A Guided Tour of Modern Medicine’s Underbelly is a NY Times book review by Dr. Abigail Zuger of the book WHITE COAT, BLACK HAT: Adventures on the Dark Side of Medicine. By Dr. Carl Elliott.
"A physician who specializes in philosophy and ethics, Dr. Elliott hails from that quiet zone of medicine where much of the job involves thinking about, talking about and doling out medications. Hence his primary focus is on the ever-evolving relationship between the high art of medicine and the big business of drugs.
...
"Doctors get pens and trinkets, football tickets, junkets to beach resorts. Less visible are the large sums handed over in “I’m going to make you a star” projects to groom them as trusted faces and voices in the service of some drug. Education and advertisement merge in these elaborate ventures, as the paid professor travels the country, lecturing about disease and, incidentally, the treatment thereof.
"These “key opinion leaders” are bad enough, but who would ever imagine that the curricula vitae of many academic physicians (those on a medical school faculty) are packed with journal articles actually written by ghostwriters sponsored by pharmaceutical companies?
"“Nobody expects American politicians to write their own speeches anymore,” Dr. Elliott reminds us, “and nobody expects celebrities to write their own memoirs.” Apparently doctors have now joined the ranks of the charismatic talking heads, mouthing the words of others.
"And just as “professor” generally describes someone who writes his or her own sentences, “ethicist” generally describes someone who dwells (or at least works) on an unusually high moral plane. But Dr. Elliott also takes a brief and very informative excursion into the world of the medical ethicists. Once they were highly principled, underpaid gadflies, trying to sort out medical decision making. Now they are part of a booming industry, and, speaking of industry, their ties to the pharmaceutical industry are many and complex. Many companies now hire their own ethicists. But who guards those guards?
...
"What a world, what a world, as the melting witch said in “The Wizard of Oz.” But there is one small consolation: at least Dr. Elliott didn’t have to call his book “White Coat, Black Heart.” Now that would have been depressing. The bottom line is that much of what he describes is simply the big business of medicine as we have allowed it to take shape. His bad actors are mostly just that: actors caught up in a script not of their own devising. They all come home in the evening, take off their black hats and hang up their white coats, just regular working stiffs out to make a buck. "
Friday, October 15, 2010
Thursday, October 14, 2010
Regulation of the hours that medical residents can work
The Chronicle of Higher Education reports Accreditor Tightens Limits on Medical Residents' 80-Hour Workweeks
"Doctors in training at teaching hospitals would continue to be limited to an 80-hour workweek, but some new limits would be imposed to cut down on errors by sleep-deprived residents under new standards approved on Tuesday by the Accreditation Council for Graduate Medical Education.
"The standards, which are scheduled to take effect in July 2011, will apply to the 111,000 medical residents who are training in accredited teaching institutions,
"Residents can work more than 80 hours some weeks, as long as the average over a four-week period doesn't exceed 80. First-year residents would be limited to working no more than 16 hours a day—down from 24 hours—and they would be supervised more closely. Residency-training programs would also have a tougher time getting exceptions to the work-hour limits.
"The changes are based on recommendations made in 2008 by the Institute of Medicine, which warned of widespread medical errors caused by sleepy residents, as well as a 16-month review of scientific writings on sleep issues, patient safety, and resident training.
"Some teaching hospitals have argued that limiting residents' work hours would hurt them financially without necessarily improving patient safety.
"The revised standards, which also deal with concerns about mistakes that occur when residents hand off patient-care responsibilities during shift changes, were developed by a 16-member task force made up of specialists from medical education, patient safety, and clinical care."
"Doctors in training at teaching hospitals would continue to be limited to an 80-hour workweek, but some new limits would be imposed to cut down on errors by sleep-deprived residents under new standards approved on Tuesday by the Accreditation Council for Graduate Medical Education.
"The standards, which are scheduled to take effect in July 2011, will apply to the 111,000 medical residents who are training in accredited teaching institutions,
"Residents can work more than 80 hours some weeks, as long as the average over a four-week period doesn't exceed 80. First-year residents would be limited to working no more than 16 hours a day—down from 24 hours—and they would be supervised more closely. Residency-training programs would also have a tougher time getting exceptions to the work-hour limits.
"The changes are based on recommendations made in 2008 by the Institute of Medicine, which warned of widespread medical errors caused by sleepy residents, as well as a 16-month review of scientific writings on sleep issues, patient safety, and resident training.
"Some teaching hospitals have argued that limiting residents' work hours would hurt them financially without necessarily improving patient safety.
"The revised standards, which also deal with concerns about mistakes that occur when residents hand off patient-care responsibilities during shift changes, were developed by a 16-member task force made up of specialists from medical education, patient safety, and clinical care."
Wednesday, October 13, 2010
Market design at Aarhus University in Denmark
The Center for Research in the Foundations of Electronic Markets is having an inaugural conference, Oct. 13-15.
The full program is here.
The first three sessions touch on a number of themes that readers of this blog will recognize:
Wednesday, October 13, 12.30 to 17.30
Session Chair Ivan Damgård
12.30-13.15 – Hervé Moulin, Rice University: Impartial decision among peers
13.15-14.00 – Peter Bogetoft, Copenhagen Business School: Missing Markets
14.00-14.45 – Jens Leth Hougaard, Copenhagen University: Rationing with rights
Session Chair Peter Bro Miltersen
15.15-16.00 – Felix Fischer, Harvard University: Mechanisms for Large-Scale Kidney Exchanges
16.00-16.45 – Lance Fortnow, Northwestern University: Bounding Rationality by Computational Complexity
16.45-17.30 – Kevin Leyton-Brown, University of British Columbia: Computational Mechanism Analysis
Thursday, October 14, 9.30 to 18:00
Session Chair Peter Bogetoft
09.30-10.15 – David Parkes, Harvard University: Mechanism Design and Accounting to Enable Efficient Peer Production and Spectrum Sharing (joint work with Ian Kash (Harvard), Michel Meulpolder (TU Delft), Rohan Murty (Harvard), Jie Tang (UC Berkeley) and Sven Seuken (Harvard))
10.15-11.00 – Ivan Damgård, Aarhus University: How to compute securely – even if you trust no one but yourself
It looks like Aarhaus is a happening place this week.
HT: Noam Nisan at AGT.
The full program is here.
The first three sessions touch on a number of themes that readers of this blog will recognize:
Wednesday, October 13, 12.30 to 17.30
Session Chair Ivan Damgård
12.30-13.15 – Hervé Moulin, Rice University: Impartial decision among peers
13.15-14.00 – Peter Bogetoft, Copenhagen Business School: Missing Markets
14.00-14.45 – Jens Leth Hougaard, Copenhagen University: Rationing with rights
Session Chair Peter Bro Miltersen
15.15-16.00 – Felix Fischer, Harvard University: Mechanisms for Large-Scale Kidney Exchanges
16.00-16.45 – Lance Fortnow, Northwestern University: Bounding Rationality by Computational Complexity
16.45-17.30 – Kevin Leyton-Brown, University of British Columbia: Computational Mechanism Analysis
Thursday, October 14, 9.30 to 18:00
Session Chair Peter Bogetoft
09.30-10.15 – David Parkes, Harvard University: Mechanism Design and Accounting to Enable Efficient Peer Production and Spectrum Sharing (joint work with Ian Kash (Harvard), Michel Meulpolder (TU Delft), Rohan Murty (Harvard), Jie Tang (UC Berkeley) and Sven Seuken (Harvard))
10.15-11.00 – Ivan Damgård, Aarhus University: How to compute securely – even if you trust no one but yourself
It looks like Aarhaus is a happening place this week.
HT: Noam Nisan at AGT.
Tuesday, October 12, 2010
The problem with Princeton
France Wrestles With Its 2 Tiers of Higher Education
The article, from the New York Times, discusses the French higher education system of Universities and Grandes Ecoles, and ends with this paragraph:
"It was Cédric Villani, a 37-year-old professor at Lyon who won the 2010 Fields Medal, who gave the most spirited reply to France’s critics. Calling himself “a pure product of the French system,” Mr. Villani, a Normalien who has often taught in the United States, said that while American academic salaries were higher “and it’s easier to make big projects,” France also has particular strengths: “Our tradition, our quality of life, our social cohesion. My big problem in Princeton was finding a place to buy a decent cheese.”
The article, from the New York Times, discusses the French higher education system of Universities and Grandes Ecoles, and ends with this paragraph:
"It was Cédric Villani, a 37-year-old professor at Lyon who won the 2010 Fields Medal, who gave the most spirited reply to France’s critics. Calling himself “a pure product of the French system,” Mr. Villani, a Normalien who has often taught in the United States, said that while American academic salaries were higher “and it’s easier to make big projects,” France also has particular strengths: “Our tradition, our quality of life, our social cohesion. My big problem in Princeton was finding a place to buy a decent cheese.”
Interview concerning San Francisco school choice
The San Francisco Briefing Room carries an audio interview by Stan Goldberg with Attila Abdulkadiroglu and me (about 30 minutes): Assignment System at Risk.
Here's his blurb: "With the deadline for submitting applications for school assignment in the San Francisco Unified School District rapidly approaching the school district has advised its independent advisors who were scheduled to program the assignment system for free that their services were not needed. Does this action imperil the implementation of the system on time? Has school district transparency moved back to the dark ages? Here’s the story from the design team’s perspective."
(Here are my previous posts on San Francisco school choice.)
Here's his blurb: "With the deadline for submitting applications for school assignment in the San Francisco Unified School District rapidly approaching the school district has advised its independent advisors who were scheduled to program the assignment system for free that their services were not needed. Does this action imperil the implementation of the system on time? Has school district transparency moved back to the dark ages? Here’s the story from the design team’s perspective."
(Here are my previous posts on San Francisco school choice.)
Monday, October 11, 2010
Results of Games 1st choice prediction competition
Here's the end (or maybe the middle) of the story that began with Predicting behavior in games: a competition
Hi: We write to inform you of the results of Games 1st choice prediction
competition. The competition focused on the prediction of behavior in repeated
Market Entry Game. We ran two sets of experiments. We published the results of
the first set, and challenged other researchers to predict the result of the
second set (see http://sites.google.com/site/gpredcomp).
Twenty-two different teams participated in the competition. The total number of
submissions was 25.
The winners are Wei Chen, Chih-Han Chen, Yi-Shan Lee, and Shu-Yu Liu from
National Taiwan University.
The runners up are Tomבs Lejarraga, Varun Dutt, and Cleotilde Gonzalez from
Carnegie Mellon University.
The winners and the runners up were invited to submit papers to Games that
describe their models in detail. Here is a short summary:
The winning model refines I-SAW (the best baseline model described in the
competition website) by the addition of the assumption of a limited memory
span. The refined model assumes: (1) Reliance on a small sample of past
experiences, (2) Strong inertia and recency effects, and (3) Surprise triggers
change.
The runner up model is based upon the Instance Based Learning (IBL) theory
proposed by Gonzalez, Lerch, and Lebiere (2003). The basic assumptions of this
model are: retrieval of past set of experiences of outcomes weighted by their
probability of retrieval from memory (i.e., blending mechanism); dependence on
recency and frequency of past experienced outcomes; and, an inertia mechanism
that depends upon surprise as a function of blended outcomes.
The results support two main suggestions:
(1) Models that assume reliance on small samples of past experiences have a
large advantage over models that assume reliance on running averages of the
previous payoffs (like traditional reinforcement learning and fictitious play
models).
(2) The difference between learning in market entry games, and learning in
individual choice tasks is not large. Indeed, the best models in the current
competition can be described as refinements of the best models in our previous
competition that focused in individual repeated choice task (see Erev et al.,
2010).
The raw data from the 80 repeated market entry games that were run in the
current competition can be found in http://sites.google.com/site/gpredcomp.
The raw data from the 120 repeated choice problems that were run in our
previous competition can be found in
http://tx.technion.ac.il/~erev/Comp/Comp.html. We encourage you to use these
data sets, to improve our understanding of the effect of experience on economic
behavior.
erev@techunix.technion.ac.il Oct 05 08:16AM +0200 ^
Hi: We write to inform you of the results of Games 1st choice prediction
competition. The competition focused on the prediction of behavior in repeated
Market Entry Game. We ran two sets of experiments. We published the results of
the first set, and challenged other researchers to predict the result of the
second set (see http://sites.google.com/site/gpredcomp).
Twenty-two different teams participated in the competition. The total number of
submissions was 25.
The winners are Wei Chen, Chih-Han Chen, Yi-Shan Lee, and Shu-Yu Liu from
National Taiwan University.
The runners up are Tomבs Lejarraga, Varun Dutt, and Cleotilde Gonzalez from
Carnegie Mellon University.
The winners and the runners up were invited to submit papers to Games that
describe their models in detail. Here is a short summary:
The winning model refines I-SAW (the best baseline model described in the
competition website) by the addition of the assumption of a limited memory
span. The refined model assumes: (1) Reliance on a small sample of past
experiences, (2) Strong inertia and recency effects, and (3) Surprise triggers
change.
The runner up model is based upon the Instance Based Learning (IBL) theory
proposed by Gonzalez, Lerch, and Lebiere (2003). The basic assumptions of this
model are: retrieval of past set of experiences of outcomes weighted by their
probability of retrieval from memory (i.e., blending mechanism); dependence on
recency and frequency of past experienced outcomes; and, an inertia mechanism
that depends upon surprise as a function of blended outcomes.
The results support two main suggestions:
(1) Models that assume reliance on small samples of past experiences have a
large advantage over models that assume reliance on running averages of the
previous payoffs (like traditional reinforcement learning and fictitious play
models).
(2) The difference between learning in market entry games, and learning in
individual choice tasks is not large. Indeed, the best models in the current
competition can be described as refinements of the best models in our previous
competition that focused in individual repeated choice task (see Erev et al.,
2010).
The raw data from the 80 repeated market entry games that were run in the
current competition can be found in http://sites.google.com/site/gpredcomp.
The raw data from the 120 repeated choice problems that were run in our
previous competition can be found in
http://tx.technion.ac.il/~erev/Comp/Comp.html. We encourage you to use these
data sets, to improve our understanding of the effect of experience on economic
behavior.
Sunday, October 10, 2010
Vacancy chains: hiring from your competitors, and having them hire from you
Six Technology Firms Agree to More Hiring Competition
"The American job market is tough for many workers, but things are looking even better than usual for highly paid engineers and scientists in Silicon Valley.
"Six leading technology companies, including Apple, Google and Intel, reached an antitrust settlement on Friday with the Justice Department that promises to increase the competition for sought-after technology workers. The government had conducted a yearlong investigation into agreements among companies not to poach employees from each other.
"The investigation focused on five agreements by the companies not to make cold calls to employees that each company had placed on a do-not-call list. Each of the pacts, according to the Justice Department filing, involved a pair of companies: Apple and Google, Apple and Adobe, Apple and Pixar, Google and Intel, and Google and Intuit.
"The agreements to curb cold-calling of each others’ workers, the Justice Department complaint said, “diminished competition to the detriment of the affected employees who were likely deprived of competitively important information and access to better job opportunities.”
"The American job market is tough for many workers, but things are looking even better than usual for highly paid engineers and scientists in Silicon Valley.
"Six leading technology companies, including Apple, Google and Intel, reached an antitrust settlement on Friday with the Justice Department that promises to increase the competition for sought-after technology workers. The government had conducted a yearlong investigation into agreements among companies not to poach employees from each other.
"The investigation focused on five agreements by the companies not to make cold calls to employees that each company had placed on a do-not-call list. Each of the pacts, according to the Justice Department filing, involved a pair of companies: Apple and Google, Apple and Adobe, Apple and Pixar, Google and Intel, and Google and Intuit.
"The agreements to curb cold-calling of each others’ workers, the Justice Department complaint said, “diminished competition to the detriment of the affected employees who were likely deprived of competitively important information and access to better job opportunities.”
Saturday, October 9, 2010
The job market in computer science
Lance Fortnow, blogging at Computational Complexity, posts what is apparently an Annual Fall Jobs Post about the academic job market in computer science. He notes that applications are being considered earlier this year, but there is also a transition in the career path of new CS theory grads, to include postdocs.
"The CRA is working on setting guidelines for job deadlines to help out with some of the gridlock in the job market. Many of the top departments have already moved their deadlines for full consideration to early December or November. Keep an eye out and remember to apply early this year."
...
"A little early to tell but this year will likely be similar to last year: a small number of tenure-track positions in TCS and a large number of postdoc positions. Out of necessity almost everyone does a postdoc now and many people doing a second or third as well.
"Have the theoretical computer science community actually moved to postdoc culture, where people are now expected to do a postdoc (or multiple postdocs) before taking a tenure-track position like physics, chemistry and biology? When did the field make that jump?"
This is a labor market that will be interesting to keep track of. (Will the appointment dates for first jobs continue moving earlier in time--i.e. are we seeing the beginning of unravelling? Or is this just a one time move to try to deal with congestion in clearing the market, so that multiple offers to a few stars don't delay things too late in the year? And, even if appointment to first jobs moves earlier, will tenure track positions move later, via postdocs? Stay tuned...)
HT: Mike Ostrovsky
"The CRA is working on setting guidelines for job deadlines to help out with some of the gridlock in the job market. Many of the top departments have already moved their deadlines for full consideration to early December or November. Keep an eye out and remember to apply early this year."
...
"A little early to tell but this year will likely be similar to last year: a small number of tenure-track positions in TCS and a large number of postdoc positions. Out of necessity almost everyone does a postdoc now and many people doing a second or third as well.
"Have the theoretical computer science community actually moved to postdoc culture, where people are now expected to do a postdoc (or multiple postdocs) before taking a tenure-track position like physics, chemistry and biology? When did the field make that jump?"
This is a labor market that will be interesting to keep track of. (Will the appointment dates for first jobs continue moving earlier in time--i.e. are we seeing the beginning of unravelling? Or is this just a one time move to try to deal with congestion in clearing the market, so that multiple offers to a few stars don't delay things too late in the year? And, even if appointment to first jobs moves earlier, will tenure track positions move later, via postdocs? Stay tuned...)
HT: Mike Ostrovsky
Friday, October 8, 2010
Organ donation legislation in California
Judd Kessler (who you could hire this year) writes about changes in CA law regarding organ donation, including live donation:
On Tuesday, October 5, California Governor Arnold Schwarzenegger ceremonially signed new organ donor legislation. There are two new bills that make a variety of changes to policy for both live and deceased organ donation in California. Here is a summary.
SB 1395 makes two changes. First, it authorizes the creation of an:
"Altruistic Living Donor Registry" where individuals can state their willingness to be a live kidney donor. (The bill allows for the possibility of extending the registry to other organs and tissues in the future.) The living donor registry would make information about potential donors available to facilitate pairwise exchanges and donor chains. According to the bill: "(a) ... The donor registry shall be designed to promote and assist live kidney donations, including donor chains, paired exchanges, and nondirected donations. The registrar shall be responsible for developing methods to increase the number of donors who enroll in the registry. (b) The registrar shall make available to the federally designated organ procurement organizations (OPOs) and transplant centers in California information contained in the registry regarding potential altruistic living donors. This information shall be used to expedite a match between identified organ donors and potential recipients."
Second, SB 1395 changes how the department of motor vehicles asks people whether they would like to register to be an organ and tissue donor upon death (i.e. a deceased donor). Currently the DMV allows potential donors to opt in. The application for a new or renewal driver's license or ID card has space to indicate a willingness to join the registry. Starting July 1, 2011, the donor registration question will require an "active" or "mandated" choice. According to the bill, the application will now: "contain a space for the applicant to enroll in the Donate Life California Organ and Tissue Donor Registry. The application shall include check boxes for an applicant to mark either (A) Yes, add my name to the donor registry or (B) I do not wish to register at this time." In addition, the DMV: "shall inquire verbally of an applicant applying in person ... at a department office as to whether the applicant wishes to enroll in the Donate Life California Organ and Tissue Donor Registry."
In Governor Schwarzenegger's speech at the bill signing he called this change to mandated choice "the next best thing" to an opt out system, where individuals would be deceased organ donors by default. He said an opt out system had been suggested to him by Steve Jobs, who recently received a liver transplant and was also in attendance at the bill signing, but that an opt-out system was not plausible due to constitutional concerns. In the Governor's words: "And we have to give [Steve Jobs] a lot of credit, because he came back, apparently from Europe or from somewhere where he called me and he said that, you know, in Europe, in Spain, they have no waiting list because you can only opt out; that if you don’t opt out then you are automatically on a donor list. So we tried to copy the same thing and we talked about that seven months ago. But our Constitution in the United States is different than the Spanish Constitution, so we could not legally do that. So we did the next best thing."
Another bill generated protections for employees who want to be living organ donors or bone marrow donors. SB 1304 requires private employers to provide paid leave for their employees who are organ donors (up to 30 days) or bone marrow donors (up to 5 days) and prevents private employers from blocking such donations by its employees or punishing them for donating. State employees already had this paid leave.
On Tuesday, October 5, California Governor Arnold Schwarzenegger ceremonially signed new organ donor legislation. There are two new bills that make a variety of changes to policy for both live and deceased organ donation in California. Here is a summary.
SB 1395 makes two changes. First, it authorizes the creation of an:
"Altruistic Living Donor Registry" where individuals can state their willingness to be a live kidney donor. (The bill allows for the possibility of extending the registry to other organs and tissues in the future.) The living donor registry would make information about potential donors available to facilitate pairwise exchanges and donor chains. According to the bill: "(a) ... The donor registry shall be designed to promote and assist live kidney donations, including donor chains, paired exchanges, and nondirected donations. The registrar shall be responsible for developing methods to increase the number of donors who enroll in the registry. (b) The registrar shall make available to the federally designated organ procurement organizations (OPOs) and transplant centers in California information contained in the registry regarding potential altruistic living donors. This information shall be used to expedite a match between identified organ donors and potential recipients."
Second, SB 1395 changes how the department of motor vehicles asks people whether they would like to register to be an organ and tissue donor upon death (i.e. a deceased donor). Currently the DMV allows potential donors to opt in. The application for a new or renewal driver's license or ID card has space to indicate a willingness to join the registry. Starting July 1, 2011, the donor registration question will require an "active" or "mandated" choice. According to the bill, the application will now: "contain a space for the applicant to enroll in the Donate Life California Organ and Tissue Donor Registry. The application shall include check boxes for an applicant to mark either (A) Yes, add my name to the donor registry or (B) I do not wish to register at this time." In addition, the DMV: "shall inquire verbally of an applicant applying in person ... at a department office as to whether the applicant wishes to enroll in the Donate Life California Organ and Tissue Donor Registry."
In Governor Schwarzenegger's speech at the bill signing he called this change to mandated choice "the next best thing" to an opt out system, where individuals would be deceased organ donors by default. He said an opt out system had been suggested to him by Steve Jobs, who recently received a liver transplant and was also in attendance at the bill signing, but that an opt-out system was not plausible due to constitutional concerns. In the Governor's words: "And we have to give [Steve Jobs] a lot of credit, because he came back, apparently from Europe or from somewhere where he called me and he said that, you know, in Europe, in Spain, they have no waiting list because you can only opt out; that if you don’t opt out then you are automatically on a donor list. So we tried to copy the same thing and we talked about that seven months ago. But our Constitution in the United States is different than the Spanish Constitution, so we could not legally do that. So we did the next best thing."
Another bill generated protections for employees who want to be living organ donors or bone marrow donors. SB 1304 requires private employers to provide paid leave for their employees who are organ donors (up to 30 days) or bone marrow donors (up to 5 days) and prevents private employers from blocking such donations by its employees or punishing them for donating. State employees already had this paid leave.
Thursday, October 7, 2010
College admissions--a state of the union interview
The Chronicle of Higher Education reports an interview with the departing head of the National Association for College Admissions Counseling (NACAC): Admission Group's Departing Leader Takes Stock
"Q. Tell me about one thing that you think is broken in the profession.
A. The number of ways to apply has grown. There’s been an increase in the number of programs under the banner of early decision or early action. There’s the increasing use of “snap apps,” which make it easy to apply. It’s hard for many of us who are long-term professionals to understand all the different ways to apply, and I think that it’s worse for kids and parents. This process should be relatively transparent, though it can’t be totally transparent.
Q. What’s good about college admissions today that wasn’t so good a decade ago?
A. Certainly there’s more information out there about college admissions. When I first started, people had no idea what college admissions was or what it really did. Now there’s far more info out there that’s helpful. To sort through all that information and figure out what’s good is the challenge. There’s far more attention paid to the process.
Q. In some ways, the national dialogue about college admissions has helped demystify the process. But are some of today’s enrollment-management tactics having the opposite effect?
A. Yes. Some of it has been demystified, but some of it has been replaced by other mysteries. There are two extremes. There are a huge number of kids who grow up in good homes where there isn’t a history of going to college. They don’t have the basic understanding that they have to have. Then there are other parents who are obsessed with admissions to certain institutions, and this leads to all kinds of mythology, or as I like to call them, suburban legends. Our challenge is to reach both of those populations—the ones that really need information for access that can change their lives, and those who are so obsessed about getting into a particular college."
"Q. Tell me about one thing that you think is broken in the profession.
A. The number of ways to apply has grown. There’s been an increase in the number of programs under the banner of early decision or early action. There’s the increasing use of “snap apps,” which make it easy to apply. It’s hard for many of us who are long-term professionals to understand all the different ways to apply, and I think that it’s worse for kids and parents. This process should be relatively transparent, though it can’t be totally transparent.
Q. What’s good about college admissions today that wasn’t so good a decade ago?
A. Certainly there’s more information out there about college admissions. When I first started, people had no idea what college admissions was or what it really did. Now there’s far more info out there that’s helpful. To sort through all that information and figure out what’s good is the challenge. There’s far more attention paid to the process.
Q. In some ways, the national dialogue about college admissions has helped demystify the process. But are some of today’s enrollment-management tactics having the opposite effect?
A. Yes. Some of it has been demystified, but some of it has been replaced by other mysteries. There are two extremes. There are a huge number of kids who grow up in good homes where there isn’t a history of going to college. They don’t have the basic understanding that they have to have. Then there are other parents who are obsessed with admissions to certain institutions, and this leads to all kinds of mythology, or as I like to call them, suburban legends. Our challenge is to reach both of those populations—the ones that really need information for access that can change their lives, and those who are so obsessed about getting into a particular college."
Wednesday, October 6, 2010
Principal agent problems, where the agent is a surgeon and the principal is a patient
Pauline Chen writes in the NY Times about The Surgeon’s Pact With the Patient
"[The] belief — that surgeons can be both Dr. Jekyll and Mr. Hyde when it comes to the doctor-patient relationship — has been embraced for generations by more than a few nonsurgical doctors, nurses and patients. Heroic in their devotion to patients when they are at their best, surgeons inexplicably seem to transform when they are at their worst. That worst usually comes on the heels of a high-risk operation and a complicated and protracted postoperative course. The nurses, other doctors and sometimes even the patient and family request palliation only; in response, the surgeon often stalls, hesitates or simply refuses.
"Since the late 1970s, ethicists and social scientists have tried explain what they viewed as surgeons’ paradoxical behavior with postoperative patients. One of the earliest researchers attributed to self-protection the surgical imperative to “do everything possible.” Inevitably, this medical sociologist reasoned, all surgeons commit a technical error over the course of their careers. By doing everything possible “for the patient,” surgeons protected themselves against the emotional distress of failure. The rationale behind this common-sense theory was straightforward: At least I did all that I could possibly do.
...
"A study* published this year offers an interesting possible answer...
"In interview after interview, the surgeons referred to a negotiation and agreement — what the researchers called “surgical buy-in” — that occurred during the consent process, long before these doctors and their patients ever entered the operating room. The surgeons believed that patients not only consented to the operation itself but also committed themselves to any care after the operation necessary for successful outcomes. They talked about the operation and postoperative care as being a “package deal” and about a tacit “two-way agreement” that included even well-articulated and well-defined numbers of postoperative days. ...
“Surgeons don’t want to invest themselves in a relationship and a technical tour de force, then have to walk away.”
*Schwarze, Margaret L. MD, MPP; Bradley, Ciaran T. MD, MA; Brasel, Karen J. MD, MPH, "Surgical "buy-in": The contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy," Critical Care Medicine: March 2010 - Volume 38 - Issue 3 - pp 843-848
"[The] belief — that surgeons can be both Dr. Jekyll and Mr. Hyde when it comes to the doctor-patient relationship — has been embraced for generations by more than a few nonsurgical doctors, nurses and patients. Heroic in their devotion to patients when they are at their best, surgeons inexplicably seem to transform when they are at their worst. That worst usually comes on the heels of a high-risk operation and a complicated and protracted postoperative course. The nurses, other doctors and sometimes even the patient and family request palliation only; in response, the surgeon often stalls, hesitates or simply refuses.
"Since the late 1970s, ethicists and social scientists have tried explain what they viewed as surgeons’ paradoxical behavior with postoperative patients. One of the earliest researchers attributed to self-protection the surgical imperative to “do everything possible.” Inevitably, this medical sociologist reasoned, all surgeons commit a technical error over the course of their careers. By doing everything possible “for the patient,” surgeons protected themselves against the emotional distress of failure. The rationale behind this common-sense theory was straightforward: At least I did all that I could possibly do.
...
"A study* published this year offers an interesting possible answer...
"In interview after interview, the surgeons referred to a negotiation and agreement — what the researchers called “surgical buy-in” — that occurred during the consent process, long before these doctors and their patients ever entered the operating room. The surgeons believed that patients not only consented to the operation itself but also committed themselves to any care after the operation necessary for successful outcomes. They talked about the operation and postoperative care as being a “package deal” and about a tacit “two-way agreement” that included even well-articulated and well-defined numbers of postoperative days. ...
“Surgeons don’t want to invest themselves in a relationship and a technical tour de force, then have to walk away.”
*Schwarze, Margaret L. MD, MPP; Bradley, Ciaran T. MD, MA; Brasel, Karen J. MD, MPH, "Surgical "buy-in": The contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy," Critical Care Medicine: March 2010 - Volume 38 - Issue 3 - pp 843-848
Tuesday, October 5, 2010
The wholesale market for art
We often think of the art market as essentially retail--each artwork is unique--but that's because we aren't art buyers for hotels, in which every room needs a painting or a print or two.
Hong Kong: Art in Big Batches
"Our first two appointments in Hong Kong were separate meetings with art consultants, Sandra Walters at Sandra Walters Art Consultancy and Nicole Jelicich at Enjay Art Consultancy. They collaborate with designers and property owners in providing art for hotels and corporate clients. They work in a volume unheard of in any gallery. Think thousands and tens of thousands of artworks. A new hotel—and there are hundreds under construction in China now—needs thousands of works for the rooms and the public areas. Both consultants have provided work for Ritz Carltons, Intercontinental Hotels, Four Seasons, Morgan Stanley and hundreds of other clients."
Hong Kong: Art in Big Batches
"Our first two appointments in Hong Kong were separate meetings with art consultants, Sandra Walters at Sandra Walters Art Consultancy and Nicole Jelicich at Enjay Art Consultancy. They collaborate with designers and property owners in providing art for hotels and corporate clients. They work in a volume unheard of in any gallery. Think thousands and tens of thousands of artworks. A new hotel—and there are hundreds under construction in China now—needs thousands of works for the rooms and the public areas. Both consultants have provided work for Ritz Carltons, Intercontinental Hotels, Four Seasons, Morgan Stanley and hundreds of other clients."
Monday, October 4, 2010
From repugnant transaction to Nobel Prize in Medicine
The Nobel Assembly at Karolinska Institutet has today decided to award
The Nobel Prize in Physiology or Medicine 2010
to
The Nobel Prize in Physiology or Medicine 2010
to
Robert G. Edwards
for the development of in vitro fertilization
From the press release:
"These early studies were promising but the Medical Research Council decided not to fund a continuation of the project. However, a private donation allowed the work to continue. The research also became the topic of a lively ethical debate that was initiated by Edwards himself. Several religious leaders, ethicists, and scientists demanded that the project be stopped, while others gave it their support."Since then,
"Approximately four million individuals have so far been born following IVF. Many of them are now adult and some have already become parents. A new field of medicine has emerged, with Robert Edwards leading the process all the way from the fundamental discoveries to the current, successful IVF therapy. His contributions represent a milestone in the development of modern medicine."
Afternoon update: Vatican official criticises Nobel win for IVF pioneer
"A Vatican official has said the awarding of the Nobel Prize for Medicine to British IVF pioneer Robert Edwards is "completely out of order".
Ignacio Carrasco de Paula, head of the Pontifical Academy for Life, said the award ignored the ethical questions raised by the fertility treatment.
He said IVF had led to the destruction of large numbers of human embryos."
Update 10/6/10: an Op Ed in the NY Times reminds us of some of the early reaction to IVF:
In Vitro Revelation
"Religious groups denounced the two scientists as madmen who were trying to play God. Medical ethicists declared that in vitro fertilization was the first step on a slippery slope toward aberrations like artificial wombs and baby farms.
"Fortunately, Louise Brown was not born a monster, but rather a healthy, 5-pound, 12-ounce blond baby girl."
Further update: here's an NPR broadcast: The Controversies That Still Lie Behind In-Vitro Fertilization?
"The Nobel Prize for medicine was awarded to Robert Edwards yesterday, who developed in vitro fertilization in the 1970. Controversial from its introduction, the practice was initially condemned by the Catholic Church. Today, while many of the original ethical issues have abated, new ones have arisen over questions about the in vitro industry's lack of regulation and the continuing debate surrounding stem cell research.
"Glenn Cohen, co-director of the Petrie-Flom Center, and assistant professof or law at Harvard University, believes the number one controversy today is the safety methods surrounding the practice."
Update 10/6/10: an Op Ed in the NY Times reminds us of some of the early reaction to IVF:
In Vitro Revelation
"Religious groups denounced the two scientists as madmen who were trying to play God. Medical ethicists declared that in vitro fertilization was the first step on a slippery slope toward aberrations like artificial wombs and baby farms.
"Fortunately, Louise Brown was not born a monster, but rather a healthy, 5-pound, 12-ounce blond baby girl."
Further update: here's an NPR broadcast: The Controversies That Still Lie Behind In-Vitro Fertilization?
"The Nobel Prize for medicine was awarded to Robert Edwards yesterday, who developed in vitro fertilization in the 1970. Controversial from its introduction, the practice was initially condemned by the Catholic Church. Today, while many of the original ethical issues have abated, new ones have arisen over questions about the in vitro industry's lack of regulation and the continuing debate surrounding stem cell research.
"Glenn Cohen, co-director of the Petrie-Flom Center, and assistant professof or law at Harvard University, believes the number one controversy today is the safety methods surrounding the practice."
Mail order husbands, on Foreign Son-in-Law Street
A Thai Region Where Husbands Are Imported.
"But unlike many other foreign husbands, Mr. Davis, 54, did not take his wife home with him, choosing instead to settle down in northeastern Thailand, a region known as Isaan.
"He is part of an expanding population of nearly 11,000 foreign husbands in the region, drawn by the low cost of living, slow pace of life and the exotic reputation of Thai women — something like a brand name for Western men seeking Asian partners. “Thai women are a lot like women in America were 50 years ago,” said Mr. Davis, before they discovered their rights and became “strong-headed and opinionated.”
“The women now know they are equal,” said Mr. Davis, a retired Naval officer who has been divorced twice, “so the situation is not as relaxed and peaceful as it is between an American and a Thai lady.”
"It is easy to spot the foreigners’ homes, with their sturdy walls and red-tiled roofs, an archipelago of affluence among the smaller, poorer houses of their new neighbors and in-laws.
"Mixed couples are common on the streets and in the markets of Udon Thani. One street where Western men gather to eat and drink is popularly known as “Foreign Son-in-Law Street.”
"But unlike many other foreign husbands, Mr. Davis, 54, did not take his wife home with him, choosing instead to settle down in northeastern Thailand, a region known as Isaan.
"He is part of an expanding population of nearly 11,000 foreign husbands in the region, drawn by the low cost of living, slow pace of life and the exotic reputation of Thai women — something like a brand name for Western men seeking Asian partners. “Thai women are a lot like women in America were 50 years ago,” said Mr. Davis, before they discovered their rights and became “strong-headed and opinionated.”
“The women now know they are equal,” said Mr. Davis, a retired Naval officer who has been divorced twice, “so the situation is not as relaxed and peaceful as it is between an American and a Thai lady.”
"It is easy to spot the foreigners’ homes, with their sturdy walls and red-tiled roofs, an archipelago of affluence among the smaller, poorer houses of their new neighbors and in-laws.
"Mixed couples are common on the streets and in the markets of Udon Thani. One street where Western men gather to eat and drink is popularly known as “Foreign Son-in-Law Street.”
Sunday, October 3, 2010
Piracy watch: can security off the coast of Somalia be privatized?
Steve Leider writes:
Piracy season is resuming off the coast of Africa with the end of the monsoon season. Several attacks have already been thwarted by ships newly equipped with safe rooms:
Over the weekend, pirates boarded the Greek-operated MV Lugela in the Indian Ocean but were frustrated to find the Ukrainian crew had locked itself in a safe room and disabled the engine. Unable to hold the mariners' lives to ransom or steer the ship back to base, the pirates left the cargo.
Nick Davis, a piracy expert with the United Kingdom-based Merchant Maritime Warfare Centre, explained that such panic rooms were cheap and effective. "You need a strong master, a well-stocked citadel, so you can sit there for up to five or seven days and wait for the cavalry," he said. "If the pirates have a dark ship and no crew, they'll just look for another." But he stressed the importance of having functioning communications equipment in the citadel.
Earlier in September, pirates boarded a German-owned ship in the Gulf of Aden. Failing to find the crew, they even called the vessel's operator out of frustration, only to be told the ship was broken and the crew "on holiday".
Nick Davis, a piracy expert with the United Kingdom-based Merchant Maritime Warfare Centre, explained that such panic rooms were cheap and effective. "You need a strong master, a well-stocked citadel, so you can sit there for up to five or seven days and wait for the cavalry," he said. "If the pirates have a dark ship and no crew, they'll just look for another." But he stressed the importance of having functioning communications equipment in the citadel.
Earlier in September, pirates boarded a German-owned ship in the Gulf of Aden. Failing to find the crew, they even called the vessel's operator out of frustration, only to be told the ship was broken and the crew "on holiday".
Unfortunately only half of the ships active in the area are believed to have such a safe room.
A multi-national naval force is also currently patrolling the area, however it has yet to substantially reduce piracy. A major UK insurer is suggesting the creation of a private navy to be placed under the command of existing international force to augment their activities:
A leading London insurer is pushing ahead with radical proposals to create a private fleet of about 20 patrol boats crewed by armed guards to bolster the international military presence off the Somali coast. They would act as escorts and fast-response vessels for shipping passing through the Suez Canal and the Indian Ocean. Jardine Lloyd Thompson Group (JLT), which insures 14 per cent of the world’s commercial shipping fleet, said the unprecedented “private navy” would work under the direct control of the military with clear rules of engagement valid under international law …
Sean Woollerson, a senior partner with JLT, told The Independent: “We are looking at setting up a private navy to escort vessels through the danger zones. We would have armed personnel with fast boats escorting ships and make it very clear to any Somali vessels in the vicinity that they are entering a protected area.
“At the moment there is a disconnect between the private security sector and the international naval force. We think we can help remedy that and place this force under the control of the multi-national force. We look after about 5,000 ships and have had 10 vessels taken in total, including a seizure where one crew member was shot and killed. Piracy is a serious problem, these are criminals basically extorting funds, so why not do something more proactive?”
The force, which would have set-up costs of around £10m, would be funded by insurers and shipping companies in return for a reduction on the anti-piracy insurance premiums, which average around £50,000 per voyage and can reach £300,000 for a super-tanker. The maritime insurance industry, much of it based in London, has borne the brunt of the financial cost of the piracy problem, paying out $300m (£191m) in ransoms and associated costs in the last two years alone.
Major obstacles remain before the private navy can set sail, such as the legal status of a private force and it relationship with the Nato-controlled naval fleet. But major shipping companies and key insurers are keen to proceed with the plan. Although private contractors already offer armed teams on board vessels, the idea of a sizeable industry-funded naval force is a major departure and evidence of the strength of feeling there that more needs to be done to counter piracy.
The proposed “private navy” would therefore act in a somewhat similar fashion to the private security contractors operating in Iraq. It will be important to clarify whether the navy would qualify as a mercenary force. While mercenaries have historically been an important part of warfare, modern international law discourages mercenaries by withholding from them the protections afforded other combatants. Article 47, Protocol I of the Geneva Convention regulates mercenaries as follows:
1. A mercenary shall not have the right to be a combatant or a prisoner of war.
2. A mercenary is any person who:
(a) is specially recruited locally or abroad in order to fight in an armed conflict;
(b) does, in fact, take a direct part in the hostilities;
(c) is motivated to take part in the hostilities essentially by the desire for private gain and, in fact, is promised, by or on behalf of a Party to the conflict, material compensation substantially in excess of that promised or paid to combatants of similar ranks and functions in the armed forces of that Party;
(d) is neither a national of a Party to the conflict nor a resident of territory controlled by a Party to the conflict;
(e) is not a member of the armed forces of a Party to the conflict; and
(f) has not been sent by a State which is not a Party to the conflict on official duty as a member of its armed forces.
2. A mercenary is any person who:
(a) is specially recruited locally or abroad in order to fight in an armed conflict;
(b) does, in fact, take a direct part in the hostilities;
(c) is motivated to take part in the hostilities essentially by the desire for private gain and, in fact, is promised, by or on behalf of a Party to the conflict, material compensation substantially in excess of that promised or paid to combatants of similar ranks and functions in the armed forces of that Party;
(d) is neither a national of a Party to the conflict nor a resident of territory controlled by a Party to the conflict;
(e) is not a member of the armed forces of a Party to the conflict; and
(f) has not been sent by a State which is not a Party to the conflict on official duty as a member of its armed forces.
Saturday, October 2, 2010
The market for knife sharpening
There was a time when knife sharpeners brought their grindstones to the meat packers and butchers who were their main customers, and sharpened customers' knives on customers' premises. Now, the NY Times reports, the model is to rent a double set of knives to customers (who now include restaurants), so that the knife sharpener can come in and exchange all the dull knives for sharp ones, and sharpen the knives on his own premises: Venerable Craft, Modern Practitioner.
Apparently this business is one with ethnic, networked roots:
"Mr. Ambrosi’s grandfather, who came to the United States in the 1920s, hailed from the poor village of Carisolo. The village, with two neighboring towns of Pinzolo and Giustino, produced many of the more than 100 commercial knife sharpeners at work today in North America, sharpeners said. "
...
"At first the immigrants came mainly to New York, but soon their offspring scattered to stake out new routes, a dozen sharpeners across the country said in interviews. Ambrosis with grindstones do business in Connecticut, New Jersey and Ohio, as well as boroughs of New York. The Binellis set up knife-sharpening businesses in Detroit, Chicago and Medford, Mass.; the Maganzinis ended up in and around Boston. The Povinellis set up shop in Buffalo and ventured to North and South Carolina and Arizona; offshoots of the Nella family went to Toronto and Vancouver, as well as Long Island, Seattle and West Jordan, Utah.
"Robert Ambrosi’s grandfather traveled the Bronx in a horse-drawn cart with a grindstone powered by a foot pedal, serving, like the other knife sharpeners, mainly butchers and meatpackers.
"Mr. Ambrosi’s father used a grindstone fueled by a battery carried in a truck. The battery had to be plugged in each night in the garage to recharge. Then in the 1950s came the great innovation — double sets of knives — that eventually freed the Ambrosis to set up their first shop."
...
"Some of the northern Italian knife sharpeners still function in the old style, as members of the New York Grinders Association. The rules used to be simple: Don’t mess with someone’s turf. Stick to your own route — the one you inherited from your father or grandfather. Avoid the vendettas that have overtaken sharpeners in other cities.
“People will trade stops,” said Rinaldo Beltrami, the association’s president.
"Mr. Ambrosi, who let his membership in the association lapse, said, “I was brought up in that way of thinking.” Yet he will still sometimes appease a competitor by saying, “Let’s sit down, we’ll have a meeting, we’ll make a borderline — I won’t bother you.”
"Yet his sons have been knocking on doors to establish new routes, and Mr. Ambrosi has developed a Web site and a mail-order service, because his sons need enough business to sustain their future families, too. "
Apparently this business is one with ethnic, networked roots:
"Mr. Ambrosi’s grandfather, who came to the United States in the 1920s, hailed from the poor village of Carisolo. The village, with two neighboring towns of Pinzolo and Giustino, produced many of the more than 100 commercial knife sharpeners at work today in North America, sharpeners said. "
...
"At first the immigrants came mainly to New York, but soon their offspring scattered to stake out new routes, a dozen sharpeners across the country said in interviews. Ambrosis with grindstones do business in Connecticut, New Jersey and Ohio, as well as boroughs of New York. The Binellis set up knife-sharpening businesses in Detroit, Chicago and Medford, Mass.; the Maganzinis ended up in and around Boston. The Povinellis set up shop in Buffalo and ventured to North and South Carolina and Arizona; offshoots of the Nella family went to Toronto and Vancouver, as well as Long Island, Seattle and West Jordan, Utah.
"Robert Ambrosi’s grandfather traveled the Bronx in a horse-drawn cart with a grindstone powered by a foot pedal, serving, like the other knife sharpeners, mainly butchers and meatpackers.
"Mr. Ambrosi’s father used a grindstone fueled by a battery carried in a truck. The battery had to be plugged in each night in the garage to recharge. Then in the 1950s came the great innovation — double sets of knives — that eventually freed the Ambrosis to set up their first shop."
...
"Some of the northern Italian knife sharpeners still function in the old style, as members of the New York Grinders Association. The rules used to be simple: Don’t mess with someone’s turf. Stick to your own route — the one you inherited from your father or grandfather. Avoid the vendettas that have overtaken sharpeners in other cities.
“People will trade stops,” said Rinaldo Beltrami, the association’s president.
"Mr. Ambrosi, who let his membership in the association lapse, said, “I was brought up in that way of thinking.” Yet he will still sometimes appease a competitor by saying, “Let’s sit down, we’ll have a meeting, we’ll make a borderline — I won’t bother you.”
"Yet his sons have been knocking on doors to establish new routes, and Mr. Ambrosi has developed a Web site and a mail-order service, because his sons need enough business to sustain their future families, too. "
Friday, October 1, 2010
Unraveling and diversity in the market for law clerks
One question about unravelling of markets--in which hiring becomes earlier, more diffuse in time, and characterized by very short duration "exploding" offers, is whether it reduces diversity. The idea is that if you have to hire people far in advance, e.g. when they are still in kindergarten, then you can't tell as much as you would like about individuals, so you had better be hiring from good kindergartens.
I'm reminded of this for two reasons. The first is a recent article on clerks in the Supreme Court:
"There are about 160 active federal appeals court judges and more than 100 more semiretired ones, yet more than half of the clerks who have served on the Roberts court came from the chambers of just 10 judges. Three judges accounted for a fifth of all Supreme Court clerks."
That from Adam Liptak in the NY Times: A Sign of the Court’s Polarization: Choice of Clerks
The second is this graph showing which law schools clerks have been coming from:
That is from a blog post from Dave Hoffman at Concurring Opinions, called The Quickly Unraveling Clerkship Market.
He writes that this year there is even more unraveling than usual, i.e. the plan for regulating the hiring of law clerks may be on its last legs, as the increasing levels of cheating we observed in previous years has apparently continued to increase.
(see Avery, Christopher, Jolls, Christine, Posner, Richard A. and Roth, Alvin E., "The New Market for Federal Judicial Law Clerks" . University of Chicago Law Review, 74, Spring 2007, 447-486. )
I'm reminded of this for two reasons. The first is a recent article on clerks in the Supreme Court:
"There are about 160 active federal appeals court judges and more than 100 more semiretired ones, yet more than half of the clerks who have served on the Roberts court came from the chambers of just 10 judges. Three judges accounted for a fifth of all Supreme Court clerks."
That from Adam Liptak in the NY Times: A Sign of the Court’s Polarization: Choice of Clerks
The second is this graph showing which law schools clerks have been coming from:
He writes that this year there is even more unraveling than usual, i.e. the plan for regulating the hiring of law clerks may be on its last legs, as the increasing levels of cheating we observed in previous years has apparently continued to increase.
(see Avery, Christopher, Jolls, Christine, Posner, Richard A. and Roth, Alvin E., "The New Market for Federal Judicial Law Clerks" . University of Chicago Law Review, 74, Spring 2007, 447-486. )
Thursday, September 30, 2010
Early decision in selective colleges
Steve Cohen at Forbes tabulates some admissions figures in his blog post: Early Decision: College Admission’s Secret Handshake
College Percentage of Class Filled by Early Acceptances
Brown 38%
Columbia 59%
Cornell 37%
Dartmouth 42%
Penn 50%
Williams 41%
Colgate 43%
Kenyon 38%
Lafayette 43%
Rice 27%
College Percentage of Class Filled by Early Acceptances
Brown 38%
Columbia 59%
Cornell 37%
Dartmouth 42%
Penn 50%
Williams 41%
Colgate 43%
Kenyon 38%
Lafayette 43%
Rice 27%
Update on that Medicare Auction
Peter Cramton writes to update us on the progress of the letter he organized about A poorly designed Medicare auction .
"I want to thank you again for being a signatory on the letter to Chairman Stark expressing our concerns with the flawed Medicare Competitive Bidding Program. I sent the letter linked below to Chairman Stark late on Sunday night. He responded within two days with a letter to the head of Medicare concluding, “I urge you to give these comments and recommendations serious consideration. I would also request that you inform me in a timely way as to whether CMS plans to incorporate any of the recommended changes and if not, why not.” The full letter is linked below.
"I want to thank you again for being a signatory on the letter to Chairman Stark expressing our concerns with the flawed Medicare Competitive Bidding Program. I sent the letter linked below to Chairman Stark late on Sunday night. He responded within two days with a letter to the head of Medicare concluding, “I urge you to give these comments and recommendations serious consideration. I would also request that you inform me in a timely way as to whether CMS plans to incorporate any of the recommended changes and if not, why not.” The full letter is linked below.
"Letter from 167 Concerned Auction Experts on Medicare Competitive Bidding Program" to Chairman Stark, Health Subcommittee, Ways and Means, U.S. House of Representatives, 26 September 2010. [Letter from Chairman Stark to CMS]
Yesterday, the deputy head of CMS, who is in charge of the competitive bidding program, contacted me to request a meeting to discuss the issues. We have not met yet, but I am optimistic that something good will come from this. Please be patient. Washington has now effectively shut down until after the elections. This will be a slow burner, but thanks to all of you the chance of a sensible outcome is positive. One could not say that a week ago.
A thousand thanks!
Best,
Peter
PS You may find the [Excerpts from replies] of interest. The excerpts are anonymous. Finally, here is a Freakonomics Blog with Ian Ayres that appeared today in the Opinion Pages of the New York Times.
Professor Peter Cramton
Economics, Tydings Hall
University of Maryland
College Park MD 20742-7211
Update: Peter and Brett E. Katzman have a followup column in The Economists' Voice (Oct. 2010): Reducing Healthcare Costs Requires Good Market Design
Update: Peter and Brett E. Katzman have a followup column in The Economists' Voice (Oct. 2010): Reducing Healthcare Costs Requires Good Market Design
Junior tennis players: turn pro or go to college?
Agents Bet on Future at the Juniors Tournament
"“Juniors are the lifeblood of the business,” said Norman Canter, an agent and owner of Renaissance Tennis Management. “Most people out here are looking for the kids born in 1995 who have demonstrated some talent and have some growing and maturing to do. But don’t kid yourself, it’s a total crapshoot.”
"What are the odds of unearthing the next Andre Agassi, or even an Andy Roddick?
"Not too long ago, McKinley said, Babolat examined the top 100 players from the International Tennis Federation’s boys’ and girls’ junior rankings over a stretch of several years. Then it tracked those players as they tried to crack the top 100 in the men’s and women’s professional tours.
"The results? About 7 percent of the world’s best juniors were able to make the transition to a top 100 men’s or women’s player. Barely 1 percent reached the top 10. Gael Monfils, for example, was the International Tennis Federation junior world champion in 2004 and reached as high as No. 9 in the A.T.P. world rankings in 2009. He was ranked 19th before losing Wednesday in the quarterfinals to Novak Djokovic.
“They are pretty discouraging numbers,” conceded McKinley, who covers America and Australia for Babolat, which earned more than $150 million in revenues in 2009. “But we’ve built our business at the grass-roots level by identifying up-and-coming juniors and making sure they are playing with our rackets and strings. They may not make it to Nadal’s level, but in their hometowns everyone knows who they are and what they are using. That is a lot of exposure and sales for us.”
"The agents, too, know it is a numbers game, and follow an adage: Sign 100 of them, and start picking up the phone when one or two start to win.
"After all, in 1998, Federer was the I.T.F. junior champion. Twelve years later, 20 percent of the $25 million in endorsements he earns as the world’s most decorated tennis player is substantial money.
"There is mounting evidence that older is better in professional tennis — the average age of the women occupying the first 10 spots in the world rankings is 26, a year older than that of the top 10 men. Patrick McEnroe, the general manager for the United States Tennis Association’s player development program, has been blunt in his assessment of what the search for teenage phenoms has done to weaken American tennis.
“The bottom line is, we lost a generation of players the last 10 years that should have gone to college but didn’t,” he said.
"Still, the juniors tournament at the United States Open remains a bustling marketplace as manufacturers and agents double down on the next-not-so-sure-thing. Lagardère made the biggest noise recently by signing Monica Puig, a 16-year-old who lives in Miami. She is ranked fourth in the I.T.F. junior rankings and won her first professional tournament in April in Spain.
"Turning pro hardly means instant riches. In addition to free equipment and clothing, companies like Babolat and Nike will offer performance bonuses for tournament victories and rankings. Winning a $10,000 Futures tournament — the fledgling pro’s starter circuit — might bring a $1,000 bonus. Rising to the top 100 tour rankings can be worth $25,000 from sponsors.
"The out-of-pocket expenses, however, are substantial; players train and practice five hours a day for 41 weeks, receive high-performance coaching and travel, and compete in 24 tournaments.
“It’s about $100,000 or $150,000 just to start a boy or girl down the professional path,” Canter said.
"The hard reality and cold cash it takes to chase a dream rarely discourages young players who have been given free equipment and courted by agents since the time they could hold a racket.
The American Ryan Harrison, 18, for example, who advanced to the second round of the main draw, said he was first approached by an agent as a 12-year-old and turned professional three years later.
"Sock, 17, the promising American, plays with Babolat rackets, wears Nike clothes and plays a mix of junior and pro tournaments, but he has yet to accept bonuses or prize money to preserve his N.C.A.A. eligibility. His father, Larry Sock, wanted his son to go to regular school and keep some semblance of a normal family life intact. ... The Socks have not decided if Jack will turn professional or go to college, perhaps at Nebraska, where his brother Eric plays for the Cornhuskers.
“They can be very persuasive,” Larry Sock said of agents. “But college sounds pretty good to me.”
"European players do not have college eligibility to protect and are often the center of the agent frenzy. But their odds of success are hardly any better. For every Maria Sharapova, there are perhaps dozens like Lera Solovieva.
"Solovieva, a Russian, was 11 and one of the most sought-after juniors in the world when Canter signed her. He got her deals with blue-chip sponsors like Nike, paid for her to live and train in Miami, and cared and outfitted her down to a set of braces. Nearly four years and $650,000 of Renaissance Tennis Management’s money later, Solovieva is back in Russia, trying to revive a career thwarted by injuries and a lack of development."
"“Juniors are the lifeblood of the business,” said Norman Canter, an agent and owner of Renaissance Tennis Management. “Most people out here are looking for the kids born in 1995 who have demonstrated some talent and have some growing and maturing to do. But don’t kid yourself, it’s a total crapshoot.”
"What are the odds of unearthing the next Andre Agassi, or even an Andy Roddick?
"Not too long ago, McKinley said, Babolat examined the top 100 players from the International Tennis Federation’s boys’ and girls’ junior rankings over a stretch of several years. Then it tracked those players as they tried to crack the top 100 in the men’s and women’s professional tours.
"The results? About 7 percent of the world’s best juniors were able to make the transition to a top 100 men’s or women’s player. Barely 1 percent reached the top 10. Gael Monfils, for example, was the International Tennis Federation junior world champion in 2004 and reached as high as No. 9 in the A.T.P. world rankings in 2009. He was ranked 19th before losing Wednesday in the quarterfinals to Novak Djokovic.
“They are pretty discouraging numbers,” conceded McKinley, who covers America and Australia for Babolat, which earned more than $150 million in revenues in 2009. “But we’ve built our business at the grass-roots level by identifying up-and-coming juniors and making sure they are playing with our rackets and strings. They may not make it to Nadal’s level, but in their hometowns everyone knows who they are and what they are using. That is a lot of exposure and sales for us.”
"The agents, too, know it is a numbers game, and follow an adage: Sign 100 of them, and start picking up the phone when one or two start to win.
"After all, in 1998, Federer was the I.T.F. junior champion. Twelve years later, 20 percent of the $25 million in endorsements he earns as the world’s most decorated tennis player is substantial money.
"There is mounting evidence that older is better in professional tennis — the average age of the women occupying the first 10 spots in the world rankings is 26, a year older than that of the top 10 men. Patrick McEnroe, the general manager for the United States Tennis Association’s player development program, has been blunt in his assessment of what the search for teenage phenoms has done to weaken American tennis.
“The bottom line is, we lost a generation of players the last 10 years that should have gone to college but didn’t,” he said.
"Still, the juniors tournament at the United States Open remains a bustling marketplace as manufacturers and agents double down on the next-not-so-sure-thing. Lagardère made the biggest noise recently by signing Monica Puig, a 16-year-old who lives in Miami. She is ranked fourth in the I.T.F. junior rankings and won her first professional tournament in April in Spain.
"Turning pro hardly means instant riches. In addition to free equipment and clothing, companies like Babolat and Nike will offer performance bonuses for tournament victories and rankings. Winning a $10,000 Futures tournament — the fledgling pro’s starter circuit — might bring a $1,000 bonus. Rising to the top 100 tour rankings can be worth $25,000 from sponsors.
"The out-of-pocket expenses, however, are substantial; players train and practice five hours a day for 41 weeks, receive high-performance coaching and travel, and compete in 24 tournaments.
“It’s about $100,000 or $150,000 just to start a boy or girl down the professional path,” Canter said.
"The hard reality and cold cash it takes to chase a dream rarely discourages young players who have been given free equipment and courted by agents since the time they could hold a racket.
The American Ryan Harrison, 18, for example, who advanced to the second round of the main draw, said he was first approached by an agent as a 12-year-old and turned professional three years later.
"Sock, 17, the promising American, plays with Babolat rackets, wears Nike clothes and plays a mix of junior and pro tournaments, but he has yet to accept bonuses or prize money to preserve his N.C.A.A. eligibility. His father, Larry Sock, wanted his son to go to regular school and keep some semblance of a normal family life intact. ... The Socks have not decided if Jack will turn professional or go to college, perhaps at Nebraska, where his brother Eric plays for the Cornhuskers.
“They can be very persuasive,” Larry Sock said of agents. “But college sounds pretty good to me.”
"European players do not have college eligibility to protect and are often the center of the agent frenzy. But their odds of success are hardly any better. For every Maria Sharapova, there are perhaps dozens like Lera Solovieva.
"Solovieva, a Russian, was 11 and one of the most sought-after juniors in the world when Canter signed her. He got her deals with blue-chip sponsors like Nike, paid for her to live and train in Miami, and cared and outfitted her down to a set of braces. Nearly four years and $650,000 of Renaissance Tennis Management’s money later, Solovieva is back in Russia, trying to revive a career thwarted by injuries and a lack of development."
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