"On the supplier side, organized crime syndicates, which are responsible for large-scale cigarette smuggling, may also surge. "We have some of the highest cost of living and the highest inflation we've had in decades in New Zealand," Reti says, "and what we know is that vulnerable groups who are desperate turn to crime." Given New Zealand's incarceration rates — over half of prisoners are Māori despite representing only 17% of the country — Reti worries that an invigorated black market will lead to a disproportionate crackdown in his community and an even higher percentage of Māori prisoners.

...

"Reti is also concerned about the economic impact on New Zealand's dairies because the anti-tobacco legislation reduces the number allowed to sell cigarettes by 90%. (Dairy is the term New Zealanders use for neighborhood convenience stores.) That might be problematic because tobacco makes up a substantial proportion of dairies' revenue, with estimates ranging from 14% to 47%. If dairies can't find other ways to increase sales, this policy "will almost decimate the small retailers, those small corner dairies," says Reti.

...

"But just as he isn't concerned about the black market, Waa thinks these economic arguments are similarly overblown. "This is my conspiracy hat on, but we suspect that a lot of these arguments are put up by the tobacco industry" to keep their product in stores. Waa points to how dairy owners submitted some 1,000 complaints to the government, all of them following a single template. In any case, Waa has little sympathy for retailers insisting on selling tobacco "because they're making money out of my people dying."

#######

Related earlier post:

Friday, March 24, 2023

Alcohol and race in Australia

Correcting science faster by making replication easier and more fun, by Brodeur, Dreber, Hoces de la Guardia & Miguel

If imitation is the sincerest form of flattery, we need to think of replication as one of the sincerest forms of inquiry in social science. (I'm more optimistic about the potential role of replication than I am about pre-registration.)

Here's a Comment in Nature that points out that we're not going to get lots of replications unless we can make them easier and more fun than they have been traditionally.

Replication games: how to make reproducibility research more systematic.  In some areas of social science, around half of studies can’t be replicated. A new test-fast, fail-fast initiative aims to show what research is hot — and what’s not.  by Abel Brodeur, Anna Dreber, Fernando Hoces de la Guardia & Edward Miguel

"we decided to try to make replication efforts in our fields of economics and political science more systematic. Our virtual, non-profit organization, the Institute for Replication, now holds one-day workshops — called replication games — to validate studies.

"Since October 2022, we’ve hosted 12 workshops across Europe, North America and Australia, with 3 more scheduled this year. Each workshop has typically involved around 65 researchers in teams of 3–5 people, re-analysing about 15 papers. The teams either try to replicate papers, by generating new data and testing hypotheses afresh, or attempt to reproduce them, by testing whether the results hold if the published data are re-analysed. For many papers in our fields of study, in which the reproduction of results often involves re-running computer codes, it’s possible to do much of this work in a single day (see ‘A typical replication games project’). Each team’s findings are released as a preprint report, and these reports will be collated and published each year as a meta-paper. 

...

"To assess large numbers of papers, collaborating with research centres and universities is essential. For example, our current goal is to reproduce and replicate studies in journals that have a high impact factor — specifically, 25% of empirical studies published from 2022 onwards in 8 leading economics journals and 3 leading political science journals, totalling about 350 papers per year. Then we plan to expand into other areas of the social sciences.

...

"Broader partnerships can expand replication efforts beyond academic papers. Earlier this year, we were invited to run replication games with the International Monetary Fund (IMF) and the World Bank, to assess economics and finance papers from the two organizations. We aim to keep running these games annually, validating not only scholarly studies but also policy-oriented reports.

"Establishing these relationships need not be time consuming. We’ve found that simply tweeting about our project and speaking about it at conferences can garner interest. That, along with word of mouth after the Oslo workshop, has been sufficient to make our project well known among economists. As a result, all the organizations that we partnered with originally contacted us — rather than the other way round — asking to get involved.

"Other researchers following in our footsteps should be aware that care is needed to avoid conflicts of interest. We receive no money from the collaborations we’re involved in, because taking payment could be viewed as unethical. At the IMF and World Bank games — where people were reproducing and replicating the work of co-workers — we decided to randomly assign participants to a study, allowed them to remain anonymous and prevented participants from assessing studies authored by direct supervisors or friends.

"It is crucial to protect researchers who check papers from career threats — particularly when an effort uncovers major errors. We recommend that an organization or institute mediates communication between the original study’s authors and the replicators, allowing the latter to remain anonymous if they wish. One of us, acting as a representative for the Institute for Replication, serves in this capacity after each replication game.

"We know that receiving an e-mail to say that someone is checking your work can be stressful. So we contact the original authors only after replicators have written up their reports, to avoid causing researchers undue worry while they wait for an effort’s results. Rather than treating the discovery of errors as a ‘gotcha’ moment, which can put authors on the defensive, we acknowledge in our correspondence that all researchers make mistakes. To help make the process collegial, we allow authors to suggest edits to the report, and ask replicators to suggest changes to the authors’ responses.

...

"We think that efforts such as ours that normalize replication will ultimately put pressure on funders and journals to play their part. We are excited to see replication efforts in our fields — and others — continue to expand. Systematic replication has the potential to make correcting science faster. Let the games begin."

Transition to residency conference: Oct 5-7

I'll be a panelist at the  the NRMP conference Transition to Residency,  in Boston, Oct 5-7

"The National Resident Matching Program® (NRMP®) will convene its stakeholder conference in Boston this year. The meeting is intended to provide a forum for robust conversation among members of the undergraduate and graduate medical education communities about issues relevant to the transition to residency."

Here's the list of plenary speakers.

Friday, Oct 6, 8:30 – 9:45 AM Plenary I

The Future of the Transition to Residency: Assessing the Impact of Proposed Change

Panelists:

John Combes, MD

Alvin Roth, PhD

Charles (Tom) Thomas, MA, MPhil

Pakistan police bust organ trafficking ring --transplants were carried out in private homes

 Outlawing compensation for donors doesn't end black markets for kidneys from living donors, but may succeed in driving them out of hospitals, and making them increasingly dangerous and black.

The BBC has the story:

Pakistan police bust organ trafficking ring that took kidneys from hundreds By Rachel Russell

"Eight members of an organ trafficking ring in north-east Pakistan have been arrested, police say.

"The ring's alleged leader, Fawad Mukhtar, is accused of extracting the kidneys of more than 300 people and transplanting them into rich clients.

...

"At least three people died from having their organs harvested in this way, authorities said.

...

"The transplants were carried out in private homes - often without the patient knowing, the chief minister of Punjab province Mohsin Naqvi said.

"A car mechanic is said to have worked as Mr Mukhtar's surgical assistant and helped lure vulnerable patients from hospitals.

"The kidneys were then sold for up to 10 million rupees (£99,000; $120,000) each, Mr Naqvi added.

...

"The commercial trade of human organs was made illegal in Pakistan in 2010.

"The punishment for those caught includes a decade-long jail term and huge fines in the hope that this will stop sales to overseas clients by exploitative doctors, middlemen, recipients and donors.

"However, there has been a rise in organ trafficking in the country as people struggle with low wages and a poor enforcement of the law."

HT: Jlateh Vincent Jappah

Transplant grand rounds in Manitoba, tomorrow on kidney exchange

 I'll be talking tomorrow to the transplant pros in Manitoba, about kidney exchange and transplants across borders, among other things.

Wednesday, Oct 4, 2023 | 1:15 PM CST

Immigration, immigration law, and illegal immigrants in legal limbo. Should we have a statute of limitations after which immigrants become legal?

We're seeing so much illegal immigration, maybe we should change some of our laws, at least to regularize the status of immigrants who have successfully built productive lives here.  One suggestion is to have a statute of limitation on the crime of illegal immigration, That could work like common law marriage, after a long enough time, the status quo becomes legal.

The NY Times has the story:

Why Can’t We Stop Unauthorized Immigration? Because It Works. Our broken immigration system is still the best option for many migrants — and U.S. employers. By Marcela Valdes

"The three most recent presidents have tried and failed to fix the problem of mass unauthorized migration into the United States. President Obama tried to balance empathy with enforcement, deferring the deportation of those who arrived as minors and instructing immigration officers to prioritize the arrest of serious criminals, even as he connected every jail in the nation to Immigration and Customs Enforcement (ICE). President Trump emphasized enforcement at all costs: revoking deferred action for minors, declaring the arrest of every undocumented person a priority, separating migrant families and trying to terminate temporary protected status for about 400,000 people — though Trump also extended deferred action to about 200,000 Venezuelans during his last full day in office.

"So far, President Biden has revived the empathy-and-enforcement strategy: resuming deferred action for minors and helping Venezuelans while also making it more difficult to qualify for asylum.

"But these variations in policy have had almost no effect on the number of migrants trying to enter the United States through the Southern border. Obama and Trump chose mostly opposing strategies, but each prioritized the arrest of unauthorized migrants in the Rio Grande Valley. Yet in 2019, before the pandemic gave Trump legal standing to force asylum seekers back into Mexico, Customs and Border Protection (C.B.P.) arrested about 82,000 more migrants there than they had at the peak of migrations in the Obama years.

...

"Until the 1920s, America received migrants with an almost open border. Our policies emphasized regulation, not restriction. A few general categories were barred from entry — polygamists and convicted criminals, for example — but almost everyone else was permitted to enter the United States and reside indefinitely. The move toward restriction began in 1882 with laws that targeted the Chinese then evolved to exclude almost every other national group as well.

"Legal immigration today is close to impossible for most people. David J. Bier of the Cato Institute recently estimated that around 3 percent of the people who tried to move permanently to the United States were able to do so legally. “Legal immigration is less like waiting in line and more like winning the lottery: It happens, but it is so rare that it is irrational to expect it in any individual case,” he wrote in a comprehensive review of the current regulations. He concludes that “trying the legal immigration system as an alternative to immigrating illegally is like playing Powerball as an alternative to saving for retirement.”

"In other words, illegal immigration is the natural consequence of the conflict between America’s thirst for foreign labor and its strict immigration laws. The world’s increasing connectedness and fluidity have just supercharged this dynamic. There are now more than 11 million undocumented immigrants inside the United States, three times the number that lived here in 1990. And during the last fiscal year, the number of C.B.P. arrests in the Rio Grande Valley hit a record: more than half a million.

...

"Among academics, another idea keeps resurfacing: a deadline for deportations. Most crimes in America have a statute of limitations, Mae Ngai, a professor of history at Columbia University, noted in an opinion column for The Washington Post.  The statute of limitations for noncapital terrorism offenses, for example, is eight years. Before the 1924 Immigration Act, Ngai wrote in her book about the history of immigration policy, the statute of limitations for deportations was at most five years. Returning to this general principle, at least for migrants who have no significant criminal record, would allow ICE officers and immigration judges to focus on the recent influx of unauthorized migrants. A deadline could also improve labor conditions for all Americans because, as Ngai wrote, “it would go a long way toward stemming the accretion of a caste population that is easily exploitable and lives forever outside the polity.”

Matching Mechanisms for Refugee Resettlement By Delacrétaz, Kominers, and Teytelboym

Learning how better to resettle refugees is not going to go out of style anytime soon.  Here's a recent AER paper:

Matching Mechanisms for Refugee Resettlement By David Delacrétaz, Scott Duke Kominers, and Alexander Teytelboym, American Economic Review 2023, 113(10): 2689–2717 https://doi.org/10.1257/aer.20210096

Abstract: "Current refugee resettlement processes account for neither the preferences of refugees nor the priorities of hosting communities. We introduce a new framework for matching with multidimensional knapsack constraints that captures the (possibly multidimensional) sizes of refugee families and the capacities of communities. We propose four refugee resettlement mechanisms and two solution concepts that can be used in refugee resettlement matching under various institutional and informational constraints. Our theoretical results and simulations using refugee resettlement data suggest that preference-based  matching mechanisms can improve match efficiency, respect priorities of communities, and incentivize refugees to report where they would prefer to settle."