US Ranks Highest in Global Overdose Deaths

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

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

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

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Here's the report:

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

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

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

 

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

AI assisted home buying and selling at Stanford

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

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

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

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

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

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

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

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

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

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

The NYT has the story:

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

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

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

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

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

...

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

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

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

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

Clinical trial of pig kidney transplants

 A clinical trial is good news.

The NYT has the story:

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

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

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

...

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

...

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

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

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

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

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

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

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

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From protectdemocracy.org:

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

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

...

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

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

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

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And now (from the NYT):

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

Challenge trials are becoming more accepted

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

The NYT has the story:

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

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

...

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

...

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

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

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

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

  ########H

Here are all my posts on challenge trials

give yourself a scare

 Want to see something scary? 

Click here: 

The White House  https://www.whitehouse.gov/

The NBER celebrates market design

 From the NBER Reporter:

Working Group Report: Market Design  By Michael Ostrovsky and Parag A. Pathak

Here are the introductory paragraphs (after which the report goes on to survey various areas of market design research).

"The Market Design Working Group, established in 2009 under the leadership of Susan Athey and Parag Pathak, is a preeminent research forum in the field of market design. The working group meets annually, alternating between Cambridge, Massachusetts, and Palo Alto, California, to present research that bridges theoretical economics and practical applications, all focused on what The Economist aptly characterized as “an intelligently designed invisible hand.”1 Research in market design has been celebrated in academic circles, as evidenced by recognitions like the 2012 Nobel Prize for work on matching markets and the 2020 Nobel Prize for auction theory, and has also been instrumental in catalyzing tangible reforms in real-world institutions and markets.

"One feature that sets market design apart from much of traditional economic theory is its unwavering commitment to practical applications. Market designers have developed a unique professional profile, equally at home in university lecture halls, hospital surgery wards, school committee meetings, and the boardrooms of technology companies. This versatility allows them to translate complex economic models and analyses into solutions for real-world problems. The field’s research has informed an impressive range of applications across various sectors of society. "

Specialized recycling--when guts are in short supply.

 Guts are in short supply these days.  Fortunately they can be recycled.

Here's a photo from Half Moon Bay.

Anti trans leads to anti transplant in Indiana Senate

 In Indiana, the Daily Journal reports on a debate that has at least temporarily stalled a bill meant to protect organ donors' access to insurance.

Living organ donor bill sparks emotional discussion in the Senate
By TheStatehouseFile.com -January 27, 2025 

"During Thursday afternoon’s Senate hearing, 10 bills were brought up for their final vote before moving to the House of Representatives. While nine of the bills passed without discussion, one of the bills, SB 111, which would, among other provisions, protect organ donors from being denied coverage by insurance companies, sparked debate

...

"Sen. Andrea Hunley, D-Indianapolis, who authored the bill with Sen. Scott Baldwin, R-Noblesville, and Sen. Kyle Walker, R-Lawrence, began the discussion by describing the necessity of protecting Hoosier organ donors. She was then questioned by Sen. Liz Brown, R-Fort Wayne.

“My concern is that if a trans woman wanted a uterine transplant, that would be covered under the bill,” said Brown.

"Brown, who mentioned her concern about uterine transplants repeatedly during the discussion, was also concerned about possible raises in insurance rates for Hoosiers."

HT: Martha Gershun

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The uterus is just a muscle, so some transplant surgeons  I've talked to think such a transplant could be done.  The pregnancy would start with IVF, and the delivery would be by C-section…

 

Presidential memo shuts down all government grants (now including NSF)

 A Presidential memo issued yesterday is shutting down all government grants, including e.g. those from the NSF.  

Here's the memo:

MEMORANDUM FOR HEADS OF EXECUTIVE DEPARTMENTS AND AGENCIES
FROM: Matthew J. Vaeth, Acting Director, Office of Management and Budget
SUBJECT: Temporary Pause of Agency Grant, Loan, and Other Financial Assistance Programs 

" The use of Federal resources to advance  Marxist equity, transgenderism, and green new deal social engineering policies is a waste of  taxpayer dollars that does not improve the day-to-day lives of those we serve. "

#######

Here's the story from NPR:

National Science Foundation freezes grant review in response to Trump executive orders, By Jonathan Lambert January 27, 2025 

"The National Science Foundation canceled all of its grant review panels this week, as the organization works to align its grantmaking process with new executive orders from the Trump administration. 

...

"More than 60 of those meetings were scheduled for this week, all of which were abruptly canceled Monday morning."

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And here's a broader view from the Washington Post:

White House pauses all federal grants, sparking confusion. Trillions of dollars could be on hold, according to an Office of Management and Budget memo. By Jeff Stein, Jacob Bogage and Emily Davies, January 27, 2025

 "The White House budget office is ordering a pause to all grants and loans disbursed by the federal government, according to an internal memo sent to agencies Monday, creating significant confusion across Washington.

"In a two-page document, Matthew J. Vaeth, the acting director of the White House Office of Management and Budget, instructs federal agencies to “temporarily pause all activities related to obligations or disbursement of all Federal financial assistance.” The memo, a copy of which was obtained by The Washington Post, also calls for each agency to perform a “comprehensive analysis” to ensure its grant and loan programs are consistent with President Donald Trump’s executive orders, which aimed to ban federal diversity, equity and inclusion initiatives, and limit clean energy spending, among other measures.

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And here's the view from Science:

Trump’s shutdown of federal diversity office at NSF breaks law that created it. CHIPS and Science Act established position to broaden participation in science  ByJeffrey Mervis

"President Donald Trump’s order yesterday shutting down diversity, equity, and inclusion (DEI) offices was part of a slew of presidential directives from the new administration that apply to every federal agency. But for the National Science Foundation (NSF), following the White House’s order required it to ignore a mandate from Congress, and the lawmakers behind it are ticked off.

“Trump’s dismantling of diversity, equity, and inclusion efforts across the federal government is just plain wrong,” said the top Democrat on the House of Representatives’s science committee, Representative Zoe Lofgren (CA). “For years, the committee has been working in a bipartisan effort to create a STEM workforce that more accurately represents the rich diversity and intellectual capacity of our nation. Trump has made hypocrites of the Republicans who joined us in spearheading diversity and equity efforts.”

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   "First they came for the socialists, and I did not speak out—because I was not a socialist.
    "Then they came for the trade unionists, and I did not speak out—because I was not a trade unionist.
    "Then they came for the Jews, and I did not speak out—because I was not a Jew.
    "Then they came for me—and there was no one left to speak for me."

    —Martin Niemöller
 

Derek Humphry, Pivotal Figure in Right-to-Die Movement, (1930-2025)

 Here's the NYT obit:

Derek Humphry, Pivotal Figure in Right-to-Die Movement, Dies at 94
His own experience assisting his terminally ill wife in ending her life set him on a path to founding the Hemlock Society and writing a best-selling guide.  By Michael S. Rosenwald, NYT,  Jan. 24, 2025

"Derek Humphry, a British-born journalist whose experience helping his terminally ill wife end her life led him to become a crusading pioneer in the right-to-die movement and to publish “Final Exit,” a best-selling guide to suicide, died on Jan. 2 in Eugene, Ore. He was 94.

His death, at a hospice facility, was announced by his family

...

"In August 1980, he and his [second] wife rented the Los Angeles Press Club to announce the establishment of the Hemlock Society, which they ran out of the garage of their home in Santa Monica.

"The organization grew quickly. In 1981, it issued “Let Me Die Before I Wake,” a guide to medicines and dosages for inducing “peaceful self-deliverance.” The group also lobbied state legislatures to enact laws making assisted suicide legal. In 1990, the Hemlock Society moved to Eugene. By then it had more than 30,000 members, but the right-to-die conversation hadn’t yet reached most dinner tables in America. 

"That changed spectacularly in 1991, after Mr. Humphry published “Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying.” The book was a 192-page step-by-step guide that, in addition to explaining suicide methods, provided Miss Manners-like tips for exiting gracefully.

...

"“Final Exit” quickly shot to No. 1 in the hardcover advice category of The New York Times’s best-seller list.

“That is an indication of how large the issue of euthanasia looms in our society now,” the bioethicist Dr. Arthur Caplan told The Times in 1991. “It is frightening and disturbing, and that kind of sales figure is a shot across the bow. It is the loudest statement of protest of how medicine is dealing with terminal illness and dying.”

"Reactions to “Final Exit” were generally divided along ideological lines. Conservatives blasted it.

“What can one say about this new ‘book’? In one word: evil,” the University of Chicago bioethicist Leon R. Kass wrote in Commentary magazine, calling Mr. Humphry “the Lord High Executioner.”  

...

"But progressives embraced the book, even as public health experts expressed concern that the methods it laid out could be used by depressed people who weren’t terminally ill. "

Executive Order of the President suspending refugee admissions to the United States

 Here's the Executive Order of the President suspending refugee admissions to the United States.

 REALIGNING THE UNITED STATES REFUGEE ADMISSIONS PROGRAM: EXECUTIVE ORDER January 20, 2025
 "The United States lacks the ability to absorb large numbers of migrants, and in particular, refugees, into its communities in a manner that does not compromise the availability of resources for Americans, that protects their safety and security, and that ensures the appropriate assimilation of refugees.  This order suspends the USRAP until such time as the further entry into the United States of refugees aligns with the interests of the United States."

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 And here's an email I received yesterday from the HIAS, the refugee resettlement agency with which my wife and I have had a long relationship.

 "Yesterday afternoon, the U.S. government decided to abruptly suspend life-saving assistance to vulnerable people around the world. HIAS, along with many partner organizations who provide humanitarian and development assistance, was issued a Stop-Work Order for many of our programs that receive State Department funding.
 

"The magnitude of the Stop-Work Orders is unprecedented and breathtakingly cruel. All around the world, programs, including ours, that provide clean water, shelter, medical care, food, and other critical services will end, leaving millions of people abandoned to face exploitation, violence, and hunger.
 

"The grave impacts also extend into the United States. HIAS and our resettlement partners are prevented from providing critical services to refugees who were welcomed here through the resettlement program and have already legally begun their new lives. Coupled with the executive order halting all new refugee admissions, this is a total shutdown of the U.S. Refugee Admissions Program.

...

"As Jews and humanitarians, HIAS will never turn our backs on refugees, even if the U.S. government has. We have a responsibility to always stand up for newcomers, who came to the U.S. with the understanding that we would help them adjust to life in a new country. We will always stand up for the rights and safety of forcibly displaced people around the world.
HIAS has always been an organization that stands for welcome — and we will continue to do all we can.
 

In solidarity,

— HIAS

Informed consent and compensation for clinical trial participants (Ambuehl, Ockenfels and Stewart in REStat)

 Here's the latest in a series of papers that suggests that participants who are attracted to e.g. clinical trials by the pay may be those who have the most trouble evaluating the costs and risks. So high pay should be paired with robust procedures for informed consent.

Ambuehl, Sandro, Axel Ockenfels, and Colin Stewart. "Who opts in? Composition effects and disappointment from participation payments." Review of Economics and Statistics 107, no. 1 (2025): 78-94.

Abstract: "Participation payments are used in many transactions about which people know little but can learn more: incentives for medical trial participation, signing bonuses for job applicants, or price rebates on consumer durables. Who opts into the transaction when given such incentives? We theoretically and experimentally identify a composition effect whereby incentives disproportionately increase participation among those for whom learning is harder. Moreover, these individuals use less information to decide whether to participate, which makes disappointment more likely. The learning-based composition effect is stronger in settings in which information acquisition is more difficult. 

"we contribute to the burgeoning literature on the moral constraints on markets (Kahneman et al., 1986; Roth, 2007; Ambuehl et al., 2015; Ambuehl, 2022; Elias et al., 2019). Around the world, the principles of informed consent are fundamental to regulations concerning human research participation, as well as to transactions such as human egg donation, organ donation, and gestational surrogacy (DHEW 1978, The Belmont Report, 1978; Faden & Beauchamp, 1986). According to these principles, the decision to participate in a transaction is ethically sound if it is made not only voluntarily but also in light of all relevant information, properly comprehended.3 Our results show that payments for participation can be in conflict with participants’ understanding about the consequences of participation. They further show that the severity of this conflict grows with respect to both the amount of the payment and the difficulty of acquiring and processing information about the consequences of the transaction."

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Earlier:

Wednesday, September 4, 2024 Incentives matter for getting participation in clinical trials by low income households

 

Sunday, March 10, 2024 Does high pay equal "undue inducement"? An experiment by Sandro Ambuehl

 

 

New marriage laws, in Thailand and Iraq (allowing same sex marriage, and child marriage, respectively)

 Same-sex couples can now marry in Thailand, and children as young as nine can now be married in Iraq.

Thailand Celebrates New Same-Sex Marriage Law With Mass Wedding  Hundreds of people began registering their marriages at a mall in Bangkok, as Thailand became one of the few places in Asia to legalize same-sex unions.   By Richard C. Paddock and Muktita Suhartono

“Today we feel secure and safe and happy,” said Ploynaplus Chirasukon, 33, who wed her partner, Kwanporn Kongpetch, 32, in the event’s first marriage. “We are happy that we have played a part in the equal marriage law reaching this point.”

Other weddings were planned around the country, and organizers say they expect more than 1,000 same-sex couples to marry on the first day." 

#######

Here's the Guardian on Iraq:

‘The end of women and children’s rights’: outrage as Iraqi law allows child marriage. The Iraqi parliament has passed a ‘terrifying’ law permitting children as young as nine to marry by Maria Talal and Hala Abdulla

"Iraqi MPs and women’s rights groups have reacted with horror to the Iraqi parliament passing a law permitting children as young as nine years old to marry, with activists saying it will “legalise child rape”.

"Under the new law, which was agreed yesterday, religious authorities have been given the power to decide on family affairs, including marriage, divorce and the care of children. It abolishes a previous ban on the marriage of children under the age of 18 in place since the 1950s.

“We have reached the end of women’s rights and the end of children’s rights in Iraq,” said the lawyer Mohammed Juma, one of the most prominent opponents of the law."