US Ranks Highest in Global Overdose Deaths

 Here's a sobering news article from JAMA:
US Ranks Highest in Global Overdose Deaths by Samantha Anderer,
JAMA. February 7, 2025. doi:10.1001/jama.2025.0240
 

"A recent Commonwealth Fund report confirmed that the US overdose death rate remains far higher than in any other country. In 2022, the US overdose rate was 324 deaths per 1 million people, 1.5 times greater than in Scotland, the second-ranked nation with 219 deaths per million people. Although Scotland saw fewer deaths in 2022 than in previous years, rates in the US continued to climb, up about 53% from 2019. For the third consecutive year, drug overdoses claimed more than 100 000 lives in the US, according to provisional 2023 data from the US Centers for Disease Control and Prevention.

"The Commonwealth Fund report cited inadequate investment in treatment and prevention strategies as a major contributor to the discrepancy between the US and the rest of the globe. Only 11% of people in the US diagnosed with opioid use disorder reported receiving substitution therapy in 2020 compared with 87% in France and 51% in Scotland. "

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Here's the report:

U.S. Overdose Deaths Remain Higher Than in Other Countries — Trend-Tracking and Harm-Reduction Policies Could Help by Evan D. Gumas

"Provisional data show that drug overdoses in the United States claimed more than 100,000 lives for a third consecutive year in 2023 — a more than 50 percent jump since 2019. By a substantial margin, the U.S. has the highest rate of overdose deaths in the world, followed by Puerto Rico — a U.S. territory. And while Scotland and Canada, the second- and third-ranked countries, saw decreases from 2021 to 2022, rates in the U.S. have remained high. Our analysis, using the latest mortality data from 2022, compares the U.S. overdose rate — 324 deaths per 1 million people, or almost 108,000 deaths in 2022 — to dozens of countries from across the globe and finds that the U.S. unequivocally has the highest rate of overdose deaths in the world.

The U.S. can learn from other countries by tracking emerging trends and adopting comprehensive approaches to prevention and treatment that prioritize public health and harm reduction.

 

 Source: Evan D. Gumas, “U.S. Overdose Deaths Remain Higher Than in Other Countries — Trend-Tracking and Harm-Reduction Policies Could Help,” To the Point (blog), Commonwealth Fund, Jan. 9, 2025. https://doi.org/10.26099/ppdk-qy10

AI assisted home buying and selling at Stanford

 Stanford's office of Faculty and Staff Housing is just now offering Stanford affiliated buyers and sellers the use of the suite of AI programs developed by the real estate startup HomeKey.

From FSH: "Homekey is the new, streamlined alternative to the traditional real estate model. Whether you are buying or selling, Homekey is a one-stop AI-based platform to help you manage the entire process, from searching for homes, valuing houses, evaluating disclosures, to finding contractors and inspectors in one  convenient location. It uses AI to help read the documents and make the search process simpler. 

"Currently Homekey is an optional free service for Stanford Non-Restricted Ground Leased properties, working together with Stanford Faculty Staff Housing office and can be used with or without a real estate agent." 

From Homekey: "Homekey is the new, streamlined alternative to the traditional real estate model.
Learn more about our one-stop AI-based platform to help you manage the entire process here.
We are launching our service on 02.07.2025 "

Altruism and financial incentives in medicine (less altruistic physicians more readily respond to payments by drug companies)

 Physicians have professional obligations to care for their patients, and also deal with financial incentives that may not perfectly align with patient care.  The paper below experimentally examines a sample of physicians for altruism, by observing their behavior in a dictator game over different budget constraints, and compares their measured altruism with the  payments they recieve from pharma companies and the extent to which they respond to those payoffs by prescribing the brand name drugs those payments promote. Lower measures on altruism correspond to more prescription of promoted drugs.

The Role of Physician Altruism in the Physician-Industry Relationship: Evidence from Linking Experimental and Observational Data  by Shan Huang, Jing Li & Anirban Basu. NBER Working Paper 33439, DOI 10.3386/w33439, January 2025

Abstract: Altruism is a key component of medical professionalism that underlies the physician's role as a representative agent for patients. However, physician behavior can be influenced when private gains enter the objective function. We study the relationship between altruism and physicians' receipt of financial benefits from pharmaceutical manufacturers, as well as the extent to which altruism mitigates physicians' responsiveness to these industry payments. We link data on altruistic preferences for 280 physicians, identified using a revealed preference economic experiment, with administrative information on their receipt of financial transfers from pharmaceutical firms along with drug prescription claims data. Non-altruistic physicians receive industry transfers that are on average 2,184 USD or 254% higher than altruistic physicians. While industry transfers lead to higher drug spending and prescribing on paid drugs, these relationships are entirely driven by non-altruistic physicians. Our results indicate that altruism is an important determinant of physicians’ relationships with and responses to industry benefits.

States' fights over abortions: New York moves to shield doctors from prosecution in states with abortion bans

 Not all politics is Federal, even in these unprecedented times.

The NYT has the story:

N.Y. Moves to Shield Doctors Who Send Abortion Pills to States With Bans.   Gov. Kathy Hochul signed a bill meant to protect medical practitioners in New York who prescribe and send abortion pills out of state.  By Benjamin Oreskes

"Gov. Kathy Hochul of New York signed a bill on Monday intended to give the state’s health care providers an extra layer of protection to shield them from prosecution in states that ban abortion.

"The newly signed law comes days after a New York doctor was indicted in Louisiana for prescribing and sending abortion pills to someone in the state. The charges represented an escalation in the fractious battle between mostly Republican-led states that ban abortion and Democratic-led states seeking to protect or expand abortion access.

"The law, which takes effect immediately, will allow health-care practitioners to avoid putting their names on prescriptions for medications used in abortions, and instead use the names of their medical practices.

"Ms. Hochul, a Democrat, said the goal was to better conceal the identity of providers in hopes of protecting them from criminal, civil or other legal action that anti-abortion states try to take against them.

...

"The legislation signed on Monday augments the state’s telemedicine abortion shield law, under which New York authorities are barred from cooperating with a prosecution or other action taken by another state against a New York abortion provider.

"New York is one of eight states to have adopted such laws. Sending the pills across state lines has become a key way to provide abortion access to women in states with bans.

"Since the Supreme Court overturned the national right to abortion in 2022, a dozen states have enacted near-total abortion bans, and others have imposed strict limits on when during a pregnancy an abortion is allowed.

"In the Louisiana case, Dr. Margaret Carpenter of New Paltz, N.Y., was charged last week, along with her medical practice, for “criminal abortion by means of abortion-inducing drugs.”

Clinical trial of pig kidney transplants

 A clinical trial is good news.

The NYT has the story:

F.D.A. Approves Studies of Pig Organ Transplants for Kidney Patients
The research offers hope to tens of thousands of patients with kidney failure who are on a long waiting list for an organ transplant. By Roni Caryn Rabin  Feb. 3, 2025

"The U.S. Food and Drug Administration has given the green light to two biotechnology companies for clinical trials that will transplant organs from genetically modified pigs into people with kidney failure. If successful, these studies could lead to the broader use of cross-species transplantation, a dream of medical scientists for centuries.

One of the companies, United Therapeutics Corporation, will begin its trial with six patients, but that number could eventually rise to 50. The other, eGenesis, said it would begin with three patients and grow the study from there.

...

"Over the past three years, five patients have been known to receive organs from pigs engineered by these companies — two who received hearts and three who received kidneys. But these surgeries were not part of a formal clinical trial.

...

"The United Therapeutics study, which is expected to begin midyear, will start with six patients who have been on dialysis for at least six months but do not have other serious medical problems. There will be a three-month waiting period between each transplant so that doctors can learn from the outcomes.

If the first six transplants are successful, the trial will expand to include up to 50 participants in what is called a phaseless trial — a type of study that combines the traditional Phase 1, Phase 2 and Phase 3 trials and can lead directly to approval."

Civil service in the United States, RIP (1883-2025)

Civil service in the U.S. may not be dead yet, but it's suffering from potentially lethal attacks.

The Pendleton Act of 1883 established the current civil service system, as a market design solution to reduce corruption in government employment, and to protect government employees from political retaliation .

From https://www.archives.gov/milestone-documents/pendleton-act

"The Pendleton Act provided that federal government jobs be awarded on the basis of merit and that government employees be selected through competitive exams. The act also made it unlawful to fire or demote for political reasons employees who were covered by the law. The law further forbade requiring employees to give political service or contributions. The Civil Service Commission was established to enforce this act."

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From protectdemocracy.org:

The civil service, explained , byAlex Tausanovitc, Michael Angeloni ,William Ford,Erica Newland, June 11, 2024

"For nearly 150 years, federal law has sought to ensure these employees are hired and fired based on merit and are empowered to exercise independent judgment without fear of political retaliation. These legal protections help the government to serve the public as a whole, rather than a president’s personal or political agenda. 

...

"For most of the 1800s, the federal government largely operated under the “spoils system,” wherein new presidents had a free hand to remove and replace federal employees — and they did so “wholesale,” generally to reward political allies. At the time, customs houses and the postal office were among the most important government services, and both were rife with corruption.

The spoils system became synonymous with graft and degraded critical government services.

"Beginning with the enactment of the Pendleton Act in 1883, which instituted a competitive hiring process and protected workers from partisan-based removal, the U.S. government slowly developed a professionalized, public-oriented civil service. The Pendleton Act was followed by a series of statutes and regulations that culminated in the Civil Service Reform Act of 1978, which largely created our current “merit system.” 

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And now (from the NYT):

Education Officials Placed on Leave in Trump’s Sprawling Effort to Curb D.E.I.  By Erica L. Green and Zach Montague, Feb. 1, 2025

Challenge trials are becoming more accepted

Challenge trials, also called human infection trials, are clinical trials in which e.g. a vaccine is tested on participants who have volunteered to be infected with the disease the vaccine is meant to prevent. It's been a source of controversy.  But maybe open letters have some effect after all?  

The NYT has the story:

Would You Get Sick in the Name of Science?  Since the pandemic, drug trials that purposely make people vomit, shiver and ache have become a research area of growing interest. All that’s needed: brave volunteers. By Brent Crane

"challenge trials have become an area of enthusiasm since the Covid-19 pandemic. Funding for trials has poured in. Countries including India, Canada and Australia are beginning to develop the capacity for conducting them. Some researchers have found it easier to recruit volunteers, who are willing to shiver, sweat, puke and ache all in the name of helping others (and earning a little cash).

...

" Researchers have found that challenge trials can be used to observe not just immune responses but also transmission and infection. And by the standards of disease research, they are nimble; the whole process can take as little as a few months. This is in contrast to the years it often takes to run a traditional trial requiring thousands of research subjects to naturally become infected with a disease.

...

" In April 2020, 35 U.S. congressional members wrote a letter calling on regulators to permit challenge trials for Covid-19 vaccines. Three months later, 177 prominent scientists, including 15 Nobel laureates, joined their call. But opponents argued that the risks of infecting volunteers with a poorly understood virus were too great. The National Institutes of Health, Food and Drug Administration and Centers for Disease Control and Prevention all refused to allow them. At least one trial, in the Netherlands, was scuttled because of the perceived risk.

"And yet, instead of torpedoing the field, the pandemic “revitalized” it, said Dr. Christopher Chiu, an immunologist at Imperial College London. In 2021, after months of deliberation, the world’s first Covid-19 challenge trial began at Imperial College London — one of two that took place between 2021 and 2022 for Covid-19 — and interest grew from there.

"In 2020, while locked down in his Brooklyn apartment, a former corporate lawyer named Joshua Morrison stumbled upon an early draft of the Journal of Infectious Diseases article arguing for Covid challenge trials. That March, Mr. Morrison and two others founded an advocacy group in Washington, D.C., as a place to organize potential volunteers for Covid-19 challenge trials. As a nod to the speed of challenge trials, they called it 1Day Sooner. Within months, the organization had tens of thousands of sign-ups.

"1Day Sooner went on to promote challenge trials for maladies including norovirus, hepatitis-C and shigella, a bacteria that can cause dysentery."

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Here are all my posts on challenge trials

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