Opioids and harm reduction: drug checking and Safe Injection Facilities

From Mason Marks writing on the Bill of Health blog at Harvard Law School:

The Opioid Crisis Requires Evidence-Based Solutions, Part III: How the President’s Commission on Combating Drug Addiction Dismissed Harm Reduction Strategies

" it is noteworthy that the Commission ignored harm reduction strategies such as drug checking, which could reduce deaths due to consumption of contaminated opioids. Many countries including Austria, Belgium, Switzerland, Portugal, Spain, Switzerland, and the Netherlands offer free and confidential drug checking (also known as pill testing) to drug users. Drug checking could reduce consumption of adulterated drugs and provides opportunities to support and counsel users who may otherwise receive no contact with medical or public health professionals. Drug checking is also a valuable source of information about drug use such as pricing, availability, effects, and composition of street drugs. This information can be used to further our understanding of drug use and its effects.

Some experts argue that drug dealers will be less likely to add dangerous adulterants to their products if they know that consumers have a mechanism to test their contents. The identification of drug contents can alert authorities to the presence of synthetic opioids, which can lead to public warnings and announcements that may further drive dealers to withdraw deadly additives from the market. The practice can also improve law enforcement efforts to reduce the illegal importation and sale of synthetic opioids. Dr. Carl Hart, Chair of the Department of Psychology at Columbia University, supports the use of free and anonymous drug checking in the United States. In a Scientific American article, heargues that the opioid crisis is a distinctly American problem. According to Hart, “Throughout Europe and other regions where opioids are readily available, people are not dying at comparable rates as those in the U.S., largely because addiction is not treated as a crime but as a public health problem.” Drug checking is one example of how European countries approach drug abuse from a public health angle rather than a punitive law enforcement perspective.

Critics of drug checking argue that it could normalize drug use or “send the wrong message” to potential users. For instance, the practice could create the appearance of safety when in fact the drugs being consumed are dangerous. ...

"Supervised injection facilities (SIFs), arguably a more controversial option than drug checking, were also ignored by the President’s Opioid Commission. SIFs provide a place for people to inject drugs under professional supervision to minimize the risk of HIV and hepatitis C infection, drug overdose, and death. They are primarily used in Switzerland, Canada, and Australia. However, the City of Denver is taking steps to become the first U.S. city to offer SIFs. In November, a plan for a pilot program won unanimous approval from a bipartisan ten-member legislative committee. However, the City’s General Assembly must approve the plan in January 2018 for it to move forward. Seattle and San Francisco are considering similar proposals. The State of Vermont is also considering using SIFs. On November 29, 2017, a commission of health and law enforcement professionals, led by State’s Attorney General Sarah George, recommended that Vermont make SIFs a part of its opioid strategy. However, the Vermont Commissioner of Public Safety and the Vermont Association of Police Chiefs disagree. The Commissioner stated, “Facilitating the ongoing use of heroin through SIFs sends the wrong message, at the wrong time, to the wrong people.”

...

"A 2014 review published in the journal Drug and Alcohol Dependence, examined the outcome of 75 studies and concluded that SIFs are an effective harm-reduction strategy not associated with increased drug use or crime. In early 2017, the Massachusetts Medical Society published its analysis of SIFs. It found that peer-reviewed research published in leading academic journals, such as JAMA and the New England Journal of Medicine, supports the conclusion that SIFs produce positive outcomes such as reduced mortality and increased access to drug treatment.

...

"Admittedly, there could be an “ick factor” associated with SIFs, and overly zealous drug control advocates could find them repugnant. However, when thousands of lives are at stake, emotional reactions to SIFs must be weighed against the scientific evidence. If the evidence suggests that SIFs are effective, then lawmakers must be courageous and allow their decisions to be guided by science rather than emotions such as disgust."

Is there an equivalence between (not) paying kidney donors and boxers or football players?

Kim Krawiecz makes a point, in several installments:

December 21, 2017
If You Oppose Paying Kidney Donors, You Should Oppose Paying Football Players And Boxers Too 
"Having concluded that simply advocating for compensated kidney donation was not sufficiently controversial, Phil Cook and I are now turning our sights on professional sports – specifically, professional football and boxing. In a piece just posted to SSRN, we contrast the compensation ban on organ donation with the legal treatment of football, boxing, and other violent sports in which both acute and chronic injuries to participants are common. While there is some debate about how best to regulate these sports in order to reduce the risks, there appears to be no serious debate about whether participants should be paid. Indeed, for the best adult football players, college scholarships and perhaps a professional contract worth multiple millions are possible."


December 22, 2017
Paying Kidney Donors, Football Players, And Boxers: Medical Risks
"the medical risks to a professional career in football, boxing, and other violent sports are much greater both in the near and long term than the risks of donating a kidney. Injuries in such sports are common, and retired players are very often disabled by the long-term effects of these injuries as well the cumulative effect of thousands of blows to the body."

December 24, 2017
Paying Kidney Donors, Football Players, And Boxers: Informed Consent And It’s Limits
"We believe that if NOTA were amended to allow payments to donors, potential kidney donors could be protected against being unduly tempted through the existing structure of screening, counseling, and delay, perhaps with some additional protections to prevent hasty decisions. On the other hand, it is not clear that NFL recruits have such protections in place.

"Whether and when sane, sober, well-informed, adults should be banned by government authority from choosing to engage in an activity that risks their own life and limb is an ancient point of contention. There are a variety of hazardous activities that are permitted with no legal bar to receiving compensation. Included on this list are such occupations as logging, roofing, commercial fishing, and military service. Also included are violent sports such as football, boxing, and mixed martial arts (MMA). These examples illustrate a broad endorsement of the principle that consenting adults should be allowed to exchange (in a probabilistic sense) their physical health and safety for financial compensation, even in some instances where the ultimate product is simply providing a public entertainment.
...
"In short, to the extent that the ban on compensated kidney donation is grounded in a concern that the lure of money may cause donors to disregard the risks of the procedure and subsequent long-term effects, that concern applies with even more force to participation in violent sport.

"This, of course, is just a taste of our analysis and evidence, so read the full paper* for more."

*If We Allow Football Players and Boxers to Be Paid for Entertaining the Public, Why Don't We Allow Kidney Donors to Be Paid for Saving Lives?
Law and Contemporary Problems, Vol. 81, No. 3, 2018
and by Philip J. Cook Kimberly D. Krawiec

December 25, 2017
Paying Kidney Donors, Football Players, And Boxers: Exploitation, Race, Class

"We believe that using words like “coercion” and “exploitation” to characterize the introduction of a new option by which poor people (and others) could earn a substantial amount of money provides more heat than light on this situation. The legitimate ethical concern is that so many Americans are poor, with inequality increasing over time. But that observation does not support a ban on compensation, which in fact limits the options available to the poor and thereby makes a bad situation (their lack of marketable assets) worse. But for anyone not persuaded by this argument, we note that these social-justice concerns apply with at least equal force to compensating boxers; most American professional boxers were raised in lower-income neighborhoods, and are either black or Hispanic.
...
"As more has become known about the dangers of the repeated head trauma, similar arguments regarding football have become more prominent. About 70% of NFL players are black, and Pacific Islanders are also overrepresented as compared to the American population. Accordingly, much attention has been paid to the concussion crisis as a race and class problem. As one observer recently noted, “What’s a little permanent brain damage when you’re facing a life of debilitating poverty?” In reality, NFL players are better educated themselves, and come from better educated homes, than is average for Americans, in part because the NFL typically recruits college students. Still, some NFL players, like some would-be kidney donors, come from poverty."


December 26, 2017
If You Oppose Paying Kidney Donors, You Should Oppose Paying Football Players And Boxers Too: Wrap-Up

"In this series of posts, I’ve discussed a new draft that Phil Cook and I are circulating, If We Allow Football Players and Boxers to Be Paid for Entertaining the Public, Why Don't We Allow Kidney Donors to Be Paid for Saving Lives?. Our claim, which I laid out in my first post, is that there is a stronger case for compensating kidney donors than for compensating participants in violent sports. If this proposition is accepted, one implication is that there are only three logically consistent positions: allow compensation for both kidney donation and for violent sports; allow compensation for kidney donation but not for violent sports; or allow compensation for neither. Our current law and practice is perverse in endorsing a fourth regime, allowing compensation for violent sports but not kidney donation.

A common argument in support of the ban on kidney donation is that if people were offered the temptation of substantial compensation, some would volunteer to donate against their own “true” best interests. This argument is often coupled with a social justice concern, namely that if kidney donors were paid, a large percentage of volunteers would be poor and financially stressed, and for them the offer of a substantial financial inducement would be coercive. In sum, a system of compensated donation would provide an undue temptation, and end up exploiting the poor.

To these arguments we offer both a direct response, and a response by analogy with violent sport. My posts have touched on a few key points. First, the medical risks to a professional career in football, boxing, and other violent sports are much greater both in the near and long term than the risks of donating a kidney. On the other hand, the consent and screening process in professional sports is not as developed as in kidney donation. The social justice concerns stem from the fact that most players are black and some come from impoverished backgrounds."

The post goes on to point out that the (life savings) benefits to kidney patients from kidney donation are huge, and it's hard to argue that they are less deserving or get less benefit than sports spectators. But you get the idea...

Why Don’t Americans Eat Horse?

From Eater.com, a long interesting summary of
Why Don’t Americans Eat Horse?
The red meat is common in many cultures, but rarely makes it on menus in the U.S. by Tim Forster

"Killing horses isn’t technically banned in the U.S.; variations on an outright horse slaughter ban have surfaced but floundered in Congress several times since 2006. But appropriations committees did successfully ban funding to the USDA to inspect horse meat in 2007 — and if there’s no money for inspections, there’s no guarantee of safety, therefore it can’t be sold. In the words of a USDA spokesperson, “If there is no mark of inspection, then horse meat is not allowed to move in our national commerce.” This spelled the end for America’s three horse-slaughter facilities, closed a decade ago. (Their products had primarily been sent overseas.)"

He makes the cultural argument (cowboys tamed the West), but I'm not convinced...

Law Review submissions

Law reviews, often among the most prestigious publications for law professors, are unusual in a number of respects.*  They are edited by students. And they allow multiple submissions: a paper may be simultaneously submitted to many journals, which respond with exploding offers of acceptances.

Northwestern U. Law Review is exploring a different model: different from the usual law review submissions, but still very different from most academic disciplines.  Here's the announcement via the Faculty Lounge:

Northwestern University Law Review Exclusive Submission Window

This just in:

The Northwestern University Law Review is pleased to announce our exclusive submission track for Spring 2018 submissions. We will accept exclusive submissions from January 1, 2018-January 14, 2018 at 11:59 PM Central Time. For all articles submitted in accordance with the instructions outlined below, the Law Review guarantees Articles Board consideration and a publication decision by February 5, 2018.

More details are here, and after the jump.

Articles receiving a publication offer via the exclusive submission track will be published in Volume 113 in the fall of 2018. Participating authors must agree to withhold the article submitted through our exclusive submission track from submission to any other publication until receiving a decision back from us. Authors not receiving publication offers are free to submit elsewhere after notification of our publication decision, which will occur no later than February 5, 2018. 

Please note that by submitting an article via the exclusive submission track, the author agrees to accept a binding publication offer, should one be extended

*************


*related posts:

Wednesday, January 20, 2010

Peer review and markets for ideas, in law and science

Thursday, April 21, 2011

Exploding offers and the market culture of law reviews

Tuesday, September 25, 2012

Law review submissions: too cheap?

The courts take an interest in organ allocation rules

The rules for how deceased donor organs are allocated to patients needing transplants are set by a long-established, slow and thorough bureaucratic process overseen by UNOS, which typically involves the deliberation of multiple committees and the solicitation of comments from many parties and the public.

Recently the courts have taken an interest however. Here's a story from Modern Healthcare, about a court case brought on behalf of a particular patient in urgent need of a transplant.

As stakeholders debate organ allocation rules, courts may push change

"UNOS, the private, not-for-profit in charge of the organ transplant system, divides the country into 11 regions, essentially demarcating borders within which organs move from donor to recipient.

"The system was abruptly changed as a result of the first legal challenge to these borders in years, which came Nov. 19, in Holman's name.

"Attorneys filed an emergency complaint against HHS on her behalf. They sought an injunction on UNOS' regional policy that is much-debated but seldom changed.

"The Holman lawsuit set in motion a rapid succession of government counter-appeals and new court orders. It culminated in a Thanksgiving change to a rule on lung allocation, expanding the procurement area to a 250-mile radius around a patient's donor service area.
...
"As stakeholders debate the what-ifs, the waitlists in organ-scarce regions aren't getting shorter and patients like Holman and de la Rosa may spur the courts to draw their own conclusions, and possibly their own boundaries."

HT: Frank McCormick
***************

And here's a story on the still-complex current state of affairs for the allocation of deceased-donor livers, from the NY Times:
Greater Access to Donated Livers Promised to Transplant Patients

Organ donation in the UK: the particular case of children

Children in need of transplants, particularly very young children, need appropriately sized organs, which can come from deceased donors of similar age. But there are obstacles, including family consent:

Despite removal of many obstacles, UK child organ donation rates remain low

"Despite the removal of many logistical/professional obstacles, and clear guidance from national bodies, UK child organ donation rates remain lower than in other comparable countries, say experts in a leading article published online in the Archives of Disease in Childhood.

"Many families of dying children are simply not even given the chance to consider the option, and potentially save another child's life, they argue.
...
"Family refusal remains a major obstacle to organ donation from children, emphasise the authors, but that is where trained staff are key, as they can ensure that "families are given the chance to consider donation, and that it is broached at the most appropriate time by the most appropriate person, and in the most appropriate way," say the authors.

"Immediate focus should be given to consent rates and supporting family decision-making, they urge."

Wild (and abandoned) horses are starving, because we love them too much

Chris Stewart, a horse-loving Republican congressman from Utah, writes in the NY Times:

The Hard Truth About the West’s Wild Horse Problem

"The federal government’s Wild Horse and Burro Program is broken, leaving thousands of animals to starve. The Bureau of Land Management says that the nearly 27 million acres it manages for wild horses and burros can sustain only about 27,000 animals. This year, the bureau estimates that there were more than 72,000 wild horses on the land, almost 50,000 too many and all fighting to survive.
...
"This isn’t just a horse management disaster, it’s a financial disaster too. In addition to the 72,000 horses it oversees on the range, the B.L.M. keeps about 45,000 horses that it has removed from the wild in corrals, off-range pastures and in sanctuaries. Over their lifetime, these horses will cost taxpayers roughly $1 billion overall, according to the B.L.M. That’s $1 billion we could otherwise spend on defense, education, job training or any other worthy cause.
...
"the bulk of the blame lies with shortsighted decision-making by misinformed but well-meaning members of Congress.

"Congress had once supported laws that allowed for proper management of these animals. Horses in excess of what the land could sustain were to be captured, put up for adoption, sold without restriction — including to slaughterhouses, which the B.L.M. does not do as a matter of policy — and as a last resort, humanely euthanized. The program wasn’t perfect, but the B.L.M. was able to keep the herds’ numbers in check while ensuring that the ranges were viable and healthy year after year.

"But since 2010, Congress has used annual appropriations acts to significantly restrict the ability of the B.L.M. to sell or euthanize horses. "
************

This is clearly not the situation intended by those who put in place the laws and regulations that prevent wild horse populations from being managed.  Maybe it's time to eat horsemeat, for the sake of the horses?  Not likely soon in the U.S.: see my previous posts on that...

Altruism is not a one-dimensional personality characteristic

It's important to remember that people are complex.

Teacher From Hudson Who Donated Kidney Busted For Drug Pushing
The kidney donation saved his father's life.

"A Hudson County high school teacher involved in a kidney exchange that saved his father's life was busted at his apartment with cocaine and pot for sale, authorities said."

Three stories of kidney donations (and one of a grinch that wants to limit them)

I regularly see stories about kidney donation and kidney exchange: they've become so common that they are hardly news. But they are still very moving.  For today, as some of you open your Christmas gifts, here are three recent ones.

The first, from the Toledo (Ohio) Blade features Mike Rees and the Alliance for Paired Donation, and a kidney transplant to a former Blade correspondent, from his daughter:  A daughter’s enduring gift

Here's one from the San Francisco Chronicle, about a police officer who decided to give a kidney to a stranger:
SF police officer’s kidney donation leads to lifesaving chain of events

And here's another story of a kidney exchange chain:
THE ULTIMATE GIFT: Three kidney patients meet their donors at Duke

If those stories make you feel good about donors, they should. And you can feel a little good about economics too, since it is through kidney exchange that many donations happen.

But maybe you should stop here for today, and hold on to that feeling of peace and good will.

Because I also have a less cheerful story, about a vigorous resistance to the idea that donors should be allowed to save the patients they love even if they don't have health insurance, perhaps because they live in a country in which health insurance doesn't cover transplantation.  I'm speaking about efforts to obstruct Global Kidney Exchange , which is a way of inviting such patient-donor pairs to participate in American kidney exchange, free of charge, with their care paid for by the savings to the American health care system that are achieved by transplanting a patient who would otherwise be on dialysis (which is more expensive). At the link above you can see my posts about how GKE works, how it has received support from the American Society of Transplant Surgeons, and how it has attracted statements of opposition, concerned that, because it is free of charge, it resembles organ trafficking.

A new statement of opposition, from the group that calls itself the Declaration of Istanbul Custodian Group, has appeard on their web site:
STATEMENT OF THE DECLARATION OF ISTANBUL CUSTODIAN GROUP CONCERNING ETHICAL OBJECTIONS TO THE PROPOSED GLOBAL KIDNEY EXCHANGE PROGRAM

It's an 8 page document (read it all at the link), but they summarize their position (on p2) this way:
"Although attractive at first glance, the GKEP proposal should be rejected for many reasons. It is deceptive; it creates major ethical problems, such as disproportionately helping the rich over the poor and undermining rather than advancing the welfare of kidney patients in LMICs; it amounts to international organ trafficking; and it will be difficult to administer in a way that actually prevents unethical and even illegal acts.  In the end, “reverse transplant tourism” differs from ordinary transplant tourism only with regards to the people who travel—organ recipients or organ donors—and not in the commercial nature of the organ “donation.”


So...I've written a lot about repugnant transactions (starting with this 2007 article), and repugnance to transactions involving body parts is something that has to be taken with the utmost seriousness.  In the coming year I'll devote some further effort to answering this and other objections with the seriousness that the subject demands.

But, today, in honor of the great Christmas festival of gift exchange, I'll just address this opposition to kidney exchange with these lines from Dr. Seuss's famous book How the Grinch Stole Christmas

"Every Who down in Whoville liked Christmas a lot.
But the Grinch who lived just North of Whoville did not!

The Grinch hated Christmas! The whole Christmas season!
Now, please don't ask why. No one quite knows the reason.

It could be, perhaps, that his shoes were too tight.
It could be his head wasn't screwed on just right.

But I think that the most likely reason of all
May have been that his heart was two sizes too small."

The riskiest job in medicine

 The November December Message from the ASTS President Jean Edmond refers to an auto accident involving the ambulance transporting a liver to be transplanted.

"Our donor team, two fellows, a surgical resident, and a medical student were involved in a high speed car crash coming back with a liver from Long Island. Fortunately, all were seat-belted and as they stood in a daze around the crushed ambulance, the first thing they worried about was getting the liver safely back to Cornell for the implant. This moment captures the selfless devotion of our young people as they carry out the lifesaving work that we all do every day."

Here's an article about that:

The Riskiest Job in Medicine: Transplant Surgeons and Organ Procurement Travel, by M. J. Englesbe, and R. M. Merion, in the American Journal of Transplantation,  Volume 9, Issue 10, October 2009, 2406–2415

Abstract

Transplant surgeons are exposed to workplace risk due to the urgent nature of travel related to organ procurement. A retrospective cohort study was completed using data from the Scientific Registry of Transplant Recipients and the National Transportation Safety Board. A web-based survey was administered to members of the American Society of Transplant Surgeons. The survey response rate was 38% (281/747). Involvement in ≥1 procurement-related travel accident was reported by 15% of respondents; surgeons reported 61 accidents and 11 fatalities. Air travel was used in 26% of procurements and was involved in 56% of accidents. The risk of fatality while traveling on an organ procurement flight was estimated to be 1000 times higher than scheduled commercial flight. Involvement in a ‘near miss accident’ was reported by 80.8%. Only 16% of respondents reported feeling ‘very safe’ while traveling. Procurement of organs by the geographically closest transplant center would have reduced the need for air travel (>100 nautical miles) for lung, heart, liver and pancreas procurement by 35%, 43%, 31% and 49%, respectively (p < 0.0001). These reductions were observed in each Organ Procurement and Transplantation Network region. Though these data have important limitations, they suggest that organ procurement travel is associated with significant risk. Improvements in organ procurement travel are needed.

Safe travels, all of you out there...

Auction design wins a national high school science prize

Market design may be expanding out into high schools...

Maryland and New York Students Capture $100,000 Scholarship Prizes in 2017 SIEMENS Competition in Math, Science and Technology


WASHINGTON, DC, December 5, 2017 – Four high school students, one from Bethesda, MD, and a team from Dix Hills and Melville, NY, were awarded grand prizes of $100,000 scholarships for their significant accomplishments in scientific research in the 2017 Siemens Competition in Math, Science & Technology. The Competition is the nation's premier science research competition for high school students and seeks to promote excellence by encouraging students to undertake individual or team research projects. For more information go to: www.siemens-foundation.org​

Andrew Komo, a senior at Montgomery Blair High School in Silver Spring, MD, won the $100,000 grand prize in the Individual category for developing a coded system that protects online auctions from threats, such as cheating and fraud."

HT: Scott Kominers

AEA interviews: the video

Going to the AEA to interview for a job?  Here's a video in which various already-employed economists reflect on the process of becoming employed...

Here's the webpage: Interviewing at AEA? Watch this first.  Laughs, Scares, and Wisdom from AEAs Past!

School choice among different kinds of schools

Chalkbeat on the changing face of school districts, and the role played by universal-enrollment school choice:

A ‘portfolio’ of schools? How a nationwide effort to disrupt urban school districts is gaining traction

"Several years ago, Indianapolis Public Schools looked like a lot of urban school districts. The vast majority of students attended traditional public schools, though enrollment was dwindling, and the district had an adversarial relationship with its small but growing number of charter schools.

"That’s no longer true. The district is actively turning over schools to charter operators, and it’s rolling out a common enrollment system for district and charter schools that could make it easier for charters to grow. Nearly half of the district’s students now attend charters or district schools with charter-like freedoms.

...

"A growing number of philanthropists, advocates, and policymakers say the way to improve schools is to upend the traditional school district. Usually pointing to the same cities as models — Indianapolis, along with Denver, New Orleans, and Washington D.C. — they want to see more charter schools and more district schools run like charter schools.

...

"Another piece of the portfolio playbook is supporting enrollment systems that allow families to easily choose among district and charter schools.

"Adding new schools and new choices can make things harder on parents, who must navigate several enrollment processes to make a choice and get assigned to a school. Common enrollment systems create a single place to navigate it all — while also ensuring that all parents are exposed to new schools, and making it especially clear to district leaders which schools are attracting the fewest students.

“In addition to efficiency for families, unified enrollment helps the system make better decisions about which schools to replicate, recruit, incubate, scale, and maximize and, perhaps, where to locate them,” according to an Education Cities report.

"Denver, New Orleans, and Washington D.C. all have common enrollment systems, and Indianapolis just adopted one. In Denver, the use of a streamlined system did in fact increase enrollment in charters among low-income students and English-language learners, though in New Orleans parents said it was actually harder to navigate initially."

************

U.S. laws on gestational surrogacy, state by state

The surrogacy agency & law firm Creative Family Connections LLC publishes a very informative interactive map (you can click on each state): 

STATE-BY-STATE INTERACTIVE MAP FOR COMMERCIAL SURROGACY

Here's a picture (green is where it's a go...)

“GREEN LIGHT” STATES

Surrogacy is permitted for all parents, pre-birth orders are granted throughout the state, and both parents will be named on the birth certificate. Go to the state page for more detailed information.

CA, CT, DC, DE, ME, NH, NV, RI

Surrogacy is permitted but results may be dependent on various factors or venue; OR only a post-birth parentage order is available. In some birth states additional post-birth legal procedure may be required. Click on any state on the map for more detailed information.

AL, AK, CO, FL, GA, HI, IL, KS, KY, MA, MD, MN, MO, MT, NC, ND, NM, OH, OK, OR, PA, SC, SD, TX, UT, VT, WI, WV

Note: The state where the baby is born must have a procedure to allow both parents to be named on the birth certificate without action in another state.

“YELLOW LIGHT” STATES

Proceed with caution. Surrogacy is practiced, but there are potential legal hurdles; or results may be inconsistent. Click on any state on the map for more detailed information.

AK, IA, ID, MS, MT, NE, TN, VA, WY

Proceed with caution. Surrogacy is practiced, but there are potential legal hurdles; or results may be inconsistent. Click on any state on the map for more detailed information.

AZ, IN

“RED LIGHT” STATES

STOP! Statute or published case law prohibits compensated surrogacy contracts, OR a birth certificate naming both parents cannot be obtained. Click on any state on the map for more detailed information.

LA, MI, NJ, NY, WA

Supervised injection facilities for opioids

From Statnews:
As a doctor, I was opposed to supervised injection facilities. Now I’m ready to give them a try  By Henry L. Dorkin (the president of the Massachusetts Medical Society).

"Over the last few years, I have watched with a blend of amazement and grave concern as an odd phenomenon has unfolded against the backdrop of our nation’s opioid crisis: Despite the clear need to battle this ongoing epidemic with all of the tools at our disposal, one evidence-proven option — supervised injection facilities — is being overlooked, and even disparaged.
...
"A supervised injection facility is a safe, clean space where individuals can inject drugs they already possess under the supervision of trained medical staff. The facilities also offer sterile injection equipment. The advantage is that medical expertise is immediately present in case an emergency occurs. At the same time, these on-site clinicians can facilitate pathways to treatment and rehabilitation from the chronic disease of opioid abuse disorder.
...
"As a physician and president of the Massachusetts Medical Society, I was initially inclined to oppose the concept of supervised injection facilities. How, I thought, could a health care professional, someone grounded in ethics and an oath to “do no harm,” stand by and watch as individuals inject street drugs into their veins?
...
"The concept of supervised injection facilities fits well with the overarching and proven public health philosophy of harm reduction: meeting patients where they are in their disease to eliminate existing barriers to rehabilitation.

With lives being lost each day from all segments of our society, dealing in theoretical solutions can be counterproductive. Fortunately, supervised injection facilities operating in other parts of the world have yielded substantial and evidence-backed reductions of death, disease, and expenditures.

"To better understand the utility of these facilities, the Massachusetts Medical Society created a task force to examine the evidence for and against supervised injection facilities. This group produced a report that reviewed all available data regarding the use of supervised injection facilities around the world.

"The report clearly showed that these facilities save lives. For example, after the Insite facility opened in Vancouver, British Columbia — the first supervised injection facility in North America — researchers reported a 35 percent decrease in the number of lethal overdoses in that area.

...

"Shortly after our medical society overwhelmingly voted to adopt a policy in support of a pilot supervised injection facility program in Massachusetts, the American Medical Association adopted a similar policy.

...

"As we continue to look for ways to increase access to recovery programs for those with opioid use disorder, we must remember that in order to get people into recovery, they must first stay alive."

More on the endorsement of Global Kidney Exchange by the ASTS

The October 2017 Message from the ASTS President Jean Edmond is now online, and I gather it would have been fun to be present at their discussion of GKE, prior to their decision to endorse it:

"We had several intense discussions during the Council meeting that highlighted the values of a strong and diverse Council. The intense ethical debate regarding the global kidney exchanges espoused by Mike Rees and Alvin Roth was addressed. Our ASTS culture prizes innovation and disruptive approaches to our challenges, and we therefore chose to support their work in a public statement with full recognition of the need to protect the vulnerable from exploitation."


Here's my earlier post on that: Monday, October 30, 2017, Global Kidney Exchange endorsed by the American Society of Transplant Surgeons

High frequency ticket buying, by scalper bots

Freakonomics asks Why Is the Live-Event Ticket Market So Screwed Up?

They talk to a bunch of good economists.  Here's Eric Budish on the subject of why it's odd that tickets are "underpriced," in the sense that it's profitable for software bots to buy them up before the humans can get in the act, and then resell them...

"BUDISH: That’s competition on — to an economist — a strange dimension: competition on speed rather than price; that’s the connection to my stuff on high-frequency trading. It’s competition, but it’s not a productive form of competition."

Read (or listen) to the whole thing at the link.