IVF for sex selection: legal in the U.S

Slate has the story:

The Parents Who Want Daughters—and Daughters Only. Sex selection with IVF is banned in much of the world. Not in the U.S. by Emi Nietfeld

"Sex selection was once controversial in the U.S. and is banned in almost every other country. Many Americans unaware of the process still assume that it’s that way. In reality, it has now become a standard part of IVF here. For some, the option to sex select is a perk of an otherwise exacting process. For others, it’s the whole point of doing IVF in the first place.

...

"Still, “the very act of sex selection is sexist,” argues Arianne Shahvisi, a professor of philosophy at Brighton and Sussex Medical School in the U.K., where elective sex selection is illegal.

...

"It’s not just the U.K. Virtually all the industrialized world—including Canada, Australia, and every European country besides Cyprus—bans sex selection except in rare medical cases. Most nations prohibit the practice on the grounds that it promotes sexism and that the children born from it may be harmed by gendered expectations. Widespread preference for a certain sex can also skew the population—as in India and China, where abortion and infanticide of girls have resulted in tens of millions more men than women. 

...

"In 1994 the American Society for Reproductive Medicine, the nonprofit that provides the industry’s professional guidelines, condemned sex selection for nonmedical reasons. Yet with no enforcement power, the guidelines remained just that. Unlike in most peer nations, IVF in America is mostly privately paid and weakly regulated. Instead, market forces dominate. By 2018, despite the ASRM’s recommendation that they not offer sex selection, 75 percent of clinics continued to provide the service. Since then, the ASRM’s ethics committee has updated its position to a neutral stance."

Top Trading Cycles (TTC) is characterized by strategy proofness and individual rationality on a large set, by Özgün Ekici

 Here's a very nice result about TTC:

 Pair-efficient reallocation of indivisible objects, by Özgün Ekici, Theoretical Economics 19 (2024), 551–564

Abstract: We revisit the classical object reallocation problem under strict preferences. When attention is constrained to the set of Pareto-efficient rules, it is known that top trading cycles (TTC) is the only rule that is strategyproof and individually-rational. We relax this constraint and consider pair-efficiency. A rule is pair-efficient if it never induces an allocation at which a pair of agents gain from trading their assigned objects. Remarkably, even in the larger set of pair-efficient rules, we find that TTC is still the only rule that is strategyproof and individually-rational. Our characterization result gives strong support to the use of TTC in object reallocation problems.

Sperm donation from Denmark to the UK and elsewhere

 The Daily Mail has the story:

'They invaded us once by boat and now they're doing it with sperm!' Why hundreds of British women are giving birth to 'Viking babies' conceived with Danish donors

"These are the main Danish export products - beer, Lego and sperm!"'

"So why are so many British women going Danish? According to Dr Alan Pacey, a fertility expert at the University of Sheffield, one of the reasons is a shortage of homegrown sperm.

'We don't have enough donors in the UK to meet the national need,' he explains. 'We don't have the clinic infrastructure sufficient to recruit enough donors - even when men want to donate.

...

"'The NHS is used to treating patients and you get a fee for treating patients. You don't get a fee for screening a donor that you may not ultimately accept.'

"Compounding the problem for British clinics is the 2005 law that forces men to waive their anonymity, meaning sperm donors face the prospect of offspring turning up on their doorstep once they reach the age of 18.

"Nevertheless, although Danish clinics, among them the world's largest sperm bank, Cryos, cannot sell semen from anonymous donors to British women, business is booming thanks to the huge numbers of local men happy to sign up anyway.

...

"Experts such as Laura Witjens, CEO of the National Gamete Donation Trust, say the excellent customer service deployed by Copenhagen's sperm banks has also contributed to the Viking baby boom.

'It's much easier for a British clinic to order sperm from Denmark which is Fed-exed the next day than to try and recruit their own donors and all the hassle that goes with them,' says Witjens.

'The Danish model is customer service driven. It knows how to deal well with customers, it has a good website, and that's what we could do in the UK as well - it's not rocket science.'

HT: Mario Macis

Increasing the supply of transplantable organs, in the long term, and sooner.

 Here's an article on the website of The American Council on Science and Health, on technologies that might eventually replace the need for human organ transplants, and on policies to increase their supply while still needed.

We Urgently Need More Organs For Transplantation. Science And Policy Can Come To The Rescue. By Henry I. Miller, MS, MD and Sally Satel, MD

"Both scientific and policy advancements could provide desperately needed organs for transplantation. For example, there have been some promising early studies using kidneys from pigs genetically engineered to prevent rejection, but a policy change – paying human donors for donating organs – could be implemented immediately and would be a game changer.

...

"[A] sector of medicine that desperately needs breakthroughs is the transplantation of solid organs, which are in severely short supply. Currently, more than 100,000 Americans are waiting for transplants, and due to a shortage of hearts, lungs, livers, and kidneys, at least 17 die each day. Donor organs — from a living person or cadaver — must match the rejection recipient’s tissue type and size; they are often not perfect. By one estimate, approximately half of transplanted organs are rejected by recipients’ bodies within 10-12 years, despite a constantly expanding understanding of what causes rejection. Another obstacle is that the organ procurement system in the U.S. is inefficient, inconsistent, and unaccountable – in short, a mess that causes preventable deaths.

"We are making progress, but too slowly. Two new high-tech approaches to providing organs for transplantation might ultimately both eliminate the need for organ donors and reduce the risk of tissue rejection. And there is also a low-tech approach that would require only a tweak in healthcare policy.

"Organs produced by 3D bioprinting"

...

"Organs from genetically modified pigs"

...

"The low-tech policy approach

"Although friends and relatives and even the occasional “good Samaritan” donor can donate kidneys, they must be given without compensation. Under section 301(a) of the National Organ Transplant Act of 1984 (NOTA), it is a federal crime for “any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce.”  Therefore, we propose a federal tax credit for living donors willing to save the life of a stranger. The value of the reward should be between $50,000 and $100,000, which physicians and others who endorse donor compensation believe would be sufficient to address the organ shortage. An economic analysis published in 2022 estimated that a reward of $77,000 could encourage sufficient donations to save 47,000 patients annually.

"The credit would be universally available—refundable in cash for people who do not owe income tax, not phased out at high-income levels, and available under the alternative minimum tax. NOTA’s restriction on payments by organ recipients and other private individuals and organizations would not change—it would still be illegal for recipients to buy organs.

"A qualified organ donation would be subject to stringent safeguards. As all donors are now, prospective compensated donors would be carefully screened for physical and emotional health. A minimum six-month waiting period before the donation would filter out impulsive donors and donations by financially desperate individuals seeking instant cash.

"In addition to saving lives, the credit would save the government money, perhaps as much as $14 billion per year, by reducing expenditures on dialysis. Thus, donors would receive financial compensation from the government for contributing to the public good and bearing the risk of a surgical operation to remove the organ.

"This would be a compassionate and pragmatic policy. Moreover, it could be implemented immediately, rapidly clearing much of the backlog of Americans waiting for organs in advance of the longer-term high-tech approaches.

"The organ shortage kills thousands of Americans every year. We must do all we can to alleviate it now."

HT: Frank McCormick

Interviews with school choice stakeholders

 Here's a paper about school choice in New Orleans, organized around interviews with New Orleans "Experts and Administrators" on the one hand and "Activists and Educators" on the other. 

Akchurin, Maria, and Gabriel Chouhy. "Designing Better Access to Education? Unified Enrollment, School Choice, and the Limits of Algorithmic Fairness in New Orleans School Admissions." Qualitative Sociology (2024): 1-43.

Abstract: "Economic sociologists have long recognized that markets have moral dimensions, but we know less about how everyday moral categories like fairness are reconciled with competing market principles like efficiency, especially in novel settings combining market design and algorithmic technologies. Here we explore this tension in the context of education, examining the use of algorithms alongside school choice policies. In US urban school districts, market design economists and computer scientists have applied matching algorithms to build unified enrollment (UE) systems. Despite promising to make school choice both fair and efficient, these algorithms have become contested. Why is it that algorithmic technologies intended to simplify enrollment and create a fairer application process can instead contribute to the perception they are reproducing inequality? Analyzing narratives about the UE system in New Orleans, Louisiana, USA, we show that experts designing and implementing algorithm-based enrollment understand fairness differently from the education activists and families who use and question these systems. Whereas the former interpret fairness in narrow, procedural, and ahistorical terms, the latter tend to evaluate fairness with consequentialist reasoning, using broader conceptions of justice rooted in addressing socioeconomic and racial inequality in Louisiana, and unfulfilled promises of universal access to quality schools. Considering the diffusion of “economic styles of reasoning” across local public education bureaucracies, we reveal how school choice algorithms risk becoming imbued with incommensurable meanings about fairness and justice, compromising public trust and legitimacy. The study is based on thirty interviews with key stakeholders in the school district’s education policy field, government documents, and local media sources."

"Designing and implementing algorithm-based UE systems entails complex moral and political considerations, including questions about how to operationalize what is fair when giving priority to some students over others. The designers and supporters of these systems argue that, by automating and randomizing assignments to oversubscribed schools, UE algorithms are not only efficient, but also impartial and, therefore, value-neutral. Yet as policy instruments, their use is explicitly predicated on normative grounds: centralized enrollment platforms seek to make choice more transparent and fair, which in practice means weakening the influence of social privileges in access to educational opportunities. But even if UE systems constitute powerful technologies that deliver simple and efficient enrollment across the board, providing greater access to school choice, is it possible that they still end up eroding public trust and contributing to the perception they are reproducing inequality? And if so, why?

,,,

"We argue that a crucial reason why technically irreproachable policy instruments like UE algorithms may fall short of eliciting sufficient moral consensus and become enmeshed in political disputes is that core values like fairness are defined and interpreted differently across the contexts where such instruments are created and used.

...

"We examine the multivalent meanings of algorithmic fairness through a study of OneApp, the unified enrollment system developed more than a decade ago in New Orleans, Louisiana (NOLA).Footnote1 Well-known as a national exemplar of market-based school reform, New Orleans is unique in that all the city’s public-school students now attend charter schools, a radical experiment widely celebrated by the school reform movement that has nevertheless elicited heated debate. Our study shows that a paradigmatic clash has emerged between how fairness in the enrollment process is understood “from above” and “from below.” Fairness tends to be interpreted in narrow, procedural, and ahistorical terms by education experts who design and shepherd UE through implementation, even if many do imbue UE with the normative purpose of limiting the influence of social privilege in access to school choice. By contrast, education activists tend to evaluate fairness with consequentialist reasoning and in terms of broader conceptions of justice rooted in addressing the history of socioeconomic and racial inequality in New Orleans, and the unfulfilled promise of access to quality schools for all. From a top-down perspective, then, UE algorithms are seen as a positive step towards making the school system a more equitable marketplace. In this view, an algorithm-based enrollment system plays a critical role in the democratization of choice. Seen from below by those left out, however, the same algorithms legitimize an inherently unjust market system where chance still determines (unequal) access to educational opportunity. Moreover, the fact that parents need to participate in an algorithmic process instead of directly enrolling their kids in a good-quality neighborhood school signals the absence of real equity.

...

"promoting choice options such as charter schools has yielded benefits to both students who enroll in them and—via competitive effects—those who attend schools nearby (Berends 2015; Jabbar et al. 2022) in some (but not all) cases. On the other hand, researchers have also warned that choice policies can exacerbate existing inequalities, insofar as access to valued information, social networks, and resources are crucial for capitalizing on the new opportunities that become available in a more competitive marketplace

...

“market design” is perhaps the specialization area that most enthusiastically embodies the “performative” aspect of economics practice—the idea that economists not only describe markets but also perform them through sociotechnical devices (Caliskan and Callon 2009; Callon 1998; MacKenzie and Millo 2003).  ... For too long, the design of “fair”, “efficient”, and “transparent” UE algorithms has remained a technical matter in the hands of experts, not an object of study worth analyzing from sociological, political, or even philosophical standpoints.

...

"Interviews consisted of a semi-structured component following an interview guide and a component relying on vignettes designed to compare how our interviewees conceptualize fairness across the same four scenarios. After the first part of the interview, we typically took turns reading vignettes aloud and asking the same set of follow-up questions to our respondents. For example, the first scenario describes Malcolm, a hypothetical student whose family uses OneApp to apply to elementary school and he gets his fifth-choice school, which is rated a C. We then ask respondents to evaluate whether Malcolm has been treated fairly, gradually adding new information about his socioeconomic status, racial background, and disability status.

...

"In this study, we do not rely on statistical sampling logic and do not seek to make generalizable claims about perceptions of fairness regarding OneApp among all administrators or all NOLA families using this UE system. Instead, we aim to show how studying an algorithmic tool reveals how experts and community leaders embedded in the same education policy field have different ways of conceptualizing and talking about fairness. 

...

"For instance, when we described the experience of a hypothetical student, Malcolm, whose parents used OneApp to apply to elementary school last year, many respondents rejected the notion of procedural fairness outright. In the scenario, Malcolm and his family had secured a spot in a school with the letter grade C that was their fifth preference. When we asked our respondents whether Malcolm had been treated fairly, one respondent from an education justice organization replied, “No, I don’t think it’s fair and it makes me wonder what is a better way because [the explanation we hear is], ‘We need more quality seats.’ I’m like, ‘Oh really? How are we going to get there?’ Because we want more quality seats” 

#########

The article goes on to point out that the school district hasn't published the algorithm code or flow charts, which adds to suspicions of unfairness.  My inclination is that such things should be in the public domain, which might help the discussion focus on the very different issues of how schools are assigned, and why not all schools are first rate.

Simulating European kidney exchange, by Druzsin, Biró, Klimentova, and Fleiner

There are a big variety of procedures used for kidney exchange in Europe.  Here are a set of simulations meant to explore their effects.

Druzsin, Kristóf, Péter Biró, Xenia Klimentova, and Rita Fleiner. "Performance evaluation of national and international kidney exchange programmes with the ENCKEP simulator." Central European Journal of Operations Research (2024): 1-21.

"we are aware of four international KEPs running worldwide:

• Czech-Austrian-Israeli collaboration,

• KEPSAT involving Italy, Portugal, Spain,

• STEP, run by Scandiatransplant,

• NZKX by Australia and New Zealand.

One of the main aspects that can differ in between international KEPs is collaboration polices. In KEPSAT each of the three countries conducts a national matching run first, and only after that they seek for international cycles in the remaining pools. The other three international KEPs merge their pools and conduct one single matching run."

#######

Not surprisingly, maximizing domestic kidney exchange first leaves only hard to match pairs, which limits the effectiveness of international cooperation.  A 2023 paper from Portugal reports that, since 2017, only three Portuguese pairs were matched in the KEPSAT program with Spain and Italy.

Tuesday, March 12, 2024

Kidney exchange between Portugal and Spain, and prospects for global kidney exchange

Talks to doctors and students in Italy

 I just returned from a busy trip to Italy, that began with a talk to physicians in Rome about kidney exchange, after which I moved on to talk to students in Padua.

Both were fun in different ways.  Here are some of the students gathered for a spritz after one of my talks in Padua.

Richard Slayman: first recipient of pig kidney transplant dies after two months. (RIP)

 Here's the story from the Guardian:

Pig kidney ‘xenotransplant’ patient dies two months later. No indication that Richard ‘Rick’ Slayman’s receipt of genetically modified kidney caused his death, says Massachusetts transplant team

"The first recipient of a genetically modified pig kidney transplant has died about two months later, with the hospital that performed the surgery saying it did not have any indication the transplant was the cause.

...

"In a statement, Slayman’s family thanked his doctors. “Their enormous efforts leading the xenotransplant gave our family seven more weeks with Rick, and our memories made during that time will remain in our minds and hearts,” the statement said.

"They said Slayman underwent the surgery in part to provide hope for the thousands of people who need a transplant to survive. “Rick accomplished that goal and his hope and optimism will endure forever.”

"In April, New Jersey woman Lisa Pisano also received a genetically modified pig kidney as well as a mechanical pump to keep her heart beating.

########

I'm not aware of any medical journal reports so far on these transplants--reporting has just been by press release...

Jim Simons (1938-2024)

 Jim Simons, the great investor and philanthropist of math and computer science, died yesterday.

Here's the announcement from the Simons Foundation.

Simons Foundation Co-Founder, Mathematician and Investor Jim Simons Dies at 86

And here's the NYT:

Jim Simons, Math Genius Who Conquered Wall Street, Dies at 86. Using advanced computers, he went from M.I.T. professor to multibillionaire. His Medallion fund had 66 percent average annual returns for decades.

Kidney exchange in Germany?

 A draft law to make kidney exchange legal in Germany, and to allow nondirected donation, is making some progress: here (with the help of Google Translate) is a news story on the proposed new law.

Living kidney donation should be made easier

"In order to reduce the organ shortage in Germany, Federal Health Minister Karl Lauterbach (SPD) wants to make living kidney donations easier. This emerges from a draft amendment to the Transplantation Act. The Star first reported.

"According to the draft, the previously prescribed “proximity ratio” for so-called cross donations will no longer apply in the future. To date, couples in which one person wants to donate a kidney to the other but this is not possible due to incompatibility are only allowed to “cross-donate” with another couple in a comparable situation if there is a close relationship between the couples. This is intended to prevent organ trafficking and commercialization.

"In the future, this cross donation could be made without proximity, thereby significantly expanding the circle of recipients. According to the draft bill, the donation should be anonymous and organized by transplant centers. The aim of anonymity is to prevent money from being paid for an organ.

"Anonymous kidney donations should also be possible in principle. In the future, people in Germany could donate a kidney for selfless reasons without knowing who it is going to. In countries like the USA, this option has existed for a long time."

HT: Dorothea Kubler

The design of markets, in Padua (video)

Yesterday I had the pleasure of speaking about market design in the Aula Magna of the University of Padua, where Galileo lectured.  Below is a video. I start to speak around minute 14:20.

Update: here's a post-talk photo:

Ignazio Marino is running for the EU Parliament

 When in Rome, I met with Ignazio Marino (transplant surgeon, former Mayor of Rome) who is now running for the EU Parliament.  He posted a 1 minute video on his various social media accounts of our conversation about his hopes for kidney exchange in Europe.

https://www.facebook.com/share/v/kKA4y38ZSKfkm6Rg/?mibextid=WC7FNe

 

https://x.com/ignaziomarino/status/1787469504563315115?s=48

 

https://www.instagram.com/reel/C6oYf1CicYw/?igsh=aGtheDc0cGxtZ3c4

 

Kidney exchange in Italy, Europe and the U.S.: video of my talk in Rome

 Here is a video recording of my talk in Rome yesterday at the  Istituto Superiore di Sanità. There are some introductions by people with vast accomplishments in Italian transplantation and kidney exchange, Giuseppe Feltrin (director of the National Transplant Center), Antonio Nicolò (professor of Economic Theory at the University of Padua) and Lucrezia Furian (Kidney and Pancreas Transplant Surgery Unit - Department of Surgical, Oncological and Gastroenterological Sciences of the University Hospital of Padua)*. 

My talk begins at 27:55.

x

*Although her web page didn't yet reflect this, Dr. Furian was very recently promoted to the rank of Full Professor of Surgery.  Congratulations Lucrezia!

The Design of Markets. Una Nobel Lecture (Two talks in Padua, on Tuesday and Wednesday)

 Following my talk in Rome today, I'll be speaking in Padua tomorrow and Wednesday, first giving a seminar on controversial markets, and then a public lecture on market design.

The Design of Markets. Una Nobel Lecture di Alvin Eliot Roth

"On Wednesday 8 May the University of Padua hosts the  Nobel Lecture

...

"The meeting opens with greetings from the vice-rector Antonio Parbonetti  and the director of the Galilean School of Higher Studies,  Gianguido Dall'Agata . The guest is introduced by Antonio Nicolò , coordinator of the Social Sciences Class of the Galilean School.

...

"The Nobel Lecture, which is held in English , is  open to the public . To participate, reservations are required 

You can also follow the meeting via  live streaming on YouTube .

---

The Padua Nobel Lecture by Alvin Eliot Roth is preceded, on Tuesday 7 May at 3pm, by a seminar aimed exclusively at professors, researchers, fellows of the Department of Economic Sciences of the University of Padua - dSEA .
The Economics Seminar  is entitled " Controversial markets and repugnant transactions " and is held at the department headquarters in via del Santo 33 in Padua.

Baby formula and U.S. supply chains

 Martha Gershon points me to her latest column, to be followed in due time by a book on feeding babies in America.

The U.S. needs a reliable supply of baby formula. A new bill in Congress can help      By Martha Gershun and Rosa DeLauro  May 2, 2024

"Here’s the background: In February 2022, Abbott recalled three brands of its baby formula after four babies became sick with bacterial infections after consuming the company’s formula. When a Food and Drug Administration inspection uncovered traces of a potentially deadly bacteria in Abbott’s main production plant in Sturgis, Mich., the company shut down the plant, which at the time produced more than 40% of U.S. formula. The shutdown caused cascading supply chain problems, creating a severe shortage of baby formula that lasted more than a year."

Free speech and universities

 At Stanford, recent event are helping us remember that our speech policy is the First Amendment.

That hasn't always been front of mind at Stanford, and now that it is, it is still distressing to see a student wearing a Hamas headband on campus, but it's worth remembering that freedom of speech is important, and important at universities. (The First Amendment is generally understood to also imply freedom of association, so you should feel free not to hire a Hamas supporter who graduates from Stanford.)

Here's the First Amendment:

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

Because the First Amendment only restricts government from abridging the freedom of speech, private universities (although not public ones) are entitled to have more restrictive speech codes.  But in California, the 1992 Leonard Law forbids private secular universities from restricting student speech  protected by the First Amendment.

In 1994, a court ruled (in the case of Corry v. Stanford) that a Stanford prohibition of certain "fighting words" when addressed to individuals violated the Leonard Law. Stanford's then president, Gerhard Casper, subsequently addressed the faculty senate, giving his thoughts on speech at a university:

Statement on Corry vs. Stanford University (by Gerhard Casper)

Here are his concluding sentences:

"Harassment, threats or intimidation continue to be unacceptable. Should they go beyond what is protected by law, we will invoke university disciplinary procedures. Otherwise, we shall continue to do what we always have done. We shall counter prejudice with reason. The work of reason is hard work, as is the work of building and maintaining a great private university. I invite all faculty, students and staff to continue the work of reason."

Matching markets and organ transplantation at the Istituto Superiore di Sanità in Rome on Monday

 I'm traveling this weekend to help inaugurate  the celebration of the 90th anniversary of Italy's Istituto Superiore di Sanità (Higher Institute of Health).  Below is their press release, which also notes that my talk will mark the 20th anniversary of the publication of my paper with Tayfun Sonmez and Utku Unver:

Roth, Alvin E., Tayfun Sonmez, and M. Utku Unver, "Kidney Exchange," Quarterly Journal of Economics, 119, 2, May, 2004, 457-488

Nobel Prize winner Alvin Roth opens the series of conferences dedicated to the 90th anniversary of the ISS

"Thanks to his work, 'crossover' kidney transplants are possible; next May 6th lectio magistralis in person and streaming.

"The cycle of scientific conferences that the Istituto Superiore di Sanità dedicates to the 90th anniversary of its foundation begins with a lectio magistralis by the Nobel Prize winner for economics Alvin Roth. On May 6th at 12.30 pm, Professor Roth, whose work has paved the way for the possibility of carrying out crossed kidney transplants between incompatible couples, will hold a keynote address entitled "Matching markets and organ transplantation".

"Exactly 20 years ago, in May 2004, Roth published "Kidney Exchange" in the Quarterly Journal of Economics (the oldest economic studies journal in the United States), the article in which the scholar exposed his "matching theory" by applying it to problem of compatibility between donor and recipient in living kidney transplantation and the need to find a sufficient number of donors for patients waiting for an organ. Roth demonstrated mathematically that, by cross-referencing the immunological data of all couples in which a healthy person wants to donate a kidney to a sick family member but cannot do so due to lack of compatibility, all patients could receive the organ they need. For his studies on stable allocations, defined by the Royal Swedish Academy as "a masterpiece of economic engineering", Roth was awarded the Nobel Prize in 2012.

"Starting from that first algorithm developed by Roth, today cross-kidney transplant programs between incompatible couples (called "crossover") have become a reality in many countries around the world: in Italy 132 transplants of this type have been carried out so far thanks to crossing of 85 pairs of donors and recipients, as part of a complex clinical and logistical program managed by the National Transplant Center which has so far involved 20 different hospitals. In 2023 alone there were 17 crossover transplants, of which 2 were carried out thanks to international exchange programmes: the first, last June, performed in Padua thanks to the crossing with two other Spanish couples, one in Bilbao and one in Barcelona, and the second in Vicenza, with an exchange organized with the Porto hospital.

"Professor Roth will hold his dissertation at the invitation of the National Transplant Center, the Galilean School of Higher Studies and the Department of Economic and Business Sciences of the University of Padua, the university at which the Stanford University economist will continue his series of conferences in Italy. The event, which will be held in the Pocchiari Hall of the Higher Institute of Health starting from 12.30, will be attended by Rocco Bellantone (president of the ISS), Giuseppe Feltrin (director of the National Transplant Center), Antonio Nicolò (professor of Economic Theory at the University of Padua) and Lucrezia Furian ( responsible for the Kidney and Pancreas Transplant Surgery Unit - Department of Surgical, Oncological and Gastroenterological Sciences of the University Hospital of Padua).

"It will be possible to follow the event in person (the request for accreditation can be made to ufficio.stampa@iss.it) and in streaming on the Institute's home page."

Gambling addiction

 When gambling opportunities were rare and often illegal in the U.S., gambling addiction was a less visible problem than it is becoming today.

Here's a story from the NYT, about a sports news broadcaster who went to prison after pursuing fraudulent schemes to raise money to pay his gambling debts:

Saturday Mornings With the ‘Voice of Problem Gambling’  Craig Carton, the bombastic sports broadcaster, shows a different side on a weekly show that focuses on the stories of gambling addicts like himself.  By Zach Schonbrun

“There’s a preconceived notion of the kind of guy or gal that is a gambling addict,” Mr. Carton said. “And now you’re listening to schoolteachers and doctors and lawyers and first responders and librarians — normal people who went down a road never having any expectation of having a problem.”

...

"The show’s arrival coincided with an explosion in gambling as 38 states legalized sports betting. The National Council on Problem Gambling estimates that 1 percent of U.S. adults meet the criteria for a gambling disorder, and that an additional 2 to 3 percent are “experiencing problems” due to “moderate” gambling behavior.

"That suggests that most Americans are capable of gambling responsibly, and Mr. Carton believed he could, too. He had gambled his whole life.

...

"The incident that he says “accelerated” his descent into problematic gambling didn’t come until 2014, when Mr. Carton, in his typical bombastic fashion, proclaimed on the air with Mr. Esiason that he could take $10,000 and turn it into $25,000 overnight playing blackjack. To his surprise, Mr. Esiason handed him $10,000 in cash a few weeks later during a special taping at the Borgata, a casino hotel in Atlantic City. Mr. Carton backed up his boast, winning $80,000 playing blackjack.

"But the seeds of compulsion were planted. Almost immediately, Mr. Carton began receiving calls from listeners eager to test his magic touch. Soon he was being handed duffel bags of cash and ushered into private parlors at casinos.

“That just gave me access to more money,” Mr. Carton said. “And when you’re already going down a road where you want to gamble all the time anyway, if you’re betting $100 a hand, and now you’re betting $1,000 a hand, you can’t go back to $100. It just became progressive.”

He won a lot, but at the rate he was going, the odds weren’t in his favor. Debts snowballed; then the federal agents arrived. The judge at his sentencing, Colleen McMahon, introduced herself to him as “Colleen from New York — first time, long time,” echoing a common phrase used by callers into WFAN’s shows. She then told Mr. Carton, “You have indeed descended into a hell of your own making.”

"Mr. Carton’s public disgrace resonated with Dan Trolaro, a former investment adviser for Prudential who spent four and a half years in state prison in New Jersey for stealing $1.9 million in client money. He had committed the thefts to feed an online gambling addiction.

"Mr. Trolaro went on to work for the nonprofit Council on Compulsive Gambling of New Jersey, which is the home of the 1-800-GAMBLER addiction hotline.

...

"On a recent Monday evening, Mr. Carton stood with a microphone in a lecture hall at the LaPenta School of Business at Iona University in New Rochelle, N.Y. For an hour, he implored the 40 or so students in attendance not to follow in his footsteps.

“I’m not here to tell you not to gamble,” he said. “But I am here to tell you that, if you allow it, gambling can ruin your life.”

"The event was presented by FanDuel, the largest online sports book in the country. Mr. Carton is on his second contract as the company’s paid ambassador for “responsible gaming,” a relationship that, he admits, carries the appearance of conflict with his efforts to combat addiction. He insists the arrangement allows him to carry his message to a wider audience."

#####

See also Gamblers Anonymous  https://www.gamblersanonymous.org/ga/

Menthol cigarettes get a reprieve

 The WSJ has the story:

Biden Administration Shelves Plan to Ban Menthol Cigarettes. White House had been weighing health benefit of ban against angering some Black voters   By Jennifer Maloney, Liz Essley Whyte, and Andrew Restuccia

"The Biden administration is reversing course on its plan to ban menthol cigarettes, after the White House weighed the potential public-health benefits of banning minty smokes against the political risk of angering some Black voters in an election year. 

...

Menthols account for more than a third of all cigarettes sold in the U.S. each year and are predominantly used by Black and Hispanic smokers. Some 81% of Black smokers used menthols in 2020, compared with 30% of white smokers and 51% of Hispanic smokers, according to a Wall Street Journal analysis of data from the National Survey on Drug Use and Health.

Some Black community leaders had fought the measure, saying a ban would expand the illicit market for cigarettes and lead police to racially profile Black smokers. The American Civil Liberties Union and some members of the Congressional Black Caucus expressed similar concerns.

...

"By contrast, Rep. Robin Kelly (D., Ill.), chair of the Congressional Black Caucus Health Braintrust, said she was “deeply disappointed that the FDA has chosen to abandon its established plan to ban menthol cigarettes… This is a common-sense plan which could have saved hundreds of thousands of lives.”

"Political considerations have swayed the Biden administration’s thinking on this public-health issue, said Mitch Zeller, who served as director of the FDA’s Center for Tobacco Products until 2022. “The science is clear that there will be a massive health benefit from removing menthol cigarettes,” he said."

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All my posts on menthol here.

Proposed age-adjusted smoking ban in the U.K.

 The BBC has the story, about a proposal to ban smoking for everyone currently under the age of 18. (What could go wrong?)

What is the UK smoking ban, how will it work and when will it start? By Aurelia Foster, BBC News

"Prime Minister Rishi Sunak effectively wants to ban smoking in the UK.

MPs have voted to back the government's plans to create a "smoke-free generation", and reduce the number of smoking-related deaths.

What is the smoking ban?

The restrictions will apply to the sale of cigarettes in the UK rather than the act of smoking itself.

Under the new law, each year the legal age for cigarette sales - currently 18 - will increase by one year.

It means that people born in or after 2009 will never be able to legally buy cigarettes, leading to an effective ban.

The law will not affect those who are allowed to buy cigarettes now.

To crack down on under-age sales, the government says it will introduce £100 on-the-spot fines for shops in England and Wales which sell tobacco and vapes to under-age people.

Local authorities will retain the proceeds to reinvest into enforcement of the law.

This would be on top of £2,500 fines that courts can already impose.

The government says it will spend £30m on enforcement, which will include tackling the availability of cigarettes on the black market.

The new rules will apply in all duty free shops in the UK, but anyone buying cigarettes abroad would be able to bring them back to the UK as long as they were legally acquired elsewhere.

The government aims to have the new system in force by 2027.

Mr Sunak wants to work with the governments of Wales, Scotland and Northern Ireland to introduce the legislation across the UK."

HT: Oğuzhan Çelebi

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Earlier: 

Thursday, March 14, 2024

New Zealand repeals anti-smoking law that would have prevented tobacco sales to anyone born after 2008

Text of the new EU regulations on Substances of Human Origin

 Kim Krawiec points me to this newly published document, with the 'final' regulations intended to prevent compensation of donors of Substances of Human Origin (SoHO), such as blood plasma.  How this will effect the five EU member states that compensate plasma donors remains to be seen, as these regulations are now scheduled to go into effect only in 2027.

REGULATION (EU) 2024/… OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL … on standards of quality and safety for substances of human origin intended for human application 

After a quick read, I think these are the sections of the new regulations that are most relevant to their elements of market design, and compensation to donors.

(4)… safety standards are to be based on the fundamental principle that the human body or its parts as such are not to be a source of financial gain.

…

(26) Solid organs are excluded from the definition of SoHO for the purposes of this Regulation and, thus, from the scope of this Regulation. Their donation and transplantation are significantly different, determined, inter alia, by the effect of ischemia in the organs, and are regulated in a dedicated legal framework, set out in Directive 2010/53/EU of the European Parliament and of the Council

…

(57) Article 3 of the Charter prohibits making the human body and its parts as such a source of financial gain. The use of financial incentives for SoHO donations can have an impact on the quality and safety of SoHO, posing risks to the health of both SoHO donors and recipients and therefore to the protection of human health. Without affecting the responsibilities of the Member States for the definition of their health policy, and for the organisation and delivery of health services and medical care, SoHO donation should be voluntary and unpaid, and be founded on the principles of altruism of the SoHO donor and solidarity between donor and recipient. Such solidarity should be built from the local and regional levels up to the national and Union levels, aiming for self-sufficiency of critical SoHO, and spreading the responsibility for donation evenly across the Union population to the extent possible. Voluntary and unpaid SoHO donation contributes to the respect for human dignity and to protecting the most vulnerable persons in society. It also contributes to high safety standards for SoHO and therefore to the protection of human health, increasing public trust in donation systems. AM\P9_AMA(2023)0250(244-244)_EN.docx 49/306 PE748.903v01-00 EN United in diversity EN 

(58) It is recognised, including by the Council of Europe Committee on Bioethics in its ‘Guide for the implementation of the principle of prohibition of financial gain with respect to the human body and its parts from living or deceased donors’ from March 2018, that while financial gain should be avoided, compensation should be able to be acceptable to prevent SoHO donors being financially disadvantaged by their donation. Therefore, compensation to remove any such risk is deemed appropriate as long as it endeavours to guarantee financial neutrality and does not result in a financial gain for the SoHO donor or constitute an incentive that would cause a SoHO donor to not disclose relevant aspects of their medical or behavioural history or to donate in any way that could pose risks to their own health and to that of prospective recipients, in particular by donating more frequently than is allowed. It should be possible for compensation to consist of the reimbursement of expenses incurred in connection with SoHO donation or of making good of any losses, preferably based on quantifiable criteria, associated with the donation of SoHO.

Whatever the form of compensation, including through financial and nonfinancial means, compensation schemes should not result in competition between SoHO entities for SoHO donors, including cross-border competition and in particular between SoHO entities collecting SoHO for different purposes, such as the manufacture of medicinal products versus human application as a SoHO preparation. The setting of an upper limit for compensation at national level and the application of compensation that is financially neutral for the SoHO donor have the effect of removing any incentive for SoHO donors to donate to one SoHO entity rather than another, significantly mitigating the risk that compensation differences might result in competition between SoHO entities, in particular between public and private sectors. It should be possible for Member States to delegate the setting of such conditions to independent bodies, in accordance with national law. Prospective SoHO donors should be able to receive information regarding the possibility of having their expenses reimbursed or of receiving compensation for other losses, through information tools, such as website 'Question and Answer' pages, information email addresses, telephone lines or other such neutral channels of factual information dissemination. However, because of the risk of undermining the voluntary and unpaid character of SoHO donation, references to compensation schemes should not be included in advertising, promotion and publicity activities that form part of SoHO donor recruitment campaigns, for example using advertising billboards or posters, on television, newspaper, magazine or social media advertisements or similar.

(59) SoHO entities should not offer financial incentives or inducements to potential SoHO donors or to those giving consent on their behalf as such an action would be contrary to the principle of voluntary and unpaid donation. Refreshments and small gifts, such as pens or badges, should not be considered as inducements and the practice of offering them to SoHO donors is acceptable as a recognition of their efforts. On the other hand, rewards or benefits, such as payment of funeral expenses, or payment of health insurance unrelated to the SoHO collection, should be considered as inducements, and as such contrary to the principle of voluntary and unpaid donation and should not be permitted.

(60) This Regulation is not meant to cover research using SoHO when that research does not involve human application, for example in vitro research or research in animals. However, SoHO used in research involving studies where they are applied to the human body should comply with this Regulation. In order to avoid undermining the effectiveness of this Regulation, and in particular in view of the need to ensure a consistently high level of protection for SoHO donors, and sufficient availability of SoHO for recipients, the donation of SoHO that will be exclusively for use in research without any human application should also comply with the standards concerning voluntary and unpaid donation set out in this Regulation.

…

(68) In cases where the availability of critical SoHO or products manufactured from critical SoHO depends on potential commercial interests, such as those related to the production and distribution of plasma-derived products, there is a risk of not having the interests of patients and research at the forefront, and thus to jeopardise the quality and safety of SoHO, SoHO donors and recipients. There could even be situations in which some products with low profitability are no longer produced, thereby hampering their accessibility for patients. Therefore, by considering all reasonable efforts for an appropriate and continuous supply of critical SoHO, Member States contribute to limiting the risk of shortages of products manufactured from critical SoHO.

(69) The exchange of SoHO between Member States is necessary for ensuring optimal patient access and sufficiency of supply, particularly in the case of local crises or shortages. For certain SoHO that need to be matched between the SoHO donor and the SoHO recipient, such exchanges are essential to allow SoHO recipients to receive the treatment they need in the optimal timeframe. This is for instance the case of hematopoietic stem cell transplants, for which the level of compatibility between the SoHO donor and the SoHO recipient has to be high, which requires coordination at a global level, so that each SoHO recipient has as many options as possible to identify a compatible SoHO donor.

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“Next steps (from the European Commission): 

The Council will now formally adopt the new European Health Data Space regulation which is expected to be published in the Official Journal in autumn. It will then become applicable in different stages according to use case and data type.

The Council will also formally adopt the new revised legislation to increase the safety and quality of substances of human origin, which will become applicable in 2027.

#####

Earlier:

Monday, April 22, 2024

Plasma donation in the EU: compensated and uncompensated

Main causes of death around the world, 1990-2021

 Here's a recent article from the Lancet that traces leading causes of death around the world, in more than a thousand countries and subnational locations.  Kidney disease went from #18 in 1990 to #9 in 2019, to #11 in 2021 (when Covid entered the list at #2)  So it looks like the rest of the world is catching up to the developed world in chronic disease as compared to infectious disease.

Naghavi, Mohsen, Kanyin Liane Ong, Amirali Aali, Hazim S. Ababneh, Yohannes Habtegiorgis Abate, Cristiana Abbafati, Rouzbeh Abbasgholizadeh et al. "Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021." The Lancet (2024).

Most diseases are causing less premature death, but Diabetes and Chronic Kidney Disease (CKD) are among the few that are causing more premature death, along with Malaria, AIDS, Covid and Other Pandemic Related Mortality (OPRM). (War is not included in the study.)