Monday, December 9, 2024

Converting to Judaism in the Wake of October 7th, by Jeannie Suk Gersen in the New Yorker

 I was moved by this New Yorker article by Harvard law professor Jeannie Suk Gersen

Converting to Judaism in the Wake of October 7th
For decades, I maintained a status quo of living like a Jew without being one. When I finally pursued conversion, I discovered that I was part of a larger movement born of crisis.  By Jeannie Suk Gersen

"The Talmud says that a person who comes to a court to convert is to be questioned as to his motivation and asked, “Don’t you know that the Jewish people at the present time are anguished, suppressed, despised, and harassed, and hardships are frequently visited upon them?”

Sunday, December 8, 2024

The market for hitmen is thin

 The NYT has the story (but it isn't much of a story, the 'experts' don't know much...)

Was Brian Thompson’s Killer a Hit Man? Unlikely, Experts Say.
The murder of Brian Thompson did not appear to have been committed by a coldly calculating professional, according to people who study criminal behavior.   By Annie Correal

"None of this looks like the work of a professional, the experts said. (Assassinations occur but are usually ordered by governments or criminal groups like drug cartels, and rarely leave behind much evidence, they said.)"

Saturday, December 7, 2024

The market for kidneys is strong

 "For 2025, Bickell expects the market for kidneys to be very strong."

Alas, it's a story about kidney beans, from RealAgriculture.com:

Edible Bean School: Genetics and markets drive kidney bean opportunity 

 

Earlier related post: (different market, same joke)

Saturday, August 22, 2020 Organs for sale

 



 

Friday, December 6, 2024

Blood supply in West Africa

 Here are some thoughts on blood shortages in West Africa by Jappah and Tao. (Jappah has just returned from Sierra Leone...)

To meet demand, blood donation should not rely solely on volunteers
A misalignment between supply and demand especially hurts people in low-income nations.
by Jlateh Vincent Jappah and Ruoying (Carol) Tao, Harvard Public Health, December 4, 2024

"The World Health Organization advocates for 100 percent voluntary, non-remunerated blood donation—a position that was more defensible in the 1970s, before widespread screening for bloodborne diseases like hepatitis. Today, two-thirds of the world face shortages of blood and blood products, leading to many preventable deaths, especially among women and children. More than 80 percent of the world’s population has access to only 20 percent of the global blood supply. These global inequities in blood and blood product supplies are unacceptable.

"Africa, in particular, faces a disproportionate demand for blood and blood products. The continent relies heavily on family-based donation, which is not sustainable. Policies about blood supply in Africa, meanwhile, are generally based on research generated outside the continent—and in that research field, the idea of addressing blood shortages in Africa by providing adequate incentives and compensation to blood donors is met with skepticism.

"We are conducting research with nonprofit organizations such as Lifeline Nehemiah Projects and with government agencies in West Africa, and shortly we will begin field experiments, to study whether non-cash incentives increase blood donation.

...

"The misalignment between blood supply and demand is especially acute in low-income countries, where the demand for blood is high due to disease burdens, traumatic injuries, and medical conditions that require transfusions. Blood shortages in these regions are also driven by factors such as a higher prevalence of sickle cell anemia and bloodborne pathogens. And yet problems such as poor nutrition limit people’s ability to donate blood voluntarily.

...

"Blood donation should not rely solely on charity but also on empowering individuals and communities to meet their own needs. In Sierra Leone, for instance, humanitarian organizations provide food and transportation to blood banks, to encourage blood donations. These incentives have significantly increased donation rates, though blood banks sometimes struggle with supply shortages, such as blood bags and needles."


Jlateh Vincent Jappah is a physician and a Ph.D. candidate in health policy at Stanford University. He is a fellow at the McCoy Family Center for Ethics in Society at Stanford.

Ruoying (Carol) Tao
Ruoying (Carol) Tao is a Ph.D. student in health care management and economics at The Wharton School at the University of Pennsylvania. She previously worked in health care management consulting.

##########

Earlier:

Wednesday, August 28, 2024 WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood, by Krawiec and Roth

 

Thursday, December 5, 2024

Medical Treatments for Transgender Minors--Oral argument in Supreme Court

 Yesterday the Supreme Court heard oral arguments about the Tennessee ban on transgender treatment for minors.

Supreme Ct. Hears Case on Medical Treatments for Transgender Minors
"The Supreme Court heard oral argument in United States v. Skrmetti, a case on whether Tennessee’s ban on transgender medical treatments for minors violated the Equal Protection Clause of the 14th Amendment. Tennessee enacted its law in March of 2023, which stated that there was a “compelling interest” to protect minors from physical and emotional harm by banning health care providers from administering hormone/puberty blockers and surgery to minors for transgender purposes. Transgender minors and their families sued the state, and the Justice Department intervened on their behalf, arguing the law discriminated on the basis of sex. A district court then stopped the ban on hormone and puberty blockers, but the Sixth Circuit Court of Appeals reversed that decision. The Justice Department then appealed to the Supreme Court. Chase Strangio, who argued on behalf of trans minors and their parents, was the first openly transgender lawyer to argue before the Court. 

Opening statement (text compiled from uncorrected Closed Captioning):

"MR. CHIEF JUSTICE, AND MAY IT PLEASE THE COURT, THIS CASE IS ABOUT ACCESS TO MEDICATIONS THAT HAVE BEEN SAFELY PRESCRIBED FOR DECADES TO TREAT MANY CONDITIONS INCLUDING GENDER DYSPHORIA. BUT SB-1 SINGLES OUT AND BANS ONE PARTICULAR USE. IN TENNESSEE THESE MEDICATIONS CAN'T BE PRESCRIBED TO ALLOW A MINOR TO IDENTIFY WITH OR LIVE AS A GENDER INCONSISTENT WITH THE MINOR SEX. IT DOESN'T MATTER WHAT PARENTS DECIDE IS BEST FOR THEIR CHILDREN. IT DOESN'T MATTER WHAT PATIENTS WOULD CHOOSE FOR THEMSELVES, AND IT DOESN'T MATTER IF DOCTORS BELIEVE THIS TREATMENT IS ESSENTIAL FOR INDIVIDUAL PATIENTS. SB 1 CATEGORICALLY BANS TREATMENT WHEN AND ONLY WHEN IT'S INCONSISTENT WITH THE PATIENT'S BIRTH SEX. TENNESSEE SAYS THAT SWEEPING BAN IS JUSTIFIED TO PROTECT ADOLESCENT HEALTH, BUT THE STATE MAINLY ARGUES THAT IT HAD NO OBLIGATION TO JUSTIFY THE LAW AND THAT SB 1 SHOULD BE UPHELD SO LONG AS IT'S NOT WHOLLY IRRATIONAL. THAT'S WRONG. SB 1 REGULATES BY DRAWING SEX-BASED LINES AND DECLARES THAT THOSE LINES ARE DESIGNED TO ENCOURAGE MINORS TO APPRECIATE THEIR SEX. THE LAW RESTRICTS MEDICAL CARE ONLY WHEN PROVIDED TO INDUCE PHYSICAL EFFECTS INCONSISTENT WITH BIRTH SEX. SOMEONE ASSIGNED FEMALE AT BIRTH CAN'T RECEIVE MEDICATION TO LIVE AS A MALE, BUT SOMEONE ASSIGNED MALE CAN. IF YOU CHANGE THE INDIVIDUAL SEX, IT CHANGES THE RESULT. THAT'S A SEX CLASSIFICATION FULL STOP, AND A LAW LIKE THAT CAN'T STAND ON BARE RATIONALITY. HERE TENNESSEE MADE NO ATTEMPT TO TAILOR ITS LAW TO ITS STATED HEALTH CONCERNS. RATHER THAN IMPOSE MEASURED GUARDRAILS SB 1 BANS THE CARE OUTRIGHT NO MATTER HOW CRITICAL IT IS FOR AN INDIVIDUAL PATIENT. THAT IS A STARK DEPARTURE OF PEDIATRIC CARE IN ALL OTHER CONTEXT. SB 1 LEAVES THE SAME MEDICATIONS AND MANY OTHERS ENTIRELY UNRESTRICTED WHEN USED FOR ANY OTHER PURPOSE EVEN WHEN THOSE USES PREVENT SIMILAR RISKS. THE SIXTH CIRCUIT NEVER CONSIDERED WHETHER TENNESSEE COULD JUSTIFY THAT SEX-BASED LINE BECAUSE THE EQUAL PROTECTION CLAUSE REQUIRES MORE, THIS COURT SHOULD REMAND SO THAT SB 1 CAN BE UNDER THE CORRECT STANDARD. I WELCOME THE COURT'S QUESTIONS. 

########

HT: Kim Krawiec

 

Medpage Today summarized the hearings under this headline:

Supreme Court Appears Likely to Uphold Bans on Transgender Care for Minors
— Justices' decision is not expected for several months

Wednesday, December 4, 2024

Adultery is no longer a crime in New York State.

 Not only is jaywalking no longer a crime in New York City, the seldom-enforced criminal law against adultery in New York State has now been repealed. 

My sense is that the jaywalking ban was rolled back in part because it was inequitably enforced, while the ban on adultery was so rarely brought to trial that it was simply obsolete.

NPR has the story:

Adultery is no longer illegal in New York, By Ayana Archie 

"Adultery is no longer a crime in New York.

"Gov. Kathy Hochul on Friday signed off on repealing a 1907 law prohibiting the act.

"New York's penal law previously said that "a person is guilty of adultery when he engages in sexual intercourse with another person at a time when he has a living spouse, or the other person has a living spouse."

"It was considered a Class B misdemeanor, which carries a jail sentence of up to three months.

"The New York State Senate called the law "outdated."

#########

Interestingly, surveys indicate  both that most Americans disapprove of adultery, but that the frequency of adultery is quite high. So it's the law that is outdated, not the act.

Also interesting is that adultery is still forbidden under the Uniform Code of Military Justice.  This comes up in discussions about President Trump's nominee to be Secretary of Defense (where he will preside over servicemen and women who are forbidden to follow the examples of their Secretary and their Commander in Chief...)

Here's the NYT on that:

Pete Hegseth’s Mother Accused Her Son of Mistreating Women for Years  by Sharon LaFraniere and Julie Tate

"Reports of his infidelity have focused attention on his character and leadership, particularly for a civilian overseeing the military, where active-duty service members can be subject to prosecution for adultery under the Uniform Code of Military Justice."

Tuesday, December 3, 2024

Dating apps and the marriage market

 Dating apps may have peaked, at least in the UK, where younger users are at least thinking that they would like to find a match through in-person interaction (i.e. more like their grandparents than like many of their parents.)

Dating apps have been a boon not only for people trying to match up, but also for economists who are sometimes asked to explain to non-economists why we think of  "marriage markets."  I've often found that people who don't think marriage is a market nevertheless agree that dating apps are very market-like.

The Guardian has the story:

Gen Z is breaking up with dating apps,,, Tinder, Hinge, Bumble and Grindr have all seen dip in use since last year, by Dan Milmo

"The UK’s dating scene is swiping left on popular apps such as such as Tinder and Hinge as younger people turn to real-life ways of connecting with potential partners, according to the UK’s communications watchdog.


"Ofcom said the UK’s top four dating apps had seen a dip in use since 2023, with Tinder losing 600,000 users, Hinge shedding 131,000, Bumble declining by 368,000 and Grindr falling by 11,000.

"Ofcom said the overall number of adults visiting a dating service in May this year – nearly 5 million, or about one in 10 – was broadly in line with the same period in 2023, but the slight decline could be linked to the shifting dating habits of members of gen Z, the demographic cohort born between the mid-90s and 2010. 

...

"Tinder’s owner, Match Group, has admitted issues with attracting a younger audience, saying in January that its leading app would be focusing on “shaping an in-app experience that resonates better with today’s younger users”. It said gen Z users were seeking “a lower-pressure, more authentic way to find connections”.


"Ofcom also found that dating services still had the biggest reach in younger adult age groups, reaching 18% of 18- to 24-year-olds and a similar proportion of 25- to 34-year-olds. It said two gay dating apps, Sniffies and Scruff, had entered the top 10 most popular dating apps."

########

I'm  pretty confident that dating apps will be with us for quite some time, some of which will introduce new matchmaking tools to frustrate and entertain and even match these young folks.

Monday, December 2, 2024

IVF mistakes that would have confounded King Solomon

 IVF helps many people welcome children into their families, but also makes possible mistakes that would have confounded King Solomon.

Haaretz has the story:

Israeli Court Orders Birth Mother to Give Toddler to Biological Parents After IVF Mix-up by Chen Maanit
"A woman in her third trimester of pregnancy discovered that she had been implanted with the wrong embryo two years ago. An Israeli judge has ruled that the toddler, now two years old, be raised by her biological parents."  

 

HT: Itai Ashlagi 

*******

And another, on this side of the ocean, from the NYT:

An I.V.F. Mix-Up, a Shocking Discovery and an Unbearable Choice
Two couples in California discovered they were raising each other’s genetic children. Should they switch their girls?   By Susan Dominus

"Wolf believes that the public becomes aware of only a fraction of the errors that occur in fertility-clinic labs. In ZoĆ« and May’s cases, as in the case of the twins carried by the Korean American woman in New York, the mistake was apparent because the children were a different race from the birth parents. In most instances, parents who accept and bond with their baby may never suspect something is wrong. Even when discovered, such mistakes rarely make the news. “Most of my cases you never hear about, because we settle them before we file lawsuits,” Wolf said. “And the settlement agreements have confidentiality agreements, because the clinics want to ensure that there will be no negative publicity as a result of its error.”

"I.V.F. procedures are underregulated relative to most medical procedures, says Dov Fox, a law professor at the University of San Diego with a focus on bioethics. States do not mandate that fertility clinics report preventable and damaging mistakes when they happen, as is required of hospitals. Some emblematic problems, Fox told me, included clinics or labs relying on pen-and-paper labeling systems and faulty screening measures; Wolf cited a failure of clinic employees to respond to alarms on the freezers that store embryos. “I sometimes think of our lawsuits as the policing of the fertility industry,” Wolf said, “because nobody else is holding them accountable.”

"Now heavily dominated by private equity, the industry is rife with for-profit, high-volume fertility clinics operating in a regulatory dead zone. Oversight of fertility clinics has been limited, Fox said, because of the challenges it poses politically: Although many conservatives would like to impose restrictions, including limiting the number of embryos a lab can create, they have historically not wanted to jeopardize efforts to restrict abortion by also attacking I.V.F., which is broadly popular. Many Democrats, meanwhile, have been reluctant to regulate the industry for fear of opening the door to restrictions that might, for example, limit who is eligible for I.V.F. (as in some countries, where gay couples are excluded). Fox expects that the overturning of Roe v. Wade will lead to new scrutiny of I.V.F., which might ultimately threaten its wide availability."

Sunday, December 1, 2024

Workers' rights for sex workers in Belgium

 Sex work isn't merely legal in Belgium, it's now recognized as work.

The BBC has the story:

 Belgium's sex workers get maternity leave and pensions under world-first law by Sofia Bettiza

"Under a new law in Belgium - the first of its kind in the world ... Sex workers will be entitled to official employment contracts, health insurance, pensions, maternity leave and sick days. Essentially, it will be treated like any other job.

...

“There are tens of millions of sex workers worldwide. Sex work was decriminalised in Belgium in 2022 and is legal in several countries including Germany, Greece, the Netherlands and Turkey. But establishing employment rights and contracts is a global first.

“This is radical, and it’s the best step we have seen anywhere in the world so far,” says Erin Kilbride, a researcher at Human Rights Watch. “We need every country to be moving in that direction.” 

...

"Pimps who control sex work will be allowed to operate legally under the new law - provided they follow strict rules. Anyone who has been convicted of a serious crime will not be allowed to employ sex workers.

...

"Under Belgium’s new law, each room where sexual services take place must be equipped with an alarm button that will connect a sex worker with their “reference person”.

"But Julia believes there is no way to make sex work safe.

“In what other job would you need a panic button? It’s not the oldest profession in the world, it’s the oldest exploitation in the world.”

"How to regulate the sex industry remains a divisive issue globally. But for Mel, bringing it out of the shadows can only help women. "


UTSOPI A line of five people holding a black banner, with their other hand in the air as part of a protest - there are many people behind them, in a city street. The banner is for the Belgian Union for Sex Workers (UTSOPI).

HT: Vincent Jappah

Saturday, November 30, 2024

Britain moves towards legalizing medical aid in dying

 The Guardian has the story:

MPs vote for bill to legalise assisted dying in England and Wales
Terminally ill adults with less than six months to live will be given right to die under proposed legislation,
by Jessica Elgot, Eleni Courea and Rowena Mason 

"MPs have taken a historic step toward legalising assisted dying in England and Wales after backing a bill that would give some terminally ill people the right to end their lives.

"The Commons backed the bill by 330 votes in favour to 275 against, a majority of 55. Keir Starmer and Rachel Reeves both voted in favour, Labour MPs told the Guardian.

"The private member’s bill, brought by the Labour MP Kim Leadbeater, gives terminally ill adults with less than six months to live the right to die once the request has been signed off by two doctors and a high court judge.

"The change is unlikely to occur for three years as the bill must pass several more hurdles in parliament and will not be brought before MPs again until April. The government is likely to assign a minister to help work on the bill, without formally giving its support.

...

" Peter Prinsley, a Labour MP and surgeon, said he had changed his mind over his years in medicine after witnessing the “terrifying loss of dignity and control in the last days of life”.

“When I was a young doctor I thought it unconscionable. But now I’m an old doctor and I feel sure it’s the right change. I have seen uncontrollable pain, choking, and I’m sorry to say the frightful sight of a man bleeding to death whilst conscious as a cancer has eaten away at a carotid artery.”

"Opponents of the bill said it would fundamentally change the relationship between the state and its citizens, and between doctors and patients. They argued the bill was rushed and the safeguards for vulnerable people were insufficient."

##########

Earlier:

October 15, 2024 Medical aid in dying comes up for a vote in England

Friday, November 29, 2024

Cheating on exams in India , and exam design suggestions from Spain

 India, where government jobs are allocated based on scores on a variety of national exams, cheating is a big business. One form it takes is sale of upcoming exam questions. 

An experiment conducted in Spain by Klijn, Alaoui, and Vorsatz, which introduced multiple versions of an online exam, suggests that this may reduce cheating by people who take the exam after others have already taken it.

 From the NYT:

These Exams Mean Everything in India. Thieves See a Gold Mine.
In a country where government jobs are highly coveted, the tests that govern hiring are a lucrative target for criminal gangs. By Mujib Mashal and Hari Kumar

 "Allotting jobs on the basis of exam results conveys a sense of fairness. But with competition so fierce, the temptation to seek shortcuts can be strong.

"Some aspirants, while spending long hours in study groups, also keep an eye out for shadowy figures offering access to exams.

 

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

From the Indian Express

Bill in Lok Sabha to check paper leaks, use of unfair means in govt recruitment exams
At present, there is no specific substantive law to deal with unfair means adopted or offences committed by various entities involved in the conduct of public examinations by the central government and its agencies. 

"The Public Examinations (Prevention of Unfair Means) Bill, 2024, introduced by Union Minister of State for Personnel Jitendra Singh, mentions “leakage of question paper or answer key”, “directly or indirectly assisting the candidate in any manner unauthorisedly in the public examination” and “tampering with the computer network or a computer resource or a computer system” as offences done by a person, group of persons or institutions."

####### 

 And here's an experiment with exam design, involving a Spanish exam:

Online Academic Exams: Does Multiplicity of Exam Versions Mitigate Cheating?  by Flip Klijn,  Mehdi Mdaghri Alaoui, and Marc Vorsatz


Abstract: We study academic integrity in a final exam of a game theory course with 463 undergraduate students at a major Spanish university. The exam is an unproctored online multiple-choice exam without backtracking. A key characteristic is that for each (type of) problem, groups of students receive different versions. Moreover, each problem version is assigned to one subgroup during one stage of the exam and to another subgroup during an immediately consecutive later stage. Thus, we can exploit grade points and timestamps to study students’ academic integrity. We observe a significant decrease in completion time at each later stage; however, surprisingly, there is no corresponding impact on average grade points. The precise number of different versions does not seem to have an effect on either variable. Our findings thus suggest that employing a limited number of distinct problem versions (as few as two) can diminish cheating effectiveness in online exams."

Thursday, November 28, 2024

Walk free in NYC, where jaywalking is no longer a crime

In NYC jaywalking is no longer a crime, or at least it won't be at the end of January, if I read the story correctly.  But I'm guessing is that it will be hard to tell the difference.

Here's the story from the NYT:

Jaywalking Is a New York Tradition. Now It’s Legal, Too.  New Yorkers can cross the street wherever they please without fear of a summons. By Emma G. Fitzsimmons, Oct. 29, 2024

"Telling New Yorkers, famously short of patience and time, not to cross the street mid-block did little to curb the illegal practice. Neither did the threat of fines: A violation carried a potential fine of up to $300, and hundreds of people received tickets each year.

"But after decades of mostly turning the other way, city officials finally decriminalized jaywalking, crossing against a traffic signal or outside a crosswalk. The City Council passed a bill last month to allow pedestrians to cross the street wherever they please, and it became law over the weekend, after Mayor Eric Adams ran out of his allotted time to decide whether to veto or sign the bill.

;;;

"About 200 people have died over the last five years while crossing streets in the middle of a block or against the light — about 34 percent of all pedestrian fatalities, according to city transportation officials.

"The law goes into effect in 120 days. Liz Garcia, a spokeswoman for the mayor, said in a statement that New Yorkers should still be cautious when crossing the street."

Wednesday, November 27, 2024

The labor market for Ob-Gyn docs, in states that criminalize abortion

 States that criminalize abortion (and hence also care for miscarriages) are losing obstetricians...

The New Yorker has the story:

The Texas Ob-Gyn Exodus. Amid increasingly stringent abortion laws, doctors who provide maternal care have been fleeing the state.  By Stephania Taladrid 

"Across Texas, reports were surfacing of women being sent home to manage miscarriages on their own. In 2021, the state had passed a law known as S.B. 8, banning nearly all abortions after electrical activity is detected in fetal cells, which typically happens around the sixth week of gestation. The law encouraged civilians to sue violators, in exchange for the possibility of a ten-thousand-dollar reward.

From a medical standpoint, the treatment for abortion and miscarriage was the same—and so, even though miscarriage care remained legal, physicians began putting it off, or denying it outright. After Roe was overturned, the laws in Texas tightened further, so that abortion was banned at any phase of pregnancy, unless the woman was threatened with death or “substantial impairment of a major bodily function.” Violations could send practitioners to prison for life.

...

"the new laws were already having an effect on the health-care system. Across Texas, residency applications in ob-gyn dropped significantly. Data from the Gender Equity Policy Institute revealed a fifty-six-per-cent spike in maternal deaths in the state between 2019 and 2022. When the Supreme Court overturned Roe v. Wade, Texas was no longer an outlier; in the weeks after the ruling, thirteen states moved to ban abortion. By then, Serapio and Salcedo had already left Texas. Another ob-gyn at the practice, Pam Parker, would follow soon.

...

"Kornberg was moving to Los Angeles to finish her residency. Like the doctors who had left before her, Kornberg had come to see herself as “part of the problem,” she said. “I have the knowledge, all the support staff, everything to be able to help this person avoid one of these horrible outcomes—and they’re begging me to do it, but I’m not allowed to.” The bans felt like a personal attack, she said: “The state sees you as a felon.” When the act of caring for pregnant women in Texas could carry the same penalty as murder, the inevitable conclusion for Kornberg was “You don’t want me here? Fine, I’ll leave.”

...

"A report released last month by Manatt Health, a health-care consultancy based in Los Angeles, confirmed Brown’s fears. Manatt surveyed hundreds of ob-gyns in Texas to examine the impact of abortion bans. Seventy-six per cent of respondents said that they could no longer treat patients in accordance with evidence-based medicine. Twenty-one per cent said that they were either considering leaving the state or already planning to do so; thirteen per cent had decided to retire early. The report found “historic and worsening shortages” of ob-gyns, which “disproportionately impact rural and economically disadvantaged communities.” As in the Rio Grande Valley, the bans were shrinking the field’s future workforce: residency programs across Texas have seen a sixteen-per-cent drop in applications.

"Texas is among the twenty-one states where abortion is banned or severely restricted. In Idaho, nearly a quarter of the state’s ob-gyns have left since the ban went into effect, and rural hospitals have stopped providing labor and delivery services. In Louisiana, three-quarters of rural hospitals no longer offer maternity care. "

Tuesday, November 26, 2024

Payments to physicians from medical vendors

 A useful rule of thumb when studying the design of markets is that when you see many related rules against something, that something may still be happening.  In yesterday's post I described the code of conduct that speakers at a medical conference are asked to subscribe to, mostly concerning payments received from medical vendors.  Below is a contemporary article about the incidence of such payments, to cardiologists (interventional cardiologists in particular), starting when they are still trainees.

Dhruva SS, Han M, Jing Y, Trock BJ, Hogan SO, Redberg RF. Industry Payments to Cardiology Fellows and Early-Career Cardiologists. JAMA Intern Med. 2024;184(9):1123–1125. doi:10.1001/jamainternmed.2024.3130 

Here's the introduction to the paper:

"Industry marketing payments to physicians may compromise the objectivity and integrity of clinical decision-making, playing a role in nonrecommended care, higher health care costs, and reduced patient trust. Payments to trainees merit scrutiny because these payments may be formative on future practice. The Association of American Medical Colleges (AAMC) recommends policies “that prohibit the acceptance of any gifts from industry by physicians…and trainees.”1 The Accreditation Council for Graduate Medical Education (ACGME) states “promotional activities by industry can seriously compromise the professional relationships that form the substance of medicine.”2 The National Academy of Medicine (NAM) also argues financial relationships do not benefit the educational mission in ways that offset the risks created.3 We quantified industry payments to cardiology fellows and the association of these payments with payments received after training."

And here is a summary of the results:

"During the year before fellowship graduation, 1993 fellows (80%) in procedural intensive subspecialties and 2057 of 3055 (67%) in nonprocedural intensive subspecialties received industry payments. Median (IQR) payment amount per physician in procedural intensive subspecialties was $1801 ($282-$4445; median [IQR] payments, 17 [4-38]). In nonprocedural intensive subspecialties, median (IQR) payment amount received per physician was $198 ($0-$893; median [IQR] payments, 3 [0-13]).

"A median (IQR) of 3 (2-5) years after fellowship, 2385 physicians (96%) in procedural intensive subspecialties and 2483 (81%) in nonprocedural intensive subspecialties received industry payments.
Median (IQR) payment amount per physician per year was $1112 ($372-$2870) and $277 ($95-$838), respectively."

Monday, November 25, 2024

Medical conference code of conduct

  Different fields have different conference cultures, and these change over time.  I've agreed to give a talk at a conference that physicians may attend for Continuing Medical Education (CME) credit, and it came with the following list of things for me to attest. Most of them seem to be assurances that my discussion will not be influenced by companies that have paid me in some way.

Attestations

  • The content and/or presentation of the information with which I am involved will promote quality or improvements in health care and will not promote a specific proprietary business interest of an ineligible company.
  • Content for this activity, including any presentation of therapeutic options, will be well-balanced, unbiased, and evidence-based. Opinions that are not supported by evidence or are supported by limited or preliminary evidence will be so identified. Recommendations involving clinical medicine will be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to will conform to the generally accepted standard of experimental design, data collection, and analysis.
  • I have not and will not accept any honoraria, additional payments, or reimbursements directly for this CE activity from an ineligible company.
  • I understand that my presentation and/or content may need to be peer-reviewed prior to the activity, and will provide educational content and resources in advance as requested.
  • If I am discussing specific healthcare products or services, I will use generic names to the extent possible. If I need to use trade names, I will use trade names from several companies when available, and not just trade names from any single company.
  • If I am discussing any product use that is off-label, I will disclose that the use or indication in question is not currently approved by the FDA.
  • If I have been trained or utilized by a commercial interest or its agent as a speaker (e.g., speaker's bureau) for any ineligible company, the promotional aspects of that presentation will not be included in any way with this activity.
  • If I am presenting research funded by a commercial interest, the information presented will be based on generally accepted scientific principles and methods and will not promote the ineligible company or the funding company

 

Sunday, November 24, 2024

A medically aided death in New Jersey: Pat Koch Thaler

 Following a full life, a peaceful end.

Pat Koch Thaler, Sister to a Famed Mayor, Chose to Die on a Saturday
Ms. Thaler, a former dean at N.Y.U., used her last interview to reminisce about her brother, Ed, and to publicize the alternatives to prolonging pain and suffering. By Sam Roberts

"After 22 years of fending off cancer, Ms. Thaler had run out of miracles. Twice the disease had gone into remission, only to return. One kidney had been removed. She had been bombarded by radiation, chemotherapy and ablation. Finally, the tumors had been declared inoperable.

“My mother died in agony,” Ms. Thaler recalled. Her mother was 62, misdiagnosed and undergoing an operation to remove her gall bladder when surgeons found her body was riddled with cancer.

"Of her own experience, Ms. Thaler said she had been offered a drug that “would slow things down, but would have some serious side effects.”

“And I decided, I’m 92 and a half years old, I have lived a very, very rich life, a very happy life, and I didn’t want to torture myself anymore,” she said. “I did what I could, and knowing that the law is on my side, I decided to take advantage.”

"A New Jersey law that took effect in 2019 allows a mentally alert adult — whose prognosis of having less than six months to live has been certified by two doctors — to self-administer a lethal prescription. The powdery medication is mixed with three ounces of juice, must be consumed within two minutes, immediately induces sleep and, within hours, causes death.

...

"Ms. Thaler spent her last few days paying bills, disposing of her furniture, distributing her artwork to her children and grandchildren, and confirming the funeral arrangements

...

"She chose Saturday, she said, because her children worked, and she wanted a time that would be most convenient. Wearing a white long-sleeved shirt and loose black pants in her apartment, surrounded by her family, she took the powdered medication mixed in apple juice under a doctor’s supervision at 11 a.m.

"At 4:58 p.m., she was pronounced dead."

Saturday, November 23, 2024

Competition between drug testing and drug taking in bicycle racing

 Some time ago the Cycling Independent Reform Commission (CIRC) issued a report on performance enhancing drugs in bicycle racing, which makes clear that there is vigorous competition between drug taking and drug testing...

CIRC report: 20-90 percent of modern peloton still doping
Doping has waned in professional cycling, but remains a serious issue, the CIRC report contends 

"The days of 15 percent gains in performance through massive EPO doping seem to be a thing of the past, according to CIRC. Instead, riders are skirting the edges of the anti-doping system, taking advantage of Therapeutic Use Exemptions, using overnight gaps in testing and a deep understanding of the Biological Passport to micro-dose without getting caught. Some are taking drugs that aren’t yet banned, like Tramadol, and using pill regimens that dull pain or improve recovery. 

...

"The Athlete’s Biological Passport (ABP), enacted in 2008, is named as a primary catalyst of the change, and a “paradigm shift.”

"CIRC wrote: “Prior to the ABP, only three riders were convicted of blood doping. In the first three years of the ABP, 26 riders were found positive for the presence of EPO stimulating agents in their specimens. In 20 out of the 26 positive cases, it was the abnormal blood profile which raised suspicions leading to a targeted anti-doping urinary or blood test.”

"An unheralded but important landmark in the decrease in doping, according to CIRC, was the introduction in 2008 of anti-doping chaperones at all UCI races. The report cites this change as a catalyst to a cleaner peloton, as riders could no longer quickly prepare for a test with masking agents or similar dodges.

...

"The CIRC concluded that it is still possible to micro-dose using EPO without getting caught by the Biological Passport, largely thanks to the lack of nighttime testing.

"The lack of testing between 11 p.m. and 6 a.m. is a problem, according to the report. Testers are currently barred from testing riders between these hours, unless a rider is under suspicion. This allows for micro-dosing, as “riders are confident that they can take a micro-dose of EPO in the evening because it will not show up by the time the doping control officers could arrive to test at 6 a.m.”

...

"CIRC wrote: “Corticoids are widely used today both to reduce pain and therefore improve endurance capability and to achieve weight loss to improve power/weight ratio.”

######

CIRC Report: Executive summary

"The general view is that at the elite level the situation has improved, but that doping is still taking place. It was commented that doping is either less prevalent today or the nature of doping practices has changed such that the performance gains are smaller. The CIRC considers that a culture of doping in cycling continues to exist, albeit attitudes have started to change. The biggest concern today is that following the introduction of the athlete biological passport, dopers have moved on to micro-dosing in a controlled manner that keeps their blood parameters constant and enables them to avoid detection. In contrast to the findings in previous investigations, which identified systematic doping organised by teams, at the elite level riders who dope now organise their own doping programmes with the help of third parties who are primarily outside the cycling team. At the elite level, doping programmes are generally sophisticated and therefore doctors play a key role in devising programmes that provide performance enhancement whilst minimising the risk of getting caught.

Friday, November 22, 2024

America Has an Organ Shortage. Could Paying Donors Close the Gap? Podcast from BYU radio.

 Here's a podcast on the shortage of organs for transplant, and on the controversies about compensating organ donors, and plasma donors.

America Has an Organ Shortage. Could Paying Donors Close the Gap?   Top of Mind with Julie Rose | BYU radio
 

"There are more than 100,000 people on the waitlist for an organ transplant. Every day 17 of them die. Most organs for transplant come from deceased donors. But the organs in highest demand for transplantation are kidneys and livers – both of which can be donated while a person is still alive. So, we could save thousands of lives each year if more people were willing make a living organ donation. Some advocates say giving donors money would increase organ donations enough to eliminate the entire waitlist. But federal law makes it illegal to buy or sell organs. Ethicists have real concerns about coercion and exploitation, too. In this podcast episode, we're exploring America's organ shortage and asking whether paying donors could close the gap.  
Guests:
David Galbenski, liver transplant recipient and co-founder of the Living Liver Foundation (https://livingliver.org/)

Elaine Perlman, kidney donor, Executive Director of Waitlist Zero and leading advocate for the End Kidney Deaths Act (http://waitlistzero.org/)

Kathleen McLaughlin, journalist and author of Blood Money; The Story of Life, Death, and Profit Inside America's Blood Industry

Al Roth, Nobel-prize winning economist, Stanford University, expert in market design and game theory (https://marketdesigner.blogspot.com/)"


I'm interviewed at the end of the podcast, starting at minute 39:

x

Thursday, November 21, 2024

If I don't do it someone else will: markets and morals

 Here's a paper reporting an experiment that suggests that people are more willing to ignore the negative externalities they impose on others in a market in which they have little effect on quantities consumed. (They interpret this as being a moral question, hence the title.)

Ziegler, Andreas GB, Giorgia Romagnoli, and Theo Offerman. "Morals in multi-unit markets." Journal of the European Economic Association, Volume 22, Issue 5, October 2024, Pages 2225–2260, https://doi.org/10.1093/jeea/jvae001

"Abstract: We examine how the erosion of morals, norms, and norm compliance in markets depends on the market power of individual traders. Previously studied markets allow traders to exchange at most one unit and provide market power to individual traders by de-activating two forces: (i) the replacement logic, whereby immoral trading is justified by the belief that others would trade otherwise and (ii) market selection, by which the least moral trader determines aggregate quantities. In an experiment, we compare single-unit to (more common) multi-unit markets, which may activate these forces. Multi-unit markets, in contrast to single-unit markets, lead to a complete erosion of morals. This is associated primarily with a deterioration in norm compliance: the observed level of immoral trade is in contrast with the prevailing social norm. The replacement logic is the main mechanism driving this finding.


HT: Stephanie Wang


Wednesday, November 20, 2024

School choice, school quality, and student performance

 School choice, which allows children to move away from neighborhood schools, doesn't by itself improve school quality, although it may allow under-performing schools to become smaller, which may make them easier to fix, or to close.

Here are two  recent assessments of two different transportation options available to Boston public school students. Both conclude that school quality matters.

The first is an op-ed in the Boston Globe saying that school choice among Boston public schools has led to too much transportation and not enough innovation. (One of the authors, Parag Pathak, played a critical role in designing  Boston's current school choice system.)

Boston needs to reexamine school assignment system
Rather than investing in high-cost travel to send students to schools across the city, Boston should consider redirecting those funds toward improving schools close to home.
By Joshua Angrist, Parag Pathak and Amanda Schmidt 

"Boston’s school assignment system has changed considerably since the 1970s. Busing today is voluntary: Students can choose to attend schools far from where they live as well as a range of neighborhood schools. This choice allows historically disadvantaged students to attend schools with more peers of different backgrounds, an option that many choose. Roughly three-quarters of students opted to enroll in non-neighborhood schools in the 2000s and 2010s. A recent study by our organization, MIT Blueprint Labs, shows that today’s assignment system works in the sense of facilitating integration.

However, the costs of the current system are high. Among the 100 US school districts with the highest enrollment, Boston maintains the greatest per-student transportation costs in the country. As of 2021, the city spent over $2,000 per student on travel, equivalent to 8 percent of per-pupil school spending.

Furthermore, the educational gains afforded by district-wide choice are less clear than the integration gains. Our research, which uses credible, randomized methods designed by Blueprint Labs to gauge the causal effect of enrollment at different types of schools, paints a nuanced picture of the benefits of travel to non-neighborhood schools. Black and Hispanic students who travel to a non-neighborhood school have more white and Asian peers than they otherwise would. But travel does not impact learning as measured by MCAS scores, high school graduation rates, or college enrollment. We argue that this is because in the current BPS choice system — unlike the separate and unequal system of 1974 — the schools students travel to are no better than those nearby.

...

"The vast sums that now go to cross-neighborhood transportation might be better spent. The city might instead invest in programs with proven educational benefits. Saga Education’s effective high-dosage tutoring program, for example, cost just $1,800 per student in 2023. This spending may do more to close racial achievement gaps than non-neighborhood assignment.

"Some might counter that choice is intrinsically valuable and that neighborhood schools are likely to be more segregated than the schools that many historically disadvantaged families choose today. These undeniable benefits must be weighed, however, against alternative uses of the money that flows to busing. Boston schools have improved greatly since 1974: Dropout rates for all students have declined, and gaps by race, while still present, have narrowed. School assignment plans originating in 1974 may therefore be less useful today. It’s time to consider changing transportation policy in light of these changes in the city’s education landscape."

####### 

Here's a paper, about a different transportation program available to some* Boston students, which takes them out of Boston to schools in neighboring towns and cities in the metropolitan area.  Moving to those suburban schools apparently improves student performance more than moving from one Boston school to another.

 Busing to Opportunity? The Impacts of the METCO Voluntary School Desegregation Program on Urban Students of Color  by Elizabeth Setren, NBER Working Paper 32864, DOI 10.3386/w32864, August 2024

Abstract: School assignment policies are a key lever to increase access to high performing schools and to promote racial and socioeconomic integration. For over 50 years, the Metropolitan Council for Educational Opportunity (METCO) has bussed students of color from Boston, Massachusetts to relatively wealthier and predominantly White suburbs. Using a combination of digitized historical records and administrative data, I analyze the short and long run effects of attending a high-performing suburban school for applicants to the METCO program. I compare those with and without offers to enroll in suburban schools. I use a two-stage least squares approach that utilizes the waitlist assignment priorities and controls for a rich set of characteristics from birth records and application data. Attending a suburban school boosts 10th grade Math and English test scores by 0.13 and 0.21 standard deviations respectively. The program reduces dropout rates by 75 percent and increases on-time high school graduation by 13 percentage points. The suburban schools increase four-year college aspirations by 17 percentage points and enrollment by 21 percentage points. Participation results in a 12 percentage point increase in four-year college graduation rates. Enrollment increases average earnings at age 35 by $16,250. Evidence of tracking to lower performing classes in the suburban schools suggests these effects could be larger with access to more advanced coursework. Effects are strongest for students whose parents did not graduate college."

*"The program is very popular: 50 percent of Black youth in Boston applied and 20 percent of Latinx youth in the past 20 years"

...

"After demonstrating the comparability of students with and without offers, I estimate the impact of receiving an offer to the program and the impact of participating in the program. Offers to enroll in suburban districts serve as instrumental variables and all models control for approximate waitlist position using age at the time of application, gender, and race controls. Therefore the estimates compare the outcomes of those who enroll in METCO to applicants with similar demographics, who applied at similar times, but did not enroll because they were not selected from the waitlist."

Tuesday, November 19, 2024

AI assisted job applications (and application screening)

 NBC news has the story:

AI is supposed to make applying to jobs easier — but it might be creating another problem
Companies have touted new AI technology that allows users to apply to thousands of jobs per day, flooding job openings with resumes.
  By Sophia Pargas

"With the help of new AI software, applicants can now revise their resumes and cover letters, receive live interview scripts and launch chatbots to submit thousands of applications almost instantly.

...

"LazyApply, Simplify and AI Hawk are all AI services that launch assistants to help collect applicant information and submit automated job applications through sites like LinkedIn and Indeed. Using the tools, job seekers can save hundreds of hours — and apply to up to thousands of jobs a day, according to the services.

"AI Apply, which claims its users are “80% more likely to get hired,” offers tools like a cover letter and resume builder, an auto-apply feature, an interview practice generator and a specialized interview buddy. A premium membership starts at $38 a month, according to the website — a cost AI Apply notes is much lower and more accessible than the cost of a career counselor.

...

"According to the company’s respective websites, OfferGoose has helped applicants land over 17,000 job offers, and AI Apply has over 340,000 “freelancers and job seekers” using the service.

"Nevertheless, many companies have enlisted additional safeguards to detect the use of AI. Some employers now require e-confirmation codes to submit applications and prevent automated submissions. Others have added prompts asking AI bots to use specific words like “banana” in responses to catch chat-generated application answers, according to longtime job recruiter and tech agency director of talent Mike Peditto.

"But job seekers are not the only party using AI in the application process, according to a recent University of Washington study. The researchers estimated that “99% of Fortune 500 companies are already using some sort of AI assistance when making hiring decisions,” and found that resume-screening tools have an incredible bias toward white, male applicants — with the large language models favoring white-associated males roughly 85% of the time and disadvantaging Black males in “up to 100% of cases.”

"The use of AI by both applicants and employers has created a distinct dynamic, in which applicants are using AI, but are also reticent about employers screening them with AI."

Monday, November 18, 2024

What preferences are revealed by market designs? by Oğuzhan Ƈelebi (who is on the job market)

Oğuzhan Ƈelebi is on the job market this year (listed on the job market websites of both MIT and Stanford where he's finishing a two year postdoc). He has a new paper that takes a really novel approach to market design.  It looks at the implicit preference relation (if one exists) that a mechanism reveals when a revealed preference analysis is done of the choices it makes from different possible menus of alternatives. The specific focus is on preferences for diversity revealed by mechanisms used in connection with affirmative action.

Diversity Preferences and Affirmative Action, by Oğuzhan Ƈelebi 

Abstract: "In various contexts, institutions allocate resources using rules that determine selections given the set of candidates. Many of these rules feature affirmative action, accounting for both identity and (match) quality of individuals. This paper studies the relationship between these rules and the preferences underlying them. I map the standard setting of market design to the revealed preference framework, interpreting choice rules as observed choices made across different situations. I provide a condition that characterizes when a rule can be rationalized by preferences based on identities and qualities. I apply tests based on this condition to evaluate real-world mechanisms, including India’s main affirmative action policy for allocating government jobs, and find that it cannot be rationalized. When identities are multidimensional, I show that non-intersectional views of diversity can be exploited by dominant groups to increase their representation and cause the choice rules to violate the substitutes condition, a key requirement for the use of stable matching mechanisms. I also characterize rules that can be rationalized by preferences separable in diversity and quality, demonstrating that they lead to a unique selection within the broader set of policies that reserve places based on individuals’ identities."

########

He's a target of opportunity for any department interested in market design.

Sunday, November 17, 2024

Opt-out defaults do not increase organ donation rates, in Public Health

 No one said market design was going to be easy...(well, some people did, but it turns out it isn't.)

Dallacker, M., L. Appelius, A. M. Brandmaier, A. S. Morais, and R. Hertwig. "Opt-out defaults do not increase organ donation rates." Public Health 236 (2024): 436-440. 

"Objectives: To increase organ donation rates, many countries have switched from an opt-in (‘explicit consent’) default for organ donation to an opt-out (‘presumed consent’) default. This study sought to determine the extent to which this change in default has led to an increase in the number of deceased individuals who become organ donors.
 

"Study design: Longitudinal retrospective analysis.
 

"Methods: We conducted a retrospective analysis of within-country longitudinal data to assess the effect of changing the organ donation default policy from opt-in to opt-out. Our analysis focused on the longitudinal deceased donor rates in five countries (Argentina, Chile, Sweden, Uruguay, Wales) that had adopted this change. Using a Bayesian aggregated binomial regression model, we estimated the odds of organ donation within each country over time, as well as the effect of the policy switch.
 

"Results: Switching from an opt-in to an opt-out default did not result in an increase in donation rates when averaged across countries. Moreover, the opt-out default did not lead to even a gradual increase in donations: there was no discernible difference in the linear rate of change of donations after the change in default. Finally, the COVID-19 pandemic was associated with a reduction in the odds of donation across all five countries.
 

Conclusions: Our longitudinal analysis suggests that changing to an opt-out default does not increase organ donation rates. Unless flanked by investments in healthcare, public awareness campaigns, and efforts to address the concerns of the deceased's relatives, a shift to an opt-out default is unlikely to increase organ donations."

 


...

"Family objections, often a significant barrier to deceased organ donation, should also be addressed. In many countries—including Chile, Sweden, and Wales—the consent of next of kin is necessary for organ donation. The veto power given to families has also been cited as a reason why the opt-out default does not significantly improve donation rates over the opt-in system.27,28 Considering expressed preferences, whether of the deceased or their relatives, overrides the default. Ultimately, the implications for transplantation outcomes between opt-in and opt-out defaults only differ in the rare cases when no explicit statements of preference were made by either the deceased or their relatives. A previous cross-country scenario analysis has shown that, when family preferences are honoured, shifting from an opt-in to an opt-out default alone would only increase organ recovery by 0%–5%.29 

######

 HT: Frank McCormick


Related:

Monday, July 22, 2024 Don't take "No" for an answer in deceased organ donor registration (a paper forthcoming after ten+ years)