Here's SMBC on price discovery:
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Friday, December 29, 2023
Price discovery
Thursday, December 28, 2023
Limitations of harm reduction: will Oregon recriminalize drug use?
The NYT has the story:
To Revive Portland, Officials Seek to Recriminalize Public Drug Use. State and local leaders are proposing to roll back part of the nation’s pioneering drug decriminalization law and step up police enforcement. by Mike Baker
"After years of rising overdoses and an exodus of business from central Portland, Oregon Gov. Tina Kotek said on Monday that state and city officials are proposing to roll back a portion of the nation’s most wide-ranging drug decriminalization law in a bid to revive the troubled city.
"Under the plan brokered by Gov. Kotek, a Democrat, state lawmakers would be asked to consider a ban on public drug use and police would be given greater resources to deter the distribution of drugs. Ms. Kotek said officials hoped to restore a sense of safety for both visitors and workers in the city’s beleaguered urban core, which has seen an exodus of key retail outlets, including REI, an institution in the Pacific Northwest.
“When it comes to open-air drug use, nobody wants to see that,” Ms. Kotek said in an interview. “We need different tools to send the message that that is not acceptable behavior.”
...
"Oregon voters in 2020 approved the nation’s first law decriminalizing possession of small amounts of hard drugs, including fentanyl, heroin and methamphetamines. The ballot measure sought to end the use of jail as a punishment for drug users and instead treat addiction as a health issue. The effort was to be joined with major new investments in drug treatment, but those new systems have been slow to develop.
...
"Last month, Seattle implemented a new law that prohibits possession of drugs and public use.
...
"Ms. Kotek’s task force does not have the power to immediately ban public drug use, but the panel called for the Legislature to take up the issue in the coming session along with changes that could reduce barriers to prosecuting those who deliver drugs. Lawmakers have already been discussing potential changes to the decriminalization law."
Wednesday, December 27, 2023
Medical aid in dying considered in Britain, and evolving in Canada
The Guardian has the story about England and Wales, and the NYT has a story on Canada.
Here's the Guardian:
Senior Conservative and Labour figures said they would back changes to legislation on the issue in England and Wales. by Michael Savage
"Two former health secretaries on Saturday night became the latest senior figures to join the growing demands for a new attempt to legalise assisted dying, as a prominent Tory said he is willing to champion the legislation in parliament.
"With both former Conservative minister Stephen Dorrell and Labour’s Alan Milburn stating they back changing the law in England and Wales, the Observer understands that a Labour government would make time and expert advice available for an assisted dying bill should MPs back it in a free House of Commons vote.
"The news comes as campaigners hope to hold a new vote on the issue early in the next parliament, almost 10 years after the last attempt to alter the law. Kit Malthouse, a former cabinet minister, said he was “absolutely” prepared to front a new private member’s bill on the matter.
...
"Doing nothing is not a passive choice. Leaving the law as it is will consign many thousands of people who may want a different end to a horrible death.”
...
"Milburn, who served as health secretary under Tony Blair, said: “When people today expect to have control over so many aspects of their lives, it feels paradoxical that we are denied the same about how we want to die. It’s perhaps the most important decision any of us can make. To deny that choice feels increasingly anachronistic. The time has come for a free vote in parliament on the issue.”
...
"However, other senior figures such as Michael Gove have expressed doubts about any change.
"Critics of an assisted dying law have also warned about the difficulties in defining who is eligible, the danger of people being pressured into a decision and subsequent attempts to widen the law.
"Alistair Thompson, a spokesperson for Care Not Killing, a group that opposes assisted dying, pointed to polling that suggested public support for assisted dying may have actually fallen since the mid-1990s.
"He also raised questions about the effects of the drugs used for the process in Oregon and said the law would be widened. “As we saw in the Netherlands and Belgium, limits on who qualifies for an assisted death have been swept away,” he said.
“At a time when we have seen how fragile our healthcare system is, how underfunding puts pressure on services, when up to one in four Britons who would benefit from palliative care aren’t receiving it, and when our nation’s hospices are facing a massive shortfall in their income, I would suggest this should be the focus of attention, rather than discussing again this dangerous and ideological policy.”
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And here's the NYT on the controversy in Canada:
Death by Doctor May Soon Be Available for the Mentally Ill in Canada. The country is divided over a law that would allow patients suffering from mental health illnesses to apply for assisted death. By Vjosa Isai Dec. 27, 2023
"Canada already has one of the most liberal assisted death laws in the world, offering the practice to terminally and chronically ill Canadians.
"But under a law scheduled to take effect in March assisted dying would also become accessible to people whose only medical condition is mental illness, making Canada one of about half a dozen countries to permit the procedure for that category of people.
...
"There is still uncertainty and debate over whether assisted death will become available to the mentally ill early next year as scheduled. Amid concerns over how to implement it, Parliament has delayed putting it into place for the past three years and could delay it again."
Tuesday, December 26, 2023
Market Design in El Mercurio--Chile's oldest newspaper
Last Tuesday, in Chile I was interviewed by Eduardo Olivares, the editor for Economics and Business of El Mercurio, which published the interview yesterday. We talked for an hour about market design generally, about how markets work when they're working well or working badly, and we spoke about school choice (where Chile is a leader) and transplantation (where it is not). The interview is behind a paywall, but below are some extracts (retranslated back into English via Google Translate).
On markets generally:
—Many people ask that “markets be free,” as has recently happened in Argentina. Should they be free?
“That's a complicated question. Markets should be free to function well, but they need conditions that allow them to function well. Having a free market does not necessarily mean a market without rules. A wheel can spin freely because it has a well-greased axle and bearings. A wheel by itself cannot turn very well, and the same goes for the market.”
—Who puts the oil in the wheel gears?
“That's the job of market design. Part of what makes markets work well are good market rules. The government has a role in regulating markets, concerning property rights and things like that. But on another level, entrepreneurs do things. Here in Santiago I [can]... call an Uber using the same app and rules I use in California. Uber is a marketplace for passengers and drivers. The rules can be made by both private organizations and the government.”
On prices:
—Do prices matter?
"A lot. “Prices are important to help allocate scarce resources, but also to make them less scarce.”
...
—When do they not matter?
“Let me start with when they matter a lot: in commodity markets. If you want to buy commodities, price is really the only thing that's happening. But when 'El Mercurio' wants to hire journalists, it doesn't limit itself to offering a salary: it wants it to be a good job, with special reporters. Price is important, but in other markets other things are also important. When you get a new job, the first question your friends ask you is not what the salary is, but who you work for.”
On school choice:
“Most markets are not commodity markets... In some markets we don't like prices to work at all. One of the places where Chile is a leader in market design is school choice: how people are assigned to schools and Chile has done a lot of work on this, although mainly for public schools.”
—What do you know about this system in Chile?
“Not long ago, before there was centralized and widespread school choice in Chile, there were the usual problems with decentralized school choice; That is, parents had to get up early to get in line, and they had a difficult process to register their children.”
—The new system has been criticized. Some claim it caused more people to choose the private system over the public school system. Isn't it similar to what is happening in New York, for example?
“There is something to that. In New York and Boston we also have a system that we call charter schools: free access schools, but organized by private entities, even if they are municipal schools. And they also have different standards. School choice is important, but it does not solve the problems of poverty or income inequality. Now, one of the reasons we have school choice in the United States and perhaps also in Chile is because we think that, otherwise, there is a danger that the poor will be condemned to send their children to poor schools. .
—Has there been any successful case in which parents can honestly rank the order of preference for the school they want their children to go to?
“In Chile, procedures are used that [make it] what game theorists call a dominant strategy to express true preferences. The [remaining] problem is not in creating systems that make it safe to express preferences, but in distributing the information so that people can form preferences sensibly. In the United States, the hardest families to reach are those who don't speak English at home, so it's sometimes difficult to communicate with them. And different families have different feelings about what kind of schools their children should attend.”
“The benefits of school choice come from the fact that some schools may be high quality for some children but not for others, so we would like children to attend the schools that are best quality for them.”
On kidneys:
—You are famous for the proposal that allowed the “kidney exchange.” Years after the first experience, what do you see now in this type of market?
“Kidney exchange is working quite well in the US, but it works especially well for patients who are not too difficult to match. Even in the US, a fairly large country, we have patients who are so difficult to match that we have trouble finding a kidney for them.”
—And in other countries?
“Smaller countries, with 20 million inhabitants, like Chile, would benefit if we could make national borders not so important. When we look at transplants per million inhabitants, Chile is in the middle of the world. But since it is a small country, when the total number of transplants performed is analyzed, Chile has very few. Kidneys are obtained from both deceased and living donors. In Chile, as in much of the world, the majority of transplants come from deceased donors. Kidney exchange would allow more transplants to come from living donors ... “Twenty million is not enough, so it would be very good to see in South America an exchange of kidneys that can cross between countries, which is not so easy to do.”
Equality of exchange and the role of perceptions
“One of the things that worries people when talking about transplants is that [they think it might be] a medical process that exploits the poor. Of course, the thing about kidney exchange is that each pair of people gives one kidney and receives one kidney. It is very egalitarian. I think kidney exchange is a good place to combat this notion that transplantation is like trafficking,” he notes.
—Notions, perceptions are very important. Many people think of “exchange” as the exchange of securities in the stock market.
“That's right, but not every exchange involves money. One of the discussions about money in the world that is taking place in the European Union at the moment is about payment to blood plasma donors. In the EU, only Germany, Austria, the Czech Republic and Hungary pay blood plasma donors. And those are the only EU countries that have as much blood plasma as they need. The others have to import everything, and they do it from the United States. The United States is the Saudi Arabia of blood plasma (…) The World Health Organization says that plasma must be obtained in each country, and from unpaid donors. You have to be self-sufficient... an economist finds that a little funny. Blood is a matter of life and death. “When there is a pandemic, we do not tell countries that they must be self-sufficient [in vaccines].”
—When we talk about these exchanges of blood plasma and kidneys, school choice systems, we are talking about the same idea: coincident or paired markets. But the concept of the market has been so questioned, especially by some political groups, for so long...
"It's true. Now, kidney exchange is special because money doesn't change hands. Money changes hands to get medical care, you have to pay doctors, nurses and hospitals. But we are not talking about buying kidneys from donors, but rather that, at the patient level, each pair receives a kidney and donates a kidney. It is radically egalitarian. Many people who think about markets may not think of it as a market, but I think that's a mistake. Many markets are not just about money… we would worry much less about markets if income and wealth inequality did not exist. “What worries us about markets is that some people are poor and some people are rich, and markets seem like a way to give the rich an advantage.”
“There is no doubt that being rich is better than being poor. The real question is what do we do to alleviate poverty. Making it invisible is not the same as alleviating it. One of the reasons I think many countries don't allow blood and plasma donors to be paid is because they don't like the way that looks. It reminds them that some people would like to get some money and would donate blood for it.”
Apparently, according to the caption, I'm "affable and smiling" (although not in this picture:)
I was in Chile to participate in what turned out to be a wonderful workshop on market design at the University of Chile, organized by Itai Ashlagi, José Correa, and Juan Escobar.
Some related recent posts:
Saturday, December 23, 2023
Market design: some press accounts in Chile
Wednesday, December 20, 2023
Update (Dec. 27): Here's an account of my closing public talk from the U. Chile's Center for Mathematical Modeling, one of the hosts of the market design workshop.
And here's a picture at the close, including some of those mentioned above: At my far left in the picture is José Correa, who in addition to his other roles is Vice Rector for Information Technologies. Next to him is Alejandra Mizala, prorrector (provost) of the university. Next to her (immediately to my left) is Rector of the University of Chile, Rosa Devés, and immediately to my right is market designer and director of the MIPP Millennium Institute, Juan Escobar. Next to him is Héctor Ramírez, director of the Center for Mathematical Modeling. And next to him (at my far right) is professor Rafael Epstein who (along with Correa, Escobar, and his daughter Natalie Epstein) has been involved with school choice in Chile, among other things.
Monday, December 25, 2023
Auctioning fresh fish, quickly. by Hafalir, Kesten, Sherstyuk and Tao
Here's an auction for when leisurely price discovery is costly.
When Speed is of Essence: Perishable Goods Auctions by Isa Hafalir, , Onur Kesten, , Katerina Sherstyuk, , Cong Tao. December 2023
Abstract: We study a remarkable auction used in several fish markets around the world, notably in Honolulu and Sydney, whereby high-quality fish are sold fast through a hybrid auction that combines the Dutch and the English formats in one auction. Speedy sales are of essence for these perishable goods. Our theoretical model incorporating “time costs” demonstrates that such Honolulu-Sydney auction is preferred by the auctioneer over the Dutch auction when there are few bidders or when bidders have high time costs. Our laboratory experiments confirm that with a small number of bidders, Honolulu-Sydney auctions are significantly faster than Dutch auctions. Bidders overbid in Dutch, benefiting the auctioneer, but bidding approaches risk-neutral predictions as time costs increase. Bidders fare better in the Honolulu-Sydney format compared to Dutch across all treatments. We further observe bidder attempts to tacitly lower prices in Honolulu-Sydney auctions, substantiating existing concerns about pricing in some fish markets.
From the introduction:
"We explore a seemingly peculiar and largely under-studied dynamic auction format employed in several perishable goods markets around the world, such as in Honolulu and Sydney fish markets. In this auction, the auctioneer sets a starting price that is neither as low as in an English auction nor as high as in a Dutch, but at a middle ground, allowing bidders to bid at the onset (either by raising their hands during a verbal Honolulu auction or by clicking a button during an automated Sydney clock auction). If at least one bidder bids, the auction proceeds as an English (ascending price) auction. If there is no initial interest, the price begins to drop, as in a Dutch (descending price) auction. However, once a bidder bids, other bidders are allowed to counter-bid, potentially reverting the auction to an English auction. Although this auction format has been documented (Feldman, 2006) and is apparently employed in a number of fish markets in France and Denmark (Guillotreau and Jim´enez-Toribio, 2006; Laks´a and Marszalec, 2020) as well as in Honolulu and Sydney,2 little is understood about the reasons for its emergence and its advantages over more traditional descending-only Dutch auction that is also commonly used for perishable goods."
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Update:
Joshua Gans points me to this related paper in Management Science
Channel Auctions
Eduardo M. Azevedo , David M. Pennock, Bo Waggoner , E. Glen Weyl
Published Online:4 Mar 2020 https://doi.org/10.1287/mnsc.2019.3487
Abstract
Standard auction formats feature either an upper bound on the equilibrium price that descends over time (as in the Dutch auction) or a lower bound on the equilibrium price that ascends over time (as in the English auction). We show that in some settings with costly information acquisition, auctions featuring both (viz., a narrowing channel of prices) outperform the standard formats. This Channel auction preserves some of benefits of both the English (truthful revelation) and Dutch (security for necessary information acquisition) auctions. Natural applications include housing, online auction sites like eBay, recording transactions on blockchains, and spectrum rights.
This paper was accepted by Joshua Gans, business strategy.
Sunday, December 24, 2023
Kidney exchange as an innovation in organization
Here's a two minute video summary of an address I gave in 2014, just noticed now, which seems still pretty up to date. A lot of progress has been made through new ways of organizing transplants, and there's plenty of organizational innovation still needed.
State-of-the-Art Address - World Transplant Congress 2014
Saturday, December 23, 2023
Market design: some press accounts in Chile
The recent market design workshop in Santiago was pretty thrilling, and I was asked to give some interviews and a public talk, which have now generated some press about market design.
Here's a post-talk story:
Google translate does a good job, and the piece includes a video of my talk (starting at around minute 20:45 after a long wait between the start of live streaming and the actual start of the talk...). You can hear the talk in Spanish (only), the acute listener will notice that it's given in a woman's voice...)
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Another article also has some pictures of the audience, and as this was the last act of the market design workshop, readers of this blog may recognize some people in one of the photos.
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Some earlier stories were published after I was interviewed during the workshop also in Spanish, also accessible by G translate):
“An international collaboration in South America for kidney transplantation would be useful”
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After the workshop we explored Chile's Atacama with some colleagues including Itai Ashlagi and Ravi Jagadeesan:
Friday, December 22, 2023
Decline and decay of nudges
Here's the latest paper to suggest that small "nudges" can have much less of a lasting effect than was initially thought.
The Semblance of Success in Nudging Consumers to Pay Down Credit Card Debt by Benedict Guttman-Kenney, Paul D. Adams, Stefan Hunt, David Laibson, Neil Stewart & Jesse Leary, NBER WORKING PAPER 31926 DOI 10.3386/w31926 December 2023
Abstract: We run a field experiment and a survey experiment to study an active choice nudge. Our nudge is designed to reduce the anchoring of credit card payments to the minimum payment. In our field experiment, the nudge reduces enrollment in Autopaying the minimum from 36.9% to 9.6%. However, the nudge does not reduce credit card debt after seven payment cycles. Nudged cardholders tend to choose Autopay amounts that are only slightly higher than the minimum payment. The nudge lowers Autopay enrollment resulting in increasing missed payments. Finally, the nudge reduces manual payments by cardholders enrolled in Autopay.
Thursday, December 21, 2023
Cash for kidneys report in the Telegraph
The Telegraph has this story, by Samuel Lovett, Nandi Theint, and Nicola Smith. For some reason I can't copy the headline, but the URL is pretty informative: https://www.telegraph.co.uk/global-health/science-and-disease/kidney-organ-trafficking-scandal-private-healthcare-india-myanmar/ 3 December 2023 • 9:00am
"One of the world’s biggest private hospital groups is embroiled in a ‘cash for kidneys’ racket in which impoverished people from Myanmar are being enticed to sell their organs for profit.
"India’s Apollo Hospitals, a multi-billion dollar company with facilities across Asia, boasts that it conducts more than 1,200 transplants a year, with wealthy patients arriving for operations from all over the world, including the UK.
"Paying for organs is illegal in India, as it is across most of the world, but a Telegraph investigation has revealed that desperate young villagers from Myanmar are being flown to Apollo’s prestigious Delhi hospital and paid to donate their kidneys to rich Burmese patients.
“It’s big business,” one of the racket’s ‘agents’ told an undercover Telegraph reporter. Those involved “work together to get around the obstacles between the two governments,” she added. The hospital “asks the official questions. And on this side they tell the official lies.”
"The scam involves the elaborate forging of identity documents and staging of ‘family’ photographs to present donors as the relatives of would-be patients. Under Indian and Burmese laws, a patient cannot receive an organ donation from a stranger in normal circumstances.
"Apollo Hospitals said it was “completely shocked” by the Telegraph’s findings and would launch an internal investigation. “Any suggestion of our wilful complicity or implicit sanctioning of any illegal activities relating to organ transplants is wholly denied,” it added.
Wednesday, December 20, 2023
Public lecture today at the Casa Central de la Universidad de Chile:“Quién obtiene qué y por qué: La nueva economía del diseño de mercados”
Alvin Roth, Premio Nobel de Economía, dictará charla magistral en Casa Central de la Universidad de Chile [Alvin Roth, Nobel Prize winner in Economics, will give a keynote talk at the Central House of the University of Chile]
“Who gets what and why: The new economics of market design” is the name of the talk that Alvin Roth, 2012 Nobel Prize winner in Economics, will give on Wednesday, December 20, at 12:00 p.m., in the Hall of Honor of the Central House of the University of Chile.
The activity is organized by the Millennium Institute for Research on Market Imperfections and Public Policies (MIPP), the Center for Mathematical Modeling (CMM) of the University of Chile and the Ring Project “Information and Computing in Market Design” and in it Roth will speak about his renowned book in which he explains about the frequent “matching” markets, in which money is not a determining factor.
The talk will be in English and will have simultaneous translation into Spanish. [La charla será en inglés y contará con traducción simultánea al español.]
The talk will be in the Salón de Honor de Casa Central, which sounds like it will be an impressive venue.
Tuesday, December 19, 2023
Experimental economics, in Economics textbooks
Here's a paper surveying introductory economics textbooks for statements (or lack of statements) about experimental economics, over fifty years. (That's just about the period in which I've been doing experiments, since starting a long collaboration with the late Keith Murnighan when we were both new assistant professors at the U of I in 1974, although in fact the article covers 1970-2019.) Note from the figure below that textbooks lag not just the progress of science, but even its widespread recognition: Kahneman and Smith won their Nobel for experiments in 2002.
Changing perceptions about experimentation in economics: 50 years of evidence from principles textbooks, by Saileshsingh Gunessee and Tom Lane, Journal of Behavioral and Experimental Economics, Volume 107, December 2023.
"Abstract: Traditionally, economists often argued experiments play little or no useful role in our science. This paper employs a novel approach to track the historical evolution of this doctrine from 1970 to 2019, by constructing a dataset of 278 introductory economics textbooks. Quantitative and qualitative analysis shows that anti-experimental views were dominant and largely unchanged until 2000, but there has since been a trend towards textbooks making positive statements about experimentation. However, remarks that economic experiments are impossible have been (almost) eliminated only in the last decade, evidencing a sluggish change in perceptions. Supplementary interviews with key textbook authors confirm the historical trend of increased enthusiasm towards experiments, and suggest they are now accepted within the economic mainstream. Our findings hold important implications for how the empirical methodology of economics is understood by practitioners and students."
Based on the introductory chapter of each textbook, they "classified the book's position on economic experiments into one of five categories:
"1. The book's introduction states that doing experiments in economics is impossible, or that economic experiments are never done (hereafter, Impossible/Not Done).
"2. The book's introduction states that doing experiments in economics is difficult, or that economic experiments are rare (hereafter, Difficult/Rare).
"3. The book's introduction states that experiments are done in economics, or refers to economic experiments without mentioning their being rare or any difficulties involved in conducting them (hereafter, Done).
"4. The book's introduction does not mention experimentation in economics (hereafter, No Mention).9
"5. The book does not contain an introductory section (hereafter, No Intro)."
Monday, December 18, 2023
Algorithmic Mechanism Design With Investment, by Akbarpour, Kominers, Li, Li, and Milgrom,
Mechanisms that are computationally complex may require approximation in implementation, which can change the incentive properties of the exact mechanism. But progress can be made...
Algorithmic Mechanism Design With Investment, by Mohammad Akbarpour, Scott Duke Kominers, Kevin Michael Li, Shengwu Li, Paul Milgrom, Econometrica, First published: 07 December 2023, https://doi.org/10.3982/ECTA19559
Abstract: We study the investment incentives created by truthful mechanisms that allocate resources using approximation algorithms. Some approximation algorithms guarantee nearly 100% of the optimal welfare in the allocation problem but guarantee nothing when accounting for investment incentives. An algorithm's allocative and investment guarantees coincide if and only if its confirming negative externalities are sufficiently small. We introduce fast approximation algorithms for the knapsack problem that have no confirming negative externalities and guarantees close to 100% for both allocation and investment.
From the introduction:
"Approximation algorithms can be combined with pricing rules to produce truthful mechanisms, provided that the algorithm is “monotone” (Lavi, Mu'Alem, and Nisan (2003)). In this paper, we study the ex ante investment incentives created by such mechanisms.
"Suppose that one bidder can make a costly investment to change its value before participating in a truthful mechanism. As an initial result, we show that all truthful mechanisms using the same allocation algorithm entail the same investment incentives, so we can regard the investment incentives as properties of the algorithm itself.
"If an allocation algorithm exactly maximizes total welfare, then the corresponding truthful mechanism is a Vickrey–Clarke–Groves (VCG) mechanism. For VCG mechanisms, any single bidder's investment is profitable if and only it improves total welfare (Rogerson (1992)). In this respect, the VCG mechanisms are essentially unique. We find that a truthful mechanism aligns a bidder's investment incentives with welfare maximization only if there is some set of allocations such that, for generic valuation profiles, its allocation algorithm exactly maximizes welfare over that set. Many practical approximation algorithms do not have this structure and, as a result, lack efficient investment incentives.
"One might also hope that if an allocation algorithm approximately maximizes total welfare, then it generates approximately efficient investment incentives—but we show to the contrary that arbitrarily good approximations can have arbitrarily bad investment guarantees. To make this statement precise, we evaluate an algorithm's performance on any particular instance by the welfare it achieves divided by the maximum welfare. We refer to the worst-case ratio over all instances when values are exogenous as the allocative guarantee, and the worst-case ratio when one bidder's ex ante investment endogenously determines its value as the investment guarantee.1 (The investment guarantee measures welfare net of investment costs.)
"Because the investment guarantee is a worst case over instances and over investment technologies, it is never more than the allocative guarantee. We characterize the algorithms for which the allocative and investment guarantees are equal, and apply those results to evaluate and improve upon standard approximation algorithms."
Sunday, December 17, 2023
Market Design Workshop 18 - 20 December 2023 Santiago, Chile
Market Design Workshop 18 - 20 December 2023 Santiago, Chile
Here is the list of participants, and the program.
I'll be speaking on Monday and then again on Wednesday.
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Unrest and then Covid delayed this conference:
Tuesday, December 17, 2019
Market design workshop in Santiago, SUSPENDED
Politics can certainly get in the way of economics, even academic economics, as it turns out. The organizers of a conference on matching and market design that I had planned to attend prudently decided several weeks ago to postpone it, in light of the street demonstrations taking place in Chile.
Saturday, December 16, 2023
Ben Edelman on Microsoft AI tools
Ben Edelman, the Chief Economist for Web Experiences, Strategy, and Policy at Microsoft, has some new papers on his blog, about Microsoft AI tools.
Friday, December 15, 2023
Who Shall Live? (3rd edition) by Victor R. Fuchs and Karen Eggleston
Shortly before he passed away in September at the age of 99, Vic Fuchs finished the third edition of his book Who Shall Live?, now with a coauthor, Karen Eggleston.
It just came out now, in time for his 100th birthday next month.
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Sunday, September 17, 2023
Thursday, December 14, 2023
Managing blood supplies by using blood more judiciously
Medpage has the story:
"Given the ongoing blood shortages that we are facing, which has been called a "crisis" in the blood industry, patient blood management looks like a giant step towards the triple aim in medicine: improving the patient experience, clinical outcomes, and cost."
Doing More With Less Blood — Blood management programs can save money and resources by Steven Frank, MD
"At Johns Hopkins, since our patient blood management efforts began in 2012, we launched two distinct programs running side by side synergistically. The first program aims to reduce avoidable transfusions for the roughly 99% of patients who accept blood, while the second program provides optimal care for the remaining 1% of patients who wish to avoid transfusion for personal or religious reasons, the vast majority of whom are Jehovah's Witnesses.
...
"treating preoperative anemia with $4 worth of iron tablets to avoid using $400 worth of blood just makes sense. Wouldn't you rather come to surgery with your own red blood cells, rather than needing a transfusion with someone else's?
""Keeping the blood in the patient" is the other major concept behind patient blood management. Simple things can reduce bleeding, such as keeping patients warm during surgery; lowering the blood pressure (controlled hypotension); tranexamic acid (an inexpensive medication that reduces bleeding by about 30%opens in a new tab or window); Cell Savers to return surgical blood loss to the patient; and using smaller phlebotomy tubes to send lab tests. All of these strategies can be bundled together to achieve this goal.
"After a decade of experience, we crunched the numbers to assess our return on investment (ROI) with our comprehensive patient blood management program, while also looking at patient outcomes. The bottom line was a 7.5-fold ROI, meaning that for every dollar spent on patient blood management, over $7 were either saved or generated in return. This calculation is based on a $3 million annual reduction in blood acquisition cost, along with a $5 million annual net margin on revenue generated by caring for patients under the Center for Bloodless Medicine and Surgery.
"At the same time, clinical outcomes were either the same or better while giving less blood. Heart attack, stroke, thrombotic events, and respiratory and kidney problems were unchanged, while the incidence of hospital-acquired infection decreased. This latter finding is very believable based on high-level evidence (meta-analysis of 18 randomized trials) that transfusions predispose patients to infections. Furthermore, by avoiding transfusions for those who do not need them, we make more blood available for those who really do -- like trauma victims and cancer patients.
"Given the ongoing blood shortages that we are facing, which has been called a "crisis" in the blood industry, patient blood management looks like a giant step towards the triple aim in medicine: improving the patient experience, clinical outcomes, and cost."
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See, earlier in the NEJM:
by Harvey G. Klein, M.D., J. Chris Hrouda, B.H.S., and Jay S. Epstein, M.D., October 12, 2017
N Engl J Med 2017; 377:1485-1488
DOI: 10.1056/NEJMsb1706496
Wednesday, December 13, 2023
Black market monkeys for medical research
Monkeys used in medical research are supposed to come from carefully bred laboratory colonies, but the rising price has led to black markets, which is bad for both monkeys and for medical researchers. (And monkeys are useful for medical research because of their relatively close relation to humans, which makes for difficult conversations regardless of their source...)
The Guardian has the story:
$20,000 monkeys: inside the booming illicit trade for lab animals by Phoebe Weston
"An international shortage of lab monkeys has driven up prices, incentivising a booming illicit trade. The problem risks undermining research, creating new pandemics, and fuelling wildlife trafficking. As the trade expands, a once-thriving species is now on the edge: in 2022, it was added to the IUCN list of endangered species. Some animal rights activists are calling to end the trade altogether.
"Long-tailed macaques are the most heavily traded primate species in the world, according to a paper published in September, and much of this is for laboratory research. The US National Association for Biological Research says non-human primates remain a critical resource for research, with about 70,000 monkeys imported a year to study infectious diseases, the brain and the creation of new drugs. Difficulty getting monkeys is compromising important research, Sacha says. Before the pandemic he was paying between $2,000 (£1,600) and $5,000 for an animal. Now, it’s about $20,000. “For a couple of years during lockdown it was near impossible to get them,” he says.
"He is not alone. Almost two-thirds of researchers struggled to find monkeys in 2021, according to a report from the US National Academies of Sciences, Engineering, and Medicine, which found that the supply of monkeys for research is at crisis point. According to an article in Science, the report is the “strongest government statement yet on the precarious state of monkey research”. A similar picture is coming from Europe, where a shortage of monkeys has resulted in some research being abandoned.
"Long-tailed macaques (the monkey most commonly used in medical research) are protected under international trade law and special permits are required to import the animals into the US.
"Laboratories need pathogen-free primates that are in good condition and so do not want monkeys that have been wild-caught. With prices so high, however, traffickers are incentivised to catch them in the wild and launder them in via established breeding colonies.
"For decades, China was the largest supplier, but it banned the wild animal trade in 2020 in light of the Covid pandemic. Demand for monkeys increased significantly in the following years, but supply did not. Cambodia has since significantly increased exports to plug the gap and tap into this increasingly lucrative market.
...
"Animal rights campaigners want the US government to end the “cruel trade”, saying it poses a significant threat to public health. The National Academies report says investing in non-animal “organ on a chip” technology could reduce overall demand.
"It also recommended that the US expand its domestic breeding facilities – which it can then regulate. Sacha says: “We shouldn’t be reliant on external countries for these animals that are really critical to our ability to test new therapeutics and vaccines and medicines.”
Tuesday, December 12, 2023
Waiting for HRSA's request for bids to reorganize deceased organ recovery and allocation
Frank McCormick's invaluable email newsletter includes this Bloomberg article on potential bidders who may emerge when HRSA puts out bids to break up the functions that UNOS presently aggregates for managing the deceased donor organ system. I'm still not at all sure what bids will be forthcoming, especially since the planned request for bids is still quite opaque.
Big Tech, Startups Look to Revamp Troubled Organ Donation System by Tony Pugh
"Later this fall, the Health Resources and Services Administration plans to solicit bids for the first round of contracts on the OPTN modernization project. The competition will usher in a years-long effort to both stand up new digital technology that better serves the 100,000-plus people on the organ waiting list, while increasing accountability, equity, and efficiency in the way organs are recovered, matched, and transplanted."
Often when I see a short quote broken up into even smaller pieces I worry that it might not accurately represent what was actually said, but this quote is spot on:
“When I
look at” the current software used to match organs with possible recipients and
to send accept-or-refuse offers to transplant surgeons, “it reminds me of the
1980s,” said Nobel Prize-winning Stanford
University economist Alvin E. Roth, who studies how kidneys are matched with
suitable candidates.
Monday, December 11, 2023
Market Design and Maintenance (new NBER working paper, from a conference)
This paper began as a presentation at the NBER conference on New Directions in Market Design, in the Spring of 2023
Market Design and Maintenance by Alvin E. Roth. NBER WORKING PAPER 31947DOI 10.3386/w31947, ISSUE DATE December 2023
Abstract: Because no marketplace operates in isolation from the larger world, marketplace designs may need to adapt to changes in the larger environments. I discuss such changes in connection with the labor markets for new doctors, new Ph.D. economists, and for kidney exchange transplants. But while practical market design presents a host of challenges, it also offers many rewards. Among the rewards to market designers themselves is the opportunity to become intimately familiar with markets that shape the lives and careers of their participants.
************
There will eventually be a conference volume published by U. Chicago Press, and some of the papers are already online, and slides and videos from the conference are here.
Sunday, December 10, 2023
Signaling for residency programs in dermatology, general surgery, and internal medicine
We're starting to see some data from signaling for residency applications. This paper observes that programs are more likely to interview candidates who send them a signal. (Economists will worry that this reflects which programs are signaled and not just the effect of a signal...) These three specialties have relatively few signals, more like economics than like Orthopedic Surgery (which has 30 signals). And the table indicates that more interviews are offered than signals received, so that's another difference from Ortho...)
Rosenblatt, Adena E., Jennifer LaFemina, Lonika Sood, Jennifer Choi, Jennifer Serfin, Bobby Naemi, and Dana Dunleavy. "Impact of Preference Signals on Interview Selection Across Multiple Residency Specialties and Programs." Journal of Graduate Medical Education 15, no. 6 (2023): 702.
"Abstract
"Background Program signaling is an innovation that allows applicants to express interest in specific programs while providing programs the opportunity to review genuinely interested applicants during the interview selection process.
"Objective To examine the influence of program signaling on “selected to interview” status across specialties in the 2022 Electronic Residency Application Service (ERAS) application cycle.
"Methods Dermatology, general surgery-categorical (GS), and internal medicine-categorical (IM-C) programs that participated in the signaling section of the 2022 supplemental ERAS application (SuppApp) were included. Applicant signal data was collected from SuppApp, applicant self-reported characteristics collected from the MyERAS Application for Residency Applicants, and 2020 program characteristics collected from the 2020 GME Track Survey. Applicant probability of being selected for interview was analyzed using logistic regression, determined by the selected to interview status in the ERAS Program Director’s WorkStation.
"Results Dermatology had a 62% participation rate (73 of 117 programs), GS a 75% participation rate (174 of 232 programs), and IM-C an 86% participation rate (309 of 361 programs). In all 3 specialties examined, on average, signaling increased the likelihood of being selected to interview compared to applicants who did not signal. This finding held across gender and underrepresented in medicine (UIM) groups in all 3 specialties, across applicant types (MDs, DOs, international medical graduates) for GS and IM-C, and after controlling for United States Medical Licensing Examination Step 1 scores.
"Conclusions Although there was variability by program, signaling increased likelihood of being selected for interview without negatively affecting any specific gender or UIM group."
Data from future years will be needed to determine how signaling is influencing the distribution of residents to programs.
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