The history of the market for injectable insulin

First came the great, long awaited discovery. The NY Times has a great account by Dr. Abigail Zuger: Rediscovering the First Miracle Drug.

It's well worth reading the whole thing, but here's one snippet that caught my eye:

"“In some sense, the breakthrough is the easy part,” he said. “Then the real work begins.”

"For both insulin and the AIDS drugs the big challenge was “getting it from here to there,” Dr. Sepkowitz said. The expense and logistics of large-scale insulin manufacture were initially daunting. But soon trainloads of frozen cattle and pig pancreas from the giant Chicago slaughterhouses began to arrive at Lilly’s plant. By 1932 the drug’s price had fallen by 90 percent. "

Diabetes remains a killer disease, but now it's a chronic disease that haunts adults, instead of quickly killing children. 

"But the miracle went only so far: insulin was not a cure. In 1921, New York City’s death rate from diabetes was estimated to be the highest in the country, and today the health department lists diabetes among the city’s top five killers. Now though, it is adults who die, not children. What insulin did was turn a brief, deadly illness into a long, chronic struggle, and both the exhibit and the book, “Breakthrough,” by Thea Cooper and Arthur Ainsberg, on which it is based highlight the complicated questions that inevitably follow medical miracles: Who will get the drug first? Who will pay for it? Who will make enough for everyone?"

Diabetes is of course one of the big causes of kidney failure, and a real cure would go a long way to easing the long lines of people waiting for kidney transplants while undergoing dialysis. (Here's a good recent article on the various dialysis options from the WSJ.)

Rakesh Vohra on repugnant contracts for onions

Over at the Leisure of the Theory Class,  Rakesh  Vohra takes up the question of the day, which is Onions, and in particular, Public Law 85-839, which states

"No contract for the sale of onions for future delivery shall be made on or subject to the rules of any board of trade in the United States."

He invites us to consider why that might be a repugnant transaction. (And in the comments, a reader raises the related question of futures contracts on Hollywood movies, and speculation in general...)

Comment on the proposed NRMP scramble following the resident match

The NRMP website asked for comments on the NRMP's new plan for organizing the post-match scramble, and some of my young colleagues and I were moved to send one in:

Comment on the NRMP’s “Supplemental Offer and Acceptance Program” Proposed to Replace the Post-Match Scramble by Peter A. Coles, Clayton R. Featherstone, John William Hatfield, Fuhito Kojima, Scott Duke Kominers, Muriel Niederle, Parag A. Pathak, and Alvin E. Roth.

Executive Summary: "Historical precedent and economic principles suggest that the Supplemental Offer and Acceptance Program (SOAP) proposed for the NRMP Scramble will lead to unsatisfactory outcomes by forcing participants to make unnecessarily difficult decisions and giving them strong incentives to break the rules laid out in the SOAP proposal. We suggest, as an alternative Scramble mechanism, that the NRMP run a “Second Match” for the Scramble participants using rules similar to those of the Main Match."


Here's my previous post: Cleaning up the scramble for medical residents with SOAP

Is the law clerk hiring regime on its last legs?

That's the question asked by an Oct 18 article in the National Law Journal. Clerkship scramble: The system for placing them with federal judges is breaking down by Karen Sloan. The article notes both that many judges are hiring law students as clerks earlier than the current guidelines allow, and also, interestingly, that an increasing number of judges are essentially hiring later, by hiring law grads rather than current law students.

"Are the Wild West days of federal clerk hiring back? That's what some law school administrators and judges fear. They worry that the voluntary system whereby federal judges wait until September of the 3L year to hire clerks is teetering. Judges are choosing clerks earlier in the year and are being inundated with applications as the legal job market narrows. And a trend toward hiring the already graduated means fewer positions are available for fresh law graduates.


"There has been a definite strain on the system over the past couple of years," said Sheila Driscoll, director of judicial clerkships at George Washington University Law School and the chairwoman of the National Association for Law Placement's (NALP) judicial clerkship section. "People are really worried that it's not going to last."

"Before 2003, judges hired clerks as early as they pleased. That's when two appellate judges persuaded most of their peers to agree to a voluntary plan that pushed federal clerk hiring back from the 2L year to September of the 3L year.


"The reform has outlasted many previous attempts to make the process orderly and fair, but the prevailing sense among placement officers and even judges is that more judges are jumping the gun. The Administrative Office of the U.S. Courts doesn't track which judges hire before September, but plenty of anecdotal evidence suggests that judges are picking clerks during the summer and earlier, leaving applicants to wonder about the fairness and transparency of the process. "
...
"Certain circuits openly acknowledge that most of their judges don't follow the plan — most notably the 4th, 5th, 10th and 11th circuits. The judges on the 4th Circuit voted several years ago to bypass the hiring plan altogether, said Chief Judge William Traxler Jr. "There was a long discussion and a division of opinion, but the majority did not want to go along with it," he said.


"One clerkship adviser at a top law school said that many judges are openly advertising their desire to receive applications as soon as 2L grades are available — a change from years past, when judges would solicit early applications less brazenly. The adviser did not want to be identified by name because the situation is delicate for law school administrators trying to give their students the best chance to land clerkships while still adhering to the official time line. Students, meanwhile, have to do more legwork to find out which judges are hiring and when.
...
"The hiring plan received a boost in 2005 with the introduction of the Online System for Clerkship Application and Review (OSCAR), which allows applicants and law schools to submit materials online and lets judges sort applications by specific criteria, such as school or grade-point average. The system will not release student applications to judges until the September kickoff date, which helps encourage compliance. Judge participation has climbed steadily since OSCAR's introduction, but there is no guarantee that judges who advertise positions on OSCAR will wait until September to make decisions.


"You can have a judge who only uses OSCAR for purposes of posting clerkship opportunities, but doesn't adhere to the schedule," said Judge Nicholas Garaufis, who sits on the U.S. District Court for the Eastern District of New York and chairs the judiciary's OSCAR working group. "That judge can reach out to applicants who send papers in the mail at any point."

"The frenzy places judges not in preferred cities on the East or West coasts in a tough spot — it's harder for students to make it to their chambers during the whirlwind interview period.

"Quite frankly, we just saw that other areas of the country were not following the plan," said Chief Judge Mary Beck Briscoe of the 10th Circuit. "By the time students would come out to the Midwest for interviews, the candidates with the highest credentials had already been hired."

"Briscoe recalled one candidate two years ago who was hired by another judge while literally in transit to an interview with her in Lawrence, Kan.

"The declining legal job market and the ease of applying with multiple judges through OSCAR have resulted in a dramatic increase in the number of applications. In 2009, OSCAR funneled 401,576 applications to judges — a 324% increase from the 94,693 applications received in 2005.

"With so many applications coming in, some law school career counselors and students worry that connections are playing an even bigger role in the process, as judges look for ways to cut through hundreds or even thousands of applicants. One judge in the Eastern District of Pennsylvania received 1,900 applications, said Melissa Lennon, assistant dean for career planning at Temple University James E. Beasley School of Law. "What is going to cut through 1,900 applications? Nothing but a phone call," she said.
...
"Another factor is that the rules don't cover applications from people who have already graduated — judges may hire them at any point. That's a real incentive to hire alumni instead of law students, according to judges and law school administrators. "I think some judges don't like the hiring frenzy that takes place on the first day they can interview 3Ls under the rules," said New York University School of Law Dean Richard Revesz. "A way to avoid that and still comply with the rules is to hire alumni."


"Plenty of judges are going that route. Although federal court administrators don't track the percentage of alumni and law student clerk hires, OSCAR data show that clerkship applications from alumni eclipsed those from law students in 2009 — a first.

"Harvard University clerkship adviser Kirsten Solberg said approximately one-third of Harvard's federal and state clerks are alumni. The shift has been rapid at Temple, where alumni make up about 40% of the school's clerks, compared to about 25% the previous year, Lennon said. "

My previous posts on the judicial clerk market are here. My papers on that market are here.

The market for marijuana in CA--buying is almost legal, selling and growing not

Another transaction takes another step from repugnant to not: Schwarzenegger approves bill downgrading marijuana possession of ounce or less to an infraction

"Gov. Arnold Schwarzenegger, who opposes legalization of marijuana for recreational use, has approved legislation downgrading possession of an ounce or less from a misdemeanor to an infraction.

"Supporters say the change will keep marijuana-related cases from becoming court-clogging jury trials, even though the penalty will remain a fine of up to $100, with no jail time. Violations will not go on a person's record as a crime.

"I am signing this measure because possession of less than an ounce of marijuana is an infraction in everything but name," Schwarzenegger wrote in a message released after he signed the bill. "In this time of drastic budget cuts, prosecutors, defense attorneys, law enforcement and the courts cannot afford to expend limited resources prosecuting a crime that carries the same punishment as a traffic ticket."
...
"The governor's action immediately became a point of contention in the campaigns for and against Proposition 19 on the statewide November ballot, which would legalize marijuana for recreational use. Schwarzenegger opposes the measure."

At the same time, marijuana cultivation remains illegal in CA, e.g: Mendocino officials pursue third day of marijuana eradications
"Mendocino County Sheriff's officials, assisted by state and federal agencies, made several more arrests in the third day of eradicating illegal marijuana grows and sales in Round Valley on Thursday.

On Tuesday 17 people were arrested, and another 20 were arrested on Wednesday, officials reported."

Phone sex as a repugnant transaction

I was struck by the opening paragraphs of this story:

"In some ways, working as a phone-sex dominatrix is lot simpler than being on a college faculty. Your relationship with others is clearly defined, no one formally complains about anything you say to them, and you stand little risk of getting caught up in messy struggles over power.

"It gets complicated, however, if you try to do both jobs...."

That is from a Chronicle of Higher Education story about troubles in the English department at the University of New Mexico: In Professor-Dominatrix Scandal, U. of New Mexico Feels the Pain

Now you can buy copies of successful college applications

The Chronicle of Higher Education reports on a new business venture aimed at applicants to selective colleges. For Sale: Successful Ivy League Applications—Only $19.99  By Eric Hoover

"The path to the nation’s most selective colleges is crowded with entrepreneurs—independent consultants, test-preparation companies, and publishers of a zillion guides. They peddle information and insight, along with strategies for unlocking coveted gates. Recently, Howard Yaruss decided to join them.

"Mr. Yaruss is the founder of the Application Project Inc., which sells copies of successful applications to Ivy League colleges. Want to browse applications submitted by 21 members of Brown University’s 2009-10 freshman class? You can buy access to them for $19.99 on the company’s Web site, WeGotIn.net. For the same price, you can see applications filed by 14 members of the 2009-10 freshman class at Columbia University. Or you can buy both sets for $34.99.

"It’s all in the name of transparency, says Mr. Yaruss, who touts his new service a way to show students what successful applications look like—and what admissions officers look for when they evaluate them. Seeing how accepted applicants presented themselves, he says, can help high-school students, especially those who lack affluence, college savvy, and knowledgeable counselors.

“It’s the one remaining part of the process that’s shrouded in mystery,” Mr. Yaruss says. “Students spend thousands of dollars preparing for the SAT. We’re offering this for the cost of a trade paperback.”
...
"Alice Kleeman, a college counselor at Menlo-Atherton High School, in California, calls the service “revolting.” She suspects that the site might cause students to think they have no chance if they happen to lack the academic records, personal experiences, and writing abilities of students who were accepted.

"Ms. Kleeman also thinks there’s a high likelihood of abuse. “Even if students have the integrity not to simply lift responses from these apps, the site could also have the potential of causing students to believe they should submit something just like these apps, rather than their own authentic app,” Ms. Kleeman says. “I would hate to see my students spending money for something like this.”

Waiting lists

In the Chronicle of Higher Education, Toni Adleberg, a recent NYU graduate compares her experiences on the waiting list for graduate admissions, and the wait for a new liver: They'll Just Have to Wait.

Commerce and self interest in medicine

A Guided Tour of Modern Medicine’s Underbelly is a NY Times  book review by Dr. Abigail Zuger of  the book WHITE COAT, BLACK HAT: Adventures on the Dark Side of Medicine. By Dr. Carl Elliott.

"A physician who specializes in philosophy and ethics, Dr. Elliott hails from that quiet zone of medicine where much of the job involves thinking about, talking about and doling out medications. Hence his primary focus is on the ever-evolving relationship between the high art of medicine and the big business of drugs.

...
"Doctors get pens and trinkets, football tickets, junkets to beach resorts. Less visible are the large sums handed over in “I’m going to make you a star” projects to groom them as trusted faces and voices in the service of some drug. Education and advertisement merge in these elaborate ventures, as the paid professor travels the country, lecturing about disease and, incidentally, the treatment thereof.


"These “key opinion leaders” are bad enough, but who would ever imagine that the curricula vitae of many academic physicians (those on a medical school faculty) are packed with journal articles actually written by ghostwriters sponsored by pharmaceutical companies?

"“Nobody expects American politicians to write their own speeches anymore,” Dr. Elliott reminds us, “and nobody expects celebrities to write their own memoirs.” Apparently doctors have now joined the ranks of the charismatic talking heads, mouthing the words of others.

"And just as “professor” generally describes someone who writes his or her own sentences, “ethicist” generally describes someone who dwells (or at least works) on an unusually high moral plane. But Dr. Elliott also takes a brief and very informative excursion into the world of the medical ethicists. Once they were highly principled, underpaid gadflies, trying to sort out medical decision making. Now they are part of a booming industry, and, speaking of industry, their ties to the pharmaceutical industry are many and complex. Many companies now hire their own ethicists. But who guards those guards?
...
"What a world, what a world, as the melting witch said in “The Wizard of Oz.” But there is one small consolation: at least Dr. Elliott didn’t have to call his book “White Coat, Black Heart.” Now that would have been depressing. The bottom line is that much of what he describes is simply the big business of medicine as we have allowed it to take shape. His bad actors are mostly just that: actors caught up in a script not of their own devising. They all come home in the evening, take off their black hats and hang up their white coats, just regular working stiffs out to make a buck. "

Regulation of the hours that medical residents can work

The Chronicle of Higher Education reports Accreditor Tightens Limits on Medical Residents' 80-Hour Workweeks

"Doctors in training at teaching hospitals would continue to be limited to an 80-hour workweek, but some new limits would be imposed to cut down on errors by sleep-deprived residents under new standards approved on Tuesday by the Accreditation Council for Graduate Medical Education.


"The standards, which are scheduled to take effect in July 2011, will apply to the 111,000 medical residents who are training in accredited teaching institutions,

"Residents can work more than 80 hours some weeks, as long as the average over a four-week period doesn't exceed 80. First-year residents would be limited to working no more than 16 hours a day—down from 24 hours—and they would be supervised more closely. Residency-training programs would also have a tougher time getting exceptions to the work-hour limits.

"The changes are based on recommendations made in 2008 by the Institute of Medicine, which warned of widespread medical errors caused by sleepy residents, as well as a 16-month review of scientific writings on sleep issues, patient safety, and resident training.

"Some teaching hospitals have argued that limiting residents' work hours would hurt them financially without necessarily improving patient safety.

"The revised standards, which also deal with concerns about mistakes that occur when residents hand off patient-care responsibilities during shift changes, were developed by a 16-member task force made up of specialists from medical education, patient safety, and clinical care."

Market design at Aarhus University in Denmark

The Center for Research in the Foundations of Electronic Markets is having an inaugural conference, Oct. 13-15.

The full program is here.
The first three sessions touch on a number of themes that readers of this blog will recognize:

Wednesday, October 13, 12.30 to 17.30

Session Chair Ivan Damgård
12.30-13.15 – Hervé Moulin, Rice University: Impartial decision among peers
13.15-14.00 – Peter Bogetoft, Copenhagen Business School: Missing Markets
14.00-14.45 – Jens Leth Hougaard, Copenhagen University: Rationing with rights

Session Chair Peter Bro Miltersen
15.15-16.00 – Felix Fischer, Harvard University: Mechanisms for Large-Scale Kidney Exchanges
16.00-16.45 – Lance Fortnow, Northwestern University: Bounding Rationality by Computational Complexity
16.45-17.30 – Kevin Leyton-Brown, University of British Columbia: Computational Mechanism Analysis

Thursday, October 14, 9.30 to 18:00
Session Chair Peter Bogetoft
09.30-10.15 – David Parkes, Harvard University: Mechanism Design and Accounting to Enable Efficient Peer Production and Spectrum Sharing (joint work with Ian Kash (Harvard), Michel Meulpolder (TU Delft), Rohan Murty (Harvard), Jie Tang (UC Berkeley) and Sven Seuken (Harvard))
10.15-11.00 – Ivan Damgård, Aarhus University: How to compute securely – even if you trust no one but yourself

It looks like Aarhaus is a happening place this week.

HT: Noam Nisan at AGT.

The problem with Princeton

France Wrestles With Its 2 Tiers of Higher Education
The article, from the New York Times, discusses the French higher education system of Universities and Grandes Ecoles, and ends with this paragraph:

"It was Cédric Villani, a 37-year-old professor at Lyon who won the 2010 Fields Medal, who gave the most spirited reply to France’s critics. Calling himself “a pure product of the French system,” Mr. Villani, a Normalien who has often taught in the United States, said that while American academic salaries were higher “and it’s easier to make big projects,” France also has particular strengths: “Our tradition, our quality of life, our social cohesion. My big problem in Princeton was finding a place to buy a decent cheese.”

Interview concerning San Francisco school choice

The San Francisco Briefing Room carries an audio interview by Stan Goldberg with Attila Abdulkadiroglu and me (about 30 minutes): Assignment System at Risk.
Here's his blurb: "With the deadline for submitting applications for school assignment in the San Francisco Unified School District rapidly approaching the school district has advised its independent advisors who were scheduled to program the assignment system for free that their services were not needed. Does this action imperil the implementation of the system on time? Has school district transparency moved back to the dark ages? Here’s the story from the design team’s perspective."


(Here are my previous posts on San Francisco school choice.)

Results of Games 1st choice prediction competition

Here's the end (or maybe the middle) of the story that began with Predicting behavior in games: a competition

: Results of Games 1st choice prediction competition

erev@techunix.technion.ac.il Oct 05 08:16AM +0200 ^

Hi: We write to inform you of the results of Games 1st choice prediction
competition. The competition focused on the prediction of behavior in repeated
Market Entry Game. We ran two sets of experiments. We published the results of
the first set, and challenged other researchers to predict the result of the
second set (see http://sites.google.com/site/gpredcomp).

Twenty-two different teams participated in the competition. The total number of
submissions was 25.

The winners are Wei Chen, Chih-Han Chen, Yi-Shan Lee, and Shu-Yu Liu from
National Taiwan University.

The runners up are Tomבs Lejarraga, Varun Dutt, and Cleotilde Gonzalez from
Carnegie Mellon University.

The winners and the runners up were invited to submit papers to Games that
describe their models in detail. Here is a short summary:

The winning model refines I-SAW (the best baseline model described in the
competition website) by the addition of the assumption of a limited memory
span. The refined model assumes: (1) Reliance on a small sample of past
experiences, (2) Strong inertia and recency effects, and (3) Surprise triggers
change.

The runner up model is based upon the Instance Based Learning (IBL) theory
proposed by Gonzalez, Lerch, and Lebiere (2003). The basic assumptions of this
model are: retrieval of past set of experiences of outcomes weighted by their
probability of retrieval from memory (i.e., blending mechanism); dependence on
recency and frequency of past experienced outcomes; and, an inertia mechanism
that depends upon surprise as a function of blended outcomes.

The results support two main suggestions:

(1) Models that assume reliance on small samples of past experiences have a
large advantage over models that assume reliance on running averages of the
previous payoffs (like traditional reinforcement learning and fictitious play
models).

(2) The difference between learning in market entry games, and learning in
individual choice tasks is not large. Indeed, the best models in the current
competition can be described as refinements of the best models in our previous
competition that focused in individual repeated choice task (see Erev et al.,
2010).

The raw data from the 80 repeated market entry games that were run in the
current competition can be found in http://sites.google.com/site/gpredcomp.
The raw data from the 120 repeated choice problems that were run in our
previous competition can be found in
http://tx.technion.ac.il/~erev/Comp/Comp.html. We encourage you to use these
data sets, to improve our understanding of the effect of experience on economic
behavior.
 

Vacancy chains: hiring from your competitors, and having them hire from you

Six Technology Firms Agree to More Hiring Competition

"The American job market is tough for many workers, but things are looking even better than usual for highly paid engineers and scientists in Silicon Valley.

"Six leading technology companies, including Apple, Google and Intel, reached an antitrust settlement on Friday with the Justice Department that promises to increase the competition for sought-after technology workers. The government had conducted a yearlong investigation into agreements among companies not to poach employees from each other.

"The investigation focused on five agreements by the companies not to make cold calls to employees that each company had placed on a do-not-call list. Each of the pacts, according to the Justice Department filing, involved a pair of companies: Apple and Google, Apple and Adobe, Apple and Pixar, Google and Intel, and Google and Intuit.

"The agreements to curb cold-calling of each others’ workers, the Justice Department complaint said, “diminished competition to the detriment of the affected employees who were likely deprived of competitively important information and access to better job opportunities.”

The job market in computer science

Lance Fortnow, blogging at Computational Complexity, posts what is apparently an Annual Fall Jobs Post about the academic job market in computer science. He notes that applications are being considered earlier this year, but there is also a transition in the career path of new CS theory grads, to include postdocs.

"The CRA is working on setting guidelines for job deadlines to help out with some of the gridlock in the job market. Many of the top departments have already moved their deadlines for full consideration to early December or November. Keep an eye out and remember to apply early this year."

...
 
"A little early to tell but this year will likely be similar to last year: a small number of tenure-track positions in TCS and a large number of postdoc positions. Out of necessity almost everyone does a postdoc now and many people doing a second or third as well.

"Have the theoretical computer science community actually moved to postdoc culture, where people are now expected to do a postdoc (or multiple postdocs) before taking a tenure-track position like physics, chemistry and biology? When did the field make that jump?"

This is a labor market that will be interesting to keep track of. (Will the appointment dates for first jobs continue moving earlier in time--i.e. are we seeing the beginning of unravelling? Or is this just a one time move to try to deal with congestion in clearing the market, so that multiple offers to a few stars don't delay things too late in the year?  And, even if appointment to first jobs moves earlier, will tenure track positions move later, via postdocs?  Stay tuned...)

HT: Mike Ostrovsky

Organ donation legislation in California

Judd Kessler (who you could hire this year) writes about changes in CA law regarding organ donation, including live donation:

On Tuesday, October 5, California Governor Arnold Schwarzenegger ceremonially signed new organ donor legislation. There are two new bills that make a variety of changes to policy for both live and deceased organ donation in California. Here is a summary.


SB 1395 makes two changes. First, it authorizes the creation of an:
"Altruistic Living Donor Registry" where individuals can state their willingness to be a live kidney donor. (The bill allows for the possibility of extending the registry to other organs and tissues in the future.) The living donor registry would make information about potential donors available to facilitate pairwise exchanges and donor chains. According to the bill: "(a) ... The donor registry shall be designed to promote and assist live kidney donations, including donor chains, paired exchanges, and nondirected donations. The registrar shall be responsible for developing methods to increase the number of donors who enroll in the registry. (b) The registrar shall make available to the federally designated organ procurement organizations (OPOs) and transplant centers in California information contained in the registry regarding potential altruistic living donors. This information shall be used to expedite a match between identified organ donors and potential recipients."

Second, SB 1395 changes how the department of motor vehicles asks people whether they would like to register to be an organ and tissue donor upon death (i.e. a deceased donor). Currently the DMV allows potential donors to opt in. The application for a new or renewal driver's license or ID card has space to indicate a willingness to join the registry. Starting July 1, 2011, the donor registration question will require an "active" or "mandated" choice. According to the bill, the application will now: "contain a space for the applicant to enroll in the Donate Life California Organ and Tissue Donor Registry. The application shall include check boxes for an applicant to mark either (A) Yes, add my name to the donor registry or (B) I do not wish to register at this time." In addition, the DMV: "shall inquire verbally of an applicant applying in person ... at a department office as to whether the applicant wishes to enroll in the Donate Life California Organ and Tissue Donor Registry."

In Governor Schwarzenegger's speech at the bill signing he called this change to mandated choice "the next best thing" to an opt out system, where individuals would be deceased organ donors by default. He said an opt out system had been suggested to him by Steve Jobs, who recently received a liver transplant and was also in attendance at the bill signing, but that an opt-out system was not plausible due to constitutional concerns. In the Governor's words: "And we have to give [Steve Jobs] a lot of credit, because he came back, apparently from Europe or from somewhere where he called me and he said that, you know, in Europe, in Spain, they have no waiting list because you can only opt out; that if you don’t opt out then you are automatically on a donor list. So we tried to copy the same thing and we talked about that seven months ago. But our Constitution in the United States is different than the Spanish Constitution, so we could not legally do that. So we did the next best thing."

Another bill generated protections for employees who want to be living organ donors or bone marrow donors. SB 1304 requires private employers to provide paid leave for their employees who are organ donors (up to 30 days) or bone marrow donors (up to 5 days) and prevents private employers from blocking such donations by its employees or punishing them for donating. State employees already had this paid leave.

College admissions--a state of the union interview

The Chronicle of Higher Education reports an interview with the departing head of the National Association for College Admissions Counseling (NACAC): Admission Group's Departing Leader Takes Stock

"Q. Tell me about one thing that you think is broken in the profession.

A. The number of ways to apply has grown. There’s been an increase in the number of programs under the banner of early decision or early action. There’s the increasing use of “snap apps,” which make it easy to apply. It’s hard for many of us who are long-term professionals to understand all the different ways to apply, and I think that it’s worse for kids and parents. This process should be relatively transparent, though it can’t be totally transparent.

Q. What’s good about college admissions today that wasn’t so good a decade ago?

A. Certainly there’s more information out there about college admissions. When I first started, people had no idea what college admissions was or what it really did. Now there’s far more info out there that’s helpful. To sort through all that information and figure out what’s good is the challenge. There’s far more attention paid to the process.

Q. In some ways, the national dialogue about college admissions has helped demystify the process. But are some of today’s enrollment-management tactics having the opposite effect?

A. Yes. Some of it has been demystified, but some of it has been replaced by other mysteries. There are two extremes. There are a huge number of kids who grow up in good homes where there isn’t a history of going to college. They don’t have the basic understanding that they have to have. Then there are other parents who are obsessed with admissions to certain institutions, and this leads to all kinds of mythology, or as I like to call them, suburban legends. Our challenge is to reach both of those populations—the ones that really need information for access that can change their lives, and those who are so obsessed about getting into a particular college."

Principal agent problems, where the agent is a surgeon and the principal is a patient

Pauline Chen writes in the NY Times about The Surgeon’s Pact With the Patient
"[The] belief — that surgeons can be both Dr. Jekyll and Mr. Hyde when it comes to the doctor-patient relationship — has been embraced for generations by more than a few nonsurgical doctors, nurses and patients. Heroic in their devotion to patients when they are at their best, surgeons inexplicably seem to transform when they are at their worst. That worst usually comes on the heels of a high-risk operation and a complicated and protracted postoperative course. The nurses, other doctors and sometimes even the patient and family request palliation only; in response, the surgeon often stalls, hesitates or simply refuses.

"Since the late 1970s, ethicists and social scientists have tried explain what they viewed as surgeons’ paradoxical behavior with postoperative patients. One of the earliest researchers attributed to self-protection the surgical imperative to “do everything possible.” Inevitably, this medical sociologist reasoned, all surgeons commit a technical error over the course of their careers. By doing everything possible “for the patient,” surgeons protected themselves against the emotional distress of failure. The rationale behind this common-sense theory was straightforward: At least I did all that I could possibly do.
...
"A study* published this year offers an interesting possible answer...
"In interview after interview, the surgeons referred to a negotiation and agreement — what the researchers called “surgical buy-in” — that occurred during the consent process, long before these doctors and their patients ever entered the operating room. The surgeons believed that patients not only consented to the operation itself but also committed themselves to any care after the operation necessary for successful outcomes. They talked about the operation and postoperative care as being a “package deal” and about a tacit “two-way agreement” that included even well-articulated and well-defined numbers of postoperative days. ...
“Surgeons don’t want to invest themselves in a relationship and a technical tour de force, then have to walk away.”


*Schwarze, Margaret L. MD, MPP; Bradley, Ciaran T. MD, MA; Brasel, Karen J. MD, MPH, "Surgical "buy-in": The contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy," Critical Care Medicine: March 2010 - Volume 38 - Issue 3 - pp 843-848

The wholesale market for art

We often think of the art market as essentially retail--each artwork is unique--but that's because we aren't art buyers for hotels, in which every room needs a painting or a print or two.

Hong Kong: Art in Big Batches

"Our first two appointments in Hong Kong were separate meetings with art consultants, Sandra Walters at Sandra Walters Art Consultancy and Nicole Jelicich at Enjay Art Consultancy. They collaborate with designers and property owners in providing art for hotels and corporate clients. They work in a volume unheard of in any gallery. Think thousands and tens of thousands of artworks. A new hotel—and there are hundreds under construction in China now—needs thousands of works for the rooms and the public areas. Both consultants have provided work for Ritz Carltons, Intercontinental Hotels, Four Seasons, Morgan Stanley and hundreds of other clients."