Among American Episcopalians, and in the Anglican Communion worldwide, the issue of gay marriage has involved a contentious debate on what some regard as a repugnant transaction. That appears to be coming to a head.
Gay marriage approval sounds death knell for Anglican unity
"Bishops in the US dealt a death blow to hopes for unity in the worldwide Anglican Church when they approved in principle services for same-sex partnerships. The decision will finally split the Communion between Bible-based conservative evangelicals and liberal modernisers.
The bishops at the Episcopal General Convention voted by 104 to 30 to “collect and develop theological resources and liturgies” for blessing same-sex relationships, to be considered at the next convention in 2012.
The resolution notes the growing number of states that allow gay marriage, civil unions and domestic partnerships, and gives bishops in those regions discretion to provide a “generous pastoral response” to couples in local parishes. It was passed on Wednesday, hours after the Episcopal Church voted on Tuesday to allow the consecration of gay bishops. The motion passed by 99 to 45 among the bishops and by 72 per cent to 28 per cent among church deputies, made up of clergy and laity.
The decisions on gay consecrations and same-sex blessings end the uneasy truce agreed after the consecration of the openly gay Gene Robinson as Bishop of New Hampshire in 2003. "
Sunday, July 19, 2009
Saturday, July 18, 2009
Eugene Volokh on kidney transplantation and the law
Volokh writes:
"Should a Parent Be Required To Donate a Kidney to a Child Who Needs a Life-Saving Transplant?"
"A commenter asked this as a rhetorical question, suggesting, I think, that the answer must obviously be "no." But I don't see why, assuming that we're talking about a minor child of the parent. Parents are rightly seen as having duties to their children. These include the duties to work to support the child for 18 years (more controversially, that's extended even beyond 18 years in many child support decisions, but for now I set that aside); to care for the child; to bear a post-viability fetus, at least absent some substantial threat to the mother's life or health; and more.
Why wouldn't this also extend to the obligation to provide a life-saving transplant, at least when the risk is as low (not zero, but very low) as it is for kidney transplants? You bring a child into the world, and you incur major obligations to it; why shouldn't this be one of them?"
Volokh has earlier written, in the Harvard Law Review, an article titled
MEDICAL SELF-DEFENSE, PROHIBITED EXPERIMENTAL THERAPIES, AND PAYMENT FOR ORGANS.
He argues there that there may be a right to self defense (similar the right to use lethal force against an attacker) that would invalidate bans on experimental medical treatments, and bans on the sale of kidneys for transplant. That is, he argues that a person at risk of dying from kidney failure is being denied her right of self defense--medical self defense--when she is legally prevented from trying to buy a kidney.
Here's a relevant paragraph, which follows some other analogies:
"Olivia is dying of kidney failure. A kidney transplant would likely save her life, just as an abortion would save Alice’s, lethal self-defense might save Katherine’s, and an experimental treatment might save Ellen’s. But the federal ban on payment for organs sharply limits the availability of kidneys, so Olivia must wait years for a donated kidney; she faces a 20% chance of dying before she can get one. Barring compensation for goods or services makes them scarce. Alice and Ellen would be in extra danger if doctors were only allowed to perform abortions or experimental treatments for free. Katherine likely wouldn’t be able to defend herself with a gun or knife if weapons could only be donated. Likewise, Olivia’s ability to protect her life is undermined by the organ payment ban."
HT: Steve Leider
"Should a Parent Be Required To Donate a Kidney to a Child Who Needs a Life-Saving Transplant?"
"A commenter asked this as a rhetorical question, suggesting, I think, that the answer must obviously be "no." But I don't see why, assuming that we're talking about a minor child of the parent. Parents are rightly seen as having duties to their children. These include the duties to work to support the child for 18 years (more controversially, that's extended even beyond 18 years in many child support decisions, but for now I set that aside); to care for the child; to bear a post-viability fetus, at least absent some substantial threat to the mother's life or health; and more.
Why wouldn't this also extend to the obligation to provide a life-saving transplant, at least when the risk is as low (not zero, but very low) as it is for kidney transplants? You bring a child into the world, and you incur major obligations to it; why shouldn't this be one of them?"
Volokh has earlier written, in the Harvard Law Review, an article titled
MEDICAL SELF-DEFENSE, PROHIBITED EXPERIMENTAL THERAPIES, AND PAYMENT FOR ORGANS.
He argues there that there may be a right to self defense (similar the right to use lethal force against an attacker) that would invalidate bans on experimental medical treatments, and bans on the sale of kidneys for transplant. That is, he argues that a person at risk of dying from kidney failure is being denied her right of self defense--medical self defense--when she is legally prevented from trying to buy a kidney.
Here's a relevant paragraph, which follows some other analogies:
"Olivia is dying of kidney failure. A kidney transplant would likely save her life, just as an abortion would save Alice’s, lethal self-defense might save Katherine’s, and an experimental treatment might save Ellen’s. But the federal ban on payment for organs sharply limits the availability of kidneys, so Olivia must wait years for a donated kidney; she faces a 20% chance of dying before she can get one. Barring compensation for goods or services makes them scarce. Alice and Ellen would be in extra danger if doctors were only allowed to perform abortions or experimental treatments for free. Katherine likely wouldn’t be able to defend herself with a gun or knife if weapons could only be donated. Likewise, Olivia’s ability to protect her life is undermined by the organ payment ban."
HT: Steve Leider
Friday, July 17, 2009
Organ tranplants and law in Japan
Japanese transplant law and practice are in flux. Recent news stories convey different parts of the story.
Japan’s Parliament Eases Rules on Organ Transplants, Death Law
July 13 (Bloomberg) -- Japan’s parliament approved legislation to ease restrictions on organ transplants in a move that backers say will save thousands of lives.
The upper house today approved a bill passed in the lower chamber last month that eliminates the need for a written will for organ donations. The new rules also accept a lack of brain function as a legal definition of death.
Doctors performed 11 heart transplants in Japan last year, according to the Japanese Circulation Society, compared with more than 2,000 in the U.S. The 12-year-old limitations lawmakers voted to end today had forced Japanese to travel overseas for transplants “as a last resort to survive,” according to a joint statement from medical groups including the Japan Society for Transplantation.
Each year, about 400 Japanese die because they aren’t able to get a heart transplant, while 2,000 pass away without a new liver, according to statistics presented to lawmakers last year by the society.
Travelling overseas--to the U.S.--for a heart transplant isn't an easy thing to arrange:An organ in U.S. won't be cheap
" Japanese who traveled to the United States to get new hearts were charged as much as about $1.63 million for the operation in 2008, or five times higher than in previous years, medical sources well-versed in organ transplants said Thursday.
...The average fee charged to 42 Japanese who went to the U.S. for heart transplants between 1998 and 2008 rose to about ¥80 million last year, compared with between ¥30 million and ¥70 million in the past, they said.
One child patient was charged as much as ¥160 million for the operation last year, while another was required to put down a deposit of ¥400 million in March, the sources said.
In the U.S., the only country that accepts Japanese for heart transplants, nationals are charged $300,000 on average in hospital and physician fees for the operation, they said, adding that the figure does not include pre- and posttreatment fees."
Japan lifts ban on children donating organs
"Japan lifted a ban Monday on organ donations from children, reversing a restriction that created such a dearth of small organs in the country that young patients were forced to seek transplants abroad.
The law will allow children, defined as those under 15, who are brain dead to donate their organs — a sea change in this country, where organ donating is sensitive because of Buddhist beliefs consider the body sacred and reject its desecration."
Kids under 15 can give organs
"The bill, known as Plan A, which won Lower House approval last month, allows brain-dead children under age 15 to be an organ donor with the family's consent and recognizes brain death as legal death.
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...The current transplant law, enacted 12 years ago, forbids brain-dead people under age 15 from becoming an organ donor. Supporters of Plan A had aimed to revise the law to increase the self-sufficiency of domestic organ availability, but some lawmakers argued brain death is too sensitive an issue and thus should not be universally recognized as actual death. " (HT: Jun Wako)
Related recent post: Children can't get organ donations in Japan, because they can't be deceased donors
Japan’s Parliament Eases Rules on Organ Transplants, Death Law
July 13 (Bloomberg) -- Japan’s parliament approved legislation to ease restrictions on organ transplants in a move that backers say will save thousands of lives.
The upper house today approved a bill passed in the lower chamber last month that eliminates the need for a written will for organ donations. The new rules also accept a lack of brain function as a legal definition of death.
Doctors performed 11 heart transplants in Japan last year, according to the Japanese Circulation Society, compared with more than 2,000 in the U.S. The 12-year-old limitations lawmakers voted to end today had forced Japanese to travel overseas for transplants “as a last resort to survive,” according to a joint statement from medical groups including the Japan Society for Transplantation.
Each year, about 400 Japanese die because they aren’t able to get a heart transplant, while 2,000 pass away without a new liver, according to statistics presented to lawmakers last year by the society.
Travelling overseas--to the U.S.--for a heart transplant isn't an easy thing to arrange:An organ in U.S. won't be cheap
" Japanese who traveled to the United States to get new hearts were charged as much as about $1.63 million for the operation in 2008, or five times higher than in previous years, medical sources well-versed in organ transplants said Thursday.
...The average fee charged to 42 Japanese who went to the U.S. for heart transplants between 1998 and 2008 rose to about ¥80 million last year, compared with between ¥30 million and ¥70 million in the past, they said.
One child patient was charged as much as ¥160 million for the operation last year, while another was required to put down a deposit of ¥400 million in March, the sources said.
In the U.S., the only country that accepts Japanese for heart transplants, nationals are charged $300,000 on average in hospital and physician fees for the operation, they said, adding that the figure does not include pre- and posttreatment fees."
Japan lifts ban on children donating organs
"Japan lifted a ban Monday on organ donations from children, reversing a restriction that created such a dearth of small organs in the country that young patients were forced to seek transplants abroad.
The law will allow children, defined as those under 15, who are brain dead to donate their organs — a sea change in this country, where organ donating is sensitive because of Buddhist beliefs consider the body sacred and reject its desecration."
Kids under 15 can give organs
"The bill, known as Plan A, which won Lower House approval last month, allows brain-dead children under age 15 to be an organ donor with the family's consent and recognizes brain death as legal death.
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...The current transplant law, enacted 12 years ago, forbids brain-dead people under age 15 from becoming an organ donor. Supporters of Plan A had aimed to revise the law to increase the self-sufficiency of domestic organ availability, but some lawmakers argued brain death is too sensitive an issue and thus should not be universally recognized as actual death. " (HT: Jun Wako)
Related recent post: Children can't get organ donations in Japan, because they can't be deceased donors
Thursday, July 16, 2009
New Key Opinion Leaders in Transplantation
I'll be spending this weekend in Jackson Hole, Wyoming, participating in an unfamiliar ritual. The Transplantation Society introduces what they call "New Key Opinion Leaders," surgeons and others with notable accomplishments. The ritual is that each new KOL is supposed to be introduced by an old KOL. Typically a young surgeon is introduced by an old one, etc.
Here is the program. There's something a little unusual about Section 6, devoted to developments in Living Donor Exchange: Like the actor who isn't a doctor but plays one on TV, I have been asked to introduce Mike Rees, the kidney exchange innovator who is the founder of the Alliance for Paired Donation.
He and I will talk about Market Design and Kidney Exchange.
Here's the program for the session we are a part of: I'm looking forward to learning the latest.
Session 6: Living Donor Exchange
Chairs: Alan Leichtman, MI, USA and Miran Epstein, UK
Presentation 6.1
KOL: Robert A. Montgomery, Johns Hopkins Hospital, MD, USA
New KOL: Dr. Dorry L. Segev, MD, USA
Title: Living Donor Exchange: Optimization and Application
Presentation 6.2
KOL: Gabriel Danovitch, University of California in Los Angeles, CA, USA
New KOL: Dr. Jeffrey Veale, CA, USA
Title: Challenges in the Development of Living Donor Exchange Programs
Presentation 6.3
KOL: Alvin E. Roth, Harvard Business School, MA, USA
New KOL: Dr. Michael Rees, University of Toledo Medical Center, OH, USA
Title: Market Design and Kidney Exchange
Presentation 6.4
KOL: Laura A. Siminoff, Virginia Commonwealth University, VA, USA
New KOL: Dr. Heather Marshall Traino, VA, USA
Title: Improving Rates of Living Donation among Minority Population
Here is the program. There's something a little unusual about Section 6, devoted to developments in Living Donor Exchange: Like the actor who isn't a doctor but plays one on TV, I have been asked to introduce Mike Rees, the kidney exchange innovator who is the founder of the Alliance for Paired Donation.
He and I will talk about Market Design and Kidney Exchange.
Here's the program for the session we are a part of: I'm looking forward to learning the latest.
Session 6: Living Donor Exchange
Chairs: Alan Leichtman, MI, USA and Miran Epstein, UK
Presentation 6.1
KOL: Robert A. Montgomery, Johns Hopkins Hospital, MD, USA
New KOL: Dr. Dorry L. Segev, MD, USA
Title: Living Donor Exchange: Optimization and Application
Presentation 6.2
KOL: Gabriel Danovitch, University of California in Los Angeles, CA, USA
New KOL: Dr. Jeffrey Veale, CA, USA
Title: Challenges in the Development of Living Donor Exchange Programs
Presentation 6.3
KOL: Alvin E. Roth, Harvard Business School, MA, USA
New KOL: Dr. Michael Rees, University of Toledo Medical Center, OH, USA
Title: Market Design and Kidney Exchange
Presentation 6.4
KOL: Laura A. Siminoff, Virginia Commonwealth University, VA, USA
New KOL: Dr. Heather Marshall Traino, VA, USA
Title: Improving Rates of Living Donation among Minority Population
Wednesday, July 15, 2009
China outlaws shock treatment for uncontrollable urge to blog
Those of you reading this will be glad to know
China bans electric shock therapy for internet addicts
"China has outlawed the use of electric shock therapy to treat internet addiction, after a scandal at a hospital in the Northern province of Shandong."
"Internet addiction has become a growing problem in China, where officials believe as many as four million people spend more than six hours a day online.
Several clinics have sprung up, offering parents the chance to "cure" their children of the uncontrollable urge to blog..."
China bans electric shock therapy for internet addicts
"China has outlawed the use of electric shock therapy to treat internet addiction, after a scandal at a hospital in the Northern province of Shandong."
"Internet addiction has become a growing problem in China, where officials believe as many as four million people spend more than six hours a day online.
Several clinics have sprung up, offering parents the chance to "cure" their children of the uncontrollable urge to blog..."
Surrogate motherhood continued: where did I come from?
As the market for surrogate wombs becomes more usual, and as the kids grow up, some new twists are added to the question "where did I come from?"
Here's a story that makes clear that surrogacy has been around for a while. It's one of the first articles I've seen that takes for granted that surrogacy is not a repugnant transaction, a point underlined by its placement on the front page of the NY Times:
No Stork Involved, but Mom and Dad Had Help .
Here's a story that makes clear that surrogacy has been around for a while. It's one of the first articles I've seen that takes for granted that surrogacy is not a repugnant transaction, a point underlined by its placement on the front page of the NY Times:
No Stork Involved, but Mom and Dad Had Help .
Tuesday, July 14, 2009
The secondary ticket industry (scalping, to you)
The "secondary ticket industry" has a trade show, meeting tomorrow in Las Vegas, about which they say: "Ticket Summit is the leading trade show and conference in the secondary ticket industry."
These are the folks who sell tickets on the aftermarket (often after buying them on the primary market before others can), and who are often called by the more familiar, less charitable name of scalpers.
Grownup economists recognize that there's a place for secondary markets, but I wonder if a convention of ticket re-sellers doesn't have something of the flavor of a sex-workers' conference, in the sense that the participants are engaged in an industry that is often viewed as repugnant, and which is hemmed in by legal constraints that are sometimes ignored.
My attention was drawn to the conference by one of the speakers, Christian Hassold, who I met when he did an undergrad thesis on secondary ticket sales. The most interesting undergraduate theses are written by students with a real passion for what they are studying, and Christian, who is now off in the entrepreneurial world, has continued to write about ticket sales on his blog The Ticket Economist.
He always seemed like the kind of guy you would like to take in a game with, and it turned out that he's good at getting tickets too: his blog mixes reviews of news and scholarship with some practical advice: see e.g. Buying from a Scalper? Five Do’s and Don’ts, and Bargaining for Tickets on the Street.
TTE points to two thoughtful essays on scalping. One is by Trent Reznor of the band Nine Inch Nails: TR thoughts on ticket re-sellers / scalping (which also includes some interesting links).
Another is this Slate article by Mark Gimein:
Is Ticket Scalping All That Bad? Miley Cyrus' new crackdown on concert gouging just shows how complex the problem is.
These are the folks who sell tickets on the aftermarket (often after buying them on the primary market before others can), and who are often called by the more familiar, less charitable name of scalpers.
Grownup economists recognize that there's a place for secondary markets, but I wonder if a convention of ticket re-sellers doesn't have something of the flavor of a sex-workers' conference, in the sense that the participants are engaged in an industry that is often viewed as repugnant, and which is hemmed in by legal constraints that are sometimes ignored.
My attention was drawn to the conference by one of the speakers, Christian Hassold, who I met when he did an undergrad thesis on secondary ticket sales. The most interesting undergraduate theses are written by students with a real passion for what they are studying, and Christian, who is now off in the entrepreneurial world, has continued to write about ticket sales on his blog The Ticket Economist.
He always seemed like the kind of guy you would like to take in a game with, and it turned out that he's good at getting tickets too: his blog mixes reviews of news and scholarship with some practical advice: see e.g. Buying from a Scalper? Five Do’s and Don’ts, and Bargaining for Tickets on the Street.
TTE points to two thoughtful essays on scalping. One is by Trent Reznor of the band Nine Inch Nails: TR thoughts on ticket re-sellers / scalping (which also includes some interesting links).
Another is this Slate article by Mark Gimein:
Is Ticket Scalping All That Bad? Miley Cyrus' new crackdown on concert gouging just shows how complex the problem is.
Monday, July 13, 2009
Virginia Postrel on Kidney Exchange, and other (less distinguished) news coverage
Virginia Postrel's latest article in the Atlantic is about kidney exchange: ...With Functioning Kidneys for All.
She writes well (check out her Dynamist blog). In addition, as someone who gave one of her kidneys to a friend, she writes with a personal as well as a professional interest and authority. Her article mostly talks about kidney exchange as it is developing in the U.S., but also discusses possible donor compensation, and the international black market.
The article is well worth reading, and contains interesting links (including to this paper, in the New England Journal of Medicine, about a ten-transplant kidney chain, of which I'm happy to be among the coauthors).
It's a great thing to have kidney exchange covered in the press, because that allows more potential kidney exchange candidates to hear about the possibility, and it allows potential donors to know just how big an impact they could have. On this latter point, Postrel's article points out that
"Since the current transplant system extols altruism, one way to end the [long deceased donor waiting] list would be to find more altruists. With, say, 50,000 new living donors, deceased donation could easily pick up the slack. Again, the numbers aren’t that big. The Southern Baptist Convention includes 42,000 member churches; the United Methodist Church, whose Web site earlier this year featured the quote, “As United Methodists, we’re life savers,” counts more than 34,000 U.S. congregations. If each congregation produced just one new living donor, the waiting list would disappear. "
But press coverage is a bit puzzling. Not all of it is as careful and accurate and well reported as the Postrel article. (Which is not to say that even inaccurate coverage still isn't a good thing, for the way it spreads the news.) But I've been a little bemused at the way coverage sometimes simply follows press releases. Here's a story for those of you who find media an interesting subject.
Remember that NEJM article I mentioned above? It got a lot of press when it came out in March, maybe because the NEJM embargoes its articles until a day before publication, and that creates some buzz. That journal article reported a novel, non-simultaneous chain of transplants which begain in July 2007, in which 10 donors gave kidneys to 10 recipients, involving 6 transplant centers in 5 states. The innovative surgeon who was responsible for organizing that, Mike Rees, was the lead author of that article, and is the founder of the Alliance for Paired Donation. I thought the coverage was pretty accurate, perhaps because it was a news story that was about an article in a medical journal that the reporters could refer to.
But not all press releases are about peer-reviewed journal articles. This past week there have been a lot of stories about another remarkable accomplishment, another such chain, which accomplished 8 transplants, almost as many. It was organized out of Johns Hopkins, one of the leading hospitals doing kidney exchange in the U.S. It's not surprising that Hopkins surgeons should be among those pushing this kind of innovation forward; two of them who were involved in this new chain were among the coauthors of the NEJM article. And, while the accomplishment, so soon after the NEJM article, is noteworthy, the news coverage is in some ways as remarkable.
Here's the lead paragraph of the first of two stories about it in the Washington Post: "A Maryland transplant surgeon says he and doctors at four hospitals in four states have transplanted eight kidneys and he considers that the largest series of multi-kidney donations ever. "
The second Post story, the next day, repeats that claim (under the headline Successful Eight-Way Chain of Surgeries Involving Johns Hopkins Is a First:
"The first-of-its-kind surgery -- believed to be the largest chain of donations in history -- involved hospitals in four cities..."
The Post isn't alone. A few days later, after a chance to do some more in depth reporting and fact checking, the (July 11) CBS evening news reports on how one of the patients experienced "...a surprise rescue - the chance to be a part of the biggest multi-city, multi-patient domino kidney exchange ever."
There are three surprises for those interested in news reporting. First, the surgeon quoted above in the first Post story is one of the coauthors of the NEJM article about the earlier, larger chain, so that quote was an odd slip of the tongue (or, maybe he was misquoted, or maybe that's what's required to get kidney exchange the press coverage it deserves). Second, the AP and Post and CBS evening news reporters weren't aware of the earlier chain despite all the press coverage it received, including this (March 12) story (also) on the CBS Evening News about the earlier chain: A Transplant Surgeon Matches 10 Donors With Recipients In The Longest Chain In History .
But the third surprise is that there's a really great human interest story about this latest, Hopkins led chain. It's not just about the surgeons, it's also about the donors. One of the donors was a Hopkins hospital administrator, who had seen first hand the good that kidney donors can do, and wanted to help a friend, but turned out to be incompatible with that friend. That is just the kind of situation that kidney exchange was invented to help. (How do I know this? I read the Hopkins press release, which was headlined
Johns Hopkins leads first 16-patient, multicenter 'domino donor' kidney transplant.
The subheadline was "Johns Hopkins vice president 1 of the donors".
So, hats off to the Hopkins surgeons and their talented colleagues at Barnes-Jewish Hospital in St. Louis, INTEGRIS Baptist Medical Center in Oklahoma City and Henry Ford Hospital in Detroit. And a deep bow to the donors. As for the reporters, yours is a noble craft too; kidney exchange is complicated, keep trying.
(And thank you, Virginia, for your thoughtful story in the Atlantic.)
She writes well (check out her Dynamist blog). In addition, as someone who gave one of her kidneys to a friend, she writes with a personal as well as a professional interest and authority. Her article mostly talks about kidney exchange as it is developing in the U.S., but also discusses possible donor compensation, and the international black market.
The article is well worth reading, and contains interesting links (including to this paper, in the New England Journal of Medicine, about a ten-transplant kidney chain, of which I'm happy to be among the coauthors).
It's a great thing to have kidney exchange covered in the press, because that allows more potential kidney exchange candidates to hear about the possibility, and it allows potential donors to know just how big an impact they could have. On this latter point, Postrel's article points out that
"Since the current transplant system extols altruism, one way to end the [long deceased donor waiting] list would be to find more altruists. With, say, 50,000 new living donors, deceased donation could easily pick up the slack. Again, the numbers aren’t that big. The Southern Baptist Convention includes 42,000 member churches; the United Methodist Church, whose Web site earlier this year featured the quote, “As United Methodists, we’re life savers,” counts more than 34,000 U.S. congregations. If each congregation produced just one new living donor, the waiting list would disappear. "
But press coverage is a bit puzzling. Not all of it is as careful and accurate and well reported as the Postrel article. (Which is not to say that even inaccurate coverage still isn't a good thing, for the way it spreads the news.) But I've been a little bemused at the way coverage sometimes simply follows press releases. Here's a story for those of you who find media an interesting subject.
Remember that NEJM article I mentioned above? It got a lot of press when it came out in March, maybe because the NEJM embargoes its articles until a day before publication, and that creates some buzz. That journal article reported a novel, non-simultaneous chain of transplants which begain in July 2007, in which 10 donors gave kidneys to 10 recipients, involving 6 transplant centers in 5 states. The innovative surgeon who was responsible for organizing that, Mike Rees, was the lead author of that article, and is the founder of the Alliance for Paired Donation. I thought the coverage was pretty accurate, perhaps because it was a news story that was about an article in a medical journal that the reporters could refer to.
But not all press releases are about peer-reviewed journal articles. This past week there have been a lot of stories about another remarkable accomplishment, another such chain, which accomplished 8 transplants, almost as many. It was organized out of Johns Hopkins, one of the leading hospitals doing kidney exchange in the U.S. It's not surprising that Hopkins surgeons should be among those pushing this kind of innovation forward; two of them who were involved in this new chain were among the coauthors of the NEJM article. And, while the accomplishment, so soon after the NEJM article, is noteworthy, the news coverage is in some ways as remarkable.
Here's the lead paragraph of the first of two stories about it in the Washington Post: "A Maryland transplant surgeon says he and doctors at four hospitals in four states have transplanted eight kidneys and he considers that the largest series of multi-kidney donations ever. "
The second Post story, the next day, repeats that claim (under the headline Successful Eight-Way Chain of Surgeries Involving Johns Hopkins Is a First:
"The first-of-its-kind surgery -- believed to be the largest chain of donations in history -- involved hospitals in four cities..."
The Post isn't alone. A few days later, after a chance to do some more in depth reporting and fact checking, the (July 11) CBS evening news reports on how one of the patients experienced "...a surprise rescue - the chance to be a part of the biggest multi-city, multi-patient domino kidney exchange ever."
There are three surprises for those interested in news reporting. First, the surgeon quoted above in the first Post story is one of the coauthors of the NEJM article about the earlier, larger chain, so that quote was an odd slip of the tongue (or, maybe he was misquoted, or maybe that's what's required to get kidney exchange the press coverage it deserves). Second, the AP and Post and CBS evening news reporters weren't aware of the earlier chain despite all the press coverage it received, including this (March 12) story (also) on the CBS Evening News about the earlier chain: A Transplant Surgeon Matches 10 Donors With Recipients In The Longest Chain In History .
But the third surprise is that there's a really great human interest story about this latest, Hopkins led chain. It's not just about the surgeons, it's also about the donors. One of the donors was a Hopkins hospital administrator, who had seen first hand the good that kidney donors can do, and wanted to help a friend, but turned out to be incompatible with that friend. That is just the kind of situation that kidney exchange was invented to help. (How do I know this? I read the Hopkins press release, which was headlined
Johns Hopkins leads first 16-patient, multicenter 'domino donor' kidney transplant.
The subheadline was "Johns Hopkins vice president 1 of the donors".
So, hats off to the Hopkins surgeons and their talented colleagues at Barnes-Jewish Hospital in St. Louis, INTEGRIS Baptist Medical Center in Oklahoma City and Henry Ford Hospital in Detroit. And a deep bow to the donors. As for the reporters, yours is a noble craft too; kidney exchange is complicated, keep trying.
(And thank you, Virginia, for your thoughtful story in the Atlantic.)
Sunday, July 12, 2009
Dynasties in college legacy admissions
Along with other kinds of affirmative action, colleges are likely to give preferential status to applicants whose parents and other close relatives have attended. The idea seems to be that having a relationship with a family increases donations. (For example, imagine that one of your descendents will become a billionaire and look for a big philanthropic outlet. If everyone in the family has gone to Family U., maybe this urge will turn into a new campus building, whereas if everyone in your family went to a different college, maybe this philanthropy would go to the poor...)
This intuition receives some support in a recent paper, by authors at Stanford and Princeton, who study an anonymous but selective university.
Family Bonding with Universities by Jonathan Meer, Stanford University, and Harvey S. Rosen, Princeton University
From the abstract:
"One justification offered for legacy admissions policies at universities is that that they bind entire families to the university. Proponents maintain that these policies have a number of benefits, including increased donations from members of these families. We use a rich set of data from an anonymous selective research institution to investigate which types of family members have the most important effect upon donative behavior. We find that the effects of attendance by members of the younger generation (children, children-in-law, nieces and nephews) are greater than the effects of attendance by older generations (parents, parents-in-law, aunts and uncles). "
This intuition receives some support in a recent paper, by authors at Stanford and Princeton, who study an anonymous but selective university.
Family Bonding with Universities by Jonathan Meer, Stanford University, and Harvey S. Rosen, Princeton University
From the abstract:
"One justification offered for legacy admissions policies at universities is that that they bind entire families to the university. Proponents maintain that these policies have a number of benefits, including increased donations from members of these families. We use a rich set of data from an anonymous selective research institution to investigate which types of family members have the most important effect upon donative behavior. We find that the effects of attendance by members of the younger generation (children, children-in-law, nieces and nephews) are greater than the effects of attendance by older generations (parents, parents-in-law, aunts and uncles). "
Saturday, July 11, 2009
Indirect affirmative action in Texas college admissions
When the state of Texas ruled out race as an explicit criterion in college admissions, it adopted a rule that any Texas students in the top 10% of their high school class would be given automatic admission to the state university of their choice. Because Texas high schools are collectively diverse, that guaranteed a diverse freshman class. But it proved to be a very rigid way of matching students to schools, and the policy is about to end: Texas Vote Curbs a College Admission Guarantee Meant to Bolster Diversity.
"The University of Texas, Austin, a top-ranked institution, had sought changes to the program for years because it allowed admissions officials almost no latitude in putting together a class and endangered some important but less popular departments, like music. Last fall, 81 percent of the members of the incoming class were admitted under the 10 percent rule.
Suburban parents with students at schools with rigorous standards also complained that the law discriminated against their children, since it was harder to make the cut at such schools than at smaller, rural and some urban schools. "
...
"The law given final approval by the Senate on Saturday caps the number of students let in under the rule at three-quarters of the class, giving university officials discretion over the makeup of the last quarter. Sponsors of the bill had wanted a lower cap — 50 percent — but their colleagues in the House would go no lower.
Supporters said it was not a moment too soon. The state has only three top-rated universities — the University of Texas at Austin, Texas A&M University and Rice University — and it had been projected that the entire incoming class at the Austin campus would be made up of top-10-percent students by 2013."
...
"Bill Powers, the president of the University of Texas, Austin, said that, left untouched, the previous law would have forced the university, in the long run, to accept more students than it had the capacity to teach. What is more, the automatically admitted students tended to opt for popular majors, and it had become a struggle to find talented students for programs like architecture, engineering, music, art and geosciences, he said.
While still restrictive, Mr. Powers said, the new law would give admissions officers more flexibility to reach down into high school classes for students who may be brilliant in some regards, like in music, but not in the top 10 percent.
“Judging people on one criterion is not the way to do admissions policy,” he said. “No one else in the country does it.” "
"The University of Texas, Austin, a top-ranked institution, had sought changes to the program for years because it allowed admissions officials almost no latitude in putting together a class and endangered some important but less popular departments, like music. Last fall, 81 percent of the members of the incoming class were admitted under the 10 percent rule.
Suburban parents with students at schools with rigorous standards also complained that the law discriminated against their children, since it was harder to make the cut at such schools than at smaller, rural and some urban schools. "
...
"The law given final approval by the Senate on Saturday caps the number of students let in under the rule at three-quarters of the class, giving university officials discretion over the makeup of the last quarter. Sponsors of the bill had wanted a lower cap — 50 percent — but their colleagues in the House would go no lower.
Supporters said it was not a moment too soon. The state has only three top-rated universities — the University of Texas at Austin, Texas A&M University and Rice University — and it had been projected that the entire incoming class at the Austin campus would be made up of top-10-percent students by 2013."
...
"Bill Powers, the president of the University of Texas, Austin, said that, left untouched, the previous law would have forced the university, in the long run, to accept more students than it had the capacity to teach. What is more, the automatically admitted students tended to opt for popular majors, and it had become a struggle to find talented students for programs like architecture, engineering, music, art and geosciences, he said.
While still restrictive, Mr. Powers said, the new law would give admissions officers more flexibility to reach down into high school classes for students who may be brilliant in some regards, like in music, but not in the top 10 percent.
“Judging people on one criterion is not the way to do admissions policy,” he said. “No one else in the country does it.” "
Friday, July 10, 2009
Market for doctors: work rules for surgical residents
Surgical residents are young doctors in training, and there is an ongoing conflict playing out between perceptions of their training needs and patient well being and safety. The Boston Globe reports: MGH cited on surgeons' overload, Trainees' hours exceed safety rule; Hospital says it has fixed problem.
"Junior surgeons at Massachusetts General Hospital have been working too many hours, in violation of patient safety rules, according to a national accrediting organization that is threatening to put the hospital’s surgery training program on probation.
The Accreditation Council for Graduate Medical Education cited the hospital because a significant number of its surgeons in training, known as residents, were exceeding hour limits and working seven days straight. The organization believes these workloads contribute to fatigue-related mistakes, and has given the hospital until Aug. 15 to fix the problem."
...
" But five years after the hour restrictions were adopted, Warshaw and other surgeons said frustration is building at the nation’s teaching hospitals, because residents believe the rules interfere with their work and ultimately may harm, rather than help, patients.
The council acknowledged the tension in its April 13 letter to Mass. General, in which reviewers wrote: “The greatest challenge . . . has been getting the culture of the residents to change.’’
..." Dr. Thomas Nasca, head of the accreditation council, lamented in a letter to training programs earlier this year that residents are placed in an “ethical quandary’’ because “we compel them to lie [about their hours] if they do the right thing for their patients.’’
Still, the council is stepping up enforcement, and 5 percent to 10 percent of surgery programs were cited last year, including many of the country’s most prestigious training programs. Beth Israel Deaconess Medical Center was threatened with probation last year, but has since reined in residents’ workloads."
...
"Surgeons are adamantly opposed to tougher limits, saying there is little evidence that sending residents home after a prescribed work shift has improved patient care and that the rules actually may be hurting residents’ education. General surgery residents need to complete at least 750 cases during their five-year training so they are ready to operate on their own once they finish.
Any change would also have financial implications for teaching hospitals, where the nation’s 107,000 residents provide the majority of care."
I haven't done any work related to residents' work rules, but I've done a lot of work related to how residents get hired....
"Junior surgeons at Massachusetts General Hospital have been working too many hours, in violation of patient safety rules, according to a national accrediting organization that is threatening to put the hospital’s surgery training program on probation.
The Accreditation Council for Graduate Medical Education cited the hospital because a significant number of its surgeons in training, known as residents, were exceeding hour limits and working seven days straight. The organization believes these workloads contribute to fatigue-related mistakes, and has given the hospital until Aug. 15 to fix the problem."
...
" But five years after the hour restrictions were adopted, Warshaw and other surgeons said frustration is building at the nation’s teaching hospitals, because residents believe the rules interfere with their work and ultimately may harm, rather than help, patients.
The council acknowledged the tension in its April 13 letter to Mass. General, in which reviewers wrote: “The greatest challenge . . . has been getting the culture of the residents to change.’’
..." Dr. Thomas Nasca, head of the accreditation council, lamented in a letter to training programs earlier this year that residents are placed in an “ethical quandary’’ because “we compel them to lie [about their hours] if they do the right thing for their patients.’’
Still, the council is stepping up enforcement, and 5 percent to 10 percent of surgery programs were cited last year, including many of the country’s most prestigious training programs. Beth Israel Deaconess Medical Center was threatened with probation last year, but has since reined in residents’ workloads."
...
"Surgeons are adamantly opposed to tougher limits, saying there is little evidence that sending residents home after a prescribed work shift has improved patient care and that the rules actually may be hurting residents’ education. General surgery residents need to complete at least 750 cases during their five-year training so they are ready to operate on their own once they finish.
Any change would also have financial implications for teaching hospitals, where the nation’s 107,000 residents provide the majority of care."
I haven't done any work related to residents' work rules, but I've done a lot of work related to how residents get hired....
Thursday, July 9, 2009
Contraception: reversal of the direction of repugnance?
What is viewed as a repugnant transaction can change over time, and even reverse direction entirely. An example is that laws in the US have gone from prohibiting contraception to prohibiting pharmacists from declining to provide contraception.
Repugnance to contraception is far older than effective contraception, with roots sometimes attributed to the Bible*. In the United States, the Comstock Law of 1873 made it a Federal crime to sell or distribute contraceptives or information about them, and many states followed with bans of their own. These were not finally overturned until the Supreme Court, in Griswold v. Connecticut (1965), overturned Connecticut's ban on contraception, and found that the Connecticut law violated a fundamental right of privacy. (Here's a summary of the case.)
More recently, a number of states have passed laws requiring hospitals and health care providers to inform rape victims of the availability of "morning after" contraception, and sometimes requiring pharmacies to stock it and dispense it: 50 State Summary of Emergency Contraception Laws.
This in turn has raised the question of whether health care providers and pharmacists who find contraception repugnant can or should be compelled to provide information about it. One of the final acts of the Bush administration was to issue regulations allowing pharmacists and doctors to decline to provide contraception or information about it if they found it morally repugnant:
Bush's Last-Minute 'Conscience' Rules Cause Furor
"Health care workers, hospitals and even entire insurance companies could decline to perform, refer or pay for abortion or any other health care practice that violates a "religious belief or moral conviction" under new rules issued by the outgoing Bush administration.
"This rule protects the right of medical providers to care for their patients in accord with their conscience," said Health and Human Services Secretary Michael Leavitt.
But opponents of the rule, now set to take effect Jan. 19, say it could threaten patients' health. "This is a very wide, broadly written regulation that upsets what has been a carefully established balance between respecting the religious views of providers, while also making sure that we're guaranteeing patients access to health care," said Cecile Richards, president of the Planned Parenthood Federation of America. "
(See the rule here, called (confusingly) Ensuring That Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Federal Law)
Subsequently, these conscience clauses have come under attack:
Obama administration may rescind 'conscience rule'
Repugnance to contraception is far older than effective contraception, with roots sometimes attributed to the Bible*. In the United States, the Comstock Law of 1873 made it a Federal crime to sell or distribute contraceptives or information about them, and many states followed with bans of their own. These were not finally overturned until the Supreme Court, in Griswold v. Connecticut (1965), overturned Connecticut's ban on contraception, and found that the Connecticut law violated a fundamental right of privacy. (Here's a summary of the case.)
More recently, a number of states have passed laws requiring hospitals and health care providers to inform rape victims of the availability of "morning after" contraception, and sometimes requiring pharmacies to stock it and dispense it: 50 State Summary of Emergency Contraception Laws.
This in turn has raised the question of whether health care providers and pharmacists who find contraception repugnant can or should be compelled to provide information about it. One of the final acts of the Bush administration was to issue regulations allowing pharmacists and doctors to decline to provide contraception or information about it if they found it morally repugnant:
Bush's Last-Minute 'Conscience' Rules Cause Furor
"Health care workers, hospitals and even entire insurance companies could decline to perform, refer or pay for abortion or any other health care practice that violates a "religious belief or moral conviction" under new rules issued by the outgoing Bush administration.
"This rule protects the right of medical providers to care for their patients in accord with their conscience," said Health and Human Services Secretary Michael Leavitt.
But opponents of the rule, now set to take effect Jan. 19, say it could threaten patients' health. "This is a very wide, broadly written regulation that upsets what has been a carefully established balance between respecting the religious views of providers, while also making sure that we're guaranteeing patients access to health care," said Cecile Richards, president of the Planned Parenthood Federation of America. "
(See the rule here, called (confusingly) Ensuring That Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Federal Law)
Subsequently, these conscience clauses have come under attack:
Obama administration may rescind 'conscience rule'
"February 27, 2009
WASHINGTON — Taking another step into the abortion debate, the Obama administration Friday will move to rescind a controversial rule that allows health-care workers to deny abortion counseling or other family-planning services if doing so would violate their moral beliefs, according to administration officials.The rollback of the "conscience rule" comes just two months after the Bush administration announced it last year in one of its final policy initiatives.The new administration's action seems certain to stoke ideological battles between supporters and opponents of abortion rights over the responsibilities of doctors, nurses and other medical workers to their patients.Seven states, including California, Illinois and Connecticut, as well as two family planning groups, have filed suits challenging the Bush rule, arguing it sacrifices the health of patients to religious beliefs of medical providers."
(See the proposed rule here: Rescission of the Regulation Entitled ``Ensuring That Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Federal Law''; Proposal)
So it appears that we have come full circle in a certain sense, and now have laws that prohibit the withholding of information about contraception (and contraception itself), where once we had laws forbidding the dissemination of contraception and information about it.
(No wonder the study of repugnant transactions doesn't lend itself to simple theories about what is and is not repugnant...)
*The biblical story that is sometimes interpreted as indicating repugnance to contraception is the story of Onan in Genesis 38. However that story is complex, and it is far from clear to me that contraception is the issue.
Wednesday, July 8, 2009
Jury design
How to design a committee to determine when a probability is "beyond a reasonable doubt?" That's the task facing juries in criminal cases. (Juries are like prediction markets for the past: they are charged with determining probabilities ex post.)
In all but two States, the rule is that unanimous agreement is required. But the States aren't unanimous. A current challenge to a non-unanimous Oregon conviction raises the question: Guilty by a 10-2 Vote: Efficient or Unconstitutional?
"...Oregon is one of only two states that does not require juries to reach unanimous verdicts in criminal cases. Like Louisiana, it allows convictions by a vote of 10 to 2.
In a pair of decisions in 1972, the Supreme Court said that was all right, that the Constitution does not require states to insist on unanimity.
But the decisions, one each from Oregon and Louisiana, were badly fractured and internally inconsistent. They concededly ignored the historical record and made assumptions about jury behavior that have been called into question by more recent research."
...
"According to the Oregon Criminal Defense Lawyers Association, most felony convictions in the state are the products of nonunanimous juries. Oddly, misdemeanor convictions still require a unanimous vote, though from a six-member jury. That means, the association said in a brief supporting Mr. Bowen, that prosecutors face a lighter burden in more serious cases.
Oregon does require a unanimous vote in first-degree murder cases, and Louisiana requires it in capital cases.
A unanimity rule would seem to reinforce the requirement that prosecutors prove their cases beyond a reasonable doubt. Two jurors out of 12, if you do the math, represent about 17 percent of the panel. That’s a fair amount of doubt."
In all but two States, the rule is that unanimous agreement is required. But the States aren't unanimous. A current challenge to a non-unanimous Oregon conviction raises the question: Guilty by a 10-2 Vote: Efficient or Unconstitutional?
"...Oregon is one of only two states that does not require juries to reach unanimous verdicts in criminal cases. Like Louisiana, it allows convictions by a vote of 10 to 2.
In a pair of decisions in 1972, the Supreme Court said that was all right, that the Constitution does not require states to insist on unanimity.
But the decisions, one each from Oregon and Louisiana, were badly fractured and internally inconsistent. They concededly ignored the historical record and made assumptions about jury behavior that have been called into question by more recent research."
...
"According to the Oregon Criminal Defense Lawyers Association, most felony convictions in the state are the products of nonunanimous juries. Oddly, misdemeanor convictions still require a unanimous vote, though from a six-member jury. That means, the association said in a brief supporting Mr. Bowen, that prosecutors face a lighter burden in more serious cases.
Oregon does require a unanimous vote in first-degree murder cases, and Louisiana requires it in capital cases.
A unanimity rule would seem to reinforce the requirement that prosecutors prove their cases beyond a reasonable doubt. Two jurors out of 12, if you do the math, represent about 17 percent of the panel. That’s a fair amount of doubt."
Tuesday, July 7, 2009
Market Design, Experimental Economics, and Game Theory
I've recently agreed to become a director of Market Design Group, Inc., primarily for the pleasure of being associated with the stellar group of auction designers and game theorists who are the other principals of the firm.
I've also become the president elect of the Economic Science Association, the professional association that was founded to promote experimental economics.
There was a time when relatively few people saw a connection between market design and experimental economics (or were interested in either). But the connection of market design and experimental economics to each other, both directly, and through the connection of each to game theory, is becoming clearer. It helps that market design has moved from the theoretical to the practical, with economists increasingly becoming involved in design projects that go through to the establishment of successful markets.
Here are half a dozen experiments I've collaborated on related to market design (with links to my collaborators):
Kagel, John H. and A.E. Roth, "The dynamics of reorganization in matching markets: A laboratory experiment motivated by a natural experiment," Quarterly Journal of Economics, February, 2000, 201-235.
McKinney, C. Nicholas, Niederle, Muriel and Alvin E. Roth, "The collapse of a medical labor clearinghouse (and why such failures are rare)," American Economic Review, 95, 3, June, 2005, 878-889.
Niederle, Muriel, and Alvin E. Roth, "Market Culture: How Rules Governing Exploding Offers Affect Market Performance," American Economic Journal: Microeconomics, 1, 2, 2009, forthcoming.
Haruvy, Ernan, Alvin E. Roth, and M. Utku Unver,, “The Dynamics of Law Clerk Matching: An Experimental and Computational Investigation of Proposals for Reform of the Market,” Journal of Economic Dynamics and Control, 30, 3 , March 2006, Pages 457-486.
Ariely, Dan, Axel Ockenfels, and Alvin E. Roth, "An Experimental Analysis of Ending Rules in Internet Auctions," Rand Journal of Economics, 36, 4, Winter 2005, 891-908.
Katok, Elena, and Alvin E. Roth, "Auctions of Homogeneous Goods with Increasing Returns: Experimental Comparison of Alternative 'Dutch' Auctions," Management Science, 50, 8, August 2004, 1044-1063.
I've also become the president elect of the Economic Science Association, the professional association that was founded to promote experimental economics.
There was a time when relatively few people saw a connection between market design and experimental economics (or were interested in either). But the connection of market design and experimental economics to each other, both directly, and through the connection of each to game theory, is becoming clearer. It helps that market design has moved from the theoretical to the practical, with economists increasingly becoming involved in design projects that go through to the establishment of successful markets.
Here are half a dozen experiments I've collaborated on related to market design (with links to my collaborators):
Kagel, John H. and A.E. Roth, "The dynamics of reorganization in matching markets: A laboratory experiment motivated by a natural experiment," Quarterly Journal of Economics, February, 2000, 201-235.
McKinney, C. Nicholas, Niederle, Muriel and Alvin E. Roth, "The collapse of a medical labor clearinghouse (and why such failures are rare)," American Economic Review, 95, 3, June, 2005, 878-889.
Niederle, Muriel, and Alvin E. Roth, "Market Culture: How Rules Governing Exploding Offers Affect Market Performance," American Economic Journal: Microeconomics, 1, 2, 2009, forthcoming.
Haruvy, Ernan, Alvin E. Roth, and M. Utku Unver,, “The Dynamics of Law Clerk Matching: An Experimental and Computational Investigation of Proposals for Reform of the Market,” Journal of Economic Dynamics and Control, 30, 3 , March 2006, Pages 457-486.
Ariely, Dan, Axel Ockenfels, and Alvin E. Roth, "An Experimental Analysis of Ending Rules in Internet Auctions," Rand Journal of Economics, 36, 4, Winter 2005, 891-908.
Katok, Elena, and Alvin E. Roth, "Auctions of Homogeneous Goods with Increasing Returns: Experimental Comparison of Alternative 'Dutch' Auctions," Management Science, 50, 8, August 2004, 1044-1063.
Monday, July 6, 2009
Rental market for textbooks
Here's a story about Chegg.com, which rents textbooks: We Rent Movies, So Why Not Textbooks?
"Yet the Craigslist model didn’t work. When classes ended in the spring, sellers couldn’t find many buyers online and sold their used books to the college store, often for pennies on the dollar. By the time students migrated back to campus in the fall, willing online sellers were few and far between. "
...
"With demand for good deals on textbooks running high, Chegg’s success comes in large part from being able to address those inefficiencies. While Chegg primarily rents books, it is also essentially acting as a kind of “market maker,” gathering books from sellers at the end of a semester and renting — or sometimes selling — them to other students at the start of a new one. "
See also http://www.bookrenter.com/, http://www.bookswim.com/, http://www.campusbookrentals.com/...
"Yet the Craigslist model didn’t work. When classes ended in the spring, sellers couldn’t find many buyers online and sold their used books to the college store, often for pennies on the dollar. By the time students migrated back to campus in the fall, willing online sellers were few and far between. "
...
"With demand for good deals on textbooks running high, Chegg’s success comes in large part from being able to address those inefficiencies. While Chegg primarily rents books, it is also essentially acting as a kind of “market maker,” gathering books from sellers at the end of a semester and renting — or sometimes selling — them to other students at the start of a new one. "
See also http://www.bookrenter.com/, http://www.bookswim.com/, http://www.campusbookrentals.com/...
Sunday, July 5, 2009
"It's like fishing..." Indoor prostitution in Taiwan and Rhode Island
Taiwan has begun a process of legalizing prostitution : "Taiwan's cabinet will issue regulations within six months, when new regulations take effect, covering locations in Taiwan approved for prostitution."
"It's like fishing," Su said. "The activity may be legal, but in some places you can't do it."
"Taiwan outlawed prostitution 11 years ago, but older sections of the capital Taipei still teem with underground sex workers in bars and night clubs on the upper floors of high-rise buildings."
"Taiwan is the latest place to legalise prostitution. New Zealand allowed brothels to operate freely in 2003, when parliament narrowly voted to overturn 100-year-old sex laws. A court in Bangladesh decriminalized the trade in 2000, but for women only."
And in Rhode Island, things may be moving in the opposite direction.
The Providence Journal has a story about how indoor prostitution was decriminalized in Rhode Island (perhaps inadvertently, the story suggests) as part of legislation aimed at strengthening laws against public solicitation: Behind closed doors: How R.I. decriminalized prostitution. (HT: MR). The story goes on to describe ongoing attempts to reverse that:
"This year, as they have for the last three years, several state lawmakers are pushing to rewrite the 1980 law. A bill that passed the House earlier this month clearly states that anyone who engages in sex for money is guilty of a misdemeanor, punishable by up to six months in jail and a $1,000 fine. The bill is awaiting a hearing in the Senate Judiciary Committee. " (emphasis added)
Money is at the root of a lot of repugnance.
"It's like fishing," Su said. "The activity may be legal, but in some places you can't do it."
"Taiwan outlawed prostitution 11 years ago, but older sections of the capital Taipei still teem with underground sex workers in bars and night clubs on the upper floors of high-rise buildings."
"Taiwan is the latest place to legalise prostitution. New Zealand allowed brothels to operate freely in 2003, when parliament narrowly voted to overturn 100-year-old sex laws. A court in Bangladesh decriminalized the trade in 2000, but for women only."
And in Rhode Island, things may be moving in the opposite direction.
The Providence Journal has a story about how indoor prostitution was decriminalized in Rhode Island (perhaps inadvertently, the story suggests) as part of legislation aimed at strengthening laws against public solicitation: Behind closed doors: How R.I. decriminalized prostitution. (HT: MR). The story goes on to describe ongoing attempts to reverse that:
"This year, as they have for the last three years, several state lawmakers are pushing to rewrite the 1980 law. A bill that passed the House earlier this month clearly states that anyone who engages in sex for money is guilty of a misdemeanor, punishable by up to six months in jail and a $1,000 fine. The bill is awaiting a hearing in the Senate Judiciary Committee. " (emphasis added)
Money is at the root of a lot of repugnance.
Saturday, July 4, 2009
Getting what you measure: college rankings version
As the rankings of universities conducted by the magazine US News and World Reports have become more influential, there are a growing number of reports of the ways, fair and not so fair, that universities respond to what USNWR tries to measure.
Clemson University has been in the news in connection with their stated efforts to rise higher in the US News and World Report rankings of colleges.
They and their critics agree that they want to do this; the question is are they doing it in the right way for the right reasons.
Here's a critic who says no:Researcher Offers Unusually Candid Description of University's Effort to Rise in Rankings:
"Clemson University is run in an almost single-minded direction, with nearly all policies driven by how they will help the land-grant institution rise in U.S. News & World Report’s rankings, according to a university official whose candid comments stirred debate among conference-goers here on Tuesday."
and the reply:
Clemson Assails Allegations That It Manipulates 'U.S. News' Rankings
"Clemson University, stung by charges by one of its own researchers that it willfully manipulates the U.S. News & World Report rankings, fired back on Wednesday, saying the accusations are “outrageous” examples of “urban legends” that have surrounded the university’s campaign to reach the top 20 of public research universities.“The accusation that Clemson, its staff, and administrators have engaged in unethical conduct to achieve a higher ranking is untrue and unfairly disparages the sincere, unwavering, and effective efforts of faculty and staff to improve academic quality over the past 10 years,” reads a statement issued by the university’s chief spokeswoman, Catherine T. Sams. “While we have publicly stated our goal of a top-20 ranking, we have repeatedly stressed that we use the criteria as indicators of quality improvement and view a ranking as the byproduct, not the objective.” "
Here's a summary: Clemson Explains Its Approach to U.S. News Rankings
And here's a story about alleged simple mis-counting at USC's School of Engineering: More Rankings Rigging , and a summary reflecting the relation between what is measured and what is reported: Gaming the Rankings. Here's an illuminating paragraph:
"Any performance measure is ripe to be gamed. The percentage of alumni giving is a measure worth 5 percent of a ranking in U.S. News. A few years ago, Albion College made its own stir in the higher education rankings world when it increased its percentage of alumni making donations with the stroke of a pen. As The Wall Street Journal reported, the college recorded a $30 donation from a graduating senior as a $6 alumnus gift for the next five years. Clemson, in its systematic approach to raising its rank — “no indicator, no method, no process off limits to create improvement,” as Watt stated — solicited alumni donations in such a way as to increase their giving rate: Alumni were encouraged to give as little as $5 annually."
Note incidentally that there are different ways to try to rise in the rankings, and some may be strictly gaming (e.g. soliciting and/or reporting the same $30 contribution in a different way), while others (lowering the number of classes with more than 20 students) may have a positive effect by themselves. But whenever the goal is one thing, but what is or can be measured is another, there of course will be incentives to respond to what is being measured.
Clemson University has been in the news in connection with their stated efforts to rise higher in the US News and World Report rankings of colleges.
They and their critics agree that they want to do this; the question is are they doing it in the right way for the right reasons.
Here's a critic who says no:Researcher Offers Unusually Candid Description of University's Effort to Rise in Rankings:
"Clemson University is run in an almost single-minded direction, with nearly all policies driven by how they will help the land-grant institution rise in U.S. News & World Report’s rankings, according to a university official whose candid comments stirred debate among conference-goers here on Tuesday."
and the reply:
Clemson Assails Allegations That It Manipulates 'U.S. News' Rankings
"Clemson University, stung by charges by one of its own researchers that it willfully manipulates the U.S. News & World Report rankings, fired back on Wednesday, saying the accusations are “outrageous” examples of “urban legends” that have surrounded the university’s campaign to reach the top 20 of public research universities.“The accusation that Clemson, its staff, and administrators have engaged in unethical conduct to achieve a higher ranking is untrue and unfairly disparages the sincere, unwavering, and effective efforts of faculty and staff to improve academic quality over the past 10 years,” reads a statement issued by the university’s chief spokeswoman, Catherine T. Sams. “While we have publicly stated our goal of a top-20 ranking, we have repeatedly stressed that we use the criteria as indicators of quality improvement and view a ranking as the byproduct, not the objective.” "
Here's a summary: Clemson Explains Its Approach to U.S. News Rankings
And here's a story about alleged simple mis-counting at USC's School of Engineering: More Rankings Rigging , and a summary reflecting the relation between what is measured and what is reported: Gaming the Rankings. Here's an illuminating paragraph:
"Any performance measure is ripe to be gamed. The percentage of alumni giving is a measure worth 5 percent of a ranking in U.S. News. A few years ago, Albion College made its own stir in the higher education rankings world when it increased its percentage of alumni making donations with the stroke of a pen. As The Wall Street Journal reported, the college recorded a $30 donation from a graduating senior as a $6 alumnus gift for the next five years. Clemson, in its systematic approach to raising its rank — “no indicator, no method, no process off limits to create improvement,” as Watt stated — solicited alumni donations in such a way as to increase their giving rate: Alumni were encouraged to give as little as $5 annually."
Note incidentally that there are different ways to try to rise in the rankings, and some may be strictly gaming (e.g. soliciting and/or reporting the same $30 contribution in a different way), while others (lowering the number of classes with more than 20 students) may have a positive effect by themselves. But whenever the goal is one thing, but what is or can be measured is another, there of course will be incentives to respond to what is being measured.
Friday, July 3, 2009
Medical tourism and medical data
An Op-Ed in the NY Times reports on the difficulty of evaluating how well foreign hospitals do compared to American hospitals: Overseas, Under the Knife . A big difficulty is that appropriate data aren't collected on medical outcomes:
"There is reason to think the quality of care at some foreign hospitals may be comparable to quality in the United States. More than 200 offshore hospitals have been accredited by the Joint Commission International, an arm of the organization that accredits American hospitals. Many employ English-speaking surgeons who trained at Western medical schools and teaching hospitals.
So should offshore surgery be welcomed as a modest way to make American health care more affordable? We can’t know until we can directly compare the outcomes with those of American surgery. To begin, we must adopt a uniform way for American hospitals and surgeons to report on the frequency of short-term surgical complications.
Medicare could do this by requiring that all participating hospitals and surgeons count pre-surgical risk factors and post-surgical complications during hospitalization and for 30 days afterward, when most short-term problems become evident. The system used for many years by Veterans Affairs hospitals to reduce surgical complications is the best option for this, since it is available to all American doctors through the American College of Surgeons. So far, however, only a small minority of surgeons participate in this or any other valid national system of reporting surgical outcomes.
Patients and their surgeons also need comparable measurements of long-term success. Medicare should lead by adopting Sweden’s method of monitoring hip joint replacement outcomes. It tracks, for example, a patient’s ability to walk without pain six years after surgery.
Finally, Medicare should invite accredited offshore hospitals and their affiliated doctors to participate in all of its comparative performance reporting systems. Beyond informing Americans contemplating treatment abroad, such comparisons would allow us to learn if our care is the world’s best — and to accelerate our improvement efforts if it is not. "
Agreeing on what data to collect, and collecting it, isn't easy. (And of course what data you collect can influence what outcomes you get in ways that aren't all desirable.) But the lack of outcome data is a weak link in American medicine, which makes it difficult to evaluate alternative practices and procedures. I see this in discussions about kidney exchange, and my guess is that this is a big problem in improving medicine and the medical marketplace generally.
"There is reason to think the quality of care at some foreign hospitals may be comparable to quality in the United States. More than 200 offshore hospitals have been accredited by the Joint Commission International, an arm of the organization that accredits American hospitals. Many employ English-speaking surgeons who trained at Western medical schools and teaching hospitals.
So should offshore surgery be welcomed as a modest way to make American health care more affordable? We can’t know until we can directly compare the outcomes with those of American surgery. To begin, we must adopt a uniform way for American hospitals and surgeons to report on the frequency of short-term surgical complications.
Medicare could do this by requiring that all participating hospitals and surgeons count pre-surgical risk factors and post-surgical complications during hospitalization and for 30 days afterward, when most short-term problems become evident. The system used for many years by Veterans Affairs hospitals to reduce surgical complications is the best option for this, since it is available to all American doctors through the American College of Surgeons. So far, however, only a small minority of surgeons participate in this or any other valid national system of reporting surgical outcomes.
Patients and their surgeons also need comparable measurements of long-term success. Medicare should lead by adopting Sweden’s method of monitoring hip joint replacement outcomes. It tracks, for example, a patient’s ability to walk without pain six years after surgery.
Finally, Medicare should invite accredited offshore hospitals and their affiliated doctors to participate in all of its comparative performance reporting systems. Beyond informing Americans contemplating treatment abroad, such comparisons would allow us to learn if our care is the world’s best — and to accelerate our improvement efforts if it is not. "
Agreeing on what data to collect, and collecting it, isn't easy. (And of course what data you collect can influence what outcomes you get in ways that aren't all desirable.) But the lack of outcome data is a weak link in American medicine, which makes it difficult to evaluate alternative practices and procedures. I see this in discussions about kidney exchange, and my guess is that this is a big problem in improving medicine and the medical marketplace generally.
Thursday, July 2, 2009
Senate Judiciary Committee and College Football Playoffs
The United States Senate Committee on the Judiciary had the following item on its home page yesterday:
"Did You Know? The Senate Judiciary Committee conducted 104 hearings and business meetings in the 110th Congress, more than any other Senate Committee"
There is only one meeting so far on next week's calendar:
Tuesday 7/7/2009
Subcommittee on Antitrust, Competition Policy and Consumer Rights
"The Bowl Championship Series: Is it Fair and In Compliance with Antitrust Law? "
Here's the AP story: Senate to Hold Hearing on College Football's BCS
"The Senate plans to hold a hearing next week looking into antitrust issues surrounding the Bowl Championship Series. It's the second time this year that Congress is shining a light on the polarizing system college football uses to crown its national champion."
...
"Sen. Orrin Hatch of Utah, the subcommittee's top Republican and the lawmaker who sought the hearing, did not return telephone and e-mail messages left at his office Tuesday.
In an essay for Sports Illustrated being released Wednesday, Hatch wrote that the Sherman Antitrust Act prohibits contracts, combinations or conspiracies designed to reduce competition.
''I don't think a more accurate description of what the BCS does exists,'' Hatch wrote. He noted that six conferences get automatic bids to participate in series, while others do not. The system, he argued, ''intentionally and explicitly favors certain participants.''
...
Football fans in Hatch's state were furious that Utah was bypassed for the national championship despite going undefeated in the regular season. Hatch noted that President Barack Obama and others have called for the BCS to be replaced with a playoff system."
...
"David Frohnmayer, president of the University of Oregon and chairman of the BCS Presidential Oversight Committee, expressed a preference Tuesday for the current system, saying the proposals for a playoff system ''disrespect our academic calendars, and they utterly lack a business plan.'' "
College football bowls used to be an unravelled market, and, whatever its other flaws, the BCS system has largely eliminated that problem. While I'm rooting for the Judiciary Committee in their own competition to hold the most hearings, I hope that their efforts will not do too much harm to one of the main reasons we have colleges.
"Did You Know? The Senate Judiciary Committee conducted 104 hearings and business meetings in the 110th Congress, more than any other Senate Committee"
There is only one meeting so far on next week's calendar:
Tuesday 7/7/2009
Subcommittee on Antitrust, Competition Policy and Consumer Rights
"The Bowl Championship Series: Is it Fair and In Compliance with Antitrust Law? "
Here's the AP story: Senate to Hold Hearing on College Football's BCS
"The Senate plans to hold a hearing next week looking into antitrust issues surrounding the Bowl Championship Series. It's the second time this year that Congress is shining a light on the polarizing system college football uses to crown its national champion."
...
"Sen. Orrin Hatch of Utah, the subcommittee's top Republican and the lawmaker who sought the hearing, did not return telephone and e-mail messages left at his office Tuesday.
In an essay for Sports Illustrated being released Wednesday, Hatch wrote that the Sherman Antitrust Act prohibits contracts, combinations or conspiracies designed to reduce competition.
''I don't think a more accurate description of what the BCS does exists,'' Hatch wrote. He noted that six conferences get automatic bids to participate in series, while others do not. The system, he argued, ''intentionally and explicitly favors certain participants.''
...
Football fans in Hatch's state were furious that Utah was bypassed for the national championship despite going undefeated in the regular season. Hatch noted that President Barack Obama and others have called for the BCS to be replaced with a playoff system."
...
"David Frohnmayer, president of the University of Oregon and chairman of the BCS Presidential Oversight Committee, expressed a preference Tuesday for the current system, saying the proposals for a playoff system ''disrespect our academic calendars, and they utterly lack a business plan.'' "
College football bowls used to be an unravelled market, and, whatever its other flaws, the BCS system has largely eliminated that problem. While I'm rooting for the Judiciary Committee in their own competition to hold the most hearings, I hope that their efforts will not do too much harm to one of the main reasons we have colleges.
Wednesday, July 1, 2009
Chinese college admissions exams
Americans have the SATs, Chinese have the gao kao:
All-Nighter? For This Test, Some Chinese Cram All Year
"China may be changing at head-twirling speed, but the ritual of the gao kao (pronounced gow kow) remains as immutable as chopsticks. One Chinese saying compares the exam to a stampede of “a thousand soldiers and 10 horses across a single log bridge.”
The Chinese test is in some ways like the American SAT, except that it lasts more than twice as long. The nine-hour test is offered just once a year and is the sole determinant for admission to virtually all Chinese colleges and universities. About three in five students make the cut."
Many students who don't do well in one year study for an additional year and take the exam again:
Furthermore, different regions have different rules about how the exam is used in the application process. In some regions, students take the exam and learn their scores before deciding how to fill out a rank order list of applications (in which the first choice is a critical one). These students know how well they did on the exam compared to others in their region, so the only uncertainty is how many other students will apply to each top university, and hence where the exam cutoffs will be that will be needed to get in under quota.
In other regions, students make their applications after taking the exam, but before the results are announced, so they only have an estimate of how well they did compared to others. And in still other regions, students must decide on their applications before even taking the exam, so they only have information about how well they have performed on other measures compared to other students.
Thus, along with the ordinary difficulties of applying to university, different strategic decisions about how to deal with the application process face students in different regions.
All-Nighter? For This Test, Some Chinese Cram All Year
"China may be changing at head-twirling speed, but the ritual of the gao kao (pronounced gow kow) remains as immutable as chopsticks. One Chinese saying compares the exam to a stampede of “a thousand soldiers and 10 horses across a single log bridge.”
The Chinese test is in some ways like the American SAT, except that it lasts more than twice as long. The nine-hour test is offered just once a year and is the sole determinant for admission to virtually all Chinese colleges and universities. About three in five students make the cut."
Many students who don't do well in one year study for an additional year and take the exam again:
"Mr. Liu calculated that his score leaped by more than 100 points over last year’s dismal performance. But he was still downcast, uncertain whether he would make the cutoff to apply to top-tier universities. The cutoff mark can vary by an applicant’s place of residence and ethnicity."
That last point is actually a very interesting feature of college admissions in China. As I understand it, the exam for the elite universities is the same exam everywhere, but it is administered and evaluated differently in different regions. Thus Peking University (whose name in English survived the change in the English spelling of the city to Beijing) sets a different admissions threshhold for different regions. I believe it also has a different quota of students from different regions, so that students from a given region compete only with each other for admission to PU (or Beida, as it is known in Mandarin).Furthermore, different regions have different rules about how the exam is used in the application process. In some regions, students take the exam and learn their scores before deciding how to fill out a rank order list of applications (in which the first choice is a critical one). These students know how well they did on the exam compared to others in their region, so the only uncertainty is how many other students will apply to each top university, and hence where the exam cutoffs will be that will be needed to get in under quota.
In other regions, students make their applications after taking the exam, but before the results are announced, so they only have an estimate of how well they did compared to others. And in still other regions, students must decide on their applications before even taking the exam, so they only have information about how well they have performed on other measures compared to other students.
Thus, along with the ordinary difficulties of applying to university, different strategic decisions about how to deal with the application process face students in different regions.
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