Wednesday, May 17, 2017

Dialysis: Last Week Tonight with John Oliver (HBO)

Laughing through the tears...


The video briefly mentions a new living donor information source and database, Give and Live.

Tuesday, May 16, 2017

Replication in Economics

Professor Bob Reed at U of Canterbury points me to The Replication Network, a website he co-founded with Dr Maren Duvendack of  U of E. Anglia to promote replication in Economics, and assemble information about replication studies.

See also their paper and the others in the  Papers and Proceedings (May 2017)  issue of the American Economic Review, which begins with a section on replication:
REPLICATION IN MICROECONOMICS
REPLICATION AND ETHICS IN ECONOMICS: THIRTY YEARS AFTER DEWALD, THURSBY, AND ANDERSON

Monday, May 15, 2017

Replicability and credibility of scientific research as a challenge to market design

A recent issue of PLOS Biology carries a call for some market design:

The credibility crisis in research: Can economics tools help?
Thomas Gall, John P. A. Ioannidis, Zacharias Maniadis
Published: April 26, 2017 https://doi.org/10.1371/journal.pbio.2001846

Abstract: The issue of nonreplicable evidence has attracted considerable attention across biomedical and other sciences. This concern is accompanied by an increasing interest in reforming research incentives and practices. How to optimally perform these reforms is a scientific problem in itself, and economics has several scientific methods that can help evaluate research reforms. Here, we review these methods and show their potential. Prominent among them are mathematical modeling and laboratory experiments that constitute affordable ways to approximate the effects of policies with wide-ranging implications.

Sunday, May 14, 2017

The gastroenterology fellowship match is thriving

The journal of Digestive Diseases and Sciences reports that the state of the Gastro match is good:

  • Robert J. Huang
    • 1
  • George Triadafilopoulos
    • 1
  • David Limsui
    • 1
  1. 1.Gastroenterology and Hepatology Stanford University Medical Center  
Fellows and Young Gis Section
DOI: 10.1007/s10620-017-4593-z
Cite this article as:
Huang, R.J., Triadafilopoulos, G. & Limsui, D. Dig Dis Sci (2017). doi:10.1007/s10620-017-4593-z







Abstract: Following a period of uncertainty and disorganization, the gastroenterology (GI) national leadership decided to reinstitute the fellowship match (the Match) under the auspices of the National Residency Matching Program (NRMP) in 2006. Although it has now been a decade since the rebirth of the Match, there have been limited data published regarding progress made. In this piece, we discuss reasons for the original collapse of the GI Match, including most notably a perceived oversupply of GI physicians and a poor job market. We discuss the negative impacts the absence of the Match had on programs and on applicants, as well as the impetus to reorganize the Match under the NRMP. We then utilize data published annually by the NRMP to demonstrate that in the decade since its rebirth, the GI Match has been remarkably successful in terms of attracting the participation of applicants and programs. We show that previous misguided concerns of an oversupply of GI physicians were not realized, and that GI fellowship positions remain highly competitive for internal medicine applicants. Finally, we discuss possible implications of recent changes in the healthcare landscape on the GI Match.

Saturday, May 13, 2017

Media coverage and organ donor registration

How organ donation is covered in the press might effect donor registrations. Here's a paper from the PNAS:

Effect of media presentations on willingness to commit to organ donation

     Significance

    We often encounter cases of organ donation in the press or on television. How might these stories affect readers? We found that reading coverage of cases that include identifying information about the receiver (saved by organ donations) increased participants’ willingness to commit to organ donation themselves, to donate the organs of a deceased relative, or to support a transition to an “opt-out” policy. Conversely, identifying the deceased donor induced thoughts of death rather than about saving lives, resulting in fewer participants willing to donate organs or to support policies that facilitate organ donation. We show that most of the stories that appear in the press include an identified donor rather than an identified receiver, possibly reducing organ donations.

    Friday, May 12, 2017

    Living versus deceased donor kidneys (LD kidneys last longer...)

    It appears that even a not so well matched living donor kidney lasts longer than a deceased donor kidney...

    Living Donation Has a Greater Impact on Renal Allograft Survival Than HLA Matching in Pediatric Renal Transplant Recipients
    Marlais, Matko MRCPCH; Hudson, Alex MSc; Pankhurst, Laura MSc; Fuggle, Susan V. D.Phil.; Marks, Stephen D. MD
    TRANSPLANTATION, Dec. 2016 Volume: 100  Issue: 12  Pages: 2717-2722

    Background: Living donor (LD) kidney transplantation accounts for around half of all pediatric renal transplant recipients and results in improved renal allograft survival. The aim of this study was to determine the effect of HLA matching on deceased and LD renal allograft outcomes in pediatric recipients.
    Methods: Data were obtained from the UK Transplant Registry held by NHS Blood and Transplant on all children who received a donation after brain death (DBD) or LD kidney-only transplant between 2000 and 2011. HLA-A, HLA-B and HLA-DR mismatches were categorized into 4 levels and 2 groups. Data were fully anonymized.
    Results: One thousand three hundred seventy-eight pediatric renal transplant recipients were analyzed; 804 (58%) received a DBD donor kidney, 574 (42%) received an LD kidney. Five-year renal allograft survival was superior for children receiving a poorly HLA-matched LD kidney transplant (88%, 95% confidence interval [95% CI], 84-91%) compared with children receiving a well HLA-matched DBD kidney transplant (83%, 95% CI, 80-86%, log rank test P = 0.03). Five-year renal allograft survival was superior for children receiving an LD kidney with 1 or 2 HLA-DR mismatches (88%, 95% CI, 84-91%) compared with children receiving a DBD kidney with 0 HLA-DR mismatches (83%, 95% CI, 80-86%, log rank test P = 0.03).
    Conclusions: In children, poorly HLA-matched LD renal transplant outcomes are not inferior when compared with well HLA-matched DBD renal transplants. It is difficult to justify preferentially waiting for an improved HLA-matched DBD kidney when a poorer HLA-matched LD kidney transplant is available.

    Thursday, May 11, 2017

    You can register as an organ donor in MN when you get a fishing license

    Organ donation isn't just for drivers' licenses in Minnesota:
    Fish, hunt, save lives: MN first to offer organ donor option on fishing license

    "Organ donation through the Department of Natural Resources license registration website went live March 1, and already 4,300 people have checked the donor box. It’s only available online, not in stores, and works the same as the organ donation option on a driver’s license."

    Wednesday, May 10, 2017

    recovering more deceased donor kidneys

    Here's a post from the American Society of Neprology (ASN):
    Old Age Should Not Exclude Organ Donation After Death
    Kidneys from elderly deceased individuals can function for years after transplantation
    "New research suggests that age cut-offs for deceased organ donors prevent quality kidneys from being available to patients in need of life-saving transplants. A study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN) found that even kidneys from donors ≥80 years of age can function for years after transplantation."
    The article, entitled “Long-term Outcomes and Discard Rate of Kidneys by Decade of Extended Criteria Donor Age,” will appear online at http://cjasn.asnjournals.org/ on December 15, 2016, doi:10.2215/CJN.05990616. 

    **********
    And from the journal Transplantation
    Diagnosing the Decades-Long Rise in the Deceased Donor Kidney Discard Rate in the U.S.  by Stewart, Darren E. M.S., UNOS; Garcia, Victoria C. M.P.H., UNOS; Rosendale, John D. M.S., UNOS; Klassen, David K. M.D., UNOS; Carrico, Bob J. Ph.D., UNOS

    "Abstract--Background: The proportion of deceased donor kidneys recovered for transplant but discarded increased steadily in the U.S. over 2 decades, from 5.1% in 1988 to 19.2% by 2009. Over 100,000 patients are waiting for a kidney transplant, yet 3,159 kidneys were discarded in 2015.
    ...

    "Results: This study found that at least 80% of the discard rate rise can be explained by the recovery of kidneys from an expanding donor pool and changes in biopsy and pumping practices. However, a residual discard rate increase could not be explained by changes in these factors. From 1987 to 2009, median donor age rose from 26 to 43 years; median KDRI increased from 1.1 to 1.3. Our findings suggest the increase from 10% to 30% in the proportion of kidneys pumped during the 2000's served as a buffer keeping the discard rate from rising even higher than it did.


    "Conclusions: The majority of the kidney discard rate rise can be explained by the broadening donor pool. However, the presence of an unexplained, residual increase suggests behavioral factors (e.g., increased risk aversion) and/or allocation inefficiencies may have played a role. Reducing risk aversion, improving allocation, and more often pumping less-than-ideal, yet potentially transplantable kidneys, may help reverse the trend."

    Tuesday, May 9, 2017

    The job market for economists: Planet Money podcast (24 minutes)

    If you want to relive (or anticipate) your experience on the job market for new Ph.D. economists, here is the podcast for you.  Journalists Adrian Ma and Robert Smith follow  a brave new Ph.D. who talked to them while he interviewed for jobs. They also talk to many other people at the AEA meetings in Chicago, and discuss how some candidates might fall through the cracks. They talk to me (around minute 15) about the signaling mechanism that the AEA introduced. (The candidate they followed signaled the Census Bureau, just before the federal government announced a hiring freeze, but is now gainfully employed:)





    #769: Speed Dating For Economists

    We visit a job market created by economists, for economists. It's a hyper-efficient, optimized system, tested by game theorists, tweaked by a Nobel Prize winner, but it requires comfortable shoes.


    Monday, May 8, 2017

    Assisted suicide--the musical

    A Theatrical Rebuttal to the Farce of ‘Dignicide’
    The creator of ‘Assisted Suicide: The Musical’ says euthanasia denies the value of people who have illnesses or disabilities.

    Liz Carr, an actress with disabilities created a popular London musical to speak out against assisted suicide...

    So she created a musical. Much of “Assisted Suicide” involves Ms. Carr taking on her alter ego, a character named Documentary Liz. Film footage shows Documentary Liz living a humdrum disabled life, while a lachrymose melody plays and a narrator dourly describes the scene: “Liz feels trapped, imprisoned by her difficult circumstances. Liz has few freedoms, few choices on a day-to-day basis.”

    Onstage, the real Ms. Carr rolls her eyes and provides a running commentary, acidly mocking the documentary clichés. “Music is always used very manipulatively,” she tells me. “The music feeds the emotional journey. It tells you, ‘This is a tragedy. This has one way to go.’ ” The aim is to normalize a choice that was unthinkable a generation ago, with the result that people like her are impelled to conclude: “You know what, my life isn’t worth living.”

    Growing up with a severe disability, Ms. Carr recalls, “life was bleak.” She excelled at academics, but no amount of therapy seemed to improve her physical ability. She was never consciously suicidal, “but I didn’t see a future or an escape. I couldn’t see a point. So in that sense I’ve been to very dark places.” She pressed on, however, and now enjoys national prominence as an actress and disability activist.

    Ms. Carr, who was born in 1972, considers herself lucky that euthanasia wasn’t on the cultural radar when she was young. “Assisted suicide has become part of the narrative of death, of illness, of disability,” she says. That was the work of euthanasia proponents, who knew that “it takes 15 to 20 years to get social support and to get the culture to change—then you pass the law.”

    Sunday, May 7, 2017

    Interview about Who Gets What and Why, in Portugese

    The Portugese translation of Who Gets What and Why is called Como Funcionam Os Mercados (How markets work)

    Here's an interview about it:
    O novo mundo dos mercados
     Google translate: "The new world of markets"


    Saturday, May 6, 2017

    A non-directed kidney donor speaks about his experience (which started with a Freakonomics podcast)

    Here's more on Ned Brooks, the non-directed donor who heard about kidney exchange chains on a Freakonomics podcast:

    Ned Brooks: Donating His Kidney was Life-Changing. For Him

    “The concept of leverage was absolutely the driver for me, “ recalls Ned. “The idea that my one wholly redundant kidney could impact multiple lives, not just the patients themselves but their children, their parents, was huge.”

    And the idea of starting a kidney donation chain touched his competitive side: “How many lives could my kidney donation impact?”
    ***************

    See my earlier post

    Friday, February 26, 2016





    Friday, May 5, 2017

    Highlights from the Barcelona GSE 10th Anniversary Celebration

    You can find videos and photos from the 10th anniversary celebration of the Barcelona Graduate School of Economics (BGSE) here.  (The celebration took place on March 31 and April 1.)

    I took part in a set of presentations on "The Practical Influence of Economic Research," with  Richard Blundell,  Matt Jackson, Anne Krueger, me, and Chris Sims ." BGSE Director Teresa Garcia-Milà moderated the discussion.

    You can watch and listen to the whole thing here.



    My remarks are from minute 33:50 to minute 45:00. (Among other things, I recall one of my first talks on kidney exchange, given almost 15 years ago at the Barcelona Clinic, a leading transplant center, and discuss how kidney exchange has come to account for a large percentage of living donor kidneys in Spain, as well as in the U.S.)

    Thursday, May 4, 2017

    William J. Baumol (1922-2017)

    Many will remember Baumol for his explication of why labor costs go up in industries in which productivity does not. I mostly think about his theory of contestable markets, that markets can achieve perfect competition even if made up by big, strategic players, so long as entry into the market is easy, so that prices are disciplined by the need to keep out entrants.

    Here's Vox:
    William Baumol, whose famous economic theory explains the modern world, has died  May 4, 2017

    Here's his List of Publications

    Milliman Lecture in Economics at UW, May 4

    If you're in Seattle this evening...

    2017 Biennial Endowed Milliman Lecture in Economics

    Alvin Roth, 2012 Nobel Laureate in Economic Sciences and Professor of Economics, Stanford University
    "Markets and Marketplaces: The New and Not So New Economics of Market Design
    Thursday, May 4, 2017
    6:30 p.m., Dempsey Hall 302 (Anthony's Executive Forum)
    ********

    Here's an announcement with some other details...
    Nobel Laureate Alvin Roth to Give 2017 Milliman Lecture in Economics

    Wednesday, May 3, 2017

    Mike Rees in India to help remove obstacles to kidney exchange

    The Times of India reports:
    Paired kidney donations may mitigate patients’ agonizing wait

    "On Tuesday, at an event organized by Gift Your Organ Foundation, Dr Michael Rees, CEO, Alliance for Paired Kidney Donation, USA, and Dr Eric Velez, founder of ProRenal, a Mexico-based organization, discussed the possibilities of paired kidney transplants that can be a solution for Indian patients. The duo played key roles in making the world's first-ever global paired transplant possible.
    ...
    "The US, in 2017, brought required amendments to its National Organ Transplant Act (NOTA) to allow paired donations. Alliance for Paired Kidney Donation has a transplant matching software that does the matching between donors and recipients.

    "In Mexico, 1.2 lakh people suffer from end-stage renal disorder and only 2600-2800 patients undergo transplants every year, said Dr Eric Velez.

    "Shalini Rajneesh, principal secretary, health and family welfare, said Alliance for Paired Kidney Donation agreed to share their software with the Jeeva Sarthakate Society of Karnataka (earlier known as ZCCK) for free. The state-owned society works on organ transplants and coordinates with patients awaiting organs through the registry. "The software does a perfect match between donors and recipients to allow the swap transplant," she said.

    "Asked if the legal framework allows live kidney donation between unrelated donors, she said as a long-term plan, the government will look into the issues and bring in required amendments. The main barrier is people do not want to donate and there is a need to create awareness, she added.

    "Currently, transplants among unrelated donors are put through a series of checks to ensure that it does not lead to kidney racket.

    'Transplants between spouses getting tougher'

    "Dr Sankaran Sundar, a nephrologist who has coordinated more than 2,500 transplants so far, said the existing legal framework makes it difficult for patients to pursue transplants among unrelated donors.

    "Karnataka has seen only six swap kidney transplants. Even among the spousal donors (when the couple want to share a kidney), it's been difficult to get approval from the authorization committee. When the kidney transplant is between a father/mother and son/daughter, or between siblings, it's easy to establish relationship. But when it is between a couple, it's tough, as marriage certificate has also been found to have been doctored in many cases," said Dr Sankaran Sundar."
    ********

    Here's another account, from the Deccan Chronicle
    Bengaluru: Path-breaking tech to facilitate kidney transplants

    Tuesday, May 2, 2017

    The threshold structure of Top Trading Cycles (TTC) by Leshno and Lo

    A new look at top trading cycles:

    The Simple Structure of Top Trading Cycles inSchool Choice
    Jacob D. Leshno and Irene Lo  April 25, 2017

    Abstract: "Many cities determine the assignment of students to schools through a school choice mechanism. The prominent Top Trading Cycles (TTC) mechanism has attractive properties for school choice, as it is strategy-proof, Pareto efficient, and allows school boards to guide the allocation by specifying priorities. However the combinatorial description of TTC makes it non-transparent to parents and difficult for designers to analyze. We give a tractable characterization of the TTC mechanism for school choice: the TTC assignment can be simply described by n^2 admission thresholds, where n is the number of schools, and these thresholds can be easily observed after running the mechanism. To calculate these thresholds, we de fine TTC through trade balance equations. In a continuum model these equations correspond to a differential equation whose solution can give closed form expressions for the admission thresholds.

    The model allows us to compute comparative statics, and evaluate welfare. As applications of the model we solve for optimal investment in school quality, explore the design of the priority structure, and provide comparisons between TTC and other school choice mechanisms that help explain empirical findings. To validate the continuum model we show that it gives a good approximation for strongly converging economies. Our analysis draws on an interesting connection between continuous trading procedures and continuous time Markov chains."

    Monday, May 1, 2017

    School choice in Chicago: GoCPS

    Here's an account from New Schools for Chicago:
    Chicago Board of Education Approves the Single Application
    "Yesterday, the Chicago Public Schools Board of Education voted unanimously in favor of moving to a single application for all public high schools in the city. This decision comes just after a recently released report from the Institute for Innovation in Public School Choice (IIPSC) and New Schools for Chicago outlining the feedback and recommendations of parents from across the city. "
    **********

    And here's a news story from WTTW:

    "The Board of Education voted unanimously Wednesday to approve a new common application for students entering district high schools this fall. The new model, called “GoCPS,” is aimed at transparency and efficiency in that application process, according to CPS Chief Education Officer Janice Jackson.

    “We cannot have a system that allows some people to feel that they can access with ease while others feel like it’s too complicated and choose to disengage," she said. "So moving forward, GoCPS allows us to bring more people into the fold, but it also allows us an opportunity to use technology to support them.”

    In the current system, students can fill out multiple applications and receive offers from high schools.

    With GoCPS, students will fil out a single application, rank their school choices and receive a maximum of two offers – one each from a selective and non-selective school. If they choose to reject those offers, students would go through the process a second time and receive new offers.

    If those too are rejected, the student would be placed in their neighborhood school with the option to apply for a transfer within the first 20 days of the school year."
    **********

    And here's the IIPSC report: