Congestion in peer review, and an experiment in Nature (the journal)

 Too many papers, and not enough qualified reviewers willing or able to spend the time reviewing them.  And when a paper is reviewed, revised and published, there may have been valuable scientific discussions that went on in private

Nature has a column about the first problem, and is conducting an experiment with published papers that might help alleviate the second.

Here's the column about congestion:

Stop the peer-review treadmill. I want to get off. Faced with a deluge of papers, journal editors are struggling to find willing peer reviewers. by Amber Dance

"In November 2022, health economist Chris Sampson found himself in desperate need of a hero. As associate editor for Frontiers in Health Services, he’d been trying to get a paper reviewed since April. He’d sent out about 150 invitations to potential reviewers and received four reviews, but only one of sufficient quality to be useful.

...

"Sampson’s plight is a problem faced by editors the world over in the face of uncontrolled growth in the number of journals and papers. The tally of articles indexed by the citation database Web of Science tripled from about one million in 1990 to nearly three million in 2016, according to the website Publons

...

"Balazs Aczel is a psychologist at Eötvös Loránd University in Budapest who studies the processes of science. Using a data set covering more than 87,000 scholarly journals, Aczel and his colleagues estimated that researchers globally, in aggregate, spent the equivalent of more than 15,000 years on peer review in 2020 alone2. And many scientists are declining to review more frequently.

...

"Many scientists are increasingly frustrated with journals — Nature among them — that benefit from the unpaid work of reviewing while charging high fees to publish in them or read their content. 

...

"Yates and others suggest that cash payments would solve the problem, but others say such a system would be unethical and unsustainable."

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And here's an editorial about the experiment involving published papers and their referee reports (but not, apparently, involving unpublished papers):

Nature is trialling transparent peer review — the early results are encouraging. Last year, nearly half of Nature authors agreed to publish anonymous referee reports. We hope that more will consider doing so this year.  EDITORIAL, Nature, 01 March 2022

"Research papers are the product of lengthy discussions between authors and reviewers — guided by editors. These peer-review conversations can last for months at a time and are essential to progress in research. There is widespread agreement that the robustness and clarity of papers are enhanced in this process.

"Peer-review exchanges are mostly kept confidential, meaning that the wider research community and the world have few opportunities to learn what is said in them. Such opacity can fuel perceptions of secrecy in publishing — and leaves reviewers and their key role in science publication underappreciated. It also robs early-career researchers of the opportunity to engage with examples of the inner workings of a process that is key to their career development.

"In an attempt to change things, Nature Communications has since 2016 been encouraging authors to publish peer-review exchanges. In February 2020, and to the widespread approval of Twitter’s science community, Nature announced that it would offer a similar opportunity. Authors of new manuscript submissions can now have anonymous referee reports — and their own responses to these reports — published at the same time as their manuscript. Those who agree to act as reviewers know that both anonymous reports and anonymized exchanges with authors might be published. Referees can also choose to be named, should they desire.

"A full year’s data are now in, and the results are encouraging. During 2021, nearly half (46%) of authors chose to publish their discussions with reviewers, although there is variation between disciplines 

...

"The benefits to research are huge. Opening up peer review promotes more transparency, and is valuable to researchers who study peer-review systems. It is also valuable to early-career researchers more broadly. Each set of reports is a real-life example, a guide to how to provide authors with constructive feedback in a collegial manner.

Publishing peer-review exchanges, in addition, recognizes the effort that goes into the endeavour. Peer review is integral to being a researcher. Making reviewers’ work public illustrates the lengths that researchers will go in the service of scholarship. According to one study, reviewers in total do tens of millions of hours of peer review each year (B. Aczel et al. Res. Integr. Peer Rev. 6, 14; 2021). Yet this contribution is rarely recognized in research evaluation systems. As we have reported, there is growing interest in reforming these systems to better represent how science is done. If more researchers agree to open up their peer-review exchanges, we can all play a part in making that happen.

Nature 603, 8 (2022)

Gamete exchange

 Here's a cheerful story of peer to peer assisted reproduction, from the Washington Post:

Two couples couldn’t have babies, so they helped each other  By Kyle Melnick

"Neva and her wife, Kelsey, were considering using a surrogate or an in vitro method to have a child. John and his wife, Amy, couldn’t carry a pregnancy because of a hysterectomy Amy underwent to treat endometriosis.

“Just give us your sperm,” Neva recalled telling John. “We’ll have a baby, and then we’ll just give you an egg. It’s not a big deal.”

...

"In 2020, John donated sperm so that Kelsey could become pregnant through an insemination service. The Bentons’ baby was born the next year in Kansas. Kelsey, now 32, then acted as a surrogate for the Cardenases and birthed the Arizona couple’s child in July.

...

"the couples bought an insemination kit and wrote up a surrogacy contract with an attorney’s assistance. Kelsey tracked her menstrual cycles; John, who’s now 41, took pills and adjusted his diet to produce healthy sperm."

New technologies and new controversies: using CRISPR to edit human genes

 New technologies are often accompanied by new repugnancies, i.e. by controversies about their moral appropriateness. The future of using CRISPR to edit human genes is still before us, and its history (even to date) has yet to be written. But I'm struck by how it both interacts with and recapitulates older controversies and repugnancies, including those involving HIV, and adoption and assisted reproduction.

The New Yorker has the story:

The Transformative, Alarming Power of Gene Editing. A rogue scientist showed that crispr gives humans the ability to transform ourselves. But should we?  By Dana Goodyear  September 2, 2023

"The Chinese researcher He Jiankui was jailed for creating customized babies. Some observers argue that the real problem wasn’t him—it was the lure of the technology.

...

"To start, he would focus on what he believed was an achievable task: eradicating a disease governed by a single gene. He selected aids, an illness regarded in China as both pernicious and shameful but one for which there might be an elegant fix. H.I.V. enters human cells by way of a receptor created by a gene called CCR5. JK planned to use the gene-editing tool crispr to disrupt CCR5 in human embryos, which would, in theory, render the babies impervious to infection.

"The experiment required volunteers, and, through a chat group associated with an H.I.V./aids charity, he began recruiting couples: H.I.V.-positive men married to uninfected women. Chinese law denies in-vitro fertilization and adoption to H.I.V.-positive people, and natural conception carries a risk of transmission. For couples with an infected partner, JK’s program was a chance at parenthood. It promised confidentiality, which was critical for a marginalized community; an H.I.V. diagnosis in China can cost a person his job. The treatments would take place discreetly, at facilities where only key employees were aware of the experiment.

...

"as scientists from around the world prepared for a gene-editing conference in Hong Kong, JK released a series of YouTube videos, announcing the birth of a set of twins, edited as embryos with crispr. A slim, nervous-seeming man in a pale-blue shirt, he looked earnestly into the camera and said, “Two beautiful little Chinese girls named Lulu and Nana came crying into the world, as healthy as any other babies.” He went on to explain how, when each was only a single cell, he had used crispr to delete CCR5. “I understand my work will be controversial,” he said. “But I believe families need this technology, and I’m willing to take the criticism for them.”

"China’s state-run media celebrated the news, but the scientific community reacted with dismay. A group of Chinese researchers condemned the study as madness. David Baltimore, a Nobel Prize-winning biologist who chaired the Hong Kong event, called it “irresponsible,” saying, “I think there has been a failure of self-regulation by the scientific community.

...

"There were three edited babies, he acknowledged: along with Lulu and Nana, another was on the way.

...

"The Chinese government swiftly withdrew its enthusiasm for JK’s research, and, soon after he returned to the mainland, his lab was locked and he was placed under house arrest. In 2019, he was sentenced to three years in prison for “illegal medical practices,” and fined nearly half a million dollars. Two of his collaborators were given lesser sentences and fined. Among scientists, there was a pervasive sense of embarrassment. JK had misused a powerful technology and gambled with the health of children—experimental subjects he himself had created—without, in the scientists’ view, a compelling medical reason to compensate for the risk. Urnov told me, “He has taken a jar of tar, poured it over the field of crispr, and left an indelible stain. We will never wash that stain off. I am prepared to say that he’s not a fellow-scientist. He’s persona non grata.”

"JK was released from prison in the spring of 2022, and quickly resumed his efforts at gene editing. 

...

"He said that his new lab would be a nonprofit providing affordable gene therapy for rare conditions, and that he would focus first on Duchenne muscular dystrophy, a fatal disease that causes irreversible muscle damage, primarily in boys. This time, his patients would be not embryos but young children desperate for a cure. I asked if it was an attempt to redeem himself in the scientific community. “I don’t know if I’d use the word ‘redeem,’ ” he said. “I want to do it to help people today.”

...

"As for the debacle that his experiment had caused, JK would admit to no greater error than bad timing. “I do acknowledge that I have done it too quickly,” he said. In one of his YouTube videos, he predicted that in twenty or thirty years gene-edited babies will no longer be controversial, or even remarkable. He likened himself to the pioneering founder of the field of I.V.F., Robert Edwards, whose career had followed a heroic arc. In 1978, when the first I.V.F. baby was born, Edwards was a figure of scandal and opprobrium. In 2010, he was awarded the Nobel Prize."

Talent wars in private equity: continued unraveling

 The WSJ has the latest:

Hectic Private-Equity Recruitment Process Leaves Firms Looking for Alternatives. July talent-grab leaves some firms frustrated with process for hiring entry-level workers. by Chris Cumming, Aug. 30, 2023

"Private-equity firms are recruiting workers with less and less Wall Street experience every year, hoping to beat out their competitors to hire the most impressive recent college graduates. 

...

"Over about 48 hours every year, hundreds of first-year investment bankers file through private-equity offices for a battery of interviews and tests, hoping to land an offer in one of the world’s most highly paid industries.

...

"This year’s recruitment process kicked off July 21—the earliest date ever—for positions starting in 2025. Firms hired candidates who have mostly just graduated from college and are beginning two-year bank-analyst programs, making offers that kick in after their programs end.

HT: Isaac Sorkin

Nudges, shoves, regulations and designs: debate in Behavioral and Brain Sciences

Do "nudges" provide low cost solutions to big economic problems? Are they crowding out more effective, but harder or more expensive approaches?

The latest volume of Behavioral and Brain Sciences, Volume 46 - 2023, (a journal optimized to achieve impact factor, which counts references to previously published articles) contains 34 responses to the (previously published) target article*

The i-frame and the s-frame: How focusing on individual-level solutions has led behavioral public policy astray

• Nick Chater, George Loewenstein
• Published online  05 September 2022, e147

#####

Here are two of the responses that might be of most direct interest to regular readers of this blog:

• Behavioral market design

• Axel Ockenfels

• Behavioral mechanism design

• Samuel Bowles

########

The issue includes two separate responses by the authors of Nudge:

Select Nudging is being framed

• Nudging is being framed

• Richard H. Thaler
•  

• Conspiracy theory

• Cass R. Sunstein

 

##########

And here's a reply to all the commentary by the authors of the target article:

• Where next for behavioral public policy?

• Nick Chater, George Loewenstein
• "Academic papers are rarely born out of personal struggles. Our target article was."
•  
• ############

*Earlier post:

Thursday, June 16, 2022

Behavioral economics and market design are quite different -- Nick Chater and George Loewenstein reflect

 

Computer science award

A computer scientist whose work I follow has won an award that reflects on both his teachers and students.

Aaron Roth receives 2023 CyLab Distinguished Alumni Award 

"Aaron Roth, the Henry Salvatori Professor of Computer Science and Cognitive Science at the University of Pennsylvania, has been named CyLab's 2023 Distinguished Alumni Award winner.

...

"Roth earned his Ph.D. in Computer Science from Carnegie Mellon University in 2010, where he was advised by former CMU Professor Avrim Blum. His dissertation, 'New Algorithms for Preserving Differential Privacy,' gave new methods for performing computations on private data.

"Nominated by his former advisee, now Assistant Professor in CMU's School of Computer Science, Steven Wu, the award recognizes Roth's excellence in algorithms and machine learning, leadership in the field, and commitment to his students.

"As my advisor, Aaron is nothing less than a beacon of inspiration, marked by his relentless curiosity, exceptional instinct for identifying the most exciting questions, creative problem-solving acumen, and impeccable eloquence in communication," said Wu.

"Advising is one of the best parts of my job," said Roth. "Being recognized by one of my former students at the University where I earned my Ph.D. is really special."

Signaling for Orthopaedic surgery residencies

 The Journal of Bone and Joint Surgery reports a small survey about signaling behavior among applicants for orthopaedic surgery residencies.

Deckey, David G., Eugenia Lin, Coltin RB Gerhart, Joseph C. Brinkman, Karan A. Patel, and Joshua S. Bingham. "Decoding the Signals: An Analysis of Preference Signaling in the 2023 Orthopaedic Surgery Residency Match." JBJS Open Access 8, no. 3 (2023).

"While previously used in other specialties, the preference signaling program (PSP) was implemented in the 2022 to 2023 orthopaedic surgery residency application process for the first time. The PSP allowed for 30 signaling tokens to be sent by applicants to programs of their choice to indicate particular interest in a program.

...

"An anonymous electronic survey was emailed to all orthopaedic surgery residency applicants who applied to the authors' institution during the 2022 to 2023 application cycle. The survey was sent after match lists were submitted and closed before the release of match results. 

...

"The survey was completed by 101 applicants. Applicants applied to a mean of 90 programs (range: 10-197) and received an average of 12 interview invitations (range: 0-39). Applicants almost uniformly used all 30 signals, with nearly two-thirds signaling their home programs (65%, 49/76), and nearly all applicants sending signals to programs at which they performed away rotations (95.7%, 88/92). Applicants received a mean of 9 invitations from programs they signaled, compared with 2 invitations from programs they did not signal."

#######

Applicants report sending signals to all the programs that would have been expected to automatically give them interviews even in the absence of a signaling mechanism--namely their home programs and those which they have spent time visiting in 'away rotations.'

In the Economics job market, which may have been the first to introduce signaling, we limited applicants to 2 signals, and advised them not to signal jobs in which they already had well established mutual interests, i.e. not to signal jobs which they felt would interview them without signals. One of the ideas behind the Econ signaling mechanism is that there are many ways applicants can send signals of interest within a network to which they are well connected. Since some applicants are better connected than others, we were offering some signals that could be sent out of network.

It will be interesting to understand if signals to Ortho residencies are helping promote out of network interviews, or are largely strengthening the network connections already established by medical schools (home programs) and away rotations.

Navigating NYC school choice: advice for families

 Each year a new cohort of families has to navigate school choice in New York City.  The city offers lots of resources for gathering information.  One advantage of employing methods that make it safe to reveal true preference orders is that at least one aspect of the process is straightforward. (Of course, constructing a list of 12 schools out of the many available isn't easy.)

The NY Times offers a guide, which is full of information on how to go about gathering information with which to form preferences over schools:

Applying to N.Y.C. Public Schools Can Feel Daunting. Here’s What to Know. What matters when choosing a school? How should you compare options? And what’s the best strategy for getting your first choice?  By Troy Closson, Sept. 5, 2023,

"What’s the best strategy when applying?

"You should rank schools and programs in order of your true preference. There is no better approach. Students are considered for a lower choice only if a higher ranked school does not have space.

"Admissions experts suggest creating a complete list of 12 schools with a balance of programs, priorities and demand per seat, which you can find on MySchools. Apply by the deadline; there is also no benefit to applying earlier"

HT: Parag Pathak

*******

Another resource:

Abdulkadiroglu, Atila , Parag A. Pathak, and Alvin E. Roth, "Strategy-proofness versus Efficiency in Matching with Indifferences: Redesigning the NYC High School Match,'' American Economic Review, 99, 5, Dec. 2009, pp1954-1978. 

Same sex unions take a limited step forward in Hong Kong

 The Washington Post has the story:

Hong Kong court hands rare victory to advocates of same-sex unions, By Lily Kuo and Vic Chiang September 5, 2023 

"In a partial victory for Hong Kong’s LGBTQ community, the city’s top court on Tuesday ordered the government to give same-sex couples some form of legal recognition.

"The surprise ruling, which stopped short of meeting demands for full marriage equality, stated that the Hong Kong government had violated gay citizens’ constitutional rights by not granting them an “alternative framework” such as civil unions or civil partnerships.

"The majority verdict decided by five judges on the Court of Final Appeal gave Hong Kong two years to create a new framework that would confer “legal recognition” on same-sex relationships “in order to provide them with a sense of legitimacy, dispelling any sense that they belong to an inferior class of persons whose relationship is undeserving of recognition.”

...

“We are not addressing the question of whether in terms of social policy for Hong Kong same sex unions should be recognized with rights and obligations similar to those presently enjoyed by heterosexual couples. That is a question for the government and the legislature; and social policy is not a question for the court to decide,” wrote Justice Johnson Lam."

Repugnance watch: same sex weddings in Nigeria are illegal even for guests

 The NYT has the story:

Nigeria Arrests Dozens Over Same-Sex Wedding. A 2014 law makes such unions illegal in the country. Anyone found guilty of taking part can also face up to 10 years in prison. By Emma Bubola 

"The police in Nigeria have arrested over 60 people who were in attendance at what the authorities claimed was a same-sex wedding, reinforcing a crackdown on L.G.B.T.Q. people in Africa’s most populous nation.

"The police also broadcast the identities of some of those arrested on social media and encouraged members of the public to help “uphold the moral standards of the society” by providing relevant information — moves that raised concern that those who attended the event would be subjected to stigma or violence.

"Under a 2014 law, anyone entering a same-sex marriage or civil union in Nigeria can be imprisoned for up to 14 years. Those who administer or witness such a ceremony can face up to 10 years in prison. At the time it was enacted, the U.S. secretary of state, John Kerry, said the law violated basic human rights protections."

Covid medication: allocation, information, hesitancy, and uptake: what are some things we have learned?

 I've posted before about how informational advertising about vaccine availability and safety seems to have had a positive effect on vaccination rates among disadvantaged populations. There was particular concern in the U.S. at one point that Black people were less likely to receive vaccines and other medications than other Americans.

Today's post collects several papers about the effect of randomly allocating invitations for temporarily scarce Covid medications, while giving members of disadvantaged groups a higher probability of receiving an invitation.  Included will be an editorial warning us that we shouldn't be satisfied to judge the outcome of a market design by its intended outcome ("Moving Beyond Intent and Realizing Health Equity").

There are market design lessons in these last few years of Covid experience that I hope will help make the responses to future pandemics more effective. Not least of these is that the allocation of public health  and medical resources turns out to be quite different from  the allocation of other kinds of resources, in many important ways that reflect the broader economic and social environments in which different kinds of allocation takes place.

###

Here's a paper in the most recent issue of JAMA Health Forum, by a team that includes both medical professionals and market designers.

Weighted Lottery to Equitably Allocate Scarce Supply of COVID-19 Monoclonal Antibody , by Erin K. McCreary, PharmD1; Utibe R. Essien, MD, MPH2,3; Chung-Chou H. Chang, PhD4,5; Rachel A. Butler, MHA, MPH6; Parag Pathak, PhD7; Tayfun Sönmez, PhD8; M. Utku Ünver, PhD8; Ashley Steiner, BS9; Maddie Chrisman, PT, DPT10; Derek C. Angus, MD, MPH11; Douglas B. White, MD, MAS11, JAMA Health Forum. 2023;4(9):e232774. Sept. 1, doi:10.1001/jamahealthforum.2023.2774 

"Objective  To describe the development and use of a weighted lottery to allocate a scarce supply of tixagevimab with cilgavimab as preexposure prophylaxis to COVID-19 for immunocompromised individuals and examine whether this promoted equitable allocation to disadvantaged populations.

"Design, Setting, and Participants  This quality improvement study analyzed a weighted lottery process from December 8, 2021, to February 23, 2022, that assigned twice the odds of drug allocation of 450 tixagevimab with cilgavimab doses to individuals residing in highly disadvantaged neighborhoods according to the US Area Deprivation Index (ADI) in a 35-hospital system in Pennsylvania, New York, and Maryland. In all, 10 834 individuals were eligible for the lottery. Weighted lottery results were compared with 10 000 simulated unweighted lotteries in the same cohort performed after drug allocation occurred.

"Main Outcomes:  Proportion of individuals from disadvantaged neighborhoods and Black individuals who were allocated and received tixagevimab with cilgavimab.

"Results:  Of the 10 834 eligible individuals, 1800 (16.6%) were from disadvantaged neighborhoods and 767 (7.1%) were Black. Mean (SD) age was 62.9 (18.8) years, and 5471 (50.5%) were women. A higher proportion of individuals from disadvantaged neighborhoods was allocated the drug in the ADI-weighted lottery compared with the unweighted lottery (29.1% vs 16.6%; P < .001). The proportion of Black individuals allocated the drug was greater in the weighted lottery (9.1% vs 7.1%; P < .001). Among the 450 individuals allocated tixagevimab with cilgavimab in the ADI-weighted lottery, similar proportions of individuals from disadvantaged neighborhoods accepted the allocation and received the drug compared with those from other neighborhoods (27.5% vs 27.9%; P = .93). However, Black individuals allocated the drug were less likely to receive it compared with White individuals (3 of 41 [7.3%] vs 118 of 402 [29.4%]; P = .003).

...

"Conclusions and Relevance:  The findings of this quality improvement study suggest an ADI-weighted lottery process to allocate scarce resources is feasible in a large health system and resulted in more drug allocation to and receipt of drug by individuals who reside in disadvantaged neighborhoods. Although the ADI-weighted lottery also resulted in more drug allocation to Black individuals compared with an unweighted process, they were less likely to accept allocation and receive it compared with White individuals. Further strategies are needed to ensure that Black individuals receive scarce medications allocated."

...

"The lottery was repeated over several weeks, but we chose to examine only the first assignment. The interpretation of later rounds is problematic because eventually all individuals were offered tixagevimab with cilgavimab. By focusing on the first draw, we can specifically evaluate whether the intent of the lottery was met."

##############

Closely related reports:

White, D.B., McCreary, E.K., Chang, C.C.H., Schmidhofer, M., Bariola, J.R., Jonassaint, N.N., Persad, G., Truog, R.D., Pathak, P., Sonmez, T. and Unver, M.U., 2022. A multicenter weighted lottery to equitably allocate scarce COVID-19 therapeutics. American Journal of Respiratory and Critical Care Medicine, 206(4), pp.503-506.

Rubin, E., Dryden-Peterson, S.L., Hammond, S.P., Lennes, I., Letourneau, A.R., Pathak, P., Sonmez, T. and Ünver, M.U., 2021. A novel approach to equitable distribution of scarce therapeutics: institutional experience implementing a reserve system for allocation of COVID-19 monoclonal antibodies. Chest, 160(6), pp.2324-2331.*

White, D.B. and Angus, D.C., 2020. A proposed lottery system to allocate scarce COVID-19 medications: promoting fairness and generating knowledge. Jama, 324(4), pp.329-330.

###########

And here's an editorial in the same issue of JAMA Health Forum as the most recent article, pointing out that less-disadvantaged patients among those living in census blocks identified as disadvantaged (in particular  commercially insured and White patients) were much more likely to receive the treatment:

Moving Beyond Intent and Realizing Health Equity, by Atheendar S. Venkataramani, MD, PhD, Invited Commentary, September 1, 2023, JAMA Health Forum. 2023;4(9):e232525. doi:10.1001/jamahealthforum.2023.2525

"In a study published in this issue of JAMA Health Forum, McCreary and colleagues3 report on a landmark effort at the University of Pittsburgh Medical Center (UPMC) to distribute equitably a scarce monoclonal antibody resource, tixagevimab with cilgavimab, for COVID-19 preexposure prophylaxis in immunocompromised individuals. In December 2021, UPMC received an allotment of 450 doses of tixagevimab with cilgavimab from the Pennsylvania Department of Health to cover a large health system with 35 hospitals and 800 outpatient facilities through February 2022. In an ex ante effort to mitigate health disparities and respond to guidance from the Commonwealth of Pennsylvania to allocate scarce resources in a manner that accounts for multiple ethical objectives, UPMC convened an advisory group of clinicians, community stakeholders, and experts in community outreach.

...

"The lottery was constructed using the Area Deprivation Index (ADI) to ensure that patients in highly disadvantaged neighborhoods had an equal opportunity to access tixagevimab with cilgavimab. Patients living in neighborhoods with ADIs above a specific cutoff that has been shown to best target less affluent, rural, and Black patients received 2 entries in the lottery, compared with 1 entry for patients in more advantaged neighborhoods. In their study, McCreary and colleagues3 found that this process resulted in equitable access: similar proportions of individuals in more advantaged and more disadvantaged neighborhoods (about 28% in each group) received tixagevimab with cilgavimab during the study period, although Black patients who were allocated the drug in the lottery were significantly less likely to receive it compared with White patients (7.3% vs 29.4%).

...

"Having identified its patient population, UPMC required only patient addresses as well as publicly available data on ADIs to implement the lottery intervention. The ADIs are defined at the census block group level, which include about 1000 residents on average. Thus, UPMC was able to achieve equitable opportunity to access tixagevimab with cilgavimab across small localities with very different socioeconomic profiles.

...

On the other hand, higher-resolution data that specifically measure the types of intersecting, reinforcing, and cumulative disadvantages faced by historically marginalized groups5 may be needed to achieve equitable outcomes across other dimensions, such as race and ethnicity. Within census blocks, patients assigned the same ADI levels but who may have faced relatively fewer structural barriers compared with Black patients or patients receiving Medicaid—namely, commercially insured and White patients—were more likely to access tixagevimab with cilgavimab conditional on being allocated to receive it in the lottery

...

"The lower rates of drug receipt among Black patients also underscores the importance of complementary investments and operational decisions to address additional structural barriers to accessing medical technology.

...

"The study by McCreary and colleagues3 represents the type of courageous and rigorous work that is needed to chart a path forward in determining how best to bridge the access gap for leading-edge medical technology. Future work would benefit from the same type of clarity demonstrated in this study by including clear definitions for how equity should be operationalized, attempting to address fragmentation between clinical services and services that address social drivers of health, aligning incentives, and addressing historical barriers that have made it difficult to achieve health equity."

##########

*Earlier:

Saturday, August 14, 2021

A lottery for antibody treatment, with slots reserved for vulnerable patients

Protest against political persecution of Prof Muhammad Yunus, and more general threats to democracy in Bangladesh

 The Bangladesh Daily Star publishes an open letter, and the NY Times provides some general background.

Here's the  open letter to Prime Minister Sheikh Hasina:

‘Judicial harassment of Yunus’: 104 Nobel laureates, 79 global figures voice concern

"A total of 104 Nobel Laureates and 79 other global figures in an open letter to Prime Minister Sheikh Hasina yesterday expressed concern about the safety and freedom of Nobel Laureate Prof Muhammad Yunus.

...

"As you know, Prof Yunus' work, which has been inspirational to all of us, focuses on how social business can be a force for international progress resulting in zero poverty, zero unemployment, and zero net carbon emissions. He is a leading example of how Bangladesh and Bangladeshis have contributed to global progress in recent decades. We sincerely wish that he be able to continue his path-breaking work free of persecution or harassment.

...

"According to the case documents, officials of the Inspection for Factories and Establishments Department on August 16, 2021, inspected the office of Grameen Telecom in the capital's Mirpur and found several violations of labour laws.

"On June 6 this year, the court framed charges against the accused -- including Prof Yunus -- in the case. The trial began on August 22.

...

"In its review, the law firm said, "Professor Yunus is facing six months in prison for a crime that he not only did not commit, but that legally does not exist….Events are moving quickly in Bangladesh driven by a forthcoming election and a presumed desire to imprison Prof Yunus prior to that election….Not only are the allegations entirely without merit, but the legal process is wrong in law….A miscarriage of justice is happening in Bangladesh and the state must not be allowed to carry it to its conclusion."

"Following are the Nobel Laureates who are the signatories of the letter:

PEACE: Barack H. Obama, 2009; José Ramos-Horta, 1996; Mairead Corrigan-Maguire, 1976; Shirin Ebadi, 2003; Leymah Roberta Gbowee, 2011; Albert Arnold Gore Jr., 2007; Tawakkol Karman, 2011; Denis Mukwege, 2018; Nadia Murad, 2018; Maria Ressa, 2021; Oscar Arias Sanchez, 1987; Juan Manuel Santos, 2016; Rigoberta Menchu Tum, 1992; and Jody Williams, 1997.

CHEMISTRY: Peter Agre, 2003; Thomas R. Cech, 1989; Martin Chalfie, 2008; Emmanuelle Charpentier, 2020; Aaron Ciechanover, 2004; Johann Deisenhofer, 1988; Jacques Dubochet, 2017; Joachim Frank, 2017; Walter Gilbert, 1980; Alan Heeger, 2000; Richard Henderson, 2017; Dudley R. Herschbach, 1986; Avram Hershko, 2004; Roald Hoffmann, 1981; Robert Huber, 1988; Martin Karplus, 2013; Brian K. Kobilka, 2012; Yuan T. Lee, 1986; Robert J. Lefkowitz, 2012; Jean-Marie Lehn, 1987; Michael Levitt, 2013; Tomas Lindahl, 2015; Paul L. Modrich, 2015; John C. Polanyi, 1986; Jean-Pierre Sauvage, 2016; Sir John E. Walker, 1997; Arieh Warshel, 2013; and Sir Gregory P. Winter, 2018.

ECONOMICS: Oliver Hart, 2016; Finn E. Kydland, 2004; Paul R. Milgrom, 2020; Edmund Phelps, 2006; Alvin E. Roth, 2012; Vernon L. Smith, 2002; and Joseph E. Stiglitz, 2001.

LITERATURE: J. M. Coetzee, 2003; Herta Muller, 2009; Orhan Pamuk, 2006; and Wole Soyinka, 1986.

MEDICINE: Harvey J. Alter, 2020; David Baltimore, 1975; Françoise Barré-Sinoussi, 2008; J. Michael Bishop, 1989; Elizabeth H. Blackburn, 2009; William C. Campbell, 2015; Peter C. Doherty, 1996; Jeffrey Connor Hall, 2017; Leland H. Hartwell, 2001; Jules A. Hoffmann, 2011; Tasuku Honjo, 2018; H. Robert Horvitz, 2002; Sir Michael Houghton, 2020; Craig C. Mello, 2006; Edvard Moser, 2014; May-Britt Moser, 2014; Sir Paul M. Nurse, 2001; Ardem Patapoutian, 2021; Sir Peter J. Ratcliffe, 2019; Charles M. Rice, 2020; Sir Richard J. Roberts, 1993; Michael Rosbash, 2017; Gregg L. Semenza, 2019; Hamilton O. Smith, 1978; Jack W. Szostak, 2009; Harold E. Varmus, 1989; Eric F. Wieschaus, 1995; Torsten N. Wiesel, 1981; and Michael W. Young, 2017.

PHYSICS: Barry Clark Barish, 2017; Steven Chu, 1997; Andre Geim, 2010; Sheldon Glashow, 1979; David J. Gross, 2004; John L. Hall, 2005; Takaaki Kajita, 2015; Anthony J. Leggett, 2003; John C. Mather, 2006; Michel Mayor, 2019; Arthur B. McDonald, 2015; Konstantin Novoselov, 2010; Giorgio Parisi, 2021; James Peebles, 2019; Roger Penrose, 2020; William D. Phillips, 1997; H. David Politzer, 2004; Brian P. Schmidt, 2011; Horst L. Stormer, 1998; Daniel C. Tsui, 1998; Carl E. Wieman, 2001; and David J. Wineland, 2012."

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The letter also appeared as an ad in the International edition of the New York Times:

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

And here's the NY Times story: 

Quietly Crushing a Democracy: Millions on Trial in Bangladesh

The most active rivals to the country’s ruling party face dozens, even hundreds, of court cases each, paralyzing the opposition as a crucial election approaches. By Mujib Mashal 

"Bangladesh’s multiparty democracy is being methodically strangled in crowded courtrooms across this country of 170 million people.

"Nearly every day, thousands of leaders, members and supporters of opposition parties stand before a judge. Charges are usually vague, and evidence is shoddy, at best. But just months before a pivotal election pitting them against the ruling Awami League, the immobilizing effect is clear.

"About half of the five million members of the main opposition party, the Bangladesh Nationalist Party, are embroiled in politically motivated court cases, the group estimates. The most active leaders and organizers face dozens, even hundreds, of cases."

Innovations in medicine: psychedelic drugs to treat depression

 Here's an editorial in JAMA that accompanies a report on treating some depressive patients using psilocybin therapy.

Psychedelic Therapy—A New Paradigm of Care for Mental Health, by Rachel Yehuda, PhD Amy Lehrner, PhD JAMA. Published online August 31, 2023. doi:10.1001/jama.2023.12900

"An increasing number of clinicians and researchers have become interested in the potential of psychedelic drugs for the treatment of mental health disorders, including depression, anxiety, posttraumatic stress disorder, eating disorders, and addictions.1,2

"Currently, most psychedelic compounds are illegal under federal law. They were placed on the most restrictive class of drugs, Schedule I, in the 1970s as part of the “war on drugs,” meaning that they were considered to have high potential for abuse with no accepted medical use.2 However, the ever-growing global mental health crisis, coupled with the shortage of effective therapeutic strategies, has given rise to a reconsideration of the therapeutic potential of these compounds in recent years.

...

"The study by Raison et al provides an excellent example of the promise of this new approach using psilocybin therapy for patients with major depressive disorder.3 Although the trial was relatively small, it demonstrated that a single dose of psilocybin in the context of a 6-week period that included active psychotherapy resulted in a rapid, robust, and sustained reduction in depressive symptoms.

"Psilocybin is a naturally occurring compound belonging to a class of compounds known as tryptamines, similar to lysergic acid diethylamide (LSD), dimethyltryptamine (DMT), and mescaline. Understanding its therapeutic efficacy requires an appreciation of the context in which it is used, and not just its pharmacological profile or biological mechanism of action. The psychotherapy that occurs with the psychedelic medication is a critical component of this approach.4

...

"The social, economic, and public health impacts of untreated mental disorders demand solutions. If psychedelic therapies do prove to have enduring effects after just a single or a few administrations in the context of a few sessions for preparation and integration, they have the potential to offer not just a new approach to mental health care, but an entirely new paradigm of care."

Innovations in addiction technology--illicitly manufactured fentanyl (IMF) combined with xylazine

 The fight against addictions is complicated by the fact that those who sell addictive goods can be innovative on many levels. (In the case of legal addictive substances such as nicotine, we are becoming accustomed to that competition, e.g. in connection with the growth of non-combustible vaping.)

Here's an article about innovation involving illegal opioids.

The emerging fentanyl–xylazine syndemic in the USA: challenges and future directions, by David T Zhu, Joseph Friedman, Philippe Bourgois, Fernando Montero, Suzanne Tamang, Lancet, August 24, 2023 DOI:https://doi.org/10.1016/S0140-6736(23)01686-0

"Xylazine, a non-opioid analgesic and sedative approved only for non-chronic veterinary use, is spreading across unregulated North American drug markets and becoming increasingly implicated in opioid overdoses. Between 2018 and 2021 in the USA, estimated fatal drug poisonings involving xylazine, often co-occurring with synthetic opioids such as fentanyl, increased from 260 to 3480 cases.1 This use of xylazine takes place in the context of the ongoing US opioid overdose crisis, which is expected to claim an estimated 1·2 million additional lives by 2029, barring urgent substantial policy reforms.2 The White House Office of National Drug Control Policy identified fentanyl adulterated or associated with xylazine (FAAX) as an emerging threat and in July, 2023, issued a response plan leveraging the Emerging Threats Committee and other vital stakeholders.3 Although this is a welcome strategy that sets out the federal government's plan to address xylazine, further non-punitive efforts and public health interventions are needed from health-care systems, policy makers, and community leaders to address the longer-term structural factors driving this crisis.

...

"Although more evidence is needed about why xylazine is combined with fentanyl, some reports suggest that by adding xylazine as an adulterant for synthetic opioids such as IMF, manufacturers can potentially maximise profits and distinguish their brand in the market, attracting a wider customer base.6,  7 This has most notably been observed in Philadelphia, PA, USA—regarded as an epicentre of the emerging xylazine crisis in mainland USA—where over 90% of the city's street opioid supply has shifted to FAAX.8 Further, xylazine has been described by people who use drugs as lengthening the sedative effects of IMF—solving the disadvantage of fentanyl's short duration of effect—thereby postponing craving and physical withdrawal symptoms"