Two emininent economists have been thinking about design on the largest of scales.
Roger Myerson thinks about nation building in general, and Iraq in particular, and reflects on the role of political leaders' reputations, for patronage among other things.
Paul Romer thinks about macro-market-design in the form of new "charter cities," to be modeled roughly on Hong Kong.
Here is Roger, in "A Field Manual for the Cradle of Civilization:Theory of Leadership and Lessons of Iraq, " Journal of Conflict ResolutionVolume 53 Number 3 June 2009 470-482. (HT Paul Milgrom)
"Agency incentive problems in government make patronage an essential aspect of statebuilding, and political leaders become fundamentally constrained by their reputations. Democratic competition requires many leaders to develop independent reputations for exercising power and patronage responsibly, which can be encouraged by political decentralization."
Roger then recounts Xenophon's description of the rise of Cyrus (Koresh), the Persian leader.
"The key to Cyrus’s success was his apparent love of justice, which was inculcated by his education and which enabled him to earn the trust and loyalty of a great army. But what kind of justice was it that Cyrus loved so much? It was certainly not justice for poor peasants, whose crops were gathered to support his conquering forces.
What Cyrus loved was justice for the soldiers who served his cause. Apparently Cyrus’s greatest pleasure in life was to judge the valor of troops in battle and to reward them richly for their accomplishments, asking nothing for himself. As a mechanic knows the names of his tools, Cyrus learned the names of all the captains in his army, so that each could be confident of his service being remembered. When everybody recognized Cyrus as the best leader to distribute their booty after a victory, he could take power, first over the multinational coalitional forces and, ultimately, over Asia."
Paul Romer, explains the idea of charter cities here, and in a Q&A at Freakonomics, here: Can “Charter Cities” Change the World? A Q&A With Paul Romer
He argues that to credibly move to better rules, you might have to do some things all at once and start fresh. (He suggests a good place to start would be to have a new Cuban city administered by Canada at Guantanamo Bay, to try to recreate the experience of Hong Kong.)
He too isn't afraid to think big:
"Q. It all sounds great as a theoretical exercise, but honestly, don’t your colleagues tell you that something like this will never happen?
A. They do say this, which is actually kind of ironic when you line it up with the other things they say. They recognize that the construct of a charter city is something that could make everyone better off. They admit that there is no technological or economic constraint that keeps us from building many of these. Then they say that for political reasons, it will never happen. They tell me that you can’t change politics; you can’t overcome nationalism; there is no way for countries to work together to extend the reach of good rules. Then these same economists suggest that we should just stick to business as usual. We should offer conventional economic advice and assume that political systems will naturally follow our advice when we point to something that could make everyone better off. But of course, they have already revealed that they don’t believe this. What’s going on here is a kind of self-censoring. Economists seem to think that we should propose things that are acceptable and that political systems will pursue, but that we should avoid proposing or even discussing things that are controversial or politically incorrect. I think we’d do our jobs better if we just said what’s true without trying to be amateur politicians. "
Romer and Myerson seem to have different views of where economics ends and politics begins.
Wednesday, October 28, 2009
Tuesday, October 27, 2009
Does a decrease in the number of traffic fatalities increase live kidney donation?
Over at Economic Logic, the Economic Logician reviews an article, The Effect of Traffic Safety Laws and Obesity Rates on Living Organ Donations by Jose Fernandez and Lisa Stohr. It finds that a decrease in availability of deceased donor organs (through an increase in helmet and seatbelt laws) elicits some increase in live donor kidney donation.
Here's the abstract, followed by EL's summary.
Abstract: This paper uses variation in traffic safety laws and obesity rates to identify substitution patterns between living and cadaveric kidney donors. Using panel data from 1988-2008, we find that a 1% decrease in the supply of cadaveric donors per 100,000 increases the supply of living donors per 100,000 by .7%. With respect to traffic safety laws, a national adoption of partial helmet laws is estimated to decrease cadaveric donors by 6%, but leads to a 4.2% increase in the number of living donors, or a net effect of 1.8% decrease in the supply of kidney donations. The recent rise in obesity rates is estimated to increase living donor rates by roughly 18%. Lastly, we find evidence that increases in disposable income per capita is associated with an increase in the number of non-biological living donors within a state, but is not found to have an effect on biological donor rates.
And here is EL's summary:
"There are times where you really wonder why authors would even think that some variables could be correlated and how they then come up with a story that can explain this statistical relationship coming from seemingly nowhere. The paper by Jose Fernandez and Lisa Stohr is one of these.To quote their abstract, "this paper uses variation in traffic safety laws and obesity rates to identify substitution patterns between living and cadaveric kidney donors." Despite reading this sentence ten times, I could not make any theoretical sense of it. But reading through the paper, a good story can be made. Tightening traffic safety laws reduces the number of fatalities, and thus the number of cadaveric organ donors. An increase in obesity increases the demand for organs, in particular kidneys. Thus one can instrument for supply and demand using these measures. With this in mond, one can then study how variations in the supply of supply of cadaveric organs (which are of poor value) and demand can motivate living donors to come forward, as they trade off the usefulness of their donation with the personal harm it will inflict upon them. Fernandez and Stohr fiand that donors respond indeed to cadaveric supply and to the increase in demand due to obesity."
Here's the abstract, followed by EL's summary.
Abstract: This paper uses variation in traffic safety laws and obesity rates to identify substitution patterns between living and cadaveric kidney donors. Using panel data from 1988-2008, we find that a 1% decrease in the supply of cadaveric donors per 100,000 increases the supply of living donors per 100,000 by .7%. With respect to traffic safety laws, a national adoption of partial helmet laws is estimated to decrease cadaveric donors by 6%, but leads to a 4.2% increase in the number of living donors, or a net effect of 1.8% decrease in the supply of kidney donations. The recent rise in obesity rates is estimated to increase living donor rates by roughly 18%. Lastly, we find evidence that increases in disposable income per capita is associated with an increase in the number of non-biological living donors within a state, but is not found to have an effect on biological donor rates.
And here is EL's summary:
"There are times where you really wonder why authors would even think that some variables could be correlated and how they then come up with a story that can explain this statistical relationship coming from seemingly nowhere. The paper by Jose Fernandez and Lisa Stohr is one of these.To quote their abstract, "this paper uses variation in traffic safety laws and obesity rates to identify substitution patterns between living and cadaveric kidney donors." Despite reading this sentence ten times, I could not make any theoretical sense of it. But reading through the paper, a good story can be made. Tightening traffic safety laws reduces the number of fatalities, and thus the number of cadaveric organ donors. An increase in obesity increases the demand for organs, in particular kidneys. Thus one can instrument for supply and demand using these measures. With this in mond, one can then study how variations in the supply of supply of cadaveric organs (which are of poor value) and demand can motivate living donors to come forward, as they trade off the usefulness of their donation with the personal harm it will inflict upon them. Fernandez and Stohr fiand that donors respond indeed to cadaveric supply and to the increase in demand due to obesity."
Monday, October 26, 2009
Markets for body parts, continued
While it's illegal to buy or sell organs for treatment, there's a legal market for "tissues" such as bone. But it's still fenced in with lots of repugnance. As with solid organs, the issue of "objectification" (or "commodification") of the body is a big issue, which bears on who may be compensated for what, among other things..
Inside a Creepy Global Body Parts Business
Even if it is unrealistic to expect that all commercialization of the body could be ruled out in modern medicine, says Schneider, it is important to set boundaries. For that reason, she insists that human tissue ought to be used sparingly -- that is, only when such use is medically necessary and clearly superior to other forms of treatment.
The conviction that the body is much more than an object has also shaped the policies of the World Health Organization (WHO), the European Parliament and the European Council, the EU's body representing the leaders and ministers of the 27-member bloc. All of these bodies condemn the practice of trading in human body parts to turn a profit.
In Germany, the country's organ transplant act regulates the removal of tissue. Only those who have consented to organ and tissue harvesting are considered as donors. If a person dies and is not already a donor, his or her closest relatives can consent to donation. Paragraph 17 of the transplant act explicitly states: "Trading in organs or tissue intended for use in the medical treatment of others is prohibited." Physicians who remove tissue can only be paid suitable compensation for their efforts. The law calls for prison sentences of up to five years for violation of the trading prohibition."
Inside a Creepy Global Body Parts Business
"According to the American Academy of Orthopedic Surgeons, more than a million bone parts are used in transplants every year. In no other country is it possible to make so much money with body parts. If a body were disassembled into its individual parts, then processed and sold, the total proceeds could amount to $250,000 (€176,000). For a single corpse! The US tissue industry generates total revenues of about $1 billion a year, says journalist Martina Keller, a co-author of this article and the author of the German book, "Cannibalized: The Human Corpse as a Resource." "
...
Even if it is unrealistic to expect that all commercialization of the body could be ruled out in modern medicine, says Schneider, it is important to set boundaries. For that reason, she insists that human tissue ought to be used sparingly -- that is, only when such use is medically necessary and clearly superior to other forms of treatment.
The conviction that the body is much more than an object has also shaped the policies of the World Health Organization (WHO), the European Parliament and the European Council, the EU's body representing the leaders and ministers of the 27-member bloc. All of these bodies condemn the practice of trading in human body parts to turn a profit.
In Germany, the country's organ transplant act regulates the removal of tissue. Only those who have consented to organ and tissue harvesting are considered as donors. If a person dies and is not already a donor, his or her closest relatives can consent to donation. Paragraph 17 of the transplant act explicitly states: "Trading in organs or tissue intended for use in the medical treatment of others is prohibited." Physicians who remove tissue can only be paid suitable compensation for their efforts. The law calls for prison sentences of up to five years for violation of the trading prohibition."
Sunday, October 25, 2009
Right to die in England
There has been some interim resolution of the continued debate in England about whether those who assist a terminally ill relative who wishes to commit suicide, in particular by accompanying them to a clinic in Switzerland, will face prosecution. The current resolution is, it's still illegal, but guidelines have been issued to give some legal safety.
Campaigners win the fight to legalise assisted suicide
Assisted suicide investigations will focus on who stood to benefit
"People who stand to benefit financially from a person’s death are likely to be the ones prosecuted for assisting a suicide, under guidelines to be issued this week. "...
"The policy...will aim to clarify when individuals are more likely to be prosecuted or more likely not to be, he said.
Mr Starmer told the Andrew Marr Show on BBC One that such factors will include whether the person has a clear and settled intention to commit suicide, whether they have been encouraged or just assisted to do so, and whether those helping them have anything to gain from their death."
..."As many as 115 people from Britain have gone to Dignitas, the Swiss clinic, to die, but no one has been prosecuted so far. Last month Mr Starmer said that the landmark guidelines would apply in the UK as well as overseas.
Under current legislation, those who “aid, abet, counsel or procure” someone else’s suicide can be prosecuted and jailed for up to 14 years. Ms Purdy, from Undercliffe in Bradford, West Yorkshire, wants to know what would happen to her Cuban husband, Omar Puente, if he helped her to travel abroad to end her life. She took her case to the Lords after the High Court and Court of Appeal held that it was for Parliament, not the courts, to change the law.
The Lords agreed that changes were a matter for Parliament, but upheld Ms Purdy’s argument that the DPP should put in writing the factors he regarded as relevant in deciding whether or not to prosecute."
The guidelines, which were issued on schedule, drew a predictably wide range of reactions, some of which can be found at the end of this story in the Times: Assisted suicide guidelines do not give immunity against prosecution, says DPP
Campaigners win the fight to legalise assisted suicide
Assisted suicide investigations will focus on who stood to benefit
"People who stand to benefit financially from a person’s death are likely to be the ones prosecuted for assisting a suicide, under guidelines to be issued this week. "...
"The policy...will aim to clarify when individuals are more likely to be prosecuted or more likely not to be, he said.
Mr Starmer told the Andrew Marr Show on BBC One that such factors will include whether the person has a clear and settled intention to commit suicide, whether they have been encouraged or just assisted to do so, and whether those helping them have anything to gain from their death."
..."As many as 115 people from Britain have gone to Dignitas, the Swiss clinic, to die, but no one has been prosecuted so far. Last month Mr Starmer said that the landmark guidelines would apply in the UK as well as overseas.
Under current legislation, those who “aid, abet, counsel or procure” someone else’s suicide can be prosecuted and jailed for up to 14 years. Ms Purdy, from Undercliffe in Bradford, West Yorkshire, wants to know what would happen to her Cuban husband, Omar Puente, if he helped her to travel abroad to end her life. She took her case to the Lords after the High Court and Court of Appeal held that it was for Parliament, not the courts, to change the law.
The Lords agreed that changes were a matter for Parliament, but upheld Ms Purdy’s argument that the DPP should put in writing the factors he regarded as relevant in deciding whether or not to prosecute."
The guidelines, which were issued on schedule, drew a predictably wide range of reactions, some of which can be found at the end of this story in the Times: Assisted suicide guidelines do not give immunity against prosecution, says DPP
Right to die in Montana?
May a physician help a terminally ill patient commit suicide? Or is that a terminally repugnant transaction, which even a willing patient and physician should be prevented by law from completing?
The question has been raised in Montana, and will go to the state supreme court: Montana Court to Rule on Assisted Suicide Case
"Washington and Oregon allow physicians to help terminally ill people hasten their deaths, but in those states the laws were approved by voters in statewide referendums, and neither state’s highest court has examined the issue of a constitutional right to die.
In Montana, the question will be decided by the seven-member State Supreme Court. A lower-court judge ruled in Mr. Baxter’s favor last December — on the very day Mr. Baxter died — and the State of Montana appealed the ruling."
...
"“There are moral arguments, philosophical arguments on both sides, bioethical arguments on both sides, even medical and public health arguments on both sides,” Anthony Johnstone, the state solicitor at the Montana attorney general’s office, who will argue the case for the state, said in defense of current laws that prohibit physician-assisted death. "
...
"“This case is part of a journey,” said Ms. Tucker, who is director of legal affairs for Compassion and Choices, a national group that advocates to protect and expand the rights of the terminally ill and is also one of the plaintiffs. “It’s about empowering patients and giving them the right to decide when they have suffered enough.”"
Update: Dec 31, 2009. Montana Ruling Bolsters Doctor-Assisted Suicide
"The Montana Supreme Court ruled on Thursday that state law protects doctors in Montana from prosecution for helping terminally ill patients die. But the court, ruling with a narrow majority, sidestepped the larger landmark question of whether physician-assisted suicide is a right guaranteed under the state’s Constitution."
The question has been raised in Montana, and will go to the state supreme court: Montana Court to Rule on Assisted Suicide Case
"Washington and Oregon allow physicians to help terminally ill people hasten their deaths, but in those states the laws were approved by voters in statewide referendums, and neither state’s highest court has examined the issue of a constitutional right to die.
In Montana, the question will be decided by the seven-member State Supreme Court. A lower-court judge ruled in Mr. Baxter’s favor last December — on the very day Mr. Baxter died — and the State of Montana appealed the ruling."
...
"“There are moral arguments, philosophical arguments on both sides, bioethical arguments on both sides, even medical and public health arguments on both sides,” Anthony Johnstone, the state solicitor at the Montana attorney general’s office, who will argue the case for the state, said in defense of current laws that prohibit physician-assisted death. "
...
"“This case is part of a journey,” said Ms. Tucker, who is director of legal affairs for Compassion and Choices, a national group that advocates to protect and expand the rights of the terminally ill and is also one of the plaintiffs. “It’s about empowering patients and giving them the right to decide when they have suffered enough.”"
Update: Dec 31, 2009. Montana Ruling Bolsters Doctor-Assisted Suicide
"The Montana Supreme Court ruled on Thursday that state law protects doctors in Montana from prosecution for helping terminally ill patients die. But the court, ruling with a narrow majority, sidestepped the larger landmark question of whether physician-assisted suicide is a right guaranteed under the state’s Constitution."
Saturday, October 24, 2009
Right to wed in Vermont
Same-Sex Marriages Begin in Vermont
"Vermont is one of five states that now allow same-sex couples to marry. Massachusetts, Connecticut, New Hampshire and Iowa are the others.
Vermont, which invented civil unions in 2000 after a same-sex couple challenged the inequality of state marriage statutes, was a mecca for gay couples who to that point had no way to officially recognize their relationships.
Since then, other states have allowed gay marriage, as did Vermont, which in April became the first state to legalize gay marriage through a legislative decree and not a court case."
See my other posts on same sex marriage, and more generally on repugnant transactions, i.e. transactions that some people want to do but that others object to.
"Vermont is one of five states that now allow same-sex couples to marry. Massachusetts, Connecticut, New Hampshire and Iowa are the others.
Vermont, which invented civil unions in 2000 after a same-sex couple challenged the inequality of state marriage statutes, was a mecca for gay couples who to that point had no way to officially recognize their relationships.
Since then, other states have allowed gay marriage, as did Vermont, which in April became the first state to legalize gay marriage through a legislative decree and not a court case."
See my other posts on same sex marriage, and more generally on repugnant transactions, i.e. transactions that some people want to do but that others object to.
Friday, October 23, 2009
Egg "donation"
Do a google search for egg donor and and open a window on a thriving marketplace for human eggs, with well established companies such as Egg Donation, Inc. ("where dreams come true") competing with a host of others. The word "donor" is entirely vestigial in this context (as the "..., Inc.") makes clear, and the repugnance that used to accompany such sales is becoming vestigial as well.
The Minneapolis Star Tribune ran an interesting story about that firm some time ago, by Josephine Marcotty and Chen May Yee: Oct. 21, 2007: Miracles for sale.
The article describes the modern egg donor:
"The clinics want donors who have a healthy blend of altruistic and financial motives -- women who want to help infertile women but who are practical enough not to do it for free. "
The Minneapolis Star Tribune ran an interesting story about that firm some time ago, by Josephine Marcotty and Chen May Yee: Oct. 21, 2007: Miracles for sale.
The article describes the modern egg donor:
"The clinics want donors who have a healthy blend of altruistic and financial motives -- women who want to help infertile women but who are practical enough not to do it for free. "
Wednesday, October 21, 2009
Choosing sex of children: repugnant in Britain but not in U.S.
The Times reports: US clinic offers British couples the chance to choose the sex of their child
"A new clinic in Manhattan is appealing to British couples who want to pick the sex of their next child — a process that is banned in the United Kingdom.
Pre-implantation genetic diagnosis (PGD), which can reveal the sex of an embryo, is prohibited in Britain except when it is used to screen for genetic diseases.
The United States relaxed its regulations on sex selection in 2001 and American medical centres report interest from British patients who find out about their “family balancing” services through online advertisements. "
...
"As recent healthcare debates show, many Americans balk at government involvement in medicine. Robert Brzyski, chairman of the ethics committee at the American Society for Reproductive Medicine, said: “The tradition in the US has been to not interfere with the reproductive choices of American citizens.” "
...
"Although evidence suggests that British patients tend to pick sons and daughters in roughly even numbers, most US clinics will treat only those parents who already have a child of the other sex. "
...
"David Karabinus, a director at the Virginia institute, believes that elective sex selection will eventually be seen as just another form of reproductive medicine. “Just as there was an overreaction about IVF, there will be a gradual acceptance as we prove it’s safe. It’s there if people want it.” "
"A new clinic in Manhattan is appealing to British couples who want to pick the sex of their next child — a process that is banned in the United Kingdom.
Pre-implantation genetic diagnosis (PGD), which can reveal the sex of an embryo, is prohibited in Britain except when it is used to screen for genetic diseases.
The United States relaxed its regulations on sex selection in 2001 and American medical centres report interest from British patients who find out about their “family balancing” services through online advertisements. "
...
"As recent healthcare debates show, many Americans balk at government involvement in medicine. Robert Brzyski, chairman of the ethics committee at the American Society for Reproductive Medicine, said: “The tradition in the US has been to not interfere with the reproductive choices of American citizens.” "
...
"Although evidence suggests that British patients tend to pick sons and daughters in roughly even numbers, most US clinics will treat only those parents who already have a child of the other sex. "
...
"David Karabinus, a director at the Virginia institute, believes that elective sex selection will eventually be seen as just another form of reproductive medicine. “Just as there was an overreaction about IVF, there will be a gradual acceptance as we prove it’s safe. It’s there if people want it.” "
Tuesday, October 20, 2009
Living donor liver transplants
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" "
"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" "
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)
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