Incentives matter for getting participation in clinical trials by low income households

 Here's a study that casts some light (via a randomized experiment) on the importance of incentives to get representative participation in clinical trials.

Nonrepresentativeness in Population Health Research: Evidence from a COVID-19 Antibody Study By Deniz Dutz, Michael Greenstone, Ali Hortaçsu, Santiago Lacouture, Magne Mogstad, Azeem M. Shaikh, Alexander Torgovitsky, and Winnie van Dijk, AER: Insights 2024, 6(3): 313–323, https://doi.org/10.1257/aeri.20230195

Abstract: "We analyze representativeness in a COVID-19 serological study with randomized participation incentives. We find large participation gaps by race and income when incentives are lower. High incentives increase participation rates for all groups but increase them more among underrepresented groups. High incentives restore representativeness on race and income and also on health variables likely to be correlated with seropositivity, such as the uninsured rate, hospitalization rates, and an aggregate COVID-19 risk index."

"We analyze representativeness in a unique COVID-19 serological study. Unlike most studies, the Representative Community Survey Project (RECOVER)COVID-19 serological study experimentally varied financial incentives for participation. The study was conducted on households in Chicago (the target population). Randomly sampled households were sent a package that contained a self-administered blood sample collection kit and were asked to return the sample by mail to be tested for the presence of COVID-19 antibodies (“seropositivity”). Households in the sample were randomly assigned one of three levels of financial compensation for participating in the study: $0, $100, or $500.

"We find that households in neighborhoods with high shares of minority and poor households are grossly underrepresented at lower incentive levels. High incentives increase participation rates for all groups but increase them more among underrepresented groups. A $500 incentive restores representativeness in terms of neighborhood-level race and poverty status. Representativeness is also restored in health variables likely to be correlated with seropositivity, such as the uninsured rate, hospitalization rates, and an aggregate COVID-19 risk index. Since incentives were randomly assigned and only revealed after the household was contacted, the noncontact rates at $0 and $100 should be the same as at $500, implying that differential hesitancy to participate is responsible for much of the nonrepresentativeness that we find at lower incentives.

"We are not aware of studies that randomize financial incentives in population health studies. It is well appreciated that racial minorities and lower-income households participate in health research at lower rates.1  The impact of incentives on survey participation rates conditional on demographic characteristics has been studied in the survey methodology literature (see Groves et al. 2009; Singer and Ye 2013, and references therein). The incentives used in this literature are typically an order of magnitude smaller than the incentives in the RECOVER study."

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Some earlier related posts:

Monday, February 22, 2021

Ethical Payment in Human Infection Challenge Studies in the American Journal of Bioethics

Monday, March 1, 2021

Compensating challenge vaccine trial participants: further discussion in the American Journal of Bioethics

Thursday, October 29, 2020

Paying participants in challenge trials of Covid-19 vaccines, by Ambuehl, Ockenfels, and Roth

"we note that increasing hourly pay by a risk-compensation percentage as proposed in the target article provides compensation proportional to risk only if the risk increases proportionally with the number of hours worked. (Some risky tasks take little time; imagine challenge trials to test bulletproof vests.) "

Sunday, November 1, 2020

What do we know about the effects of payments to participants in challenge trials for vaccines, and other public spirited activities?

It's illegal to sell cicada infused liquor in Illinois

 Alcohol and insects don't mix in Illinois.  

The Chicago Sun Times has the story:

Suburban brewery fined for selling cicada-infused Malört shot. Noon Whistle Brewing garnered headlines for selling the creative drink during the rare overlap of two cicada broods. But it turns out the shot wasn’t just disgusting — it was also illegal.  By  David Struett 

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It's a good think the Illinois Liquor Control Commission wasn't running the IRB that approved Sandro Ambuehl's experiment that involved eating insects.

Sunday, March 10, 2024

Does high pay equal "undue inducement"? An experiment by Sandro Ambuehl

Oregon ends decriminalization of drugs, continues to experiment

 Here's the story in the Washington Post

Hard drugs illegal again in Oregon as first-in-nation experiment ends

"Sunday marks the end of an experiment that drug-reform advocates called a pioneering and progressive measure to better help people. Oregon legislators reassessed Measure 110 this year and decided to again make it a misdemeanor to possess a minor amount of drugs — essentially anything besides marijuana. Selling and manufacturing illicit drugs was and is still illegal in Oregon.

...

"On Feb. 29, the Oregon House of Representatives voted 51-7 to recriminalize drugs, with bipartisan support. The Oregon Senate did the same by a vote of 21-8 the next day. Gov. Tina Kotek (D) signed recriminalization into law April 1.

"Data shows how the [decriminalization] law was used in practice. The Oregonian reported that circuit court data collected by the Oregon Judicial Department from when the law went into effect Feb. 1, 2021, to Aug. 26, 2024, showed that the state’s circuit courts imposed just under $900,000 in fines under the measure but collected only $78,000 of those fines.

"The conviction rate for the 7,227 people cited was 89 percent, with most of those because people didn’t show up to court, the Oregonian reported. Data showed that 85 people completed the substance abuse screening in lieu of a conviction.

"The most commonly cited drug was methamphetamine, accounting for 54 percent of citations. Fentanyl and other Schedule II drugs, the Oregonian reported, ranked second at 31 percent."

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And here's the Guardian's coverage:

Oregon: drug possession to be a crime again as decriminalization law expires. First-in-nation trial comes to an end, as new law gives those caught with hard drugs option of charges or treatment

"The new recriminalization law, HB4002, will give those caught with illicit drugs – including fentanyl, heroin and meth – the choice to either be charged with possession or treatment, which includes completing a behavioral health program and participating in a “deflection program” to avoid fines.

"Personal-use possession would be a misdemeanor punishable by up to six months in jail. It aims to make it easier for police to crack down on drug use in public and introduced harsher penalties for selling drugs near places such as parks.

"The recriminalization law encourages, but does not mandate, counties to create treatment alternatives to divert people from the criminal justice system and toward addiction and mental health services."

The first four patients who received transplants of organs from genetically modified pigs

 NBC reports on the four patients who have so far received organ transplants from genetically modified pigs.

Their loved ones died after receiving pig organ transplants. The families have no regrets. Four people have received hearts or kidneys from pigs. Some of their relatives recount a roller coaster of hope and uncertainty. By Aria Bendix

"David Bennett Sr., had severe congestive heart failure and wasn’t a candidate for a human transplant. He knew he would likely die soon. There was nothing more to do — other than take a chance on a novel, cutting-edge surgery. Bennett Sr. and his son agreed it was worth the risk.  

"The achievement made headlines around the world after the transplant surgery in January 2022.

...

"But two months later, Bennett Sr.’s body rejected the heart and he died at age 57. In a paper, his doctors at the University of Maryland Medical Center explained that his body had likely produced too many antibodies that fought off the new organ.

...

Three other patients have followed in Bennett Sr.’s footsteps and received pig organs, most recently a pig kidney transplant in April. Together, they represent the pioneer patients of the burgeoning field of xenotransplantation. For their families, three of which spoke to NBC News about the experience, the journey came with a roller coaster of emotions, from uncertainty to blind hope — and, ultimately, admiration for their loved one’s decision. 

...

"None of the patients survived more than three months. To the public, that might seem like failure. But to the families, the transplants accomplished their goals: to buy their loved ones more time and advance research that could potentially save lives one day."

Compensating plasma donors, or buying plasma from the U.S.? Europe clutches its pearls (The Economist)

 The Economist summarizes the plasma situation well.

The plasma trade is becoming ever-more hypocritical. Reliance on America grows, as other countries clutch their pearls

"Last year American blood-product exports accounted for 1.8% of the country’s total goods exports, up from just 0.5% a decade ago—and were worth $37bn. That makes blood the country’s ninth-largest goods export, ahead of coal and gold. All told, America now supplies 70% or so of the plasma used to make medicine.

...

"America’s booming blood trade is not an unmitigated success story, however, since it reflects problems elsewhere. The trade is mostly driven by two factors. The first is greater demand for plasma products: doctors have found ever more uses for the medicines, especially intravenous immunoglobulin. According to Marketing Research Bureau, a data firm, the market for immunoglobulin has grown by 5-7% a year for the past quarter of a century.

"The second reason is restrictions on plasma collection in other countries, owing to a combination of misplaced worries about safety and concerns about the morality of rewarding people for their bodily fluids. It is, for instance, illegal to pay for plasma donation in Britain, although the National Health Service does offer gifts and acknowledgments when donors reach certain milestones. In June the European Parliament approved new regulations that allow compensation to be offered for donations, but ban it from being mentioned in advertising and cap payments to an amount proportionate to the value of time spent donating. 

...

"Such qualms do not stop countries from importing American blood. Britain and Canada are almost entirely dependent on the country’s plasma; Europe brings in lots, too. China, a great rival of America in other areas of trade, is also more than happy to take advantage of America’s supply. Some 43% of Chinese imports of blood products now come from its geopolitical rival, up from just 14% a decade ago, according to figures from the UN. Chinese policymakers ban imports of plasma—a legacy of an attempt to prevent the spread of HIV in the 1980s—with the exception of a single protein, known as albumin. That alone is driving the trade.

"Some countries are even more flagrant in their double standards. France lobbied against the European Union’s recent regulatory changes, arguing that they risked making the human body a commodity, as is “already a reality in the United States”. At the same time, the French government is the sole shareholder in a company that owns six plasma centres in America, which pay donors, with the fluid collected available for use in France."

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Here are all my posts about plasma.

Automated bidding in auctions

 Part of the future of market design (as artificial intelligence evolves from large language models to something more like general AI) will involve not only the design of marketplace rules, but also design of the marketplace participants.  So a good way to get some sense of that future is to look at parts of it that have already arrived.  And there are lots of algorithms already at work participating in high frequency markets.  Here's a paper surveying automated bidding on ad auctions, by a big group of authors at Google.

Auto-bidding and Auctions in Online Advertising: A Survey by Gagan Aggarwal, Ashwinkumar Badanidiyuru, Santiago R. Balseiro, Kshipra Bhawalkar, Yuan Deng, Zhe Feng, Gagan Goel, Christopher Liaw, Haihao Lu, Mohammad Mahdian, Jieming Mao, Aranyak Mehta, Vahab Mirrokni, Renato Paes Leme, Andres Perlroth, Georgios Piliouras, Jon Schneider, Ariel Schvartzman, Balasubramanian Sivan, Kelly Spendlove, Yifeng Teng, Di Wang, Hanrui Zhang, Mingfei Zhao, Wennan Zhu, and Song Zuo

Abstract: In this survey, we summarize recent developments in research fueled by the growing adoption of automated bidding strategies in online advertising. We explore the challenges and opportunities that have arisen as markets embrace this autobidding and cover a range of topics in this area, including bidding algorithms, equilibrium analysis and efficiency of common auction formats, and optimal auction design

Optimism and pessimism on psychedelic drugs as medicine

 "Psychedelics" may prove to be a broad church, with psilocybin and LSD quite different from MDMA, etc., but here are two articles that express very different views about the progress towards making them part of standard medical practice.

Here's some optimism in Columbia Magazine:

The Magic and Mystery of Psychedelic Therapies.  As new trials show that psilocybin and LSD may help treat depression and anxiety, mental-health providers get ready for a revolution.  By Paul Hond |

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And here's some pessimism, in the NYT:

How Psychedelic Research Got High on Its Own Supply, By Caty Enders

"The drug company Lykos Therapeutics had spent much of this year expecting to vault to meteoric heights. It had sent an application to the Food and Drug Administration seeking approval to use MDMA to treat post-traumatic stress disorder. Lykos expected F.D.A. approval; it was banking on it.

"And then on Aug. 9, the F.D.A.’s decision came through: rejection. It was the capstone to months of increasingly loud concerns being voiced over the quality of Lykos’s clinical trials. And in the wake of the F.D.A. decision, the journal Psychopharmacology retracted three papers related to research on MDMA, citing “unethical conduct,” an apparent reference to allegations of sexual abuse on the part of an unlicensed therapist at one of the trial sites. Several of the authors of the retracted papers were affiliated with Lykos.

"It is a shocking decrescendo for a drug that had been promoted for years as best positioned to lead a psychedelic mental health revolution. The F.D.A.’s rejection signals greater uncertainty for the future of psychedelic medicine."

WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood, by Krawiec and Roth

 Requiring national self sufficiency in blood and plasma supplies is particularly hard on low and middle income countries, as is limiting the possibility of participating in active kidney exchange programs.

WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood by Kimberly D. Krawiec and Alvin E. Roth : August 24, 2024,   Available at SSRN: https://ssrn.com/abstract=4935827

Abstract: This chapter critiques the twin World Health Organization (WHO) principles of self-sufficiency and nonremuneration in organs and blood, urging a more sensible approach to the scarce resources of blood products and transplantable organs. WHO and other experts have failed to acknowledge the tension between self-sufficiency and nonremuneration in blood products--no country that fails to pay plasma donors is self-sufficient. Furthermore, international cooperation and cross-border transplantation provide numerous benefits, especially in smaller countries and those without well-developed domestic exchange programs. The combination of these twin principles denies to health care many of the benefits that trade has brought to so many other human endeavors and the effects are particularly damaging to low and middle income countries. Substances of human origin are special, but not so special that we prohibit plasma or organ donation. We should be open to exploring and experimenting with ways to bring to health care some of the benefits that trade has brought to so many other human endeavors, such as the production and distribution of food and lifesaving vaccines and other medicines.

Here's the concluding paragraph:

"We close by noting that the combination of the nonremuneration principle and the self-sufficiency principle deny to health care many of the benefits that trade has brought to so many other human endeavors. Substances of human origin are special, but not so special that we prohibit plasma or organ donation. So we should be open to exploring and experimenting with ways to bring to health care some of the benefits that trade has brought to so many other human endeavors, such as the production and distribution of food and lifesaving vaccines and other medicines."

Why Mpox Vaccines Aren’t Flowing to Africans in Desperate Need.

 The NYT has the story: read it and weep...

Why Mpox Vaccines Aren’t Flowing to Africans in Desperate Need. Drugmakers have supplies ready to ship that are necessary to stop a potential pandemic. But W.H.O. regulations have slowed access. By Stephanie Nolen

"There are no vaccines for mpox available in the Democratic Republic of Congo, the epicenter of a global health emergency declared last week, even though the country first asked for the shots two years ago and the manufacturers say they have supplies.

...

"So where are the shots? They are trapped in a byzantine drug regulatory process at the World Health Organization.

...

"Three years after the last worldwide mpox outbreak, the W.H.O. still has neither officially approved the vaccines — although the United States and Europe have — nor has it issued an emergency use license that would speed access.

"One of these two approvals is necessary for UNICEF and Gavi, the organization that helps facilitate immunizations in developing nations, to buy and distribute mpox vaccines in low-income countries like Congo.

"While high-income nations rely on their own drug regulators, such as the Food and Drug Administration in the United States, many low- and middle-income countries depend on the W.H.O. to judge what vaccines and treatments are safe and effective, a process called prequalification.

"But the organization is painfully risk-averse, concerned with a need to protect its trustworthiness and ill-prepared to act swiftly in emergencies, said Blair Hanewall, a global health consultant who managed the W.H.O. approvals portfolio as a deputy director of the Bill & Melinda Gates Foundation, a key funder, for more than a decade."

Are Swedish gangs becoming the hitmen of Scandanavia?

 We're accustomed to drug violence among gangs even in wealthy countries, but here's a story from The Times (of London) suggesting that the drug and biker gangs in Sweden are going in for contract killing as well.

How Swedish gangs are exporting young contract killers across Scandinavia. Crime bosses are behind a wave of youths being hired for attacks in Denmark and Norway, with fears the trend could spread further

"Sweden is accused of exporting its gang violence problem to its Nordic neighbours after at least 25 young Swedes on suspected contract-killing or bombing missions were arrested in Denmark over the past four months.

...

"Part of the problem, according to Markus Kaakinen, a criminologist at the University of Helsinki, is that Sweden’s notoriously trigger-happy drug gangs are outgrowing their home market. As a result they are not only setting up distribution outposts in countries such as Norway and Finland but are also moving in on “transit” states that serve as conduits for the international drug trade, such as Denmark and Spain, where they compete with the local criminal networks.

...

"Yet that is not the main thing that bothers experts. What really worries them is a previously unknown phenomenon: Swedish youths are being anonymously hired through social media for acts of violence in Denmark, as though they were Deliveroo drivers.

“This is something very new: the recruiting of very young, completely unknown adolescents,” Kaakinen said. “There’s increasing demand for violence and these gangs have noticed that it’s less risky for them to use these channels.”

...

"he Swedish authorities are already having a hard enough time getting a grip on their country’s conventional gang wars, where kingpins with nicknames such as the “Kurdish Fox”, “The Strawberry” and “The Greek” pursue their vendettas through teenage amateur assassins hired on a semi-freelance basis.

...

"Danish ministers feel their state has dealt relatively well with its own problems along similar lines. There are estimated to be about 1,500 active gang members in a population of 5.9 million, while Sweden has roughly 14,000 in a population of 10.5 million."

Travel for medical aid in dying

 CBS has the story:

Why Americans are traveling to Vermont and Oregon to die

""Dying with medical assistance wasn't an option when Milano learned in early 2023 that her disease was incurable. At that point, she would have had to travel to Switzerland — or live in the District of Columbia or one of the 10 states where medical aid in dying was legal.

"But Vermont lifted its residency requirement in May 2023, followed by Oregon two months later. (Montana effectively allows aid in dying through a 2009 court decision, but that ruling doesn't spell out rules around residency. And though New York and California recently considered legislation that would allow out-of-staters to secure aid in dying, neither provision passed.)

...

"At least 26 people have traveled to Vermont to die, representing nearly 25% of the reported assisted deaths in the state from May 2023 through this June, according to the Vermont Department of Health. In Oregon, 23 out-of-state residents died using medical assistance in 2023, just over 6% of the state total, according to the Oregon Health Authority."

Tattoos

 Tattoos used to signal something different than they do today.

The NYT has the story.

The Price of Getting Inked. Whether it’s the expense of getting tattooed or the cost to have one removed, Americans are paying for their ink. By Julia Rothman and Shaina Feinberg

"Once considered countercultural — something for sailors and misfits — tattoos are now culturally ubiquitous: Nearly one-third of American adults have at least one, according to a survey by Pew Research.

...

"The global tattoo market, which currently brings in about $2.2 billion, is expected to grow to more than $4 billion by 2032, according to Fortune Business Insights, a market research firm. There are over 20,000 tattoo parlors in the United States."

Blood donation by family members in India: LGBT donors still banned

 In India, where the shortage of blood supplies is addressed by having family members donate, the ban on donation by LGBT people is a serious constraint.

The BBC has the story:

LGBT Indians demand end to 'discriminatory' ban on blood donation  by Umang Poddar

"In 2018, India's top court legalised gay sex in a landmark ruling - but the country still doesn't allow transgender people and gay and bisexual men to donate blood.

"People from the LGBT community say the decades-old ban is "discriminatory" and have gone to court to challenge it.

...

"Activists argue that apart from it being discriminatory, the ban is also irrational because of the high demand for blood transfusions in the country.

"A study published by the Public Library of Science in 2022 estimated that India faced an annual deficit of around one million units of blood."

HT: Vincent Jappah

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Earlier:

Tuesday, November 28, 2023

"Professional blood donors" in India (where paying blood donors is illegal)

Surrogacy under continued attack in Italy

The language of repugnance is strong in these latest developments.

The NYT has the story:

Has Power Moderated Italy’s Leader? Not to Same-Sex Parents.  Prime Minister Giorgia Meloni has mostly shown a pragmatic streak abroad. But at home, her government is plunging many gay families into panic. 

"Surrogacy is already illegal if conducted in Italy. But the government of Prime Minister Giorgia Meloni wants to expand the prohibition. It has promoted a bill that would also punish Italians who make use of surrogacy even in places abroad where it is legal, like in parts of the United States. Those Italians who do could face up to two years in prison and be fined the equivalent of about a million dollars.

"Italy’s lower chamber of Parliament approved the bill last summer, and the Senate’s justice committee greenlighted it last month. The Senate is expected to vote on it as soon as the fall.

...

"No one can convince me that it is an act of freedom to rent one’s womb,”  [Prime Minister Meloni] said in the spring at an event in Rome. “No one can convince me that it is an act of love to consider children as an over-the-counter product in a supermarket.”

“Uterus renting is a shameful, inhuman practice,” she said. “It will become a universal crime.”

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Earlier

Wednesday, April 5, 2023

Surrogacy under siege in Italy

Kidney Exchange among Austria, Czech Republic, and Israel

 Here's an article that includes description of the joint Austria, Czech Republic and Israel kidney exchanges.

Böhmig, Georg A., Thomas Müller‐Sacherer, and Ondrej Viklicky. "Kidney Paired Donation—European Transnational Experience in Adults and Opportunities for Pediatric Kidney Transplantation." Pediatric Transplantation 28, no. 6 (2024): e14840.

"One approach to expanding the pool, akin to deceased donor kidney transplantation through the transnational Eurotransplant Organization, involves the establishment of cross-border KPD joint programs. In Europe, several joint programs have successfully conducted such transplants, one of which is the Scandiatransplant Exchange Program, inaugurated in 2019. As of February 2023, this program has facilitated 49 transplantations [29]. Another transnational initiative, the focus of this article, is the joint program involving Austria, the Czech Republic, and Israel. This collaboration resulted in the first transnational live donor kidney exchange in Europe, a two-way exchange between Vienna and Prague in 2017 [30].

"The Vienna and Prague Kidney Paired Donation (KPD) programs were merged in 2015 following a consensus on medical, psychological, and immunological requirements [23]. ... Both programs agreed on a binational algorithm, utilizing a computer algorithm developed in Prague. This algorithm not only facilitates the calculation of ABO-incompatible combinations but also includes the option of Non-Directed Altruistic Donor (NEAD) chains initiated by altruistic donors [23].

...

"Recent developments in the transnational program include its expansion to additional centers. Prague initiated a transnational cooperation with the national KPD program in Israel, successfully conducting the first ring exchange in 2019. In this context, transplantations cannot be realized simultaneously due to the financial burden associated with the need for two private flights. Later, this cooperation extended to the Vienna center, leading to the first exchange between Vienna and Israel in 2022, involving a simultaneous three-way chain with one Vienna and two Israel pairs. Innsbruck has also joined the international KPD program as a second Austrian center, participating in local exchanges and one 2-way exchange with Prague (2020). A good example of different approaches in timing of surgeries among Prague and Israel centers (non-simultaneous) in one hand and Vienna (simultaneous surgeries) in the other hand is Czech-Austrian-Israel international NEAD chain initiated in Prague which has lasted for several years, prioritized smaller exchanges and has not been terminated so far. Such a NEAD chain used both altruistic and bridge donors in Prague. Terminated NEAD chain may allow to prioritize patient at special need. For example, our short 3-country NEAD chain was terminated to offer transplantation to a previous kidney donor who donated 20 years ago but unfortunately developed end stage kidney disease. Such approach may have implications also in pediatrics."

Inter-hospital kidney exchange in Saudi

 Transplant centers .already conduct kidney exchange in the Kingdom, but now an effort is being launched to make exchange between centers feasible

Saudi Arabia launches National Kidney Exchange Program between families

"RIYADH — The Saudi Center for Organ Transplantation (SCOT) launched on Wednesday the National Kidney Exchange Program between families.

"The program enables reciprocal kidney transplant between a pair of patients and their donors for the first time in the Kingdom, between families at King Fahd Specialist Hospital in Dammam, and King Abdulaziz Medical City at the National Guard in Riyadh, under the supervision of the SCOT.

...

"In its first phase, the exchange program will cover kidney transplant centers at King Abdulaziz Medical City of the National Guard in Riyadh, and King Fahd Specialist Hospital in Dammam, followed by all kidney transplant centers in various regions of the Kingdom.

"The center called on all kidney transplant programs in the Kingdom to participate in the National Kidney Exchange Program between families so as to achieve the program’s goal of increasing the percentage of living donors from 10 percent to 30 percent in the second phase."

Uterus transplants--update

Reproductive options continue to grow... Here's an update on transplantation of the uterus.

Uterus Transplant in Women With Absolute Uterine-Factor Infertility, by Giuliano Testa, MD, MBA1; Greg J. McKenna, MD1; Anji Wall, MD, PhD1; et alJohanna Bayer, MD1; Anthony R. Gregg, MD2; Ann Marie Warren, PhD3,4; Seung Hee S. Lee, MD1; Eric Martinez, MD1; Amar Gupta, MD1; Robert Gunby, MD2; Liza Johannesson, MD, PhD1,5, JAMA. Published online August 15, 2024. doi:10.1001/jama.2024.11679

"Assisted reproductive technologies have provided millions of women with fertility options. However, absolute uterine infertility, affecting 1 in 500 women, remains a barrier in reproductive medicine. Absolute uterine infertility can be acquired or congenital and due to either a dysfunctional or an absent uterus. Affected women who want to have children traditionally choose between adoption or surrogacy where legally available. The development of uterus transplant offers an option for women with absolute uterine infertility to experience pregnancy and childbirth. Since the first successful uterus transplant in 2011,1 more than 100 uterus transplant procedures have been performed worldwide, using grafts from living or deceased donors. Although no registry exists that precisely reports the number of live births resulting from these procedures, it is estimated that there are more than 70 live births worldwide.2,3 As of May 1, 2024, there have been 48 uterus transplants and 33 live births in the US."

Incentives for blood donation in China

 College students have serious (and competitive) incentives to donate blood in China.  This is from Ariana Tang's blog

blood donation bonus points for scholarship credits

"Incentives and Care for Blood Donating Students and Faculty at Shanghai University of Finance and Economics

"Students and faculty who participate in voluntary blood donation will receive a blood donation care package. This package includes a blood donation care card loaded with a nutrition subsidy of 220 RMB (previously, a 20 RMB meal subsidy was added to the care card). This card can be used at various campus restaurants and supermarkets.

"Additionally, the package contains a snack worth 40 RMB. Students who participate in voluntary blood donation will also receive an extra 0.5 points towards their scholarship.

"[translated excerpts from the official call-to-donation announcement, original file (in Chinese) archived here]

"scholarship system mechanics

"Key points: (1) scholarships are awarded by ranking of a score, and blood donation bonus is often a tie-breaker (2) scholarships are very important, and competitive.

"The major scholarship that students compete for—the ‘People’s Scholarship’ issued by the National Bureau of Education—quota is allocated to each class according to a designated ratio. For example, I compete among the pilot class with a total of 18 students for the following quota:

First-place: 18*2% = 0.36 -> 1 person.

Second-place 18*6% = 1.08 -> 1 person.

Third-place: 18*12% = 2.16 -> 2 person.

Students are ranked by their ‘comprehensive evaluation score’ which is mainly a weighted sum of their grades, physical exercises, adding a ‘bonus points’ which includes the aforementioned blood donation incentive:

...

"Notably, students can earn up to 0.5 points for each voluntary blood donation, with the potential to accumulate 1 point for two donations within a year.

...

competitions

The bonus from blood donations can decisively influence scholarship outcomes"

...

"the donation rush

"Scholarship is not only about money. The mental value that it carries, and more importantly, winning the ‘People’s Scholarship’ is a necessary for applying for further honors. Because of this huge incentive, students rush to get their blood donated.

"Given the scarcity of blood donation opportunities—only five to six campus visits yearly by the Shanghai blood center, each time offering around 150-200 quotas—students often queue from as early as 6 a.m. to secure a donation form. Latecomers, even those arriving slightly past 7 a.m., risk missing out due to the limited number of forms available.

"I’ve been there. Only got a form the second time."

Interview with Daron Acemoglu – on AI and crypto

 Interview with Daron Acemoglu – Frank Pagano

"What exponential technologies will change our world, in your opinion, by 2030 – between Blockchain, AI, Spatial Computing, Quantum?

"Difficult to say. All of these are highly hyped. Which technologies will flourish and find impactful applications remains to be seen. I don’t believe that blockchain has the potential to have pervasive effects except in a few narrow applications. AI is a different story. Even though much of what is written and said about AI is an exaggeration, there is no doubt that AI is advancing rapidly, and it is being rolled out in many sectors. Just on that basis, I expect it will impact many sectors of the economy, including social media, communication and human resource management. Whether it can penetrate other activities, such as finance, law, education and healthcare remain to be seen. More importantly, even if it does become widely used in sectors such as education and healthcare, there is a big difference between good use and bad use. For example, rolling out ChatGPT to millions of students and encouraging them to learn from the chatbot rather than their teachers is easy. Making sure that they learn the right material and learn effectively is much harder.

...

"Do you think the financial and banking system will accept at some point crypto, or even just bitcoin? What’s your take on the future of the financial system, which should be open for all, and where financial fees should become a commodity, namely equal to zero?

"I hope not. Right now, cryptocurrencies are valuable for three simple reasons: they permit illicit activities; there is some premium because if one of them becomes widely accepted, the company in charge of it would become fabulously wealthy; and there is a bubble component to many cryptocurrencies, with gullible investors sometimes being encouraged to pay excessive valuations for some currencies. None of those sources of valuation are socially beneficial. My view is that cryptocurrencies could be useful in some very narrow circumstances, but they should be very heavily regulated."

Preference signaling in the Political Science job market

 There is now signaling in the Political Science job market:  They allow job candidates to send up to three signals: here's the APSA's page with frequently asked questions about signaling.

Aside from the procedures APSA members should use, their site offers some general comments about signaling. Some excerpts:

What is the history of signaling as applied to specialized labor markets like that for political science PhDs?

 The American Economics Association (AEA) Ad Hoc Committee on the Job Market, including Roth, applied his research to the economics PhDs job market over 15 years ago. Since the 1970s, the job market for economists has been organized around the AEA and related associations’ annual meeting (called the Allied Social Sciences Associations, or the “ASSA”) in January and since 2006, economists have utilized signaling for job interviews that take place at the ASSA. For those who don’t secure a position there, a job “scramble” that is more public takes place later in the spring. These events act as clearinghouses to clear congestion resulting from candidates applying for almost all positions due to their need to secure a position, and also prevents “unraveling,” where employers make offers earlier and earlier each year to get the best possible candidate they can.[1] The AEA Ad Hoc Committee on the Job Market offers detailed advice on signaling for (economics) PhDs going on the job market here.

Why would the political science job market benefit from signaling?

The number of political science job postings per PhD on the job market has decreased considerably since 2011, when there were two job openings for each candidate as it recovered from the Great Recession.[1] After the COVID pandemic, the higher education job market seems to be showing signs that it is recovering more slowly, and political science is no exception to this trend. The behavior of the higher education job markets runs counter to the general labor market trend in the US where jobs are currently outnumbering jobseekers.[2]  Currently there are almost two candidates per job opening on APSA eJobs.[3] The political science job market is also congested in 2023. In the last few years, candidates have reported applying for upwards of 25-50, more than 51, or more than 100 positions in a job market cycle, making the possibilities for matches endless.[4]

After the job market at APSA’s Annual Meeting in September, the job market for political science PhDs is decentralized and thin, lacking a centralizing timeframe, location, or deadline, with the only way for candidates to let employers know they are interested is to contact the hiring committee or send in an application for the position. Jobs are being posted earlier each year to secure the best candidates by utilizing the APSA Annual Meeting as a job market clearinghouse. For the remainder of the academic year, those participating in the job market lack any kind of intentionally designed mechanism to structure their path to a job placement before the next academic year..[5] For all these reasons: a surplus of jobseekers, market congestion (applying to all jobs), market unraveling (earlier and earlier offers), the political science job market would benefit from being approached with the market design tools that have been shown to alleviate these inefficiencies.

Citations

How will signaling benefit candidates and employers at APSA Annual Meeting/ Interview Services?

 Due to job market congestion, the job market centralized around the APSA Annual Meeting/ Interview Services would benefit from a mechanism for candidates and employers to be able to decipher meaningful interest more easily from candidates for positions, and to allow institutions to view candidates more equally across characteristics outside of institutional prestige, rank, or publication records. Due to the large number of candidates relative to jobs, we believe signaling can increase the number of matches facilitated, decrease the number of applications both written and submitted by candidates and reviewed by hiring committees, and decrease the stress of all participants in the market. We have created a pilot program to beta test how signaling will work for employers and candidates utilizing Interview Services at the Annual Meeting.

SITE: Empirical Market Design, today and Friday

 Session 10: Empirical Market Design  (schedule at the link)

Thu, Aug 15 2024, 8:00am - Fri, Aug 16 2024, 5:00pm PDT

Organized by

Claudia Allende Santa Cruz, Stanford University

Adam Kapor, Princeton University

Paulo Somaini, Stanford University

Empirical Market Design is an emerging research field, blending the theoretical underpinnings of market design with novel empirical approaches that are sometimes related to those used applied microeconomics, public economics, and industrial organization. This innovative approach aims to rigorously analyze and understand policy-relevant scenarios, with the focus on harnessing the efficiency and equity benefits of market forces. This session will include papers that employ empirical tools to design better markets and inform policy decisions, ultimately contributing to a more equitable and efficient outcomes.

Olympic scorekeeping (choose your comparison set)

 There are many local angles to the coverage of the Olympics. Some of them have to do with scoring systems.  Here's a story from the WSJ that counts medals in a way that's familiar where I live...

Which College Won the Olympics?  At the Paris Games, there were medalists from more than 100 schools. But there was one college that outperformed most countries—again. By Ben Cohen, Andrew Beaton,  and  Joshua Robinson

"When the Paris Olympics ended on Sunday, the final medal table looked exactly the way that everyone around the world expected. Team USA was once again at the top, followed by China, Great Britain, host France, Australia, Japan, Italy—and Stanford. 

...

"Stanford took home 39 medals, more than double the number of any other U.S. school—and more than the Netherlands, South Korea, Germany and Canada. ...

Harvard did well too:

"The eggheads from Cambridge, Mass., might not be known for starring in mainstream sports, but they thrive once every four years, when fencing, rowing and triathlon become the focus of global attention. This year, Harvard won 13 medals because the Crimson also came up big on the track, where sprinter Gabby Thomas blasted her way to three golds, and on two wheels, as cyclist Kristen Faulkner took gold in the women’s road race and the velodrome. "

End Kidney Deaths Act intoduced in Congress

 Here's the press release from the Congressional sponsors:

Malliotakis Introduces Bipartisan End Kidney Deaths Act, August 12, 2024

"(WASHINGTON, DC) - Today Congresswoman Nicole Malliotakis (NY-11) joined Reps. Don Bacon (NE-02), Josh Harder (CA-09) and Joe Neguse (CO-02) in introducing the End Kidney Deaths Act, bipartisan legislation that would provide a refundable tax credit to living kidney donors who donate kidneys to strangers, specifically those waiting the longest on the kidney waitlist.

"Specifically, the End Kidney Deaths Act will provide a $10,000 refundable tax credit per year for five years ($50,000 total) to living kidney donors who donate kidneys. If enacted, this legislation is expected to save up to 100,000 Americans currently on the waitlist and save taxpayers an estimated $10 to $37 billion."

...

VIEW THE BILL TEXT HERE

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And here's the Coalition to Modify NOTA 's press release(which includes quotes from some of their long list of supporters...)

LIFE-SAVING END KIDNEY DEATHS ACT INTRODUCED TO CONGRESS; PROJECTED TO SAVE 100K LIVES AND $37 BILLION OVER 10 YEARS

Washington DC – The End Kidney Deaths Act (H.R. 9275) has just been introduced by Congressional Representative Malliotakis (R-NY) and Representative Harder (D-CA). This bill will save up to 100,000 American lives and $37 billion tax dollars over the next decade by offering refundable tax credits to encourage living kidney donation in this ten-year pilot program. The End Kidney Deaths Act will provide all Americans who donate kidneys to strangers at the top of the kidney waitlist with a refundable tax credit of $10,000 each year for five years, totaling $50,000."

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Earlier:

Saturday, July 22, 2023

Modify NOTA: a new effort

Kidney exchange in Brazil: prelude

 Yesterday I flew home from a busy visit to Brazil, with Mike Rees and Dr. Gustavo Ferreira.  

On Wednesday we all traveled to the capital, Brasilia, meeting with government ministries and agencies about how to move kidney exchange forward there.

Our most promising meeting on Wednesday was with the company that organizes the hospitals associated with Brazil's Federal universities. We talked about research possibilities

Wednesday Aug 7: Brazilian Hospital Services Company

Our most important meeting was on Thursday with the Ministry of Health  We talked about how clinical trials of kidney exchange in Brazil could help guide changes in Brazil's organ transplant laws and regulations.

Thursday: Brazil Ministry of Health, August 8 2024

On Friday we traveled to Juiz de Fora where we participated in a transplant symposium at the Santa Casa hospital there

On Saturday we had an exciting finish to the trip, but it's not my story to tell yet, so I'll blog again after there is an official announcement.

Earlier:

Tuesday, February 27, 2024

Stanford Impact Labs announces support for kidney exchange in Brazil, India, and the U.S.

AI in college admissions

 College admissions staff must expect to be seeing a lot of personal essays written and edited by chatbots.

Here's a company, Kollegio.AI that is offering more kinds of help than that in applying to college.

They say: "Kollegio is a 100% AI and data-driven college counseling platform helping students with every aspect of the college admissions process. We pride ourselves in using ethical AI to help level the playing field."

Leading Causes of Death in the US, 2019-2023.

 Covid has dropped out of the top 10.

Leading Causes of Death in the US, 2019-2023. by Farida B. Ahmad, MPH1; Jodi A. Cisewski, MPH1; Robert N. Anderson, PhD1, JAMA.  August 8, 2024. doi:10.1001/jama.2024.15563

Designing Complex Experiments, by Susan Athey and Guido Imbens

 Here's a tantalizing set of slides about online experiments

Designing Complex Experiments: Some Recent Developments SUSAN ATHEY AND GUIDO IMBENS

This is from the 

NBER Summer Institute 2024

SI 2024 Methods Lecture: New Developments in Experimental Design and Analysis

the above link contains pointers to background papers.

Pediatric Heart Transplants: rethinking the waitlist, by Power, Sweat...Almond et al.

 Here's a paper on the design of the waitlist for pediatric heart transplants.  It's accompanied by an editorial in the journal, and a discussion at Stanford Medical School.

Here's the article

Alyssa Power, MD,a,* Kurt R. Sweat, PHD,b,* Alvin Roth, PHD,b John C. Dykes, MD,a Beth Kaufman, MD,a Michael Ma, MD,c Sharon Chen, MD, MPH,a Seth A. Hollander, MD,a Elizabeth Profita, MD,a David N. Rosenthal, MD,aLynsey Barkoff, NP,a Chiu-Yu Chen, MD, PHD,a Ryan R. Davies, MD,d Christopher S. Almond, MD, MPH, Contemporary Pediatric Heart Transplant Waitlist Mortality  Journal of the American College of Cardiology, Volume 84, Issue 7, 13 August 2024, Pages 620-632

ABSTRACT

BACKGROUND In 2016, the United Network for Organ Sharing revised its pediatric heart transplant (HT) allocation policy.

OBJECTIVES This study sought to determine whether the 2016 revisions are associated with reduced waitlist mortality and capture patient-specific risks.

METHODS Children listed for HT from 1999 to 2023 were identified using Organ Procurement and Transplantation Network data and grouped into 3 eras (era 1: 1999-2006; era 2: 2006-2016; era 3: 2016-2023) based on when the United Network for Organ Sharing implemented allocation changes. Fine-Gray competing risks modeling was used to identify factors associated with death or delisting for deterioration. Fixed-effects analysis was used to determine whether allocation changes were associated with mortality.

RESULTS Waitlist mortality declined 8 percentage points (PP) across eras (21%, 17%, and 13%, respectively; P < 0.01). At listing, era 3 children were less sick than era 1 children, with 6 PP less ECMO use (P < 0.01), 11 PP less ventilator use (P < 0.01), and 1 PP less dialysis use (P < 0.01). Ventricular assist device (VAD) use was 13 PP higher, and VAD mortality decreased 9 PP (P < 0.01). Non-White mortality declined 10 PP (P < 0.01). ABO-incompatible listings increased 27 PP, and blood group O infant mortality decreased 13 PP (P < 0.01). In multivariable analyses, the 2016 revisions were not associated with lower waitlist mortality, whereas VAD use (in era 3), ABO-incompatible transplant, improved patient selection, and narrowing racial disparities were. Match-run analyses demonstrated poor correlation between individual waitlist mortality risk and the match-run order.

CONCLUSIONS The 2016 allocation revisions were not independently associated with the decline in pediatric HT waitlist mortality. The 3-tier classification system fails to adequately capture patient-specific risks. A more flexible allocation system that accurately reflects patient-specific risks and considers transplant benefit is urgently needed. 

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Here's the accompanying editorial in JACC

Getting to Transplant Should Not Be the Goal, by David L.S. Morales MD and Benjamin S. Mantell MD, PhD

And here's the Stanford article:

Heart transplant list doesn’t rank kids by medical need, Stanford Medicine-led study finds. More babies and children survive the wait for a heart transplant than in the past, but improvements are due to better medical care, not changes to wait-list rules, a new study finds. August 5, 2024 - By Erin Digitale

“The current system is not doing a good job of capturing medical urgency, which is one of its explicit goals,” said the study’s co-lead author, economist Kurt Sweat, PhD, who conducted the research as a graduate student in economics at Stanford University. "

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Kurt's job market paper was on heart transplants for adult patients.

Friday, April 26, 2024

Kurt Sweat defends his dissertation

Update: here's another commentary on the article:

Fewer Kids Now Die While Awaiting Heart Transplant, but There’s Room for Improvement Twenty years of data show mortality has dropped. Still, with one in eight children dying on the wait list, more needs to be done.  By Yael L. Maxwell

How Do Financial Obstacles Affect Decision-Making Among Potential Living Organ Donors?

 Here's a report on the effects of helping living organ donors with their expenses.

Mandell, Rebecca J., Abigail R. Smith, Kimberly A. Gifford, Barry A. Hong, Nathan P. Goodrich, Amit K. Mathur, Melissa A. Fava, Akinlolu O. Ojo, and Robert M. Merion. "How Do Financial Obstacles Affect Decision-Making Among Potential Living Organ Donors?" Progress in Transplantation (2024): 15269248241268679.

Abstract: Introduction: Living donation increases the organ supply, but associated non-medical expenses can disincentivize donation. Programs aimed at increasing living donation need to better understand how financial obstacles, including lost wages, impact the decision to pursue donation. Methods/Approach: Forty-eight interviews were conducted and analyzed using a grounded theory approach. Findings: Three key themes were identified that influenced decision-making: emotional attachment, temporal flexibility, and job security. These themes emerged when dividing interview participants into 3 groups: close relationship donors, broader network donors, and non-directed donors, representing donation to a family member or friend, a specific person they do not know well or at all, or a non-specified individual, respectively. Most close relationship donors wanted to donate regardless of personal financial cost, based on emotional attachment to the recipient. Wage reimbursement did not typically affect their decision-making but could reduce stress. Since non-directed donors did not donate to a specific individual, they could wait to achieve financial stability before donating, if needed. While wage reimbursement might create more proximate stability, non-directed donors had the flexibility to postpone donations until they could independently achieve financial stability. Lacking emotional attachment and temporal flexibility, broader network donors were particularly active decision-makers and most influenced by wage reimbursement. Across all groups, donors with job security were more resolute about donating. Conclusion: The findings underscore the importance of lost wage reimbursement to facilitate donation and reduce stress, and policies to protect donor job security."

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Related posts:

Thursday, March 31, 2022

National Living Donor Assistance Center (NLDAC) support for lost wages and dependent care

Saturday, September 17, 2022

Non-directed organ donors and NLDAC financial support