Tim Harford on British queues (and how queues get long)

 Here's a column in the FT on congestion and growing queue length, which (also) shows why Tim Harford is one of my favorite economics journalists.

How British Queues Got Out of Hand 

[Why are ambulances increasingly delayed?] "The obvious explanation is that there are not enough ambulances, but the deeper problem is that ambulances themselves are being delayed in discharging patients into A&E units, which are themselves often overwhelmed: in the first quarter of 2014, 134 patients waited more than 12 hours in A&E before being admitted; 10 years later the figure was 141,693. The long delays in A&E are in part the result of the hospital beds all being full and that, in turn, is in part because hospitals sometimes struggle to discharge vulnerable patients into an overstretched social care system. All of these problems are a kind of queue and they all interact in a surprising way: you can die waiting for an ambulance because there aren’t enough nursing homes in your area.

...

"when bottlenecks feed into bottlenecks, some strategic thinking is required to fix the system. There is often more than one bottleneck in a congested system and opening that bottleneck will sometimes mean the same queue builds up somewhere else."

Alex Chan on market design and organ transplants (and how to begin a video)

Alex Chan, at HBS:) 

https://youtu.be/8n6A9wO1yt0?si=VsaT0AVNgYc7VdnB

Redesigning transplant and OPO center incentives (Chan and Roth in JAMA; Bae, Sweat, Melcher and Ashlagi in JAMA Surgery)

 

Chan A, Roth AE. Reimagining Transplant Center Incentives Beyond the CMS IOTA Model. JAMA. Published online January 26, 2026. doi:10.1001/jama.2025.26194 

 "On July 1, 2025, the Centers for Medicare & Medicaid Services (CMS) launched the Increasing Organ Transplant Access (IOTA) model, a national experiment in revising how transplant centers are evaluated and paid.

"For decades, transplant centers were primarily judged by 1-year graft and patient survival for patients who underwent a transplant. That standard, designed to safeguard quality, sometimes constrained access to transplants by rewarding risk avoidance rather than expansion. This contributed to persistent kidney shortages, alongside continued organ nonutilization.1

"The IOTA model marks a deliberate rebalancing. CMS is tying payment not primarily to short-term survival, but to 3 domains: achievement (60 points for transplant volume), efficiency (20 points for kidney offer acceptance), and quality (20 points for graft survival).

...

"A kidney transplant begins with an organ procurement organization (OPO). Yet OPOs remain outside the IOTA payment framework, perpetuating fragmentation between procurement and transplant.

"Recent experience with OPO performance metrics illustrates how narrow incentives can distort behavior. After CMS introduced tier-based OPO evaluations in 2021, lower-performing OPOs increased organ recovery, which also sharply increased discards, reliance on higher-risk organs, and out-of-sequence kidney placements,3 raising concerns about fairness to waitlisted patients.4 

...

"Emerging economic and experimental research suggests that joint accountability—rewarding procurement and transplant entities together for improving population health—can both shift recovery, discard, and transplant numbers and produce improved gains in patient health (Table).1 Without such system-level metrics spanning OPOs and transplant centers, IOTA will operate within a fragmented ecosystem where incentives push procurement and transplant in different, sometimes counterproductive, directions."

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See also

Bae H, Sweat KR, Melcher ML, Ashlagi I. Organ Procurement Following the Centers for Medicare and Medicaid Services Performance Evaluations. JAMA Surg. 2026;161(1):97–100. doi:10.1001/jamasurg.2025.5074 

 

Jennifer Mnookin to be Columbia University's next president

Among President Mnookin's many accomplishments is one that I haven't seen mentioned in the announcements of her appointment. 

 Here's the announcement from Columbia:

Columbia University’s Board of Trustees has appointed Jennifer L. Mnookin, a nationally recognized legal scholar who serves as the Chancellor of the University of Wisconsin-Madison, to be the next president of Columbia University, effective July 1, 2026. 

Here's the NYT:

Columbia Selects University of Wisconsin Chancellor as Its President.
Jennifer Mnookin has led the flagship campus of the state university system since 2022. She takes the helm at Columbia after a tumultuous period.    By Sharon Otterman

 

And here's the very different context in which I first came to know of her:

Father and daughter legal scholars complete successful kidney transplant  By Stephanie Francis Ward  December 15, 2020,

"When Robert Mnookin, a longtime Harvard Law School professor, needed a new kidney, he got some help from another member of the legal academy—his daughter, Jennifer Mnookin, the dean of the University of California at Los Angeles School of Law. "

Repugnance: two overviews (one by humans, one by Ai)

Here are two overviews of repugnance, one by economists in a forthcoming book chapter, and one from xAi via its large language model, in Grokipedia.

First, here's the human report, by three veteran scholars of repugnant transactions and controversial markets:

 The Morality of Market Exchanges: Between Societal Values and Tradeoffs   by Julio J. Elias, Nicola Lacetera & Mario Macis
NBER Working Paper 34647 DOI 10.3386/w34647  January 2026

"Certain behaviors in markets are unambiguously unethical. In other cases, however, voluntary exchanges that can create gains from trade remain contested on moral grounds, because of what is traded or of the price at which the exchange occurs. This chapter offers a framework to analyze these contested markets and provides examples of two general instances. First, we examine “repugnant” transactions involving the human body—such as compensated organ donation and gestational surrogacy—where concerns about dignity, exploitation, and inequality conflict with welfare gains from expanding supply. Second, we study price gouging in emergencies, where demands for a “just price” clash with the incentive and allocation roles of price adjustments under scarcity. Across both cases, we synthesize evidence on societal attitudes and highlight how support for policy options depends on perceived trade-offs between autonomy, fairness and efficiency, and on institutional features that can separate compensation from allocation."
 

And here's the first sentence of a long overview of repugnance at Grokipedia, an Ai generated encyclopedia launched in October 2025:

Repugnancy costs
"Repugnancy costs denote the multifaceted disutilities—including reputational harm, social sanctions, moral distress, and enforcement expenses—that emerge when voluntary transactions clash with dominant cultural or ethical norms, effectively rationing or prohibiting markets even among consenting parties. "

Peer review isn't sufficient to detect/deter fraud in science

 Economists shouldn't be surprised that, in many fields of science, there is some incidence of deliberate fraud.  Being a scientist is an attractive job, and to some extent a competitive one.  Rewards flow to those who publish in top (read "competitive")  journals.  In big lab based, grant-dependent science, the ability to keep working may even depend on such publications coming at a steady rate, to keep the grants coming to keep the lab funded.  

Most journals do their gatekeeping by peer review.  But peers aren't detectives, they are volunteers who can mostly judge a paper primarily by what evidence it presents.* So we are seeing some growth in after-publication review by fraud hunters, typically also volunteers.

Here's an article by two interesting, interested observer/participants,  Ivan Oransky (a co-founder of Retraction Watch) and Alice Dreger: 

Science journals retract 500 papers a month. This is why it matters
A small team of volunteers is tracking thousands of falsified studies, including cases of bribery, fraud and plagiarism  by Ivan Oransky | Alice Dreger 

 "So, how bad is the whole problem now? Much worse, it turns out, than when Retraction Watch was founded in 2010.

...

"The Dana-Farber case, unearthed by whistleblower Sholto David, exemplifies a key change behind the massive rise in retractions. Sleuths such as David — typically volunteers — function as true heroes of modern science, spending days and nights detecting plagiarism as well as suspicious data, statistics and more. Looking at studies by Dana-Farber researchers, David found that images of mice, said to have been taken at different stages of an experiment, appeared to be identical, and identified bone marrow samples taken from humans that were presented in a misleading way. This kind of painstaking work has only become possible on any sort of scale thanks to the development of forensic tools, some powered by AI. 

...

"All the large publishing houses now employ research integrity teams to review allegations and retract papers if necessary.  

 ...

"Rather than giving up, we should pay more attention to how we create perverse incentives — promoting quantity of publication over quality, and sexiness over meticulousness. Perhaps most importantly, we need to help the world understand that, when splashy results turn out to be incorrect and are retracted or amended, that’s all part of how we get closer to the truth. 

######

*Peer review is not without other problems, don't get me started. But my sense is that, not unlike democracy, it does pretty well by comparison with alternatives. 

Organ attack (the game)

 Here's a game that looks like it could be a gift for the organ trafficker in your life. (It was sent to me by a former student.)  The subtitle of the game is "The Family Friendly Game of Organ Harvesting."

  We opened it after a recent dinner with transplant-adjacent colleagues, but found to our disappointment that it was better suited to epidemiologists than to organ traffickers--the attacks you can make on other players' organ cards are all diseases, so you can't ever take possession of another player's organs. Without the prospect of the advertised organ harvesting, my fellow traffickers and I lost interest.

 

 

HT: Jacob Leshno