Unraveling of Forensic Psychiatry fellowships makes participants paranoid on both sides of the market

 Where lawyers speak naturally about rules, psychiatrists don't shy away from talking about feelings, and the current disorder in the market for forensic psychiatry fellowships is making many participants miserable.

The Fellowship Application Process Must Be Reformed  by Octavio Choi, Journal of the American Academy of Psychiatry and the Law Online September 2021, 49 (3) 300-310; DOI: https://doi.org/10.29158/JAAPL.210088-21

"These are unhappy days in the world of forensic psychiatry fellowship programs. Here is the crux of the problem: too much product, not enough customers. Agapoff and colleagues report that for the 2016–2017 academic year, forensic psychiatry fellowships achieved a 56 percent fill rate, with 65 residents spread over 44 programs offering a total of 116 positions.1 Since then, the number of forensic programs has continued to grow, up to 48 ACGME-accredited programs offering 127 positions in 2018–2019. Seventy-three of those positions were filled, equating to a 57.5 percent fill rate.2 Things were better in the older days. According to ACGME records, in 2012–2013 there were about the same number of active residents (70) in just 36 programs.3

"The implications are clear: forensic fellowship programs are increasingly desperate to recruit a small number of applicants. From the perspective of program directors such as me, the rational strategy to pursue in this situation is to identify promising applicants early and try to sign them up before anyone else can get to them. Indeed, in recent years, fierce competition has led programs to make earlier and earlier offers that are time-limited (also known as the “exploding offer”). Paranoia is high. Given the nontransparent nature of most transactions in the applications process (no one really knows what anyone else is up to), and lack of objective referees, it only takes the slightest hint of malfeasance for outrage and fear of missing out to amplify.

"The overriding fear of many program directors is that they will not fill their available positions. In addition to bruised egos, being left with open positions means contracts will be left unfilled, possibly leading to cancellation and, ultimately, reduction or elimination of programs. Literally, to not fill risks death (of the program). The imperative, then, is to avoid not filling at all costs.

"On the other side is a paradox. For applicants, low fill rates should translate into a buyer's market, yet because the market is unregulated, the current system inflicts much suffering on them. As one recent applicant succinctly described the process: “it's a hot mess.” Competition by programs for the limited number of applicants has led to earlier and earlier offers being made with shorter and shorter times to decide; too short to adequately assess and receive offers from other programs. Indeed, the whole point of an exploding offer, from the program's point of view, is to curtail assessment of other programs by forcing applicants to make decisions before they might otherwise be ready. In marketing parlance, the idea is to pick up a bargain by taking a good off the market before it can be fairly priced.

...

"The failure of the current system is not about program directors being bad people. It is about the fragile nature of voluntary agreements during difficult times. The math is simple. If each program director has a 95 percent chance of behaving ethically over the course of the applications cycle, and there are 48 programs, there is only a .95 to the forty-eighth power probability (=8.5% chance) that all 48 directors will behave ethically in any given year. A single program director acting less-than-fully ethically is enough to kickstart a paranoid feedback loop that devolves into chaos: “If program X isn't playing by the rules, I don't see why I need to keep playing by the rules, especially if it's going to hurt me.”

"But note that system failure does not even require any actual unethical behavior; all that is required is the perception that others are behaving unethically, a perception that is encouraged to flourish in the context of desperation and lack of transparency"

Market design in Tokyo

 Fuhito Kojima and Hiroaki Odahara report on some of the projects presently underway at the University of Tokyo Market Design Center (UTMD), which include matching for child care, for medical residencies, and for internal labor markets.

Kojima, F., Odahara, H. Toward market design in practice: a progress report. Japanese Economic Review, (2021). https://doi.org/10.1007/s42973-021-00103-w

Abstract: In recent years, many developments have been made in matching theory and its applications to market design. This paper surveys some selected topics from this research area and describe our own work. We also describe the newly established University of Tokyo Market Design Center (UTMD), which works as a vehicle for practical implementation.

Muriel Niederle receiving the Morgenstern Medal: intro and speech (video)

Here's the video of Muriel Niederle receiving her  2021 Oskar Morgenstern Medal.

Starting at minute 25:45 you can hear Jean Robert Tyran introducing Muriel and her work. She is honored for her work in market design and her studies of gender in economic environments. The introduction is well worth listening to.  Muriel's talk begins at minute 52, and is called "A Gender Agenda." (She begins by noting "A lot of economists are not female.")

The United Arab Emirates and the Alliance for Paired Kidney Exchange formalize their relationship

 From the Abu Dhabi Government Media Office, this Oct. 7 announcement:

SEHA, Alliance for Paired Kidney Donation Formalize Partnership to Promote Paired Kidney Donation

"Abu Dhabi Health Services Company, (SEHA), the UAE’s largest healthcare network, and Alliance for Paired Kidney Donation (APKD), a non-profit organization based in Ohio, U.S, have signed a Memorandum of Understanding (MoU) following their recent collective success in facilitating paired kidney donations.

"With both organizations sharing a common goal to elevate opportunities for donation and transplants for both local and international patients with kidney disease, this strategic agreement will see SEHA and APKD working closely together to build a paired kidney donation program in the UAE, as well as facilitate transplant opportunities for patients with kidney failure seeking the right match kidney from the UAE or abroad.

"Dr. Tarek Fathey, Group Chief Executive Officer, SEHA, said: “A fundamental element of our constant growth and development as SEHA is building fruitful partnerships and relationships with global pioneers. Collaborating with APKD strengthens our position to significantly add to the UAE’s healthcare ecosystem and will introduce ample opportunities for us to transform kidney care locally, regionally and internationally.”

"As part of the agreement, SEHA Kidney Care (SKC), part of the SEHA network and Abu Dhabi’s go-to for kidney disease and treatment, will benefit from the opportunity to engage in training modules in health information technology systems applications (including Kidney Match – APKD’s paired organ exchange software), develop educational and scientific research papers and studies, and the exchange of medical, technical, and administrative experience.

"Dr. Ali Al Obaidli, Chief Medical Officer, SKC & Chairman of the UAE National Transplant Committee, said: “The key to the success of paired kidney donations is collaboration, locally and internationally. Thankfully, in the UAE, we boast a robust foundation of healthcare stakeholders and partners who will be integral in the build and roll-out of such a program. Building on our support, we are pleased to formalize a long-term partnership with APKD – by strengthening our relationship, we are unlocking pathways into countries across the world that will facilitate life-saving solutions for kidney disease patients across the globe, as well as build and bolster a paired kidney program here in the UAE that will benefit our citizens and residents.”

The APKD provides a powerful matching platform... that works with governments and hospitals around the world to match living kidney donors with patients in need within and across borders.

On a recent visit to the UAE, ... Dr. Alvin Roth, said: “Kidney disease is a global problem that requires a global solution. The UAE, with its diverse population and solid healthcare infrastructure, is well positioned to lead the charge. ....”

Dr. Michael Rees, MD PhD, Chief Executive Officer, APKD, said: “.... We are thrilled to partner with the UAE’s largest healthcare network in efforts to elevate the country’s infrastructure to not only heal its residents, but to contribute to the global healthcare landscape in terms of cross-country paired donations and transplants and research.”

Kidney donation and the strange, viral story of the "Bad Art Friend"

 A short story about a kidney donor prompted a long article in the NY Times Magazine last week, and that article has gone viral. Here's the article:

Who Is the Bad Art Friend? Art often draws inspiration from life — but what happens when it’s your life? Inside the curious case of Dawn Dorland v. Sonya Larson.   By Robert Kolker

Here are some paragraphs that set the stage for the drama described in the article.

"On June 24, 2015, a year after completing her M.F.A. in creative writing, Dorland did perhaps the kindest, most consequential thing she might ever do in her life. She donated one of her kidneys, and elected to do it in a slightly unusual and particularly altruistic way. As a so-called nondirected donation, her kidney was not meant for anyone in particular but instead was part of a donation chain, coordinated by surgeons to provide a kidney to a recipient who may otherwise have no other living donor. 

...

"Several weeks before the surgery, Dorland decided to share her truth with others. She started a private Facebook group, inviting family and friends, including some fellow writers from GrubStreet, the Boston writing center where Dorland had spent many years learning her craft. After her surgery, she posted something to her group: a heartfelt letter she’d written to the final recipient of the surgical chain, whoever they may be."

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The NYT article goes on to tell a sad story about how some of the "fellow writers" took a dislike to the kidney donor, feeling that her good deed was inspired by nothing more than attention seeking.  One of them published a short fiction called "The Kindest," about just such a supposed donor (depicted as a racist or at least racially insensitive "white savior").  It contained a letter vey much like the one the real kidney donor shared.  Some but not all of the dispute that followed involves the question about whether this met the legal definition of plagiarism.

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This is a good place to (re)state my own view, as someone with a long interest in kidney exchange, that kidney donors, especially nondirected donors, are heroes whose donation does a world of good.  Thousands of kidney transplants have been facilitated by kidney exchange chains begun by nondirected donors.  I've met a number of such donors, and they seem to me to be by and large selfless people who did something wonderful that became a significant part of their lives, even though they don't generally regard themselves as heroes.

Listen to some of their stories here, in interviews of donors by a donor: Donor Diaries Podcast

Of course, they probably have to be a bit careful telling their stories, and discussions among donors might be safe spaces where they won't be misunderstood.  That's surely an experience that donors have in common with other people who have done or experienced something remarkable, such as military veterans who are Medal of Honor winners, and who give each other needed support when recognized as such.

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But how about art?

Here's a story in the New Yorker reviewing the short story described in the NY Times Magazine article. It asks whether the short story in question qualifies as the kind of art that might justify the liberties the author took.

The Short Story at the Center of the “Bad Art Friend” Saga.  A Times Magazine feature has prompted feverish discourse about the ethics of artistic appropriation. Is the art in question any good?  By Katy Waldman

"This raises the question of whether Larson did any better of a job exploiting Dorland’s kidney donation for personal gain, insofar as exploiting existing material for personal gain is a pretty good working definition of being a writer.

"By my reading, she did not. Larson lifted an extremely potent premise—the needy organ donor, seeking connection and validation—and crafted a story that manages to diminish its built-in intrigue. In fact, “The Kindest” falls short in precisely the ways the saga laid out in the Times Magazine piece might lead us to expect: it makes a cartoon of the donor character, and it over-relies on identity-inflected hand-waving. Also, the prose is bad."

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I don't know how much of a larger lesson is contained in all this, aside from the observation that even acts of great generosity can be viewed with suspicion, by those who are so inclined.  This may have something to do with why the efforts against black markets in kidneys have turned into an obsessive campaign against compensation for donors and  repugnance to any transactions that resemble rewarding donors for their generosity.

I think this is a shame. To put it another way, even if some donors were to be motivated by attention seeking, isn't it better for society if they seek attention by behaving heroically in such beneficial ways? (Just think about all the wasteful or destructive ways that attention seekers sometimes seek attention...)

I'm sticking to my view of donors as heroes. 

(I even have a paper about heroism and kidney donation:

Niederle, Muriel and Alvin E. Roth, “Philanthropically Funded Heroism Awards for Kidney Donors?, Law & Contemporary Problems, 77:3, 2014, 131-144.  )

Ryan Oprea wins the Exeter Prize for the paper "What Makes a Rule Complex?"

 The Exeter Prize Committee has circulated the cheerful announcement below, about the latest winner of that prize (which has a very distinguished history):

"We are happy to announce the winner of the 2021 Exeter Prize for the best paper published in the previous calendar year in a peer-reviewed journal in the fields of Experimental Economics, Behavioural Economics and Decision Theory.

"The winner is Ryan Oprea (University of California at Santa Barbara) for his paper “What Makes a Rule Complex”, published in The American Economic Review. 

"This paper offers a crisp experimental measurement of complexity. It offers a rich description of how complexity affects actual humans, which has tremendous potential for informing policy making as well as theoretical research across disciplines (from psychology, computer science, and cognitive science to economics). In the experiment the subjects are asked to implement various decision rules. Five dimensions of complexity are studied: the number of states and transitions, existence of absorbing states and redundant states, and a measure of working memory. The paper looks at three different measures of behaviour: the error rate, the implementation time, and the subjects' own willingness to pay to get the decision rule implemented by a computer. The experiment also measures how fast people learn various decision rules and how transferable this knowledge is. This paper offers a new impetus for research, getting us outside of our comfortable box of constrained optimization. This is a risky and challenging attempt, with a high upside potential.

"The winning paper was selected by the panel of Nina Mazar (Boston University), Rosemarie Nagel (ICREA-UPF-Universitat Pompeu Fabra), and Tomasz Strzalecki (Harvard University). "

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Here's the paper:

What Makes a Rule Complex?  AMERICAN ECONOMIC REVIEW, VOL. 110, NO. 12, DECEMBER 2020  (pp. 3913-51  "By Ryan Oprea*

"We study the complexity of rules by paying experimental subjects to implement a series of algorithms and then eliciting their willingness-to-pay to avoid implementing them again in the future. The design allows us to examine hypotheses from the theoretical “automata” literature about the characteristics of rules that generate complexity costs. We find substantial aversion to complexity and a number of regularities in the characteristics of rules that make them complex and costly for subjects. Experience with a rule, the way a rule is represented, and the context in which a rule is implemented (mentally versus physically) also influence complexity"

Natural experiments win a Nobel in Economics: Angrist, Card and Imbens

 Congratulations to David Card, Josh Angrist, and Guido Imbens. Natural experiments and their statistical analysis join laboratory experiments and randomized control trials in the pantheon of modern empirical tools in economics celebrated in Stockholm:

The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 2021

The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 2021 was divided, one half awarded to David Card "for his empirical contributions to labour economics", the other half jointly to Joshua D. Angrist and Guido W. Imbens "for their methodological contributions to the analysis of causal relationships."