How to allocate scarce health resources without discriminating against people with disabilities

One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the ’QALY trap’: we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination

Multilevel Bayesian framework for modeling the production, propagation and detection of ultra-high energy cosmic rays

Ultra-high energy cosmic rays (UHECRs) are atomic nuclei with energies over ten million times energies accessible to human-made particle accelerators. Evidence suggests that they originate from relatively nearby extragalactic sources, but the nature of the sources is unknown. We develop a multilevel Bayesian framework for assessing association of UHECRs and candidate source populations, and Markov chain Monte Carlo algorithms for estimating model parameters and comparing models by computing, via Chib's method, marginal likelihoods and Bayes factors. We demonstrate the framework by analyzing measurements of 69 UHECRs observed by the Pierre Auger Observatory (PAO) from 2004-2009, using a volume-complete catalog of 17 local active galactic nuclei (AGN) out to 15 megaparsecs as candidate sources. An early portion of the data ("period 1," with 14 events) was used by PAO to set an energy cut maximizing the anisotropy in period 1; the 69 measurements include this "tuned" subset, and subsequent "untuned" events with energies above the same cutoff. Also, measurement errors are approximately summarized. These factors are problematic for independent analyses of PAO data. Within the context of "standard candle" source models (i.e., with a common isotropic emission rate), and considering only the 55 untuned events, there is no significant evidence favoring association of UHECRs with local AGN vs. an isotropic background. The highest-probability associations are with the two nearest, adjacent AGN, Centaurus A and NGC 4945. If the association model is adopted, the fraction of UHECRs that may be associated is likely nonzero but is well below 50%. Our framework enables estimation of the angular scale for deflection of cosmic rays by cosmic magnetic fields; relatively modest scales of $\approx\!3^{\circ}$ to $30^{\circ}$ are favored. Models that assign a large fraction of UHECRs to a single nearby source (e.g., Centaurus A) are ruled out unless very large deflection scales are specified a priori, and even then they are disfavored. However, including the period 1 data alters the conclusions significantly, and a simulation study supports the idea that the period 1 data are anomalous, presumably due to the tuning. Accurate and optimal analysis of future data will likely require more complete disclosure of the data.Comment: Published in at http://dx.doi.org/10.1214/13-AOAS654 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Notes on Automating Stem and Leaf Displays

The stem-and-leaf display is a natural semi-graphic technique to include in statistical computing systems. This paper discusses the choices involved in implementing both automated and flexible versions of the display, develops an algorithm for the automated version, examines various implementation considerations, and presents a set of semi-portable FORTRAN subroutines for producing stem-and-leaf displays.

There are new rules for election forecasting in the 21st century

Predicting election results is just as much an art as it a science, writes David Wasserman. He argues that in recent decades, new trends in many of the subjective factors of elections have emerged and forecasters need to take them into account. These include the increased importance of migration patterns, the tendency for voters to vote for the party over the person, and shifts in campaign financing away from individual candidates and towards large party committees

How to Compromise on Saving the Most Lives: A Commentary on Hellman and Nicholson, “Rationing and Disability”

Deborah Hellman and Kate Nicholson’s “Rationing Disability” is a skillfully integrated analysis of the legal and ethical challenges of avoiding disability discrimination in setting priorities for the allocation of scarce lifesaving resources. Their analysis goes beyond the important but narrow question of what it means to wrongfully discriminate against people with disabilities in this context to the broader question of how to find a principled compromise between the consequentialist goals of public health and the potentially conflicting public value of “equal concern and respect” for each person. I will focus on this broader issue. I agree with much of their analysis, as well as with their conclusion that the “reserve approach” offers both a principled and practical compromise between these deeply embedded values. And until their article made me rethink the issue, I agreed with the authors that the “probability of survival” (PS) and “resource intensity” (RI) principles they see as presenting close calls were equally consequentialist, relying to the same extent on the tenacious appeal of the imperative to save the most lives when all cannot be saved

The Moral Cost of Compensatory Damage Claims in Reproductive Negligence Cases

In this original and important work, Dov Fox makes a compelling case for rethinking and reformulating the way that negligent conduct by reproductive health professionals is understood, and in the way the harms resulting from that misconduct are rectified. He seeks a unified account of this negligence and harm that recognizes the “gravamen of the offense” as the wrongful interference with reproductive planning while also recognizing three distinct categories of adverse outcomes: deprived, imposed, and confounded procreation. Fox argues that the injuries in each category differ from each other sufficiently to justify the recognition of three distinct torts

Regulation of Imports and Foregn Investment in the United States on National Security Grounds

Traditionally, concerns over the effects of trade and investment on national security have centered upon the transfer of products and technologies with potential military uses. However, national security concerns also arise with respect to the economic and military impact of imports and of foreign acquisition of domestic assets. The United States has a longstanding statute, section 232 of the Trade Expansion Act of 1962, that allows the President to restrict imports of goods on national security grounds. More recently, another statute, popularly referred to as the Exon-Florio Act, provides the President with authority to bar the acquisition of United States companies or businesses by foreign persons on national security grounds. Thus, United States law provides for the regulation of inward flows of both goods and capital for reasons of national security. This article will examine the substance, interpretation, and application of these laws, and comment upon possible future developments in light of evolving trends in the global economy