Saturday, August 16, 2014

Immigration of scientists

In http://nypost.com/2014/06/08/the-science-of-immigration/, the NY Post notes that, since 2000, "immigrants have been awarded 24 of the 68 Nobel Prizes won by Americans in chemistry, medicine and physics."

My colleague Petra Moser looks particularly at the wave of immigration of German Jews after the Nazis took power: German Jewish Émigrés and U.S. Invention

"Our research provides new evidence on this question by examining the impact on innovation of German Jewish scientists who fled from Nazi Germany to the United States after 1932. Historical accounts suggest that these émigrés revolutionized U.S. innovation. In physics, for example, émigrés such as Leo Szilard, Eugene Wigner, Edward Teller, John von Neumann, and Hans Bethe formed the core of the Manhattan project that developed the atomic bomb. In chemistry, émigrés such as Otto Meyerhof (Nobel Prize 1922), Otto Stern (Nobel Prize 1943), Otto Loewi (Nobel Prize 1936), Max Bergmann, Carl Neuberg, and Kasimir Fajans “soon effected hardly less than a revolution. … Their work … almost immediately propelled the United States to world leadership in the chemistry of life” (Sachar 1992, p. 749).

Alternative accounts, however, suggest that émigrés’ contributions may have been limited due to administrative hurdles and antisemitism. Jewish scientists met with a “Kafkaesque gridlock of seeking affidavits from relatives in America [and] visas from less-than-friendly United States consuls” (Sachar 1992, p. 495). Once they were in the United States, a rising wave of antisemitism made it difficult for these scientists to find employment; in “the hungry 1930s, antisemitism was a fact of life among American universities as in other sectors of the U.S. economy” (Sachar 1992, p. 498).

Our paper presents a systematic empirical analysis of how German Jewish émigrés affected U.S. innovation. Taking advantage of the fact that patents are a good measure of innovation in chemistry, because chemical innovations are exceptionally suitable to patent protection (e.g., Cohen, Nelson, and Walsh 2002; Moser 2012), we focus on changes in chemical inventions. By comparison, the contributions of émigré physicists (including those who worked on the Manhattan Project) are difficult to capture empirically because they produced knowledge that was often classified and rarely patented.
...
"In sum, our research shows that high-skilled German Jewish immigrants created large and persistent benefits for innovators in the United States. In interpreting these results it is important to keep in mind that the émigrés in our data were exceptionally qualified scientists comparable to present-day academic superstars. Our analysis indicates that policies, which encourage the immigration of such scientists, can be an effective mechanism to encourage innovation.

This Research Brief is based on Moser, Voena, and Waldinger (2013), available at http://www.nber.org/papers/w19962. All works cited are provided there."

Friday, August 15, 2014

Competition, Market Design, and Medicare Part D

The Congressional Budget Office (CBO) has a new report about Competition and the Cost of Medicare's Prescription Drug Program:

 "Medicare Part D was designed to foster competition between plan sponsors to constrain drug spending. In assessing the impact of competition, CBO found that a larger number of plan sponsors in a region was associated with lower bids, on average, for the group of plans analyzed. … However, between 2007 and 2010, the average total number of plan sponsors per region fell by 4 (from 22 to 18), because more sponsors exited the market or merged with other sponsors than entered the market; that decrease in competition is associated with higher bids and higher government spending. … As Part D is currently structured, two features of the program could be changed to encourage plan sponsors to submit lower bids for their plans. First, in the component of Part D that serves low-income beneficiaries, the government usually pays the full amount of a plan's bid up to a threshold, regardless of whether other plans bid lower. Second, low-income beneficiaries enrolled in plans whose bid rises above the threshold are automatically reassigned in equal proportions to plans with bids below the threshold (unless a beneficiary has actively signed up for a particular plan). Both of those features encourage plans to set their bids close to (though below) the threshold. … The rules of the program could be altered, however, in ways that would continue to protect low-income beneficiaries but would also lower bids and government spending. For example, the government could adopt a reassignment mechanism that preferentially assigned low-income beneficiaries to the plans with premiums furthest below the benchmark; that approach would provide a stronger incentive to plans to submit low bids and would reduce the government’s spending even if plans did not alter their bids."

The full report is here:
Competition and the Cost of Medicare’s Prescription Drug Program
http://cbo.gov/sites/default/files/cbofiles/attachments/45552-PartD.pdf 

and an accompanying technical working paper on competition here:

Examining the Number of Competitors and the Cost of Medicare Part D
by Andrew Stocking, James Baumgardner, Melinda Buntin, and Anna Cook

Thursday, August 14, 2014

New York Prosecutors Charge Payday Lenders With Usury

The New York Times has the story: New York Prosecutors Charge Payday Lenders With Usury

"A trail of money that began with triple-digit loans to troubled New Yorkers and wound through companies owned by a former used-car salesman in Tennessee led New York prosecutors on a yearlong hunt through the shadowy world of payday lending.
On Monday, that investigation culminated with state prosecutors in Manhattan bringing criminal charges against a dozen companies and their owner, Carey Vaughn Brown, accusing them of enabling payday loans that flouted the state’s limits on interest rates in loans to New Yorkers.
Such charges are rare. The case is a harbinger of others that may be brought to rein in payday lenders that offer quick cash, backed by borrowers’ paychecks, to people desperate for money, according to several people with knowledge of the investigations.
“The exploitative practices — including exorbitant interest rates and automatic payments from borrowers’ bank accounts, as charged in the indictment — are sadly typical of this industry as a whole,” Cyrus R. Vance Jr., the Manhattan district attorney, said on Monday.
...
"The indictment offers a detailed look at the mechanics of the multibillion-dollar payday loan industry, which offers short-term loans with interest rates that can soar beyond 500 percent. ...
The payday lending operation began when borrowers applied for loans on websites like MyCashNow.com. From there, borrowers’ information was passed to another company, owned by Mr. Brown, that originated the loans. The information then wound up with another company, owned by Mr. Brown, that collected payments from borrowers."
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Here are some previous posts on payday loans.

Wednesday, August 13, 2014

Good news about a dangerous disease (hepatitis), at a high price

The good news is that there's a cure. The bad news is that it isn't cheap. Here's the NY Times headline on what is proving to be a blockbuster drug:
$1,000 Hepatitis Pill Shows Why Fixing Health Costs Is So Hard--Critics Raise Concerns About Sovaldi

"A new drug for the liver disease hepatitis C is scaring people. Not because the drug is dangerous — it’s generally heralded as a genuine medical breakthrough — but because it costs $1,000 a pill and about $84,000 for a typical person’s total treatment."

The story raises a number of interesting points.  Here's one:

"Until now, doctors would mostly treat hepatitis C patients’ symptoms. Some drugs attacked the virus itself, but they did not work very well. And most had side effects, including fever, depression and anemia, that about half the patients were not healthy enough to tolerate.

Those drugs were also expensive — the most effective drug cocktail before Sovaldi cost about $70,000 — but because few patients chose them, the price tag did not cause a big reaction. Sovaldi is different. Patients want this drug, with its high success rate and smaller list of side effects. That means a big financial shock to the health care system all at once."

Tuesday, August 12, 2014

Surrogacy and surrogacy law in the Hague

The Hague Conference on Private International Law has produced a document on surrogacy:
PRIVATE INTERNATIONAL LAW ISSUES SURROUNDING THE STATUS OF CHILDREN, INCLUDING ISSUES ARISING FROM INTERNATIONAL SURROGACY ARRANGEMENTS

There's a meeting on the subject this week:

International Forum on Intercountry Adoption & Global Surrogacy

11-13 August 2014

Livestream

The plenary sessions will be broadcast live via the ISS livestream facility

Twitter

Follow the discussions on Twitter using #icaforum2014

About

The International Forum on Intercountry Adoption & Global Surrogacy  intends to provide an opportunity for scholars and practitioners to come together to provide an evidence base for international adoption and surrogacy problems and/or best practices that might inform Hague Convention policymakers and HCIA Central Authorities. Crosscutting themes will thus reflect topics pertinent to the special commission.

Participants

Forum participants will include scholars and activists working in the field of international adoption and surrogacy.

Keynote Speakers

 Photo of Norma Cruz
Human rights defender for mothers and their children abducted into international adoption
Founder of the Survivors Foundation, Guatemala
2005 Nobel Peace Prize nominee
Winner of US State Department's 2009 International Woman of Courage Award

Former Secretary General of the Hague Conference on Private International Law (1996-2013) who initiated and laid the groundwork for the 1993 Hague Convention on Protection of Children and Cooperation in Respect of Intercountry Adoption
Director of the Sama-Resource Group for Women and Health. 
Specialist in the social, medical, ethical and economic implications of inter country adoption and surrogacy for women and for society as a whole.
Here's a skeptical article from Al Jazeera: Offshore babies: The murky world of transnational surrogacy

Monday, August 11, 2014

Stanley Reiter 1925-2014

Ricky Vohra brings the news: Stanley Reiter (1925-2014)

He was a pioneer of mechanism design, and an academic institution builder, at Northwestern, and at Purdue before that.

Transplanting teeth in the 1700's

Michael Sobolev at the Technion drew my attention to two copies of a 1787 engraving depicting tooth transplantation.

<em>Transplanting Teeth</em> (c.1790) [Engraving]

One copy of the picture is on this site of the British Dentistry Association, which offers the following commentary:

Thomas Rowlandson (1756-1827)
Engraving hand coloured on paper
1787 
This is one of Rowlandson’s best-known works with a dental subject. The transplanting of teeth was particularly popular at the end of the eighteenth century. Poor people were paid to have their healthy teeth removed for immediate placement into the waiting mouths of wealthy, older patients whose own teeth had decayed and been extracted. The treatment went out of fashion as it had several disadvantages. Long term success was extremely rare, and furthermore syphilis could be transmitted with the transplanted tooth.
The central scene shows a fashionably attired dentist removing a tooth from a poor chimney-sweep with a tooth key (note the forceps on the floor, used to shake the tooth lose prior to extraction). An aristocratic lady, who is to receive the tooth, watches with apprehension. She has to resort to her smelling salts to overcome the smell of the poor person, seated next to her. On the right, one of the dentist’s assistants is examining the next patient, an elegantly dressed young lady with clenched hands, as she anticipates her forthcoming extraction. In the rear, between these two groups is a dandy examining his newly transplanted tooth in a mirror. On the extreme left, two poor sellers are leaving the room; one is holding his hand to his painful jaw while the other is disdainfully examining the miserly payment she has received for her tooth.
On the notice on the door is the statement: "Most money given for live teeth". Teeth from the dead were also transplanted. The social comment contained in this caricature is directed at the abuse of the poor, not at the transplanting procedure. To underline the satire the rich are in bright colours and the poor are drab and dull.
The museum has recently been involved in a film about transplanting of teeth in the 18th century; watch it here.
If you enjoyed this print why not visit the BDA shop on-line to buy a copy of 'Open Wide: A Series of Eighteenth and Ninetheenth Century Caricatures on Dentistry'? 

Another copy of the picture is on this site, with this commentary:
Annotation
This print is by Thomas Rowlandson (1756-1827) and is dated 1787. It is a satirical comment upon the real practice of rich gentlemen and ladies of the 18th century paying for teeth to be pulled from poor children and transplanted in their gums. The dentist present is portrayed as a quack. There are even two quacking ducks on the placard advertising his fake credentials. He is busy pulling teeth from the mouth of a poor young chimney sweep. Covered in soot and exhausted, he slumps in a chair. Meanwhile the dentist's assistant transplants a tooth into a fashionably dressed young lady's mouth. Two children can be seen leaving the room clutching their faces and obviously in pain from having their teeth extracted. As people lost most of their teeth by age 21 due to gum disease, teeth transplants were popular for some time in England although they rarely worked.

Source
Thomas Rowlandson, "Transplanting Teeth," The Wellcome Library, Annotated by Lynda Payne.

How to Cite This Source
Thomas Rowlandson, "Transplanting Teeth (c.1790) [Engraving]," in Children and Youth in History, Item #164, http://chnm.gmu.edu/cyh/primary-sources/164 (accessed July 10, 2014). Annotated by Lynda Payne


(And here's an earlier post on transplantation of teeth: http://marketdesigner.blogspot.com/2011/04/live-donor-teeth-and-george-washington.html )

Sunday, August 10, 2014

A call for more productive dialog between proponents and opponents of payments to kidney donors

In the American Journal of Transplantation, a letter to the editor containing a modest proposal:

A Regulated System of Incentives for Living Kidney Donation: It Is Time for Opposing Groups to Have a Meaningful Dialogue!
by A. J. Matas, and R. E. Hays

"The shortage of organs is a crisis in clinical transplantation. In spite of numerous attempts to increase both living and deceased kidney donation rates in the United States, there has not been a change in the last 10 years. The combination of an increasing number of transplant candidates and no change in donation rates has resulted in increased waiting times and significant morbidity and mortality for those waiting. In the last 10 years, over sixty thousand candidates have been removed from the waiting list because of death or becoming too sick for undergoing transplantion [1]. A regulated system of incentives has the potential to increase living donation rates and thereby reduce transplant candidate morbidity and mortality.

Despite the potential benefits to recipients, the concept of a trial of incentives remains controversial, with strong proponents and opponents [2-7]. Both groups have the same facts. Both agree that there is a shortage of organs; both favor removal of disincentives to donation; both likely agree that incentives may increase donation (only a trial will determine this) and that increased donation rates benefit patients and society. In addition, both are committed to the safety and well being of donors; both are opposed to unregulated underground markets and agree that such systems have done a disservice to donors and recipients.
...
proponents emphasize the potential benefit of a regulated system (for recipients), and use key words such as organ crisis, transplant candidate mortality and societal benefit. Opponents emphasize the potential risk to donors, and the impact that approving a system might have on society's moral perspective, and, citing the harms of unregulated markets, use key words such as coercion, exploitation, undermining dignity, repugnance and commodification. Second, proponents emphasize local, structured trials in countries, such as the United States, capable of providing structure, regulation and transparency. Opponents emphasize developing a worldwide policy, and state that because many countries cannot provide regulation and transparency, incentives should be banned in all countries.

Is there a way to move forward? Based on their perspective of the data, proponents suggest that a well-designed trial—in a country with effective systems in place for regulation and monitoring, and with appropriate entry criteria and end points—would answer the critical questions that determine whether or not a regulated system of incentives is worth exploring further [2]. If a trial were to show increased donation rates but poor donor outcomes (health, psychosocial [social losses; regret]) compared to conventionally accepted donors, the system would be unacceptable, and scrapped. With their perspective, opponents identify—to date, theoretical—concerns about the impact on donors and aim for a global “one size fits all” policy.

Worldwide, transplanters could and should agree that lack of effective regulation regarding living donation is dangerous to donors and recipients alike. At the same time, it needs to be recognized that as people die on the transplant waitlist, discounting a possible way to increase access to transplant without first testing its impact, outcomes, and pros/cons on donors and recipients is premature. Opting not to conduct a trial of a regulated system of incentives has real consequences—morbidity and mortality in those with end-stage renal disease; and, it could be argued further, exploits current living donors who (in the United States) incur significant financial burdens by donating [9].

It is time for those with the full spectrum of opinions on the issue to have a meaningful dialogue. Given that the two groups share the same facts and the same concerns about donor safety, one possible way to initiate discussion is to narrow the field of focus. Perhaps, it should start with discussion as to whether or not, in a regulated system of incentives, both donor and recipient interests can be protected, and whether or not it is necessary to have a single global policy. If individual national policies are to be considered, the groups could discuss whether or not countries such as the United States, that can provide effective regulation and monitoring, and have maximized conventional donation, could consider trials of incentives in the context of the current impact of the organ shortage on their transplant candidates."

Saturday, August 9, 2014

Friday, August 8, 2014

The State of the OPTN/UNOS KPD Pilot Program

Here's the report: The State of the OPTN/UNOS KPD Pilot Program, on the kidney exchange program begun by UNOS in 2010.

The report is full of informative figures, but this one tells much of the story: in 2013 the program started to overcome some of  the many logistical difficulties that it faced, and the original market design legacy that had initially limited exchanges to two way exchanges and prohibited and then limiting chains. Here's hoping that the trend will continue: UNOS is a natural home for kidney exchange in that it already deals with all the transplant centers, and that it would be in a position to integrate living and deceased donation (if only it were more nimble in overcoming political and regulatory barriers and embracing best practices...).


Wednesday, August 6, 2014

A new Johnny Appleseed of school choice--Gabriela Fighetti joins IIPSC

The Institute for Innovation in Public School Choice (IIPSC) has announced a new hire, Gaby Fighetti. There's a brief announcement on the IIPSC webpage, and Neil Dorosin writes as follows:

"I am thrilled to announce that Gabriela Fighetti is joining our team at IIPSC! We have known Gaby for many years, most recently through our partnership during her tenure at the Louisiana Recovery School District where she led the effort to design and implement OneApp, a model system that continues to inspire people in cities across the United States. Gaby will bring her substantial skills and expertise to cities across the country as they update their enrollment and choice systems. She is a brilliant and thoughtful person, and she will make IIPSC better as we continue to support this critically important work.
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Gabriela Fighetti joined the Recovery School District in July 2011. She is responsible for developing enrollment policies and systems to ensure equitable access to the portfolio of school options in New Orleans. As part of this work, Fighetti manages the implementation of OneApp, the New Orleans Public School Enrollment Process, the process by which over 10,000 students apply annually to attend nearly 90% of the public schools in New Orleans.

Prior to joining the RSD, Fighetti worked for the New York City Department of Education (NYC DOE). During her seven year tenure at the NYC DOE, Fighetti held numerous leadership roles in the Division of Portfolio where she managed the enrollment projections process for the system of 1,700 schools, and the facilities and expansion plans of charter school operators. Fighetti studied at Columbia University, earning a Bachelor of Arts degree at Barnard College and a Master of Arts degree in public administration at the School for International and Public Affairs. "
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Gaby's story is a little bit like Neil's. Neil was the director of high school operations for the New York City Department of Education when Atila Abdulkadiroglu, Parag Pathek and I helped design their high school choice system. Neil saw what well-organized school choice can do, and founded IIPSC with our support, to sow the seeds in other cities.

Gaby oversaw IIPSC's work in New Orleans, and is joining IIPSC to keep planting those apple seeds...

Tuesday, August 5, 2014

Which law schools produce the highest percentage of clerks in Federal courts?

Clerkships, by law school, from U.S. News & World Report.

Federal Judicial Clerkship Rankings
School (name) (state)2015 Best Law Schools rankPercent of 2012 employed J.D. grads with federal judicial clerkshipsPercent of 2012 employed J.D. grads with state and local judicial clerkships
Yale University(CT)136.3%3.3%
Stanford University (CA)329.1%2.9%
Harvard University (MA)218.5%4.4%
University of Chicago415%1.9%
Duke University(NC)1014.3%6.9%
Vanderbilt University (TN)1612.6%4.9%
University of Virginia812.6%6.2%
University of Notre Dame (IN)2611%2.4%
University of Pennsylvania710.6%3.8%
University of Georgia2910.3%7.2%
University of Alabama2310.1%3.2%
University of Michigan—Ann Arbor (MI)109.6%3.7%
University of Texas—Austin159%3.2%
Columbia University (NY)48.1%0.9%
University of Southern California (Gould)207.9%0%
Cornell University (NY)137.3%2.8%
University of California—Berkeley97.1%2.4%
Northwestern University (IL)127.1%2.2%
Washington and Lee University(VA)436.9%13.8%
Emory University (GA)196.6%4.3%
Wake Forest University (NC)316.6%2.9%

Monday, August 4, 2014

Surrogacy in China and in Thailand

The NY Times carries this story about the illegal market for surrogates/babies in China: China Experiences a Booming Underground Market in Child Surrogacy,

The WSJ carries this story about the legal market in Thailand: Abandonment of Thai Baby Raises Questions on Global Surrogacy Rules--Australian Couple Leaves Thai Mother With Down Syndrome Baby

(While paid surrogacy is illegal in China, it is legal in the U.S., and an ad for this surrogacy agency ran alongside the story when I read it...)

The Times story on China begins this way:
WUHAN, China — In a small conference room overlooking this city’s smog-shrouded skyline, Huang Jinlai outlines his offer to China’s childless elite: for $240,000, a baby with your DNA, gender of your choice, born by a coddled but captive rural woman.
The arrangement is offered by Mr. Huang’s Baby Plan Medical Technology Company, with branches in four Chinese cities and up to 300 successful births each year.
As in most countries, surrogacy is illegal in China. But a combination of rising infertility, a recent relaxation of the one-child-per-family policy and a cultural imperative to have children has given rise to a booming black market in surrogacy that experts say produces well over 10,000 births a year.
The trade links couples desperate for children with poor women desperate for cash in a murky world of online brokers, dubious private clinics and expensive trips to foreign countries.


“China’s underground market shows that there is a need for surrogacy in society,” said Wang Bin, an associate professor at Nankai University’s law school. “And where there is a need, there is a market.”

The WSJ story on Thailand (and Australia) begins with this:

SYDNEY—An Australian couple's abandonment of a baby with Down syndrome with his Thai surrogate mother has raised questions about a trade that is banned in many developed countries but can be lucrative for women on low incomes elsewhere.
Australian officials said they were looking into issues relating to surrogacy in Thailand after expressing concern at how Pattharamon Janbua, a 21-year-old Thai street food vendor, was left to raise her baby son by the unnamed Australian couple, who took only his twin sister instead. She does not have Down syndrome.
"It's a very, very sad story," said Australian Prime Minister Tony Abbott, basing his remarks on earlier media reports rather than an official briefing. "It illustrates some of the pitfalls involved in this particular business."
The plight of Ms. Pattharamon and her son, Gammy, underscores what can go wrong in cross-border commercial surrogacy deals, where a mother agrees to carry a child on behalf of another woman for profit.
In an interview with The Wall Street Journal, Ms. Pattharamon said she feared being plunged deeply into debt by the high medical costs of caring for a son with disabilities, and claimed that the agent who brokered the surrogacy arrangement with the Australian couple reneged on paying her in full. Efforts to reach the agent weren't successful.
"The alleged circumstances of the case raise broader issues relating to surrogacy in Thailand," said a spokeswoman for Australia's Department of Foreign Affairs and Trade. "Australian Government agencies are examining these issues in consultation with authorities in Thailand."
Laws on surrogacy differ around the world. While many countries, including Germany and France, prohibit women from carrying another woman's child altogether, others ban payments that go beyond compensation for medical expenses, or limit the use of fertility treatments or donor eggs. In Australia and the U.S., laws on surrogacy also vary from state to state.
For many childless couples, the answer is to look overseas where there are fewer restrictions. In Thailand, for example, commercial surrogacy is a medical gray area. There are no laws directly relating to the practice of surrogacy, and it is largely unregulated. As a result, many agencies and health clinics in Thailand aim to profit from matching surrogate mothers with egg donors

Sunday, August 3, 2014

Danish sperm donors and British babies

The Telegraph has the story: Invasion of the Viking babies--With a growing demand for donor fathers, women are turning to Danish sperm banks


"Donors are paid a similar sum in Britain, but clinics can’t recruit enough men to keep up with the growing demand for sperm (the number of women with female partners having donor insemination, for example, rose by 23 per cent between 2010 and 2011). The percentage of new registered donors from overseas has more than doubled in recent years, from 11 to 24 per cent – and around a third of those imports are from Denmark.

“It’s a bit like the Viking invasion of 800AD,” says Dr Allan Pacey, a fertility expert from the University of Sheffield and current chairman of the British Fertility Society. “They’ve invaded us once by boat, and now they’re doing it by sperm.”

"Part of the problem is down to our system, with donor recruitment generally carried out on a small scale in British fertility clinics. On average, just one in every 20 men who applies will be suitable to donate. Men do not only need to have high-quality sperm: they also have to undergo a full range of screening tests for genetically inherited diseases and sexually transmitted infections, and their family medical histories must be assessed. Those deemed suitable will need to commit to regular visits to the clinic, usually during the working day. It’s often easier for a clinic to suggest their clients use a Danish donor, where a specialist sperm bank has the resources to devote to finding the 5 per cent who fit the bill.

"Although some bigger fertility clinics here do have a ready supply of donors, inter-clinic competition means that those who don’t tend to recommend an overseas sperm bank. Olivia Montuschi, of the Donor Conception Network, a charity for those affected by donor conception, told me that patients are not being informed about the clinics that have donors available. “Clinics like to retain their own patients, not share them, and they keep information about donors at other clinics to themselves,” she says.