The market for chocolate

The NY Times has the story, just in time for Valentine's Day:

Everything You Don’t Know About Chocolate
The beloved bar has come a long way in quality and complexity. Here’s a primer on how it’s made, and how to choose the best and most ethically produced.
By Melissa Clark

"One of the biggest ethical concerns about chocolate-making is the cacao supply chain. In the current system, the vast majority of cacao beans are sold as a commodity crop without regard to quality. Because farmers aren’t paid more for better beans, there’s no incentive for them to plant finer-flavored cultivars. Nor would they have the money to do so. In West Africa, which grows 60 to 70 percent of the world’s beans, many cacao farmers live below the poverty line, making less than $1.90 a day.
...
"While some chocolate makers buy directly from farmers, most of the micro, bean-to-bar makers in the United States get beans from one of two direct-trade cacao importers, Uncommon Cacao and Meridian Cacao. Both have strong social goals that include living wages for the farmers."

Online dating while female--the case of Bumble

The above figure is from the following Bloomberg story about (and critical of) the dating app Bumble.

For Bumble, the Future Isn’t Female, It’s Female Marketing
Whitney Wolfe Herd set out to build a safer dating app for women, but it’s not clear that she’s made a measurable difference. by Claire Suddath.

Organ sharing in San Diego--UNOS Region 5 educational collaborative

I'll be flying to San Diego later this morning to take part in the UNOS Region 5 Educational Collaborative

Here's the Agenda.

I'll speak at 1:00pm:
Who Gets What and Why?
•An interview with Nobel Prize winning economist Alvin Roth
 Moderator: Brian Beck, Donor Connect
Who Gets What and Why? •An interview with Nobel Prize winning economist Alvin Roth Alvin Roth Ph.D. Organization Moderator: Brian Beck, Donor ConnectWho Gets What and Why? •An interview with Nobel Prize winning economist Alvin Roth Alvin Roth Ph.D. Organization Moderator: Brian Beck, Donor Connect

An experiment with a blood donor registry in Australia

Forthcoming in Management Science:
Redesigning the Market for Volunteers: A Donor Registry
Stephanie A. Heger, Robert Slonim, Ellen Garbarino, Carmen Wang, Daniel Walle

Abstract. This paper addresses volunteer labor markets where the lack of price signals, nonpecuniary motivations to supply labor, and limited fungibility of supply lead to market failure. To address the causes of the market failure, we conduct a field experiment with volunteer whole blood donors where we introduce a market-clearing mechanism (henceforth: the Registry). Our intention-to-treat estimates suggest that subjects invited to the Registry, regardless of joining, are 66% more responsive to critical shortage appeals than control subjects. While the Registry increases supply during a critical shortage episode, it does not increase supply when there is no shortage; thus, the Registry significantly improves coordination between volunteer donors and collection centers, thereby improving market outcomes. We find evidence that the Registry’s effectiveness stems from crowding-in volunteers with purely altruistic motives and volunteers with a preference for commitment.

"In partnership with the Australian Red Cross Blood Service, we introduced a Registry throughout Australia using a large-scale field experiment that unfolded over two rounds. We drew the sample for our experiment from the population of long-lapsed donors. Long-lapsed donors are donors who have given at least one successful whole blood donation but have not donated in at least the past 24 months"

*******

Update: Management Science, Volume 66, Issue 8, August 2020

 

The blowback following Trump's executive order concerning dialysis

It turns out that traditional dialysis providers are not rallying behind President Trump's suggestion that home dialysis could serve many more patients.

The Washington Post has the story:

Trump touted a kidney-care initiative in his State of the Union. But things are not going so smoothly. 
By Christopher Rowland

"The Trump administration has delayed a signature health-care initiative to boost the number of U.S. kidney patients who undergo dialysis at home and get transplants, amid resistance from kidney doctors and large dialysis companies whose payments from the Medicare system could be reduced under the plan.

Trump listed his plan to improve kidney care as a key initiative in his State of the Union speech this week.

But doctors and large dialysis corporations are seeking to remove or reduce proposed financial penalties for underperforming clinics. The new plan was supposed to take effect Jan. 1, but now the timetable is unclear."

Deceased donor organs, lost to transplantation due to problems in transportation

NBC News has the story:

Lost luggage: How lifesaving organs for transplant go missing in transit
Scores of organs — mostly kidneys — are trashed each year and many more become critically delayed while being shipped on commercial airliners.
Feb. 8, 2020, By JoNel Aleccia

" a new analysis of transplant data finds that a startling number of lifesaving organs are lost or delayed while being shipped on commercial flights, the delays often rendering them unusable.
...
"Between 2014 and 2019, nearly 170 organs could not be transplanted and almost 370 endured “near misses,” with delays of two hours or more, after transportation problems, according to an investigation by Kaiser Health News and Reveal from the Center for Investigative Reporting. The media organizations reviewed data from more than 8,800 organ and tissue shipments collected voluntarily and shared upon request by the United Network for Organ Sharing, or UNOS, the nonprofit government contractor that oversees the nation’s transplant system. Twenty-two additional organs classified as transportation “failures” were ultimately able to be transplanted elsewhere.

"Surgeons themselves often go to hospitals to collect and transport hearts, which survive only four to six hours out of the body. But kidneys and pancreases — which have longer shelf lives — often travel commercial, as cargo. As such, they can end up missing connecting flights or delayed like lost luggage. Worse still, they are typically tracked with a primitive system of phone calls and paper manifests, with no GPS or other electronic tracking required.

"Transplant surgeons around the country, irate and distressed, told KHN that they have lost the chance to transplant otherwise usable kidneys because of logistics.

...

"One contributing factor is the lack of a national system to transfer organs from one region to another because they match a distant patient in need.

"Instead, the U.S. relies on a patchwork of 58 nonprofit organizations called organ procurement organizations, or OPOs, to collect the organs from hospitals and package them. Teams from the OPOs monitor surgeries to remove organs from donors and then make sure the organs are properly boxed and labeled for shipping and delivery.

"From there, however, the OPOs often rely on commercial couriers and airlines, which are not formally held accountable for any ensuing problems."

***************

And here's a related podcast at Reveal news: Lost in Transplantation


HT: Frank McCormick 

Market designs to reduce the costs of high frequency trading, by Baldauf and Mollner

A forthcoming paper by Markus Baldauf and Joshua Mollner considers two designs to reduce the costs of (and incentives for) very high frequency trading. One is frequent batch auctions (on also which see Budish et al.), and the other is allowing market  participants to cancel bids or asks while imposing a delay on acceptances of those bids or asks, so that spreads will not have to be widened to defend against faster traders.

High-Frequency Trading and Market Performance
Journal of Finance, Forthcoming
Last revised: 25 Jan 2020
Markus Baldauf
University of British Columbia (UBC) - Division of Finance
and
Joshua Mollner
Northwestern University - Kellogg School of Management



Abstract
We study the consequences of high-frequency trading (HFT) — and potential policy responses — via the tradeoff between liquidity and information production. Faster speeds facilitate HFT with consequences for this tradeoff: information production diminishes because informed traders have less time to trade before HFTs react, but liquidity (measured by the bid-ask spread) improves because informational asymmetries decline. HFT also pushes outcomes inside the frontier of this tradeoff. However, outcomes can be restored to the frontier by replacing the limit order book (LOB) with either of two alternative mechanisms: delaying all orders except cancellations or frequent batch auctions.

What is the cost of high frequency trading? by Aquilina, Budish, and O'Neill

A recent WSJ article highlights a paper by Aquilina, Budish, and O'Neill:

Ultrafast Trading Costs Stock Investors Nearly $5 Billion a Year, Study Says
U.K. regulator’s study says ‘latency arbitrage’ imposes a small but significant tax on investors
"High-frequency traders earn nearly $5 billion on global stock markets a year by taking advantage of slightly out-of-date prices, imposing a small but significant tax on investors, a new study says."
********

And here's the original paper from Britain's Financial Conduct Authority:

Quantifying the High-Frequency Trading 'Arms Race': A new methodology and estimates
Occasional papers 27/01/2020
by Matteo Aquilina, Financial Conduct Authority,
Eric Budish, University of Chicago Booth School of Business and NBER and Peter O’Neill, Financial Conduct Authority


"The authors use stock exchange message data to quantify the negative aspect of high-frequency trading, known as 'latency arbitrage.' The key difference between message data and widely-familiar limit order book data is that message data contain attempts to trade or cancel that fail."

 Summary:
"The authors use stock exchange message data to quantify the negative aspect of high-frequency trading, known as “latency arbitrage.” The main results show:

• races are frequent, fast and worth only small amounts per race
• a large proportion of daily trading volume is in races
• race participation is concentrated
• in aggregate, these small races make up a meaningful proportion of price impact
• in aggregate, these small races add up to meaningful harm to liquidity
• in aggregate, these small races add up to a meaningful total ‘size of the prize’
• The paper finds that while there is only a small detriment per transaction as a result, it adds up to a 17% reduction in the cost of liquidity and $5bn a year in tax on trading volume."

70th Anniversary of the National Science Foundation (NSF)

The (U.S.) National Science Foundation is celebrating its 70th anniversary today in Washington DC.
 Here's the program: 70th Anniversary Symposium

I'll be participating in the afternoon:

Science Breakthroughs
Panel featuring NSF-funded science breakthroughs from the last decade. The topics covered in this panel will feature a mix of major breakthroughs, as well as research that has led to significant impacts on society. In addition, the panelists will be a diverse set of researchers, including those earlier in their careers.

Moderator: Amy Harmon, Correspondent, New York Times
Panelists: Jennifer Dionne, 2019 Waterman Award recipient & Associate Professor, Stanford University
Shep Doeleman, 2019 Breakthrough Prize & NSF Diamond Award recipient & Director, EHT at Harvard-Smithsonian Center for Astrophysics
Margaret Leinen, Director, Scripps Institute & Vice Chancellor & Dean, Marine Sciences
Nergis Mavalvala, Professor & Associate Head, Department of Physics, MIT
Alvin Roth, Nobel Prize in Economics 2012 & Professor of Economics, Stanford University 

Market Design at 25, May 14-15 in Washington DC

The NBER is holding a conference in May, in Washington.

"The conference, which has been organized by Irene Lo, Michael Ostrovsky, and Parag Pathak, is timed to roughly commemorate the 25th anniversary of the first FCC spectrum auction, in 1994, the redesign of the National Resident Match Program (begun in 1995, completed in 1998), and the launch of the sulphur dioxide allowance-trading program under Title IV of the Clean Air Act Amendments (amended in 1990, initiated in 1995).  The conference goal is to assess the key contributions of market design in a number of specific fields and policy areas, and to identify key open questions that are priorities for future research."

Market Design @ 25

Authors Please upload your paper and slides here.

Irene Y. Lo, Michael Ostrovsky, and Parag A. Pathak, Organizers

May 14-15, 2020

JW Marriott Hotel, 1331 Pennsylvania Avenue, Washington, DC

Conference Code of Conduct

Thursday, May 14
8:00 am	Continental Breakfast
8:30 am	Spectrum Auctions
	- Opening speaker: Jessica Rosenworcel, FCC Commissioner
	- Overview: Paul Milgrom, Stanford University
	- Viewpoint: Evan Kwerel, FCC
9:55 am	Break
10:10 am	Matching and Broadening the Definition of Markets
	- Overview: Alvin Roth, Stanford University and NBER
	- Viewpoint 1: Edward Glaeser, Harvard University and NBER
	- Viewpoint 2: Susan Athey, Stanford University and NBER
11:20 am	Break
11:35 am	Market Design for the Environment
	- Overview: Michael Greenstone, University of Chicago and NBER
	- Viewpoint 1: Richard Schmalensee, Massachusetts Institute of Technology and NBER
	- Viewpoint 2: Nathan Keohane, Environmental Defense Fund
12:45 pm	Lunch
2:15 pm	Market Design in Healthcare
	- Overview: Amy Finkelstein, Massachusetts Institute of Technology and NBER
	- Viewpoint 1: Marc Miller, LJAF / Former MedPac
	- Viewpoint 2: Kate Ho, Princeton University and NBER
3:25 pm	Market Design in Transportation
	- Overview: Michael Ostrovsky, Stanford University and NBER
	- Viewpoint 1: David Shmoys, Cornell University
	- Viewpoint 2: TBA
4:35 pm	Break
4:50 pm	Market Design in Developing Countries
	- Overview: Kevin Lleyton-Brown, University of British Columbia
	- Viewpoint 1: Tavneet Suri, Massachusetts Institute of Technology and NBER
	- Viewpoint 2: Jishnu Das, Georgetown University
6:00 pm	Adjourn
6:30 pm	Conference Dinner
Friday, May 15
7:45 am	Continental Breakfast
8:15 am	Market Design for Education
	- Overview: Parag Pathak, Massachusetts Institute of Technology and NBER
	- Viewpoint 1: Derek Neal, University of Chicago and NBER
	- Viewpoint 2: Neerav Kingsland, City Fund
9:25 am	Break
9:40 am	Market Design for Organ Transplantation
	- Overview: Tayfun Sonmez, Boston College
	- Viewpoint 1: Nikhil Agarwal, Massachusetts Institute of Technology and NBER
	- Viewpoint 2: Jennifer Erickson, formerly White House OSTP
10:50 am	Break
11:05 am	Market Design for Public Housing
	- Overview: Nathan Hendren, Harvard University and NBER
	- Viewpoint 1: Winnie van Dijk, University of Chicago and NBER
	- Viewpoint 2: Marge Turner, Urban Institute
12:15 pm	Lunch
1:15 pm	Electricity Market Design
	- Overview: Mar Reguant, Northwestern University and NBER
	- Viewpoint 1: Bob Wilson, Stanford University
	- Viewpoint 2: Shmuel Oren, University of California at Berkeley
2:25 pm	Market Design in Online Markets
	- Overview: Preston McAfee, formerly Caltech and Microsoft
	- Viewpoint 1: Hal Varian, Google
	- Viewpoint 2: Irene Lo, Stanford University
3:35 pm	Break
3:50 pm	Market Design in Financial Markets
	- Overview: Darrell Duffie, Stanford University and NBER
	- Viewpoint 1: Eric Budish, University of Chicago and NBER
	- Viewpoint 2: Gary Gensler, Massachusetts Institute of Technology
5:00 pm	Adjourn

Presenting results anecdatally (and other stories about presenting data to policy makers)

I've recently been involved in several efforts to present data to policy makers who, rightly or wrongly, react more strongly to well-told stories than to comparisons of data distributions.

The reason that scientists of all sorts are distrustful of stories--i.e. anecdotes--is that anecdotes can be outliers, unrepresentative of the underlying data. (Think of political ads that feature particularly memorable crimes committed by paroled prisoners, or immigrants, etc.)

But while comparing data distributions may be more persuasive to scientists, anecdotes, responsibly presented, remain useful for communicating with non-scientists.  And so I've found myself arguing to colleagues that we should present data "anectdataly,"  by illustrating our statistical results with anecdotes that represent well the underlying statistical data.

So...we're in neologism territory here, inventing appropriate new words.

andecdatum. (plural: anecdata)

1. noun.  an anecdatum is a single story that represents the underlying data distribution, e.g. by illustrating its mean or mode. (Compare to "anecdote".)

anecdata

1. plural of anecdatum
2. a collection of stories that together illustrate key features of a statistical distribution (or comparisons of distributions) that may not be well illustrated by a single anecdatum.

anecdatal   

1. adjective: stories illustrating statistical evidence collected as part of systematic scientific evaluation: (as in "the statistical presentation was supplemented with anecdatal evidence.")

anecdataly (also anecdatally)

1. adverb. (as in "the executive summary was presented anecdataly and with summary statistics, with the details of the data presented in the body of the report.")

Unraveling of appellate court clerkships (only more so)

Steve Leider writes:

"I know you keep an eye on the unraveling of judicial hiring.  Listening to a podcast about the supreme court they gave an example of even more extreme advance hiring.  At about 51:30 minutes into this podcast (recorded at Michigan, ...) they talk about an Appeal's Court judge (Judge Katzmann, 2nd Circuit) currently hiring for the 2024 term.

https://strict-scrutiny.simplecast.com/episodes/standing-cheese 

 As one of the hosts noted - "A law student could get married, give birth, and have a baby - and the baby would be in pre-K before the clerkship even starts."

Caught between a block and a high place: legal cannabis firms struggling to compete with the still thriving black market

Blocked from using federal bankruptcy protections, cannabis businesses that are legal under state laws but illegal under federal laws are facing financial difficulties.
Bloomberg has the story:

Pot Firms’ Grim Reality: Cash Crunch, No U.S. Bankruptcy Access

"It was only a year ago that exuberance enveloped the marijuana industry. Legalization was spreading and the growth potential seemed boundless.

"But that bubble has burst as the reality of a difficult regulatory landscape sunk in. Since March, stocks are down by about two-thirds. Capital markets have largely frozen for all but the strongest companies. And now a cash crunch is leaving some on the verge of going bust. Only, thanks to the illegal status of cannabis under U.S. federal laws, firms there are blocked from seeking protection in bankruptcy court."
*******
And this from the LA Times:
Two years in, California’s legal marijuana industry is stuck. Should voters step in?
 PATRICK MCGREEVY DEC. 24, 2019
" Two years after California began licensing pot shops, the industry remains so outmatched by the black market that a state panel recently joined some legalization supporters in calling for significant change
...
"In its annual draft report, the Cannabis Advisory Committee warned Gov. Gavin Newsom and California legislators that high taxes, overly burdensome regulations and local control issues posed debilitating obstacles to the legal marijuana market.
...
“as much as 80% of the cannabis market in California remains illicit.”
...
"The 22-member advisory panel — made up of industry leaders, civil rights activists, local officials, law enforcement and health experts — noted that California is expected to generate $3.1 billion in licensed pot sales in 2019, making it the largest market for legal cannabis in the world. But nearly three times as much — $8.7 billion — is expected to be spent on unlicensed sales."

*********
And in Canada (from the NYT):
From Canada’s Legal High, a Business Letdown
Investors poured money into Canada’s marijuana market, but one year after legalization, the euphoria has evaporated.

"...provincial governments in Ontario and Quebec, whose residents account for about two-thirds of Canada’s population, have opened or licensed legal pot shops at a glacial pace — despite a clear demand. Potential customers are still underserved with just 24 legal marijuana shops for Ontario’s 17.5 million residents. So many are still buying on the black market.

"And freed from taxation, the black market is generally cheaper across the country.
...
"Despite the crushing business disappointments, there has been a bright spot: Prime Minister Justin Trudeau’s experiment in legalizing cannabis has not turned Canada into a stoner nation, as was widely feared.

"Marijuana-impaired motorists are not menacing the nation’s highways, and workers are not getting high on the job. There has not even been much change in marijuana use, except for a small rise among people over 65, according to Statistics Canada, the government census agency.
**********

And, from the Washington Post, internationally:
America’s marijuana growers are the best in the world, but federal laws are keeping them out of global markets
Federal prohibitions are getting in the way of efforts to grow the U.S. marijuana business into a global industry. That’s allowed Canadian cannabis growers to dominate the export market.
Markian Hawryluk, Dec. 27, 2019

"Because marijuana is legal in many states but still illegal federally, marijuana growers are unable to ship their products to other countries or even other American states that have legalized the drug. So while U.S. cannabis firms have driven product innovation and mastered large-scale grow operations, they restlessly wait for the export curtain to lift.
...
"With 11 states plus Washington, D.C., approving recreational use and 33 states legalizing medical marijuana, industry insiders believe marijuana may be legalized nationally in the near future, greatly expanding their market.

"In November, the House Judiciary Committee passed a bill with more than 50 co-sponsors that would effectively make marijuana legal in the U.S. Though unlikely to pass Congress immediately, it is seen as a sign of hope for the future."

Long kidney exchange in Ahmedabad, India

Vivek Kute writes with the news:
IKDRC completes India’s longest cross-transplant chain

"Institute of Kidney Diseases and Research Center, Institute of Transplantation Sciences (IKDRC-ITS) Ahmedabad, India is pleased to share the news of an exciting milestone for the patients with end stage renal disease with incompatible living kidney donors. Our transplant team has completed longest Kidney Exchange transplant chain in India as well as Asia involving 10 donor-recipients pairs over 5 days in January 2020. Two kidney transplant surgeries were performed each on 4, 6 and 7 January, 3 transplants on 8 January and last kidney transplant was completed on 22 January 2020.
...
". The success of this program can be attributed to the selflessness of the more than 500 family members who have stepped forward to be living organ donors. Dr Vivek Kute Professor of Nephrology maintains the single center registry of incompatible pairs. Dr Vivek Kute  and his team is greatful to Prof. Michael Rees and Prof. Alvin Roth for providing the Alliance for Paired Donations software for computer allocation at free of cost. Transplant team members are Dr Vineet Mishra, Dr Pranjal Modi, Dr Himanshu Patel, Dr Jamal Rizvi, Dr Vivek Kute, Dr Bina Butala and others."

Residency explorer (for new doctors)

Amidst all the concerns about the ballooning number of applications and interviews involved in preparing for the NRMP resident match, here's a site (still in test mode) from the AAMC, intended to help applicants explore residency programs before applying:

Residency Explorer

"Residency Explorer helps medical students and applicants to U.S. residency programs research programs in their specialty of interest and compare themselves to previous matched applicants at those programs.

...
"Residency Explorer delivers insights and information based on:
Residency applicant data from AAMC (ERAS)
Matched applicant data from NRMP
USMLE data from the USMLE Program
COMLEX-USA data from the NBOME
Residency program directory information from ACGME
Program characteristics from the National GME Census Survey, jointly administered by the AAMC and AMA, to which 95% of residency programs self-report information about their programs.
Purpose
The purpose of the Residency Explorer is to help residency applicants understand how they compare the applicants who previously matched at programs as well as explore program characteristics across many areas of interest."

More on social studies of markets--from José Ossandón

José Ossandón writes, in response to my earlier post about social studies of markets:

" I was very glad to find the post in your blog that mentions an special issue we edited in the journal Economy & Society (January 6^th http://marketdesigner.blogspot.com/2020/01/social-studies-of-markets-marketplaces.html ). I was less happy though when I read that you found the whole thing too abstract and hard to follow.

Of course, the type of research-problem that motivate us are very different. While your object is the design of markets, we are trying to find out how to study market designers. But, I would hope you and your colleagues can also understand what we do. With this in mind, I wrote a summary, that ended in the five points below, trying to be as clear as possible. Hope these – certainly very sketchy - notes will make what concern us more understandable.

1. Policy makers around the world increasingly rely on markets as solutions for the most various collective issues. We denominate markets that are also policy instruments ‘markets for collective concerns’. The increasing reliance on markets for collective concerns opens relevant questions for researchers in different social scientific disciplines.

2. Historians of economic ideas, for instance, have pointed out that there has been a crucial transformation in the concept of market in economics. Few decades ago, markets were understood in opposition to organization and design. There was, on the one hand, the market as a form of spontaneous coordination, and, on the other, planned designed formal organization. Today, instead, markets are seen as object of design. This is not only a conceptual change. To use Ian Hacking’s categories, there has been a transition from description to intervention. Today, economists see the market as an object of engineering.

3. To sociologists of work, it could be argued that what we see is the consolidation of a new profession. The historical intersection that generated the niche for the market designer is, perhaps paradoxically, not the success but the failure of markets. When markets originally created as policy instruments did not work as well as those who developed them expected to work (for example, school choice and competition didn’t simply increase quality of learning), decision makers didn’t go back to non-market instruments. Instead, they turned to experts in market repair. Market designers’ claim of professional jurisdiction, to use Andrew Abbott’s term, is that, to work properly markets require them.

4. For economic sociologists, these developments trigger new problems. Traditionally, economic sociologists assume that one of their roles is to produce sociological definitions of the concept of market (i.e. if markets are a type of social formation: what are the basic elements that delimit markets as a particular social form?). Studying the market of market designers, however, requires a different stance. When studying market designers, the concept of markets is not something sociologists can define in advance, it becomes an empirical variable. Market designers are practitioners that mobilize different and varying conception of markets, and those who study them have to follow these modifications case to case.

5. Finally, for scholars in science and technology studies, it becomes relevant to know more about the practice of market designers. Today, crucial matters of collective concern (for instance, a fairer and better school system, a solution for electronic waste, or how to build a more sustainable energy grid), depends, at least partially, on the work of experts on market design. As market designers are tasked with crucial collective responsibilities, it becomes very important to understand better issues like how these technical scientists conceive their vocation, the type of ethic of their work, and how they understand responsibility and collaboration.

Hope this helps and thanks a lot for keeping an interest in our work,

Best regards

José"

He also pointed me towards his paper

 Ossandón, José (2019) : Notes on market design and economic sociology,economic sociology_the european electronic newsletter, ISSN 1871-3351, Max Planck Institutefor the Study of Societies (MPIfG), Cologne, Vol. 20, Iss. 2, pp. 31-39,

which considers parallels between the social studies of markets and the growth of market design in economics.

Early admissions for medical residencies? An anguished response to the increasing numbers of applications and interviews.

Here's a proposal to introduce something like the early admissions programs that have become common in college admissions (where they cause new problems while partially addressing the issue of too many applications...)

Improving the Residency Application and Selection Process
An Optional Early Result Acceptance Program
Maya M. Hammoud, MD, MBA1; John Andrews, MD2; Susan E. Skochelak, MD, MPH2
JAMA. Published online January 23, 2020. doi:10.1001/jama.2019.21212

"from 2011 to 2019, applications per applicant increased from 15.2 to 34.8 for family medicine, from 30.5 to 61.3 for obstetrics and gynecology, and from 21.6 to 51.9 for psychiatry.1 Similarly, the number of applications received by each program also has increased across all specialties, some by more than 200%. For example, from 2011 to 2019, the mean number of applications received by family medicine programs increased from 76 to 251 and received by psychiatry programs increased from 115 to 446.1

"A cycle involving increased numbers of applications and increased reliance on standardized testing has resulted in behavioral changes in both applicants and residency programs. Currently, senior medical students spend large amounts of time and money during the last year of medical school applying to an increasing number of programs and meeting the demands of the residency application process.
...
"Meanwhile, to process the high volume of applications received, programs are likely relying more on quantitative metrics, such as United States Medical Licensing Examination (USMLE) Step 1 scores, for screening.
...
"A new approach to help decrease the number of applications by giving students the option of an early application and expeditious result match program may be helpful. One possible approach might be an early result acceptance program (ERAP), in which students would be permitted to apply to a maximum of 5 programs, and programs would be limited to filling half of all their available spots."

Patricia Kravey on non-directed organ donation

From my recent email, a nuanced yet inspiring story from non-directed donor Patricia Kravey.

"I’ve been meaning to write you for five years so it’s time I finally got around to it, but I’ll try to keep it short.

I’d been thinking about being an altruistic for many years without people being able to understand why. When my husband heard your interview on Freakonomics he finally got it and shared the podcast with me.

Your chapter on Kidney Chains has changed my life and the five people who received kidneys in the chain I was a part of. Without the power of knowledge from your book I would not have understood why my hospital was resistant to creating a national chain that went outside their hospital system. From your chapter I called the National Kidney Registry and UNOS to ask how they formed chains, how many people could receive kidneys in their chains and the barriers hospitals encounter in joining their programs. On the phone I was thrilled to speak to Ruthanne Leishman, she was in your book, she was famous!

After learning the cost for hospital to join NKR even though they have lengthy donor chains; I told my hospital, where I was also an employee, that I would only be donating through them if they participated in a chain through UNOS. Despite my request to wait the hospital ran their program and matched me internally. So I had this heavy weight of decision to give to the highly sensitized person my hospital matched me with or to pursue a donor chain. After sleepless nights I came up with what I thought was the perfect solution. I would agree to give to the recipient within the hospital and their mismatched donor would be the person officially enrolled in the UNOS program.

The surgery to my anonymous recipient went smoothly. I cried when the doctors told me he was doing well.

Months later I bumped into my transplant coordinator in the hallway at the hospital and she excitedly told me a news story was being released tonight. The mismatched donor of the person I had given to had completed her surgery and the kidney chain and continued on in the mad rush of 24 hours across the country. The news story was going to be about the hospital’s first national donor chain and the person who started it.

Since my donation wasn’t within the exciting 24 hours my hospital had decided I wasn’t part of the chain. I wasn’t included in the news story or even formally told about it. The story showed my recipient who I hadn’t decided if I was going to meet yet. My colleagues saw the story that night and could tell it was my story that didn’t include me.

Your book helped me understand why the hospital and the media would do that as well.

I did meet my recipient in person later. He was a lovely man. Charming, appreciative and so full of energy. He visited me at my office at the hospital several times and he sent a gift for my baby shower. I felt very lucky and grateful to have met him.

Four years after the transplant he died. Skin cancer got him. His wife told me the doctors had led him to believe that the kidney he’d received from me could be passed on. Of course it couldn’t be since it could contain cancer cells.

I have mixed feelings about being an altruist donor. It wasn’t perfect. It wasn’t the story or the fulfilling experience I had hoped it would be. But it was better and it benefited more people because of you. I hope people tell you everyday that your work has changed lives.

Thank you.

Best regards,

Patricia Kravey (Harvey)

https://komonews.com/news/healthworks/seattle-kidney-chain-changes-8-lives-its-the-gift-of-life

https://blog.swedish.org/swedish-blog/how-donating-a-kidney-gave-me-joy-and-someone-else-his-life-back

(in rereading my interview in Swedish Medical Center's blog, I’m embarrassed that I didn’t cite you!)"

100 years since Prohibition

An op-ed in the NY Times points out that Prohibition didn't start suddenly when the 18th Amendment went into effect in January 1920--it was a popular movement that had started with ordinary legislation.

Why Americans Supported Prohibition 100 Years Ago
Temperance crusaders weren’t crackpots. They were fighting the business of making money off addiction.  By Mark Lawrence Schrad

"The United States had already been “dry” for the previous half-year thanks to the Wartime Prohibition Act. And even before that, 32 of the 48 states had already enacted their own statewide prohibitions.

“With little that differed from normal wartime prohibition drinking habits, New York City entered at 12:01 o’clock this morning into the long dry spell,” this newspaper solemnly noted.

...

"Temperance was the longest-running, most widely supported social movement in both American and global history. Its foe wasn’t the drink in the bottle or the drunk who drank it, but the drink traffic: powerful business interests — protected by a government reliant on liquor taxes — getting men addicted to booze, and then profiting handsomely by bleeding them and their families dry.

...

"For a better understanding of temperance and prohibition, forget Bible-thumping “thou shalt nots.” Think instead about a major industry making outlandish profits by getting people hooked on an addictive substance that could kill them. Maybe that industry uses some of those profits to buy corrupt political cover by currying favor with government and oversight bodies. Let’s call this substance “opioids,” and the industry, “Big Pharma.”

"This is the same type of predatory capitalism that the temperance-cum-prohibition movement fought 100 years ago. Should big businesses be able to use addiction to reap tremendous profits from the poor? If your answer is no, and you were around 100 years ago, you likely would have joined the vast majority of Americans calling for the prohibition of liquor traffic."

The black market for haggis

If you celebrated Burns night last night, in honor of the Scottish poet who was born on January 25 1759, you may have eaten haggis.  And if it was the real thing, and you live in the U.S., then you were on the receiving end of smuggled goods.

The NY Times has the story:

Building the Perfect Meal With Sheep Lungs and a Suitcase
A federal agency bans the sale of sheep lungs, a key ingredient for Haggis. Lovers of the distinctive Scottish dish have found ways around that.

"On Saturday, Scots across the world will dine on haggis to celebrate the birthday of Robert Burns, the 18th-century Scottish poet. But for haggis purists in the United States, celebrating Burns Night can be a challenge. Since the 1970s, the Department of Agriculture’s food-safety division has banned the sale of sheep lungs, which give traditional haggis its distinctive crumbly texture.

"Many of the millions of Americans with Scottish ancestry have happily settled for an increasingly wide array of lung-less haggis (or, repulsed by the thought of eating sheep innards, avoided the dish entirely). For decades, however, a small but impassioned contingent has resorted to illicit methods to bring authentic haggis onto American soil, motivated by a commitment to tradition and a fondness for the taste and texture of boiled lung.

“If people want something, they’re going to get it,” said Patrick Angus Carr, the chairman of the New York branch of the Saint Andrew’s Society, a Scottish heritage group. “How much cocaine and fentanyl is smuggled into the country every day?”