Saturday, May 27, 2017

Should historians of science adjudicate scientific awards?

Historian of Economics Beatrice Cherrier blogs about the two Golden Goose Awards that have been made for various parts of market design (in 2013 and 14), and suggests that more deserving topics could have been picked...

How about every historian of science nominates a candidate for the Golden Goose Award?

Friday, May 26, 2017

The big dialysis business

Here's an interesting report that goes well with the John Oliver video a little while ago:
Why DaVita is being regulated, investigated, and sued

In a business where individual patients may pay vastly different fees depending on whether they are being supported by Medicare or by private insurance, there is room for game playing.

Thursday, May 25, 2017

Supporting science during the budget process--an op-ed in Alabama

Government funding of science is important, and at risk.  Here's an opinion piece that ran yesterday in Alabama, which seeks to bring some of the direct benefits in Alabama to the attention of Alabama's citizens and representatives in Washington (using the active kidney exchange program in Alabama as an example).

Trump budget puts future scientific advances at risk
By Alvin E. Roth, the Craig and Susan McCaw Professor of Economics at Stanford University
and Dr. Jayme Locke, Associate Professor at UAB School of Medicine and the Director of the Incompatible Kidney Transplant Program and Transplant Analytics, Informatics & Quality

Here are the final paragraphs:

"As the Director of the Incompatible Kidney Transplant Program at UAB and a Nobel Prize winning economic researcher, we have seen first-hand the power of science to connect those suffering with disease with vital cures.

We applaud Senator Shelby as a leader of the Senate Appropriations Committee, and Representatives Aderholt and Roby on the House Appropriations Committee, as well as all of the Alabama Congressional delegation on their work to support vital R&D investments in a bipartisan way.

We are hopeful that leaders will once again demonstrate that funding America's future innovation is a bipartisan imperative. "

Wednesday, May 24, 2017

School choice in Chile

La Tercera reviews the adoption of a deferred acceptance school choice system in parts of Chile:
Resultados y desafíos del nuevo sistema de admisión escolar

Google translate:
Results and challenges of the new school admission system

"The implementation of this new system counted on the participation of all the relevant actors. Schools actively informed parents about the various aspects of their educational programs and their vacancies. After accessing this information (either in person or via the web platform designed by Mineduc), the parents declared a list of preferences of the schools in which they wanted to enroll their children . The system is designed so that they express their preferences about different establishments in an honest and transparent way.

Many colleges have more applicants than quotas. To decide which students will be admitted to a facility, applicants are listed. This list respects the priorities indicated in the Law of Inclusion and guarantees equal opportunities by solving ties in a random manner.

Allocation mechanisms similar to those implemented in Magallanes are used in several countries around the world, highlighting the cases of the USA. (Boston and New York, among others), Holland and Finland. In each case, the DA algorithm must solve local demands that make each implementation unique and interesting. In Chile, for example, the law establishes priority criteria for applicants, so the allocation algorithm must give preponderance to siblings and children of officials, as well as those students considered to be priority because of their socioeconomic situation.

Our review of the 2016 process is positive. 3,580 students participated in two rounds of application: 3,147 exclusively in the main round, 222 in the second round and 211 in both. Of these applicants, in the main round, 1,959 (58.3%) were assigned to their first option, while in the second round this number reached 357 (82%). In the full process 3,107 students were assigned to one of their preferences, while 258 were withdrawn from the process. International experience shows that these numbers are positive. In New York, for example, in the process of admission to secondary education in 2006, about 40% of students were assigned to their favorite school.

One of the challenges for the next implementations is the simplification of the different stages of the process. Likewise, it is important to inform parents and guardians to motivate them to use the new admission system and, in this way, increase the chances of their children staying in a school that satisfies them. Our challenge is to scale this system to make the school assignment of all children in Chile."

Tuesday, May 23, 2017

Informed consent laws, memorialized in an obituary

The NY Times has the obituary, which recalls a long ago medical tragedy (he was left paralyzed by a surgery he had when he was 19) that gave rise to laws about informed consent:
Jerry Canterbury, Whose Paralysis Led to Informed Consent Laws, Is Dead at 78

"Yet by the time of his death, that surgery — with its horrific outcome — had taken its place in the annals of medical law. It had led to a landmark court ruling that fundamentally transformed how doctors deal with patients in evaluating the risks of potential treatment.

“This is probably one of the handful of most significant medicolegal cases in United States history,” said Jacob M. Appel, a doctor and bioethicist.

"The ruling, by a federal appeals court in Washington in 1972, declared that before a patient provided informed consent to surgery or other proposed treatment, a doctor must disclose the risks, benefits and alternatives that a reasonable person would consider relevant.

"Previously, the onus of soliciting that information had rested with the patient, and any description of risks was provided at the doctor’s discretion. A doctor had been considered negligent only when treatment was administered against the patient’s wishes.

“It would not be an exaggeration to say that the opinion is the cornerstone of the law of informed consent” to medical treatment, “not only in the United States, but in other English-speaking countries, too,” said Prof. Alan Meisel, who teaches law and psychiatry at the University of Pittsburgh School of Law."


Monday, May 22, 2017

Broken Chains and Reneging: A Review of 1,748 Kidney Paired Donation Transplants

Broken chains in non-simultaneous kidney exchange chains begun by non-directed donors are not a big problem at all.
Here's the article, forthcoming in  the American Journal of Transplantation:

Broken Chains and Reneging: A Review of 1,748 Kidney Paired Donation Transplants
Nick Cowan, H. Albin Gritsch, Nima Nisseri, Joe Sinacore, Jeffrey Veale
Accepted manuscript online: 10 May 2017
DOI: 10.1111/ajt.14343

Abstract: Concerns regarding the potential for broken chains and reneges within kidney paired donation (KPD) and its effect on chain length have been previously raised. While these concerns have been tested in simulation studies, “real world” data has yet to be evaluated. The purpose of this study was to evaluate the actual rate and cause of broken chains within a large KPD program. All patients undergoing renal transplantation through the National Kidney Registry from 2008 through May 2016 were included for analysis. Broken chains and loops were identified. A total of 344 chains and 78 loops were completed during the study period yielding a total of 1,748 transplants. Twenty broken chains and one broken loop were identified. The mean chain length (# of transplants) within broken chains was 4.8 compared to 4.6 of completed chains (p=0.78). The most common causes of a broken chain were donor medical issues incurred while acting as a bridge donor (n=8), donors electing not to proceed (n=6), and kidneys being declined by the recipient surgeon (n=4). All recipients involved in a broken chain have subsequently received a transplant. Based on the results broken chains are infrequent, rarely due to lack of donor motivation, and have no significant impact on chain length.

Sunday, May 21, 2017

New York City school choice in the NY Times: Not all NYC high schools are good yet

The NY Times recently ran this story, largely critical of school choice in NYC:
The Broken Promises of Choice in New York City Schools
The city’s high school admissions process was supposed to give every student a real chance to attend
a good school. But 14 years in, it has not delivered.
By ELIZABETH A. HARRIS and FORD FESSENDEN MAY 5, 2017

Here's a paragraph that summarizes the main point:
"Ultimately, there just are not enough good schools to go around. And so it is a system in which some children win and others lose because of factors beyond their control — like where they live and how much money their families have."

The story follows several students at a  middle school in the Bronx:
"The Times spent months following the high school application process at Pelham Gardens, where families do not have the advantages that routinely open doors to the city’s best schools. Many families are new to the country, and most are poor."

Parag Pathak (who played a critical role in organizing the NYC high school match--see e.g. here and here) wrote a letter to the NY Times summarizing his reaction to the story. As it appears that the Times won't publish the letter, he gave me permission to reproduce it:

"May 5, 2017

In “The Broken Promises of Choice in New York City Schools,” Elizabeth Harris and Ford Fessenden miss a key point in describing the New York City High School choice system. The choice system does not create good schools.  It exists because there aren’t enough good schools.

I worked with NYC DOE to design the choice system described by authors.   By any objective measure, this system provided better access to schools than the one it replaced.  Without a comparison to the old system, Harris and Fessenden’s description of choice outcomes is misleading.  In the old system, half of applicants from Pelham Gardens (zip code 10469) were assigned to choices they did not rank; in 2003, that number drops to 23%. Under the new system, students from that neighborhood also travelled two miles further to schools they wanted.  Across the city, the new system allows more kids to go to schools they ranked and the benefits were largest for those most likely to be administratively assigned, like those in Pelham Gardens (see, http://economics.mit.edu/files/10633.   This is not to say the process is perfect and couldn’t be improved.  But it is foolish to expect the process to produce miracles, without changing the set of school options.

A broader premise of the article is that schools with highest test scores and graduation rates are indeed “the best.”  Our research, including on NYC’s exam schools (http://economics.mit.edu/files/9773), strongly suggests otherwise.  Naïve discussions of school quality and the role of school choice confuse efforts to improve school quality, where our attention should be devoted. 

Parag Pathak
Carlton Professor of Economics, MIT"

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For reference, here's the 2003 NY Times story that covered the school choice system when it was introduced: