Monday, August 11, 2014

Transplanting teeth in the 1700's

Michael Sobolev at the Technion drew my attention to two copies of a 1787 engraving depicting tooth transplantation.

<em>Transplanting Teeth</em> (c.1790) [Engraving]

One copy of the picture is on this site of the British Dentistry Association, which offers the following commentary:

Thomas Rowlandson (1756-1827)
Engraving hand coloured on paper
1787 
This is one of Rowlandson’s best-known works with a dental subject. The transplanting of teeth was particularly popular at the end of the eighteenth century. Poor people were paid to have their healthy teeth removed for immediate placement into the waiting mouths of wealthy, older patients whose own teeth had decayed and been extracted. The treatment went out of fashion as it had several disadvantages. Long term success was extremely rare, and furthermore syphilis could be transmitted with the transplanted tooth.
The central scene shows a fashionably attired dentist removing a tooth from a poor chimney-sweep with a tooth key (note the forceps on the floor, used to shake the tooth lose prior to extraction). An aristocratic lady, who is to receive the tooth, watches with apprehension. She has to resort to her smelling salts to overcome the smell of the poor person, seated next to her. On the right, one of the dentist’s assistants is examining the next patient, an elegantly dressed young lady with clenched hands, as she anticipates her forthcoming extraction. In the rear, between these two groups is a dandy examining his newly transplanted tooth in a mirror. On the extreme left, two poor sellers are leaving the room; one is holding his hand to his painful jaw while the other is disdainfully examining the miserly payment she has received for her tooth.
On the notice on the door is the statement: "Most money given for live teeth". Teeth from the dead were also transplanted. The social comment contained in this caricature is directed at the abuse of the poor, not at the transplanting procedure. To underline the satire the rich are in bright colours and the poor are drab and dull.
The museum has recently been involved in a film about transplanting of teeth in the 18th century; watch it here.
If you enjoyed this print why not visit the BDA shop on-line to buy a copy of 'Open Wide: A Series of Eighteenth and Ninetheenth Century Caricatures on Dentistry'? 

Another copy of the picture is on this site, with this commentary:
Annotation
This print is by Thomas Rowlandson (1756-1827) and is dated 1787. It is a satirical comment upon the real practice of rich gentlemen and ladies of the 18th century paying for teeth to be pulled from poor children and transplanted in their gums. The dentist present is portrayed as a quack. There are even two quacking ducks on the placard advertising his fake credentials. He is busy pulling teeth from the mouth of a poor young chimney sweep. Covered in soot and exhausted, he slumps in a chair. Meanwhile the dentist's assistant transplants a tooth into a fashionably dressed young lady's mouth. Two children can be seen leaving the room clutching their faces and obviously in pain from having their teeth extracted. As people lost most of their teeth by age 21 due to gum disease, teeth transplants were popular for some time in England although they rarely worked.

Source
Thomas Rowlandson, "Transplanting Teeth," The Wellcome Library, Annotated by Lynda Payne.

How to Cite This Source
Thomas Rowlandson, "Transplanting Teeth (c.1790) [Engraving]," in Children and Youth in History, Item #164, http://chnm.gmu.edu/cyh/primary-sources/164 (accessed July 10, 2014). Annotated by Lynda Payne


(And here's an earlier post on transplantation of teeth: http://marketdesigner.blogspot.com/2011/04/live-donor-teeth-and-george-washington.html )

Sunday, August 10, 2014

A call for more productive dialog between proponents and opponents of payments to kidney donors

In the American Journal of Transplantation, a letter to the editor containing a modest proposal:

A Regulated System of Incentives for Living Kidney Donation: It Is Time for Opposing Groups to Have a Meaningful Dialogue!
by A. J. Matas, and R. E. Hays

"The shortage of organs is a crisis in clinical transplantation. In spite of numerous attempts to increase both living and deceased kidney donation rates in the United States, there has not been a change in the last 10 years. The combination of an increasing number of transplant candidates and no change in donation rates has resulted in increased waiting times and significant morbidity and mortality for those waiting. In the last 10 years, over sixty thousand candidates have been removed from the waiting list because of death or becoming too sick for undergoing transplantion [1]. A regulated system of incentives has the potential to increase living donation rates and thereby reduce transplant candidate morbidity and mortality.

Despite the potential benefits to recipients, the concept of a trial of incentives remains controversial, with strong proponents and opponents [2-7]. Both groups have the same facts. Both agree that there is a shortage of organs; both favor removal of disincentives to donation; both likely agree that incentives may increase donation (only a trial will determine this) and that increased donation rates benefit patients and society. In addition, both are committed to the safety and well being of donors; both are opposed to unregulated underground markets and agree that such systems have done a disservice to donors and recipients.
...
proponents emphasize the potential benefit of a regulated system (for recipients), and use key words such as organ crisis, transplant candidate mortality and societal benefit. Opponents emphasize the potential risk to donors, and the impact that approving a system might have on society's moral perspective, and, citing the harms of unregulated markets, use key words such as coercion, exploitation, undermining dignity, repugnance and commodification. Second, proponents emphasize local, structured trials in countries, such as the United States, capable of providing structure, regulation and transparency. Opponents emphasize developing a worldwide policy, and state that because many countries cannot provide regulation and transparency, incentives should be banned in all countries.

Is there a way to move forward? Based on their perspective of the data, proponents suggest that a well-designed trial—in a country with effective systems in place for regulation and monitoring, and with appropriate entry criteria and end points—would answer the critical questions that determine whether or not a regulated system of incentives is worth exploring further [2]. If a trial were to show increased donation rates but poor donor outcomes (health, psychosocial [social losses; regret]) compared to conventionally accepted donors, the system would be unacceptable, and scrapped. With their perspective, opponents identify—to date, theoretical—concerns about the impact on donors and aim for a global “one size fits all” policy.

Worldwide, transplanters could and should agree that lack of effective regulation regarding living donation is dangerous to donors and recipients alike. At the same time, it needs to be recognized that as people die on the transplant waitlist, discounting a possible way to increase access to transplant without first testing its impact, outcomes, and pros/cons on donors and recipients is premature. Opting not to conduct a trial of a regulated system of incentives has real consequences—morbidity and mortality in those with end-stage renal disease; and, it could be argued further, exploits current living donors who (in the United States) incur significant financial burdens by donating [9].

It is time for those with the full spectrum of opinions on the issue to have a meaningful dialogue. Given that the two groups share the same facts and the same concerns about donor safety, one possible way to initiate discussion is to narrow the field of focus. Perhaps, it should start with discussion as to whether or not, in a regulated system of incentives, both donor and recipient interests can be protected, and whether or not it is necessary to have a single global policy. If individual national policies are to be considered, the groups could discuss whether or not countries such as the United States, that can provide effective regulation and monitoring, and have maximized conventional donation, could consider trials of incentives in the context of the current impact of the organ shortage on their transplant candidates."

Saturday, August 9, 2014

Friday, August 8, 2014

The State of the OPTN/UNOS KPD Pilot Program

Here's the report: The State of the OPTN/UNOS KPD Pilot Program, on the kidney exchange program begun by UNOS in 2010.

The report is full of informative figures, but this one tells much of the story: in 2013 the program started to overcome some of  the many logistical difficulties that it faced, and the original market design legacy that had initially limited exchanges to two way exchanges and prohibited and then limiting chains. Here's hoping that the trend will continue: UNOS is a natural home for kidney exchange in that it already deals with all the transplant centers, and that it would be in a position to integrate living and deceased donation (if only it were more nimble in overcoming political and regulatory barriers and embracing best practices...).


Wednesday, August 6, 2014

A new Johnny Appleseed of school choice--Gabriela Fighetti joins IIPSC

The Institute for Innovation in Public School Choice (IIPSC) has announced a new hire, Gaby Fighetti. There's a brief announcement on the IIPSC webpage, and Neil Dorosin writes as follows:

"I am thrilled to announce that Gabriela Fighetti is joining our team at IIPSC! We have known Gaby for many years, most recently through our partnership during her tenure at the Louisiana Recovery School District where she led the effort to design and implement OneApp, a model system that continues to inspire people in cities across the United States. Gaby will bring her substantial skills and expertise to cities across the country as they update their enrollment and choice systems. She is a brilliant and thoughtful person, and she will make IIPSC better as we continue to support this critically important work.
-----
Gabriela Fighetti joined the Recovery School District in July 2011. She is responsible for developing enrollment policies and systems to ensure equitable access to the portfolio of school options in New Orleans. As part of this work, Fighetti manages the implementation of OneApp, the New Orleans Public School Enrollment Process, the process by which over 10,000 students apply annually to attend nearly 90% of the public schools in New Orleans.

Prior to joining the RSD, Fighetti worked for the New York City Department of Education (NYC DOE). During her seven year tenure at the NYC DOE, Fighetti held numerous leadership roles in the Division of Portfolio where she managed the enrollment projections process for the system of 1,700 schools, and the facilities and expansion plans of charter school operators. Fighetti studied at Columbia University, earning a Bachelor of Arts degree at Barnard College and a Master of Arts degree in public administration at the School for International and Public Affairs. "
***************

Gaby's story is a little bit like Neil's. Neil was the director of high school operations for the New York City Department of Education when Atila Abdulkadiroglu, Parag Pathek and I helped design their high school choice system. Neil saw what well-organized school choice can do, and founded IIPSC with our support, to sow the seeds in other cities.

Gaby oversaw IIPSC's work in New Orleans, and is joining IIPSC to keep planting those apple seeds...

Tuesday, August 5, 2014

Which law schools produce the highest percentage of clerks in Federal courts?

Clerkships, by law school, from U.S. News & World Report.

Federal Judicial Clerkship Rankings
School (name) (state)2015 Best Law Schools rankPercent of 2012 employed J.D. grads with federal judicial clerkshipsPercent of 2012 employed J.D. grads with state and local judicial clerkships
Yale University(CT)136.3%3.3%
Stanford University (CA)329.1%2.9%
Harvard University (MA)218.5%4.4%
University of Chicago415%1.9%
Duke University(NC)1014.3%6.9%
Vanderbilt University (TN)1612.6%4.9%
University of Virginia812.6%6.2%
University of Notre Dame (IN)2611%2.4%
University of Pennsylvania710.6%3.8%
University of Georgia2910.3%7.2%
University of Alabama2310.1%3.2%
University of Michigan—Ann Arbor (MI)109.6%3.7%
University of Texas—Austin159%3.2%
Columbia University (NY)48.1%0.9%
University of Southern California (Gould)207.9%0%
Cornell University (NY)137.3%2.8%
University of California—Berkeley97.1%2.4%
Northwestern University (IL)127.1%2.2%
Washington and Lee University(VA)436.9%13.8%
Emory University (GA)196.6%4.3%
Wake Forest University (NC)316.6%2.9%

Monday, August 4, 2014

Surrogacy in China and in Thailand

The NY Times carries this story about the illegal market for surrogates/babies in China: China Experiences a Booming Underground Market in Child Surrogacy,

The WSJ carries this story about the legal market in Thailand: Abandonment of Thai Baby Raises Questions on Global Surrogacy Rules--Australian Couple Leaves Thai Mother With Down Syndrome Baby

(While paid surrogacy is illegal in China, it is legal in the U.S., and an ad for this surrogacy agency ran alongside the story when I read it...)

The Times story on China begins this way:
WUHAN, China — In a small conference room overlooking this city’s smog-shrouded skyline, Huang Jinlai outlines his offer to China’s childless elite: for $240,000, a baby with your DNA, gender of your choice, born by a coddled but captive rural woman.
The arrangement is offered by Mr. Huang’s Baby Plan Medical Technology Company, with branches in four Chinese cities and up to 300 successful births each year.
As in most countries, surrogacy is illegal in China. But a combination of rising infertility, a recent relaxation of the one-child-per-family policy and a cultural imperative to have children has given rise to a booming black market in surrogacy that experts say produces well over 10,000 births a year.
The trade links couples desperate for children with poor women desperate for cash in a murky world of online brokers, dubious private clinics and expensive trips to foreign countries.


“China’s underground market shows that there is a need for surrogacy in society,” said Wang Bin, an associate professor at Nankai University’s law school. “And where there is a need, there is a market.”

The WSJ story on Thailand (and Australia) begins with this:

SYDNEY—An Australian couple's abandonment of a baby with Down syndrome with his Thai surrogate mother has raised questions about a trade that is banned in many developed countries but can be lucrative for women on low incomes elsewhere.
Australian officials said they were looking into issues relating to surrogacy in Thailand after expressing concern at how Pattharamon Janbua, a 21-year-old Thai street food vendor, was left to raise her baby son by the unnamed Australian couple, who took only his twin sister instead. She does not have Down syndrome.
"It's a very, very sad story," said Australian Prime Minister Tony Abbott, basing his remarks on earlier media reports rather than an official briefing. "It illustrates some of the pitfalls involved in this particular business."
The plight of Ms. Pattharamon and her son, Gammy, underscores what can go wrong in cross-border commercial surrogacy deals, where a mother agrees to carry a child on behalf of another woman for profit.
In an interview with The Wall Street Journal, Ms. Pattharamon said she feared being plunged deeply into debt by the high medical costs of caring for a son with disabilities, and claimed that the agent who brokered the surrogacy arrangement with the Australian couple reneged on paying her in full. Efforts to reach the agent weren't successful.
"The alleged circumstances of the case raise broader issues relating to surrogacy in Thailand," said a spokeswoman for Australia's Department of Foreign Affairs and Trade. "Australian Government agencies are examining these issues in consultation with authorities in Thailand."
Laws on surrogacy differ around the world. While many countries, including Germany and France, prohibit women from carrying another woman's child altogether, others ban payments that go beyond compensation for medical expenses, or limit the use of fertility treatments or donor eggs. In Australia and the U.S., laws on surrogacy also vary from state to state.
For many childless couples, the answer is to look overseas where there are fewer restrictions. In Thailand, for example, commercial surrogacy is a medical gray area. There are no laws directly relating to the practice of surrogacy, and it is largely unregulated. As a result, many agencies and health clinics in Thailand aim to profit from matching surrogate mothers with egg donors

Sunday, August 3, 2014

Danish sperm donors and British babies

The Telegraph has the story: Invasion of the Viking babies--With a growing demand for donor fathers, women are turning to Danish sperm banks


"Donors are paid a similar sum in Britain, but clinics can’t recruit enough men to keep up with the growing demand for sperm (the number of women with female partners having donor insemination, for example, rose by 23 per cent between 2010 and 2011). The percentage of new registered donors from overseas has more than doubled in recent years, from 11 to 24 per cent – and around a third of those imports are from Denmark.

“It’s a bit like the Viking invasion of 800AD,” says Dr Allan Pacey, a fertility expert from the University of Sheffield and current chairman of the British Fertility Society. “They’ve invaded us once by boat, and now they’re doing it by sperm.”

"Part of the problem is down to our system, with donor recruitment generally carried out on a small scale in British fertility clinics. On average, just one in every 20 men who applies will be suitable to donate. Men do not only need to have high-quality sperm: they also have to undergo a full range of screening tests for genetically inherited diseases and sexually transmitted infections, and their family medical histories must be assessed. Those deemed suitable will need to commit to regular visits to the clinic, usually during the working day. It’s often easier for a clinic to suggest their clients use a Danish donor, where a specialist sperm bank has the resources to devote to finding the 5 per cent who fit the bill.

"Although some bigger fertility clinics here do have a ready supply of donors, inter-clinic competition means that those who don’t tend to recommend an overseas sperm bank. Olivia Montuschi, of the Donor Conception Network, a charity for those affected by donor conception, told me that patients are not being informed about the clinics that have donors available. “Clinics like to retain their own patients, not share them, and they keep information about donors at other clinics to themselves,” she says.

Saturday, August 2, 2014

Some fundamental results on matching and market design by Marilda Sotomayor

When I was at the recent conference Celebrating the 70th Birthday of Marilda Sotomayor, July 25-30 at the University of Sao Paulo, one of the talks I gave was to introduce Marilda before she spoke.

I concentrated on the results in these four papers.

Some Remarks on the Stable Matching Problem,  David Gale and Marilda Sotomayor, Discrete Applied Mathematics, 1985 (decomposition)

Multi-Item Auctions, Gabrielle Demange, David Gale, and Marilda Sotomayor, Journal of Political Economy, 1986 (simultaneous ascending auction)

A Further Note on the Stable Matching Problem, Gabrielle Demange, David Gale, and Marilda Sotomayor, Discrete Applied Mathematics, 1987 (limits to manipulation)

A Non-constructive Elementary Proof of the Existence of Stable Marriages, Marilda Sotomayor, Games and Economic Behavior, 1996 (structure, still to come?)

I pointed out that some theory is fundamental because it plays a big role in producing new theory, and understanding mathematical structure, and some theory is fundamental because it helps us understand the world, make sense of empirical observations, and explains how and why successful market designs work.

In the latter category, I've come to appreciate the theorem about the limits to which stable matching mechanisms can be manipulated by misrepresenting preferences in simple matching markets:

Limits on successful manipulation (Demange, Gale, and Sotomayor). Let P be the true preferences (not necessarily strict) of the agents, and let P differ from P in that some coalition  C of men and women misstate their preferences. Then there is no matching m, stable for P, which is preferred to every stable matching under the true preferences P by all members of C

Taken together with the variety of empirical and theoretical observations that say that the set of stable matchings is generally quite small, this result states that in general very few agents will be in a position to profitably manipulate their preferences. So it can be viewed as providing an explanation of why stable matching mechanisms have succeeded so well empirically, despite the theoretical result in Roth (1982) stating that no stable matching mechanism can always make it a dominant strategy for agents to reveal their true preferences.

Here's a picture of Marilda at the conference:

Here's an interview (in Portugese) about the conference, and here's a newspaper story (for which Google translate does a reasonable job): Uma semana com 4 Nobéis de Economia. (Here's another: Nobel de Economia fala sobre a matemática dos encontros.) And finally here's a video (in English, with music) of an interview I gave about matching and market design, and the kind of work that Marilda and I have done.

Friday, August 1, 2014

Further celebration of Marilda Sotomayor in Rio today

Here is the announcement:
The FGV/EPGE Escola Brasileira de Economia e Finanças is hosting a Workshop on Game Theory on August, 1st, in honor of Marilda Sotomayor, on the occasion of her 70th birthday. Some important specialists on the topic as Salvador Barberá, Steve Brams, Inés Macho-Stadler, Abraham Neyman, David Perez Castrillo, Myrna Wooders will present their work. There will be also the special participation of the 1994 Nobel-Prize Winner John Nash. This workshop is organized by FGV/EPGE and supported by FGV/EPGEIPEA and EPRG.

And here's the program.

Thursday, July 31, 2014

What do British fertility tourists choose in America? It's a girl!

The Telegraph reports:  Number of women travelling to America to choose sex of child rises 20%

"The number of British couples having fertility treatment in America so they can choose the sex of their child is increasing by a fifth every year, a leading doctor has said.
Dr Daniel Potter, who runs a large fertility clinic in America, treats 10 patients from Britain a month who want to have IVF treatment only in order to select the gender of the baby.
Eight in ten couples from Britain are choosing to have a girl, he said.
Hundreds more could be travelling to other clinics across America and the numbers are rising by 20 per cent a year, Dr Potter said.
Sex selection is banned in Britain unless done so for medical reasons and an investigation by the Telegraph discovered doctors willing to authorise abortions on the grounds of gender.
Dr Potter who runs the HRC clinic in Newport Beach in California, said 80 per cent of couples from Britain are choosing to have a girl.
It had been feared that allowing sex selection would lead to an imbalance between the genders with fewer girls born for cultural reasons.
However Dr Potter said the women he sees are desperate for a girl having grown up playing with dolls and always imagined they would have daughter.
He told the Telegraph: "Some have only one child but most have two or three of the same gender. The process is driven by the mother who has identified with little girls since her own childhood and has always had a place for a daughter. When they do not have one, it is like a death and they grieve for their little girl."
Dr Potter's patients often do not need fertility treatment in order to conceive but go through the process so that the resulting embryos can be screened and the chosen sex transferred to the womb.
The whole process costs around US$15,000 and requires a 12 day stay near the clinic.
Dr Potter said: "I think that pregnancy termination as a method of gender selection is not acceptable but I also believe that is it not for me to impose my values on other people."

Wednesday, July 30, 2014

Increasing access to transplantation: my talk at the World Transplant Congress

In my talk at the WTC, I focused on increasing access to transplantation.

For increasing access to kidney exchange I proposed
Learn from best practices, and develop new ones
1. Allow non-simultaneous chains to be long when needed
2. Make it safe for transplant centers to enroll easy to match pairs, including compatible pairs
3. Reduce financial barriers to participation by transplant centers (introduce a standard acquisition charge?)
4. Consider International kidney exchange
5. Consider NDD chains initiated by deceased donors

I also spoke about repugnant transactions and how they change over time, and about
Removing disincentives to donation, and providing incentives
Without exploiting the poor and vulnerable
Israeli model: priorities and reimbursed lost wages
Continued discussion of disincentives and providing incentives in ways that will ease the shortage of organs without leading to exploitation

Frank Delmonico, in his Presidential address, spoke about how transplantation emphasizes the common humanity of all people, as we would see if we looked at the earth from the moon:



The auditorium was a big one...here is what it looked like before it filled up:



Here's a video of an interview I gave after my talk.


And here's a video of an interview with clips from my talk, set to music...

Tuesday, July 29, 2014

World transplant congress


Here's the program of the 2014 World Transplant Congress,

Joint meeting of

The logo of ASTSThe logo of TTSThe logo of AST
And here's my part of the program...my working title is "Transplantation: One economist’s perspective," and I'll talk about how changes in the organization of transplantation have increased access to transplants, and how further changes might lead to further improvements.



Here's some background on the meeting:


In 2006, history was made in the field of transplantation medicine. The largest meeting in transplant science was held in Boston, The World Transplant Congress (WTC). This meeting was a joint collaboration of the American Society of Transplant Surgeons (ASTS), The Transplantation Society (TTS), and the American Society of Transplantation (AST) with record breaking attendance. There were over 6500 specialists in this field as well as an additional 1000 exhibit personnel.  
The three societies are joining together again for the Word Transplant Congress 2014, being held July 26 – 31 in San Francisco, California. WTC 2014 will bring together transplant scientists, physicians, surgeons, trainees, nurses, organ procurement personnel, pharmacists and other associated transplant professionals from around the world.  
Also speaking at the conference will by Shinya Yaminaka, who shared the 2012 Nobel Prize in medicine for his work on turning ordinary cells into stem cells. Here's a story in Nephrology News: Nobel Laureates to deliver lectures at Transplant Congress

"Recent progress in iPS cell research towards regenerative medicine
Professor Shinya Yamanaka, MD, PhD, is the Director of the Center for iPS Cell Research and Application (CiRA) at Kyoto University in Japan. In 2012, he was awarded the Nobel Prize in Physiology or Medicine for the discovery of reprogramming and converting mature, specialized cells into pluripotent cells, capable of developing into all tissues of the body.

During his State-of-the-Art address on Wednesday, July 30, Dr. Yamanaka will provide characteristics of induced pluripotent stem cells (iPSCs), which have the ability to proliferate and differentiate into multiple lineages. He will discuss technologies related to iPSC generation, in addition to improvements achieved in iPSC production in terms of both safety and efficiency. These iPSCs and subsequently differentiated target cells/ tissues would provide unprecedented opportunities in regenerative medicine, disease modelling, proof-of-concept studies in drug development, drug screening, and future personalized medicine."

Monday, July 28, 2014

Council of Europe reaffirms opposition to all forms of payment for human organs

Press release - DC085(2014)
A Council of Europe Convention to combat trafficking in human organs
Strasbourg, 09.07.2014 – The Committee of Ministers of the Council of Europe has adopted an international convention to make trafficking in human organs for transplant a criminal offence, to protect victims and to facilitate cooperation at national and international levels in order to prosecute more effectively those responsible for trafficking.
The Convention calls on governments to establish as a criminal offence the illegal removal of human organs from living or deceased donors:
- where the removal is performed without the free, informed and specific consent of the living or deceased donor, or, in the case of the deceased donor, without the removal being authorised under its domestic law;
- where, in exchange for the removal of organs, the living donor, or a third party, receives a financial gain or comparable advantage;
- where in exchange for the removal of organs from a deceased donor, a third party receives a financial gain or comparable advantage.
The Convention also provides protection measures and compensation for victims as well as prevention measures to ensure transparency and equitable access to transplantation services.
Due to its worldwide scope, the Convention will be open shortly for signature by member states and non-member states of the Council of Europe. Spain has offered to host the ceremony for the opening for signature by the end of 2014/beginning of 2015.
Link to the Convention and its explanatory report - For more information see the factsheet