Wednesday, March 8, 2017

Global kidney exchange (and pushback) in the American Journal of Transplantation

I've written earlier about the possibility of Global Kidney Exchange (GKE), in which foreign patient-donor pairs who cannot afford transplantation are invited to join American kidney exchange chains. The idea is that the cost of the foreign pair's surgeries and postoperative care can be paid for by the savings that result whenever an American is transplanted (because transplantation is so much cheaper than dialysis).

The March issue of the American Journal of Transplantation  contains a report of the first foreign pair, and the chain of exchanges that included them.

Curiously, the issue also contains an editorial that is profoundly ambivalent about GKE, in a way that makes clear that the issues of repugnance that surround organ donation, and incentives, and equity, and patients and donors from developing countries, are not vanishing in the face of the benefits that GKE provides to patient-donor pairs from developing countries.

Finally, for those in a hurry, here's a nice summary by Timothy Taylor on his blog the Conversable Economist: Global Kidney Exchange.

Here's our paper reporting the first global kidney exchange chain:

Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation
by M. A. Rees, T. B. Dunn, C. S. Kuhr, C. L. Marsh, J. Rogers, S. E. Rees, A. Cicero, L. J. Reece, A. E. Roth, O. Ekwenna, D. E. Fumo, K. D. Krawiec, J. E. Kopke, S. Jain, M. Tan, S. R. Paloyo
American Journal of Transplantation, Volume 17, Issue 3 March 2017, Pages 782–790

Abstract: Organ shortage is the major limitation to kidney transplantation in the developed world. Conversely, millions of patients in the developing world with end-stage renal disease die because they cannot afford renal replacement therapy—even when willing living kidney donors exist. This juxtaposition between countries with funds but no available kidneys and those with available kidneys but no funds prompts us to propose an exchange program using each nation's unique assets. Our proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient–donor pairs with immunological barriers and developing-world patient–donor pairs with financial barriers. By making developed-world health care available to impoverished patients in the developing world, we replace unethical transplant tourism with global kidney exchange—a modality equally benefitting rich and poor. We report the 1-year experience of an initial Filipino pair, whose recipient was transplanted in the United states with an American donor's kidney at no cost to him. The Filipino donor donated to an American in the United States through a kidney exchange chain. Follow-up care and medications in the Philippines were supported by funds from the United States. We show that the logistical obstacles in this approach, although considerable, are surmountable.

Here's an illustration of the idea:

Figure 1


And here's the first chain, to date: the Filipino pair is pair 1 (the chain was begun by an American nondirected donor who donated to the Filipino patient, whose donor in turn continued the chain...).

****************
And here's the accompanying editorial:
Walking a Tightrope or Blazing a Trail?
by A. C. Wiseman, J. S. Gill

Abstract: Engaging compatible kidney donor–recipient pairs from other countries for participation in a paired kidney exchange program in the United States poses a number of ethical challenges that deserve close scrutiny. Rees et al's article is on page 782.

Here's one sentence that illustrates the power of repugnance (it suggests that maybe the Filipino pair who joined the kidney exchange were really being exploited...):
"At a societal level, American patients received a disproportionate share of the societal benefit enabled by the participation of the compatible Filipino pair in KPE, which may not be adequately remedied by the payment for transplantation and posttransplant care."
*************

Update: and here's our coauthor Kim Krawiec at the Faculty Lounge: GKE Debate in Current Issue of The American Journal of Transplantation

Tuesday, March 7, 2017

Matching deceased organs to patients

Here's colorful story about the software that offers deceased donor organs to patients, via their surgeons:
Matching hearts — and kidneys and lungs. This website makes organ transplants in the US possible

Here's a UNOS page on How organs are matched.

Monday, March 6, 2017

Tom Starzl (1926-2017)

Dr. Thomas E. Starzl has passed away at 90. He pioneered the first liver transplants in the 1960's. He came to the University of Pittsburgh in 1981 (a year before I did) and was a towering figure there, a local hero as well as an international one,.  He made Pitt, and Pittsburgh a world center for transplantation, and for the education of transplant surgeons.

Here's the NY Times obituary: Dr. Thomas E. Starzl, Pioneering Liver Surgeon, Dies at 90

Here's the announcement from the University of Pittsburgh: Thomas E. Starzl, M.D., Ph.D., ‘Father of Transplantation,’ Dies at 90

Sunday, March 5, 2017

Third Workshop on Marketplace Innovation, Stanford, June 1-2, 2017

Third Workshop on Marketplace Innovation

Stanford University, Stanford, California

June 1-2, 2017

Abstract submission deadlineMarch 15, 2017
Notification of acceptanceApril 1, 2017
Workshop registration deadlineMay 1, 2017


Organizers

Ramesh Johari, Management Science and Engineering, Stanford University
Ilan Lobel, Stern School of Business, New York University
Costis Maglaras, Columbia Business School, Columbia University
Gabriel Weintraub, Graduate School of Business, Stanford University

Description

Markets are an ancient institution for matching the supply for a good or service with its demand. Physical markets were typically slow to evolve, with simple institutions governing trade, and trading partners generally facing a daunting challenge in finding the “right” partner. The information technology revolution, however, has generated a sea change in how markets function: now, markets are typically complex platforms, with a range of mechanisms involved in facilitating matches among participants. Recent trends point to an unprecedented level of control over the design, implementation, and operation of markets: more than ever before, we are able to engineer the platforms governing transactions among market participants. As a consequence, market operators or platforms can control a host of variables such as pricing, liquidity, visibility, information revelation, terms of trade, and transaction fees. Given these variables, market participants often face complex problems when optimizing their own decisions. In the supply side such decisions may include the assortment of products to offer and their price structure, while in the demand side they may include how much to bid for different goods and what feedback to offer about past purchasing experiences. The decisions made by the platform and the market participants interact, sometimes in intricate and subtle ways, to determine market outcomes.
In this workshop we seek work that improves our understanding of these markets, both from the perspective of the market operator and the market participants. With respect to the former we are particularly interested in work that derives useful insights on how to design these markets, taking into account their operational details and engineering and technological constraints. With respect to the market participants, we seek work that introduces novel approaches to optimize their decisions and improves our understanding of their interactions within the market. We look for a mix of approaches including modeling, theory, and empirics, using a wide range of tools drawn from operations management, game theory, auctions and mechanism design, optimization, stochastic modeling, revenue management, econometrics, or statistics.
The list of markets to be studied includes but it is not restricted to:
  • Online marketplaces, such as eBay, Etsy, etc.
  • Internet advertising, including sponsored search and display ad exchanges
  • Sharing economy markets, such as Uber/Lyft, AirBnb, etc.
  • Online labor markets, such as Amazon mTurk, Upwork, Thumbtack, etc.
  • Procurement markets, such as technology-enabled government procurement
  • Health care exchanges
  • Financial exchanges

Plenary speakers

The workshop will have several invited distinguished plenary speakers from academia and industry, including:
  • Susan Athey, Stanford GSB
  • Omar Besbes, Columbia Business School
  • Vivek Farias, MIT Sloan
  • Ashish Goel, Stanford MS&E
  • Garud Iyengar, Columbia IEOR
  • Paul Milgrom, Stanford Economics
  • Asu Ozdaglar, MIT EECS
  • Bob Phillips, Uber
  • Tuomas Sandholm, Carnegie Mellon Computer Science
  • Hal Varian, Google

Abstract submission

To present in the workshop we invite abstract submissions of at most one page. Papers will be accepted either for a regular presentation, or as a poster. There are no proceedings for this workshop, so we welcome submissions of work-in-progress, or work that is submitted or accepted for publication elsewhere. 

Saturday, March 4, 2017

Kdo dostává co – a proč : Who Gets What and Why in Czech

Kdo dostává co – a proč   (Who Gets What and Why--Czech translation)

Who Gets What and Why: Czech

Friday, March 3, 2017

The Retail Market for Illicit Drugs

Outlawing a market is often the first step in the design of the illegal black market that results. Here's a paper from the most recent AER on the market for crack cocaine:

A Structural Model of the Retail Market for Illicit Drugs
By Manolis Galenianos and Alessandro Gavazza

Abstract: We estimate a model of illicit drugs markets using data on purchases of  crack  cocaine.  Buyers  are  searching  for  high-quality  drugs,  but  they determine drugs’ quality (i.e., their purity) only after consuming  them.  Hence,  sellers  can  rip  off  first-time  buyers  or  can  offer  higher-quality drugs to induce buyers to purchase from them again. In  equilibrium,  a  distribution  of  qualities  persists.  The  estimated  model  implies  that  if  drugs  were  legalized,  in  which  case  purity  could be regulated and hence observable, the average purity of drugs would  increase  by  approximately  20  percent  and  the  dispersion  would decrease by approximately 80 percent. Moreover, increasing penalties may raise the purity and affordability of the drugs traded by increasing sellers’ relative profitability of targeting loyal buyers versus first-time buyers.

Thursday, March 2, 2017

Who Gets What and Why in Spanish for Latin America

Here's the Spanish translation of my book Who Gets What and Why, for Latin America, published by Oceana.


Lo que sea de cada quien. La economía de las relaciones y el diseño de mercado

I gather from Manu Vespa that "Lo Que Sea De Cada Quien" is an idiom common in some parts of Latin America which means something like "To Each His Own." (More literally it seems to be "Whatever could be for each person..."

Google translate renders the title as "Whatever it is for each one. The economy of relationships and market design"
************

The Spanish translation for Spain was a much more literal "Who gets what and why":
Quién obtiene qué y por qué
LA NUEVA ECONOMÍA DEL DISEÑO DE MERCADOS

Wednesday, March 1, 2017

Surrogacy in China: available but illegal

The Global Times has this story:
Surrogacy to ‘remain illegal’ By Liu Caiyu  

"China will not legalize surrogacy and will crack down on the crime, China's top health authority said Wednesday, after the People's Daily published an article hinting at support for the practice for older mothers.

Surrogacy is a complex problem involving law and ethics, and most nations and regions in the world ban any form of surrogacy and punish participating institutes and personnel, said Mao Qunan, a spokesperson with China's National Health and Family Planning Commission (NHFPC), said Wednesday during a press conference in Beijing.

"The commission and the government will continue to crack down on surrogacy and ensure the public can get safe and effective assisted reproductive technology," Mao said.

Since China eased its one-child policy in 2014, allowing couples to have a second child if either parent is an only child, and further loosened it to allow all couples to have two children in January 2016, more older mothers are trying to conceive, but are finding it difficult, a People's Daily article on Friday said.

The article quoted a doctor as saying that nearly 90 percent of women cannot conceive naturally after the age of 45. The average age for a final pregnancy is around the age of 40, although the number of older women giving birth has seen a continuous increase.

Among the 90 million families in China eligible to have a second child, 60 percent of the women are above 35 years old and 50 percent are over  40, data released by the NHFPC in January 2016 shows. In 1996, only 0.4 percent of women above 45 gave birth, rising to 4 percent in 2005 and 10 percent in 2015, it said.

Although China has a huge demand for surrogacy services, from both an ethical and legal standpoint, it is not feasible to legalize it now, Xia Yinlan, a professor at the China University of Political Science and Law,  told the Global Times.

"Legalizing surrogacy could worsen the problem of trafficked women, which is not humane and would increase discrimination against women," said Xia."

Tuesday, February 28, 2017

Incentives in Computer Science--Tim Roughgarden

There was a time when only economists worried about incentives, but as this great looking computer science course by Tim Roughgarden shows, that time is long past...

CS 269I: Incentives in Computer Science



Instructor:
  • Tim Roughgarden (Office hours (note new time): Mondays 12:15-1:15 PM, Gates 474. Email: tim@cs.stanford.edu.)

Prerequisites: Mathematical maturity at the level of undergraduate algorithms (CS161). Programming maturity at the level of 106B/X.
Course Description: Many 21st-century computer science applications require the design of software or systems that interact with multiple self-interested participants. This course will provide students with the vocabulary and modeling tools to reason about such design problems. Emphasis will be on understanding basic economic and game theoretic concepts that are relevant across many application domains, and on case studies that demonstrate how to apply these concepts to real-world design problems. Topics include auction and contest design, equilibrium analysis, cryptocurrencies, design of networks and network protocols, matching markets, reputation systems, and social choice. Possible case studies include BGP routing, Bitcoin, eBay's reputation system, Facebook's advertising mechanism, Mechanical Turk, and dynamic pricing in Uber/Lyft.
General references: Twenty Lectures on Algorithmic Game Theory, Cambridge University Press, 2016. See also the Amazon page.
  • This textbook is based on the course CS364A. The overlap with 269I will be roughly 20-25%. Though if you enjoy this course, you're likely to also enjoy many of the topics in this book.
The following collection is older and targeted more to researchers than to students, but is still useful for several topics.
  • Algorithmic Game Theory, Cambridge University Press, 2007. Read the entire book online by clicking here (look under the "Resources" tab).
We will also draw on the following books for some of the lectures.
Lecture notes

Coursework

Tentative Syllabus (will likely change)

  • Week 1: Introduction to incentives through killer examples.
  • Week 2: Social choice (voting, Arrow's impossibility theorem, etc.).
  • Week 3: Incentives in peer-to-peer and social networks (e.g., incentives in BitTorrent).
  • Week 4: Incentives in communication networks (routing, flow control, etc.).
  • Week 5: Incentives in cryptocurrencies (like Bitcoin).
  • Week 6: Reputation systems. Incentives in crowdsourcing.
  • Week 7: Basic auction theory (eBay, sponsored search auctions).
  • Week 8: Advanced auction theory and mechanism design (Facebook advertising auctions, contest design).
  • Week 9: Scoring rules and prediction markets.
  • Week 10: Lessons from behavioral economics (i.e., how do people make decisions, anyway?).

Detailed Lecture Schedule


  • Lecture 1 (Mon Sept 26): The incentives of the Draw, past and present. Pareto optimality and strategyproofness. College admissions. One-sided vs. two-sided markets. The National Resident Matching Program (NRMP). Supplementary reading:
  • Lecture 2 (Wed Sept 28): Stable matchings. Properties of the deferred acceptance (Gale-Shapley) mechanism. Could college admissions go through a centralized clearinghouse? Supplementary reading:
  • Lecture 3 (Mon Oct 3): Participatory democracy. Strategic voting. Spoilers and the 2000 US election. Majority, plurality, ranked-choice voting, Borda counts. Gibbard-Satterthwaite and the impossibility of reasonable strategyproof voting rules. Arrow's Impossibility Theorem. Compromises, single-peaked preferences, and the median voting rule. Supplementary reading and resources:
    • Participatory budgeting in general and at Stanford.
    • The rank aggregation problem.
    • Reasonably short proofs of the Gibbard-Satterthwaite and Arrow impossibility theorems are here (see Sections 1.2.3 and 1.2.4).
    • Chapter 23 of the Easley/Kleinberg book (see general references).
  • Lecture 4 (Wed Oct 5): Subjective vs. objective interpretations of voting rules. Metaphor: linear regression as the maximum likelihood solution with normally distributed errors. Marquis de Condorcet and majority rule as a maximum likelihood estimator. The Kemeny-Young rule. Knapsack voting and its properties. Supplementary reading and resources:
    • The dramatic life of Marquis de Condorcet.
    • See Pnyx for an implementation of the Kemeny rule.
    • Knapsack voting, by Goel/Krishnaswamy/Sakshuwong (2014).
    • Section 15.2 of the Parkes/Suen book (see general references).
  • Lecture 5 (Mon Oct 10): Incentives in peer-to-peer (P2P) networks. History lesson: Napster, Gnutella, etc. Free riding on Gnutella. Prisoner's Dilemma. Repeated Prisoner's Dilemma: the grim trigger and Tit-for-Tat stategies. Tit-for-tat in the BitTorrent reference client. Strategic clients (BitThief and BitTyrant). Supplementary reading:
  • Lecture 6 (Wed Oct 12): Coordination games. Technology adoption and network cascades. Individual vs. collective preferences in public good problems. Case study: badge design in Stack Overflow, Coursera, etc. Supplementary reading:
  • Lecture 7 (Mon Oct 17): Selfish routing and network over-provisioning. Braess's paradox and Pigou's example. The price of anarchy. Modest over-provisioning guarantees near-optimal routing.
  • Lecture 8 (Wed Oct 19): The Border Gateway Protocol for Internet routing. Stable routings: non-uniqueness and non-existence. Dispute wheels and the convergence of BGP to a unique solution. Incentive issues. Incentive-compatability with path verification. Supplementary reading:
  • Lecture 9 (Mon Oct 24): Incentives in Bitcoin mining. Transactions and the Bitcoin blockchain protocol. Forks. Incentive issues: the 51% attack, the double-spend attack, and selfish mining. Supplementary reading:
  • Lecture 10 (Wed Oct 26): Incentives in crowdsourcing. Bitcoin in a regime with high transaction fees. The DARPA Network Challenge and incentivizing recruitment. Sybil attacks and possible solutions. The "Wisdom of the Crowd": fact or fiction? Herding behavior and information cascades. Supplementary reading:
  • Lecture 11 (Mon Oct 31): Incentives in societal networks (guest lecture by Balaji Prabhakar). "Nudges" for changing behavior. Case studies in Bangalore, Singapore, and at Stanford.
  • Lecture 12 (Wed Nov 2): Adverse selection, moral hazard, and reputation systems. The market for lemons. Analogs in health insurance, the labor market, and online platforms. Moral hazard. Reputational effects in the n-person Prisoner's Dilemma. Whitewashing and the pay-your-dues strategy. Sybil attacks. Case study: the evolution of eBay's reputation system. Supplementary reading:
  • Lecture 13 (Mon Nov 7): Auction design basics. How would you bid in a first-price auction? The Vickrey auction and truthfulness. Welfare maximization. Introduction to sponsored search auctions.
  • Lecture 14 (Wed Nov 9): The theory of first-price auctions. Externalities. VCG: a truthful sponsored search auction. GSP vs. VCG. Supplementary reading:
  • Lecture 15 (Mon Nov 14): Revenue equivalence of the GSP and VCG sponsored search auctions. VCG in AdSense and Facebook. The general VCG mechanism and its truthfulness. Practical issues with VCG. Supplementary materials:
  • Lecture 16 (Wed Nov 16): Revenue maximization. Bayesian optimal auctions. Monopoly prices. Optimality of Vickrey with a monopoly price reserve. Case study: reserve prices in Yahoo! keyword auctions. Prior-independent auctions and the Bulow-Klemperer theorem. Further reading:
  • Lecture 17 (Mon Nov 28): Strictly proper scoring rules. Incentivizing honest opinions. Output agreement. Peer prediction. Further reading:
    • Section 27.4 of the AGT book (see general references).
    • Chapter 17 of the Parkes/Suen book (see general references).
  • Lecture 18 (Wed Nov 30): Prediction markets. The Iowa Electronic Markets and continuous double auctions. The Policy Analysis Market and the Wisdom of Crowds. Market scoring rules and automated market-makers. Further reading:
  • Lecture 19 (Mon Dec 5): Behavioral economics. Time-inconsistent planning: procrastination, choice reduction, and undue obedience. Upper and lower bounds on cost ratios. Naive vs. sophisticated agents. Further reading:
  • Lecture 20 (Wed Dec 7): Fair division. The cut and choose protocol and envy-freeness. The Selfridge-Conway envy-free protocol for 3 players. Recent advances for 4 or more players. The rent division problem, and the maxmin envy-free solution. Further reading:


Monday, February 27, 2017

Donor sibling registry: matching donor-conceived sibs

The Donor sibling registry is a matching service to help identify half siblings of  "donor conceived people," i.e. people who were conceived from donor sperm or eggs, and who may know only an anonymized donor number.  If your numbers match, you might want to arrange a meeting...

Sunday, February 26, 2017

Who can be a common law couple?

Being a couple is about a lot of things, including survivor rights and medical visitation and decision-making rights...

Inseparable Israeli Sisters Fighting to Be Recognized as a Common Law Couple
"A day in court with two nonagenarian sisters, refugees from the Holocaust and constant companions, who seek the unprecedented status so that the one who lives longer can inherit the other's old-age allowance."

"The claimants, it turned out, are asking the National Insurance Institute to recognize each of them as being eligible to receive a next-of-kin allowance upon the other’s death. Effectively, they want the NII to grant them common-law status recognition.
A disturbing thought ran through the judge’s head. “Are you telling me that …” she said to attorney Igra who, guessing her thought, dismissed it with an “Absolutely not,” and placed before the judge a court ruling stating that sexual relations are not a condition for common-law recognition.
Relieved, the judge went on to sum up the lives of the two sisters in a few sentences, as she began reading her judgment. The claimants have lived in the same unit of a protected housing project since 2007. The claimants never married, are single and have no children. The claimants have a joint back account, and their old-age allowances have always been deposited in that account. The claimants manage their income and their expenses from the same bank account. The claimants purchased adjoining burial plots. The claimants’ only journeys abroad took place between 1995 and 1998, and always together, according to the Interior Ministry’s border inspection records.
...
"The Labor Court, though acknowledging the innovation and feasibility of the claim, did not accept it"

This request was not accepted by the Israeli court, but it is food for thought.


Saturday, February 25, 2017

Interview on Who Gets What and Why: American Monetary Association, Jason Hartman

This interview was conducted some time ago, but I just now saw the link...and listening to it just now, it seems to me that we had a pretty interesting discussion.
(the link at the title below will take you to the podcast...)

AMA 126 – Who Gets What and Why, The New Economics of Matchmaking & Market Design with Alvin Roth


Jason Hartman talks with Alvin Roth, Craig & Susan McGaw Professor of Economics at Stanford and author of “Who Gets What and Why”
Key Takeaways
[5:28] – what aspect of the real estate market surprises him the most
[11:45] – The market of organ donation
[16:24] Repugnant Transactions
[20:51] Government’s role in contracts
[24:56] Signals and two kinds of messages we send

Friday, February 24, 2017

Reducing disincentives to living organ donation in New York State

Josh Morrison of Waitlist Zero is pictured in this encouraging story:

Albany considers bill to pay live organ-donors' costs
Supporters want to remove economic barriers that they say keep many potential donors from coming forward

"A new bill could make New York the first state in the country to directly compensate living organ donors—who typically donate a kidney or a portion of their liver to a transplant patient—for lost wages, child care and other expenses.

The Living Donor Support Act, introduced by Democratic Assemblyman Richard Gottfried of Manhattan and Republican Sen. Kemp Hannon of Long Island, chair of the Senate Health Committee, has broad support from lawmakers. It already unanimously passed Hannon’s committee, and it has 18 Senate co-sponsors and 27 Assembly co-sponsors.

In addition to helping donors with expenses, the bill seeks to increase education about the option of living transplants for patients, who are disproportionately poor and members of minority groups.

“Our goal is to make transplants easy to ask for and easy to give,” said Josh Morrison, executive director and co-founder of Waitlist Zero, a Brooklyn-based nonprofit that championed the bill. Morrison donated one of his own kidneys as a good Samaritan five years ago at the age of 26.

For dialysis patients in particular, getting a kidney transplant from a living donor could save money and improve their quality of life, but patients often aren't informed of that option, Morrison said."


HT: Frank McCormick

Thursday, February 23, 2017

Fifty shades of stigma: repugnance for legal but kinky sex

As a wider variety of sexual behavior becomes free of legal restrictions, some are still misunderstood or regarded as repugnant by much of the population, including medical professionals, even as they are featured (gently) in popular books and movies like “Fifty Shades of Gray.”

The Journal of Sexual Medicine explores the extent to which practitioners of kinky sex may feel that they cannot be frank with their physicians:

"Fifty Shades of Stigma: Exploring the Health Care Experiences of Kink-Oriented Patients"
Jessica F. Waldura, MD, Ishika Arora, BS, Anna M. Randall, DHS, John Paul Farala, MD, Richard A. Sprott, PhD

Abstract: "The term kink describes sexual behaviors and identities encompassing bondage, discipline, domination and submission, and sadism and masochism (collectively known as BDSM) and sexual fetishism. Individuals who engage in kink could be at risk for health complications because of their sexual behaviors, and they could be vulnerable to stigma in the health care setting. However, although previous research has addressed experiences in mental health care, very little research has detailed the medical care experiences of kink-oriented patients."

Results: "...The study found that kink-oriented patients have genuine health care needs relating to their kink behaviors and social context. Most patients would prefer to be out to their health care providers so they can receive individualized care. However, fewer than half were out to their current provider, with anticipated stigma being the most common reason for avoiding disclosure. Patients are often concerned that clinicians will confuse their behaviors with intimate partner violence and they emphasized the consensual nature of their kink interactions."

Wednesday, February 22, 2017

Hardy Hendren and the resident match

The journal Surgery has published (early online) an account by Hardy Hendren, recounting the drama at the origin of the resident match:
The 1951 Harvard student uprising against the intern match
Don K. Nakayama, MD, MBAa, , , W. Hardy Hendren III, MD, FRCSb
a Departments of Surgery, Florida International University, Sacred Heart Medical Group, Pensacola, FL
b Harvard Medical School, Massachusetts General Hospital, and Children's Hospital Boston, Boston, MA
Available online 18 January 2017
[Update: the published version appears in Volume 161, Issue 6, June 2017, Pages 1728-1734]

Here's the first paragraph:
"In the fall of 1951, a group of Harvard medical students led by W. Hardy Hendren, III organized a national movement against the newly instituted match that would assign graduating seniors to hospital internship programs. Before then, hospitals with intern positions to fill rushed to secure commitments from students, who in turn accepted the first decent offer that came their way. Knowing that students could not risk waiting for a better offer, hospitals pushed them into making early commitments. When some students began getting offers in their junior and sophomore years, medical schools, professional groups, and hospitals organized the National Inter-association Committee on Internships to deal with the issue. The intern match was thus organized and scheduled to take place in 1952. When the plan was announced in mid-October 1951, Hendren recognized that the proposed algorithm placed students at a disadvantage if they did not get their first choice of hospitals. Facing resistance at every step from the National Inter-association Committee on Internships and putting his standing at Harvard Medical School at risk, Hendren led a nationwide movement of medical students to change the procedure to one that favored students' choices. Their success [less than] 1 month later established in the inaugural match the fundamental ethic of today's National Resident Matching Program to favor students' preferences at every step of the process."
*************

In my book Who Gets What and Why, I wrote about Hendren and these events in part as follows p138):
"One student who noticed this flaw in the proposed design was Hardy Hendren. He was preparing to graduate from Harvard Medical School in 1952, just as the clearinghouse was getting started. When he told me about it years later over lunch in Cambridge MA, he had already retired (in 1998) from Boston Children’s Hospital, where he had been chief of surgery. (His colleagues had given him the nickname “Hardly Human,” for the long, complicated surgeries he was able to conduct.) Hardy entered the Navy during WWII, in 1943 when he was seventeen, and trained as a pilot before returning to college and medical school. As you can imagine, with that background, as he prepared to seek his first job as a doctor, he wasn’t shy about expressing his concerns that the clearinghouse was unsafe for students.
"Hardy also wasn’t one to wait around for bureaucrats. And so, with a group of fellow students, he formed the National Student Internship Matching Committee, which organized opposition to the proposed algorithm. The Committee recommended that it be replaced with a different way of processing the preference lists to determine a match: it became known as the Boston Pool Plan. This was, in fact, the algorithm that was finally implemented when the clearinghouse was used to match students and positions in 1952."

After some discussion of stability, and the fact that the Boston Pool Plan is equivalent to the hospital proposing deferred acceptance algorithm, I wrote (p141):
"Back in 1952, economists hadn’t yet figured out any of this, which makes Hardy Hendren’s insight and his committee’s grassroots efforts all the more impressive."

Tuesday, February 21, 2017

Ken Arrow (1921-2017)

How will we do Economics without Ken Arrow?

After living to a vigorous 95, he passed away today after a mercifully short illness.  He was in the hospital for about two weeks, then went home. He had ups and downs, but a week and a half ago I found him dressed and at his computer.

 Even when he was feeling poorly, he was always the smartest person in the room.
*********

Update: here's the NY Times obit--Kenneth Arrow, Nobel-Winning Economist Whose Influence Spanned Decades, Dies at 95

Here's the Stanford obituary: Nobel Prize-winner Kenneth Arrow dies
Nobel Prize-winning economist Kenneth Arrow was a leading figure in the field of economic theory. He inspired generations of students through his decades-long teaching at Stanford.

And the Washington Post: Kenneth Arrow, Nobel laureate and seminal economist with wide impact, dies at 95

And Scott Kominers in Bloomberg: Kenneth Arrow Made Great Models, and Was One, by 

Here's Ken's nephew Larry Summers in the WSJ: Farewell to Kenneth Arrow, a Gentle Genius of Economics
Lawrence H. Summers remembers his uncle, Nobel Prize-winning economist Kenneth Arrow

Here's Vic Fuchs (writing about Arrow's 1963 paper Uncertainty and the Welfare Economics of Medical Care):
Kenneth Arrow’s Legacy And The Article That Launched A Thousand Studies

*****************
Update, April 29:
The Lancet remembers Ken Arrow. Their obituary is gated, but here are two sentence that I contributed...

 "When asked if Arrow is indeed up there with there with greats, the Stanford University Professor of Economics Alvin Roth, himself a Nobel Laureate, answers with a corrective twist. “The greats are up there with him”, he replies. “He was arguably the most important economist of the 20th century.
...
" “He was always the smartest person in the room”, says Roth, “but he wore it very lightly”


Here's more by Larry Summers: Kenneth Arrow Commemoration at the Institute for Advanced Studies

Travel bans and rank order lists for the resident match

Residency programs have to submit their rank order lists of applicants by Feb 22. Should they try to match with doctors from countries subject to a possible renewed US travel ban?

Travel Ban Confusion Complicates Match Day Decisions

"UPDATE:  The Trump administration announced February 16 that it would discontinue its legal push in appeals court to reinstate their travel ban, but would instead issue a new, revised immigration order next week. No other details were given.
As medical school students look ahead to Match Day on Friday, March 17, some international students have additional anxiety in light of the uncertainty surrounding President Trump's executive order banning travel for people in seven Muslim-majority countries.
Residency programs also have to decide whether they will hold spots for students from the targeted countries who may not be allowed to come to the United States if legal rulings change.
First comes decision day February 22, when preferences must be ranked by both programs and students.
"Some applicants are concerned that the program directors won't rank them and there's concern from programs on whether the students can begin training on time," Mona Signer, president and CEO of the National Resident Matching Program (NRMP), told Medscape Medical News.
Trump's executive order, issued on January 27, aims to prevent citizens of seven majority-Muslim countries — Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen — from entering the United States for 90 days. It suspended entry of all refugees for 120 days and barred refugees from Syria indefinitely. A federal judge has since imposed an emergency stay, halting the key parts of the executive order.
The administration's next step is unclear, but news sources have reported that Trump may take the fight to the Supreme Court or issue a revised order.
According to the Association of American Medical Colleges (AAMC), 260 medical students have applied to US residency programs from the seven countries the ban covers.
Questions include whether the ban will be reinstated, and, if it is reinstated, whether medical students would be exempted. Some worry the ban could spread to other countries. Last year, 3769 non-US citizens who studied medicine abroad matched into a US residency program, according to the American College of Physicians."

Monday, February 20, 2017

The European Network for Collaboration on Kidney Exchange Programmes

Here's the website of the European Network for Collaboration on Kidney Exchange Programmes (ENCKEP), whose goal is to widen and deepen kidney exchange in Europe.

It's still a work in progress, with gated areas.

For those who have registered, the slides from the recent Tallinn conference are here, with updates from Austria, Switzerland, Slovakia, Portugal, Netherlands, Poland, Czech Republic, Italy, Spain, France and the UK.


The conveners are Prof Joris VAN DE KLUNDERT at vandeklundert@bmg.eur.nl, and
Dr David MANLOVE at David.Manlove@glasgow.ac.uk .

I'm a (non-European) supporter of this effort.

Sunday, February 19, 2017

Offensive trademarks

Can repugnant speech also be intellectual property? The Supreme Court has a case that touches on this. The NY Times has this recent story: Justices Appear Willing to Protect Offensive Trademarks

"The Supreme Court on Wednesday appeared deeply skeptical about the constitutionality of a federal law that denies protection to disparaging trademarks. Almost every member of the court indicated that the law was hard to reconcile with the First Amendment.
The court’s decision in the case, concerning an Asian-American dance-rock band called the Slants, will probably also effectively resolve a separate one in favor of the Washington Redskins football team.
The law denies federal trademark protection to messages that may disparage people, living or dead, along with “institutions, beliefs or national symbols.”
Malcolm L. Stewart, a deputy solicitor general, said the trademark law does not bar any speech, as the Slants remain free to continue to use their name. The law “places a reasonable limit on access to a government program rather than a restriction on speech,” he said, and so “does not violate the First Amendment.”
Continue reading the main story
But Justice Elena Kagan said that even government programs may not discriminate based on speakers’ viewpoints.
“The point is that I can say good things about something, but I can’t say bad things about something,” she said of the law. “And I would have thought that that was a fairly classic case of viewpoint discrimination.” Viewpoint discrimination by the government, the Supreme Court has said, is presumptively unconstitutional.
Justice Anthony M. Kennedy said the law interfered with free expression.
“We have a culture in which we have T-shirts and logos and rock bands and so forth that are expressing a point of view,” he said. “They are using the market to express views.”

Saturday, February 18, 2017

Memorial conference for Professor Reinhard Selten, April 28


Memorial conference for Professor Reinhard Selten
Friday, April 28th 2017, Bonn,

Reinhard Selten was a pioneer of the analysis of strategic interaction of both fully rational players (game theory) and boundedly rational humans (experimental economics). From 1984 until his death in 2016, he was associated with the University of Bonn, where he established one of the first experimental laboratories in economics. In 1994, Selten was awarded the Nobel Memorial Prize in Economic Sciences, together with John Harsanyi and John Nash, for their pioneering analysis of equilibria in the theory of non-cooperative games.
To honor his outstanding contributions to Economics, the University of Bonn and the University of Cologne are hosting a memorial conference for Reinhard Selten. The aim is to bring together renowned speakers presenting work connected to or inspired by Selten’s research. The conference will take place on Friday, April 28th 2017 at the Günnewig Hotel Bristol in Bonn, Germany. To help us with our planning, please register as soon as possible if you plan to attend!

Organisers

Friday, February 17, 2017

Vatican statement on organ transplantation

When I posted recently about the Vatican conference on organ trafficking and transplant tourism I focused on the participation of China, and the reaction it drew.

Now I've had a closer second look at the conference statement  (whose title is Statement of the Pontifical Academy of Sciences Summit on Organ Trafficking and Transplant Tourism). (UPDATED LINK HERE: https://www.pas.va/en/events/2017/organ_trafficking/final_statement.html )

It's a very tough statement, which casts quite a broad net when talking about "crimes against humanity." Here's the opening paragraph:

"In accordance with the Resolutions of the United Nations and the World Health Assembly, the 2015 Vatican Summit of Mayors from the major cities of the world, the 2014 Joint Declaration of faith leaders against modern slavery, and the Magisterium of Pope Francis, who in June 2016, at the Judges’ Summit on Human Trafficking and Organized Crime, stated that organ trafficking and human trafficking for the purpose of organ removal are “true crimes against humanity [that] need to be recognized as such by all religious, political and social leaders, and by national and international legislation,” we, the undersigned participants of the Pontifical Academy of Sciences Summit on Organ Trafficking, resolve to combat these crimes against humanity through comprehensive efforts that involve all stakeholders around the world."

Here's the paragraph defining what those crimes against humanity are, which to my eye seems to conflate three very different things. It is number 1 in their list of recommendations.

"That all nations and all cultures recognize human trafficking for the purpose of organ removal and organ trafficking, which include the use of organs from executed prisoners and payments to donors or the next of kin of deceased donors, as crimes that should be condemned worldwide and legally prosecuted at the national and international level."

That is, if I read the full statement correctly (you should read it yourself), they are proposing that 

  1. taking organs from executed prisoners, 
  2. making payments to living donors, and 
  3. making payments to next of kin of deceased donors 

should all be considered crimes against humanity.  

Incidentally, the phrase "crimes against humanity"  is one that I hear most often in the context of genocide, although I recognize that it is also used for other horrific crimes that target populations.

I am not encouraged that this will lead to a sensible discussion about either incentives for donation or (even) removing financial disincentives.