Sunday, October 11, 2020

5000 Market Design blog posts and counting

 Peter Coles and I started this blog in September 2008, to help alert students in our market design class at Harvard that market design was everywhere.  Sometime recently I passed the 5000 posts mark.  It turns out I like to blog about market design, broadly construed. And I'm still teaching market design.

The modal tag on my posts turns out to be repugnance, as I've been fascinated by trying to understand which kinds of transactions and markets get social support and which don't. Various design efforts that I've been involved in also have been the subject of multiple posts, with tags like residents and fellowsschool choice, and kidney exchange

Some of my favorite posts (from an incomplete series, whenever I manage to get a picture) commemorate dissertation defences. And under a variety of tags (such as market designers) I like to mark when students and colleagues are celebrated or win a prize. (I look forward to writing more of those.)

Less fun is the growing number of posts tagged  RIP, in which I note the passing of people with whom I've intersected, mostly but not always in a market design connection.

In the first years of the blog I allowed comments, but after I got involved in kidney exchange, I had to regularly erase comments--typically sprinkled each night among old posts--that offered to buy kidneys, at unrealistically high prices, phishing for fools. So at some point I shut down comments, noted in this post: August 25, 2018  No comment(s)

Here are ten posts from the last five years that caught my eye as I scrolled through them before giving up on the clunky scrolling device:

September 30, 2020 A modest proposal for the design of presidential debates

March 2, 2018 The Economist discusses repugnant transactions

Saturday, October 10, 2020

De-adopting zombie medical procedures

What happens to medical procedures that are found to be no more effective than placebos?  Some live on for quite a while. One thing that works is to stop paying for them.

Here's an article in JAMA:

De-adopting Low-Value Care--Evidence, Eminence, and Economics

Brian W. Powers, MD, MBA1; Sachin H. Jain, MD, MBA2,3; William H. Shrank, MD, MHSA1   JAMA. Published online October 2, 2020. doi:10.1001/jama.2020.17534 

"An often cited shortcoming of the US health care system is the slow pace with which new innovations are adopted into routine clinical practice.1 A parallel problem receives comparably less attention: the US and other countries are slow to abandon practices that provide little or no benefit to patients. Despite robust research cataloguing common practices that confer little or no value,2,3 these practices remain widespread, accounting for an estimated $67 billion in spending annually.4 For example, estimates suggest that the Centers for Medicare & Medicaid Services (CMS) spends more than $274 million annually on carotid artery disease screening for asymptomatic patients and more than $111 million annually on cervical cancer screening for women older than 65 years.2 The concept of de-adopting these and other low-value services is embedded in the Less Is More series in JAMA Internal Medicine5 and in the Choosing Wisely campaign from the American Board of Internal Medicine.6"

Friday, October 9, 2020

Jobs for market designers in Washington D.C. and at Facebook

 I still get a small thrill when I see jobs for market designers appear, appropriately, in places that not so very long ago hadn't heard of market design.. Here's an ad from the Congressional Budget Office.

Climate and Energy Economist, Congressional Budget Office – Washington DCPublished October 2, 2020  

"The Energy, Environment, and Infrastructure Unit conducts research and analysis on certain topics of interest to the Congress, including climate change, energy and related environmental issues, transportation and infrastructure, and federal policy toward research and development. In the coming years, the unit expects to expand its capacity to model the effects of climate change and climate change policy on the budget and the economy.

...

"Qualifications: Applicants must have either a Ph.D. in economics or a related discipline or a master’s degree with five years of experience in one of those fields. They should also have strong quantitative and modeling skills; preference will be given to candidates with experience modeling energy markets or systems. A background in industrial organization or market design, public finance, or a related microeconomic field is desirable"

********

And here's an ad for a crypto-economist at Facebook:

Novi Economics/Blockchain at Facebook

"Description: Novi is a Facebook subsidiary whose goal is to provide financial services for Libra, a new global currency powered by blockchain technology. The first product Novi will introduce is a digital wallet, which will be available in Messenger, WhatsApp and as a standalone app. The first version of Novi will support peer-to-peer payments and a few other ways to pay such as QR codes which small merchants can use to accept payments in Libra. Over time there will be many other use-cases for Novi including in-store payments, integrations into Point-of-Sale systems, and more. When launched, Novi will have strong fraud and privacy protections. The Novi digital wallet is expected to launch in 2020.

"The Novi economics team is seeking exceptional candidates from all fields, with a special focus on applied microeconomics, development, macroeconomics, finance, and market design, to join our team. Individuals in this role are expected to have deep expertise and the ability to leverage economic theory into real-world, practical solutions for blockchain based problems."

Thursday, October 8, 2020

PNAS celebrates Janet Currie

 The National Academy of Sciences celebrates Janet Currie in the current issue of PNAS, with an interview and an inaugural article.

QnAs with Janet Currie, by Tinsley H. Davis, PNAS September 29, 2020 117 (39) 24008-24009; https://doi.org/10.1073/pnas.2017808117

"Many mental illnesses arise in adolescence, and a study of national insurance claims in the United States finds a large variance in how adolescent patients are treated even within the same zip code. The findings, reported in Janet Currie’s Inaugural Article (IA) (1), reveal that 45% of adolescents receive first-line treatments that are not approved by the US Food and Drug Administration (FDA) (1). Currie, elected to the National Academy of Sciences in 2019, has studied children’s health for three decades. A professor of economics and public affairs at Princeton University, Currie has undertaken pioneering economic analysis of child development, including analysis of the effects of the Head Start program on children (23) and the effects of expansions of the Medicaid program for pregnant women and children (45). In her IA (1), Currie analyzes a large national dataset to reveal disparities in treatment that cannot be attributed to supply-side factors, such as limited availability of treatment providers."

Here's the first question and answer:

"PNAS:What is the link between health and economics?

"Currie: Health can have an impact on how much human capital, like education, people are able to acquire. Moreover, healthcare is a business, and it accounts for almost 20% of US GDP [gross domestic product]. So there are two strands: One is thinking about health as a business, and another is thinking about health as a form of wealth. My work generally focuses more on that second aspect of health as a form of human capital. The Inaugural Article (1) brings those two strands together to a certain extent because mental health problems in children are one of the things that causes them to have less human capital than they might otherwise, and I’m looking at how those children with mental health problems end up getting treated by the healthcare system."

And here is her INAUGURAL ARTICLE

Treatment of mental illness in American adolescents varies widely within and across areas

Emily Cuddy and  Janet CurriePNAS September 29, 2020 117 (39) 24039-24046; https://doi.org/10.1073/pnas.2007484117

"Abstract: Many mental health disorders first manifest in adolescence, and early treatment may affect the course of the disease. Using a large national database of insurance claims, this study focuses on variations in the type of care that adolescent patients receive when they are treated for an initial episode of mental illness. We found large variations in the probability that children receive follow-up care and in the type of follow-up care received across zip codes. We also found large variations in the probability that children receive drug treatments that raise a red flag when viewed through the lens of treatment guidelines: Overall, in the first 3 mo after their initial claim for mental illness, 44.85% of children who receive drug treatment receive benzodiazepines, tricyclic antidepressants, or a drug that is not Food and Drug Administration-approved for their age. On average, these children are 12 y old. While the supply of mental health professionals impacts treatment choices, little of the overall variation is explained by supply-side variables, and at least half of the variation in treatment outcomes occurs within zip codes. These results suggest that other factors, such as physician practice style, may play an important role in the types of treatment that children receive."

Wednesday, October 7, 2020

Informs Auctions and Market Design (AMD) Online Seminar Series

I recently gave a talk on kidney exchange, to help launch the Informs Auctions and Market Design (AMD) Online Seminar Series.  If I've done it right, the video below should begin at minute 6, skipping the first 6 minutes of silence when Zoom was started but the talk had not.


 

Tuesday, October 6, 2020

An open letter to Canadian health authorities on laws against compensating Canadian plasma donors

 The letter is available on a website called Donation Ethics: Ethicists and Economists for Ethical Donation-Compensation Practices  organized by Peter M. Jaworski and  David Faraci. (I am among the signers.)

"Ethicists and Economists express concerns about banning compensation for plasma donors with regards to ensuring the security of a safe Immune Globulin Product Supply.

"Submission to the Expert Panel on Immune Globulin Product Supply and Related Impacts in Canada

"INTRODUCTION

We are professional ethicists in the fields of medical ethics, business ethics, and/or normative ethics, and academic economists who study how incentives and other mechanisms affect individual behaviour. We all share the goal of improving social welfare.

"The Provinces of Québec (1994),1 Ontario (2014),2 and Alberta (2017)3 have passed Voluntary Blood Donation Acts or their equivalents that prohibit, amongst other things, compensation for plasma donations for purposes of further processing into plasma-derived medicinal products (hereafter: “PDMPs”), like Immune Globulin (hereafter: “Ig”). Currently, the Nova Scotia legislature is debating a Voluntary Blood Donations Act,4 and the British Columbia government has suggested that it is interested in pursuing similar legislation.5

...

"CONCLUSION

"In our view, none of the moral objections to the compensatory model are persuasive. Furthermore, there is a strong moral presumption against standing in the way of a model that is the most likely to promote security not only of Canada’s supply of PDMPs, including Ig, but also of the global supply. We urge Québec, Ontario, and Alberta to reconsider the Acts currently prohibiting compensation in their provinces.

"Finally, we note that well-informed opponents of the compensatory model should not suggest that PDMPs, including Ig, made with compensated donors are riskier or less safe than PDMPs, including Ig, made with uncompensated donors. This presumption may be harmful to patients."


Monday, October 5, 2020

How King Uzziah became corrupt and was stricken with Covid and quarantined (II Chronicles 26)

Chronicles II chapter 26 describes how King Uzziah became corrupt and power hungry, so that the Lord infected him with the untranslatable disease that the Chronicler called "zaraath," which required him to be quarantined for the rest of his life.

Here it is, starting from verse 16.
 
And when he became strong, his heart became haughty until he became corrupt, and he trespassed against the Lord his God, and he came into the Temple of the Lord to burn incense on the altar of incense. טזוּכְחֶזְקָת֗וֹ גָּבַ֚הּ לִבּוֹ֙ עַד־לְהַשְׁחִ֔ית וַיִּמְעַ֖ל בַּֽיהֹוָ֣ה אֱלֹהָ֑יו וַיָּבֹא֙ אֶל־הֵיכַ֣ל יְהֹוָ֔ה לְהַקְטִ֖יר עַל־מִזְבַּ֥ח הַקְּטֹֽרֶת:
17And Azariah the priest came after him, and ,with him were priests of the Lord, eighty mighty men. יזוַיָּבֹ֥א אַֽחֲרָ֖יו עֲזַרְיָ֣הוּ הַכֹּהֵ֑ן וְעִמּ֞וֹ כֹּֽהֲנִ֧ים| לַֽיהֹוָ֛ה שְׁמוֹנִ֖ים בְּנֵי־חָֽיִל:
18And they stood beside Uzziah the king and said to him, "It is not for you, Uzziah, to burn incense to the Lord, but for the priests, sons of Aaron, who are consecrated to burn [incense]. Leave the Sanctuary, for you have trespassed, and it will not be glory for you from the Lord God." יחוַיַּֽעַמְד֞וּ עַל־עֻזִּיָּ֣הוּ הַמֶּ֗לֶךְ וַיֹּ֚אמְרוּ לוֹ֙ לֹֽא־לְךָ֣ עֻזִּיָּ֗הוּ לְהַקְטִיר֙ לַֽיהֹוָ֔ה כִּ֣י לַכֹּֽהֲנִ֧ים בְּנֵי־אַֽהֲרֹ֛ן הַֽמְקֻדָּשִׁ֖ים לְהַקְטִ֑יר צֵ֚א מִן־הַמִּקְדָּשׁ֙ כִּ֣י מָעַ֔לְתָּ וְלֹֽא־לְךָ֥ לְכָב֖וֹד מֵֽיְהֹוָ֥ה אֱלֹהִֽים:
19And Uzziah became furious, and in his hand was a censer to burn, and in his fury with the priests, the zaraath shone upon his forehead before the priests in the House of the Lord, over the altar of incense. יטוַיִּזְעַף֙ עֻזִּיָּ֔הוּ וּבְיָד֥וֹ מִקְטֶ֖רֶת לְהַקְטִ֑יר וּבְזַעְפּ֣וֹ עִם־הַכֹּֽהֲנִ֗ים וְ֠הַצָּרַעַת זָֽרְחָ֨ה בְמִצְח֜וֹ לִפְנֵ֚י הַכֹּֽהֲנִים֙ בְּבֵ֣ית יְהֹוָ֔ה מֵעַ֖ל לְמִזְבַּ֥ח הַקְּטֹֽרֶת:
20And Azariah, the chief priest, and all the priests, turned to him, and behold he was stricken with zaraath on his forehead; so they rushed him out of there, and he too hastened to leave, for the Lord had smitten him. כוַיִּ֣פֶן אֵלָ֡יו עֲזַרְיָהוּ֩ כֹהֵ֨ן הָרֹ֜אשׁ וְכָל־הַכֹּֽהֲנִ֗ים וְהִנֵּה־ה֚וּא מְצֹרָע֙ בְּמִצְח֔וֹ וַיַּבְהִל֖וּהוּ מִשָּׁ֑ם וְגַם־הוּא֙ נִדְחַ֣ף לָצֵ֔את כִּ֥י נִגְּע֖וֹ יְהֹוָֽה:
21And King Uzziah was stricken with zaraath until the day of his death, and he lived in a house of retirement, for it had been decreed from the House of the Lord,


HT: Aviya Kushner in the Forward

Sunday, October 4, 2020

Grocery supply chains: TNR reviews "The Secret Life of Groceries"

 The New Republic reviews The Secret Life of Groceries: The Dark Miracle of the American Supermarket, by Benjamin Lorr,  (It tells you more than you want to know about supply chains, from farmed shrimp in Thailand to American long haul trucking...)

There’s No Such Thing as Ethical Grocery Shopping--“The Secret Life of Groceries” exposes the dark secrets of America’s food supply. by Josephine Livingstone

Having read the review but not the book, it sounds like a broad based followup on this 2015 story from the Guardian:

Shrimp sold by global supermarkets is peeled by slave labourers in Thailand

by Associated Press: Margie Mason, Robin McDowell and Esther Htusan in Samut Sakhon and Martha Mendoza in Washington Mon 14 Dec 2015

Saturday, October 3, 2020

Convalescent plasma continues to be used for treatment of covid-19, but demand is flat

 The WSJ has the story:

Wanted in Covid-19 Fight: ‘Superdonors’ of Convalescent Plasma--Blood banks and researchers are mobilizing to find recovered Covid-19 patients who have high levels of antibodies and are willing to donate regularly   By Amy Dockser Marcus


"Blood banks and researchers are mobilizing to find recovered Covid-19 patients who could be blood plasma “superdonors,” people who have high levels of antibodies against the disease and are willing to donate regularly.

"The hunt has intensified in the past month, after the Food and Drug Administration authorized the use of convalescent plasma, derived from patients who have survived the virus, as a potential therapy for hospitalized patients.

...

"Right now, demand for plasma overall is flat, said Dr. Claudia Cohn, chief medical officer for AABB, a group representing the transfusion medicine and cellular therapy community. She said it could reflect reservations about the strength of existing data, the waning of the pandemic in certain areas of the country, or concerns that the authorization was issued under political pressure from the White House—a suggestion the FDA has pushed back on but that continues to generate debate.

"Doctors said an expected upturn in demand for convalescent plasma didn’t materialize after the authorization, although they are prepared for one should infections surge later this year."

Friday, October 2, 2020

Trading truthfulness for efficiency in the Israeli medical internship market, by Ariel Rosenfeld and Avinatan Hassidim


Too smart for their own good: Trading truthfulness for efficiency in the Israeli medical internship market, by Ariel Rosenfeld and Avinatan Hassidim, Judgment and Decision Making, Vol. 15, No. 5, September 2020

Abstract: The two most fundamental notions in mechanism design are truthfulness and efficiency. In many market settings, such as the classic one-sided matching/assignment setting, these two properties partially conflict, creating a trade-off which is rarely examined in the real-world. In this article, we investigate this trade-off through the high-stakes Israeli medical internship market. This market used to employ a standard truthful yet sub-optimal mechanism and it has recently transitioned to an “almost” truthful, more efficient mechanism. Through this in-the-field study, spanning over two years, we study the interns’ behavior using both official data and targeted surveys. We first identify that substantial strategic behaviors are exercised by the participants, virtually eliminating any efficiency gains from the transition. In order to mitigate the above, we performed an intervention in which conclusive evidence was provided showing that, for most of the interns, reporting truthfully was much better than what they actually did. Unfortunately, a re-examination of the market reveals that our intervention had only minor effects. These results combine to question the practical benefits of “almost” truthfulness in real-world market settings and shed new light on the typical truthfulness-efficiency trade-off."


Here's their description of the prior, inefficient random serial dictatorship rule:

"For about two and a half decades, until 2014, each intern was asked to submit her ranking of the hospitals relevant for her graduation class, and the assignment itself was decided by the RSD mechanism (with a few minor house rules aimed at providing special treatment for special intern groups such as PhD students and parents of young children), which has come to be known as the Internship Lottery. Up until a few years ago when the system was finally computerized, interns physically gathered in a large auditorium and ID numbers were drawn out of a hat. The RSDT mechanism has been deployed since 2014 in an attempt to increase efficiency (Bronfman et al., 2015) (see (Roth & Shorrer, 2015) for a review and discussion on the transition choice)."

And here (out of the sequence in the paper) is a quick description of the new, efficient mechanism.

"To mitigate the fact that the probability vectors induced by the RSD mechanism may be far from optimal, the RSDT mechanism was proposed: First, after each intern submits a ranked list of hospitals, a large number of RSD simulations is performed to approximate the true probability vector for each intern. Then, using a fitted utility function over probability vectors (learned through structured surveys), probabilities are automatically traded between the interns though a Linear Program (LP) which optimizes social welfare. The LP guarantees that each intern’s expected utility (given the utility function) is no-worse than what she had before the trade."

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

Related post:

Thursday, March 26, 2015

Thursday, October 1, 2020

Becky Morton, RIP

 Becky Morton has passed away after a short illness. She was a pioneer in bringing experimental methods to political science, as an individual investigator, an editor and journal founder, textbook writer, and as an institution builder, who made NYU Abu Dhabi a center of experimental work.

Here's the announcement from NYU:

Mourning the Passing of Rebecca Morton September 27, 2020

"She was an extraordinary academic leader for the development of research and teaching in the social sciences at NYUAD, serving as Associate Dean of Faculty Affairs and Development, Program Head of Political Science, and Global Network Professor of Politics and Economics. Becky was the founding Director of the Social Science Experimental Laboratory at NYUAD, one of her proudest creations. Her unfailing commitment to nurturing early career scholars was epitomized in the postdoctoral program in the social science division, which she led as director until the beginning of fall. Becky’s intellectual engagement with colleagues, students, and our postdoctoral fellows helped forge a lively and successful research community in social science.

"Becky Morton was an outstanding scholar whose work ranged across economics and political science. Committed to interdisciplinary inquiry, she was the author and co-author of four books and numerous articles in prominent economics and political science journals, such as the American Economic Review, American Journal of Political Science, American Political Science Review, Journal of Law and Economics, Journal of Politics, and Review of Economic Studies."

*******

Here's one of her books:

Experimental Political Science and the Study of Causality: From Nature to the Lab"         By Rebecca B. Morton, Kenneth C. Williams


Here's her editor's introduction to the first issue of the Journal of Experimental Political Science, in 

Welcome to JEPS!,  Journal of Experimental Political Science,Volume 1, Issue 1, Spring 2014 , pp. 1-5, by Rebecca B. Morton  Joshua A. Tucker

In short, she was a force for experiments in political science, despite having a Ph.D. in Economics (and, as I recall, drinking Coke for breakfast).

Wednesday, September 30, 2020

A modest proposal for the design of presidential debates

 1. Turn off the microphone of whoever isn't supposed to be speaking.

Tuesday, September 29, 2020

Human infection challenge trial(s) for covid-19 vaccine likely to start in UK in January

 The Financial Times has the story:

UK to test vaccines on volunteers deliberately infected with Covid-19--‘Human challenge trials’ intended to accelerate vaccine development programmes   by  Clive Cookson.

"London is to host the world’s first Covid-19 human challenge trials — in which healthy volunteers are deliberately infected with coronavirus to assess the effectiveness of experimental vaccines.

"The UK government-funded studies are expected to begin in January ...

"The researchers, who did not want to comment publicly ahead of the launch, said the trials would play a vital role in narrowing the large field of promising Covid-19 vaccines likely to move into clinical testing early next year.

"Volunteers will be inoculated with a vaccine and a month or so later receive a “challenge” dose of Sars-Cov-2, the virus that causes Covid-19, under controlled conditions."

"About 2,000 potential volunteers have signed up for challenge studies in the UK through the US-based advocacy group 1Day Sooner, which campaigns for Covid-19 infection trials and has enlisted 37,000 people worldwide. Traditional clinical trials need tens of thousands of participants and researchers would struggle to attract enough for multiple vaccine studies."

Monday, September 28, 2020

Judicial clerkships in the time of coronavirus--uneven compliance with the pilot hiring plan, and post-clerkship connections

 An article in the UC Davis Law Review Online discusses the hiring of law clerks by U.S. judges, during the current pandemic,  with reference to the  Federal Law Clerk Hiring (Pilot) Plan which is in its second year this year. (The plan calls for judges to delay hiring second year law students until June, and to leave offers open for at least 48 hours.)

The Federal Law Clerk Hiring Pilot and the Coronavirus Pandemic  by Carl Tobias, UC Davis Law Review Online, 2020,54, 1-20.

The article says that compliance with the plan is uneven, but that "numerous jurists who support the nascent pilot are Democratic Presidents' confirmees ... while copious judges who seem to oppose the pilot  in turn are GOP chief executives' appointees..." (p9).

**********

An article in the NY Times talks about why clerkships are so valuable to clerks:

Law Firms Pay Supreme Court Clerks $400,000 Bonuses. What Are They Buying?   Inside information and influence with the clerks’ former bosses may figure in the transactions, a new study suggests     by Adam Liptak

"Supreme Court justices make $265,600 a year. The chief justice gets $277,700.

"Their law clerks do a lot better. After a year of service at the court, they are routinely offered signing bonuses of $400,000 from law firms, on top of healthy salaries of more than $200,000."

The article goes on to talk about the influence that clerks have later in their careers, when arguing cases before their former bosses. It's based on this article

The Influence of Personalized Knowledge at the Supreme Court: How (Some) Former Law Clerks Have the Inside Track by Ryan C. Black1 and Ryan J. Owens, Political Research Quarterly, 2020.

Abstract: When arguing at the U.S. Supreme Court, former High Court law clerks enjoy significant influence over their former justices. Our analysis of forty years of judicial votes reveals that an attorney who formerly clerked for a justice is 16 percent more likely to capture that justice’s vote than an otherwise identical attorney who never clerked. What is more, an attorney who formerly clerked for a justice is 14 to 16 percent more likely to capture that justice’s vote than an otherwise identical attorney who previously clerked for a different justice. Former clerk influence is substantial, targeted, and appears to come from clerks’ personalized information about their justices. These results answer an important empirical question about the role of attorneys while raising normative concerns over  fairness in litigation.

Sunday, September 27, 2020

Removing financial disincentives to living organ donation: HRSA publishes Final Rule

 The Health Resources and Services Administration (HRSA), Health and Human Services Department (HHS) has published its Final Rule in the Federal Register

Removing Financial Disincentives to Living Organ Donation--A Rule by the Health and Human Services Department on 09/22/2020

"SUMMARY: This final rule amends the regulations implementing the National Organ Transplant Act of 1984, as amended (NOTA), to remove financial barriers to organ donation by expanding the scope of reimbursable expenses incurred by living organ donors to include lost wages, and child-care and elder-care expenses incurred by a caregiver. HHS is committed to reducing the number of individuals on the organ transplant waiting list by increasing the number of organs available for transplant. This final rule is associated with Section 8 of the Executive Order (E.O.) 13879 titled “Advancing American Kidney Health,” issued on July 10, 2019, which directed HHS to propose a regulation allowing living organ donors to be reimbursed for related lost wages, child-care expenses, and elder-care expenses through the Reimbursement of Travel and Subsistence Expenses Incurred toward Living Organ Donation program authorized under section 377 of the Public Health Service (PHS) Act, as amended."

...

"The National Living Donor Assistance Center (NLDAC) [4] operates the living organ donor reimbursement program funded by HRSA's Reimbursement of Travel and Subsistence Expenses Incurred toward Living Organ Donation grants program. Under the authority provided under section 377 of the PHS Act, as amended, the program is operated via cooperative agreement. The program's purpose is to help remove financial disincentives for living organ donations. In adherence to the authority outlined in the PHS Act, the program's Eligibility Guidelines currently provide that “qualifying expenses” include those incurred by the donor and his/her accompanying person(s) as part of: (1) Donor evaluation, (2) hospitalization for the living donor surgical procedure, and/or (3) medical or surgical follow-up, clinic visits, or hospitalization within two calendar years following the living donation procedure.

...

"Through this final rule, the Secretary determines that reimbursement for lost wages, and child-care and elder-care expenses incurred by a caregiver, is appropriate for living organ donors who incur such expenses toward their organ donation."

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

The final rule authorizes the National Living Donor Assistance Center (NLDAC) to expand the category of expenses that it can reimburse, for those who meet its income and other conditions.

I'm on NLDAC's Advisory Board, and at the present time I haven't heard that NLDAC's budget will be increased to fund the expanded expenses it is now permitted to reimburse.

Saturday, September 26, 2020

The unsharing economy: part time gig evicting people from their apartments

 Vice.com has the story:


Gig Economy Company Launches Uber, But for Evicting People--A company called Civvl says evicting people is the "FASTEST GROWING MONEY MAKING GIG DUE TO COVID-19."  By Ashwin Rodrigues

"In its Craigslist ads, posted across the country, Civvl explains the opportunity plainly: "There is plenty of work due to the dismal economy."

"Unemployment is at a record high and many cannot or simply are not paying rent and mortgages," the ads state. "We are being contracted by frustrated property owners and banks to secure foreclosed residential properties."

Civvl aims to marry the gig economy with the devastation of a pandemic, complete with signature gig startup language like "be your own boss," and "flexible hours," and "looking for self-motivated individuals with positive attitudes:" "FASTEST GROWING MONEY MAKING GIG DUE TO COVID-19," its website says. "Literally thousands of process servers are needed in the coming months due courts being backed up in judgements that needs to be served to defendants."

...

"The company, at first glance, appears to be some kind of _Nathan For You-_esque prank: siccing precarious gig jobs onto vulnerable people. But Civvl is connected to a larger—and real—gig economy company called OnQall, which describes itself as an app that provides "on-demand task services to non-urban communities beyond main city areas." OnQall is the developer behind other, more believable TaskRabbit-esque apps, like LawnFixr, CleanQwik, and MoveQwik. Given the fact that Civvl is advertising all over the country and that OnQall, though not popular, does exist, it seems as though Civvl actually is an attempt to simplify the process of evicting people who cannot pay their rent during a pandemic.

...

"There is a federal ban on evictions, declared by the CDC, but landlords are still attempting to press on. There is a penalty for violating the ban, which can include a combination of fines and jail time. Civvl did not respond to a question about how the company ensures evictions are legal, though based on the Terms of Service, it appears to pass all risk onto the companies using its platform, stating that it simply "provides lead generation to independent contractors," and does not actually carry out the work itself.  

HT: Sandro Ambuehl

Friday, September 25, 2020

The WHO proposal for allocating scarce vaccines: thinking of healthcare while dealing with politics by discussing ethics

From the Guardian:

'Landmark moment': 156 countries agree to Covid vaccine allocation deal--Covax plan will counter rising threat of ‘vaccine nationalism’, prioritising vulnerable healthcare systems and frontline workers  by Peter Beaumont

"A coalition of 156 countries has agreed a “landmark” deal to enable the rapid and equitable global distribution of any new coronavirus vaccines to 3% of participating countries’ populations, to protect vulnerable healthcare systems, frontline health workers and those in social care settings.

"The Covid-19 vaccine allocation plan – co-led by the World Health Organization and known as Covax – has been set up to ensure that the research, purchase and distribution of any new vaccine is shared equally between the world’s richest countries and those in the developing world.

"Sixty-four higher income economies have already joined Covax, which includes commitments from 35 economies as well as the European commission, which will procure doses on behalf of the 27 EU member states plus Norway and Iceland, with 38 more expected to join in the coming days.

...

"Recognising that the first useful vaccines to emerge may be in short supply, approved vaccines will initially be made available to a tightly targeted 3% of the population of participating countries, building over time to 20% of each country’s most vulnerable population.

...

"According to a document detailing the arrangement, under the scheme “all countries should gradually receive tranches [of vaccine] to cover each subset of their [initial] target groups … until they can cover 3% of the population”.


The document continues: “At this point of the pandemic, a reasonable scenario would be that, while the supply of Covid-19 vaccines remains very scarce, countries should focus initially on reducing mortality and protecting the health system.


“This … would enable, for example, the vaccination of frontline workers in health and social care settings in most countries … Additional tranches will follow gradually as more supply becomes available.”

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

And this from the Washington Post:

World Health Organization unveils plan for distributing coronavirus vaccine, urges cooperation    By Emily Rauhala

"Under the plan, rich and poor countries pool money to provide manufacturers with volume guarantees for a slate of vaccine candidates. The idea is to discourage hoarding and focus on vaccinating high-risk people in every participating country first.

"So far, 64 higher-income countries have signed up, WHO officials said, but they added that 38 more are expected to do so in the coming days. Notably missing: Russia, China and the United States.

"China has not made an ann"ouncement either way. The White House said this month that the United States would not join, in part because the administration doesn’t want to work with the WHO, and will instead take a go-it-alone approach.

...

"The framework makes clear that each participating country can decide whom to vaccinate first, but it is based on the idea that doses for 3 percent of a country’s population could be used to vaccinate medical workers first and then other high-risk groups.

...

"“It seems like a compromise position,” said Thomas J. Bollyky, a senior fellow at the Council on Foreign Relations and the director of its global health program. “It’s not exactly what you would do if you were driven strictly by public health.”

"In a policy report this month for the journal Science, critics offered an alternate framework called the Fair Priority Model, which is critical of the country-based approach"

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

Here's the Science article:

An ethical framework for global vaccine allocation, by Ezekiel J. Emanuel1, Govind Persad2, Adam Kern3, Allen Buchanan4, Cécile Fabre5, Daniel Halliday6, Joseph Heath7, Lisa Herzog8, R. J. Leland9, Ephrem T. Lemango10, Florencia Luna11, Matthew S. McCoy1, Ole F. Norheim12, Trygve Ottersen13, G. Owen Schaefer14, Kok-Chor Tan15, Christopher Heath Wellman16, Jonathan Wolff17, Henry S. Richardson18

"The Fair Priority Model is primarily addressed to three groups. One is the COVAX facility—led by Gavi, the World Health Organization (WHO), and the Coalition for Epidemic Preparedness Innovations (CEPI)—which intends to purchase vaccines for fair distribution across countries (5). A second group is vaccine producers. Thankfully, many producers have publicly committed to a “broad and equitable” international distribution of vaccine (2). The last group is national governments, some of whom have also publicly committed to a fair distribution (1).

...

"The Fair Priority Model proceeds in three phases, preventing more urgent harms earlier (see the Table). Phase 1 aims at reducing premature deaths and other irreversible direct and indirect health impacts. Phase 2 continues to address enduring health harms but additionally aims at reducing serious economic and social deprivations such as the closure of nonessential businesses and schools. Restoring these activities will lower unemployment, reduce poverty, and improve health. Finally, phase 3 aims at reducing community transmission, which in turn reduces spread among countries and permits the restoration of prepandemic freedoms and economic and social activities."


Thursday, September 24, 2020

Unintended Consequences of Criminalizing Sex Work in East Java Indonesia, by Cameron, Seager, and Shah

 

Crimes Against Morality: Unintended Consequences of Criminalizing Sex Work

Lisa Cameron, Jennifer Seager, Manisha Shah

NBER Working Paper No. 27846 September 2020

 Abstract: We examine the impact of criminalizing sex work, exploiting an event in which local officials unexpectedly criminalized sex work in one district in East Java, Indonesia, but not in neighboring districts. We collect data from female sex workers and their clients before and after the change. We find that criminalization increases sexually transmitted infections among female sex workers by 58 percent, measured by biological tests. This is driven by decreased condom access and use. We also find evidence that criminalization decreases earnings among women who left sex work due to criminalization, and decreases their ability to meet their children's school expenses while increasing the likelihood that children begin working to supplement household income. While criminalization has the potential to improve population STI outcomes if the market shrinks permanently, we show that five years post-criminalization the market has rebounded and the probability of STI transmission within the general population is likely to have increased.


"Sex work is not directly addressed in Indonesian national law. As a result, sex work is widespread and largely tolerated throughout Indonesia, including East Java. However, a section of law titled “Crimes Against Morals” can be read to apply to sex work and has been used by local officials in some areas to close down sex worksites. On July 11, 2014, the Malang District government announced that on November 28, 2014, it would close all formal sex worksites within the district as a “birthday present” to Malang (Sukarelawati, 2014). The closures aligned with anniversary celebrations in Malang District and had religious overtones, being justified on the basis of sex work being banned by all religions (Tribunews.com, 2014).

Wednesday, September 23, 2020

Pandemic disruptions in the market for medical residents

 The coronavirus pandemic and associated lockdowns and limitations have stressed a number of labor markets, including the one for new physicians.  Here's an article from the Journal of Surgical Education that suggests that, in a world of online interviewing, the number of interviews might usefully be capped. They also recommend signalling...

The Case for Capping Residency Interviews

Helen Kang Morgan, MD,*,1 Abigail F. Winkel, MD,† Taylor Standiford, BS,‡ Rodrigo Muñoz, MD,§ Eric A. Strand, MD,║ David A. Marzano, MD,* Tony Ogburn, MD,¶ Carol A. Major, MD,# Susan Cox, MD,⁎⁎ and Maya M. Hammoud, MD, MBA

J Surg Educ. 2020 Sep 14, doi: 10.1016/j.jsurg.2020.08.033 [Epub ahead of print] PMCID: PMC7489264

"As a result of the COVID-19 pandemic, residency programs will make an abrupt shift to virtual interviews in the 2021 residency application cycle.1 ... Medical students, medical schools, and residency programs have needed to react to sudden developments such as cancelled clinical electives, delayed or cancelled United States Medical Licensing Exams (USMLE),2 significant limitations on visiting student elective and sub-internship rotations,3 and changes in Electronic Residency Application Service (ERAS) timelines.4 Given this context, applicants may opt to increase their total number of residency applications as well as interviews accepted and completed, especially since they will no longer be limited by travel and cost deterrents.5, 6, 7 Likewise, residency programs are no longer logistically restrained to configure an applicant's interview schedule on a single day, and will have the ability to schedule interviews throughout multiple days and during non-business hours. In-person interactions provided by traditional interview day experiences have historically weighed heavily in determining mutual compatibility8 , 9; thus, both stakeholder groups will be looking to raise their chances of finding a match, including potentially increasing the number of interviews.

This is particularly troublesome given the current state of residency application processes, "fraught with misaligned stakeholder incentives.10, 11, 12, 13, 14, 15 Although the ratio of positions per applicant is higher now than ever before, the number of applications per applicant have risen.16 , 17 These numbers have increased rapidly in certain specialties, with the mean number of applications per applicant in obstetrics and gynecology (OBGYN) rising from 28 in 2010 to 66 in 2019.18 The consequences of application inflation are numerous and include decreased abilities for residency programs to perform holistic review of applicants with increased reliance on metrics such as USMLE scores. Residency programs also need to devote significant faculty and administrative time for the interview processes.19 The consequence of application inflation that will be of crucial importance this application cycle is the growing awareness that a small percentage of applicants has been receiving a disproportionate percentage of interview offers.20 , 21 In the era of virtual interviews, if these applicants choose to schedule all of their interview offers, there is a real potential for detrimental downstream effects to other applicants. This may also lead to a greater number of unfilled residency spots, with a larger number of programs and applicants required to enter into the Supplemental Offer and Acceptance Program. Given the paucity of data to inform best practices, there is a pressing need to model the potential effects of current application processes and applicant strategies in this disrupted application cycle."
...
"All stakeholders urgently need equitable solutions that address both individual and systems-level problems for this coming application cycle and beyond.30 Capping the number of interviews that an applicant can schedule could remedy 1 pressing flaw in current application interview processes. Implementing caps at the interview scheduling stage is preferable to capping at the application stage given the multiple complexities that must be considered such as DO and IMG status, and overall competitiveness. In addition, exceptions may need to be made for individuals participating in the Couples Match. The potential legal implications of mandatory interview caps are in the infancy of exploration. Capping interviews would likely not violate anti-trust laws given that applicants would still have the choice of where they would like to interview, however these issues would need to be further investigated. New measures such as preference signaling mechanisms30, 31, 32 need to be urgently considered in order for programs to be able to prioritize whom to offer interviews. The use of “tokens” would enable applicants to be able to convey interest to a set number of programs; this has been well-described in graduate PhD economics education literature.33 It will be imperative for “fit” to not become a proxy for decisions guided by unconscious bias,34 but instead, for principles of equity and inclusion to guide change during this time of accelerated change."


HT: Marc Melcher

Tuesday, September 22, 2020

Filtering 'inappropriate' content is still a challenge for AI--human monitoring of YouTube

The Financial Times has the story:

YouTube reverts to human moderators in fight against misinformation--Video platform relied on machines after lockdown but found they over-censored borderline content

by Alex Barker and Hannah Murphy 

"Google’s YouTube has reverted to using more human moderators to vet harmful content after the machines it relied on during lockdown proved to be overzealous censors of its video platform.

"When some of YouTube’s 10,000-strong team filtering content were “put offline” by the pandemic, YouTube gave its machine systems greater autonomy to stop users seeing hate speech, violence or other forms of harmful content or misinformation.

"But Neal Mohan, YouTube’s chief product officer, told the Financial Times that one of the results of reducing human oversight was a jump in the number of videos removed, including a significant proportion that broke no rules." 

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

Wired Magazine has a good backgrounder on the AI attempt to alter the recommender engine:

YouTube’s Plot to Silence Conspiracy Theories--From flat-earthers to QAnon to Covid quackery, the video giant is awash in misinformation. Can AI keep the lunatic fringe from going viral?

by Clive Thompson