Continuous distribution of deceased donor organs for transplant: proposal and public comment

 Ned Brooks of the National Kidney Donor Organization (NKDO) writes that the comment period is soon ending for proposed changes in the way deceased donor organs are offered.

short videos here https://optn.transplant.hrsa.gov/policies-bylaws/a-closer-look/continuous-distribution/ and 

some additional background and opportunity to submit comments here:    https://optn.transplant.hrsa.gov/policies-bylaws/public-comment/continuous-distribution-of-kidneys-and-pancreata-committee-update/

His concern, and that of other comments visible at the site is whether the priority given to former living kidney donors is being diluted.  (The proposal isn't described in sufficient detail for me to form an opinion on this, or on a number of other matters.)

Jon Bendor's Ph.D. seminar on behavioral political economy, Stanford GSB, Spring quarter (PE660)

 Professor Jonathan Bendor is teaching PE660 (Spring 2023), his phd seminar on behavioral political economy in the Spring quarter.  He writes that it is "basically an introduction to the cognitive sciences for social science phd students."  And he's not planning to teach it next year, so if you're planning to take it, now is the time.

The introduction to his syllabus is worth quoting:

"This course studies the cognitive scientific foundations of political economy. It builds on the explosion of research in cognitive psychology, evolutionary anthropology, and allied fields over the last few decades to provide perspectives on political beliefs and behavior that are not tweaks on theories of complete rationality; they are distinct ideas with their own premises of how humans think, plan, and decide.  These premises do not posit that we are irrational.  Such claims are wildly off the mark; they cannot explain how we have become the dominant species on this planet.  Instead, they describe a clever but computationally constrained primate whose evolution, cultural as well as biological, has produced a characteristic configuration of mental software and external symbol systems (writing, numbers). The representational and computational capacities of this software and these symbol systems, combined with our unusual ability to cooperate with unrelated strangers, has in a remarkably short time produced massive knowledge-intensive political institutions that can deploy nuclear-powered aircraft carriers and can use epidemiology and molecular genetics to combat epidemics.  Such achievements warrant explanations.

"In short, we are boundedly rational, but that’s only half the story; we’re also really really clever problem-solvers. This course explores theories that explain both halves in a relatively unified way.  

"Course Requirements

"The main requirement is a commitment to a mindset. You will get much more out of the course if you explicitly commit yourself to taking the ideas on their own terms.  If you consciously or unconsciously try to assimilate them as minor modifications of expected utility theory or noncooperative game theory you’ll be depriving yourself of valuable cognitive diversity. 

"What I’m asking you to do isn’t easy. It is natural in this context to try to assimilate new ideas by reinterpreting them as minor modifications of the familiar.  I want you to exert conscious effort to fight this tendency. The brain/mind of homo sapiens is arguably the most complex object on Earth and our behavior is sometimes correspondingly complex. Like all social scientists, political economists need all the help we can get in trying to understand this extraordinary species. So do yourself a favor and expand your mental repertoire.  When you read Kahneman’s Thinking: Fast and Slow or Henrich’s The Secret of Our Success, try to think like a cognitive/social psychologist or an evolutionary anthropologist, respectively.  During class discussions try to help others do the same. "

Here's the reading list:

Daniel Kahneman.  THINKING, FAST AND SLOW (2011).

Joseph Henrich.  THE SECRET OF OUR SUCCESS: HOW CULTURE IS DRIVING HUMAN EVOLUTION, DOMESTICATING OUR SPECIES, AND MAKING US SMART (2016).

Sloman, S. & P. Fernbach.  THE KNOWLEDGE ILLUSION: WHY WE NEVER THINK ALONE (2018).

Richard Nelson and Sidney Winter.  AN EVOLUTIONARY THEORY OF ECONOMIC CHANGE (1982).

Joshua Greene.  MORAL TRIBES: EMOTION, REASON, AND THE GAP BETWEEN US AND THEM (2013).

J. Bendor, D. Diermeier, D. Siegel, and M. Ting.  A BEHAVIORAL THEORY OF ELECTIONS (2011).

Robert McCauley. WHY RELIGION IS NATURAL AND SCIENCE IS NOT (2011).

Blood money: plasma and ambivalence

 The Guardian has a long review of the book Blood Money, by Kathleen McLaughlin, who is dependent on blood plasma, but suggests reasons to be ambivalent about the American market for paid plasma.

‘It’s gamified’: inside America’s blood plasma donation industry. In her new book Blood Money, Kathleen McLaughlin uses a personal lens to examine an industry that rewards mass plasma donation  by David Smith

"So who is the typical blood seller and why do they do it? McLaughlin had expected to find the poorest of the poor but, it transpires, most of them are screened out because a plasma donor must have a permanent address.

“What I found instead was a lot of people who, say, 25 years ago would have been middle class, and they just don’t make enough money for that lifestyle any more. I get the sense that one of the biggest demographics is college students. We’re talking about like big public universities where there are a lot of students who don’t come from wealthy backgrounds; I’ve talked to people who use this money to buy books, to pay to go out for a night, for ‘beer money’.

“You will also find people in communities like Flint, Michigan, where I spent a lot of time, who used to be able to expect to have this very normal American middle-class lifestyle and wages and benefits no longer keep pace with that. There are people doing it to buy groceries and to pay for housing. There are also people who are selling plasma to take a vacation."

...

"And whereas donating blood for free is lauded, donating it for money is stigmatised. “If you think about blood donation, it’s something that we consider quite heroic. If you go to the Red Cross and donate blood, you’re saving a life, you’re not getting paid for it.

“But somehow this practice of donating plasma for pay comes with a pretty heavy stigma. A lot of the people I interviewed who do sell plasma had not told their families that they do it because they were afraid of what their families would think: there would be some kind of judgment or their families would be worried about their health or concerned that they don’t have enough money.

‘The stigma is entirely linked to the fact that we stigmatise poverty in the United States. We look down on it. We don’t respect people who aren’t wealthy in the same way that we respect wealthy people. It’s been interesting for me to see the way that people view selling plasma as being somehow problematic and that’s definitely contributed to the fact that this industry is kind of hidden.”

"Still, should we make a moral judgment about the blood industry? It is not, after all, pushing an addictive substance like opioids, but rather is helping the health of people in America and around the world, McLaughlin included. She replies: “We need to ask ourselves that. From my perspective as someone who depends on this substance, what people are doing is incredibly altruistic.

“I also think a lot of people are being financially coerced to do it and, the way the system is set up, you get paid more per donation for each donation you make. It’s gamified in such a way that people are encouraged to donate quite often and because it is a hidden industry, most Americans haven’t really considered if this is who we want to be.

“If you know that there are potentially millions of Americans who have sold their plasma to pay for things like groceries and vacations, are you OK with that? For me, it’s more a matter of getting people to think about it, that our economic situation is such that this is part of our fabric now and are we comfortable with being that way or do we want to think more deeply about how we can make this more feel more of a choice for people?”

"She adds: “The industry itself isn’t necessarily the problem. The problem is that we have let this industry become a part of people’s incomes. I don’t know that that’s the kind of society we want to be.”

“It’s these places where people are economically fragile, not necessarily desperately poor. The kind of fragility that we didn’t have 25 or 30 years ago when there were more social-safety protections.”

Donkey meat for sale on Amazon: is a donkey a horse in California?

 Is a donkey a horse in California, where state law prohibits the sale of horse meat for human consumption. In particular, the 1998 law states:

"This measure prohibits both the slaughter of horses for human consumption and the sale of horsemeat for human consumption in California. In addition, horses could not be sent out of California for slaughter in other states or countries for human consumption. Under the measure horses include any horse, pony, burro, or mule."

I'm neither a lawyer nor a linguist, but, for what it's worth, "burro" is the Spanish word for donkey.

Wired has the story:

Amazon Has a Donkey Meat Problem. "The online retailer sells products meant for human consumption that contain donkey meat. A new lawsuit claims that’s illegal in California."

"A legal complaint filed in California last week by the law firm Evans & Page on behalf of the Center for Contemporary Equine Studies, a nonprofit, claims Amazon’s continued sale of these donkey-based products is more than distasteful—it may be illegal.  

"The Center alleges that Amazon’s distribution and sale of ejiao violates an obscure California animal welfare law called the Prohibition of Horse Slaughter and Sale of Horsemeat for Human Consumption Act. The 1998 ballot initiative, known at the time of its passage as Proposition Six, makes the sale of horsemeat for human consumption a crime on the grounds that horses, like dogs and cats, are not food animals and deserve similar protections. The Center is arguing that, under the statute, horsemeat is defined to mean any part of any equine, including donkeys. 

"For Frank Rothschild, director of the Center for Contemporary Equine Studies, the law is clear: Donkeys are equines, and the sale of ejiao for human consumption in California is illegal. “We are a scientific organization and not in the business of national advocacy. We want the defendants to stop selling ejiao because it’s illegal,” he says. “That’s the law.”

"Bruce Wagman, an attorney unaffiliated with the complaint who has practiced animal law in California for 30 years, says that while the center presents a reasonable argument, it’s unclear whether a judge would agree because the law’s wording leaves room for interpretation. “Horsemeat is not really defined in the text of the relevant statute,” he says. “But the spirit of Proposition Six is absolutely to prevent equines, including donkeys, from being slaughtered for people to consume. Period.”

"The complaint demands that Amazon stop selling ejiao immediately. If a judge ultimately finds Amazon in violation of the law, the state of California could fine Amazon for each sale. This type of regulatory pressure is not unprecedented. In 2018, prosecutors in three California counties accused Amazon of violating a 2004 state law banning sales of foie gras. In a settlement, Amazon agreed not to sell the fatty goose liver in California and paid $100,000 in civil penalties. "

HT: Jacob Leshno

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My other posts on consumption of horse meat, and foie gras.

Provocative lecture on repugnant transactions at San Jose State University tomorrow

 My ambition is always to give a provocative lecture, and tomorrow evening I'll be officially doing so, when I deliver the David S. Saurman Provocative Lecture, on repugnant markets at SJSU.

Reconsideration of covid convalescent plasma

Recently Statnews reported that Covid convalescent plasma (CCP) may in fact be useful in preventing severe illness, despite the fact that earlier clinical trials did not show success in reversing severe illness:

Covid convalescent plasma: the ‘little engine that could’  By Michael J. Joyner, Nigel Paneth and Arturo Casadevall

"Unlike monoclonal antibodies, which can be defeated by new SARS-CoV-2 variants, CCP collected from vaccinated donors after recent breakthrough infections (VaxCCP) evolves with the variants and retains the ability to neutralize them. What makes CCP an even more promising therapy is that there are now many potential donors available in the U.S. who have been vaccinated and had recent breakthrough infections.

...

"An array of data, including randomized controlled trials and careful retrospective studies, show a clear survival benefit when CCP is given to immunocompromised individuals who test positive for SARS-CoV-2. There are also impressive case reports and case series showing that Covid convalescent plasma, especially VaxCCP, is effective in patients with smoldering Covid-19.

...

"the early “major” RCTs that tested the efficacy of CCP on survival in hospitalized patients tested the wrong use case. These studies treated patients who were too sick for too long to benefit from antibody therapy. But the major “negative” trials all showed evidence of effectiveness among people who received CCP earlier, who were not already desperately ill, who were immunocompromised, or who received the most antibodies. Unfortunately, these positive signals, which were consistent with impressive real-world data on Covid-19 and CCP, were buried under the top-line results."

*********

Earlier posts on convalescent plasma

Australia legalizes medical use of psychedelics

 Scott Cunningham points out that Australia has become the first country to legalize the medical use of certain psychedelics. 

Here's the announcement from the Australian Government's Therapeutic Goods Administration (TGA)

Change to classification of psilocybin and MDMA to enable prescribing by authorised psychiatrists

"From 1 July this year, medicines containing the psychedelic substances psilocybin and MDMA (3,4-methylenedioxy-methamphetamine) can be prescribed by specifically authorised psychiatrists for the treatment of certain mental health conditions.

The Therapeutic Goods Administration (TGA) will permit the prescribing of MDMA for the treatment of post-traumatic stress disorder and psilocybin for treatment-resistant depression. These are the only conditions where there is currently sufficient evidence for potential benefits in certain patients.

Prescribing will be limited to psychiatrists, given their specialised qualifications and expertise to diagnose and treat patients with serious mental health conditions, with therapies that are not yet well established. To prescribe, psychiatrists will need to be approved under the Authorised Prescriber Scheme by the TGA following approval by a human research ethics committee. The Authorised Prescriber Scheme allows prescribing permissions to be granted under strict controls that ensure the safety of patients.

The decision acknowledges the current lack of options for patients with specific treatment-resistant mental illnesses. It means that psilocybin and MDMA can be used therapeutically in a controlled medical setting. However, patients may be vulnerable during psychedelic-assisted psychotherapy, requiring controls to protect these patients.

For these specific uses, psilocybin and MDMA will be listed as Schedule 8 (Controlled Drugs) medicines in the Poisons Standard. For all other uses, they will remain in Schedule 9 (Prohibited Substances) which largely restricts their supply to clinical trials."

*********

Scott shares a post by Shane Pennington on drugs that contrasts the Australian (medical) decision with the U.S. Drug Enforcement Agency's (legal) decision to maintain the ban on these drugs, despite the growing medical evidence (from U.S. studies, on which the Australian government relied) that psychedelics have some important medical uses.

"To support its decision, the TGA relied heavily on studies conducted in the U.S. and recent U.S. Food and Drug Administration (FDA) decisions recognizing psilocybin and MDMA’s extraordinary therapeutic potential. Around the same time, DEA shot down a petition—based on those same arguments and evidence—that Matt and I submitted on behalf of a palliative-care doctor, requesting rescheduling of psilocybin under U.S. law. The DEA’s four-sentence analysis completely ignored the same studies and FDA decisions that persuaded the Australian regulator to reschedule.  

"The dramatically different fates of these similar petitions reveal a troubling reality about U.S. drug law: Under DEA’s watch, the scientific and medical determinations of the nation’s leading public health agency carry considerable weight around the world but are often ignored at home. That revelation should terrify anyone interested in rational, evidence-driven drug policy. "

******

But the States are the laboratory of democracy: here's an earlier related post.

Sunday, November 13, 2022

Colorado legalizes magic mushroom/psilocybin therapies

Illegal to sell fur coats in California

 The NY Times has the story. (And you still can't eat horsemeat here.)

Fur Sales Are Illegal in California. Does Anyone Care?.The popularity of fur products had been diminishing in the state even before the new ban. By Max Berlinger

"a law banning the sale and manufacture of luxury pelts like mink, sable, chinchilla, lynx, fox, rabbit and beaver that went into effect in California in January has so far been largely met with a shrug 

...

“There was a bigger ripple when Chanel stopped selling crocodile.” 

"With California’s mild climate and eco-conscious reputation, some have said that a ban on fur sales in the state is more of a symbolic gesture than practical measure.

"The statewide ban, the first of its kind in the country, codifies what was a growing movement happening at the city level in recent years. (Los Angeles, West Hollywood, San Francisco and Berkeley had similar bans before.) This law extends the city bans already in effect in some areas across the country’s most populous state, one that, despite certain clichés, encompasses a wide variety of landscapes and political affiliations."

**********

Here's the bill, California Assembly Bill 44, which forbids sale or manufacture of new fur products (but permits sale of existing garments):

"This bill would make it unlawful to sell, offer for sale, display for sale, trade, or otherwise distribute for monetary or nonmonetary consideration a fur product, as defined, in the state. The bill would also make it unlawful to manufacture a fur product in the state for sale. The bill would exempt from these prohibitions used fur products, as defined, fur products used for specified purposes, and any activity expressly authorized by federal law."

Kidney exchange in Mexico

 Here's a report from the journal Cirugia y Cirujanos  (Surgery and Surgeons) on the experience with kidney exchange (aka kidney paired donation) at the Central Military Hospital in Mexico City, where 

Donación renal pareada: beneficio de este programa en la tasa de trasplantes y sobrevida del injerto

Kidney paired donation: benefit of this program on the transplant rate and graft survival  by Lucino Bahena-Carrera, Héctor F. Noyola-Villalobos, Edgar E. Ramos-Díaz, Marco A. Loera-Torres, Ricardo Mendiola-Fernández y Mónica L. Razo-Padilla, Cirugia y Cirujanos 91, no. 1 (2023): 50-57.

 Abstract: 

"Objective: To demonstrate the experience since the transplant program under paired kidney donation implementation; program that increases the donation rate by 25-30% in hospitals with no inferior graft survival compared to directed living donor kidney transplantation. 

"Method: Observational, analytical, longitudinal and prospective study from December 2018 to July 2021. All G5 KDIGO chronic kidney patients who were HLA or ABO incompatible with their original donors in the pretransplant protocol and who were transplanted under the paired kidney donation program, were included. 

"Results: 22 kidney transplants were performed under this program. Survival of the graft and the patient 1 year after transplantation was 100%. The post-transplant glomerular filtration rate was 72.5 ± 17 ml/min/1.73 m2  body surface. 36.3% of hypersensitized patients were successfully transplanted. The in-hospital donation rate increased by 33.33%. 

"Conclusions: Transplantation under the kidney paired donation program constitutes a real modality of successful transplantation when there is incompatibility with the original donor. The greater use and socialization of this program can increase the country kidney transplantation rate, reducing the waiting list. Our hospital represents the largest experience published in Mexico with this transplant program

First kidney exchange between Cyprus and Israel

 The Cyprus Mail has the story

First exchange kidney transplant between Cyprus and Israel, By Jonathan Shkurko, March 1, 2023

"The first ever crossover organ transplant involving Cyprus and Israel took place on Wednesday after two kidneys were exchanged at the old Larnaca airport in the morning.

"The effort follows an exchange agreement signed between the two countries.

"The agreement stipulates that organs belonging to donors in Cyprus that are incompatible with the recipients, will be exchanged with compatible organs arriving from Israel.

"The kidney received from Israel was transported to the new transplant clinic at Nicosia general, whereas the one donated by Cyprus was flown to Tel Aviv.

...

"During the organs’ exchange at Larnaca airport, the director of Israel Transplant Organisation Tamar Ashkenazi said she was very happy to see the results of the transnational agreement.

“I hope we will continue with more organs exchanges in the future, as we are already doing with Austria, Czech Republic and United Arab Emirates,” Ashkenazi said. 

*********

Earlier:

Thursday, December 19, 2019

International kidney exchange between Israel and Czech Republic

Monday, October 4, 2021

More on the UAE-Israel kidney exchange

Itai Ashlagi's kidney exchange software has played a role in all these exchanges.

Evaluating kidney patients and donors without consideration of race

 Somewhere in the history of nephrology, a patient's race was included as a factor in estimating their kidney function.  This has at various times been important for various kinds of treatment, including of course preventive treatment, as well as starting dialysis, and entry and perhaps priority on kidney transplant waitlists. And it has also been important for evaluating the quality of deceased donor kidneys that can be offered for transplantation. There have been important recent changes in this, and more may be on the way. The current issue of JAMA devotes a number of articles to that, linked below.

Viewpoint Redressing the Harms of Race-Based Kidney Function Estimation Dinushika Mohottige, MD, MPH; Tanjala S. Purnell, PhD, MPH; L. Ebony Boulware, MD, MPH Audio: Race-Neutral Estimates of Kidney Function: Enhancing Equity Video: Race-Neutral Estimates of Kidney Function: Enhancing Equity Time to Abolish Metrics That Sustain Systemic Racism in Kidney Allocation John S. Gill, MD, MS; Burnett Kelly, MD, MBA; Marcello Tonelli, MD, SM Medical News & Perspectives Race-Based Equations Delayed Black Patients From Getting Onto Kidney Transplant Lists—An Unprecedented New Policy Seeks to Undo the Damage Jennifer Abbasi PREVIOUSLY PUBLISHED JAMA | Research Association of Estimated GFR Calculated Using Race-Free Equations With Kidney Failure and Mortality by Black vs Non-Black Race Orlando M. Gutiérrez, MD, MMSc; Yingying Sang, MS; Morgan E. Grams, MD, MHS, PhD; et al JAMA | Opinion Race-Free Estimation of Kidney Function: Clearing the Path Toward Kidney Health Equity L. Ebony Boulware, MD, MPH; Dinushika Mohottige, MD, MPH; Matthew L. Maciejewski, PhD JAMA Network Open | Research Association of the Estimated Glomerular Filtration Rate With vs Without a Coefficient for Race With Time to Eligibility for Kidney Transplant Leila R. Zelnick, PhD; Nicolae Leca, MD; Bessie Young, MD, MPH; et al Audio Race-Neutral Estimates of Kidney Function: Enhancing Equity Video

Join the conversation. Follow JAMA on Twitter.

Democracy & “Noxious” Markets, by Debra Satz

 The Winter 2023 issue of Daedalus is about Creating a New Moral Political Economy, edited by Margaret Levi & Henry Farrell.

The article by Debra Satz will strike a chord with market designers: she takes very seriously that markets are tools that need thoughtful design.

Democracy & “Noxious” Markets, by Debra Satz

"my argument is not a lawyer’s brief against markets. No large democratic society can or should entirely dispense with markets. Not only are markets among the most powerful tools we have for generating growth in living standards and incentivizing innovation, but also Smith was right to see their democratic potential as ways of enabling cooperation among independent, free, and equal individuals. As tools, however, we should think carefully about where to use them and how to design them when we do. While a neoliberal worldview sees efficient markets enhancing freedom and well-being everywhere, the reality is more complex. Some markets foreclose options that would better support democratic institutions and culture. Sometimes, closing off market options makes everyone better off. Consider that if individuals are free not to purchase health insurance on the market, the cost of publicly provided insurance will increase: healthy individuals are more likely to opt out of health insurance, leaving sicker individuals in the pool to be insured and raising the costs of their insurance, leading more people to forgo holding such insurance, driving the prices up even higher."

Among the markets she is concerned about are school choice, and military service:

"some of the ways parents prioritize their own children can lead to worse outcomes for other children and to the furthering of educational inequities, as well as to other social ills like instability and conflict. Evidence indicates, for example, that choice schools in the United States are more homogenous than public schools with respect to social class and race. Researchers have also shown that when public school choice is available, educated parents are especially likely to factor child demographics in their school selections.11 This may be because school quality is very hard to judge and parents default to markers such as the reading and math levels of other students. These levels, in turn, are heavily influenced by social class. It is likely that some parents take race and class directly as proxies for school quality."

...

"Extending the reach of markets even more, war has been further outsourced to private military contractors: in 2009, there were more private military contractors in Afghanistan than U.S. military troops.17 Hiring private mercenaries and outsourcing national security to a subsection of our population might spare our citizens, but as political philosopher Michael Sandel has noted, it changes the meaning of citizenship.18 In what sense are we “all in this together” if most citizens never need to think hard about decisions to go to war? Whatever the efficiency pros and cons of the decision to outsource fighting and allocate military service through market means, doing so changes our relationships with one another and our sense of a common life."

"My argument so far suffers from treating the state and market as two stark alternatives for the allocation of goods and services in society. So I now want to consider ways in which the benefits of markets can be harnessed—through design—to better serve important democratic goals. "

...

"One important mechanism is providing greater roles for worker voice. This can be done through such reforms as changing labor laws to support forms of worker association, like trade unions, allowing worker representatives on company boards, and strengthening democracy at work through diverse forms of ownership including worker-managed and -owned firms. Empowering the associational organization of labor would also help redress the background social conditions that render workers vulnerable to the oligarchic power of their employers.

"There are other examples in which careful design and policy can limit the “noxiousness” of a particular market for democracy. Policies such as a negative income tax can strengthen the power of workers, and campaign finance laws can diminish the power of money in elections. Others have argued for reforms to our current system of commodified legal representation within an adversarial system, and for single-payer health care systems."

Here's her concluding paragraph:

"Beyond education, we need to pay special attention to particular markets that affect democratic functioning and stability. Such markets include but are not limited to markets in legal representation, media and news markets, markets relating to national defense, and markets governing political rights. Politicians and other commentators usually write unreflectively, as if all markets were the same. They are not. Markets affect not only the distribution of income and wealth, but also our capacities, and our views of each other. Their strengths but also their limits depend on the fact that they are radically individualizing. But in some contexts, that individualizing threatens the practice of democracy. Markets have moral and even “spiritual” consequences relevant to our shared public life, and our evaluations of them must also attend to those consequences. A new political economy needs to take this larger evaluative frame into account."

******

The next article in the issue is a thoughtful essay on markets for personal care of the young and the elderly, organized in various ways, including care within families, written as a commentary on the Satz article: 

Is There a Proper Scope for Markets?  by Marc Fleurbaey

AEA committee on the job market considers early and exploding offers

 John Cawley chairs the AEA committee on the job market, and recently tweeted the request for information below.  Feel free to communicate with him on twitter or directly, as I'll be glad to rely on him to compile and forward all the responses. (I'm one of the few economists not on most social media...but I really will try to read all responses:) (Click to enlarge...)

Judge shopping for abortion rulings

 Justice (like politics, sausage and econometrics) is constructed in complex ways. The Washington Post has a story on the case against an anti-abortion drug, now being heard by federal judge Matthew Kacsmaryk in Amarillo Texas, which could result in a nationwide ban on that drug.  The case concerns medical issues about drug regulation, and isn't directly concerned with the legal controversy about abortion rights.

The Texas judge who could take down the abortion pill. A devout Christian, Matthew Kacsmaryk has been shaped by his deep antiabortion beliefs. By Caroline Kitchener and  Ann E. Marimow  February 25, 2023 

"The abortion pills lawsuit, which Kacsmaryk could rule on any day, is the latest in a long line of politically explosive cases to appear on the judge’s docket. In a practice known as “forum shopping,” conservative groups have zeroed in on the Amarillo division of the Northern District of Texas as a go-to place to challenge a wide range of Biden administration policies. Because Amarillo is a federal district with a single judge, plaintiffs know their arguments will be heard by Kacsmaryk — who, like any federal judge, is positioned to issue rulings with nationwide implications.

"Appeals from Kacsmaryk’s district follow a path that has regularly yielded favorable outcomes for conservatives — reviewed first by the U.S. Court of Appeals for the 5th Circuit, which upheld a strict Texas abortion ban long before Roe v. Wade was overturned, then ultimately by the conservative-controlled Supreme Court."

********

Here's a related story from Medpage Today:

A Ban on the Abortion Drug Mifepristone Is Looming— A Texas lawsuit may be disastrous for effective abortion access and FDA's authority by Lawrence O. Gostin, JD, LLD, and Sarah Wetter, JD, MPH, February 23, 2023

"In the most consequential and controversial attack on reproductive rights since the overturning of Roe v. Wade, a Texas judge could ban the safest, most effective, and most common method for abortion in all 50 states. The hyper-conservative anti-abortion group Alliance Defending Freedom  (ADF) is seeking to overturn the FDA's approval of mifepristone (Mifeprex), a medication in a two-pill regimen used to terminate pregnancies through the first 10 weeks gestation. The lawsuit does not target the other medication, misoprostol (Cytotec), which FDA approved to treat stomach ulcers, and can be prescribed off-label for abortion.

...

"Given the FDA's rigorous risk evaluation and mitigation strategy (REMS) for mifepristone and its safe use for 23 years, the case is utterly frivolous and political, but due to "judge shopping" the repercussions for reproductive health and equity are real. Perversely, a single federal trial judge has the power to block a federal law, rule, or action on a national scale. The case could make its way to the Supreme Court, with potentially disastrous consequences for safe, effective abortion access and the authority of the FDA."

opens in a new tab or windowfor mifepristone and its safe use for 23 years, the case is utterly frivolous and political, but due to "judge shopping" the repercussions for reproductive health and equity are real. Perversely, a single federal trial judge has the power to block a federal law, rule, or action on a national scale. The case could make its way to the Supreme Court, with potentially disastrous consequences for safe, effective abortion access and the authority of the FDA.

Judd Kessler on Market Rules

 Judd Kessler is writing a book (that I'm looking forward to reading):

Harm reduction at work in NYC's opioid crisis

 The NY Times follows some harm reduction workers through their work in New York City, including a city-sponsored safe injection facility.  Not so easy to do, and not so easy to read.

One Year Inside a Radical New Approach to America’s Overdose Crisis. By Jeneen Interlandi

"Since its official opening on Nov. 30, 2021, OnPoint has met with both praise and protest. Shopkeepers and school principals routinely thank Mr. Jones and his colleagues for their daily rounds of needle collection. But local civic groups have been furious about yet another substance abuse program in a neighborhood dense with them and have argued that, however well intentioned, the organization’s approach will only make a bad problem worse. People who are addicted to drugs need tough love and harsh consequences, they insist, not coddling. Community outreach’s mission was therefore twofold: Convince skeptics that programs like these can be a net positive for the community and persuade those with substance use disorders to accept the lifeline that OnPoint was offering."

Incarceration isn't always the best treatment for drug addiction

 Here's a NY Times editorial:

America Has Lost the War on Drugs. Here’s What Needs to Happen Next.  Feb. 22, 2023

It begins with this bit of history, and ends with a call for evidence-based solutions:

"For a forgotten moment, at the very start of the United States’ half-century long war on drugs, public health was the weapon of choice. In the 1970s, when soldiers returning from Vietnam were grappling with heroin addiction, the nation’s first drug czar — appointed by President Richard Nixon — developed a national system of clinics that offered not only methadone but also counseling, 12-step programs and social services. Roughly 70 percent of the nation’s drug control budget was devoted to this initiative; only the remaining 30 percent went to law enforcement.

"The moment was short-lived, of course. Mired in controversy and wanting to appear tough on crime, Nixon tacked right just months before resigning from office, and nearly every president after him — from Reagan to Clinton to Bush — followed the course he set. Before long, the funding ratio between public health and criminal justice measures flipped. Police and prison budgets soared, and anything related to health, medicine or social services was left to dangle by its own shoestring.

...

"Study the solutions. Leading public health agencies, including the Food and Drug Administration and the Centers for Disease Control and Prevention, failed to prevent or even adequately respond to the opioid epidemic that has engulfed the nation. But health officials can still step up. As opioid settlement funds are deployed (along with federal dollars) and harm reduction programs are begun, the C.D.C. especially should impartially study what is working and what is not. The response to this crisis should finally be based on evidence.

"The nation’s leaders are not the only ones with work to do. To fully replace the war on drugs with something more humane or more effective, the public will have to come to terms with the prejudices that war helped instill. That means accepting that people who use drugs are still members of our communities and are still worthy of compassion and care. It also means acknowledging the needs and wishes of people who don’t use drugs, including streets free of syringe litter and neighborhoods free of drug-related crime. These goals are not mutually exclusive. In fact, they go hand in hand. But to make them a reality, lawmakers and other officials will have to lead the way."

Money Laundering

 Financial regulation plays a big role in law enforcement, by helping investigators to follow the money, which is often easier than following the crimes that generate the money. So, for example, drug dealers and others have trouble turning their income (which is often in cash) into bank accounts that can be used to buy the things that legal money can buy.  Money laundering involves turning ill got gains into reportable income.  Gambling, it turns out, offers some possibilities: if I come into the casino with some cash, and come out with some cash, it's hard to prove that I'm paying tax on more than my winnings.

Here's a story that touches on that, from the WSJ:

Cantor Fitzgerald Gambling Affiliate to Pay $22.5 Million to Settle Probes. CG Technology is said to have admitted aiding and abetting illegal gambling and money laundering   By Kate O’Keeffe and Alexandra Berzon

"Cantor Fitzgerald LP’s sports-betting affiliate has agreed to pay $22.5 million in penalties and forfeiture to the U.S. government in conjunction with its involvement in illegal gambling and money laundering, according to people familiar with the matter.

...

"The agreement comes as the U.S. Treasury and Justice Departments have been increasingly focused in recent years on potential money-laundering violations at casinos. The probes generally center on how the gambling companies allegedly help to facilitate money laundering or fail to report suspicious activities.

...

"Two people who were running their own illegal bookmaking operations elsewhere laundered money through Cantor as part of this system, the people said."

The market for (and marketing of) baby formula

 The Lancet has a series of articles on baby formula.  It begins with this editorial, and is followed by three articles:

Unveiling the predatory tactics of the formula milk industry, The Lancet, Published: February 07, 2023 DOI:https://doi.org/10.1016/S0140-6736(23)00118-6

"For decades, the commercial milk formula (CMF) industry has used underhand marketing strategies, designed to prey on parents' fears and concerns at a vulnerable time, to turn the feeding of young children into a multibillion-dollar business. The immense economic power accrued by CMF manufacturers is deployed politically to ensure the industry is under-regulated and services supporting breastfeeding are under-resourced. These are the stark findings of the 2023 Breastfeeding Series, published in The Lancet today."

******

VOLUME 401, ISSUE 10375, P472-485, FEBRUARY 11, 2023 Breastfeeding: crucially important, but increasingly challenged in a market-driven world, by Prof Rafael Pérez-Escamilla, PhD  Cecília Tomori, PhD Sonia Hernández-Cordero, PhD Phillip Baker, PhD Aluisio J D Barros, PhD MD France Bégin, PhD Donna J Chapman, PhD Laurence M Grummer-Strawn, PhD Prof David McCoy, PhD Purnima Menon, PhD Paulo Augusto Ribeiro Neves, PhD Ellen Piwoz, PhD Prof Nigel Rollins, MD Prof Cesar G Victora, PhD MD Prof Linda Richter, PhD on behalf of the 2023 Lancet Breastfeeding Series Group†  Open Access Published: February 07, 2023 DOI:https://doi.org/10.1016/S0140-6736(22)01932-8

"When possible, exclusively breastfeeding is recommended by WHO for the first 6 months of life, and continued breastfeeding for at least the first 2 years of life, with complementary foods being introduced at 6 months postpartum.9 Yet globally, many mothers who can and wish to breastfeed face barriers at all levels of the socioecological model proposed in The Lancet's 2016 breastfeeding Series."

 VOLUME 401, ISSUE 10375, P486-502, FEBRUARY 11, 2023 Marketing of commercial milk formula: a system to capture parents, communities, science, and policy by Prof Nigel Rollins, MD  Ellen Piwoz, ScD Phillip Baker, PhD Gillian Kingston, PhD Kopano Matlwa Mabaso, PhD Prof David McCoy, DrPH  Paulo Augusto Ribeiro Neves, PhD  Prof Rafael Pérez-Escamilla, PhD  Prof Linda Richter, PhD  Prof Katheryn Russ, PhD  Prof Gita Sen, PhD  Cecília Tomori, PhD  Prof Cesar G Victora, MD  Paul Zambrano, MD  Prof Gerard Hastings, PhD  on behalf of the 2023 Lancet Breastfeeding Series Group  Open Access Published:  February 07, 2023 DOI:https://doi.org/10.1016/S0140-6736(22)01931-6

"Despite proven benefits, less than half of infants and young children globally are breastfed in accordance with the recommendations of WHO. In comparison, commercial milk formula (CMF) sales have increased to about US$55 billion annually, with more infants and young children receiving formula products than ever. "

 VOLUME 401, ISSUE 10375, P503-524, FEBRUARY 11, 2023 The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress by Phillip Baker, PhD Julie P Smith, PhD Prof Amandine Garde, PhD Laurence M Grummer-Strawn, PhD Benjamin Wood, MD Prof Gita Sen, PhD Prof Gerard Hastings, PhD  Prof Rafael Pérez-Escamilla, PhD  Chee Yoke Ling, LLB  Prof Nigel Rollins, MD Prof David McCoy, DrPH  on behalf of the 2023 Lancet Breastfeeding Series Group†  Open Access Published: February 07, 2023 DOI:https://doi.org/10.1016/S0140-6736(22)01933-X

"The first and second papers in this Series8,  9 present several reasons for the global rise of CMF in human diets, including the CMF industry's exploitation of parental anxieties; ubiquitous marketing; and absent or inadequate protection and support for breastfeeding within health-care systems, work settings, and households. In this Series paper, we look further upstream and examine the root causes of low worldwide breastfeeding rates10 to understand why so many women and families are prevented from making and implementing informed decisions about feeding and caring for infants and young children; why so many policy makers and health-care professionals are co-opted by CMF marketing and other commercial forces; and why so many countries have not prioritised and implemented policies to protect, promote, and support breastfeeding. It is important to note that we use the terms women and breastfeeding throughout this Series for brevity, and because most people who breastfeed identify as women; we recognise that not all people who breastfeed or chestfeed identify as women."

**********

Among my previous posts on milk are some noting that there are shortages of human breast milk, and that in many places the sale of breast milk is banned (in some places out of concern that poor mothers would sell their milk instead of feeding their children, and in some places out of concerns that the sale of breast milk is repugnant even from mothers who produce milk in excess to their children's needs.)  

Thus (in different times, places, and circumstances) there is repugnance both to the sale of mothers' milk and to the sale of substitutes for it.

It's hard to navigate the Ophthalmology and Urology labor market without a couples match

The Ophthalmology and Urology matches are earlier than the NRMP resident match, and do not offer a couples match. Based on a survey of Ophthalmology and Urology match participants, the authors outline the need for a couples match.

Navigating the Ophthalmology & Urology Match with a Significant Other by lSamantha S. Massenzio MD *, Tara A. Uhler MD †, Erik M. Massenzio MD †, Emily Sun BS *, Divya Srikumaran MD *, Marisa M. Clifton MD ‡, Laura K. Green MD §, Grace Sun MD ║, Jiangxia Wang MS ¶, Fasika A. Woreta MD, MPH *  https://doi.org/10.1016/j.jsurg.2022.07.026  Journal of Surgical Education, Volume 80, Issue 1, January 2023, Pages 135-142

"Highlights:

• There is an increasing number of couples applying for residency

• Ophthalmology and urology applicants cannot utilize the NRMP Couples Match system

• A Couples Match is highly desired by applicants to these two specialties

• The lack of a Couples Match is a deterrent to these specialties for some applicants

• Systems to aid applicants to these specialties with significant others are needed"