Thursday, February 23, 2017

Fifty shades of stigma: repugnance for legal but kinky sex

As a wider variety of sexual behavior becomes free of legal restrictions, some are still misunderstood or regarded as repugnant by much of the population, including medical professionals, even as they are featured (gently) in popular books and movies like “Fifty Shades of Gray.”

The Journal of Sexual Medicine explores the extent to which practitioners of kinky sex may feel that they cannot be frank with their physicians:

"Fifty Shades of Stigma: Exploring the Health Care Experiences of Kink-Oriented Patients"
Jessica F. Waldura, MD, Ishika Arora, BS, Anna M. Randall, DHS, John Paul Farala, MD, Richard A. Sprott, PhD

Abstract: "The term kink describes sexual behaviors and identities encompassing bondage, discipline, domination and submission, and sadism and masochism (collectively known as BDSM) and sexual fetishism. Individuals who engage in kink could be at risk for health complications because of their sexual behaviors, and they could be vulnerable to stigma in the health care setting. However, although previous research has addressed experiences in mental health care, very little research has detailed the medical care experiences of kink-oriented patients."

Results: "...The study found that kink-oriented patients have genuine health care needs relating to their kink behaviors and social context. Most patients would prefer to be out to their health care providers so they can receive individualized care. However, fewer than half were out to their current provider, with anticipated stigma being the most common reason for avoiding disclosure. Patients are often concerned that clinicians will confuse their behaviors with intimate partner violence and they emphasized the consensual nature of their kink interactions."

Wednesday, February 22, 2017

Hardy Hendren and the resident match

The journal Surgery has published (early online) an account by Hardy Hendren, recounting the drama at the origin of the resident match:
The 1951 Harvard student uprising against the intern match
Don K. Nakayama, MD, MBAa, , , W. Hardy Hendren III, MD, FRCSb
a Departments of Surgery, Florida International University, Sacred Heart Medical Group, Pensacola, FL
b Harvard Medical School, Massachusetts General Hospital, and Children's Hospital Boston, Boston, MA
Available online 18 January 2017

Here's the first paragraph:
"In the fall of 1951, a group of Harvard medical students led by W. Hardy Hendren, III organized a national movement against the newly instituted match that would assign graduating seniors to hospital internship programs. Before then, hospitals with intern positions to fill rushed to secure commitments from students, who in turn accepted the first decent offer that came their way. Knowing that students could not risk waiting for a better offer, hospitals pushed them into making early commitments. When some students began getting offers in their junior and sophomore years, medical schools, professional groups, and hospitals organized the National Inter-association Committee on Internships to deal with the issue. The intern match was thus organized and scheduled to take place in 1952. When the plan was announced in mid-October 1951, Hendren recognized that the proposed algorithm placed students at a disadvantage if they did not get their first choice of hospitals. Facing resistance at every step from the National Inter-association Committee on Internships and putting his standing at Harvard Medical School at risk, Hendren led a nationwide movement of medical students to change the procedure to one that favored students' choices. Their success [less than] 1 month later established in the inaugural match the fundamental ethic of today's National Resident Matching Program to favor students' preferences at every step of the process."

In my book Who Gets What and Why, I wrote about Hendren and these events in part as follows p138):
"One student who noticed this flaw in the proposed design was Hardy Hendren. He was preparing to graduate from Harvard Medical School in 1952, just as the clearinghouse was getting started. When he told me about it years later over lunch in Cambridge MA, he had already retired (in 1998) from Boston Children’s Hospital, where he had been chief of surgery. (His colleagues had given him the nickname “Hardly Human,” for the long, complicated surgeries he was able to conduct.) Hardy entered the Navy during WWII, in 1943 when he was seventeen, and trained as a pilot before returning to college and medical school. As you can imagine, with that background, as he prepared to seek his first job as a doctor, he wasn’t shy about expressing his concerns that the clearinghouse was unsafe for students.
"Hardy also wasn’t one to wait around for bureaucrats. And so, with a group of fellow students, he formed the National Student Internship Matching Committee, which organized opposition to the proposed algorithm. The Committee recommended that it be replaced with a different way of processing the preference lists to determine a match: it became known as the Boston Pool Plan. This was, in fact, the algorithm that was finally implemented when the clearinghouse was used to match students and positions in 1952."

After some discussion of stability, and the fact that the Boston Pool Plan is equivalent to the hospital proposing deferred acceptance algorithm, I wrote (p141):
"Back in 1952, economists hadn’t yet figured out any of this, which makes Hardy Hendren’s insight and his committee’s grassroots efforts all the more impressive."

Tuesday, February 21, 2017

Ken Arrow (1921-2017)

How will we do Economics without Ken Arrow?

After living to a vigorous 95, he passed away today after a mercifully short illness.  He was in the hospital for about two weeks, then went home. He had ups and downs, but a week and a half ago I found him dressed and at his computer.

 Even when he was feeling poorly, he was always the smartest person in the room.

Update: here's the NY Times obit--Kenneth Arrow, Nobel-Winning Economist Whose Influence Spanned Decades, Dies at 95

Here's the Stanford obituary: Nobel Prize-winner Kenneth Arrow dies
Nobel Prize-winning economist Kenneth Arrow was a leading figure in the field of economic theory. He inspired generations of students through his decades-long teaching at Stanford.

And the Washington Post: Kenneth Arrow, Nobel laureate and seminal economist with wide impact, dies at 95

And Scott Kominers in Bloomberg: Kenneth Arrow Made Great Models, and Was One, by 

Travel bans and rank order lists for the resident match

Residency programs have to submit their rank order lists of applicants by Feb 22. Should they try to match with doctors from countries subject to a possible renewed US travel ban?

Travel Ban Confusion Complicates Match Day Decisions

"UPDATE:  The Trump administration announced February 16 that it would discontinue its legal push in appeals court to reinstate their travel ban, but would instead issue a new, revised immigration order next week. No other details were given.
As medical school students look ahead to Match Day on Friday, March 17, some international students have additional anxiety in light of the uncertainty surrounding President Trump's executive order banning travel for people in seven Muslim-majority countries.
Residency programs also have to decide whether they will hold spots for students from the targeted countries who may not be allowed to come to the United States if legal rulings change.
First comes decision day February 22, when preferences must be ranked by both programs and students.
"Some applicants are concerned that the program directors won't rank them and there's concern from programs on whether the students can begin training on time," Mona Signer, president and CEO of the National Resident Matching Program (NRMP), told Medscape Medical News.
Trump's executive order, issued on January 27, aims to prevent citizens of seven majority-Muslim countries — Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen — from entering the United States for 90 days. It suspended entry of all refugees for 120 days and barred refugees from Syria indefinitely. A federal judge has since imposed an emergency stay, halting the key parts of the executive order.
The administration's next step is unclear, but news sources have reported that Trump may take the fight to the Supreme Court or issue a revised order.
According to the Association of American Medical Colleges (AAMC), 260 medical students have applied to US residency programs from the seven countries the ban covers.
Questions include whether the ban will be reinstated, and, if it is reinstated, whether medical students would be exempted. Some worry the ban could spread to other countries. Last year, 3769 non-US citizens who studied medicine abroad matched into a US residency program, according to the American College of Physicians."

Monday, February 20, 2017

The European Network for Collaboration on Kidney Exchange Programmes

Here's the website of the European Network for Collaboration on Kidney Exchange Programmes (ENCKEP), whose goal is to widen and deepen kidney exchange in Europe.

It's still a work in progress, with gated areas.

For those who have registered, the slides from the recent Tallinn conference are here, with updates from Austria, Switzerland, Slovakia, Portugal, Netherlands, Poland, Czech Republic, Italy, Spain, France and the UK.

The conveners are Prof Joris VAN DE KLUNDERT at, and
Dr David MANLOVE at .

I'm a (non-European) supporter of this effort.

Sunday, February 19, 2017

Offensive trademarks

Can repugnant speech also be intellectual property? The Supreme Court has a case that touches on this. The NY Times has this recent story: Justices Appear Willing to Protect Offensive Trademarks

"The Supreme Court on Wednesday appeared deeply skeptical about the constitutionality of a federal law that denies protection to disparaging trademarks. Almost every member of the court indicated that the law was hard to reconcile with the First Amendment.
The court’s decision in the case, concerning an Asian-American dance-rock band called the Slants, will probably also effectively resolve a separate one in favor of the Washington Redskins football team.
The law denies federal trademark protection to messages that may disparage people, living or dead, along with “institutions, beliefs or national symbols.”
Malcolm L. Stewart, a deputy solicitor general, said the trademark law does not bar any speech, as the Slants remain free to continue to use their name. The law “places a reasonable limit on access to a government program rather than a restriction on speech,” he said, and so “does not violate the First Amendment.”
Continue reading the main story
But Justice Elena Kagan said that even government programs may not discriminate based on speakers’ viewpoints.
“The point is that I can say good things about something, but I can’t say bad things about something,” she said of the law. “And I would have thought that that was a fairly classic case of viewpoint discrimination.” Viewpoint discrimination by the government, the Supreme Court has said, is presumptively unconstitutional.
Justice Anthony M. Kennedy said the law interfered with free expression.
“We have a culture in which we have T-shirts and logos and rock bands and so forth that are expressing a point of view,” he said. “They are using the market to express views.”

Saturday, February 18, 2017

Memorial conference for Professor Reinhard Selten, April 28

Memorial conference for Professor Reinhard Selten
Friday, April 28th 2017, Bonn,

Reinhard Selten was a pioneer of the analysis of strategic interaction of both fully rational players (game theory) and boundedly rational humans (experimental economics). From 1984 until his death in 2016, he was associated with the University of Bonn, where he established one of the first experimental laboratories in economics. In 1994, Selten was awarded the Nobel Memorial Prize in Economic Sciences, together with John Harsanyi and John Nash, for their pioneering analysis of equilibria in the theory of non-cooperative games.
To honor his outstanding contributions to Economics, the University of Bonn and the University of Cologne are hosting a memorial conference for Reinhard Selten. The aim is to bring together renowned speakers presenting work connected to or inspired by Selten’s research. The conference will take place on Friday, April 28th 2017 at the G├╝nnewig Hotel Bristol in Bonn, Germany. To help us with our planning, please register as soon as possible if you plan to attend!


Friday, February 17, 2017

Vatican statement on organ transplantation

When I posted recently about the Vatican conference on organ trafficking and transplant tourism I focused on the participation of China, and the reaction it drew.

Now I've had a closer second look at the conference statement  (whose title is Statement of the Pontifical Academy of Sciences Summit on Organ Trafficking and Transplant Tourism).

It's a very tough statement, which casts quite a broad net when talking about "crimes against humanity." Here's the opening paragraph:

"In accordance with the Resolutions of the United Nations and the World Health Assembly, the 2015 Vatican Summit of Mayors from the major cities of the world, the 2014 Joint Declaration of faith leaders against modern slavery, and the Magisterium of Pope Francis, who in June 2016, at the Judges’ Summit on Human Trafficking and Organized Crime, stated that organ trafficking and human trafficking for the purpose of organ removal are “true crimes against humanity [that] need to be recognized as such by all religious, political and social leaders, and by national and international legislation,” we, the undersigned participants of the Pontifical Academy of Sciences Summit on Organ Trafficking, resolve to combat these crimes against humanity through comprehensive efforts that involve all stakeholders around the world."

Here's the paragraph defining what those crimes against humanity are, which to my eye seems to conflate three very different things. It is number 1 in their list of recommendations.

"That all nations and all cultures recognize human trafficking for the purpose of organ removal and organ trafficking, which include the use of organs from executed prisoners and payments to donors or the next of kin of deceased donors, as crimes that should be condemned worldwide and legally prosecuted at the national and international level."

That is, if I read the full statement correctly (you should read it yourself), they are proposing that 

  1. taking organs from executed prisoners, 
  2. making payments to living donors, and 
  3. making payments to next of kin of deceased donors 

should all be considered crimes against humanity.  

Incidentally, the phrase "crimes against humanity"  is one that I hear most often in the context of genocide, although I recognize that it is also used for other horrific crimes that target populations.

I am not encouraged that this will lead to a sensible discussion about either incentives for donation or (even) removing financial disincentives.