The first global kidney exchange: temporarily ungated link

Here's a shareable link to the paper below, which I blogged about earlier without having an ungated link. This link is good til October 27. [Update: here's a possibly longer lasting ungated link.}
Along with the medical details of this successful kidney exchange chain, the paper shares some of the arguments we've heard suggesting that Global Kidney Exchange might be objectionable, and our replies, in considerable detail:)

Complete Chain of the First Global Kidney Exchange Transplant and 3-yr Follow-up

Author links open overlay panelDanielle N.BozekabTy B.DunncChristian S.KuhrdChristopher L.MarsheJeffreyRogersfSusan E.ReesbLauraBasagoitiagRobert J.BrunneraAlvin E.RothhObiEkwennaabDavid E.FumoabKimberly D.KrawieciJonathan E.KopkebPuneetSindhwaniaJorgeOrtizaMiguelTanjSiegfredo R.PaloyoklJeffrey D.PunchmMichael A.Reesab

https://doi.org/10.1016/j.euf.2018.07.021Get rights and content

Abstract

Background

Global Kidney Exchange (GKE) offers an opportunity to expand living renal transplantation internationally to patients without financial means. These international pairs are entered into a US kidney exchange program that provides long-term financial support in an effort to identify opportunities for suitable exchanges for both these international pairs and US citizens.

Objective

While the promise of GKE is significant, it has been met with ethical criticism since its inception in 2015. This paper aims to demonstrate the selection process and provide >3 yr of follow-up on the first GKE donor and recipient from the Philippines.

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About the link, Elsevier writes: 

To help you and the other authors access and share this work, we have created a Share Link – a personalized URL providing 50 days' free access to the article. Anyone clicking on this link before October 27, 2018 will be taken directly to the final version of your article on ScienceDirect, which they are welcome to read or download. No sign up, registration or fees are required.

Your personalized Share Link:
https://authors.elsevier.com/c/1XhNI8Yy0L8qol

Societal Support for Paying Plasma Donors in Canada By Nicola Lacetera and Mario Macis

Here's a concise summary of recent work by Lacetera and Macis, as a Cato Institute Research Brief:

Societal Support for Paying Plasma Donors in Canada
By Nicola Lacetera and Mario Macis

They begin with a concise statement of why repugnance is important for economics:

"The legal status and regulation of economic transactions do not depend only on considerations regarding their economic efficiency, but also on whether a society supports the occurrence of trades through a price mechanism (if at all). Concerns that individuals engaging in certain transactions may be exploited or unduly influenced, that the terms of trade may not be fair, or that some transactions violate human dignity, the sanctity of life, or traditional institutions may lead a society to prohibit certain trades. These principles may take priority over material considerations and may contribute to defining common identities or a collective conscience that allows complex societies to be tied together. "

The article is "based on and includes excerpts from Nicola Lacetera and Mario Macis, “Moral NIMBY-ism? Understanding Societal Support for Monetary Compensation to Plasma Donors in Canada,” Law and Contemporary Problems 81 (2018): 83–105, https://scholarship.law.duke.edu/lcp/vol81/iss3/5.

The DOJ may not get the last word on supervised injection sites

The WP has the story:
Cities defiant after Justice Department’s threat on ‘supervised injection sites

"Cities seeking to open sites where illegal drug users are monitored to prevent overdoses responded defiantly Tuesday to a Justice Department threat to take “swift and aggressive action” against that approach to the nationwide opioid epidemic.

"Plans for those “supervised injection sites” — under consideration in San Francisco, Philadelphia, New York City, Seattle and elsewhere — collided with a stern Justice Department warning issued last week, threatening to create a standoff between federal and local authorities like the confrontation over “sanctuary cities.”

As they have before, some liberal-leaning cities trying to cope with conditions on their streets find themselves at odds with more-restrictive Trump-era policy and enforcement.
...
More than 72,000 people died of drug overdoses in 2017, led by more than 49,000 deaths from opioids, according to preliminary statistics released last month by the Centers for Disease Control and Prevention."
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Earlier related post:

Sunday, September 2, 2018

The DOJ argues against harm reduction measures for drug addicts

EconSpark: AEA Economics Discussion Forum

The AEA has launched a moderated discussion forum for issues of interest to economists, including (but not limited to) the Economics job market.

EconSpark: AEA Economics Discussion Forum

I just signed up (and tried my hand at answering a question:)

Repugnance watch: In Paris: are public urinals (for men) sexist?

The NY Times has the story:

With Tampons and Concrete, Vandals Hit Paris Urinals Seen as Sexist

"To some, the new street urinals in Paris are a mere eyesore, to say nothing of the men using them. To others, they are no less than an emblem of sexism, still more evidence that men’s needs are put above women’s."

Ignazio Marino on global kidney exchange

Ignazio Marino, the veteran transplant surgeon who also happens to have been Mayor of Rome, kindly shared with me this post from his blog.  He writes about kidney exchange and his hopes for global kidney exchange, pioneered by our colleague Mike Rees.  He writes about the great benefits that global kidney exchange could bring, and some of the international support it has received, but also about the fact that it has generated opposition in some quarters.

Here's his post:
Organ transplants: the revolutionary proposal of a Nobel Prize,
which concludes with these paragraphs:

"One of the objectives of the Global Kidney Exchange program is to provide quality health care , including but not limited to transplantation, for patients with end stage renal disease in the least developed countries, who would have no access to dialysis or transplantation. and would die.

"If I can transplant the kidney to an Italian patient because I find another compatible couple in Ethiopia, where a patient may not even have the possibility of hemodialysis, the person in Ethiopia will live because he will have a new kidney, and the person in Italy will live better - once transplanted - costing much less to the National Health Service. I think this is a good example of what in English is defined as a win win situation , in which everyone wins.

"However, there are criticisms. One of the concerns raised by great professionals like Francis Delmonico, professor emeritus at Harvard University, is how to control this international exchange of organs from an ethical and legal point of view.

"If an international chain of people is established, whose motive is always affection, but in which even people who are not always emotionally related come into play, there is the risk that the horrible crime of organ trafficking may in some way creep up.

"I believe the difference between the crime of organ trafficking in some countries and the idea behind the Global Kidney Exchange Program lies in the fact that this project is completely transparent, verifiable and controllable, and that transplants occur or would occur only in well-identified and qualified medical centers.

"The Global Kidney Exchange in 2017 had the endorsement of the American Society of Transplant Surgeons (the society that brings together all American surgeons in the transplant community). The first chain has already been built in the United States and success rate has been 100%.

"On 22 January 2018 the president of the Istituto Superiore di Sanità, Prof. Walter Ricciardi, in his role as a member of the Executive Board of the World Health Organization, promoted this idea.

"I am convinced that we should not be afraid of innovation simply because we are afraid of ourselves and of our inability to monitor ethical aspects. Especially when the benefit for human beings, rich or poor, regardless of citizenship, could be really great.""

The perils of (too) sharply reducing opioid prescriptions

The ongoing opioid epidemic in the U.S. (and elsewhere) has at least some of its origins in the over-prescription of opioid painkillers. So there is a lot of interest in how, and how much, to cut back on prescribing these drugs.  The two articles below raise some flags about cutting back too sharply, and warn of the long road ahead in any event (partly because people in chronic pain and people who have become addicted to prescription painkillers sometimes enter the market for illegal narcotics when they lose their prescriptions).

Sally Satel directs my attention to this article in Politico:

How the opioid crackdown is backfiring
Hundreds of chronic pain patients responding to a POLITICO survey describe being refused opioid prescriptions they had relied on for years with sometimes devastating consequences.

"Many of POLITICO’s respondents described being tapered off narcotics too quickly, or worse, turned away by doctors and left to navigate on their own. Some said they coped by using medical marijuana or CBD oil, an extract from marijuana or hemp plants; others turned to illicit street drugs despite the fear of buying fentanyl-laced heroin linked to soaring overdose death numbers. A few, like Fowlkes, contemplated suicide."
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And here is an article by some of my Stanford colleagues that explores a model to make some predictions. It is forthcoming in The American Journal of Public Health (AJPH) (and published online first):

Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic
Allison L. Pitt, MS, Keith Humphreys, PhD, and Margaret L. Brandeau, PhD

"Objectives.To estimate health outcomes of policies to mitigate the opioid epidemic.

Methods.We used dynamic compartmental modeling of US adults, in various pain,opioid use, and opioid addiction health states, to project addiction-related deaths, lifeyears, and quality-adjusted life years from 2016 to 2025 for 11 policy responses tothe opioid epidemic.

Results.Over 5 years, increasing naloxone availability, promoting needle exchange,expanding medication-assisted addiction treatment, and increasing psychosocial treatment increased life years and quality-adjusted life years and reduced deaths. Other policies reduced opioid prescription supply and related deaths but led some addicted prescription users to switch to heroin use, which increased heroin-related deaths. Over a longer horizon, some such policies may avert enough new addiction to outweigh the harms. No single policy is likely to substantially reduce deaths over 5 to 10 years.

Conclusions.Policies focused on services for addicted people improve population health without harming any groups. Policies that reduce the prescription opioid supply may increase heroin use and reduce quality of life in the short term, but in the long term could generate positive health benefits. A portfolio of interventions will be needed for eventual mitigation. (Am J Public Health.Published online ahead of print August 23,2018: e1–e7. doi:10.2105/AJPH.2018.304590)"
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Note the contrast between these views and those of the Department of Justice as expressed by Deputy Attorney General Rod Rosenstein in yesterday's post.

The DOJ argues against harm reduction measures for drug addicts

In an opinion piece in the NY Times, Rod Rosenstein,  the deputy attorney general of the United States, comes out against harm reduction measures for drug addiction, such as those being considered in several U.S. cities and States.  He argues that increased prosecution is the way to go, and threatens to go after cities that institute "safe injection sites."

Fight Drug Abuse, Don’t Subsidize It
Americans struggling with addiction need treatment and reduced access to deadly drugs. They do not need a taxpayer-sponsored haven to shoot up.

By Rod J. Rosenstein

"Last year, San Francisco assembled a task force to establish an injection site, and last week the California State Senate passed a bill that would allow San Francisco to operate such sites and grant legal immunity to the drug users who visit them. In May, the mayor of New York City announced a plan to open four injection sites. A Seattle task force approved a similar plan, and city officials have pitched outfitting a van as a mobile injection site. Numerous states, including Colorado, Massachusetts, Vermont and Maine, have explored similar options to help their residents use hard-core drugs.

"One obvious problem with injection sites is that they are illegal. It is a federal felony to maintain any location for the purpose of facilitating illicit drug use. Violations are punishable by up to 20 years in prison, hefty fines and forfeiture of the property used in the criminal activity. The law also authorizes the federal government to obtain civil injunctions against violators. Because federal law clearly prohibits injection sites, cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action.
...
"To end the drug crisis, we should educate everyone about the dangers of opioid drugs, help drug users get treatment and aggressively prosecute criminals who supply the deadly poison. Under the leadership of President Trump and Attorney General Jeff Sessions, the Department of Justice is delivering results. Many federal, state and local agencies are working with us to combat opioid addiction. Cities and counties should join us and fight drug abuse, not subsidize it."
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Here are my other posts on harm reduction.

Market design class at Harvard taught by Scott Kominers

If you are a Harvard student, check out Scott Kominer's Fall market design class.
Here's the course outline.

Market Design

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Economics 2099 -- Harvard University -- Fall 2018 

Description:

This course explores the theory and practice of market design. Key topics include auctions, labor market matching, school choice programs, online markets, organ exchange systems, financial market design, and matching with contracts. The first half of the course will introduce market design and its technology; subsequent weeks will discuss recent papers alongside their classical antecedents.

Information on Logistics, Requirements, and Readings:

See the course syllabus (posted August 29, 2018).

Enrollment Application:

https://tinyurl.com/2099app/.

Assignment Deadlines:

A short proposal summary/plan will be due on October 17, 2018. The final proposal will be due on December 10, 2018 (the last day of Reading Period).

Schedule:

Date	Topic	Guest(s)
September 4, 2018	Introduction/Overview
September 11, 2018	The Market Designer's Toolbox
September 18, 2018	Food Supply, Scrip Systems, and Pseudo-Markets	Erica Moszkowski
September 25, 2018	School Choice
October 2, 2018	Generalized Matching	Ravi Jagadeesan
October 9, 2018	Markets for Intellectual Property
October 16, 2018	Auction Theory	Shengwu Li
October 23, 2018	The US Spectrum Incentive Auction
October 30, 2018	Organ Allocation
November 6, 2018	Finance, Cryptocurrency, and Blockchain
November 13, 2018	Inequality and Urban Issues	Edward L. Glaeser
November 20, 2018	New Horizons	Zoë Cullen, Andrey Fradkin David Parkes, Utku Ünver, Kate Vredenburgh
November 27, 2018	Refugees, Immigration, and Economic Development	Benjamin Roth
December 4, 2018	Student Talks/Course Wrap

Internal Harvard Website:

https://canvas.harvard.edu/courses/43959/.

Office Hours Calendar:

https://2099-officehours.youcanbook.me/.

The market for influence, by Fainmesser and Galeotti (the movie)

Here's a nicely done "trailer" for a paper by Itay Fainmesser and Andrea Galeotti. It's a three minute video...
"The Market for Influence" by Itay Fainmesser and Andrea Galeotti from Itay Fainmesser on Vimeo.

For you dinosaurs who prefer an abstract to a trailer, here it is, with the whole movie paper at the link.

The Market for Influence

Itay P Fainmesser

Johns Hopkins University - Carey Business School

Andrea Galeotti

University of Essex

Date Written: August 2018

Abstract

Influencer marketing is the fast-growing practice in which marketers purchase product endorsements from influencers — who are individuals with many followers and strong reputations in niche markets. This paper develops a model of the market interactions between influencers, followers, and marketers. Influencers trade off the increased revenue they obtain from more paid endorsements with the negative impact that this has on their followers’ engagement, which in turn affects the price marketers are willing to pay for their endorsement. Our analysis provides testable predictions on how the price that influencers receive depends on the size of their audience and how an improvement in the online search technology affects influencers’ competition for followers and marketers. We show that, in equilibrium, over- and under-provision of paid endorsements coexist. We evaluate the strategic effects of recent, transparency-motivated policy interventions implemented by competition authorities in the US and Europe, requiring influencers to clearly indicate marketer-sponsored content.

Suggested Citation:

Fainmesser, Itay P and Galeotti, Andrea, The Market for Influence (August 2018). Available at SSRN: https://ssrn.com/abstract=3207810 or http://dx.doi.org/10.2139/ssrn.3207810

  Before the paper was made into a movie, I had earlier posted about it and a related news article here:

Wednesday, July 18, 2018

Matching endorsements to endorsers

Blasphemy as a repugnant transaction. versus free speech as a protected transaction

Here's a headline from The Guardian which basically tells the whole of the news story:

Muhammad cartoon contest in Netherlands sparks Pakistan protests
Islamist leader says ‘only jihad’ is sufficient to punish ‘blasphemous’ Wilders stunt

"The Dutch prime minister, Mark Rutte, has termed the event “disrespectful” but defended the right to hold it on the grounds of freedom of expression.

"On Monday, Pakistan’s senate passed a resolution condemning the competition and Khan vowed to take up the issue at the UN general assembly in September. He said Islamic countries should cooperate to create laws against blasphemy similar to those against Holocaust denial in European countries."
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Here's the story in the Pakistani newspaper Dawn:

TLP rally on its way to Islamabad as demand for expulsion of Netherlands envoy remains unfulfilled

"The emotions of all Muslims against blasphemous caricatures is the same," Chaudhry, the information minister added. "A joint front is imperative against blasphemy."
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Update: Far-right Dutch MP cancels Muhammad cartoon competition
Geert Wilders drops plans for controversial contest in November following death threats

"“To avoid the risk of victims of Islamic violence, I have decided not to let the cartoon contest go ahead,” the far-right opposition politician said in a written statement on Thursday night.

"Wilders, who for years has lived under round-the-clock protection because of death threats sparked by his fierce anti-Islam rhetoric, said he does not want others put in danger by the contest he planned for November."

James Mirrlees 1936-2018

Here's the brief initial announcement from the University of Cambridge:

Professor Sir James Mirrlees 1936-2018

"It is with great sadness that I write to say that Professor Sir James Mirrlees has passed away. Jim died yesterday at his home in Cambridge.

"Jim is widely known as the author of some of the most luminous and influential papers in modern economics. He was awarded a Nobel Prize for his work in public economics in 1996. But over and above his great intellectual achievement, Jim was widely respected and held in great affection for his generosity in encouraging and supporting economists from all over the world."

Sanjeev Goyal FBA
Chair, Faculty of Economics

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Jim last visited Stanford less than a year ago, last October, to participate in a conference remembering Ken Arrow.

Here's a video of his talk, which begins with an introduction by John Shoven, explaining a little-known early connection between Jim and Ken:

European Collaboration on Kidney Exchange (program for meeting in Italy)

Note the various discussions of transnational kidney exchange...some of that will involve exchange within the EU, and some will involve dealing with the very diverse European views on extending kidney exchange to include pairs from countries that aren't able to pay for it, i.e. on global kidney exchange.

EUROPEAN NETWORK FOR COLLABORATION ON KIDNEY EXCHANGE PROGRAMMES

ENCKEP Meeting

August 30^th – Sept 1^st 2018

Hotel Palazzo Viceconte, Via S. Potito 7, Matera, Italy

DRAFT PROGRAMME (as of 15 June)

Thursday, August 30 2018

14:00 - 14:15    Welcome and introduction. David Manlove (UK)

14:15 - 15:15    Summary of activity on data collection and summarisation of best practices in KEPs

(ENCKEP Working group 1) Peter Biro (HU)

- Summary of Handbook 1: Kidney Exchange Practices in Europe.

- Summary of Handbook 2: Modelling and Optimisation in the European Kidney Exchange Programmes.

15:15- 15:45     Coffee-break

15:45 – 16:45    Round-table: Moderators: Lisa Burnapp (UK), Bernadette Haase (NL)

Consolidating the ENCKEP view on ethical and legal aspects of transnational KEPs

Discussants: Lucrezia Furian (IT), Frank Dor (UK), Franco Citterio (IT)

ü  inclusion of altruistic donors and managing reciprocity between participating countries

ü  inclusion of compatible pairs: what criteria should we use?

ü  deceased donors to initiate ‘chains’: should we and could we?

17:00 - 18:00 Inputs for ENCKEP

ü  Bridging clinical and OR aspects of KEPs. Paolo Ferrari (CH)

ü  Alternative approaches for transplant recipients with antibodies- A UK perspective. Nizam Mamode (UK)

Friday, August 31 2018

09:00 – 11:00 Working Group 1: Data collection and summarisation of best practices in KEPs

                        Moderator: Lisa Burnapp

ü  Developing an ethical and legal framework for transnational KEPs.

11:00 - 11:30    Coffee break

11:30 - 13:00    Working Group 2: National KEPs: models, optimisation methods and technology                          Part 1.             Moderator: Paolo Tubertini

ü  Findings of Handbook 1: proposing a standardised framework for designing KEPs based on identified optimality criteria and data models).

ü  Kick-off discussion on Handbook 2 (“Standards to describe and assess the structure and efficiency of existing and proposed KEPs”).

ü  Publications arising from the handbooks

13:00 - 14:00    Lunch

14:00 - 14:30    Working Group 2: National KEPs: models, optimisation methods and technology                         Part 2. Moderator: TBC

14:30 - 15:30    Working Group 3: Transnational KEPs and practical collaboration - Part 1. Moderator: Xenia Klimentova

What can we learn from cadaveric transnational programs?

o   Scandiatransplant experience. Tommy Andersson (SE)

o   Eurotransplant experience Jacob de Boer (NL)

·        Presentations on current pilot programs on transnational KEP

o   Scandiatransplant (if started)

o   Austria- Czech Republic. Tomas Marada (CZ)

15:30 - 16:00    Coffee break

16:00 - 17:00    Working Group 3: Transnational KEPs and practical collaboration. - Part 2. Moderator: Xenia Klimentova

Spain-Italy-Portugal. Maria Valentin (ES), Paola Di Ciaccio (IT), Catarina Bolotinha/Ana França (PT).

Discussion on further steps and developments.

17:00 - 17:30    Working Group 4: Dissemination of results

Moderator: Christian Jacquelinet

Discuss publication policy of Action deliverables, and dissemination tools such as handbooks, publications, software, conference presentations and via the Action website.

Saturday, September 1 2018

09:00 – 16:30 Training School for clinicians

09:00 - 09:30    Presentation of ENCKEP Action. David Manlove (UK)

09:30 - 11:00

l  European KEPs: Theory into Practice (Aline Hemke (NL)/Lisa Burnapp (UK)/Tomas Marada (CZ) /Karine Hadaya (CH)).  Focusing on practicalities and logistics

   

11:00 - 11:30    Coffee break

11:30 - 12:30

l  National authorities: experience with using optimisation software.  Matthew Robb (UK), Catarina Bolotinha (PT), Maria Valentin (SP)

l  Italy, Portugal and Spain: collaboration on KEPs. Maria Valentin (ES), Catarina Bolotinha/Ana França (PT), Paola Di Ciaccio (IT)

12:30 - 14:00    Lunch

14:00 - 15:00    Perspectives from the USA

l  UNOS and KEPs in the USA. Ruthanne Leishman.

l  Market Failures. Itai Ashlagi.

15:00 - 15:30    Coffee break

15:30 - 16:30    Ethical and legal issues relating to transnational KEPs

                        Moderators: Lisa Burnapp (UK), Bernadette Haase (NL)

l  Introductory talk (title TBC) Martin Buijsen (NL)