Ben Edelman, the Chief Economist for Web Experiences, Strategy, and Policy at Microsoft, has some new papers on his blog, about Microsoft AI tools.
Saturday, December 16, 2023
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.
********
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."
**********
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.
Saturday, December 9, 2023
JOE Job Openings for Economists: 2023 versus the past 4 years
Here's the latest note on the job market from the AEA's Committee on the Job Market. It reflects a tight job market (but may also reflect that fewer than 100% of available jobs are published in the JOE, and this may be in flux). The full memo is at the link below, and I'm summarizing here some of the highlights (trigger warning:(
JOE Job Openings by Sector, 2023 versus the past 4 years
"To: Members of the American Economic Association
From: AEA Committee on the Job Market: John Cawley (chair), Matt Gentzkow, Brooke Helppie-McFall, Al Roth, Peter Rousseau, and Wendy Stock Date: December 8, 2023
This memo reports the cumulative number of unique job openings on Job Openings for Economists (JOE), by sector and week, compared to the same week in recent years.
Some clarifications on the data and graphs in this memo:
• ...
• The data described in this memo cover ISO weeks 1 through 48, which in 2023 ended December 3.
• The counts that are graphed and discussed are the number of job openings. To clarify, it is not the number of job listings; a listing may include multiple openings.
• ...
• On each graph, the year-to-date cumulative number of job openings is listed for the past five years separately: 2019-2023. The graphs are shown below, overall and by sector.
Figure 1 (on p. 3) shows the total number of job openings in 2023, compared to recent years. As of the end of week 48, there have been 2,924 jobs listed on JOE since the beginning of 2023, which is 14.7% lower than at the same week in 2022, 8.7% lower than the same week in 2021, 21.9% higher than the same week in 2020 (the worst COVID year), and 15.9% lower than the same week in 2019, the last pre- COVID year.
Subsequent graphs compare the number of job openings separately by sector. Figure 2 shows that 741 full-time academic positions in the U.S. have been listed on JOE so far in 2023; this is 16.5% lower than at the same week in 2022, 0.4% lower than at the same week in 2021, 109.3% higher than at the same week in 2020, and 8.2% lower than the same week in 2019 - see p. 4.
Figure 4 shows that 949 full-time academic job openings in institutions outside the U.S. have been listed on JOE so far in 2023; that is 7.2% lower than at the same week in 2022, 9.5% lower than the same week in 2021, 11.1% higher than at the same week in 2020, and 16.7% lower than the same week in 2019 - see p. 6.
Figure 6 shows that 508 full-time non-academic positions (in the U.S. or abroad) have been listed on JOE so far in 2023; that is 26.8% lower than at the same week in 2022, 30.0% lower than at the same week in 2021, 18.2% lower than the same time in 2020 and 35.4% lower than the same week in 2019 - see p. 8.
Over the past four years, roughly 92% of the calendar year’s job listings have been posted by the end of November. In January 2024, we will post a year-end report that includes the final numbers for 2023.
The AEA Executive Committee and the Committee on the Job Market provide the following guidance for the job market, to ensure common expectations, fairness, and a thick job market. This guidance concerns the timing of interview invitations, the interviews themselves, and exploding job offers.
...
 |
Friday, December 8, 2023
Computers in Econ (and in market design)
The current issue of the journal Œconomia. is devoted to The Computerization of Economics. Computers, Programming, and the Internet in the History of Economics
It includes this surprisingly grumpy-sounding take on market design, particularly on its intersection with game theory:
Nik-Khah, Edward. "The Closed Market: Platform Design and the Computerization of Economics." Œconomia. History, Methodology, Philosophy 13-3 (2023): 877-905.
Here's a paragraph that caught my eye:
"In his book Who Gets What—And Why, the market designer Alvin Roth pronounced firms such as Google, Amazon, and Uber to be “markets,” proclaiming, “Successful designs depend greatly on the details of the market, including the culture and psychology of the participants” (Roth, 2015). One need not actually find an example of an economist counseling advisees to skip that additional course in game theory and take up cultural anthropology to arrive at the sense that matters had taken a surprising turn: only a decade before one regularly encountered brash claims that all social science worth its salt must be reducible to game theory, with market design cited as evidence for why this must be so (e.g., Binmore, 2004)."
#####
Here's the table of contents of the issue:
Thursday, December 7, 2023
Drug addiction: not just opioids
Consumption of addictive drugs seems to come in deadly cocktails these days, which is making interdiction of drugs, and treatment of addiction more complicated.
The NYT has the story:
‘A Monster’: Super Meth and Other Drugs Push Crisis Beyond Opioids. Millions of U.S. drug users now are addicted to several substances, not just opioids like fentanyl and heroin. The shift is making treatment far more difficult. By Jan Hoffman
"The United States is in a new and perilous period in its battle against illicit drugs. The scourge is not only opioids, such as fentanyl, but a rapidly growing practice that the Centers for Disease Control and Prevention labels “polysubstance use.”
Over the last three years, studies of people addicted to opioids (a population estimated to be in the millions) have consistently shown that between 70 and 80 percent also take other illicit substances, a shift that is stymieing treatment efforts and confounding state, local and federal policies.
“It’s no longer an opioid epidemic,” said Dr. Cara Poland, an associate professor at the Michigan State University College of Human Medicine. “This is an addiction crisis.”
...
"The incursion of meth has been particularly problematic. Not only is there no approved medical treatment for meth addiction, but meth can also undercut the effectiveness of opioid addiction therapies. Meth explodes the pleasure receptors, but also induces paranoia and hallucinations, works like a slow acid on teeth and heart valves and can inflict long-lasting brain changes.
"The Biden administration has been pouring billions into opioid interventions and policing traffickers, but has otherwise lagged in keeping pace with the evolution of drug use. There has been comparatively little discussion about meth and cocaine, despite the fact that during the 12-month period ending in May 2023, over 34,000 deaths were attributed to methamphetamine and 28,000 to cocaine, according to provisional federal data.
...
"Like opioids, which originally came from the poppy, meth started out as a plant-based product, derived from the herb ephedra. Now, both drugs can be produced in bulk synthetically and cheaply. They each pack a potentially lethal, addictive wallop far stronger than their precursors."
Wednesday, December 6, 2023
Applying for medical residencies: a consensus statement from Internal Medicine
The Alliance for Academic Internal Medicine has released a "consensus statement" with many proposals about application and interview caps, and signaling.
Catalanotti, Jillian S., Reeni Abraham, John H. Choe, Kelli A. Corning, Laurel Fick, Kathleen M. Finn, Stacy Higgins et al. "Rethinking the Internal Medicine Residency Application Process to Prioritize the Public Good: A Consensus Statement of the Alliance for Academic Internal Medicine." The American Journal of Medicine (2023).
It also includes a call for data and analysis:
"AAIM proposes increasing internal medicine program preference signals to 15, using tiered signaling with three “gold” and 12 “silver” signals, and setting an interview cap of 15 in the 2024-2025 recruitment season, with participation by all internal medicine programs. The Alliance recommends that all internal medicine programs participate in ACI. AAIM recommends that programs transparently share information about their use of preference signals and other application screening methods and calls for real-time data analysis to explore impact, inform future iterations and identify potential harms.
"The Alliance calls upon ERAS and NRMP as well as Thalamus® and other interview scheduling platforms to transparently share data, to embrace change, and to perform analyses needed to inform this process. For example, recent modeling with eight years of retrospective NRMP data in OBGYN demonstrated that an early match round may increase the number of “mutually dissatisfied applicant-program pairs” and that a multiple-round match process could introduce potential rewards for gamesmanship, a prime factor addressed by the current process.35 AAIM applauds this analysis and hopes that the new collaboration between ERAS and Thalamus® may provide useful interview data to inform this proposal and further interventions."
And here is reference 35 in that last paragraph, about which I've blogged before.
Early vs Single Match in the Transition to Residency: Analysis Using NRMP Data From 2014 to 2021
J Grad Med Educ, 15 (2) (Apr 2023), pp. 219-227, 10.4300/JGME-D-22-00177.1
Tuesday, December 5, 2023
Monday, December 4, 2023
Convalescent plasma: the picture is getting clearer
Slowly, there is evidence accumulating that convalescent plasma is helpful in treating patients with severe Covid, if it is administered early. There is also evidence that it doesn't help much once the disease has become well established, particularly when the primary symptoms become due to the body's own immune reaction. These caveats help explain why early reports did not find an effect of convalescent plasma--i.e. it helped only a subset of the patients to whom it was administered. But for those it was sometimes life saving. Here is a recent paper from the New England Journal of Medicine.
Convalescent Plasma for Covid-19–Induced ARDS in Mechanically Ventilated Patients by Benoît Misset, M.D., Michael Piagnerelli, M.D., Ph.D., Eric Hoste, M.D., Ph.D., Nadia Dardenne, M.Sc., David Grimaldi, M.D., Ph.D., Isabelle Michaux, M.D., Ph.D., Elisabeth De Waele, M.D., Ph.D., Alexander Dumoulin, M.D., Philippe G. Jorens, M.D., Ph.D., Emmanuel van der Hauwaert, M.D., Frédéric Vallot, M.D., Stoffel Lamote, M.D., et al., October 26, 2023, N Engl J Med 2023; 389:1590-1600 DOI: 10.1056/NEJMoa2209502
"Abstract
BACKGROUND
Passive immunization with plasma collected from convalescent patients has been regularly used to treat coronavirus disease 2019 (Covid-19). Minimal data are available regarding the use of convalescent plasma in patients with Covid-19–induced acute respiratory distress syndrome (ARDS).
METHODS
In this open-label trial, we randomly assigned adult patients with Covid-19–induced ARDS who had been receiving invasive mechanical ventilation for less than 5 days in a 1:1 ratio to receive either convalescent plasma with a neutralizing antibody titer of at least 1:320 or standard care alone. Randomization was stratified according to the time from tracheal intubation to inclusion. The primary outcome was death by day 28.
RESULTS
A total of 475 patients underwent randomization from September 2020 through March 2022. Overall, 237 patients were assigned to receive convalescent plasma and 238 to receive standard care. Owing to a shortage of convalescent plasma, a neutralizing antibody titer of 1:160 was administered to 17.7% of the patients in the convalescent-plasma group. Glucocorticoids were administered to 466 patients (98.1%). At day 28, mortality was 35.4% in the convalescent-plasma group and 45.0% in the standard-care group (P=0.03). In a prespecified analysis, this effect was observed mainly in patients who underwent randomization 48 hours or less after the initiation of invasive mechanical ventilation. Serious adverse events did not differ substantially between the two groups.
CONCLUSIONS
The administration of plasma collected from convalescent donors with a neutralizing antibody titer of at least 1:160 to patients with Covid-19–induced ARDS within 5 days after the initiation of invasive mechanical ventilation significantly reduced mortality at day 28. This effect was mainly observed in patients who underwent randomization 48 hours or less after ventilation initiation."
#####
Here are my posts on convalescent plasma, and the confusing initial reports about its effects.
Sunday, December 3, 2023
Photos from the daily market design activity at Stanford
Two photos remind me of the day to day market design activity at Stanford.
Tinglong Dai joined our Wednesday market design coffee and sent along this picture. (You can see who came by plane and who came by bike...) He wrote about his visit here.
And Matias Cersosimo successfully defended his dissertation on Friday, which included market design experiments like this one.
Welcome to the club, Matias.
Saturday, December 2, 2023
Design of (international) kidney exchange: ex-post rejection versus ex-ante withholding
Here's a paper by several Dutch computer scientists, which seems to be motivated by the problem of international kidney exchange within the EU, in which there are lots of concerns about fairness between countries. But (as the paper notes) these could also apply to individual transplant centers, in the U.S. context. The thrust of the paper is that looking for exchanges that won't be rejected ex post in a full information environment may be more productive than looking for ways to incentivize countries or transplant centers to reveal their full sets of patient donor pairs in an incomplete information environment.
Blom, Danny, Bart Smeulders, and Frits Spieksma. "Rejection-Proof Mechanisms for Multi-Agent Kidney Exchange." Games and Economic Behavior (2023).
Abstract: Kidney exchange programs (KEPs) increase kidney transplantation by facilitating the exchange of incompatible donors. Increasing the scale of KEPs leads to more opportunities for transplants. Collaboration between transplant organizations (agents) is thus desirable. As agents are primarily interested in providing transplants for their own patients, collaboration requires balancing individual and common objectives. In this paper, we consider ex-post strategic behavior, where agents can modify a proposed set of kidney exchanges. We introduce the class of rejection-proof mechanisms, which propose a set of exchanges such that agents have no incentive to reject them. We provide an exact mechanism and establish that the underlying optimization problem is
we also describe computationally less demanding heuristic mechanisms. We show rejection-proofness can be achieved at a limited cost for typical instances. Furthermore, our experiments show that the proposed rejection-proof mechanisms also remove incentives for strategic behavior in the ex-ante setting, where agents withhold information.
Friday, December 1, 2023
Fairness in algorithms: Hans Sigrist Prize to Aaron Roth
The University of Bern's Hans Sigrist Prize has been awarded to Penn computer scientist Aaron Roth, and will be celebrated today.
Here are today's symposium details and schedule:
Here's an interview:
Aaron Roth: Pioneer of fair algorithms In December 2023, the most highly endowed prize of the University of Bern will go to the US computer scientist Aaron Roth. His research aims to incorporate social norms into algorithms and to better protect privacy. by Ivo Schmucki
"There are researchers who sit down and take on long-standing problems and just solve them, but I am not smart enough to do that," says Aaron Roth. "So, I have to be the other kind of researcher. I try to define a new problem that no one has worked on yet but that might be interesting."
"Aaron Roth's own modesty may stand in the way of understanding the depth of his contributions. In fact, when he authored his doctoral thesis on differential privacy about 15 years ago and then wrote on the fairness of algorithms a few years later, terms like “Artificial Intelligence” and “Machine Learning” were far from being as firmly anchored in our everyday lives as they are today. Aaron Roth was thus a pioneer, laying the foundation for a new branch of research.
"I am interested in real problems. Issues like data protection are becoming increasingly important as more and more data is generated and collected about all of us," says Aaron Roth about his research during the Hans Sigrist Foundation’s traditional interview with the prize winner. He focuses on algorithmic fairness, differential privacy, and their applications in machine learning and data analysis.
...
"It is important that more attention is paid to these topics," says Mathematics Professor Christiane Tretter, chair of this year's Hans Sigrist Prize Committee. Tretter says that many people perceive fairness and algorithms as two completely different poles, situated in different disciplines and incompatible with each other. "It is fascinating that Aaron Roth’s work shows that this is not a contradiction."
...
"The first step to improving the analysis of large data sets is to be aware of the problem: "We need to realize that data analysis can be problematic. Once we agree on this, we can consider how we can solve the problems," says Aaron Roth."
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