Tuesday, January 31, 2023

Donating blood while gay

 The Washington Post brings us up to date:

FDA to ease blood donation ban on gay men, allow monogamous to give. By Laurie McGinley, Teddy Amenabar and  Fenit Nirappil 

"Gay and bisexual men in monogamous relationships will no longer be forced to abstain from sex to donate blood under federal guidelines to be proposed in coming days, ending a vestige of the earliest days of the AIDS crisis.

"The planned relaxation of restrictions by the Food and Drug Administration follows years of pressure by blood banks, the American Medical Association and LGBT rights organizations to abandon rules some experts say are outdated, homophobic and ineffective at keeping the nation’s blood supply safe."

"The new approach eliminates rules that target men who have sex with men and instead focuses on sexual behaviors by people, regardless of gender, that pose a higher risk of contracting and transmitting HIV"

Monday, January 30, 2023

Tonya Ingram (1991-2022), health activist, died while waiting for a kidney

 Tonya Ingram, a poet and health activist who testified in Congress about the long waiting list for kidney transplants, died last month while still waiting.  Saturday's New York Times had a moving column about her activism, her struggle and her long wait.

Tonya Ingram Feared the Organ Donation System Would Kill Her. It Did. By Kendall Ciesemier (Ms. Ciesemier is a writer, a producer and an organ recipient.) Jan. 28, 2023

Here's her obit in the LA Times:

Tonya Ingram, an inspiring L.A. poet and ‘lupus warrior,’ died waiting for a kidney by Jireh Deng, JAN. 23, 2023

Market design isn't only about trying to allocate scarce resources effectively, it's also about working to make them less scarce.

Sunday, January 29, 2023

Paul David (1935-2023)

 My Stanford colleague Paul David has died. He was an exceptional, iconic economic historian.

Gavin Wright has written this obit:

Professor Paul David died at the age of 87

"Always an economic historian, Paul soon extended his horizons in diverse and seemingly disparate ways.  He became a strong advocate of the view that historical research should be fundamental to the economics discipline; in brief; “history matters.”  The essence of the argument was captured by Paul’s incisive account of the persistence of the QWERTY typewriter keyboard despite its technical disadvantages, one of the most cited articles in all of economics (AER 1985).  “History Matters” is the title of a festschrift presented by a group of Paul’s former students in 2004, in which the editors write: “No scholar has more forcefully and influentially argued the case for making economics a truly historical social science – one that, like evolutionary biology, gives past events a central role in understanding the present.” 

"A continuing focus throughout Paul’s career was the diffusion of new technologies.  An important early paper considered the adoption of the mechanical reaper in the American Midwest.  Invention occurred in the 1830s, yet the first wave of adoption occurred only in the 1850s.  The twenty-year delay, according to Paul, was explained by the fact that a minimum scale was required to cover the fixed costs of purchasing the reaper.  Only when farms size passed this “threshold” did mechanization make economic sense.  Specialists have debated the specifics ever since, but the basic form of Paul’s diffusion model has been highly influential.  In many respects it formalized the accounts of delayed diffusion presented by our late colleague Nate Rosenberg, and thus became something of a “Stanford school” of thought in this area.  Scrolling forward to 1990, the era of the “Solow paradox,” Paul offered an analogy between the delayed productivity effects of computer technology and a similar lag in the impact of electrification between the 1880s and the 1920s.  With the IT-driven productivity surge of the late 1990s, this article also attained iconic status (AER 1990)."

Saturday, January 28, 2023

Signaling in the markets for new doctors

 Signaling of interest is catching on in medical labor markets for residents and fellows.

Here's some material from Thalamus (which describes itself as "Complete GME interview management solution for applicants & programs. Easy, secure, and automated interview scheduling to optimize in-person & virtual recruitment.")

The Ultimate Guide to Preference Signaling for Medical Residency Applicants and Programs 2022-2023.

It all seems to have started with the signaling mechanism we use in Economics.

From Part 1: 

"The Emergence of Preference Signaling:
Preference signaling was first implemented in 2006, as part of the recruitment process for economics graduate students administered through the American Economics Association (AEA). Since then, there have been several useful studies analyzing this process by leading economists at institutions including Harvard and Stanford. These include “Preference Signaling in Matching Markets” and “The Job Market for New Economists: A Market Design Perspective.”

"Of note, one of the authors on the latter article is Dr. Alvin E. Roth, who won the Nobel Prize in Economics for proving certain key attributes of the matching algorithm that is used today by the National Resident Matching Program (NRMP), where Dr. Roth currently serves as a board member. This article has been cited in papers throughout GME that examine preference signaling in specialties including Otolaryngology and Orthopaedic Surgery."

Friday, January 27, 2023

Liver exchange pilot program at UNOS

 In another step for liver exchange, here's the announcement from UNOS, which recently registered its first patient-donor pair:

UNOS launches first national liver paired donation pilot program

"An innovative approach to matching livers to patients in need aims to increase lifesaving transplants by expanding the number of living liver donations. United Network for Organ Sharing (UNOS) has launched the UNOS Liver Paired Donation (LPD) pilot program, the first nation-wide initiative facilitating liver paired donation matches; the project is led by UNOS Labs in collaboration with transplant and donation professionals from across the country.

"More than 10,000 people are currently waiting for a liver transplant, and increasing paired donation can make a difference. “The community recognized a critical need,” said Ruthanne Leishman, who manages UNOS paired donation programs. “While the idea of swapping livers is new, transplant programs have successfully been swapping kidneys since 2002.” Leishman was part of the UNOS team that initiated the Organ Procurement and Transplantation Network (OPTN) Kidney Paired Donation (KPD) pilot program in 2010, at a time when there were fewer living liver donor transplants. Since that time, living liver donations have become safer and more viable, contributing to the development of living liver donation programs throughout the country. There were 603 living liver donor transplants in the United States in 2022.

"The UNOS LPD pilot program includes 15 experienced transplant programs across the country who have together performed hundreds of living liver transplants over the years. “UNOS Labs has collaborated with a team of some of the most respected transplant professionals in the country. Working with this high caliber of transplant professionals has helped UNOS build a strong program that will increase living donor transplants,” said Leishman.

"While some transplant hospitals have swapped livers within their own or neighboring hospitals, the UNOS LPD program now makes it possible to swap livers across the country. The larger pool of potential living donors means candidates can have increased access to living liver donations, and transplant hospitals have the opportunity to grow their living transplants programs through collaboration.

"The first donor and recipient pair registered in the program are at UCHealth Transplant Center in Aurora, Colo., and are waiting for a match.

“The UNOS LPD program has totally shifted our frame of mind,” says Jaime Cisek, Living Donor Coordinator at UC Health Transplant Center. “It used to be that if someone was incompatible because of their blood type, or there was a significant size discrepancy, then there was no point in working them up. Now, nobody is off the table. Now we’re able to consider that there is somebody out there who is compatible and make that swap.”

"The UNOS LPD program offers living liver donors assistance with both medical and non-medical expenses related to donation, such as travel expenses, lost wages and dependent care. This financial assistance was made possible through a partnership with the National Living Donor Assistance Center (NLDAC) and a generous gift from living liver transplant recipient and UNOS financial supporter David Landes. "

Thursday, January 26, 2023

Blasphemy in Pakistan

 How to strengthen a ban that already allows the death penalty for repugnant speech?  The NYT has the story:

Pakistan Strengthens Already Harsh Laws Against Blasphemy. Insulting Islam or its founder is already a capital offense, but now those who insult people connected to the Prophet Muhammad could get prison time. By Salman Masood

"Pakistan’s blasphemy laws, which can already mean death for those deemed to have insulted Islam or the Prophet Muhammad, can now also be used to punish anyone convicted of insulting people who were connected to him.

"The move this week by Parliament to further strengthen the nation’s strict blasphemy laws, which are often used to settle personal scores or persecute minorities, has raised concerns among rights activists about the prospect of an increase in such persecution, particularly of religious minorities, including Christians.


"Those convicted of insulting the Prophet Muhammad’s wives, companions or close relatives will now face 10 years in prison, a sentence that can be extended to life, along with a fine of 1 million rupees, roughly $4,500. It also makes the charge of blasphemy an offense for which bail is not possible.


"Taking a stand on the issue can also be dangerous, as the assassination of two senior politicians more than a decade ago made clear. In 2011, Salmaan Taseer, the governor of Punjab Province, was fatally shot by one of his own bodyguards. Mr. Taseer had been an outspoken opponent of the blasphemy laws and had campaigned for the release of Asia Bibi, a Christian convicted of insulting the Prophet Muhammad. Shahbaz Bhatti, a federal minister and a Christian who had also opposed the death sentence imposed on Ms. Bibi, was fatally shot the same year."

Wednesday, January 25, 2023

Academic authorship for sale

 Here's a news story in Nature:

Multimillion-dollar trade in paper authorships alarms publishers. Journals have begun retracting publications with suspicious links to sites trading in author positions.  by Holly Else

"Research-integrity sleuths have uncovered hundreds of online advertisements that offer the chance to buy authorship on research papers to be published in reputable journals.

"Publishers are investigating the claims, and have retracted dozens of articles over suspicions that people have paid to be named as authors, despite not participating in the research. Integrity specialists warn that the problem is growing, and say that other retractions are likely to follow.


"Most of the adverts are posted on social-media sites including Facebook and Telegram, as well as the websites of companies that claim to offer academic publishing services. They often include the title of the paper, the journal it will be published in, the year of publication and the position of authorship slots available for purchase. Prices range from hundreds to thousands of US dollars depending on the research area and the journal’s prestige."


Here is the underlying working paper, on arxiv,  to which the story refers:

Publication and collaboration anomalies in academic papers originating from a paper mill: evidence from a Russia-based paper mill  by Anna Abalkina

This study attempts to detect papers originating from the Russia-based paper mill International publisher LLC. A total of 1009 offers published during 2019-2021 on the this http URL website were analysed. The study allowed us to identify at least 434 papers that are potentially linked to the paper mill including one preprint, a duplication paper and 15 republications of papers erroneously published in hijacked journals. Evidence of suspicious provenance from the paper mill is provided: matches in title, number of coauthorship slots, year of publication, country of the journal, country of a coauthorship slot and similarities of abstracts. These problematic papers are coauthored by scholars associated with at least 39 countries and submitted both to predatory and reputable journals. This study also demonstrates collaboration anomalies and the phenomenon of suspicious collaboration in questionable papers and examines the predictors of the Russia-based paper mill. The value of coauthorship slots offered by International Publisher LLC in 2019-2021 is estimated at $6.5 million. Since the study analysed a particular paper mill, it is likely that the number of papers with forged authorship is much higher.

Tuesday, January 24, 2023

"Financial incentives for vaccination do not have negative unintended consequences," in Nature

 Here's a recent article in Nature whose title effectively summarizes its conclusions, and brings some evidence from RCTs to bear on the issue of whether financial incentives corrupt innate values:

Florian H. Schneider, Pol Campos-Mercade, Stephan Meier, Devin Pope, Erik Wengström & Armando N. Meier, "Financial incentives for vaccination do not have negative unintended consequences. Nature (2023). https://doi.org/10.1038/s41586-022-05512-4

Abstract: Financial incentives to encourage healthy and prosocial behaviours often trigger initial behavioural change1,2,3,4,5,6,7,8,9,10,11, but a large academic literature warns against using them12,13,14,15,16. Critics warn that financial incentives can crowd out prosocial motivations and reduce perceived safety and trust, thereby reducing healthy behaviours when no payments are offered and eroding morals more generally17,18,19,20,21,22,23,24. Here we report findings from a large-scale, pre-registered study in Sweden that causally measures the unintended consequences of offering financial incentives for taking the first dose of a COVID-19 vaccine. We use a unique combination of random exposure to financial incentives, population-wide administrative vaccination records and rich survey data. We find no negative consequences of financial incentives; we can reject even small negative impacts of offering financial incentives on future vaccination uptake, morals, trust and perceived safety. In a complementary study, we find that informing US residents about the existence of state incentive programmes also has no negative consequences. Our findings inform not only the academic debate on financial incentives for behaviour change but also policy-makers who consider using financial incentives to change behaviour.

"We exploit a randomized controlled trial (RCT) in the context of financial incentives for COVID-19 vaccination (P.C.-M. et al., unpublished, and ref. 5). Participants were offered payments of 200 Swedish krona (SEK; about US $24 at the time) for taking a first dose of a COVID-19 vaccine, which increased first-dose uptake by 4 percentage points 30 days after the trial (uptake remained higher even 3 months later). The RCT setting is ideal in that it allows us to compare individuals who were randomly offered financial incentives for vaccination with individuals who were not offered any financial incentives. We combine the RCT data with new Swedish administrative records for second-dose uptake and with rich, individual-level survey data.


"We complement our evidence from Sweden with evidence on the effects of large-scale incentive programmes implemented by US state governments. In a pre-registered study in the USA (n = 3,062), participants randomly assigned to the incentives condition received detailed information about their state’s COVID-19 vaccine incentive programme, whereas participants in the control condition did not receive this information. Because most of the participants were unaware that their state offered incentives for vaccination, this experimental design overcomes the identification problems by creating random variation in perceived exposure to incentives. In line with the evidence from Sweden, we find no negative impacts of being informed about incentive programmes on the willingness of participants to take a further dose"

Monday, January 23, 2023

Incentives for deceased organ donation, in Asia

 Here's a discussion, in an Asian context, of providing incentives to families to consent to deceased donation.

Introducing Incentives and Reducing Disincentives in Enhancing Deceased Organ Donation and Transplantation by Kai Ming ChowMBChB⁎ Curie AhnMD† Ian DittmerMBChB‡ Derrick Kit-SingAuLMCHK§ IanCheungMBBS║ Yuk LunChengMBChB¶ Chak SingLau MBChB Deacons Tai-KongYeungMBBS║ Philip Kam-TaoLi MD Seminars in Nephrology,  Available online 27 December 2022

*Department of Medicine and Therapeutics, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong

† Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

‡Department of Renal Medicine, Auckland City Hospital, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

§Centre for Bioethics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong

║Cluster Services Division, Hospital Authority, Kowloon, Hong Kong

¶Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong

#Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong, China

Summary: Despite the effectiveness of solid organ transplantation, progress to close the gap between donor organs and demand remains slow. An organ shortage increases the waiting time for transplant and involves significant costs including patient morbidity and mortality. Against the background of a low deceased organ donation rate, this article discusses the option of introducing incentives and removing disincentives to deceased organ donation. Perspectives from ethics, general public opinion, and the health care profession are examined to ensure a comprehensive appraisal and illustrate different facets of opinion on this complex area. Special cultural and psychosocial considerations in Asia, including the family based consent model, are discussed.

This sentence caught my eye:

"After suggestion by Economics Nobel Laureate Alvin Roth for the community to unite to remove disincentives to kidney donation, the transplant community and academia have been having more discussion and analysis. That, in part, hinges on the estimates of the economic welfare gain for the society as a whole."



"It is widely recognized that deceased organ donation rates in Asian countries have been significantly lower than that in Western countries.


"No one disputes the social and cultural beliefs in the decision to donate organs. 


"An example of honoring the principles of reciprocity in incentivizing organ donor registrations is the organ allocation priority policy. Israel became the first country in 2008 to enact legislation incorporating such incentives based on individuals’ willingness to donate into their organ procurement system.26,42,43 The policy provides an incentive or motivation by the reciprocal altruistic dictum that “each partner helping the other while he helps himself,”42 granting priority on organ donor waiting lists to those individuals who registered as organ donors by signing a donor card for at least 3 years. Subsequent observations in Israel, as analyzed 5 years after introduction of the new policy, included an increase in the authorization rate of next of kin of unregistered donors, as well as a two-fold higher likelihood of next-of-kin authorization for donation when the deceased relative was a registered donor.44

"How does the concept of reciprocity apply for Asian societies? Will the results from Israel be replicated in Asia? Although social exchange theory should be a universal normal applicable to all human relationships, cultural influence or patterns might differ. Previous research on reciprocity across different cultural contexts, indeed, has shown that East Asians tend to reciprocate in kind and emphasize more on equity-based theory than Americans.45 Viewed through such a lens of “to give is to take,” it is relevant to quote another similar example in Taiwan, where incentives were provided to deceased organ donors’ families. In brief, after a person has become a deceased organ donor in Taiwan, up to three of his or her blood relatives will be granted priority to receive a deceased donor organ should they be on the waiting list for transplantation.46

"At the heart of the issue is the family based consent that is unique and vital, albeit not exclusive, in Confucian tradition within Chinese societies. It is important to note that organ donation is more often a family based consent process in Chinese culture than those “from a Western cultures”. As such, family priority right provided in the Israel or Chinese model would be more likely to motivate organ donation within a family based ethical culture.47 As in any discussion of culture's influence on organ donation decision, we must be mindful that East Asians tend to favor family centered decision making.


"If the concept of reimbursing funeral expenses for deceased organ donors is explored further then these four tenets are suggested as a guide: Tenet 1: the overarching principle is to appreciate and recognize the altruistic behavior of organ donors, and not the next of kin. Tenet 2: the second priority of reimbursing funeral expenses is to motivate the passive-positive public to sign up for organ donation. Tenet 3: the ultimate beneficiary from an incentive system is society, with an improved deceased organ donation rate. Government and charitable organizations, but not organ recipients, should be the source of payment. Tenet 4: as a token of expressing gratitude to the deceased organ donors, funeral expenses reimbursement preferably should be offered to those who have expressed the wish to donate (donor registration); they should have been provided the option to decline the offer."

Sunday, January 22, 2023

The trade in guns and drugs on the Mexico-US border

 It's well known that a lot of illegal drugs enter the U.S. over the border with Mexico.  Less well known in the U.S. is that a lot of guns cross illegally into Mexico over that border, destined for Mexican drug cartels.  

Here's a story from the Guardian:
How Texas’s gun laws allow Mexican cartels to arm themselves to the teeth by Sam Garcia.

"Despite Mexico’s well-documented high levels of violence, legally purchasing guns there is actually quite difficult. The nation of nearly 130 million people has a single store that can legally sell guns.


"Mexican foreign affairs ministry legal adviser Alejandro Celorio Alcántara estimates that half a million guns annually are purchased legally in the US and then brought into Mexico illegally. About 70% of guns seized in Mexico from 2014 to 2018 and submitted for tracing had originally come from the US, according to officials with the American bureau of alcohol, tobacco, firearms and explosives (ATF).


Here's another report:

Dribs and Drabs: The Mechanics of Small Arms Trafficking from the United States

"Robust arms export licensing regimes are necessary but not sufficient for stopping small arms trafficking. Many of the traffickers studied did not apply for arms export licences or attempt to exploit licensing exemptions; they simply bypassed the licensing system entirely. At the same time, recent examples of attempted and successful diversion of authorized small arms exports highlight the continued need for rigorous licensing and post-shipment end-use monitoring.

"Arms trafficking from the United States goes well beyond gun-running to Mexico. Traffickers in the 159 cases studied shipped weapons, parts, ammunition, and accessories to at least 46 countries and foreign territories on six continents. Intended recipients of these items range from Honduran farm workers to a Finnish motorcycle gang 

"The illicit trade in parts and accessories for small arms is more significant than commonly assumed. Networks that traffic in firearms parts are among the most prolific and geographically expansive of the smuggling operations studied"

HT: Sarah Hirsch

Saturday, January 21, 2023

Post Roe (post Dobbs) legal efforts to secure rights established in previous Court decisions

 Since the Supreme Court ruling in Dobbs that overturned Roe and said that abortion was subject to regulation by each State, and not an individual right, there have been attempts in Washington to moderate some of its potential effects, particularly in light of Justice Thomas' opinion that the ruling could lead the way to rolling back other rights established by previous court rulings.

There have been some successes and some failures.

Here's a story from the Guardian about some new regulations and interpretations.

The US government just took two big steps on abortion. Will they matter? While the decisions cannot undo abortion bans in the 13 states they exist, it could make a huge difference where the right is protected  by Poppy Noor

"This week, the federal government announced two decisions designed to improve abortion access in the US. The first, a rule change made by the Food and Drug Administration, allows pharmacies to dispense mifepristone, one of the two drugs needed for a medication abortion. The second, an opinion drafted by the justice department, gives the US Postal Service the all clear to continue mailing abortion pills, even to states where abortion is severely restricted.


These decisions cannot undo abortion bans in the 13 states where they exist. While major pharmacies such as Walgreens and CVS have announced they will seek certification to dispense mifepristone, a prescription for it still will not be legal in states with a ban. Anyone distributing or taking abortion pills in banned states could still face severe consequences. And the justice department opinion will not protect anyone sending pills to a banned state from being prosecuted in that state, or anyone who takes the pills knowingly to induce an abortion from being investigated.

But in states where abortion is protected, both moves could make a big difference, advocates say.

Take California as an example, which recently expanded access for abortion care in its state constitution. Until now, abortion pills had to be dispensed by a doctor, an abortion clinic, or a mail order pharmacy. But even in California, many people live hundreds of miles away from an abortion clinic.


"It is unclear whether the FDA ruling will see pharmacies dispensing mifepristone in states with limits on abortion that fall short of total bans."


One of the concerns is that some states may declare fetuses to be persons, in a way that would extend their abortion bans to also include forms of assisted reproductive technology such as IVF, which create embryos to allow infertile couples start families.  An effort to protect IVF was introduced just before the close of the previous Congress, but it wasn't made into law, and the new Congress is likely to be less sympathetic.

Right to Build Families Act of 2022 (proposed by Senator Tammy Duckworth, but not enacted)

"A BILL To prohibit the limitation of access to assisted reproductive technology, and all medically necessary care surrounding such technology."



Wednesday, December 14, 2022

Friday, January 20, 2023

Repugnant and deleted blog posts: AI and the Justice Stewart test

 As someone who sometimes writes and speaks about repugnant transactions and controversial markets, I'm aware that people may object not only to the things I write about, but also to the fact that I write about them. So I was surprised but not shocked when I got a notice earlier this week that two of my blog posts had been deleted by Google, which runs the site that hosts this blog.  And another two were put behind a warning that readers have to acknowledge before being allowed to read them.

The emails had a link at which I could request that the deletions be reviewed, and my two deleted posts were promptly restored.  But which posts were deleted, by what I assume was an algorithm?

Here are the subject lines from the two emails about deleted posts (and the now restored posts themselves):

Your post titled "NY Times debate: Is Prostitution Safer when It's Legal?" has been deleted

Sunday, May 20, 2012


Your post titled "Legal prostitution and crime in the Netherlands" has been deleted

Thursday, November 9, 2017

So I guess the word "prostitution" plays a role in the decision to delete these two posts, but that can't be the whole story, since I now have about 80 posts that I labeled as concerning prostitution, at least in part. (To put things in perspective, I have well over a thousand posts labeled as concerning 'repugnance'.) Also, the algorithm that deleted them is probably new, since the posts themselves were old but were only deleted and then restored this week.

The two  (also old) posts  that were put behind an "adult" warning screen also seem to have now been released from this distinction: here are the email headings and posts, which you can once again see without certifying your adult status:

Your post titled "Ethnic dating sites" has been put behind a warning for readers

Friday, September 3, 2010


Your post titled "Markets for adult entertainments" has been put behind a warning for readers

Saturday, February 21, 2009

So algorithms searching for inappropriate content (even those employed by the leader in algorithmic search) still fall short of Justice Stewart's famous 1964 declaration about pornography, that it was difficult to define, but "I know it when I see it.


Earlier related post:

Monday, October 19, 2020

Thursday, January 19, 2023

NPR on black markets for kidneys from Nepal, for India

Here's an 8-minute video from National Public Radio about the black market for kidneys, trafficked from Nepal to India.  Some of the people interviewed indicate that they were duped; others decline to cooperate with prosecutors against the black market recruiters. A particular Indian hospital is named. Frank Delmonico makes an appearance near the end.  

(The video doesn't discuss any of the larger issues about the causes and consequences of the shortage of organs for transplant that make black markets busy and profitable, or how these might be addressed through legal and ethical efforts to increase the availability of transplants.)


HT: Frank McCormick
Here's a post on the legal market for kidneys in Iran.
Here's an article from earlier this week in the Washington Monthly
We Have to Make Organ Donors Whole. by Sally Satel, January 17, 2023 
"I’m alive because of kidney donations, but there wouldn’t be an organ shortage if we made it easier for those willing to literally give a piece of themselves. New York is taking a good first step."
related earlier post:

Wednesday, January 18, 2023

Collective bargaining by medical residents

 The WSJ has the story:

Medical Residents Unionize Over Pay, Working Conditions. Doctors-in-training say they want to advocate for themselves and patients  By Dominique Mosbergen

"Physicians-in-training at top teaching hospitals across the country are joining unions, demanding higher pay and better working conditions.

"The Committee of Interns and Residents, the largest group representing doctors in residency and fellowship programs, said it added chapters at five teaching hospitals last year and two in 2021, up from a prepandemic pace of roughly one a year. CIR, which is affiliated with the Service Employees International Union, said it represents about 15% of the nation’s 140,000 residents and fellows. 

"The pandemic’s strains spurred residents to organize, said Simranvir Kaur, a fourth-year resident specializing in obstetrics and gynecology at Stanford Medicine, where most of some 1,400 Stanford residents voted to form a union last May. 


"Stanford, which is based in Palo Alto, Calif., said it is negotiating a union contract with its residents and declined to comment further.


"The American Medical Association’s ethics code advises physician unions not to engage in strikes by withholding essential medical services from patients. 

"CIR said that residents’ first priority is patients and that unionized residents would vote to strike only as a last resort. The last time a CIR union went on strike was in 1981."

Tuesday, January 17, 2023

Organ trafficking in America, on National Geographic TV, premiering tomorrow

National Geographic TV tweets about a new series on organ trafficking, premiering tomorrow night, with a video trailer that suggests that they think there is substantial organ trafficking to U.S. patients.

@MarianaVZ  uncovers the hidden world of organ trafficking in an all-new #TraffickedWithMarianavanZeller. Don't miss the season premiere, this Wednesday at 9/8c on National Geographic.

I'm a bit skeptical about the scope of organ trafficking to U.S. patients, because as far as I can tell there isn't a lot of evidence of Americans with mysterious transplants showing up for post-transplant care at American transplant centers. But I haven't seen the show. (Not being a subscriber I doubt that I will, but I imagine I'll hear from some of you who do.)

HT: Alex Chan

Monday, January 16, 2023

School choice, by Atila Abdulkadiroğlu and Tommy Andersson

 Here's what looks to be a magisterial survey of school choice by two pioneers of the theory and practice of market design.

School choice by Atila Abdulkadiroğlu and Tommy Andersson, Handbook of the Economics of Education, Available online 3 January 2023, https://doi.org/10.1016/bs.hesedu.2022.11.001 

Abstract: School districts in the United States and around the world are increasingly moving away from traditional neighborhood school assignment, in which pupils attend closest schools to their homes. Instead, they allow families to choose from schools within district boundaries. This creates a market with parental demand over publicly-supplied school seats. More frequently than ever, this market for school seats is cleared via market design solutions grounded in recent advances in matching and mechanism design theory. The literature on school choice is reviewed with emphasis placed on the trade-offs among policy objectives and best practices in the design of admissions processes. It is concluded with a brief discussion about how data generated by assignment algorithms can be used to answer contemporary empirical questions about school effectiveness and policy interventions.

Sunday, January 15, 2023

Predicting the future in Japan: Kojima, Narita, Saito and Uchida

A new book in Japanese has appeared, whose translated title is "Future Prediction of Geniuses."

My attempt to post about it caused html errors on the blog, so this is a replacement for the original post, with just a link to the twitter thread here: https://twitter.com/booksmagazine/status/1611291463291404288

Google translate works pretty well at letting English speakers know what it says.

Saturday, January 14, 2023

The power of kidneys, altruism, and books. (And recommendation of a doctor in the UK)

 Here's a story, about kidneys and about books, in inews.co.uk:

‘It’s a gift with no conditions attached’: Why I donated my kidney to a person I’ll never meet. 250 people die each year in the UK because there are not enough kidneys available. So when GP Richard Armitage discovered altruistic donation was possible, he gave away an organ. By Tom Ough

"Despite being a GP, Richard Armitage had spent most of his career unaware that altruistic donations were possible. In this respect, Armitage, 34, was like many of his colleagues in the medical profession. That changed in 2017. Armitage, visiting the Nobel Laureate Museum Stockholm, bought a book by Alvin Roth, an economist who won a Nobel Prize in 2012. The book was Who Gets What — and Why: The New Economics of Matchmaking and Market Design, and in it Roth wrote how we allocate things within markets that aren’t dictated by money.

"Examples include the allocation of children to schools, doctors to hospitals, and kidneys to people with end-stage renal disease. Roth discussed what is known as non-directed altruistic kidney donations – in short, kidneys donated to strangers. Sitting on the plane home, Armitage read the book with fascination. When he returned to Nottingham he checked the NHS website to see whether non-directed altruistic kidney donation was possible in the UK. It was.

"In 2018 altruistic donors began being routinely added to the UK Living Kidney Sharing Scheme (UKLKSS), which oversees this sharing of organs by living donors. Apparently as a result of the move, in 2019 there was a 60 per cent rise in altruistic donations – from 124 to 183. Twenty-eight per cent of kidney transplants are now from living donors.
"It seemed a good application of the kind of moral philosophy that Armitage had discovered the same year, 2017, when he read Famine, Affluence and Morality. It is an influential essay in which Peter Singer, an Australian philosopher, argued that the West should be donating far more resources to humanitarian causes.
"All of Armitage’s intellectual discovery, including his reading of Roth’s writing on kidney donation, happened in one year, 2017 – also the year that Armitage finished his GP training. It marked the end of “a 10-year head-down slog” that began with the first day of medical school. “After I passed my last exam, it felt like I finally lifted my head up and asked: ‘But why am I doing this?’”

"And so Armitage’s first conversation with his regional kidney transplant centre was followed by an appointment with a Living Donor Nurse, who explained what donation would entail: the testing, the preparation, the surgery. Armitage was invited to speak to his loved ones and consider whether he was ready; it turned out he wasn’t.

"There were several hold-ups. At first, Armitage felt the beginning of his GP career was the wrong time to take weeks off work. Then Covid stalled the NHS’s kidney-sharing scheme. Armitage still wanted to donate his kidney, and successfully underwent a battery of investigations: a renal tract ultrasound scan, an electrocardiogram, chest X-ray, various fasted blood tests, and an X-ray of his kidney. As per the requirements of the donation scheme, Armitage met a clinical psychologist to discuss his state of mind, put the psychologist in touch with a loved one in order to independently assess his state of mind, and met a representative of the Human Tissue Authority to ensure that he was not donating his kidney under duress or for financial gain.
"Armitage spent several weeks in Ukraine as part of his work for the charity UK-Med, which sent British medics to deliver emergency healthcare. “That obviously meant I couldn’t continue with the donation process,” he says with some understatement. But when he got home, he told the donor team he was ready. “Can we crack on?”, he asked.

"The operation was on 23 November. Everything was in place; Armitage was part of a chain on which three people with end-stage renal disease were due a kidney.
"And just before he was discharged – three days after surgery, having convinced the hospital staff he was ready to take care of himself – he was informed that all the recipients in the chain now had working kidneys. “That was a very meaningful moment that made it all worthwhile,” says Armitage."

Friday, January 13, 2023

Affirmative action in India--a market design perspective, by Ashutosh Thakur, Orhan Aygün, Bertan Turhan, and M. Bumin Yenmez

 The policy portal Ideas for India has an e-symposium on recent developments in affirmative action in India, with an informative introduction by Parikshit Ghosh, and short papers by Ashutosh Thakur, and by Orhan Aygün, Bertan Turhan,  and M. Bumin Yenmez. It's encouraging to see that the attention to these issues by such serious market designers is getting prompt exposure to policy makers in India.

Here's the introduction (which I've copied in it's entirety, with links):

Introduction to e-Symposium: The architecture of affirmative action 12 December, 2022 by Parikshit Ghosh

The Supreme Court of India recently upheld an amendment that excluded Scheduled Castes, Scheduled Tribes and Other Backwards Classes from the Economically Weaker Section (EWS) quota, restricting it only to general category applicants. However, the specifics of how this reservation policy is executed can have important social and political implications. 

Across this week, from 12-16 December, this I4I e-Symposium brings together articles that provide a theoretical basis – using principles of market design, and search and matching theory – for more efficient implementation of reservation policies. Anchored by I4I’s Editor-in-Chief Parikshit Ghosh, the e-Symposium aims to open a discussion on the architecture of affirmative action, from the mechanisms of vertical and horizontal reservations, to ensuring efficiency in meeting diversity targets.

The authors of the Indian Constitution had the wisdom to see that our tryst with destiny will be unfulfilled if we do not confront the ghosts from our past. Even as Articles 14 and 15 pronounced equal treatment for all, Article 15(4) paved the way for reservations targetted at socially disadvantaged groups. The founders of the Indian republic understood that a newly independent nation had a historic opportunity to not only break the shackles of colonialism, but also oppression in all its forms. A narrow, ahistorical notion of meritocracy did not suit this mandate. 

Still, after more than seven decades of experience, questions swirl around our reservation policy. Who deserves protection? When should it be withdrawn? Is social disadvantage synonymous with economic deprivation? Grappling with these difficult issues requires not only input from the social sciences, but also an engagement with ethics and politics. Unlike the design of airports or the sale of spectrum, this is an area where the public interest cannot entirely be left to academics and bureaucrats. 

However, affirmative action does not involve only the setting of diversity targets – which is fundamentally an expression of democratic will – but also calls for the design of concrete institutional rules to achieve these targets with the least sacrifice of the meritocratic ideal. Should general category seats be filled before the SC/ST seats or vice versa? If an OBC candidate with disability is recruited, should it count towards fulfilling both the OBC and disability quotas, or just one of them? How exactly these finer points are settled can be profoundly consequential, as economists have learnt from several decades of research on market design (Roth 2007)

While affirmative action targets have been well articulated by legislatures, the rules for implementing them have been left ill specified, requiring courts to step in time and again. Many landmark judgments of the Supreme Court are attempts to reduce the confusion and conflict arising from procedural ambiguity. 

Unfortunately, this design aspect of reservation policy, what I call the architecture of affirmative action, has not only received scant attention in the media and public debate, but its importance seems to go largely unrecognised. Our aim with this e-Symposium is to start that conversation. 

In Indra Sawhney vs. Union of India (1992), the Supreme Court mandated the earmarking of certain positions for caste-based categories (like SCs, STs and OBCs) – what has come to be known as vertical reservation – but left the fulfillment of diversity targets for other categories (such as persons with disabilities) more flexible – an arrangement referred to as horizontal reservation. In the opening article of this symposium, Ashutosh Thakur revisits this issue and provides a critique of vertical reservations. Among other things, it has no built-in sunset clause and requires legislatures to continuously revise quotas as disadvantaged groups economically catch up with others. 

The next two articles come from researchers who have studied how to devise efficient ways of meeting diversity goals, as well as matching two sides of a market (for example, assigning students to schools or colleges) in a sensible way. In the second article of the series (their first), Orhan Aygun, Bertan Turhan and Bumin Yenmez point out that though the five judge bench upheld restricting the Economically Weaker Section (EWS) quota to general category applicants, SC/ST/OBC candidates could still make themselves eligible for these positions by not declaring their caste identity, and explore the implications of such a loophole. 

The final article examines the process through which rank holders from the joint entrance examination (JEE) are assigned to the various Indian Institutes of Technology (IITs) and other technical colleges. The assignment must respect student merit ranks, their stated preference over institutions and programmes, and the quota requirements within each institution. In addition to that, the judgment in Ashok Kumar Thakur vs Union of India (2008) stipulates that unfilled OBC quota seats (but not SC/ST quotas) should be made available to general category applicants to reduce wastage. This is clearly a complex task.   

The system currently in place was designed by the government, in consultation with a group of computer scientists and market designers (Baswana et al. 2019). It is based on the celebrated Gale-Shapley algorithm1 and tries to ensure that within the constraints of the diversity requirement, the allocation is fair and efficient. Many readers may be unaware that a rare confluence of legislative will, judicial oversight and technocratic finesse has designed the staircase to success so many Indians aspire to step on. Yet, as Aygun, Turhan and Yenmez point out through simple and illuminating examples, when it comes to de-reserving unfilled OBC seats, the current system has subtle flaws that can and ought to be corrected. 

After 75 years of Independence, we can take some pride in our quest for an affluent and just society, yet be vigilant about the gaps in that attempt and strive to bridge them. 

Design choices for implementing affirmative action

Ashutosh Thakur

Ashutosh Thakur explains the various ways in which affirmative action policies can be implemented, and discusses the underlying trade-offs and issues at hand...

Challenges of executing EWS reservation efficiently

Orhan Aygün, Bertan Turhan, M. Bumin Yenmez

Aygün, Turhan, and Yenmez look at the implications of reserved category members having to choose between applying for positions on the basis of their caste or income...

Improving admissions to technical colleges in India

Orhan Aygün, Bertan Turhan, M. Bumin Yenmez

Aygün, Turhan, and Yenmez examines the process through which JEE rank holders are assigned to the various IITs and other technical colleges...


  1. The Gale–Shapley algorithm is an algorithm used for finding a solution to the stable matching problem, and has been described as solving both the college admission problem and the stable marriage problem.

Further Reading