What has G-d been doing since the Creation? (Matchmaking, of course...))

My recently graduated student Jacob Leshno left me with a wonderful parting gift: he (and his dad) arranged to have a sofer, a Hebrew scribe, write out one of my favourite passages from the Talmud, which suggests that matching is a very big deal indeed...

A Roman lady asked R. Jose b. Halafta: ‘In how many days did the Holy One, blessed be He, create His world”’  He answered: ‘In six days, as it is written, For in six days the Lord made heaven and earth, etc.(Ex. XXXI, 17).  She asked further: ‘And what has He been doing since that time?’  He answered: ‘He is joining couples [proclaiming]: “A’s wife [to be] is allotted to A; A’s daughter is allotted to B; (So-and-so’s wealth is for So-and-so).”’  Said she: ‘This is a thing which I, too, am able to do.  See how many male slaves and how many female slaves I have; I can make them consort together all at the same time.’  Said he: ‘If in your eyes it is an easy task, it is in His eyes as hard a task as the dividing of the Red Sea.’ He then went away and left her.  What did she do?  She sent for a thousand male slaves and a thousand female slaves, placed them in rows, and said to them: ‘Male A shall take to wife female B; C shall take D and so on.’  She let them consort together one night.  In the morning they came to her; one had a head wounded, another had an eye taken out, another an elbow crushed, another a leg broken; one said ‘I do not want this one [as my husband],’ another said: ‘I do not want this one [as my wife].’

Midrash Rabbah (VaYikra Rabbah)

Translated into English under the editorship of Rabbi Dr. H. Freedman, and Maurice Simon,

Leviticus, Chapters I-XIX translated by Rev. J. Israelstam, Soncino Press, London, 1939

Chapter VIII (TZAV)

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And if empirical evidence is needed that some marriages are arranged in heaven, consider the wedding this evening of Dvorah Marciano and Assaf Romm in Jerusalem, and the upcoming weddings of Ilana Turko and Judd Kessler on Shelter Island, and Theresa Morin and Brian Hall on Little Cranberry Island, and a little further ahead of Coren Apicella and Eduardo Azevedo, and Katie Baldiga and Luke Coffman. (Not to mention lots of anniversaries that come to mind, including Emilie's and my recent 35th:). It appears that economists are also into matching...)
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Update (from Jacob Leshno): here is the line by line translation...

מטרוניתא שאלה את ר' יוסי בר חלפתא, אמרה לו:	A Roman lady asked R. Jose b. Halafta:
בכמה ימים ברא הקב"ה את עולמו?	‘In how many days did the Holy One, blessed be He, create His World?”
אמר לה: לששת ימים, דכתיב (שמות לא): כי ששת ימים עשה ה' את השמים וגו'.	He answered: ‘In six days, as it is written, For in six days the Lord made heaven and earth, etc.’
אמרה לו: ומאותה שעה עד עכשיו מהו יושב ועושה?	She asked further: ‘And what has He been doing since that time?’
אמר לה: מזווג זווגים. אשתו של פלוני לפלוני,	He answered: ‘He is joining couples: “A’s wife [to be allotted] to A;
בתו של פלוני לפלוני, ממונו של פלוני לפלוני.	A’s daughter is allotted to B; (so-and-so’s wealth is for so-and-so).”
אמרה לו: הדא הוא?! אף אני יכולה לעשות כן. כמה עבדים יש לי וכמה שפחות יש לי ואני יכולה לזווגם בשעה אחת!	Said she:  ‘This is a thing which I, too, am able to do. See how many male slaves and how many female slaves I have; I can make them consort together all at the same time.’
אמר לה: אם קלה היא בעיניך, קשה היא לפני הקדוש ברוך הוא, כקריעת ים סוף!	Said he: ‘If in your eyes it is an easy task, it is in His eyes as hard a task as the dividing of the Red Sea.’
הניחה והלך לו.	He then went away and left her.
מה עשתה?	What did she do?
שלחה והביאה אלף עבדים ואלף שפחות והעמידה אותן שורות שורות.	She sent for a thousand male slaves and a thousand female slaves, placed them in rows
אמרה להם: פלוני ישא לפלונית, פלוני לפלונית, זווגן בלילה אחת.	, and said to them: ‘Male A shall take to wife female B; C shall take D and so on She let them consort together one night.
לצפרא אתין לגבה, דין מוחו פציעה ודין עינו שמוטה ודין אציליה פריך ודין ארכובה חבירה.	In the morning they came to her; one had a head wounded, another had an eye taken out, another an elbow crushed, another a leg broken;
דין אמר: לינא בעיא לדין, ודין אמר: לינא בעיא לדין.	one said: ‘I do not want this one,’ another said: ‘I do not want this one
מיד שלחה והביאה את ר' יוסי בר חלפתא אמרה לו: רבי! אמת היא תורתכם, נאה משובחת היא!	Immediately she sent for Rabi Jose b. Halafta, told him: Rabi! True is your wisdom and fair it is
יפה אמרת כל מה שאמרת.	Well said all that you have spoken

First year of the new medical residency scramble, SOAP

I've written before about the new Supplemental Offer and Acceptance Program (SOAP), and the National Resident Matching Program has now released a report on its first year of operation.

There were 1,100 unfilled first year positions at the end of the main match, and 815 unmatched seniors graduating from U.S. medical schools (and many more unmatched applicants when foreign medical schools are included). Most of the unmatched positions were in family medicine and in "preliminary" rotations in surgery and internal medicine.

After the first day of the SOAP exploding offer process (i.e. after two rounds of exploding offers), only 267 positions remained, and 98 of these remained unfilled. So, most of the action happened the first day.

Medical schools complained that students were asked to "commit" to programs prior to receiving an offer, and thought that rounds should be longer. Residency programs thought rounds should be shorter.

In line with the criticisms of the design offered earlier (see here), I anticipate that next year more students will be asked to "commit" before receiving an offer (even though it's against the rules), and that even more of the action will be concentrated in the first day and the first round, with more of the market shifting out of the formal scramble, either officially or de facto, through the offline "commitment" process....

As I was quoted saying last year (see here), "If it's really, really tempting for people on both sides to break the rules," says Roth, "often the rules get broken."


HT: Nikhil Agarwal

David Warsh on Stanford Econ

David Warsh, in his role as economist-watcher, in The Providence Journal today (along with some observations about the market for newspapers):


"The Stanford University buildup in economics, financed by the riches of Silicon Valley, continues apace. Susan Athey and Guido Imbens, of Harvard, a married couple, last week accepted an offer. Previously announced was the decision of Alvin Roth, of Harvard Business School, to relocate to Palo Alto. Other offers are said to be in the works.


"Athey and Roth are market designers, at the forefront of especially exciting developments in present-day economics, in which the nexus with technology is especially germain. (Imbens is a highly rated econometrician.) Athey started a research laboratory for Microsoft in Cambridge that has since grown to considerable size. I don't suppose that the leadership of economics itself is in any danger of tipping out of Massachusetts. But it's clearly easier to make things happen on the Left Coast."

N.A.A.C.P. Endorses Same-Sex Marriage

N.A.A.C.P. Endorses Same-Sex Marriage

"The board of the N.A.A.C.P. voted to endorse same-sex marriage on Saturday, putting the weight of the country’s most prominent civil rights group behind a cause that has long divided some quarters of the black community.
...
"Borrowing a term used by gay right’s advocates, the resolution stated: “We support marriage equality consistent with equal protection under the law provided under the Fourteenth Amendment of the United States Constitution.”
...
"The strongest opposition to gay weddings within the black community has come from church leaders, whose opinions may not be swayed by the N.A.A.C.P. In its resolution, the board appeared to be sensitive to those objections, reaffirming its support for religious freedom.
...
"Black and white Americans are divided on same-sex marriage in similar numbers, according to the results of four aggregated polls conducted by The New York Times and CBS News over the past year.

 "Yet there is greater opposition among black Democrats than white Democrats. Sixty-one percent of white Democrats supported legalizing marriage for gay couples, compared with 36 percent of black Democrats, while 35 percent of black Democrats opposed any legal recognition, compared with 18 percent of white Democrats."

Kidney black markets are hard to stop

It's difficult to collect reliable evidence about criminal activity, but The Guardian reports on recent WHO estimates of illegal kidney sales. Illegal kidney trade booms as new organ is 'sold every hour':  World Health Organisation estimates 10,000 black market operations involving human organs take place each year


"Evidence collected by a worldwide network of doctors shows that traffickers are defying laws intended to curtail their activities and are cashing in on rising international demand for replacement kidneys driven by the increase in diabetes and other diseases.

"Patients, many of whom will go to China, India or Pakistan for surgery, can pay up to $200,000 (nearly £128,000) for a kidney to gangs who harvest organs from vulnerable, desperate people, sometimes for as little as $5,000.
...
"The Guardian contacted an organ broker in China who advertised his services under the slogan, "Donate a kidney, buy the new iPad!" He offered £2,500 for a kidney and said the operation could be performed within 10 days.

"The resurgence of trafficking has prompted the WHO to suggest that humanity itself is being undermined by the vast profits involved and the division between poor people who undergo "amputation" for cash and the wealthy sick who sustain the body parts trade.

"The illegal trade worldwide was falling back in about 2006-07 – there was a decrease in 'transplant tourism'," said Luc Noel, a doctor and WHO official who runs a unit monitoring trends in legitimate and underground donations and transplants of human organs. But he added: "The trade may well be increasing again. There have been recent signs that that may well be the case. There is a growing need for transplants and big profits to be made. It's ever growing, it's a constant struggle. The stakes are so big, the profit that can be made so huge, that the temptation is out there."

"Lack of law enforcement in some countries, and lack of laws in others, mean that those offering financial incentives to poor people to part with a kidney have it too easy, Noel said."
...
"A medical source with knowledge of the situation said: "While commercial transplantation is now forbidden by law in China, that's difficult to enforce; there's been a resurgence there in the last two or three years.

"Foreigners from the Middle East, Asia and sometimes Europe come and are paying $100,000 to $200,000 for a transplant. Often they are Chinese expats or patients of Chinese descent."

"Some of China's army hospitals were believed to be carrying out the transplants, the source added.

"The persistence of the trade is embarrassing for China. The health ministry in Beijing has outlawed it and has also promised to stop harvesting organs from executed prisoners by 2017, a practice that has brought international condemnation.

"Jim Feehally, a professor of renal medicine at University Hospitals of Leicester NHS trust, said: "Since the Declaration of Istanbul the law on trafficking has been changed in the Philippines – which was one of the centres of transplant tourism – and the Chinese government realises that things have to change." Feehally is also president of the International Society of Nephrology, which represents 10,000 specialist kidney doctors worldwide. "Trafficking is still continuing – it's likely that it is increasing," he said. "We know of countries in Asia, and also in eastern Europe, which provide a market so that people who need a kidney can go there and buy one."

"The key issue, Feehally said, was exploitation. "You are exploiting a donor if they are very poor and you are giving them a very small amount of money and no doctor is caring for them afterwards, which is what happens.

"The people who gain are the rich transplant patients who can afford to buy a kidney, the doctors and hospital administrators, and the middlemen, the traffickers. It's absolutely wrong, morally wrong." ************

HT: Rubén Martínez Cárdenas

Mike Rees and Greece: an intercontinental kidney exchange

Greece and USA Complete First Intercontinental Kidney Paired Donation Transplant

International Press Conference at the Embassy of Greece (6/1/12, 11:00 a.m.)

Five Lives Saved and Three More Transplants Scheduled

Six Transplant Centers across USA and One in Greece Involved

               Washington, May 29, 2012 - Medical history was made when a 31-year-old Oklahoma woman altruistically donated her kidney to a stranger—a Greek man living in Athens, Greece.  In return, the Greek man’s wife has now donated one of her kidneys to another person in Wilkes-Barre, Pa., completing the first intercontinental kidney exchange and opening a door that potentially can save thousands of lives in the U.S., as well as others throughout the world. 

               The United States and Greece will be holding an international press conference announcing this first intercontinental Kidney Paired Donation (KPD) and subsequent pay-it-forward chain of kidney transplants. The announcement will be made at the Embassy of Greece by Ambassador Vassilis Kaskarelis, on Friday, June 1, at 11 a.m. 

               The process known as “Kidney Paired Donation (KPD)” takes place when a donor who is incompatible with their designated recipient promises to donate their kidney to a stranger in order to enable their designee to receive a compatible kidney from another stranger. Most often KPDs are between designated donors but can also be started or facilitated by an altruistic donor (someone who gives a kidney without expecting a kidney back for a loved one). Though paired exchanges have been taking place in the U.S. for over 10 years, the idea and concept of enlarging the donor pool, thereby getting more Americans transplanted, by including other nations, has been problematic due to the transplant laws governing other nations as well as those in the United States. 

               The break-through came as a result of the tireless efforts of Dora Papaioannou-Helmis, who had been working to save her husband’s life and to advocate for changes to the Greek law regarding organ transplantation. Dora and Michalis were the first internationals entered into America’s “Alliance for Paired Donation” recipient and donor pool. This achievement was the result of the close work and cooperation between Greece and the U.S.

Michael Rees, MD, PhD, Director of Transplantation at the University of Toledo Medical Center and CEO of the Alliance for Paired Donation, will give an account of what occurred for this intercontinental KPD to become possible. Dora and Michalis, the Greek couple that participated in the KPD, will be present at the press conference, along with Elizabeth Gay, the altruistic donor who started the chain, and the recipient and donor from Pennsylvania. In addition, Greek and U.S. physicians from the hospitals involved in this chain of transplants and those who facilitated and helped change the Greek law, will be present to answer questions.

The Alliance for Paired Donation is an American non-profit organization (501-c-3) supported by public, private, corporate and government grants that facilitates kidney paired exchanges throughout the world. Services provided are completely free for both donors and recipients. Often, financial support for travel, food, and lodging is provided by the Alliance for Paired Donation, when necessary.

What: International Press Conference                                                                                     RSVP or for Further Information

When: Friday, June 1, 2012                                                                                                       Embassy of Greece – Press Office

Time: 11:00 a.m.                                                                                                                        Maria Galanou, Press Attaché

Where: Embassy of Greece                                                                                                       P: 202-332-2727, M: 202-657-1236

2217 Massachusetts Avenue, N.W., Washington, D.C.                                                          Email: pressoff@greekembassy.org 

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Update from Jewish Hospital Transplant Center in Louisville: "The chain began when a 31-year-old Oklahoma woman, Elizabeth Gay, altruistically donated her kidney to a stranger—Dora’s husband, Michalis.  In return, Dora donated one of her kidneys to another person in Wilkes-Barre, Pa., completing the first intercontinental exchange and opening a door that potentially can save thousands of American lives, as well as others throughout the world.  A kidney from the donor in Wilkes-Barre, Pa. was flown to Jewish Hospital for JoAnn Breckinridge, and thus the chain continues.

“We were honored to be part of the first international paired kidney donation,” said Marvin.  “It only takes one caring individual to start the chain that can save so many lives.  We are grateful to the generosity of each donor that was part of this paired donation.”

"The successful transplants were also completed at: The University of Toledo Medical Center, in Toledo, OH; Geisinger Wyoming Valley Medical Center in Wilkes-Barre, PA; and Scripps Green Hospital in La Jolla, CA. Three more transplants in the chain will take place shortly at Piedmont Hospital in Atlanta and the University of Colorado Hospital in Denver. To date, one Greek and four American lives have been saved and three more transplants are expected within weeks as a result of the first intercontinental kidney donor chain. 

"Though paired exchanges have been taking place in the United States for over 10 years, the idea of enlarging the donor pool by including other nations, thereby getting more Americans transplanted, has been problematic due to the variability in national transplant laws. As a result of Dora’s efforts and the keen insight of the Greek government to adopt new health laws regarding organ transplantation, kidney paired transplantation became legal in Greece. In essence, this allowed the Greek national health insurance system to pay for kidney transplants emanating from a paired exchange system within and outside of the country."
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Further update: the Toledo Blade celebrates Mike Rees: Local surgeon aids historic kidney swap

A remnant of Prohibition ends in Washington State.

One of the remaining remnants of Prohibition crumbled in Washington State today (i.e. starting June 1), when the state monopoly on liquor gives way to the newly privatized system.

I posted earlier about the auction for all 167 state liquor stores, and that auction resulted in the stores being sold individually (and not all to one bidder, as was one of the possibilities of the auction, which had an "entirety" option ). As it turns out, individual bids added up to more than any entirety bids, and so those stores are now individually in private hands, including 18 stores that had to be reauctioned when the original winners defaulted (see here for a news story  on the reauction at a link which will likely last longer).

The NIH's National Institute on Alcohol Policyand Alcoholism compiles information on state policies on the sale of alcohol, which has remained a somewhat repugnant transaction in many places, with a storied American history. See their Alcohol Policy Information System.

 This map shows that there will be only seven states with state owned liquor stores now.

The sale of alcohol was prohibited by the 18th amendment to the Constitution in 1919, and Prohibition was ended by the 21st amendment to the Constitution in 1933.

When I searched for 18th amendment, the top items were links to the amendment, but when I searched for 21st amendment, the top link was to a San Francisco brewery and restaurant with that name:) (It's a popular name, here's the Boston restaurant...). So the sale of alcohol is a recovered (or recovering) repugnant market. It will be interesting to see how some  other repugnant transactions end or begin in the coming years.

First circuit rules Defense of Marriage Act unconstitutional

Late breaking news from Boston on the judicial/legislative/elective battles going on over same sex marriage's shaky status as a repugnant transaction: Appeals Court Rules Against Defense of Marriage Act

"A federal appeals court ruled unanimously Thursday that the Defense of Marriage Act, passed by Congress in 1996, discriminates against married same-sex couples by denying them the same federal benefits afforded to heterosexual couples.

"The decision will have no immediate effect because it anticipates an appeal to the United States Supreme Court.

"In upholding an earlier decision by a lower court, Thursday’s ruling, by a three-judge panel of the First United States Circuit Court of Appeals in Boston, is the first time an appeals court has declared the federal law unconstitutional.

"The ruling dealt narrowly with the question of federal benefits for same-sex couples, not with the legality of same-sex marriage itself.
...
“Today’s landmark ruling makes clear once again that DOMA is a discriminatory law for which there is no justification,” Martha Coakley, attorney general of Massachusetts, said in a statement. It was under Ms. Coakley’s direction that Massachusetts became the first state, in 2009, to complain formally that DOMA was unconstitutional.

"A federal judge in Massachusetts found in 2010 that the law violated the equal protection clause of the constitution by denying benefits to one class of married couples — gay men and lesbians — but not to others.

"The appeals court on Thursday agreed, saying the law interfered with the right of a state to define marriage. The benefits denied to same-sex couples range from the right to file joint tax returns, which can reduce a couple’s payments, to the ability to collect death benefits.

"While both sides wait to see whether the Supreme Court takes the case — Ms. Bonauto said that every expert she had talked to predicted it would — the ruling will not be enforced, meaning that same-sex couples cannot begin to collect federal benefits.

"The first circuit covers Maine, Massachusetts, New Hampshire, Rhode Island and Puerto Rico.

"Since DOMA was passed, eight states and the District of Columbia have approved same-sex marriage; the states are Connecticut, Iowa, Maryland, Massachusetts, New Hampshire, New York, Vermont and Washington. Maryland and Washington's laws are not yet in effect.

"President Obama campaigned against the law in 2008 and said in 2011 that his administration would not defend it. That has left the Bipartisan Legal Advisory Group, appointed by the Republican majority in the House, to defend the case. The group has said that Congress wanted to preserve DOMA because it provided a traditional and uniform definition of marriage, helping the federal government to distribute federal benefits."
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Here's the ruling.

Search firms in university hiring could become illegal in Illinois

Search firms for hiring university administrators could become illegal for public universities in Illinois: Illinois Bill Would Ban Use of Search Firms in Hiring at Public Universities

"A bill pending before the State Senate would prohibit public universities from "contracting with outside search firms, executive search firms, or similar organizations." Supporters of the legislation say that paying consultants to find candidates is a poor use of taxpayer and tuition dollars, and that hiring is a responsibility that should fall to those on the university's payroll.
...
"Universities across the country have increasingly turned to outside consultants, at least for hiring at the presidential level. Search consultants were used to recruit nearly 60 percent of recently hired presidents, a jump from 49 percent four years ago, according to an American Council on Education survey released this year.
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Update, May 31: Illinois Legislators Approve Limits on Use of Search Firms in Public Universities' Hiring

"Illinois legislators have approved a bill that would restrict the use of search firms to fill vacancies at public universities, but the measure backs away from earlier proposals that would have banned the increasingly popular practice entirely.

"The amended bill, which passed the Illinois House of Representatives and the State Senate this week, would allow universities to contract with search firms to help fill presidential vacancies, but it would limit their use in other cases. Before employing outside consultants to aid in nonpresidential searches, a university and its board of trustees would have to "demonstrate a justifiable need for guidance from an individual or firm with specific expertise in the field of the hiring." The bill would require the state's public institutions to enact policies that define the criteria for when hiring a search firm is necessary.

"The bill, HB 5914, will next be sent to the governor, who is reviewing the legislation, his spokesperson said Wednesday.

"The University of Illinois objected to earlier versions of the bill that featured a complete ban on outside search consultants, arguing that such a prohibition would impede its ability to compete for well-qualified candidates. Over the past several months, the university has sought to persuade the legislation's sponsors to relax the language in the bill."

The market for medical referrals

The medical profession finds (explicit) advertising repugnant, but specialists depend upon referrals, so there's a marketing industry at work: The Surprising Secret Behind Doctor Referrals

"Most patients assume that if they've got an ailment their family doctor can't fix, they'll be referred to a specialist who's, well, special for reasons they expect: ... So it may come as a surprise that the nattily dressed guy or gal sitting two chairs down in the waiting room, the one who brought that jumbo tin of caramel popcorn for the front-desk staff, may play a role in determining the next surgeon they see.


"With specialists' operating margins having fallen in the past decade and health care reforms putting increasing pressure on their bottom line, more are turning to this burgeoning group of marketing pros to open new-patient pipelines. For anywhere from $3,000 to $10,000 a month, these so-called referral-development consultants will provide marketing plans and dispatch a "physician liaison" to pound the pavement and praise the doctors' prowess. The pitches can focus as much on waiting-room decor as on clinical credentials, but in the end, marketers say, they're sparing doctors the roadside-billboard approach to bringing in patients, and reshaping a long-ignored, but important component of doctoring. "I tell doctors how to sell their business without looking needy, cheesy, greedy or sleazy," says Stewart Gandolf, founding partner of Healthcare Success Strategies, a Southern California medical marketing firm, which says it helped double referrals for one Midwest ophthalmologist in a six-month period.

"But while no one can fault a doctor for trying to drum up business in tough times, critics say that medicine and marketing can make for strange bedfellows. To be sure, accepting payment for a referral is illegal and patient advocates say that no doctor will intentionally make a bad referral....[But] a steady stream of thank-you gifts might keep a specialist top-of-mind. (Even years later, the Mobile, Ala., dental community still raves about one oral surgeon's gift basket: ribs and bottles of Jack Daniels.)

...

"The American Medical Association's Code of Medical Ethics requires doctors to provide patients with "relevant information" about potential procedures, but has no guidelines on what to tell them about the specialist to whom they're being sent. "It goes against the basic trust that is the centerpiece of the physician patient relationship," says Peter Clark, director of the Institute of Catholic Bioethics 

...

"If doctors are just getting in on the referral game, hospitals have been at it for some time -- and on a larger scale. Whereas patients see a hospital only as a place for serious tests and procedures, administrators see a hospital also as a collection of business areas (radiology, ORs, cancer centers) with specific revenue targets -- goals most readily reached when providers send along more patients. When hospitals buy physician practices and become their bosses, federal law prevents them from tying doctors' compensation to in-house referrals. But they are allowed to incentivize them by offering bonuses based on the overall performance of the hospital. "Go into a hospital board room, and 99 percent of the time they're talking about referrals and physician relations," says Timothy Crowley, a former managing director at Leerink Swann, a health care investment bank.

"Indeed, at a recent Hospital and Physician Relations Summit in Scottsdale, Ariz., hospital administrators and doctors gathered for three days to collectively fret about everything from "physician alignment" to "referral leakage." In one session, a Pennsylvania hospital official identifies one type of leak -- proactive patients doing their own doctor research -- as a growing challenge. Not that patients can't be corralled. Many hospitals now employ staffers called "navigators," who help recovering patients with paperwork and follow-up appointments. Part of their job, though, is insuring that the patients' next specialist has the same hospital logo on his or her lab coat.

The Need for (long) Chains in Kidney Exchange

That's the title of a new paper that explores (using random graph theory) the dramatic success of long non-simultaneous chains in kidney exchange (aka kidney paired donation), since the first one was organized by Michael Rees through the Alliance for Paired Donation. They are a big part of the success of Garet Hil's National Kidney Registry as well.

Here's the paper: The Need for (long) Chains in Kidney Exchange
by Itai Ashlagi David Gamarnik Michael A. Rees Alvin E. Roth

Abstract
It has been previously shown that for sufficiently large pools of patient-donor pairs, (almost) efficient kidney exchange can be achieved by using at most 3-way cycles, i.e. by using cycles among no more than 3 patient-donor pairs. However, as kidney exchange has grown in practice, cycles among n > 3 pairs have proved useful, and long chains initiated by non-directed, altruistic donors have proven to be very effective. 


We explore why this is the case, both empirically and theoretically. We provide an analytical model of exchange when there are many highly sensitized patients, and show that large cycles of exchange or long chains can significantly increase efficiency when the opportunities for exchange are sparse. As very large cycles of exchange cannot be used in practice, long non-simultaneous chains initiated by non-directed donors significantly increase efficiency in patient pools of the size and composition that presently exist. Most importantly, long chains benefit highly sensitized patients without harming low-sensitized patients.

Michael Sandel on markets and economists

The Boston Review hosts a Forum on Michael Sandel's arguments against markets:

Forum:
How Markets Crowd Out Morals

Shout

Michael J. Sandel

Some economists think markets can benefit all spheres of human activity. But they’re wrong: markets can erode important goods and social norms.


Not only are there some things money can’t buy, but there are also many things it shouldn’t.

---

Responses

Richard Sennett

When the market is everywhere, we lead a socially impoverished existence.

Matt Welch

Because Sandel disagrees with people’s choices, he wants to take those choices away.

Anita L. Allen

Financial incentives are improperly used to induce African Americans to embrace “good” behaviors.

Debra Satz

Debating the place of the market is less about the value of goods than about inequality.

Herbert Gintis

Tolerance, equality, and democracy have only flourished in market societies.

Lew Daly

Making money, formerly an exclusive realm of cosmic evil, is now “doing God’s work.”

Samuel Bowles

Even market enthusiasts know that society can’t function if people are the amoral, self-interested calculators of blackboard economics.

Elizabeth Anderson

The profit motive is corrupting the justice system.

John Tomasi

Free markets are a kind of fairness.

Michael J. Sandel replies

By keeping markets in their place, we can avoid their corrosive effects.

---

Sandel lays out his views more fully than in the quote at the top of the page (if not always more clearly) in the lead essay of the forum: How Markets Crowd Out Morals, and in his reply to the commentators, some sympathetic and some less so. Bowles and Welch and Gintis all suggest that the level of the discussion could be raised by considering evidence, of various kinds.

See my earlier posts on Michael Sandel's views on markets.

Update: Nicholas Kristof weighs in in his May 30 NY Times column, citing some of the more lurid examples of things bought and sold.

NY Times debate on school choice and (residential) segregation

Is Segregation Back in U.S. Public Schools?

DEBATERS

• 

  Integrating Rich and Poor Matters Most

  RICHARD D. KAHLENBERG, CENTURY FOUNDATION
• 

  Busing Isn’t the Answer, Choice Is

  TERRY L. STOOPS, JOHN LOCKE FOUNDATION
• 

  Busing Taught Me Valuable Lessons

  ERIC MONTGOMERY, BUSED IN SCHOOL
• 

  Worth the Commute

  PAGE LEGGETT, BUSED IN HIGH SCHOOL
• 

  Focus on Better Education Instead

  LANCE T. IZUMI, PACIFIC RESEARCH INSTITUTE
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  Draw Out Diversity With Unique Offerings

  PEDRO NOGUERA, NEW YORK UNIVERSITY
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  ZIP Code Shouldn’t Affect School Quality

  MICHELLE RHEE, STUDENTSFIRST
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  True Integration Is Difficult and Necessary

  DONNA BIVENS, UNION OF MINORITY NEIGHBORHOODS, BOSTON

INTRODUCTION

Emily Berl for the New York Times

Last week marked the 58th anniversary of theBrown v. Board of Education decision, which declared racial segregation of public schools unconstitutional. But segregation, now due largely to geography, still remains an issue for most school systems, from New York City toCharlotte, N.C., and beyond. In his article in The Sunday Review, David L. Kirp, the author of “Kids First,” said that “desegregation is effectively dead.”

How can we integrate public schools when neighborhoods have become more segregated? Is it time to bring back busing? What other options and solutions are out there for providing a quality education for all children?

Kidney exchange in San Antonio

Adam Bingaman and his colleagues at the Methodist Specialty and Transplant Hospital,  in San Antonio, Texas, report on their stellar experience with kidney exchange (kidney paired donation). One key to their success is that they enroll compatible as well as incompatible pairs.

A. W. Bingaman, F. H. Wright Jr., M. Kapturczak, L. Shen, S. Vick, C. L. Murphey, "
Single-Center Kidney Paired Donation: The Methodist San Antonio Experience, American Journal of Transplantation, published online 30 April, 2012

Abstract: Many potential kidney transplant recipients are unable to receive a live donor transplant due to crossmatch or blood type incompatibility. Kidney paired donation increases access to live donor transplantation but has been significantly underutilized. We established a kidney paired donation program including consented incompatible donor/recipient pairs as well as compatible pairs with older non-human leukocyte antigen identical donors. Over a 3-year period, a total of 134 paired donor transplants were performed, including 117 incompatible pairs and 17 compatible pairs. All transplants were done with negative flow cytometry crossmatches and five were done with desensitization combined with paired donation. Kidney paired donation transplants included two-way and three-way exchanges as well as three chains initiated by nondirected donors. Of the sensitized recipients transplanted by paired donation, 44% had calculated panel reactive antibody levels greater than 80%. Transplantation of females and prior transplant recipients was significantly higher with paired donation. Only three episodes of rejection occurred and no transplants were lost due to rejection. These data highlight the potential of kidney paired donation and suggest that all transplant centers should be actively engaged in paired donation to increase access to live donor transplantation.

Adults for adultery?

The Telegraph reports: British women drive demand for extramarital dating websites: More than a million British adults have subscribed to extramarital affair dating websites, with up to 400,000 unique users logging on each week.

"MaritalAffair.co.uk, one of the largest sites of its kind, has almost 600,000 members. Analysis shows most members are parents aged 35 to 54, university educated, and browse from their own homes. Women using the site on a weekly basis outnumber the site three to one.
"Ashley Madison, a US-based website specialising in “discreet affairs” said it received a new British member every 45 seconds. More than 150,000 Britons use the site each week."

NEAD chains in kidney exchange: more on long chains

GE healthymagination’s online health blog, Healthy Outlook, has an article by Jane Langille on the unusually long Nonsimultaneous Extended Altruistic Donor (NEAD) Chain I blogged about earlier, organized by Garet Hil's National Kidney Registry.

The article briefly mentions the work that Itai Ashlagi and I are doing to help optimize long chains, which have the potential to increase not only the number of transplants, but the number of transplants received by the most highly sensitized patients. (More on this soon...)

Harvard after the return of early admissions

Harvard Yield for Class of 2016 Soars to 81%

"In the first year of Harvard’s renewed early admissions program, the yield for the class of 2016 soared to nearly 81 percent, a significant increase from last year’s rate of 77 percent, the University announced on Thursday.

...

In December, Harvard admitted 772 students under its early action program. Another 1,260 acceptances were extended in March. Overall, 1,641 of those admitted to the Class of 2016 accepted their offer of admission from Harvard.

Due to this high yield a very small number of students will be taken off the waitlist, approximately 25, Fitzsimmons said. The admissions office began reviewing waitlisted applications on Thursday, he added.

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Congratulations to the class of 2016, and congratulations to the class of 2012, who graduate today.

Practical Exchange Design by McAfee and Vassilvitskii

Google's Preston McAfee and Sergei Vassilvitskii offer a breezy Overview of Practical Exchange Design

Its conclusions:

"A rich set of tools and know-how for building and improving exchanges is being developed. In particular, to summarize the findings, we recommend:


Intentionally designing a language for expressing trades, that accommodates distinctions that matter substantially but not those of lesser importance,


Designing the trading algorithm so that a straightforward strategy performs well,


Permitting iterative adjustment of bid and asked prices simplifies participant strategies but should be binding on the participants,


Publishing suitably aggregated marketplace statistics makes markets more efficient in several different ways,


Setting prices in a relatively coarse fashion without significant efficiency loss,


Treating somewhat different products as identical to simplify participation,


Keeping the exchange neutral, and not heavily tilting it toward one type of participant,


Minimizing algorithmic complexity that makes sensible participation difficult,


Publishing appropriate marketplace statistics to mitigate unavoidable complexities,


Creating rudimentary tools to help participants increase market e fficiency,


Attaining modest levels of revenue can be raised with a straight percentage charge and switching to value-added pricing for greater levels of revenue.


Economic analysis is an imperfect guide to the design of markets. Consequently, new designs should be tested in a laboratory setting prior to use in the world. Moreover, an understanding of what participants actually value is critical to a successful design."

Public attitudes on compensation for donors

Poll: Americans Show Support For Compensation Of Organ Donors

"Federal law bans payments for organs. But given the need, we wondered what Americans thought about compensation for three kinds of donations that can be made while people are alive: kidneys, bone marrow and a portion of liver big enough to help someone whose liver is failing.

"So we asked 3,000 adults across the country as part of the NPR-Thomson Reuters Health Poll, and here's what they told us.
  "If compensation took the form of credits for health care needs, about 60 percent of Americans would support it. Tax credits and tuition reimbursement were viewed favorably by 46 percent and 42 percent, respectively. Cash for organs was seen as OK by 41 percent of respondents.

"Among people who said some form of compensation was acceptable, 72 percent said it should come from health insurers, followed by private charities at 62 percent and the federal government at 44 percent.
"For all forms of compensation, rates of support tended to fall among older respondents.

"There's been longstanding resistance to compensating donors financially in this country. There are concerns about exploitation and also worries that even small amounts of compensation would undercut a system that depends on altruism."

HT: Steve Leider (and see Leider, Stephen and Alvin E. Roth, “Kidneys for sale: Who disapproves, and why?” American Journal of Transplantation, 10 (May), 2010, 1221-1227.)

Is market life sucking the meaning out of real life?

Are too many things available to buy? That seems to be a theme of much recent literature that, at its worst, regrets how the economy has sucked the meaning out of life ever since the invention of trade and agriculture. The idea is that economic life weakens the close bonds with kin and community we used to build while we helped each other ward off starvation.

Markets are not the only focus of that concern: the expansion of cities and the encroachment of technology are others. For technology, think of the internet and social media, but don't forget the earlier effects of the automobile and the phonograph. As for  what you can buy these days with money, and the growth of markets, don't forget bottle feeding and washing machines, and women in the labor force.

But even if we have no nostalgia for the bad old days, it doesn't hurt to be aware of how the increasing scope of markets, like the growth of cities and technology, changes how we relate to one another.

In a recent NY Times Op Ed, the sociologist Arlie Russell Hochschild, who teaches at Berkeley, writes of her concerns about the increased reach of markets, The Outsourced Life. The article is accompanied by pictures of ads for all sorts of services that can now be bought and sold, from birthday party planners to cooking coaches, to upgraded accommodations in a private prison, to someone offering a service called "rent a dad."

The article announces her new book on the subject, The Outsourced Self: Intimate Life in Market Times

I recently received a review copy (one of the few signs that the world notices a blog).

It is a thoughtful book, on a topic in which I have a professional interest, but I wasn't encouraged when it began by regretting the loss of small town community that the author experienced as a child visiting her grandmother's farm. She visited from the city, a life her parents had chosen, and which she later chose herself. But the book is saved from nostalgia for the lost world by the acknowledgement of how much easier it would have been to take care of her elderly grandmother, years later when she was frail, if only she had lived near a city and the services that money could buy, and which a granddaughter could not easily deliver from far away.

So, and here is the interesting part of this kind of discussion, the loss of community isn't just something that happens because people choose to move to cities for the better opportunities and bigger markets they offer (even though they may regret, at least in memory, leaving the town behind). Loss of community is also something that happens to those left behind, as the towns are thinned out by those who moved on, so less community remains. Professor Hochschild and her parents chose to move away from the farm, and didn't ever really want to go back, but there's no going back even if they did want to: that old community isn't there anymore.

Of course, some of it was never really there. The book compares her grandfather's courtship of two sisters, one of whom became her grandmother and the other who apparently made a poor marriage (to "a n'er-do-well farmer"), with today's internet dating. Internet dating also doesn't always work out, it seems. Her grandmother did better with the old fashioned process, but it wasn't so great for her great-aunt.
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Closely related is Michael Sandel's book What Money Can't Buy: The Moral Limits of Markets (about which and whom I have blogged before). While Hoschschild's lost world is that of her grandparents' youth, Sandel regrets the changes he sees since he was young himself: here's a recent review (whose title is a summary of it's contents):.
What Money Can't Buy: The Moral Limits of Markets, By Michael Sandel: Should you pay to jump the queue – or for a new kidney? It's hard to define where cash has no place.

Sandel turns out to be a childhood friend of NY Times columnist Thomas Friedman, who writes about Sandel's book in a May 12 column called This Column Is Not Sponsored by Anyone
" Seen in isolation, these commercial encroachments seem innocuous enough. But Sandel sees them as signs of a bad trend: “Over the last three decades,” he states, “we have drifted from having a market economy to becoming a market society. A market economy is a tool — a valuable and effective tool — for organizing productive activity. But a ‘market society’ is a place where everything is up for sale. It is a way of life where market values govern every sphere of life.”

"Why worry about this trend? Because, Sandel argues, market values are crowding out civic practices. When public schools are plastered with commercial advertising, they teach students to be consumers rather than citizens. When we outsource war to private military contractors, and when we have separate, shorter lines for airport security for those who can afford them, the result is that the affluent and those of modest means live increasingly separate lives, and the class-mixing institutions and public spaces that forge a sense of common experience and shared citizenship get eroded."
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Tim Harford shared his thoughts on Sandel on markets on Google+:  He asks, "Why oh why is Michael Sandel so famous?"
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The role of markets in life, how these have changed over time, and peoples' perceptions of these things, are well worth the attention of economists. I initially organized my thoughts on the subject in my 2007 article Repugnance as a constraint on markets, and it's a subject I return to often in blog posts on repugnance and repugnant transactions.
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