Gambling as a public health issue (Lancet)

 Here's a warning about gambling from the Lancet:

The Lancet Public Health Commission on gambling   October 24, 2024

"Executive Summary: Gambling is not an ordinary kind of leisure; it can be a health-harming, addictive behaviour. The harms associated with gambling are wide-ranging, affecting not only an individual's health and wellbeing, but also their wealth and relationships, families and communities, and deepening health and societal inequalities. By examining these harms, the Commission unveils the intersections between the social, commercial, legal, and political determinants of health. The Commission sheds light on the increasingly complex commercial ecosystem for gambling and its digital transformation which offer unparalleled capacities for gambling. The Commission calls on governments and policymakers to treat gambling as a public health issue—just as for other addictive and health-harming commodities, such as alcohol and tobacco—and provides recommendations to prevent and mitigate the broad range of harms associated with gambling.

Dating apps, featuring Hinge (NPR podcast)

 NPR has a podcast on dating apps.

"Unanswered messages. Endless swiping. An opaque algorithm. The backlash to online dating feels like it's reached a fever pitch recently. For today's Love Week episode, why people are unhappy with online dating and what Hinge's CEO is trying to do about it. Also, a Nobel Prize economist delivers a little tough love."

NPR podcast: https://www.npr.org/2024/10/24/1211597183/love-week-online-dating-hinge-ceo-justin-mcleod

x

WUSTL Economic Theory Conference 2024, today and tomorrow in St. Louis

 I'm traveling to St. Louis, to Washington University, to join the

WUSTL Economic Theory Conference 2024

Location: The Charles F. Knight Center Executive Education & Conference Center; Classroom 220 is on the WashU Campus (145, D2). All sessions, lunch, and dinner will be held here.

Program:

Friday, October 25:

8:00 – 9:00 am Breakfast (Anheuser-Busch Dining Hall)

Session I (Classroom 220)

9:00 – 9:45 am David Levine (Royal Holloway University)
“Behavioral Mechanism Design as a Benchmark for Experimental Studies“

9:45 – 10:30 am Navin Kartik (Columbia University)
“Convex Choice” joint with Andreas Kleiner

10:30 – 10:50 am Coffee Break (2nd Floor Break Area)

Session II (Classroom 220)

10:50 – 11:35 am Laura Doval (Columbia University)
“Calibrated Mechanism Design” joint with Alex Smolin

11:35 – 12:20 pm Simon Board (UCLA)

Lunch 12:30 pm – 1:30 pm; Hot Slider Buffet Bar will be placed outside the meeting room for guests to grab. Beverages will be available on the 2nd floor break station. Guests can eat in the classroom, at the lounge seating on the 2nd floor of the Knight Center, or outside on WashU’s campus.

Session III (Classroom 220)

1:40 – 2:25 pm Federico Echenique (UC Berkeley)
“Stable Matching as Transportation“

2:25 – 3:10 pm Faruk Gul (Princeton University)

3:10 – 3:30 PM Coffee Break 

Session IV (Classroom 220)

3:30 – 4:15 pm Vasiliki Skreta (UT Austin)

4:15 – 5:00 pm Bruno Strulovici (Northwestern University)
“Symbolic vs. Substantive Taxation Principles with Unobservable Actions“

Dinner 5:30 – 8:00 pm, Classroom 340 (3rd floor)

---

Saturday, October 26:

7:00 – 9:00 am  Breakfast (Anheuser-Busch Dining Hall)

Session V (Classroom 220)

9:00 – 9:45 am Nageeb Ali (Penn State University)
“From Design to Disclosure”

9:45 – 10:30 am Marina Agranov (Caltech)
“Beliefs of Others: an Experimental Study”

10:30 – 10:50 am Coffee Break

Session VI (Classroom 220)

10:50 – 11:35 am Michael Ostrovsky (Stanford University)
“Transportation as Stable Matching“

11:30 – 12:20 pm Mehmet Ekmekci (Boston College)

12:30 – 1:30 pm; Boxed Lunches will be placed outside the meeting room for guests to grab. Beverages will be available on the 2nd floor break station. Guests can eat in the classroom, at the lounge seating on the 2nd floor of the Knight Center, or outside on WashU’s campus.

---

Public Lecture

Bryan Cave Moot Courtroom (A-B Hall, Room 310)

3:00 – 4:00 PM Al Roth (Stanford University)
“Market Design and Regulation”
Al Roth will give highlights of the market design he pioneered, such as kidney exchange and school choice. He will also discuss open questions regarding controversial markets, which may include blood plasma, abortion, IVF and surrogacy, marijuana, guns, and digital data.

23 Nobel Prize-winning economists call Harris’ economic plan ‘vastly superior’ to Trump’s

 23 Nobel Prize-winning economists call Harris’ economic plan ‘vastly superior’ to Trump’s
By Phil Mattingly, CNN

"More than half of the living US recipients of the Nobel Prize for economics signed a letter that called Vice President Kamala Harris’ economic agenda “vastly superior” to the plans laid out by former President Donald Trump.

"Twenty-three Nobel Prize-winning economists signed onto the letter, including two of the three most recent recipients.

“While each of us has different views on the particulars of various economic policies, we believe that, overall, Harris’ economic agenda will improve our nation’s health, investment, sustainability, resilience, employment opportunities, and fairness and be vastly superior to the counterproductive economic agenda of Donald Trump,” the economists write in the letter obtained by CNN.

 #########

Here's the letter, and the signatories:

"We, the undersigned, believe that Kamala Harris would be a far better steward of our economy than Donald Trump and we support her candidacy.
The details of the presidential candidates’ economic programs are not fully laid out yet, but what they’ve said, combined with what they’ve done in the past, gives us a clear picture of alternative economic visions, policies, and practices.
While each of us has different views on the particulars of various economic policies, we believe that, overall, Harris’s economic agenda will improve our nation’s health, investment, sustainability, resilience, employment opportunities, and fairness and be vastly superior to the
counterproductive economic agenda of Donald Trump.
His policies, including high tariffs even on goods from our friends and allies and regressive tax cuts for corporations and individuals, will lead to higher prices, larger deficits, and greater inequality. Among the most important determinants of economic success are the rule of law and economic and political certainty, and Trump threatens all of these.
By contrast, Harris has emphasized policies that strengthen the middle class, enhance competition, and promote entrepreneurship. On issue after issue, Harris’s economic agenda will do far more than Donald Trump’s to increase the economic strength and well-being of our  nation and its people.
Simply put, Harris’s policies will result in a stronger economic performance, with economic growth that is more robust, more sustainable, and more equitable."

Signed,
Daron Acemoglu (2024)
George A. Akerlof (2001)
Abhijit Banerjee (2019)
Sir Angus Deaton (2015)
Peter A. Diamond (2010)
Douglas Diamond (2022)
Esther Duflo (2019)
Robert F. Engle III (2003)
Claudia Goldin (2023)
Sir Oliver Hart (2016)
Guido W. Imbens (2021)
Simon Johnson (2024)
Eric S. Maskin (2007)
Daniel L. McFadden (2000)
Robert C. Merton (1997)
Roger B. Myerson (2007)
William D. Nordhaus (2018)
Edmund S. Phelps (2006)
Paul M. Romer (2018)
Alvin E. Roth (2012)
Robert J. Shiller (2013)
Joseph E. Stiglitz (2001)
Richard H. Thaler (2017) 

#########

Earlier:

Wednesday, June 26, 2024 Feedback (from Trump campaign) on open letter by economists

Lanchester Prize (Post 1 of 2)

 The 2024 INFORMS meetings in Seattle this weekend was the occasion of a number of awards, including the Lanchester Prize, the big publication award in operations research and management science.  Congratulations to the two winning publication teams.

One of the teams will be familiar to the readers of this blog: Itai Ashlagi, Yash Kanoria, Jacob Leshno, Mark Braverman and Peng Shi.  They received the award for a series of papers on matching, about which I'll blog in a subsequent post.

Frederick W. Lanchester Prize

The Lanchester Prize is awarded for the best contribution to operations research and the management sciences published in English in the past five years. 

Learn more about the Lanchester Prize and how to be nominated on the INFORMS website.

WINNING TEAM ONE

Anatoli Juditsky

Université Grenoble-Alpes

Arkadi Nemirovski

Georgia Tech

WINNING TEAM TWO

Itai Ashlagi

Stanford University

Yash Kanoria

Columbia University

Jacob Leshno

Chicago University

Mark Braverman

Princeton University

Peng Shi

University of Southern California

Honorable Mention

Guillermo Gallego

The Chinese University of Hong Kong, Shenzhen

Huseyin Topaloglu

Cornell University

 

 

Stability vs. No Justified Envy, by Romm, Roth and Shorrer

 Here's a recent paper that clarifies some of the prior literature on comparing stability in two-sided matching with a related kind of envy-freeness in allocations of goods to individuals using priorities.

Romm, Assaf, Alvin E. Roth, and Ran I. Shorrer, "Stability vs. No Justified Envy," Games and Economic Behavior, Volume 148, November 2024, Pages 357-366  https://doi.org/10.1016/j.geb.2024.10.002
 
Abstract: Stability and “no justified envy” are used almost synonymously in the matching theory literature. However, they are conceptually different and have logically separate properties. We generalize the definition of justified envy to environments with arbitrary school preferences, feasibility constraints, and contracts, and show that stable allocations may admit justified envy. When choice functions are substitutable, the outcome of the deferred acceptance algorithm is both stable and admits no justified envy.

Payments for election-related actions

 Buying votes is illegal, but other election related offers may seem odd but are legal.  

The Guardian has the story.

‘There are certain things that we don’t allow to be sold’: why vote buying in the US is illegal. by George Chidi

"Last week, Tesla CEO Elon Musk offered a $47 payment to people who refer registered voters in swing states to sign a petition supporting free speech and gun rights. The billionaire’s political action committee is using the petition to gather contact information in a last push for support of Donald Trump’s campaign.

"Responding to that offer, card game company Cards Against Humanity, long a Musk foe, announced it will pay up to $100 to each person who didn’t vote in 2020, who apologizes for that, makes a plan to vote and posts in public the phrase “Donald Trump is a human toilet.” Residents of swing states can earn the most money.

"The card game company told the New York Times that more than 1,150 people had been paid through the program as of Wednesday afternoon.

"Vote buying in illegal under US law, but Cards Against Humanity’s site claims that it is “exploiting a legal loophole to pay America’s blue-leaning non-voters”.

"The Guardian talked with Richard Hasen, a professor specializing in election law and director of the Safeguarding Democracy Project at the UCLA School of Law, about the legality – if not the propriety – of these offers.

Q:"I want to get a sense from you about where the line is. What’s legal and what’s not? What are we looking at with Trump buying $100 worth of groceries for somebody at the store, or Musk with this $47 thing, or the reaction by Cards Against Humanity to that? How much of this is legal, and how much isn’t?

A: "It’s all legal. The Cards Against Humanity one comes closest, but there’s a pretty bright line. You cannot pay someone to vote, to register to vote, to vote in a particular way in a federal election. Elon Musk is not paying anyone to vote. He’s paying for leads. I mean, if he’s actually going to pay people to vote, that’s a different question.

Italy criminalizes surrogacy from abroad

 Italy has banned its citizens from accessing surrogacy in other countries where it is legal.  It will be interesting to see how they enforce this. (But of course gay couples will have fewer opportunities to skirt the law than couples who could pretend to have had a pregnancy..)

The NYT has the story:

Italy Criminalizes Surrogacy From Abroad, a Blow to Gay and Infertile Couples. The new law was pushed by the party of Giorgia Meloni, Italy’s conservative prime minister. by Emma Bubola

"Italy passed a law on Wednesday that criminalizes seeking surrogacy abroad, a move the country’s conservative government said would protect women’s dignity, while critics see it as yet another crackdown by the government on L.G.B.T. families, as the law will make it virtually impossible for gay fathers to have children.

"Surrogacy is already illegal in Italy. But the government of Prime Minister Giorgia Meloni has vowed to broaden the ban to punish Italians who seek it in countries where it is legal, like in parts of the United States."

###########

Earlier:

Thursday, August 22, 2024  Surrogacy under continued attack in Italy

Proof of human

 TheTuring test was to see if computers could pass for humans, but as AI increasingly passes those tests, there may be increasing demands for humans to prove their humanity.  World (renamed from Worldcoin this week) plans to attack that task, in a privacy preserving way (i.e. you verify that you are human without identifying yourself).

Reuters has the story:

 Sam Altman's rebranded Worldcoin ramps up iris-scanning crypto project, By Anna Tong, October 17, 20242

"SAN FRANCISCO, Oct 17 (Reuters) - - Worldcoin, a cryptocurrency project founded by OpenAI CEO Sam Altman, said on Thursday it was rebranding to World Network and was ramping up efforts to scan every human's iris using its "orb" devices.

"Its core offering is its World ID, which the company describes as a "digital passport" to prove that its holder is a real human and tell the difference with AI chatbots online"

#########

Two snapshots I took at their event on Thursday:

"Market Design and Regulation" at Washington University, Oct 26 (but registration today)

 I'll be giving a public talk at Wash U in St. Louis on Saturday Oct 26, but here's a call for registration that suggests registration may close today. 

"Public Lecture with Al Roth (Stanford University); "Market Design and Regulation"

"Al Roth won the Nobel Memorial Prize in Economic Sciences in 2012. All who are interested in hearing Al Roth speak are invited to register.

"Registration will close on October 18, 2024. Registration is required to attend.

"Professor Roth will give highlights of market design that he pioneered such as kidney exchange and school choice in the first half of the talk. In the second half, Professor Roth will talk about controversial markets that may include topics such as blood plasma, abortion, IVF and surrogacy, marijuana, guns, digital data, etc. "

 

Opioids and transplantable organs

 Here's a paper that looks at how overdose deaths have joined automobile fatalities as a major source of deceased organ donations.

Opioids and Organs: How Overdoses Affect the Supply and Demand for Organ Transplants by Stacy Dickert-Conlin, Todd Elder, Bethany Lemont, and Keith Teltser, American Journal of Health Economics, 2024

"Abstract: As the incidence of fatal drug overdose quadrupled in the US over the past two decades, patients awaiting organ transplants may be unintended beneficiaries. We use Vital Statistics mortality data, merged with the universe of transplant candidates in the US from the Scientific Registry of Transplant Recipients, to study the extent to which the growth in opioid-related deaths affects the supply of deceased organ donors and transplants. Using two separate identification strategies, we find that opioid-related deaths led to more than 26,000 organ transplants in the US between 2000 and 2018. We find that transplant centers are increasingly recovering organs from overdose victims for transplant, with the association between opioid-related deaths and organ donors more than doubling between 2000 and 2018. We also present evidence that transplant candidates are more willing to use organs from those who died of opioid-related causes when organ shortages are relatively severe."

"The share of donors dying via overdose is now as large as the share killed in motor vehicle accidents, a sobering reflection of the opioid epidemic that produced a fourfold increase in annual overdose deaths between 1999 and 2019 (CDC 2020)."

NBER market design workshop at Stanford, tomorrow and Saturday

 Tomorrow and Saturday, market design at Stanford...

NBER Market Design Working Group Meeting, Fall 2024   DATE October 18-19, 2024

LOCATION SIEPR, Stanford University, Koret-Taube Conference Center, 366 Galvez Street

ORGANIZERS Michael Ostrovsky and Parag A. Pathak

  Format: 35 minute presentation, followed by 10 minute discussion.

Friday, October 18

9:00 am Continental Breakfast

9:30 am Designing Dynamic Reassignment Mechanisms: Evidence from GP Allocation, Ingrid Huitfeldt, University of Oslo, Victoria Marone, University of Texas at Austin and NBER, Daniel C. Waldinger, New York University and NBER

10:15 am Dynamic Matching with Post-allocation Service and its Application to Refugee Resettlement, Kirk C. Bansak, University of California, Berkeley, Soonbong Lee, Yale University, Vahideh Manshadi, Yale University, Rad Niazadeh, University of Chicago, Elisabeth Paulson, Harvard University

11:00 am  Break

11:30 am  Social Learning in Lung Transplant Decisions, Laura Doval, Columbia University, Federico Echenique, University of California, Berkeley, Wanying Huang, Monash University, Yi Xin, California Institute of Technology

12:15 pm  Endogenous Priority in Centralized Matching Markets: The Design of the Heart Transplant Waitlist, Kurt R. Sweat, Johns Hopkins University

1:00 pm Lunch

2:00 pm  Mechanism Reform: An Application to Child Welfare, E. Jason Baron, Duke University and NBER, Richard Lombardo, Harvard University, Joseph P. Ryan, University of Michigan, Jeongsoo Suh, Duke University, Quitze Valenzuela-Stookey, University of California, Berkeley

2:45 pm  The Competitive Core of Combinatorial Exchange, Simon Jantschgi, University of Oxford, Thanh T. Nguyen, Purdue University, Alexander Teytelboym, University of Oxford

3:30 pm  Break

4:00 pm  "Bid Shopping" in Procurement Auctions with Subcontracting(slides), Raymond Deneckere, University of Wisconsin-Madison, Daniel Quint, University of Wisconsin-Madison

4:45 pm Ads in Conversations: Market Thickness and Match Quality, Martino Banchio, Bocconi University, Aranyak Mehta, Google Research, Andres Perlroth, Google Research

5:30 pm Adjourn

7:00 pm  Group Dinner  Il Fornaio Palo Alto, 520 Cowper Street, Palo Alto, CA

Saturday, October 19

8:30 am Continental Breakfast

9:00 am Dynamic Auctions with Budget-Constrained Bidders: Evidence from the Online Advertising Market, Shunto J. Kobayashi, Boston University, Miguel Alcobendas, Yahoo Research

9:45 am The Welfare Effects of Sponsored Product Advertising, Chuan Yu, Harvard University

10:30 am Break

11:00 am An Empirical Analysis of the Interconnection Queue, Sarah Johnston, University of Wisconsin-Madison, Yifei Liu, University of Wisconsin-Madison, Chenyu Yang, University of Maryland

11:45 am  Iterative Network Pricing for Ridesharing Platforms Chenkai Yu, Columbia University, Hongyao Ma, Columbia University

12:30 pm  Lunch and Adjourn

New fellows of the Econometric Society

Congratulations to the 42 newly elected Fellows of the Econometric Society. That's up from 29 new Fellows elected in 2023, which is a step towards the goal (about which I blogged last year*) of electing more Fellows.  But elections depend on recognition that isn't equally available to every specialty and geography, so there are still many nominees and others who would be jewels in the crown of the Society.

"The Society is pleased to announce the election of 42 new Fellows of the Econometric Society. The 2024 Fellows of the Econometric Society follow.

Jerome Adda, Bocconi University 

Cristina Arellano, Federal Reserve Bank of Minneapolis (Secondary affiliation: Latin America)

Costas Arkolakis, Yale University

John Asker, University of California, Los Angeles (Secondary affiliation: Australasia)

David Atkin, Massachusetts Institute of Technology

Paul Beaudry, University of British Columbia

Sascha O. Becker, University of Warwick and Monash University

Sandra E. Black, Columbia University

Estelle Cantillon, Universite Libre de Bruxelles

Alessandra Casella, Columbia University

Thomas Chaney, University of Southern California

David Dorn, University of Zurich

Janice Eberly, Northwestern University, Kellogg School of Management

Kfir Eliaz, Tel Aviv University

Erica Field, Duke University

Andrea Galeotti, London Business School

Francisco Gallego, Pontificia Universidad Caatolica de Chile

Maitreesh Ghatak, London School of Economics (Secondary affiliation: Asia)

Olivier Gossner, CNRS - CREST; London School of Economics

Ayşe Ökten İmrohoroğlu, University of Southern California

Henrik Kleven, Princeton University

Kala Krishna, The Pennsylvania State University

Jeanne Lafortune, Pontificia Universidad Catolica de Chile

Francesco Lippi, LUISS University; Einaudi Institute for Economics and Finance

Deborah J. Lucas, Massachusetts Institute of Technology

Annamaria Lusardi, Stanford University

N. Gregory Mankiw, Harvard University

Kalina Manova, University College London

Elena Manresa, New York University

Enrique G. Mendoza, University of Pennsylvania (Secondary affiliation: Latin America)

Ismael Y. Mourifie, Washington University in St Louis (Secondary affiliation: Africa)

Barry Nalebuff, Yale School of Management

Andrew Newman, Boston University

Efe A. Ok, New York University

Guillermo Ordonez, University of Pennsylvania

Maria Petrova, Universitat Pompeu Fabra

Mar Reguant, IAE-CSIC; Northwestern University

Diego Restuccia, University of Toronto

Andrés Rodríguez-Clare, University of California, Berkeley (Secondary affiliation: Latin America)

Andrea Weber, Central European University

Luigi Zingales, University of Chicago Booth School of Business

Gabriel Zucman, Paris School of Economics; University of California, Berkeley

Finally, the Society would like to express its gratitude to the members of the 2024 Fellows Nominating Committee: Jan Eeckhout (chair), Mariacristina De Nardi, Marcela Eslava, Richard Holden, Yuichi Kitamura, Yaw Nyarko, and Nathan Nunn."

 

As I wrote last year, Congratulations again to the new Fellows, who have received the carefully considered and frugally awarded applause of their peers. 

##########

*Last year:

Tuesday, October 10, 2023

Econometric Society Fellows (2023), procedures, and some thoughts on prizes in general

Medical aid in dying comes up for a vote in England

 The upcoming vote on legalizing medical aid in dying in England and Wales has attracted controversy along lines that will be familiar to readers of this blog, concerning both fundamental values and slippery slopes.  But a comment by British Cardinal Vincent Nichols introduces an argument that I hadn't heard stated so clearly before, about the religious significance of suffering.  But first, here's the background, from the BMJ.

MPs set for historic vote on bill to legalise assisted dying in England and Wales,  by Clare Dyer, 07 October 2024  BMJ 2024;387:q2191

"A bill to legalise assisted dying for terminally ill people in England and Wales is expected to be introduced in the House of Commons on 16 October.

...

"Hundreds of terminally ill people from the UK have travelled to the Swiss clinic Dignitas to end their lives. But friends and relatives who help them are at risk of prosecution for assisting a suicide, which carries a maximum prison sentence of 14 years.

...

"Surveys of public opinion show that about two thirds of the public support allowing assisted dying. The BMA dropped its opposition in 2021 to take a neutral position on a change in the law."

##########

And here is a story about objections from a religious point of view, from the senior Catholic official in England.

UK’s top Catholic bishop urges faithful to lobby MPs to oppose assisted dying  by Hayden Vernon Sat 12 Oct 2024 

"The archbishop of Westminster continued: “The suffering of a human being is not meaningless. It does not destroy that dignity. It is an intrinsic part of our human journey, a journey embraced by the eternal word of God, Christ Jesus himself. He brings our humanity to its full glory precisely through the gateway of suffering and death.”

#############

Earlier:

Friday, March 1, 2024

Medical aid in dying--the ongoing debate in Britain

Nobel prize in economics to Daron Acemoglu, Simon Johnson, James A. Robinson

  "The Royal Swedish Academy of Sciences has decided to award the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 2024 to Daron Acemoglu, Simon Johnson, James A. Robinson “for studies of how institutions are formed and affect prosperity”

These three have a broad scope of work together.  One aspect that fits well with this year's prizes in Physics and Chemistry is a connection to artificial intelligence, particularly in the book Power and Progress by Acemoglu and Johnson:  

Power and Progress: Our Thousand-Year Struggle Over Technology and Prosperity  May 16, 2023 by Daron Acemoglu and Simon Johnson 

Here's the blurb by Abhijit Banerjee and Esther Duflo

"One powerful thread runs through this breathtaking tour of the history and future of technology, from the Neolithic agricultural revolution to the ascent of artificial intelligence: Technology is not destiny, nothing is pre-ordained. Humans, despite their imperfect institutions and often-contradictory impulses, remain in the driver’s seat. It is still our job to determine whether the vehicles we build are heading toward justice or down the cliff. In this age of relentless automation and seemingly unstoppable consolidation of power and wealth, Power and Progress is an essential reminder that we can, and must, take back control."

Stable matching in Scientific American

 Here's a short article in Scientific American, describing the deferred acceptance algorithm and mentioning some uses for stable matching. (When I was a child, Scientific American opened a window on science for me...)

The ‘Stable Marriage Problem’ Solution Underpins Dating Apps and School Admissions. An elegant matchmaking algorithm called Gale-Shapley can find the best possible pairings for everybody.   By Max Springer

"Let’s create a reality dating show unlike any other in one key aspect. First, we’ll rent a villa on a tropical island. Then we’ll fly in five men and five women, each with their own (heterosexual) dating preferences. Our goal, though, is the exact opposite of the Love Island franchise: we want absolutely zero drama. Can we ensure that everyone pairs off with a partner and sticks with them, without jealousy rearing its ugly head?" 

########

Along the way they briefly quote these luminaries (in the order in which they appear): 

Vijay Vazirani, Jon Kleinberg, Utku Ünver, and Éva Tardos.

Kim Krawiec interview about WHO demands for national self sufficiency in blood donation and kidney exchange

 The University of Virginia takes note of the recent Krawiec & Roth paper I blogged about in August.

Here is their interview with Kim about the paper:

WHO Stifles International Blood and Organ Donations, Argue Professors. Professor Kimberly Krawiec, Nobel Prize Winner Alvin E. Roth of Stanford Argue World Health Organization Policies Need Revision

Here are the first two Q&As

"What motivated you to critique the WHO principles of self-sufficiency and nonremuneration in organs and blood? ​

"The severe shortage of both blood products and transplantable organs, especially kidneys, was our motivation and has motivated much of our other work, both together and separately. In the United States alone, the organ transplant waiting list is approximately 100,000 people, and if current trends continue, it will only grow in the coming years.

"Shortages of blood products present a similar challenge. Although wealthy countries are typically able to satisfy domestic whole blood needs, the vast majority of low- and middle-income countries (LMIC) are not. As a result, in many LMIC, shortages of blood for transfusion contribute to maternal death, death from traffic accidents and complications from childhood anemia. Moreover, even wealthy countries experience seasonal shortages of whole blood or deficiencies in some blood components, such as platelets, which are harder to collect and have a shorter shelf life.

The shortage of plasma-derived medicinal products (PDMPs) is particularly severe and entirely preventable. PDMPs are life-saving treatments for multiple acute and chronic conditions for which there are no alternative treatments. Yet these life-saving therapies are unavailable to much of the world’s population. The United States, one of the few countries to pay plasma donors, supplies 70% of the world’s plasma needs, with Germany, Austria, Hungary, Czechia and Latvia (which also permit some form of payment for plasma donors) supplying another 20% of the world total. In other words, a handful of countries supply plasma to the rest of the world, including other wealthy countries. Meanwhile, LMIC who can neither collect and process their own nor afford to purchase blood products on the open market (or are prevented from doing so under the terms of the foreign aid that supports their health system) simply do without, to the detriment of their citizens.

"How do current WHO policies on organ and blood donation contribute to this problem?

"WHO policy mandates both national (or sometimes only regional) self-sufficiency and an absence of remuneration for both blood products and transplantable organs — what we refer to in the paper as “the twin principles.” These twin principles are unhelpful separately and unworkable together. Their effect on blood products is particularly stark — no country that fails to compensate donors is self-sufficient in plasma collection and few LMIC collect sufficient supplies of whole blood.

"The self-sufficiency mandate presents a real hurdle to progress in transplantation, especially for smaller countries and LMIC. This is especially the case because some of the most exciting and promising developments for increasing the availability of transplants have been in kidney exchange, a mechanism that leverages in-kind exchange, rather than financial compensation, to encourage and facilitate donation among those with willing but incompatible partners. But kidney exchange works best when a large pool of patient-donor pairs can engage with one another. So, requiring that transplantation be contained within national boundaries unnecessarily limits access to transplants that could be achieved only by cross-border exchange."

Medical Aid in Dying Laws in the U.S.

 JAMA has a review of the current state of medical aid in dying in the 12 U.S. jurisdictions (if Delaware proceeds) that now allow it.

Medical Aid in Dying Laws: More Accessible in More States by Thaddeus Mason Pope, JD, PhD, JAMA. 2024;332(14):1139-1140. doi:10.1001/jama.2024.15925

"Delaware may soon become the 12th US jurisdiction to authorize medical aid in dying. The Ron Silverio/Heather Block End-of-Life Options Law1 becomes a statute as soon as the governor acts and takes effect once the Delaware Department of Health and Social Services promulgates regulations to implement the statute. Delaware could follow 11 other US jurisdictions that have authorized medical aid in dying; more than 15 000 patients have received prescriptions for medical aid in dying since 1998 in California, Colorado, Hawaiʻi, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, Washington, and Washington, DC.

...

"Medical aid in dying has become an increasingly prominent end-of-life option. More than 20 states considered new medical aid in dying legislation in 2024, and most of the 11 jurisdictions that previously authorized medical aid in dying have amended their original statutes during the past 5 years (eTable in the Supplement).2-6 When enacting or amending medical aid in dying statutes, state policymakers have been carefully recalibrating the balance between safety and access

...

"Medical aid in dying is only available to terminally ill adults with decision-making capacity. They must have an “incurable and irreversible illness” with a prognosis of 6 months or less. If patients can navigate the other eligibility requirements and safeguards, they can get a prescription for lethal medications that they might later self-ingest to hasten their death.6

"Hospice and palliative care are often sufficient to address the suffering of patients, and one-third of those who receive medical aid in dying prescriptions never obtain them from the pharmacy or ingest them.3,4 Most of the remaining patients administer the prescriptions by mixing the powdered drugs with 2 oz to 3 oz of apple juice or push a plunger on a feeding or rectal tube. The patients fall asleep within minutes and usually die within an hour. There is never intravenous administration of the prescriptions or clinician- or third-party administration of the prescriptions.

...

"The Delaware end-of-life options law would require the patient to make 3 requests, 2 of which must be separated by at least 15 days.1 A waiting period has been a requirement in all jurisdictions that have authorized medical aid in dying. However, significant evidence showed that many patients either died or lost decision-making capacity before expiration of the waiting period.4 Many states (California, Colorado, Hawaiʻi, New Mexico, Oregon, and Washington) have either shortened their waiting periods or permit the waiting period to be waived when the patient is likely to die or lose decision-making capacity.

"The Delaware end-of-life options law would be limited to residents of Delaware1; however, for nonresidents, Delaware residency can be established by renting an apartment in Delaware.4 Residency requirements remain an additional hurdle in a long list of obstacles that terminally ill patients must navigate to become eligible. Within the past 2 years, both Oregon and Vermont removed their residency requirements.2,4,6 And the constitutionality of New Jersey’s residency requirement is being challenged in federal court.6 Nationwide, many bills proposed in 2024 omitted residency preconditions.

...

"Commentators regularly express concerns about the use of medical aid in dying in Canada7 and in Europe. It is important to protect vulnerable populations from coercion, duress, and inadequately considered choices; patients should not be steered toward choosing to request medical aid in dying. In addition, the adverse effects of orally ingested medications must be mitigated.4 In California, SB 1196 would have probably solved that problem by permitting (self-administered) intravenous administration of the end-of-life prescriptions. However, any change that would allow intravenous administration and other new and imminent expansions for medical aid in dying raise their own set of novel challenges for US clinicians.

"Given the number of bills and other indicators of interest, medical aid in dying is likely to be authorized in more states over the next few years, and the use medical aid in dying is likely to increase with more accessible terms and conditions. Although medical aid in dying continues to be used by less than 1% of dying patients,2 it is becoming a more integral part of end-of-life care."

Kidney exchange in Brazil, continued (with pictures)

 In August I posted about a trip to Brazil with Mike Rees where we traveled with Dr. Gustavo Ferreira, the director of transplantation at the hospital Santa Casa de Misericórdia de Juiz de Fora

Part of our trip was spent in the capital, Brasilia, talking to the government about extending Brazilian transplant law to allow kidney exchange, after which we went to Juiz de Fora.  Here's my blog post about that trip:  Kidney exchange in Brazil: prelude. 

That post concluded by saying "On Saturday we had an exciting finish to the trip, but it's not my story to tell yet, so I'll blog again after there is an official announcement."

Now Brazil's first three-way kidney exchange has been announced, as part of a clinical trial that I hope will help change Brazilian law to allow kidney exchange as a regular medical procedure.  The three donors and three recipients all did well, and left the hospital very shortly after the actual surgeries, but came back to tell their stories to the Brazilian news show Profissão Repórter (Professional Reporter). You can see the video here  https://globoplay.globo.com/v/12997336/

It's in Portuguese but you will quickly get the idea, presented even more briefly on Instagram by the transplant nephrologist Dr. Juliana Bastos here: https://www.instagram.com/reel/DA4JBVIsFta/?igsh=d2hnb3hoNjJxN2I4     where you can see the three incompatible patient-donor pairs rearrange themselves for the camera into the three-way exchange in which each patient received an organ from a compatible donor. (Dr. Bastos recently added a PhD to her MD, with a dissertation on kidney exchange.)

Here's another Instagram link to the video.

I had the privilege of observing parts of five of the six surgeries (three nephrectomies and three transplants), and some pictures are below.  

If someone directs a movie about this kind of transplant surgery, there will be two dramatic scenes, one in which the donated kidney is carried across the hall to the transplant operating room, and the second showing the moment the clamps are removed from the blood vessels of the transplanted kidney, so that it turns from grey to pink as blood returns to it. 

But here's a photo I took at  the start of what I think is the most dramatic moment of the surgery, as the artery from the kidney is just about to be connected to the artery of the recipient.

The artery from the donated kidney is the small white tube being pointed to by the instrument held in the fingers at the top right of the picture. Immediately in front of it--the long red tube--is the artery of the recipient, to which it must be connected so that blood can again flow to the kidney.  Notice that a small incision has already been made in the recipient's artery--this is where the two will be attached. The connection has to be perfect, so that the blood can flow without obstruction that could cause a clot.

The surgeon who first figured out how to do this kind of vascular surgery, Dr. Alexis Carrel, won the 1912 The Nobel Prize in Physiology or Medicine

I was able to follow the proceedings thanks to the running commentary offered to me by the Brazilian surgeons and by Mike Rees (who wasn't busy doing surgery). That wasn't the only kind of support Mike offered me in the OR (as I balanced on a pair of stools to better appreciate the commentary):

And here's a post-op picture of most of the big team that made it happen:

##########

Parabéns ao Gustavo e à Juliana! Congratulations. Your work and leadership can make a big difference not just to your patients, but to people all over Brazil.

#############

Earlier:

Monday, August 12, 2024

Kidney exchange in Brazil: prelude

IV fluid shortages in the U.S.--perhaps we should allow international imports?

There's a hurricane-induced shortage of intravenous (IV) fluid.  Maybe we should import some? (But...international borders...)

An obstacle is that FDA approval of the factories is usually needed, but can be (and in the past has been) suspended, to allow imports from places that do their own high quality inspection (like Australia and Ireland in 2017--I guess it's good that the labels are in English) .  

More generally, after the Covid pandemic we learned of the fragility of supply chains that have concentrated overseas sources (like surgical masks from Wuhan).  The reaction has been to onshore more production. But concentrated domestic production also makes for fragile supply chains, and being able to diversify to overseas producers could strengthen them.

Statnews has the story:

White House should declare national emergency over IV fluid shortages caused by Helene, says hospital group. Hurricane Helene shuttered a Baxter plant that manufactures 60% of IV solutions for the U.S.  By Brittany Trang 

"Amid Hurricane Helene shuttering a major IV solution manufacturing plant and Hurricane Milton now barreling toward other IV manufacturing facilities in central Florida, the American Hospital Association on Monday asked the Biden administration to declare a shortage of IV solutions and invoke national emergency powers to ease the crisis. 

'In late September, Hurricane Helene shut down a Baxter plant in Marion, N. C., which manufactures approximately 60% of the IV solutions for the U.S. Both Baxter and “all other suppliers” of IV solutions have restricted how much their customers can order and have stopped taking new customers, AHA president Rick Pollack wrote in the organization’s letter to Biden. As a result, hospitals have declared internal shortages and restricted IV use. 

...

"In addition, the letter asked for the government to declare a national emergency and public health emergency so that Medicare and Medicaid rules around IV infusions can become more flexible, and to invoke the Defense Production Act to expand the production of IV solutions and bags. The AHA also suggested the government put the Federal Trade Commission and Department of Justice on alert for price gouging during the shortage.

Another step the FDA could take is to allow the importation of IV bags from other countries,* as it did when Hurricane Maria shut down Baxter’s Puerto Rico-based IV saline plants in 2017. That shortage mostly affected small IV bags. According to Vizient, a health care performance improvement company, the North Carolina Baxter plant is largely a producer of large IV bags, including saline, dextrose, and Ringer’s lactate solutions.

#####

*In 2017: "To address a shortage of intravenous solution bags exacerbated by Hurricane Maria, the Food and Drug Administration has granted permission for a health supply company to import certain products to the United States from Australia and Ireland."

#########

Related:

Wednesday, August 28, 2024

WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood, by Krawiec and Roth