"In every state where a ballot measure asked Americans to reconsider the drug war, voters sided with reformers. In Arizona, Montana, New Jersey, and South Dakota, voters legalized marijuana for recreational purposes. In Mississippi and South Dakota (separate from the full legalization measure), voters legalized medical marijuana.
"In Oregon, voters decriminalized — but not legalized — all drugs, including cocaine and heroin. Also in Oregon, voters legalized the use of psilocybin, a psychedelic drug found in magic mushrooms, for supervised therapeutic uses.
"In Washington, DC, voters in effect decriminalized psychedelic plants, following the lead of several other cities.
"With its vote, Oregon became the first state in the US to decriminalize all drugs in modern times. And marijuana is now legalized in 15 states and DC, although DC still doesn’t allow sales."
"In Arizona, Mississippi, Montana, New Jersey and South Dakota, voters decisively passed measures liberalizing marijuana laws. Marijuana will now be legal for medical use in about 35 states and for recreational use in 15 states.
...
"Under the new Oregon measure, manufacturing or selling drugs will still be crimes, but possession of small amounts of heroin, cocaine or methamphetamine would be equivalent to a traffic ticket. The aim is to steer people into treatment so that they can get help with their addictions."
The New Yorker has an interesting story that sheds light on how we think of honorable or exceptional military service, and how claims about it are not so easy to verify and are (therefore) sometimes made falsely in public ways. (The story focuses on a Republican primary campaign for sheriff in a Texas county, in which both candidates lied about their military service.)
"Politicians lie to get us into wars; generals lie about how well things are going; soldiers lie about what they did during their service. In 1782, when George Washington awarded ribbons and badges to valorous Revolutionary War troops, he was already worrying about pretenders. “Should any who are not entitled to these honors have the insolence to assume the badges of them they shall be severely punished,” he wrote. When Walter Washington Williams, thought to be the last surviving veteran of the Confederate Army, died, in 1959, President Eisenhower called for a national day of mourning. It turned out that Williams had fabricated his service, and that the second-longest-surviving Confederate soldier probably had, too. In fact, according to the Civil War historian William Marvel, “every one of the last dozen recognized Confederates was bogus.” But it’s only recently that lying about military service has been considered a particularly heinous form of lying, one with its own name: stolen valor.
...
"...wearing an unearned military medal was against the law, but there was no particular consideration given to lies about military service; the same chapter of the federal statute also made it illegal to proffer a fake police badge, pretend to be a member of 4-H, or misuse the likeness of Smokey Bear. That began to change in 2004, after an Arizona man was featured in a local newspaper as a highly decorated veteran who had, among other improbable exploits, assisted in the capture of Saddam Hussein. Sterner helped expose him as a liar, but he was frustrated that there was no criminal penalty. It wasn’t illegal to lie about a medal—it was only when you pinned it on your lapel that you broke the law.
...
"The Stolen Valor Act of 2005, written in part by Pam Sterner, was introduced the year that millions of filmgoers watched “Wedding Crashers,” in which Vince Vaughn and Owen Wilson’s characters lie about being Purple Heart recipients. On September 7, 2006, the act, which made it a federal crime to falsely claim receipt of a military award or decoration, passed in the Senate by unanimous consent; President George W. Bush signed it into law soon afterward. But, six years later, in United States v. Alvarez, the Supreme Court ruled in favor of Xavier Alvarez, a water-district official in Southern California, who had been convicted of lying about receiving the Medal of Honor. (Alvarez had also falsely claimed to be a professional ice-hockey player and to have been married to a Mexican movie star.) The Court found that the Stolen Valor Act violated the First Amendment. Congress passed an amended statute, which made it illegal to fraudulently wear medals, embellish rank, or make false claims of service in order to obtain money or some other tangible benefit, making stolen valor an issue of fraud rather than of speech. "
From the journal The Laryngoscope, a thoughtful description of the growing interest in signaling for medical residency interviewing (which I believe will be implemented for Otolaryngology residency positions in the coming year).
C.W. David Chang MD Steven D. Pletcher MD Marc C. Thorne MD, MPH Sonya Malekzadeh MD
First published: 06 October 2020 https://doi.org/10.1002/lary.29151
"The impact of the coronavirus disease 2019 pandemic extends beyond patient care and into graduate medical education (GME). The pandemic has created disarray in the residency application process. Visiting rotations and residency interviews—two cornerstones of the application cycle—are gone.
"Just as the pandemic has exposed healthcare disparities in medical care, it also shines a light on inequalities with GME. Even before the pandemic, many residency specialties observed a meteoric rise in the number of applications submitted by each applicant. In 2019, otolaryngology applicants submitted an average of 72 applications, an 80% rise over 15 years.1 This increase drives a cycle of programs receiving more applications and students feeling the need to apply more broadly to maintain competitiveness. Students with monetary resources are better able to mitigate match risk through prolific residency application and by traveling for away rotations to cultivate faculty advocates. Financially disadvantaged applicants may find it more difficult to amass influential social capital.
"With the deluge of applications, applicants are unable to distinguish themselves from the crowd. Such dilution impairs the applicants' abilities to credibly convey interests to programs. Similarly, the program director has a hard time selecting candidates from a pool of excellent applicants for interview.
"The interview is a limited resource. Selection committees often react to this scarcity by declining to interview qualified candidates they think (but do not really know) are unlikely to choose their program and instead interview candidates who they think (but do not really know) are more likely to accept an offer. This approach is inefficient.
"Preference signaling is an intriguing solution. Since 2006, the American Economic Association has operated a signaling service to facilitate job interviews for graduate students. This applicant‐initiated concept aligns goals of interested applicants with programs. Students send signals to up to two employers to indicate their interest in receiving an interview. In reviewing their outcomes, signals were found to increase probability of interview, especially for niche scenarios (nongraduate applicants, applications to liberal arts colleges, and small city locations).2 Signaling has received interest among medical residency specialties as well.3, 4
...
"The Otolaryngology Program Directors Organization (OPDO) Council has worked diligently with stakeholders to incorporate their input throughout the development process. We thank members and leaders of the academic otolaryngology community, including the Association of Academic Departments in Otolaryngology (AADO), the Society of University Otolaryngologists (SUO), and the greater community of program directors for their support. We appreciate the guidance and valuable insight from the Association of American Medical Colleges (AAMC)—specifically the Group on Student Affairs (GSA), the Committee on Student Affairs (COSA), and the Electronic Residency Application Service (ERAS)—along with the National Resident Matching Program (NRMP). We are hopeful that signaling will improve the residency interview selection process by facilitating the successful pairing of applicants with programs."
"In November of 2019, University of Pennsylvania computer science professors Michael Kearns and Aaron Roth releasedThe Ethical Algorithm: The Science of Socially Aware Algorithm Design. Kearns is the founding director of the Warren Center for Network and Data Sciences, and the faculty founder and former director of Penn Engineering’s Networked and Social Systems Engineering program. Roth is the co-director of Penn’s program in Networked and Social Systems Engineering and co-authoredThe Algorithmic Foundations of Differential Privacywith Cynthia Dwork. Kearns and Roth are leading researchers in machine learning, focusing on both the design and real-world application of algorithms.
Their book’s central thesis, which involves “the science of designing algorithms that embed social norms such as fairness and privacy into their code,” was already pertinent when the book was released. Fast forward one year, and the book’s themes have taken on even greater significance.
Amazon Science sat down with Kearns and Roth, both of whom recently became Amazon Scholars, to find out whether the events of the past year have influenced their outlook. We talked about what it means to define and pursue fairness, how differential privacy is being applied in the real world and what it can achieve, the challenges faced by regulators, what advice the two University of Pennsylvania professors would give to students studying artificial intelligence and machine learning, and much more."
There is starting to be an empirical literature associated with payments for socially productive activities, such as participating in challenge trials of vaccines, donating plasma, etc.
Here's a blog post in the Medical Ethics blog of the Journal of Medical Ethics:
I am a reluctant letter signer, but this election season I have signed two open letters. My reluctance stems in part from the fact that, when I am one among many who sign a letter, I'm often prominently mentioned in the resulting news stories, even though my expertise on the subject of the letter is no more than the other signers.
But, we are entering on an important election, and I'm a concerned citizen. So, I let myself be counted (even if over-counted), and when asked to explain, I sometimes feel moved to respond.
"As of Friday, 1,027 prominent economists from major institutions across America, including numerous Nobel winners, had signed the open letter, which is being updated until Election Day.
"The number of signatures has increased by more than 300 since last Friday, when it was first created.
"Alvin Roth, who shared the Nobel Memorial Prize in Economic Sciences in 2012, told Business Insider he signed the letter because he was "concerned that some voters might believe President Trump's essentially false claims that his careless stewardship has been good for the US economy."
"Roth said: "That certainly isn't the view of those who study these things. Letters like this may also help many people know that they are not the only ones to notice that the current president is trying to keep us divided and misinformed." He added that "democracy depends on reliable information, and the letter was meant to provide some of that."
...
"Roth, an economics professor at Stanford University, believes the re-election of Trump could severely damage the US economy. ...economic progress in the US is made through working with trading partners, he said.
"But "President Trump prefers trade wars, with government subsidies to help staunch the bleeding in those parts of the economy that are harmed," such as the damage to American overseas agricultural markets, Roth added.
"Roth said that if Biden were elected as president, he would most likely appoint advisors who have knowledge in their areas of responsibility, and could therefore "restore America's relations with our allies and trading partners."
"Biden's tax and economic policies will not aim to benefit only the wealthiest Americans and political supporters, according to Roth, who emphasized how divided the country he believes the country is."
"Scientists at Imperial College London plan to deliberately infect volunteers with the coronavirus early next year, launching the world’s first effort to study how vaccinated people respond to being intentionally exposed to the virus and opening up a new, uncertain path to identifying an effective vaccine.
"The hotly contested strategy, known as a human challenge trial, could potentially shave crucial time in the race to winnow a number of vaccine candidates. Rather than conducting the sort of trials now underway around the world, in which scientists wait for vaccinated people to encounter the virus in their homes and communities, researchers would purposely infect them in a hospital isolation unit.
"Scientists have used this method for decades to test vaccines for typhoid, cholera and other diseases, even asking volunteers in the case of malaria to expose their arms to boxes full of mosquitoes to be bitten and infected. But whereas the infected could be cured of those diseases, Covid-19 has few widely used treatments and no known cure, putting the scientists in charge of Britain’s study in largely uncharted ethical territory.
...
"The volunteers in London will be paid roughly Britain’s minimum wage, which is about £9, or $11, per hour, for their time in taking part in the trial and their two to three weeks in mandatory quarantine. The researchers said they were wary of offering additional incentives that could cloud the judgment of volunteers."
************
And here's a recent NBER paper on the efficiency of challenge trials:
Donald A. Berry, Scott Berry, Peter Hale, Leah Isakov, Andrew W. Lo, Kien Wei Siah & Chi Heem Wong
ID w27882, DOI 10.3386/w27882, October 2020
Abstract: We compare and contrast the expected duration and number of infections and deaths averted among several designs for clinical trials of COVID-19 vaccine candidates, including traditional randomized clinical trials and adaptive and human challenge trials. Using epidemiological models calibrated to the current pandemic, we simulate the time course of each clinical trial design for 504 unique combinations of parameters, allowing us to determine which trial design is most effective for a given scenario. A human challenge trial provides maximal net benefits—averting an additional 1.1M infections and 8,000 deaths in the U.S. compared to the next best clinical trial design—if its set-up time is short or the pandemic spreads slowly. In most of the other cases, an adaptive trial provides greater net benefits.
"Participants in medical studies perform a service. Outside the domain of research participation, there is nearly universal agreement that workers providing a service should be compensated fairly, and that work involving more discomfort and risk should be compensated more generously. Accordingly, labour regulations impose floors (minimum wage laws), not caps on compensation. Caps, even if intended to protect against undue inducement, also raise concerns about illegal price-fixing that disadvantages workers. Such limits on payment for egg donors have successfully been challenged in court.
...
"Payment caps can lead to attempts to circumvent the regulation. For example, many countries that prevent payment for the donation of blood plasma instead import it from the USA where payment is legal—the volume of the US export market for plasma products approaches $20 billion per year.ii Similarly, restrictions on CHIM trial payments may lead to an increase in trials in countries with less stringent regulation.
...
"we note that increasing hourly pay by a risk-compensation percentage as proposed in the target article provides compensation proportional to risk only if the risk increases proportionally with the number of hours worked. (Some risky tasks take little time; imagine challenge trials to test bulletproof vests.) To ensure that equal consequences are compensated with equal amounts across a wide variety of studies, we instead recommend a three-part contract consisting of: (1) salary for time involvement that is adjusted to account for the amount of discomfort experienced during participation, (2) insurance against ex post adverse outcomes and (3) ex ante compensation for risks that cannot be compensated ex post (such as death). Such a scheme also increases transparency about what is requested from participants and thus contributes to high-quality participation decisions."
...
"The current discussion about payment in challenge trials is important because the potential benefits of well-designed challenge trials that could accelerate the development of safe and effective vaccines are enormous. Overall, economic research has shown, first, that ethical concerns over high payments may rely on intuitive predictions about behavioural effects that find little or no empirical support, and that the dangers of underpayment are at least as real as those of overpayment. Second, a part of the ethics literature attaches significantly more weight to concerns of undue inducement than the general population. Accordingly, it appears to us that there is sufficient public support for preparing for challenge trials, with paid participants, without a need for excessive ethical concern that payments might inadvertently become too generous to trial participants."
"No sooner had Cyprus moved this week to suspend its scandal-ridden programme that offered EU “golden passports” to rich investors than others began jostling to fill the gap.
“Choose Montenegro citizenship instead of Cyprus!” trumpeted the website of Discus Holdings, an official agent of the Montenegrin scheme, pointing to the visa-free access available to Europe’s 26-country common Schengen travel zone.
...
"Attention has focused on the three EU members — Cyprus, Malta and Bulgaria — that offer full citizenship in exchange for investment. But many other European countries, including France, the UK and Austria, offer “golden visas” granting a right of abode to the wealthy — and a potential path to nationality after a qualifying period of residence."
"Barrett co-wrote a 1998 law review article in which she distinguished the dilemmas Catholic judges might face in following church teachings against capital punishment, as well as what she called a more “absolute” doctrine banning abortion and euthanasia, which “take away innocent life.” (updated link: http://pragerfan.com/articles/Catholic_Judges_Capital_Cases.pdf )
...
"Eight of the 50 states and D.C. have permitted physician-assisted suicide, by statute or referendum. (In one, Montana, the state Supreme Court decreed it as a matter of state law, and legislators have tried, unsuccessfully so far, to overturn that ruling.)
"The Dutch government announced plans this week to allow doctors to end the lives of terminally ill children who are under 13 years old, a decision that is bound toinflame the debate over physician-assisted death.
"The Netherlands already allows doctors to facilitate the deaths of people who are over 12 or less than a year old as long as parents have given their consent.
"In a letter to parliament on Tuesday, the Dutch health minister, Hugo de Jonge, proposed expanding the law to include children between the ages of 1 and 12 who are dying and suffering.
“In a small number of cases, palliative care isn’t sufficient,” Mr. de Jonge wrote. “Because of that, some children suffer unnecessarily without any hope of improvement.”
"Canada, parts of Australia and Colombia have also legalized physician-assisted death for adults in certain cases.
...
"Eight states and Washington, D.C., have laws that allow mentally competent adults with a terminal illness and six months or less to live to obtain prescription medication that will hasten their deaths, according to Death With Dignity, an Oregon-based nonprofit that supports such laws."
********
The first link above is to this Gallup Poll report:
Here's an announcement from Harvey Mysel, the founder of the Living Kidney Donors Network, about information available for people in need of a kidney transplant.
Overcome
the myth that you need to ASK someone to donate
Explain
that it’s all about sharing YOUR STORY and the importance
of having advocates share it too.
Having
Your Donor Find YOU! consists of 9 videos, each under 3 minutes with Supporting
Resources that helps you develop the campaign that’s outlined in the videos.
The program will soon be available in Spanish.
The NBER market design conference is on Zoom this year, today through Saturday, starting each day at noon Eastern time (9am Pacific time). I'll be speaking today at 2:45 EST (11:45 PST), about a new proposal for global kidney exchange using chains that begin overseas and end in the U.S., and about the background and history to this proposal, which initially met with considerable opposition.
2:45 pm
Mohammad Akbarpour, Stanford University Afshin Nikzad, University of Southern California Michael A. Rees, University of Toledo Medical Center Alvin E. Roth, Stanford University and NBER Global Kidney Chains
Here's an announcement I received from Ned Brooks, the founder of NKDO, National Kidney Donation Organization (formerly Donor to Donor). If I understand correctly, the different talks and interviews will be available at the link after first streaming in conference style, starting at 9am Pacific time. It includes a video of Ned interviewing me.
I'll update this post as necessary.
"This Wednesday, October 21st, NKDO,
National Kidney Donation Organization (formerly Donor to Donor) will release
the virtual National Kidney Donor Advocate Conference. This event is designed
to give volunteer living donor advocates the information they need to be more
effective advocates for living donation. Transplant industry experts across the
country will be presenting to you and delivering invaluable advice about their
area of expertise.
The conference will stream on our YouTube channel beginning at 12:00 noon
Eastern this Wednesday. The conference will be in segments and accessed through
the “playlist”, either streaming as one event or accessed at different points
in the conference. The link is https://www.youtube.com/channel/UCsoS-yavRQCVl7bwcjT2iCA ,
which will go live at noon Eastern on Wednesday.
- Have you ever wondered about the transplant surgeons who do the surgery? What
they are thinking and what they would like you to know? Dr. Joshua Mezrich,
transplant surgeon at UWMadison and author of “When Death Becomes Life: Notes
from a Transplant Surgeon” talks about his experience with organ donors and
recipients.
- Are you a living donor or a transplant recipient, or expecting to be one? Do
you remember the experience of being evaluated at the transplant center and
listening to all the information, and maybe feeling a little overwhelmed?
Living Donor Coordinator Marian Charlton and Patient Coordinator Janet Hiller
are two of the most respected voices in transplant, and they will tell you what
they want you to know to better understand the process. Anyone who goes through
this experience or has a loved one in transplant will want to see these
segments.
- Living kidney donors deserve all protections available, from reimbursement
for out-of-pocket costs and lost wages to medical coverage for medical issues
that may arise months or years after donation. Garet Hil, founder and CEO of
the National Kidney Registry, talks about the suite of protections available to
living donors through Donor Shield.
- Are you a kidney patient in need of a donor? Harvey Mysel, a two-time
kidney recipient and founder and CEO of the Living Kidney Donor Network, talks
about how to have your kidney donor find you.
- All kidney patients will benefit by watching nephrologist Dr. David Serur
talk about kidney disease and what every kidney patient and advocate needs to
know to be properly informed about how to deal with renal disease.
- Non-directed, or altruistic, donors are a rare breed, though we are trying to
change that. No one knows the brain of the non-directed donor better than
Professor Abigail Marsh, who has been studying non-directed donors for years.
If you want to better understand why someone will happily donate a kidney to a
stranger, this presentation will help answer that question. Prof. Marsh
is the author of “The Fear Factor: How One Emotion Connects Altruists,
Psychopaths, and Everyone In-Between.”
- If you listen to podcasts, you are probably familiar with “Freakonomics”
and its creator, Stephen Dubner. It was the Freakonomics interview with Prof.
Roth that set Donor to Donor and NKDO into motion, and our interview with Mr.
Dubner will interest anyone who understands “the power of the pod”.
- Jim Gleason is a heart transplant recipient and the president of TRIO,
Transplant Recipients International Organization. Mr. Gleason is a motivational
speaker who asks the question, “Are you a cookie monster?”
Date: October 21, 2020 Time: 7:00am-8:00am Place: Webinar
Rishwain Visiting Speaker: Alvin E. Roth, PhD
Al Roth is the Craig and Susan McCaw Professor of Economics at Stanford University and the George Gund Professor Emeritus of Economics and Business Administration at Harvard University. He shared the 2012 Nobel memorial prize in Economics. His research interests are in game theory, experimental economics, and market design. In the 1990’s he directed the redesign of the National Resident Matching Program (NRMP) and currently is a member of the Board of Directors. He has been involved in the design and organization of kidney exchange, which helps incompatible patient-donor pairs find life-saving compatible kidneys for transplantation. He is on the Advisory Board of the National Living Donor Assistance Center (NLDAC). His work on kidney transplantation led him to become interested in repugnant transactions, and more generally how markets, and bans on markets, gain or fail to gain social support.
The University of California, San Francisco School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. CME Course MGR21045
UCSF designates this live activity for a maximum of 43 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
*The above credit is inclusive of credit for all Fiscal Year 2020-2021 Department of Surgery Grand Rounds.
Disclosure declaration – No one in a position to control the content of this activity has a relationship with an ACCME-defined commercial interest. Planners Wen Shen, MD, Julie Ann Sosa, MD, MA, Lygia Stewart, MD, and Ryutaro Hirose, MD, have stated that they have no relationships to disclose. Speaker Roth has stated that he has no relevant relationships to disclose.
This activity is supported by the Department of Surgery’s Howard Naffziger Endowment Fund.