Sunday, January 2, 2011

Baroque kidney donation story from Mississippi

Sister's kidney donation condition of Miss. parole

"JACKSON, Miss. (AP) — For 16 years, sisters Jamie and Gladys Scott have shared a life behind bars for their part in an $11 armed robbery. To share freedom, they must also share a kidney.

"Mississippi Gov. Haley Barbour suspended the sisters' life sentences on Wednesday, but 36-year-old Gladys Scott's release is contingent on her giving a kidney to Jamie, her 38-year-old sister, who requires daily dialysis.

"The sisters were convicted in 1994 of leading two men into an ambush in central Mississippi the year before. Three teenagers hit each man in the head with a shotgun and took their wallets — making off with only $11, court records said.

"Jamie and Gladys Scott were each convicted of two counts of armed robbery and sentenced to two life sentences."

And here's the unsurprising reaction to linking parole to kidney donation: Mississippi Gov "unethical" over jail release: surgeon

"Mississippi Governor Haley Barbour acted unethically when he suspended a woman's life sentence on condition she donate a kidney to her sister, a prominent transplant surgeon said on Thursday.
...
"A condition of Gladys Scott's release is that she donate a kidney to her sister in an operation that should be performed urgently, Barbour said in a statement on Wednesday. She had agreed to be a donor for her sister, who requires dialysis.
...
"Michael Shapiro, chief of organ transplantation at Hackensack University Medical Center in New Jersey, criticized the decision to impose a condition for the release.

"While Governor Barbour probably meant nothing nefarious by this decision, what he did was unethical and possibly illegal. He is unaware of the procedures of transplantation that include making sure donors are not coerced," Shapiro said.

"There were also medical reasons why such a condition was inappropriate, not least that Barbour may not know whether Jamie Scott is suitable or healthy enough for a transplant, said Shapiro, chair of the ethics committee of the nonprofit United Network for Organ Sharing.

"Shapiro also questioned whether Barbour ordered Scott released because her treatment was a financial burden on the state.

"If either party could be turned down for medical concerns, the transplant team would feel pressured to continue with the transplant or send them back to prison. It is a position they should not be put in," he said."


HT: Mike Ostrovsky

Saturday, January 1, 2011

Peter Cramton's Market Design blog

Welcome to fellow market designer and now fellow blogger Peter Cramton, who has just initiated his Market Design blog.

Experiments by psychologists and economists (on happiness)

From The Economist: an article on happiness leads indirectly to a very important conclusion about experiments (see below):The U-bend of life: Why, beyond middle age, people get happier as they get older

"Happiness doesn’t just make people happy—it also makes them healthier. John Weinman, professor of psychiatry at King’s College London, monitored the stress levels of a group of volunteers and then inflicted small wounds on them. The wounds of the least stressed healed twice as fast as those of the most stressed. At Carnegie Mellon University in Pittsburgh, Sheldon Cohen infected people with cold and flu viruses. He found that happier types were less likely to catch the virus, and showed fewer symptoms of illness when they did. So although old people tend to be less healthy than younger ones, their cheerfulness may help counteract their crumbliness.

"Happier people are more productive, too. Mr Oswald and two colleagues, Eugenio Proto and Daniel Sgroi, cheered up a bunch of volunteers by showing them a funny film, then set them mental tests and compared their performance to groups that had seen a neutral film, or no film at all. The ones who had seen the funny film performed 12% better. This leads to two conclusions. First, if you are going to volunteer for a study, choose the economists’ experiment rather than the psychologists’ or psychiatrists’. Second, the cheerfulness of the old should help counteract their loss of productivity through declining cognitive skills—a point worth remembering as the world works out how to deal with an ageing workforce.

Friday, December 31, 2010

Top 2010 stories about repugnant transactions (and all time top repugnant transactions)

Repugnant transactions are those that some people don't want other people to engage in. They have had a big effect on which transactions we see, and which we don't. They change over time, sometimes quickly when they start to change, but they persist for a long time. How about these?

Top 5 in 2010

Top 5 of all time
  • Sex (outside of marriage, same sex marriage, pornography prostitution…)
  • Servitude: Slavery and serfdom and indentured servitude, women’s (lack of) rights (wasn’t so repugnant, now very much so)
  • Worship (Inquisition, expulsions, heresy, religious wars)
  • Interest on loans (was repugnant, no longer so much)
  • Alcohol and mind-altering and addictive drugs (makes the list because of all the associated crime)

Thursday, December 30, 2010

Dubner interviews me about kidney sales and such

Repugnance radio* turns out to have two parts, and the second part is a Freakonomics blog post with a link to a podcast (which you can also download free at itunes), in which my voice is heard. Organ transplants are the main subject, from various angles.

Remind me to figure out how to have mood music come on when I speak, as I do in the podcast... (I might choose different mood music...)

If there's a transcript on the web at some point, I'll link to that for those of you who don't have a half hour to listen. 

*The Levitt quote about economists in my earlier post about the NPR broadcast also made it into the podcast...

Repugnance radio

Freakonomics Radio on NPR's Marketplace had a short segment called It's repugnant, but hey, it's efficient!, in which they speak about organ sales, among other things.

In it, Steve Levitt says
"One of the easiest ways to differentiate an economist from almost anyone else in society is to test them with repugnant ideas. Because economists, either by birth or by training, have their mind open, or skewed in just such a way that instead of thinking about whether something is right or wrong, they think about it in terms of whether it's efficient, whether it makes sense. And many of the things that are most repugnant are the things which are indeed quite efficient, but for other reasons -- subtle reasons, sometimes, reasons that are hard for people to understand -- are completely and utterly unacceptable."

In the comments, they get the following crack:
"There is one organ that nobody will ever need: The brain of an economist."

Wednesday, December 29, 2010

First live kidney donor dies at 79 (56 years after donating to his twin)

Ronald Lee Herrick became the first live kidney donor when, as a college freshman, he donated a kidney to his twin.
Here's the Globe obit: World's first organ donor dies at 79
"On Dec. 23, 1954, Dr. Joseph Murray removed a kidney from Ronald and implanted it in Richard. Years later, Murray shared a Nobel Prize for his groundbreaking work. For the Herrick twins, the results were more immediate and personal. Ronald gave Richard about eight more years of life.


"The older and more serious of the twins, Ronald Herrick didn't talk about his key role in opening a new venue in medicine unless someone asked, and even then he had to be drawn out if the conversation lasted more than a few sentences. Unassuming and modest, he taught math for decades in high school, junior high, and college. On the side, he kept his hand in farming because he grew up on a family farm and loved the physical work of agriculture.

"Mr. Herrick, who suffered from heart ailments that prompted him to retire from teaching and farming in 1997, died Monday in the Augusta Rehabilitation Center in Augusta, Maine, where he was recuperating from heart surgery in October. He was 79 and lived in Belgrade, Maine."

Here's another account: First successful organ donor dies
"Ronald Lee Herrick, who became a medical pioneer in 1954 when he donated a kidney to his twin brother in what is considered the world’s first successful organ transplant, has died at the age of 79.


"The native of Rutland, Mass., died in Augusta, Maine, on Monday, while recovering from heart surgery. A retired math teacher in Northborough before moving to Maine, he was quiet about his role in the groundbreaking operation at the former Peter Bent Brigham Hospital in Boston. His gift created a new field of medicine, as this Globe story says.

"I didn't think too much about it," Herrick said during an interview when the 50th anniversary of the operation was celebrated in 2004. "We had all kinds of meetings beforehand. I agreed, and there was no real problem."

"When the identical twins were 23 years old, Ronald’s brother Richard was dying of chronic kidney inflammation.

"Organ transplants had been attempted before, but they had failed. Kidney specialists at the Brigham believed taking a kidney from an identical twin would avoid the recently recognized problem of rejection, in which the recipient's immune system attacks the transplanted organ as foreign.

"The doctors -- including Dr. Joseph E. Murray, who later won the Nobel Prize in medicine -- were right. The operation was a success and Richard, a Coast Guard veteran who had been failing while on an early form of dialysis, recovered, married his recovery room nurse, and became the father of two children. He died of a heart attack eight years later.

"Here was a person who was near death and was able to return to normal life," Dr. Michael J. Zinner, chief of surgery at Brigham and Women's Hospital, the successor to Peter Bent Brigham Hospital, said in 2004. "This ushered in a new era, when surgery would no longer simply be used to treat acute illnesses like appendicitis or a traffic accident (injury) but now could be used to treat a chronic illness and make patients better."

HT: Steve Leider

Elton John and husband have a son by a surrogate mom

Lots of formerly repugnant transactions get mentioned in this brief, happy story: Elton John, Husband Welcome New Son

"Elton John must have been really nice this past year. The legendary singer and songwriter and his husband welcomed a new child into their lives on Christmas Day.

"The "Benny and the Jets" singer and filmmaker David Furnish are the parents to a 7-pound, 15-ounce boy named Zachary Jackson Levon Furnish-John. The baby was delivered through an unidentified surrogate mother.

"The child is the first for John, 63. Us Weekly confirmed the adoption on Monday.

"...In the past, the British native attempted to adopt an HIV-positive child from the Ukraine with Furnish, but was forbidden to by government officials due to both John's age and marital status."

Tuesday, December 28, 2010

Medical marijuana in NJ

Marijuana--an herb whose recreational properties became well known before its medicinal ones--continues to be regarded as a repugnant transaction even in places where laws are being adapted to make marijuana available as a prescription drug.

Democrats Shape Marijuana Law: A Challenge to Gov. Christie's Approach

"New Jersey Senate Democrats are pushing ahead with a challenge to the Christie administration's rules for the state's new medical marijuana program, despite a supposedly bipartisan compromise the governor announced earlier this month.

"Democrats are unhappy with regulations to implement the program, saying it falls short of a law already described as the most restrictive in the country. The rules would limit the potency of marijuana, among other specifications contrary to the law signed in January just before Mr. Christie took office.

"In putting his own stamp on the program, Mr. Christie says he is trying to make sure New Jersey doesn't become another California or Colorado, where critics say it is too easy for healthy people to buy pot intended for those with medical problems."

Monday, December 27, 2010

Joel Klein steps down as NYC school chancellor

In an interview in the NY Times about his tenure as chancellor (Departing Schools Chief: ‘We Weren’t Bold Enough’), Klein says this about school choice:
"There are schools in this city that I would send my children to without a moment’s hesitation, and others that I wouldn’t. Schools have to turn around from within. There’s not somebody at a central office who waves a wand on this stuff. That’s why I want to give people choices."


Here are my papers on school choice in NYC.

Sunday, December 26, 2010

Repugnance by residence: only Dutch can buy marijuana in Maastricht now

It's official:

The prohibition on the admission of non-residents to Netherlands ‘coffee-shops’ complies with European Union law "Around 2.7 million tourists a year who visited Maastricht’s 14 coffee shops will have to look elsewhere for their cannabis, as the Court of Justice of the European Union upheld a ruling that prohibits non-Dutch residents from entering those venues.

“The rules are intended to put an end to the public nuisance caused by the large number of tourists wanting to purchase or consume cannabis in the coffee-shops in the municipality of Maastricht,” the court ruled, according to a press release published on its website."

HT: Bettina Klaus

Saturday, December 25, 2010

'tis the season to exchange gift cards

Cardpool is making a market in gift cards, offering to buy yours, and sell you those cashed in by others.
"You are always buying directly from us and selling directly to us. Cardpool buys our gift cards directly from our customers, verifies the authenticity and balance of each gift card, and holds on to them until a buyer is found. Even though we may never find a buyer for a given gift card, we pay sellers within 24 hours of receiving their gift card."

Here's how they address the trust problem involved with putting a gift card in the mail to them:

"How do I know I'll receive payment after sending you my gift cards?"
"Great question! Although there is a bit of a leap of faith here, we've received glowing reviews from CNN, NBC, ABC, CBS, FOX, NPR, The New York Times, The Wall Street Journal, and many other highly reputable publications. In addition, we're backed by the same founders, CEOs, and investors responsible for many of the brands we've come to love including Google, Facebook, PayPal, Zappos, StubHub, Twitter, Skype, Slide, Lotus, Mint, and many others. We were only able to do this by putting our customers first.
If you'd like to learn more, read about us in the news and learn more about our investors."

Unlike the original-issue market for gift cards, exchanged gift cards come in discrete amounts (sometimes they are the unused credit from the originally issued amount, or sometimes they are merchandise credit for goods that were returned). For example, when I looked there were four cards from the retailer Ann Taylor, in face value amounts $197.53, $212.17, $235.44, and $257.09, all being offered at a 15% discount...



HT: Joshua Gans

Friday, December 24, 2010

The market for clinical rotations for medical students

After studying in classrooms for two years, medical students head to hospitals for medical roations or clerkships. Some of the Carribean medical schools that serve primarily American students pay American hospitals to supervise their students, which is upsetting some existing relationships, the Chronicle reports: Students From Caribbean Med Schools Head for New York, Angering Some Local Programs --The trend angers some medical educators, who say their trainees are being crowded out of clinical rotations

"Thousands of students from offshore medical schools flock to teaching hospitals in the United States each year to complete the clinical portion of their education. In New York, the number of students performing third- and fourth-year hospital rotations from these offshore programs now almost equals the number of students from the state's own medical schools.

"That is making a number of medical educators in the state angry. They say their students are being crowded out of opportunities, in part because the offshore medical schools are paying hospitals to secure the spots—something they say their budgets prohibit them from doing. Some also say many offshore students have been poorly supervised and are inadequately prepared to practice medicine."

And here is the NY Times on the subject: Medical Schools in Region Fight Caribbean Flow

"The dispute also has far-reaching implications for medical education and the licensing of physicians across the country. More than 42,000 students apply to medical schools in the United States every year, and only about 18,600 matriculate, leaving some of those who are rejected to look to foreign schools. Graduates of foreign medical schools in the Caribbean and elsewhere constitute more than a quarter of the residents in United States hospitals.

"With experts predicting a shortage of 90,000 doctors in the United States by 2020, the defenders of these schools say that they fill a need because their graduates are more likely than their American-trained peers to go into primary and family care, rather than into higher-paying specialties like surgery.

"New York has been particularly affected by the influx because it trains more medical students and residents — fledgling doctors who have just graduated from medical school — than any other state. The New York medical school deans say that they want to expand their own enrollment to fill the looming shortage, but that their ability to do so is impeded by competition with the Caribbean schools for clinical training slots in New York hospitals."


HT: Muriel Niederle

Thursday, December 23, 2010

Internet poker

Internet poker has gotten awfully popular without yet getting correspondingly legal: Legalizing Internet poker gets push from Harry Reid in lame-duck session

"Senate Majority Leader Harry M. Reid (D-Nev.) is pushing a bill that would give official government approval to Texas hold-'em, five-card stud and other Internet poker games, which currently exist in a legal twilight zone dominated by companies operating from the Isle of Man and other exotic foreign locales.

"The idea is to lure some of that multibillion-dollar business into the United States - and give the federal government up to $3 billion in annual revenues in the process.

"The measure would be a boon for Las Vegas-based casinos, which supported Reid in his hard-fought reelection campaign and are eager to enter the lucrative world of online gaming. Many states and localities, including the District, have started thinking about legalizing Internet gaming on their own, giving federal lawmakers even more incentive to act.

"Under the status quo, Internet poker is played by millions of Americans every day in an essentially unregulated environment," Reid said in a statement this week. "The legislation I am working on would get our collective heads out of the sand and create a strict regulatory environment to protect U.S. consumers, prevent underage gambling and respect the decisions of states that don't allow gambling."

Wednesday, December 22, 2010

Incest is still a repugnant transaction

Professor charged with incest with his daughter
"Political science professor xxx, 46, was charged Thursday with having a sexual relationship with his daughter, 24.

"He was arrested Wednesday morning and charged with one count of incest in the third degree at an arraignment hearing on Thursday. According to police, the relationship appears to have been consensual."

According to NY State Law:
"255.25 Incest.
A person is guilty of incest when he or she marries or engages in sexual intercourse or deviate sexual intercourse with a person whom he or she knows to be related to him or her, either legitimately or out of wedlock, as an ancestor, descendant, brother or sister of either the whole or the half blood, uncle, aunt, nephew or niece. Incest is a class E felony."

Over at Slate, there's an argument by William Saletan that even if incest is of a sort that can't lead to children (e.g. "deviate sexual intercourse"), it is repugnant because of its destruction of family relationship. His article has a particularly chilling quote:
"Read... what Woody Allen's son says about his dad: "He's my father married to my sister. That makes me his son and his brother-in-law. That is such a moral transgression. I cannot see him. I cannot have a relationship with my father …"

Tuesday, December 21, 2010

Surrogate births, payments, and legal rights in Britain, continued

The Telegraph reports Childless couples win the right to pay surrogate mothers: Childless couples will be able to pay surrogate mothers large sums of money to have babies for them, following a landmark High Court ruling.

"A senior family court judge allowed a British couple to keep a newborn child even though they had technically broken the law by giving more than “reasonable expenses” to the American natural mother.


"Mr Justice Hedley said the existing rules on payments were unclear, and that the baby’s welfare must be the main consideration. Only in the “clearest case” of surrogacy for profit would a couple be refused the necessary court order to keep the baby.

"His comments, among the first in recent years on the subject by a senior legal figure, will be taken by many infertile couples as a welcome sign that they can now pay women to bear children for them without fear of breaking the law, and so be denied a family.

"Mr Justice Hedley warned that the courts would continue to consider the amount of money paid in each individual case, to ensure that a market is not established.

...
"Surrogacy was regulated in Britain in 1985, after Kim Cotton was paid £6,500 to carry a child conceived using her own egg but the sperm of a man whose wife was infertile, in what is known as “straight surrogacy”. In “host surrogacy”, embryos are created through IVF using the eggs and sperm of both intended parents are transferred to the surrogate mother.


"Under the Surrogacy Arrangements Act 1985, companies were banned from brokering deals between couples and potential mothers for profit. All arrangements have to be based on trust rather than money, and are not legally binding. Only “reasonable expenses”, which now can average £15,000, are allowed and must be agreed upon by the parties.

"In 1990, another law introduced the system of Parental Orders which couples must obtain following the birth in order to be regarded as the surrogate baby’s legal parents, rather than the natural mother.
...
"It is estimated that each year just 70 women in Britain have surrogate babies, but many more couples desperate to start a family now travel to countries such as India where the “reasonable expenses” will be far lower.


"In the current case, the unnamed British couple had made contact with a woman in Illinois, where no restrictions on payments to surrogate mothers apply. Her baby had been allowed to enter Britain on temporarily on a US passport, but the judge granted a Parental Order so it can now stay in the country with its new parents.

"Mr Justice Hedley agreed that the criteria, which also require that the surrogate acted of her own free will and that one of the couple must be a biological parent of the baby, had been “fully met” by the “most careful and conscientious parents”.

"However some have criticised the implications of his comments that payments above “reasonable expenses” were acceptable.

"Andrea Williams, director of the Christian Legal Centre, said: “Children are not commodities to be bought and sold. It is not the case that everybody has the right to a child, whatever the cost.

The regulations that we have in this place regarding surrogacy are supposed to ensure that there is no element of profit in the whole process."
Here is my earlier post on this matter: Surrogacy, payments, and parental rights in Britain: Couples who pay surrogate mothers could lose right to raise the child.

Monday, December 20, 2010

Mathematics and medicine: a cautionary tale

Mathematics is valuable in many areas of application, including medicine, but there are hazards to having doctors diagnose their own mathematical needs. A hilarious example was just brought to my attention; a well-cited medical paper that reinvents one of the first lessons of high school calculus (which the author goes on to name after himself):
A mathematical model for the determination of total area under glucose tolerance and other metabolic curves. by M M Tai, Diabetes Care February 1994 vol. 17 no. 2 152-154 .

Here's the abstract in its entirety:
"OBJECTIVE--To develop a mathematical model for the determination of total areas under curves from various metabolic studies. RESEARCH DESIGN AND METHODS--In Tai's Model, the total area under a curve is computed by dividing the area under the curve between two designated values on the X-axis (abscissas) into small segments (rectangles and triangles) whose areas can be accurately calculated from their respective geometrical formulas. The total sum of these individual areas thus represents the total area under the curve. Validity of the model is established by comparing total areas obtained from this model to these same areas obtained from graphic method (less than +/- 0.4%). Other formulas widely applied by researchers under- or overestimated total area under a metabolic curve by a great margin. RESULTS--Tai's model proves to be able to 1) determine total area under a curve with precision; 2) calculate area with varied shapes that may or may not intercept on one or both X/Y axes; 3) estimate total area under a curve plotted against varied time intervals (abscissas), whereas other formulas only allow the same time interval; and 4) compare total areas of metabolic curves produced by different studies. CONCLUSIONS--The Tai model allows flexibility in experimental conditions, which means, in the case of the glucose-response curve, samples can be taken with differing time intervals and total area under the curve can still be determined with precision. "

Google Scholar reveals that this paper is Cited by 137, most of which appear to be un-ironic.

Incidentally, while scholars like to properly reference things, who knows if the world would be better if the author had cited a calculus textbook, and pointed out that this method had been well known for hundreds of years. Very likely the medical journal would have declined to publish it if they had realized it wasn't new. (It says something about the difficulty a medical journal faces in evaluating mathematical ideas that none of the referees recognized this.) And the citations the paper has received suggest that at least to some subsequent researchers, this elementary calculus lesson, delivered in a medical journal, filled a gap in their education and proved useful. On the other hand, if the paper had instead pointed out that there is lots of widely available software to do numerical integration, it might have been even more useful to docs who needed to find areas under curves.

One of the delights of interdisciplinary work is how fruitful it can be. This is particularly true in market design, which almost always involves work between economists and experts in other things who are  directly involved in some market.

One of the frustrations of interdisciplinary work is that it involves translation between different cultures. For example, parts of market design are fairly mathematical, or involve ideas from economics (e.g. about incentives) that may be unfamiliar to non-economists.

My work on kidney exchange has had more than its share of both the delights and the frustrations, in part because the non-economist experts involved--kidney surgeons--are so very expert at what they do. I've had the good fortune to be part of teams of market designers and surgeons who work really well together.

But the translation barrier to the rest of the medical profession is formidable, particularly because matching for kidney exchange is quite mathematical, and doctors are mostly selected for their talents in other things. This makes for great complementarities when you find the right docs, but it's always hard for the medical journals to evaluate contributions that have an element of mathematics, and things can go badly wrong when a doctor overestimates the breadth of his competency, which is an occupational hazard for people whose daily work involves giving advice to patients whose lives depend on it.

HT: Assaf Romm

Sunday, December 19, 2010

Prizes for solutions to problems

An Australian firm, Kaggle, hosts problem solving and prediction competitions, and describes itself this way: "Kaggle is an innovative solution for statistical/analytics outsourcing. ...Companies, governments and researchers present datasets and problems - the world's best data scientists then compete to produce the best solutions. At the end of a competition, the competition host pays prize money in exchange for the intellectual property behind the winning model."

One of their current competitions requires participants to predict travel time on Sydney's M4 freeway from past travel time observations.

Other approaches for eliciting solutions to problems by offering prizes are found at Innocentive, and Challenge.gov, both of which list problems for which people can offer solutions for evaluation.

Saturday, December 18, 2010

The end of 'don't ask don't tell...'

Senate Repeals ‘Don’t Ask, Don’t Tell’


Another formerly repugnant transaction bites the dust...

The World Bank goes all in on carbon markets

The NY Times reports: World Bank Will Help Finance Carbon Markets

"As the United Nations climate change talks in Cancún lurch slowly toward an uncertain conclusion, the World Bank is stepping in to help developing countries set up pollution credit markets to help pay for clean development programs.

"Robert B. Zoellick, the World Bank president, will appear before delegates here on Wednesday to announce the creation of a multimillion-dollar program to create trading mechanisms to stimulate clean energy projects and to slow the destruction of tropical forests, one of the primary sources of global warming emissions. ...
...
"The list of countries that will take part in the carbon market initiative was not announced, but they are expected to include China, Mexico, Indonesia and Chile. Other countries are expected to join as more funds become available, bank officials said.

"The European Union already has a carbon market, known as the Emissions Trading System, which barters pollution credits for European industries for climate-friendly projects, mainly in the developing world. Legislation to create a similar national trading system in the United States stalled in Congress this year.

"Such programs are controversial because they have been at times poorly monitored and the price for carbon credits has fluctuated wildly. Many poorer nations also complain that their natural resources have been turned into commodities traded on exchanges in wealthy countries.

“Carbon markets are an irreparably flawed means of addressing climate change,” Karen Orenstein of the environmental group Friends of the Earth told Reuters. “They are unreliable and subject to fraud, and they open the door to offset loopholes that undermine environmental integrity.”

"The World Bank hopes to devote as much as $100 million to provide technical support and other aid to help developing countries establish carbon exchanges and other ways of raising private funds to help reduce emissions and adapt to climate changes."