Obesity is a growing medical problem...in unexpected ways

Obesity contributes to many diseases, including kidney and liver diseases that eventually require transplants. But it impacts the medical system in other ways. The Telegraph has the story:  Hospitals buy special fridges to store overweight bodies as obesity crisis escalates: Doctors warn Britain's obesity crisis could 'cripple' the NHS as hospitals are being forced to buy and rent specialist equipment to deal with overweight patients

"Britain’s obesity crisis is so serious that hospitals are buying specialist equipment to keep bodies cool because they are too large to fit into mortuary fridges."

Speaking about school choice to high school teachers (video)

I recently gave a talk at SIEPR, to high school teachers, about school choice. They had good questions, which start after minute 38 in the video (the early questions are hard to hear, but you can infer their gist from my answers, and the later questioners have a microphone...)

Many groups are starting to advocate experiments on compensating organ donors

There's a lot of discussion these days about clinical trials of incentives for organ donation as a way of increasing supply.

Here's a blog post from the AST, the American Society of Transplantation, on removing financial disincentives:  The Cost of Giving

" it is increasingly obvious that we impose on donors’ financial risk, a concept that threatens our perceptions of donation as an altruistic act. Gill et al (JASN, 2014 Jul 17, epub) documented, in the recent economic downturn, greatest decline in living donation among those most challenged socioeconomically, indicating the role of financial risk in discouraging “altruistic” donors.
All this is occurring against a backdrop of intense controversy regarding “incentives” for donation that has raged for years, incorporating both national and global perspectives on ethics, economics, black markets, free markets, and so on. Amidst so much controversy, though, some light is beginning to emerge. Strong ethical and economic arguments can be advanced for and against incentives. The Declaration of Istanbul outlines important precepts that address unethical practices, including underground markets, on a global basis. However, in the United States, with a well-developed organ recovery infrastructure and rule of law, examples from the underground market (as were the basis of a recent New York Times expose) may be less relevant. There is emerging support in the US for a regulated infrastructure that could address the financial implications of organ donation. The National Living Donor Assistance Center (NLDAC) already offers limited assistance for those means-tested as unable themselves to underwrite the cost of donation. Extending assistance to eliminate all financial costs regardless of means, including access to healthcare, is now considered a mainstream view (far from the reception for a similar proposal from a small working group eight years ago: Gaston et al, AJT 6: 2548, 2006).
...
"Participants in two recent meetings (both held in Chicago in June and sponsored in part by AST) will soon be publishing white papers that seek to clarify the discussion regarding compensation of living donors in the US. It is obvious that a great deal can be done within NOTA to remove disincentives (as both white papers are likely to endorse). In medicine, it is usually desirable to address controversy with evidence, as might be obtained via limited demonstration projects of targeted incentives. Though these would likely require amendment of NOTA, such has already occurred twice with the Charlie Norwood and HOPE acts, both crafted in response to a changing environment and both endorsed by AST. Our task, if we are to do everything possible for our wait-listed patients and protecting all the interests of potential donors, is to make sure we get the nuances right."


And here is an open letter, signed by a variety of interested parties
HOW TO END THE WAIT FOR ORGAN TRANSPLANTS

"We support current efforts to prevent diabetes and hypertension and to make the donation process fairer and more efficient, but they will not resolve the shortage. Additional approaches must be tried. Sadly, transplant policy has been governed by an unsubstantiated assumption: that donors cannot receive benefits for donating without being exploited or coerced. It is critical to examine that assumption. We hereby call for the swift initiation of evidence-based research on ways to offer benefits to organ donors in order to expand the availability of transplants."

Brand names and informed consumers--pharmacists seem to like generic drugs

Here's an illuminating look at the economics of brands, as in brand-name products, when there are close substitutes available.

"Do Pharmacists Buy Bayer? Sophisticated Shoppers and the Brand Premium" 
Chicago Booth Research Paper No. 14-17
by BART J. BRONNENBERG,  JEAN-PIERRE H. DUBE,  MATTHEW GENTZKOW,  JESSE M. SHAPIRO

We estimate the effect of information on consumers’ willingness to pay for branded goods in physically homogeneous consumer packaged goods categories. In a case study of headache remedies, we find that college education, working in a healthcare occupation, and other proxies for product knowledge predict more purchases of private labels relative to brands. Pharmacists devote almost 90 percent of headache remedy purchases to private labels, against 71 percent for the average consumer. The effect of knowledge is similar across a broad set of health products, and in a set of relatively homogeneous food products, but smaller for food and drink products overall. We conclude that a significant share of the willingness to pay for brands in these categories would disappear in a world where consumers were fully informed.

Of Markets and Money: video of 12 minute interview

Here's a video of a 12 minute interview I gave to Deutsche Welle while in Lindau, which just appeared here. It starts with my education in Operations Research, and moves on to market design and economics generally. A busy 12 minutes.

You can do a lot of good if you don't worry about who gets the credit

Shane Greenstein's' piece on false claims of credit for inventing email got me thinking about the larger question of attributing and claiming credit (especially after I initially mis-identified Shane as his co-blogger JG who shared the post to G+...).  Often, accomplishments have many parents. (And sometimes someone who helps disseminate the news is mistakenly credited as its source.)

Market design in particular is an outward facing part of economics, and much of what needs to be accomplished requires economists to play a helping role. So I've always liked the sentiment in the title of this post, whose origins turn out to be (fittingly) hard to attribute. Quote Investigator looks into it and finds many early origins and variations.

[1] A man may do an immense deal of good, if he does not care who gets the credit for it.

[2] This was the opportunity for a man who likes to do a good thing in accordance with the noble maxim … “Never mind who gets the credit.”

[3] The way to get things done is not to mind who gets the credit of doing them.

[4] There is no limit to what a man can do who does not care who gains the credit for it.

"These sayings are certainly not identical, but they are closely interlinked thematically. Quotation number [1] appeared in a diary entry from the year 1863 in which the words were recorded as spoken by a Jesuit Priest named Father Strickland. This is the earliest citation located by QI.

In 1896 the text of [2] was published, and the phrase “Never mind who gets the credit” was dubbed the noble maxim of Edward Everett Hale.

In 1905 quotation [3] was published, and the words were attributed to Benjamin Jowett who was a theologian and classical scholar at Oxford University. But one of the author’s who made this attribution decided it was flawed, and in a later book he reassigned credit for the saying from Jowett to a “Jesuit Father”. This is probably a reference to Father Strickland. This maxim is the same as quote [A] given by the questioner above.

Expression [4] was used by Charles Edward Montague in 1906, but he did not claim coinage of the phrase. He said it was the favorite saying of his friend and colleague the journalist William T. Arnold. But Montague did not credit Arnold as originator either. He left the attribution anonymous by using the locution “someone has said”.

In 1922 Montague published a close variant of saying [4], “There is no limit to what a man can do so long as he does not care a straw who gets the credit”, in his book “Disenchantment”. For this reason he is sometimes cited in modern texts and databases.

Finally, quotation [B] which is similar to [4] appeared in the 1980s on a small plaque atop the desk in the Oval Office of the White House during the Presidency of Ronald Reagan."

[B] There is no limit to what a man can do or where he can go if he doesn’t mind who gets the credit.

Shane Greenstein on a false history of email

Sometimes people believe that they deserve more credit than they're getting, and Shane Greenstein writes about a man who believes he should be credited with inventing email.  (Earlier this morning I mistakenly identified the author of the post as Shane's co-blogger Joshua Gans; apologies to both.) Apparently the fellow who thinks he invented email and should get the credit for it is pretty clearly mistaken, but the Huffington Post took the bait, and so Shane organizes his post about how that makes HuffPo a much less trustworthy news source than he had hoped. (Apparently some things on the internet just aren't true...)  HuffPo and the Loss of Trust

"Now for the detail: HuffPo published a multipart history of email that is historically inaccurate. Yes, you read correctly. More specifically, a few of the details are correct, but those are placed next to some misleading facts, and these are embedded in a certifiably very misleading historical narrative. The whole account cannot be trusted.

The account comes from one guy, Shiva Ayyadurai, who did some great programming as a teenager. He claims to have invented electronic mail in 1978 when he was fourteen. He might have done some clever programming, but electronic mail already existed by the time he did his thing. Independent invention happens all the time in technological history, and Shiva is but another example, except for one thing. He had his ideas a little later than others, and the other ideas ended up being more influential on subsequent developments. Shiva can proudly join the long list of geeky teenagers who had some great technical skills at a young age, did some cool stuff, and basically had little impact on anybody else.

Except that Shiva won’t let it go. This looks like nothing more than Shiva’s ego getting in the way of an unbiased view.

Look, it is extremely well established that the email systems in use today descended from a set of inventors who built on each other’s inventions. They did their work prior to 1978. For example, it is well documented that the “@” in every email first showed up in 1971. Ray Tomlinson invented that. Others thought it was a good idea, and built on top of the @. We all have been doing it ever since. Moreover, this is not ancient history. Tomlinson has even written about his experiences, and lots of people know him. This is easy to confirm.

Though Ayyadurai’s shenanigans were exposed a few years ago, he persists. In the HuffPo piece yet again he pushes the story in which his inventions played a central place in the history of electronic mail. This time he has a slick infographic telling his version of things, and he managed to get others to act as shills for his story. He also now accuses others of fostering a conspiracy against his views in order to protect their place in history and deny him his.As if. “A teenager invented electronic mail” might be a great headline, and it might sound like a great romantic tale, but this guy is delusional."

Shane focuses on trust in news sources, but I can't help sympathize a bit with the delusional guy.  I know of many cases in which someone feels, often with considerable justice, that they don't get the credit they deserve. That's part of the problem with apportioning credit, and it may be a near universal feeling. You can certainly witness it among academics, and probably also among top athletes who don't make it to the Olympic podium or the Hall of Fame, and maybe even among some of those who do. Maybe a good sanity check on whether you are delusional is if you think there's a conspiracy...

You know game theory is becoming mainstream when...

...There's a company offering to do your game theory homework for you...(I'll leave out the URL to avoid steering traffic...)

My talk in Baku, on Repugnant Markets, Prohibited Transactions (video)

Back in May I was in Baku, where I was a guest of the State Customs Committee of the Republic of Azerbaijan, and the International Network of Customs Universities (INCU). I spoke on Repugnant Markets and Prohibited transactions.

Customs departments have a natural interest in those things, because they have two jobs: to raise revenue by collecting taxes from legal imports, and to prevent illegal imports. A lot of illegal imports are goods for which it’s illegal to make a market at all, like narcotic drugs, or elephant ivory. Trading in drugs and ivory are both forbidden by United Nations conventions as well as by domestic laws. But black markets exist in drugs and ivory also, so customs departments have their work cut out for them.

I recently got the link to the video of my talk, which lasts about an hour.

Could/should eating rabbits become repugnant?

We see lots of old repugnancies fading away (such as bans on same sex marriage), but new ones form from time to time too (like the ban on eating horse meat in California, which went into effect in 1998). Now Whole Foods is selling rabbit meat, and demonstrators are demonstrating their repugnance. The Atlantic has the story:
Are Rabbits Pets or Meat? : "Some people are incensed that Whole Foods is selling rabbit meat, and the debate they're caught up in reveals the contradictions in how we relate to different creatures in different ways. "

"No one is talking about selling kittens and puppies at the meat counter, but for the group of bunny-loving pet owners protesting near the Whole Foods in Union Square, they might as well be. Fifty or so women and men of all ages carry signs, pass out flyers and pamphlets, and try to spread their message to passing Manhattanites. “Boycott Whole Foods,” they say, “because they’re killing rabbits.”

Earlier this year, after developing its own welfare standards, Whole Foods launched a rabbit-meat pilot program across several North American regions that involves selling whole rabbit carcasses. In response, rabbit-protection activists organized a day of action this past weekend outside of more than 40 stores across the country. 

“Remember,” explains one website dedicated to this day, “Whole Foods says they are carrying rabbit meat because of customer demand. We need to show that enough customers demand that Whole Foods NOT carry rabbit meat.”

...

“God, that’s disgusting!” a woman says as she walks by, accepting a pamphlet from one of the protesters. “Rabbit is delicious,” says another, waving away the flyer. For every person who stops to the sign the petition, there are plenty more who don’t care or can’t be bothered."

HT: Muriel Niederle

NY Times editorial on reducing the kidney shortage

Here it is. They don't endorse a cash market, but are interested in everything else...
Ways to Reduce the Kidney Shortage

The United States and many other nations are confronting a heart-rending problem: The number of kidneys available for transplants falls far short of the need.

While some argue that the way to reduce the growing shortage is to pay living donors for kidneys, either in cash or government benefits, there are many ways to increase the supply without paying for human organs, which is prohibited by the 1984 National Organ Transplant Act and generally opposed by the World Health Organization.

In the United States, the number of kidney transplants fell to 14,000 last year, while the waiting list for kidneys currently exceeds 100,000 patients. The average wait time for a transplant has risen to almost five years; more than 4,000 people die each year while waiting and a great many more, possibly thousands, become too sick to undergo transplantation and are dropped from the wait lists.

The first step in easing the shortage is to end the current shameful waste of organs.

Hundreds of kidneys taken from deceased donors that are suitable for transplant are discarded every year, probably more than 1,000 some experts say. Surgeons typically hope to transplant a kidney within 24 hours to 36 hours of the time it is recovered and placed on ice for evaluation. Sometimes the clock runs out before a suitable recipient can be found. The United Network for Organ Sharing, which runs the allocation system, will revise its formulas in December in ways that it believes will increase the utilization of donated kidneys and thus reduce wastage.

Meanwhile, many patients, possibly in the hundreds, who do receive transplants become ill again because they can’t afford to pay for antirejection drugs that can cost more than $1,000 a month; Medicare stops paying for the drugs after three years unless the patient is old or disabled. Congress ought to extend coverage for as long as necessary.

Equally important is increasing the number of people who agree in advance to donate their organs for transplantation or research. Many people already do that through driver’s license check-offs, but a stronger national campaign to get more people to allow donation could help increase the kidney supply.

To encourage more living donors, some disincentives could be corrected. Some experts propose that government agencies or health insurers pay all costs a living donor faces, like travel and lodging for trips to the transplant center for evaluation and then for surgery, dependent care while recovering from the surgery and wages lost while recuperating.

Others want to make sure that donors can jump to the top of the transplant list if they develop disease in their remaining kidney, and also allow their loved ones to jump to the top of the list if they unexpectedly need a transplant. Some say donors should be given government-paid life insurance to cover a death during surgery or later complications from the surgery.

The American Society of Transplant Surgeons and American Society of Transplantation have proposed pilot projects to test the effect of many of these ideas. Most of these proposals seem consistent with the Declaration of Istanbul, a consensus statement adopted in 2008 by an international meeting of experts that aimed to increase the kidney supply while protecting poor people from illegal organ traffickers. But some may skirt close to infringing the federal law.

A few advocates would go further by having state or federal agencies offer benefits to donors, perhaps a tax credit, college tuition, early access to Medicare or a contribution to a retirement fund. But such benefits, though not cash, clearly have monetary value, and raises the troubling issue of inducing people — most likely the poor — to sell their kidneys, which violates federal law.

There are lots of reforms that could be made without resorting to paying for kidneys. Congress ought to hold hearings on the best ways to reduce the shortage and save more lives on the waiting list."

Don't take "No" for an answer: a reconsideration of how to do deceased donor registration

Don't Take 'No' For An Answer: An Experiment With Actual Organ Donor Registrations

Judd B. Kessler, Alvin E. Roth

NBER Working Paper No. 20378
Issued in August 2014
NBER Program(s):   HC 

Over 10,000 people in the U.S. die each year while waiting for an organ. Attempts to increase organ transplantation have focused on changing the registration question from an opt-in frame to an active choice frame. We analyze this change in California and show it decreased registration rates. Similarly, a "field in the lab" experiment run on actual organ donor registration decisions finds no increase in registrations resulting from an active choice frame. In addition, individuals are more likely to support donating the organs of a deceased who did not opt-in than one who said "no" in an active choice frame.

The paper has attracted a small bit of more or less accurate press and blog attention, which is good for a paper that attempts to shed light on what may be a mistaken public policy initiative. Here's a sample.

One way to boost organ donations: Just keep asking

Don’t Take No For an Answer: Lessons From Organ Donation

In The Papers: Skills Gap, Organ Donation And Parental Politics

Ask often to get more organ donors

Banks for blood and sperm

At The Atlantic,  Rebecca Rosen writes about Banks of Blood and Sperm: How the idea of a "bank" shapes the way people think about storing and distributing body fluids, in an interview of  Kara Swanson, the author of Banking on the Body (which I blogged about here).

Very interesting.  For example:

"What happened as the metaphor [of a bank] became more used in the 1950s and 1960s, was that a backlash developed against the market implications of the metaphor. The doctors and lay people who ran blood banks in the 1950s and 1960s, pushed the metaphor to its extremes—they told patients that each transfusion was a “loan” that needed to be repaid. Patients could repay in kind, or pay stiff replacements fees instead—fees that a bank could use to buy blood from a professional donor—always with the goal of keeping sufficient inventory.

The emphasis on buying and selling led blood banks into trouble in the courts—attorneys for patients injured from transfusions (which happened sometimes, if mismatched blood was given, or the blood contained a disease) argued that banked blood was a product. Product liability law was developing to find the manufacturer of a dangerous product liable even without negligence. Doctors, blood banks, and hospitals were horrified to have themselves considered product manufacturers. They began to backpedal from the banking metaphor by trying to make banked blood seem less like a product exchanged in markets.

What happened, with blood banks, and also with other kinds of banks, is that the banking metaphor and the backlash encouraged doctors, patients, and those of us who might be suppliers, to focus on one aspect—the supplier. Was the supplying body paid or unpaid? Paid suppliers, who were obviously entering into a market transaction, were treating their bodies as a source of private property, and were acting as though they were selling a product. Unpaid suppliers, were seen as giving gifts, out of altruism, and keeping themselves out of a market."
...
"In law, we thus divide body products into two categories: those which we legally mandate as gifts only—all organs—and everything else, which can be gifted or sold, at the discretion of the supplier. Organs is defined broadly—bone marrow, for example, is an “organ.” This means that bone marrow, which can now be extracted from the blood in a procedure similar to the way blood plasma is harvested, cannot be sold by anyone. (Blood plasma is routinely sold, by the way.)
...
"I argue in the book that the simple pay-suppliers/don’t-pay-suppliers approach to thinking about body products, which resulted from the banking metaphor, needs to be replaced with more nuanced thinking. Should we treat different types of organs (hearts v. bone marrow) differently? Can we think about compensation schemes that are not free markets, but are managed to support the public goals of increasing body-product supply? Can those schemes protect suppliers and recipients alike by keeping suppliers safe from exploitation, and recipients safe from diseased products? I use history to suggest that the answers can sometimes be yes. Body products used to be routinely paid for, and doctors thought about these potential problems and addressed them. Over time, we have forgotten this past, and come to assume that buying body products is always dangerous and bad.

I like to remind people that lots of altruistic gestures are compensated—the doctors, and nurses, and everyone who works on a transplant operation are all in caring professions. They are doing those jobs because they want to help people (at least we hope and assume so). But we wouldn’t suggest that they shouldn’t be paid because to offer payment for such efforts would be insulting or immoral or cause their altruistic tendencies to be replaced by mercenary concerns.

Yet that is how we treat organ supply—that offering money would do all those bad things. Why should the supplier of a body product be the only person in that life-saving supply chain who is not compensated? People might choose not to be compensated, but if they want to be, and if more folks will act as suppliers with that incentive, why not?

To give a more specific historical example, let’s think about mothers’ milk stations in the 1930s. At that time, in most cities, such a station existed. It was established and supervised by a doctor or doctors, and its daily operations were run by nurses. Lactating women came to the station to express their breast milk and were paid by the ounce. Payment was used to ensure an adequate supply. The supply was used for sick and/or premature infants who lack a maternal source of milk."

**************
In the meantime, here's a news article published around the same time, from the business side:
More blood banks merging to cut costs--Officials cite need for new model

"The proposed merger of Green Tree’s Institute for Transfusion Medicine with Florida-based OneBlood is the latest in a series of blood bank consolidations nationally, symptomatic of lean times for hospitals as they try to cut costs and reduce transfusions.

The deal, announced July 25, would create one of the largest blood banks in the country, with combined revenues of $480 million, if it goes through. The two firms jointly distribute nearly 2 million units of blood annually, serving 313 hospitals in eight states.

Only the American Red Cross would collect and distribute more blood."

Patients can register at multiple transplant centers to get on multiple (regional) organ waiting lists

You don't have to be Steve Jobs to get a transplant in Memphis.
Here's an interview on multiple-listing yourself.

Multiple Listing to Reduce Wait Times for Transplant Patients
Mediaplanet sat down with Dr. Sridhar Tayur, owner of OrganJet, to learn how to list smartly.

MP: How does geographical location affect an organ transplant?
ST: The wait times are strongly correlated to geography. In New York, New Jersey, Boston, Atlanta, Chicago and Los Angeles, the wait times for kidney and liver transplants are very high compared to those at centers elsewhere. Patients in the high wait areas can list in a center with low wait in other geographies, depending on their insurance coverage and ability to travel or move.
...
MP: How can one find a low wait transplant center near their home?

ST: The data is available publicly through Scientific Registry of Transplant Recipients' website and is updated periodically.

MP: What can early transplantation mean for patients?

ST: In the case of kidney transplantation, you could get a transplant before you even go on dialysis. If you are already on dialysis, earlier transplantation has two benefits: better outcomes and less time on dialysis. It is also important to know, for kidney patients who have been on dialysis for a while or have been listed in one center for a while, they can transfer this wait time so far to a different center and so take credit for "time served." For a liver patient, getting a transplant at a lower Model for End Stage Liver Disease (MELD) score also means better outcomes and less inconvenience during pre-transplant time. In all cases, the outcomes are better and life before and after transplant is better. Listing in more than one place is allowed and patients should look into the many benefits of multiple listing. 

Kidney exchange makes inroads in Florida

3-way kidney exchange at Jackson Memorial Hospital first in Fla. history

..."Jasko and Figueroa are just one pair in a three-way kidney exchange that happened at Jackson Memorial Hospital on July 9. It's the first of its kind in Florida.
...
"In all, six people took part in six life-saving surgeries. The four-hour procedure had to happen at the same time.

"All donor surgeries have to start at the same time," said Dr. Giselle Guerra, medical director of the Living Kidney Donor Program. "(We) can't have a donor back out. If they back out, it breaks the pair and we can't proceed."

Kidney exchange is coming to New Zealand

 Here's an announcement from New Zealand: Govt to launch kidney exchange service

"An extra 100 people could receive kidney transplants over the next four years under a new donor service the Government is establishing.
Health Minister Tony Ryall says there's a serious shortage of kidneys - while there were around 110 transplants last year there are still more than 600 people waiting for a transplant.
A National Renal Transplant Service is being set up which will coordinate services across the country.
There will be a kidney exchange system allowing donors and recipients who are not compatible with each other to be listed for possible swaps with other pairs.
A $4 million campaign to raise awareness and encourage more people to donate organs is already under way."

A bump on the road to the private sale of public parking spots

San Francisco orders parking spot auction app to cease-and-desist

he City Attorney of San Francisco has sent an immediate cease-and-desist letter to the makers ofMonkeyParking, a smartphone app that allows drivers to auction off their parking spaces.

In the Monday letter, City Attorney Dennis Herrera cited a city code that forbids drivers who "enter into a lease, rental agreement, or contract of any kind" for public parking spots. The violation is punishable by up to $300 in fines.

The Rome-based makers of the app have until July 11, 2014 to comply, and they could then face a lawsuit brought by the city. In addition to the City by the Bay, the startup also operates in the Italian capital.

"Technology has given rise to many laudable innovations in how we live and work—and MonkeyParking is not one of them," Herrera said in a statement. "It's illegal, it puts drivers on the hook for $300 fines, and it creates a predatory private market for public parking spaces that San Franciscans will not tolerate. Worst of all, it encourages drivers to use their mobile devices unsafely—to engage in online bidding wars while driving. People are free to rent out their own private driveways and garage spaces should they choose to do so. But we will not abide businesses that hold hostage on-street public parking spots for their own private profit."

The city said that it will also be sending similar letters to two other parking-related smartphone app-based startups.

MonkeyParking told Ars that it strongly believed in the company’s business model.

“As a general principle we believe that a new company providing value to people should be regulated and not banned,” Paolo Dobrowolny, MonkeyParking’s CEO, wrote to Ars in a statement. “This applies also to companies like Airbnb, Uber, and Lyft that are continuously facing difficulties while delivering something that makes users happy. Regulation is fundamental in driving innovation, while banning is just stopping it.”

HT: Scott Kominers

The market for marijuana in Washington State, prior to legalization.

A RAND report assesses the marijuana market in the State of Washington prior to the legalization of marijuana through Initiative 502. Among the key findings are that consumption was estimated at over 120 metric tons annually, and that King, Snohomish and Pierce counties are happening places.


Before the Grand Opening: Measuring Washington State's Marijuana Market in the Last Year Before Legalized Commercial Sales

by Beau Kilmer, Jonathan P. Caulkins, Gregory Midgette, Linden Dahlkemper, Robert J. MacCoun, Rosalie Liccardo Pacula

Research Questions: What is the size of the marijuana market of Washington state in 2013?  How much marijuana do users in Washington consume and how to they obtain it?

Abstract: In 2012, Washington state voters passed Initiative 502 (I-502), which removed the prohibition on the production, distribution, and possession of marijuana for nonmedical purposes and required the state to regulate and tax a new marijuana industry. Legalization of possession went into effect almost immediately, but the revolutionary aspect of the law — allowing businesses to openly produce and distribute commercial-scale quantities for nonmedical use — is expected to be fully implemented in 2014.

...This report estimates the total weight of marijuana consumed in Washington in 2013 using data from existing household surveys as well as information from a new web-based consumption survey. Although the principal motivation for the study was estimating the size of the market, the report also describes various characteristics of the market, including traits of marijuana users in Washington and how they obtain marijuana.

While the Washington Office of Financial Management projected that 85 metric tons (MT) of marijuana would be consumed in the state in 2013, this report suggests that estimate is probably too low, perhaps by a factor of two. There is inevitable uncertainty surrounding estimates of illegal and quasi-illegal activities, so it is better to think in terms of a range of possible sizes, rather than a point estimate. Analyses suggest a range of 135–225 MT, which might loosely be thought of as a 90-percent confidence interval, with a median estimate close to 175 MT.

Key Findings

Marijuana consumption in Washington in 2013 is larger than the 85 metric tons (MT) previously projected by the Washington Office of Financial Management.
Even before adjusting for survey undercounting, our estimates suggest a 90-percent confidence interval of approximately 120–175 MT. The difference is largely driven by our use of more recent data.

It is difficult to know by how much surveys understate actual consumption.
Many of the relevant studies were published over a decade ago and times have changed; the NSDUH methodology has been improved substantially, and a national increase in marijuana use over the 2000s may have influenced willingness to self-report.
It is also unclear how applicable national and regional studies are to the state of Washington. After reviewing the evidence and attempting to adjust for undercounting, results from our simulation suggest consumption likely falls within the interval of 135–225 MT, with a median estimate close to 175 MT.

Three counties account for about 50 percent of marijuana users in Washington.
King County accounts for about 30 percent of the marijuana users, while Snohomish and Pierce counties each account for roughly 11 percent.

The literature is surprisingly thin concerning how much marijuana users consume during a typical day of use.
That general deficit becomes all the more acute when focusing on a particular jurisdiction and time, such as Washington in 2013. The emphasis has traditionally been on counting users, not counting grams.
However, by augmenting that thin literature with data from the web-based consumption survey developed by RAND, we estimate that Washington residents who use marijuana 21 or more times per month consume, on average, 1.3–1.9 grams during a typical use day.

Multiple datasets provide information about the potency of the marijuana consumed in Washington.
None is ideal, and there is no way to take a random sample of the universe of marijuana that is sold or consumed. But the available information suggests that lower-potency forms account for only a modest share of the Washington market and probably a smaller share than they do nationwide.

Surrogacy in Thailand

The NY Times discusses the market for surrogate child birth in Thailand, and possible new legislation making it illegal to pay for surrogacy:
In Thailand’s Surrogacy Industry, Profit and a Moral Quagmire

"PAK OK, Thailand — Soon after the first surrogate mother from this remote village gave birth, neighbors noticed her new car and conspicuous home renovations, sending ripples of envy through the wooden houses beside rice paddies and tamarind groves.
...
"In the two years since, carrying babies for foreigners, mainly couples from wealthier Asian nations, quickly became a lucrative cottage industry in the farming communities around Pak Ok, a six-hour drive from Bangkok. Officials say at least 24 women out of a population of about 13,000 people have since become paid surrogate mothers.
...
"The baby boomlet here was just one of several bizarre and often ethically charged iterations of Thailand’s freewheeling venture into what detractors call the womb rental business, an unguided experiment that the country’s military government now says it is planning to end.

"Commercial surrogacy has been available for at least a decade in Thailand, one of only a handful of countries where it is allowed, and one of only two in Asia, making it a prime destination for couples in the region from countries where the practice is banned.

"Officials estimate that there are several hundred surrogate births here each year, a number that does not include foreign surrogates, including many hired by Chinese couples, who come to Thailand for the embryo implantation then return home to carry out the pregnancy.

"But a pair of recent scandals have focused scrutiny on the largely unregulated industry, raising ethical questions and prompting the government’s crackdown.
...
"More recently, police raids on surrogacy clinics in Bangkok uncovered the case of a Japanese man who had fathered around a dozen babies through surrogates — the exact number is not known — whose births were only weeks or months apart. Last week the global police agency, Interpol, said it had begun an investigation into the motives and background of the Japanese man.

"Commentators have lamented that Thailand, which already had a reputation for prostitution, was now becoming, as one television anchor called it, the “womb of Asia.”

"Others described surrogacy as the exploitation of the weak and poor by wealthy couples from more developed nations.
...
"Thai officials say surrogates are paid about $10,000 for a successful pregnancy, more for twins, in addition to a monthly allowance of around $450 and free lodging in Bangkok, where the women are either instructed or choose to carry out their pregnancies.
...
Among the villagers, there is sympathy for the surrogates and anger at what is seen as a witch hunt by the authorities for women who took part in a practice that is not yet illegal.

“There’s nothing wrong with surrogacy — you are helping people who can’t have a baby,” said Pakson Thongda, 42, whose daughter twice sold eggs to a fertility clinic for about $1,000 each time. “I understand the feeling of a mother who really, really wants a child.”

"The surrogacy business in Thailand has provided a low-cost alternative to the United States, the world’s largest paid surrogacy destination, and was an outgrowth of the country’s effort to promote itself as a destination for medical tourism. The Thai industry also benefited from regulations in India, which prohibit same-sex couples from hiring surrogate mothers. India is the only other Asian country where surrogacy is legal.

"Commercial surrogacy has operated in a legal gray area. There are no laws banning it, but there are some hurdles. Thai law defines a mother as the person who gives birth, so in order for the biological parents to gain custody, the surrogate mother must renounce her parental rights — a concession that may require legal wrangling.

"The police investigations and the pending law have left a number of foreign couples wondering whether they will be able to bring their surrogate babies home. One Australian couple, unable to complete the legal procedures for twins born in July by a Thai surrogate, have been raising funds on the Internet to help pay for the legal costs.

"The authorities in Australia have requested that the Thai junta allow “transitional arrangements,” before the law banning commercial surrogacy comes into effect.

"The law, which the junta has vowed to pass soon through its rubber-stamp Parliament, would still allow surrogacy, but without payment. Surrogacy brokers and advertising offering surrogacy services would be banned.

"The junta has not publicly explained its decision, but Sriamporn Salikoop, a senior Supreme Court judge, said the ban was needed to prevent exploitation of Thai surrogates."

Non-directed kidney donation up in Britain

The Telegraph has the story: Why I wanted to donate a kidney to a complete stranger

"Altruistic kidney donation has, in the past year, increased by 55 per cent, with 118 living people donating a kidney. The practice only became legal in 2006, and the following year only six procedures were recorded. Since then the numbers have risen exponentially.
Transplant experts believe that cases such as that of the 85-year-old woman who this year became Britain’s oldest living kidney donor – “Why do I need two kidneys to sit at home knitting and watching television?”, she asked – have inspired others to follow suit.
Before 2006, only family and close friends were allowed to give up their kidney for people suffering from kidney dysfunction. The authorities were wary of a trade in organs that could lead to an exploitative or coercive relationship between recipient and donor.
The current legislation, drawn to prevent this, states that donors are not allowed to know the identity of the recipient, although recipients are allowed to get in touch with donors, if they choose to, after the operation. This is so that the recipient is not made to feel any moral or financial obligation.

Repugnant markets and forbidden transactions: video of my talk at Lindau

Here's a 30 minute video of my recent lecture at Lindau, on Repugnant Markets and Forbidden Transactions

 

Video - Alvin E. Roth (2014)

mediatheque.lindau-nobel.org

Market design (and kidney exchange) as an example of the uses of economics | 2 minute video from Lindau

Market design (kidney exchange in particular) as a useful part of economics, in 2 minutes, from Lindau.

Matching markets, and repugnant transactions | 3 minute video from Lindau

Here's a 3 minute video from the Lindau meetings, about matching markets, and repugnant transactions. (Next blog post will be from home in CA...)

Debate on kidney markets in the NY Times

How Much for a Kidney?

INTRODUCTION

According to the World Health Organization, 80,000 kidney transplants are performed worldwide each year. Nicole Bengiveno/The New York Times

The demand for transplantable organs far exceeds the supply. That has led to an increase in the illegal trafficking of kidneys, which represent the majority of living-donor transplants because a person can live with only one.

Should people in need of a kidney transplant be allowed to pay someone to donate one of theirs, or would that let the rich exploit the poor?

READ THE DISCUSSION »

DEBATERS

• 

  Test Incentives for Organ Donations

  SALLY SATEL, EDITOR, "WHEN ALTRUISM ISN'T ENOUGH"
• 

  Fix the System, Don’t Swap It for the Free Market

  JEREMY CHAPMAN, TRANSPLANT PHYSICIAN
• 

  Protecting Donors and Patients

  ARTHUR J. MATAS, TRANSPLANT SURGEON
• 

  An Economic Class War

  KATRINA A. BRAMSTEDT, MEDICAL ETHICIST
• 

  Cover the Costs for Donors

  ALEXANDER M. CAPRON, PROFESSOR OF HEALTH CARE LAW AND FRANCIS L. DELMONICO, TRANSPLANT SURGEON
• 

  Make Donation Appealing

  DANIEL R. SALOMON AND ALAN LANGNAS, TRANSPLANT SURGEONS
• 

  Paying Donors Would Set Us Back

  RUDOLPH GARCIA-GALLONT, TRANSPLANT SURGEON

Banning trade in ivory: two stories about enforcement in the U.S.

The NY Times has a story on the new NY law on ivory: Battling the Ivory Trade

"New York’s Governor Andrew Cuomo on Tuesday signed one of the toughest laws in the nation banning the sale of elephant ivory and rhinoceros horns as a “stand against a dangerous and cruel industry.”

The new law, which goes into effect immediately, was written to protect elephants that are being slaughtered at the rate of 96 a day in Africa. If it works as intended, the flow of ivory into New York — often ranked the number one importer of ivory in the United States — should soon slow to virtually nothing.

In the past, traders have found a way to get around bans, often by simply providing fraudulent paper work. But the new law is much stricter. New York will not allow trade in anything but 100-year-old antiques with small amounts of ivory (and documented proof of provenance), musical instruments made before 1975, pieces used for education or scientific purposes such as museums and items handed down through estates.

Even more important, the law dramatically increases penalties for those caught trading in these products. "
***************

Sometimes enforcement leads to silly incidents: Teens' Bagpipes Seized at US Border Over Ivory

"Campbell Webster, of Concord, and his friend Eryk Bean, of Londonderry, were returning from Canada on Sunday after a bagpipe competition that served as a tuneup for the world championships in Glasgow, Scotland. The 17-year-olds, fresh off winning several top prizes in Canada, got to a small border crossing in Vermont when they were told they'd have to relinquish their pipes because they contain ivory.

The U.S. prohibits importing ivory taken after 1976. Even though the boys had certificates showing their ivory is older — Campbell's pipes date to 1936 — U.S. Customs and Border Protection seized the pipes in Highgate Springs, Vermont. Well, not all of them: The boys took every other part possible and left the ivory with Border Patrol so nobody else could make a full set out of the parts.

"This has been an awful headache," said Lezlie Webster, Campbell's mother. "At one point at the Canadian border, they said, 'no way are we going to get our pipes back.'"

After contacting New Hampshire's congressional delegation and gathering more than 3,000 signatures on an online petition, the boys are getting their pipes back and were set to fly from Boston to Scotland on Tuesday. But the hassle is lingering like a sour note: Lezlie Webster said the boys had to shell out $576 in extra fees because they took the pipes across the border at a "non-designated crossing.""

An interview in which I was asked if we should change the way we teach economics

Here's a set of questions and answers exchanged over email last month with a reporter in Brazil (my answers in italics):

Dear Professor Roth,

I work for Exame, which has been the best-selling economic magazine in Brazil for the last 40 years. I’m now writing a piece on whether the content of economics degrees should or should not change and I wonder if I could ask you some questions. The questions are below. You could either write the answers or I can call you anytime you like before Thursday, 24th.

Best wishes,

Eduardo Salgado


1) Should the content of economics degrees change? Why? Why not?
I guess you mean should we change what we teach young economists, and of course the only answer is “of course!”  What we teach young physicists and biologists and doctors and civil engineers changes as we learn more about those things, and economics is no different.

2) Has the criticism of economics been exaggerated after the 2008 crisis? To what extent is the current debate on content useful?
I think the 2008 crisis has been useful for pointing out that economics is, in many of its parts, still a very young science. For an analogy, think of medicine, which is the part of biology that we most often look to for advice, and is also a young science in many of its parts. Each year we worry that there might be an influenza epidemic due to whatever new strain of flu is observed in Asia that year, and each year vaccines are prepared, in an attempt to avert a disaster like the influenza pandemic of 1918. So far we’ve been lucky, but it’s not because we have a deep understanding of what could cause another epidemic or how to prevent it. But if another epidemic occurs, we’ll need to rely more on doctors and medicine, not less. So, while we need to understand epidemics better, that’s not a deep criticism of medicine, just an acknowledgement of some of its current limitations. Similarly for economic crises, and economics.

3) What changes should be made?
One of the things we’re devoting more attention to at Stanford is the kind of economic engineering called market design, which pays attention to the detailed rules by which particular marketplaces operate, and to experimental economics, which gives us a tool to better understand how people behave in economic environments.

4) Has economics teaching become too wedded to scientific pretension? Was excessive faith invested in abstract mathematical models?
Abstract mathematical models are very useful, in combination with other kinds of investigation. A lot of my work is devoted to market design, and my colleagues and I build a lot of marketplaces that have some of their ancestry in abstract mathematical models (including some of those explored by the famous Brazilian economist Marilda Sotomayor, in whose honor there is a conference next week).  Mathematical models are becoming increasingly important as we start to explore really big data sets, since not only do you need mathematical tools to test hypotheses on data, you need models to even suggest what hypotheses you should be testing. Theory and observation work best in combination…

Why Don’t We Eat Swans?

Why Don’t We Eat Swans Anymore? asks an article in Modern Farmer. They are eaten, after all, on the TV series Game of Thrones, and medieval recipes survive.  But not just anyone could eat a swan then, and apparently not today either, at least in England:

"Often served at feasts, roast swan was a favored dish in the courts of Henry VIII and Elizabeth I, particularly when skinned and redressed in its feathers and served with a yellow pepper sauce; others preferred to stuff the bird with a series of increasingly smaller birds, in the style of a turducken. Swans have been the property of the Crown since around the twelfth century, but Edward IV’s Act Concerning Swans in 1482 clearly defined that ownership. To this day, Queen Elizabeth II participates in the yearly Swan Upping, in which the royal Swan Master counts and marks swans on the Thames, and the kidnapping and eating of swans can be considered a treasonous crime. Great Britain’s royals are still allowed to eat swan, as are the fellows of St. John’s College of Cambridge, but to the best of our knowledge, they no longer do. Thanks to stories like Leda and the Swan and Lohengrin, the birds appear almost mythical; a restaurant on the Baltic island of Ruegen had swan on their menu for a short time, before protests began and it was swiftly removed."

Religion and deceased donation in Israel

The NY Times accompanies its story on kidney brokers with one on why deceased donation is complicated in Israel
A Clash of Religion and Bioethics Complicates Organ Donation in Israel

The story begins with a photo from the funeral of the soccer player Avi Cohen, who was a registered organ donor at the time of his death, but whose organs weren't donated when religious objections to brain death were raised.

" In the Book of Genesis, it is written that when the great flood submerged the land it extinguished “all in whose nostrils was the breath of life.” Across nearly 2,000 years of Talmudic debate, Jewish scholars have returned to that verse in holding that life ends at the moment when breathing stops. One 19th-century code instructed that if a person appeared lifeless, a light feather was to be placed before his nose: “If it does not flutter,” the text advised, “he is certainly dead.”

The sages could not have anticipated that their writings would provide the underpinnings for cultural resistance to organ donation from the deceased in 21st-century Israel. But their definition of mortality, which can conflict with modern acceptance of brain death, is cited among several reasons Israel has among the lowest rates of deceased organ donation of any developed country."

Kidney brokers

Costa Rica cracks down on commercial sales of kidneys, some involving patients and brokers from Israel: The New York Times has the story.
Transplant Brokers in Israel Lure Desperate Kidney Patients to Costa Rica
By KEVIN SACK  AUG. 17, 2014

"Some physicians and ethicists question the relative morality of allowing thousands to die just because the means of saving them is considered repugnant. A regulated marketplace, they say, could all but eliminate the shortage. It is no accident, they argue, that the only country that allows compensation for donors — Iran — effectively has no waiting list.

Experts list China, Egypt, India, Pakistan, Sri Lanka, Turkey, Eastern Europe and the former Soviet republics as hot spots for organ trafficking. But illicit transplants usually go undetected unless there is a surgical mistake or a payment dispute. Prosecutions are thwarted by false affidavits, toothless laws and lack of international cooperation, particularly regarding extradition.

Over the last decade, the authorities have pursued only a handful of cases worldwide. Few have sidelined the brokers, who seem bolder than ever. Some, like Mr. Volfman, who leases office space atop a mirrored skyscraper in Ramat Gan, have moved out of the shadows. They brazenly ply their trade even while under police scrutiny, posting Facebook photos of the luxury cars and five-star hotel rooms they rent on the road.

The Times found that brokers in recent years typically have charged clients $100,000 to $200,000 to cover expenses associated with a transplant. As with other scarce luxuries, pricing can be elastic."

Romesh Vaitilingam previews market design at Lindau

The economics writer Romesh Vaitilingam writes about my upcoming participation in the Lindau meetings:
Virtual Visit at Alvin Roth’s Lab: Designing Markets