Healthcare as a modern jobs engine, by Gottlieb, Mahoney, Rinz and Udalova

Here's a paper with cheerful results about employment and wages in health care.

Rise of Healthcare Jobs  by Joshua D. Gottlieb, Neale Mahoney, Kevin Rinz, and Victoria Udalova, NBER Working Paper No. 33583  March 2025

ABSTRACT: "Healthcare employment has grown more than twice as fast as the labor force since 1980, overtaking retail trade to become the largest industry by employment in 2009. We document key facts about the rise of healthcare jobs. Earnings for healthcare workers have risen nearly twice as fast as those in other industries, with relatively large increases in the middle and upper-middle parts of the earnings distribution. Healthcare workers have remained predominantly female, with increases in the share of female doctors offsetting increases in the shares of male nurses and aides. Despite a few high-profile examples to the contrary, regions experiencing manufacturing job losses have not systematically reinvented themselves by pivoting from ``manufacturing to meds.'' 

...

"In 2006, healthcare overtook manufacturing in terms of employment, and in 2009 healthcare overtook retail trade to become the largest industry by employment in the U.S. 

...

"We show that employment growth has been fairly uniform across most clinical occupations. The exception is a new category known as midlevels, which includes physician assistants and nurse practitioners. This category—which was too small to be consistently measured prior to 2010—has more than doubled since 2010, growing from 227,000 to 505,000 workers. As of 2022, there were more midlevels than primary care physicians, and midlevels provided more than half of primary care services in the U.S. (HRSA, 2023).

"This healthcare employment growth was accompanied by strong earnings growth, especially for nurses and midlevels in the middle and upper-middle parts of the clinical occupational distribution. Specifically, earnings grew nearly twice as fast for healthcare workers as for non-healthcare workers from 1980 to 2022; during this window, average healthcare earnings rose from 4% below to over 14% above the average for non-healthcare workers. While the top percentile of the wage distribution has fared better outside of healthcare, healthcare wages have grown faster for the rest of the distribution, and are particularly strong between the middle and the 95th percentiles. Indeed, with strong employment growth and earnings growth that outpaced the rest of the economy outside the very top, it is reasonable to conclude that healthcare has been a modern middle-class “jobs engine.”

 

 "The descriptive analysis in this paper offers three key findings about the rise of healthcare jobs: the relatively strong growth of earnings in the middle and upper-middle parts of the distribution, including for nurses and midlevels; the partial convergence in gender ratios across clinical occupations; and the scant evidence of a systematic manufacturing-to-meds transition, despite high-profile examples."

House panel launches antitrust probe of medical residency system

 What's old is new again, as questions about the market for doctors focuses on the Match (as opposed to accreditation of residencies by medical specialty boards, etc.)

Reuters has the story:

US House panel launches antitrust probe of medical residency system  By Mike Scarcella 

"March 17 (Reuters) - A U.S. congressional committee is investigating how medical students are placed in residency training programs, seeking documents from major university hospitals, the American Medical Association and other organizations as part of an antitrust probe.
The Republican leadership of the House Judiciary Committee’s antitrust panel sent the hospitals and groups letters on Friday saying they are investigating whether restrictions on hiring practices in the medical residency market suppress aspiring doctors' mobility and pay and contribute to doctor shortages."

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Earlier:

Monday, May 28, 2018

Protecting and Preserving Competition in Matching Markets--Antitrust and the Medical Match (video)

 My talk there begins with a description of the Match and its history, and I address antitrust starting right around minute 30.  (There's also a bonus video about how the Match would work at Harry Potter's Hogwarts...)

Match Day: new doctors can be eloquent

 Last Friday was Match Day, when medical students learn where they matched to a residency position.

Here's the story from Stanford:

Students open envelopes and learn their futures on Match Day
In concert with graduating medical students around the nation, members of Stanford School of Medicine’s Class of 2025 discovered where they’re spending the next leg of their training journey. 

"on the third Friday in March, all at the same time (noon on the East Coast), the medical students learn their fates.

This year, 81 Stanford Medicine graduates matched to residency programs in specialties ranging from psychiatry to ophthalmology to pediatrics. About 40% are staying at Stanford Health Care – a typical proportion.

...

"Basil Baccouche (who matched to internal medicine at Brigham and Women’s), chosen by his classmates to speak at the event, highlighted emotional moments during medical school.

“Medical school was the first time many of us saw the beginnings of life and the coming of death. The astonishing responsibility of caring for another person,” he said.

“I’ll never forget the first time I delivered a baby. Suddenly, there was one more of us in the room, and I began to cry.”

Digital DNA still needs to find a business model

 DNA information is digital, so for a while we seemed poised on a 'viral' bio-informatics revolution, which may still come.  23andMe looked like the start of the consumer side of that business, but people only need  to upload their data once, and the rest of the business didn't take off...

 The WSJ has the story:

23andMe Went From a $6 Billion Giant to Bankruptcy. Its Former CEO Won’t Walk Away.
Anne Wojcicki aims to buy the assets of her failed DNA-testing company after her prior bids were rejected   By Rolfe Winkle

"23andMe, once valued at $6 billion, has filed for bankruptcy after burning through $1 billion and laying off over half its staff.

"Former CEO Anne Wojcicki's ambitious plans to use 23andMe's genetic data for drug discovery and healthcare services failed to generate revenue.

"Despite her supervoting shares, Wojcicki's bids to buy back the company were rejected by two boards of directors."

...

"On Sunday night, the company filed for bankruptcy protection, its survival uncertain. Wojcicki immediately vowed to buy it back.

...

"With FDA support and a $99 price tag, the tests had mass-market appeal. As stories filtered out about people discovering lost siblings or parents, 23andMe went viral. 

...

"People only need to take, and pay for, one DNA test."

A government of yes men

Apparently KSA is afflicted with a government of yes men catering to a prince. (Fortunately that could never happen here...)

The WSJ has the story. (The headline and subhead are sufficient):

What Went Wrong at Saudi Arabia’s Futuristic Metropolis in the Desert
Neom executives shielded the crown prince from the challenges of his fantastical plans, including by engaging in ​‘deliberate manipulation​’ of financials, an internal report​ ​found .   By  Eliot Brown and Rory Jones
 

 

Cannabis, NYC style (2025)

 Here's a modern view from Times Square. (Note the warning and font size in yellow at the bottom of the sign...)

 

 

Scalping driver's license appointments in Miami

 Queue parasites...

In Miami, Scalpers Had the Hot Tickets … to Driver’s License Appointments
The tax collector’s office in Miami-Dade County, Fla., said it uncovered scalpers using the free online-appointment system to book slots and resell them for $25 to $250. 

"The county tax collector’s office announced on Monday that it had “uncovered a network of appointment scalpers” benefiting from access to motor vehicles offices by “hoarding free appointments and reselling them for a profit.”

“We know who they are and how they operate,” Dariel Fernandez, the Miami-Dade tax collector, said in a statement. “We will not accept any appointment obtained through system abuse.”

"The scalpers found so far have not been punished, because the practice was not illegal, but there is already an effort to change that and make it a civil offense.

...

"The suspicious activity in Miami-Dade was discovered this year after the tax collector’s office began to take the processing of driver’s licenses from the Florida Department of Highway Safety and Motor Vehicles, as had been approved under a constitutional amendment. During the transition, new software and security protocols were adopted in at least two locations in Miami."

Atul Gawande on the destruction of USAID

 Here's an interview with Atul Gawande, about the destruction of USAID.  The latter part of the url says it succinctly: https://www.newyorker.com/podcast/the-new-yorker-radio-hour/atul-gawande-on-elon-musks-surgery-with-a-chainsaw

Hundreds of Thousands Will Die
The writer, surgeon, and former U.S.A.I.D. senior official Atul Gawande on the Trump Administration’s decimation of foreign aid and the consequences around the world.
By David Remnick 

"A lot of people are going to die as a result of this. Am I wrong?

"The internal estimates are that more than a hundred and sixty thousand people will die from malaria per year, from the abandonment of these programs, if they’re not restored. We’re talking about twenty million people dependent on H.I.V. medicines—and you have to calculate how many you think will get back on, and how many will die in a year. But you’re talking hundreds of thousands in Year One at a minimum. But then on immunization side, you’re talking about more than a million estimated deaths."

Market design comes to the "new new economic sociology" (and vice versa)

 In the Journal of Cultural Economy, sociologists reflect on their involvement with engineers in a project to integrate wind-generated electricity in Denmark.

Ossandón, J., & Pallesen, T. (2025). The new new economic sociology – the market intervention test. Journal of Cultural Economy, 1–21. https://doi.org/10.1080/17530350.2025.2451252 

 

ABSTRACT: "This paper explores what happens when the ‘new new economic sociology’ – the figure created with Callon’s importation of ANT to the study of markets – intervenes in market interventions. Empirically, the paper examines a situation in which a researcher moves out of her habitual position of studying economists and engineers doing markets, to instead take part in an effort of engineering a market. The paper has two contributions. One is analytical. We propose a framework to inspect that special constrained situation in which the new new economic sociology coexists with market design. The second contribution is more practical. We hope what we propose in this paper, will help others in a similar situation to understand the particular direction of their intervention. "

Lise Vesterlund is celebrated at the Copenhagen Business School

 Here's the announcemnt; the ceremony is tomorrow.

They reveal hidden structures in the economy and job market: Lise Vesterlund and Mariana Mazzucato appointed honorary doctors at CBS.

"On Friday 21 March, two of the world’s most influential economists and research pioneers will be appointed honorary doctors at CBS. Join us for open lectures where they share their insights into gender equality, economic value creation and the invisible structures shaping the job market."

 "How can we create a fairer workplace where top talent is promoted, and women’s careers are not held back by invisible burdens? This is the question that Professor Lise Vesterlund, co-author of the critically acclaimed book The No Club: Putting a Stop to Women’s Dead-End Work, has dedicated her research to. She is now being appointed honorary doctor at Copenhagen Business School, and in her open lecture she will explore the invisible structures at play and the issue of gender equality in the workplace."

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Bonus picture, from (I think) an early workshop for The Handbook  Experimental Economics vol. 2:

Low back pain: meta-analysis

 The NYT has the story:

What Works for Low Back Pain? Not Much, a New Study Says
Researchers looked at 56 treatments for acute and chronic pain. Few of them were effective. By Nina Agrawal

"Acetaminophen. Acupuncture. Massage. Muscle relaxants. Cannabinoids. Opioids. The list of available treatments for low back pain goes on and on. But there’s not good evidence that these treatments actually reduce the pain, according to a new study that summarized the results of hundreds of randomized trials.

Low back pain affects an estimated one in four American adults and is the leading contributor to disability globally. In most diagnosed cases, the pain is considered “nonspecific,” meaning it doesn’t have a clear cause. That’s also partly what makes it so hard to treat.

In the study, published on Tuesday in the journal BMJ Evidence-Based Medicine, researchers reviewed 301 randomized trials that compared 56 noninvasive treatments for low back pain, like medications and exercise, with placebos. 

...

The researchers found that only one treatment — the use of nonsteroidal anti-inflammatory drugs, or NSAIDs, like ibuprofen and aspirin — was effective at reducing short-term, or acute, low back pain. Five other treatments had good enough evidence to be considered effective at reducing chronic low back pain. These were exercise; spinal manipulation, like you might receive from a chiropractor; taping the lower back; antidepressants; and the application of a cream that creates a warming sensation. Even so, the benefit was small.


“The big takeaways from this paper are that low back pain is exceptionally difficult to treat,” said Steve Davidson, the associate director of the N.Y.U. Pain Research Center, who was not involved in the study. “There are a few treatments that they found that were effective, but those that were effective are marginally clinically effective.”

Drone warfare in Ukraine (beating plowshares into swords...)

 The WSJ has the story

All-Robot Assault Opens New Chapter in Front-Line Warfare.  Ukraine’s drone-only attack was the first of its kind and is set to carve a path for more fully automated warfare  By  Alistair MacDonald and Ievgeniia Sivorka 

"When working on land drones, Kopach, who was set to begin a doctorate program in math at a U.S. university before the war broke out, studied the rover NASA used on Mars, with a particular focus on its wheels."

Making America contagious again: Measles

 Nature has the story:

Will RFK Jr’s vaccine agenda make America contagious again?
Fears are rising that infectious diseases such as measle pbtycould make a comeback now that the anti-vaccine advocate is in charge of the US public-health system.  By Heidi Ledford

"Measles was declared eliminated from the United States in 2000, but sporadic outbreaks still occur when unvaccinated travellers bring the virus in from abroad. This year’s outbreak has proved deadly: in February, an unvaccinated and otherwise healthy six-year-old in Texas became the first person in a decade to die from measles in the United States. Officials are evaluating another possible measles death in New Mexico.

"At least 95% of a population must be vaccinated against measles to achieve herd immunity, whereby enough of a population is immune that a disease will not spread. In the United States, the level dropped just below that, to 93% during the COVID-19 pandemic, and has yet to recover. Measles is one of the most infectious human diseases, meaning that even a slight dip in vaccine coverage can make a big difference, says Ashley Gromis, a social epidemiologist at the RAND Corporation, a think tank in Santa Monica, California.

"The 95% vaccination goal also assumes that unvaccinated individuals are evenly distributed throughout the population, she says. In practice, that is rarely the case. In Texas, about 94% of children entering kindergarten are vaccinated against measles. But in the region where the current outbreak began, only 82% are. “These pockets in which you have lots of susceptible individuals helps disease start circulating,” says Gromis.

Such numbers mean the United States is now “dangerously close” to losing ‘elimination’ status for measles, says Margaret Doll, an epidemiologist at Albany College of Pharmacy and Health Sciences in New York. Given that prospect, it is particularly important for public-health officials to promote vaccines, she says. “You would like that message to be supported by our leading health authorities.”

...

"For Gardner, the turmoil surrounding childhood vaccines is reminiscent of the politicization that crept into COVID-19 vaccine discussions during the pandemic. “It’s really discouraging to see that happening again,” she says."

##########

And this from MedPage Today:

RFK Jr. Falsely Claims Measles Vax Causes Deaths 'Every Year'
— Vaccine expert debunks recent statements from nation's top health official by Greg Laub,  March 14, 2025 

A Canadian MAID doctor recalls her first time

 Yesterday's post was about medical aid in dying (MAID) in Switzerland, and the decision of a courageous scientist.  Below are some excerpts from a story in the Guardian about how MAID looks from a Canadian doctor's point of view.

‘We’re going to talk about death today – your death’: a doctor on what it’s like to end a life rather than extend one.  I used to focus on maternity and newborn care, but when Canada legalised assisted dying in 2016, I began helping people with a different transition  By Dr Stefanie Green 

"I get down to the essentials. “Why do you want to die?”

"Harvey smirks. “I don’t! I’d rather live. I’ve had a great life. But it seems I no longer have much say in the matter.”

...

“I’ve got great friends, great kids, we’re blessed with family all around us. I know I’m lucky. I’ve been married to this gal here for 52 years … ” He trails off, holds Norma’s hand, shakes it at me a bit and swallows some emotion before continuing. “I really wanted to make it to 52 years, and I did.” He’s quieter now, his energy already drained. “Now I’m ready.”

"Harvey is straightforward with me. He knows he is dying, that it will not be long, but he wants to control the how and the when.

“I want Norma and the kids with me at the end,” he says with a flash of spirit, “here, in my home, in my own bedroom … I want to do it my way. I want to have my friends over this weekend, have one last bash, maybe even sneak a sip of a beer.” He smiles at the thought. “I’ve seen friends linger on at the end … in bed … out of their minds. I’m not interested in putting myself or my family through that.”

"Harvey ticks every box of eligibility. He is capable of making his own decisions, he is making a voluntary request, and he has a grievous and irremediable condition. He will need to sign an official request form, and Norma assures me it will be completed by the end of the day, witnessed by two independent people. After that, a mandatory 10-day reflective period can begin. The law also requires a second clinical opinion, so I will call a local colleague to see if he is available.

"The next few days are busy. As is expected with his liver failure, Harvey continues to decline cognitively. If he declines too much, too quickly, he won’t be able to give his final consent immediately before the procedure, which is required. Because the second doctor and I agree this risk is imminent, we are allowed to shorten the waiting period. Harvey chooses a date three days out."

Danny Kahneman's final decision

Danny Kahneman spent his life thinking about how humans make decisions.  His final decision was to travel to Switzerland to avail himself of the medical aid in dying laws there. (A number of American states permit medical aid in dying, but only for those who have been diagnosed as very near death.)  Danny chose to depart on his own schedule.

 The WSJ has the story:

The Last Decision by the World’s Leading Thinker on Decisions
Shortly before Daniel Kahneman died last March, he emailed friends a message: He was choosing to end his own life in Switzerland. Some are still struggling with his choice.  By Jason Zweig, March 14, 2025 

"In mid-March 2024, Daniel Kahneman flew from New York to Paris with his partner, Barbara Tversky, to unite with his daughter and her family. They spent days walking around the city, going to museums and the ballet, and savoring soufflés and chocolate mousse. Around March 22, Kahneman, who had turned 90 that month, also started emailing a personal message to several dozen of the people he was closest to.

“On March 26, Kahneman left his family and flew to Switzerland. His email explained why:

“This is a goodbye letter I am sending friends to tell them that I am on my way to Switzerland, where my life will end on March 27.”

###########

I wasn't among the recipients of Danny's email, but I am not surprised.  Here is my blog post from a year ago, noting his passing:

Wednesday, March 27, 2024 Danny Kahneman (1934-2024)

"His death was confirmed by his stepdaughter Deborah Treisman, the fiction editor for the New Yorker. She did not say where or how he died."

Lawfare and market design: New legal standard for medical malpractice

 In the U.S. at least, a not insignificant part of medical practice (sometimes called "defensive medicine") is shaped and enforced by medical malpractice suits. The American Law Institute has formulated new guidelines for such suits.

Aaron DG, Robertson CT, King LP, Sage WM. A New Legal Standard for Medical Malpractice. JAMA. Published online February 26, 2025. doi:10.1001/jama.2025.0097 

"Abstract
Importance  Patients in the US have persistent needs for safe, evidence-based care. Physicians in the US report fear of liability risk and the need to practice “defensive medicine.” In 2024, the American Law Institute revised the legal standard for assessing medical negligence. Understanding the implications of this change is crucial for balancing patient safety, physician autonomy, and the legal system’s role in health care.

Observations  The updated standard from the American Law Institute shifts away from the traditional reliance on customary practice toward a more patient-centered concept of reasonable medical care. Although this revised standard still includes elements of prevailing medical practice, it defines reasonable care as the skill and knowledge regarded as competent among similar medical clinicians under comparable circumstances and acknowledges that, in some cases, juries can override customary practices if they fall short of contemporary standards. The restatement also embraces evidence-based practice guidelines, while leaving questions open about the variations in the quality of those guidelines. The restatement makes additional recommendations regarding informed consent and other aspects of physician-patient communication.

Conclusions and Relevance  The new standard of care from the American Law Institute represents a shift away from strict reliance on medical custom and invites courts to incorporate evidence-based medicine into malpractice law. Although states may adopt the recommendations from the American Law Institute at different times and to varying degrees, the restatement offers health professionals and the organizations in which they practice an opportunity to reconsider how medical negligence will be assessed, and to focus more directly on promoting patient safety and improving care delivery. Nonetheless, physicians should recognize that, at least for now, many courts will continue to rely significantly on prevailing practice in assessing medical liability."

 ...

"The restatement from the ALI centers medical negligence on reasonable care rather than on customary care. It reads: “The standard of reasonable medical care is the care, skill, and knowledge regarded as competent among similar medical providers in the same or similar circumstances.”27 The restatement reassures physicians that its competency-based standard of reasonableness does not require above average or even average care. The comments accompanying the restatement observe that “those who have less than median or average skill may still be competent and qualified.”28 In other words, medical care need only be acceptable (above a minimum floor) to meet the standard.

"The restatement lists circumstances that may be relevant in determining reasonable medical care, including “the state of medical knowledge and the treatment options available at the time,” with the commentary acknowledging the importance of “prevailing professional practices” (ie, custom).29 The restatement takes account of the “resources available to the provider in the particular location or practice setting” in assessing the reasonableness of care, but it no longer factors in deference to the practice habits of physicians within any given locality or community.27

"Physicians have, at times, been slow to adapt to changes in medical science, relying instead on habits from their own, possibly decades-old training, which may reproduce structural inequities.30,31 Much of what is learned in medical school and training will change during practice.32 Examples include (1) cardiac stenting may be no better than medical management for stable coronary artery disease,33 (2) use of low-dose aspirin to prevent cardiac arrest may be harmful for many patients,34 (3) many older adults are prescribed medications on the Beers list that may harm their health,35 (4) many cancer treatments do not serve patient interests,36,37 and (5) opioids are far riskier than commonly believed 20 years ago.38,39 Although the restatement from the ALI will allow physicians to point to “prevailing professional practices,”29 it will also allow injured plaintiffs to point to the best scientific evidence and argue that a reasonable physician would have practiced accordingly. "

 

Colombia proposes coca leaf legalization

 The Guardian has the story:

Colombia urges UN to remove coca leaf from harmful substances list
Foreign minister says legalisation of main ingredient of cocaine the only way to stop drug trafficking and violence  Agence France-Press in Vienna
 
"Colombia, whose president, Gustavo Petro, is a vocal critic of the US-led war on drugs, has urged the UN to remove coca – the main ingredient in cocaine – from a list of harmful substances.

Used not only for cocaine, the coca leaf is also chewed as a stimulant in countries such as Colombia, Peru, Bolivia and Ecuador, or brewed into a tea thought to combat altitude sickness.

"Colombian foreign minister Laura Sarabia, in an address to the UN’s commission on narcotic drugs in Vienna, insisted on Monday that the leaf “is itself not harmful to health”.

"Removing it from a 1961 UN list of harmful narcotics, where it sits alongside cocaine and heroin, would allow it to be used to “its full potential in industrial applications such as fertilisers and beverages,” she said.

"She argued that legalisation was the only way to stop drug traffickers monopolising the plant – forcing rural communities to grow it for them, and razing forests for its cultivation.
...
Colombia is the world’s main producer of cocaine – much of its production in the hands of drug cartels and violent guerrilla groups.

In 2023, the South American country set a new record last year for coca leaf cultivation and cocaine production, which rose 53% from 1,738 tonnes (1,915 US tons) to 2,600 tonnes, according to the UN.

The United States is the biggest cocaine consumer.

...

“If you want peace, you have to dismantle the business (of drug trafficking),” he said during a government meeting. “It could easily be dismantled if they legalise cocaine in the world. It would be sold like wine.”

"Sarabia on Monday insisted that changing the approach from a punitive one towards a more humanitarian one did not imply “normalising or coexisting with drug trafficking”.

Nicotine underlip: Zyn, snu to manage (and start) nicotine addiction

Move over vapes: more ways to access nicotine without starting a fire: (I understand these are quite popular among our MBA students...)

  The New Yorker has the story:

Zyn and the New Nicotine Gold Rush. White snus pouches were designed to help Swedish women quit cigarettes. They’ve become a staple for American dudes. By Carrie Battan  March 10, 2025 

"In November, 2024, Sweden was declared “smoke-free” because its adult smoking rate had dipped below five per cent. As smoking has declined, so have related illnesses, such as emphysema; Sweden has one of the lowest rates of lung cancer in the E.U. This shift is broadly described in academic papers as “the Swedish Experience.”

"And yet the Swedes have an immense appetite for nicotine, the addictive chemical found in tobacco. About a third of Swedish people consume nicotine, and they mostly get their fix from snus—small, gossamer pouches that look like dollhouse pillows, which users nestle in their gums. Snus pouches deliver nicotine to the bloodstream through sensitive oral membranes; Swedes refer to the resulting buzz as the nicokick.

...

"Scandinavians have a proud history of snus usage. During the mid-seventeenth century, ground-up sniffing tobacco became popular in the French royal court and made its way to Sweden. Later, working-class Swedes started adding liquid to the powder and placing it against their gums, as a claylike paste. The preportioned pouches that are common today were introduced in the nineteen-seventies, as more people turned to snus in order to stop smoking. In the early nineteen-nineties, when Sweden held a referendum on whether to join the E.U., which had a bloc-wide snus ban, voters adorned their cars with bumper stickers that read, “E.U.? Not without my snus.” Ultimately, Sweden was granted an exemption from the ban in exchange for stricter warning labels.

...

"Until recently, the word “snus” referred solely to a pungent product made of tobacco leaves. But, over the past decade, the earthy brown substance has been joined by white snus, a new product with a characteristically Swedish design elegance. White snus, which consists of pure nicotine mixed with filling agents, has little natural odor and does not stain the teeth the way that the traditional kind can. It was developed by Swedish scientists to appeal to women, a constituency that hadn’t historically taken to brown snus. The creators also had ambitions to eventually reach Americans.

...

"In 2019, after five years of selling in select shops, mostly in the Southwest and Pacific Northwest, Swedish Match took Zyn national. Three years later, sales of nicotine pouches had increased by six hundred and forty-one per cent, and Philip Morris acquired the company for sixteen billion dollars. By this point, Zyn was a mainstay for a growing variety of users: purple-state early adopters, hockey and baseball players, Wall Street guys, medical students, truck drivers, and anyone who could use a quick jolt.

...

"Nicotine can have cardiovascular effects, including heightened blood pressure, heart rate, and cholesterol. Some pouch users complain of mouth lesions from long-term use. Yet more figures in addiction research are acknowledging the importance of smokeless tobacco products in the fight against cigarettes. In a recent interview, Ann McNeill, a pioneering scholar of tobacco addiction, said she’d started to see the benefit of adopting a harm-reduction approach—getting people to trade one dangerous habit for another, significantly less dangerous one. 

...

"Today’s nicotine entrepreneurs cite Juul as both an inspiration and a cautionary tale; the product’s appeal was so broad that teen-agers flocked to it. When the 2024 National Youth Tobacco Survey was published, Coogan and others in the industry were relieved: the rate of underage pouch usage had remained relatively low, at 1.8 per cent. Because of the Juul debacle, Zyn flavors in the U.S. are restricted to mint, coffee, cinnamon, and citrus varieties. "

Technology and the health care labor force--perfusionists

 The evolving health care labor force provides a window on technology and employment.  There are now a substantial number of clinical perfusionists, who are health care workers who operate heart-lung machines during open heart surgery.  In fact, there are now calls for a centralized clearinghouse for their training programs.

 Johnson, Blaine. "The feasibility of a national matching service for perfusion education program applicants." The Journal of ExtraCorporeal Technology 57, no. 1 (2025): 53-55. 

"Abstract: The perfusion profession is experiencing rapid advancement, creating an array of new opportunities for professional growth and educational expansion. However, this increase in demand is juxtaposed with a concerning limitation in the availability of positions for prospective students and may leave many qualified applicants without admission. This letter explores how implementing a national matching service alongside a centralized application service could streamline the application process for perfusion education programs in the United States. Over the last two decades, the number of available positions in perfusion education programs has surged significantly. This growth presents new challenges in recruitment due to varying requirements and timelines, often resulting in unstable matches. A national matching service could standardize acceptances, mitigate unfair practices, and enhance applicants’ and program decision-making. By ensuring a fair and efficient system, the national matching service could support the growing need for qualified healthcare perfusionists and promote the perfusion profession’s advancement."

Immigration policy and the U.S. health care labor force (David Cutler in JAMA Health)

 Many American health care workers are immigrants, so a reduction in immigration is likely to have consequences for health care.

Trump’s Most Important Health Policy May Be at the Border  by David M. Cutler, JAMA Health Forum. 2025 doi:10.1001/jamahealthforum.2025.0617 

"Immigrants comprise a large segment of health care employment. According to labor market data, roughly one-quarter of practicing physicians are non–US born, as are 16% of registered nurses. Immigrants account for an even larger share of employment among low-wage health care workers, including 40% of home health aides, 28% of personal care aides, and 21% of nursing assistants. The immigrant share of these occupations has been increasing over time because US-born individuals are less likely to do these jobs at the current rates of pay.

...

"It is not known what percentage of the non–US-born health care workforce is undocumented. However, 2022 data from the Pew Research Center estimates that, overall, 23% of immigrants (11 million people) in the US are unauthorized. If that same proportion applies to health care workers (such as those in home health care and nursing homes), it implies that roughly 5% of health care support workers are unauthorized immigrants (23% are non–US born and 23% might be unauthorized).

"Thus, one might anticipate a reduction in the health care support labor force of roughly 5%.

...

"A 5% or greater reduction in low-wage health care workers would be massive. To give a sense of what this might mean, employment in nursing homes and residential care facilities is already about 5% below what would have been expected given growth rates before the COVID-19 pandemic. That employment reduction led to backlogs in hospitals during COVID-19 because patients were not able to be discharged to long-term care facilities. Adding a further reduction in postacute care capacity might create backlogs similar to the COVID-19 levels or perhaps even farther.

...

"The immigration enforcement actions of the Trump administration overall may be critical for health care in the next few years. Health care professionals and organizations will need to monitor these effects carefully, looking at policies far beyond the traditional boundaries of medicine."