One of the reasons that kidney exchange is proving successful is that the dangers to donors seem to be quite low. In principle, liver exchange is also a possibility: a healthy donor can donate one lobe of his liver, and expect it to grow back. But a recent study of live-donor liver transplants at the pioneering University of Pittsburgh Medical Center reveals that the rate of complications for live liver donors may be quite high: UPMC liver transplant study finds flaws: Study reveals high rate of complications from UPMC procedures that used living donors .
"The study looked specifically at operations in which the larger, right lobe of the donor's liver was removed, and said that "no matter how carefully right lobar [living donor liver transplant] is applied, the historical verdict on the ethics of this procedure may be harsh. There is no precedent of a surgical procedure that exposes healthy persons to such a high risk on behalf of others."
While all 121 liver donors were still alive at the time the study was written, more than 10 percent of them also suffered serious postoperative complications.
The study also concluded that while some people argue that living donor transplants keep recipients from becoming critically ill while waiting for an organ, "in a reversal of fortune," 11 of the 121 recipients became so sick after their initial transplants that they had to get second livers from deceased donors. Only five of the 11 were still alive at the time the study was written."
The article also offers a window on the complicated decisions facing transplant surgeons generally (and not just liver transplant surgeons) about which patients should be offered a transplant. The news story quotes one doctor summarizing the issue as follows:
""I think the study's authors are ...also are bringing out the whole issue that we need to be careful and not just charge ahead and let cowboys do this procedure" "
Tuesday, October 20, 2009
Monday, October 19, 2009
Kidney Exchange and Nurse Coordinators
Lots of people play critical roles in making kidney exchange a reality, and a recent article emphasizes the enormous role played by nurse coordinators: Nurses: Kidney Exchange Registries Increase Compatability, Hope:
"Nurses Make It Happen: The foundation for these exchange programs is collaboration among transplant centers and the cornerstone is the nurse coordinator at each facility. These nurses are in frequent contact and are negotiating solutions as problems occur. They coordinate schedules and shipping arrangements to get the kidneys where they are needed in the shortest possible time. “We often ship the kidney to the recipient because it can be hard for donors to travel,” Charlton says. “There are times the donor is in California and the recipient is on the East Coast. The coordination among transplant centers is a massive undertaking.”Morgievich and Charlton agree the nurses who coordinate the exchanges are the driving force that makes the whole complex machine run. Larger transplant centers are the major players because they have the expertise and resources to be innovative about approaches to exchanges. Operating room schedules have to be coordinated, and detailed logistical communication schedules are set up across miles and time zones, so that as the living donor kidneys are removed and prepared for transport across the hall or across the continent, the recipient is ready. Although the surgical procedure is similar in every case, surgeons share details about the anatomy of the organ with the receiving surgical team. "
"Morgievich notes that if anyone entered “kidney exchange” into an Internet search engine five years ago, they would have had negligible results. A Google search today produced 1.2 million results in less than a second.“This is a whole new ball game, and we’ve had to create new ways to look at sharing best practices. We’ve even had to create a language for the way it works,” she says. “When we have paired donor and recipients combined with an altruistic donor, we usually have a donor at the end of the chain. We sometimes hold that donor over or find an appropriate recipient from the wait list. That last donor in the chain is called a ‘bridge donor’ because sometimes they wait until we can organize another series of exchanges. They are the bridge to the new chain.” "
Here's the google search for kidney exchange, and here are my previous blog posts with kidney exchange as a tag.
"Nurses Make It Happen: The foundation for these exchange programs is collaboration among transplant centers and the cornerstone is the nurse coordinator at each facility. These nurses are in frequent contact and are negotiating solutions as problems occur. They coordinate schedules and shipping arrangements to get the kidneys where they are needed in the shortest possible time. “We often ship the kidney to the recipient because it can be hard for donors to travel,” Charlton says. “There are times the donor is in California and the recipient is on the East Coast. The coordination among transplant centers is a massive undertaking.”Morgievich and Charlton agree the nurses who coordinate the exchanges are the driving force that makes the whole complex machine run. Larger transplant centers are the major players because they have the expertise and resources to be innovative about approaches to exchanges. Operating room schedules have to be coordinated, and detailed logistical communication schedules are set up across miles and time zones, so that as the living donor kidneys are removed and prepared for transport across the hall or across the continent, the recipient is ready. Although the surgical procedure is similar in every case, surgeons share details about the anatomy of the organ with the receiving surgical team. "
"Morgievich notes that if anyone entered “kidney exchange” into an Internet search engine five years ago, they would have had negligible results. A Google search today produced 1.2 million results in less than a second.“This is a whole new ball game, and we’ve had to create new ways to look at sharing best practices. We’ve even had to create a language for the way it works,” she says. “When we have paired donor and recipients combined with an altruistic donor, we usually have a donor at the end of the chain. We sometimes hold that donor over or find an appropriate recipient from the wait list. That last donor in the chain is called a ‘bridge donor’ because sometimes they wait until we can organize another series of exchanges. They are the bridge to the new chain.” "
Here's the google search for kidney exchange, and here are my previous blog posts with kidney exchange as a tag.
Sunday, October 18, 2009
The kidney supply chain
The Minneapolis Star Tribune has given its health reporter Josephine Marcotty unusual scope to write about kidney transplantation in a multi-part series on kidney failure, treatment, and transplantation, and she has done them proud.
Part 1: 'Survival of the savviest' explored the challenges of being on dialysis, waiting for a deceased donor, and looking for a live one.
"But the two supply systems -- living and deceased -- remain radically different. Organs from deceased donors are viewed as a public asset -- like national parks -- and their allocation is highly regulated for fairness and transparency. There are disparities in who earns a spot on the deceased donation list, but they are generally viewed as a consequence of inequities in the overall health care system. A living donation, on the other hand, is a private gift from one person to another. Except for a federal law that makes selling organs a felony, there is no oversight and no support for living donation by the government or the transplant community. As a consequence, finding a living donor is often a matter of wealth, social advantage -- or pure luck."
Part 2: Balancing life and death looks at the process by which willing live kidney donors are accepted or rejected, a process that involves both whether their kidney is compatible with their intended recipient, and their own health. The story says that the first undirected living donor was accepted in Minnesota. More generally,
"Competition between transplant centers is fierce. Minnesota, for example, has four hospitals that compete for kidney patients and organs. If one transplant center changes its standards, sooner or later the others often follow. One reason is that everyone, except perhaps the living donor, benefits. Patients fare better because kidneys from living people tend to be better quality than those from the deceased. The doctors have more control over the complex surgeries. Hospitals, for their part, make more money. Medicare pays an average of $106,000 for a transplant, regardless of whether the kidney comes from a living or deceased donor. And living donor transplants generally cost less -- about 15 to 20 percent less at the university hospital, for example. That means the hospital stands to make 15 to 20 percent more per surgery."... "Nevertheless, taking a kidney from a living person presents daunting ethical questions. In the early days of transplant medicine, things were simpler. Only genetically related relatives were accepted as donors. But family dynamics are complex; doctors and hospital social workers sometimes had to find ways to say "no'' on behalf of reluctant relatives who couldn't find the courage to say no themselves. "There's much more coercion in families than outside of families," said Dr. Stephen Textor, a kidney specialist at the Mayo Clinic. In other cases, saying no was next to impossible. "The people who really pushed it? Spouses," Garvey said. "You have your husband sitting in front of you, dying. They were telling us, 'Who are you to tell me I can't be a donor?' They were right." "
Kidney failure, Part 3: A revolution: trading donors is the installment that first caught my eye, as it deals with kidney exchange. Marcotty reports on what must have been some long interviews with Mike Rees, the surgeon responsible for many of the most important innovations in kidney exchange.The article begins with this subheadline:
"Kidney exchanges use the oldest economic model of all - trade. Computer matching can start a chain of transplants, but the idea has a long way to go."
I even make a cameo appearance in her story, where I often am, on the phone:
"Then in December 2006, Rees spent an hour-and-a-half on the phone with Alvin Roth, a Harvard economist who specializes in matching theory.
Roth has devised many matching programs, including the national system that fits medical students with specialty training centers.
He also studies what has been jokingly described as "ick-onomics" -- the economics of repugnance. For instance, most people abhor the idea of selling human body parts for transplant. But trade? That doesn't usually trigger the same kind of visceral reaction, he said."
Marcotty describes how Rees initiated the first non-simultaneous chain, through the words of the altruistic donor, Matt Jones, who started it off.
"It began with Matt Jones, a 30-year-old father of five who worked for Enterprise car rental in Petoskey, Mich. He was determined to give his kidney to anyone who needed it.
His first attempt to donate fell apart when the patient unexpectedly got a kidney from the deceased list. But after putting time and money into travel and testing, and persuading his fiancé at the time that it was a good idea, he wasn't about to give up. He called Rees.
"He tells me, 'I have this idea of doing a chain,'" Jones said in an interview. "'It's never been done. There are some people who think I'm crazy.'
"I said, 'Sounds like a great idea.' "
(Mike spends a lot of time on the phone too:)
(Here's my earlier post about that first non-simultaneous chain.)
Marcotty continues the story of non-simultaneous chains: "In March, Rees described his chain in a New England Journal of Medicine article titled "A nonsimultaneous, extended, altruistic-donor chain.... The number of transplants from swaps and chains is growing exponentially. In July, an eight-way multi-hospital series of transplants was conducted in four states over three weeks. In March, a series of six transplants was conducted at three hospitals around New York in 36 hours.
In Boston last spring, kidney exchanges were one of the hottest topics at the American Transplant Congress, a major international conference. Hundreds of surgeons, nurses and social workers absorbed PowerPoint slides that illustrated intricate webs of matches by race, age, medical condition, genetics and blood type. Instead of presentations on anti-rejection drugs, they learned about software programs."
Part 4: The ethics of kidney donation: Two views
The two views are pro and con on whether compensation for donors would improve the supply of donor kidneys, or whether this is too repugnant to contemplate. The pro position is taken by Dr. Arthur Matas, an eminent surgeon and former president of the American Transplant Society. His bottom line:
"It is immoral to stand by and watch patients die when we have the means to save them. A regulated system of compensation for donation has the potential of saving lives, shortening the waiting list and improving transplant outcomes. A regulated system protects the interests of donors. Unless Congress lifts the ban against compensation and allows pilot programs, we are guaranteed more needless death and suffering."
The con position is taken by Jeffrey Kahn, a bioethicist. His bottom line:
"Organ donation has always relied on the altruism of donors and their loved ones, with the hope that any risk for the patient is balanced by the benefit of the good deed. But most people have a price at which they might ignore whatever qualms they have about donation and become willing sellers. That changes the relationship -- from giving a gift to being paid enough to ignore the risk.
A market allows this shift, and it is a change we should be loath to accept."
Declaration of Istanbul update
I received an email regarding the 2008 Declaration of Istanbul, intended to slow/halt/reverse transplant tourism and black markets for organs. It states in part:
"On September 30, 2009, the Steering Committee of the Declaration of Istanbul met in Beirut, Lebanon, in conjunction with the Congress of the Asian Society of Transplantation, to formulate a strategy and plans for the continued implemention of the Declaration."
"Updates:
· Since the November 2008 Steering Committee meeting, there has been a reduction in organ trafficking and transplant tourism in China, the Philippines, and Pakistan. Israel has enacted legislation that impedes Israeli citizens from receiving insurance coverage for transplants performed outside of Isreal if the destination country prohibits foreign patients from undergoing transplantation. There has been a recorded reduction in foreign transplants in Colombia from 12 % to 1 % of transplants performed.
· More than 80 professional organizations and societies have endorsed the Declaration of Istanbul.
· On October 13, 2009 a Joint Report by the Council of Europe and the United Nations will be presented in New York at the United Nations to launch a global effort in combating human organ trafficking.
· In March 2010, the WHO will hold its 3rd Global Consultation on transplantation in Madrid, Spain (in collaboration with TTS and ONT) to foster the development of self sufficiency in each nation in providing organ transplants for its residents. "
"Mission Statement:
The Mission of the Declaration of Istanbul Custodian Group (DICG) is to promote, implement and uphold the Declaration of Istanbul so as to combat organ trafficking, transplant tourism and transplant commercialism and to encourage adoption of effective and ethical transplantation practices around the world. "
"The following GOALS have been identified for these revised Task Forces:
I. Professional Organizations:
· Professional Organizations require that speakers at scientific and educational meetings on clinical organ transplantation disclose whether the clinical and research activities being reported have complied with the Principles of the Declaration of Istanbul.
· Professional Organizations have an established mechanism for determining the appropriateness of accepting presentations on clinical organ transplantation based on the disclosure of their compliance with the Principles of the Declaration of Istanbul.
· Organizations that endorse the Declaration of Istanbul establish mechanisms to promote, implement and uphold the Declaration (for example, through their ethics committees, awards and membership criteria).
II. Medical and Scientific Journals:
Medical and scientific journals require that authors of articles relating to clinical organ transplantation disclose whether the clinical and research activities being reported have complied with the Principles of the Declaration of Istanbul.
Medical and scientific journals have an established mechanism for determining the appropriateness of accepting presentations on clinical organ transplantation based on the disclosure of their compliance with the Principles of the Declaration of Istanbul.
III. Pharmaceutical Companies and Other Research Sponsors:
· Pharmaceutical companies establish a mechanism to ensure that the clinical studies of organ transplantation they support comply with the Principles of the Declaration of Istanbul.
· Pharmaceutical companies disclose whether the clinical studies of organ transplantation they support comply with the Principles of the Declaration of Istanbul.
· All organizations and individuals that fund clinical studies of organ transplantation establish a mechanism to ensure that these studies comply with the Principles of the Declaration of Istanbul.
· All organizations and individuals that fund clinical studies of organ transplantation disclose whether these studies comply with the Principles of the Declaration of Istanbul.
IV. Violations of the Declaration:
· Violations of the Principles of the Declaration are drawn to the attention of relevant healthcare authorities and institutions and medical societies as well as to the World Health Organization and other relevant intergovernmental organizations.
V. Government and Healthcare Institutions:
· Governments and responsible national authorities adopt and implement policies, laws and regulations in accordance with the Principles of the Declaration of Istanbul and the WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation.
· Hospitals and other healthcare institutions engaged in organ transplantation services adopt and implement policies in accordance with the Principles of the Declaration.
· National and institutional ethics committees develop policies concerning organ transplantation which are in accordance with the Principles of the Declaration."
In related news, the United Nations and the Council of Europe have launched a study on "Trafficking in organs, tissues and cells and trafficking in human beings for the purpose of the removal of organs". (Here's a brief news report.)
"On September 30, 2009, the Steering Committee of the Declaration of Istanbul met in Beirut, Lebanon, in conjunction with the Congress of the Asian Society of Transplantation, to formulate a strategy and plans for the continued implemention of the Declaration."
"Updates:
· Since the November 2008 Steering Committee meeting, there has been a reduction in organ trafficking and transplant tourism in China, the Philippines, and Pakistan. Israel has enacted legislation that impedes Israeli citizens from receiving insurance coverage for transplants performed outside of Isreal if the destination country prohibits foreign patients from undergoing transplantation. There has been a recorded reduction in foreign transplants in Colombia from 12 % to 1 % of transplants performed.
· More than 80 professional organizations and societies have endorsed the Declaration of Istanbul.
· On October 13, 2009 a Joint Report by the Council of Europe and the United Nations will be presented in New York at the United Nations to launch a global effort in combating human organ trafficking.
· In March 2010, the WHO will hold its 3rd Global Consultation on transplantation in Madrid, Spain (in collaboration with TTS and ONT) to foster the development of self sufficiency in each nation in providing organ transplants for its residents. "
"Mission Statement:
The Mission of the Declaration of Istanbul Custodian Group (DICG) is to promote, implement and uphold the Declaration of Istanbul so as to combat organ trafficking, transplant tourism and transplant commercialism and to encourage adoption of effective and ethical transplantation practices around the world. "
"The following GOALS have been identified for these revised Task Forces:
I. Professional Organizations:
· Professional Organizations require that speakers at scientific and educational meetings on clinical organ transplantation disclose whether the clinical and research activities being reported have complied with the Principles of the Declaration of Istanbul.
· Professional Organizations have an established mechanism for determining the appropriateness of accepting presentations on clinical organ transplantation based on the disclosure of their compliance with the Principles of the Declaration of Istanbul.
· Organizations that endorse the Declaration of Istanbul establish mechanisms to promote, implement and uphold the Declaration (for example, through their ethics committees, awards and membership criteria).
II. Medical and Scientific Journals:
Medical and scientific journals require that authors of articles relating to clinical organ transplantation disclose whether the clinical and research activities being reported have complied with the Principles of the Declaration of Istanbul.
Medical and scientific journals have an established mechanism for determining the appropriateness of accepting presentations on clinical organ transplantation based on the disclosure of their compliance with the Principles of the Declaration of Istanbul.
III. Pharmaceutical Companies and Other Research Sponsors:
· Pharmaceutical companies establish a mechanism to ensure that the clinical studies of organ transplantation they support comply with the Principles of the Declaration of Istanbul.
· Pharmaceutical companies disclose whether the clinical studies of organ transplantation they support comply with the Principles of the Declaration of Istanbul.
· All organizations and individuals that fund clinical studies of organ transplantation establish a mechanism to ensure that these studies comply with the Principles of the Declaration of Istanbul.
· All organizations and individuals that fund clinical studies of organ transplantation disclose whether these studies comply with the Principles of the Declaration of Istanbul.
IV. Violations of the Declaration:
· Violations of the Principles of the Declaration are drawn to the attention of relevant healthcare authorities and institutions and medical societies as well as to the World Health Organization and other relevant intergovernmental organizations.
V. Government and Healthcare Institutions:
· Governments and responsible national authorities adopt and implement policies, laws and regulations in accordance with the Principles of the Declaration of Istanbul and the WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation.
· Hospitals and other healthcare institutions engaged in organ transplantation services adopt and implement policies in accordance with the Principles of the Declaration.
· National and institutional ethics committees develop policies concerning organ transplantation which are in accordance with the Principles of the Declaration."
In related news, the United Nations and the Council of Europe have launched a study on "Trafficking in organs, tissues and cells and trafficking in human beings for the purpose of the removal of organs". (Here's a brief news report.)
Peter Singer on compensating kidney donors
Kidneys for Sale? by Peter Singer
The distinguished Princeton philosopher of bioethics takes a nuanced view of the matter of compensation for donors, in a discussion of organ sales that touches on New York, Singapore, and Iran.
HT: Joshua Gans
The distinguished Princeton philosopher of bioethics takes a nuanced view of the matter of compensation for donors, in a discussion of organ sales that touches on New York, Singapore, and Iran.
HT: Joshua Gans
Saturday, October 17, 2009
31 States have laws against price gouging
So reports Michael Giberson at KP, based on a Master's thesis by Cale Wren Davis, supervised by Randy Rucker at Montana State. The thesis is here: AN ANALYSIS OF THE ENACTMENT OF ANTI-PRICE GOUGING LAWS.
I'm struck by how relatively recent anti price gouging laws are: 27 of the 31 were passed in the 1990s or 2000s, with the rest passed in 1979 (NY), 1983 (HI), 1986 (CT), and 1986 (MS).
The laws come into force when some kind of state of emergency has been declared, and most set a price ceiling at "pre-emergency prices," although some set a ceiling higher than that, the highest being 25% above pre-emergency prices.
I'm struck by how relatively recent anti price gouging laws are: 27 of the 31 were passed in the 1990s or 2000s, with the rest passed in 1979 (NY), 1983 (HI), 1986 (CT), and 1986 (MS).
The laws come into force when some kind of state of emergency has been declared, and most set a price ceiling at "pre-emergency prices," although some set a ceiling higher than that, the highest being 25% above pre-emergency prices.
"No Toilet, No Bride" in rural India
Emily Wax at the Washington Post reports on some consequences of the increased education and economic power of rural Indian women: In India, New Seat of Power for Women. Prospective Brides Demand Sought-After Commodity: A Toilet.
"About 665 million people in India -- about half the population -- lack access to latrines. But since a "No Toilet, No Bride" campaign started about two years ago, 1.4 million toilets have been built here in the northern state of Haryana, some with government funds, according to the state's health department.
Women's rights activists call the program a revolution as it spreads across India's vast and largely impoverished rural areas.
"I won't let my daughter near a boy who doesn't have a latrine," said Usha Pagdi, who made sure that daughter Vimlas Sasva, 18, finished high school and took courses in electronics at a technical school.
"No loo? No 'I do,' " Vimlas said, laughing as she repeated a radio jingle. "
"About 665 million people in India -- about half the population -- lack access to latrines. But since a "No Toilet, No Bride" campaign started about two years ago, 1.4 million toilets have been built here in the northern state of Haryana, some with government funds, according to the state's health department.
Women's rights activists call the program a revolution as it spreads across India's vast and largely impoverished rural areas.
"I won't let my daughter near a boy who doesn't have a latrine," said Usha Pagdi, who made sure that daughter Vimlas Sasva, 18, finished high school and took courses in electronics at a technical school.
"No loo? No 'I do,' " Vimlas said, laughing as she repeated a radio jingle. "
Friday, October 16, 2009
Harvard's financial report
Here's a link to the Harvard University Financial Report for fiscal year 2009.
Simultaneous offers in a computer science search at Harvard
Michael Mitzenmacher writes about some job searches in computer science, including one that he chaired that was able to make 6 simultaneous offers, and ended up hiring 3 people. He argues that making simultaneous offers sends a signal. (It is certainly a signal about the support the university is offering to the department, and the direction that it is taking...)
"in our last search (which I was leading), where we ended up making 6 offers (and got 3 acceptances). We (the hiring committee) recognized that we were making a rather significant request to have 6 simultaneous outstanding offers. We also recognized the dangers in trying to sequentialize these offers. First, there was the internal danger -- the complex discussions (we had such a great committee, we wouldn't have argued) we would have had to undertake to rank-order everyone we wanted to make an offer to. And second, there's the external danger that the candidate -- who will, of course, find out they were the "second choice" -- takes the ordering as a negative signal and becomes more inclined to take another offer. One can argue whether or not a candidate should take such an ordering as a signal, or whether such a reaction is a purely emotional response. (See Mihai's post, for example, and judge for yourself in that case.) But it was clear to us that, even if no such signal was intended, there was a high risk that would be the interpretation from the standpoint of the candidate.Mihai's post provides a solid empirical data point that we were right to have this concern; it's something I will keep in mind (and if necessary point to) in future hiring discussions. I'm glad we were able to make 6 simultaneous offers, and give all of the candidates we made offers to the right signal."
HT: Itai Ashlagi, who is on the job market this year
"in our last search (which I was leading), where we ended up making 6 offers (and got 3 acceptances). We (the hiring committee) recognized that we were making a rather significant request to have 6 simultaneous outstanding offers. We also recognized the dangers in trying to sequentialize these offers. First, there was the internal danger -- the complex discussions (we had such a great committee, we wouldn't have argued) we would have had to undertake to rank-order everyone we wanted to make an offer to. And second, there's the external danger that the candidate -- who will, of course, find out they were the "second choice" -- takes the ordering as a negative signal and becomes more inclined to take another offer. One can argue whether or not a candidate should take such an ordering as a signal, or whether such a reaction is a purely emotional response. (See Mihai's post, for example, and judge for yourself in that case.) But it was clear to us that, even if no such signal was intended, there was a high risk that would be the interpretation from the standpoint of the candidate.Mihai's post provides a solid empirical data point that we were right to have this concern; it's something I will keep in mind (and if necessary point to) in future hiring discussions. I'm glad we were able to make 6 simultaneous offers, and give all of the candidates we made offers to the right signal."
HT: Itai Ashlagi, who is on the job market this year
Thursday, October 15, 2009
Interviewing for the medical match
A recent article* in the Journal of the American Medical Association talks about the strategic behavior that precedes the submission of rank order preference lists to the medical match. The author was a student member of the NRMP board of directors who then participated in the match, and he describes the ways in which residency directors skirted the Match rules against soliciting information or commitments about how students would rank them. He also describes the kinds of signaling and information exchange that might not be unusual in other job markets, but which might have less consequence than in a centralized clearinghouse.
"I was startled when my first interview with an assistant program director abruptly turned from an easygoing chat to an unfriendly challenge:“Why would you ever come here?” Throughout the rest of the season, other interviewers often pushed the MPA’s boundaries, asking me,“How seriously are you considering our program?” or similar questions. Such inquiries are not violations, strictly speaking, but they still suggested that I had to make a commitment to be competitive. Worse, several interviewers did commit unambiguous violations: “If you want to match here, you have to let us know,” or “If we had a position for you, would you come here?”
...
" The atmosphere of gamesmanship extended beyond interviews. Some programs offered me formal “revisits” while others left it to me to request them. I wondered if it was necessary to travel to programs to improve my chances there. Soon after, program directors, faculty, or even residents I had met in passing started making recruitment calls, sometimes weekly.
No matter how friendly these callers were, their overtures always seemed to end with awkward pauses inviting me to make a commitment. After each one finished, I gave my standard reply, which soon became rote: “I loved visiting your program and would be honored to train there.” "
..."(Another program director inveighed against gamesmanship on the morning of a visit, but later that day, an interviewer stated outright that in order to match there I had to make a commitment to them.)... As the ranking deadline approached, I felt compelled to tell my top-ranked program that it was first, and painstakingly crafted enthusiastic e-mails to others. Many of the other applicants I know did the same.
Most of us applicants were rewarded for participating in these courtship rituals. I was told I was “ranked to match” by a number of programs, and it was public knowledge that other students were receiving similar commitments. That said, whatever relief these assurances gave us was tempered by horror stories from years past.One student had been sent real estate clippings from his top-choice program, covered with breathless Post-it notes: “Looking forward to seeing you here!” Weeks later, he was shocked to match at a different program."
*(Fisher, Carl Erik, 2009, "Manipulation and the Match," JAMA, 302,12 (Oct 1), 1266-7.)
Wednesday, October 14, 2009
Inside a philosophy search (from the labor demand side)
Lou Marinoff describes the search process that led to the hiring of two philosophers this year at City College of the City University of New York. They received 637 applications. They could have used an electronic application process...
"This posed a major filing challenge since less well-organized applicants sent in their materials in dribs and drabs. Hundreds of letters of recommendation not bundled with applications had to be opened, tallied and filed. At times, six boxes had to be displaced to file one piece of paper. It became a common sight to behold members of our search committee trundling half a dozen boxes to their offices on handcarts so they could keep up with the incoming deluge."
"The committee’s next task was to compile a “long list” of applicants to interview at the upcoming American Philosophical Association (APA) Eastern Division annual meeting. We had less than four weeks to identify and notify the candidates we wanted to meet with in time for the event, held December 27–30 in Philadelphia."
"How did we prune our field from 637 to 27? An important selection criterion was holding a Ph.D. from a good university. ...
A second criterion was research and publication. ...
Third, we needed evidence of undergraduate teaching ability as well as versatility. ...We looked for evidence of outstanding teaching ability, variety, and potential for curriculum development.
Finally, we wanted evidence of administrative service. "
After the interviews came the flyouts:
"We attained consensus on six finalists whom we invited to campus in February 2009. They ran a gauntlet of meetings, and each one had to give a “guest lecture” for an undergraduate course in progress – as opposed to reading a paper in a departmental colloquium. We knew they could all read and write well enough, or they wouldn’t have been finalists."
And finally came the negotiations with the administration
"Not long after handing our final rankings to Dean Reynolds, he called me into his office. He informed me that the abundant fruits of our search, and the energy we had invested in it, had not escaped the notice of our senior administration. Prudentially, I recalled the second of three infamous Chinese curses: “May the government be aware of you.” But this time it was a blessing."
"This posed a major filing challenge since less well-organized applicants sent in their materials in dribs and drabs. Hundreds of letters of recommendation not bundled with applications had to be opened, tallied and filed. At times, six boxes had to be displaced to file one piece of paper. It became a common sight to behold members of our search committee trundling half a dozen boxes to their offices on handcarts so they could keep up with the incoming deluge."
"The committee’s next task was to compile a “long list” of applicants to interview at the upcoming American Philosophical Association (APA) Eastern Division annual meeting. We had less than four weeks to identify and notify the candidates we wanted to meet with in time for the event, held December 27–30 in Philadelphia."
"How did we prune our field from 637 to 27? An important selection criterion was holding a Ph.D. from a good university. ...
A second criterion was research and publication. ...
Third, we needed evidence of undergraduate teaching ability as well as versatility. ...We looked for evidence of outstanding teaching ability, variety, and potential for curriculum development.
Finally, we wanted evidence of administrative service. "
After the interviews came the flyouts:
"We attained consensus on six finalists whom we invited to campus in February 2009. They ran a gauntlet of meetings, and each one had to give a “guest lecture” for an undergraduate course in progress – as opposed to reading a paper in a departmental colloquium. We knew they could all read and write well enough, or they wouldn’t have been finalists."
And finally came the negotiations with the administration
"Not long after handing our final rankings to Dean Reynolds, he called me into his office. He informed me that the abundant fruits of our search, and the energy we had invested in it, had not escaped the notice of our senior administration. Prudentially, I recalled the second of three infamous Chinese curses: “May the government be aware of you.” But this time it was a blessing."
Tuesday, October 13, 2009
Academic hiring wikis and jobmarket rumors
The internet offers a number of free-form information sharing sites for academic job seekers.
Had a bad experience on the job market? (Think things are hard in economics?) Check out the Universities to fear wiki, on which anonymous accounts of bad interviews in (mostly) humanities departments are recounted (e.g. travel expenses not reimbursed after flyouts, etc.)
See also Universities to love, which is also part of the Academic Jobs Wiki collection (you could start one in your field...).
Had a bad experience on the job market? (Think things are hard in economics?) Check out the Universities to fear wiki, on which anonymous accounts of bad interviews in (mostly) humanities departments are recounted (e.g. travel expenses not reimbursed after flyouts, etc.)
See also Universities to love, which is also part of the Academic Jobs Wiki collection (you could start one in your field...).
Some specific fields that seem to have active rumor/wiki participation (by no means all accurate in content or agreeable in tone):
IR RUMOR MILL and Jobs Board (if you have to ask, "IR" = International Relations)
Astrophysics Job Rumor Mill (where you can find an ad for an Intergalactic Medium Fellowship)
Monday, October 12, 2009
Nobel to Elinor Ostrom and Olliver Williamson
I like it. I recall thinking when Ronald Coase won a Nobel that Williamson should have shared it. And Lin Ostrom is one of the few political scientists whose work I know reasonably well, very much oriented towards design (including the use of laboratory experiments).
Salary databases
This week, as economics graduate students start preparing their job market information, I'm planning to have several posts about job markets. I'll concentrate mostly on academic job markets, mostly in other disciplines. Today I'll focus on information about salaries.
Markets do many things, and one of them is to set wages. Americans are reticent about income, so there's always some interest in stories like this one in the Washington Post: What Washingtonians Make , from the President to an Abraham Lincoln portrayor (not the same guy)
One domain in which salaries are more or less public is government, which includes the pay of professors at state universities. At universities where salaries are public, this changes the culture a bit. When I was a professor at the University of Illinois, the fact that salaries were public (in those days you could check out the state budget book from the library, and find your name in it) meant that my young colleagues and I talked about our raises, and what they might mean, much more freely than at universities where salaries were private, not to say secret.
Non profit corporations of all sorts also have to reveal limited salary information on IRS form 990, stating the pay of officers and the top 5 salaries to non officers. This involves some game playing. When that requirement went into effect, I was teaching at the University of Puttsburgh. The first year, if memory serves, the top 5 salaries to non officers all went to active surgeons in the medical school. The second year, none of those surgeons was listed, the top 5 non-officer salaries were all much lower, and went to medical school department chairs. The surgeons weren't paid less, they had just shifted their compensation from reportable salary to non-reportable practice plan payments.
Below is a miscellaneous collection of searchable databases, including State salaries and Form 990's, thanks to the Freedom of Information Act.
State salary databases
http://wikifoia.pbworks.com/State-Salary-Database from Wikifoia, "The wiki for helping people understand and use the Freedom of Information Act at the state and local level."
Sunshine Review, "Establishing the Standard for Government Transparency" Public Employee Salaries
http://umich.highedsalaries.com/ Higher Education Salaries, seems to have salaries for Michigan, George Mason U, and Purdue... (Michigan was a pioneer in making salaries public on the web Faculty and staff salary record.Ann Arbor, Mich. : University of Michigan (excel spreadsheets, by year)) {Update from the comments: The student newspaper at Michigan has put up a better, searchable database of the Michigan salary information: http://data.michigandaily.com/tmdsal }
Ontario public salary disclosure for 2009 Ontario universities http://www.fin.gov.on.ca/english/publications/salarydisclosure/2009/univer09.html
British Columbia public salaries, with a searchable database.
Non profit companies: ERI Nonprofit Organization Information (IRS Form 990 data, including "Part V List of Officers, Directors, Trustees and Key Employees," and "Compensation of Five Highest Paid Employees Other Than Officers, Directors and Trustees (Schedule A)". (Some organizations fill out these forms more transparently than others.)
Private sector: I don't know of any comparable resources for private sector salaries (where no sunshine or freedom of information acts apply), although there are places where you can get samples rather than full databases, e.g. Glassdoor.com has http://www.glassdoor.com/Salaries/index.htm, and PayScale has a variety of surveys reporting average salaries, e.g. http://www.payscale.com/research/US/Country=United_States/Salary , with an index here http://www.payscale.com/index/US
Misc. updates:
Here is the summary of the Association to Advance Collegiate Schools of Business 2008-09 US SALARY SURVEY REPORT.
Here is a collection of state university salary databases.
and here: http://www.collegiatetimes.com/databases/salaries
university and college president salaries
The Dec. 2010 Forward publishes a list of salaries of Jewish community organization leaders.
Markets do many things, and one of them is to set wages. Americans are reticent about income, so there's always some interest in stories like this one in the Washington Post: What Washingtonians Make , from the President to an Abraham Lincoln portrayor (not the same guy)
One domain in which salaries are more or less public is government, which includes the pay of professors at state universities. At universities where salaries are public, this changes the culture a bit. When I was a professor at the University of Illinois, the fact that salaries were public (in those days you could check out the state budget book from the library, and find your name in it) meant that my young colleagues and I talked about our raises, and what they might mean, much more freely than at universities where salaries were private, not to say secret.
Non profit corporations of all sorts also have to reveal limited salary information on IRS form 990, stating the pay of officers and the top 5 salaries to non officers. This involves some game playing. When that requirement went into effect, I was teaching at the University of Puttsburgh. The first year, if memory serves, the top 5 salaries to non officers all went to active surgeons in the medical school. The second year, none of those surgeons was listed, the top 5 non-officer salaries were all much lower, and went to medical school department chairs. The surgeons weren't paid less, they had just shifted their compensation from reportable salary to non-reportable practice plan payments.
Below is a miscellaneous collection of searchable databases, including State salaries and Form 990's, thanks to the Freedom of Information Act.
State salary databases
http://wikifoia.pbworks.com/State-Salary-Database from Wikifoia, "The wiki for helping people understand and use the Freedom of Information Act at the state and local level."
Sunshine Review, "Establishing the Standard for Government Transparency" Public Employee Salaries
http://umich.highedsalaries.com/ Higher Education Salaries, seems to have salaries for Michigan, George Mason U, and Purdue... (Michigan was a pioneer in making salaries public on the web Faculty and staff salary record.Ann Arbor, Mich. : University of Michigan (excel spreadsheets, by year)) {Update from the comments: The student newspaper at Michigan has put up a better, searchable database of the Michigan salary information: http://data.michigandaily.com/tmdsal }
Ontario public salary disclosure for 2009 Ontario universities http://www.fin.gov.on.ca/english/publications/salarydisclosure/2009/univer09.html
British Columbia public salaries, with a searchable database.
Non profit companies: ERI Nonprofit Organization Information (IRS Form 990 data, including "Part V List of Officers, Directors, Trustees and Key Employees," and "Compensation of Five Highest Paid Employees Other Than Officers, Directors and Trustees (Schedule A)". (Some organizations fill out these forms more transparently than others.)
Private sector: I don't know of any comparable resources for private sector salaries (where no sunshine or freedom of information acts apply), although there are places where you can get samples rather than full databases, e.g. Glassdoor.com has http://www.glassdoor.com/Salaries/index.htm, and PayScale has a variety of surveys reporting average salaries, e.g. http://www.payscale.com/research/US/Country=United_States/Salary , with an index here http://www.payscale.com/index/US
Misc. updates:
Here is the summary of the Association to Advance Collegiate Schools of Business 2008-09 US SALARY SURVEY REPORT.
Here is a collection of state university salary databases.
and here: http://www.collegiatetimes.com/databases/salaries
university and college president salaries
The Dec. 2010 Forward publishes a list of salaries of Jewish community organization leaders.
Sunday, October 11, 2009
Last minute tickets at sold out Fenway
The Red Sox, whose home games are always sold out, reserve some tickets for last minute purchase: At Sold-Out Fenway, a Way in for Patient Fans .
"For every home contest, whether a weekday game in April or a Game 7 in October, the Red Sox set aside some tickets for fans who did not plan ahead. There may be a few dozen seats available, there may be a few hundred. The point is, they are available, every game, for those who waited too long but are willing to wait a bit longer.
Starting five hours before the scheduled first pitch, fans can line up on the sidewalk near Gate E, around the corner from hectic Yawkey Way. There is a red-and-white sign reading “Game Day Ticket Sales,” and there are a pair of green roll-up doors. Two hours before the game, the doors are raised and tickets are sold at face value. "
...
"“To us, it’s part of a long-term strategy,” said Ron Bumgarner, the team’s vice president for ticketing. “We do not want every fan at Fenway Park to be a season-ticket holder with 81 games. We want as many different people in Red Sox Nation as possible to be able to come to the games.”
Such a system comes with strict rules, and several copies of them are pasted near Gate E. First, five hours is deemed the perfect amount of wait time — too short to spend the night (which used to be allowed, but created the predictable unruliness) but long enough to make it a bit of a chore.
Second, fans must stay in line and cannot save spaces for other fans. In other words, no sitting across the street at the Cask ’n Flagon, or under the center-field stands at the Bleacher Bar, draining beverages while a buddy reserves a spot until the last minute.
Third, once the tickets are purchased — only one per person — fans must enter the ballpark. That means no scalping the ticket to the highest bidder, a temptation for big games."
"For every home contest, whether a weekday game in April or a Game 7 in October, the Red Sox set aside some tickets for fans who did not plan ahead. There may be a few dozen seats available, there may be a few hundred. The point is, they are available, every game, for those who waited too long but are willing to wait a bit longer.
Starting five hours before the scheduled first pitch, fans can line up on the sidewalk near Gate E, around the corner from hectic Yawkey Way. There is a red-and-white sign reading “Game Day Ticket Sales,” and there are a pair of green roll-up doors. Two hours before the game, the doors are raised and tickets are sold at face value. "
...
"“To us, it’s part of a long-term strategy,” said Ron Bumgarner, the team’s vice president for ticketing. “We do not want every fan at Fenway Park to be a season-ticket holder with 81 games. We want as many different people in Red Sox Nation as possible to be able to come to the games.”
Such a system comes with strict rules, and several copies of them are pasted near Gate E. First, five hours is deemed the perfect amount of wait time — too short to spend the night (which used to be allowed, but created the predictable unruliness) but long enough to make it a bit of a chore.
Second, fans must stay in line and cannot save spaces for other fans. In other words, no sitting across the street at the Cask ’n Flagon, or under the center-field stands at the Bleacher Bar, draining beverages while a buddy reserves a spot until the last minute.
Third, once the tickets are purchased — only one per person — fans must enter the ballpark. That means no scalping the ticket to the highest bidder, a temptation for big games."
Saturday, October 10, 2009
Sentenced to prison? Hire a consultant.
The NY Times reports (in the Sports section) that
Consultants Are Providing High-Profile Inmates a Game Plan for Coping
"The former Giants wide receiver Plaxico Burress, who is serving a two-year sentence for a weapons charge, recently joined a growing list of high-profile inmates who have hired prison consultants to help them navigate their entry to a confined life. Others have included Bernard L. Madoff, Michael Vick, Mike Tyson, Martha Stewart and Leona Helmsley."
Consultants Are Providing High-Profile Inmates a Game Plan for Coping
"The former Giants wide receiver Plaxico Burress, who is serving a two-year sentence for a weapons charge, recently joined a growing list of high-profile inmates who have hired prison consultants to help them navigate their entry to a confined life. Others have included Bernard L. Madoff, Michael Vick, Mike Tyson, Martha Stewart and Leona Helmsley."
Book publishers, and book citations
It is customary when citing a book in the bibliography of a scholarly article to include the publisher, and the name of a city associated with that publisher. This seems to be a holdover from the days when publishers were relatively small, and perhaps when the British and American versions of a book with the same publisher might have some differences. And maybe knowing the city would help you find the book.
But book publishing has changed, and when I look at the front material of a scholarly book today, as often as not I see something like
"Morgan Kaufmann Publishers, An Imprint of Academic Press, A Division of Harcourt, Inc., San Francisco, San Diego, New York, Boston, London, Sydney, Tokyo."
Maybe it's time to change our citation conventions. (Or maybe, next time you're in Sydney, you'll have a special opportunity to pick up that book...)
But book publishing has changed, and when I look at the front material of a scholarly book today, as often as not I see something like
"Morgan Kaufmann Publishers, An Imprint of Academic Press, A Division of Harcourt, Inc., San Francisco, San Diego, New York, Boston, London, Sydney, Tokyo."
Maybe it's time to change our citation conventions. (Or maybe, next time you're in Sydney, you'll have a special opportunity to pick up that book...)
Friday, October 9, 2009
Complementarities in markets and computers
One thing that makes it difficult for markets to clear efficiently is if goods are complements, so that you only want good A if you can also have good B (e.g. you need two licences of adjacent-frequency radio spectrum to carry out your broadband business plan, or you are willing to take job A only if your spouse can get an appropriate job in the same city). If the market isn't designed to take this into account, there might be coordination failures, in which some buyer ends up having paid good money but having gotten only part of what he needs, or in which you and your spouse end up with jobs in different cities. Combinatorial auctions, and labor clearinghouses that accomodate couples, are market designs that seek to avoid these kinds of coordination failures.
The same kind of thing can cause your computer to freeze. If program A needs parts X and Y of your computer memory, and so does program B, and they each lock up one of those components while they try to call the other, you may have to send the children out of the room and reboot. The programming solutions for avoiding this can involve some sort of clearinghouse. Here's an article on the subject from Dr. Dobb's Journal: Lock Options, A compile-time deadlock prevention scheme.
The introduction begins:
"The two major problems in concurrent programs are data races and deadlocks. Races occur when two or more threads are accessing shared memory without proper synchronization. Deadlocks occur when synchronization is based on locking and multiple threads block each other's progress. In a typical deadlock scenario, thread A locks the mutex X, and thread B locks the mutex Y. Now, in lockstep, thread A tries to lock Y and B tries to lock X. Neither can make progress, waiting forever for the other thread to release its lock. The program freezes.
In a sense, data races are the opposite of deadlocks. The former result from not enough synchronization, the latter usually happen when there's too much synchronization and it gets out of hand.
There are sophisticated schemes to prevent races and/or deadlocks, but they either require special language support or strict discipline on the part of programmers. Here I present a solution based on a well-known deadlock-avoidance protocol and show how it can be enforced by the compiler. It can be applied to programs in which the number of locks is fixed and known up front."
HT: Ted Roth
The same kind of thing can cause your computer to freeze. If program A needs parts X and Y of your computer memory, and so does program B, and they each lock up one of those components while they try to call the other, you may have to send the children out of the room and reboot. The programming solutions for avoiding this can involve some sort of clearinghouse. Here's an article on the subject from Dr. Dobb's Journal: Lock Options, A compile-time deadlock prevention scheme.
The introduction begins:
"The two major problems in concurrent programs are data races and deadlocks. Races occur when two or more threads are accessing shared memory without proper synchronization. Deadlocks occur when synchronization is based on locking and multiple threads block each other's progress. In a typical deadlock scenario, thread A locks the mutex X, and thread B locks the mutex Y. Now, in lockstep, thread A tries to lock Y and B tries to lock X. Neither can make progress, waiting forever for the other thread to release its lock. The program freezes.
In a sense, data races are the opposite of deadlocks. The former result from not enough synchronization, the latter usually happen when there's too much synchronization and it gets out of hand.
There are sophisticated schemes to prevent races and/or deadlocks, but they either require special language support or strict discipline on the part of programmers. Here I present a solution based on a well-known deadlock-avoidance protocol and show how it can be enforced by the compiler. It can be applied to programs in which the number of locks is fixed and known up front."
HT: Ted Roth
Thursday, October 8, 2009
Real estate; disaggregating a bundle of services
There are cracks beginning to show in the way real estate is sold. For a long time, the only realistic option for selling a home was to employ a full service realtor, who sells a whole package of services bundled together, and charges five or six percent of the selling price of the house.
But as the internet has eroded the Multiple Listing Service monopoly on home listings, it is beginning to be possible for sellers to put their own homes on the market, with the assistance of a la carte services from realtors.
One such service in the Boston area, http://eplacehomes.com/ offers just such an a la carte "menu of services". It will be interesting to see where this leads, in a market whose standard, full service contract, with a 6% realtor's commission, became strained as house prices rose into seven figures in many communities. (See this earlier post on broker rebates to buyers.)
But as the internet has eroded the Multiple Listing Service monopoly on home listings, it is beginning to be possible for sellers to put their own homes on the market, with the assistance of a la carte services from realtors.
One such service in the Boston area, http://eplacehomes.com/ offers just such an a la carte "menu of services". It will be interesting to see where this leads, in a market whose standard, full service contract, with a 6% realtor's commission, became strained as house prices rose into seven figures in many communities. (See this earlier post on broker rebates to buyers.)
Wednesday, October 7, 2009
Skydeck360: Signaling in the MBA Job Market
Harvard students Abhinav Agrawal, Patrick Chun and Yasser Salem have launched a platform for students to signal interest to employers looking to hire MBA students. The premise of the platform is quite similar to the signaling mechanism used by the AEA, in that the scarcity of the signals is what creates credibility:
"Skydeck360 will go live in October, and will initially be available for only [1st year MBA] students. The tool is designed for simplicity: all students have to do is sign up on the Skydeck360 website and indicate their top choice companies. This data will then be automatically aggregated and shared with recruiters by Skydeck360 in early November."
One interesting facet of the platform is that it is run as an entrepreneurial venture, rather than by the school itself, and so is an interesting marriage of signaling and entrepreneurial market design...
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