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

NY Times debate: Is Prostitution Safer when It's Legal?

and

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

Thursday, November 9, 2017

Legal prostitution and crime in the Netherlands

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

Ethnic dating sites

and

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

Saturday, February 21, 2009

Markets for adult entertainments

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

Censoring repugnant words by algorithm

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.

Monday, June 27, 2022

A Forum on Kidneys for Sale in Iran, in Transplant International

******* 

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:

Sunday, January 1, 2023

New York State's Living Donor Support Act (LDSA, S. 1594) was signed by Governor Hochul on Dec. 29

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."

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

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.

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.

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."

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...

Read More

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...

Read More

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...

Read More

Note: 

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 

• Baswana, S, P Chakrabarti, S Chandran, Y Kanoria and U Patange (2019), ‘Joint Seat Allocation 2018: An algorithmic perspective’, arXiv Technical Report.
• Roth, AE (2007), ‘The Art of Designing Markets’, Harvard Business Review, October.

Surrogacy around the world and across international boundaries

Here's a wide ranging survey of the literature on surrogacy practice around the world.

Brandão, Pedro, and Nicolás Garrido. "Commercial Surrogacy: An Overview." Revista Brasileira de Ginecologia e Obstetrícia/RBGO Gynecology and Obstetrics 44, no. 12 (2022): 1141-1158.

Abstract: "Objective Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide.

"Methods This is a review of the literature published in the 21st century on commercial surrogacy.

"Results A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers.

"Conclusion Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated."

Here's the beginning of the section on "transnational" surrogacy:

"The denial of surrogacy in most countries, for all or for some (such as single people or same-sex couples), its cost or the lack of available carriers led to an important transnational search for these (and other) reproductive treatments.[155] [156] This phenomena has been called reproductive, procreative or fertility tourism, transnational reproduction or cross border reproductive care.[157] [158] [159] [160] [161] [162] In European countries alone and concerning any kind of ART, in 2010, a total of 24,000 to 30,000 cycles of cross border fertility treatment within the continent were estimated each year, involving 11,000 to 14,000 patients.[163] Transnational surrogacy is one of the fastest-growing cross-border reproductive treatments.[164] Choosing where to perform the surrogacy treatment usually entails finding the right equilibrium between legal guarantees and costs.[165] Due to the variety of legislations, costs and availability of donors and carriers between countries, patients may search for other countries to do the entire process of surrogacy, or different phases of the surrogate treatment in more than one country.[158] As an example, a male couple may get their donated oocytes from South Africa, where there are many donors available, do the IVF, recruit the surrogate and embryo transfer in Georgia (Sakartvelo), due to attractive prices, and fly the gestational carrier to the USA to deliver the baby, where children may be registered by both parents.[166] [167]" 

Kidney Transplantation Across International Boundaries

 When global kidney exchange was first proposed it met with some hysterical reactions, equating it to organ trafficking.  It is good to see that being replaced by more sober, well informed discussion. Here's a recent paper on how data might be collected and shared.

The Role of Registries in Kidney Transplantation Across International Boundaries  by G. V. Ramesh Prasad, Manisha Sahay, and Jack Kit-Chung, Seminars in Nephrology, Available online 27 December  2022, https://doi.org/10.1016/j.semnephrol.2022.07.001 

Summary: Transplant professionals strive to improve domestic kidney transplantation rates safely, cost efficiently, and ethically, but to increase rates further may wish to allow their recipients and donors to traverse international boundaries. Travel for transplantation presents significant challenges to the practice of transplantation medicine and donor medicine, but can be enhanced if sustainable international registries develop to include low- and low-middle income countries. Robust data collection and sharing across registries, linking pretransplant information to post-transplant information, linking donor to recipient information, increasing living donor transplant activity through paired exchange, and ongoing reporting of results to permit flexibility and adaptability to changing clinical environments, will all serve to enhance kidney transplantation across international boundaries.

"Most KT activity occurs within a country's confines, but the increasing ease of worldwide travel and communication, and the ongoing organ shortage both motivate KT efforts across international boundaries.

...

"This review explores the specific role of patient-based registries in activating and viably maintaining KT activity across official international borders.

...

"Fewer than two thirds of countries have some form of a KT registry. With KT, however, unlike for many other therapies for which registries exist, there are two parties to consider; the donor and the recipient, and their two distinct phases of pre- and post-KT health.

...

"Transplant tourism remains a peril when promoting international transplantation. By contrast, an increasing number of international LDs now travel abroad to the home country of recipients for undergoing their donor nephrectomy.75 This travel for transplantation differs from transplant tourism by referring to the movement of organs, donors, recipients, or transplant professionals across jurisdictional borders in the absence of organ trafficking. Travel for transplantation may be increased through registries.

...

"The third and arguably most important pillar of increasing international transplant activity is to increase LD transplant activity. International comparisons based on donor source readily illustrate the varied relative proportion of DD and LD transplants worldwide.4 Large developed countries such as Canada, the United States, and Australia have developed registries to share LD organs across vast distances,80 with the goal to benefit highly sensitized recipients who have a medically suitable but immunologically incompatible LD, but at the same time maximizing the total number of KT procedures performed. Paired exchange programs and domino transplant chains81 triggered by altruistic nondirected donors best illustrate these accomplishments. Complicated computer algorithms are used to accomplish these two goals. It is important to remember, however, that organs such as kidneys are not to be treated merely as physical objects external to the human body.82 Organ donors are being paired, not organs. International LD transplants are best implemented through a paired exchange,83 as long as strict oversight policies have already been developed to respect human dignity, minimize financial burden, and ensure adequate follow-up care. Involving LICs and LMICs in paired exchange can reduce international access inequities immediately by overcoming both biological and economic imperfections. Linked registries will also permit the expansion of clinical expertise and ensure that donors and recipients are selected appropriately. Linked registries will facilitate regular follow-up evaluation and data sharing. Challenges to international LD transplantation that are best addressed through paired exchange programs include sharing hospital and travel costs, providing health insurance, respecting social and cultural norms, and ensuring administrative oversight including a mechanism for dispute resolution. The close administrative oversight provided by a paired exchange registry serves to ensure LD safety, which becomes especially pertinent when the donor belongs to a less developed country. Travel for transplantation can be encouraged, while morally burdensome transplant tourism and incentivized donation84 can be defeated. For all this to occur, however, an international registry must be much more than simply a clearinghouse for organs."

Cross-border transplantation between China and Hong Kong

 Here are two recent reports of the first cross-border transplant between China proper and Hong Kong.

From the Global Times:

First organ donation between mainland and HK saves 4-month old baby By Wan Hengyi

"A medical team of the Hong Kong Children's Hospital successfully transplanted a heart donated from the mainland to a 4-month-old baby in Hong Kong Special Administrative Region on Saturday, achieving a historic breakthrough in the sharing of human organs for emergency medical assistance between the two places for the first time.

"The donated heart, which had been matched by China's Organ Transplant Response System (COTRS) through several rounds and had no suitable recipient, was successfully matched in Hong Kong through the joint efforts between 24 departments and 65 medical experts in the mainland and Hong Kong.

"Cleo Lai Tsz-hei, the recipient of the transplant from Hong Kong, was diagnosed with heart failure 41 days after birth and was in critical condition. Receiving a heart transplant was the only way to keep her alive, according to media reports.

"Moreover, the acceptable heart donation for Cleo requires a donor weighing between 4.5 kilograms and 13 kilograms, and the chances of a suitable donor appearing in Hong Kong are slim to none.

...

"COTRS initiated the allocation of a donated heart of a child with brain death due to brain trauma in the mainland on December 15. As a very low-weight donor, no suitable recipients were found after multiple rounds of automatic matching with 1,153 patients on a national waiting list for heart transplants in the COTRS system. In the end, the medical assistance human organ-sharing plan between the Chinese mainland and Hong Kong was launched.

"Some netizens from the Chinese mainland asked why a baby from Hong Kong who has not lined up in the COTRS system can get a donated heart when there is a huge shortage of donated organs in the mainland.

"In response, the organ coordinator told the Global Times that the requirements for organ donation are extremely high, noting that all the prerequisites including the conditions of the donor and recipient, the time for the organ to be transported on the road and the preparation for surgery must reach the standards before the donation can be completed.

"The COTRS system has already gone through several rounds of matching, which is done automatically by computer without human intervention, said the organ coordinator. 

"Medical teams from both jurisdictions, as well as customs officers in Shenzhen and Hong Kong, carried out emergency drills to reduce the customs clearance time to eight minutes, racing against the four-hour limit for preserving donated hearts, said Wang Haibo, head of the COTRS for medical assistance contact between the mainland and Hong Kong.

"The collection of donated hearts began at 17:00 pm on Friday, and the hearts were delivered to the Hong Kong Children's Hospital at 20:00 pm under the escort of Hong Kong police on the same day. At 1:00 am on Saturday, Cleo's heart transplant operation in Hong Kong was successfully completed, and she has not required extracorporeal circulation support at present."

********

And from the South China Morning Post:

Hong Kong could greatly benefit from cross-border organ imports mechanism, doctors say after local baby receives heart from mainland China  by Jess Ma

"Hong Kong could greatly benefit from cross-border organ donations given the city’s persistently low rate of residents willing to sign up to become donors, doctors have said after a local baby girl received a heart from mainland China in the first arrangement of its kind.

...

"Hong Kong’s organ donation rate is currently among the lowest in the world, at 3.9 donors per a million people in 2019, down from 5.8 in 2015, according to research conducted by the Legislative Council.

...

"Medical lawmaker David Lam Tzit-yuen and election committee legislators Elizabeth Quat Pei-fan and Rebecca Chan Hoi-yan urged the government to begin discussions on legal frameworks and procedures for cross-border transplants, saying that the mainland had a robust donation system and that organ sharing between the city and the mainland was not unusual.

"Human rights groups and lawyers have accused the mainland of forcibly harvesting organs from executed prisoners, a practice that then health minister Huang Jiefu publicly acknowledged in 2005. The government announced in 2015 that organ donations would only come from “voluntary civilian organ donors,” but critics argued prisoners were not excluded under the system.

But Chan argued that the mainland’s efforts to improve the transparency and ethics of its organ donation system over the past decade should be acknowledged.

“I disagree that this would be the beginning of a slippery slope. The transparency of the mainland’s organ donation system has been a lot clearer and stricter,” Chan said, adding that a lot of work had been done across the border to prohibit organ harvesting and trading."

Non-compete clauses are anti-competitive: Lina Kahn (FTC chair) in the NYT

 An op-ed this morning by the chair of the FTC explains her opposition to non-compete clauses in labor contracts (which are already non-enforceable in California), following last week's proposed Non-Compete Clause Rulemaking

Lina Khan: Noncompetes Depress Wages and Kill Innovation,  by By Lina M. Khan (chair of the Federal Trade Commission) Jan. 9, 2023 

"Noncompetes were long assumed to apply mainly to high-level executives with access to sensitive corporate information. But their use has exploded in the past few decades, extending far beyond the boardroom. Today, experts estimate that one out of every five American workers, or about 30 million people, are bound by a noncompete. Studies and media reports have found noncompetes routinely invoked against fast-food workers, arborists and manual laborers, to name a few examples. Just this week, the Federal Trade Commission, where I am chair, settled allegations against a company in Michigan that prohibited its workers — security guards earning at or near the minimum wage — from going to work for a competitor within a 100-mile radius of their job location for two years. 

...

"over the past few decades, several states restricted the enforceability of noncompete clauses to various degrees, usually because of court decisions. This created natural experiments, allowing researchers to draw causal inferences about their impact.

"Their most staggering finding: Noncompete clauses systemically drive down wages, even for workers who aren’t bound by one. Every worker stuck in a job represents a position that isn’t opening up for someone else. And if employers know their workers can’t leave, they have less incentive to offer competitive pay and benefits, which puts downward pressure on wages for everyone.

...

"the evidence to date suggests that noncompetes suppress wages, reduce competition and keep innovative ideas from breaking into the market. One study even found that noncompetes lead to higher prices for consumers by reducing competition in the heavily concentrated health care sector.

"Noncompetes are the type of restriction that Section 5 of the F.T.C. Act, a federal law passed by Congress more than a century ago, is supposed to prevent. That’s why the F.T.C. last week proposed a rule forbidding companies to subject workers to noncompetes. Under the proposal, noncompetes would be designated an “unfair method of competition,” which the law prohibits. The rule would apply to professions across the board — janitors, nurses, engineers, journalists. Because employers often try to use noncompetes even when they’re unenforceable, the rule would require companies to proactively notify employees currently subject to noncompetes that those restrictions are now void.

"People might worry that eliminating noncompetes would make it impossible for companies to hold on to their secrets. But there is good reason to believe that more-targeted alternatives, such as nondisclosure agreements and trade secret law, would get the job done without imposing such a burden on the economy."

Moral certainties versus moral tradeoffs

 An article and a commentary in PNAS raise the possibility that  economists and psychologists and moral philosophers concerned with morally contested transactions may be able to engage in more useful discussions. A problem is that economists mostly think about tradeoffs while many moral philosophers (or at least those who write about medical ethics) often think of morality as involving absolutes. (This is clearly illustrated in discussions about repugnant transactions, such as those involving compensation of donors of blood plasma or kidneys, for example.)

The PNAS article is   

Guzmán, Ricardo Andrés, María Teresa Barbato, Daniel Sznycer, and Leda Cosmides. "A moral trade-off system produces intuitive judgments that are rational and coherent and strike a balance between conflicting moral values." Proceedings of the National Academy of Sciences 119, no. 42 (2022): e2214005119. https://doi.org/10.1073/pnas.2214005119

"Significance: Intuitions about right and wrong clash in moral dilemmas. We report evidence that dilemmas activate a moral trade-off system: a cognitive system that is well designed for making trade-offs between conflicting moral values. When asked which option for resolving a dilemma is morally right, many people made compromise judgments, which strike a balance between conflicting moral values by partially satisfying both. Furthermore, their moral judgments satisfied a demanding standard of rational choice: the Generalized Axiom of Revealed Preferences. Deliberative reasoning cannot explain these results, nor can a tug-of-war between emotion and reason. The results are the signature of a cognitive system that weighs competing moral considerations and chooses the solution that maximizes rightness.

"Abstract: How does the mind make moral judgments when the only way to satisfy one moral value is to neglect another? Moral dilemmas posed a recurrent adaptive problem for ancestral hominins, whose cooperative social life created multiple responsibilities to others. For many dilemmas, striking a balance between two conflicting values (a compromise judgment) would have promoted fitness better than neglecting one value to fully satisfy the other (an extreme judgment). We propose that natural selection favored the evolution of a cognitive system designed for making trade-offs between conflicting moral values. Its nonconscious computations respond to dilemmas by constructing “rightness functions”: temporary representations specific to the situation at hand. A rightness function represents, in compact form, an ordering of all the solutions that the mind can conceive of (whether feasible or not) in terms of moral rightness. An optimizing algorithm selects, among the feasible solutions, one with the highest level of rightness. The moral trade-off system hypothesis makes various novel predictions: People make compromise judgments, judgments respond to incentives, judgments respect the axioms of rational choice, and judgments respond coherently to morally relevant variables (such as willingness, fairness, and reciprocity). We successfully tested these predictions using a new trolley-like dilemma. This dilemma has two original features: It admits both extreme and compromise judgments, and it allows incentives—in this case, the human cost of saving lives—to be varied systematically. No other existing model predicts the experimental results, which contradict an influential dual-process model."

Here is their first example:

"Two countries, A and B, have been at war for years (you are not a citizen of either country). The war was initiated by the rulers of B, against the will of the civilian population. Recently, the military equilibrium has broken, and it is certain that A will win. The question is how, when, and at what cost.

"Country A has two strategies available: attacking the opposing army with conventional weapons and bombing the civilian population. They could use one, the other, or a combination of both. Bombing would demoralize country B: The more civilians are killed, the sooner B will surrender, and the fewer soldiers will die—about half from both sides, all forcibly drafted. Conventional fighting will minimize civilian casualties but maximize lives lost (all soldiers).

"More precisely: If country A chooses not to bomb country B, then 6 million soldiers will die, but almost no civilians. If 4 million civilians are sacrificed in the bombings, B will surrender immediately, and almost no soldiers will die. And, if A chooses an intermediate solution, for every four civilians sacrificed, approximately six fewer soldiers will die.

"How should country A end the war? What do you feel is morally right?"

**********

Here is the followup commentary:

Lieberman, Debra, and Steven Shenouda. "The superior explanatory power of models that admit trade-offs in moral judgment and decision-making." Proceedings of the National Academy of Sciences 119, no. 51 (2022): e2216447119.

"We make “moral” decisions each day (should I stay and help my graduate student with her thesis thereby delaying dinner for my children? And if I do stay, how long is acceptable until the trade-off tips in favor of my children—30 min? An hour? Longer?). There are costs associated with every act, and part of the human condition is that we seek to balance our duties to everyone in our social network.

"Moral judgments, as the above example illustrates, lead to intermediate, compromise solutions. For this reason, the value of moral dilemmas like the trolley problem that yield only binary outcomes is limited to the superficial exploration of normative theories within philosophy—not the underlying mental software driving moral cognition

...

"As a philosophical tool, the trolley problem playfully probes certain (limited) contours of moral decision-making. But, as a methodology imported from philosophy into cognitive science to illuminate moral cognition, the translation is impoverished because it yields only binary, extreme solutions and prevents moral trade-offs or compromise judgments. "

It's hard to enforce the ban on cannabis in Kansas

 Just as markets need social support, bans on markets need social support.  Even in Kansas, apparently, where marijuana remains completely outlawed. (Kansas borders on Colorado and Missouri, where (even) recreational use of marijuana is legal, and on Arkansas, and Oklahoma, where medical use is legal.)

The Guardian has the story:

A dying cancer patient used cannabis to ease pain. His hospital called the police. ‘You’d think they would have shown compassion’: patient’s son decries Kansas police who issued citation as father suffered.  by Lois Beckett

"Hospital staff in Kansas called the police on a man dying of cancer who was using cannabis products to cope with his symptoms, in an incident that has since sparked outrage and renewed calls to rethink the state’s strict cannabis laws.

"The encounter took place in mid-December, when police in the city of Hays say two officers showed up at the cancer patient’s hospital room to issue him a citation for a drug violation. 

...

"Because of the Christmas holiday, the city prosecutor had not seen the email about dismissing the charge until after the police interaction with the cancer patient had already become a viral news story, the police chief said. He said he personally let the patient know on 27 December that the police department was not pursuing the citation and that he would not have to appear in court.

"More than a hundred people have called or emailed the Hays police department, upset about news reports of officers’ interactions with the cancer patient, the chief said. "

Nicotine will be with us for a long time--survey of middle school use

 Sales of tobacco products to minors are generally illegal in the U.S., but a survey shows that doesn't stop children from smoking and vaping.  Here's a report from the Centers for Disease Control and Prevention, in JAMA

Tobacco Use Remains High in Middle and High Schools by Bridget M. Kuehn, MSJ

JAMA. 2022;328(24):2389-2390. doi:10.1001/jama.2022.20058

"Nearly 1 in 9 US middle and high school students reported tobacco product use in the past 30 days—most commonly e-cigarettes—according to a CDC and US Food and Drug Administration analysis of data from the 2022 National Youth Tobacco Survey (NYTS). The researchers estimated that approximately 3.08 million students in 6th to 12th grade currently use tobacco products.

...

"The data show that 16.5% of high school students and 4.5% of middle school students reported using a tobacco product in the past 30 days. About 14% of high school students and about 3% of middle school students used electronic cigarettes. Nearly 4% of all those surveyed reported using any combustible tobacco product.

"Several subgroups of students reported even higher rates of tobacco product use. About 16% of students who identified as lesbian, gay, bisexual, or transgender reported current use of these products. The 2022 NYTS survey was the first to provide data on tobacco product use among American Indian or Alaska Native, Asian, multiracial, or Native Hawaiian or other Pacific Islander youths. It found that American Indian or Alaska Native youth reported the highest rate of a tobacco product use of any racial or ethnic group, at 13.5%.

"The report also found a link between social determinants of health and tobacco product use. For example, students who had experienced severe psychological distress or were from less affluent households were more likely to report current tobacco product use. More than a quarter of students with low academic achievement reported current use. "

Sell a kidney to save a life? by Dylan Walsh, in WIRED.

 Martha Gershun alerts me to this story which appeared this morning in WIRED, in which the author, a kidney transplant recipient (24 years ago), considers the history of the long debate about whether kidney donors might be compensated, to end the shortage of life-saving kidney transplants.  It's very well written, and contains some details (e.g. dialog between Al Gore and Barry Jacobs) that I hadn't seen before.  It's well worth reading the whole thing.

Would You Sell One of Your Kidneys? Each year thousands die because there aren’t enough organs for transplants, and I may be one of them. It’s time to start compensating donors. by Dylan Walsh

Here's the first sentence:

"WHEN WE WERE teenagers, my brother and I received kidney transplants six days apart. "

Here's some history of transplantation itself:

"In 1963, the world’s preeminent kidney transplant surgeons met in DC to discuss the state of the field. They were few in number and dispirited. Roughly 300 operations had been performed by then, with only 10 percent of patients surviving more than six months, according to one account. The procedure remained no more than “highly experimental,” in the words of even its fiercest proponents. But the prevailing gloom lifted when two little-known surgeons from Denver, Thomas Starzl and Thomas Marchioro, presented results from a series of transplants they’d performed. They had managed to flip the outcomes: 10 percent failure, 90 percent success. A euphoric shock spread through the crowd, which quickly gave way to skepticism. The results were studied, confirmed, and eventually replicated. "

Here's a bit about the origins of the legal ban on compensating donors (the 1984 National Organ Transplant Act, or NOTA):

"In 1967, one study found that roughly 8,000 people were eligible for a kidney transplant; only 300 received one.

"IT TOOK ABOUT a decade for someone of enterprising disposition to step into this gap. H. Barry Jacobs was a Virginia doctor who lost his license to practice medicine in 1977 for attempting to defraud Medicare. He spent 10 months in jail and shortly after his release turned his energies to the unregulated business of organ brokering. His company, International Kidney Exchange Ltd., was built around the fact that most of us are born with two kidneys but can function with one. If one kidney is removed, the other grows larger and works harder, filtering more blood to cover as best it can for its emigrant twin. This redundancy supported Jacobs’ straightforward business model. He would connect people who wanted to sell one of their kidneys, for a price of their choosing, with people who needed one. As a mi"ddleman, Jacobs would charge a brokerage fee to the recipients.

"At the time, Al Gore, then a member of the US House of Representatives, was developing the National Organ Transplant Act, which centered on establishing a repository to match organ donors with those in need of a transplant. Upon hearing of Jacobs’ plan, Gore also took up the question of compensation. Jacobs appeared before the Subcommittee on Health and the Environment on October 17, 1983, and spoke with truculence. He talked about one doctor who had testified before him “sitting on his butt” and failing to seriously address the problem of organ shortages. He interrupted and challenged his questioners. His testimony, above all, highlighted the likely abuses in an unregulated organ market.

“I have heard you talk about going to South America and Africa, to third-world countries, and paying poor people overseas to take trips to the United States to undergo surgery and have a kidney removed for use in this country,” Gore said. “That is part of your plan, isn't it?”

“Well, it is one of the proposals,” Jacobs said.

...

"This exchange gave public force to a debate that had been unfolding in the dimmer theater of academia ever since transplantation first became possible. ...Proponents of an organ market had historically invoked the crisp—some say cold—logic of utilitarianism. A properly designed market, they suggested, would provide economic surplus to both the organ donor, in the form of money, and to the recipient, in the form of a longer, healthier life. Opponents of a market typically crafted their dissents from the gossamer realm of ethics."

There's more, both personal and policy.  

Good luck to all who need a kidney and to those who donate them. Maybe we'll make some more progress in 2023.

"It Is Time for Interventional Cardiology Fellowship to Join the National Resident Matching Program," say its leaders

 The current appointment process for interventional cardiology fellows is early and congested, and programs feel obliged to make exploding offers, often to internal candidates, without much opportunity for external candidates and programs to become acquainted. In short, they are facing the problems with decentralized hiring that have led many medical specialties to use a centralized match to organize the labor market for residencies and fellowships.  Here's a proposal that this fellowship program should join the Match in order to have a more orderly, better informed process.

Vallabhajosyula, Saraschandra, Sabeeda Kadavath, Alexander G. Truesdell, Michael N. Young, Wayne B. Batchelor, Frederick G. Welt, Ajay J. Kirtane, Anna E. Bortnick, and ACC Interventional Section Leadership Council. "It Is Time for Interventional Cardiology Fellowship to Join the National Resident Matching Program." Cardiovascular Interventions 15, no. 17 (2022): 1762-1767.

"In this perspective article, which is a summation of the deliberations of the American College of Cardiology Interventional Section Leadership Council, we describe the current process of interventional cardiology fellowship candidate selection and opportunities for improvement by joining the Match.

...

"Current Application Process

...

"the date for program review of applications starts on December 1st (1½ years before the start of the interventional cardiology training program to which applicants are applying), although programs are free to offer spots earlier. At the time applications are submitted, cardiovascular medicine fellows in traditional 3-year programs have variable exposure to the cardiac catheterization laboratory. In our experience, for many applicants, the timing of the application process precludes an adequate diagnostic catheterization laboratory experience in order to inform decision-making. ... program leadership is heavily reliant on candidate performance in the interview and on subjective evaluation through letters of recommendation from faculty mentors who have typically had a single year of exposure to applicants.

Residency interviews, in person vs by zoom, at Stanford

 

Residency interviews in the digital era by Isabel Beshar1, William J Tate2, Dan Bernstein3  Postgraduate Medical Journal 98, no. 1166 (2022): 892-894.

Abstract: "In the midst of the SARS-CoV-2 pandemic, the US Association of American Medical Colleges (AAMC) required residency programme transition from in-person to virtual interviews for all applicants. The new virtual format upended a system that has relied on programmes and applicants balancing the likelihood of acceptance with the financial and time demands of cross-country travel.

"In this commentary, we address the history of residency interviewing in the USA and the emerging changes that are taking place in light of virtual interviews. We discuss the advantages of the new online format, including the reduced cost for applicants and programmes, as well as the decreased carbon footprint.

"We also discuss the inequities of virtual interviewing, involving a national maldistribution of interviews to only the top-tier candidates. We share previously unpublished data on the number of virtual interviews accepted by Stanford’s 2020 residency applicants, compared with those conducted in person in 2019. We find Stanford applicants in all fields accepted more interviews: from a mean of 8 in 2019 to 14 in 2020, a change of 160% on average. Despite this, only half of Stanford 2020 applicants interviewing in the virtual format thought they had accepted more interviews than they would have in person.

"We comment on how transitions to online interviewing may be affecting medical schools and applicants disproportionately. Ultimately, we highlight the need and offer ideas for additional regulation on behalf of the AAMC to ensure a more equitable distribution of interview opportunities."

...

"At our institution—Stanford School of Medicine—and as applicants of the 2020–2021 cycle ourselves—we saw the effect of this firsthand. We administered a survey to all students participating in the match process in both the 2019 (in-person) and 2020 (virtual) years. In the survey, respondents identified the residency programme or programmes to which they applied as well as the number of interviews they attended.

Synthetic biology and the ethics of eating (Virgina Postrel in the WSJ)

 Remarkable changes will keep coming.  Here's Virginia Postrel in the WSJ on how changes in the food supply might influence both repugnance towards meat eating and towards technology:

Synthetic Meat Will Change the Ethics of Eating. Consumers will soon be able to dine on chicken and other animal proteins grown in a factory, upending the way we think about nature and technology  By Virginia Postrel

"Most Americans aren’t about to give up chicken, but we’d rather not dwell on where it comes from. In the not-too-distant future, however, the trade-off between conscience—or ick factors—and appetite may no longer be relevant. Instead of slaughtering animals, we’ll get our meat from cells grown in brewery-like vats, with no blood and guts. In November, that science-fiction vision came a crucial step closer to reality when the Food and Drug Administration gave its OK to the slaughter-free chicken from Upside Foods, a San Francisco-based startup originally known as Memphis Meats. The company must still work with the Agriculture Department to establish inspection procedures and win labeling approval. It plans to first offer the meat to high-end restaurants.

...

"Synbio executives talk like animal lovers and environmental activists. But synbio is still a form of engineering, a science of the artificial. As such, its ethical appeal represents a significant cultural shift. Since the first Earth Day in 1970, businesses large and small have emerged from the conviction that “natural” foods, fibers, cosmetics, and other products are better for people and the planet. It’s an attitude that harks back to the 18th- and 19th-century Romantics: The natural is safe and pure, authentic and virtuous. The artificial is tainted and deceptive, a dangerous fake. Gory details aside, the “factory” in factory farming makes it sound inherently bad.

"Synthetic biology upends those assumptions, raising environmental and ethical standards by making them easier and more enjoyable to achieve."

*******

Some commentators on her WSJ article criticized it as "woke propaganda."

*******

Earlier:

Tuesday, November 22, 2022

Lab grown meat: taking slaughter out of the food chain

Monday, May 30, 2022

Eliminating cruelty (and methane) from the food chain: lab-grown ("no-kill") meat

New York State's Living Donor Support Act (LDSA, S. 1594) was signed by Governor Hochul on Dec. 29

 Frank McCormick forwards this email:

From: Elaine Perlman

Sent: Thursday, December 29, 2022 5:44 PM

Subject: Governor Hochul Has Signed the Living Donor Support Act!

 "Hello!

I am delighted to inform you all that the New York State's Living Donor Support Act (LDSA, S. 1594) was signed by Governor Hochul today.

 New York is becoming the best state for organ donation!

 Thank you for your advocacy in support of this legislation. The LDSA will save more New Yorkers' lives.

 Waitlist Zero's Executive Director Josh Morrison wrote the legislation. State Senator Rivera from The Bronx and Assembly Member Gottfried from Manhattan sponsored the bill.

 This spring, a team from the NKDO, NKF, DOVE, LiveOn New York, and Waitlist Zero lobbied for the bill's passage in Albany. Soon after, the LDSA was unanimously passed by both houses.

 This new law creates the opportunity for New York's living donors to avoid going into debt to donate. Living donors will be reimbursed for their lost wages and out-of-pocket expenses. New York will be the first state in the country to offer this opportunity for donation to be cost neutral for donors.

 Currently the Federal Government only reimburses when both the recipient and donor make less than 350% of the poverty line (around $47,000). The LDSA will reimburse the lost wages of donors who make up to $125,000 as well as the costs of donation (travel, childcare, etc).

 In addition, the LDSA will ensure that all potential recipients will be educated about transplantation.

 There are currently 8,569 people on New York's transplant wait lists, 7,234 of whom are awaiting a kidney. With the LDSA, we anticipate that far more New Yorkers will benefit from a living organ donation.

Here is the press release.

On Tuesday, January 3rd from 4-5pm ET, we will have a virtual celebration and toast the passage of the LDSA! Here is our zoom link.

Please share this good news far & wide!

Best,

 Elaine

Director, Waitlist Zero "

***********

Because the National Living Donor Assistance Center (NLDAC) is a payer of last resort, the NY law will replace NLDAC for NY donors who do meet the means test, and so it will also allow the NLDAC budget to go further.

********

Update: Frank McCormick writes to alert me that, like the authorization for NLDAC,  the NY State law (https://www.nysenate.gov/legislation/bills/2021/S1594) "requires that the Program shall be payer of last resort..." I hope that this doesn't turn into a competition to be the payer of last resort in a way that might cause some NY donors to fall between the cracks, and not be reimbursed either by NLDAC or the State of New York.