FDA Proposes Reducing Nicotine to Nonaddictive Level in Cigarettes: I see 5 possible futures

 Here's the FDA press release:

FDA Proposes Significant Step Toward Reducing Nicotine to Minimally or Nonaddictive Level in Cigarettes and Certain Other Combusted Tobacco Products
Agency Encourages Public Input on Proposal That Aims to Prevent Millions of Premature Deaths 

 " the U.S. Food and Drug Administration issued a proposed rule that, if finalized, would make cigarettes and certain other combusted tobacco products minimally or nonaddictive by limiting the level of nicotine in those products. If finalized, the United States would be the first country globally to take such a bold, life-saving action to prevent and reduce smoking-related disease and death. The FDA first announced its intent to propose such a ruleExternal Link Disclaimer in 2018, and today’s announcement is an important next step in the rulemaking processExternal Link Disclaimer. The agency intends to seek input on the proposal, including through public comment and the FDA’s Tobacco Products Scientific Advisory Committee"

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Here are some predictions of possible outcomes of this proposal.

1. (p>.5) No new regulation: We soon see Trump-branded, musk-flavored high-nicotine cigarettes.  (no lives saved)

Conditional on the proposals being enacted (i.e. p<.5)

2.  Cigarette makers find workarounds (nicotine supplements you can add to your smokes, new organic chemicals functionally equivalent to nicotine, etc. (few lives saved)

3. Black markets emerge: get your full-nicotine cigarettes at the same time you get your Mexican coca cola made with sugar instead of corn syrup. (some lives saved)

4. Smokers switch to non-combustables: Big Tobacco becomes Big vaping, chewing, and under-lip snus, snuff, and oral nicotine pouches. (maybe significant lives saved, but no decrease in nicotine addiction, and maybe substantial increase. Lung cancer down, oral cancers up.)

5. (low probability but we can hope): Smokers quit, and few young people start to smoke: tobacco use drops so low that deaths attributable to smoking drop below those attributable to alcohol or opioids.

Stanford celebrates Daron Acemoglu with the 2025 Sage-CASBS Award

 Stanford's Center for Advanced Studies in the Behavioral Sciences announces:

Daron Acemoglu Wins 2025 Sage-CASBS Award

"Sage and the Center for Advanced Study in the Behavioral Sciences (CASBS) at Stanford University are pleased to announce Daron Acemoglu as winner of the 2025 Sage-CASBS Award. 

He will deliver a public award lecture at the Center for Advanced Study in the Behavioral Sciences on April 24, 2025.

...

"Established in 2013, the Sage-CASBS Award recognizes outstanding achievement in the behavioral and social sciences that advances our understanding of pressing social issues. The award underscores the role of the social and behavioral sciences in enriching and enhancing public discourse and good governance. Past winners of the award include Daniel Kahneman, psychologist and Nobel laureate in economics; Pedro Noguera, Distinguished Professor of Education at the University of Southern California; Kenneth Prewitt, former director of the U.S. Census Bureau and the Carnegie Professor of Public Affairs, Emeritus at Columbia University; William Julius Wilson, the Lewis P. and Linda L. Geyser University Professor, Emeritus at Harvard University; Carol Dweck, the Lewis and Virginia Eaton Professor of Psychology at Stanford University; Jennifer Richeson, the Philip R. Allen Professor of Psychology at Yale University; Elizabeth Anderson, the John Dewey Distinguished University Professor of Philosophy and Women’s & Gender Studies at the University of Michigan; and Alondra Nelson, former acting director of the White House Office of Science and Technology Policy and the Harold F. Linder Chair and Professor of Social Science at the Institute for Advanced Study.

Why is achieving financial neutrality in organ donation so hard?

For some years now, many opponents of compensation for kidney donors have come to agree that at least donors should not have to bear large expenses to donate.  But it has been hard to operationalize this apparent agreement.

Here's a paper that (somewhat inadvertently) explains why.  They take the position that it is ethically allowable to compensate donors for out of pocket financial expenses, but ethically forbidden to do so in a way that might  sometime pay some donor for an expense  they might have incurred even if they hadn't donated. (So, for example, they forbid paying anything towards funeral expenses for deceased donors.)

This was a point of view that I encountered when I was on the advisory board of NLDAC, the federally funded U.S. agency that can pay some expenses for poor donors. Originally NLDAC issued special credit cards to donors who qualified, that could only be used for airfare, hotels, and restaurants, i.e. for travel and meals.  But some donors indicated that they preferred not to eat in restaurants, but to go to a supermarket and bring food back to eat in their hotel room.  NALDAC eventually decided that the special credit card could also be used for grocery stores, even though this meant that some donor might sometime buy a dozen apples, and bring the uneaten ones with them when they returned home, and thus have received some compensation in addition their travel expenses. (When I write it like that it seems that I must be exaggerating, but here's an article that argues that any inadvertent generosity to donors would cross a red line, and must therefore be avoided.)

Supporting Financial Neutrality in Donation of Organs, Cells, and Tissues, by Martin, Dominique E. PhD1; Capron, Alexander M. LLB2; Fadhil, Riadh A. S. MD3; Forsythe, John L. R. MD4; Padilla, Benita MD5; Pérez-Blanco, Alicia PhD6; Van Assche, Kristof PhD7; Bengochea, Milka MD8; Cervantes, Lilia MD9; Forsberg, Anna PhD10; Gracious, Noble MD11; Herson, Marisa R. PhD1; Kazancioğlu, Rümeyza MD12; Müller, Thomas PhD13; Noël, Luc MD14; Trias, Esteve MD15; López-Fraga, Marta PhD16,
Transplantation 109(1):p 48-59, January 2025. | DOI: 10.1097/TP.0000000000005197 

Abstract: "The avoidance of financial gain in the human body is an international ethical standard that underpins efforts to promote equity in donation and transplantation and to avoid the exploitation of vulnerable populations. The avoidance of financial loss due to donation of organs, tissues, and cells is also now recognized as an ethical imperative that fosters equity in donation and transplantation and supports the well-being of donors and their families. Nevertheless, there has been little progress in achieving financial neutrality in donations in most countries. We present here the findings of an international ethics working group convened in preparation for the 2023 Global Summit on Convergence in Transplantation, held in Santander, Spain, which was tasked with formulating recommendations for action to promote financial neutrality in donation. In particular, we discuss the potential difficulty of distinguishing interventions that address donation-related costs from those that may act as a financial incentive for donation, which may inhibit efforts to cover costs. We also outline some practical strategies to assist governments in designing, implementing, and evaluating policies and programs to support progress toward financial neutrality in donation."

" The principle of financial neutrality in donation states that donors of organs, cells, and tissues, or donor families, should neither lose nor gain financially as a result of donation.

...

"we explore concerns regarding the use of financial incentives for donation (see Box 1) and discuss potential difficulties in distinguishing legitimate coverage of costs from practices and policies that may provide financial incentives for donation and thus violate the prohibition of trade in SoHOs. We argue that anxiety regarding the use of financial incentives may, in some countries, deter or undermine efforts to remove financial disincentives from donations. 

...

"Efforts to address the costs of living kidney donation notably became a focus in North America in the wake of a decline in living donor rates in the mid-2000s, disproportionately impacting poorer populations.

...

" Like the removal of financial disincentives to donation, avoidance of financial incentives for donation is essential for achieving financial neutrality ... "Sustained efforts are thus needed to deter use of financial incentives and ensure that efforts to promote financial neutrality in donation do not create actual or perceived incentives

...

"Some proposals intended only to cover donation-related costs may inadvertently incentivize donations or result in inappropriate financial gains.

...

"After more than a decade of expressed support for the principle of financial neutrality in donation, it is time for policymakers in all countries to act in pursuit of the goal of financial neutrality."

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Earlier: Thursday, March 31, 2022  National Living Donor Assistance Center (NLDAC) support for lost wages and dependent care

Organ transplant ban by Taliban in Afghanistan (BBC)

 Afshin Nikzad forwards me this report from  the BBC Persian service (in Farsi, but automatically translated by Chrome):

Kidney transplant halted in Afghanistan  by Sajjad Mohammadi

"A number of private hospitals in Kabul and Herat told the BBC that the Taliban government has banned kidney transplants in Afghan hospitals for a month now.

"The Taliban government's Ministry of Encouraging Good and Forbidding Evil announced about a month ago that, according to the seventh paragraph of Article 18 of the ministry's law, the sale and use of human body parts such as kidneys, liver, eyes, and hair is prohibited.

"The ministry said: "The basis and purpose of this decision is to preserve human dignity and respect, and the human body has special sanctity, and its organs should not under any circumstances be used as a means of commercialization or profiteering."

Are private firefighters repugnant (in Los Angeles)?

 The SF Chronicle has the story:

Private firefighters protected a Hollywood talent manager’s home. Why are some people so mad?
By Matthias Gafni, Susie Neilson

"Leber is one of a growing number of Californians who, faced with the growing threat of wildfires in populated areas, have turned to private firefighting teams as an added layer of protection. Supporters of private firefighting teams argue they can augment the work of government-run efforts, stepping in to fill the cracks caused by depleted city and state budgets and an ever-worsening climate crisis.

"But not everyone is a fan of private firefighters, particularly those that contract directly with homeowners outside of insurance, like the company Leber hired. Critics contend that when wealthy individuals hire their own firefighters, they compete with public teams for precious resources such as water, and could potentially interfere with those teams’ efforts by, for example, blocking or crowding narrow access points.

"Moreover, they say, private firefighters widen the already-vast chasm between rich and poor, safeguarding the interests of the former at the expense of the latter.

"“The rich suffer zero consequences of anything, even cataclysmic natural disasters,” one user wrote on X, responding to a video the Chronicle posted showing private firefighters saving Leber’s house. “Private and firefighter should not be in the same sentence,” wrote another.

Joe Torres, CEO of All Risk Shield, thinks some of these criticisms are unfair — especially during major disasters like this one.

...

"He disputed the idea that private teams siphon water away from the public: His teams primarily bring their own to a site, or draw from homeowners’ pools."

Exceptional altruism: living organ donors who donate twice

 Some living donors are moved to do it twice: first a kidney, and then later a liver, or the other way around. It appears that this is trending upwards in the last few years.

 

Second Time Around: Increased Rate of Living Donation From Repeat Organ Donors  by Carolyn N Sidoti 1, Kelly Terlizzi 1, Conor Donnelly 1, Ian S Jaffe 2, Jennifer D Motter 1, Benjamin Philosophe 3, Reed T Jenkins 3, Sarah Hussain 3, Pedro Colon 2, Amit D Tevar 4, Bonnie E Lonze 1, Babak J Orandi 1 5, Macey L Levan 1, Dorry L Segev 1 6, Allan B Massie, Clin Transplant,  2025 Jan; 39(1):
 https://onlinelibrary.wiley.com/doi/10.1111/ctr.70049

"Abstract
Introduction: Some living organ donors will decide to donate again at a later date. Evidence has indicated that this practice may have increased in recent years. We evaluated the incidence and outcomes of this practice to inform counseling of potential repeat donors.

Methods: Using SRTR data from 1994 to 2023, we identified 220 repeat living donors and their 415 recipients. We constructed donor comparison groups using weighting by the odds. We described clinical and lab results at 6 months, 1 year, and 2 years post-donation separately for kidney-second donors and liver-second donors. We compared all-cause graft failure for their recipients with those of comparison donors.

Results: The annual count of repeat living donors increased from 5 in 2018 to 25 in 2019 (p < 0.001). Of 220 donors, 159 were liver-second donors (72.3%) and 55 were kidney-second donors (25.0). The percentage of nondirected donations increased from 30.5% at first donation to 53.2% at second donation (p < 0.001). Liver-second donors had one death approximately 2.5 years post-donation. Seventeen were re-admitted and 20 experienced complications requiring an interventional procedure or re-operation. Among kidney-second donors, no deaths, re-admissions, or post-donation complications were reported. Post-donation outcomes in both groups were comparable when evaluated against organ-specific comparison donors. Recipients of repeat living donors experienced graft survival similar to recipients of comparison donors.

Conclusions: Repeat living donation may be a safe practice for carefully selected living donors in the short term; however, long term safety is unknown. Outcomes for recipients are similar to recipients of comparison donors."

...

"The first reported instance of repeat living donation occurred in 1981 when a living kidney donor went on to donate a segment of their pancreas 2.3 years later [1].  

Signaling to decongest job applications and interviews: update on the market for medical residents

 Signaling for interviews is evolving in the market for new doctors, i.e. for medical residencies.  Some specialties are allowing a relatively small number of signals (as in Economics), while others are moving towards many signals, which are functioning as soft caps on the number of applications, since many residency programs in those specialties won't give an interview to someone who doesn't signal them.

Ozair, A., Hanson, J. T., Detchou, D. K., Blackwell, M. P., Jenkins, A., Tissot, M. I., Barrie, U., & McDermott, M.  W. (2024). Program Signaling and Geographic Preferences in the United States Residency Match for Neurosurgery. Cureus, 16(9), e69780. https://doi.org/10.7759/cureus.69780