Nicotine will be with us for a long time--survey of middle school use

 Sales of tobacco products to minors are generally illegal in the U.S., but a survey shows that doesn't stop children from smoking and vaping.  Here's a report from the Centers for Disease Control and Prevention, in JAMA

Tobacco Use Remains High in Middle and High Schools by Bridget M. Kuehn, MSJ

JAMA. 2022;328(24):2389-2390. doi:10.1001/jama.2022.20058

"Nearly 1 in 9 US middle and high school students reported tobacco product use in the past 30 days—most commonly e-cigarettes—according to a CDC and US Food and Drug Administration analysis of data from the 2022 National Youth Tobacco Survey (NYTS). The researchers estimated that approximately 3.08 million students in 6th to 12th grade currently use tobacco products.

...

"The data show that 16.5% of high school students and 4.5% of middle school students reported using a tobacco product in the past 30 days. About 14% of high school students and about 3% of middle school students used electronic cigarettes. Nearly 4% of all those surveyed reported using any combustible tobacco product.

"Several subgroups of students reported even higher rates of tobacco product use. About 16% of students who identified as lesbian, gay, bisexual, or transgender reported current use of these products. The 2022 NYTS survey was the first to provide data on tobacco product use among American Indian or Alaska Native, Asian, multiracial, or Native Hawaiian or other Pacific Islander youths. It found that American Indian or Alaska Native youth reported the highest rate of a tobacco product use of any racial or ethnic group, at 13.5%.

"The report also found a link between social determinants of health and tobacco product use. For example, students who had experienced severe psychological distress or were from less affluent households were more likely to report current tobacco product use. More than a quarter of students with low academic achievement reported current use. "

Sell a kidney to save a life? by Dylan Walsh, in WIRED.

 Martha Gershun alerts me to this story which appeared this morning in WIRED, in which the author, a kidney transplant recipient (24 years ago), considers the history of the long debate about whether kidney donors might be compensated, to end the shortage of life-saving kidney transplants.  It's very well written, and contains some details (e.g. dialog between Al Gore and Barry Jacobs) that I hadn't seen before.  It's well worth reading the whole thing.

Would You Sell One of Your Kidneys? Each year thousands die because there aren’t enough organs for transplants, and I may be one of them. It’s time to start compensating donors. by Dylan Walsh

Here's the first sentence:

"WHEN WE WERE teenagers, my brother and I received kidney transplants six days apart. "

Here's some history of transplantation itself:

"In 1963, the world’s preeminent kidney transplant surgeons met in DC to discuss the state of the field. They were few in number and dispirited. Roughly 300 operations had been performed by then, with only 10 percent of patients surviving more than six months, according to one account. The procedure remained no more than “highly experimental,” in the words of even its fiercest proponents. But the prevailing gloom lifted when two little-known surgeons from Denver, Thomas Starzl and Thomas Marchioro, presented results from a series of transplants they’d performed. They had managed to flip the outcomes: 10 percent failure, 90 percent success. A euphoric shock spread through the crowd, which quickly gave way to skepticism. The results were studied, confirmed, and eventually replicated. "

Here's a bit about the origins of the legal ban on compensating donors (the 1984 National Organ Transplant Act, or NOTA):

"In 1967, one study found that roughly 8,000 people were eligible for a kidney transplant; only 300 received one.

"IT TOOK ABOUT a decade for someone of enterprising disposition to step into this gap. H. Barry Jacobs was a Virginia doctor who lost his license to practice medicine in 1977 for attempting to defraud Medicare. He spent 10 months in jail and shortly after his release turned his energies to the unregulated business of organ brokering. His company, International Kidney Exchange Ltd., was built around the fact that most of us are born with two kidneys but can function with one. If one kidney is removed, the other grows larger and works harder, filtering more blood to cover as best it can for its emigrant twin. This redundancy supported Jacobs’ straightforward business model. He would connect people who wanted to sell one of their kidneys, for a price of their choosing, with people who needed one. As a mi"ddleman, Jacobs would charge a brokerage fee to the recipients.

"At the time, Al Gore, then a member of the US House of Representatives, was developing the National Organ Transplant Act, which centered on establishing a repository to match organ donors with those in need of a transplant. Upon hearing of Jacobs’ plan, Gore also took up the question of compensation. Jacobs appeared before the Subcommittee on Health and the Environment on October 17, 1983, and spoke with truculence. He talked about one doctor who had testified before him “sitting on his butt” and failing to seriously address the problem of organ shortages. He interrupted and challenged his questioners. His testimony, above all, highlighted the likely abuses in an unregulated organ market.

“I have heard you talk about going to South America and Africa, to third-world countries, and paying poor people overseas to take trips to the United States to undergo surgery and have a kidney removed for use in this country,” Gore said. “That is part of your plan, isn't it?”

“Well, it is one of the proposals,” Jacobs said.

...

"This exchange gave public force to a debate that had been unfolding in the dimmer theater of academia ever since transplantation first became possible. ...Proponents of an organ market had historically invoked the crisp—some say cold—logic of utilitarianism. A properly designed market, they suggested, would provide economic surplus to both the organ donor, in the form of money, and to the recipient, in the form of a longer, healthier life. Opponents of a market typically crafted their dissents from the gossamer realm of ethics."

There's more, both personal and policy.  

Good luck to all who need a kidney and to those who donate them. Maybe we'll make some more progress in 2023.

"It Is Time for Interventional Cardiology Fellowship to Join the National Resident Matching Program," say its leaders

 The current appointment process for interventional cardiology fellows is early and congested, and programs feel obliged to make exploding offers, often to internal candidates, without much opportunity for external candidates and programs to become acquainted. In short, they are facing the problems with decentralized hiring that have led many medical specialties to use a centralized match to organize the labor market for residencies and fellowships.  Here's a proposal that this fellowship program should join the Match in order to have a more orderly, better informed process.

Vallabhajosyula, Saraschandra, Sabeeda Kadavath, Alexander G. Truesdell, Michael N. Young, Wayne B. Batchelor, Frederick G. Welt, Ajay J. Kirtane, Anna E. Bortnick, and ACC Interventional Section Leadership Council. "It Is Time for Interventional Cardiology Fellowship to Join the National Resident Matching Program." Cardiovascular Interventions 15, no. 17 (2022): 1762-1767.

"In this perspective article, which is a summation of the deliberations of the American College of Cardiology Interventional Section Leadership Council, we describe the current process of interventional cardiology fellowship candidate selection and opportunities for improvement by joining the Match.

...

"Current Application Process

...

"the date for program review of applications starts on December 1st (1½ years before the start of the interventional cardiology training program to which applicants are applying), although programs are free to offer spots earlier. At the time applications are submitted, cardiovascular medicine fellows in traditional 3-year programs have variable exposure to the cardiac catheterization laboratory. In our experience, for many applicants, the timing of the application process precludes an adequate diagnostic catheterization laboratory experience in order to inform decision-making. ... program leadership is heavily reliant on candidate performance in the interview and on subjective evaluation through letters of recommendation from faculty mentors who have typically had a single year of exposure to applicants.

Residency interviews, in person vs by zoom, at Stanford

 

Residency interviews in the digital era by Isabel Beshar1, William J Tate2, Dan Bernstein3  Postgraduate Medical Journal 98, no. 1166 (2022): 892-894.

Abstract: "In the midst of the SARS-CoV-2 pandemic, the US Association of American Medical Colleges (AAMC) required residency programme transition from in-person to virtual interviews for all applicants. The new virtual format upended a system that has relied on programmes and applicants balancing the likelihood of acceptance with the financial and time demands of cross-country travel.

"In this commentary, we address the history of residency interviewing in the USA and the emerging changes that are taking place in light of virtual interviews. We discuss the advantages of the new online format, including the reduced cost for applicants and programmes, as well as the decreased carbon footprint.

"We also discuss the inequities of virtual interviewing, involving a national maldistribution of interviews to only the top-tier candidates. We share previously unpublished data on the number of virtual interviews accepted by Stanford’s 2020 residency applicants, compared with those conducted in person in 2019. We find Stanford applicants in all fields accepted more interviews: from a mean of 8 in 2019 to 14 in 2020, a change of 160% on average. Despite this, only half of Stanford 2020 applicants interviewing in the virtual format thought they had accepted more interviews than they would have in person.

"We comment on how transitions to online interviewing may be affecting medical schools and applicants disproportionately. Ultimately, we highlight the need and offer ideas for additional regulation on behalf of the AAMC to ensure a more equitable distribution of interview opportunities."

...

"At our institution—Stanford School of Medicine—and as applicants of the 2020–2021 cycle ourselves—we saw the effect of this firsthand. We administered a survey to all students participating in the match process in both the 2019 (in-person) and 2020 (virtual) years. In the survey, respondents identified the residency programme or programmes to which they applied as well as the number of interviews they attended.

Synthetic biology and the ethics of eating (Virgina Postrel in the WSJ)

 Remarkable changes will keep coming.  Here's Virginia Postrel in the WSJ on how changes in the food supply might influence both repugnance towards meat eating and towards technology:

Synthetic Meat Will Change the Ethics of Eating. Consumers will soon be able to dine on chicken and other animal proteins grown in a factory, upending the way we think about nature and technology  By Virginia Postrel

"Most Americans aren’t about to give up chicken, but we’d rather not dwell on where it comes from. In the not-too-distant future, however, the trade-off between conscience—or ick factors—and appetite may no longer be relevant. Instead of slaughtering animals, we’ll get our meat from cells grown in brewery-like vats, with no blood and guts. In November, that science-fiction vision came a crucial step closer to reality when the Food and Drug Administration gave its OK to the slaughter-free chicken from Upside Foods, a San Francisco-based startup originally known as Memphis Meats. The company must still work with the Agriculture Department to establish inspection procedures and win labeling approval. It plans to first offer the meat to high-end restaurants.

...

"Synbio executives talk like animal lovers and environmental activists. But synbio is still a form of engineering, a science of the artificial. As such, its ethical appeal represents a significant cultural shift. Since the first Earth Day in 1970, businesses large and small have emerged from the conviction that “natural” foods, fibers, cosmetics, and other products are better for people and the planet. It’s an attitude that harks back to the 18th- and 19th-century Romantics: The natural is safe and pure, authentic and virtuous. The artificial is tainted and deceptive, a dangerous fake. Gory details aside, the “factory” in factory farming makes it sound inherently bad.

"Synthetic biology upends those assumptions, raising environmental and ethical standards by making them easier and more enjoyable to achieve."

*******

Some commentators on her WSJ article criticized it as "woke propaganda."

*******

Earlier:

Tuesday, November 22, 2022

Lab grown meat: taking slaughter out of the food chain

Monday, May 30, 2022

Eliminating cruelty (and methane) from the food chain: lab-grown ("no-kill") meat

New York State's Living Donor Support Act (LDSA, S. 1594) was signed by Governor Hochul on Dec. 29

 Frank McCormick forwards this email:

From: Elaine Perlman

Sent: Thursday, December 29, 2022 5:44 PM

Subject: Governor Hochul Has Signed the Living Donor Support Act!

 "Hello!

I am delighted to inform you all that the New York State's Living Donor Support Act (LDSA, S. 1594) was signed by Governor Hochul today.

 New York is becoming the best state for organ donation!

 Thank you for your advocacy in support of this legislation. The LDSA will save more New Yorkers' lives.

 Waitlist Zero's Executive Director Josh Morrison wrote the legislation. State Senator Rivera from The Bronx and Assembly Member Gottfried from Manhattan sponsored the bill.

 This spring, a team from the NKDO, NKF, DOVE, LiveOn New York, and Waitlist Zero lobbied for the bill's passage in Albany. Soon after, the LDSA was unanimously passed by both houses.

 This new law creates the opportunity for New York's living donors to avoid going into debt to donate. Living donors will be reimbursed for their lost wages and out-of-pocket expenses. New York will be the first state in the country to offer this opportunity for donation to be cost neutral for donors.

 Currently the Federal Government only reimburses when both the recipient and donor make less than 350% of the poverty line (around $47,000). The LDSA will reimburse the lost wages of donors who make up to $125,000 as well as the costs of donation (travel, childcare, etc).

 In addition, the LDSA will ensure that all potential recipients will be educated about transplantation.

 There are currently 8,569 people on New York's transplant wait lists, 7,234 of whom are awaiting a kidney. With the LDSA, we anticipate that far more New Yorkers will benefit from a living organ donation.

Here is the press release.

On Tuesday, January 3rd from 4-5pm ET, we will have a virtual celebration and toast the passage of the LDSA! Here is our zoom link.

Please share this good news far & wide!

Best,

 Elaine

Director, Waitlist Zero "

***********

Because the National Living Donor Assistance Center (NLDAC) is a payer of last resort, the NY law will replace NLDAC for NY donors who do meet the means test, and so it will also allow the NLDAC budget to go further.

********

Update: Frank McCormick writes to alert me that, like the authorization for NLDAC,  the NY State law (https://www.nysenate.gov/legislation/bills/2021/S1594) "requires that the Program shall be payer of last resort..." I hope that this doesn't turn into a competition to be the payer of last resort in a way that might cause some NY donors to fall between the cracks, and not be reimbursed either by NLDAC or the State of New York.

The year in passings

 We come to the end of another long year.

Saturday, December 10, 2022

Amnon Rapoport (1936-2022)

Monday, October 17, 2022

Jacques Drèze (1929-2022)

Thursday, September 1, 2022

Elizabeth "Betsy" E. Bailey (1939-2022)

Monday, August 29, 2022

ANTHONY PETER "TONY" MONACO M.D. 1932 - 2022--performed first kidney exchange in the U.S.

Thursday, June 30, 2022

Same sex marriage in Colorado: then and now   Clela Rorex, Clerk Who Broke a Gay-Marriage Barrier, Dies at 78.

Friday, March 18, 2022

David Schmeidler (1939-2022)

Thursday, March 10, 2022

David Bennet Sr., who lived for two months with a transplanted pig heart, RIP

Friday, February 18, 2022

The Economic Theory Conference in Memory and Honor of Hugo Sonnenschein, April 29-30, U. Chicago     (Thursday, July 15, 2021  Hugo Sonnenschein (1940-2021))

IN MEMORIAM : Roy RADNER (1927-2002) by Jean-Michel Grandmont

Dale Jorgenson (1933-2022) by Bob Hall

Remembering Professor Emeritus Stuart Mestelman. Members of the McMaster community have shared their memories of Stuart Mestelman who died on June 25, 2022.

"In 1994, Stuart and his colleagues helped found the McMaster Experimental Economics Laboratory (McEEL). Stuart served as the lab’s co-director between 1994 and 2017, long past his official retirement from McMaster in 2008."

Remembering Robert Andrew “Andy” Muller (1943 – 2021)

"Professor Emeritus of Economics and Co-Director Emeritus, McMaster Decision Science Laboratory, Robert Andrew “Andy” Muller, passed away on October 14, 2021. He was 77 years old. "

The market for battlefield intelligence

Here's a column from the Washington Post, which (although it reads partly like an ad from Palantir) emphasizes that real time battlefield data can be acquired from a variety of commercial sources:

How the algorithm tipped the balance in Ukraine, By David Ignatius

"The “kill chain” that I saw demonstrated in Kyiv is replicated on a vast scale by Ukraine’s NATO partners from a command post outside the country. The system is built around the same software platform developed by Palantir that I saw in Kyiv, which can allow the United States and its allies to share information from diverse sources — ranging from commercial satellite imagery to the West’s most secret intelligence tools.

...

"What makes this system truly revolutionary is that it aggregates data from commercial vendors. Using a Palantir tool called MetaConstellation, Ukraine and its allies can see what commercial data is currently available about a given battle space. The available data includes a surprisingly wide array, from traditional optical pictures to synthetic aperture radar that can see through clouds, to thermal images that can detect artillery or missile fire.

"To check out the range of available data, just visit the internet. Companies selling optical and synthetic aperture radar imagery include Maxar, Airbus, ICEYE and Capella. The National Oceanic and Atmospheric Administration sells simple thermal imaging meant to detect fires but that can also register artillery explosions.

"In our Kherson example, Palantir assesses that roughly 40 commercial satellites will pass over the area in a 24-hour period. Palantir normally uses fewer than a dozen commercial satellite vendors, but it can expand that range to draw imagery from a total of 306 commercial satellites that can focus to 3.3 meters. Soldiers in battle can use handheld tablets to request more coverage if they need it. According to a British official, Western military and intelligence services work closely with Ukrainians on the ground to facilitate this sharing of information.

"A final essential link in this system is the mesh of broadband connectivity provided from overhead by Starlink’s array of roughly 2,500 satellites in low-earth orbit. The system, owned by Elon Musk’s SpaceX company, allows Ukrainian soldiers who want to upload intelligence or download targeting information to do so quickly."

Towards greater gun safety in San Jose

 The mayor of San Jose, CA, has some thoughts on making guns and gun ownership less dangerous, in a  NY Times opinion column:

400 Million Guns Aren’t Going to Just Go Away. In San Jose, We’re Trying Something New. By Sam Liccardo (Mr. Liccardo, a Democrat, has been the mayor of San Jose, Calif., since 2015. He is a former federal and local prosecutor.)

"Amid the rising tide of firearms, reducing gun deaths and injuries requires new solutions. In San Jose, Calif., where I am mayor, we’ve embarked on two approaches untried in any other city or state: We’re imposing an annual fee on gun-owning residents and investing the revenues in violence prevention efforts. And on Jan. 1, the city will begin requiring gun owners to carry liability insurance to compensate victims harmed by the negligent or reckless use of a firearm.

...

"Most gun-owning residents can comply with the insurance mandate with little or no additional cost under standard homeowners’ and renters’ policies. As more jurisdictions adopt an insurance requirement — legislators in New Jersey and California have recently proposed them — we expect that the insurance industry will become increasingly invested in reducing gun-related harm. Premiums will reflect the risks of gun ownership and will adjust accordingly, in the same way that auto insurers offer “good driver” discounts or how they incentivized the installation of anti-lock brakes and airbags in the past.

"Of course, in the realm of gun regulation, no good deed goes unlitigated. Three groups sued San Jose after the ordinance imposing the fee and insurance requirement passed. A Federal District Court declined their pleas for an injunction to stop the ordinance from taking effect, finding no unconstitutional burden on Second Amendment rights where “there are no means by which a San Jose gun owner may be deprived of his or her firearm.”

Designing queues for overloaded waiting lists, by Jacob Leshno

 Here's a paper by Jacob Leshno, with a really creative new contribution to the (venerable) queuing literature. 

Leshno, Jacob D. 2022. "Dynamic Matching in Overloaded Waiting Lists." American Economic Review, December, 112 (12): 3876-3910. DOI: 10.1257/aer.20201111 (ungated working paper link here)

"Abstract: This paper introduces a stylized model to capture distinctive features of waiting list allocation mechanisms. First, agents choose among items with associated expected wait times. Waiting times serve a similar role to that of monetary prices in directing agents' choices and rationing items. Second, the expected wait for an item is endogenously determined and randomly fluctuates over time. We evaluate welfare under these endogenously determined waiting times and find that waiting time fluctuations lead to misallocation and welfare loss. A simple randomized assignment policy can reduce misallocation and increase welfare."

"A practical recommendation is the simple service-in-random order (SIRO) queuing policy. A SIRO buffer-queue mechanism has a simple description: agents who decline an item are allowed to join a priority pool for their preferred item, and agents in each priority pool have an equal probability of receiving an arriving item. We characterize the SIRO buffer-queue mechanism as the robustly optimal mechanism. This simple randomization does not fully equalize the expected wait across states, but it lessens the expected wait fluctuations and therefore reduces the misallocation probability and achieves higher welfare in equilibrium than FCFS." [FCFS= first come first served.]

"In summary, this paper offers two messages for the practical design of allocation through waiting lists. First, although many public-housing authorities have waiting list policies that discourage applicants from declining items, the analysis suggests agents should be encouraged to decline mismatched items. When the system is overloaded, an agent who declines a mismatched item allows the system to search further and assign the item to a matching agent. Furthermore, such an agent reduces the waiting costs of others by allowing them to be assigned before him. Second, equalizing the expected wait agents face when making their choice can improve welfare. This can be achieved by the SIRO buffer-queue mechanism or by partial information mechanisms. Both are practical mechanisms that offer agents more equal options at the time they make their choice, and thus reduce misallocation and improve welfare."

Suppressing vaping is hard

 The WSJ has the story:

Major effort needed to remove illegal vaping products, review finds. Group says FDA regulators are overwhelmed and reactive  By Laurie McGinley

"An independent review of the Food and Drug Administration’s tobacco regulators described them as overwhelmed, reactive and fatigued by an oppressive workload involving e-cigarettes and called for a major effort, by several parts of the Biden administration, to remove millions of illegal vaping products from the market.

"The report, by the Reagan-Udall Foundation for the FDA, also said the agency’s Center for Tobacco Products, created by federal law in 2009, has fallen short in laying out clear priorities and has been besieged by lawsuits brought by tobacco and vaping companies, on the one hand, and public health groups on the other.

"The review said there are millions of illegal vaping products on the market — involving companies that should have applied for FDA authorization and never did, or others that had their applications rejected — and that a major effort is needed to remove them."

The once and future Pasteur Act to incentivize antibiotic discovery and development

It doesn't look like Congress is going to act this year to pass the Pasteur Act.

Here's the NY Times:

Can a Federally Funded ‘Netflix Model’ Fix the Broken Market for Antibiotics? Shortages and drug-resistant germs have renewed attention on a $6 billion proposal in Congress that would reconfigure the way antimicrobial drugs are developed and sold. By Andrew Jacobs

"The broken marketplace for new antimicrobial drugs has stirred debate over a bill, languishing in Congress, that would dramatically reconfigure the way antibiotics are discovered and sold in the United States.

"The $6 billion measure, the Pasteur Act, would upend the conventional model that ties antibiotic profits to sales volume by creating a subscription-like system that would provide pharmaceutical companies an upfront payment in exchange for unlimited access to a drug once it is approved by the Food and Drug Administration.

...

The measure attempts to address the vexing economics of antibiotics: Promising new drugs often gather dust on pharmacy shelves because health providers would rather save them for patients whose infections don’t respond to existing ones. That’s because the more frequently an antibiotic is used, the more quickly it will lose its curative punch as the targeted bacteria develop the ability to survive.

...

"The bill, a decade in the making, has bipartisan support and is widely backed by researchers, health care policy experts and drug company executives. But as momentum for the bill has gained steam, opposition has emerged from a small group of doctors and health care advocates, many of them critics of Big Pharma. They say the bill is a drug-industry giveaway — and unlikely to address the problem of antibiotic resistance.

...

"It can cost a $1 billion or more to bring a new drug to market, but earning back that investment has proved increasingly elusive. Unlike blockbuster medications for chronic conditions like diabetes or high blood pressure, most antibiotics are prescribed for just days or weeks. Many hospitals, unwilling to pay the high prices that accompany new therapies, prefer to rely on cheaper but less effective options, experts say.

A number of antibiotic start-ups have gone bankrupt in recent years, sending a chill through the industry."

*****

Here's some more background from U. Minnesota:

For PASTEUR Act advocates, the finish line is in sight for antibiotic development aid by Chris Dall,   December 6, 2022

"With the clock ticking on Congress to finish its business before the end of the year, groups representing infectious disease and public health professionals and the pharmaceutical industry are trying to push a bill across the finish line that could change the antibiotic development landscape.

"The bill, known as the PASTEUR (Pioneering Antimicrobial Subscriptions to End Upsurging Resistance) Act, would create a subscription-style payment model in which the federal government would pay up front for access to Food and Drug Administration (FDA)-approved antibiotics that target drug-resistant pathogens and meet critical, unmet health needs.

"The aim of the bill, which would delink companies' profits from the volume of antibiotics sold, is to help solve the market challenges that have led many pharmaceutical companies to abandon antibiotic development and contributed to the weak pipeline for new, innovative antibiotics.

"Originally introduced in 2020 and re-introduced in June 2021, the PASTEUR Act, according to advocates, is closer than ever to becoming a reality in the wake of the COVID-19 pandemic and amid growing concern about rising antimicrobial resistance (AMR) rates and the lack of new antibiotics. But time is running out, and the how the bill might fare in the next Congress is unclear."

Epicures and Duck Farms Get a Reprieve From New York’s Foie Gras Ban

The WSJ has the latest turn of events in this long running story:

Epicures and Duck Farms Get a Reprieve From New York’s Foie Gras Ban. The city ordinance fails to pass muster with the state’s Agriculture Department. by  Megan Keller

"Good news for New York City epicures and upstate farmers: Foie gras will remain on menus in the city. They can thank the state’s Department of Agriculture and Markets, which last Wednesday found that the city’s ban on the avian delicacy violated the farmers’ rights under state law.

Foie gras is made from duck or goose livers fattened through a force-feeding process called gavage—administering gradually larger amounts of feed through a small tube in the bird’s throat. The farmers who produce foie gras say the ducks remain healthy and content throughout their lives, but some animal-rights activists consider the practice cruel. In 2019 the New York City Council enacted an ordinance banning the sale of foie gras, which was scheduled to take effect last month."

**********

Earlier: https://marketdesigner.blogspot.com/search?q=foie

 

Fifty Years of a National Program for the Treatment of Kidney Failure

 This JAMA viewpoint tells the story:

Fifty Years of a National Program for the Treatment of Kidney Failure, by Kevin F. Erickson,  Melandrea Worsley, andWolfgang C. Winkelmayer, JAMA. Published online December 19, 2022. doi:10.1001/jama.2022.23873

"Fifty years ago, on October 30, then-President Richard Nixon signed the Social Security Amendments of 1972, which created the End-Stage Renal Disease (ESRD) program. In extending Medicare benefits to people with kidney failure regardless of their age, this landmark legislation availed universal health care coverage for most persons with kidney failure.

...

"In the 1950s kidney transplant had emerged as a treatment option. By the early 1960s, innovations in dialysis machines and vascular access made it possible to treat chronic uremia with dialysis. These technological breakthroughs transformed kidney failure from a terminal illness into a treatable chronic condition. Although the first long-term dialysis center opened in 1962, most patients with kidney failure could not afford dialysis.

...

"For individuals with kidney failure, the ESRD program was transformative. By 1980, there were 58 000 patients receiving lifesaving treatment through the program, with enrollment growth averaging 22% per year. Enrollment growth spanned wide ranges of age, sex, and race, reflecting benefits across broad segments of the US population.4 Currently, more than 700 000 patients with kidney failure have Medicare coverage.

...

" In 2019, Medicare’s fee-for-service program spent $37 billion on the care of patients with kidney failure, accounting for more than 7% of overall Medicare expenditures.

...

"Despite past efforts to maintain quality and limit cost growth, major care gaps remain. Since the ESRD program’s inception, proponents of home dialysis have deplored the underuse of these modalities. Meanwhile, near-universal dialysis coverage may incentivize overtreatment with dialysis. Increasing evidence suggests that some of the sickest patients who start dialysis could instead benefit from active conservative management. A growing body of evidence also suggests that some patients who are new to dialysis may be able to safely undergo a hemodialysis regimen that includes fewer than the standard 3 treatments per week. Near-universal access to kidney failure treatment contrasts sharply with widespread limitations in access to preventive chronic kidney disease (CKD) care. This contrast is particularly poignant as it relates to racial disparities. Black patients face faster rates of CKD progression due, in part, to limited access to CKD care.9 In 2019, 33% of all patients receiving dialysis were Black individuals.

...

"the 2019 Advancing American Kidney Health initiative built on prior efforts to create a dialysis–focused alternative payment model (APM) through 6 new kidney care APMs that encourage home dialysis, kidney transplant, and advanced CKD care. It remains unclear whether dialysis-focused value-based payment initiatives will address outstanding cost and quality gaps. To date, substantial improvements in quality have not been observed.

...

"In summary, during its first 50 years the US ESRD program has provided critical access to lifesaving care for many patients with kidney failure while it has undergone a series of reforms as policy makers aim to control costs and maintain quality. Challenges in balancing cost and quality will persist as the program enters the second half-century of its existence."

Postdoctoral opportunities in kidney exchange, in the U.K. with David Manlove and Daniel Paulusma

 David Manlove writes to invite applications for postdocs with him and Daniel Paulusma to work on kidney exchange.

"There are three positions available to work on algorithms and software for kidney exchange as part of the EPSRC-funded KidneyAlgo project: New Algorithms for UK and International Kidney Exchange (https://gow.epsrc.ukri.org/NGBOViewGrant.aspx?GrantRef=EP/X013618/1 and https://gow.epsrc.ukri.org/NGBOViewGrant.aspx?GrantRef=EP/X01357X/1).

 1. Postdoctoral Research Associate at Glasgow, working with David Manlove.  This position requires expert knowledge in the areas of algorithm design and analysis and/or operational research and combinatorial optimisation.  See https://www.dcs.gla.ac.uk/~davidm/adverts/RA-advert.html for further details.  The closing date is 31 January 2023.

 2.  Postdoctoral Research Associate at Durham, working with Daniel Paulusma.  This position has a focus on researching computational complexity aspects of fairness concepts from Cooperative Game Theory.  See https://durham.taleo.net/careersection/du_ext/jobdetail.ftl?job=22002075&lang=en&src=JB10200 for further details.  The closing date is 30 January 2023.

 3. Research Software Engineer at Glasgow, working with David Manlove.  This position requires excellent programming skills and substantial prior software development experience.  See https://www.dcs.gla.ac.uk/~davidm/adverts/RSE-advert.html for further details.  The closing date is 31 January 2023.

 Please do pass this email on to anyone who you feel might be interested."

Wilderness Medicine starts a fellowship Match

 "Wilderness medicine" sounds like the sort of medicine you hope you never need as a patient.  But there is a medical fellowship program that draws on a cross-disciplinary group of docs, and their decentralized labor market has run into the usual difficulties. Here's a report on a new centralized clearinghouse, run in-house and partly manually, following a simulated run.

Davis, Christopher A., Stephanie Lareau, Taylor Haston, Arun Ganti, and Susanne J. Spano. "Implementation of a Specialty Society‒Sponsored Wilderness Medicine Fellowship Match." Wilderness & Environmental Medicine (2022, in press).

"Previously, wilderness medicine (WM) fellowships offered spots to applicants using an offer date. Due in part to increases in the number of WM fellowships and applicants, in 2021, the WM program directors (PDs) agreed to conduct the first WM fellowship match through the Wilderness Medical Society graduate medical education committee. This article outlines the process used and demonstrates its feasibility.

...

"Wilderness Medicine (WM) fellowships previously filled positions using an offer-date set by fellowship directors each fall.1 Applicant(s) were called in the order of preference by each director until all available positions were filled. Once called, applicants would have 30 min to accept or decline the offer. Limitations included the potential for verbal, nonbinding offers to influence candidates’ and directors’ actions on the offer day, as well as pressure on candidates to accept initial offers owing to the lack of knowledge regarding potential forthcoming offers. These concerns cast uncertainty on whether participants were placed in a disadvantageous position by the offer-date system.

...

"Formal fellowship matching services are not exclusively managed by the NRMP; other businesses, the military, and professional societies host matching services. The San Francisco match currently provides fellowship matching services to 22 subspecialties.6 The military does not use a computer-generated match list; the selection committee arranges negotiated pairings between programs and applicants, with the ability to place an applicant in a program they did not rank.7 The American Urological Association, in conjunction with the Society of Academic Urologists, has overseen the urology residency match program for >35 y, which includes fellowship matches.

...

"After completion of the simulated trial/test match, all PDs and WMS GME committee members agreed to participate in the proposed inaugural WM match via email or telephone verification. The deadline of October 25, 2021 was set for the submission of all rank lists to the WMS staff member by all participating applicants and programs. Individual emails were sent to both the programs and applicants to encourage timely completion of the process. On October 28, 2021, at 0900 PST/1200 EST, initial emails were sent simultaneously to each applicant and each PD to inform them of either a successful match or eligibility for the secondary match.

...

"A total of 13 programs and 15 applicants completed the match process. After the first round, 11 of 15 applicants had matched, and 2 programs and 4 candidates had the opportunity to complete the secondary match. During the secondary match period, the unfilled programs2 withdrew, obviating the need for the secondary match.

...

"Many PDs noted in 2021 that they had a significant increase in the number of applicants in 2020 and cited this as motivation for moving away from the previous telephone-based offer system and pursuing a match for the subsequent year."

Paired liver exchange in India

 Here's a report on 2-way liver exchanges conducted at Max Center for Liver and Biliary Sciences, Max Saket Hospital, New Delhi, India, each between two manually matched, non-anonymous patient-donor pairs.

Paired Exchange Living Donor Liver Transplantation: A Nine-year Experience From North India by Agrawal, Dhiraj MD, DM1; Saigal, Sanjiv MD, DM, MRCP, CCST1; Jadaun, Shekhar Singh MD, DM1; Singh, Shweta A. MD, DM1; Agrawal, Shaleen MS, MCh1; Gupta, Subhash MS, MCh1 

"Background: Paired exchange liver transplantation is an evolving strategy to overcome ABO blood group incompatibility and other barriers such as inadequate graft-to-recipient weight ratio and low remnant liver volume in donors. However, for the transplant team to carry 4 major operations simultaneously is a Herculean effort. We analyzed our experience with liver paired exchange (LPE) program over the past 9 y."

...

"Although the basic framework for LPE was adopted from the kidney paired exchange program, LPE or swap LDLT is inherently distinct, more complex, and associated with more technical, logistical, and ethical challenges.11 Both recipient and donor surgeries are long-duration surgeries and must be flawless to ensure minimum morbidity and mortality. The living donor partial hepatectomy is associated with approximately 10 times greater mortality than living donor nephrectomy, and the morbidity ranges from 9% to 24%, depending on the type of hepatectomy performed.12,13

"The logistics involved in a single-center simultaneous LPE are extensive with 4 simultaneous operations: 4 sets of teams of anesthetists, surgeons, nurses, and technicians. The blood bank must be equipped with requirements for major surges. For a single LDLT operation, it is estimated that >18 skilled team members may be needed, and in LPE, this number is doubled. Furthermore, any unanticipated difficulty due to operative anatomical variations may potentially impact both recipients’ outcomes. These constraints limit the LPE to a few high-volume centers.

...

"After the recipients and donors of an incompatible pair showed willingness for LPE, the medical suitability of each donor and recipient pair and the equity of the exchange were confirmed by a multidisciplinary forum comprising transplant hepatologists, transplant surgeons, social workers, and psychiatrists. Once 2-by-2 donor-recipient pairs were successfully matched, the transplant team informed the pairs and arranged a meeting wherein each recipient could meet their intended donor in the presence of the transplant team to discuss any anticipated issues. All participants who participated in the exchange program underwent a thorough psychosocial assessment to minimize the possibility of conflict. Donors have clarified that a poor outcome is possible in any LDLT, and in rare circumstances, their intended recipient can have a poor outcome. Through several in-depth counseling sessions, all 4 parties were independently and jointly informed about the suitability and structure of the exchange, the entire procedure, and the expected results. They were also provided with alternative options such as ABOi transplantation, deceased donor liver transplantation (DDLT), and associated risks and cost-effectiveness. Donors were allowed to opt out at any step during the process, and care was taken to avoid coercion. After the development of basic trust between all 4 participants, informed consent and a confidential agreement were signed. In India, there is a strict legal requirement for LDLT that the donor and recipient should be related to either blood or marriage. However, since LPE is an unrelated, directed donation, special approval was obtained from the ethical committee of the local authority.

...

"The 17 pairs of LPE donations included 34 directed living donors with a median age of 38.5 y (19–51 y), of which 27 were females. All donors were first-degree relatives of the recipients and included 18 spouses, 11 children, and 5 siblings. 

...

"ABO-incompatible donor-recipient pairs are encouraged to visit our center regularly, and as this is a common problem, not surprisingly, they are often able to meet another ABOi pair at the center. Furthermore, our coordinators have the telephone numbers of recipients looking for paired exchanges, and they facilitate such pairs to speak to each other on the phone. Once they show willingness to participate in the paired exchange program, their papers are submitted to the government-appointed authorization committee for clearance. Theoretically, in LPE donations, there is a potential for emotional disconnect, as opposed to ABO-incompatible LDLT. Interestingly, in our series of 34 transplants, the donor felt that they had donated to their own recipient, and on follow-up, all 4 participants seemed to have developed great emotional bonding.

"At our center, >75% of donors are first-degree relatives as “nonnear relatives” find very difficult to get governmental clearance. LPE is a transplantation between unrelated people and is, therefore, liable for exploitation. However, The Transplant Act has built in safety features as it allows only “first degree relatives” to be considered for paired exchange and also bars the organ exchanges between Indian and foreigners.

...

"It is possible that, in the future, transplant centers in India will act in tandem, and we will be able to operate pairs at 2 different centers. However, under the existing hospital-based government-appointed authorization committee, this may not be feasible unless a central clearing agency is set up."

Brothels reduce neighboring house prices in Amsterdam

 There are many reasons why communities object to prostitution, and it will not surprise you to learn that it reduces house prices in its immediate neighborhood.  Here's a  study that takes advantage of the closing of some brothels in Amsterdam:

Giambona, Erasmo, and Rafael P. Ribas. "Unveiling the Price of Obscenity: Evidence from Closing Prostitution Windows in Amsterdam." Journal of Policy Analysis and Management (2022).

Abstract: "Does legitimating sinful activities have a cost? This paper examines the relationship between housing demand and overt prostitution in Amsterdam. In our empirical design, we exploit the spatial discontinuity in the location of brothel windows created by canals, combined with a policy that forcibly closed some of the windows near these canals. To pin down their effect on housing prices, we apply a difference-in-discontinuity (DiD) estimator, which controls for the precise location of brothel windows and the effect of other policies and local developments. Our results show that the housing prices are discontinuous at the bordering canals, and this discontinuity nearly disappears after closures. The discontinuity is also found to decrease with the distance to brothels, disappearing after 300 yards. Our estimates indicate that homes right next to sex workers were 30 percent cheaper before the closures. This result seems unrelated to the presence of other businesses, such as bars and cannabis shops. Instead, the price discount is partly explained by petty crimes. However, 73 percent of the effect remains unexplained after controlling for many forms of crime and risk perception. Our findings suggest that households tend to be against the visible presence of sex workers and related nuisances, reaffirming their marginalization."

And here's the concluding paragraph:

"Overall, the legalization of prostitution can have social and economic benefits. However, our work suggests that even in a city where prostitution has been tolerated for centuries and is currently legalized, residents avoid living near brothels. This aversion results in sizable property value losses. The takeaway for policymakers is that social norms and related nuisances influence the marginalization of sex workers beyond any regulations attempting to legitimize their status."

Leveling the stock market playing field: SEC proposals

 The WSJ has the story: 

SEC Proposes Rules That Would Squeeze Stock-Market Middlemen. Agency is formally considering biggest overhaul of stock-market structure since mid-2000s  By Paul Kiernan and Alexander Osipovich

"The Securities and Exchange Commission voted Wednesday to advance the biggest changes to U.S. stock-market rules since the mid-2000s, aiming to give small investors better prices on their trades and reduce some advantages enjoyed by high-speed trading firms.... Voting to advance the rules opens them to public comment until at least March 31 before the agency can decide whether to finalize them.

...

"The broad idea motivating the proposals is to use greater competition for investors’ orders to deliver better prices, while stepping up regulations of the firms that profit from handling retail stock trades.

...

"The centerpiece of the SEC’s plans is a proposal for brokers to send many small-investor stock orders into auctions. This would enable a mix of high-speed traders and institutional investors such as hedge funds or pension funds to compete to fill the orders, with the idea that investors would get better prices as a result—higher prices if they are selling shares, or lower prices if they are buying.

"The auctions would apply to so-called marketable orders—in which investors buy or sell stocks at the currently available price—less than $200,000 in size and placed by investors who average fewer than 40 trades a day. They would be required to last between one-tenth and three-tenths of a second, roughly the duration of a blink of an eye, and would likely be run by exchanges. 

Requiring such auctions would be a big change. The SEC says brokers send more than 90% of marketable orders to wholesalers. Unlike exchanges, which display price quotes publicly and allow a variety of market players to attempt to fill orders, wholesalers trade directly against the incoming retail flow, an arrangement that effectively prevents other market players such as institutional investors from interacting with individual investors’ orders."

HT: Eric Budish

Resettling refugees using preferences of refugees and hosts

 Here's the latest report from HIAS on matching Ukrainian refugees to hosts in the U.S.

How an Innovative Algorithm Helps Ukrainian Refugees Find New Homes  By Brian Zumhagen

"Odessa residents Max and Yuna* fled Ukraine on the day the Russian invasion began, February 24, 2022. It took them 7 days to reach the Polish border.

"The couple, both in their early 20s, spent the next several months in Poland. In September, they started applying for relocation to the United States with the help of HIAS. But unlike most refugees, Max and Yuna were among the first to use a new system that allowed them to list their preferences about where to be resettled, and any special needs they might have — thanks to a matching algorithm known as RUTH, which stands for Refugees Uniting Through HIAS. (The name was also inspired by the biblical Book of Ruth, which tells the story of how Ruth is herself welcomed as a foreigner).

...

"Back in Poland, HIAS Relocation Officer Denis Ruksha said some of the refugees from Ukraine he works with are relocated through European Welcome Circles, while others are resettled through circles in the United States. For those heading to the U.S., Ruksha has been using the RUTH platform for the last 3 months, entering beneficiaries’ preferences about where they would like to be relocated, along with other information. “It allows people to mention almost everything they think is relevant,” he said. In the U.S., volunteers in HIAS Welcome Circles can, in turn, enter their own preferences, such as the number of people they can host.

...

"RUTH isn’t the first computer system with a human name that HIAS has used to make its resettlement work easier and more effective. In 2018, the organization worked with partners to create matching software named after the first immigrant registered at Ellis Island in 1892. “Annie MOORE” (Matching and Outcome Optimization for Refugee Empowerment) used past employment data to direct refugees to locations where they would have the greatest chance of finding work.

"But where Annie focused on optimizing estimated employment outcomes, RUTH makes the relocation process faster and more transparent, according to the new platform’s developers. “This is the first time ever that preferences of refugees and priorities of hosts have been systematically used in the resettlement process,” said Andrew Trapp, associate professor of operations and industrial engineering at Worcester Polytechnic Institute.

"His colleague, Alexander Teytelboym, associate professor of economics at the University of Oxford, put it this way: “We think people are more likely to thrive in places where they prefer to live. Citizens are given a choice about almost anything of such consequence — so why shouldn’t refugees?”

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Here are my previous posts on HIAS and refugee resettlement