Thursday, April 27, 2023

More anti-gay legislation in Uganda

 The NY Times has the story about new anti-gay legislation awaiting signature by Uganda's president:

We Will Hunt You’: Ugandans Flee Ahead of Harsh Anti-Gay Law. The bill, passed last month, calls for life in prison for anyone engaging in same-sex relations. President Yoweri Museveni congratulated lawmakers for their “strong stand” against L.G.B.T.Q. people.  By Abdi Latif Dahir

"Uganda’s Parliament passed a sweeping anti-gay bill in late March that threatens punishment as severe as death for some perceived offenses, and calls for life in prison for anyone engaging in same-sex relations.

...

"The bill, which passed 387 to 2, punishes anyone who leases property to gay people and calls for the “rehabilitation” of those convicted of being gay. President Yoweri Museveni, who has commended the bill, sent it back to Parliament on Thursday for “improvement,” his party said in a statement.

"The president congratulated lawmakers and religious leaders on what he called their “strong stand” against L.G.B.T.Q. people. “It is good that you rejected the pressure from the imperials,” he said, a reference to Western countries, in footage released by the public broadcaster. He spoke hours after the European Parliament denounced the bill.

"The legislation follows a groundswell of anti-gay rhetoric that has swept African countries in recent years, including in Ghana, Zambia and Kenya. Last month, lawmakers from more than a dozen African countries gathered in Uganda and promised to introduce or pass measures in their own countries that they said would protect the sanctity of the family and children against “the sin of homosexuality.”

...

"The latest move to target L.G.B.T.Q. people in Uganda has drawn support from local Christian and Muslim groups, and for years the financial and logistical backing o"f some conservative evangelical groups in the United States." 

Wednesday, April 26, 2023

Banned books

 The LA Times has the story:

Book bans are soaring in U.S. schools, fueled largely by new laws in Republican-led states by  ALEXANDRA E. PETRI

"Fearing criminal penalties, public schools throughout Missouri removed hundreds of books from their libraries after state lawmakers last year made it illegal to provide students with “sexually explicit” material — a new law that carried punishment of up to a year in prison.

"The dangers are playing out in public school districts and campus libraries across the United States, First Amendment advocates warn: Book bans, gassed up by state legislation pushed by conservative officials and groups, are stacking up at an alarming rate.

"In a report published Thursday by PEN America, the nonprofit free speech organization found 1,477 instances of books being prohibited during the first half of the 2022-23 academic year, up 28.5% from 1,149 cases in the previous semester. Overall, the organization has recorded more than 4,000 instances of banned books since it started tracking cases in July 2021.

"At issue is more than “a single book being removed in a single district,” said Kasey Meehan, the Freedom to Read program director at PEN America and a lead author of the report.

“It’s a set of ideas, it’s themes, it’s identities, it’s knowledge on the history of our country — these are the kind of bigger buckets of what is being removed, restricted, suppressed in public schools and public school libraries,” Meehan said."

Tuesday, April 25, 2023

It's against the law in North Korea to use South Korean words

 From Radio Free Asia:

North Korea sentences 20 young athletes for ‘speaking like South Koreans’. Skaters and skiers were caught on video using banned words while playing a game during training.  By Jieun Kim for RFA Korean

"About 20 aspiring North Korean winter athletes were abruptly sentenced to three to five years of hard labor in prison camps after they were found to have used South Korean vocabulary and slang while playing a word game, sources in the country say.

"It’s the latest example of authorities imposing draconian punishments to try to stamp out use of the “puppet language” and “capitalist” influences in daily life – despite the flood of illegal South Korean dramas and songs that many North Koreans secretly watch after obtaining them on thumb drives smuggled into the country.

"The ice skaters and skiers, all high school graduates under the age of 25 from Ryanggang province, were publicly disgraced at a square in Hyesan on April 3, a resident in the city on the Chinese border told Radio Free Asia’s Korean Service on condition of anonymity for security reasons.

“Residents think that it is excessive that they were sentenced between three and five years” of hard labor, another source in the city said. “It would be impossible to count how many hundreds or thousands of South Korean movies and dramas are easily available to us.”

...

"Apparently, one of the athletes took a video of the young people playing a word game called mal kkori itgi, where the object is to make a sentence that starts with the final word of the previous player’s sentence, and some of the athletes used vocabulary that was distinctly South Korean, a second source from the same province said.

"The video was found on the phone of one of the female athletes during a random inspection raid by police of her home – a frequent occurrence in North Korea when police look for contraband – and was reported to authorities. It wasn’t clear if she had taken the video or if it was sent to her, the first source said.

...

"The North Korean government recently passed the Pyongyang Cultural Language Protection Act, which underscores that the Pyongyang dialect is the standard language, and doles out severe punishments for speaking like a South Korean, or the death penalty for teaching others how to."

Monday, April 24, 2023

Michigan Senate seeks to repeal 1931 ban on unmarried cohabitation

 Michigan now has a more liberal senate than in 1931.  The Guardian has the story, about how even fossil repugnance dies hard:

Michigan Republicans fight effort to repeal ban on unmarried cohabitation. Law signed in 1931 is rarely enforced but carries penalty of prison time and $1,000 fine. by Erum Salam

"An attempt to repeal a Michigan law that punishes unmarried couples who live together is being thwarted by Republicans in the state legislature.

"The law, which dates to 1931, targets “any man or woman, not being married to each other, who lewdly and lasciviously associates and cohabits together”.

"It is rarely enforced but violations carry a penalty of up to a year in prison and a $1,000 fine.

"Senate Bill 56, which seeks to repeal the law, attracted support from all state senate Democrats and half of Republicans. But nine Republicans voted against.

...

"The bill now moves to the statehouse."

*********

Michigan Senate Bill 56: "Crimes: other; lewd and lascivious cohabitation; repeal prohibition. Amends sec. 335 of 1931 PA 328 (MCL 750.335)."

Sunday, April 23, 2023

Medical aid in dying: access for children, and for mental illness

Two recent articles discuss whether there should be categorical limits on medical aid in dying (MAID).  In the Netherlands, the law now permits euthanasia for children in certain horrific situations, and in Canada, a debate continues about the status of patients with mental illness.

 From The Conversation:

Dutch government to expand euthanasia law to include children aged one to 12 – an ethicist’s view  by Dominic Wilkinson

"Ernst Kuipers, the Dutch health minister, recently announced that regulations were being modified to allow doctors to actively end the lives of children aged one to 12 years who were terminally ill and suffering unbearably.

"Previously, assisted dying was an option in the Netherlands in rare cases in younger children (under one year) and in some older teenagers who requested voluntary euthanasia. Until now, Belgium was the only country in the world to allow assisted dying in children under 12.

...

"Dutch paediatricians and parents had reported that in a small number of cases, children and families were experiencing distressing suffering at the end of life despite being provided with palliative care.

"That included, for example, children with untreatable brain tumours who developed relentless vomiting, screaming, and seizures in their dying phase. Or children with epilepsy resistant to all treatment with tens to hundreds of seizures a day.

"The study recommended improvements in access to palliative care for children, as well as altering regulation to provide the option of assisted dying in these extreme cases.

"It has been suggested that five to ten children a year might be eligible for this option in the Netherlands.

*********

From the NYT, an opinion piece:

Medical Assistance in Dying Should Not Exclude Mental Illness By Clancy Martin

"I am a Canadian, where eligible adults have had the legal right to request medical assistance in dying (MAID) since June 2016. Acceptance of MAID has been spreading, and it is now legal in almost a dozen countries and 10 U.S. states and Washington, D.C. To my mind, this is moral progress: When a person is in unbearable physical agony, suffering from a terminal disease, and death is near, surely it is compassionate to help end the pain, if the person so chooses.

"But a debate has arisen in Canada because the law was written to include those living with severe, incurable mental illness. This part of the law was meant to take effect this year but was recently postponed until 2024."



Saturday, April 22, 2023

Strategy-proofness in Berlin in July

 "The WZB is planning an international conference on matching markets “Matching Market Design: Strategy-Proofness and Beyond” held as a two-day workshop on July 13–14, 2023, at the WZB Berlin Social Science Center, Germany. The conference will be organized by Dorothea Kübler (WZB), Christian Basteck (WZB/FU) and Vincent Meisner (TU)."

Here's the full announcement

Matching Market Design: Strategy-Proofness and Beyond  13. - 14. Juli 2023

"In the design of matching markets, it is important to elicit the privately known preferences of participants. Therefore, economists have focused on strategy-proof mechanisms which incentivize the truthful revelation of preferences and rule out any incentives to strategically misreport them. Unfortunately, as a growing body of evidence documents, strategy-proofness by itself is not sufficient to elicit truthful information on preferences.

"The workshop will bring together leading international researchers from North America, Europe, and Asia to present their latest research on this central design objective, including its limitations. In particular, we aim to discuss theoretical contributions on axiomatic characterizations, complexity notions, behavioral biases, and non-standard constraints, as well as applied work that incorporates experimental and field data."

Here's the preliminary program.

Friday, April 21, 2023

Transition from medical school to residency: defending the parts that work well (namely the NRMP Resident Match)

This post is about a recently published paper concerning the design of the market for new doctors in the U.S.  But it will require some background for most readers of this blog.   The short summary is that the market is experiencing problems related to congestion, and one of the proposals to address these problems was deeply flawed, and would have reduced market thickness and caused substantial direct harm to participants if implemented, and created instabilities that would likely have caused indirect harms to the match process in subsequent years. But this needed to be explained in the medical community, since that proposal was being  very actively advocated.

For those of you already steeped in the background, you can go straight to the paper, here.

Itai Ashlagi, Ephy Love, Jason I. Reminick, Alvin E. Roth; Early vs Single Match in the Transition to Residency: Analysis Using NRMP Data From 2014 to 2021. J Grad Med Educ 1 April 2023; 15 (2): 219–227. doi: https://doi.org/10.4300/JGME-D-22-00177.1

If the title doesn't remind you of the vigorous advocacy for an early match for select positions, here is some of the relevant back story.

The market for new doctors--i.e. the transition from medical school to residency--is experiencing growing pains as the number of applications and interviews has grown, which imposes costs on both applicants and residency programs.  

Below is a schematic of that process, which begins with applicants submitting applications electronically, which makes it easy to submit many.  This is followed by residency programs inviting some of their applicants to interview. The movement to Zoom interviews has made it easier to have many interviews also (although interviews were multiplying even before they moved to Zoom).  

After interviews, programs and applicants participate in the famous centralized clearinghouse called The Match, run by the NRMP. Programs and applicants each submit rank order lists (ROLs) ranking those with whom they interviewed, and a deferred acceptance algorithm (the Roth-Peranson algorithm) produces a stable matching, which is publicly announced on Match Day. (Unmatched people and positions are invited into a now computer-mediated scramble, called SOAP, and these matches too are announced on Match  Day.)

The Match had its origins as a way to control the "unraveling" of the market into inefficient bilateral contracts, in which employment contracts were made long before employment would commence, via exploding offers that left most applicants with very little ability to compare options.  This kind of market failure afflicted not only the market for new physicians (residents), but also the market for later specialization (as fellows). Consequently, over the years, many specialties have turned to matching for their fellowship positions as well.

  The boxes in brown in the schematic are those that constitute "The Match:" the formulation and submission of the ROLs, and the processing of these into a stable matching of programs to residents.  Congestion is bedeviling the parts in blue.

The boxes colored brown are 'The Match' in which participants formulate and submit rank order lists (ROLs), after which a deferred acceptance algorithm produces a stable matching of applicants to programs, which is accepted by programs and applicants on Match Day. The boxes in blue, the applications and interviews that precede the Match, are presently suffering from some congestion.  Some specialties have been experimenting with signals (loosely modeled on those in the market for new Economics PhDs, but implemented differently by different medical specialties).

The proposal in question was to divide the match into two matches, run sequentially, with the first match only allowing half of the available positions to be filled.  The particular proposal was to do this first for the OB-GYN specialty, thus separating that from the other specialties in an early match, with only half of the OB-GYN positions available early.

This proposal came out of a study funded by the American Medical Association, and it was claimed, without any evidence being offered, that it would solve the current problems facing the transition to residency.  Our paper was written to provide some evidence of the likely effects, by simulating the proposed process using the preferences (ROLs) submitted in previous years.  

The results show that the proposal would largely harm OB-GYN applicants by giving them less preferred positions than they could get in a traditional single match, and that it would create instabilities that would encourage strategic behavior that would likely undermine the successful operation of the match in subsequent years.

Itai Ashlagi, Ephy Love, Jason I. Reminick, Alvin E. Roth; Early vs Single Match in the Transition to Residency: Analysis Using NRMP Data From 2014 to 2021. J Grad Med Educ 1 April 2023; 15 (2): 219–227. doi: https://doi.org/10.4300/JGME-D-22-00177.1

Abstract:

"Background--An Early Result Acceptance Program (ERAP) has been proposed for obstetrics and gynecology (OB/GYN) to address challenges in the transition to residency. However, there are no available data-driven analyses on the effects of ERAP on the residency transition.

"Objective--We used National Resident Matching Program (NRMP) data to simulate the outcomes of ERAP and compare those to what occurred in the Match historically.

"Methods--We simulated ERAP outcomes in OB/GYN, using the de-identified applicant and program rank order lists from 2014 to 2021, and compared them to the actual NRMP Match outcomes. We report outcomes and sensitivity analyses and consider likely behavioral adaptations.

"Results--Fourteen percent of applicants receive a less preferred match under ERAP, while only 8% of applicants receive a more preferred match. Less preferred matches disproportionately affect DOs and international medical graduates (IMGs) compared to US MD seniors. Forty-one percent of programs fill with more preferred sets of applicants, while 24% fill with less preferred sets of applicants. Twelve percent of applicants and 52% of programs are in mutually dissatisfied applicant-program pairs (a pair in which both prefer each other to the match each received). Seventy percent of applicants who receive less preferred matches are part of a mutually dissatisfied pair. In 75% of programs with more preferred outcomes, at least one assigned applicant is part of a mutually dissatisfied pair.

"Conclusions--In this simulation, ERAP fills most OB/GYN positions, but many applicants and programs receive less preferred matches, and disparities increase for DOs and IMGs. ERAP creates mutually dissatisfied applicant-program pairs and problems for mixed-specialty couples, which provides incentives for gamesmanship."



************
I'm hopeful this paper will effectively contribute to the ongoing discussion of how, and how not, to modify the design of the whole process of transition to residency with an aim to fixing the parts that need fixing, without damaging the parts that work well, i.e. while doing no harm. 

(Signaling will likely continue to play a role in this.)



Thursday, April 20, 2023

Workshop on Experimental Economics and Entrepreneurship: call for papers

 Nico Lacetera writes:

We are happy to announce the Third Workshop on Experimental Economics and Entrepreneurship, sponsored by the Belk College of Business of the University of North Carolina at Charlotte.

The workshop is organized by David J. Cooper (University of Iowa), Florian Englmaier (Ludwig Maximilian University of Munich), Nicola Lacetera (University of Toronto), Krista Saral (University of North Carolina at Charlotte) and Artie Zillante (University of North Carolina at Charlotte). It will take place in Charlotte, NC on October 18-19, 2023, immediately preceding the North American Annual Meeting of the Economic Science Association, in the same location.

The workshop is meant to promote partnerships between economic experimenters and scholars studying entrepreneurship, and to expose graduate students and recent PhD graduates in Economics and Management to the benefits and challenges of research at the intersection of experimental economics and entrepreneurship. The workshop will include a mixture of presentations by senior scholars in entrepreneurship and experimental economics, talks by more junior scholars, and presentations by graduate students. The conference is designed to encourage participants to interact and hopefully discuss ideas for future projects.

This is an open call for submissions for doctoral students, post-doctoral researchers, and faculty who obtained their doctoral degrees in 2019 or later. If you are interested in participating and presenting your research, please apply by submitting the following material to esaconference@uncc.edu by June 1, 2013:      

•    A cover letter including contact information.
•    An extended abstract of the paper you plan to present.  This should not be more than a page long.  If a paper is available, this can be submitted as well, but this is not required for consideration.

 The decision about accepted applications will be communicated not later than June 20, 2023. Each accepted and confirmed applicant will have two hotel nights covered as well as normal travel expenses.  

In addition to the selected workshop presentations, here is the current list of invited speakers who will be attending:

 

Jennifer Brown (University of Utah)

Jana Gallus (UCLA)

Orsola Garofalo (Copenhagen Business School)

Rem Koning (Harvard Business School)

Ronnie Chaterjee (Duke University)

Tim Salmon (Southern Methodist University)


We look forward to receiving your applications!

David, Florian, Nico, Krista, Artie


Wednesday, April 19, 2023

Transplantation: progress and continued shortcomings

 Here's a guest essay from the NYT that focuses on a different set of shortcomings of organ transplantation than organ availability. The author writes about how her long history of immunosuppression, to keep her transplanted organ(s) alive, has left her vulnerable to cancer.

My Transplanted Heart and I Will Die Soon.  By Marine Buffard

"My 35 years living with two different donor hearts (I was 25 at the time of the first transplant) — finishing law school, getting married, becoming a mother and writing two books — has felt like a quest to outlast a limited life expectancy. 

...

"Organ transplantation is mired in stagnant science and antiquated, imprecise medicine that fails patients and organ donors. And I understand the irony of an incredibly successful and fortunate two-time heart transplant recipient making this case, but my longevity also provides me with a unique vantage point. Standing on the edge of death now, I feel compelled to use my experience in the transplant trenches to illuminate and challenge the status quo.

"Over the last almost four decades a toxic triad of immunosuppressive medicines — calcineurin inhibitors, antimetabolites, steroids — has remained essentially the same with limited exceptions. These transplant drugs (which must be taken once or twice daily for life, since rejection is an ongoing risk and the immune system will always regard a donor organ as a foreign invader) cause secondary diseases and dangerous conditions, including diabetes, uncontrollable high blood pressure, kidney damage and failure, serious infections and cancers. The negative impact on recipients is not offset by effectiveness: the current transplant medicine regimen does not work well over time to protect donor organs from immune attack and destruction.

"My first donor heart died of transplant medicines’ inadequate protection of the donor heart from rejection; my second will die most likely from their stymied immune effects that give free rein to cancer.

...

"Without vigorous pushback, hospitals and physicians have been allowed to set an embarrassingly low bar for achievement. Indeed, the prevailing metric for success as codified by the Health Resources and Services Administration is only one year of post-transplant survival, which relieves pressure for improvement."

*************

That one year of measured graft survival is both too short, as the author points out, and too long.  By penalizing transplant centers for transplants that fail to survive a year, the current regulations make transplant centers too risk averse, so that kidney transplants that would have only, say, an 85% chance of working well are often not conducted, leaving patients to remain on dialysis, often til death,  for that 85% chance of life.

Transplantation is, still, a modern miracle. But until we can do without it, we'll have to keep trying to do it better.

Tuesday, April 18, 2023

The World Health Organization (WHO) at 75

 An editorial in Nature considers the complicated history of  the World Health Organization. 

The WHO at 75: what doesn’t kill you makes you stronger. The World Health Organization is emerging from the peak of the pandemic bruised. Its member states must get back to prioritizing universal health care.

"When thinking about the WHO’s 75 years, it’s worth remembering the time and circumstances of its creation. In the aftermath of the Second World War, the newly established United Nations and its specialized agencies, including the WHO, were designed to future-proof the world from another global conflict. Around 80 million people died during the two world wars, many from famine or disease.

"The WHO deserves more money for its core mission — and more respect

"The WHO’s founding constitution states unequivocally: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”

"And yet, the agency’s creators chose not to prioritize robust systems of universal health care that would meet these goals. This absent focus is one factor in why infectious diseases continue to impact populations in low- and middle-income countries. The eradication of smallpox in 1980 was a big win. But for other diseases, the agency and its donors have been unable to reach targets, including in the elimination of HIV and AIDS, malaria and tuberculosis.

"The WHO does, however, have a consistent record for establishing itself as the go-to organization for setting global standards for the efficacy, safety and quality of vaccines and medicines. As we have seen during the pandemic, the agency is central to alerting the world to new infectious diseases, helped in no small measure by the revolution in biomedicine and health data, especially genomics."


In general I think the WHO does important work reasonably well, but I have reservations about their policies concerning blood and transplants, which seem to me to reflect some now outdated repugnance to the complexities of “Substances of Human Origin (SoHO)." (Not that these issues don't remain complex.)

Monday, April 17, 2023

Discriminatory quotas in admissions to universities and graduate schools (and some black humor from my father's generation)

 History doesn't exactly repeat itself, but it rhymes. (Mark Twain apparently missed the opportunity often attributed to him of saying that.) Here's a story about the history of ethnic quotas for Jews, as it played out in medicine in the 20th Century. (And at the bottom, some old jokes about coping with it...)

The History of Discriminatory Jewish Quotas in American Medical Education and Orthopaedic Training, by Solasz, Sara J. BA1; Zuckerman, Joseph D. MD1; Egol, Kenneth A. MD1,a, The Journal of Bone and Joint Surgery 105(4):p 325-329, February 15, 2023. | DOI: 10.2106/JBJS.22.00466

"By the early 1920s, formal quota systems were put in place to limit the number of Jewish applicants admitted to many American medical schools. This quota was partly a result of the second wave of Jewish immigration and the subsequent rise in antisemitism in the country. As a sign of the growing antisemitism in America, in 1920, Henry Ford published a weekly series called “The International Jew: The World’s Problem” on the front page of his newspaper, The Dearborn Independent. In this series, which continued for years, Ford fueled antisemitism both at home and abroad. The effect at the time was enormous: the feeling was that if an American icon as rich and powerful as Ford could hold this conviction so strongly, then it must be credible5,6. In addition to the effect on medical school admissions, measures were taken to deny Jewish people access to social institutions, neighborhoods, swimming pools and beaches, and employment.

...

"Harvard was known to have quotas restricting the number of Jewish students admitted to the college under the leadership of Lowell. In a letter to a philosophy professor, Lowell wrote that admitting Jewish students would ruin Harvard, “not because Jews of bad character have come; but the result follows from the coming in large numbers of Jews of any kind, save those few who mingle readily with the rest of the undergraduate body.”8

"It is within this social and political climate that the Jewish quota system appeared in medical schools throughout the U.S. Although medical school officials have always denied the existence of Jewish quotas, records from schools across the country reveal a systematic and intentional anti-Jewish prejudice. The medical historian Henry Sigerist wrote that Jewish students were subject to a “tacit, but nevertheless highly effective, quota system and in most schools the number of Jewish students rarely exceeds 10 per cent.”9 Many mainstream thinkers in higher education argued for further reductions in the acceptance rate for Jewish students, advocating for discrimination against Jews under the guise of keeping the “national ratio correct,” which would bring down the number of accepted students to represent only 3% to 4% of the total class.

...

"The most significant decrease in the number of admitted students occurred at Columbia University, which asked for the applicant’s religion, parents’ birthplaces, racial origin, and mother’s maiden name11. At the Columbia College of Physicians and Surgeons, the rate of enrollment of Jewish students between 1920 and 1940 dropped from 47% to 6%; during the same period, the rate dropped from 40% to 5% at Cornell University Medical College3. Throughout the Northeast, where the concentration of Jewish applicants was the highest, quotas appeared at schools such as Harvard Medical School, Yale School of Medicine, and the Woman’s Medical College of Pennsylvania3.

...

Facing this widespread sentiment, Jewish students hoping to gain admission to medical school were forced to take action—with some even changing their last names to avoid discrimination. Medical schools identified “Jewish names” on applications, especially when the applicants were from areas with large Jewish populations, to indirectly discriminate against Jewish students. Soon, schools expanded applications to require completion of a “change of name” section. *

...

"Prior to the establishment of the current U.S. residency “match” system, each residency position was sought individually with an application and interview and was typically followed by a near-immediate offer of a position. This system certainly provided a biased and unfair method for filling training programs.

...

"In New York State, the Education Practices Act (1948) set a precedent for other states to pass legislation to eliminate discriminatory admissions practices. As the wave of antisemitism began to fade and the need for physicians grew, medical schools and graduate medical education programs started to remove the quota systems, which came to a complete end in the 1970s."

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

*Black humor was common in my dad's generation, including jokes about name changing (sometimes told in Yiddish). Here are two, approximately remembered.

1. Shmuel and Moshe, friends from Odessa, meet in New York after both have immigrated to America.  Moshe spots him from a distance and rushes over, calling out "Shmuel!"  They embrace, and Shmuel says, "I'm called Sam now, in America.  How about you?"

Moshe says "my American name is Sean Ferguson."  Sam is astonished, and asks "how come?"  "Well," says Moshe/Sean, I had picked out a good American name, but I was so nervous when I got to Ellis Island that I couldn't remember it. So when the immigration officer asked me my name, all I could think of to say was "I've already forgotten/ ikh hab shoyn fargesn, which is what he wrote down."  (איך האב שוין פארגעסן)


2. A few years later, Sean Ferguson goes to court to change his name again, to John McMillan. The judge asks him why he wants to do that.  He says "When I apply for positions, people ask what my name used to be..."

Sunday, April 16, 2023

The (American) market for assault rifles

There was a time when Americans thought that rifles were for hunting game, and assault weapons were banned.  That has changed.

The Washington Post has the story:

The gun that divides a nation. The AR-15 thrives in times of tension and tragedy. This is how it came to dominate the marketplace – and loom so large in the American psyche. By Todd C. Frankel, Shawn Boburg, Josh Dawsey, Ashley Parker and Alex Horton 

"The AR-15 wasn’t supposed to be a bestseller.

"The rugged, powerful weapon was originally designed as a soldiers’ rifle in the late 1950s. “An outstanding weapon with phenomenal lethality,” an internal Pentagon report raved. It soon became standard issue for U.S. troops in the Vietnam War, where the weapon earned a new name: the M16.

...

"Today, the AR-15 is the best-selling rifle in the United States, industry figures indicate. About 1 in 20 U.S. adults — or roughly 16 million people — own at least one AR-15, according to polling data from The Washington Post and Ipsos.

...

"One Republican lawmaker, Rep. Barry Moore of Alabama, introduced a bill in February to declare the AR-15 the “National Gun of America.

"It also has become a stark symbol of the nation’s gun violence epidemic. Ten of the 17 deadliest U.S. mass shootings since 2012 have involved AR-15s.

...

"the U.S. firearms industry came to embrace the gun’s political and cultural significance as a marketing advantage as it grasped for new revenue.

"The shift began after the 2004 expiration of a federal assault weapons ban that had blocked the sales of many semiautomatic rifles. 

...

"Today, the industry estimates that at least 20 million AR-15s are stored and stashed across the country.

"More than 13.7 million of those have been manufactured by U.S. gunmakers just since the Newtown massacre in late 2012"

*************

NPR puts some history into perspective:

The Nashville school shooting highlights the partisan divide over gun legislation , by Ron Elving, April 1, 2023

"The Stockton schoolyard shooting in 1989

...

"The Stockton story was national news, featured on the cover of Time magazine with the headline "Armed America." Public alarm at Stockton pushed the legislature to be the first to prohibit the sale of assault weapons that year.

"Stockton was still reverberating three years later when California, the home of Republican presidents Richard Nixon and Ronald Reagan, sent two liberal Democrats, both women, to the U.S. Senate It also stocked its legislature and congressional delegation with big Democratic majorities and gave its Electoral College vote to Bill Clinton.

"One of the two women senators elected that year was former San Francisco Mayor Dianne Feinstein, who had first become mayor when her predecessor was shot to death in his office in the 1970s. She had long been outspoken on gun control and brought that commitment to Washington, D.C., becoming one of the principal sponsors of a bill banning assault weapons ban in her first year.

"The Assault Weapons Ban of 1994

"Feinstein and her cosponsors wanted to end the sale or manufacture of 14 categories of semi-automatic assault weapons. They also wanted to go beyond the California ban by outlawing copycat versions of earlier models and high-volume detachable magazines that held more than 10 rounds.

"But the bill did not address the status of an estimated one million assault weapons nationwide. "Essentially what this legislation does is create a freeze," she said. She lamented the resistance that rarely produced actual arguments among her colleagues. She said had never realized "the power of the NRA in this town."

...

"There were literally hundreds of exceptions included in the final version, distressing many of the bill's supporters. But getting the ban into the crime package to be passed in that Congress (with billions in new police funding) required many compromises. Ultimately, to get to a majority, Feinstein would have to accept a sunset provision by which her restrictions would need reenactment after 10 years.

...

"So when the 10-year expiration date on Feinstein's bill arrived in 2004, Democrats were no longer the majority party in Congress and all attempts to extend the 1994 ban were unavailing.

...

"The Sandy Hook Test in 2012

The next time serious energy developed behind renewing the ban was in the winter of 2012-2013. Barack Obama had just been reelected president, and the Senate was still in Democratic hands.

"Just as important, the effort to address the gun issue had been given an enormous boost by a new and more horrific tragedy.

"On Dec. 12, 2012, Adam Lanza, 20 — described by counselors as fascinated with mass shootings — killed his mother and took guns she had legally purchased to a Sandy Hook Elementary School in Newtown, Conn.

"There he shot dead 20 children, ages 6 and 7. He also killed six adults on the school staff. Then he killed himself.

"The national shock at the time is hard to appreciate a decade later, as there have been so many like it. 

...

"But the 113th Congress came and went in 2013 and 2014 without passing notable gun legislation. A compromise measure on background checks, offered by West Virginia Democrat Joe Manchin and Pennsylvania Republican Pat Toomey, got 54 votes in the Senate but needed 60.

"As for prospects for reviving gun legislation in the current Congress, the situation looks much as it did a decade ago. The 118th Congress has a Senate where Democrats have a nominal majority that depends on the cooperation of several independents. Feinstein is still in the Senate, the longest-serving incumbent Democrat, but planning to retire next year.

"The current House, like that of a decade ago, has a Republican majority led by a speaker whose power depends on placating a hardcore group known as the House Freedom Caucus."

Saturday, April 15, 2023

Jobs at risk from AI chatbots

 The WSJ has the alarming news:

The Fortune Cookie Industry Is in Upheaval. ‘Expect Big Changes Ahead.’ Factories split over whether to use software, instead of humans, to write the random bits of wisdom inside the wafers. ‘Society is moving too fast.’  By Angus Loten

"Over the past two decades, Charles Li, the owner and chief executive of Chicago-based fortune-cookie factory Winfar Foods Inc., has drawn on Chinese proverbs and popular sayings to write thousands of messages that go into the wafers. Mr. Li says he and his 80-year-old father-in-law spend long hours coming up with lines that are clever but still brief enough to fit on a ribbon of paper.

...

"OpenFortune Inc., a New York-based company that supplies printed messages to well over a dozen fortune-cookie factories around the world, says it has started using ChatGPT technology to potentially generate a near-limitless inventory of new messages.

"Making up the sayings in the cookies is a vigorous line of work. By some estimates, three billion fortune cookies are made by factories around the world every year. Nearly all are written by a handful of fortune-cookie factory owners, their families or small teams of copywriters."

Friday, April 14, 2023

Kidney transplants from donors who died from illegal drug use

 There was a time when the modal deceased kidney donor had suffered a head injury in an auto accident, but that time is long gone, due to increased auto safety and to the rise in drug overdose deaths.  Those latter deaths now constitute a large proportion of deceased donors, and here's a report from Canada confirming that those kidneys work well in their new owners.

Xie, Max Wenheng, Sean Patrick Kennan, Amanda Slaunwhite, and Caren Rose. "Observational Study Examining Kidney Transplantation Outcomes Following Donation From Individuals That Died of Drug Toxicity in British Columbia, Canada." Canadian Journal of Kidney Health and Disease 10 (2023): 20543581231156853.

"Abstract:

"Background: The illicit drug toxicity (overdose) crisis has worsened across Canada, between 2016 and 2021 more than 28 000 individuals have died of drug toxicity. Organ donation from persons who experience drug toxicity death has increased in recent years. 

"Objective: This study examines whether graft loss after kidney transplantation differed by donor cause of death. 

Design: Retrospective cohort. 

"Setting: Provincial transplant program of British Columbia, Canada. 

"Patients: Transplant recipients who received kidney transplantation from deceased donors aged 12 to 70 years between 2013 and 2019 (N = 1012). 

"Measurements: Transplant recipient all cause graft loss (graft loss due to any cause including death) was compared by donor cause of death from drug toxicity or other. 

"Methods: Five-year Kaplan-Meier estimates of all-cause graft survival, and 3-year complete as well as stratified inverse probability of treatment weighted Cox proportional hazards models were conducted. 

"Results: Drug toxicity death donors donated to 25% (252/1012) of kidney transplantations. Drug toxicity death donors were more likely to be young, white, males, with fewer comorbidities such as diabetes or hypertension but were more likely to have a terminal serum creatinine ≥1.5 mg/dL or be hepatitis C virus (HCV) positive. Unadjusted 5-year estimate of all cause graft survival was 97% for recipients of drug toxicity donor kidneys and 83% for recipients of non-drug toxicity donor kidneys (P < .001). Recipients of drug toxicity death donor kidneys had decreased risk of all cause graft loss compared to recipients of non-drug toxicity death donor kidneys (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.12-0.77, P = .012). This is primarily due to the reduced risk of all-cause graft loss for recipients of younger (≤35 years) drug toxicity death donor kidneys (HR: 0.05, 95% CI: 0.00-0.55, P = .015). 

"Limitations: Potential selection bias, potential unmeasured confounding. 

"Conclusions: Donation after drug toxicity death is safe and should be considered more broadly to increase deceased donor kidney donation."

...

"illicit drug toxicity remains the leading unnatural cause of death in BC accounting for more deaths than homicides, suicides, and motor vehicle incidents combined.

...

"The United States is also undergoing an opioid epidemic which began earlier than Canada and has recorded similar increases in organ donation from individuals that died of illicit drug toxicity.9-11 Studies in the United States have found that recipient survival after kidney transplantation from individuals who died from drug toxicity was similar for recipients of kidneys from donors that died of any other cause of death."

Thursday, April 13, 2023

Brain Death

 Before there was the possibility of organ transplantation, determining that someone was dead could be a relatively leisurely affair. But transplants depend on organs remaining alive after the potential organ donor has died.  If the death is due to irreversible absence of circulation and respiration (Donation after Circulatory Death – DCD), it has to be declared quickly, so that preparation for organ recovery can begin promptly. If the declaration of death is based on brain death, i.e. on irreversible absence of whole brain function (Donation after Death declared by Neurologic Criteria - DDNC), then it must occur while the potential donor is on a ventilator, so that his/her organs continue to be oxygenated.  This means that the declaration of death occurs while the ventilator is still maintaining many of the signs (respiration, heartbeat) that are usually evidence of a living person.  So deciding when someone is brain dead requires both expertise and consensus.

Here's a recent discussion of all this, including some controversy, in JAMA: 

The Uncertain Future of the Determination of Brain Death, by Robert D. Truog, JAMA. 2023;   329(12): 971-972. doi:10.1001/jama.2023.1472

"In 1980, the US Uniform Law Commission (ULC) established the Uniform Determination of Death Act (UDDA), which was subsequently adopted (with some modifications) by all 50 states.1 The law states that death is defined as either (1) the irreversible cessation of circulatory and respiratory functions or (2) the irreversible cessation of all functions of the entire brain, including the brainstem.

...

"The framers of the UDDA rejected the claim that this was a new way of defining death.2 Instead, they pointed to evidence at the time suggesting that the brain is necessary for maintaining biological functioning and that when this brain regulation is absent, homeostatic mechanisms fail, with cardiac arrest invariably occurring within 1 to 2 weeks at most. In other words, brain death and cardiopulmonary arrest were seen as equivalent and equally valid criteria for diagnosing the biological death of a patient.

"However, with improvements in critical care medicine, this equivalency has been called into question. With modern intensive care unit support, some patients can be stabilized and, if provided with mechanical ventilation and tube feedings, their bodies may survive for many years.

...

"In fact, patients with brain death may retain most of the capacities of living people, including the ability to absorb nutrition, excrete waste, heal wounds, grow, undergo puberty, and even gestate. This has led many families to reject the diagnosis and insist on the continuation of medical support for their loved ones.

"In addition, a second issue has been that, although the UDDA requires “the irreversible absence of all functions of the entire brain,” the current guidelines from the American Academy of Neurology (AAN) test for only a select number of functions and most notably do not test for hypothalamic functions, which are sometimes present in patients who are diagnosed with brain death

"In the wake of an increasing number of legal challenges related to the determination of brain death, ULC began a process in 2021 to assess whether the UDDA should be revised.1 At least 3 distinct proposals have been considered.

"Proposal 1: Revise the Guidelines to Align With the Current Definition

"One option would be to leave the UDDA intact, but revise the AAN guidelines to include testing for the absence of hypothalamic function.

...

"Proposal 2: Revise the Definition to Align With the Current Guidelines

"A second proposal has been to change the definition of brain death to be in alignment with the guidelines.

...

"Revising the UDDA so that it required not the irreversible loss of all brain functions, but rather only those functions that support consciousness and spontaneous respiration, would bring the UDDA into alignment with the AAN guidelines. This approach also has precedent, in that it is the definition that was adopted by the United Kingdom in 2008.

...

"Proposal 3: Maintain the Status Quo

"If the position endorsed by commissioner Bopp were to prevail, some states could choose to entirely eliminate the determination of death by neurologic criteria. The impact would be 2-fold: in those states it would no longer be permissible to procure transplantable organs from patients diagnosed with brain death and physicians could be required to continue to provide intensive care unit beds and life support to patients who will never regain consciousness. Such an outcome could have disastrous consequences for our existing systems of organ procurement and transplantation, leading to thousands of otherwise avoidable deaths.

"This has led some commissioners to lean in favor of not making any major revisions to the UDDA, leaving well enough alone."

Wednesday, April 12, 2023

Mega-Journals and scientific publishing

 Academic publishing is getting more varied. A recent article in JAMA focuses on the rise of 'mega-journals,' which seek to publish papers that are correct, without filtering for (referees' opinions about) novelty or importance.

The Rapid Growth of Mega-Journals: Threats and Opportunities  by John P. A. Ioannidis, MD, DSc1,2; Angelo Maria Pezzullo, MD, MSc3; Stefania Boccia, MSc, DSc, PhD3,4, JAMA. Published online March 20, 2023. doi:10.1001/jama.2023.3212

"Mega-journals, those that publish large numbers of articles per year,1 are growing rapidly across science and especially in biomedicine. Although 11 Scopus-indexed journals published more than 2000 biomedical full papers (articles or reviews) in 2015 and accounted for 6% of that year’s literature, in 2022 there were 55 journals publishing more than 2000 full articles, totaling more than 300 000 articles (almost a quarter of the biomedical literature that year). In 2015, 2 biomedical research journals (PLoS One and Scientific Reports) published more than 3500 full articles. In 2022, there were 26 such prolific journals (Table). The accelerating growth of mega-journals creates both threats and opportunities for biomedical science.

...

"we define mega-journals as open-access peer-reviewed journals that charge article processing fees and publish more than 2000 full articles in a calendar year. The 2 early-launched mega-journals, PLoS One and Scientific Reports, were also characterized by very broad publishing scope, covering scientific topics in general. 

...

"Mega-journals typically claim to publish articles based on whether they are scientifically sound rather than important and novel. Accordingly, their acceptance rates, when disclosed, are 20% to 70%

...

"It would be unfair, nevertheless, to dismiss mega-journals as simply a negative development. Several of their characteristics could be aligned also with desirable scientific practices. First, open access is a good starting point, and it can be coupled with greater transparency. If these journals routinely adopt transparent research practices, such as sharing of data, code, protocols, and statistical analysis plans, they can have a transformative effect, given their large output. Several older, broad-scope mega-journals (eg, PLoS One, Royal Society Open Science) have already championed such efforts. It is crucial that disciplinary-focused mega-journals do the same. Second, publishing technically sound scientific work regardless of the nature of the results is highly commendable. It offers opportunities to curb publication and selective reporting bias. Empirical studies are needed to investigate whether mega-journals do achieve this goal or still have selective reporting biases and variants thereof (eg, “spin”). Third, mega-journals may allow publication of results deemed undesirable in traditional specialty journals with entrenched, inbred publishing practices. Enhanced diversity of perspectives and opportunities to challenge orthodoxy are welcome, provided the journals publish rigorous data and safeguard against conflicts of interest. Securing editorial independence and maximizing transparency about conflicts for editors, reviewers, and authors will be key in reaping such benefits.

...

"At the publisher level, competition may have major indirect effects on medicine and science at large. Scientific publishing has an annual work cycle exceeding $30 billion and very large profit margins, which are possible in part because approximately 100 million hours of peer reviewers’ time is offered free yearly.8 The publishers behind the new generation of specialized mega-journals (Table) are taking this money-making recipe to new heights. Science and scientists may feel thwarted, if not entirely powerless, while big publishing corporations fight for field domination. However, it would be to the benefit of all if scientists, medical and research institutions, and funders gave credit to and rewarded journals (and publishers) that promote more transparent research and more rigorous research practices."

Tuesday, April 11, 2023

Experiments and market design, video (I'm interviewed by Chiara Spina from INSEAD)

Professor Chiara Spina interviewed me about the use of experiments in market design (20 minute video). (We spoke about a number of experiments I collaborated on with Judd Kessler, among others.)


Monday, April 10, 2023

Comstockery and abortifacients, on the way to the Supreme Court

 The Comstock Act of 1873 made it a Federal crime to distribute information or medicines for contraception or abortion, and more generally on material judged to be for "any indecent or immoral purpose."  The 1965 ruling in Griswold vs. Connecticut found the bans on contraception to be unconstitutional, and the bans on pornography were strictly limited the year before in the case Jacobellis v. Ohio.  But the Act reared its head again when it was cited by a Federal judge in Texas, Matthew J. Kacsmaryk, in his ruling that the abortion inducing drug mifepristone was illegal to distribute anywhere in the U.S., including in states where abortion is legal.

Michelle Goldberg in the NYT writes about "The Hideous Resurrection of the Comstock Act"

"suddenly, the prurient sanctimony that George Bernard Shaw called “Comstockery” is running rampant in America. As if inspired by Comstock’s horror of “literary poison” and “evil reading,” states are outdoing one another in draconian censorship. In March, Oklahoma’s Senate passed a bill that, among other things, bans from public libraries all content with a “predominant tendency to appeal to a prurient interest in sex.” Amy Werbel, the author of “Lust on Trial: Censorship and the Rise of American Obscenity in the Age of Anthony Comstock,” described how Comstock tried to suppress photographs of cross-dressing women. More than a century later, Tennessee has banned drag performances on public property, with more states likely to follow.

"And now, thanks to a rogue judge in Texas, the Comstock Act itself could be partly reimposed on America. Though the act had been dormant for decades and Congress did away with its prohibitions on birth control in 1971, it was never fully repealed. And with Roe v. Wade gone, the Christian right has sought to make use of it. The Comstock Act was central to the case brought by a coalition of anti-abortion groups in Texas seeking to have Food and Drug Administration approval of mifepristone, part of the regimen used in medication abortion, invalidated. And it is central to the anti-abortion screed of an opinion by Matthew J. Kacsmaryk, the judge, appointed by Donald Trump, who on Friday ruled in their favor.

...

"On Friday a Washington State judge issued an opinion directly contradicting Kacsmaryk’s and ordering the F.D.A. to continue to make mifepristone available. The dispute now is likely headed to the Supreme Court."

Sunday, April 9, 2023

Alcoholic beverage distributors

 The FCC investigates and regulates not just the industries we all know about, but also industries that quietly do a lot of the heavy lifting in ordinary lines of business.  Here's report of a (possible) FTC probe that sheds light on distributors of alcoholic beverages, in which big businesses I hadn't previously heard of operate in a much more concentrated fashion than I would have guessed.

Politico has the story:

Feds target alcohol pricing in new antitrust probe. The FTC has a similar investigation involving the soft drink market.

"The Federal Trade Commission has opened an investigation into the largest U.S. alcohol distributor, Southern Glazer’s Wine and Spirits, over practices related to how wine and liquor are priced and sold around the country, according to three people with knowledge of the probe.

"The FTC is investigating Southern Glazer’s Wine and Spirits for possible violations of the Robinson-Patman Act, a 1936 law prohibiting suppliers from offering better prices to large retailers at the expense of their smaller competitors, according to the people.

...

"According to a December 2022 Forbes report, Southern Glazer is the 11th largest privately held company in the U.S., with around $25 billion in revenue and distributing over 7,000 different brands of alcohol, wine, beer and other beverages. Republic National Distributing Company, the second largest alcohol distributor, which is not known to be a target in the probe, had 2022 revenues of around $12 billion, according to Forbes. Combined, the two companies account for the bulk of U.S. alcoholic beverage distribution.

Saturday, April 8, 2023

Markets in human milk, placenta, and feces

I've blogged earlier about markets for breast milk, but here is an article that considers them also in connection with placenta and feces: 

The Law of Self-Eating—Milk, Placenta, and Feces Consumption by Mathilde Cohen, Law, Technology and Humans, 3(1), pp.109-122.

"Milk, Placenta, and Feces 

"Since antiquity at least, there have been markets in human milk. Until the twentieth century, they relied primarily on wet nurses hired (or forced) to nurse infants directly on the breast.14Ancient Egyptian, Greek, and Roman pharmacopeias called for human milk as a therapeutic substance to treat burns as well as ailments affecting the ears, eyes, and genitals.15Traditional Chinese medicine  employed  human  milk  in  a  variety  of  preparations  to  cure  diseases,  such  as  debilitation,  arthritis,  rheumatism, voicelessness, amenorrhea, eye infections, and poisoning.16

"Today, markets in human milk continue to thrive.17Such markets assume two main forms: 1) informal markets through which people give or sell their milk peer-to-peer via their social circles or online; and 2) formal markets whereby profit or non-profit organizations, such as milk banks and commercial human milk companies, collect, process, and distribute milk to hospitals and a few outpatients for a fee. Human milk is sought after by three main categories of consumers: infants, adults, and researchers.

...

"Placenta

"Human placentas are used for spiritual, nutritional, medical, pharmaceutical, and cosmetic purposes. Placentophagy, or the act of eating one’s placenta after childbirth, has been practiced in the Global North since the beginningof the home-and natural-birth movement in the 1970s.22It is not an unprecedented phenomenon. Indeed, historian Jacques Gélis reported that:

    "Placentophagy, the custom of eating the newly expelled placenta,     has existed at various times amongst people of very different         cultures. From the sixteenth century onwards, European travellers to     the new world were much struck by this custom, which they         unfailingly reported.23

"According to Gélis, placentophagy was also practiced in Europe; however, “doctors and churchmen  were  more  and  more repelled, from the end of the seventeenth century onwards, by this custom . . . so ‘repugnant to humanity."  In the past decade, placentophagy has reemerged as a mainstream practice in the U.S., where it has been described as “anew  American  birth ritual.25

"Few randomized controlled trials have corroborated the benefits of placentophagy. However, placenta eaters are motivated by the hope of obtaining nourishment, hastening post-birth recovery, warding off postpartum depression, facilitating lactation, as well as spiritual motives, such as connecting with the baby and the environment. Placentas can be eaten raw or cooked."

...

"Minimally processed placental membranes have significant commercial and medical potential to treat, among other indications, eye diseases and acute and chronic wounds. The for-profit American company MiMedx also “grinds up amniotic tissue from placenta into an injectable product to treat tendinitis, strains, and other ailments.”29Much  like  human  milk,placentas  are increasingly seen as reservoirs of stem cells and thus are attractive to the field of regenerative and tissue engineering, and, more recently, as potential sources for treating coronavirus patients."

...

"Feces

"Excrement is typically regarded as disgusting; however, the medical use of human and animal feces has a long record. Heinrichvon Staden notes that:

"Most prominent among the ingredients in the Hippocratic pharmacological ‘dirt’ arsenal is the excrement of various animals. ..  .  the  belief  in  the  therapeutic  usefulness  of  excrement  was  shared  by  ancient  Mesopotamian,  Egyptian,  Greek,  Chinese, Talmudic, and Indian healers. . . . There is, therefore, abundant evidence that . . . ‘excrement therapy’—was a cross-cultural phenomenon extant already in the ancient world.32

"In Chinese medicine, human feces were used 1,700 years ago as a “suspension by mouth for patients who had food poisoning or severe diarrhea.”33

"Fast forward to the twentieth century, the community of microorganisms that dwell in the human gut has been shown to play a crucial role in human health. Fecal microbiota transplantation (“FMT”) was first identified in the modern scientific literature in 195834and has rapidly grown in popularity since the early 2010s. FMT consists in the delivery of processed stool from a healthy donor into the intestinal tract of a sick person via an enema, colonoscopy, naso-duodenal tube, capsules, or other means. As microbiologist Mark Smith and his colleagues noted, “the goal is to displace pathogenic microbes from the intestine by re-establishing a healthy microbial community.”35FMT  has  proven  strikingly  effective  in  treating Clostridium  difficile, a potentially lethal infection that most commonly affects older adults in hospitals or in long-term care facilities, typically after the  use  of  antibiotics."

...

"Despite these differences, milk, placenta, and feces share two sets of core similarities that justify their grouping in this analysis. First, milk, placenta, and feces are tissues that can be severed from the body without harm or risk of harm. Notably, milk and feces  are  replenishable  bodily  substances,  while  the  placenta  is  a  transient  organ  expelled  from  the  body  during  childbirth. Thus, far from constituting “corpse medicine”42(i.e., medicine that uses human materials obtained from dead bodies), the use of such substances can be characterized as living food or medicine. There are also no adverse health effects associated with the act of donation. Quite the opposite, good health requires that people eject the milk, placenta, and feces they produce from their bodies.  

...

"Second, these three products have similar channels of circulation, including via private, domestic consumption, peer-to-peer markets, medical and research institutions, and global markets in foods, drugs, and cosmetics. This wide scope for circulation is possible due to the potential for DIY treatments alongside higher tech uses involving special processing and expertise. Milk, placenta, and feces are collected, processed, and distributed by banks similar to other tissue banks; however, aspiring consumers can  also  obtain  milk,  placenta,  and  feces  and  use  them  on  their  own.  Unlike  blood  transfusion  or  organ  transplantation,  no professional expertise or complicated equipment is necessary to achieve basic forms of consumption. Milk, placenta, and fecescan be obtained directly from their producersafter some screening (or not) and consumed as is or minimally processed at home. Conversely, bio-banks systematically screen donors, subjecting them and their samples to a battery of tests, before processing their  products  in  various  ways;  for  example,  by freezing,  thawing,  pooling,  enriching,  freeze-drying  (in  the  case  of  milk), irradiating (in the  case of placenta), encapsulating (in the  case of stool). This is a fast-evolving field.

...

"No uniform perspective  has emerged on the  legal  classification of the  various body materials consumed by humans. In this respect, milk, placenta, and feces provide a case in point, as they do not fit neatly within the standard legal classifications for comparable products, such as foods, drugs, tissues, cosmetic ingredients, or waste products. Different countries have adopted contrasting legal regimes—or no regimes at all—to regulate these substances.

...

"In  the  so-called  post-colonial  era,  the  law  of  self-consumption  illustrates  the broader phenomenon of a “jurisprudence of disgust,” to use an expression that Alison Young developed to describe the legal censorship of provocative or “obscene” artwork.71A  significant  dimension  of  contemporary  law  making  can  be  characterized  as  a  response  to  what  is  considered disgusting around or among us, which reflects an endeavor to confine and tame what repulses us. This is particularly obvious in the context of what legal scholar Kim Krawiec calls “taboo trades” (and economist Alvin Roth dubs “repugnant markets”); that is, the exchanges and transactions of products that are considered culturally immoral and uncaring, such as those involving organs, babies, sex, drugs, and corruption."