Medical tourism: cataract surgery in Britain

Britain is both an origin and a destination for medical tourism--travel to get better or cheaper medical care--and not everyone is happy to be on the receiving end.

The Telegraph has the story: Health tourists jump queue for cataract operations on NHS as British patients wait up to eight months

"Health tourists are being given cataract surgery on the NHS ahead of British patients because their conditions are considered more of a priority, it has emerged.

Hundreds of people from countries including Zimbabwe and Nigeria have been offered the eye operations before UK taxpayers, official figures show.

They have been fast-tracked by medics as their conditions are said to be "very complex and urgent", while some hospitals have waiting times of almost eight months.

Cataract surgery is the most common treatment provided on the NHS and 300,000 operations are carried out each year."
************
For some medical tourism that takes British citizens abroad, see e.g. these earlier posts...

What do British fertility tourists choose in America? It's a girl!

Indian surrogates bearing British babies

Assisted suicide in England and Switzerland, continued

Matching refugees to towns in Britain: Tim Harford in the FT

In the Financial Times, Tim Harford writes about resettling refugees: The refugee crisis — match us if you can--‘However many refugees we decide to resettle, there’s no excuse for doing the process wastefully’

"By balancing competing demands, good matching mechanisms have alleviated real suffering in school systems and organ donation programmes. Now two young Oxford academics, Will Jones of the Refugee Studies Centre and Alexander Teytelboym of the Institute for New Economic Thinking, are trying to persuade governments to use matching mechanisms in the refugee crisis.

Most popular discussions of the crisis focus on how many refugees we in rich countries should accept. Yet other questions matter too. Once nations, or groups of countries, have decided to resettle a certain number of refugees from temporary camps, to which country should they go? Or within a country, to which area?

Different answers have been tried over the years, from randomly dispersing refugees to using the best guesses of officials, as they juggle the preferences of local communities with what they imagine the refugees might want.

In fact, this is a classic matching problem. Different areas have different capabilities. Some have housing but few school places; others have school places but few jobs; still others have an established community of refugees from a particular region. And refugee families have their own skills, needs and desires.

This is not so different a problem from allocating trainee doctors to teaching hospitals, or children to schools, or even kidneys to compatible recipients. In each case, we can get a better match through a matching mechanism. However many refugees we decide to resettle, there’s no excuse for doing the process wastefully.

There is no perfect mechanism for matching refugees to communities — there are too many variables at play — but there are some clear parameters: housing is a major constraint, as is the availability of medical care. Simple systems exist, or could be developed, that should make the process more efficient, stable and dignified."

Family consent for (and sometimes veto of) organ donation in England, and presumed consent in Wales

Here's a BBC report:
Organ donations vetoed by hundreds of bereaved families, By Jane Dreaper, 15 January 2016

"Bereaved families have blocked the donation of organs from 547 UK registered donors since 2010 - about one in seven cases, figures show.

"NHS Blood and Transplant (NHSBT) says it will no longer seek the consent of families formally, to make such "overrides" more exceptional.

"Instead, they will be given a leaflet explaining consent - or authorisation in Scotland - rests with the deceased.

"Families can still veto that consent but must provide reasons in writing.

"NHSBT expects the change to lead to a 9% rise in donors.
It said the 547 blocked donors would have provided organs for 1,200 patients."
...
"Last month, the system in Wales changed to "presumed consent", under which people are deemed to be potential donors unless they have specifically opted out."

Cap and Gown at Exeter

When I was at Exeter University in July, I not only attended a conference on market design, but also put on a cap and gown and became an honorary graduate. (I had to give back the cap, but some pictures arrived in the mail just now...)
Here I am with the Chancellor, Baroness Floella Benjamin.

Baroness Floella Benjamin and Al Roth.Exeter.July 2015

BBC show on algorithms and kidney exchange (tv documentary)

David Manlove writes from Scotland:

"BBC4 have just shown a documentary on algorithms, which featured the Gale-Shapley algorithm and kidney exchange in the UK.  In particular, it shows an excerpt of you and Lloyd Shapley receiving the Nobel Prize.

The programme was shown on 24 September – see http://www.bbc.co.uk/algorithms.  Viewers outside the UK probably cannot watch the footage, but I noticed that someone has posted the programme on YouTube.  It can currently be seen at https://www.youtube.com/watch?v=Itvwa85YkEg.  The stable marriage part starts at 20:50 and the kidney exchange part follows (from 25:40).  You and Lloyd Shapley are shown at 21:35.

In general I reckon they did a great job of making a complex subject accessible - and I thought that Marcus du Sautoy in particular was very engaging.”

*********

David's work on kidney exchange in the UK is featured in the video, which you can also see below

Kidney exchange in the UK: Algorithms

David F. Manlove and Gregg O’Malley. 2015. Paired and Altruistic Kidney Donation in the UK: Algorithms and Experimentation. J. Exp. Algorithmics19, Article 2.6 (January 2015), 1.11 pages. DOI=10.1145/2670129 http://doi.acm.org/10.1145/2670129

"We study the computational problem of identifying optimal sets of kidney exchanges in the UK. We show how to expand an integer programming-based formulation due to Roth et al. [2007] in order to model the criteria that constitute the UK definition of optimality. The software arising from this work has been used by the National Health Service Blood and Transplant to find optimal sets of kidney exchanges for their National Living Donor Kidney Sharing Schemes since July 2008. We report on the characteristics of the solutions that have been obtained in matching runs of the scheme since this time. We then present empirical results arising from experiments on the real datasets that stem from these matching runs, with the aim of establishing the extent to which the particular optimality criteria that are present in the UK influence the structure of the solutions that are ultimately computed. A key observation is that allowing four-way exchanges would be likely to lead to a moderate number of additional transplants."

Will medically assisted dying become legal in Britain?

The Telegraph has the story: Assisted dying must be legalised, demand key figures

"Political leaders must agree a plan to legalise assisted dying as one Briton a fortnight is now travelling abroad to end their lives, an alliance of prominent figures from across public life warns today.

In a letter to The Daily Telegraph, some 80 doctors, writers, actors, clerics and politicians say an “overwhelming majority” of the public now supports a change in the law and that Parliament must allow time to finally resolve the issue.

The signatories, which include Lord Carey, the former Archbishop of Canterbury and Ian McEwan, the author and winner of the Booker Prize, argue that Britain is “closer than ever” to a historic change after progress in the House of Lords on a Bill tabled by Lord Falconer, the former Lord Chancellor."
***********

In related news from England:
Right-to-die campaigner and MS sufferer Debbie Purdy - who forced the government to publish rules on assisted suicide - dies aged 51

• "Debbie Purdy has died aged 51 at Marie Curie Hospice in Bradford
• Was one of most outspoken activists in legal battle over assisted suicide
• She won a landmark ruling in the House of Lords in 2009 resulting in a guidelines on assisted suicide being published by the government
• She had been refusing food as she wanted to 'control' her death
• Her husband has paid tribute to 'a much loved wife, sister, aunt and friend' "

Death with dignity developments in Britain

In the Telegraph: Assisted suicide guidelines relaxed by Director of Public Prosecutions
Doctors and nurses who help severely disabled or terminally ill people to take their own lives are less likely to face criminal charges

"Until now all health care professionals faced a greater chance than others of being prosecuted for helping people to die because of the trust their patients placed in them.
Alison Saunders, the Director of Public Prosecutions, said this special deterrent would now only apply to those directly involved in a person's care.
Anti–euthanasia campaigners accused Ms Saunders of "decriminalising" assisted suicide by health care professionals "at a stroke of her pen".
Dr Michael Irwin, the former GP nicknamed "Dr Death" for helping several people kill themselves, said the change was a "wonderful softening" that would "make life easier" for people like him."

Obesity is a growing medical problem...in unexpected ways

Obesity contributes to many diseases, including kidney and liver diseases that eventually require transplants. But it impacts the medical system in other ways. The Telegraph has the story:  Hospitals buy special fridges to store overweight bodies as obesity crisis escalates: Doctors warn Britain's obesity crisis could 'cripple' the NHS as hospitals are being forced to buy and rent specialist equipment to deal with overweight patients

"Britain’s obesity crisis is so serious that hospitals are buying specialist equipment to keep bodies cool because they are too large to fit into mortuary fridges."

Danish sperm donors and British babies

The Telegraph has the story: Invasion of the Viking babies--With a growing demand for donor fathers, women are turning to Danish sperm banks

"Donors are paid a similar sum in Britain, but clinics can’t recruit enough men to keep up with the growing demand for sperm (the number of women with female partners having donor insemination, for example, rose by 23 per cent between 2010 and 2011). The percentage of new registered donors from overseas has more than doubled in recent years, from 11 to 24 per cent – and around a third of those imports are from Denmark.

“It’s a bit like the Viking invasion of 800AD,” says Dr Allan Pacey, a fertility expert from the University of Sheffield and current chairman of the British Fertility Society. “They’ve invaded us once by boat, and now they’re doing it by sperm.”

"Part of the problem is down to our system, with donor recruitment generally carried out on a small scale in British fertility clinics. On average, just one in every 20 men who applies will be suitable to donate. Men do not only need to have high-quality sperm: they also have to undergo a full range of screening tests for genetically inherited diseases and sexually transmitted infections, and their family medical histories must be assessed. Those deemed suitable will need to commit to regular visits to the clinic, usually during the working day. It’s often easier for a clinic to suggest their clients use a Danish donor, where a specialist sperm bank has the resources to devote to finding the 5 per cent who fit the bill.

"Although some bigger fertility clinics here do have a ready supply of donors, inter-clinic competition means that those who don’t tend to recommend an overseas sperm bank. Olivia Montuschi, of the Donor Conception Network, a charity for those affected by donor conception, told me that patients are not being informed about the clinics that have donors available. “Clinics like to retain their own patients, not share them, and they keep information about donors at other clinics to themselves,” she says.

Long lasting effects of the window tax at Cambridge University

When I recently spoke at Cambridge, I took this photo at King's College.

Wikipedia has this to say, in general...
The window tax was a property tax based on the number of windows in a house. It was a significant social, cultural, and architectural force in England, France and Scotland during the 18th and 19th centuries. To avoid the tax some houses from the period can be seen to have bricked-up window-spaces (ready to be glazed or reglazed at a later date), as a result of the tax. It was introduced in 1696 and was repealed in 1851, 156 years after first being introduced. Spain and France both had window taxes as well for similar reasons.

*****************
Update: Here's a recent paper on the window tax, brought to my attention by the authors.

The Window Tax (Working Paper) A Case Study in Excess Burden

Author(s): Schwab, Robert M. and Wallace E. Oates
Publication Date: April 2014

Dignity in dying (versus assisted suicide)

Views on what are repugnant transactions sometimes change, and it may be that those who are seeking change are wise to re-frame the issue.  Something like that is going on in the U.K. right now, where assisted suicide is illegal (as it is in most places).

Here's the website of the Campaign for Dignity in Dying, which says:
"We campaign to change the law to allow the choice of an assisted death for terminally ill, mentally competent adults, within upfront safeguards. You can help us make that change happen.

Under our current law, some dying people are forced to suffer against their wishes. If we can change the law no more people will die, but fewer will suffer. Change the law - take action."

Elsewhere they define: ASSISTED DYING
"Assisted dying is when a terminally ill, mentally competent adult, making the choice of their own free will and after meeting strict legal safeguards, takes prescribed medication which will end their life."
***********

See previous posts.

Same sex marriage in England and Wales

The first same sex marriages in England and Wales were performed Friday. Here's the story from the NY Times: First Gay Marriages Take Place in England and Wales

"LONDON — Same-sex couples began marrying in London a minute after midnight on Friday, signifying the culmination of a campaign to end a distinction many British gay couples said made them feel like second-class citizens.

"Saturday was the first day that gay couples were allowed to tie the knot in England and Wales after the government legalized same-sex marriage in July.

"Gay couples have been allowed since 2005 to enter “civil partnerships,” conferring the same legal rights as marriage, but campaigners say the distinction gives the impression that society considers gay relationships inferior.
...
"Gay marriage has faced opposition from most religious groups despite shifting public attitudes in Britain in favor of it.

"The Church of England, which leads the world’s 80 million Anglicans, has struggled to reconcile rifts within its ranks over homosexuality as it seeks to tackle rising secularism and falling attendance rates.

...
"The leading Muslim, Catholic and Sikh groups in Britain were all against the passage of the same-sex marriage law.
...
"While the number of countries legalizing gay marriage has grown significantly since the Netherlands made the first move in 2000, only 17 currently allow gay couples to marry.

"France legalized it last year despite several protests drawings hundreds of thousands onto the streets of Paris.
"Scotland, which will hold a referendum on independence from Britain in September, was the latest country to pass same-sex marriage legislation last month, despite strong opposition from the Scottish Catholic Church and the Presbyterian Church of Scotland.

"In some other parts of the world, governments have been moving in the opposite direction, clamping down on gay rights.

"Uganda attracted international opprobrium in December when it passed a controversial law that makes some homosexual acts punishable by life in prison. Homosexuality is illegal in 37 African countries.

"Russia also faced criticism over a law signed by President Vladimir V. Putin last year banning the spread of “gay propaganda” among minors.

"In England and Wales, homosexuality was decriminalized in 1967, starting off a series of reforms to give gay people the same rights as everyone else."

Update on school choice in Britain

The Telegraph reports, unfavorably, on the rise of school choice (and demise of assignment to local schools) in Britain:
:
Surge in admissions lotteries threatens children's right to place at local school
One in 12 schools is shunning traditional catchment areas in favour of rules designed to engineer a more balanced student body

"Some one in 12 schools is shunning traditional catchment areas in favour of rules designed to engineer a more balanced student body and break the middle-class stranglehold on places.

"The shift is being driven by a rise in the number of academies and free schools whose admissions policies are independent of local council control.
...
"Research by The Sunday Telegraph found that the proportion of highly oversubscribed secondary schools using lotteries or “fair banding” systems rises close to 100 per cent in parts of London. Across England, half of councils confirmed that at least one school in their area now used them.
...
"The Department for Education said admissions were run by individual schools or councils but insisted places “should be allocated in a fair and transparent way”. Parents will find out which state secondary school their children have been allocated on March 3 as part of National Offer Day.
Most schools have traditionally allocated places based on the distance between a pupil’s home and the school gates. This has allowed wealthier parents to buy property close to the best schools to secure places, with research suggesting that living in the catchment area of a highly sought-after school can add an average £31,500 “premium” to house prices.
But admissions guidance introduced by Labour allows institutions to employ a series of measures designed to break the stranglehold.
Lotteries, or “random allocation”, involve some or all applicants having their names drawn from a ballot, giving pupils living several miles away the same chance of a place as those next door.
“Fair banding” sees all applicants sit an aptitude test, with a set number of bright, average and low ability pupils being admitted. Schools usually use distance or a lottery to decide who gets a place within each ability band. Mrs Wallis said many parents “find fair banding complicated”, but insisted it was preferable to straight lotteries because “its goals are clearer”.

"Last week, The Sunday Telegraph obtained data on the admissions policies of more than 1,400 schools – 43 per cent of those nationally. Half of local authorities surveyed said at least one school in their area used lotteries, fair banding or both.
In total, one in 12 of the schools identified employed these admissions policies. Twice as many used fair banding as lotteries"

Two countries divided by a common language: translating English into American

The article (by Tim Parks) Learning to Speak American, about copyediting an English writer's English for an American audience, has some hidden lessons about friction in international trade.

Here's his first paragraph:
"In 1993 I translated all 450 pages of Roberto Calasso’s The Marriage of Cadmus & Harmony without ever using the past participle of the verb “get.” The book was to be published simultaneously by Knopf in New York and Jonathan Cape in London; to save money both editions were to be printed from the same galleys; so it would be important, I was told, to avoid any usages that might strike American readers as distractingly English or English readers as distractingly American. To my English ear “gotten” yells America and alters the whole feel of a sentence. I presumed it would be the same the other way round for Americans."

And this:
"Despite my hailing from England—a country that still uses miles—I had expressed distances in meters and kilometers and it seemed odd now to find my Italian characters speaking to each other about yards and miles and, of course, Fahrenheit, which they never would. Or saying AM and PM, rather than using the twenty-four-hour clock as they mostly do, even in ordinary conversation. Slowly, as well as being concerned that some sentences were now feeling clunky and odd, I began to wonder if American readers really needed or demanded this level of protection. Wouldn’t they soon figure out, if I said “the temperature was up in the sizzling thirties,” that I was talking Celsius? Or at least that in another part of the world people had another system for measuring temperature where thirty was considered warm? Mightn’t it be fascinating for them to be reminded that the twenty-four-hour clock, which Americans usually associate with military operations, has long been in standard civilian usage in Europe? Italy introduced it as early as 1893."
...
"America is very much a net exporter of literature. Its novels are read and translated worldwide, where readers generally accept miles and Fahrenheit, pounds and ounces, AM and PM and indeed have grown accustomed to these old-fashioned, American oddities (when it comes to doing science, of course, Americans use the more practical European systems). In Germany, for example, where around fifty percent of novels are foreign works in translation, Roth’s and Franzen’s characters are not obliged to discuss distances in kilometers.

Conversely, America imports very little—only three to four percent of novels published in the States are translations—and what it does import it tends to transform as far as possible into its own formulas and notations, in much the same way that Disney has turned every fable and myth worldwide into a version of Mickey Mouse. "

Eating horsemeat is good for horses, says Britain's Princess Anne

The Telegraph has the story (and a video):
Princess Anne: why Britain should consider eating horsemeat
"The Princess Royal, who is President of World Horse Welfare, says that Britain should consider eating horsemeat because it would improve standards of care for the animals"

 "Princess Anne was speaking at the World Horse Welfare Organisation annual meeting when she made the comments:
"Our attitudes to the horsemeat trade may have to change" she said, because those in the trade "value their horses and look after them well" and therefore "should we be considering a real market for horsemeat and would that reduce the number of welfare case?
"I think this need a debate," the Princess Royal added."

Organ donation in Britain: will it follow Israel's lead?

The idea of encouraging people to register as organ donors by giving some priority to registered donors for receiving organs should they need them is still under discussion in Britain, motivated in part by the Israeli experience.  Here's a story from the Telegraph:
Registered organ donors could be given priority for transplants
"Patients who have agreed to donate organs could be given priority if they ever need a transplant, under proposals being considered by the NHS.
...
"In a report published today (THURS) NHS Blood and Transplant published a new plan to improve organ donations.
"The report floats one approach where patients already on the Organ Donor Register would be given higher priority for transplants should they need one.
"Professor James Neuberger, associate medical director at NHS Blood and Transplant, said: “They do this in Israel and it has encouraged donation.
“It was first introduced in Singapore. While they don’t exclude those who don’t donate, it gives priority to those who are on the donor register.
“Whether it is appropriate for the UK is up for debate and discussion.”
"Any move to prioritise patients on the donor register would require a decision by ministers and a change in organ allocation rules."
******************
The subject will be debated at the upcoming National Donation and Transplantation Congress, which is being held at the University of Warwick in early September.

Here's the announcement of the debate, with Jay Lavee, the Israeli heart transplant surgeon who has been at the heart of the change to priority in Israel speaking in favor (and presumably some of the others speaking against...)

The David Price Memorial Lecture / Debate: Should we have to give in order to receive? 

Chair:   James Neuberger

Speakers:  Jacob Lavee  – Israel

  Kevin Gunning -  Intensive Care Society

  Anthony Warrens – British Transplantation Society

  Penney Lewis – UK Donation Ethics Committee

*******************
Here is the UK Organ Donation and Transplantation site, and here are some links to the NHS Blood and Transplant Service documents on current proposals:

Taking Organ Transplantation to 2020
Here's the accompanying full report (pdf)

The table is from that report, summarizing the goals and current situation.

Here's an earlier post  of mine on this subject.

Here are other earlier posts following Jay Lavee's work

Clearing: the scramble for British university admissions begins today

Admissions offers in Britain are (often) contingent on exam results, and today the A-level exam results are publiished, and the process known as Clearing begins. The Telegraph has the story (and apps to guide students through the process).
Clearing 2013: How to play the system
If you don’t get the A-level grades you want on Thursday, don’t panic. Let Andrew Marszal and the Telegraph guide you through clearing and beyond

While this particular “due date” is certain – A-level results will be published tomorrow come rain or shine – the outcome is anything but.

Based on numbers from previous years, we know that by tomorrow morning around 350,000 students will be celebrating, having secured the grades they needed to meet their university offers.

We can even speculate that one or two of them will leap joyfully into the air, shamelessly flourishing their straight A* grades for local press photographers.

But for a significant proportion of would-be undergraduates, the end of the long wait only marks the beginning of university clearing.

Once the dust had settled last year, some 167,000 teenagers found themselves eligible for clearing – the process which matches students who don’t have the university offers they want with courses that still have vacancies.

With overall application numbers slightly up for this year’s courses, it’s likely that figure could be exceeded this week.

And even those who have gained or exceeded the required grades will want to keep an eye on clearing – there is still the option of switching to a more competitive course through the parallel “adjustment” process, which carries the advantage of not having to give up your existing offer while you shop around for a better course.

So that’s why, with hundreds of thousands of teenagers making potentially life-altering decisions in the space of just a few days or even hours after receiving their results, the Telegraph has put together a range of exclusive tools to help you negotiate your application. As the exclusive media partner of Ucas, all course vacancy listings will be available only with this newspaper in England and Wales, starting from the morning of A-level results day. There will be further listings published free with your newspaper on August 16, 17 and 29 and September 5.

But bear in mind that clearing places will come and go across the clearing period until September 30, as people turn down offers and universities fill places.
**************

Here's a helpful graphic of whhere the vacant places are: http://www.telegraph.co.uk/education/universityeducation/clearing/10242726/Clearing-2013-graphic-which-universities-have-places.html

July 4 and July 1: U.S. and Hong Kong remember British rule

Happy Independence Day to all my fellow Americans. We remember today that we aren't British, and how that came to pass.

I was just in Hong Kong, and there July 1 is the anniversary of Handover Day, when Britain handed back control of Hong Kong over to the Chinese government. The celebrations include political protests, for Hong Kong's lost separateness...

Courts and assisted suicide in Britain

Here is a judicial philosophy that seems hard to sympathize with: Lord Chief Justice won't allow 'personal sympathy' to sway decision on assisted suicide

"The Lord Chief Justice, Lord Judge, said he and his fellow judges were “acutely aware of the desperate situation” faced by people such as Tony Nicklinson, the “locked-in” syndrome sufferer who starved himself to death last year after losing a right-to-die case.

"But he said “only basic principles of law” could decide whether or not there could ever be any relaxation of the ban on assisted suicide.

"He also challenged lawyers brandishing opinion poll findings pointing to strong public support for a change in the law, questioning how it was relevant, adding: “The public may change its mind next week.”

"He said the case could not be decided “on the basis of opinion polls”.

"Lord Judge was speaking as he, joined by the Master of the Rolls Lord Dyson and Lord Justice Elias, began to hear submissions as part of a wide ranging Court of Appeal challenge to the UK’s laws on euthanasia."