Kidneys and Controversies at Mt. Sinai hospital

 I gave a talk yesterday at Mt. Sinai hospital. They had encouraged me to talk about controversies, which I happily did.  They were a sympathetic audience (although the majority of their last five speakers would not have been:)

 

 

 

The End Kidney Deaths Act is reintroduced to the 119th Congress

 Resolved: lets be generous to nondirected kidney donors

H.R.2687 - To amend the Internal Revenue Code of 1986 to provide a refundable tax credit for non-directed living kidney donations.
119th Congress (2025-2026) |
Sponsor:    Rep. Malliotakis, Nicole [R-NY-11] (Introduced 04/07/2025)
Committees:    House - Ways and Means; Energy and Commerce 

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Earlier

Tuesday, January 21, 2025 The debate over compensating organ donors is heating up

Tuesday, August 13, 2024 End Kidney Deaths Act intoduced in Congress

 

 

Kennedy proposes to focus on chronic disease, but terminates large-scale long-running NIH Diabetes Prevention study

 The NYT has the story:

As Kennedy Champions Chronic Disease Prevention, Key Research Is Cut.  Two significant programs that invested in research on diabetes, dementia, obesity and kidney disease have ended since the start of the Trump administration. By Gina Kolata  April 7, 2025

"on Monday he is starting a tour in the Southwest to promote a program to combat chronic illness, emphasizing nutrition and lifestyle.
 

"But since Mr. Kennedy assumed his post, key grants and contracts that directly address these diseases, including obesity, diabetes and dementia, which experts agree are among the nation’s leading health problems, are being eliminated.

...

“This is a huge mistake,” said Dr. Ezekiel Emanuel, the co-director of the Healthcare Transformation Institute at the University of Pennsylvania’s Perelman School of Medicine."

Decades of Diabetes Research Discontinued
"Ever since its start in 1996, the Diabetes Prevention Program has helped doctors understand this deadly chronic disease. The condition is the nation’s most expensive, affecting 38 million Americans and incurring $306 billion in one recent year in direct costs. With about 400,000 deaths in 2021, it was the eighth leading cause of death.
"The program has been terminated 

..

"On March 7, the Trump administration cut $400 million in grants and contracts to Columbia, saying Jewish students were not protected from harassment during protests over the war in Gaza. The diabetes grant was among those terminated: $16 million a year that Columbia shared across 30 medical centers. The study ended abruptly.

...

"Now much of the work cannot begin, and the part that had started remains incomplete."

After the proposal: the market for weddings

Weddings are a big business. So is the business of matching brides to wedding service providers.  But there are a lot of vendors with complaints about the Knot, the biggest matchmaker of brides and service providers.

 The New Yorker has the story:

Does the Knot Have a “Fake Brides” Problem?
The popular wedding website helps d.j.s, caterers, and florists find spouses-to-be. Some venders say they’re finding something else.  By Adam Iscoe

" In addition to hosting gift registries and wedding websites, and offering reception ideas and relationship advice (“What to Know About Walmart Wedding Cakes,” “How to Prepare for Sex on Your Wedding Night,” “Dislike Your Spouse’s Last Name? Here’s What to Do”), the Knot is used by millions of couples to find their wedding venders, who pay to advertise on it. 

...

"Each year, Americans drop roughly seventy billion dollars hosting weddings. Most people think that this is too much—that couples are overspending, that venders are overcharging, and that the wedding-industrial complex verges on unethical.

...

" running a wedding business is especially tough: there are hundreds of thousands of competitors; costs are rising, owing in part to inflation; and, for many venders, bookings and budgets have decreased by about twenty-five per cent. According to a recent industry survey, a third of all wedding venders said that they are doing poorer financially than they were a year ago. “Florists are the worst,” McIntosh said. “There are so many broke florists.”

...

"Last year, the Knot facilitated four billion dollars in consumer spending via advertising on its platforms. Most of the company’s revenue comes not from brides and grooms but from wedding venders. Nine hundred thousand venders in more than ten countries use the Knot, and many pay to be advertised to couples—“leads,” in industry parlance—seeking their services. "

CDC’s laboratory on sexually transmitted diseases is shut by Trump administration

 Statnews has the story:

CDC’s top laboratory on sexually transmitted diseases is shut by Trump administration
‘We are blind,’ researcher says, noting the lab is crucial to tracking drug-resistant gonorrhea and other diseases  By Helen Branswell April 5, 2025

"At a time when the world is down to a single drug that can reliably cure gonorrhea, the U.S. government has shuttered the country’s premier sexually transmitted diseases laboratory, leaving experts aghast and fearful about what lies ahead.

"The STD lab at the Centers for Disease Control and Prevention — a leading player in global efforts to monitor for drug resistance in the bacteria that cause these diseases — was among the targets of major staff slashing at the CDC this past week. All 28 full-time employees of the lab were fired.

...

"A CDC white paper on antibiotic resistance released during the first Trump administration listed drug-resistant gonorrhea as one of five urgent threats facing the country. Antimicrobial resistance to that last drug that reliably works to cure gonorrhea, ceftriaxone, is rare but on the rise globally."

 

High school and higher education (30 second video)

 Someone recently sent me this old video snippet (about 30 seconds) from an interview in Stockholm in 2012.  Whenever I'm asked about my high school career I try to emphasize that I'm a big fan of education, even though I didn't finish high school.

Note to the un-Facebooked: if, like me, you don't have a facebook account, you may have to close a facebook come-on before you can see the video.

The market for rare (and signed) books

 Books inscribed by the author are stories in themselves.

Here's a story published last year in The New Yorker about the rare book market, and the art of selling.

A Controversial Rare-Book Dealer Tries to Rewrite His Own Ending
Glenn Horowitz built a fortune selling the archives of writers such as Vladimir Nabokov and Alice Walker. Then a rock star pressed charges.  By Tad Friend

"Every form of collecting is an effort to stop time, but book collecting is a singularly hopeful incarnation of that wish. It is nourished by twin beliefs: first, that our most glorious ideas and fancies have been bound together in crushed morocco or polished calf—sacred repositories that must be conserved against fire and water and forgetfulness. And, second, that ownership of great literature in its most talismanic form will ennoble you. Horowitz cultivates these credos in his clients, yet his usual practice is to wrest books from the grip of one, bestow them into the hands of another, then wrest them back for a third. When I told him that Susan Cheever, the writer and the daughter of John Cheever, said that Horowitz had paid her handsomely for her father’s inscribed novels and letters “because Glenn is a gentleman, and because he wanted to help me,” he seemed offended. “I like Susan enormously,” he assured me, “but I bought from her at prices that allowed me to sell the material profitably.” 

...

" Traditional collecting aims at first editions in “pristine” or “mint” condition; the booksellers’ wry joke is “Never judge a book by its contents.”

A user's guide to Experimental Economics, by Muriel Niederle

 Here's a magisterial handbook chapter, by Muriel Niederle

Experiments: Why, How, and A Users Guide for Producers as well as Consumers  by Muriel Niederle
NBER Working Paper 33630, DOI 10.3386/w33630,  March 2025A

Abstract:"This chapter is intended as an introduction to laboratory experiments, when to use, how to evaluate them, why they matter and what are the pitfalls when designing them. I hope that users as well as consumers will find Sections that broaden their views. I start with when an economist might want to run an experiment. I then discuss basic lessons when designing experiments. I introduce a language to start a systematic description of tools we have when designing experiments to show the importance or role of a new model or force in explaining behavior. The penultimate chapter provides an advanced toolkit for running experiments. I end this chapter with my views on pre-registration, pre-analysis plans and the need for replications, robustness tests and extensions. "

...

"While I hope to convey general lessons, I will make them more accessible and understandable by providing specific examples. These will often, though not always, come from my own papers, or from economists whose work I know exceptionally well (mostly my advisors, students or coauthors). While this may seem self-serving, the main reason is that for those experiments I know– rather than have to infer– why authors made certain choices. And one aspect of experiments that will become obvious almost immediately, is that they require the researcher to make a lot of decisions. This chapter therefore is in no way a literature survey, nor really a highlight of amazing papers. It rather showcases papers whose history I am exceptionally familiar with. I will also not provide negative examples, but rather present potential pitfalls, with one exception in Section 3.1 "

The Economist as Designer: Susan Athey's AEA presidential address

 Susan Athey, throughout her career and in her presidential address to the AEA, has added to our vision of how economists can make our way in the world.

Presidential Address: The Economist as Designer in the Innovation Process for Socially Impactful Digital Products  By Susan Athey,  American Economic Review 2025, 115(4): 1059–1099, https://doi.org/10.1257/aer.115.4.1059

"This paper provides an economic perspective on data-driven innovation in digital products, focusing on the role of complex experiments in measuring and improving social impact. The discussion highlights how tools and insights from economics contribute to each stage of the innovation process. Key contributions include identifying problems, developing theoretical frameworks, translating goals into measurable outcomes, analyzing historical data, and estimating counterfactual outcomes. The paper also surveys recently developed tools  designed to address challenges in designing and analyzing data from complex experiments "

##########

I'm fond of papers that consider "The Economist As..."  See e.g.

Monday, January 30, 2017 Economists as artisans, doctors, entrepreneurs...dentists, engineers and plumbers

and

The economist as engineer: Game theory, experimentation, and computation as tools for design economics,  AE Roth, Econometrica, 2002 

 

Headlines that could have been dated April 1

 This year there's one headline that stands out from all the others:

The Trump Administration Accidentally Texted Me Its War Plans
U.S. national-security leaders included me in a group chat about upcoming military strikes in Yemen. I didn’t think it could be real. Then the bombs started falling.  By Jeffrey Goldberg

##########

Back before the  November election, the headlines that seemed most Foolish were much more cheerful

 French pole vaulter video: Anthony Ammirati dislodges bar with penis, costing him medal opportunity at 2024 Olympics

    (And here's the video)

LAPD Raids Medical Lab For (Nonexistent) Weed, Get Gun Stuck In An MRI Machine

 

Open letter on Science

 Here's the NYT story out this morning,

Trump Administration Has Begun a War on Science, Researchers. Say Nearly 2,000 scientists urged that Congress restore funding to federal agencies decimated by recent cuts.

 

And here's the letter (and all the signatures):
TO THE AMERICAN PEOPLE
We all rely on science. Science gave us the smartphones in our pockets, the navigation systems in our cars, and life-saving medical care. We count on engineers when we drive across bridges and fly in airplanes. Businesses and farmers rely on science and engineering for product innovation, technological advances, and weather forecasting. Science helps humanity protect the planet and keeps pollutants and toxins out of our air, water, and food.

For over 80 years, wise investments by the US government have built up the nation’s research enterprise, making it the envy of the world. Astoundingly, the Trump administration is destabilizing this enterprise by gutting funding for research, firing thousands of scientists, removing public access to scientific data, and pressuring researchers to alter or abandon their work on ideological grounds.

The undersigned are elected members of the National Academies of Sciences, Engineering, and Medicine, representing some of the nation’s top scientists, engineers, and medical researchers. We are speaking out as individuals. We see real danger in this moment. We hold diverse political beliefs, but we are united as researchers in wanting to protect independent scientific inquiry. We are sending this SOS to sound a clear warning: the nation’s scientific enterprise is being decimated.

The administration is slashing funding for scientific agencies, terminating grants to scientists, defunding their laboratories, and hampering international scientific collaboration. The funding cuts are forcing institutions to pause research (including studies of new disease treatments), dismiss faculty, and stop enrolling graduate students—the pipeline for the next generation’s scientists.

The administration’s current investigations of more than 50 universities send a chilling message. Columbia University was recently notified that its federal funding would be withheld unless it adopted disciplinary policies and disabled an academic department targeted by the administration. Destabilizing dozens of universities will endanger higher education—and the research those institutions conduct.

The quest for truth—the mission of science—requires that scientists freely explore new questions and report their findings honestly, independent of special interests. The administration is engaging in censorship, destroying this independence.  It is using executive orders and financial threats to manipulate which studies are funded or published, how results are reported, and which data and research findings the public can access. The administration is blocking research on topics it finds objectionable, such as climate change, or that yields results it does not like, on topics ranging from vaccine safety to economic trends.

A climate of fear has descended on the research community. Researchers, afraid of losing their funding or job security, are removing their names from publications, abandoning studies, and rewriting grant proposals and papers to remove scientifically accurate terms (such as “climate change”) that agencies are flagging as objectionable. Although some in the scientific community have protested vocally, most researchers, universities, research institutions, and professional organizations have kept silent to avoid antagonizing the administration and jeopardizing their funding.

If our country’s research enterprise is dismantled, we will lose our scientific edge. Other countries will lead the development of novel disease treatments, clean energy sources, and the new technologies of the future. Their populations will be healthier, and their economies will surpass us in business, defense, intelligence gathering, and monitoring our planet’s health. The damage to our nation’s scientific enterprise could take decades to reverse.

We call on the administration to cease its wholesale assault on U.S. science, and we urge the public to join this call. Share this statement with others, contact your representatives in Congress, and help your community understand what is at risk. The voice of science must not be silenced.  We all benefit from science, and we all stand to lose if the nation’s research enterprise is destroyed.  

The views expressed here are our own and not those of the National Academies or our home institutions.

Mike Ostrovsky on congestion pricing (podcast)

Congestion pricing: as it's happening:

Congestion Pricing: Economics, Theory, Reality

March 29, 2025 • 57 mins
with @mostrovs @skominers @rhhackett

Welcome to web3 with a16z. I’m your host Robert Hackett, and today we’re talking about congestion pricing — an area of mechanism design that’s aimed at alleviating something everyone hates: traffic.

Now you may have heard this term recently since New York adopted its own version of congestion pricing at the beginning of the year. This is the first program of its kind in the U.S. — and it’s got supporters and detractors. We’ll talk about that, and we’re also going to talk about much more.

In the first part of today’s episode we’ll trace the history of the economic ideas that got us here. In the middle, we’ll dig deeper into the details of putting congestion pricing into practice, plus technological alternatives. And in the final part, we’ll explore parallels to — and implications for — crypto networks.

Our guests are Michael Ostrovsky, a Stanford Economics Professor who specializes in this area and who has done research on congestion pricing in New York. We’re also joined by a16z crypto Research Partner Scott Kominers, who is a Professor of Business Administration at Harvard Business School where he teaches market design and entrepreneurship.

Resources:

• Michael Ostrovsky's paper on congestion pricing in New York City (from before the launch, foreseeing its issues): https://web.stanford.edu/~ost/papers/nyc.pdf
• Michael Ostrovsky's thread that went viral on X shortly after the debut of congestion pricing in New York, discussing the post-launch evidence, his team's data collection efforts, and the link between observed data and predictions in the above paper: https://x.com/mostrovs/status/1876798157595476420
• Two of Ostrovsky's earlier theoretical papers on the topic: (1) https://web.stanford.edu/~ost/papers/complementarity.pdf, (2) https://web.stanford.edu/~ost/papers/sdc.pdf
• Economist William Vickrey's influential paper on congestion pricing: Vickrey, W. S. (1969). Congestion theory and transport investment. American Economic Review 59 (2), 251–260. https://matthewturner.org/ec2410/readings/Vickrey_AER_1969.pdf

Billionaires and their nannys

 Billionnaires have been moving to Palm Beach and that has changed the local market for nannys.

The New Yorker has the story:

The Six-Figure Nannies and Housekeepers of Palm Beach.  An influx of ultra-high-net-worth newcomers has increased demand for experienced—and discreet—household staff.  By Emily Witt 

"Palm Beach is an island—known locally as “the Island”—connected to the larger and less posh city of West Palm Beach, on the mainland, by a series of bridges. It was first developed as a winter escape for the wealthy, in the late nineteenth century, by the railroad and Standard Oil magnate Henry Flagler, and quickly became an old-money enclave whose pretentiousness was entwined with antisemitism and racism. 

...

" an estimated sixty-five billionaires now have homes in Palm Beach County. President Trump’s ties to Florida, especially his seventeen-acre oceanfront social club, Mar-a-Lago, have cemented South Florida as a center of financial and political power, and there’s heavy overlap between the list of his boosters and the newcomers to Palm Beach

...

"A director of estates managing a family’s eight or ten houses might earn three to five hundred thousand dollars a year and oversee dozens of employees and contractors, but even housekeepers, if they possess the right qualifications, can earn more than a hundred thousand dollars a year with benefits, and paid vacation, in certain markets

...

"Thompson said that she had already signed up two hundred and fourteen members to the Polo Club that year. (At thirty-four thousand dollars, its initiation fee is much lower than those of Palm Beach’s Carriage House, the Breakers, or Mar-a-Lago, whose fee Trump hiked in August to a million dollars.)

...

" In job interviews, Lisa Miller, senior search executive with Mahler Private Staffing, will test candidates. “One of the joys of what I do is getting them not to be discreet,” Miller said, of the interviewing process. “I ask them questions and see if they share too much.”

...

“The parents want to have the top staff, so they hire the top nannies,” she said. “They’ve been in élite people’s homes, they don’t get starstruck if they see a professional athlete or someone that’s in the White House.”

Healthcare as a modern jobs engine, by Gottlieb, Mahoney, Rinz and Udalova

Here's a paper with cheerful results about employment and wages in health care.

Rise of Healthcare Jobs  by Joshua D. Gottlieb, Neale Mahoney, Kevin Rinz, and Victoria Udalova, NBER Working Paper No. 33583  March 2025

ABSTRACT: "Healthcare employment has grown more than twice as fast as the labor force since 1980, overtaking retail trade to become the largest industry by employment in 2009. We document key facts about the rise of healthcare jobs. Earnings for healthcare workers have risen nearly twice as fast as those in other industries, with relatively large increases in the middle and upper-middle parts of the earnings distribution. Healthcare workers have remained predominantly female, with increases in the share of female doctors offsetting increases in the shares of male nurses and aides. Despite a few high-profile examples to the contrary, regions experiencing manufacturing job losses have not systematically reinvented themselves by pivoting from ``manufacturing to meds.'' 

...

"In 2006, healthcare overtook manufacturing in terms of employment, and in 2009 healthcare overtook retail trade to become the largest industry by employment in the U.S. 

...

"We show that employment growth has been fairly uniform across most clinical occupations. The exception is a new category known as midlevels, which includes physician assistants and nurse practitioners. This category—which was too small to be consistently measured prior to 2010—has more than doubled since 2010, growing from 227,000 to 505,000 workers. As of 2022, there were more midlevels than primary care physicians, and midlevels provided more than half of primary care services in the U.S. (HRSA, 2023).

"This healthcare employment growth was accompanied by strong earnings growth, especially for nurses and midlevels in the middle and upper-middle parts of the clinical occupational distribution. Specifically, earnings grew nearly twice as fast for healthcare workers as for non-healthcare workers from 1980 to 2022; during this window, average healthcare earnings rose from 4% below to over 14% above the average for non-healthcare workers. While the top percentile of the wage distribution has fared better outside of healthcare, healthcare wages have grown faster for the rest of the distribution, and are particularly strong between the middle and the 95th percentiles. Indeed, with strong employment growth and earnings growth that outpaced the rest of the economy outside the very top, it is reasonable to conclude that healthcare has been a modern middle-class “jobs engine.”

 

 "The descriptive analysis in this paper offers three key findings about the rise of healthcare jobs: the relatively strong growth of earnings in the middle and upper-middle parts of the distribution, including for nurses and midlevels; the partial convergence in gender ratios across clinical occupations; and the scant evidence of a systematic manufacturing-to-meds transition, despite high-profile examples."

House panel launches antitrust probe of medical residency system

 What's old is new again, as questions about the market for doctors focuses on the Match (as opposed to accreditation of residencies by medical specialty boards, etc.)

Reuters has the story:

US House panel launches antitrust probe of medical residency system  By Mike Scarcella 

"March 17 (Reuters) - A U.S. congressional committee is investigating how medical students are placed in residency training programs, seeking documents from major university hospitals, the American Medical Association and other organizations as part of an antitrust probe.
The Republican leadership of the House Judiciary Committee’s antitrust panel sent the hospitals and groups letters on Friday saying they are investigating whether restrictions on hiring practices in the medical residency market suppress aspiring doctors' mobility and pay and contribute to doctor shortages."

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Earlier:

Monday, May 28, 2018

Protecting and Preserving Competition in Matching Markets--Antitrust and the Medical Match (video)

 My talk there begins with a description of the Match and its history, and I address antitrust starting right around minute 30.  (There's also a bonus video about how the Match would work at Harry Potter's Hogwarts...)

Match Day: new doctors can be eloquent

 Last Friday was Match Day, when medical students learn where they matched to a residency position.

Here's the story from Stanford:

Students open envelopes and learn their futures on Match Day
In concert with graduating medical students around the nation, members of Stanford School of Medicine’s Class of 2025 discovered where they’re spending the next leg of their training journey. 

"on the third Friday in March, all at the same time (noon on the East Coast), the medical students learn their fates.

This year, 81 Stanford Medicine graduates matched to residency programs in specialties ranging from psychiatry to ophthalmology to pediatrics. About 40% are staying at Stanford Health Care – a typical proportion.

...

"Basil Baccouche (who matched to internal medicine at Brigham and Women’s), chosen by his classmates to speak at the event, highlighted emotional moments during medical school.

“Medical school was the first time many of us saw the beginnings of life and the coming of death. The astonishing responsibility of caring for another person,” he said.

“I’ll never forget the first time I delivered a baby. Suddenly, there was one more of us in the room, and I began to cry.”

Digital DNA still needs to find a business model

 DNA information is digital, so for a while we seemed poised on a 'viral' bio-informatics revolution, which may still come.  23andMe looked like the start of the consumer side of that business, but people only need  to upload their data once, and the rest of the business didn't take off...

 The WSJ has the story:

23andMe Went From a $6 Billion Giant to Bankruptcy. Its Former CEO Won’t Walk Away.
Anne Wojcicki aims to buy the assets of her failed DNA-testing company after her prior bids were rejected   By Rolfe Winkle

"23andMe, once valued at $6 billion, has filed for bankruptcy after burning through $1 billion and laying off over half its staff.

"Former CEO Anne Wojcicki's ambitious plans to use 23andMe's genetic data for drug discovery and healthcare services failed to generate revenue.

"Despite her supervoting shares, Wojcicki's bids to buy back the company were rejected by two boards of directors."

...

"On Sunday night, the company filed for bankruptcy protection, its survival uncertain. Wojcicki immediately vowed to buy it back.

...

"With FDA support and a $99 price tag, the tests had mass-market appeal. As stories filtered out about people discovering lost siblings or parents, 23andMe went viral. 

...

"People only need to take, and pay for, one DNA test."

A government of yes men

Apparently KSA is afflicted with a government of yes men catering to a prince. (Fortunately that could never happen here...)

The WSJ has the story. (The headline and subhead are sufficient):

What Went Wrong at Saudi Arabia’s Futuristic Metropolis in the Desert
Neom executives shielded the crown prince from the challenges of his fantastical plans, including by engaging in ​‘deliberate manipulation​’ of financials, an internal report​ ​found .   By  Eliot Brown and Rory Jones
 

 

Cannabis, NYC style (2025)

 Here's a modern view from Times Square. (Note the warning and font size in yellow at the bottom of the sign...)

 

 

Scalping driver's license appointments in Miami

 Queue parasites...

In Miami, Scalpers Had the Hot Tickets … to Driver’s License Appointments
The tax collector’s office in Miami-Dade County, Fla., said it uncovered scalpers using the free online-appointment system to book slots and resell them for $25 to $250. 

"The county tax collector’s office announced on Monday that it had “uncovered a network of appointment scalpers” benefiting from access to motor vehicles offices by “hoarding free appointments and reselling them for a profit.”

“We know who they are and how they operate,” Dariel Fernandez, the Miami-Dade tax collector, said in a statement. “We will not accept any appointment obtained through system abuse.”

"The scalpers found so far have not been punished, because the practice was not illegal, but there is already an effort to change that and make it a civil offense.

...

"The suspicious activity in Miami-Dade was discovered this year after the tax collector’s office began to take the processing of driver’s licenses from the Florida Department of Highway Safety and Motor Vehicles, as had been approved under a constitutional amendment. During the transition, new software and security protocols were adopted in at least two locations in Miami."