Wednesday, March 21, 2018

Kidney donor/sellers in Iran face social stigma--2 papers

The first of these two recently published papers is a report compiling interviews taken some time ago:

Coercion, dissatisfaction, and social stigma: an ethnographic study of compensated living kidney donation in Iran
Sigrid Fry‑Revere,  Deborah Chen,  Bahar Bastani,  Simin Golestani,  Rachana Agarwal, Howsikan Kugathasan, and Melissa Le
International Urology and Nephrology,, Online, February 2018

Abstract: "This article updates the qualitative research on Iran reported in the 2012 article by Tong et al. “The experiences of commercial kidney donors: thematic synthesis of qualitative research” (Tong et al. in Transpl Int 25:1138–1149, 2012). The basic approach used in the Tong et al. article is applied to a more recent and more comprehensive study of Iranian living organ donors, providing a clearer picture of what compensated organ donation is like in Iran since the national government began regulating compensated donation. Iran is the only country in the world where kidney selling is legal, regulated, and subsidized by the national government. This article focuses on three themes: (1) coercion and other pressures to donate, (2) donor satisfaction with their donation experience, and (3) whether donors fear social stigma. We found no evidence of coercion, but 68% of the paid living organ donors interviewed felt pressure to donate due to extreme poverty or other family pressures. Even though 27% of the living kidney donors interviewed said they were satisfied with their donation experience, 74% had complaints about the donation process or its results, including some of the donors who said they were satisfied. In addition, 84% of donors indicated they feared experiencing social stigma because of their kidney donation."

Here's an excerpt from the discussion of social stigma:  

"Some donors had a general sense that people had negative impressions of donors. One donor pointed out, “When people find out that you have donated, they start looking at you in a different way. They start keeping their distance.” Another donor explained what he thought was going through
people’s heads: “Oh, he sold his kidney, he’s not a good person.”
and here's a paper with reports from an internet survey:

The Social Stigma of Selling Kidneys in Iran as a Barrier to Entry: A Social Determinant of Health
Mohammad Mehdi Nayebpour  Naoru Koizumi
World Medical and Health Policy, Volume10, Issue1, March 2018,
Pages 55-64
Iran is the only country in the world currently with a legalized compensated kidney donation system, in which kidney sellers are matched with end‐stage renal disease patients through a regulated process. From a practical point of view, this model provides an abundance of kidneys for transplantation as opposed to the American model that relies on altruistic donation. The major concern about adopting the Iranian model is the possibility of exploitation. A large body of literature exists on this topic, but few have focused on its cultural aspects. This paper sheds light on the cultural implications of the Iranian model by providing empirical evidence on the social stigmas against kidney sale in Iran. We claim that these stigmas act as barriers to entry to the supply market of kidneys. Due to the conditions created by social stigmas, kidney sellers are forced to consider not only monetary rewards but also cultural factors. Thus, they tend to be more cautious and try to avoid impulsive decisions. Such social stigmas act as unofficial regulatory forces to keep kidney sale as the last resort for the poor, to diversify the supply market by age, and to stretch the decision‐making process in the absence of a mandatory waiting period for transplantation."

from the discussion:
"Our survey demonstrated that an immense amount of negative stigma is directed toward kidney sellers in Iran from society. Comparison of our findings to those reported by Ghods et al. (2001), who studied the actual characteristics of kidney sellers, reveals stark differences between perception and reality. Ghods et al. interviewed 500 kidney sellers in Iran in 2001 (Ghods et al., 2001). The study reports that only 6 percent of them were actually illiterate (while 71 percent of our respondents thought kidney sellers are illiterate), 88 percent had elementary to high school degree (while only 22 percent of our respondents thought kidney sellers have a high school education), and 6 percent had university degrees and above (6 percent of our respondents thought kidney sellers have above high school education). This gap between the actual profile and the perception of kidney sellers indicates that while Iranians benefit from the current policy, they have a grave stigma against it. The other important gap between perception and reality appears in question 5. About 15 percent of people consider that kidney sellers are drug addicts and 56 percent are not sure whether kidney sellers are drug addicts or not. This particular perception is stunning, since by law kidney sellers undergo a series of strict medical tests before becoming eligible for selling. "

Tuesday, March 20, 2018

Bar Ifrach on market design at Airbnb

Here's a talk today at the Harvard Kennedy School that caught my eye:

Bar Ifrach (Director of Data Science, Airbnb): 'Search, Pricing and Marketplace Dynamics at Airbnb'


Tuesday, March 20, 2018, 12:00pm to 1:00pm


Darman Room, Taubman Building, Harvard Kennedy School
Join us for a Behavioral Insights Student Group lunch with Bar Ifrach.
Bar Ifrach is a Director of Data Science at Airbnb, leading a group of over 60 data scientists who cover Airbnb's core business unit -- Homes -- across analytics, inference, and algorithms. In addition, Bar is a member of the Homes business' leadership team that designs strategy and oversees execution across Airbnb's main product. Bar begun his academic studies at Tel Aviv University, where he completed a BA in economics in 2007. Following that, Bar completed a PhD in operations research and economics from Columbia Business School in 2012, researching learning and pricing in online marketplaces and game theory. After a postdoc at Stanford University, Bar joined Airbnb as a data scientist in the marketplace team in 2013, where he focused on optimizing matching through personalized search and marketplace design. In 2014 Bar founded Airbnb's pricing team that currently provides prices suggestions to millions of hosts. In 2015 and 2016 Bar managed Airbnb's Marketplace data science team, fueling Airbnb's rapid growth through multiple efforts, including scaling Instant Booking to the majority of the business.
Topic of talk: Search, Pricing and Marketplace Dynamics at Airbnb
In his 2016 book Who Get What -- and Why, Nobel laureate Alvin Roth defined three general principles for successful marketplace: thickness, congestion-free, and safe and simple. In this talk, we will illustrate these principles using unique examples from Airbnb's two-sided marketplace and tie them back to Airbnb's success. In addition, we will discuss challenges and solutions in measuring the efficacy of marketplace design changes in light of these principles.

Monday, March 19, 2018

Market design and kidney exchange: Public lecture at USC

I'll be speaking at USC today:
March 19Al RothStanford 
*IEPR Distinguished Lecture Series
Location: University Club, Scriptorium
Time: 4:00 PM

Sunday, March 18, 2018

Child marriage in the U.S., and in India

Is 13 too young to marry?  If pregnant??

Not yet in Kentucky.
Vote on bill to outlaw child marriage in Kentucky delayed after opposition from conservative Family Foundation

"A bill outlawing child marriage in Kentucky had been expected to receive a vote in the Senate Judiciary Committee on Thursday, but that vote has been delayed due to last-minute opposition by the conservative Family Foundation of Kentucky, according to the bill’s lead sponsor.

"Sen. Julie Raque Adams, R-Louisville, filed Senate Bill 48 on the first day of this year’s session of the Kentucky General Assembly, which would prohibit anyone under the age of 17 from marrying and only allow 17-year-olds to marry with a judge’s approval.

"Under the current law in Kentucky, 16 and 17-year-olds can marry with their parents’ permission, and a girl of any age under 16 can marry as long as they are pregnant and marrying the expectant father. Likewise, a boy of any age can marry a woman that he impregnates under the current law.

"Adams filed the bill after media reports detailing how Kentucky has the third-highest rate of child marriage in the country — with more than 10,000 children married from 2000 to 2015"

And from Tennessee
Child marriage in Tennessee: Lawmakers take action to close legal loophole

"Two Democratic lawmakers have introduced bills to prevent marriages in Tennessee where a party is under 18 years of age, after a national nonprofit cited three cases in the state where 10-year-old girls were married to adult men.

"Sen. Jeff Yarbro, D-Nashville, who is sponsoring the legislation with Rep. Darren Jernigan, D-Old Hickory, said at a press conference Monday that while many Tennesseans believe the minimum age to marry is 18, a loophole in state law actually allows a judge to waive the age requirement and does not state a minimum age.

"The State Department views child marriage in other countries as a human rights abuse, yet it’s something that happens with frequency in Tennessee and across the country," Yarbro said"

And India: Uphill Battle Against Child Marriage Is Being Won in India, for Now
"Data released by Unicef on Tuesday found that a girl’s risk of marrying before her 18th birthday in South Asia fell by more than a third in the last decade, from nearly 50 percent to about 30 percent, in large part because of progress in India.
Child marriage here is finely threaded with other practices, including the exchange of a dowry from the bride’s family to the groom, and sometimes with sex trafficking, making it difficult to tackle any one issue without addressing others. Social workers said there are no easy solutions.
"Though India’s numbers are promising, a recent analysis of census data highlighted another disturbing finding. In pockets of India, incidents of child marriage are decreasing in rural areas, but increasing in urban settings.
Researchers involved with the study say it is unclear what is causing that phenomenon. One hypothesis is that an uptick in migration from villages to cities could mean that these weddings have simply been redistributed."

Saturday, March 17, 2018

When an academic conference can save lives (market for interventional cardiologists)

The Chronicle of Higher Ed has the story:
Academic Conferences May Save Lives — by Keeping Big-Name Doctors Busy

Here's the medical paper on which it is based:
Acute Myocardial Infarction Mortality During Dates of National Interventional Cardiology Meetings
Anupam B. Jena, Andrew Olenski, Daniel M. Blumenthal, Robert W. Yeh, Dana P. Goldman, John Romley,
Journal of the American Heart Association. 2018

"Thousands of physicians attend national scientific meetings annually. Within hospitals, the composition of physicians who attend scientific meetings may differ from nonattendees who remain behind to treat patients, potentially resulting in differences in care patterns and outcomes for patients hospitalized during meeting dates. A quasi‐experimental evaluation of outcomes of patients hospitalized with acute cardiovascular conditions during the American Heart Association (AHA) and American College of Cardiology (ACC) annual meetings compared with identical nonmeeting days in the surrounding weeks found that, within teaching hospitals, patients admitted with cardiac arrest or high‐risk heart failure during meeting dates had lower adjusted 30‐day mortality compared with similar patients on nonmeeting dates"

Friday, March 16, 2018

Match Day for medical residents--NRMP results announced

Today is Match Day: later today, graduating American medical students, and quite a number of other young doctors will learn where they will work next year.

Here's one description: The Final Countdown: Match Day 2018.

Here's another:
NRMP Match Week will Reveal Future for Thousands of Resident Physician Applicants
NRMP Main Residency Match continues to grow, with 2018 Match expected to be largest in history.

And here's my all time favorite, courtesy of Hogwarts.

Thursday, March 15, 2018

Last minute bidding on the New York Stock Exchange

The WSJ has the story (the url is better than the headline:

What’s the Biggest Trade on the New York Stock Exchange? The Last One
"The NYSE operates between 9:30 a.m. and 4 p.m., but much of the action has moved to the final moments, thanks to index funds and others that flock to the day’s closing auction"
"Last year, 26% of all trading activity on the NYSE’s flagship exchange took place in the last trade of the day, up from 17% in 2012, exchange data shows. Last year, trades at the close accounted for more than 8% of trading volume in S&P 500 stocks, nearly four times what it was in 2004, according to Credit Suisse .

"While individual investors may follow the market through the day, especially in the past turbulent weeks, it is likely they own funds that track major stock indexes like the S&P 500 whose values depend on prices determined in the closing auction.

"In this auction, traders electronically send transaction orders to the NYSE, home to more than 2,000 companies that include such blue-chip names as Boeing Co. , Walt Disney Co. and Exxon Mobil Corp. The exchange’s computers match the millions of buy and sell orders, with human traders on the NYSE floor sometimes stepping in to help.

"At least $10 billion worth of shares are traded in the NYSE’s closing auction on an average day, with a final tally of stock prices typically listed by 4:05 p.m.

The “close,” as traders call it, has grown in importance as investors pour into index-mutual funds and other vehicles that passively track various stock-market indexes, including exchange-traded funds, or ETFs. "