Professor Chiara Spina interviewed me about the use of experiments in market design (20 minute video). (We spoke about a number of experiments I collaborated on with Judd Kessler, among others.)
Tuesday, April 11, 2023
Monday, April 10, 2023
Comstockery and abortifacients, on the way to the Supreme Court
The Comstock Act of 1873 made it a Federal crime to distribute information or medicines for contraception or abortion, and more generally on material judged to be for "any indecent or immoral purpose." The 1965 ruling in Griswold vs. Connecticut found the bans on contraception to be unconstitutional, and the bans on pornography were strictly limited the year before in the case Jacobellis v. Ohio. But the Act reared its head again when it was cited by a Federal judge in Texas, Matthew J. Kacsmaryk, in his ruling that the abortion inducing drug mifepristone was illegal to distribute anywhere in the U.S., including in states where abortion is legal.
Michelle Goldberg in the NYT writes about "The Hideous Resurrection of the Comstock Act"
"suddenly, the prurient sanctimony that George Bernard Shaw called “Comstockery” is running rampant in America. As if inspired by Comstock’s horror of “literary poison” and “evil reading,” states are outdoing one another in draconian censorship. In March, Oklahoma’s Senate passed a bill that, among other things, bans from public libraries all content with a “predominant tendency to appeal to a prurient interest in sex.” Amy Werbel, the author of “Lust on Trial: Censorship and the Rise of American Obscenity in the Age of Anthony Comstock,” described how Comstock tried to suppress photographs of cross-dressing women. More than a century later, Tennessee has banned drag performances on public property, with more states likely to follow.
"And now, thanks to a rogue judge in Texas, the Comstock Act itself could be partly reimposed on America. Though the act had been dormant for decades and Congress did away with its prohibitions on birth control in 1971, it was never fully repealed. And with Roe v. Wade gone, the Christian right has sought to make use of it. The Comstock Act was central to the case brought by a coalition of anti-abortion groups in Texas seeking to have Food and Drug Administration approval of mifepristone, part of the regimen used in medication abortion, invalidated. And it is central to the anti-abortion screed of an opinion by Matthew J. Kacsmaryk, the judge, appointed by Donald Trump, who on Friday ruled in their favor.
...
"On Friday a Washington State judge issued an opinion directly contradicting Kacsmaryk’s and ordering the F.D.A. to continue to make mifepristone available. The dispute now is likely headed to the Supreme Court."
Sunday, April 9, 2023
Alcoholic beverage distributors
The FCC investigates and regulates not just the industries we all know about, but also industries that quietly do a lot of the heavy lifting in ordinary lines of business. Here's report of a (possible) FTC probe that sheds light on distributors of alcoholic beverages, in which big businesses I hadn't previously heard of operate in a much more concentrated fashion than I would have guessed.
Politico has the story:
"The Federal Trade Commission has opened an investigation into the largest U.S. alcohol distributor, Southern Glazer’s Wine and Spirits, over practices related to how wine and liquor are priced and sold around the country, according to three people with knowledge of the probe.
"The FTC is investigating Southern Glazer’s Wine and Spirits for possible violations of the Robinson-Patman Act, a 1936 law prohibiting suppliers from offering better prices to large retailers at the expense of their smaller competitors, according to the people.
...
"According to a December 2022 Forbes report, Southern Glazer is the 11th largest privately held company in the U.S., with around $25 billion in revenue and distributing over 7,000 different brands of alcohol, wine, beer and other beverages. Republic National Distributing Company, the second largest alcohol distributor, which is not known to be a target in the probe, had 2022 revenues of around $12 billion, according to Forbes. Combined, the two companies account for the bulk of U.S. alcoholic beverage distribution.
Saturday, April 8, 2023
Markets in human milk, placenta, and feces
I've blogged earlier about markets for breast milk, but here is an article that considers them also in connection with placenta and feces:
The Law of Self-Eating—Milk, Placenta, and Feces Consumption by Mathilde Cohen, Law, Technology and Humans, 3(1), pp.109-122.
"Milk, Placenta, and Feces
"Since antiquity at least, there have been markets in human milk. Until the twentieth century, they relied primarily on wet nurses hired (or forced) to nurse infants directly on the breast.14Ancient Egyptian, Greek, and Roman pharmacopeias called for human milk as a therapeutic substance to treat burns as well as ailments affecting the ears, eyes, and genitals.15Traditional Chinese medicine employed human milk in a variety of preparations to cure diseases, such as debilitation, arthritis, rheumatism, voicelessness, amenorrhea, eye infections, and poisoning.16
"Today, markets in human milk continue to thrive.17Such markets assume two main forms: 1) informal markets through which people give or sell their milk peer-to-peer via their social circles or online; and 2) formal markets whereby profit or non-profit organizations, such as milk banks and commercial human milk companies, collect, process, and distribute milk to hospitals and a few outpatients for a fee. Human milk is sought after by three main categories of consumers: infants, adults, and researchers.
...
"Placenta
"Human placentas are used for spiritual, nutritional, medical, pharmaceutical, and cosmetic purposes. Placentophagy, or the act of eating one’s placenta after childbirth, has been practiced in the Global North since the beginningof the home-and natural-birth movement in the 1970s.22It is not an unprecedented phenomenon. Indeed, historian Jacques Gélis reported that:
"Placentophagy, the custom of eating the newly expelled placenta, has existed at various times amongst people of very different cultures. From the sixteenth century onwards, European travellers to the new world were much struck by this custom, which they unfailingly reported.23
"According to Gélis, placentophagy was also practiced in Europe; however, “doctors and churchmen were more and more repelled, from the end of the seventeenth century onwards, by this custom . . . so ‘repugnant to humanity." In the past decade, placentophagy has reemerged as a mainstream practice in the U.S., where it has been described as “anew American birth ritual.25
"Few randomized controlled trials have corroborated the benefits of placentophagy. However, placenta eaters are motivated by the hope of obtaining nourishment, hastening post-birth recovery, warding off postpartum depression, facilitating lactation, as well as spiritual motives, such as connecting with the baby and the environment. Placentas can be eaten raw or cooked."
...
"Minimally processed placental membranes have significant commercial and medical potential to treat, among other indications, eye diseases and acute and chronic wounds. The for-profit American company MiMedx also “grinds up amniotic tissue from placenta into an injectable product to treat tendinitis, strains, and other ailments.”29Much like human milk,placentas are increasingly seen as reservoirs of stem cells and thus are attractive to the field of regenerative and tissue engineering, and, more recently, as potential sources for treating coronavirus patients."
...
"Feces
"Excrement is typically regarded as disgusting; however, the medical use of human and animal feces has a long record. Heinrichvon Staden notes that:
"Most prominent among the ingredients in the Hippocratic pharmacological ‘dirt’ arsenal is the excrement of various animals. .. . the belief in the therapeutic usefulness of excrement was shared by ancient Mesopotamian, Egyptian, Greek, Chinese, Talmudic, and Indian healers. . . . There is, therefore, abundant evidence that . . . ‘excrement therapy’—was a cross-cultural phenomenon extant already in the ancient world.32
"In Chinese medicine, human feces were used 1,700 years ago as a “suspension by mouth for patients who had food poisoning or severe diarrhea.”33
"Fast forward to the twentieth century, the community of microorganisms that dwell in the human gut has been shown to play a crucial role in human health. Fecal microbiota transplantation (“FMT”) was first identified in the modern scientific literature in 195834and has rapidly grown in popularity since the early 2010s. FMT consists in the delivery of processed stool from a healthy donor into the intestinal tract of a sick person via an enema, colonoscopy, naso-duodenal tube, capsules, or other means. As microbiologist Mark Smith and his colleagues noted, “the goal is to displace pathogenic microbes from the intestine by re-establishing a healthy microbial community.”35FMT has proven strikingly effective in treating Clostridium difficile, a potentially lethal infection that most commonly affects older adults in hospitals or in long-term care facilities, typically after the use of antibiotics."
...
"Despite these differences, milk, placenta, and feces share two sets of core similarities that justify their grouping in this analysis. First, milk, placenta, and feces are tissues that can be severed from the body without harm or risk of harm. Notably, milk and feces are replenishable bodily substances, while the placenta is a transient organ expelled from the body during childbirth. Thus, far from constituting “corpse medicine”42(i.e., medicine that uses human materials obtained from dead bodies), the use of such substances can be characterized as living food or medicine. There are also no adverse health effects associated with the act of donation. Quite the opposite, good health requires that people eject the milk, placenta, and feces they produce from their bodies.
...
"Second, these three products have similar channels of circulation, including via private, domestic consumption, peer-to-peer markets, medical and research institutions, and global markets in foods, drugs, and cosmetics. This wide scope for circulation is possible due to the potential for DIY treatments alongside higher tech uses involving special processing and expertise. Milk, placenta, and feces are collected, processed, and distributed by banks similar to other tissue banks; however, aspiring consumers can also obtain milk, placenta, and feces and use them on their own. Unlike blood transfusion or organ transplantation, no professional expertise or complicated equipment is necessary to achieve basic forms of consumption. Milk, placenta, and fecescan be obtained directly from their producersafter some screening (or not) and consumed as is or minimally processed at home. Conversely, bio-banks systematically screen donors, subjecting them and their samples to a battery of tests, before processing their products in various ways; for example, by freezing, thawing, pooling, enriching, freeze-drying (in the case of milk), irradiating (in the case of placenta), encapsulating (in the case of stool). This is a fast-evolving field.
...
"No uniform perspective has emerged on the legal classification of the various body materials consumed by humans. In this respect, milk, placenta, and feces provide a case in point, as they do not fit neatly within the standard legal classifications for comparable products, such as foods, drugs, tissues, cosmetic ingredients, or waste products. Different countries have adopted contrasting legal regimes—or no regimes at all—to regulate these substances.
...
"In the so-called post-colonial era, the law of self-consumption illustrates the broader phenomenon of a “jurisprudence of disgust,” to use an expression that Alison Young developed to describe the legal censorship of provocative or “obscene” artwork.71A significant dimension of contemporary law making can be characterized as a response to what is considered disgusting around or among us, which reflects an endeavor to confine and tame what repulses us. This is particularly obvious in the context of what legal scholar Kim Krawiec calls “taboo trades” (and economist Alvin Roth dubs “repugnant markets”); that is, the exchanges and transactions of products that are considered culturally immoral and uncaring, such as those involving organs, babies, sex, drugs, and corruption."
Friday, April 7, 2023
Surrogacy in Spain is hard to suppress
In a widely reported story, a Spanish celebrity has become the surrogate mother of her grandchild, with the help of sperm from her deceased son, and an American surrogate. This has raised controversy in Spain, where surrogacy is illegal.
Here's the Guardian on the story:
Spanish TV star says surrogate baby is actually her grandchild. Ana Obregón, 68, says her son, Aless Lequio García, expressed desire to have a child before death in 2020
"A heated debate in Spain triggered by a 68-year-old celebrity who was reported to have used a surrogate mother in Miami to have a baby took a twist on Wednesday when the woman announced in the socialite magazine ¡Hola! that the baby was actually the daughter of her son who died of cancer in 2020.
...
"Surrogate pregnancies are banned in Spain, although children from such pregnancies in other countries can be registered.
...
"Initial reports about the baby grabbed the attention of the Spanish media and the country’s political parties, sparking criticism from the leftist coalition government. Many leading politicians and outlets of Spanish media refer to surrogacy as “womb renting”.
"The equality minister, Irene Montero of the leftist United We Can coalition partner, said surrogate pregnancies were “a form of violence against women”. The coalition’s Socialist party said legislation should be tweaked to prevent Spaniards using surrogates in other countries.
...
"The main opposition conservative People’s party has said it is open to debating legalising such pregnancies if there is no payment involved."
********
Recent related post:
Wednesday, April 5, 2023
Thursday, April 6, 2023
Introductory workshops to the Mathematics and Computer Science of Market and Mechanism Design semester at Berkeley MSRI
The semester of Mathematics and Computer Science of Market and Mechanism Design August 21, 2023 to December 20, 2023 at Berkeley will lead off with two introductory sessions:
Connections Workshop: Mathematics and Computer Science of Market and Mechanism Design September 07, 2023 - September 08, 2023
REGISTRATION DEADLINE: AUGUST 18, 2023
TO APPLY FOR FUNDING YOU MUST REGISTER BY: MAY 17, 2023
Organizers Michal Feldman (Tel-Aviv University), LEAD Nicole Immorlica (Microsoft Research)
"The Connections Workshop will consist of invited talks from leading researchers at all career stages in the field of market design. Particular attention will be paid to real-world applications. There will also be an AMA focused on career paths with highly visible individuals in the field, and a social event intended to help workshop attendees network with each other."
and
Introductory Workshop: Mathematics and Computer Science of Market and Mechanism Design September 11, 2023 - September 15, 2023
REGISTRATION DEADLINE: AUGUST 25, 2023 TO APPLY FOR FUNDING YOU MUST REGISTER BY: MAY 21, 2023
Organizers Scott Kominers (Harvard Business School), Paul Milgrom (Stanford University), Alvin Roth (Stanford University), Eva Tardos (Cornell University)
"The workshop will open with overview/perspective talks on algorithmic game theory and the theory and practice of market design; the afternoon will feature a panel on active research areas in the field (again, at the overview level). The next 2 days will consist of introductory mini-course and tutorials, on topics such as game theory, matching, auctions, and mechanism design. The following day will focus on applicable tools and technology, such as lattice theory, limit methods, continuous optimization, and extremal graph theory. The workshop will conclude with a panel discussion on major open problems."
Earlier announcement:
Tuesday, November 8, 2022
Wednesday, April 5, 2023
Surrogacy under siege in Italy
Opposition to surrogacy in Italy has taken aim at the babies of same sex couples.
The NYT has the story:
Surrogacy Emerges as the Wedge Issue for Italy’s Hard Right. Prime Minister Giorgia Meloni has ordered municipalities to stop certifying foreign birth certificates for same-sex couples who used surrogacy, leaving some babies in a legal limbo. By Jason Horowitz
"the government of Prime Minister Giorgia Meloni ordered municipalities to obey a court ruling made in December and stop certifying foreign birth certificates of children born to Italian same-sex couples through surrogacy, which is illegal in Italy.
"The decision has left Martino Libero and several other children suspended in a legal limbo, depriving them of automatic Italian citizenship and residency rights like access to the country’s free health care system and nursery school.
...
"Milan, a city that has long served as a cosmopolitan haven for same-sex couples in Italy, has for now complied with the Meloni government order and suspended issuing Italian birth certificates.
"Without official recognition, Libero Martino, 2 months old this month, will have to leave and re-enter the country every few months to remain legal. A court could eventually recognize one of the men as the biological father — they decline to say which one is the sperm donor — and then they could start a separate adoption process for the other.
...
"Ms. Meloni’s government has sought to shift the issue away from the status of the children to the practice of surrogacy, which, while legal in the United States and Canada, is illegal or restricted in much of Europe outside of Greece, Ukraine and a few other countries. In Italy, home of the Vatican, it is not only illegal, but it is also widely opposed, including among Catholic corners of the center-left opposition.
...
"Prominent members of Ms. Meloni’s Brothers of Italy party have called surrogacy a crime “even worse than pedophilia,” in which gay couples, one of whom is usually the biological father, seek to “pass off” children as their own and mistake “children for Smurfs,” saying gay couples can uniquely afford surrogacy, even though it is overwhelmingly used more by heterosexual couples.
"The party is floating a proposal, made by Ms. Meloni when she was a member of Parliament, to make Italians’ seeking of surrogate births abroad — what she had called “procreative tourism” — illegal and “punishable with three months to two years of prison and a fine of 600,000 to a million euros.”
...
"In an interview shortly before her election, as her young daughter ran around her in a Sardinia courtyard, Ms. Meloni said she opposed gay marriage, not because she was homophobic — “I’ve got many, many homosexual friends” — but because she saw it as a step to same-sex adoption, which she opposed, and which the Roman Catholic Church successfully lobbied to exclude from a civil unions law passed in 2016.
********
Earlier:
Monday, February 20, 2023
Tuesday, April 4, 2023
The Robert Rosenthal Memorial Lecture for 2023 at BU, by Parag Pathak
Parag Pathak gave this year's Robert Rosenthal Memorial Lecture at Boston University. The title of his talk is “Still Worth the Trip? The Evolution of School Busing in Boston”
(The video below may undergo some further editing, but right now it starts with introductions at minute 3.)
You can also find the Rosenthal lectures from previous years at the link.
(I had the honor of giving the 2007 lecture... Bob Rosenthal and I are academic siblings, we were both advised by Bob Wilson.)
Monday, April 3, 2023
Test of Time Award 2023 to Immorlica & Mahdian, and Ashlagi, Kanoria & Leshno
Matching theory is recognized this year for bringing theory and observation into harmony...
The SigEcom Test of Time Award for 2023, "… for explaining an apparent gap between the theory and practice of matching markets and helping us understand why small cores are so common." goes to two papers, by five authors.
The first of the two papers is
Marriage, honesty, and stability by Nicole Immorlica and Mohammad Mahdian, Proceedings of the 16th Annual ACM-SIAM Symposium on Discrete Algorithms (SODA), 2005, pp. 53–62.
ABSTRACT: Many centralized two-sided markets form a matching between participants by running a stable marriage algorithm. It is a well-known fact that no matching mechanism based on a stable marriage algorithm can guarantee truthfulness as a dominant strategy for participants. However, as we will show in this paper, in a probabilistic setting where the preference lists of one side of the market are composed of only a constant (independent of the the size of the market) number of entries, each drawn from an arbitrary distribution, the number of participants that have more than one stable partner is vanishingly small. This proves (and generalizes) a conjecture of Roth and Peranson [23]. As a corollary of this result, we show that, with high probability, the truthful strategy is the best response for a given player when the other players are truthful. We also analyze equilibria of the deferred acceptance stable marriage game. We show that the game with complete information has an equilibrium in which a (1 - o(1)) fraction of the strategies are truthful in expectation. In the more realistic setting of a game of incomplete information, we will show that the set of truthful strategies form a (1 + o(1))-approximate Bayesian-Nash equilibrium. Our results have implications in many practical settings and were inspired by the work of Roth and Peranson [23] on the National Residency Matching Program.
**
And the second of the two papers is
Unbalanced random matching markets, by Itai Ashlagi, Yashodhan Kanoria, Jacob D. Leshno, Proceedings of the 14th ACM Conference on Electronic Commerce (EC), 2013, pp. 27–28.
ABSTRACT: We analyze large random matching markets with unequal numbers of men and women. Agents have complete preference lists that are uniformly random and independent, and we consider stable matchings under the realized preferences. We find that being on the short side of the market confers a large advantage.
"We characterize the men's average rank of their wives. For each agent, assign a rank of 1 to the agent's most preferred partner, a rank of 2 to the next most preferred partner and so forth. If there are n men and n+1 women then, we show that with high probability, in any stable matching, the men's average rank of their wives is no more than 3 log n, whereas the women's average rank of their husbands is at least n(3 log n). If there are n men and (1+λ)n women for λ0 then, with high probability, in any stable matching the men's average rank of wives is O(1), whereas the women's average rank of husbands is λ (n).
"Moreover, we find that in each case, whp, the number of agents who have multiple stable partners is o(n). Thus our results imply a limited scope for manipulation in unbalanced random matching markets for mechanisms that implement a stable match.
"These results are in stark contrast with previously known results for random matching markets with an equal number of men and women. In such balanced random matching markets, the lattice of stable matches is large, with the two extreme points of the lattice, the men optimal stable match (MOSM) and the women optimal stable match (WOSM) possessing contrasting properties. The men's average rank of their wives is just log n under the MOSM, but as large as n/log n under the WOSM, and the opposite holds for the women's average rank of their husbands. Thus, the proposing side in the Gale-Shapley deferred acceptance algorithm is greatly advantaged in a balanced market, whereas we prove that in markets with even a slight imbalance, the MOSM and WOSM are almost identical. This reveals the balanced case to be a knife edge.
"Our proof uses an algorithm which calculates the WOSM from the MOSM through a sequence of proposals by men. A woman improves if, by divorcing her husband, she triggers a rejection chain that results in a proposal back to her from a more preferred man. The algorithm lends itself to a stochastic analysis, in which we show that most rejection chains are likely to end in a proposal to an unmatched woman. Simulations show that our results hold even for small markets."
***
see also the longer version of Ashlagi, Kanoria and Leshno (with shorter abstract) in the JPE in 2017 (too recent for the test of time award itself:)
Ashlagi, Itai, Yash Kanoria, and Jacob D. Leshno. "Unbalanced random matching markets: The stark effect of competition." Journal of Political Economy 125, no. 1 (2017): 69-98.
Abstract: We study competition in matching markets with random heterogeneous preferences and an unequal number of agents on either side. First, we show that even the slightest imbalance yields an essentially unique stable matching. Second, we give a tight description of stable outcomes, showing that matching markets are extremely competitive. Each agent on the short side of the market is matched with one of his top choices, and each agent on the long side either is unmatched or does almost no better than being matched with a random partner. Our results suggest that any matching market is likely to have a small core, explaining why small cores are empirically ubiquitous.
Sunday, April 2, 2023
Blue water, green water and climate change
Much of the discussion of redesigning the markets for water focus on "blue water," i.e. surface water in rivers and lakes, and runoff from rain, and resulting accumulation in reservoirs, snowpacks, and ground water.
Here's a paper in Nature pointing out that, particularly as climates change, we also have to think of "green water," namely water from evaporation and rain, and how to manage that.
Rockström, Johan, Mariana Mazzucato, Lauren Seaby Andersen, Simon Felix Fahrländer, and Dieter Gerten. "Why we need a new economics of water as a common good." Nature (2023).
"Water managers have always had to deal with natural variability, building larger reservoirs and tapping aquifers to fight scarcity, for example. But current challenges and trends in the rest of this century demand a completely different approach: a radical shake-up in how water is governed, managed and valued, from local to global scales, including a re-evaluation of human water needs (see Supplementary information, Box S1).
"Today, the sector concentrates on flows of ‘blue’ fresh water — liquid that runs off the land and is stored in rivers, lakes, reservoirs and underground aquifers. Utilities capture and extract this water locally for drinking and sanitation, agricultural irrigation and industry.
...
"Managing fresh water on a global scale means going beyond our current fixation on capturing blue water, which constitutes 35% of all fresh water on land, to also encompass green water, which makes up the remaining 65% (see Supplementary information, Fig. S1). Flows of moisture and vapour from land and vegetation are essential for regulating the water cycle and securing future rainfall, as well enabling carbon sequestration in soils and forests.
"Globally, up to half of terrestrial precipitation originates from green water evaporated over land, with the rest from evaporation over the ocean3. Thus, landscape changes can alter water supplies in regions downwind, as well as changing local climates and streamflows. For example, deforestation in the Congo Basin lowers rainfall in neighbouring countries, and even across the Atlantic in the Amazon. Heavy irrigation of crops in India can boost the streamflow of the Yangtze River in China, through moisture transported downwind4.
"By analogy with watersheds on land, researchers refer to ‘precipitationsheds’ and ‘evaporationsheds’ in the atmosphere. Simply put, a precipitationshed is where rain comes from and an evaporationshed is where evaporation goes to. (Here, evaporation refers to total evaporation from the ocean and green water flows from land, including from soil and water bodies, as well as transpiration from vegetation.)"
Saturday, April 1, 2023
Headlines that could have appeared on April 1
Grim news largely crowded out funny news this past 12 months, but not completely (and some grim news is also funny).
National Park Service Asks Visitors to Please Stop Licking Toads (NYT, Nov, 2022)
Wyoming lawmakers propose ban on electric vehicle sales (The Hill, 01/16/23) "A group of GOP Wyoming state lawmakers want to end electric vehicle sales there by 2035, saying the move will help safeguard the oil and gas industries."
Sex on the beach: pressures of extreme polygamy may be driving southern elephant seals to early death (Guardian, March 2023)
Idaho governor signs firing squad execution bill into law, AP, March 25, 2023. "... making Idaho the latest state to turn to older methods of capital punishment amid a nationwide shortage of lethal-injection drugs. ...firing squads will be used only if the state cannot obtain the drugs needed for lethal injections.
Friday, March 31, 2023
Opioids and Appalachia by Sally Satel
Sally Satel, who has treated patients in Appalachia, writes movingly of the drug addiction problem there. Here's a paragraph that sets the stage.
"The history of opioid pain relievers in Appalachia is a prime illustration of the fact that drug epidemics rarely burst onto the scene out of nowhere. Instead, they find their place in regions that are already home to an established base of individuals who abuse similar drugs. Thus illicit OxyContin, a more potent opioid, efficiently gained popularity over Percocet and Vicodin in the same way heroin would substitute for prescription opioids as the latter grew scarce after 2010."
That's from Opioids and Appalachia by Sally Satel, in the current issue of National Affairs.
The whole thing is well worth reading; here are a few more paragraphs that caught my eye.
"The churn of pills — diverting, using, and selling them — soon had eastern Kentucky, southeastern Ohio, and West Virginia pulsing with crime. Realtors routinely told home sellers not to leave pills in their medicine chests during open houses. Funeral directors and hospice nurses cautioned the bereaved not to mention in obituaries that their loved ones had succumbed to cancer — a red flag signaling that huge bottles of pills were likely on the premises. In eastern Kentucky, local law enforcement was often stymied by close ties between people within communities. Loyalty within large families and fear of retaliation by neighbors made it hard to cultivate informants and to impanel neutral juries that would convict when prosecutors proved their case.
...
"Appalachians seemed to take the corruption in grudging stride. In one survey, 90% of over 100 Kentuckians working in law enforcement, health, and community governance said the rural OxyContin problem in the early 2000s was "fueled by a cultural acceptance of drug misuse." Indeed, many residents tolerated unlawful activity, since it generated revenue for the community from sales of pills to outsiders. This happened in places like Williamson, West Virginia — dubbed "Pilliamson" — where the local Wellness Center was a hub of reckless prescribing. Cash-laden out-of-staters flocked there to buy painkillers and, in a small area near the center, trade and sell those pills.
"Pablo Escobar and El Chapo couldn't have set things up any better," wrote Eyre. "The coal barons no longer ruled Appalachia. Now it was the painkiller profiteers."
...
"Today, opioid pills are no longer pouring into Appalachia as they once did; highly lethal products like fentanyl-laced heroin, methamphetamine, and counterfeit fentanyl pills are what people are selling."
Thursday, March 30, 2023
Deceased-donor transplants: UNOS in the crosshairs
There is unprecedented political will aiming towards reform of the system by which organs for transplant are recovered from deceased donors in the U.S. and allocated to patients in need of a transplant. Here are two opposing views about current proposals to reform or replace the current government contractor in charge of this system, UNOS, the United Network for Organ Sharing..
From NPR:
The Government's Plan To Fix A Broken Organ Transplant System, March 28, 2023
You can listen here:
"For nearly 40 years, the United Network for Sharing Organs (UNOS) has controlled the organ transplant system.
"But that's about to change. Last week, the government announced plans to completely overhaul the system by breaking up the network's multi-decade monopoly.
"For those who need an organ transplant, the process is far from easy. On average, 17 people die each day awaiting transplants. More than 100,000 people are currently on the transplant waiting list according to the Health Resources and Services Administration.
"UNOS has been criticized for exacerbating the organ shortage. An investigation by the Senate Finance Committee released last year found that the organization lost, discarded, and failed to collect thousands of life-saving organs each year.
"Can the government reverse decades of damage by breaking up control? And what does this move mean for those whose lives are on the line?
"The Washington Post's Health and Medicine Reporter Lenny Bernstein, Federation of American Scientists Senior Fellow Jennifer Erickson, and Director at the Vanderbilt Transplant Center Dr. Seth Karp join us for the conversation. Dr. Karp was also a former board member for The United Network for Sharing Organs
*********
And here's an alternate view, by three professors of surgery at the University of California San Francisco Medical Center, saying that the system isn't badly broken at all, and that attempts to fix it may lead to coordination failures that, at least in the short term, will cause additional problems.
From MedPageToday:
Our Organ Transplant System Isn't the Failure It's Made Out to Be. — Upholding the system will save lives by Peter G. Stock, MD, PhD, Nancy L. Ascher, MD, PhD, and John P. Roberts, MD, March 24, 2023
"Thanks to a robust network of hospitals, nonprofit organizations, and government support, the U.S. remains a leader in organ transplantation. This community, which is managed by United Network for Organ Sharing (UNOS), saves tens of thousands of lives every year. Despite this success, opponents of UNOS are advocating to dismantle the transplant system as we know it.
...
"As transplant surgeons with a long history of involvement with the system -- including one of us (Roberts) serving as a past Board President of UNOS/Organ Procurement and Transplantation Network (OPTN) -- we have intimate knowledge of both its successes and its shortcomings. While UNOS has room to improve operationally -- and is working to do so -- we clearly see the organization's life-changing results in our operating rooms and offices. More work lies ahead, however, such as addressing the fact that a rising number of organs are recovered but not transplanted.
"Neither UNOS nor organ procurement organizations (OPOs), which facilitate recovery and organ offers to hospitals, have control over whether medical centers ultimately accept and transplant organs into patients. Though the former two have taken all the blame to date, this remains an issue that concerns the entire system. Leaving our nation's transplant centers out of this critical discussion is a serious oversight. For our entire system to save more lives, transplant centers need to have clear organ acceptance criteria, the appropriate resources to process available organs, and the tools and flexibility to utilize organs from more medically complex donors.
...
"The recommendations for division of labor as suggested this week by Carole Johnson, administrator of the Health Resources and Services Administration (HRSA), may be well intentioned but present a significant risk of further fragmentation and negative consequences due to a lack of coordination between government agencies and contractors. This coordination is essential for a functional and successful system. UNOS specifically has been handicapped by a meager budget for years, and despite this has a well-developed system. We believe that given the recent 10-fold budget increase by the Biden administration, the current contractor has the potential to rectify the shortcomings that have been highlighted in the press."
*********
Earlier posts:
Sunday, August 14, 2022
Wednesday, March 29, 2023
Pay transparency, horizontally, vertically, and across firms, by Zoe Cullen
Information architecture is an important part of market design. Here's a nuanced review of pay transparency by Zoe Cullen, dealing with the non-obvious effects of horizontal transparency (letting workers know what similar workers are paid), vertical transparency (finding out how pay proceeds up the career ladder), and cross-firm transparency (what other firms are paying).
Is Pay Transparency Good? by Zoe B. Cullen, NBER working paper 31060, DOI 10.3386/w31060 March 2023
Abstract: Countries around the world are enacting pay transparency policies to combat pay discrimination. 71% of OECD countries have done so since 2000. Most are enacting transparency horizontally, revealing pay between co-workers of similar seniority within a firm. While these policies have narrowed co-worker wage gaps, they have also lead to counterproductive peer comparisons and caused employers to bargain more aggressively, lowering average wages. Other pay transparency policies, without directly targeting discrimination, have benefited workers by addressing broader information frictions in the labor market. Vertical pay transparency policies reveal to workers pay differences across different levels of seniority. Empirical evidence suggests these policies can lead to more accurate and more optimistic beliefs about earnings potential, increasing employee motivation and productivity. Cross-firm pay transparency policies reveal wage differences across employers. These policies have encouraged workers to seek jobs at higher paying firms, negotiate higher pay, and sharpened wage competition between employers. We discuss the evidence on pay transparency’s effects, and open questions.
And from the conclusions:
"We conclude that “horizontal” pay transparency policies that reveal pay gaps between co-workers at the same firm create unintended spillovers between worker negotiations that lower worker bargaining power and wages. This characterizes the strong majority of pay transparency policies that have been put in place over the past two decades. However, policies that focus on ameliorating information frictions in the labor market more broadly have achieved the objectives of raising wages and equity. “Cross-firm” and “vertical” pay transparency policies have proven potential to increase motivation, allocation of talent, and sharpen competition. These policies are not designed to draw attention to employers who pay similar workers different wages, but instead these policies educate workers about the full range of opportunities to earn higher wages when they make decisions about training, where to apply, and how hard to work. Our evidence on misperceptions suggests low earners have the most to gain from improved access to this information. Pay transparency policies can also have pro-competitive effects by educating employers about market wages, eroding information rents when employers have private knowledge about the value workers bring to the job.
"Cross-firm pay transparency policies have recently gained traction among policy makers. In January of 2023, California and Washington became the second and third states in the U.S. to mandate that employers include a salary range in the job postings external job candidates see, following on the heels of Colorado and New York City. This is a big step toward making pay information available at the time workers are choosing where to direct their applications, and employers expect that this will lead applicants to direct their applications toward higher paying firms, increasing wage competition."
*********
And here's a quick story about that paper in yesterday's WSJ.
Knowing Everyone’s Salaries Can Light a Fire Under Workers. Seeing a career path to advancement—and believing the process is fair—motivates employees, studies show. By Courtney Vinopal, March 28, 2023
Tuesday, March 28, 2023
Bride price in China
The NY Times has the story:
In China, Marriage Rates Are Down and ‘Bride Prices’ Are Up. China’s one-child policy has led to too few women. Grooms are now paying more money for wives, in a tradition that has faced growing resistance. By Nicole Hong and Zixu Wang
"As China faces a shrinking population, officials are cracking down on an ancient tradition of betrothal gifts to try to promote marriages, which have been on the decline. Known in Mandarin as caili, the payments have skyrocketed across the country in recent years — averaging $20,000 in some provinces — making marriage increasingly unaffordable. The payments are typically paid by the groom’s parents.
"To curb the practice, local governments have rolled out propaganda campaigns such as the Daijiapu event, instructing unmarried women not to compete with one another in demanding the highest prices. Some town officials have imposed caps on caili or even directly intervened in private negotiations between families.
...
"Officials have acknowledged their limited ability to eliminate a custom that many families see as a marker of social status. In rural areas, neighbors may gossip about women who command low prices, questioning whether something is wrong with them, according to researchers who study the custom.
*************
Earlier:
Friday, September 28, 2018
Subscribe to:
Posts (Atom)
Posts
