Three way liver exchange in Pakistan, reported in JAMA Surgery by Salman, Arsalan, and Dar, in collaboration with economist Alex Chan

 Here's an exciting account, just published in JAMA Surgery, of a three way liver exchange in Pakistan, achieved in part by collaboration with economist and market designer Alex Chan (who is on the job market this year).

Launching Liver Exchange and the First 3-Way Liver Paired Donation by Saad Salman, MD, MPH1; Muhammad Arsalan, MBBS2; Faisal Saud Dar, MBBS2, JAMA Surg. Published online December 7, 2022. doi:10.1001/jamasurg.2022.5440 (pdf)

Here are the first paragraphs:

"There is a shortage of transplantable organs almost everywhere in the world. In the US, about 6000 transplant candidates die waiting each year.1 In Pakistan, 30% to 50% of patients who needed a liver transplant are unable to secure a compatible donor, and about 10 000 people die each year waiting for a liver.2 Kidney paired donations, supported by Nobel Prize–winning kidney exchange (KE) algorithms,3 have enabled living donor kidneys to become an important source of kidneys. Exchanges supported by algorithms that systematically identify the optimal set of paired donations has yet to take hold for liver transplant.

"The innovation reported here is the successful implementation of a liver exchange mechanism4 that also led to 3 liver allotransplants and 3 hepatectomies between 3 incompatible patient-donor pairs with living donor–patient ABO/size incompatibilities. These were facilitated by one of the world’s first documented 3-way liver paired donations (LPD) between patient-donor pairs.

"Since 2018 and 2019, we have explored LPD as a strategy to overcome barriers for liver failure patients in Pakistan in collaboration with economist Alex Chan, MPH.2 With LPD, the incompatibility issues with relative donors can be solved by exchanging donors. The Pakistan Kidney and Liver Institute (PKLI) adopted a liver exchange algorithm developed by Chan4 to evaluate LPD opportunities that prioritizes clinical urgency (Model for End-stage Liver Disease [MELD] scores) while maximizing transplant-enabling 2-way or 3-way swaps that ensures that hepatectomies for every donor within each swap has comparable ex ante risk (to ensure fairness). As of March 2022, 20 PKLI liver transplant candidates had actively coregistered living and related but incompatible liver donors. Evaluating these 20 incompatible patient-donor pairs with the algorithm,4 we found 7 potential transplants by two 2-way swaps and the 3-way swap reported. In contrast to ad hoc manual identification of organ exchange opportunities, the hallmark of a scalable organ exchange program is the regular deployment of algorithms to systematically identify possible exchanges. Regular deployment of LPD algorithms is novel.

"A total of 6 procedures took place on March 17, 2022. Patient 1, a 57-year-old man, received a right liver lobe from donor 2, a 28-year-old coregistered donor of patient 2 (56-year-old man), who in turn received a right liver lobe from donor 3, a 35-year-old woman who was a coregistered donor of patient 3. Patient 3, a 46-year-old man, received a right liver lobe from donor 1, a 22-year-old woman who was a coregistered donor of patient 1, completing the cycle (Figure). Five PKLI consultant surgeons and 7 senior registrars led the hepatectomies and liver allotransplants; 6 operating rooms were used simultaneously. One month postsurgery, all patients and donors are robust with no graft rejection. All the donors are doing well in the follow-up visits and have shown no psychological issues."

Here's a sentence in the acknowledgements:

"We thank Alex Chan, MPH (Stanford University, Palo Alto, California), whose initiative and expertise in economics were the key driving forces for launching liver exchange."

*********

NB: this is a "Surgical Innovation" article, for which the journal requires that there be no more than three authors.

And here are the references cited:

1.

Chan  A, Roth  AE. Regulation of organ transplantation and procurement: a market design lab experiment. Accessed April 28, 2022. https://www.alexchan.net/_files/ugd/a47645_99b1d4843f2f42beb95b94e43547083b.pdf

2.

Salman  S, Gurev  S, Arsalan  M, Dar  F, Chan  A. Liver exchange: a pathway to increase access to transplantation. Accessed April 1, 2022. http://www.hhpronline.org/articles/2021/1/14/liver-exchange-a-pathway-to-increase-access-to-transplantation

3.

Henderson  D. On marriage, kidneys and the Economics Nobel. Wall Street Journal. October 15, 2012. Accessed March 5, 2022. https://www.wsj.com/articles/SB10000872396390443675404578058773182478536

4.

Chan  A. Optimal liver exchange with equipoise. Accessed April 23, 2022. https://www.alexchan.net/_files/ugd/a47645_36e252f4df0c4707b6431b0559b03143.pdf

5.

Hwang  S, Lee  SG, Moon  DB,  et al.  Exchange living donor liver transplantation to overcome ABO incompatibility in adult patients.   Liver Transpl. 2010;16(4):482-490. doi:10.1002/lt.22017PubMedGoogle ScholarCrossref

6.

Patel  MS, Mohamed  Z, Ghanekar  A,  et al.  Living donor liver paired exchange: a North American first.   Am J Transplant. 2021;21(1):400-404. doi:10.1111/ajt.16137PubMedGoogle ScholarCrossref

7.

Braun  HJ, Torres  AM, Louie  F,  et al.  Expanding living donor liver transplantation: report of first US living donor liver transplant chain.   Am J Transplant. 2021;21(4):1633-1636. doi:10.1111/ajt.16396

 ********

Here's a Stanford story on this collaboration:

Stanford student devises liver exchange, easing shortage of organs. A rare three-way exchange of liver transplants in Pakistan was made possible with a new algorithm developed by a Stanford Medicine student.  by Nina Bai

"The liver exchange idea actually came out of a term paper in a first-year market design class at Stanford," Chan said.

"As he learned more about liver transplants, Chan realized there were important biological and ethical differences from kidney transplants. 

...

"Instead of just finding compatible swaps, we want to find swaps that prioitize the most urgent patients first in order to prevent the most deaths," Chan said.

*******

Here are some contemporaneous stories from March in the newspaper Dawn (now that the JAMA embargo on the story is lifted):

Liver transplants at PKLI under 'swap' plan - Newspaper - Dawn

Mar 18, 2022 — A highly-trained team of the surgeons headed by PKLI Dean Prof Faisal Dar had performed liver transplants at the institute and other members ...

• First swap liver transplant surgeries at PKLI today - Dawn

  
  

  Mar 17, 2022 — An official told Dawn on Wednesday the treating doctors had recommended liver transplant of all the three patients due to their end-stage ...

Insulting the president, in Indonesia

 Sex outside of marriage, and insulting the president are to become more serious crimes in Indonesia.  (The law has a foolproof way of determining if the president has been insulted.)

The Guardian has the story:

Indonesia set to make sex outside marriage punishable by jail. MPs expected to pass new criminal code that will also make insulting the president a crime

"Indonesia’s parliament is expected to pass a new criminal code this month that would criminalise sex outside marriage and outlaw insults against the president or state institutions, prompting alarm from human rights campaigners.

"The deputy justice minister, Edward Omar Sharif Hiariej, said in an interview with Reuters that the new criminal code was expected to be passed on 15 December. “We’re proud to have a criminal code that’s in line with Indonesian values,” he said.

...

"Sex outside marriage, which under the code could be reported only by limited parties such as close relatives, could lead to up to a year in prison, while unmarried couples would be banned from living together.

...

"Insulting the president, which under the code could be reported only by the president, would carry a maximum of three years. Insulting state institutions and expressing any views counter to Indonesia’s state ideology would also be forbidden."

Test of Time Award: call for nominations

 Test of Time Award

"The SIGecom Test of Time Award recognizes the author or authors of an influential paper or series of papers published between ten and twenty-five years ago that has significantly impacted research or applications exemplifying the interplay of economics and computation.

...

"The 2023 SIGecom Test of Time Award will be given for papers published no earlier than 1998 and no later than 2013. Nominations are due by February 28th, 2023 

...

"The 2022 Test of Time Award Committee: Alvin Roth, Stanford University; Moshe Tennenholtz, The Technion; Noam Nisan (chair), The Hebrew University of Jerusalem"

The 2022 Einstein Foundation Awards

 Here are the Recipients of the 2022 Einstein Foundation Awards

Einstein Foundation Individual Award Winner 2022:

Gordon Guyatt, for his seminal contributions to evidence based medicine (including the name)

"Einstein Foundation Award winner Gordon Guyatt improved the quality of clinical research and helped bring evidence to medicine. His next mission is bringing patients into the discussion"

Einstein Foundation Institutional Award 2022:

The Psychological Science Accelerator

"The Psychological Science Accelerator, winner of the 2022 Institutional Award, has made its name by facilitating large, crowdsourced international studies in all aspects of the discipline and by democratizing and diversifying big team psychological science."

Einstein Foundation Early Career Award 2022:

Ape Research Index (the name almost speaks for itself)

Here's the description of the Award(s): The Einstein Foundation Award for Promoting Quality in Research

"The Einstein Foundation Award for Promoting Quality in Research aims to provide recognition and publicity for outstanding efforts that enhance the rigor, reliability, robustness, and transparency of research in the natural sciences, the social sciences, and the humanities, and stimulate awareness and activities fostering research quality among scientists, institutions, funders, and politicians. To acknowledge the outstanding role early career researchers (ECRs) have in promoting research quality, ECRs will be invited to propose projects that foster research quality and value. Projects will be competitively selected for funding and internationally showcased."

Here are the members of this year's award jury. (I am one of the 15 jury members).

Here's my post on last year's prizes:

Thursday, November 25, 2021

Promoting Quality in Research: the inaugural Einstein Foundation Awards, 2021

It's not so easy to become a living kidney donor: report from the Cleveland Clinic

 It's not so easy to become a living kidney donor.  Here's a report on the pipeline at the Cleveland Clinic:

Cholin, Liza K., Jesse D. Schold, Med MStat, Susana Arrigain, Emilio D. Poggio, John R. Sedor, John F. O’Toole, Joshua J. Augustine, and Alvin C. Wee. " Characteristics of Potential and Actual Living Kidney Donors: A Single Center Experience, Transplantation (2022).

It's concerning to see that 164 donor candidates were rejected at this center for being "ABO or crossmatch incompatible."  Were they told about the possibility of kidney exchange?

 

"There was a mean of 2.8 and median of 1 (1, 3) potential donors for every 1 transplant candidate that did not receive a kidney. There was a mean of 5.9 and median of 2 (1, 5) potential donors for every 1 transplant candidate that received a kidney."

HT: Frank McCormick

Roundabouts

 A straight line isn't always the safest path between two points.

The Washington Post has the story:

Roundabouts are (slowly!) eating the suburbs by Andrew Van Dam

"Compared with the hundreds of thousands of normal intersections peppering the American landscape, ruled by stop signs and traffic lights, roundabouts are rare beasts. But unlike the drivers they frequently confuse and bedevil, roundabouts are coming on fast.

...

"The modern roundabout relies on a geometric design that forces traffic to slow, plus a simple innovation born in 1960s Britain: the rule that people already in the circle get the right of way. In traditional rotaries and traffic circles, which still lurk in many East Coast cities, traffic moves faster and vehicles already in the circle often must yield to newcomers.

...

"Why add a roundabout, you might ask. Because roundabouts offer impressive safety gains. In general, a roundabout will drive down fatal crashes by 90 percent and cut all car-crash injuries by at least 75 percent, even while accommodating a higher volume of cars.

"At a rural two-way stop, the gains can be even more dramatic. A roundabout can slash all traffic injuries, both fatal and nonfatal, by almost 90 percent. After all, it’s almost impossible to blow through a roundabout at 60 miles an hour and T-bone a minivan — an all-too-common occurrence in typical rural intersections.

“That’s the beauty of the roundabout,” Rodegerdts told us. “It’s the geometry. It’s the curves that are doing the work. And not relying on a traffic-control device as the sole thing keeping you from colliding at high speed.”

***********

Nevertheless...here's a related NYT story:

The Exceptionally American Problem of Rising Roadway Deaths

Why other rich nations have surpassed the U.S. in protecting pedestrians, cyclists and motorists. By Emily Badger and Alicia Parlapiano

"In 2021, nearly 43,000 people died on American roads, the government estimates. And the recent rise in fatalities has been particularly pronounced among those the government classifies as most vulnerable — cyclists, motorcyclists, pedestrians.

...

"In the 1990s, per capita roadway fatalities across developed countries were significantly higher than today. And they were higher in South Korea, New Zealand and Belgium than in the U.S. Then a revolution in car safety brought more seatbelt usage, standard-issue airbags and safer car frames, said Yonah Freemark, a researcher at the Urban Institute.

"Fatalities fell as a result, in the U.S. and internationally. But as cars grew safer for the people inside them, the U.S. didn’t progress as other countries did to prioritizing the safety of people outside them.

“Other countries started to take seriously pedestrian and cyclist injuries in the 2000s — and started making that a priority in both vehicle design and street design — in a way that has never been committed to in the United States,” Mr. Freemark said.

"Other developed countries lowered speed limits and built more protected bike lanes. They moved faster in making standard in-vehicle technology like automatic braking systems that detect pedestrians, and vehicle hoods that are less deadly to them. They designed roundabouts that reduce the danger at intersections, where fatalities disproportionately occur.

"In the U.S. in the past two decades, by contrast, vehicles have grown significantly bigger and thus deadlier to the people they hit. Many states curb the ability of local governments to set lower speed limits. The five-star federal safety rating that consumers can look for when buying a car today doesn’t take into consideration what that car might do to pedestrians."

Gale and Shapley '62, “College admissions and the stability of marriage” at 60

 Time really flies, doesn't it? 

Here's a paper whose title didn't give away what it was about:

Bipartite choices, by Marco LiCalzi, Decisions in Economics and Finance (2022)

 Abstract This piece in the Milestones series is dedicated to the paper coauthored by David Gale and Lloyd Shapley and published in 1962 under the title “College admissions and the stability of marriage” on the American Mathematical Monthly.

LiCalzi's history of events since Gale and Shapley '62 is easy to read, and touches on many papers that will be familiar to readers of this blog.

He ends, however, with a long quote I had never seen before from  The Poverty of Historicism by Karl Popper (1957), which he suggests captures the spirit of much of market design:

“Just as the main task of the physical engineer is to design machines and to remodel and service them, the task of the piecemeal social engineer is to design social institutions, and to reconstruct and run those already in existence. The piecemeal technologist or engineer recognizes that only a minority of social institutions are consciously designed while the vast majority have just ‘grown’, as the undesigned results of human actions. [...] The technologist should study the differences as well as the similarities, expressing his results in the form of hypotheses. And indeed, it is not difficult to formulate hypotheses about institutions in technological form as is shown by the following example: “You cannot construct foolproof institutions, that is to say, institutions whose functioning does not very largely depend upon persons: institutions, at best, can reduce the uncertainty of the personal element, by assisting those who work for the aims for which the institutions are designed, and on whose personal initiative and knowledge success largely depends. (Institutions are like fortresses. They must be well designed and properly manned.)”

Same sex marriage rights reaffirmed by the Senate

After a Supreme Court ruling in 2015, it seemed secure that the right to same sex marriage was the law of the land. However the recent Supreme Court decision overturning Roe v. Wade sent the question of abortion rights back to the states, and explicitly raised the question of whether other rights, such as marriage rights, might also be overturned. Justice Thomas, in his concurring opinion in the case (Dobbs) also mentioned that the rights to contraception and to same-sex sexual relations could be reconsidered, in his view.  

It appears that there will now be Federal legislation (and not just Court rulings) defending marriage rights. 

The NYT has the story:

Same-Sex Marriage Bill Passes Senate After Bipartisan Breakthrough. The 61-to-36 vote sends the legislation back to the House, which is expected to approve it and send it to President Biden.  By Annie Karni

"There was little question that the bill’s embrace in the Senate, where proponents had a breakthrough this month in drawing a dozen Republican supporters and overcoming a filibuster, gave it the momentum required to become law.

"The bill would repeal the Defense of Marriage Act, which denied federal benefits to same-sex couples. It prohibits states from denying the validity of an out-of-state marriage based on sex, race or ethnicity. 

...

"Its path represents a significant shift in American politics and culture in which same-sex marriage, once considered a divisive political issue, has become so widely accepted by members of both parties that a measure to protect has managed to attract decisive, bipartisan majorities in both the Senate and the House.

...

"Still, more than seven out of 10 Republican senators voted against the bill, underscoring how the party has continued to cater to religious conservatives who oppose same-sex marriage long after large majorities of the American public have come to support it.

...

"In the end, 12 Republicans voted for the measure

...

"The push to pass the legislation began over the summer, after Justice Clarence Thomas suggested in his opinion in the ruling that overturned Roe v. Wade, which had established a constitutional right to abortion, that the court also “should reconsider” precedents enshrining marriage equality and access to contraception.

***********

Earlier posts:

Friday, June 26, 2015

An ancient repugnance crumbles: Same sex marriage is a right, in all 50 of the United States

Opioids and pain management: revised CDC guidelines

 Concerned over the opioid addiction epidemic in the U.S., and the increasing number of overdose related deaths, the CDC issued the 2016 CDC Opioid Prescribing Guideline, which led to reduced opioid prescriptions by doctors. Sometimes this led to the undertreatment of pain, which in turn may have led to patients accessing opioids on the black market, where they are less safe. It may also have led to suicides of patients with unbearable pain.

The CDC has now issued some updated guidelines that appear aimed at balancing concerns with over-prescription against concerns with under-treatment.

Here are the updated guidelines:

CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022

"This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1–49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1–3 months), and chronic (duration of >3 months) pain.

...

"CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient’s circumstances. Recommendations should not be applied as inflexible standards of care across patient populations. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.

A central tenet of this clinical practice guideline is that acute, subacute, and chronic pain needs to be appropriately and effectively treated regardless of whether opioids are part of a treatment regimen. 

...

"To avoid unintended consequences for patients, this clinical practice guideline should not be misapplied, or policies derived from it, beyond its intended use (67). Examples of misapplication or inappropriate policies include being inflexible on opioid dosage and duration, discontinuing or dismissing patients from a practice, rapidly and noncollaboratively tapering patients who might be stable on a higher dosage, and applying recommendations to populations that are not a focus of the clinical practice guideline (e.g., patients with cancer-related pain, patients with sickle cell disease, or patients during end-of-life care)

*********

Earlier post:

Tuesday, March 15, 2022

Opioid prescription reductions and suicides

Motorcycles as donorcycles

 Here's an article from JAMA Internal Medicine, noting that motorcycle rallies produce an increase in organ transplants.

Organ Donation and Transplants During Major US Motorcycle Rallies  by David C. Cron, MD, MS; Christopher M. Worsham, MD; Joel T. Adler, MD, MPH; Charles F. Bray, BS; Anupam B. Jena, MD, PhD,  JAMA Intern Med. Published online November 28, 2022. doi:10.1001/jamainternmed.2022.5431

"Key Points

Question  Is the incidence of organ donation and transplants higher during major US motorcycle rallies?

Findings  In this cross-sectional study of 10 798 organ donors and 35 329 recipients of these organs from a national transplant registry from 2005 to 2021, there were 21% more organ donors and 26% more transplant recipients per day during motorcycle rallies in regions near those rallies compared with the 4 weeks before and after the rallies.

Meaning  While safety measures to minimize morbidity and mortality during motorcycle rallies should be prioritized, this study showed the downstream association of these events with organ donation and transplants."

***********

Helmet laws by State (only the States in orange require all motorcycle riders to wear a helmet):

I wonder what would happen if some State passed a helmet law saying that adults are free to ride without a helmet, but doing so automatically registers the rider as a willing deceased donor. (Such a law might decrease deceased donation by convincing more riders to wear helmets.)

HT: Alex Chan

The market for large dinosaur fossils

Should fossils be regarded as national treasures, or as natural resources, or perhaps works of art? 

The NY Times has the story:

As Dinosaur Fossils Fetch Millions, There’s Many a Bone to Pick. Fossils are a multimillion-dollar business, bringing legal disputes, nondisclosure agreements and trademarks to the world of paleontology.  By Julia Jacobs and Zachary Small

"Fossil hunting has become a multimillion-dollar business, much to the chagrin of academic paleontologists who worry that specimens of scientific interest are being sold off to the highest bidders.

...

"Things were simpler at the beginning of his career, Larson said, when universities, museums and a smaller group of private collectors were the only ones who cared about buying pieces of natural history.

"It was not until 1997, with the sale of Sue, that dinosaurs started to be viewed as potential centerpieces of auctions.

...

"Many scientists are aghast at the growing commercial market, and increasingly anxious that scientifically important specimens will disappear into private mansions. Paleontologists are also concerned that the market could encourage illegal digging, and that American landowners — who, by law, generally own the fossils found on their land — would favor commercial fossil hunters over academic researchers.

“Ranchers who used to let you go and collect specimens are now wondering why they should let you have it for free,” said Jingmai O’Connor, a Field Museum paleontologist, “when a commercial collector would dig up the bones and split the profit.”

"Fossil diggers and dealers in the commercial sphere counter that if not for them, these specimens on private land would be left to erode further, never to be found.

"The United States is an outlier legally. Other dinosaur-rich nations, including Mongolia and Canada, have laws making fossils the property of the government. Thomas Carr, a paleontologist at Carthage College in Wisconsin, said he believed that the lack of protections for “natural heritage” puts scientists in the United States at a disadvantage."

Kreps II: Microeconomic Foundations II: Imperfect Competition, Information, and Strategic Interaction (coming soon)

 Princeton University Press announces:

Microeconomic Foundations II: Imperfect Competition, Information, and Strategic Interaction by David M. Kreps

"A cutting-edge introduction to key topics in modern economic theory for first-year graduate students in economics and related fields

"Volume II of Microeconomic Foundations introduces models and methods at the center of modern microeconomic theory. In this textbook, David Kreps, a leading economic theorist, emphasizes foundational material, concentrating on seminal work that provides perspective on how and why the theory developed. Because noncooperative game theory is the chief tool of modeling and analyzing microeconomic phenomena, the book stresses the applications of game theory to economics. And throughout, it underscores why theory is most useful when it supports rather than supplants economic intuition.

• Introduces first-year graduate students to the models and methods at the core of microeconomic theory today
• Covers an extensive range of topics, including the agency theory, market signaling, relational contracting, bilateral bargaining, auctions, matching markets, and mechanism design
• Stresses the use—and misuse—of theory in studying economic phenomena and shows why theory should support, not replace, economic intuition
• Includes extensive appendices reviewing the essential concepts of noncooperative game theory, with guidance about how it should and shouldn’t be used
• Features free online supplements, including chapter outlines and overviews, solutions to all the problems in the book, and more

By email, Kreps writes: "An e-book version will be released on January 3, 2023.  Physical books will only be released in late May (I gather, a bit later in England)"

Pay Transparency in New York City as the new law begins to take effect

 Here's a report from Glassdoor Economic Research:

A First Glimpse into the Impact of Pay Transparency in New York City by Daniel Zhao

"On November 1, New York City’s pay transparency law went into effect, requiring job listings to include salary ranges. While the move represents an opportunity for job seekers to get greater pay transparency, high-profile errors as the new law went into effect have raised concerns about the efficacy of the law. With similar laws going into effect on January 1, 2023 in California and Washington State, we examined Glassdoor data to give an early view into how employers are grappling with pay transparency in New York City.

"Key Findings

"Pay ranges are being published on the majority of active job listings. 60 percent of job listings in New York City have employer-provided salaries as of November 12, and there are hints of a spillover effect to neighboring states.

"Ranges have widened significantly, but remain relatively narrow. The median width of salary ranges has widened from $10,000 in October to as wide as $20,000 so far in November. Less than 3 percent of daily active job listings in November have a salary range wider than $100,000.

"Professional services like Financial Services, Information Technology and Pharmaceutical & Biotechnology are the slowest to add pay ranges to their pay ranges. This may mean enforcing pay transparency will matter more in these higher-salary industries than in lower-wage industries."

Turkey production

 This seemed like a post that I should delay until after Thanksgiving, from the extension division of Penn State:

Modern Turkey Industry. The modern turkey industry has developed a hybrid white turkey that is larger and faster growing than purebred or wild turkeys.

Lobbying for sports gambling, with cigars and whisky

 Do addictions go together?  The NY Times has the story of how legalized (online, sports) gambling lobbyists wooed state legislators with whisky and cigars (and campaign contributions, which I guess can be addictive too...). Maybe Thanksgiving football can draw in more of the gathering if there's betting involved? (Not to mention whisky...)

Gambling has long been a repugnant transaction because the consequences of gambling addiction can be destructive for individuals and families. And betting on sports has been repugnant because of the danger that athletes will be drawn into fixing matches (even in once genteel sports like tennis).  Lobbying is a competitive sport too:

Cigars, Booze, Money: How a Lobbying Blitz Made Sports Betting Ubiquitous By Eric Lipton and Kenneth P. Vogel

"Less than five years ago, betting on sports in the United States was prohibited under federal law except in Nevada casinos and a smattering of venues in other states. Sports leagues argued that the ban safeguarded the integrity of American sports, while consumer watchdogs warned that legal gambling could turn fans into addicts. In countries like Britain, sports gambling free-for-alls had left trails of addiction.

"But in 2018, the Supreme Court ruled that the federal prohibition was unconstitutional.

"DraftKings and FanDuel, giants in the fast-growing field of fantasy sports, had already mobilized an army of former regulators and politicians to press for sports betting in state capitals. Soon, in a crucial reversal, sports leagues overcame their antipathy toward gambling, which they came to see as a way to keep increasingly distracted audiences tuned in. Casino companies also hopped on board.

...

"The results of the lobbying campaign have been stunning: 31 states and Washington, D.C., permit sports gambling either online or in person, and five more have passed laws that will allow such betting in the future.

...

"In May 2018, the Supreme Court struck down the federal ban on sports gambling, ruling it infringed on states’ rights."

*******

Here's a map:

**********

The NYT has these related stories:

Key Findings From The Times’ Investigation of Sports Betting. By David Enrich

"Four years ago, it was illegal to gamble on sports in most of the United States. Today, anyone who turns on the television or visits a sports website or shows up at a stadium is likely to be inundated with ads to bet, bet, bet."

How Colleges and Sports-Betting Companies ‘Caesarized’ Campus Life. by  Anna Betts, Andrew Little, Elizabeth Sander, Alexandra Tremayne-Pengelly and Walt Bogdanich

"Ever since the Supreme Court’s decision in 2018 to let states legalize such betting, gambling companies have been racing to convert traditional casino customers, fantasy sports aficionados and players of online games into a new generation of digital gamblers. Major universities, with their tens of thousands of alumni and a captive audience of easy-to-reach students, have emerged as an especially enticing target.

"So far, at least eight universities have become partners with online sports-betting companies, or sportsbooks, many in the last year, with more expected."

Desperate for Growth, Aging Casino Company Embraced ‘Degenerate Gambler’

Image By Emily Steel

"Mr. Portnoy rarely if ever mentions the bankruptcy. Yet he and his company, Barstool Sports, are urging their tens of millions of followers to dive into the fast-growing and lightly regulated world of online sports betting."

**********

And here's a story about gambling addiction from The Times of London, which points to online, in-game gambling as a particularly addiction-prone activity (especially during the current World Cup):

Big rise in gambling addictions putting suicidal young men in hospital. NHS lambasts ‘predatory’ betting firms amid 42% increase in demand for specialist clinics by Eleanor Hayward (Ungated summary here).

"The NHS is “picking up the tab” of the online betting industry, with a surge in suicidal gambling addicts turning up to A&E, doctors have warned."

...

"“People start gambling as soon as they wake up in the morning; they’re gambling in the shower, gambling while they’re driving to work.

...

"Gaskell suggested that doctors' surgeries should routinely ask new patients whether they gambled--in the same way they asked how much alcohol people drank in a week.

...

"Figures from the Gambling Commission show the majority of online betters place bets in play...Customers are able to wager lare sums of money multiple times in a matter of seconds on unfolding events.

...

"There are 400 suicides a year in England lnked to gambling."

Improving the transition to (surgical) residency

The transition from medical school to residency is presently troubled by congestion involving (too) many applications and interviews.  It's a subject of considerable discussion in the medical community, sometimes hampered between the parts of the process that proceed the Match, and the Match itself (which is the clearinghouse run by the NRMP that, after all applications and interviews have been processed, solicits rank order lists and turns them into a matching of doctors to residency programs)..  Here's a paper that focuses sensibly on the runup to the Match, even though its title follows the (unfortunately common) practice of calling the whole process the Match.

Designing the “match of the future”: challenges and proposed solutions in the interview and match phase of the UME–GME transition by Sophia K. McKinley, Maria S. Altieri, Olabisi Sheppard, Kimberly Hendershot, Keneeshia Williams, Brigitte K. Smith on behalf of the ASE Graduate Surgical Education Committee, Global Surgical Education - Journal of the Association for Surgical Education : 17 November

Table 1 Challenges and proposed solutions in the surgical resident selection process (click to embiggen)

Lab grown meat: taking slaughter out of the food chain

 Come a day, we'll be able to eat chicken meat that wasn't grown in a chicken...

The Guardian has the story:

US declares lab-grown meat safe to eat in ‘groundbreaking’ move. The government’s approval will open the market for a food praised for being more efficient and environmentally friendly. by Oliver Milman 

"The US government has cleared the way for Americans to be able to eat lab-grown meat, after authorities deemed a meat product derived from animal cells to be safe for human consumption.

"The US Food and Drug Administration (FDA) will allow* a California company called Upside Foods to take living cells from chickens and then grow them in a controlled laboratory environment to produce a meat product that doesn’t involve the actual slaughter of any animals.

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From the FDA

*FDA Completes First Pre-Market Consultation for Human Food Made Using Animal Cell Culture Technology. Before Entering the U.S. Market, the Food Must Meet Other Federal

"The voluntary pre-market consultation is not an approval process. Instead, it means that after our careful evaluation of the data and information shared by the firm, we have no further questions at this time about the firm’s safety conclusion."

Surrogacy guidelines: necessity, not convenience

 As surrogacy becomes increasingly well established in the U.S., it is regulated not only by state laws, but  also via voluntary standards put forward by trade organizations as conditions of membership.

One is  the SOCIETY FOR ETHICS IN EGG DONATION AND SURROGACY (SEEDS), which calls itself "a nonprofit organization founded by a group of egg donation and surrogacy agencies, whose purpose is to define and promote ethical behavior by all parties involved in third party reproduction." 

They have a set of guidelines published this year which member organizations are supposed to subscribe to.  One of those guidelines seems to say that surrogacy agencies should only work with intended parents who can't have children on their own. That is, they want to facilitate surrogacies that they regard as necessary rather than those that might be merely convenient.

SOCIETY FOR ETHICS IN EGG DONATION AND SURROGACY, STANDARDS of ETHICAL CONDUCT for SEEDS MEMBER AGENCIES

"24.Agency Screening of Intended Parents

"a. An Agency shall not provide service to Intended Parents unless they demonstrate a need for surrogacy associated with a disease, condition or status characterized by:

"i. the failure to establish a pregnancy or to carry a pregnancy to live birth after regular, unprotected sexual intercourse;

"ii. a person’s inability to reproduce either as a single individual or with their partner without medical intervention; or

"iii. a licensed physician’s or mental health professional’s findings based on a patient’s medical, psychological, sexual, and reproductive history, age, physical findings and/or diagnostic testing. 

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The legal blog Above the Law has a post about this:

Should 'Social Surrogacy' Be Permitted? by Ellen Trachman

It says in part:

"What does the law say? States like Louisiana and Illinois specifically require documented medical need of intended parents in a surrogacy arrangement to comply with the state surrogacy law. Louisiana requires that a doctor “who has medically treated the intended mother … submits a signed affidavit certifying that in utero embryo transfer with a gestational carrier is medically necessary to assist in reproduction.”

"Utah previously required “medical evidence … show[ing] that the intended mother is unable to bear a child or is unable to do so without unreasonable risk.” But that provision was struck down by the State Supreme Court after determining it was unconstitutional as applied to a same-sex male couple and could not be read a in gender-neutral way. (The SEEDS standard is, by contrast, gender neutral.)

"Other states with surrogacy-specific statutes — like California, Washington, Colorado, New Jersey, and New York — are silent on medical need and, therefore, implicitly permit social surrogacy arrangements. And then those states with no surrogacy law, much of the country, permit social surrogacy by default.

"The SEEDS standard, of course, only applies to member agencies and does not prevent nonmember agencies from supporting social surrogacy arrangements or for those arrangements to occur independent of agencies."

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Stephanie Wang and I anticipated to some extent that this could be an issue in our paper

Roth, Alvin E. and Stephanie W. Wang, “Popular Repugnance Contrasts with Legal Bans on Controversial Markets,” Proceedings of the National Academy of Sciences (PNAS),  August 18, 2020 117 (33) 19792-19798.

We surveyed populations in the U.S. and several other countries on transactions that were legal in some of them and illegal in others. We presented vignettes, and asked if they should be legal.  Because we wanted to give surrogacy a good chance of being perceived as repugnant, we made clear in the surrogacy vignette that there was no medical necessity, it was sought for convenience:

"James and Erica are a married couple in [home country]. They want to have a child, but Erica does not want to become pregnant due to the demands of her career as a model. Maria is a married mother in the Philippines. Maria’s husband is out of work, and Maria has decided to become a surrogate mother to earn additional income. James and Erica hire Maria to carry and give birth to a child from James and Erica’s sperm and egg. James and Erica pay Maria a year’s average income in the Philippines, and everyone signs a contract making it clear that James and Erica are the child’s biological parents and will have custody after the child is born."

You can see in the paper (or in this 2020 blog post) that (even) under these circumstances, clear majorities favored making this kind of voluntary surrogacy legal, not only in the U.S. and Philippines where surrogacy is legal, but also in Spain and Germany where surrogacy is illegal.

Vacuum-tube valley

 Silicon valley didn't transition directly from fruit orchards to silicon chips.  Vacuum tubes took center stage for a while.

Here's a California historical landmark on the NE corner of Emerson Street and Channing Avenue in Palo Alto, commemorating the Federal Telegraph Company, founded by radio/electronics pioneer Cyril Frank Elwell (August 20, 1884 – 1963), who graduated from Stanford in 1907.

Why is it so easy to get drugs, and so hard to get drug abuse treatment? Overdose deaths continue to climb.

 Here's an update on drug abuse in the U.S., from the WSJ. One quote particularly struck me, from a mom whose child died: "it’s so easy to get drugs,”  “It’s so much more available than treatment.”

How Meth Worsened the Fentanyl Crisis. ‘We Are in a Different World.’ Methamphetamine fatalities are rising, increasingly in combination with opioids  By Jon Kamp and Arian Campo-Flores.

"One in five of the total fatal overdoses last year involved an opioid and a psychostimulant, a drug class dominated by meth, preliminary federal data show. A decade earlier, about 2% of drug deaths involved such combinations.

...

"The rise in fatalities involving stimulants, often combined with opioids, has created a fourth wave of the decadeslong U.S. overdose-death crisis, according to Dr. Daniel Ciccarone, a professor of addiction medicine at the University of California, San Francisco. Deaths from combinations of opioids and cocaine, another stimulant, are also climbing.

...

"Fentanyl drove U.S. overdose deaths to a record-breaking tally of more than 108,000 last year, according to the federal data.

"Now, the combination of meth and opioids—especially fentanyl—is supercharging those numbers. Meth-related deaths, though smaller in number, are increasing at a faster rate than opioid and overall drug fatalities.

"About 33,400 deaths last year involved psychostimulants such as meth, up more than 340% from roughly 7,500 five years earlier, the federal data show. In the same time span, deaths involving synthetic opioids like fentanyl rose about 270% to around 72,000, and overall drug fatalities rose about 71%.

...

"it’s so easy to get drugs,” said Mr. Ryan’s mother, Alicia Vigil-Ryan. “It’s so much more available than treatment.”

Market and Mechanism Design, at Berkeley's Simons Laufer Mathematical Sciences Institute, application deadline is Dec. 1

 Here's a new flyer for the 

Mathematics and Computer Science of Market and Mechanism Design, at Berkeley MSRI, August 21-December 20, 2023

Applications are due by December 1.

Notice also that MSRI has new funding and a new name, the Simons Laufer Mathematical Sciences Institute.

Abortion protections and restrictions in the midterm elections

 Here's a post-election report from the NYT on how abortion protections and restrictions fared in the midterm elections. (It tries to reflect not only specific referenda and constitutional amendments, but also the platforms of elected candidates...)

Where the Midterms Mattered Most for Abortion Access  By Allison McCann, Amy Schoenfeld Walker, John-Michael Murphy and Sarah Cahalan

"The first election to put abortion rights to the test after the Supreme Court overturned Roe v. Wade appears unlikely to reshape the map of abortion access — at least not overnight. Voters in much of the country reinforced the status quo, choosing candidates who are likely to either maintain existing protections or restrictions in their states, or deepen them."

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Here's MSNBC's roundup, in an opinion piece that looks more at specific laws on the ballot:

The 2022 midterms abortion results should surprise literally no one. When voters get a say in their own individual reproductive rights, most want to keep them. By Emma Gray,

"On Thursday, Montana’s “Born Alive” legislative referendum officially failed.

...

"This meant that Montana’s voters joined Vermonters, Michiganders, Californians and even voters in deep-red Kentucky in protecting abortion rights. Vermont, Michigan and California enshrined reproductive freedom in their state Constitutions, and in Kentucky, voters struck down a proposed constitutional amendment that would have explicitly stated that there is no right to abortion in the state."

Blood Money, by John Dooley and Emily Gallagher

 Are paid plasma donors being exploited? Here's a paper that suggests not, but rather that the payments that plasma donors receive can improve their financial well being not merely by providing additional income, but also by helping them avoid going into expensive debt.

 Dooley, John and  Emily Gallagher, Blood Money (October 11, 2021). Available at SSRN: https://ssrn.com/abstract=3940369 or http://dx.doi.org/10.2139/ssrn.3940369

Abstract: "Little is known about the motivations and outcomes of sellers in remunerated markets for human materials. We exploit dramatic growth in the number of commercial blood plasma centers in the U.S. to study the individuals who sell plasma. We find sellers tend to be young and liquidity constrained with low incomes and credit scores; they also report less access to traditional bank credit. Plasma centers absorb demand for non-traditional credit. The opening of a nearby plasma center reduces payday loan inquires and transactions by 13–18% among young borrowers. Meanwhile, foot traffic increases by over 9% at both essential and non-essential goods establishments when a new plasma center opens nearby. Our findings suggest that, at least in the short-term, constrained households use the discretionary income from plasma centers to smooth consumption without appealing to high-cost debt."

HT: Mario Macis

Eric Budish on the economics of cryptocurrencies (video of his Harris Lecture at Harvard)

 If you haven't heard Eric Budish talk about crypto, this is your chance:  here's the video of his Harris Lecture at Harvard: The Economics of Cryptocurrencies by Eric Budish

(It was delivered before the recent collapse of the FTX exchange.)

California referendum bans flavored tobacco

More midterm election news on controversial markets and repugnant transactions:

California bans flavored tobacco products, including vapes, by Nicholas Florko at Statnews

 "On Tuesday, Californians overwhelmingly voted to ban all flavored tobacco products in the state.

"The move makes California by far the largest state to ban such products, which are already illegal in a smattering of smaller states, including Rhode Island, New Jersey, and Massachusetts.

"Regulators have targeted flavored products in particular because they are overwhelmingly preferred by young people. More than 84% of young people who vape reported using flavored products, according to recently released survey data by the Centers for Disease Control and Prevention.

"California’s ban would also outlaw menthol cigarettes, which federal regulators have proposed banning nationwide because they argue such products are easier to start and harder to quit. Survey data also show that menthol cigarettes are overwhelmingly preferred by Black smokers."

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Here's a recent (massive) report on the marketing efforts that went into making menthol flavoring popular (suggesting that we can soon expect to see menthol substitutes):

Advertising Created & Continues to Drive the Menthol Tobacco Market: Methods Used by the Industry to Target Youth, Women, & Black Americans. Jackler RK, Ramamurthi D, Willett J, Chau C, Muoneke M, Zeng A, Chang M, Chang E, Bahk JR, Ramakrishnan A. SRITA Research Paper 

Full Report: high-resolution PDF link (1.62Gb) / low-resolution PDF link (46.4Mb)
Executive Summary: high-resolution PDF link (6.2Mb)

Colorado legalizes magic mushroom/psilocybin therapies

 Denver is the mile high city, and the 2022 midterm elections have now legalized therapy with magic mushrooms/psilocybin, which has medical uses in treating post-traumatic stress disorder, among other things.

Colorado becomes second state with legalized ‘medicinal psychedelics’ by Olivia Goldhill in Statnews

"Colorado is the second state to legalize psychedelics, following Oregon’s 2020 passage of a similar ballot question. Like Oregon, Colorado plans to create licensed “healing centers” where people can take magic mushrooms under supervision.

“This is a truly historic moment. Colorado voters saw the benefit of regulated access to natural medicines, including psilocybin, so people with PTSD, terminal illness, depression, anxiety and other mental health issues can heal,” Kevin Matthews and Veronica Lightning Horse Perez, leaders of Natural Medicine Colorado, which campaigned for the measure, wrote in a statement emailed to STAT.

...

"The most advanced study for psilocybin, a Phase 2b trial on the drug for treatment-resistant depression published earlier this month, found the drug was effective at inducing remission in many patients, but the results were less striking than in earlier studies."

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And from Time Magazine:

Colorado Voted to Decriminalize Psilocybin and Other Psychedelics,  by Tara Law

"Colorado voters have approved the broadest psychedelic legalization in the U.S., which would decriminalize five psychedelic substances and enable adults to receive psychedelics at licensed centers.

...

"The ballot measure decriminalizes the possession of certain psychedelic drugs for personal use in the state and specifically legalize psilocybin, the psychedelic component of magic mushrooms, for use at licensed facilities starting in 2024. (In those ways, it’s similar to 2020 measures approved in Oregon, which decriminalized possession of small amounts of drugs in 2021 and is launching a psilocybin access program in 2023.)

"However, Colorado’s Proposition 122 goes further in several ways. In addition to decriminalizing possession, it decriminalizes the growing and sharing of five psychedelics for personal use: psilocybin, psilocyn (a psychedelic also found in magic mushrooms), dimethyltryptamine (commonly known as DMT, which is found in plants and animals, including certain tree frogs), ibogaine (derived from the bark of an African shrub), and mescaline (which is primarily found in cacti; however, Prop 122 excludes peyote). It also clears a pathway for the use of all these psychedelics at “healing centers”—facilities licensed by the state’s Department of Regulatory Agencies where the public can buy, consume, and take psychedelics under supervision. The regulated access program would initially be limited to psilocybin, which would launch in late 2024, but if recommended by a Natural Medicine Advisory Board appointed by the governor, it could be expanded to include DMT, ibogaine, and mescaline in 2026."

Deceased donor organ discards on weekends, in the the Annals of Transplantation

 Hospital resources and physician incentives can be stressed on weekends, and there is historical evidence that organ discards are higher on weekends.  Here's a study suggesting that is still a thing.

Yamamoto, T., A. Shah, M. Fruscione, S. Kimura, N. Elias, H. Yeh, T. Kawai, and J. F. Markmann.  Revisiting the "Weekend Effect" on Adult and Pediatric Liver and Kidney Offer Acceptance. Annals of Transplantation. 2022 Nov;27:e937825. DOI: 10.12659/aot.937825. PMID: 36329622.

"BACKGROUND: Weekends can impose resource and manpower constraints on hospitals. Studies using data from prior allocation schemas showed increased adult organ discards on weekends. We examined the impact of day of the week on adult and pediatric organ acceptance using contemporary data.

"MATERIAL AND METHODS: Retrospective analysis of UNOS-PTR match-run data of all offers for potential kidney and liver transplant from 1/1/2016 to 7/1/2021 were examined to study the rate at which initial offers were declined depending on day of the week. Risk factors for decline were also evaluated.

"RESULTS: Of the total initial adult/pediatric liver and kidney offers, the fewest offers occurred on Mondays and Sundays. The decline rate for adult/pediatric kidneys was highest on Saturdays and lowest on Tuesdays. The decline rate for adult livers was highest on Saturday and lowest on Wednesday. In contrast, the decline rate for pediatric livers was highest on Tuesdays and lowest on Wednesdays. Independent risk factors from multivariate analysis of the adult/pediatric kidney and liver decline rate were analyzed. The weekend offer remains an independent risk factor for adult kidney and liver offer declines, but for pediatric offers, these were not significant independent risk factors.

"CONCLUSIONS: Although allocation systems have changed, and the availability of kidneys and livers have increased in the USA over the past 5 years, the weekend effect remains significant for adult liver and kidney offers for declines. Interestingly, the weekend effect was not seen for pediatric liver and kidney offers.

Marijuana legalization advances in the 2022 elections

Time Magazine published this map under the headline "Why Marijuana Had a Terrible Night in the 2022 Midterm Elections"

It doesn't look so terrible to me, so much as increasingly inevitable. The grey states on the map (where marijuana remains entirely illegal) are shrinking steadily: it doesn't appear that opponents will succeed in making America grey again.

 "Nineteen states and the District of Columbia allow recreational use of marijuana; 13 states outlaw it entirely. The rest of the states—including Arkansas, South Dakota and North Dakota—allow its use for medicinal purposes. It remains illegal under federal law."

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It's going to become increasingly hard for States to enforce draconian laws against something that is legal in neighboring states.  That doesn't mean that legalization is always going to go smoothly--the end of Prohibition didn't end alcoholism, and the end of marijuana prohibition won't make marijuana chemically safer (in fact competition will develop strains that are chemically more potent).  But removing legal risks from what would otherwise be uncontrolled black markets, and taking them out of the hands of criminals, still seems to have momentum.