Drugs, drug regulation, and chemistry: the case of nicotine (following Rob Jackler)

 My Stanford colleague Dr. Rob Jackler has a longstanding interest in nicotine as an addictive drug that continues to be effectively marketed and ineffectively regulated.

Lately he's been concerned with novel delivery systems, such as the non-combustion vaping devices offered by sellers like Juul (which  has recently been on a regulatory roller coaster.)

You can find many of his papers at the Stanford Research into the Impact of Tobacco Advertising (SRITA) site.  The most recent of these papers concerns the fact that a lot of regulation is focused on "tobacco products," but that nicotine itself--the addictive chemical in tobacco--has been successfully synthesized in the lab, and so can be marketed as a "tobacco free" product.

Here's a recent NY Times article on his work:

The Loophole That’s Fueling a Return to Teenage Vaping. Sales are rising of flavored e-cigarettes using synthetic nicotine that evades regulatory oversight, a gap that lawmakers are now trying to close.  By Christina Jewett

And here's the paper:

Marketing of “Tobacco-Free” and “Synthetic Nicotine” Products. Ramamurthi D, Chau C, Lu Z, Rughoobur I, Sanaie K, Krishna P, Jackler RK. SRITA White Paper. March 8, 2022.

"Executive Summary:

• A 2009 US law assigned tobacco regulation to the FDA, created its Center for Tobacco Products, and defined a tobacco product as derived from any component of the tobacco plant.

• As the September 2020 deadline for submission of application to the for FDA authorization of novel tobacco products (PMTA) approached, major tobacco companies submitted application for their brands, but innumerable smaller companies lacked the resources needed to undertake the extensive studies required.

• In an effort to circumvent FDA tobacco regulations, and thus exempt their products from the PMTA process, numerous brands claimed to be formulated with tobacco-free and/or synthetic nicotine.

• Following the late 2021denial of their PMTA applications, some brands which were ordered off the market promptly relaunched claiming that they had been reformulated with tobacco-free or synthetic nicotine.

• Brands claiming to use non-tobacco derived nicotine are offered in a wide array of youth-appealing sweet & fruity flavors – which have been systematically denied market authorization during the ongoing FDA PMTA process.

• Synthetic nicotine is currently expensive, costing approximately 4x tobacco derived nicotine. 

• While residuals from tobacco leaf derived nicotine are well known, byproducts of the chemical synthesis of nicotine have not been characterized for potential human toxicity and carcinogenicity.

• Justified by concerns for unknown safety risk, the FDA should insist upon toxicity/carcinogenicity studies of synthetic nicotine products before they are marketed.

• The FDA should also consider systematic testing of products claiming to be tobacco-free as at least a portion of them may prove to have chemical signatures indicative of tobacco origin.

• Some brands marketed as “tobacco-free” or “tobacco leaf-free” use a purified form of tobacco derived nicotine and thus are legally tobacco products under US law and thus subject to the PMTA requirements.

• Terms describing nicotine products as “tobacco-free,” “non-tobacco,” and “zero tobacco” need regulation as consumers may perceive such products as having reduced addictive potential.

• Marketing claims such as “clean,” “pure,” and “free of carcinogens” should be disallowed absent modified risk designation by the FDA.

• “Tobacco-free” nicotine brands have been allowed to post paid advertisements, and are widely sold on major online stores (e.g., Amazon, eBay, Google Shopping), which prohibit sale of all tobacco products.

• Underage sales of “tobacco-free” nicotine products are common via major online stores.

• As it is a potently addictive substance, and harmful to the developing adolescent brain, there is no justification for nicotine, regardless of its source, to be exempt from regulation.

• The synthetic nicotine regulatory loophole should be closed by designating such products as unauthorized drugs requiring pre-market authorization. "

********

Congress closed the synthetic nicotine loophole in March, and since July 2022 synthetic nicotine products can only be on the market if they have been authorized by the FDA – none have been so yet.   Here's the story from the Washington Post:

Congress moves to give FDA new powers over synthetic nicotine products including a youth favorite — Puff Bar e-cigarettes By Laurie McGinley, March 8, 2022

**********

There have also been bans on flavored nicotine, aimed at children as well as adults. These may be doomed to be at least partly ineffective. Menthol flavored cigarettes are likely to be banned in the U.S., and have already been banned in Britain and elsewhere. But just as cocktail mixes can be sold separately from alcohol (but ready to mix), so apparently can flavorings for cigarettes and e-cigarettes... e.g. search for "menthol flavour cards for cigarettes" or "menthol crush balls" to see how to add menthol back into your smokes in England.

Here's a recent NBER working paper comparing menthol smokers to non-menthol smokers:

Are Menthol Smokers Different? An Economic Perspective, by Yu-Chun Cheng, Donald S. Kenkel, Alan D. Mathios & Hua Wang, WORKING PAPER 30286, DOI 10.3386/w30286, July 2022

 **********

And here's an old NYT story in which Rob describes himself as “an accidental tourist in the world of advertising.”

When Doctors, and Even Santa, Endorsed Tobacco, By Stuart Elliott, Oct. 6, 2008

**********

earlier: 

Sunday, January 30, 2022

Chemistry is replacing agriculture in the supply of black market drugs

Sunday, May 2, 2021

Repugnance as paternalism: bans on flavored tobacco products

Tuesday, February 12, 2019

The new market for (and marketing of) nicotine--Robert Jackler (followed by the CDC)

The (local) labor markets for terrorists and drug traffickers

 It's so hard to hire good help nowadays, but two papers in the latest Econometrica give us some insight into how that problem is solved in the labor markets for terrorists, and for narcotics.

First terrorism, which turns out to have a local financing element, suggesting frictions in moving money and terrorists...

TERRORISM FINANCING, RECRUITMENT, AND ATTACKS, by NICOLA LIMODIO, Econometrica, Vol. 90, No. 4 (July, 2022), 1711–1742

Abstract: This  paper  investigates  the  effect  of  terrorism  financing  and  recruitment  on  attacks. I exploit a Sharia-compliant institution in Pakistan, which induces unintended and quasi-experimental variation in the funding of terrorist groups through their religious affiliation. The results indicate that higher terrorism financing, in a given location and period, generate more attacks in the same location and period. Financing exhibits a complementarity in producing attacks with terrorist recruitment, measured through data from Jihadist-friendly online fora and machine learning. A higher supply of terror is responsible for the increase in attacks and is identified by studying groups with different affiliations operating in multiple cities. These findings are consistent with terrorist organizations facing financial frictions to their internal capital market.

"I study two aspects of the relationship between terrorism financing and attacks: (1) the correlation between the timing of financing and attacks; (2) the relation between financing and recruitment in generating attacks. To investigate the first point, I follow 1750 cities over 588 months between 1970 and 2018 containing the universe of terrorist attacks (e.g.,more than 14,000 events). I also build a panel with 29 terrorist groups operating in the same number of cities and the same period. To study the second point, I combine data from multiple online fora active in Pakistan disseminating Jihadist-friendly material with the work of two judges and a machine-learning algorithm, leveraging novel techniques from the computer science literature.

"The  natural  experiment  affects  a  specific  form  of  charitable  donation  and  terrorism financing through an Islamic institution: the Zakat. During Ramadan, Muslim individuals offer this Sharia-compliant contribution to philanthropic causes. While the amount is a personal choice, the Pakistani government collects a mandatory payment through a levy on bank deposits applied immediately before Ramadan.1When the tax hits fewer people due to its unique design, there is an increase in donations. This expansion in charitable donations boosts the probability that funds reach terrorist organizations due to multiple extremist groups having a legal charity branch.2 This unintended channel through which the design of the Zakat levy promotes terrorism financing has also been acknowledged by Pakistani government officials in the past.#"

# (cited newspaper article):"Information Minister Pervaiz Rashid has advised people to pay Zakat and charity to institutions which save lives and not to those producing suicide bombers."

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

And then there's narcotics production and narco-terrorism, which to some extent runs in families.  The paper begins with this quote:

"The only way to survive, to buy food, was to grow poppy and marijuana, and from the age of 15, I began to grow, harvest, and sell.– Joaquin “El Chapo” Guzman, when asked how he became the leader of the Sinaloa drug cartel"

Making a Narco: Childhood Exposure to Illegal Labor Markets and Criminal Life Paths, by Maria Micaela Sviatschi, https://doi.org/10.3982/ECTA17082, ECONOMETRICA: JUL 2022, VOLUME 90, ISSUE 4, p. 1835-1878

Abstract: This paper provides evidence that exposure to illegal labor markets during childhood leads to the formation of industry‐specific human capital at an early age, putting children on a criminal life path. Using the timing of U.S. antidrug policies, I show that when the return to illegal activities increases in coca suitable areas in Peru, parents increase the use of child labor for coca farming, putting children on a criminal life path. Using administrative records, I show that affected children are about 30% more likely to be incarcerated for violent and drug‐related crimes as adults. No effect in criminality is found for individuals that grow up working in places where the coca produced goes primarily to the legal sector, suggesting that it is the accumulation of human capital specific to the illegal industry that fosters criminal careers. However, the rollout of a conditional cash transfer program that encourages schooling mitigates the effects of exposure to illegal industries, providing further evidence on the mechanisms.

"To establish these results, I take advantage of drug enforcement policies in Colombia that shifted coca leaf production to Peru, where 90% of coca production is used to produce cocaine. In particular, in 1999, Colombia, then the world’s largest cocaine producer, implemented Plan Colombia, a U.S.-supported military-based interdiction intervention.One of the main components was the aerial spraying of coca crops in Colombia. This intervention resulted in higher prices and expanded coca production in Peru, where production doubled in districts with the optimal agroecological conditions.2 By 2012, Peru had become the largest producer of cocaine in the world.3 

"This setting yields three useful sources of variation: (i) geographic variation in coca growing  in  Peru,  (ii)  over  time  variation  in  coca  prices  induced  by  Colombian  shocks, and (iii) variation in the age of exposure, exploiting the fact that in Peru children are more  likely  to  drop  out  from  school  in  the  transition  between  primary  and  secondary education at the ages 11–14. I thus define age-specific shocks by interacting coca suitability measures and prices. Differential exposure by age arises since children within a district or village experience the changes in coca prices at different ages and due to variation in coca suitability across districts, villages, and schools."

Efficient school choice when schools are not players: Phil Reny in the AER

 In some school choice systems, such as in New York City, the schools (represented e.g. by the school principals) as well as the students and families are strategic players. I think the weight of the evidence in those cases clearly points to the importance of having stable matchings, to forestall various forms of strategic behavior by blocking pairs.  

But in many school choice systems the individual schools (although not necessarily the school district) are not strategic players. In those, the school choice problem can usefully be viewed as a problem of allocating objects, namely school places, and only the students and their families are participants for whom we should have incentive and welfare concerns. In these cases, pairwise stability of the matching may be a fairness consideration, but not one with critical strategic or welfare implications.  A Pareto improvement in this case is one that improves matches according to student preferences--the priorities that schools have over students are part of the mechanism, but they don't have welfare consequences.

Here's a nice recent paper by Phil Reny which considers that latter situation, and investigates an outcome that improves student welfare compared to stable matchings, while still making a substantial bow to fairness of the sort captured by stability.  His results give new insight into the mechanism proposed by Onur Kestin in his famous 2010 paper in the QJE*.

Reny, Philip J. "Efficient Matching in the School Choice Problem." American Economic Review 112, no. 6 (2022): 2025-43.

Abstract: "Stable matchings in school choice needn’t be Pareto efficient and can leave thousands of students worse off than necessary. Call a matching μ priority-neutral if no matching can make any student whose priority is violated by μ better off without violating the priority of some student who is made worse off. Call a matching priority-efficient if it is priority-neutral and Pareto efficient. We show that there is a unique priority-efficient matching and that it dominates every priority-neutral matching and every stable matching. for every student in the mechanism that selects the priority-efficient matching"

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

*Kesten, Onur. "School choice with consent." The Quarterly Journal of Economics 125, no. 3 (2010): 1297-1348.

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

So I think we're now seeing a dialog between two approaches to improving student welfare in school choice environments in which pairwise stability (avoiding blocking pairs consisting of schools and students/families) doesn't seem critical to success (i.e. environments in which schools aren't able to participate in blocking pairs).  Reny and Kesten present a path towards doing that while paying a lot of respect to the priorities that schools have for students. (The success of the deferred acceptance algorithm even in these environments may have a lot to do with the fact that school administrators are often quite invested in the priorities that schools are specified to have over students, since these are intended to shape who goes to which schools.)

The alternative approach looks at an efficient and strategy-proof mechanism like top trading cycles  (TTC) that pays some respect to those priorities, but not at the expense of strategy-proofness, i.e. while keeping it completely safe for students/families to state their true preferences straightforwardly.

For that discussion, see this previous post:

Wednesday, December 9, 2020

Top trading cycles (and recollections of New Orleans), in AER:Insights, by Abdulkadiroğlu, Che, Pathak, Roth and Tercieux

***********

Update: Péter Biró alerts me to this recent paper that also relates to my concluding comments above.

Biró, P. and Gudmundsson, J., 2021. Complexity of finding Pareto-efficient allocations of highest welfare. European Journal of Operational Research, 291(2), pp.614-628.

Abstract: We allocate objects to agents as exemplified primarily by school choice. Welfare judgments of the object-allocating agency are encoded as edge weights in the acceptability graph. The welfare of an allocation is the sum of its edge weights. We introduce the constrained welfare-maximizing solution, which is the allocation of highest welfare among the Pareto-efficient allocations. We identify conditions under which this solution is easily determined from a computational point of view. For the unrestricted case, we formulate an integer program and find this to be viable in practice as it quickly solves a real-world instance of kindergarten allocation and large-scale simulated instances. Incentives to report preferences truthfully are discussed briefly.

School choice in Amsterdam: a counterfactual analysis

 Forthcoming in the JPE (It looks like the refereeing process worked its magic on this paper, whose first version was distributed in 2015...):

Haan, Monique De, Pieter Gautier, Hessel Oosterbeek, and Bas Van der Klaauw. "The performance of school assignment mechanisms in practice." 

This is the author’s accepted manuscript without copyediting, formatting, or final corrections. It will be published in its final form in an upcoming issue of Journal of Political Economy, published by The University of Chicago Press. Include the DOI when citing or quoting: https://doi.org/10.1086/721230  Copyright 2022 The University of Chicago Press.

Abstract: "We use a unique combination of register and survey data from Amsterdam to investigate the performance of school assignment mechanisms in practice. We find that Deferred Acceptance (DA) results in higher mean welfare than the adaptive Boston mechanism. This is due to students making strategic mistakes. The welfare gain o fa switch from actual Boston to DA is over 90 percent of the welfare difference be-tween actual Boston and optimal (proxy) Boston. Disadvantaged and lower ability students would benefit most from such a switch."

"We contribute to the existing literature by complementing register data of the actual choices of secondary-school students in Amsterdam with survey information from the same students. Students’ actual choices reveal their behavior under the Amsterdam version of the Boston mechanism, where students apply in the first round to one school and ties are broken by lotteries. The survey asks students to rank schools according to their true preferences. For each of the ranked schools, the survey asks students to give preference points that reflect the valuation of these schools relative to the valuation of their most-preferred school. The data enable us to (i) quantify the welfare differences between Boston and DA without making strong assumptions about beliefs and choice behavior,(ii) identify the students who are revealed-strategic under the manipulable mechanism,(iii) identify which students make mistakes in their application choices, separately for students who are revealed-strategic and those who are not, (iv) investigate what type of students are hurt (the most) by making suboptimal choices under the Boston mechanism, and (v) quantify the welfare gain of Boston without mistakes (optimal Boston) relative to actual Boston and DA."

Ideas to Increase Transplant Organ Donation, in Regulation / SUMMER 2022

 Frank McCormick points out this recent collection of short pieces in the summer issue of Regulation.

Ideas to Increase Transplant Organ Donation, edited by Ike Brannon, in Regulation / SUMMER 2022

Introduction  BY IKE BRANNON

Emulate Israel’s Program of Covering Donors’ Expenses BY JOSH MORRISON AND SAMMY BEYDA

Give Donors a Tax Credit BY SALLY SATEL AND ALAN D. VIARD

Expose OPOs to Competition BY ABE SUTTON

Help People Understand the Benefits of Donation  BY MARIO MACIS

Why kidney exchange needs to be available globally

 The situation of children with kidney failure in low and middle income countries is particularly dire.  Most transplants in LMICs are from living donors. Here's a recent paper  on that, with a case report that makes clear the need for kidney exchange, and for a relaxation of the policies that limit access to transplantation generally. 

Pais, Priya, and Aaron Wightman. "Addressing the Ethical Challenges of Providing Kidney Failure Care for Children: A Global Stance." Frontiers in Pediatrics 10 (2022).

"Case 2: An 11 year old boy with kidney failure due to FSGS* has been on the deceased donor wait-list for 5 years without receiving a transplant. He has no compatible living donors and paired exchange, or ABO incompatible transplants are not accessible. National transplant policies do not allow unrelated living organ donation. The deceased donor transplant rates in the country are very low ..."

HT: Martha Gershun

*Focal segmental glomerulosclerosis

Gender neutral words in gendered languages

Novel pronouns haven't been widely adopted in English, but committees now have chairs or chairpersons, and there are some attempts not merely to avoid assigning male or female genders to words when they're not needed (like chairman), but also to avoid suggesting genders at all.  That's going to be tougher in languages in which all words have genders, or in which the conjugation of verbs involves choosing a gender.  Take Spanish for instance.

The NY Times has the story:

In Argentina, One of the World’s First Bans on Gender-Neutral Language. The city of Buenos Aires blocked the use of gender-inclusive language in schools, reigniting off a debate that is reverberating across the world.   By Ana Lankes

"Instead of “amigos,” the Spanish word for “friends,” some Spanish speakers use “amigues.” In place of “todos,” or “all,” some write “todxs.” And some signs that would say “bienvenidos,” or “welcome,” now say “bienvenid@s.”

...

"Similar gender-neutral language is being increasingly introduced across Latin America, as well as in other languages, including English and French, by supporters who say it helps create a more inclusive society.

...

"The city government in Buenos Aires, the nation’s capital, last month banned teachers from using any gender-neutral words during class and in communications with parents. 

...

"The policy, among the first anywhere to specifically forbid the use of gender-neutral language, provoked a swift backlash. Argentina’s top education official criticized the rule and at least five organizations, a mix of gay rights and civil rights groups, have filed lawsuits seeking to overturn it.

"Jaime Perczyk, Argentina’s education minister, compared the measure to prohibitions against left-handed writing under the fascist dictatorship of Francisco Franco in Spain.

...

"Argentina is a surprising place for such a heated debate on gender-neutral language because the country has largely embraced transgender rights. In 2012, it became one the first countries in the world to pass a law allowing people to change their gender on official documents without requiring the intervention of a doctor or a mental health therapist."

Debate on international surrogacy in Norway

 In Norway, where surrogacy is illegal, there is a debate about whether surrogacy conducted legally in other countries should also be criminalized for Norwegians.

The Norwegian Broadcasting Co. (NRK) has the story (with a little help from Google translate):

Familieminister mener surrogati skal kunne være straffbart The Minister of Family Affairs believes that surrogacy should be punishable by Chris Burke Marthe  and Ingrid Tinmannsvik

"The debate about surrogacy has created debate in Norway over several years. In 2022, surrogacy is illegal in Norway.

"Minister for Children and Families Kjersti Toppe (Sp) believes it should still be illegal to have children in this way.

...

"surrogacy in itself can be compared to human trafficking. A commercial industry where there is a great danger of exploiting vulnerable women. Shall we make children an item you can order and buy?"

...

"No one knows how many surrogate children come to Norway each year. But last year, 61 Norwegian fathers said that they became the father of a child in one of the countries it is most common to go to for surrogacy. It shows figures the Ministry of Foreign Affairs has obtained from the foreign service missions.

"About 10 years ago, the Storting passed an exemption which means that people who have children through surrogacy abroad cannot be punished.

"Tops voted against the law change and still disagrees.

...

"Anette Trettebergstuen (Labor Party), Minister of Culture and Gender Equality, reacts to Toppe's comparison of surrogacy and human trafficking.

...

"She believes a ban on punishment would not work in practice.

"- Should parents who bring a baby to the country be imprisoned? It will definitely be against the best interests of the child. And even if fines were imposed, many would probably think it was worth it", she says."

HT: Øivind Schøyen

Reducing the costs of preparing for high stakes exams by reporting scores coarsely

 In many countries, national exams serve as the gateway to college admissions and other prizes, and many applicants incur great costs in time and treasure preparing for these exams.  Here's a recent NBER working paper that suggests that reporting the grades in intervals rather than by individual scores has the potential to reduce the costs devoted to exam prep sufficiently to be a Pareto improvement for students, i.e. to make them all better off, even those who obtain the highest grades, if the cost of doing so is sufficiently high.

Pareto Improvements in the Contest for College Admissions by Kala Krishna, Sergey Lychagin, Wojciech Olszewski, Ron Siegel & Chloe Tergiman, NBER WORKING PAPER 30220, DOI 10.3386/w30220, July 2022

Abstract: "College admissions in many countries are based on a centrally administered test. Applicants invest a great deal of resources to improve their performance on the test, and there is growing concern about the large costs associated with these activities. We consider modifying such tests by introducing performance-disclosure policies that pool intervals of performance rankings, and investigate how such policies can improve students’ welfare in a Pareto sense. Pooling affects the equilibrium allocation of studentso colleges, which hurts some students and benefits others, but also affects the effort students exert. We characterize the Pareto frontier of Pareto improving policies, and also identify improvements that are robust to the distribution of college seats.

"We illustrate the potential applicability of our results with an empirical estimation that uses data on college admissions in Turkey. We find that a policy that pools a large fraction of the lowest performing students leads to a Pareto improvement in a contest based on the estimated parameters. We then conduct a laboratory experiment based on the estimated parameters to examine the effect of such pooling on subjects’ behavior. The findings generally support our theoretical predictions. Our work suggests that identifying and introducing Pareto improving performance-disclosure policies may be a feasible and practical way to improve college admissions based on centralized tests."

The paper notes that:

" In many Asian countries, including China, Japan, South Korea, and Taiwan, students attend specialized “cram schools,”1 which focus on improving students’ performance on the tests. This often consists of rote learning, solving a large number of practice problems, and practicing test-taking strategies tailored to the specific test. In other countries, students hire tutors, buy books, and take specialized courses, all geared entirely toward improving their test scores. These activities likely improve students’ performance on the test, but are far less likely to generate substantial long-term improvements in students’ productive human capital. These activities do, however, carry significant costs in terms of time, money, and effort. In South Korea, for example, it is not uncommon for high school students to spend several hours a day in cram schools, and the high stakes competition for college admissions is seen as one of the main causes for the high rates of unhappiness and suicide among teenagers.2 Similar concerns have also been raised in the United States.3"

The paper explains that:

"We are interested in performance-disclosure policies that benefit all students, and refer to such policies as Pareto improving. In particular, we do not need to consider welfare tradeoffs across students. A key finding of our analysis is that Pareto improving policies often exist. This may seem surprising, since a fixed set of college seats implies that a student can be admitted to a better college only if another student is admitted to a worse college. The crucial element that makes Pareto improvements possible is that test preparation is costly. The costs students incur, as well as the resulting college assignment, are determined in equilibrium, and the equilibrium is affected by the performance-disclosure policy. Relative to the baseline contest with no coarsening, introducing a performance-disclosure policy leads to some students being admitted to better colleges; this makes them better off even if they incur higher costs, as long as the cost increase is not too large. Other students are admitted to worse colleges; if they also incur lower costs they are made better off as long as the reduction in the costs is large enough."

**********

I'm reminded of a paper that suggests that the very best students may not pay the highest costs for exam prep:

Feltovich, Nick, Richmond Harbaugh, and Ted To. "Too cool for school? Signalling and countersignalling." RAND Journal of Economics (2002): 630-649.

Ariel Pakes wins the Nemmers Prize

 Here's the announcement of the Nemmers Prize, from Northwestern University:

Northwestern announces 2022 Nemmers Prize winners. Biennial prizes recognize top scholars for outstanding achievements

"Northwestern University has announced the winners of the 2022 Nemmers Prizes in Earth sciences, economics and mathematics. The biennial prizes recognize top scholars for their lasting significance, outstanding achievements, contributions to knowledge and the development of significant new modes of analysis.

"This year’s recipients are Emily Brodsky for Earth sciences, Ariel Pakes for economics and Bhargav Bhatt for mathematics. Each will receive $200,000 and will interact with Northwestern faculty and students through lectures, conferences or seminars.

...

Ariel Pakes received the Erwin Plein Nemmers Prize in Economics, honored for his “fundamental contributions to the development of the field of empirical industrial organization as it is applied to the study of market power, prices, mergers and productivity.” He is the Thomas Professor of Economics at Harvard University.

"In his research, Pakes develops methods for empirically analyzing market responses to environmental and policy changes. He and his collaborators have developed ways to estimate and analyze consumer demand patterns that underlie pricing and product placement incentives, the production functions that underlie the analysis of firm productivity and the investment decisions that underlie the evolution of markets over time.

"Pakes and collaborators have demonstrated the usefulness of these tools by analyzing deregulation in the telecommunication industry, demand and product placement decisions in the auto industry, the impact of incentives on doctors’ hospital allocations and consumers’ choices of health insurance plans, the evolution of bidding strategies in a new electric utility market and the development of improved consumer price indices. Subsequently, these tools have become a mainstay of market interactions in much of economics and are often employed by consultancies and regulatory agencies to analyze the likely outcomes of regulatory decisions. They have also been used for internal firm planning. 

"Pakes is a member of the Econometric Society, the American Academy of Arts and Sciences and the National Academy of Sciences. He has received the Frisch Medal of the Econometric Society, the Jean-Jacques Laffont Prize for research that integrates theory with empirical analysis and the BBVA Frontiers of Knowledge Award in Economics, Finance and Management. Pakes is a laureate of the Web of Science and an honoree of the American Antitrust Institute for Outstanding Antitrust Achievement in Economics. He also is a distinguished fellow of both the Industrial Organization Society and of the American Economic Association. Pakes is a founding member of Microeconomic Insights, a home for summaries of microeconomic research that informs the public about societally relevant microeconomic issues."

Follow market design on twitter

 I don't have a twitter account, but for those of you who do, there are some accounts that tweet daily about market design and adjacent subjects, mostly by posting links. Here are three that I know about, and the urls at which they can also be viewed on the web.

Market Design Community https://twitter.com/econd47?lang=en

@econD47

An informal page to share announcements (e.g., papers, conferences, applied work, jobs) relevant to the market design community. Administered by

@d_delacretaz

.

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

EconCS Preprints & Blogs https://twitter.com/econ_cs

@econ_cs

Posts from arXiv http://cs.GT and EconCS blogs, maintained by

@kiragoldner

.

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

Market Designer Bot https://twitter.com/MarketDesignBot

@MarketDesignBot

Tweets articles from Al Roth's Market Designer Blog RSS Feed. Bot. Unaffiliated with Al Roth. For bug reports please see GitHub. Administered by

@gideonmoore

.

Legal and illegal sales of body parts

 U.S. law makes it illegal to sell deceased donor organs for transplant, i.e. to save a life, but it's otherwise legal to sell body parts or whole cadavers, for research, for instruction, etc.  Nevertheless, alongside the legal, regulated market, which requires consents and precautions, is an illegal black market which is occasionally prosecuted.  Here's a recent case, as reported in the NYT:

Funeral Home Operator Pleads Guilty in ‘Illegal Body Part Scheme’.  Megan Hess, who pleaded guilty to mail fraud, sold body parts without families’ consent... By Alex Traub

"The operator of a Colorado funeral home who was accused of stealing body parts and selling them to medical and scientific buyers, making hundreds of thousands of dollars in what the authorities called an “illegal body part scheme,” pleaded guilty to mail fraud on Tuesday, the Justice Department said.

...

"Here’s how prosecutors said the scheme worked: From about 2010 to 2018 Ms. Hess was in charge of Donor Services, a nonprofit “body broker service,” and Sunset Mesa Funeral Directors, which offered to arrange cremations, funerals and burials in the small western Colorado city of Montrose.

"Ms. Hess and her mother sometimes obtained consent from families to donate small tissue samples or tumors of their dead relative, according to an indictment in the case. On other occasions, their request was rejected, and sometimes, they never brought up the topic at all.

"In any case, the documents say, on hundreds of occasions the funeral home operators would sell heads, torsos, arms, legs or entire human bodies. Frequently, they delivered cremated remains to families with the suggestion they were the remains of their relative when, in fact, they were not, according to the indictment.

...

"The scheme included forging paperwork, such as signatures on authorization forms for donating body parts, and misleading buyers about the results of medical tests performed on the deceased, court documents said. Ms. Hess altered lab reports so that they said that people had tested negative for diseases like H.I.V. and hepatitis when they had actually tested positive, according to the authorities."

The Future of Living Donor Kidney Transplantation (videos)

On May 7, 2022 the University of Chicago hosted a Symposium on "The Future of Living Donor Kidney Transplantation: Evolving National Perspectives in Kidney Transplant "

Philip Held, one of the organizers, has provided the following guide, concluding with a link to an elegant Data Handbook that gives direct access to each talk.

 "A Symposium: The Future of Living Kidney Donor Transplantation

Earlier this year, we presented a virtual symposium on the Future of Living Kidney Donor Transplantation.  A primary focus was on the ethics of rewarding organ donors with an opening presentation by:

 ·       Janet Radcliffe Richards, a philosopher and ethicist from Oxford University.

 Other speakers and topics included:

 ·       Nobel Laureate Alvin Roth Ph.D. of Stanford University who laid out the case for paired kidney donation (aka kidney exchange), the only major technical improvement in transplantation in years.

 ·       Frank McCormick, Ph.D. presented recently published (Value in Health) research showing how the government can completely end the kidney shortage and save more than 40,000 kidney failure patients each year from premature death by rewarding living kidney donors. 

 The Symposium took place on May 7, 2022.  It was hosted by John Fung M.D. Ph.D. at the University of Chicago’s Transplantation and Transplant Institute and was funded by the National Kidney Donation Organization (NKDO) and WaitListZero.

 This Symposium presented a broad education on the subject of living kidney donation, and indeed was presented for Continuing Medical Education (CME) credits by the University of Chicago. 

 The audio-visual recording of the entire University of Chicago’s CME symposium is available, for free. Access is extremely easy and one can access any and all presentations with 3 simple clicks starting with 2 clicks here: Data Handbook."

 If you prefer you can binge on the sessions in order:

Session 1:  The Future of Living Kidney Donor Transplantation

Session 2:  The Future of Living Kidney Donor Transplantation

Session 3:  The Future of Living Kidney Donor Transplantation

My talk, called "Kidney Exchange (and Kidney Controversy)" is the first half hour of the video below of the second of three symposium sessions.

The first session of the symposium is below, starting with an intro by Philip Held, focusing on some of the inequalities that we see in dialysis and transplant, followed by the philosopher Janet Radcliffe-Richards (starting at minute 17:15), and then Sally Satel (at 59:30), and then a round table discussion starting at 1:12.

 

In the discussion I asked Dr. Radcliffe Richards (who has been a tireless advocate of thinking more clearly about the tradeoffs involved in preventing compensation of donors) what experience she could share about when and how she had been successful in convincing people to change their minds.  She replied "I don't regard myself as an expert in mind changing, except with people who are happy to follow arguments."

Session 3 is below, including talks by Martha Gerson, Thomas Peters, Arthur Matas, John Roberts,  and Josh Morrison.

These and other videos have been assembled by NKDO.

Allegations of organ trafficking for kidney transplants--in England and India

 From time to time there are stories of prosecutions for organ trafficking in connection with kidney transplants.

Here's a story developing in England. (Early reports were that the alleged donor/seller/victim was a child, but apparently he's not a minor):

From the BBC:

Ike Ekweremadu: Nigerian senator faces London organ-harvesting trial

"A prominent Nigerian senator and his wife who are accused of plotting to harvest a man's kidney in the UK will face trial at the Old Bailey.

"Ike Ekweremadu, 60, and Beatrice Nwanneka Ekweremadu, 55, are alleged to have transported a 21-year-old man from Nigeria to London.

"Prosecutors allege the couple planned to have his kidney removed so it could be given to their daughter.

...

"The alleged victim is said to have refused to consent to the procedure after undergoing tests at the Royal Free Hospital in Hampstead."

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Not long ago I participated in an online conversation including Professor Janet Radcliffe Richards, who recalls that her view that bans on kidney sales are ill-conceived arose from news in the 1980's about a case involving Turkish sellers (here's an LA Times story from then):

London Kidneys-for-Cash Scandal Prompts Action to Ban Sale of Organs BY ROBERT BARR JULY 16, 1989

"“The concept of organs being bought and sold for money is entirely unacceptable in a civilized society,” Health Minister Roger Freeman told a House of Commons committee during debate on proposed legislation outlawing organ sales. The bill is expected to pass Parliament later this month.

"Not all lawmakers agree.

“The bill will cause death where there could be life, and to prolong suffering where we could provide relief,” said Sir Michael McNair-Wilson, a Conservative Parliament member awaiting a kidney transplant.

...

"Neil Hamilton, who cast the only vote against the bill in committee, said he had pondered the dilemma facing one Turk who allegedly sold a kidney.

“His daughter was suffering from a medical problem which threatened her life, but it could not be solved in Turkey without money,” Hamilton said. “If he did not get the money for the operation, his daughter would die.”

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The situation in India is complex, since there is or was something of a long tradition of kidney sales, which are against the law, and are guarded against by authorization committees that have to approve each living donor transplant. Recently, kidney exchange has become legal in India, but the law only allows close family to be the intended donor in an incompatible patient-donor pair. Below is a report of a case where it's alleged that an attempted donor was paid, and also illegally claimed to be a family relation.

Here's the Hindustan Times story:

Ruby Hall Clinic kidney transplant ‘malpractices’ probe handed over to crime branch

"Earlier on Wednesday, police officials probing the case told Magisterial court that more cases of kidney transplants based on the relationship claims have been unearthed during the interrogation of agents Ravindra Rodge and Abhijit Gatane. Both have been arrested by the police. These two agents having donated their kidneys earlier and also played the role of middlemen in at least four kidney transplants where alleged malpractices were involved.

...

"The case pertains to a kidney swap procedure, also known as paired kidney exchange, between the Moshi man and the Kolhapur woman posing as his wife, and a mother-daughter duo from Baramati."

And here's the story in the Indian Express:

Two middlemen arrested in Pune kidney transplant malpractice case. The other accused in the case, including Ruby Hall Clinic doctors, the patient who received the kidney, and the unrelated donor who was passed off as his wife--are yet to be arrested.

"Police have arrested the two middlemen over the alleged malpractices in a kidney transplant conducted at Pune’s Ruby Hall Clinic in March in which an unrelated woman was allegedly presented as the organ receiver’s wife and promised Rs 15 lakh in return.

...

"Among the 15 people named in the FIR are the hospital’s managing trustee, Dr Purvez K Grant, deputy medical director Dr Rebecca John, legal advisor Manjusha Kulkarni, nephrologist Dr Abhay Sadre, urologists Dr Bhupat Bhati and Dr Himesh Gandhi and transplant coordinator Surekha Joshi. The police also booked the two middlemen, the patient—from Pimpri Chinchwad’s Moshi area—who received the kidney, his wife, their three family members, the woman from Kolhapur who was allegedly passed off as the patient’s wife to become the donor."

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Among the most vigorous opponents of paying kidney donors--e.g. among some of those who think it's a crime against humanity--there's also opposition to extending the scope of legal, ethical, unpaid kidney donation and transplantation, particularly in poor countries.  One reason for this is the intuition that more transplantation will cause more paid transplantation.  The cases reported above, although rare, help to support this view.

But a much stronger case can be made that it is the unavailability of transplants that causes exploitative black markets, and that increasing the availability of legal transplants will reduce the demand for illegal ones.