Introductory workshops to the Mathematics and Computer Science of Market and Mechanism Design semester at Berkeley MSRI

 The semester of Mathematics and Computer Science of Market and Mechanism Design August 21, 2023 to December 20, 2023 at Berkeley will lead off with two introductory sessions:

Connections Workshop: Mathematics and Computer Science of Market and Mechanism Design  September 07, 2023 - September 08, 2023

REGISTRATION DEADLINE: AUGUST 18, 2023

TO APPLY FOR FUNDING YOU MUST REGISTER BY: MAY 17, 2023

Organizers Michal Feldman (Tel-Aviv University), LEAD Nicole Immorlica (Microsoft Research)

"The Connections Workshop will consist of invited talks from leading researchers at all career stages in the field of market design.  Particular attention will be paid to real-world applications.  There will also be an AMA focused on career paths with highly visible individuals in the field, and a social event intended to help workshop attendees network with each other."

and

Introductory Workshop: Mathematics and Computer Science of Market and Mechanism Design  September 11, 2023 - September 15, 2023

REGISTRATION DEADLINE: AUGUST 25, 2023  TO APPLY FOR FUNDING YOU MUST REGISTER BY: MAY 21, 2023  

Organizers Scott Kominers (Harvard Business School), Paul Milgrom (Stanford University), Alvin Roth (Stanford University), Eva Tardos (Cornell University)

"The workshop  will  open  with  overview/perspective  talks  on  algorithmic  game  theory  and  the theory and practice of market design; the afternoon will feature a panel on active research areas in the field (again, at the overview level). The next 2 days will consist of introductory mini-course and tutorials, on topics such as game theory, matching, auctions, and mechanism design. The following day will focus on applicable tools and technology, such as lattice theory, limit methods, continuous optimization, and extremal graph theory. The workshop will conclude with a panel discussion on major open problems."

Earlier announcement:

Tuesday, November 8, 2022

Mathematics and Computer Science of Market and Mechanism Design, at Berkeley MSRI, August 21-December 20, 2023 (applications open)

Surrogacy under siege in Italy

 Opposition to surrogacy in Italy has taken aim at the babies of same sex couples.

The NYT has the story:

Surrogacy Emerges as the Wedge Issue for Italy’s Hard Right. Prime Minister Giorgia Meloni has ordered municipalities to stop certifying foreign birth certificates for same-sex couples who used surrogacy, leaving some babies in a legal limbo.  By Jason Horowitz

"the government of Prime Minister Giorgia Meloni ordered municipalities to obey a court ruling made in December and stop certifying foreign birth certificates of children born to Italian same-sex couples through surrogacy, which is illegal in Italy.

"The decision has left Martino Libero and several other children suspended in a legal limbo, depriving them of automatic Italian citizenship and residency rights like access to the country’s free health care system and nursery school.

...

"Milan, a city that has long served as a cosmopolitan haven for same-sex couples in Italy, has for now complied with the Meloni government order and suspended issuing Italian birth certificates.

"Without official recognition, Libero Martino, 2 months old this month, will have to leave and re-enter the country every few months to remain legal. A court could eventually recognize one of the men as the biological father — they decline to say which one is the sperm donor — and then they could start a separate adoption process for the other.

...

"Ms. Meloni’s government has sought to shift the issue away from the status of the children to the practice of surrogacy, which, while legal in the United States and Canada, is illegal or restricted in much of Europe outside of Greece, Ukraine and a few other countries. In Italy, home of the Vatican, it is not only illegal, but it is also widely opposed, including among Catholic corners of the center-left opposition.

...

"Prominent members of Ms. Meloni’s Brothers of Italy party have called surrogacy a crime “even worse than pedophilia,” in which gay couples, one of whom is usually the biological father, seek to “pass off” children as their own and mistake “children for Smurfs,” saying gay couples can uniquely afford surrogacy, even though it is overwhelmingly used more by heterosexual couples.

"The party is floating a proposal, made by Ms. Meloni when she was a member of Parliament, to make Italians’ seeking of surrogate births abroad — what she had called “procreative tourism” — illegal and “punishable with three months to two years of prison and a fine of 600,000 to a million euros.”

...

"In an interview shortly before her election, as her young daughter ran around her in a Sardinia courtyard, Ms. Meloni said she opposed gay marriage, not because she was homophobic — “I’ve got many, many homosexual friends” — but because she saw it as a step to same-sex adoption, which she opposed, and which the Roman Catholic Church successfully lobbied to exclude from a civil unions law passed in 2016.

********

Earlier:

Monday, February 20, 2023

Will Italy criminalize foreign surrogacy?

The Robert Rosenthal Memorial Lecture for 2023 at BU, by Parag Pathak

 Parag Pathak gave this year's Robert Rosenthal Memorial Lecture at Boston University. The title of his talk is “Still Worth the Trip? The Evolution of School Busing in Boston” 

(The video below may undergo some further editing, but right now it starts with introductions at minute 3.) 

You can also find the Rosenthal lectures from previous years at the link.

(I had the honor of giving the 2007 lecture... Bob Rosenthal and I are academic siblings, we were both advised by Bob Wilson.)

Test of Time Award 2023 to Immorlica & Mahdian, and Ashlagi, Kanoria & Leshno

 Matching theory is recognized this year for bringing theory and observation into harmony...

The SigEcom Test of Time Award for 2023, "… for explaining an apparent gap between the theory and practice of matching markets and helping us understand why small cores are so common." goes to two papers, by five authors.

The first of the two papers is

Marriage, honesty, and stability by Nicole Immorlica and Mohammad Mahdian, Proceedings of the 16th Annual ACM-SIAM Symposium on Discrete Algorithms (SODA), 2005, pp. 53–62.

ABSTRACT: Many centralized two-sided markets form a matching between participants by running a stable marriage algorithm. It is a well-known fact that no matching mechanism based on a stable marriage algorithm can guarantee truthfulness as a dominant strategy for participants. However, as we will show in this paper, in a probabilistic setting where the preference lists of one side of the market are composed of only a constant (independent of the the size of the market) number of entries, each drawn from an arbitrary distribution, the number of participants that have more than one stable partner is vanishingly small. This proves (and generalizes) a conjecture of Roth and Peranson [23]. As a corollary of this result, we show that, with high probability, the truthful strategy is the best response for a given player when the other players are truthful. We also analyze equilibria of the deferred acceptance stable marriage game. We show that the game with complete information has an equilibrium in which a (1 - o(1)) fraction of the strategies are truthful in expectation. In the more realistic setting of a game of incomplete information, we will show that the set of truthful strategies form a (1 + o(1))-approximate Bayesian-Nash equilibrium. Our results have implications in many practical settings and were inspired by the work of Roth and Peranson [23] on the National Residency Matching Program.

**

And the second of the two papers is

Unbalanced random matching markets, by Itai Ashlagi, Yashodhan Kanoria, Jacob D. Leshno, Proceedings of the 14th ACM Conference on Electronic Commerce (EC), 2013, pp. 27–28.

ABSTRACT: We analyze large random matching markets with unequal numbers of men and women. Agents have complete preference lists that are uniformly random and independent, and we consider stable matchings under the realized preferences. We find that being on the short side of the market confers a large advantage.

"We characterize the men's average rank of their wives. For each agent, assign a rank of 1 to the agent's most preferred partner, a rank of 2 to the next most preferred partner and so forth. If there are n men and n+1 women then, we show that with high probability, in any stable matching, the men's average rank of their wives is no more than 3 log n, whereas the women's average rank of their husbands is at least n(3 log n). If there are n men and (1+λ)n women for λ0 then, with high probability, in any stable matching the men's average rank of wives is O(1), whereas the women's average rank of husbands is λ (n).

"Moreover, we find that in each case, whp, the number of agents who have multiple stable partners is o(n). Thus our results imply a limited scope for manipulation in unbalanced random matching markets for mechanisms that implement a stable match.

"These results are in stark contrast with previously known results for random matching markets with an equal number of men and women. In such balanced random matching markets, the lattice of stable matches is large, with the two extreme points of the lattice, the men optimal stable match (MOSM) and the women optimal stable match (WOSM) possessing contrasting properties. The men's average rank of their wives is just log n under the MOSM, but as large as n/log n under the WOSM, and the opposite holds for the women's average rank of their husbands. Thus, the proposing side in the Gale-Shapley deferred acceptance algorithm is greatly advantaged in a balanced market, whereas we prove that in markets with even a slight imbalance, the MOSM and WOSM are almost identical. This reveals the balanced case to be a knife edge.

"Our proof uses an algorithm which calculates the WOSM from the MOSM through a sequence of proposals by men. A woman improves if, by divorcing her husband, she triggers a rejection chain that results in a proposal back to her from a more preferred man. The algorithm lends itself to a stochastic analysis, in which we show that most rejection chains are likely to end in a proposal to an unmatched woman. Simulations show that our results hold even for small markets."

***

see also the longer version of Ashlagi, Kanoria and Leshno (with shorter abstract) in the JPE in 2017 (too recent for the test of time award itself:)

Ashlagi, Itai, Yash Kanoria, and Jacob D. Leshno. "Unbalanced random matching markets: The stark effect of competition." Journal of Political Economy 125, no. 1 (2017): 69-98.

Abstract: We study competition in matching markets with random heterogeneous preferences and an unequal number of agents on either side. First, we show that even the slightest imbalance yields an essentially unique stable matching. Second, we give a tight description of stable outcomes, showing that matching markets are extremely competitive. Each agent on the short side of the market is matched with one of his top choices, and each agent on the long side either is unmatched or does almost no better than being matched with a random partner. Our results suggest that any matching market is likely to have a small core, explaining why small cores are empirically ubiquitous.

Blue water, green water and climate change

 Much of the discussion of redesigning the markets for water focus on "blue water," i.e. surface water in rivers and lakes, and runoff from rain, and resulting accumulation in reservoirs, snowpacks, and ground water.

Here's a paper in Nature pointing out that, particularly as climates change, we also have to think of "green water," namely water from evaporation and rain, and how to manage that.

Rockström, Johan, Mariana Mazzucato, Lauren Seaby Andersen, Simon Felix Fahrländer, and Dieter Gerten. "Why we need a new economics of water as a common good." Nature (2023).

"Water managers have always had to deal with natural variability, building larger reservoirs and tapping aquifers to fight scarcity, for example. But current challenges and trends in the rest of this century demand a completely different approach: a radical shake-up in how water is governed, managed and valued, from local to global scales, including a re-evaluation of human water needs (see Supplementary information, Box S1).

"Today, the sector concentrates on flows of ‘blue’ fresh water — liquid that runs off the land and is stored in rivers, lakes, reservoirs and underground aquifers. Utilities capture and extract this water locally for drinking and sanitation, agricultural irrigation and industry.

...

"Managing fresh water on a global scale means going beyond our current fixation on capturing blue water, which constitutes 35% of all fresh water on land, to also encompass green water, which makes up the remaining 65% (see Supplementary information, Fig. S1). Flows of moisture and vapour from land and vegetation are essential for regulating the water cycle and securing future rainfall, as well enabling carbon sequestration in soils and forests.

"Globally, up to half of terrestrial precipitation originates from green water evaporated over land, with the rest from evaporation over the ocean3. Thus, landscape changes can alter water supplies in regions downwind, as well as changing local climates and streamflows. For example, deforestation in the Congo Basin lowers rainfall in neighbouring countries, and even across the Atlantic in the Amazon. Heavy irrigation of crops in India can boost the streamflow of the Yangtze River in China, through moisture transported downwind4.

"By analogy with watersheds on land, researchers refer to ‘precipitationsheds’ and ‘evaporationsheds’ in the atmosphere. Simply put, a precipitationshed is where rain comes from and an evaporationshed is where evaporation goes to. (Here, evaporation refers to total evaporation from the ocean and green water flows from land, including from soil and water bodies, as well as transpiration from vegetation.)"

Headlines that could have appeared on April 1

 Grim news largely crowded out funny news this past 12 months, but not completely (and some grim news is also funny).

National Park Service Asks Visitors to Please Stop Licking Toads (NYT, Nov, 2022)

Wyoming lawmakers propose ban on electric vehicle sales (The Hill, 01/16/23) "A group of GOP Wyoming state lawmakers want to end electric vehicle sales there by 2035, saying the move will help safeguard the oil and gas industries."

Sex on the beach: pressures of extreme polygamy may be driving southern elephant seals to early death (Guardian, March 2023)

Idaho governor signs firing squad execution bill into law, AP, March 25, 2023. "... making Idaho the latest state to turn to older methods of capital punishment amid a nationwide shortage of lethal-injection drugs. ...firing squads will be used only if the state cannot obtain the drugs needed for lethal injections.

Opioids and Appalachia by Sally Satel

 Sally Satel, who has treated patients in Appalachia, writes movingly of the drug addiction problem there. Here's a paragraph that sets the stage.

"The history of opioid pain relievers in Appalachia is a prime illustration of the fact that drug epidemics rarely burst onto the scene out of nowhere. Instead, they find their place in regions that are already home to an established base of individuals who abuse similar drugs. Thus illicit OxyContin, a more potent opioid, efficiently gained popularity over Percocet and Vicodin in the same way heroin would substitute for prescription opioids as the latter grew scarce after 2010."

That's from Opioids and Appalachia by Sally Satel, in the current issue of National Affairs.

The whole thing is well worth reading; here are a few more paragraphs that caught my eye.

"The churn of pills — diverting, using, and selling them — soon had eastern Kentucky, southeastern Ohio, and West Virginia pulsing with crime. Realtors routinely told home sellers not to leave pills in their medicine chests during open houses. Funeral directors and hospice nurses cautioned the bereaved not to mention in obituaries that their loved ones had succumbed to cancer — a red flag signaling that huge bottles of pills were likely on the premises. In eastern Kentucky, local law enforcement was often stymied by close ties between people within communities. Loyalty within large families and fear of retaliation by neighbors made it hard to cultivate informants and to impanel neutral juries that would convict when prosecutors proved their case.

...

"Appalachians seemed to take the corruption in grudging stride. In one survey, 90% of over 100 Kentuckians working in law enforcement, health, and community governance said the rural OxyContin problem in the early 2000s was "fueled by a cultural acceptance of drug misuse." Indeed, many residents tolerated unlawful activity, since it generated revenue for the community from sales of pills to outsiders. This happened in places like Williamson, West Virginia — dubbed "Pilliamson" — where the local Wellness Center was a hub of reckless prescribing. Cash-laden out-of-staters flocked there to buy painkillers and, in a small area near the center, trade and sell those pills.

"Pablo Escobar and El Chapo couldn't have set things up any better," wrote Eyre. "The coal barons no longer ruled Appalachia. Now it was the painkiller profiteers."

...

"Today, opioid pills are no longer pouring into Appalachia as they once did; highly lethal products like fentanyl-laced heroin, methamphetamine, and counterfeit fentanyl pills are what people are selling."

Deceased-donor transplants: UNOS in the crosshairs

 There is unprecedented political will aiming towards reform of the system by which organs for transplant are recovered from deceased donors in the U.S. and allocated to patients in need of a transplant.  Here are two opposing views about current proposals to reform or replace the current government contractor in charge of this system, UNOS, the United Network for Organ Sharing..

From NPR:

The Government's Plan To Fix A Broken Organ Transplant System, March 28, 2023

You can listen here:

"For nearly 40 years, the United Network for Sharing Organs (UNOS) has controlled the organ transplant system.

"But that's about to change. Last week, the government announced plans to completely overhaul the system by breaking up the network's multi-decade monopoly.

"For those who need an organ transplant, the process is far from easy. On average, 17 people die each day awaiting transplants. More than 100,000 people are currently on the transplant waiting list according to the Health Resources and Services Administration.

"UNOS has been criticized for exacerbating the organ shortage. An investigation by the Senate Finance Committee released last year found that the organization lost, discarded, and failed to collect thousands of life-saving organs each year.

"Can the government reverse decades of damage by breaking up control? And what does this move mean for those whose lives are on the line?

"The Washington Post's Health and Medicine Reporter Lenny Bernstein, Federation of American Scientists Senior Fellow Jennifer Erickson, and Director at the Vanderbilt Transplant Center Dr. Seth Karp join us for the conversation. Dr. Karp was also a former board member for The United Network for Sharing Organs

*********

And here's an alternate view, by three professors of surgery at the University of California San Francisco Medical Center, saying that the system isn't badly broken at all, and that attempts to fix it may lead to coordination failures that, at least in the short term, will cause additional problems.

From MedPageToday:

Our Organ Transplant System Isn't the Failure It's Made Out to Be. — Upholding the system will save lives  by Peter G. Stock, MD, PhD, Nancy L. Ascher, MD, PhD, and John P. Roberts, MD, March 24, 2023

"Thanks to a robust network of hospitals, nonprofit organizations, and government support, the U.S. remains a leader in organ transplantation. This community, which is managed by United Network for Organ Sharing (UNOS), saves tens of thousands of lives every year. Despite this success, opponents of UNOS are advocating to dismantle the transplant system as we know it.

...

"As transplant surgeons with a long history of involvement with the system -- including one of us (Roberts) serving as a past Board President of UNOS/Organ Procurement and Transplantation Network (OPTN) -- we have intimate knowledge of both its successes and its shortcomings. While UNOS has room to improve operationally -- and is working to do so -- we clearly see the organization's life-changing results in our operating rooms and offices. More work lies ahead, however, such as addressing the fact that a rising number of organs are recovered but not transplanted.

"Neither UNOS nor organ procurement organizations (OPOs), which facilitate recovery and organ offers to hospitals, have control over whether medical centers ultimately accept and transplant organs into patients. Though the former two have taken all the blame to date, this remains an issue that concerns the entire system. Leaving our nation's transplant centers out of this critical discussion is a serious oversight. For our entire system to save more lives, transplant centers need to have clear organ acceptance criteria, the appropriate resources to process available organs, and the tools and flexibility to utilize organs from more medically complex donors.

...

"The recommendations for division of labor as suggested this week by Carole Johnson, administrator of the Health Resources and Services Administration (HRSA), may be well intentioned but present a significant risk of further fragmentation and negative consequences due to a lack of coordination between government agencies and contractors. This coordination is essential for a functional and successful system. UNOS specifically has been handicapped by a meager budget for years, and despite this has a well-developed system. We believe that given the recent 10-fold budget increase by the Biden administration, the current contractor has the potential to rectify the shortcomings that have been highlighted in the press."

*********

Earlier posts:

Sunday, August 14, 2022

More on UNOS in the hot seat and calls for reform of the U.S. deceased donor transplant system

Thursday, March 23, 2023

Health Resources and Services Administration (HRSA) Announces Organ Procurement and Transplantation Network Modernization Initiative.

Pay transparency, horizontally, vertically, and across firms, by Zoe Cullen

 Information architecture is an important part of market design. Here's a nuanced review of pay transparency by Zoe Cullen, dealing with the non-obvious effects of horizontal transparency (letting workers know what similar workers are paid), vertical transparency (finding out how pay proceeds up the career ladder), and cross-firm transparency (what other firms are paying).

Is Pay Transparency Good?  by Zoe B. Cullen, NBER working paper 31060, DOI 10.3386/w31060 March 2023

Abstract: Countries around the world are enacting pay transparency policies to combat pay discrimination. 71% of OECD countries have done so since 2000. Most are enacting transparency horizontally, revealing pay between co-workers of similar seniority within a firm. While these policies have narrowed co-worker wage gaps, they have also lead to counterproductive peer comparisons and caused employers to bargain more aggressively, lowering average wages. Other pay transparency policies, without directly targeting discrimination, have benefited workers by addressing broader information frictions in the labor market. Vertical pay transparency policies reveal to workers pay differences across different levels of seniority. Empirical evidence suggests these policies can lead to more accurate and more optimistic beliefs about earnings potential, increasing employee motivation and productivity. Cross-firm pay transparency policies reveal wage differences across employers. These policies have encouraged workers to seek jobs at higher paying firms, negotiate higher pay, and sharpened wage competition between employers. We discuss the evidence on pay transparency’s effects, and open questions.

And from the conclusions:

"We conclude that “horizontal” pay transparency policies that reveal pay gaps between co-workers at the same firm create unintended spillovers between worker negotiations that lower worker bargaining power and wages. This characterizes the strong majority of pay transparency policies that have been put in place over the past two decades. However, policies that focus on ameliorating information frictions in the labor market more broadly have achieved the objectives of raising wages and equity. “Cross-firm” and “vertical” pay transparency policies have proven potential to increase motivation, allocation of talent, and sharpen competition. These policies are not designed to draw attention to employers who pay similar workers different wages, but instead these policies educate workers about the full range of opportunities to earn higher wages when they make decisions about training, where to apply, and how hard to work. Our evidence on misperceptions suggests low earners have the most to gain from improved access to this information. Pay transparency policies can also have pro-competitive effects by educating employers about market wages, eroding information rents when employers have private knowledge about the value workers bring to the job.

"Cross-firm pay transparency policies have recently gained traction among policy makers. In January of 2023, California and Washington became the second and third states in the U.S. to mandate that employers include a salary range in the job postings external job candidates see, following on the heels of Colorado and New York City. This is a big step toward making pay information available at the time workers are choosing where to direct their applications, and employers expect that this will lead applicants to direct their applications toward higher paying firms, increasing wage competition."

*********

And here's a quick story about that paper in yesterday's WSJ.

Knowing Everyone’s Salaries Can Light a Fire Under Workers. Seeing a career path to advancement—and believing the process is fair—motivates employees, studies show. By Courtney Vinopal, March 28, 2023

Bride price in China

 The NY Times has the story:

In China, Marriage Rates Are Down and ‘Bride Prices’ Are Up. China’s one-child policy has led to too few women. Grooms are now paying more money for wives, in a tradition that has faced growing resistance.  By Nicole Hong and Zixu Wang

"As China faces a shrinking population, officials are cracking down on an ancient tradition of betrothal gifts to try to promote marriages, which have been on the decline. Known in Mandarin as caili, the payments have skyrocketed across the country in recent years — averaging $20,000 in some provinces — making marriage increasingly unaffordable. The payments are typically paid by the groom’s parents.

"To curb the practice, local governments have rolled out propaganda campaigns such as the Daijiapu event, instructing unmarried women not to compete with one another in demanding the highest prices. Some town officials have imposed caps on caili or even directly intervened in private negotiations between families.

...

"Officials have acknowledged their limited ability to eliminate a custom that many families see as a marker of social status. In rural areas, neighbors may gossip about women who command low prices, questioning whether something is wrong with them, according to researchers who study the custom.

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

Earlier:

Friday, September 28, 2018

Bride price in rural China

Alex Chan

 Congratulations, Alex.

Alex Chan

@alex8chan

·

Mar 24

I will join

@HarvardHBS

as an Assistant Professor next academic year! to the sacrifices my family made for me + their support… #HBS #FirstGen + my advisors who made this dream possible #AlRoth

@MurielNiederle

@LaurenceCBaker

@MichelleM_Mello

@I_am_NickBloom

@SIEPR

@Stanford

And earlier (in October)

Welcome to the club, Alex.

The economics and politics of compensating kidney donors, by McCormick and Held

Political feasibility is an unavoidable consideration in any discussion of compensating kidney donors.  McCormick and Held take the latest a stab at it. 

How to End the Kidney Shortage. Few if any of these news stories lamenting the kidney shortage or touting hightech breakthroughs mention that we already have a solution to the shortage: compensating kidney donors to induce more supply  By Frank McCormick and Philip J. Held, SPRING 2023 • REGULATION (CATO Institute).

"A crucial question remains: what level of compensation should the government offer to kidney donors? The answer is a political judgment call that involves the tradeoff between the number of patients saved from premature death and the probability of getting a particular law or regulation changed.

Junk Fees and Related Pricing Practices

 The White House is taking interest in hidden fees, both  because they interfere with competition on price (e.g. when Ticketmaster reveals fees only as someone tries to complete a purchase), and because they sometimes seem unconscionable.  Here's a White House statement.

The President’s Initiative on Junk Fees and Related Pricing Practices

"The Biden-Harris Administration is taking action on junk fees that hurt Americans’ pocketbooks and the economy."

"Exploitative or predatory fees. Excessive fees that target consumers who have limited alternative options – because they are locked into a product or service, or are otherwise economically vulnerable – can likewise impose a financial burden. As the CFPB explains, a sign of exploitative fees is that they “far exceed the marginal cost of the service they purport to cover.” Bank overdraft fees, which greatly exceed the bank’s cost of credit, and surprise “termination fees” are leading examples."

HT: Susan Athey

********

Regarding bank overdraft fees, my sense is that these drive lots of people away from the formal banking system and into the hands of high-interest-rate check cashing and payday loan services. Since we already regulate some debit card fees, I wonder if banks can't be encouraged to have some kind of debit-card-only "checking" accounts. Those would be able to prevent overdrafts, so they should be very cheap to administer, and would allow people to avoid paying very high fees and interest rates to non-bank financial services.

Alcohol and race in Australia

 In the U.S. we certainly have a complicated history around both race and alcohol, but in Australia there may be even more complications, as a recent (limited) ban on alcohol and aborigines is reinstated.

The NY Times has the story

Authorities Reinstate Alcohol Ban for Aboriginal Australians. The reaction to a rise in crime has renewed hard questions about race and control, and about the open wounds of discrimination. By Yan Zhuang

"Mr. Shaw lives in what the government has deemed a “prescribed area,” an Aboriginal town camp where from 2007 until last year it was illegal to possess alcohol, part of a set of extraordinary raced-based interventions into the lives of Indigenous Australians.

"Last July, the Northern Territory let the alcohol ban expire for hundreds of Aboriginal communities, calling it racist. But little had been done in the intervening years to address the communities’ severe underlying disadvantage. Once alcohol flowed again, there was an explosion of crime in Alice Springs widely attributed to Aboriginal people. Local and federal politicians reinstated the ban late last month. 

...

"For those who believe that the country’s largely white leadership should not dictate the decisions of Aboriginal people, the alcohol ban’s return replicates the effects of colonialism and disempowers communities. Others argue that the benefits, like reducing domestic violence and other harms to the most vulnerable, can outweigh the discriminatory effects.

...

"According to the Northern Territory police, commercial breaks-ins, property damage, assaults related to domestic violence and alcohol-related assaults all rose by about or by more than 50 percent from 2021 to 2022. Australia does not break down crime data by race, but politicians and Aboriginal groups themselves have attributed the increase largely to Indigenous people.

"This was a preventable situation,” said Donna Ah Chee, the chief executive of one of these organizations, the Central Australian Aboriginal Congress. “It was Aboriginal women, families and children that were actually paying the price,” she added.

"The organization was among those that called for a resumption of the ban as an immediate step while long-term solutions were developed to address the underlying drivers of destructive drinking. Ms. Ah Chee said she considered the policy to be “positive discrimination” in protecting those most vulnerable."

**********

Of course bans in one jurisdiction can have spillovers into others. Here's a story from the Australian Broadcasting Corporation:

Katherine reports rise in transient visitors since return of Alice Springs alcohol restrictions  By Matt Garrick and Max Rowley

"An outback town struggling with crime and homelessness is seeing an influx of transient visitors, which some believe is a direct impact of new alcohol restrictions in Alice Springs."

Health Resources and Services Administration (HRSA) Announces Organ Procurement and Transplantation Network Modernization Initiative.

Here's a long awaited HRSA announcement, indicating their intent to modernize the deceased organ procurement and allocation system in the U.S.  It's still a bit short on details, but specifically mentions budget increases. In the future it will apparently issue Requests for Proposals from organizations willing to bid on parts of the transplantation allocation system, including software. (I hope HRSA is also thinking about how organ allocation policies will be revised and kept up to date in the future, including the possibility of experimenting with proposed improvements on a regular basis.)

The press release:

HRSA Announces Organ Procurement and Transplantation Network Modernization Initiative. Initiative includes the release of new organ donor and transplant data; prioritization of modernization of the OPTN IT system; and call for Congress to make specific reforms in the National Organ Transplant Act

"[March 22, 2023] Today, the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS), announced a Modernization Initiative that includes several actions to strengthen accountability and transparency in the Organ Procurement and Transplantation Network (OPTN):

"Data dashboards detailing individual transplant center and organ procurement organization data on organ retrieval, waitlist outcomes, and transplants, and demographic data on organ donation and transplant;

"Modernization of the OPTN IT system in line with industry-leading standards, improving OPTN governance, and increasing transparency and accountability in the system to better serve the needs of patients and families;

"HRSA’s intent to issue contract solicitations for multiple awards to manage the OPTN in order to foster competition and ensure OPTN Board of Directors’ independence;

"The President’s Fiscal Year 2024 Budget proposal to more than double investment in organ procurement and transplantation with a $36 million increase over Fiscal Year 2023 for a total of $67 million; and,

"A request to Congress included in the Fiscal Year 2024 Budget to update the nearly 40-year-old National Organ Transplant Act to take actions such as:

"Removing the appropriations cap on the OPTN contract(s) to allow HRSA to better allocate resources and,

"Expanding the pool of eligible contract entities to enhance performance and innovation through increased competition.

“Every day, patients and families across the United States rely on the Organ Procurement and Transplantation Network to save the lives of their loved ones who experience organ failure,” said Carole Johnson, HRSA Administrator. “At HRSA, our stewardship and oversight of this vital work is a top priority. That is why we are taking action to both bring greater transparency to the system and to reform and modernize the OPTN. The individuals and families that depend on this life-saving work deserve no less.”

"Today, HRSA is posting on its web site at Organ Donation and Transplantation (hrsa.gov) a new data dashboard to share de-identified information on organ donors, organ procurement, transplant waitlists, and transplant recipients. Patients, families, clinicians, researchers, and others can use this data to inform decision-making as well as process improvements. Today’s launch is an initial data set, which HRSA intends to refine over time and update regularly.

"This announcement also includes a plan to strengthen accountability, equity, and performance in the organ donation and transplantation system. This iterative plan will specifically focus on five key areas: technology; data transparency; governance; operations; and quality improvement and innovation. In implementing this plan, HRSA intends to issue contract solicitations for multiple awards to manage and improve the OPTN. HRSA also intends to further the OPTN Board of Directors’ independence through the contracting process and the use of multiple contracts. Ensuring robust competition in every industry is a key priority of the Biden-Harris Administration and will help meet the OPTN Modernization Initiative’s goals of promoting innovation and the best quality of service for patients.

"Finally, the President’s Budget for Fiscal Year 2024 would more than double HRSA’s budget for organ-related work, including OPTN contracting and the implementation of the modernization initiative, to total $67 million. In addition, the Budget requests statutory changes to the National Organ Transplant Act to remove the decades old ceiling on the amount of appropriated funding that can be awarded to the statutorily required vendor(s) for the OPTN. It also requests that Congress expand the pool of eligible contract entities to enhance performance and innovation through increased competition, particularly with respect to information technology vendors.

"HRSA recognizes that while modernization work is complex, the integrity of the organ matching process is paramount and cannot be disrupted. That is why HRSA’s work will be guided by and centered around several key priorities, including the urgent needs of the more than 100,000 individuals and their families awaiting transplant; the 24/7 life-saving nature of the system; and patient safety and health. HRSA intends to engage with a wide and diverse group of stakeholders early and often to ensure a human-centered design approach that reflects pressing areas of need and ensuring experiences by system users like patients are addressed first. As a part of this commitment, HRSA has created an OPTN Modernization Website at OPTN Modernization (hrsa.gov) to keep stakeholders informed about the Modernization Initiative and provide regular progress updates."

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

Here's a related story in the NY Times:

U.S. Organ Transplant System, Troubled by Long Wait Times, Faces an Overhaul. The Biden administration announced a plan to modernize how patients are matched to organs, seeking to shorten wait times, address racial inequities and reduce deaths.  By Sheryl Gay Stolberg

"The Biden administration announced on Wednesday that it would seek to break up the network that has long run the nation’s organ transplant system, as part of a broader modernization effort intended to shorten wait times, address racial inequities and reduce the number of patients who die while waiting.

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

 Earlier, the Washington Post had a story about how the most recent (current) version of the system  for allocating deceased donors is indeed having some problems, the most serious of which (in my view) is the congestion  involved in placing an organ for transplant. (This congestion involves time in getting an organ accepted, and then transported...)

New liver transplant rules yield winners, losers as wasted organs reach record high. The number of lifesaving liver transplants has plummeted in some Southern and Midwestern states that struggle with higher death rates from liver disease  By Malena Carollo and Ben Tanen

"New rules requiring donated livers to be offered for transplant hundreds of miles away have benefited patients in New York, California and more than a dozen other states at the expense of patients in mostly poorer states with higher death rates from liver disease, a data analysis by The Washington Post and the Markup has found.

"The shift was implemented in 2020 to prioritize the sickest patients on waitlists no matter where they live. While it has succeeded in that goal, it also has borne out the fears of critics who warned the change would reduce the number of surgeries and increase deaths in areas that already lagged behind the nation overall in health-care access.

...

"The new system, called the “acuity circles” policy, has nearly doubled the median distance livers are transported, increased transport costs and coincided with the highest number of wasted livers in nearly a decade, 949 in 2021. That’s 1 in 10 donated livers. The analysis further shows a significant increase in the number of states sending donated livers beyond their own borders. In 2019, before the new policy took effect, 21 states and territories exported a majority of livers they collected. Two years later, 42 did."