Congestion in vaccine delivery: uncancelled extra appointments

 In school choice, the reason universal enrollment systems that give each child one assignment are so desirable is that if children are accepted by multiple schools, it often takes time (e.g. the first week of the school term) to sort out which children are going where, and to free up the unclaimed spaces.

The same thing is happening with decentralized appointments for Covid vaccines. The WSJ has the story:

Got Your Covid-19 Vaccine? Now Cancel Your Extra Appointments.  Pharmacies and community clinics say uncanceled appointments lead to no-shows, adding to their already heavy workload   By Jaewon Kang and Sharon Terlep

"Pharmacies and health officials are making a plea to Americans who received their Covid-19 vaccines: Cancel the other shots you booked.

"As vaccine eligibility expands and more places offer shots, many people are signing up for multiple appointments and not backing out of the ones they don’t need. The resulting influx of no-shows is forcing vaccine providers, from pharmacies to community clinics, to find last-minute replacements so doses aren’t wasted.

...

"Appointments remain tough to score in many parts of the country even though the overall supply of vaccines and the pace of inoculation are improving. Some people are making multiple bookings in hopes of getting vaccinated sooner or sometimes because they don’t receive or see confirmation emails, according to pharmacies and community vaccination sites. Others receive shots at pop-up vaccination events before scheduled appointments and don’t notify providers.

"The U.S. lacks a concrete system of tracking wasted doses. Generally, local and state officials say that demand is high enough that no-shows aren’t leading to tossed vaccines, though vaccine providers say they sometimes fail to find takers for all the doses they have thawed in time to use them all safely."

***********

Previous post:

Monday, February 15, 2021

Multiple queues for Covid vaccines, as pharmacies join the supply chain

Organ donation in England: what will be the effect of "soft opt-out"?

 Here's an article arguing that the shift from opt-in deceased organ donation to opt-out plus family consent may not be a big one unless communication between clinicians and bereaved families is improved.

Khiroya H, Sharif A, Jones J, Willis D. Will the unusual become usual? A new legal change that aims to increase discussions around organ and tissue donation in England. Future Healthc J. 2021 Mar;8(1):e170-e173. doi: 10.7861/fhj.2020-0098. PMID: 33791502; PMCID: PMC8004295.

Abstract: "UK guidelines recommend that discussions about organ and tissue donation are conducted as part of end-of-life care. However, there are several barriers to discussing organ donation, and this is reflected in a critical shortage of donors. This article explores who should start the conversation about donation and how all healthcare practitioners can maximise their communication skills to have success in this area. It is particularly pertinent to be upskilled in this area in light of the recent legal change in England, where the system moved from an opt-in to a ‘soft’ opt-out one. Based on a similar legal change that took place in Wales and global data, it is unlikely that the legal change alone will prompt an increase in donation rates in England. This article proposes suggestions to increase awareness and conversations among healthcare professionals and patients with education, public health campaigns and interventions rooted in psychological theory."

"Despite major changes in the infrastructure for organ donation in the UK since 2008, there are not enough donated organs to meet the current need.5 Only 1% of annual deaths in the UK occur in circumstances where the deceased could be a potential donor.6 Identification and availability of sufficient donor organs are are major barriers for transplantation, but the most important barrier is widely acknowledged as failure to secure consent for organ retrieval.

...
"Black, Asian and minority ethnic (BAME) groups have low rates of deceased donation, which results in significantly longer waiting times for transplantation when compared with white patients.17 Low rates of donation are due to uncertainties around religious permissibility and a lack of trust in healthcare professionals by BAME patients, coupled with clinicians’ lack of confidence in communicating with and supporting BAME families.18 There is evidence to suggest that discussing topics such as organ donation and end-of-life care is more acceptable to BAME groups if conversations are conducted by members of their own community.

...

"The law changed in England on 20 May 2020, with organ and tissue donation moving from an opt-in to a ‘soft’ opt-out system.27,28 All adults in England are now considered to be potential organ donors when they die and family permission to proceed will be sought, unless they have previously recorded a decision not to donate organs, or are in one of the excluded groups.

...

"In December 2015, a similar legal change took place in Wales where the system is ‘deemed consent’. This means that if a person has not recorded an opt-in or opt-out decision, it is considered that they have no objections towards organ and tissue donation.

...

"The opt-out system has been received positively in Wales with 71% of the Welsh public saying they were in favour of it 1 year after the change in legislation.35 However, positive attitudes among the public and increased knowledge among healthcare professionals have not translated to a rise in donors.

...

"On a global scale, the data on organ and tissue donation between opt-in and opt-out countries draw ambivalent conclusions due to dated studies and heterogeneous methodology. Confounding variables include varying economies, public health campaigns and cultural attitudes towards donation. A recent study looking at 35 countries demonstrated no significant difference in deceased organ donation or solid organ transplantation between opt-in and opt-out countries.38 This is in keeping with the short-term data that we have from the recent law change in Wales.35,36 Given that the law change itself may not make a difference in England, it is worth thinking about future avenues in education, public health and psychology that can enhance the impact of the new opt-out system."

Cloud Pricing: The Spot Market Strikes Back, by Dierks and Seuken in Management Science

 Sven Seuken writes:

"I just read your blog post about the new paper on economics of cloud computing, which is very interesting. Given that you highlighted the authors' thoughts on why auctions are not used in cloud computing markets, I thought you might be interested in a recent paper coming out of my group, which was just published at Management Science: https://pubsonline.informs.org/doi/10.1287/mnsc.2020.3907

"In our model, we assume that a cloud provider must *always* offer a standard, non-preemptible fixed-price market (because only this satisfies many customers' business needs, which is in line with the arguments that Hummel and Schwarz provide). But we show that a cloud provider can typically increase her profit and create a Pareto improvement for the users by *additionally* selling idle instances on a preemptible spot market (e.g., via an auction).

"Here's the paper and abstract:

Cloud Pricing: The Spot Market Strikes Back

Ludwig Dierks , Sven Seuken 

Published Online:25 Feb 2021 https://doi.org/10.1287/mnsc.2020.3907

Abstract: Cloud computing providers must constantly hold many idle compute instances available (e.g., for maintenance or for users with long-term contracts). A natural idea, which should intuitively increase the provider’s profit, is to sell these idle instances on a secondary market, for example, via a preemptible spot market. However, this ignores possible “market cannibalization” effects that may occur in equilibrium as well as the additional costs the provider experiences due to preemptions. To study the viability of offering a spot market, we model the provider’s profit optimization problem by combining queuing theory and game theory to analyze the equilibria of the resulting queuing system. Our main result is an easy-to-check condition under which a provider can simultaneously achieve a profit increase and create a Pareto improvement for the users by offering a spot market (using idle resources) alongside a fixed-price market. Finally, we illustrate our results numerically to demonstrate the effects that the provider’s costs and her strategy have on her profit.

Some economics of providing cloud computing, by Microsoft economists Hummel and Schwarz

 Here's a paper on an aspect of cloud computing by two Microsoft economists. (Microsoft's cloud service is called Microsoft Azure.)  In addition to the capacity question the paper models, it presents a brief, clear overview of the market for cloud computing.

Efficient Capacity Provisioning for Firms with Multiple Locations: The Case of the Public Cloud  by Patrick Hummel∗ and Michael Schwarz*   March 26, 2021

Abstract: This paper presents a model in which a firm with multiple locations strategically chooses capacity and prices in each location to maximize efficiency. We find that the firm provisions capacity in such a way that the probability an individual customer will be unable to purchase the goods the customer desires is lower in locations with greater expected demand. The firm also sets lower prices in larger locations. Finally, we illustrate that if a customer is indifferent between multiple locations, then it is more efficient to place this customer in a location with greater expected demand. These theoretical results are consistent with empirical evidence that we present from a major public cloud provider.

"2.1 Industry Overview

"The cloud computing industry is young, large, and rapidly growing. Although some of the concepts behind the public cloud were developed as early as the 1960s, all modern public clouds first emerged in the 21st century (Foote 2017). Today annual world cloud revenues exceed $250 billion and are expected to grow by another 20% in 2021 (Graham et al. 2020a).

"The public cloud consists of a wide range of services including infrastructure as a service (IaaS), platform as a service (PaaS), and software as a service (SaaS). SaaS involves providing applications such as web-based email and productivity software to a consumer that can be accessed via the Internet. PaaS provides a platform for deploying consumer created applications using the provider’s programming languages, libraries, and tools.

"And IaaS provisions fundamental computing resources such as processing, storage, and network to a consumer that can be used to deploy and run arbitrary software (Mell and Grance 2011)."

...

"2.5 Why Auctions are Not Used

...

"Since cloud providers provision enough capacity to almost always be able to meet demand, if a cloud provider used an auction to sell compute to customers, the final price at the auction would almost always be equal to the reserve price. However, since cloud customers typically have a value per unit of compute that is orders of magnitude higher than the corresponding capacity costs, in the rare event that there was not enough capacity to meet all demand, the final price in an auction would be dramatically higher

than the cloud provider’s costs. Thus, if a cloud provider used an auction to sell compute to customers, there would be a very high probability that all customers could obtain all the compute they wanted at a low price and a low probability that the final price would

be very high.

"There are two problems with this pricing that would make auctions unsuitable in practice. First, using an auction results in a very high amount of uncertainty about the final realized prices. Thus, if either the cloud provider or the cloud customers are at all risk averse, using an auction to set prices will not meet either the cloud provider’s or the cloud customers’ needs.

"Second, under an auction a cloud provider has a far stronger incentive to underinvest in capacity than under a fixed price mechanism. Under a fixed price mechanism, the cloud provider’s revenue can only go down as a result of underinvesting in capacity, as the cloud provider will not be able to service as much demand. But under an auction, underinvesting in capacity will significantly increase a cloud provider’s revenue by increasing the probability that there will not be enough capacity to meet demand, thereby increasing the probability that the final price in the auction will be very high. Thus, using a fixed price mechanism also enables a cloud provider to more credibly commit to provision the efficient amount of capacity. We illustrate these points formally in Appendix A in the

paper."

Marijuana bans continue to fall: NY and New Mexico, with more to come

 The Washington Post has the story:

New Mexico set to legalize marijuana as New York ends its pot prohibition   By Katie Shepherd

"Capping off a momentous week for legal cannabis, state legislators in New Mexico on Wednesday voted to allow recreational use of the drug — a vote that came hours after New York’s governor signed a bill legalizing marijuana.

"New Mexico’s Cannabis Regulation Act will eliminate criminal penalties for possession and use of marijuana for adults over 21 years old beginning in 2022 and create a framework for licensing sellers and taxing drug sales at up to 20 percent.

...

"The move sets up New Mexico to join 15 other states that have fully decriminalized the drug and came on the same day that Virginia Gov. Ralph Northam (D) asked state legislators to speed up his state’s legalization to allow adults to start using the drug as early as July.

...

"Despite widespread changes on the state level, marijuana remains illegal under federal laws. The discrepancy causes obstacles for the cannabis industry, which has been locked out of traditional banking arrangements and interstate commerce. Even in states where cannabis use is legal, some government employees have been told not to use the drug or face termination."

Reforming organ transplant regulation: create an Office of Organ Policy (Roth and Segal in STAT)

 Here's an opinion piece published yesterday in STAT, which applauds some recent changes in transplant regulations, and suggests some more, including bringing the regulators under one roof, the better to see the many different moving parts that are now regulated separately.

Reforming and improving organ transplant systems will save lives, taxpayer dollars, By Alvin E. Roth and Greg Segal   April 2, 2021

"All of this work raises an even more important question: What is wrong with the U.S. policymaking approach to organ donation that it took decades to enact such commonsense, bipartisan, and popular policies?

"We believe the problem has largely been a fracturing of governmental responsibilities, leading to siloed thinking and lack of clear responsibility to develop good policy. Because no single person or agency in government has ownership of the organ donation process, the buck is continually passed, to the detriment of patients and taxpayers.

"The Biden-Harris administration has a chance to fix this, and should heed calls to create a dedicated Office of Organ Policy. Such an office could execute a unified vision that puts patients first, rather than falling victim to a bureaucracy that lets problems go unsolved for decades."

Sixth Marketplace Innovation Workshop (MIW) , May 24-27, 2021 (Abstract submission deadline this Sunday)

 Here's a conference announcement and looming submission deadline:

Sixth Marketplace Innovation Workshop (MIW)

The conference will be virtual, May 24-27, 2021

Abstract submission deadline: April 4, 2021 (11:59pm EST)

Organizers

Itai Ashlagi, Management Science and Engineering, Stanford University

Omar Besbes, Columbia Business School, Columbia University

Nicole Immorlica, Microsoft Research

Gabriel Weintraub, Graduate School of Business, Stanford University

Fanyin Zheng, Columbia Business School, Columbia University

Description: Markets are an ancient institution for matching the supply for a good or service with its demand. Physical markets were typically slow to evolve, with simple institutions governing trade, and trading partners generally facing a daunting challenge in finding the “right” partner. The information technology revolution, however, has generated a sea of change in how markets function: now, markets are typically complex platforms, with a range of mechanisms involved in facilitating matches among participants. Recent trends point to an unprecedented level of control over the design, implementation, and operation of markets: more than ever before, we are able to engineer the platforms governing transactions among market participants. As a consequence, market operators or platforms can control a host of variables such as pricing, liquidity, visibility, information revelation, terms of trade, and transaction fees. On its part, given these variables, market participants often face complex problems when optimizing their own decisions. In the supply side such decisions may include the assortment of products to offer and their price structure, while in the demand side they may include how much to bid for different goods and what feedback to offer about past purchasing experiences. The decisions made by the platform and the market participants interact, sometimes in intricate and subtle ways, to determine market outcomes.

In this workshop we seek work that improves our understanding of these markets, both from the perspective of the market operator and the market participants. With respect to the former we are particularly interested in work that derives useful insights on how to design these markets, taking into account their operational details and engineering and technological constraints. With respect to the market participants, we seek for work that introduces novel approaches to optimize their decisions and improves our understanding of their interactions within the market. We look for a mix of approaches including modeling, theoretical, and empirical, using a wide range of tools drawn from operations management, game theory, auctions and mechanism design, optimization, stochastic modeling, revenue management, econometrics, or statistics.

The list of markets to be studied includes but it is not restricted to:

Online marketplaces, such as eBay, Etsy, etc.

Internet advertising, including sponsored search and display ad exchanges

Sharing economy markets, such as Uber/Lyft, AirBnb, etc.

Online labor markets, such as Amazon mTurk, Upwork, etc.

Procurement markets, such as technology-enabled government procurement

Health care exchanges

Financial exchanges

Plenary speakers

The workshop will have several invited distinguished plenary speakers from academia and industry, including:

Hunt Allcott, Microsoft Research

Sinan Aral, MIT

Nikhil Devanur, Amazon

Ramesh Johari, Stanford University

Ilan Lobel, New York University

Vahideh Manshadi, Yale University

Daniela Saban, Stanford University

Catherine Tucker, MIT

Workshop format

The workshop will be virtual and will run every day from 11am EST to 2pm EST from May 24 to May 27, 2021. There will a mix of plenary speakers and contributed talks.

Submissions

Submissions are now open here. Submissions should consist of 1-page extended abstracts. The submission deadline is April 4, 2021 (11:59pm EST time).

Headlines that could have appeared April 1

 You can't make these things up:

Murderer who tackled London Bridge attacker with narwhal tusk pardoned

Wild Mountain Thyme trailer blamed for Irish accent

A Chinese County Aims to Curb Dog Walking by Threatening to Kill the Dog

Denmark launches children's TV show about man with giant penis

Thieves pelt French police with Burgundy wine in motorway chase

Dutch officials seize ham sandwiches from British drivers

US Renal Data System 2020 Annual Data Report

 Here's the USRDS Annual Data Report for 2020. Volume 2 concerns End Stage Renal Disease (ESRD)

Incidence, Prevalence, Patient Characteristics, and Treatment Modalities

"Across the 18 ESRD Networks, adjusted incidence of ESRD in 2018 ranged from 284.6 cases per million in Network 1 (New England) to 434.6 cases per million in Network 14 (Texas) (Table 1.2).

"The adjusted incidence of ESRD among Blacks fell 1.7% between 2017 and 2018. The ratio of adjusted incidence in Blacks versus Whites was 2.7, the lowest value since at least 1980 (Figure 1.4).

"The adjusted prevalence of ESRD increased to a new high of 2,242 cases per million people in 2018 (Figure 1.5).

"At the end of 2018, there were 554,038 (70.7%) patients undergoing dialysis and 229,887 (29.3%) patients with a functioning kidney transplant (Figure 1.6).

Transplantation

"In 2018, the cumulative number of kidney transplants reached an all-time high of 22,393, an increase of 6.5% since 2017 (Figure 6.9). However, the kidney transplant rate among ESRD patients increased only slightly between 2017 and 2018, from 3.5 to 3.6 transplants per 100 patient-years.

"In 2018, the number of patients with ESRD who were newly added to the kidney transplant waiting list hit an all-time high of 26,726 patients (Figure 6.1).

"The total number of individuals with ESRD on the kidney transplant waiting list hit an all-time high in 2014 (Figure 6.2). Since that time, it has decreased, but the decrease has been predominantly among those with inactive status, with only a small decline in those on the waiting list with active status.

...

"The percentage of prevalent ESRD patients who received dialysis and were on the waiting list for a kidney transplant reached 13.5% at the end of 2018 (Figure 6.4), continuing a decrease that began in 2013

...

"Adjusted 1-year graft survival among deceased donor transplant recipients in 2017 improved to 93.0%, and adjusted 1-year graft survival among living donor transplant recipients in 2017 was 96.9% (Figure 6.16)."

Postmortems on the Texas electricity market failure

 The weather related failures of the Texas electricity market have prompted a number of fairly rapid postmortems (if that's the right word for a market that has since been restored to working order for normal circumstances).

Perhaps the most authoritative of these is by Peter Cramton, the veteran market designer who was vice chair and an independent director of the Electrical Reliability Council of Texas (ERCOT) board before resigning on February 24, 2021, at the request of Governor Abbott, along with the other non-Texan directors. 

Last Monday he posted a paper with his views on what happened and what improvements deserve consideration. A summary of the paper appeared in Utility Dive on Tuesday. The long piece covers more ground; the short article hits the highlights.

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

Here's  a Q&A at the Yale School of Management, which goes intro some of the history of the market:

Why the Texas Power Market Failed, Q&A with Ed Hirs 

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

Here's an op-ed from the Dallas Morning News, asking why the emergency prices weren't ended as soon as adequate supply was restored:

Why didn’t ERCOT put a stop to the massive electricity price spikes during the outages? Rather than allow power markets to return to normal, regulators kept prices at emergency level.  By Rob Snyder

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

And these two posts, with different perspectives by different commentators, the first by a sociologist and the second by a geographer and a political scientist, appear on the University of Chicago's Stigler Center blog Promarket:

The Texas Blackouts and the Problems of Electricity Market Design  BY GEORG RILINGER, March 24, 2021

and

The Texas Power Failure: How One Market Model Discovered Its Natural Limits  BY EVE VOGEL, STEVEN K. VOGEL March 25, 2021

The market for radiation oncologists

 Dr. Wes Talcott at Yale points me to some contemporary discussion of the labor force in radiation oncology.  As with a number of other medical specialties, there's a tension between the number of staff needed to prep a patient for treatment and the number of new board certified specialists needed to supervise such treatment. Residents fill the first kind of position, and time and training transforms them into the second.

The contemporary discussion seems to focus on proposals that individual residency programs should reduce the number of residency positions they need to fill, in a decentralized manner, either by offering fewer positions in the Match, or declining to fill positions that aren't filled in the main Match. There is a concern that a coordinated reduction in positions would invite antitrust scrutiny, although other specialties (such as gastroenterology*) have managed that.

Here's an article from the International Journal of Radiation Oncology*Biology*Physics:

Chicken Little or Goose-is-Cooked? The State of the US Radiation Oncology Workforce: Workforce Concerns in US Radiation Oncology by Chirag Shah, MD and Trevor J. Royce, MD, MS, MPH, Published:March 11, 2021 DOI: https://doi.org/10.1016/j.ijrobp.2020.11.056  

"oversupply worries have reached a fever pitch among trainees, with the job market being the primary concern and 52% perceiving an increasingly competitive market10; these concerns have manifested in a precipitous decline in student interest, with 14% of RO residency positions unmatched in the 2020 Match (compared with previous rates of near 0%) and worse numbers expected for the 2021 match."

#####################

Here's a reply, suggesting that the current situation presents an opportunity for the RO profession to remake itself in various ways:

When in a Hole, Stop Digging: In Reply, Workforce Concerns in US Radiation Oncology  Louis Potters, MD, FASTRO, FACR,  Published:March 11, 2021, International Journal of Radiation Oncology*Biology*Physics, DOI: https://doi.org/10.1016/j.ijrobp.2020.12.024

#####################

A different kind of reply is that fewer U.S. medical graduates are applying for RO residency positions in the Match:

No Longer a Match: Trends in Radiation Oncology National Resident Matching Program (NRMP) Data from 2010-2020 and Comparison Across Specialties  by Chelain R.GoodmanM.D., Ph.D.aAustinSimM.D., J.D.hElizabeth B.JeansM.Ed, M.D.dJustin D.AndersonM.D.bSarahDooleyM.D.cAnkitAgarwalM.D., M.B.A.gKarenTyeM.D., M.S.eAshleyAlbertM.D.fErin F.GillespieM.D.iRahul D.TendulkarM.D.kClifton D.FullerM.D., Ph.D.aBrian D.KavanaghM.D.jShauna R.CampbellD.O. Available online 11 March 2021,In Press, Journal Pre-proof International Journal of Radiation Oncology*Biology*Physics https://doi.org/10.1016/j.ijrobp.2021.03.006

"In the 2020 NRMP, 122 US MD senior graduates preferentially ranked radiation oncology, a significant decrease from 2010-2019 (Median [Interquartile Range],187 [170-192], p<0.001). Across all specialties, radiation oncology experienced the greatest declines in the 2020 NRMP cycle relative to 2010-2019 in both the number of ERAS applicants from the US and Canada (-31%) as well as the percentage of positions filled by US MD or DO senior graduates (-28%). Of 189 available positions, 65% (n=122) were filled by US MD senior graduates who preferentially ranked radiation oncology as their top choice of specialty, a significant decrease from 2010-2019 (Median=92% [IQR, 88-94%], p=0.002). The percentage of radiation oncology programs and positions unfilled prior to the SOAP was significantly increased in 2020 compared to 2010-2019 (Programs: 29% versus 8% [5-8%], p<0.001; Positions: 19% versus 4% [2-4%], p<0.001). Despite >99% (n=127 of 128) of US senior applicants successfully matching in the 2020 NRMP, 16 of 24 remaining unfilled positions were filled via the SOAP. Radiation oncology was the top utilizer of the 2020 SOAP, filling 15% of total positions versus a median of 0.9% [0.3-2.3%] across all specialties (p<0.001).

Conclusions

Supply of radiation oncology residency positions now far exceeds demand by graduating US medical students. Efforts to nullify a market correction revealed by medical student behavior via continued reliance on the SOAP to fill historical levels of training positions may not be in the best of interest of trainees, individual programs, or the specialty as a whole."

##################

*The reduction in gastroenterology residency positions was combined with an increase of a year in required training, and this combination contributed to the unraveling of the gastro Match, which has since been restored. See the background discussion in

McKinney, C. Nicholas, Niederle, Muriel and Alvin E. Roth, "The collapse of a medical labor clearinghouse (and why such failures are rare)," American Economic Review, 95, 3, June, 2005, 878-889.

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

Update: here's a discussion of the RadOnc situation by the Rad Onc Virtual Visiting Professor Network

Discovering Auctions: Contributions of Paul Milgrom and Robert Wilson by Teytelboym, Li, Kominars, Akbarpour and Dworczak

 Here's a celebratory account of the Nobel winning work of Milgrom and Wilson. The authors have used the new AEA symbol for random ordering of authors, which I can't reproduce here (it's an r in a circle..)

Discovering Auctions: Contributions of Paul Milgrom and Robert Wilson

by (in random order) Alexander Teytelboym  Shengwu Li  Scott Duke Kominers Mohammad Akbarpour Piotr Dworczak,  March 13, 2021

Abstract: The 2020 Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel was awarded to Paul R. Milgrom and Robert B. Wilson for “improvements to auction theory and inventions of new auction formats.” In this survey article, we review the contributions of the laureates, emphasizing the subtle interplay between deep theoretical questions and practical design challenges that resulted in one of the most successful fields of economics.

Kim Krawiec to UVA

 Controversial markets are coming to Virginia:

Here's the announcement from the U. of Virginia:

Kimberly Krawiec, Expert in Controversial Markets, To Join Faculty

"Kimberly D. Krawiec, a leading expert in market regulation, will join the University of Virginia School of Law faculty in the fall.

...

“Kim is a major contemporary voice on misconduct and trade within forbidden or contested markets,” Dean Risa Goluboff said in welcoming Krawiec to the faculty.

...

"Krawiec, who visited at UVA Law in 2004, has taught both large lecture classes and smaller ones, including her recent favorites Taboo Trades and Forbidden Markets, and Advanced Contracts. “Taboo Trades” is also the name of the podcast she launched in August, which so far has covered topics ranging from marijuana legalization to blood and other “repugnant transactions.”

Ethical payment for research participation

 Discussions of ethical questions turn out to have less math or data than other discussions, but more, well, discussion...  Here's our reply to issues raised in the prior discussion in the preceding issues of the American Journal of Bioethics.

Holly Fernandez Lynch, Thomas C. Darton, Jae Levy, Frank McCormick, Ubaka Ogbogu, Ruth O. Payne, Alvin E. Roth, Akilah Jefferson Shah, Thomas Smiley & Emily A. Largent (2021) Plumbing the Depths of Ethical Payment for Research Participation, The American Journal of Bioethics, DOI: 10.1080/15265161.2021.1895364

"In closing, we’ll respond to Savulescu’s lamentation that our article did not offer “a full economic evaluation of a proposed HIC study such as the UK, with a proposal for a specific amount” (2021). Although we understand this criticism, and considered it ourselves, we were hesitant to make this final move, as there are several different amounts and rationales that could be ethically justified under our framework. Nonetheless, analyzing a particular protocol and the range of payment offers that might be justifiable would be a compelling next step."

Debating deaccessioning

 The museum world is divided about deaccessioning--i.e. selling art to finance things other than the purchase of more art, such as museum operations.

The NY Times has the story:

Selling Art to Pay the Bills Divides the Nation’s Museum Directors. Bitter debate has ensued as museum leaders around the country discuss whether to permanently embrace a pandemic-spurred policy that allows the sale of art to cover some operating costs.  By Robin Pogrebin and Zachary Small

"It started as a stopgap measure to respond to the pandemic, a temporary two-year loosening of an Association of Art Museum Directors’ policy that has long prohibited American institutions from selling art from their collections to help pay the bills.

"But more and more museums are taking advantage of the policy and the association began discussing making it permanent, an idea that, depending on which institution you talk to, either makes perfect sense or undermines the very rationale for their existence.

...

"The longstanding policy — enforced by the museum director’s association and widely embraced by its members — has been that the art owned by institutions was held for the public benefit and, as such, should be mostly retained.

"Some items could be sold — known as deaccessioning — but they were supposed to be artworks that were duplicative or no longer in line with the museum’s mission, and the proceeds were to be dedicated to the acquisition of other art, not to underwriting staff salaries or other operating costs.

...

"The stark differences of opinion among museum leaders were evident last week when the association convened two unusual, mandatory sessions to gather feedback from members about the rules for such sales.

...

"It’s difficult to say what would happen if the association pushed through a policy that was unpopular with half of its membership since issues that have divided museum directors at this level have been rare.

"Many have already lined up on either side of the debate. Campbell, who is now the director and chief executive of the Fine Arts Museums of San Francisco, in an Instagram post warned that “Deaccessioning will be like crack cocaine to the addict — a rapid hit, that becomes a dependency.”

...

"Nonetheless, more than 25,000 people have signed a petition urging the Met to reconsider. “We call on the Met’s board to do the job they signed up for: to give, to support the institution,” says the petition, started by the art critic Tyler Green. “We call upon the Met’s senior staff leadership to resist any attempts to sell off the art the Met holds in the public trust.”

"Some museum leaders worry that donors will be less likely to contribute art if they fear it would be sold, or that formerly generous trustees, seeing the cash available from art sales, may become less likely to donate money."

Negotiating climate change, by Schmidt and Ockenfels in PNAS

 Now that there's light at the end of the Covid tunnel, we can turn our attention back to big problems:

Focusing climate negotiations on a uniform common commitment can promote cooperation  by Klaus M. Schmidt and  Axel Ockenfels, PNAS March 16, 2021 118 (11) e2013070118; https://doi.org/10.1073/pnas.2013070118

Edited by Lise Vesterlund, University of Pittsburgh, and accepted by Editorial Board Member Paul R. Milgrom

Abstract: International cooperation on the reduction of greenhouse gas emissions, disarmament, or free trade needs to be negotiated. The success of such negotiations depends on how they are designed. In the context of international climate change policy, it has been proposed [e.g., M. L. Weitzman J. Assoc. Environ. Resour. Econ. 1, 29–49 (2014)] that shifting the negotiation focus to a uniform common commitment (such as a uniform minimum carbon price) would lead to more ambitious cooperation. Yet, a proof-of-concept for this important claim is lacking. Based on game theoretical analyses, we present experimental evidence that strongly supports this conjecture. In our study, human subjects negotiate contributions to a public good. Subjects differ in their benefits and costs of cooperation. Participation in the negotiations and all commitments are voluntary. We consider treatments in which agreements are enforceable, and treatments in which they have to be self-enforcing. In both situations, negotiating a uniform common commitment is more successful in promoting cooperation than negotiating individual commitments (as in the Paris Agreement) and complex common commitments that tailor the commitment to the specific situation of each party (as attempted with the Kyoto Protocol). Furthermore, as suggested by our model, a uniform common commitment benefits most from being enforced.

College admissions, exam optional

 The WSJ has a report focusing on post-covid, exam optional college admissions:

College Admission Season Is Crazier Than Ever. That Could Change Who Gets In.  By waiving SATs and ACTs, highly selective schools invited an unprecedented wave of applications, upending the traditional decision process.  By Melissa Korn and Douglas Belkin

"Ivy League schools and a host of other highly selective institutions waived SAT and ACT requirements for the class of 2025, resulting in an unprecedented flood of applications and what may prove the most chaotic selection experiment in American higher education since the end of World War II.

...

"Harvard University received more than 57,000 freshman applications for next fall’s entering class, a 42% year-over-year jump. Yale, Columbia and Stanford universities were so overwhelmed they also pushed back the date to announce admission decisions. The University of Southern California’s applications pool beat the prior record by 7%. And New York University topped 100,000 applications, up 17% from last year.

...

"Testing isn’t the only conundrum admissions officials are confronting. Grade-point averages—normally a key data point—were complicated by last year’s spring semester, when many high schools offered pass-fail options to students who were suddenly finishing junior year online. Sports and other extracurricular activities were canceled in pockets of the country, stripping teens of leadership opportunities to boast about on applications.

"Still, tests are the biggest single X-factor this year. Test administrations for the SAT and ACT across much of the country were canceled because of public-health concerns about crowding teens into auditoriums. More than 1,600 four-year colleges didn’t require that applicants submit standardized test scores this admissions cycle, since so many students couldn’t take the exams as scheduled. The movement behind test-optional policies had gained some high-profile backers over the past decade, but the trickle turned to a tsunami when 600 more joined the roster since last March.

...

"With the gates to many more selective schools no longer guarded by standardized tests, tens of thousands of additional students applied. In a year when nothing was certain, anything seemed possible—so what the heck, seniors thought, why not apply to Harvard?

...

"Data from the Common App, a standard application used by more than 900 schools, show that applications through March 1 were up 11% nationwide. But the number of applicants rose by just 2.4%, meaning roughly the same number of students are just sending out more applications. The flurry of applications was concentrated at more selective colleges."

Elite public schools move away from exams

 Covid cancelled exams for many exam schools: will they stay exam free in the future?  Several cities are moving in that direction.

Here's NBC, on Boston Latin:

A golden ticket: Efforts to diversify Boston's elite high schools spur hope and outrage. Exam schools loom large as symbols of opportunity and inequality in American public schools. Now, the nation's twin crises are shaking them to their core.  By Melissa Bailey, The Hechinger Report

Here's SF Chronicle on Lowell High School:

S.F. school board strips Lowell High of its merit-based admissions system  by Jill Tucker

"the San Francisco Board of Education voted 5-2 to use the same lottery-based system to assign students to Lowell High as other district high schools instead of maintaining the previous system that used test scores and grades."

Here's the NY Times on gifted programs for the youngest children:

N.Y.C. schools will replace the gifted and talented admissions exam with a lottery this year. By Eliza Shapiro

Same sex marriage in Japan takes a step forward

In The U.S., court decisions paved the way for same sex marriage.  Now there's a court decision in Japan. The NY Times has the story:

Landmark Ruling Cracks Door Open for Same-Sex Marriage in Japan. A court found that it was unconstitutional for the country not to recognize the unions. But change would come only if Parliament passes legislation. By Ben Dooley and Hisako Ueno

"A Japanese court on Wednesday ruled that the country’s failure to recognize same-sex marriages was unconstitutional, a landmark decision that could be an important step toward legalizing the unions across the nation.

"The ruling, handed down by a district court in the northern city of Sapporo, came in a civil suit against the Japanese government by three same-sex couples. 

...

"The ruling will not, however, change the law. Same-sex marriages will be recognized in Japan only if Parliament enacts legislation, Mr. Dmitrenko said. Lawmakers have repeatedly declined to take up such a bill.

"Still, activists saw the court’s decision as an important step in tearing down barriers to normalizing gay marriage in Japan, the only country in the Group of 7 nations that has not legalized same-sex unions.

"The unions are not explicitly banned in Japan, but they are not recognized by the national government or most localities. In recent years, some local governments have moved to provide gay couples with certificates acknowledging their marriage, but the documents have little legal or practical value.

"National authorities have long argued that their position is supported by a provision in the country’s constitution that stipulates marriage can occur only with the consent of both sexes, a provision that was intended to stop Japan’s once common practice of arranged marriages."

Match Day 2021 for medical residents

 Yesterday was Match Day, during Covid Year, and the aggregate data are reassuring that virtual (instead of in-person) interviews left the Match, in aggregate, much as before. The NRMP reports on match results, and Thalamus reports on interviews among the largest specialties.

Here's the NRMP press release:

Press Release: NRMP Delivers Strong Residency Match During Uncertain Times

"The 2021 Main Residency Match was the largest in NRMP history. There were 38,106 total positions offered, the most ever, and 35,194 first-year (PGY-1) positions offered, an increase of 928 (2.7%) over 2020. The growth in positions was supported by continued growth in the number of Match-participating programs. A record-high 5,915 programs were part of the Match, 88 more than 2020. In five years, the number of Match-participating programs has increased by 845 (16.7%), spurred in part by the completion of the transition to the single accreditation system for allopathic and osteopathic programs.

"Rather than faltering in these uncertain times, program fill rates increased across the board. Of the 38,106 total positions available, 36,179 filled, representing a 2.6 percent increase of filled positions over 2020. Of the 35,194 first-year positions available, 33,535 filled, representing a 2.9 percent increase of first-year filled positions. Those fill rates drove the percent of all positions filled from 94.6 to 94.9 percent and the percent of PGY-1 positions filled from 94.6 to 94.8 percent in 2021. There were 1,927 unfilled positions after the matching algorithm was processed, a decline of 71 (3.6%) compared to 2020.

...

"Percent of Applicants Matched to PGY-1 Positions Declines Slightly for Seniors; Rates Remain High. With all applicant groups demonstrating increases in the number of applicants submitting rank ordered lists of programs and ultimately matching to first-year PGY-1 positions, the overall percent matched declined modestly for some groups. Specifically, the percent of U.S. MD seniors matched to PGY-1 positions declined from 93.7 to 92.8, and the percent of U.S. DO seniors matched to PGY-1 positions declined from 90.7 to 89.1 percent. Non-U.S. citizen IMGs saw the largest decline, from 61.1 percent in 2020 to 54.8 percent in 2021. The unavailability of medical licensure examinations in the early stages of the pandemic coupled with permanent changes to the scoring and administration of those examinations by the end of 2020 created significant challenges for IMGs this year and likely contributed to the decline. Additionally, changes in clinical rotations may have affected match rates. The overall percent of applicants matched to PGY-1 positions declined from 80.8 to 78.5 percent."

***********

And here's a post from Thalamus, the interview managing service whose motto is "connecting the docs."

Explaining COVID’s Impact on the 2020-2021 Virtual Recruitment Season and NRMP Match Outcomes  March 19, 2021 by Team Thalamus

Here are their concluding remarks:

"1. The number of interview invitations stayed the same.

"2. The number of interviews completed by both applicants and programs went up. 

"3. The rate of interview cancellations decreased. 

"4. And while the candidates receiving the top 20% of interview offers completed more interviews than other candidates, overall applicants and programs both completed more interviews, thereby lengthening rank lists and providing each greater opportunity to match.

"While the slight decrease in match rates is due to a disproportionally larger number of applicants entering the match in comparison to the growth rates of the number of available residency positions, more candidates matched than ever before, because significantly more unique applicants received opportunities to interview.

"And therefore, overall, the match rate held steady as it has had in recent years, driven by its Nobel Prize winning application of the stable marriage algorithm.  

"Of course, there are several factors at play here including where applicants and programs enter preferences of where or whom they would like to match, respectively.  Similarly, given visa restrictions "IMGs were particularly disadvantaged this year more than usual, which lead to their larger resultant drop in their match rate.  There are continued challenges here including increasing the number of positions of available training positions to match a continued acceleration and growth of the applicant pool, and data can help expand upon this work. "

"Overall, the challenges of over-interviewing in GME was not greatly affected by the virtual interview process, and the greatly hypothesized “match crisis” appears to have been avoided.  Yet, this process shed significantly light on a continued systemic problem: Due to a lack of transparency, applicants continue to overapply, and residency programs continue to over-interview, creating a costly and anxiety-ridden process for all.  Data and technology can help change this for the future as COVID leaves its recognizable mark on the medical residency recruitment and match process."