Thursday, July 20, 2023

Senate Finance Subcommittee on Health Care --testimony on organ transplants, going on now

Watch right now or listen later.  UNOS is not popular in the Senate.

 https://www.c-span.org/video/?529461-1/health-advocates-testify-improving-organ-transplant-system

Health Advocates Testify on Improving Organ Transplant System

Patients and health professionals testify on the effectiveness of the organ transplant system before the Senate Finance Subcommittee on Health Care.

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Another set of links:Subcommittee Hearing
Subcommittee on Health CareDate: Thursday, July 20, 2023Time: 10:00 AMLocation: 215 Dirksen Senate Office Building

Pitfalls of digital scholarship: Machiavelli and Matching

 One of the alluring features of the digitization of texts is that they can be searched, their citations can be examined and cross-referenced, and facts about texts, and the literatures that they comprise, can be detected.  But of course,  digital searches can also lead you astray.

Something like that may have happened in this study of business ethics. (Relax, this isn't a blog post about questionable ethics in science.)  

Maity, M., Roy, N., Majumder, D. et al. Revisiting the Received Image of Machiavelli in Business Ethics Through a Close Reading of The Prince and Discourses. J Bus Ethics (2023). https://doi.org/10.1007/s10551-023-05481-2

The authors of the above paper searched in journals related to business and economics, for papers  about Niccolò Machiavelli, the 16th century author of The Prince, whose name has entered into the language to describe the kind of advice he gave: Machiavellian.

Looking at the most highly cited papers, and their network of co-citations (i.e. citations of each other) they find three clusters in the Machiavelli literature. They note that two of the clusters include many citations from one to the other, but that the third cluster (in green) is not connected to the other two.  The third cluster they label "matching problems in markets." (In fairness, the authors of the paper note this separation, and concentrate their analysis on the first two clusters.)



Here are the papers in the clusters. The papers in cluster 3 will be familiar to many readers of this blog.


Here in larger font is cluster 3, of papers on "Matching problems in markets": Abdulkadiroǧlu et al. (2003), Abdulkadiroǧlu and Sönmez (2003), Dubins and Freedman, (1981), Gale and Shapley (1962), Gale and Sotomayor (1985a), Gale and Sotomayor (1985b), Kojima and Pathak (2009), Roth (1982, 1984a, 1984b, 1985, 2002), Roth and Sotomayor (1990), Roth and Peranson (1999).

This cluster indeed contains well cited papers that cite one another. Yet I'm pretty sure that none of them cite Machiavelli, nor would most readers think that they connect to The Prince.

This latter cluster was almost surely included because of the titles of two of the included papers, neither of which in fact cites Machiavelli. (His name made it into the titles in a sort of jokey way, having to do with the fact that players in matching games may sometimes profit from behaving unstraightforwardly.) They are:

Dubins, Lester E., and David A. Freedman. "Machiavelli and the Gale-Shapley algorithm." The American Mathematical Monthly 88, no. 7 (1981): 485-494.

and

Gale, David, and Marilda Sotomayor. "Ms. Machiavelli and the stable matching problem." The American Mathematical Monthly 92, no. 4 (1985): 261-268.


But Machiavelli might be proud to be included in an economic literature on incentives.

Wednesday, July 19, 2023

Black markets for alcohol in Iran

 Prohibition (of alcohol) didn't work in the U.S. from 1920-1933, and it's not working in Iran today, despite "the Islamic Republic’s longstanding ban on the sale and consumption of alcohol, which is punishable by a penalty of up to 80 lashes and fines."

The NYT has the story:

Alcohol Poisonings Rise in Iran, Where Bootleggers Defy a Ban. Iran’s prohibition of the drinking and selling of alcohol has led to a flourishing underground market. But even officials have acknowledged a wave of hospitalizations and deaths in recent months.  By Farnaz Fassihi and Leily Nikounazar

"Rather than stopping drinking, the ban over time has led to a flourishing and  dangerous bootleg market. In the past three months, a wave of alcohol poisonings has spread across Iranian towns big and small, with an average of about 10 cases per day of hospitalizations and deaths, according to official tallies in local news reports.

"The culprit is methanol, found in homemade distilled alcohol and counterfeit brand bottles, apparently circulating widely, according to Iranian media reports and interviews with Iranians who drink, sell and make alcohol.

"The clerical rulers who took power after the 1979 revolution, instituting a theocracy, banned the consumption and selling of alcohol in accordance with Islamic rules prohibiting intoxication. Religious minorities are exempt. Over the decades, reports of methanol contaminations occasionally surfaced, but not in the scope and frequency seen in recent months....

"Even officials are now publicly acknowledging that the problem has escalated. Mehdi Forouzesh, Tehran’s chief coroner, said in a news conference in June that the number of hospitalizations and deaths from methanol poisoning had sharply risen. In only Tehran, he said, it had climbed by 36.8 percent since the beginning of March.

...

"Many Iranians love to drink, and nothing has dissuaded them from a tradition deeply rooted in ancient Persian culture. Homemade alcohol and imported bottles of liquor flow freely at many parties, weddings and social gatherings. Some upscale restaurants secretly serve patrons vodka in pots of tea."

Tuesday, July 18, 2023

Can Britain Fix Its National Health Service?

 The NYT has the story

A National Treasure, Tarnished: Can Britain Fix Its Health Service? As it turns 75, the N.H.S., a proud symbol of Britain’s welfare state, is in the deepest crisis of its history. By Mark Landler

"As it turns 75 this month, the N.H.S., a proud symbol of Britain’s welfare state, is in the deepest crisis of its history: flooded by aging, enfeebled patients; starved of investment in equipment and facilities; and understaffed by doctors and nurses, many of whom are so burned out that they are either joining strikes or leaving for jobs abroad.

...

"More than 7.4 million people in England are waiting for medical procedures, everything from hip replacements to cancer surgery. That is up from 4.1 million before the coronavirus pandemic began in 2020.

"Mortality data, exacerbated by long wait times, paints a bleak picture. In 2022, the number of excess deaths rose to one of the highest levels in the last 50 years, and those numbers have kept rising, even as the pandemic has ebbed.

"In the first quarter of 2023, more than half of excess deaths — that is, deaths above the five-year average mortality rate, before the pandemic — were caused by something other than Covid-19. Cardiovascular-related fatalities, which can be linked to delays in treatment, were up particularly sharply

...

"Seeking to solve the problem, Prime Minister Rishi Sunak last month announced a 15-year plan to recruit and train 300,000 nurses and doctors, budgeting 2.4 billion pounds (about $3 billion) for the first five years. But critics point out that the plan does not fund wage increases, the only surefire way to prevent workers from leaving.

...

"No mainstream politician proposes to privatize the N.H.S.: The specter of the inequitable U.S. health system still horrifies many Britons. And in some ways, the service remains a marvel, one of the world’s most comprehensive, taxpayer-funded health care providers — “free at the point of delivery,” in the words of its utopian motto. It still offers annual physical exams, mammograms, vaccinations and other services at a level that visiting Americans find impressive."

Monday, July 17, 2023

Affirmative action in India

 Here's an interesting paper by Orhan AygĂĽn and Bertan Turhan. It comes with something of a backstory, which accounts for its quite delayed publication (delays both in initial acceptance and then in publication after acceptance*). I gather it will appear in the next issue of Management Science.

How to De-Reserve Reserves: Admissions to Technical Colleges in India by Orhan AygĂĽn and Bertan Turhan, Management Science (forthcoming),  Published Online:11 Nov 2022 https://doi.org/10.1287/mnsc.2022.4566

Abstract: "We study the joint implementation of reservation and de-reservation policies in India that has been enforcing comprehensive affirmative action since 1950. The landmark judgment of the Supreme Court of India in 2008 mandated that whenever the OBC category (with 27% reservation) has unfilled positions, they must be reverted to general category applicants in admissions to public schools without specifying how to implement it. We disclose the drawbacks of the recently reformed allocation procedure in admissions to technical colleges and offer a solution through “de-reservation via choice rules.” We propose a novel priority design—Backward Transfers (BT) choice rule—for institutions and the deferred acceptance mechanism under these choice rules (DA-BT) for centralized clearinghouses. We show that DA-BT corrects the shortcomings of existing mechanisms. By formulating India’s legal requirements and policy goals as formal axioms, we show that the DA-BT mechanism is unique for the concurrent implementation of reservation and de-reservation policies."


*This paper spent a long time waiting to be published, because of what seems to have been a priority dispute that, after the paper was accepted for publication,  was pursued through  allegations of research misconduct. The editorial office of Management Science conducted an investigation that determined that there was no reason not to proceed with publication.

#######

Update: here's the citation to the published version

https://doi.org/10.1287/mnsc.2022.4566

Sunday, July 16, 2023

National Living Donor Assistance Center (NLDAC): I rotate off the advisory board

 After seven years, I'm rotating off the advisory board of the National Living Donor Assistance Center (NLDAC). During that time, NLDAC's ability to assist living donors increased substantially, and now includes some reimbursement for lost wages, for example.

 At our meetings I learned to appreciate some of the subtleties involved in the interaction between government regulation and organ transplantation.




Saturday, July 15, 2023

Marijuana and military recruitment

 Here's a proposal for a bit pf reality-based legislation that has some bipartisan support. DefenseOne has the story:

Proposed marijuana waivers acknowledge blunt recruiting truths. Lawmakers on both sides of the aisle want to remove a barrier to joining the U.S. military.  by LAUREN C. WILLIAMS 

"As the military services struggle to meet recruiting goals, lawmakers in the divided House seem united on a proposed fix: relaxing the Pentagon’s policies on marijuana use.

“I do not believe we should be testing for cannabis [in] people who want to join the military,” Rep. Matt Gaetz, R-Fla., told the House Rules Committee during a hearing on Tuesday. “We should be thinking about cannabis more in terms of alcohol.”

Gaetz testified in support of his amendment that would ban drug testing for marijuana as a condition of enlistment or to become a commissioned officer. 

“We are having a recruiting crisis,” he said, noting that many “people use cannabis under the color of state law.” So far, 23 states and Washington, D.C. have legalized the recreational use of marijuana.

"The Florida lawmaker stressed that his amendment wouldn’t preclude DOD from prohibiting marijuana use for individuals actively serving in the military, but that cannabis testing is “an unnecessary gate” for recruitment. In 2021, Gaetz sought to overturn U.S. election results."

Friday, July 14, 2023

Harm reduction is not a panacea: drug use and drug policy in Portugal, and San Francisco

 The Washington Post has a story about Portugal, and the SF Chronicle has one as well. Both stories touch on the tensions between treating drug addicts with respect, and assuring that cities remain safe and livable.  

Here's the Washington Post:

Once hailed for decriminalizing drugs, Portugal is now having doubts  By Anthony Faiola and Catarina Fernandes Martins

"Portugal decriminalized all drug use, including marijuana, cocaine and heroin, in an experiment that inspired similar efforts elsewhere, but now police are blaming a spike in the number of people who use drugs for a rise in crime. In one neighborhood, state-issued paraphernalia — powder-blue syringe caps, packets of citric acid for diluting heroin — litters sidewalks outside an elementary school.

"Porto’s police have increased patrols to drug-plagued neighborhoods. But given existing laws, there’s only so much they can do. 

...

"Portugal became a model for progressive jurisdictions around the world embracing drug decriminalization, such as the state of Oregon, but now there is talk of fatigue. Police are less motivated to register people who misuse drugs and there are year-long waits for state-funded rehabilitation treatment even as the number of people seeking help has fallen dramatically. The return in force of visible urban drug use, meanwhile, is leading the mayor and others here to ask an explosive question: Is it time to reconsider this country’s globally hailed drug model?

“These days in Portugal, it is forbidden to smoke tobacco outside a school or a hospital. It is forbidden to advertise ice cream and sugar candies. And yet, it is allowed for [people] to be there, injecting drugs,” said Rui Moreira, Porto’s mayor. “We’ve normalized it.”

...

" In the United States alone, overdose deaths, fueled by opioids and deadly synthetic fentanyl, topped 100,000 in both 2021 and 2022 — or double what it was in 2015. According to the National Institutes of Health, 85 percent of the U.S. prison population has an active substance use disorder or was jailed for a crime involving drugs or drug use.

"Across the Atlantic in Europe, tiny Portugal appeared to harbor an answer. In 2001, it threw out years of punishment-driven policies in favor of harm reduction by decriminalizing consumption of all drugs for personal use, including the purchase and possession of 10-day supplies. Consumption remains technically against the law, but instead of jail, people who misuse drugs are registered by police and referred to “dissuasion commissions.” 

...Other countries have moved to channel drug offenses out of the penal system too. But none in Europe institutionalized that route more than Portugal. Within a few years, HIV transmission rates via syringes — one the biggest arguments for decriminalization — had plummeted. From 2000 to 2008, prison populations fell by 16.5 percent. Overdose rates dropped as public funds flowed from jails to rehabilitation. There was no evidence of a feared surge in use.

...

"But in the first substantial way since decriminalization passed, some Portuguese voices are now calling for a rethink of a policy that was long a proud point of national consensus. Urban visibility of the drug problem, police say, is at its worst point in decades

...

"A newly released national survey suggests the percent of adults who have used illicit drugs increased to 12.8 percent in 2022, up from 7.8 in 2001, though still below European averages.

...

"Porto’s mayor and other critics, including neighborhood activist groups, are not calling for a wholesale repeal of decriminalization — but rather, a limited re-criminalization in urban areas and near schools and hospitals to address rising numbers of people misusing drugs."

...

"After years of economic crisis, Portugal decentralized its drug oversight operation in 2012. A funding drop from 76 million euros ($82.7 million) to 16 million euros ($17.4 million) forced Portugal’s main institution to outsource work previously done by the state to nonprofit groups,

...

"Twenty years ago, “we were quite successful in dealing with the big problem, the epidemic of heroin use and all the related effects,” GoulĂŁo said in an interview with The Washington Post. “But we have had a kind of disinvestment, a freezing in our response … and we lost some efficacy.”

*******

And here are some related paragraphs about San Francisco, in a story in the San Francisco Chronicle about a concentration of drug dealers from Honduras:

THIS IS THE HOMETOWN OF SAN FRANCISCO’S DRUG DEALERS By Megan Cassidy and Gabrielle Lurie |  July 10, 2023

"Like many other U.S. cities, San Francisco shifted years ago to treating drug use more like a disease than a crime. The heavy policing approach of the War on Drugs era failed to slow dealers or decrease demand while overcrowding jails and disproportionately punishing people of color, studies show.

"Now one of the most progressive cities in the nation is fracturing over concerns that it has become too permissive. What to do about the Honduran dealers is a key political issue as a major citywide election approaches in 2024.

"On a weekday afternoon in June, a man in his early 30s lay motionless on a SoMa sidewalk outside the Federal Building. On his right, a dozen users smoked fentanyl and crack cocaine or hung bent at the waist, heads suspended at their knees. To his left, a handful of dealers, cloaked in black but for the space around their eyes, continued selling while a passerby revived the man with Narcan, the nasal-spray antidote to opioid overdoses, and as paramedics arrived to treat him a few minutes later.

“I’m so mad at them for ruining my neighborhood,” said Kevin DeMattia, who owns Emperor Norton’s bar and has lived in the Tenderloin for the past 25 years. “Businesses are dying because people don’t want to come to the Tenderloin.  They’re ruining the neighborhood in so many ways. They’re poisoning people. … They’re this cancer, this aggressive, metastasizing cancer on the Tenderloin — the dealers and the addicts.”


Thursday, July 13, 2023

Laurie Lee interviews me about kidney exchange, repugnance, and more (podcast)

 Laurie Lee interviews me in her podcast Donor Diaries.

https://www.buzzsprout.com/1748941/13094958?t=35 (You don’t have to log in; just click on “Listen Now”.)

***********

Here is her written description:

"Exchanging kidneys is a complicated process that involves multiple collaborations between kidney patients, living donors, transplant centers, insurance companies, airlines and more.  It’s truly remarkable if you stop to think about the number of people and organizations that need to come together to make 1 paired exchange possible.  We only started exchanging kidneys between non-compatible pairs a little over 20 years ago, so it’s a somewhat new process.  Have you ever wondered how this was made possible?

"Meet Nobel Laureate Al Roth who is an economist and Stanford University professor.  Al designs markets.  He’s one of the prominent players who has made kidney exchange possible.  In a nutshell, his work has revolutionized kidney exchange around the world by using economic theory to make kidneys more available.

"In October 2012, Al was the co-recipient of the 2012 Nobel Memorial Prize in Economic Sciences, together with Lloyd S. Shapley, for “ the theory of stable allocations and the practice of market design."

"Al Roth is well known for his application of economics to real world problems.  In this podcast episode we touch a wide range of topics ranging from paired exchanges, prostitution, surrogacy, and more.  All of these markets are examples of repugnant markets.  Kidney Donation can be characterized as a repugnant market, and Al will tell us all about it! 

Links:

Wednesday, July 12, 2023

The harmful human rights impact of unjustified criminalization of individuals and communities: ICJ statement

 The International Commission of Jurists (ICJ) has published a set of legal principles  for a human rights-based approach to criminal laws proscribing conduct associated with sex, reproduction, drug use, HIV, homelessness and poverty.

The 8 March Principles for a Human Rights-Based Approach to Criminal Law Proscribing Conduct Associated with Sex, Reproduction, Drug Use, HIV, Homelessness and Poverty

It opens with a foreword by Edwin Cameron, Retired Justice, Constitutional Court of South Africa, Inspecting Judge, Judicial Inspectorate for Correctional Service.  The first paragraphs are:

"From long years in the law, and as a proudly gay man, I know profoundly how criminal law signals which groups are deemed worthy of protection – and which of condemnation and ostracism. In this way, the criminal law performs an expressive function – and it has dramatic consequences on people’s lives. It sometimes entails a harshly discriminatory impact on groups identified with the disapproved or stigmatised conduct.

"To add to this, criminal proscriptions may reinforce structural inequalities; they may codify discrimination, invest them with the law’s power and may foster stigma. All this may wreak terrible harm.

"Criminal law may thus impel hostility, exclusion, inequality, discrimination and marginalization of individuals and groups, sometimes to the point of violence. As a result, human rights, democratic values and social inclusiveness all suffer." 

...

"The Principles are based on general principles of criminal law and international human rights law and standards. They seek to offer a clear, accessible and workable legal framework – as well as practical legal guidance – on applying the criminal law to conduct associated with:

sexual and reproductive health and rights, including termination of pregnancy;

consensual sexual activities, including in contexts such as sex outside marriage, same-sex sexual relations, adolescent sexual activity and sex work;

gender identity and gender expression;

HIV non-disclosure, exposure or transmission;

drug use and the possession of drugs for personal use; and

homelessness and poverty. 

***********

And here are the first paragraphs of the Introduction:

"Criminal law is among the harshest of tools at the disposal of the State to exert control over individuals. As such, it ought to be a measure of last resort, where other less restrictive means of achieving legitimate interests are insufficient. However, globally, States have exhibited a growing trend towards overcriminalization.

While retribution, deterrence, incapacitation and rehabilitation are generally considered to be its main purposes, criminal law may also perform an expressive function, through public condemnation of certain conduct seen as deserving reprobation and punishment. The desire to harness this expressive function is a critical factor contributing to the proliferation of criminal law.

The unjustified criminalization of individuals and sometimes entire communities is increasingly impeding progress in advancing human rights in many areas, including: racial and gender equality; reproductive autonomy; disability; economic justice; civil liberties; sexual orientation; gender identity; education; youth development; and public health.

Moreover, in recent years, in some quarters, there has been a backlash against human rights, especially against sexual and reproductive health and rights and the human rights of women, lesbian, gay, bisexual, transgender, non-binary, gender diverse and intersex persons, as well as against sex workers, people who use drugs and people experiencing homelessness and/or living in poverty.

"In particular, there has been continued use and, in some cases, a new proliferation of arbitrary criminal laws proscribing conduct associated with sex, reproduction, drug use and the possession of drugs for personal use, HIV, homelessness and poverty. These laws have led to egregious human rights violations, including by engendering and perpetuating stigma, harmful gender stereotypes and discrimination based on grounds such as sex, sexual orientation, gender identity, gender expression and other protected fundamental characteristics. 

"Unless criminal laws proscribing the above-mentioned conduct are directed at coercion or force or otherwise at the absence of consent, their mere existence – let alone their threatened or actual enforcement – violates human rights."

**********

See Saturday's post, concerning Canada's "The Protection of Communities and Exploited Persons Act," which is designed to protect sex workers.



Tuesday, July 11, 2023

NYC police officer receives a kidney through Kidneys for Communities (KFC:)

 Police magazine has the story of an anonymous living kidney donor who wanted his/her kidney to go to a first responder, facilitated by  Kidneys for Communities.

NYPD Officer Received Kidney Transplant with Aid of Nonprofit Group and PBA. Kidneys for Communities' Kidneys for First Responders initiative is designed to improve access to and facilitate living kidney donations by connecting those who want to help first responders with those who are in need of a lifesaving kidney donation.  July 7, 2023

"Kidneys for Communities, a national community-directed living kidney donation program, launched its Kidneys for First Responders initiative with its first kidney transplant recipient, New York City Police Officer Melissa Quinones, with assistance from the Police Benevolent Association of the City of New York.

******

And here's the KFC press release (doesn't that acronym already sound familiar?):

Kidneys for Communities Announces their ‘Kidneys for First Responders’ Initiative

"Kidneys for Communities’ Kidneys for First Responders initiative is designed to improve access to and facilitate living kidney donations by connecting those who want to help first responders with those who are in need of a lifesaving kidney donation"

"As Dr. Lloyd E. Ratner, who performed Quinones’ transplant, affirms, “The community-directed model, now available to interested communities and pioneered by Kidneys for Communities, is a common-sense approach to growing the pool of living kidney transplant donors. As more communities come on board, we expect it will shorten the critical waiting time for transplant recipients and save lives.”."