Civil Unions Advance in Illinois
"Illinois lawmakers on Wednesday approved legislation allowing civil unions in this state, and the governor has indicated he will sign it, making Illinois one of only a handful of states to grant to same-sex couples a broad array of legal rights and responsibilities similar to those of marriage.
"Advocates of the legislation, who had pressed the matter for years, pointed to the outcome as a sign that acceptance of gay men and lesbians is growing and not only on the coasts.
“Sober, clear-minded, cautious Midwesterners are taking this action,” said Rick Garcia of Equality Illinois, a gay-rights group.
"Opponents complained about the timing of the vote (during a fall session before newly elected legislators arrive) and said they feared civil union legislation might ultimately harm the institution of marriage. “This will be the entry to a slippery slope,” Ron Stephens, a Republican state representative, said. “The next thing we’ll see will be consideration of gay marriage.”
"Five states and the District of Columbia allow same-sex marriage, while New Jersey grants civil unions similar to the measure expected to take effect here in July. Four other states grant domestic partnerships with broad legal rights — bonds that some experts said carry many of the rights provided under Illinois’s new legislation if not the precise ceremonial recognition suggested by civil union.
"The Illinois provision will provide couples many legal protections now granted to married couples, including emergency medical decision-making powers and inheritance rights. The legislation allows heterosexual couples to seek civil unions, too.
Thursday, December 9, 2010
Wednesday, December 8, 2010
National kidney exchange in Canada
Here's a recent announcement from Canadian Blood Services: Kidney Exchange Registry Goes National, Living Donor Paired Exchange becomes first Canada-wide organ donation registry
"OTTAWA, ON - November 30, 2010 -- Yesterday, the Living Donor Paired Exchange performed the first match run to include kidney patients and donors from all across Canada. In doing so, it became the first Canada-wide organ donation registry.
"The LDPE registry facilitates living kidney donations between patients with a willing but incompatible donor and another pair in the same situation. It is a partnership between Canadian Blood Services and transplant programs across the country, and was launched as a three-province pilot in January 2009. Since then, all other provinces have gradually joined the registry, and with Quebec firming up its participation in October, the initiative has become Canada-wide in scope.
"The inclusion of all provinces in the LDPE is a significant development for patients as it increases the pool of donors. And of course the larger the pool, the more likely patients are to find a match and receive the transplant they need," said Dr. Graham Sher, CEO, Canadian Blood Services. "This is a prime example of how better collaboration and integration can improve donation and transplantation rates in this country, and ultimately, save more lives. It is what sets top performing countries apart."
"The LDPE has registered 185 donor/recipient pairs from across the country, and has been responsible for facilitating 57 kidney transplants since the launch with an additional 16 scheduled for surgery in the weeks ahead.
"Critical to the registry's success has been the inclusion of non-directed donors - a person who is entered into the registry, unpaired and willing to donate to any one in need. "Non-directed donors are selfless heroes that have created 'domino exchanges' which are responsible for 45 of the 57 transplants to date," said Dr. Ed Cole, Chair of the National Kidney Registries Advisory Committee and University Health Network Physician-in-Chief. "Non-directed donors greatly increase the number of available matches, but best of all, since they enter as a single rather than a pair, it means that at the end of the domino chain, one patient on the deceased donor waiting list also gets a transplant."
"OTTAWA, ON - November 30, 2010 -- Yesterday, the Living Donor Paired Exchange performed the first match run to include kidney patients and donors from all across Canada. In doing so, it became the first Canada-wide organ donation registry.
"The LDPE registry facilitates living kidney donations between patients with a willing but incompatible donor and another pair in the same situation. It is a partnership between Canadian Blood Services and transplant programs across the country, and was launched as a three-province pilot in January 2009. Since then, all other provinces have gradually joined the registry, and with Quebec firming up its participation in October, the initiative has become Canada-wide in scope.
"The inclusion of all provinces in the LDPE is a significant development for patients as it increases the pool of donors. And of course the larger the pool, the more likely patients are to find a match and receive the transplant they need," said Dr. Graham Sher, CEO, Canadian Blood Services. "This is a prime example of how better collaboration and integration can improve donation and transplantation rates in this country, and ultimately, save more lives. It is what sets top performing countries apart."
"The LDPE has registered 185 donor/recipient pairs from across the country, and has been responsible for facilitating 57 kidney transplants since the launch with an additional 16 scheduled for surgery in the weeks ahead.
"Critical to the registry's success has been the inclusion of non-directed donors - a person who is entered into the registry, unpaired and willing to donate to any one in need. "Non-directed donors are selfless heroes that have created 'domino exchanges' which are responsible for 45 of the 57 transplants to date," said Dr. Ed Cole, Chair of the National Kidney Registries Advisory Committee and University Health Network Physician-in-Chief. "Non-directed donors greatly increase the number of available matches, but best of all, since they enter as a single rather than a pair, it means that at the end of the domino chain, one patient on the deceased donor waiting list also gets a transplant."
Tuesday, December 7, 2010
School districts face a multitude of problems
My colleagues and I mostly interact with municipal school districts regarding questions of school choice. But of course school boards and districts have to deal with a whole multitude of problems, some of which sometimes impact their school choice decisions (either directly, or just because some problems are even more pressing).
In NY, Class Sizes Grew in City Despite ’07 Deal to Cut Them.
And here's a story, that in discussing opposition to Mayor Bloomberg's newly nominated schools Chancellor, also provides a good summary of the size of the changes he and Chancellor Joel Klein tackled: Frustrations With Mayor Are Backdrop to Nominee Uproar
"Mr. Klein took office soon after the State Legislature handed the mayor control of the school system — no one yet knew how it would play out, and few would have imagined the scope of the overhaul that the mayor has since engineered. Mr. Bloomberg had yet to dissolve the 32 school districts that were a bedrock of the system and that, while chronically corrupt in some places, were also a crucial lifeline for parents with questions and concerns.
"Sure, people who follow such things knew that the Board of Education, once a hotbed of political squabbling, would be replaced by a panel whose majority would be appointed by the mayor. But no one foresaw that if the mayor’s appointees disagreed with his policies they would be fired, as two were on the eve of a controversial panel vote in 2004, rendering the panel toothless. Now that it is clear that mayoral control really means mayoral control, the question of who would execute the mayor’s wishes has taken on more importance. "
Boston also has serious budget problems, which directly affect school choice: School officials in Hub urge closings
"The scenarios following Superintendent Carol R. Johnson’s recommendations last month to close several schools represent the stark realities confronting the school system as it prepares for its fourth consecutive year of budget cutting. The district is projecting a $63 million shortfall for the school year beginning September 2011. Last night, officials said the 2012-13 school year could be even worse, with an anticipated $91 million shortfall...
"The 40-minute financial presentation last night did little to quell the protests from the schools recommended for closure: the East Zone Learning Center, Emerson Elementary, Clap Elementary, Social Justice Academy, and the Engineering School in Hyde Park....
"In January, the school district is expected to raise once again the divisive issue of changing the way the district assigns students to schools after a similar attempt failed two years ago amid public uproar. The effort is intended to reduce busing costs by shrinking the geographic regions from which families can choose schools. If the district comes up with a palatable plan, any savings are not expected to be realized for at least two years."
and
More schools targeted to close in Hub
"The School Committee is slated to vote Dec. 15 on Johnson’s proposal. The committee needs to act quickly because next month parents start submitting their choices of where they want to send their children to school next fall.
...
"But some of those buildings might not sit empty for long. In a separate announcement late yesterday afternoon, Johnson and Mayor Thomas M. Menino said some buildings may be leased to charter schools, which are planning an aggressive expansion in the city."
In San Francisco, there are problems on the school district staff: San Francisco School Administrators Schemed to Take Money, Documents Say
"A group of San Francisco Unified School District administrators, including an associate superintendent, engaged in a long-running scheme to funnel district money into their personal bank accounts via nonprofit community organizations, according to internal documents. "
In short, market design takes place, when it does, amidst a noisy, difficult background, particularly in tough financial times.
In NY, Class Sizes Grew in City Despite ’07 Deal to Cut Them.
And here's a story, that in discussing opposition to Mayor Bloomberg's newly nominated schools Chancellor, also provides a good summary of the size of the changes he and Chancellor Joel Klein tackled: Frustrations With Mayor Are Backdrop to Nominee Uproar
"Mr. Klein took office soon after the State Legislature handed the mayor control of the school system — no one yet knew how it would play out, and few would have imagined the scope of the overhaul that the mayor has since engineered. Mr. Bloomberg had yet to dissolve the 32 school districts that were a bedrock of the system and that, while chronically corrupt in some places, were also a crucial lifeline for parents with questions and concerns.
"Sure, people who follow such things knew that the Board of Education, once a hotbed of political squabbling, would be replaced by a panel whose majority would be appointed by the mayor. But no one foresaw that if the mayor’s appointees disagreed with his policies they would be fired, as two were on the eve of a controversial panel vote in 2004, rendering the panel toothless. Now that it is clear that mayoral control really means mayoral control, the question of who would execute the mayor’s wishes has taken on more importance. "
Boston also has serious budget problems, which directly affect school choice: School officials in Hub urge closings
"The scenarios following Superintendent Carol R. Johnson’s recommendations last month to close several schools represent the stark realities confronting the school system as it prepares for its fourth consecutive year of budget cutting. The district is projecting a $63 million shortfall for the school year beginning September 2011. Last night, officials said the 2012-13 school year could be even worse, with an anticipated $91 million shortfall...
"The 40-minute financial presentation last night did little to quell the protests from the schools recommended for closure: the East Zone Learning Center, Emerson Elementary, Clap Elementary, Social Justice Academy, and the Engineering School in Hyde Park....
"In January, the school district is expected to raise once again the divisive issue of changing the way the district assigns students to schools after a similar attempt failed two years ago amid public uproar. The effort is intended to reduce busing costs by shrinking the geographic regions from which families can choose schools. If the district comes up with a palatable plan, any savings are not expected to be realized for at least two years."
and
More schools targeted to close in Hub
"The School Committee is slated to vote Dec. 15 on Johnson’s proposal. The committee needs to act quickly because next month parents start submitting their choices of where they want to send their children to school next fall.
...
"But some of those buildings might not sit empty for long. In a separate announcement late yesterday afternoon, Johnson and Mayor Thomas M. Menino said some buildings may be leased to charter schools, which are planning an aggressive expansion in the city."
In San Francisco, there are problems on the school district staff: San Francisco School Administrators Schemed to Take Money, Documents Say
"A group of San Francisco Unified School District administrators, including an associate superintendent, engaged in a long-running scheme to funnel district money into their personal bank accounts via nonprofit community organizations, according to internal documents. "
In short, market design takes place, when it does, amidst a noisy, difficult background, particularly in tough financial times.
Monday, December 6, 2010
Kidney sales and incentives for donors: current controversy
The American Journal of Transplantation has over the past year been full of surveys about the attitudes of various groups towards compensation of organ donors, including particularly live kidney donors. The groups surveyed have included transplant surgeons, the general public, kidney patients, and kidney donors. The surveys reveal a great deal of variance within groups, but a surprising willingness across groups to consider various kinds of compensation for donors, especially when subject to government regulation. So there's at least a suggestion that some kinds of payment to donors may one day become a "formerly repugnant transaction," i.e. it seems that its status as a repugnant transaction may be shifting.
The discussion was punctuated by a signed editorial, with a surprisingly contemptuous tone, called “Kidneys for Sale: Whose Attitudes Matter?” It took the point of view that kidney transplantation is a business run by kidney surgeons, and that no one else's opinions should be consulted on matters of health policy related to kidney patients.
This is an especially surprising view given that kidney disease is treated very specially by Medicare, to the great benefit of kidney patients (as well as kidney surgeons). (Medicare is financed primarily by payroll taxes and general tax revenues, as well as premia paid by beneficiaries, and it presently spends about $8 billion a year on dialysis, for example; see Medpac for good Medicare background).
But the view of the editorialists that kidney transplantation is only about surgeons seems to be a fringe view (certainly not shared by the surgeons I've had an opportunity to work with on kidney exchange, although they have varied opinions on donor compensation). Subsequent letters to the AJT rebuked the editorialists, not only for their contemptuousness, but also for misrepresenting the data from the survey of transplant surgeons.
Below are the citations, with abstracts of the articles, and excerpts from the editorial and letters, since those don't have abstracts.
Stimulus for Organ Donation: A Survey of the American Society of Transplant Surgeons Membership by J. R. Rodrigue, K. Crist, J. P. Roberts, R. B. Freeman Jr., R. M. Merion and A. I. Reed, Am J Transplant 2009; 9 (September): 2172–176.
"Federal legislation has been proposed to modify the National Organ Transplant Act in a way that would permit government-regulated strategies, including financial incentives, to be implemented and evaluated. The Council and Ethics Committee of the American Society of Transplant Surgeons conducted a brief webbased survey of itsmembers’ (n = 449, 41.6% response rate) views on acceptable or unacceptable strategies to increase organ donation. The majority of the membership supports reimbursement for funeral expenses, an income tax credit on the final return of a deceased donor and an income tax credit for registering as an organ donor as strategies for increasing deceased donation. Payment for lost wages, guaranteed health insurance and an income tax credit are strategies most strongly supported by the membership to increase living donation. For both deceased and living donation, the membership is mostly opposed to cash payments to donors, their estates or to next-of-kin. There is strong support for a government-regulated trial to evaluate the potential benefits and harms of financial incentives for both deceased and living donation. Overall, there is strong support within the ASTS membership for changes to NOTA that would permit the implementation and careful evaluation of indirect, government-regulated strategies to increase organ donation."
"How Different Conceptions of Risk Are Used in the Organ Market Debate," by A. Aronsohn, J. R. Thistlethwaite, Jr., D. L. Segev, and L. F. Ross, American Journal of Transplantation, 10, 4, 931-937, APR 2010
"The success of kidney and liver transplantation is hindered by a shortage of organs available for transplantation. Although currently illegal in nearly all parts of the world, a living 'donor' or 'vendor' kidney market has been proposed as a means to reduce or even end this shortage. Physician members of the American Society of Transplantation, the American Society of Transplant Surgeons and the American Association for the Study of Liver Disease were surveyed regarding organ markets for both living kidney and living liver transplantation. The survey queried respondents about their attitudes toward directed living donation, nondirected living donation, the potential legalization of living donor organ markets and the reasons for their support or opposition to organ markets. Partial or completed surveys were returned by 346 of 697 eligible respondents (50%). While virtually all supported or strongly supported directed living donation (98% and 95% for kidney and liver lobes, respectively), the vast majority disagreed or strongly disagreed with the legalization of living donor organ markets (80% for kidneys and 90% for liver lobes). Both those who support and those who oppose a legalized living donor organ market rate risk to the donor among the most important factors to justify their position."
Leider, Stephen and Alvin E. Roth, “Kidneys for sale: Who disapproves, and why?” American Journal of Transplantation, 10 (May), 2010, 1221-1227.
"The shortage of transplant kidneys has spurred debate about legalizing monetary payments to donors to increase the number of available kidneys. However, buying and selling organs faces widespread disapproval.
We survey a representative sample of Americans to assess disapproval for several forms of kidney market, and to understand why individuals disapprove by identifying factors that predict disapproval, including disapproval of markets for other body parts, dislike of increased scope for markets and distrust of markets generally. Our results suggest that while the public is potentially receptive to compensating kidney donors, among those who oppose it, general disapproval toward certain kinds of transactions is at least as important as concern about specific policy details. Between 51% and 63% of respondents approve of the various potential kidney markets we investigate, and between 42% and 58% want such markets to be legal. A total of 38% of respondents disapprove of at least one market.
Respondents who distrust markets generally are not more disapproving of kidneymarkets; however we find significant correlations between kidney market disapproval and attitudes reflecting disapproval toward certain transactions—including both other body markets andmarket encroachment into traditionally nonmarket exchanges, such as food preparation."
Patient Willingness to Pay for a Kidney for Transplantation, by D. K. Herold,
American Journal of Transplantation, Volume 10, Issue 6, pages 1394–1400, June 2010
"While kidney transplantation is the most cost-effective treatment available for end-stage renal disease (ESRD) and affords patients with the best quality of life, the current supply of kidneys does not meet the demand. A potential solution to increasing the supply is to compensate living donors for a kidney. The purpose of this study was to describe ESRD patient willingness to pay for a kidney. Using a self-administered survey, 107 patients in 31 U.S. states completed the survey. The quantitative method and descriptive survey design employed descriptive, correlational, nonparametric and multivariate statistical tests to evaluate the data. Of participants, 78.5% were willing to pay for a kidney; there were significant correlations between gender, health status, household income, preferred source of a kidney and willingness to pay. Men, patients with poor and fair health status and those with household incomes ≥$50 000 were more willing to pay. Step-wise regression analysis found price and doctor’s influence accounting for 52% of variance in willingness to pay. As price increased and doctor’s opinion mattered, willingness to pay increased. This study supports development of additional studies with
larger sample sizes and patients on kidney transplant waiting lists."
"For Love or Money? Attitudes Toward Financial Incentives Among Actual Living Kidney Donors", by M. C. Van Buren, E. K. Massey, L. Maasdam, W. C. Zuidema, M. T. Hilhorst, J. N. IJzermans and W. Weimar, American Journal of Transplantation, Volume 10, Issue 11, pages 2488–2492, November 2010
"Due to lengthening waiting lists for kidney transplantation, a debate has emerged as to whether financial incentives should be used to stimulate living kidney donation. In recent surveys among the general public approximately 25% was in favor of financial incentives
while the majority was opposed or undecided. In the present study, we investigated the opinion of living kidney donors regarding financial incentives for living kidney donation. We asked 250 living kidney donors whether they, in retrospect, would have wanted a financial reward for their donation.We also investigated whether theywere in favor of using financial incentives in a government-controlled system to stimulate living anonymous donation. Additionally, the type of incentive deemed most appropriate was also investigated.
In general almost half (46%) of the study population were positive toward introducing financial incentives for living donors. The majority (78%) was not in favor of any kind of reward for themselves as they had donated out of love for the recipient or out of altruistic principles. Remarkably, 60% of the donorswere in favor of a financial incentive for individuals donating anonymously. A reduced premium or free health insurance was the preferred incentive."
And here is the editorial against finding out what non-surgeons think:
D. L. Segev and S. E. Gentry “Kidneys for Sale: Whose Attitudes Matter?” American Journal of Transplantation 2010; 10: 1113–1114
"...Should we devote resources to investigating the nuances of public attitudes toward these markets? Probably not, for two major reasons."
"First, nothing else is relevant until physicians support organ sales....
"Second, and more importantly from a logistical standpoint, is that it will take an act of Congress—that is the reversal of the National Organ Transplant Act (NOTA) of 1984—to make organ markets a reality. And this act will be nearly impossible to come by."
And the following two entries are letters to the editor objecting to the Segev-Gentry editorial, the first by Arthur Matas (a kidney transplant surgeon and former president of the American Society of Transplant Surgeons), the second by Sally Satel, a doctor, kidney recipient, and commentator working at the American Enterprise Institute.
A. J. Matas, Department of Surgery, University of Minnesota
"Markets or Incentives: Terminology Is Critical," American Journal of Transplantation 2010; 10: 2374
"I am disappointed in Segev and Gentry’s Editorial (1) regarding Leider and Roth’s survey, which was recently published in The American Journal of Transplantation (2). Leider and Roth conducted a survey of public attitudes regarding markets for living and deceased donation. They found that a majority of respondents approved of either individual or government payment for either living or deceased donation (although there was considerably stronger support for government payment).
"Segev and Gentry respond by noting that a survey of the membership of the American Society of Transplant Surgeons (ASTS) showed that only 20% were in favor of ‘cash
payments’ for donation (3). Segev and Gentry are correct. But what they did not note in their editorial,was that for deceased donation, the majority of ASTS respondents were
in favor of funeral expenses (73%), an income tax credit (65%) and about halfwere in favor of a donation to a charity selected by the donor’s family (51%) and reimbursement
of next-of-kin expenses (56%). For living donation, the majority supported payment of lost wages (76%), payment of health insurance premiums (72%) or an income tax credit
(64%) and 56% supported payment of life insurance premiums."...
"It is a disservice to the debate and discussion to present only part of the ASTS survey results. There are other issues with Segev and Gentry’s Editorial. They suggest that doing these kinds of public opinion surveys are a waste of resources because: (a) physicians are against ‘sales’ and (b) to establish trials of ‘organ markets’ would require changing the law (1). However, using the same survey data that they quote (see above), (a) physicians are in favor of incentives (and before trials of incentives could be developed the law would need to be changed) and (b) legislators are certainly going to be more inclined to change the law if the public supports such a change. Finally, they conclude that the many recent advances in donation may solve the tremendous organ shortage problem,
making need for incentives moot. But the data says otherwise; in spite of laparoscopic nephrectomy, use of ECDs, DCD, desensitization and paired exchange, there has been little or no increase in donation over the last few years and the wait list for a kidney transplant has continued to grow (4)."
Sally Satel, "The Physicians’ Voice Is Only One of Many," American Journal of Transplantation 2010; 10: 2558
"...medical policy is a social activity, not a guild enterprise. The traditions and preferences of learned practitioners have a large role, to be sure, but they are not, nor
should they be, the sole determinants of clinical policies."
...
"As for physician opinion, Segev and Gentry relate only half of the story. True, a mere one-fifth of physician respondents to an ASTS poll endorsed cash payments to donors (1). Unmentioned, however, is the highly significant fact that 64% of respondents favored income tax credits to living donors (12% were neutral or undecided). This finding has critical policy relevance because it is regulated in-kind benefits, such as tax credits, not free market cash exchange, that have long been the basis for serious reform efforts in Congress and in state legislatures. Notably, the American Medical Association has endorsed proposals for pilot trials on three occasions between 1995 and 2008 (1995, 2003 and 2008) (3)."
The discussion was punctuated by a signed editorial, with a surprisingly contemptuous tone, called “Kidneys for Sale: Whose Attitudes Matter?” It took the point of view that kidney transplantation is a business run by kidney surgeons, and that no one else's opinions should be consulted on matters of health policy related to kidney patients.
This is an especially surprising view given that kidney disease is treated very specially by Medicare, to the great benefit of kidney patients (as well as kidney surgeons). (Medicare is financed primarily by payroll taxes and general tax revenues, as well as premia paid by beneficiaries, and it presently spends about $8 billion a year on dialysis, for example; see Medpac for good Medicare background).
But the view of the editorialists that kidney transplantation is only about surgeons seems to be a fringe view (certainly not shared by the surgeons I've had an opportunity to work with on kidney exchange, although they have varied opinions on donor compensation). Subsequent letters to the AJT rebuked the editorialists, not only for their contemptuousness, but also for misrepresenting the data from the survey of transplant surgeons.
Below are the citations, with abstracts of the articles, and excerpts from the editorial and letters, since those don't have abstracts.
Stimulus for Organ Donation: A Survey of the American Society of Transplant Surgeons Membership by J. R. Rodrigue, K. Crist, J. P. Roberts, R. B. Freeman Jr., R. M. Merion and A. I. Reed, Am J Transplant 2009; 9 (September): 2172–176.
"Federal legislation has been proposed to modify the National Organ Transplant Act in a way that would permit government-regulated strategies, including financial incentives, to be implemented and evaluated. The Council and Ethics Committee of the American Society of Transplant Surgeons conducted a brief webbased survey of itsmembers’ (n = 449, 41.6% response rate) views on acceptable or unacceptable strategies to increase organ donation. The majority of the membership supports reimbursement for funeral expenses, an income tax credit on the final return of a deceased donor and an income tax credit for registering as an organ donor as strategies for increasing deceased donation. Payment for lost wages, guaranteed health insurance and an income tax credit are strategies most strongly supported by the membership to increase living donation. For both deceased and living donation, the membership is mostly opposed to cash payments to donors, their estates or to next-of-kin. There is strong support for a government-regulated trial to evaluate the potential benefits and harms of financial incentives for both deceased and living donation. Overall, there is strong support within the ASTS membership for changes to NOTA that would permit the implementation and careful evaluation of indirect, government-regulated strategies to increase organ donation."
"How Different Conceptions of Risk Are Used in the Organ Market Debate," by A. Aronsohn, J. R. Thistlethwaite, Jr., D. L. Segev, and L. F. Ross, American Journal of Transplantation, 10, 4, 931-937, APR 2010
"The success of kidney and liver transplantation is hindered by a shortage of organs available for transplantation. Although currently illegal in nearly all parts of the world, a living 'donor' or 'vendor' kidney market has been proposed as a means to reduce or even end this shortage. Physician members of the American Society of Transplantation, the American Society of Transplant Surgeons and the American Association for the Study of Liver Disease were surveyed regarding organ markets for both living kidney and living liver transplantation. The survey queried respondents about their attitudes toward directed living donation, nondirected living donation, the potential legalization of living donor organ markets and the reasons for their support or opposition to organ markets. Partial or completed surveys were returned by 346 of 697 eligible respondents (50%). While virtually all supported or strongly supported directed living donation (98% and 95% for kidney and liver lobes, respectively), the vast majority disagreed or strongly disagreed with the legalization of living donor organ markets (80% for kidneys and 90% for liver lobes). Both those who support and those who oppose a legalized living donor organ market rate risk to the donor among the most important factors to justify their position."
Leider, Stephen and Alvin E. Roth, “Kidneys for sale: Who disapproves, and why?” American Journal of Transplantation, 10 (May), 2010, 1221-1227.
"The shortage of transplant kidneys has spurred debate about legalizing monetary payments to donors to increase the number of available kidneys. However, buying and selling organs faces widespread disapproval.
We survey a representative sample of Americans to assess disapproval for several forms of kidney market, and to understand why individuals disapprove by identifying factors that predict disapproval, including disapproval of markets for other body parts, dislike of increased scope for markets and distrust of markets generally. Our results suggest that while the public is potentially receptive to compensating kidney donors, among those who oppose it, general disapproval toward certain kinds of transactions is at least as important as concern about specific policy details. Between 51% and 63% of respondents approve of the various potential kidney markets we investigate, and between 42% and 58% want such markets to be legal. A total of 38% of respondents disapprove of at least one market.
Respondents who distrust markets generally are not more disapproving of kidneymarkets; however we find significant correlations between kidney market disapproval and attitudes reflecting disapproval toward certain transactions—including both other body markets andmarket encroachment into traditionally nonmarket exchanges, such as food preparation."
Patient Willingness to Pay for a Kidney for Transplantation, by D. K. Herold,
American Journal of Transplantation, Volume 10, Issue 6, pages 1394–1400, June 2010
"While kidney transplantation is the most cost-effective treatment available for end-stage renal disease (ESRD) and affords patients with the best quality of life, the current supply of kidneys does not meet the demand. A potential solution to increasing the supply is to compensate living donors for a kidney. The purpose of this study was to describe ESRD patient willingness to pay for a kidney. Using a self-administered survey, 107 patients in 31 U.S. states completed the survey. The quantitative method and descriptive survey design employed descriptive, correlational, nonparametric and multivariate statistical tests to evaluate the data. Of participants, 78.5% were willing to pay for a kidney; there were significant correlations between gender, health status, household income, preferred source of a kidney and willingness to pay. Men, patients with poor and fair health status and those with household incomes ≥$50 000 were more willing to pay. Step-wise regression analysis found price and doctor’s influence accounting for 52% of variance in willingness to pay. As price increased and doctor’s opinion mattered, willingness to pay increased. This study supports development of additional studies with
larger sample sizes and patients on kidney transplant waiting lists."
"For Love or Money? Attitudes Toward Financial Incentives Among Actual Living Kidney Donors", by M. C. Van Buren, E. K. Massey, L. Maasdam, W. C. Zuidema, M. T. Hilhorst, J. N. IJzermans and W. Weimar, American Journal of Transplantation, Volume 10, Issue 11, pages 2488–2492, November 2010
"Due to lengthening waiting lists for kidney transplantation, a debate has emerged as to whether financial incentives should be used to stimulate living kidney donation. In recent surveys among the general public approximately 25% was in favor of financial incentives
while the majority was opposed or undecided. In the present study, we investigated the opinion of living kidney donors regarding financial incentives for living kidney donation. We asked 250 living kidney donors whether they, in retrospect, would have wanted a financial reward for their donation.We also investigated whether theywere in favor of using financial incentives in a government-controlled system to stimulate living anonymous donation. Additionally, the type of incentive deemed most appropriate was also investigated.
In general almost half (46%) of the study population were positive toward introducing financial incentives for living donors. The majority (78%) was not in favor of any kind of reward for themselves as they had donated out of love for the recipient or out of altruistic principles. Remarkably, 60% of the donorswere in favor of a financial incentive for individuals donating anonymously. A reduced premium or free health insurance was the preferred incentive."
And here is the editorial against finding out what non-surgeons think:
D. L. Segev and S. E. Gentry “Kidneys for Sale: Whose Attitudes Matter?” American Journal of Transplantation 2010; 10: 1113–1114
"...Should we devote resources to investigating the nuances of public attitudes toward these markets? Probably not, for two major reasons."
"First, nothing else is relevant until physicians support organ sales....
"Second, and more importantly from a logistical standpoint, is that it will take an act of Congress—that is the reversal of the National Organ Transplant Act (NOTA) of 1984—to make organ markets a reality. And this act will be nearly impossible to come by."
And the following two entries are letters to the editor objecting to the Segev-Gentry editorial, the first by Arthur Matas (a kidney transplant surgeon and former president of the American Society of Transplant Surgeons), the second by Sally Satel, a doctor, kidney recipient, and commentator working at the American Enterprise Institute.
A. J. Matas, Department of Surgery, University of Minnesota
"Markets or Incentives: Terminology Is Critical," American Journal of Transplantation 2010; 10: 2374
"I am disappointed in Segev and Gentry’s Editorial (1) regarding Leider and Roth’s survey, which was recently published in The American Journal of Transplantation (2). Leider and Roth conducted a survey of public attitudes regarding markets for living and deceased donation. They found that a majority of respondents approved of either individual or government payment for either living or deceased donation (although there was considerably stronger support for government payment).
"Segev and Gentry respond by noting that a survey of the membership of the American Society of Transplant Surgeons (ASTS) showed that only 20% were in favor of ‘cash
payments’ for donation (3). Segev and Gentry are correct. But what they did not note in their editorial,was that for deceased donation, the majority of ASTS respondents were
in favor of funeral expenses (73%), an income tax credit (65%) and about halfwere in favor of a donation to a charity selected by the donor’s family (51%) and reimbursement
of next-of-kin expenses (56%). For living donation, the majority supported payment of lost wages (76%), payment of health insurance premiums (72%) or an income tax credit
(64%) and 56% supported payment of life insurance premiums."...
"It is a disservice to the debate and discussion to present only part of the ASTS survey results. There are other issues with Segev and Gentry’s Editorial. They suggest that doing these kinds of public opinion surveys are a waste of resources because: (a) physicians are against ‘sales’ and (b) to establish trials of ‘organ markets’ would require changing the law (1). However, using the same survey data that they quote (see above), (a) physicians are in favor of incentives (and before trials of incentives could be developed the law would need to be changed) and (b) legislators are certainly going to be more inclined to change the law if the public supports such a change. Finally, they conclude that the many recent advances in donation may solve the tremendous organ shortage problem,
making need for incentives moot. But the data says otherwise; in spite of laparoscopic nephrectomy, use of ECDs, DCD, desensitization and paired exchange, there has been little or no increase in donation over the last few years and the wait list for a kidney transplant has continued to grow (4)."
Sally Satel, "The Physicians’ Voice Is Only One of Many," American Journal of Transplantation 2010; 10: 2558
"...medical policy is a social activity, not a guild enterprise. The traditions and preferences of learned practitioners have a large role, to be sure, but they are not, nor
should they be, the sole determinants of clinical policies."
...
"As for physician opinion, Segev and Gentry relate only half of the story. True, a mere one-fifth of physician respondents to an ASTS poll endorsed cash payments to donors (1). Unmentioned, however, is the highly significant fact that 64% of respondents favored income tax credits to living donors (12% were neutral or undecided). This finding has critical policy relevance because it is regulated in-kind benefits, such as tax credits, not free market cash exchange, that have long been the basis for serious reform efforts in Congress and in state legislatures. Notably, the American Medical Association has endorsed proposals for pilot trials on three occasions between 1995 and 2008 (1995, 2003 and 2008) (3)."
Sunday, December 5, 2010
"Una persona altruista puede salvar muchas vidas"
"A selfless person can save many lives".
That's Mike Rees, the founder and guiding light of the Alliance for Paired Donation, being interviewed in El Pais about kidney exchange and non-simultaneous non-directed donor chains, which he pioneered.
(I even get a shout out: "La idea de la cadena me vino en diciembre de 2006, cuando conocí al profesor de Economía en la Universidad de Harvard Alvin Roth. Me hizo comprender que los emparejamientos no eran el modo más efectivo con los transplantes. Él es un experto en la llamada Teoría de Juegos, y me ayudó a desarrollar un modelo de cadena de trasplantes eficiente en que se deja de lado el incentivo económico.")
And here's the background story: Una cadena de trasplantes eterna, "An eternal chain of transplants"
HT: Flip Klijn and Jordi Masso
That's Mike Rees, the founder and guiding light of the Alliance for Paired Donation, being interviewed in El Pais about kidney exchange and non-simultaneous non-directed donor chains, which he pioneered.
(I even get a shout out: "La idea de la cadena me vino en diciembre de 2006, cuando conocí al profesor de Economía en la Universidad de Harvard Alvin Roth. Me hizo comprender que los emparejamientos no eran el modo más efectivo con los transplantes. Él es un experto en la llamada Teoría de Juegos, y me ayudó a desarrollar un modelo de cadena de trasplantes eficiente en que se deja de lado el incentivo económico.")
And here's the background story: Una cadena de trasplantes eterna, "An eternal chain of transplants"
HT: Flip Klijn and Jordi Masso
Cory Doctorow on copyright
Cory Doctorow in The Guardian: What do we want copyright to do?
"when we talk about copyright, we're not just talking about who pays how much to get access to which art, we're talking about a regulation that has the power to midwife, or strangle, enormous amounts of expressive speech."
...
"it's been more than a century since legal systems around the world took away songwriters' ability to control who performed their songs. This began with the first records, which were viewed as a form of theft by the composers of the day. You see, composers back then were in the sheet-music business: they used a copying device (the printing press) to generate a product that musicians could buy.
"When recording technology came along, musicians began to play the tunes on the sheet music they'd bought into microphones and release commercial recordings of their performances. The composers fumed that this was piracy of their music, but the performers said: "You sold us this sheet music – now you're telling us we're not allowed to play it? What did you think we were going to do with it?"
"The law's answer to this was a Solomonic divide-the-baby solution: performers were free to record any composition that had been published, but they had to pay a set rate for every recording they sold. This rate was paid to a collective rights society, and today, these societies thrive, collecting fees for all sorts of "performances" where musicians and composers get little or no say. For example, radio stations, shopping malls, and even hairdressers buy licences that allow them to play whatever music they can find. The music is sampled by more or less accurate means and dispersed to artists by more or less fair means."
...
"Rather than having the right to specify who may use your works, you merely get the right to get paid when the use takes place.
"Now, on hearing this, you might be thinking: "Good God, that's practically Stalinist! Why can't a poor creator have the right to choose who can use her works?" Well, the reason is that creators (and, notably, their industrial investors) are notoriously resistant to new media. The composers damned the record companies as pirates; the record labels damned the radio for its piracy; broadcasters vilified the cable companies for taking their signals; cable companies fought the VCR for its recording "theft." Big entertainment tried to kill FM radio, TV remote controls (which made it easy to switch away from adverts), jukeboxes, and so on, all the way back to the protestant reformation's fight over who got to read the Bible.
"Given that new media typically allow new creators to create new forms of material that is pleasing to new audiences, it's hard to justify giving the current lotto winners a veto over the next generation of disruptive technologies. Especially when the winners of today were the pirates of yesteryear. Turnabout is fair play."
"when we talk about copyright, we're not just talking about who pays how much to get access to which art, we're talking about a regulation that has the power to midwife, or strangle, enormous amounts of expressive speech."
...
"it's been more than a century since legal systems around the world took away songwriters' ability to control who performed their songs. This began with the first records, which were viewed as a form of theft by the composers of the day. You see, composers back then were in the sheet-music business: they used a copying device (the printing press) to generate a product that musicians could buy.
"When recording technology came along, musicians began to play the tunes on the sheet music they'd bought into microphones and release commercial recordings of their performances. The composers fumed that this was piracy of their music, but the performers said: "You sold us this sheet music – now you're telling us we're not allowed to play it? What did you think we were going to do with it?"
"The law's answer to this was a Solomonic divide-the-baby solution: performers were free to record any composition that had been published, but they had to pay a set rate for every recording they sold. This rate was paid to a collective rights society, and today, these societies thrive, collecting fees for all sorts of "performances" where musicians and composers get little or no say. For example, radio stations, shopping malls, and even hairdressers buy licences that allow them to play whatever music they can find. The music is sampled by more or less accurate means and dispersed to artists by more or less fair means."
...
"Rather than having the right to specify who may use your works, you merely get the right to get paid when the use takes place.
"Now, on hearing this, you might be thinking: "Good God, that's practically Stalinist! Why can't a poor creator have the right to choose who can use her works?" Well, the reason is that creators (and, notably, their industrial investors) are notoriously resistant to new media. The composers damned the record companies as pirates; the record labels damned the radio for its piracy; broadcasters vilified the cable companies for taking their signals; cable companies fought the VCR for its recording "theft." Big entertainment tried to kill FM radio, TV remote controls (which made it easy to switch away from adverts), jukeboxes, and so on, all the way back to the protestant reformation's fight over who got to read the Bible.
"Given that new media typically allow new creators to create new forms of material that is pleasing to new audiences, it's hard to justify giving the current lotto winners a veto over the next generation of disruptive technologies. Especially when the winners of today were the pirates of yesteryear. Turnabout is fair play."
Saturday, December 4, 2010
College football teams are hard to rank
At least that's the conclusion of a recent NY Times article, Who’s No. 1?, written before the Thanksgiving weekend games were played. It begins by noting
"This is the 13th year of the Bowl Championship Series, the byzantine and unpopular system that is supposed to guarantee that the college-football season ends with a championship game between the sport’s two best teams. Comparing teams that usually do not play one another — there are 120 major college-football programs, and each one competes in just 12 games each season — was never going to be easy. Like three egg rolls served to a party of four at a Chinese restaurant, the portions never seem to divide up quite as neatly as they should. This year, for instance, four programs — Oregon, Auburn, Boise State and Texas Christian — have spent much of the season in contention for the two positions in the championship."
...
"In addition to the championship game, the B.C.S. involves four beauty-contest games: the Fiesta, Orange, Rose and Sugar bowls. In the last four years, the teams ranked lower than their opponents by the B.C.S. formula have won 12 of the 20 games established by the system. The putative underdog has also won 6 of the last 8 title games: last year’s championship, in which the higher-rated Alabama defeated Texas, was something of a novelty. If the No. 2 team routinely beats the No. 1 team, it’s worth asking whether the B.C.S. rankings are valid.
...
"Without high-quality out-of-conference games, every major conference is in essence an island unto itself. We can identify the best team in the Pac 10, or the best team in the S.E.C. But we don’t have any good way of comparing the Pac 10 against the S.E.C., or against any other conference. It doesn’t matter how smart your computer rankings are, or how wizened the participants in your poll: there simply isn’t enough worthwhile data to work with."
I've written earlier posts about college football bowls, and how the present system arose in part out of an effort to roll back the unraveling of dates at which teams and bowls were matched...
"This is the 13th year of the Bowl Championship Series, the byzantine and unpopular system that is supposed to guarantee that the college-football season ends with a championship game between the sport’s two best teams. Comparing teams that usually do not play one another — there are 120 major college-football programs, and each one competes in just 12 games each season — was never going to be easy. Like three egg rolls served to a party of four at a Chinese restaurant, the portions never seem to divide up quite as neatly as they should. This year, for instance, four programs — Oregon, Auburn, Boise State and Texas Christian — have spent much of the season in contention for the two positions in the championship."
...
"In addition to the championship game, the B.C.S. involves four beauty-contest games: the Fiesta, Orange, Rose and Sugar bowls. In the last four years, the teams ranked lower than their opponents by the B.C.S. formula have won 12 of the 20 games established by the system. The putative underdog has also won 6 of the last 8 title games: last year’s championship, in which the higher-rated Alabama defeated Texas, was something of a novelty. If the No. 2 team routinely beats the No. 1 team, it’s worth asking whether the B.C.S. rankings are valid.
...
"Without high-quality out-of-conference games, every major conference is in essence an island unto itself. We can identify the best team in the Pac 10, or the best team in the S.E.C. But we don’t have any good way of comparing the Pac 10 against the S.E.C., or against any other conference. It doesn’t matter how smart your computer rankings are, or how wizened the participants in your poll: there simply isn’t enough worthwhile data to work with."
I've written earlier posts about college football bowls, and how the present system arose in part out of an effort to roll back the unraveling of dates at which teams and bowls were matched...
Friday, December 3, 2010
School choice in NY and Chicago
In NYC, the high school choice process seems to be working smoothly: High School Applications are due back to counselors Friday, December 3, 2010.
In Chicago, priorities at various schools are still being adjusted: Chicago parents scramble with new rules for best schools, Moms and dads schmooze at open houses and pay for expert advice as many applicants go after a few coveted spots
HT: Parag Pathak
In Chicago, priorities at various schools are still being adjusted: Chicago parents scramble with new rules for best schools, Moms and dads schmooze at open houses and pay for expert advice as many applicants go after a few coveted spots
HT: Parag Pathak
Thursday, December 2, 2010
Transplant budget cuts in Arizona
Arizona Cuts Financing for Transplant Patients
"Even physicians with decades of experience telling patients that their lives are nearing an end are having difficulty discussing a potentially fatal condition that has arisen in Arizona: Death by budget cut.
"Effective at the beginning of October, Arizona stopped financing certain transplant operations under the state’s version of Medicaid. Many doctors say the decision amounts to a death sentence for some low-income patients, who have little chance of survival without transplants and lack the hundreds of thousands of dollars needed to pay for them.
“The most difficult discussions are those that involve patients who had been on the donor list for a year or more and now we have to tell them they’re not on the list anymore,” said Dr. Rainer Gruessner, a transplant specialist at the University of Arizona College of Medicine. “The frustration is tremendous. It’s more than frustration.”
"Organ transplants are already the subject of a web of regulations, which do not guarantee that everyone in need of a life-saving organ will receive one. But Arizona’s transplant specialists are alarmed that patients who were in line to receive transplants one day were, after the state’s budget cuts to its Medicaid program, ruled ineligible the next — unless they raised the money themselves.
"Francisco Felix, 32, a father of four who has hepatitis C and is in need of a liver, received news a few weeks ago that a family friend was dying and wanted to donate her liver to him. But the budget cuts meant he no longer qualified for a state-financed transplant.
"He was prepared anyway at Banner Good Samaritan Medical Center as his relatives scrambled to raise the needed $200,000. When the money did not come through, the liver went to someone else on the transplant list."
Update: here's an article in Slate by Sally Satel: Cutting Human Lives: What should we make of Arizona's new law for rationing organ transplants?
"Even physicians with decades of experience telling patients that their lives are nearing an end are having difficulty discussing a potentially fatal condition that has arisen in Arizona: Death by budget cut.
"Effective at the beginning of October, Arizona stopped financing certain transplant operations under the state’s version of Medicaid. Many doctors say the decision amounts to a death sentence for some low-income patients, who have little chance of survival without transplants and lack the hundreds of thousands of dollars needed to pay for them.
“The most difficult discussions are those that involve patients who had been on the donor list for a year or more and now we have to tell them they’re not on the list anymore,” said Dr. Rainer Gruessner, a transplant specialist at the University of Arizona College of Medicine. “The frustration is tremendous. It’s more than frustration.”
"Organ transplants are already the subject of a web of regulations, which do not guarantee that everyone in need of a life-saving organ will receive one. But Arizona’s transplant specialists are alarmed that patients who were in line to receive transplants one day were, after the state’s budget cuts to its Medicaid program, ruled ineligible the next — unless they raised the money themselves.
"Francisco Felix, 32, a father of four who has hepatitis C and is in need of a liver, received news a few weeks ago that a family friend was dying and wanted to donate her liver to him. But the budget cuts meant he no longer qualified for a state-financed transplant.
"He was prepared anyway at Banner Good Samaritan Medical Center as his relatives scrambled to raise the needed $200,000. When the money did not come through, the liver went to someone else on the transplant list."
Update: here's an article in Slate by Sally Satel: Cutting Human Lives: What should we make of Arizona's new law for rationing organ transplants?
Pentagon report calls for repeal of "don't ask, don't tell"
Pentagon calls for repeal of ‘don’t ask’
"Ending a ban on gays serving openly in the armed services would not harm long-term military effectiveness, the Pentagon said yesterday in a long-awaited report that is expected to speed a vote on the repeal of the “don’t ask, don’t tell’’ policy."
...
"That call shifted the focus to moderate members of the Senate, including Scott Brown of Massachusetts, who had said they wanted to read the report before voting on whether to end the policy. The House has passed a bill overturning the policy, but a Republican-led threat of a filibuster halted a similar effort in the Senate in the fall.
...
"There were few clues yesterday about whether Republicans would embrace the findings of the report. “I haven’t looked at it,’’ Brown said. “As soon as I get back to the office and get a free minute, I’ll start digesting it.’’
...
"The study, conducted over nine months, found that 70 percent of troops surveyed believed that allowing gays and lesbians to serve openly in the military would have mixed, positive, or no impact. The other 30 percent thought there would be negative consequences, with opposition strongest among combat troops.
"The survey was based on responses from about 115,000 troops and 44,300 military spouses.
“We are both convinced that our military can do this, even during this time of war,’’ concluded the cochairs of the report, Pentagon general counsel Jeh Johnson and Army General Carter Ham.
"Overall, nearly seven out of 10 respondents in the Pentagon’s survey said they believe that they have already served with someone who is gay. Of those, only 8 percent cited a negative impact on their unit.
“We have a gay guy. He’s big, he’s mean, and he kills lots of bad guys,’’ one member of the special operations force is quoted as saying. “No one cared that he was gay.’’
Update: Dec 9, Senate Stalls Bill to Repeal Gay Policy in Military
"Ending a ban on gays serving openly in the armed services would not harm long-term military effectiveness, the Pentagon said yesterday in a long-awaited report that is expected to speed a vote on the repeal of the “don’t ask, don’t tell’’ policy."
...
"That call shifted the focus to moderate members of the Senate, including Scott Brown of Massachusetts, who had said they wanted to read the report before voting on whether to end the policy. The House has passed a bill overturning the policy, but a Republican-led threat of a filibuster halted a similar effort in the Senate in the fall.
...
"There were few clues yesterday about whether Republicans would embrace the findings of the report. “I haven’t looked at it,’’ Brown said. “As soon as I get back to the office and get a free minute, I’ll start digesting it.’’
...
"The study, conducted over nine months, found that 70 percent of troops surveyed believed that allowing gays and lesbians to serve openly in the military would have mixed, positive, or no impact. The other 30 percent thought there would be negative consequences, with opposition strongest among combat troops.
"The survey was based on responses from about 115,000 troops and 44,300 military spouses.
“We are both convinced that our military can do this, even during this time of war,’’ concluded the cochairs of the report, Pentagon general counsel Jeh Johnson and Army General Carter Ham.
"Overall, nearly seven out of 10 respondents in the Pentagon’s survey said they believe that they have already served with someone who is gay. Of those, only 8 percent cited a negative impact on their unit.
“We have a gay guy. He’s big, he’s mean, and he kills lots of bad guys,’’ one member of the special operations force is quoted as saying. “No one cared that he was gay.’’
Update: Dec 9, Senate Stalls Bill to Repeal Gay Policy in Military
Wednesday, December 1, 2010
Harvard reviewing its decision to abolish early admissions
The Crimson reports: Harvard Examining Early Admissions--College reviews decision to eliminate early admissions
"The College is reevaluating its three-year-old decision to eliminate early admissions, Harvard’s top admissions official acknowledged yesterday.
...
"Fitzsimmons’ comments came in response to an announcement by the University of Virginia that it plans to offer a new Early Action option to students applying next year.
"In Sept. 2006, Harvard announced that it would no longer offer its Early Action program, which allowed high-school seniors to receive an admissions decision in December but did not mandate that they attend if accepted. Within the month, Princeton and Virginia followed suit, cancelling their Early Decision programs, which had similar timing but bound accepted students to attend, in favor of a single admissions notification date.
"The three schools have jointly conducted 18-city recruiting tours since the announcement of the decision, and some officials acknowledged at the time that they hoped other top universities would follow suit in eliminating early admissions programs.
"All three schools said at the time that early admissions programs were unfavorable to less affluent students, who sometimes forgo the programs in order to apply to many universities during the regular decision cycle and compare financial aid offers from different schools.
"Virginia Dean of Admission Gregory W. Roberts said yesterday that the elimination of Early Decision has indeed increased diversity at his university.
“Socioeconomically and racially, the enrolling classes for the past three years have been significantly more diverse,” Roberts said. But he added that the school’s new Early Action program—which allows applicants to apply to other schools’ early admissions programs concurrently and does not compel them to attend Virginia if admitted—will not discourage underprivileged students from applying.
“From a university institutional self-interest perspective, we felt like there were students we were missing who were interested in applying and receiving early notification,” Roberts said. “We felt like we will be able to enroll the same type of class...and also respond to student interest.”
A subsequent Crimson editorial supports early action if it promotes diversity, and seems a bit obtuse about the relationship between Harvard's admissions policies and those of other schools:
HT: Rezwan Haque
update: a Feb 10, 2011 Crimson article updates the story (no decision has been reached yet) and focuses on the signaling aspect of early decision:
"Amy Sack, president of college counseling firm Admissions Accomplished, said that Harvard’s lack of an early admissions program has not discouraged her students from applying to the College. According to Sack, students who want to attend Harvard usually apply early to comparable schools such as Stanford University or Yale University, both of which offer non-binding early action admissions programs.
"The College is reevaluating its three-year-old decision to eliminate early admissions, Harvard’s top admissions official acknowledged yesterday.
...
"Fitzsimmons’ comments came in response to an announcement by the University of Virginia that it plans to offer a new Early Action option to students applying next year.
"In Sept. 2006, Harvard announced that it would no longer offer its Early Action program, which allowed high-school seniors to receive an admissions decision in December but did not mandate that they attend if accepted. Within the month, Princeton and Virginia followed suit, cancelling their Early Decision programs, which had similar timing but bound accepted students to attend, in favor of a single admissions notification date.
"The three schools have jointly conducted 18-city recruiting tours since the announcement of the decision, and some officials acknowledged at the time that they hoped other top universities would follow suit in eliminating early admissions programs.
"All three schools said at the time that early admissions programs were unfavorable to less affluent students, who sometimes forgo the programs in order to apply to many universities during the regular decision cycle and compare financial aid offers from different schools.
"Virginia Dean of Admission Gregory W. Roberts said yesterday that the elimination of Early Decision has indeed increased diversity at his university.
“Socioeconomically and racially, the enrolling classes for the past three years have been significantly more diverse,” Roberts said. But he added that the school’s new Early Action program—which allows applicants to apply to other schools’ early admissions programs concurrently and does not compel them to attend Virginia if admitted—will not discourage underprivileged students from applying.
“From a university institutional self-interest perspective, we felt like there were students we were missing who were interested in applying and receiving early notification,” Roberts said. “We felt like we will be able to enroll the same type of class...and also respond to student interest.”
A subsequent Crimson editorial supports early action if it promotes diversity, and seems a bit obtuse about the relationship between Harvard's admissions policies and those of other schools:
Prioritize Socioeconomic Diversity
If Early Action negatively impacts the applicant pool, it should not return
"Harvard Dean of Admissions and Financial Aid William R. Fitzsimmons ’67 announced last week that the College is in the process of re-evaluating its decision to eliminate early admissions. The program, known as Early Action, allowed applicants to receive a non-binding admissions notification in the winter. The college removed this option four years ago because top officials felt it gave an unfair edge to candidates from more affluent backgrounds. Such a groundbreaking decision deserves the critical reconsideration Harvard is currently undergoing, but administrators must stay true to their commitment to socioeconomic diversity. If such an evaluation reveals that a return to Early Action would compromise this priority, the program must not be reinstated.This news comes on the heels of the University of Virginia’s announcement that it will reinstate early admissions; UVA had followed Harvard’s lead in eliminating its Early Decision option in 2006 and now exemplifies a growing trend of restoring related programs in competitive universities across the country. Whatever Harvard decides to do at the end of its evaluation, such actions should not be influenced by other schools’ choices. We hope that the admissions office acts solely according to what best serves Harvard and its goals."
HT: Rezwan Haque
update: a Feb 10, 2011 Crimson article updates the story (no decision has been reached yet) and focuses on the signaling aspect of early decision:
"Amy Sack, president of college counseling firm Admissions Accomplished, said that Harvard’s lack of an early admissions program has not discouraged her students from applying to the College. According to Sack, students who want to attend Harvard usually apply early to comparable schools such as Stanford University or Yale University, both of which offer non-binding early action admissions programs.
“I think it would be nice for them to be able to indicate that Harvard is their first choice. It would let them not have to play the game as much,” she said. “I think my students would be happy if Harvard brings it back.”
"In 2006, the last year early admission was offered, Harvard received 4,008 early action applications.
"The early acceptance rate was 21.5 percent compared to below nine percent overall."
Tuesday, November 30, 2010
More on economists at hi tech firms
John Horton (who is interested in online labor markets) writes in response to my post about economists at Amazon to let me know about this recent story in the San Jose Mercury News:
Google, Yahoo, other Silicon Valley tech giants add economists to arsenal
"In the wake of the example of UC Berkeley economist Hal Varian, who helped Google perfect the auction process behind its multibillion-dollar search advertising revenue stream, big Internet companies are competing to woo economists away from universities or work with them on specific projects. Yahoo has been among the most aggressive, but eBay, Amazon.com, Facebook and other companies also are recruiting practitioners of what used to be called "the dismal science." Illustrating how crucial companies think those skills are, Microsoft CEO Steve Ballmer personally recruited economist Susan Athey from Harvard.
"Other companies have recognized that economists really have a lot to contribute," said Varian, who joined Mountain View-based Google full time in 2007 after having worked as a consultant for the search giant since 2002. Google has 10 economists, statisticians and other quantitative analysts on Varian's staff, and is looking to hire more.
"Internet companies see the economists as critical in their efforts to fine-tune advertising networks that serve millions of online ad impressions a day, and to better understand e-commerce platforms with tens of millions of buyers and sellers. Economists can also help determine whether new businesses or approaches will be effective."
...
"Yahoo chief economist Preston McAfee, who joined the Sunnyvale company from the California Institute of Technology in 2007, has long believed that economics could be a practical discipline, like engineering. McAfee now heads a team of seven Ph.D. economists and five game-theory/algorithmic scientists who work with software engineers to create products that aren't just smart but are also savvy.
"Engineers are pretty nice people, and they assume the rest of the world is pretty nice like them," said McAfee. "But that's not the way most people are. And if you build (software) assuming that's the way people are, it will get heavily spammed. So one of the roles that economics plays at Yahoo and other tech companies is to be just a little more suspicious about human nature."
...
"One of Varian's first jobs was to polish Google's nascent search advertising, in which advertisers bid for keywords that bring up their text ad when someone Googles that term. Search advertising has since transformed Google into a corporate colossus.
"Eric Schmidt said, 'Take a look at this ad auction,' " said Varian, "and I sat down to try to model the behavior of that auction, and wrote the first model ever of what I call a position auction.
"At that time, I talked to my fellow economists and said, 'You know, there really are some interesting things going on here,' and they would say, 'Is that economics?' And now, of course, years later, people say, 'Wow, how did you know that was going to be so big?' And the answer is, I didn't. I just thought it was really interesting and it turned out to be big."
Google, Yahoo, other Silicon Valley tech giants add economists to arsenal
"In the wake of the example of UC Berkeley economist Hal Varian, who helped Google perfect the auction process behind its multibillion-dollar search advertising revenue stream, big Internet companies are competing to woo economists away from universities or work with them on specific projects. Yahoo has been among the most aggressive, but eBay, Amazon.com, Facebook and other companies also are recruiting practitioners of what used to be called "the dismal science." Illustrating how crucial companies think those skills are, Microsoft CEO Steve Ballmer personally recruited economist Susan Athey from Harvard.
"Other companies have recognized that economists really have a lot to contribute," said Varian, who joined Mountain View-based Google full time in 2007 after having worked as a consultant for the search giant since 2002. Google has 10 economists, statisticians and other quantitative analysts on Varian's staff, and is looking to hire more.
"Internet companies see the economists as critical in their efforts to fine-tune advertising networks that serve millions of online ad impressions a day, and to better understand e-commerce platforms with tens of millions of buyers and sellers. Economists can also help determine whether new businesses or approaches will be effective."
...
"Yahoo chief economist Preston McAfee, who joined the Sunnyvale company from the California Institute of Technology in 2007, has long believed that economics could be a practical discipline, like engineering. McAfee now heads a team of seven Ph.D. economists and five game-theory/algorithmic scientists who work with software engineers to create products that aren't just smart but are also savvy.
"Engineers are pretty nice people, and they assume the rest of the world is pretty nice like them," said McAfee. "But that's not the way most people are. And if you build (software) assuming that's the way people are, it will get heavily spammed. So one of the roles that economics plays at Yahoo and other tech companies is to be just a little more suspicious about human nature."
...
"One of Varian's first jobs was to polish Google's nascent search advertising, in which advertisers bid for keywords that bring up their text ad when someone Googles that term. Search advertising has since transformed Google into a corporate colossus.
"Eric Schmidt said, 'Take a look at this ad auction,' " said Varian, "and I sat down to try to model the behavior of that auction, and wrote the first model ever of what I call a position auction.
"At that time, I talked to my fellow economists and said, 'You know, there really are some interesting things going on here,' and they would say, 'Is that economics?' And now, of course, years later, people say, 'Wow, how did you know that was going to be so big?' And the answer is, I didn't. I just thought it was really interesting and it turned out to be big."
Monday, November 29, 2010
Wolverines beat Buckeyes in organ donation this year
For you Michigan fans who were disappointed this weekend on the football field, here's some heartening news:U-M beats Ohio State in annual organ donation challenge
"Ann Arbor, Mich. - U-M racked up a victory over Ohio State this week, signing up more people to the state’s organ donor list and winning the annual Wolverine-Buckeye challenge.
"U-M signed up 79,958 donors to Ohio State’s 57,083 in the challenge that ended at midnight on Thanksgiving.
"We all enjoy winning a victory against our rival from Ohio," says Tony Denton, Executive Director of University Hospitals and Chief Operating Officer, U-M Hospitals and Health Centers.
"But the real winners will be the people who rely on these life-saving gifts, organs and tissues that will give thousands of people a second chance at life," Denton says.
"Every day, 19 people die while waiting for an organ transplant and another 138 people are added to the national waiting list. The University of Michigan Health System began a new effort this year, dubbed Wolverines For Life, to encourage organ, tissue, eye, blood, and bone marrow donation by U-M employees, patients, students, alumni, fans and everyone in the state of Michigan.
"To kick off this effort, U-M Football Coach Rich Rodriguez, along with Health System leaders, encouraged people to join in the annual Wolverine-Buckeye challenge. The challenge allowed people to sign up as organ donors upon their death and have their pledge tallied for their favorite school.
HT: Steve Leider
"Ann Arbor, Mich. - U-M racked up a victory over Ohio State this week, signing up more people to the state’s organ donor list and winning the annual Wolverine-Buckeye challenge.
"U-M signed up 79,958 donors to Ohio State’s 57,083 in the challenge that ended at midnight on Thanksgiving.
"We all enjoy winning a victory against our rival from Ohio," says Tony Denton, Executive Director of University Hospitals and Chief Operating Officer, U-M Hospitals and Health Centers.
"But the real winners will be the people who rely on these life-saving gifts, organs and tissues that will give thousands of people a second chance at life," Denton says.
"Every day, 19 people die while waiting for an organ transplant and another 138 people are added to the national waiting list. The University of Michigan Health System began a new effort this year, dubbed Wolverines For Life, to encourage organ, tissue, eye, blood, and bone marrow donation by U-M employees, patients, students, alumni, fans and everyone in the state of Michigan.
"To kick off this effort, U-M Football Coach Rich Rodriguez, along with Health System leaders, encouraged people to join in the annual Wolverine-Buckeye challenge. The challenge allowed people to sign up as organ donors upon their death and have their pledge tallied for their favorite school.
HT: Steve Leider
Market design at Amazon
The following job market ad at Econ-jobs.com for a new economist at Amazon caught my eye, both for what it suggests about the kind of internal research Amazon hopes to do, and about what kind of economists they hope to hire:
"Economists at Amazon will be expected to work directly with chief economist Patrick Bajari and senior management on key business problems faced in retail, international retail, cloud computing, third party merchants, search, Kindle and operations. Amazon economists will apply the frontier of economic thinking to market design, pricing, forecasting, online advertising and other areas. You apply econometric modeling, working with our world class data systems, and economic theory to business problems. In addition, economists at Amazon will be expected to maintain an independent and active research agenda, publishing in leading academic journals."
"Basic Qualifications: PhD in Economics or anticipating completion of a PhD in Economics by Aug 2011
"Preferred Qualifications:
Strong background in econometrics, industrial organization, economic theory and quantitative methods
Ability to work in a fast paced business environment
Strong research track record
Effective verbal and written communication skills
Most companies don't hire researchers who publish. Companies that do often are aiming at people who already have academic jobs, and want to keep the possibility open of returning to academia, and in that case the ability to publish (permission to use company data plus time to write papers) is a perk aimed at attracting the right kind of people.
I don't know how much success Amazon has had in the past at hiring economists with active research agendas, but now that they've hired Bajari they clearly have some prospects, particularly if they will be open to having their economists publish about some of the very interesting design problems that Amazon faces, as a marketplace for goods, for merchants, and for computing services.
Amazon likely has particularly good data--they seem to be able to keep track of the same commodity sold by their various different vendors. And each of their three big marketplaces offers the possibility for conducting very interesting experiments.
So...maybe Amazon will start being a source of new research in market design. We'll have to wait and see.
And incidentally, does anyone remember when only banks had a post called Chief Economist? That title is now a tech title too (e.g. Hal Varian at Google and Susan Athey at Microsoft.) Together with the employment of microeconomists under other job titles (e.g. Preston McAfee, David Reiley and Michael Schwarz at Yahoo!, and Paul Milgrom in various entrepreneurial ventures over the years), it's a sign that market design and experiments and related ideas are coming of age.
"Economists at Amazon will be expected to work directly with chief economist Patrick Bajari and senior management on key business problems faced in retail, international retail, cloud computing, third party merchants, search, Kindle and operations. Amazon economists will apply the frontier of economic thinking to market design, pricing, forecasting, online advertising and other areas. You apply econometric modeling, working with our world class data systems, and economic theory to business problems. In addition, economists at Amazon will be expected to maintain an independent and active research agenda, publishing in leading academic journals."
"Basic Qualifications: PhD in Economics or anticipating completion of a PhD in Economics by Aug 2011
"Preferred Qualifications:
Strong background in econometrics, industrial organization, economic theory and quantitative methods
Ability to work in a fast paced business environment
Strong research track record
Effective verbal and written communication skills
Most companies don't hire researchers who publish. Companies that do often are aiming at people who already have academic jobs, and want to keep the possibility open of returning to academia, and in that case the ability to publish (permission to use company data plus time to write papers) is a perk aimed at attracting the right kind of people.
I don't know how much success Amazon has had in the past at hiring economists with active research agendas, but now that they've hired Bajari they clearly have some prospects, particularly if they will be open to having their economists publish about some of the very interesting design problems that Amazon faces, as a marketplace for goods, for merchants, and for computing services.
Amazon likely has particularly good data--they seem to be able to keep track of the same commodity sold by their various different vendors. And each of their three big marketplaces offers the possibility for conducting very interesting experiments.
So...maybe Amazon will start being a source of new research in market design. We'll have to wait and see.
And incidentally, does anyone remember when only banks had a post called Chief Economist? That title is now a tech title too (e.g. Hal Varian at Google and Susan Athey at Microsoft.) Together with the employment of microeconomists under other job titles (e.g. Preston McAfee, David Reiley and Michael Schwarz at Yahoo!, and Paul Milgrom in various entrepreneurial ventures over the years), it's a sign that market design and experiments and related ideas are coming of age.
Sunday, November 28, 2010
Microfinancial crisis
The NY Times reports India Microcredit Faces Collapse From Defaults
"India’s rapidly growing private microcredit industry faces imminent collapse as almost all borrowers in one of India’s largest states have stopped repaying their loans, egged on by politicians who accuse the industry of earning outsize profits on the backs of the poor.
...
"Initially the work of nonprofit groups, the tiny loans to the poor known as microcredit once seemed a promising path out of poverty for millions. In recent years, foundations, venture capitalists and the World Bank have used India as a petri dish for similar for-profit “social enterprises” that seek to make money while filling a social need. Like-minded industries have sprung up in Africa, Latin America and other parts of Asia.
"But microfinance in pursuit of profits has led some microcredit companies around the world to extend loans to poor villagers at exorbitant interest rates and without enough regard for their ability to repay. Some companies have more than doubled their revenues annually.
"Now some Indian officials fear that microfinance could become India’s version of the United States’ subprime mortgage debacle, in which the seemingly noble idea of extending home ownership to low-income households threatened to collapse the global banking system because of a reckless, grow-at-any-cost strategy. "
"India’s rapidly growing private microcredit industry faces imminent collapse as almost all borrowers in one of India’s largest states have stopped repaying their loans, egged on by politicians who accuse the industry of earning outsize profits on the backs of the poor.
...
"Initially the work of nonprofit groups, the tiny loans to the poor known as microcredit once seemed a promising path out of poverty for millions. In recent years, foundations, venture capitalists and the World Bank have used India as a petri dish for similar for-profit “social enterprises” that seek to make money while filling a social need. Like-minded industries have sprung up in Africa, Latin America and other parts of Asia.
"But microfinance in pursuit of profits has led some microcredit companies around the world to extend loans to poor villagers at exorbitant interest rates and without enough regard for their ability to repay. Some companies have more than doubled their revenues annually.
"Now some Indian officials fear that microfinance could become India’s version of the United States’ subprime mortgage debacle, in which the seemingly noble idea of extending home ownership to low-income households threatened to collapse the global banking system because of a reckless, grow-at-any-cost strategy. "
Saturday, November 27, 2010
The market for guns in the U.S.
That's the subject of this Treasury Dept. report, published in 2000: Commerce in Firearms in the United States
"Each year, about 4-1/2 million new firearms, including approximately 2 million handguns, are sold in the United States. An estimated 2 million secondhand firearms are sold each year as well. A critical part of the mission of the Bureau of Alcohol, Tobacco and Firearms (ATF) is to prevent diversion of these firearms from the legal to the illegal market, and to keep them out of the hands of criminals, unauthorized juveniles and other prohibited persons under the Gun Control Act (GCA). This report presents data on the firearms market and describes ATF’s regulatory enforcement programs to prevent firearms trafficking. Criminal investigation, which is also central to ATF’s anti-trafficking work, is discussed in separate reports."
More on the site Mayors Against Illegal Guns and their 2008 report The Movement of Illegal Guns in America, which uses "trace data" on guns used in crimes to track where they were purchased.
"Each year, about 4-1/2 million new firearms, including approximately 2 million handguns, are sold in the United States. An estimated 2 million secondhand firearms are sold each year as well. A critical part of the mission of the Bureau of Alcohol, Tobacco and Firearms (ATF) is to prevent diversion of these firearms from the legal to the illegal market, and to keep them out of the hands of criminals, unauthorized juveniles and other prohibited persons under the Gun Control Act (GCA). This report presents data on the firearms market and describes ATF’s regulatory enforcement programs to prevent firearms trafficking. Criminal investigation, which is also central to ATF’s anti-trafficking work, is discussed in separate reports."
More on the site Mayors Against Illegal Guns and their 2008 report The Movement of Illegal Guns in America, which uses "trace data" on guns used in crimes to track where they were purchased.
Friday, November 26, 2010
Irish horses going the way of Celtic tigers
Facing Starvation: The Sad Plight of Ireland's Abandoned Horses
"During Ireland's boom years, thousands of people bought horses as a status symbol. But with the economy in crisis, many owners can't afford to keep them. Some 20,000 abandoned horses are roaming Ireland and could face starvation this winter.
...
"A horse slaughterhouse in Kilkenny processed more than 3,000 horses last year, five times more than in 2005. Most of the horse steaks are exported to France.
"But only well-nourished horses whose health has been comprehensively logged are allowed to be slaughtered. One wrong drug and the meat is labelled as unsellable. Contrary to EU rules, most Irish horses don't carry implanted microchips containing their most important data. So their remains can't even be processed into dog food. The absence of microchips also makes it impossible to track where an abandoned horse came from. That makes it tempting for troubled owners just to dump their horses by the roadside because it would cost €300 to have the animal put down and disposed of by a vet."
For some related previous posts, see
Why can't you eat horse meat in the U.S.? and Abandoned horses not headed for foreign tables
"During Ireland's boom years, thousands of people bought horses as a status symbol. But with the economy in crisis, many owners can't afford to keep them. Some 20,000 abandoned horses are roaming Ireland and could face starvation this winter.
...
"A horse slaughterhouse in Kilkenny processed more than 3,000 horses last year, five times more than in 2005. Most of the horse steaks are exported to France.
"But only well-nourished horses whose health has been comprehensively logged are allowed to be slaughtered. One wrong drug and the meat is labelled as unsellable. Contrary to EU rules, most Irish horses don't carry implanted microchips containing their most important data. So their remains can't even be processed into dog food. The absence of microchips also makes it impossible to track where an abandoned horse came from. That makes it tempting for troubled owners just to dump their horses by the roadside because it would cost €300 to have the animal put down and disposed of by a vet."
For some related previous posts, see
Why can't you eat horse meat in the U.S.? and Abandoned horses not headed for foreign tables
Thursday, November 25, 2010
Misc. kidney chains and exchanges
The UNOS National Kidney Paired Donation Pilot System is cautiously expanding its scope to include non-directed donor chains
"St. Louis: The OPTN/UNOS Board of Directors, meeting Nov. 8-9, approved a proposal to broaden potential participation in the recently established national pilot program for kidney paired donation (KPD) transplantation.
"The pilot program was initially approved for operation to match only two to three pairs of transplant candidates and their intended donors. All of these intended donors had meant to donate to a specific recipient before they were found to be medically incompatible with that person. (For additional resource information about the paired donation process, visit the OPTN website: http://optn.transplant.hrsa.gov/resources/KPDPP.asp.
"Once the newly approved protocol is implemented, pairs can be matched with a "non-directed donor" - a person who chooses to be a living donor but does not come forward to help a specific patient. By including one non-directed donor and a series of other donor/candidate pairs, a chain of transplants can be performed that ends with the transplantation of a candidate who had been awaiting a deceased donor transplant. This is known as "donor chain."
"The pilot program is intended to determine whether having a national base for paired donation can result in more transplants," said OPTN/UNOS President Charles Alexander, RN, M.S.N., M.B.A. The transplant community asked us to take some extra time to study whether and how to add non-directed donors and chains; A number of transplant centers and paired donation organizations have been performing chains for years with good results, and the consensus is that this option should be part of the national pilot."
Here's the Washington Post story about the UNOS pilot: Pilot transplant project aims to spur kidney swaps
In the meantime, kidney exchange is also spreading regionally, as the following stories indicate.
Here's a video about a recent, large non-simultaneous chain at Georgetown, which accomplished 16 transplants.
Transplant exchanges allow more to benefit from donations : Oct 29, 2010: Sanford Health transplant leader once personally touched by donation when daughter received new liver
"Sanford Transplant Services, part of Sanford Health of Fargo, N.D., has been in place since 1989 and has completed more than 580 transplants. Dr. Bhargav Mistry has been an instrumental leader in the program and has completed more than 400 of those transplants. Hospital leaders and others say Mistry's commitment to the excellence and genuine care for his patients has built the program into what it is today - a nationally recognized transplant program offering the latest in surgery and technology.
"An example of that innovation occurred in July 2010, when an anonymous kidney donor set off a sequence of 10 surgeries involving 10 patients and resulting in five people receiving kidney transplants.
"The rare chain of surgeries - the first of its kind in North Dakota - was made possible using a unique paired exchange program involving multiple transplant centers based in Minneapolis. Under a transplant chain, or exchange, a potential recipient and her willing, but incompatible, donor family member, friend or other donor are listed in a waiting "pool," along with other mismatched pairs.
"Then, when any potential donor on the list is determined to be compatible for any potential recipient also on the list, the donor gives their organ anonymously if a donation match will also be made for his partner.
...
"In this case, a Minneapolis non-directed donor, or an anonymous donor who meets strict criteria to donate a kidney, was a match for a potential recipient in Fargo in the paired exchange pool.
"Therefore, the donor's kidney was recovered and flown to Fargo. Two surgeries later, a kidney from Fargo was driven to Minneapolis, extending the chain with four more transplants at Abbott Northwestern Hospital and University of Minnesota Medical Center, Fairview. In total, 10 people produced five successful kidney transplants.
...
"Mistry seems incredibly compassionate about his chosen career; in fact, he has been personally affected by the need for donation. His daughter, Karishma Mistry, was born without a gall bladder, and doctors told the Mistrys years ago that she would eventually need a new liver.
"I decided to go into transplantation a few months before she was born," Mistry said. "I didn't know we would be in this kind of situation. I think it was just fate."
"In October of 2005, Karishma was added to the transplant list, when complications with her condition arose. In May 2006, the Mistrys received a call that a donor had been found. Today, the teenage girl is doing well and lives a full life. "
(See also Transplant surgeon's daughter gets liver transplant after long wait )
Large non-simultaneous chain in San Antonio at Methodist Specialty and Transplant Hospital, includes 16 transplants: here's a video report from CNN.
And here's a paper on the virtual matching process...
Virtual Crossmatch Approach to Maximize Matching in Paired Kidney Donation.
Am J Transplant. 2010 Nov 10;
Authors: Ferrari P, Fidler S, Wright J, Woodroffe C, Slater P, Van Althuis-Jones A, Holdsworth R, Christiansen FT
Abstract: "We developed and tested a new computer program to match maximal sets of incompatible live donor/recipient pairs from a national paired kidney donation (PKD) registry. Data of 32 incompatible pairs included ABO and 4 digit-high-resolution donor and recipient HLA antigens and recipient’s HLA antibodies. Three test runs were compared, in which donors were excluded from matching to recipients with either donor-specific antibodies (DSA) >8000MFI (mean fluorescent intensity) at low-resolution (Run 1) or >8000MFI at high-resolution (Run 2) or >2000MFI and high-resolution (Run 3). Run 1 identified 22 703 possible combinations, with 20 pairs in the top ranked, Run 2 identified 24 113 combinations, with 19 pairs in the top ranked and Run 3 identified 8843 combinations, with 17 pairs in the top ranked. Review of DSA in Run 1 revealed that six recipients had DSA 2000-8000MFI causing a possible positive crossmatch resulting in breakdown of two 3-way and three 2-way chains. In Run 2, four recipients had DSA 2000-8000MFI, also potentially causing breakdown of three 2-way chains. The more prudent approach of excluding from matching recipients with DSA with >2000MFI reduces the probability of matched pairs having a positive crossmatch without significantly decreasing the number of possible transplants."
"St. Louis: The OPTN/UNOS Board of Directors, meeting Nov. 8-9, approved a proposal to broaden potential participation in the recently established national pilot program for kidney paired donation (KPD) transplantation.
"The pilot program was initially approved for operation to match only two to three pairs of transplant candidates and their intended donors. All of these intended donors had meant to donate to a specific recipient before they were found to be medically incompatible with that person. (For additional resource information about the paired donation process, visit the OPTN website: http://optn.transplant.hrsa.gov/resources/KPDPP.asp.
"Once the newly approved protocol is implemented, pairs can be matched with a "non-directed donor" - a person who chooses to be a living donor but does not come forward to help a specific patient. By including one non-directed donor and a series of other donor/candidate pairs, a chain of transplants can be performed that ends with the transplantation of a candidate who had been awaiting a deceased donor transplant. This is known as "donor chain."
"The pilot program is intended to determine whether having a national base for paired donation can result in more transplants," said OPTN/UNOS President Charles Alexander, RN, M.S.N., M.B.A. The transplant community asked us to take some extra time to study whether and how to add non-directed donors and chains; A number of transplant centers and paired donation organizations have been performing chains for years with good results, and the consensus is that this option should be part of the national pilot."
Here's the Washington Post story about the UNOS pilot: Pilot transplant project aims to spur kidney swaps
Here's a press release from Carnegie Mellon University highlighting the role of software in that effort: Organ Network Uses Carnegie Mellon Algorithm To Match Live Kidney Donors With Recipients, National Pilot Program Facilitates Kidney Paired-Donation Transplants (no chains were allowed in this initial pilot...)
In the meantime, kidney exchange is also spreading regionally, as the following stories indicate.
Here's a video about a recent, large non-simultaneous chain at Georgetown, which accomplished 16 transplants.
Transplant exchanges allow more to benefit from donations : Oct 29, 2010: Sanford Health transplant leader once personally touched by donation when daughter received new liver
"Sanford Transplant Services, part of Sanford Health of Fargo, N.D., has been in place since 1989 and has completed more than 580 transplants. Dr. Bhargav Mistry has been an instrumental leader in the program and has completed more than 400 of those transplants. Hospital leaders and others say Mistry's commitment to the excellence and genuine care for his patients has built the program into what it is today - a nationally recognized transplant program offering the latest in surgery and technology.
"An example of that innovation occurred in July 2010, when an anonymous kidney donor set off a sequence of 10 surgeries involving 10 patients and resulting in five people receiving kidney transplants.
"The rare chain of surgeries - the first of its kind in North Dakota - was made possible using a unique paired exchange program involving multiple transplant centers based in Minneapolis. Under a transplant chain, or exchange, a potential recipient and her willing, but incompatible, donor family member, friend or other donor are listed in a waiting "pool," along with other mismatched pairs.
"Then, when any potential donor on the list is determined to be compatible for any potential recipient also on the list, the donor gives their organ anonymously if a donation match will also be made for his partner.
...
"In this case, a Minneapolis non-directed donor, or an anonymous donor who meets strict criteria to donate a kidney, was a match for a potential recipient in Fargo in the paired exchange pool.
"Therefore, the donor's kidney was recovered and flown to Fargo. Two surgeries later, a kidney from Fargo was driven to Minneapolis, extending the chain with four more transplants at Abbott Northwestern Hospital and University of Minnesota Medical Center, Fairview. In total, 10 people produced five successful kidney transplants.
...
"Mistry seems incredibly compassionate about his chosen career; in fact, he has been personally affected by the need for donation. His daughter, Karishma Mistry, was born without a gall bladder, and doctors told the Mistrys years ago that she would eventually need a new liver.
"I decided to go into transplantation a few months before she was born," Mistry said. "I didn't know we would be in this kind of situation. I think it was just fate."
"In October of 2005, Karishma was added to the transplant list, when complications with her condition arose. In May 2006, the Mistrys received a call that a donor had been found. Today, the teenage girl is doing well and lives a full life. "
(See also Transplant surgeon's daughter gets liver transplant after long wait )
Large non-simultaneous chain in San Antonio at Methodist Specialty and Transplant Hospital, includes 16 transplants: here's a video report from CNN.
And here's a paper on the virtual matching process...
Virtual Crossmatch Approach to Maximize Matching in Paired Kidney Donation.
Am J Transplant. 2010 Nov 10;
Authors: Ferrari P, Fidler S, Wright J, Woodroffe C, Slater P, Van Althuis-Jones A, Holdsworth R, Christiansen FT
Abstract: "We developed and tested a new computer program to match maximal sets of incompatible live donor/recipient pairs from a national paired kidney donation (PKD) registry. Data of 32 incompatible pairs included ABO and 4 digit-high-resolution donor and recipient HLA antigens and recipient’s HLA antibodies. Three test runs were compared, in which donors were excluded from matching to recipients with either donor-specific antibodies (DSA) >8000MFI (mean fluorescent intensity) at low-resolution (Run 1) or >8000MFI at high-resolution (Run 2) or >2000MFI and high-resolution (Run 3). Run 1 identified 22 703 possible combinations, with 20 pairs in the top ranked, Run 2 identified 24 113 combinations, with 19 pairs in the top ranked and Run 3 identified 8843 combinations, with 17 pairs in the top ranked. Review of DSA in Run 1 revealed that six recipients had DSA 2000-8000MFI causing a possible positive crossmatch resulting in breakdown of two 3-way and three 2-way chains. In Run 2, four recipients had DSA 2000-8000MFI, also potentially causing breakdown of three 2-way chains. The more prudent approach of excluding from matching recipients with DSA with >2000MFI reduces the probability of matched pairs having a positive crossmatch without significantly decreasing the number of possible transplants."
Wednesday, November 24, 2010
The (duopolistic, Federally funded) market for dialysis
Robin Fields in The Atlantic discusses dialysis: “God Help You. You're on Dialysis.”
It begins:
"In October 1972, after a month of deliberation, Congress launched the nation’s most ambitious experiment in universal health care: a change to the Social Security Act that granted comprehensive coverage under Medicare to virtually anyone diagnosed with kidney failure, regardless of age or income..."
But most of the story focuses on the dire situation of those in dialysis.
"Dialysis entered the American consciousness in the early 1960s as the country’s signature example of medical rationing. In those days, kidney disease killed about 100,000 people a year. Chronic dialysis was possible, thanks to two inventions: the artificial-kidney machine developed by the Dutch doctor Willem Kolff during World War II and a vascular-access device designed by Belding Scribner, a pioneering Seattle physician who opened the first outpatient dialysis center in the United States. But treatments were expensive, and most private insurers would not pay for them. At Scribner’s medical center, the Life or Death Committee parceled out the few slots, weighing not only the health of patients and their income, but also their perceived social worth.
"News reports about the committee’s work sparked one of the earliest national debates over the right to care and put pressure on the government to step in. A turning point came when Shep Glazer, vice president of the largest patient group, made an emotional appeal to the House Ways and Means Committee, as he underwent dialysis on the hearing-room floor. “If your kidneys failed tomorrow, wouldn’t you want the opportunity to live?” asked the 43-year-old father of two. “Wouldn’t you want to see your children grow up?”
"The measure establishing taxpayer funding for treatment of end-stage renal disease, signed into law by President Nixon, was expansive, and its lopsided, bipartisan approval reflected the times. Many lawmakers—even conservatives—thought the United States would adopt a European-style national health-care system. Also, the program that took effect in July 1973 was expected to have about 35,000 patients and cost about $1 billion in its 10th year.
"Those estimates came to seem almost laughable. The number of dialysis patients surpassed 35,000 by 1977 and has gone up from there. The growth reflected not only lower-than-expected transplant rates and the spread of diabetes, but also positive trends, like better cardiac care. With Americans living long enough for their kidneys to fail and no disqualifying conditions for the program, even the oldest and sickest patients increasingly were prescribed dialysis. Upwards of 100,000 now start treatment each year. “It’s been a perfect example of that line, ‘Build it and they will come,’” said Dr. Jay Wish, director of dialysis services for University Hospitals Case Medical Center in Cleveland.
"Because the kidney program absorbed that unforeseen wave—and thus, prolonged so many lives—some call it one of the great success stories of modern medicine. Still, the annual bill for the program quickly outpaced early projections, surging past $1 billion within six years. Per-patient expenditures were expected to drop as technology advanced. Instead they have risen steadily, as drug and hospitalization costs grew for the program’s increasingly frail clientele."
...
"Problems like those that regulators found in McMurry’s clinic are partly rooted in economics. The government’s payment policies for dialysis have created financial incentives that, in some ways, have worked against better patient care, while enabling for-profit corporations to dominate the business.
When the end-stage-renal-disease program began, hospitals provided most of the care on a nonprofit basis. But spurred by the guarantee of Medicare money, the marketplace met the growing demand for services through the expansion of for-profit companies. Today, more than 80 percent of the nation’s 5,000 clinics are for-profit. Almost two-thirds of all clinics are operated by two chains: Colorado-based DaVita and Fresenius, a subsidiary of a German corporation that is the leading maker of dialysis machines and supplies.
From the start, the government’s payment rules rewarded efficiency. Medicare set a rate for dialysis treatments, originally $138 per session, and covered a maximum of three treatments a week for most patients. Providers could keep whatever they didn’t spend on care. There were no penalties for poor results and no bonuses for good ones. Unlike other Medicare rates, the payment wasn’t adjusted upward for inflation.
Lawmakers cut the base rate to about $123 per treatment in 1983, after the program’s cost came in higher than expected and audits showed providers averaging profits of more than 20 percent. Dialysis companies responded like any other business facing a drop in prices, said Philip J. Held, a nationally recognized researcher on kidney disease and an economist by training. They chopped expenses by shortening treatments, thinning staff, and assigning tasks once done by nurses to unlicensed technicians. Some reused dialyzers, the filters that clean the patient’s blood. “It changed the nature of the service,” Held said of the rate cut. “You get what you pay for. The price was lower, but the product was dramatically different.”
The government created another perverse incentive by allowing clinics to bill Medicare separately for certain medications, reimbursing them at a markup over what they paid drug makers. Dialysis companies embraced the opportunity: doses of Epogen, prescribed to treat anemia, and similar medications tripled between 1989 and 2005, becoming Medicare’s single largest pharmaceutical expense. “Their core business became giving patients injectable drugs,” said Richard A. Hirth, a professor of health management and policy at the University of Michigan School of Public Health. “Dialysis was just the loss leader that got [patients] in the door.”
It begins:
"In October 1972, after a month of deliberation, Congress launched the nation’s most ambitious experiment in universal health care: a change to the Social Security Act that granted comprehensive coverage under Medicare to virtually anyone diagnosed with kidney failure, regardless of age or income..."
But most of the story focuses on the dire situation of those in dialysis.
"Dialysis entered the American consciousness in the early 1960s as the country’s signature example of medical rationing. In those days, kidney disease killed about 100,000 people a year. Chronic dialysis was possible, thanks to two inventions: the artificial-kidney machine developed by the Dutch doctor Willem Kolff during World War II and a vascular-access device designed by Belding Scribner, a pioneering Seattle physician who opened the first outpatient dialysis center in the United States. But treatments were expensive, and most private insurers would not pay for them. At Scribner’s medical center, the Life or Death Committee parceled out the few slots, weighing not only the health of patients and their income, but also their perceived social worth.
"News reports about the committee’s work sparked one of the earliest national debates over the right to care and put pressure on the government to step in. A turning point came when Shep Glazer, vice president of the largest patient group, made an emotional appeal to the House Ways and Means Committee, as he underwent dialysis on the hearing-room floor. “If your kidneys failed tomorrow, wouldn’t you want the opportunity to live?” asked the 43-year-old father of two. “Wouldn’t you want to see your children grow up?”
"The measure establishing taxpayer funding for treatment of end-stage renal disease, signed into law by President Nixon, was expansive, and its lopsided, bipartisan approval reflected the times. Many lawmakers—even conservatives—thought the United States would adopt a European-style national health-care system. Also, the program that took effect in July 1973 was expected to have about 35,000 patients and cost about $1 billion in its 10th year.
"Those estimates came to seem almost laughable. The number of dialysis patients surpassed 35,000 by 1977 and has gone up from there. The growth reflected not only lower-than-expected transplant rates and the spread of diabetes, but also positive trends, like better cardiac care. With Americans living long enough for their kidneys to fail and no disqualifying conditions for the program, even the oldest and sickest patients increasingly were prescribed dialysis. Upwards of 100,000 now start treatment each year. “It’s been a perfect example of that line, ‘Build it and they will come,’” said Dr. Jay Wish, director of dialysis services for University Hospitals Case Medical Center in Cleveland.
"Because the kidney program absorbed that unforeseen wave—and thus, prolonged so many lives—some call it one of the great success stories of modern medicine. Still, the annual bill for the program quickly outpaced early projections, surging past $1 billion within six years. Per-patient expenditures were expected to drop as technology advanced. Instead they have risen steadily, as drug and hospitalization costs grew for the program’s increasingly frail clientele."
...
"Problems like those that regulators found in McMurry’s clinic are partly rooted in economics. The government’s payment policies for dialysis have created financial incentives that, in some ways, have worked against better patient care, while enabling for-profit corporations to dominate the business.
When the end-stage-renal-disease program began, hospitals provided most of the care on a nonprofit basis. But spurred by the guarantee of Medicare money, the marketplace met the growing demand for services through the expansion of for-profit companies. Today, more than 80 percent of the nation’s 5,000 clinics are for-profit. Almost two-thirds of all clinics are operated by two chains: Colorado-based DaVita and Fresenius, a subsidiary of a German corporation that is the leading maker of dialysis machines and supplies.
From the start, the government’s payment rules rewarded efficiency. Medicare set a rate for dialysis treatments, originally $138 per session, and covered a maximum of three treatments a week for most patients. Providers could keep whatever they didn’t spend on care. There were no penalties for poor results and no bonuses for good ones. Unlike other Medicare rates, the payment wasn’t adjusted upward for inflation.
Lawmakers cut the base rate to about $123 per treatment in 1983, after the program’s cost came in higher than expected and audits showed providers averaging profits of more than 20 percent. Dialysis companies responded like any other business facing a drop in prices, said Philip J. Held, a nationally recognized researcher on kidney disease and an economist by training. They chopped expenses by shortening treatments, thinning staff, and assigning tasks once done by nurses to unlicensed technicians. Some reused dialyzers, the filters that clean the patient’s blood. “It changed the nature of the service,” Held said of the rate cut. “You get what you pay for. The price was lower, but the product was dramatically different.”
The government created another perverse incentive by allowing clinics to bill Medicare separately for certain medications, reimbursing them at a markup over what they paid drug makers. Dialysis companies embraced the opportunity: doses of Epogen, prescribed to treat anemia, and similar medications tripled between 1989 and 2005, becoming Medicare’s single largest pharmaceutical expense. “Their core business became giving patients injectable drugs,” said Richard A. Hirth, a professor of health management and policy at the University of Michigan School of Public Health. “Dialysis was just the loss leader that got [patients] in the door.”
Tuesday, November 23, 2010
Signaling (by candidates) and advertising (by employers) on the Economics job market
John Cawley has been carefully reading the ads in Job Openings for Economists, and he notices that advertisers have been taking explicit note of the signaling mechanism in the economics job market.
He notes:
"University College London writes in their JOE ad that: "We will pay particular attention to the applications of candidates who have signalled their interest in UCL through the AEA signalling system."
and the JOE ad for U Mass - Amherst states: Candidates will be interviewed at ASSA (Denver) and are encouraged to use AEA signaling.
(Here's a direct link to our recent paper:
The Job Market for New Economists: A Market Design Perspective, by Peter Coles, John Cawley, Phillip B. Levine, Muriel Niederle, Alvin E. Roth, and John J. Siegfried (Journal of Economic Perspectives—Volume 24, Number 4—Fall 2010—Pages 187–206) )
He notes:
"University College London writes in their JOE ad that: "We will pay particular attention to the applications of candidates who have signalled their interest in UCL through the AEA signalling system."
and the JOE ad for U Mass - Amherst states: Candidates will be interviewed at ASSA (Denver) and are encouraged to use AEA signaling.
(Here's a direct link to our recent paper:
The Job Market for New Economists: A Market Design Perspective, by Peter Coles, John Cawley, Phillip B. Levine, Muriel Niederle, Alvin E. Roth, and John J. Siegfried (Journal of Economic Perspectives—Volume 24, Number 4—Fall 2010—Pages 187–206) )
Subscribe to:
Posts (Atom)
Posts
