Saturday, October 31, 2020

Why I have signed election day letters

 I am a reluctant letter signer, but this election season I have signed two open letters.  My reluctance stems in part from the fact that, when I am one among many who sign a letter, I'm often prominently mentioned in the resulting news stories, even though my expertise on the subject of the letter is no more than the other signers.

But, we are entering on an important election, and I'm a concerned citizen.  So, I let myself be counted (even if over-counted), and when asked to explain, I sometimes feel moved to respond.

Here's the latest, from Business Insider:

More than 1,000 economists have now signed letter urging voters to reject 'reckless and selfish' Trump on Election Day. Alvin Roth, a Nobel winner, tells us why he's among them.

by Kate Duffy.

"As of Friday, 1,027 prominent economists from major institutions across America, including numerous Nobel winners, had signed the open letter, which is being updated until Election Day.

"The number of signatures has increased by more than 300 since last Friday, when it was first created.

"Alvin Roth, who shared the Nobel Memorial Prize in Economic Sciences in 2012, told Business Insider he signed the letter because he was "concerned that some voters might believe President Trump's essentially false claims that his careless stewardship has been good for the US economy."

"Roth said: "That certainly isn't the view of those who study these things. Letters like this may also help many people know that they are not the only ones to notice that the current president is trying to keep us divided and misinformed." He added that "democracy depends on reliable information, and the letter was meant to provide some of that."

...

"Roth, an economics professor at Stanford University, believes the re-election of Trump could severely damage the US economy. ...economic progress in the US is made through working with trading partners, he said.  

"But "President Trump prefers trade wars, with government subsidies to help staunch the bleeding in those parts of the economy that are harmed," such as the damage to American overseas agricultural markets, Roth added.

"Roth said that if Biden were elected as president, he would most likely appoint advisors who have knowledge in their areas of responsibility, and could therefore "restore America's relations with our allies and trading partners."

"Biden's tax and economic policies will not aim to benefit only the wealthiest Americans and political supporters, according to Roth, who emphasized how divided the country he believes the country is."

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Related posts:

Monday, October 26, 2020

Friday, October 30, 2020

Challenge trials for Covid-19 vaccine are being planned (and a recent NBER cost/benefit analysis)

 Here's the NY Times:

To Test Virus Vaccines, U.K. Study Will Intentionally Infect Volunteers--The hotly contested strategy of deliberate exposure, known as a human challenge trial, could speed up the process of identifying effective coronavirus vaccines.  By Benjamin Mueller

"Scientists at Imperial College London plan to deliberately infect volunteers with the coronavirus early next year, launching the world’s first effort to study how vaccinated people respond to being intentionally exposed to the virus and opening up a new, uncertain path to identifying an effective vaccine.

"The hotly contested strategy, known as a human challenge trial, could potentially shave crucial time in the race to winnow a number of vaccine candidates. Rather than conducting the sort of trials now underway around the world, in which scientists wait for vaccinated people to encounter the virus in their homes and communities, researchers would purposely infect them in a hospital isolation unit.

"Scientists have used this method for decades to test vaccines for typhoid, cholera and other diseases, even asking volunteers in the case of malaria to expose their arms to boxes full of mosquitoes to be bitten and infected. But whereas the infected could be cured of those diseases, Covid-19 has few widely used treatments and no known cure, putting the scientists in charge of Britain’s study in largely uncharted ethical territory.

...

"The volunteers in London will be paid roughly Britain’s minimum wage, which is about £9, or $11, per hour, for their time in taking part in the trial and their two to three weeks in mandatory quarantine. The researchers said they were wary of offering additional incentives that could cloud the judgment of volunteers."

************

And here's a recent NBER paper on the efficiency of challenge trials:

A Cost/Benefit Analysis of Clinical Trial Designs for COVID-19 Vaccine Candidates

Donald A. Berry, Scott Berry, Peter Hale, Leah Isakov, Andrew W. Lo, Kien Wei Siah & Chi Heem Wong

ID w27882, DOI 10.3386/w27882, October 2020

Abstract: We compare and contrast the expected duration and number of infections and deaths averted among several designs for clinical trials of COVID-19 vaccine candidates, including traditional randomized clinical trials and adaptive and human challenge trials. Using epidemiological models calibrated to the current pandemic, we simulate the time course of each clinical trial design for 504 unique combinations of parameters, allowing us to determine which trial design is most effective for a given scenario. A human challenge trial provides maximal net benefits—averting an additional 1.1M infections and 8,000 deaths in the U.S. compared to the next best clinical trial design—if its set-up time is short or the pandemic spreads slowly. In most of the other cases, an adaptive trial provides greater net benefits.


Thursday, October 29, 2020

Paying participants in challenge trials of Covid-19 vaccines, by Ambuehl, Ockenfels, and Roth

 Here's a new short paper in Journal of Medical Ethics: (it's ungated, you can read it all at the link): 

Payment in challenge studies from an economics perspective 

by Sandro Ambuehl, Axel Ockenfels, and Alvin E. Roth

published online early, Oct 28, 2020. http://dx.doi.org/10.1136/medethics-2020-

"Participants in medical studies perform a service. Outside the domain of research participation, there is nearly universal agreement that workers providing a service should be compensated fairly, and that work involving more discomfort and risk should be compensated more generously. Accordingly, labour regulations impose floors (minimum wage laws), not caps on compensation. Caps, even if intended to protect against undue inducement, also raise concerns about illegal price-fixing that disadvantages workers. Such limits on payment for egg donors have successfully been challenged in court.

...

"Payment caps can lead to attempts to circumvent the regulation. For example, many countries that prevent payment for the donation of blood plasma instead import it from the USA where payment is legal—the volume of the US export market for plasma products approaches $20 billion per year.ii Similarly, restrictions on CHIM trial payments may lead to an increase in trials in countries with less stringent regulation.

...

"we note that increasing hourly pay by a risk-compensation percentage as proposed in the target article provides compensation proportional to risk only if the risk increases proportionally with the number of hours worked. (Some risky tasks take little time; imagine challenge trials to test bulletproof vests.) To ensure that equal consequences are compensated with equal amounts across a wide variety of studies, we instead recommend a three-part contract consisting of: (1) salary for time involvement that is adjusted to account for the amount of discomfort experienced during participation, (2) insurance against ex post adverse outcomes and (3) ex ante compensation for risks that cannot be compensated ex post (such as death). Such a scheme also increases transparency about what is requested from participants and thus contributes to high-quality participation decisions."

...

"The current discussion about payment in challenge trials is important because the potential benefits of well-designed challenge trials that could accelerate the development of safe and effective vaccines are enormous. Overall, economic research has shown, first, that ethical concerns over high payments may rely on intuitive predictions about behavioural effects that find little or no empirical support, and that the dangers of underpayment are at least as real as those of overpayment. Second, a part of the ethics literature attaches significantly more weight to concerns of undue inducement than the general population. Accordingly, it appears to us that there is sufficient public support for preparing for challenge trials, with paid participants, without a need for excessive ethical concern that payments might inadvertently become too generous to trial participants."

***********

Our article is an invited commentary on

Related comments appear in

  1. Compensating for research risk: permissible but not obligatory
    Holly Fernandez Lynch et al., J Med Ethics
  2. Payment of COVID-19 challenge trials: underpayment is a bigger worry than overpayment
    Jennifer Blumenthal-Barby et al., J Med Ethics, 2020
  3. How much money would it take for you to be infected with COVID-19 for research?
    By Olivia Grimwade and Julian Savulescu., JME blog, 2020

Wednesday, October 28, 2020

Citizenship for sale

 The Financial Times has the latest:

Cyprus scandal exposes EU ‘golden passport’ problem by Michael Peel

"No sooner had Cyprus moved this week to suspend its scandal-ridden programme that offered EU “golden passports” to rich investors than others began jostling to fill the gap.

“Choose Montenegro citizenship instead of Cyprus!” trumpeted the website of Discus Holdings, an official agent of the Montenegrin scheme, pointing to the visa-free access available to Europe’s 26-country common Schengen travel zone.

...

"Attention has focused on the three EU members — Cyprus, Malta and Bulgaria — that offer full citizenship in exchange for investment. But many other European countries, including France, the UK and Austria, offer “golden visas” granting a right of abode to the wealthy — and a potential path to nationality after a qualifying period of residence."


Monday, October 26, 2020

Vote! Here's another open letter, this one from business school professors

 Open letters are in season, and I've signed another one.  You can too, at the link.

An Open Letter & Call for Action - Signed by Business School Professors from Across America
Click here to add your name.

*************
Related recent post

Thursday, October 22, 2020

Sunday, October 25, 2020

The Economist reflects on market designers as economic engineers, in celebration of the Milgrom-Wilson Nobel

 Here is The Economist on Milgrom and Wilson:

The Nobel prize in economics rewards advances in auction theory--For the third time since 2007, it goes to designers of market mechanisms


HT: Mary Wilson

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Related recent posts:

Monday, October 12, 2020

Medically assisted dying and the U.S. Supreme Court

 The Washington Post has the story:

Judge Amy Coney Barrett and the future of physician-assisted suicide  by 

Charles Lane

"Barrett co-wrote a 1998 law review article in which she distinguished the dilemmas Catholic judges might face in following church teachings against capital punishment, as well as what she called a more “absolute” doctrine banning abortion and euthanasia, which “take away innocent life.”

...

"Eight of the 50 states and D.C. have permitted physician-assisted suicide, by statute or referendum. (In one, Montana, the state Supreme Court decreed it as a matter of state law, and legislators have tried, unsuccessfully so far, to overturn that ruling.)

Saturday, October 24, 2020

Medically assisted dying, at any age, in the Netherlands

 The NY Times has the story:

Netherlands to Allow Doctors to Help End Lives of Terminally Ill Children--Hugo de Jonge, the Dutch health minister, said that “incurably ill” children ages 1 to 12 should be able to die with the help of a doctor.  By Maria Cramer and Claire Moses

"The Dutch government announced plans this week to allow doctors to end the lives of terminally ill children who are under 13 years old, a decision that is bound to inflame the debate over physician-assisted death.

"The Netherlands already allows doctors to facilitate the deaths of people who are over 12 or less than a year old as long as parents have given their consent.

"In a letter to parliament on Tuesday, the Dutch health minister, Hugo de Jonge, proposed expanding the law to include children between the ages of 1 and 12 who are dying and suffering.

“In a small number of cases, palliative care isn’t sufficient,” Mr. de Jonge wrote. “Because of that, some children suffer unnecessarily without any hope of improvement.”

...

"Three other European countries — Luxembourg, Belgium and Switzerland — allow physician-assisted death, though the laws differ in each country. Belgium allows children to die with the help of a doctor, but in Luxembourg, the law is restricted to adults with an incurable medical condition.

"Canada, parts of Australia and Colombia have also legalized physician-assisted death for adults in certain cases.

...

"Eight states and Washington, D.C., have laws that allow mentally competent adults with a terminal illness and six months or less to live to obtain prescription medication that will hasten their deaths, according to Death With Dignity, an Oregon-based nonprofit that supports such laws."

********

The first link above is to this Gallup Poll report:

MAY 31, 2018,  Americans' Strong Support for Euthanasia Persists  BY MEGAN BRENAN

"72% say doctors should be able to help terminally ill patients die

"Fewer, 65%, express support when the question includes "commit suicide"

"54% think doctor-assisted suicide is morally acceptable"

Friday, October 23, 2020

Information for those in need of a kidney donor, from Harvey Mysel, founder of the Living Kidney Donors Network

Here's an announcement from Harvey Mysel, the founder of the Living Kidney Donors Network, about information available for people in need of a kidney transplant.

 Living Kidney Donors Network has released its new FREE online program Having Your Donor Find YOU! for those who need or will need a kidney transplant. www.havingyourdonorfindyou.org That may seem like an unusual title, but that’s what really happens. You get the word out and someone will be motivated to help you…your donor finds you. 

The program’s 3 goals are to:

  1. Motivate someone in need to pursue a living donor
  2. Overcome the myth that you need to ASK someone to donate
  3. Explain that it’s all about sharing YOUR STORY and the importance of having advocates share it too.

 Having Your Donor Find YOU! consists of 9 videos, each under 3 minutes with Supporting Resources that helps you develop the campaign that’s outlined in the videos. The program will soon be available in Spanish

 Should you be involved with an organization that would like to offer the program to your patients or followers, you can have your own URL: www.your_name.havingyourdonorfindyou.org Here’s an example: www.nekf.havingyourdonorfindyou.org 

Thursday, October 22, 2020

Open letter by economists opposing re-election of current U.S. president

 Open Letter: 690 Economists Oppose Trump's Re-Election

Don't forget to vote.

********

update: 932 economists the last time I checked.

NBER market design meeting today through Saturday on Zoom

The NBER market design conference is on Zoom this year, today through Saturday, starting each day at noon Eastern time (9am Pacific time).  I'll be speaking today at 2:45 EST (11:45 PST), about a new proposal for global kidney exchange using chains that begin overseas and end in the U.S., and about the background and history to this proposal, which initially met with considerable opposition.


2:45 pm
Mohammad Akbarpour, Stanford University
Afshin Nikzad, University of Southern California
Michael A. Rees, University of Toledo Medical Center
Alvin E. Roth, Stanford University and NBER
Global Kidney Chains

The full schedule, with links to papers, is here:

Market Design Working Group Meeting

Michael Ostrovsky and Parag A. Pathak, Organizers

October 22-24, 2020, on Zoom.us


 

Wednesday, October 21, 2020

Ned Brooks interviews me at the National Kidney Donor Organization virtual conference (video)

 For easy access, here's the video of my talk at the National Kidney Donor Organization virtual conference, about which I blogged this morning.  We talked about kidney exchange, global kidney exchange, and repugnant transactions...



National Kidney Donor Advocate Conference, on YouTube

 Here's an announcement I received from Ned Brooks, the founder of  NKDO, National Kidney Donation Organization (formerly Donor to Donor).  If I understand correctly, the different talks and interviews will be available at the link after first streaming in conference style, starting at 9am Pacific time. It includes a video of Ned interviewing me.

I'll update this post as necessary. 


"This Wednesday, October 21st, NKDO, National Kidney Donation Organization (formerly Donor to Donor) will release the virtual National Kidney Donor Advocate Conference. This event is designed to give volunteer living donor advocates the information they need to be more effective advocates for living donation. Transplant industry experts across the country will be presenting to you and delivering invaluable advice about their area of expertise.

The conference will stream on our YouTube channel beginning at 12:00 noon Eastern this Wednesday. The conference will be in segments and accessed through the “playlist”, either streaming as one event or accessed at different points in the conference. The link is  https://www.youtube.com/channel/UCsoS-yavRQCVl7bwcjT2iCA , which will go live at noon Eastern on Wednesday.


- Have you ever wondered about the transplant surgeons who do the surgery? What they are thinking and what they would like you to know? Dr. Joshua Mezrich, transplant surgeon at UWMadison and author of “When Death Becomes Life: Notes from a Transplant Surgeon” talks about his experience with organ donors and recipients.


- Are you a living donor or a transplant recipient, or expecting to be one? Do you remember the experience of being evaluated at the transplant center and listening to all the information, and maybe feeling a little overwhelmed? Living Donor Coordinator Marian Charlton and Patient Coordinator Janet Hiller are two of the most respected voices in transplant, and they will tell you what they want you to know to better understand the process. Anyone who goes through this experience or has a loved one in transplant will want to see these segments.


- Living kidney donors deserve all protections available, from reimbursement for out-of-pocket costs and lost wages to medical coverage for medical issues that may arise months or years after donation. Garet Hil, founder and CEO of the National Kidney Registry, talks about the suite of protections available to living donors through Donor Shield.


-  Are you a kidney patient in need of a donor? Harvey Mysel, a two-time kidney recipient and founder and CEO of the Living Kidney Donor Network, talks about how to have your kidney donor find you.


- Professor Alvin Roth won the Nobel Prize in Economics for his work creating the algorithms that contributed to the creation of the “kidney chain”, a development that transformed kidney transplant procedures. Prof. Roth discusseshis work and the business known by the intriguing moniker of “repugnanttransactions.”


- All kidney patients will benefit by watching nephrologist Dr. David Serur talk about kidney disease and what every kidney patient and advocate needs to know to be properly informed about how to deal with renal disease. 


- Non-directed, or altruistic, donors are a rare breed, though we are trying to change that. No one knows the brain of the non-directed donor better than Professor Abigail Marsh, who has been studying non-directed donors for years. If you want to better understand why someone will happily donate a kidney to a stranger, this presentation will help answer that question.  Prof. Marsh is the author of “The Fear Factor: How One Emotion Connects Altruists, Psychopaths, and Everyone In-Between.”


- If you listen to podcasts, you are probably familiar with “Freakonomics” and its creator, Stephen Dubner. It was the Freakonomics interview with Prof. Roth that set Donor to Donor and NKDO into motion, and our interview with Mr. Dubner will interest anyone who understands “the power of the pod”.


- Jim Gleason is a heart transplant recipient and the president of TRIO, Transplant Recipients International Organization. Mr. Gleason is a motivational speaker who asks the question, “Are you a cookie monster?”



Here's the video of my video

Tuesday, October 20, 2020

Surgery Grand Rounds at UCSF. "Kidneys and Controversies: Kidney Exchange Within and Across Borders" Oct 21 (7am PST)

 Tomorrow at dawn I'll give a seminar to the surgeons at UCSF, about kidney exchange, and the controversies it has overcome, and is overcoming.

Surgery Grand Rounds | Kidneys and Controversies: Kidney Exchange Within and Across Borders

Date: October 21, 2020 Time: 7:00am-8:00am Place: Webinar

Rishwain Visiting Speaker: Alvin E. Roth, PhD

Al Roth is the Craig and Susan McCaw Professor of Economics at Stanford University and the George Gund Professor Emeritus of Economics and Business Administration at Harvard University. He shared the 2012 Nobel memorial prize in Economics. His research interests are in game theory, experimental economics, and market design. In the 1990’s he directed the redesign of the National Resident Matching Program (NRMP) and currently is a member of the Board of Directors. He has been involved in the design and organization of kidney exchange, which helps incompatible patient-donor pairs find life-saving compatible kidneys for transplantation. He is on the Advisory Board of the National Living Donor Assistance Center (NLDAC). His work on kidney transplantation led him to become interested in repugnant transactions, and more generally how markets, and bans on markets, gain or fail to gain social support.


The University of California, San Francisco School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.  CME Course MGR21045

UCSF designates this live activity for a maximum of 43 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

*The above credit is inclusive of credit for all Fiscal Year 2020-2021 Department of Surgery Grand Rounds.

Disclosure declaration – No one in a position to control the content of this activity has a relationship with an ACCME-defined commercial interest. Planners  Wen Shen, MD, Julie Ann Sosa, MD, MA, Lygia Stewart, MD, and Ryutaro Hirose, MD, have stated that they have no relationships to disclose. Speaker Roth has stated that he has no relevant relationships to disclose.

This activity is supported by the Department of Surgery’s Howard Naffziger Endowment Fund.

Join Webinar: https://ucsf.zoom.us/j/252447171?pwd=MWt0bG9vTjBSZEo1UnpidXRVWWU2UT09 

Monday, October 19, 2020

Censoring repugnant words by algorithm

 Some people like to say things that other people think they shouldn't say.  In the age of the internet, politeness can be (somewhat) automated, by banning certain words.  But of course, words have contexts. Here's a funny story from the Guardian:

Overzealous profanity filter bans paleontologists from talking about bones--A virtual conference was thrown into confusion when the platform hosting the event came with a pre-packaged ‘naughty word’ censor by Poppy Noor.

"Participants in a virtual paleontology session found themselves caught between a rock and a hard place last week, when a profanity filter prevented them from using certain words – such as bone, pubic, stream and, er, beaver – during an online conference.

"The US-based Society of Vertebrate Paleontology (SVP) held its annual meeting virtually this year due to the pandemic, but soon found its audience stifled when they tried to use particular words.

"Convey Services, which was was handling the conference, used a “naughty-word filter,” for the conference, outlawing a pre-selected list of words.

"“Words like ‘bone’, ‘pubic’, and ‘stream’ are frankly ridiculous to ban in a field where we regularly find pubic bones in streams,” said Brigid Christison, a master’s student in biology attending the event

...

"Some discovered bias in the algorithm, too. Jack Tseng, a vertebrate paleontologist from the University of Berkley pointed out that the filter had banned the common surname Wang but not Johnson – even though both are frequently used as slang words to describe a man’s genitals."

********

Here's Dr. Tseng's tweet:

Z. Jack Tseng, @Tseng_ZJ

"Wang" is banned but not "Johnson" (both used as slangs). This western-centric filter erasing the surname of 90+ million Chinese but not <2 million people of European descent is unexpectedly on brand for 2020,  ! My PhD advisor is X. **** by the way. "

**********

Previous related posts:


HT: Muriel Niederle


Sunday, October 18, 2020

Breast milk and the marketing of breast milk substitutes during the pandemic

 

Here's an article in the Lancet:

Marketing of breastmilk substitutes during the COVID-19 pandemic by Christoffer van Tulleken, Charlotte Wright, Amy Brown, David McCoy, and Anthony Costello, October 08, 2020DOI:https://doi.org/10.1016/S0140-6736(20)32119-X

"It is of concern that the US$70 billion infant formula industry has been actively exploiting concerns about COVID-19 to increase sales, in violation of the WHO International Code of Marketing of Breast-milk Substitutes (the Code)1 and national law in many countries.

"Globally, infants who are not exclusively breastfed are 14 times more likely to die than infants who are exclusively breastfed.2 Lockdown measures have diminished household income, and the UN World Food Programme estimates that by the end of 2020, 265 million people may be facing food insecurity,3,  4 making breastfeeding even more important. Public bodies that are independent of industry influence, including WHO5,  6 and the Royal College of Paediatrics and Child Health,7 have unanimously asserted that no evidence exists to suggest breastfeeding increases the risk of infants contracting COVID-19, and that skin-to-skin contact remains essential for newborn health and maternal health.

"By contrast, large manufacturers of breastmilk substitutes have inappropriately positioned themselves as sources of public health expertise, and suggested various unnecessary hygiene measures, the use of expressed breastmilk, and the separation of mothers from their babies. Such recommendations undermine breastfeeding and thus increase the risk of infant death. Baby Milk Action and the International Baby Food Action Network8 have documented numerous infringements of both the Code and laws associated with COVID-19."

Saturday, October 17, 2020

Broad public support for challenge trials for Covid-19 vaccines

 A broad based survey suggests that challenge trials are not generally regarded as repugnant.

Broad Cross-National Public Support for AcceleratedCOVID-19 Vaccine Trial Designs

by David Broockman, Joshua Kallay, Alexander Guerrero, Mark Budolfson, Nir Eyal, Nicholas P. Jewell , Monica Magalhaes,  Jasjeet S. Sekhony

Abstract: A vaccine for COVID-19 is urgently needed. Several vaccine trial designs may significantly accelerate vaccine testing and approval, but also increase risks to human subjects. Concerns about whether the public would see such designs as ethically acceptable represent an important roadblock to their implementation, and the World Health Organization has called for consulting the public regarding them. Here we present results from a pre-registered cross-national survey (n = 5,920) of individuals in Australia, Canada, Hong Kong, New Zealand, South Africa, Singapore, the United Kingdom, and the United States. The survey asked respondents whether they would prefer scientists to conduct traditional trials or one of two accelerated designs: a challenge trial or a trial integrating a Phase II safety and immunogenicity trial into a larger Phase III efficacy trial. We find broad majorities prefer for scientists to conduct challenge trials (75%, 95% CI: 73-76%) and integrated trials (63%, 95% CI: 61-65%) over standard trials. Even as respondents acknowledged the risks, they perceived both accelerated trials as similarly ethical to standard trial designs, and large majorities characterized them as "probably" or "definitely ethical" (72%, 95% CI: 70-73% for challenge trials; 77%, 95% CI 75-78% for integrated trials). This high support is consistent across every geography and demographic subgroup we examined, including people of diverging political orientations and vulnerable populations such as the elderly, essential workers, and racial and ethnic minorities. These findings bolster the case for these accelerated designs and can help assuage concerns that they would undermine public trust in vaccines.

Friday, October 16, 2020

NRMP conference on Transition into Residency: Oct 16-17


My title will be "The Match as part of the larger system of transition to residency."

One of the topics I expect to discuss is the proliferation of applications and interviews, in the NRMP and also in many of the fellowship matches.

Thursday, October 15, 2020

Frequent flier programs during the pandemic slowdown in air travel

 It turns out that frequent flier programs get a lot of their income from credit cards that reward purchases with miles. So they are one of airlines' big profit centers, that hasn't suffered so much from the slowdown in air travel.

Here's a NY Times story:

Airline Miles Programs Sure Are Profitable. Are You the Loser? United and Delta have been boasting to lenders about fat margins in frequent-flier mile programs. Time for customers to pay a bit more attention.  By Ron Lieber

"Even as the coronavirus pandemic has sapped the ability and desire to travel, miles programs are a winner for the airlines. In the first half of 2020, Delta’s passenger revenue fell 60 percent, but the cash the airline got from American Express’s purchases of miles for its customers fell less than 5 percent. ...

"United puts a different but no less illuminating set of words and numbers to our mile lust. It goes into granular detail in its pitch about its ability to “nimbly” control its mile redemption costs on “peak days.” That explains why it’s so hard to use your miles to get a great deal during school vacations, Mardi Gras or other occasions."


******

Here's Market Watch:

Airlines are using frequent flyer programs to sell debt. Here’s how it works  By Sunny Oh

"In essence, miles are sold to credit card companies who offer them as part of their reward programs to their customers. The revenues earned from selling the miles are much higher than the cost of any flight travel redeemed by passengers,

...

"In a June filing, United Airlines valued their MileagePlus loyalty program at $21.9 billion which is around double the total market capitalization of the company itself."

Wednesday, October 14, 2020

Some links following the Nobel Prize to Milgrom and Wilson

 In my limited experience (but not just limited to my own experience) Nobel prizewinners are often asked about how they were notified of the fact that they won the prize, and by whom. Paul Milgrom and Bob Wilson certainly have one of the best stories to answer that question, and millions of people have already viewed the video from the Milgroms' Nest doorbell camera, as Bob tried to arouse Paul and give him the news.

Here's how USA Today covered that story:

Doorbell camera captures moment Nobel Prize winner is told by fellow recipient he's won

Paul Milgrom discovered via a Nest camera that he'd won the Nobel Prize in Economic Sciences.<>

The Nest doorbell broadcast also to Paul's wife Eva, who was visiting family in Stockholm, and who was alerted at the same time he was. Here's the view from the Swedish press (including a video of the video playing on her laptop...):

Här väcks pristagaren av sin kollega: ”Du har vunnit Nobelpriset” 
(Google translate: Here the laureate is awakened by his colleague: "You have won the Nobel Prize")

That before-dawn encounter was recounted in this early interview:
"AS: We just spoke with Paul Milgrom and he said that he heard the news by you walking across the street and ringing his doorbell.

RW: Well that’s right because he had turned his phone off for the … to get a good night’s sleep, and so somebody had to wake him, and he lives across the street so I just walked over and knocked on the door. I roused him.

AS: I think … I think this must be a first in the history of the Nobel Prize.

RW: Yes, how many times does … first to have a knock on the door, which sounds like something from the 19th century, and secondly that in fact the two of us live only, what, 40 m apart."
*****************

It turns out that Bob Wilson went to Lincoln High School in Nebraska (and that you can never escape your high school):

MARGARET REIST, Lincoln Journal Star Oct 13, 2020 
"The Lincoln High School wall of distinguished alumni — the one with photos lining the school's main hallway — will need to make room for another photo.

"Robert Wilson, who graduated from Lincoln High in 1955, left for Harvard on a prestigious scholarship and ultimately landed at Stanford, won the Nobel Prize in economics Monday."
***********


************
The day of the prize, the NY Times story by Jeanna Smialek got this fairly coherent quote from me before dawn:

“They haven’t just profoundly changed the way we understand auctions — they have changed how things are auctioned,” said Alvin E. Roth, a Nobel laureate himself who was one of Mr. Wilson’s doctoral students. 
***********
Joshua Gans, one of Paul's students, republished the remarks he had made on the occasion of Paul's 65th birthday (long ago...)
"There are so many things one could say about Paul but it turned out that I said what I wanted to say back in 2013 at a conference in his honor to celebrate his 65th Birthday."
*************
Bob's longtime colleague (and my one time housemate when we were grad students) David Kreps has a lovely essay, which includes this quote from Hugo Sonnenschein: 
"Great economists write great papers. But the greatest economists are those who found new schools of thought." 
He writes that Bob's 
" impact on the discipline of economics, in my opinion, puts him in the company of giants such as Ken Arrow and Paul Samuelson: Bob is, as much as anyone, the founder of the “School of Economic Theory as Engineering.” Both in his own work, but even more through his influence on his students and colleagues, Bob has brought economic theory to the real world, both as a mechanism for understanding “how things work” and then in the design of better institutions. The Nobel Prize announced today is for his and Paul’s work on the design of complex auctions, such as the spectrum auctions, which is a prime example of economic theory as engineering. But, in addition:
  • Bob himself has taken the theory of nonlinear pricing to practical applications in electricity markets.
  • His student, Nobel Laureate Al Roth, brought matching-markets theory to the design of assignment algorithms, assigning MDs to internships, and to kidney exchange “markets.”
  • His student, Nobel Laureate Bengt Holmstrom, brought incentive theory to practical considerations in the design of pay-for-performance systems (some in collaboration with Milgrom) and, more recently, to issues in financial institutions.
  • His student and co-Nobel Laureate Paul Milgrom, besides his work on auction design, and in collaboration with our colleague John Roberts, brought economic theory to bear on the design and management of complex organizations (which, for my money, is even more important than his pathbreaking work on auctions; Paul could have been given the Nobel for any of several different topics, and his work on “the modern corporation” happens to be my personal favorite).
  • And it continues: A third generation — students of Paul, Bengt, and Al, as well as others who have embraced this style of work and so became “adopted” members of Bob’s tribe — are building an intellectual edifice that mixes superb theory with real-world insight and applicability."
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Did you know that Paul has a company?  Here's the tribute on the Auctionomics website: 
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And amidst all the toasts, I had occasion to recall that the first footnote of my 2002 paper "The Economist as Engineer..." said 
"This paper is dedicated to Bob Wilson, the Dean of Design."


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Earlier post: 

Monday, October 12, 2020


Tuesday, October 13, 2020

Drug delivery: antibiotics and vaccines

 Two recent papers discuss different issues concerning drug delivery to those in need, where the obstacles may be individual reluctance to take the drug (antibiotics) or lack of social support for the drug program (for vaccines):

Predicting and improving patient-level antibiotic adherence

Isabelle Rao, Adir Shaham, Amir Yavneh, Dor Kahana, Itai Ashlagi, Margaret L. Brandeau & Dan Yamin, Health Care Management Science (2020), 05 October 2020

Abstract: Low adherence to prescribed medications causes substantial health and economic burden. We analyzed primary data from electronic medical records of 250,000 random patients from Israel’s Maccabi Healthcare services from 2007 to 2017 to predict whether a patient will purchase a prescribed antibiotic. We developed a decision model to evaluate whether an intervention to improve purchasing adherence is warranted for the patient, considering the cost of the intervention and the cost of non-adherence. The best performing prediction model achieved an average area under the receiver operating characteristic curve (AUC) of 0.684, with 82% accuracy in detecting individuals who had less than 50% chance of purchasing a prescribed drug. Using the decision model, an adherence intervention targeted to patients whose predicted purchasing probability is below a specified threshold can increase the number of prescriptions filled while generating significant savings compared to no intervention – on the order of 6.4% savings and 4.0% more prescriptions filled for our dataset. We conclude that analysis of large-scale patient data from electronic medical records can help predict the probability that a patient will purchase a prescribed antibiotic and can provide real-time predictions to physicians, who can then counsel the patient about medication importance. More broadly, in-depth analysis of patient-level data can help shape the next generation of personalized interventions.

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Covid-19: how to prioritize worse-off populations in allocating safe and effective vaccines

Harald Schmidt, Parag Pathak, Tayfun Sönmez, and M Utku Ünver, BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3795 (Published 05 October 2020)

"When compared with previous pandemics covid-19 is unique, not only in its substantial economic impact but in exposing the consequences of historical and ongoing structural disadvantages among minority groups,123 particularly in the US. Minorities have experienced far higher rates of unemployment, infections, hospital admissions, and deaths.23456 So, as safe and effective vaccines become likely but in limited supply, should policy makers prioritize worse-off minorities in their allocation of stocks?

"Traditional allocation focuses on maximizing overall benefits, with less regard to how these benefits are distributed among different population groups. Giving more vaccines to disadvantaged groups who are expected to live less long would generally be deemed undesirable. However, the current debate around covid-19 vaccines indicates a profound reorientation in what worse-off population groups are owed."