Nicotine in New Zealand, banned for the future generation.

 In New Zealand, the incidence of smoking is down, but not so much among the Maori. And now there's a law that cuts nicotine content of cigarettes, and (get this) "bans the next generation of New Zealanders — anyone born after 2008 or currently 14 years old or younger — from ever buying cigarettes in the country. " (That's going to be a complicated age restriction to administer in, say, 10 years from now...)

NPR has the story:

It's one of the world's toughest anti-smoking laws. The Māori see a major flaw  by Simar Bajaj

"In 2011, New Zealand set one of the most audacious public health targets in the world: to slash its cigarette smoking rate to 5% by 2025.

"The rate was 18% at the time. Fast forwarding over a decade later, the country seems on track to reach this goal ahead of the 2025 target — but only for its European and Asian populations. Māori, on the other hand, had the country's highest smoking rate at 20% in 2021, and they are expected to reach the 5% goal only 40 years later in 2061 per government modeling.

...

"Every year, 4,000 Māori die in New Zealand, and cigarettes are responsible for nearly a quarter of these deaths, according to an estimate in The New Zealand Medical Journal. The study also found that smoking explains a third of the seven-year life expectancy gap between Māori and other New Zealanders.

...

"Last December, in an all-hands-on-deck effort to get Māori across the 2025 finish line, New Zealand passed one of the strongest anti-tobacco laws in global history.

"Specifically, the legislation limits the amount of nicotine in cigarettes to non-addictive levels and reduces the number of retailers allowed to sell cigarettes from 600 currently to 60 by July 2024.

"Most remarkably, the law bans the next generation of New Zealanders — anyone born after 2008 or currently 14 years old or younger — from ever buying cigarettes in the country. "The denicotinization and retail reduction are important for us to get to the lower than 5% smoking rate," says New Zealand's Health Minister Ayesha Verrall, "and then the smoke-free generation policy is to keep us there."

...

"Fears that the crackdown on smoking will backfire

"Tobacco regulation is like a game of whack-a-mole: Knock a product out of one market, and it'll usually pop up in another possibly illegal transaction. In 2019, illicit tobacco represented almost 12% of New Zealand's consumption, and this new legislation may further relegate tobacco to the black market, according to Māori physician and Parliament member Shane Reti, who has tribal affiliations to Ngā Puhi, Ngāti Wai, Ngāti Hine and Ngāti Kura. What he's particularly concerned about is that, given high rates of tobacco addiction in his community, this expanded black market will disproportionately impact Māori via more dangerous cigarettes and police crackdowns.

...

"The risk of such smuggled tobacco, Reti points out, is that it would exist wholly outside New Zealand's safety regulations. As such, he posits that these cigarettes would be more addictive and toxic for Māori who continue to smoke, with higher levels of nicotine and heavy metals like lead. (It is presently illegal to import tobacco into New Zealand without a permit.)

"On the supplier side, organized crime syndicates, which are responsible for large-scale cigarette smuggling, may also surge. "We have some of the highest cost of living and the highest inflation we've had in decades in New Zealand," Reti says, "and what we know is that vulnerable groups who are desperate turn to crime." Given New Zealand's incarceration rates — over half of prisoners are Māori despite representing only 17% of the country — Reti worries that an invigorated black market will lead to a disproportionate crackdown in his community and an even higher percentage of Māori prisoners.

...

"Reti is also concerned about the economic impact on New Zealand's dairies because the anti-tobacco legislation reduces the number allowed to sell cigarettes by 90%. (Dairy is the term New Zealanders use for neighborhood convenience stores.) That might be problematic because tobacco makes up a substantial proportion of dairies' revenue, with estimates ranging from 14% to 47%. If dairies can't find other ways to increase sales, this policy "will almost decimate the small retailers, those small corner dairies," says Reti.

...

"But just as he isn't concerned about the black market, Waa thinks these economic arguments are similarly overblown. "This is my conspiracy hat on, but we suspect that a lot of these arguments are put up by the tobacco industry" to keep their product in stores. Waa points to how dairy owners submitted some 1,000 complaints to the government, all of them following a single template. In any case, Waa has little sympathy for retailers insisting on selling tobacco "because they're making money out of my people dying."

#######

Related earlier post:

Friday, March 24, 2023

Alcohol and race in Australia

Correcting science faster by making replication easier and more fun, by Brodeur, Dreber, Hoces de la Guardia & Miguel

If imitation is the sincerest form of flattery, we need to think of replication as one of the sincerest forms of inquiry in social science. (I'm more optimistic about the potential role of replication than I am about pre-registration.)

Here's a Comment in Nature that points out that we're not going to get lots of replications unless we can make them easier and more fun than they have been traditionally.

Replication games: how to make reproducibility research more systematic.  In some areas of social science, around half of studies can’t be replicated. A new test-fast, fail-fast initiative aims to show what research is hot — and what’s not.  by Abel Brodeur, Anna Dreber, Fernando Hoces de la Guardia & Edward Miguel

"we decided to try to make replication efforts in our fields of economics and political science more systematic. Our virtual, non-profit organization, the Institute for Replication, now holds one-day workshops — called replication games — to validate studies.

"Since October 2022, we’ve hosted 12 workshops across Europe, North America and Australia, with 3 more scheduled this year. Each workshop has typically involved around 65 researchers in teams of 3–5 people, re-analysing about 15 papers. The teams either try to replicate papers, by generating new data and testing hypotheses afresh, or attempt to reproduce them, by testing whether the results hold if the published data are re-analysed. For many papers in our fields of study, in which the reproduction of results often involves re-running computer codes, it’s possible to do much of this work in a single day (see ‘A typical replication games project’). Each team’s findings are released as a preprint report, and these reports will be collated and published each year as a meta-paper. 

...

"To assess large numbers of papers, collaborating with research centres and universities is essential. For example, our current goal is to reproduce and replicate studies in journals that have a high impact factor — specifically, 25% of empirical studies published from 2022 onwards in 8 leading economics journals and 3 leading political science journals, totalling about 350 papers per year. Then we plan to expand into other areas of the social sciences.

...

"Broader partnerships can expand replication efforts beyond academic papers. Earlier this year, we were invited to run replication games with the International Monetary Fund (IMF) and the World Bank, to assess economics and finance papers from the two organizations. We aim to keep running these games annually, validating not only scholarly studies but also policy-oriented reports.

"Establishing these relationships need not be time consuming. We’ve found that simply tweeting about our project and speaking about it at conferences can garner interest. That, along with word of mouth after the Oslo workshop, has been sufficient to make our project well known among economists. As a result, all the organizations that we partnered with originally contacted us — rather than the other way round — asking to get involved.

"Other researchers following in our footsteps should be aware that care is needed to avoid conflicts of interest. We receive no money from the collaborations we’re involved in, because taking payment could be viewed as unethical. At the IMF and World Bank games — where people were reproducing and replicating the work of co-workers — we decided to randomly assign participants to a study, allowed them to remain anonymous and prevented participants from assessing studies authored by direct supervisors or friends.

"It is crucial to protect researchers who check papers from career threats — particularly when an effort uncovers major errors. We recommend that an organization or institute mediates communication between the original study’s authors and the replicators, allowing the latter to remain anonymous if they wish. One of us, acting as a representative for the Institute for Replication, serves in this capacity after each replication game.

"We know that receiving an e-mail to say that someone is checking your work can be stressful. So we contact the original authors only after replicators have written up their reports, to avoid causing researchers undue worry while they wait for an effort’s results. Rather than treating the discovery of errors as a ‘gotcha’ moment, which can put authors on the defensive, we acknowledge in our correspondence that all researchers make mistakes. To help make the process collegial, we allow authors to suggest edits to the report, and ask replicators to suggest changes to the authors’ responses.

...

"We think that efforts such as ours that normalize replication will ultimately put pressure on funders and journals to play their part. We are excited to see replication efforts in our fields — and others — continue to expand. Systematic replication has the potential to make correcting science faster. Let the games begin."

Transition to residency conference: Oct 5-7

I'll be a panelist at the  the NRMP conference Transition to Residency,  in Boston, Oct 5-7

"The National Resident Matching Program® (NRMP®) will convene its stakeholder conference in Boston this year. The meeting is intended to provide a forum for robust conversation among members of the undergraduate and graduate medical education communities about issues relevant to the transition to residency."

Here's the list of plenary speakers.

Friday, Oct 6, 8:30 – 9:45 AM Plenary I

The Future of the Transition to Residency: Assessing the Impact of Proposed Change

Panelists:

John Combes, MD

Alvin Roth, PhD

Charles (Tom) Thomas, MA, MPhil

Pakistan police bust organ trafficking ring --transplants were carried out in private homes

 Outlawing compensation for donors doesn't end black markets for kidneys from living donors, but may succeed in driving them out of hospitals, and making them increasingly dangerous and black.

The BBC has the story:

Pakistan police bust organ trafficking ring that took kidneys from hundreds By Rachel Russell

"Eight members of an organ trafficking ring in north-east Pakistan have been arrested, police say.

"The ring's alleged leader, Fawad Mukhtar, is accused of extracting the kidneys of more than 300 people and transplanting them into rich clients.

...

"At least three people died from having their organs harvested in this way, authorities said.

...

"The transplants were carried out in private homes - often without the patient knowing, the chief minister of Punjab province Mohsin Naqvi said.

"A car mechanic is said to have worked as Mr Mukhtar's surgical assistant and helped lure vulnerable patients from hospitals.

"The kidneys were then sold for up to 10 million rupees (£99,000; $120,000) each, Mr Naqvi added.

...

"The commercial trade of human organs was made illegal in Pakistan in 2010.

"The punishment for those caught includes a decade-long jail term and huge fines in the hope that this will stop sales to overseas clients by exploitative doctors, middlemen, recipients and donors.

"However, there has been a rise in organ trafficking in the country as people struggle with low wages and a poor enforcement of the law."

HT: Jlateh Vincent Jappah

Transplant grand rounds in Manitoba, tomorrow on kidney exchange

 I'll be talking tomorrow to the transplant pros in Manitoba, about kidney exchange and transplants across borders, among other things.

Wednesday, Oct 4, 2023 | 1:15 PM CST

Immigration, immigration law, and illegal immigrants in legal limbo. Should we have a statute of limitations after which immigrants become legal?

We're seeing so much illegal immigration, maybe we should change some of our laws, at least to regularize the status of immigrants who have successfully built productive lives here.  One suggestion is to have a statute of limitation on the crime of illegal immigration, That could work like common law marriage, after a long enough time, the status quo becomes legal.

The NY Times has the story:

Why Can’t We Stop Unauthorized Immigration? Because It Works. Our broken immigration system is still the best option for many migrants — and U.S. employers. By Marcela Valdes

"The three most recent presidents have tried and failed to fix the problem of mass unauthorized migration into the United States. President Obama tried to balance empathy with enforcement, deferring the deportation of those who arrived as minors and instructing immigration officers to prioritize the arrest of serious criminals, even as he connected every jail in the nation to Immigration and Customs Enforcement (ICE). President Trump emphasized enforcement at all costs: revoking deferred action for minors, declaring the arrest of every undocumented person a priority, separating migrant families and trying to terminate temporary protected status for about 400,000 people — though Trump also extended deferred action to about 200,000 Venezuelans during his last full day in office.

"So far, President Biden has revived the empathy-and-enforcement strategy: resuming deferred action for minors and helping Venezuelans while also making it more difficult to qualify for asylum.

"But these variations in policy have had almost no effect on the number of migrants trying to enter the United States through the Southern border. Obama and Trump chose mostly opposing strategies, but each prioritized the arrest of unauthorized migrants in the Rio Grande Valley. Yet in 2019, before the pandemic gave Trump legal standing to force asylum seekers back into Mexico, Customs and Border Protection (C.B.P.) arrested about 82,000 more migrants there than they had at the peak of migrations in the Obama years.

...

"Until the 1920s, America received migrants with an almost open border. Our policies emphasized regulation, not restriction. A few general categories were barred from entry — polygamists and convicted criminals, for example — but almost everyone else was permitted to enter the United States and reside indefinitely. The move toward restriction began in 1882 with laws that targeted the Chinese then evolved to exclude almost every other national group as well.

"Legal immigration today is close to impossible for most people. David J. Bier of the Cato Institute recently estimated that around 3 percent of the people who tried to move permanently to the United States were able to do so legally. “Legal immigration is less like waiting in line and more like winning the lottery: It happens, but it is so rare that it is irrational to expect it in any individual case,” he wrote in a comprehensive review of the current regulations. He concludes that “trying the legal immigration system as an alternative to immigrating illegally is like playing Powerball as an alternative to saving for retirement.”

"In other words, illegal immigration is the natural consequence of the conflict between America’s thirst for foreign labor and its strict immigration laws. The world’s increasing connectedness and fluidity have just supercharged this dynamic. There are now more than 11 million undocumented immigrants inside the United States, three times the number that lived here in 1990. And during the last fiscal year, the number of C.B.P. arrests in the Rio Grande Valley hit a record: more than half a million.

...

"Among academics, another idea keeps resurfacing: a deadline for deportations. Most crimes in America have a statute of limitations, Mae Ngai, a professor of history at Columbia University, noted in an opinion column for The Washington Post.  The statute of limitations for noncapital terrorism offenses, for example, is eight years. Before the 1924 Immigration Act, Ngai wrote in her book about the history of immigration policy, the statute of limitations for deportations was at most five years. Returning to this general principle, at least for migrants who have no significant criminal record, would allow ICE officers and immigration judges to focus on the recent influx of unauthorized migrants. A deadline could also improve labor conditions for all Americans because, as Ngai wrote, “it would go a long way toward stemming the accretion of a caste population that is easily exploitable and lives forever outside the polity.”

Matching Mechanisms for Refugee Resettlement By Delacrétaz, Kominers, and Teytelboym

Learning how better to resettle refugees is not going to go out of style anytime soon.  Here's a recent AER paper:

Matching Mechanisms for Refugee Resettlement By David Delacrétaz, Scott Duke Kominers, and Alexander Teytelboym, American Economic Review 2023, 113(10): 2689–2717 https://doi.org/10.1257/aer.20210096

Abstract: "Current refugee resettlement processes account for neither the preferences of refugees nor the priorities of hosting communities. We introduce a new framework for matching with multidimensional knapsack constraints that captures the (possibly multidimensional) sizes of refugee families and the capacities of communities. We propose four refugee resettlement mechanisms and two solution concepts that can be used in refugee resettlement matching under various institutional and informational constraints. Our theoretical results and simulations using refugee resettlement data suggest that preference-based  matching mechanisms can improve match efficiency, respect priorities of communities, and incentivize refugees to report where they would prefer to settle."

Dean Karlan interview about USAID, by Dylan Matthews at Vox

 Evidence! (versus bureaucracy...). Dean Karlan is the man in the middle.

The US hired a leading economist to fix how it allocates foreign aid. Here’s his plan. Dean Karlan explains his plan to get USAID to take evidence more seriously.  By Dylan Matthews

Would you like to take over the UNOS/OPTN contract? HRSA's presolicitation notice for OPTN Transition

 Yesterday's email brought this, from the Health Resources and Services Administration (HRSA):

THIS IS A PRESOLICATION NOTICE ONLY

On March 22, 2023, the Health Resources and Services Administration (HRSA) announced a Modernization Initiative (https://www.hrsa.gov/optn-modernization) to strengthen accountability and transparency in the Organ Procurement and Transplantation Network (OPTN). The OPTN Modernization Initiative is centered on putting patients first, prioritizing information flow to clinicians, promoting innovation through continuous competition, and enhancing transparency and accountability. HRSA's planned approach and timelines for the first year of the multi-year modernization process focuses on design, implementation, and oversight, including contract solicitations that will be released in 2023 and 2024.

Subject to the availability of funds, the Health Resources and Services Administration’s (HRSA), Health Systems Bureau, is planning to issue a multi-vendor solicitation by December 2023 to establish the OPTN Transition contracts to provide the services necessary to ensure the OPTN and the OPTN Board of Directors can effectively carry out all mandated functions, including governance, operations, and enhancement of the OPTN.

A competitive solicitation will be issued with a period of performance of 12 months base plus four 12-month option periods and allow at least 60 days for proposal submission. The required services will be procured following FAR Part 15 - Contracting by Negotiation and FAR 16.5 Indefinity Delivery Contracts.

The North American Industrial Classification System (NAICS) code for this acquisition is 541611, and the size standard is 24.5 million.

All future information regarding this acquisition, including the solicitation and any amendments, will be distributed solely through the SAM.gov website (www.sam.gov). Copies of the solicitation document and its related documents, as appropriate, will be posted on this website. Interested parties are responsible for monitoring the SAM.gov website to ensure they have the most up-to-date information regarding this acquisition. The Government will not reimburse interested parties for any costs associated with responding to this notice.

For further information, please contact Naomi Inazawa, 5600 Fishers Lane, Rockville, MD 20857, (240) 461-7245 and NInazawa@hrsa.gov.

#######

Some background is here (and this site will probably be updated...

Organ Procurement and Transplantation Network Modernization Initiative.  President Biden Signed the Securing the U.S. Organ Procurement and Transplantation Network Act into Law  Friday, September 22, 2023

The growing role of kidney exchange in the U.S.

 Here's a paper accepted for publication in the American Journal of Transplantation, tracing the growing role of kidney exchange in the U.S. (But much remains to be done...)

Temporal Trends in Kidney Paired Donation in the United States: 2006 – 2021 UNOS/OPTN Database Analysis  by Neetika Garg, MD, Carrie Thiessen, MD, PhD, Peter P. Reese, MD, PhD, Matthew Cooper, MD, Ruthanne Leishman, RN, MPH, John Friedewald, MD, Asif A. Sharfuddin, MD, Angie G. Nishio Lucar, MD, Darshana M. Dadhania, MD, MS, Vineeta Kumar, MD, Amy D. Waterman, PhD, Didier A. Mandelbrot, MD  PII: S1600-6135(23)00694-9 DOI: https://doi.org/10.1016/j.ajt.2023.09.006 To appear in: American Journal of Transplantation

Abstract:  Kidney paired donation (KPD) is a major innovation that is changing the landscape of kidney transplantation in the United States. We used the 2006 - 2021 United Network for Organ Sharing data to examine trends over time. KPD is increasing, with one in 5 living donor kidney transplants (LDKT) in 2021 facilitated by KPD. The proportion of LDKT performed via KPD was comparable for non-Whites and Whites. An increasing proportion of KPD transplants is going to non-Whites. End-chain recipients are not identified in the database. To what extent these trends reflect how end-chain kidneys are allocated, as opposed to increase in living donation among minorities, remains unclear. Half the LDKT in 2021 in sensitized (PRA ≥80%) and highly sensitized (PRA ≥98%) groups occurred via KPD. Yet, the proportion of KPD transplants performed in sensitized recipients has declined since 2013, likely due to changes in the deceased donor allocation policies and newer KPD strategies such as compatible KPD. In 2021, 40% of the programs reported not performing any KPD transplants. Our study highlights the need for understanding barriers to pursuing and expanding KPD at the center level, and the need for more detailed and accurate data collection at the national level.

Facial recognition software and autocracy

 Here's a somewhat chilling recent NBER paper:

Exporting the Surveillance State via Trade in AI  by Martin Beraja, Andrew Kao, David Y. Yang & Noam Yuchtman  WORKING PAPER 31676   DOI 10.3386/w31676  September 2023

We document three facts about the global diffusion of surveillance AI technology, and in particular, the role played by China. First, China has a comparative advantage in this technology. It is substantially more likely to export surveillance AI than other countries, and particularly so as compared to other frontier technologies. Second, autocracies and weak democracies are more likely to import surveillance AI from China. This bias is not observed in AI imports from the US or in imports of other frontier technologies from China. Third, autocracies and weak democracies are especially more likely to import China’s surveillance AI in years of domestic unrest. Such imports coincide with declines in domestic institutional quality more broadly. To the extent that China may be exporting its surveillance state via trade in AI, this can enhance and beget more autocracies abroad. This possibility challenges the view that economic integration is necessarily associated with the diffusion of liberal institutions.

The EU considers tightening bans on compensating donors of Substances of Human Origin (SoHO)

 Peter Jaworski considers an  EU proposal this month to harmonize across the EU bans on paying donors for Substances of Human Origin (SoHO).  Presently Germany, Austria and Chechia allow payment to plasma donors.

The E.U. Doesn't Want People To Sell Their Plasma, and It Doesn't Care How Many Patients That Hurts. The United States currently supplies about 70 percent of the plasma used to manufacture therapies for the entire world.  by PETER JAWORSKI 

"The European Union looks like it might take the foolish step of banning financial incentives for a variety of substances of human origin, including blood, blood plasma, sperm, and breast milk. The legislation on the safety and quality of Substances of Human Origin includes an approved amendment that says donors can only be compensated for "quantifiable losses" and that such donations are to be "financially neutral." This legislation is supposed to harmonize the rules across the 27 member countries, promote safety, with the ban on financial incentives intended to avoid commodification and the exploitation of the poor. 

...

"Already the E.U. is dependent on plasma collected in the United States for around 40 percent of the needs of its 300,000 rare disease patients. They're not as dependent as Canada because Germany, Austria, Hungary, and the Czech Republic allow a flat-fee donor compensation model and so are able to have surplus collections that contribute 56 percent of the E.U. total. The remaining 23 countries, each of which runs a plasma collection deficit, manage just 44 percent. 

"So what is likely to happen if the new rules make this flat-fee donor compensation model illegal? Will safety improve and commodification and exploitation be avoided? No, the E.U. will just become even more dependent on the United States."

Smart toilets and data privacy

 Something to sit and think about:

Smart toilets could leak your medical data, warn security experts. by Matthew Sparkes New Scientist, Volume 259, Issue 3456, 2023, Page 14, ISSN 0262-4079, https://doi.org/10.1016/S0262-4079(23)01720-7. 

"A range of start-ups and research projects have developed smart toilets to monitor everything from heart rate to the consistency of stools and the presence of certain proteins in urine that indicate disease. One device even features an “anus camera” that takes a photo from below for identification, something that has been described as the “polar opposite of facial recognition”.*

...

"One concern was the privacy of people other than the owner: are visitors consenting to have photographs or measurements taken? There were also worries about the risk of losing sensitive data to hackers, as well as the possibility of companies selling the data on. And if smart toilets were installed in public areas or workplaces, there would be questions about who has access to that data, it was argued.The group of experts concluded that smart toilets shouldn't be sold as consumer devices, but instead as medical devices that have to meet high regulatory standards for privacy and safety (arXiv, doi.org/ksx5).

"Chase Moyle at smart toilet start-up Coprata says he set out to build a consumer device because creating a medical device under US Food and Drug Administration regulations would raise the price by a factor of 10. It would also mean that, in the US, insurance companies would only offer it to people with diagnosed conditions.

...

"Alan Woodward at the University of Surrey, UK, says so-called internet of things (IoT) devices, such as heart rate monitors and CCTV cameras, have often been found to have security flaws, including a smart toilet with a computer-controlled bidet. He fears the same could be true for medical-focused smart toilets. “With a lot of IoT devices, security has never been uppermost in the mind and yet something like a smart toilet is collecting some very personal data,” he says. “They're making these weird devices because they can, but nobody's thought through ‘should we?’”

#########

See also (for the first instance of that quote I can find):

‘Smart toilet’ monitors for signs of disease. A disease-detecting “precision health” toilet can sense multiple signs of illness through automated urine and stool analysis, a new Stanford study reports.  April 6, 2020 - By Hanae Armitage, Stanford Medicine News

"One of the most important aspects of the smart toilet may well be one of the most surprising — and perhaps unnerving: It has a built-in identification system. “The whole point is to provide precise, individualized health feedback, so we needed to make sure the toilet could discern between users,” Gambhir said. “To do so, we made a flush lever that reads fingerprints.” The team realized, however, that fingerprints aren’t quite foolproof. What if one person uses the toilet, but someone else flushes it? Or what if the toilet is of the auto-flush variety?

"They added a small scanner that images a rather camera-shy part of the body. You might call it the polar opposite of facial recognition. In other words, to fully reap the benefits of the smart toilet, users must make their peace with a camera that scans their anus.

“We know it seems weird, but as it turns out, your anal print is unique,” Gambhir said. The scans — both finger and nonfinger — are used purely as a recognition system to match users to their specific data. No one, not you or your doctor, will see the scans."

#######

Also, Meet the winners of the 2023 Ig Nobel Prizes 

"Public Health Prize

Citation: "Seung-min Park, for inventing the Stanford Toilet, a device that uses a variety of technologies—including a urinalysis dipstick test strip, a computer vision system for defecation analysis, an anal-print sensor paired with an identification camera, and a telecommunications link—to monitor and quickly analyze the substances that humans excrete."

Nobel Symposium on Social Networks Lund, Sweden, August, 2023

A Nobel Symposium on Social Networks was held in Lund last month.The papers don't appear to be online, but it ended with a round table discussion:

"You can join in online when the symposium ends with an open “round table discussion” with a panel of leading scientists on August 24 at 14:00. The discussion will be introduced by Tommy Andersson, Professor in Economics at LUSEM and Member of the Committee for the Prize in Economic Sciences in Memory of Alfred Nobel.

The panelists are Prof. Matthew Jackson, Prof. Albert-Laszlo Barbasi, Prof. Kathleen M. Carley, Prof. Damon Centola, Prof. Vittoria Colizza, and Prof. David Lazer."

Stanford was well represented. Aside from my colleague Matt Jackson, Mark Granovetter joined the symposium itself by Zoom (which I guess is a weak link).

Round table discussion: Nobel Symposium on the Future of Network Analysis

 

Nobel watchers, take note.

Big ideas at Stanford; interviews by Ran Abramitzky

 

Big Ideas

Stanford’s Nobel Laureates and MacArthur “Genius” Fellows talk with H&S Senior Associate Dean Ran Abramitzky about their award-winning research and their personal and professional paths.

Open to the Stanford community.

Autumn quarter (Thursdays, 3 – 4:20 pm, at CEMEX. The talk series is open to the Stanford community, and is also offered to undergrads as a 1-unit course (syllabus attached).

9/28: Market Design with Alvin Roth

10/12: Causal Inference with Guido Imbens

10/19: Energy with Steven Chu

10/26: Pediatric Neuro-oncology with Michelle Monje

11/2: Auctions with Paul Milgrom and Robert Wilson

11/9: Experimental Physics with Monika Schleier-Smith

11/16: Bioorthogonal Chemistry with Carolyn Bertozzi

11/30: Natural Language Processing with Dan Jurafsky

12/7: Innovation with Heidi Williams

Update:

Ran Abramitzky and Al Roth

Support for hepatitis C human challenge studies, in The Lancet Gastroenterology & Hepatology

 Here's a call for action, in The Lancet Gastroenterology & Hepatology:

Joint statement in support of hepatitis C human challenge studies by Harvey J Alter, Eleanor Barnes, Mia J Biondi, Andrea L Cox, Jake D Eberts, Jordan J Feld, T Jake Liang, Josh Morrison, Charles M Rice, Naglaa H Shoukry, David L Thomas, Jennifer Van Gennip, Charles Weijer, on behalf of other signatories †, Published:September 20, 2023 DOI:https://doi.org/10.1016/S2468-1253(23)00314-X

"We, the 121 undersigned, believe that human challenge studies among adult volunteers will be critical in the development of hepatitis C vaccines.

...

"Despite the advent of safe and highly effective direct-acting antiviral (DAA) treatments, the ongoing toll of hepatitis C remains high among low-income and middle-income countries and vulnerable populations such as people who inject drugs. Millions of new infections occur annually, outpacing cures in some regions,1 with progress further disrupted by the COVID-19 pandemic. Without a change in strategy and the development of new tools, we will not reach the ambitious goal set out by WHO of elimination of viral hepatitis as a public health threat by 2030. This will require an effective hepatitis C vaccine—“the best insurance for the future”, as highlighted by a recent announcement of the White House national hepatitis C elimination programme.2

...

"Human challenge studies for a hepatitis C vaccine could accelerate vaccine development dramatically. The effort to establish the model and test an initial vaccine candidate could take as little as 3 years. If that candidate fails, subsequent studies to test others could provide evidence of efficacy as quickly as 1 year.

"It is only because of the remarkably effective treatments that we can now consider human challenge studies for hepatitis C. With DAAs, cure rates of people without cirrhosis are reliably over 98%, with highly effective salvage regimens for the few who do not respond to a first course of therapy.5,  6 We are confident that in the era of DAAs, human challenge studies can be done in accordance with the highest ethical and safety standards. Healthy volunteers providing fully informed consent would be infected for at most 6 months before treatment and would be free to go about their lives with the right to request treatment and withdrawal from a study at any time. Acute infection causes no or few symptoms in most, and unlike in most challenge studies, where the risk of transmission necessitates quarantine of participants, the risk of passing hepatitis C to others is very low in day-to-day life.

"The impact of a vaccine would be enormous: reducing transmission, preventing cirrhosis, and most importantly, markedly reducing the rate of liver cancer, the world's second-most deadly cancer in terms of total fatalities.7 The global success of hepatitis B vaccine in achieving these goals exemplifies the importance of an effective hepatitis C vaccine. With the prospect of such a significant advance, we have confidence that people will volunteer to participate in hepatitis C challenge studies, and with such a strong team of experts worldwide, we are confident this approach will lead to the development of a successful hepatitis C vaccine."

**********

† Here's the full list of 121 signers of the letter

*********

1Day Sooner has a related web page with some background: https://www.1daysooner.org/hepatitis-c-open-letter

**********

Earlier related posts:

Monday, May 15, 2023

Eliminating Hepatitis C, now that there's a cure (even though it's expensive)

Saturday, August 26, 2023

Challenge trials for a Hepatitis C vaccine

Sunday, November 1, 2020

What do we know about the effects of payments to participants in challenge trials for vaccines, and other public spirited activities?

Drugs, drug economics, and violence in Colombia and Ecuador, as Colombia withdraws from the war on drugs

 Fighting a war on drugs hasn't yielded clear successes (at any point in the supply chain), but surrendering is no picnic either. The WSJ has the story from Colombia, and the Guardian reports on the situation in Ecuador.

Here's the WSJ story:

Colombian Cocaine Production Sees Record Surge. The country’s output of the drug, which reaches far corners of the world, rises 24%, U.N. says. By Juan Forero

"Colombia has set a record in the estimated production of cocaine, the United Nations said Monday, as President Gustavo Petro’s government tries a less punitive approach to fighting drugs.

"The amount of cocaine manufactured in Colombia, the world’s largest producer, rose to 1,738 tons in 2022, compared with 1,400 tons the year before, a 24% increase, with the cocaine shipped not only to the U.S. but increasingly to Europe and other continents, said officials presenting the U.N. Office on Drugs and Crime’s annual report on Colombia’s cocaine trade. Some 22 million people worldwide consume the drug.

...

"The size of Colombia’s coca fields and the production of cocaine has been rising fast since 2013, when the government of then-President Juan Manuel Santos began a process that by 2015 phased out a U.S.-sponsored program to spray coca fields from crop dusters with the herbicide glyphosate. 

...

"The leftist government of Petro, who took office 13 months ago, has characterized the war on drugs as a failure and veered away from a hard-line approach to dealing with coca farmers. For Colombia to reduce cocaine production to 900 tons by 2026, Justice Minister Néstor Iván Osuna, said Bogotá would hold negotiations with armed groups, build roads and provide social services. The state also offered assistance for the so-called cocaleros, or farmers, to produce legal crops.

...

"There is additional cause for concern, he said, because of the increasing importance to traffickers of 15 so-called “productive enclaves,” which make up only 14% of all the land dedicated to coca but produce 44% of all the coca in Colombia. In those regions, powerful gangs are intensely focused on the production of high-quality cocaine and the entire economy is linked with the cocaine trade. Those regions are particularly lawless as well as close to transnational drug routes.

...

"About 65% of all the coca in Colombia is now in the provinces of Nariño and Putumayo, which border Ecuador, and Norte de Santander in the northeast bordering Venezuela. All three provinces are hard-hit by violence and lack schools, paved roads, hospitals and other state institutions—as is Ecuador, where the homicide rate has skyrocketed as Colombian cocaine has flowed in."

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Here's the Guardian report on Ecuador:

‘We should treat it as a war’: Ecuador’s descent into drug gang violence. Successive governments have been unable to rein in violence as South American country became cocaine superhighway.  by Dan Collyns 

"In recent years, the South American nation has experienced a nightmarish descent into violence, with successive governments proving unable to rein in organized crime factions. Last month, the cartels showed their power with a mass hostage-taking in six prisons, in an apparent response to the prison transfer of a senior gang leader.

"Before that, presidential candidate Fernando Villavicencio was shot dead in broad daylight less than two weeks before the election’s first round.

...

"But the country’s armed forces and police appear to be losing the battle against the narcos who have turned the country into a cocaine superhighway as gangs – both inside and outside the weak and overcrowded prison system – vie for drug trafficking routes, with backing from powerful Mexican cartels.

"Drug trafficking is not new in Ecuador, thanks to its location – sandwiched between the world’s main cocaine producers Colombia and Peru – its porous borders and major Pacific Ocean ports. The amount of cocaine seized at the country’s ports has tripled since 2020 to 77.4 tonnes last year.

"But in recent years, the scale of the accompanying violence has rocketed. Ecuador saw 4,600 violent deaths in 2022, double the previous year, and the country is set to break the record again with 3,568 violent deaths in the first half of 2023. Of those, nearly half were in Guayas, the province that includes Guayaquil, where nearly 1,700 people have been murdered so far this year.

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Earlier posts on further down the supply chain:

Tuesday, August 8, 2023

Homelessness and fentanyl, in Oregon and California

Friday, July 14, 2023

Harm reduction is not a panacea: drug use and drug policy in Portugal, and San Francisco

Mathematics and Computer Science of Market and Mechanism Design: SLMath introductory workshop (videos)

Last week I gave the opening talk of the week long  Introductory Workshop at SLMath, on Mathematics and Computer Science of Market and Mechanism Design.  Some of the video lectures are now online here (consisting mostly of slides and voice).

My talk introduces the general themes of market design by recounting the history and challenges facing the market for new doctors from 1900 through this year.

Berkeley's Simons Laufer Mathematical Sciences Institute (SLMath), formerly known as the Mathematical Sciences Research Institute (MSRI) has a commanding view of the SF Bay.

Organ transplantation in China: in transition--and controversy about paying funeral costs

 I recently spoke at the CAST transplant conference in Hong Kong (see picture), and the underlying theme of my talk, and of many talks there, was the transition of transplantation in China, and what its future might hold.

Jie-Fu HUANG is the other speaker on Zoom (to my right and your left), and Haibo Wang is on the far left on stage.

Here are two of my opening slides (using 2021 data from the Global Observatory on Donation and Transplantation)

On the left, you see that, today, China and India already perform more kidney transplants than any country in the world except the U.S.  On the right, you see that, by virtue of their large populations, they accomplish this despite their quite low rates of transplants per million population, compared to the U.S. and countries in Europe.  So if China and India can raise their transplant rates to rates comparable to the U.S. and Europe, most of the transplants in the world will be done in Asia, and many many additional lives will be saved.

Note that China mostly transplants kidneys from deceased donors, while India mostly transplants kidneys from living donors. So they have different paths (and plenty of untapped potential) for raising donation and transplantation rates.  And their paths to their current positions have also been very different.

Here is a recent account reflecting China's recent progress:

Chen, Zhitao, Han, Ming, Dong, Yuqi, Zeng, Ping, Liao, Yuan, Wang, Tielong, et al. (2023). First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China: 5-year Experience at a High-volume Donor and Recipient Liver Transplant Center. Transplantation, 107, 1855-1859. https://doi.org/10.1097/TP.0000000000004561

" In 1972, our center performed the first living donor kidney transplantation in China. Since then, kidney and liver transplant programs have evolved. By the beginning of the 21st century, organ transplantation had advanced, and clinical liver transplants have been performed successfully at the First Affiliated Hospital of Sun Yat-sen University.1

"Organ shortage has been a prominent feature at our institution as it has been around the world. Starting in the early 1980s, many organs had been procured from inmates on death rows. This unethical approach has been rightfully criticized by the worldwide community. As a consequence, the source of organs for transplants has solely been replaced by voluntary donations from Chinese citizens since January 1, 2015.

...

"Moreover, policies and methods for humanitarian aid to donor families were established. Those policies follow WHO guidelines while recognizing specific aspects of the Chinese culture. The State Ministry of Health and the Red Cross Society of China launched a pilot project on organ donation after the death of citizens in 2010 and established the China Organ Donation Committee. The principle of this pilot project was to learn from the experiences and standards in developed countries while recognizing national conditions and the social reality in China aiming to build an ethical and effective scientific organ donation and transplantation system.2

**********

In the same issue of Transplantation as the above article is this invited commentary by Ascher and Delmonico, both former Presidents of The Transplanation Society (of which Transplantation is the official journal). They largely approve of the effort China has made in transplants, but they have a big reservation.

Ascher, Nancy, MD, PhD & Delmonico, Francis. (2023). Organ Donation and Transplantation in China. Transplantation, 107, 1880-1882. https://doi.org/10.1097/TP.0000000000004562

"The date of 2015 is important for the review of any organ transplantation report from China because of the public proclamation in the media in 2015 prohibiting the use of organs from executed prisoners. Clinical transplantation articles antecedent to 2015 have been consistently rejected by Transplantation and the international community because the source of the transplanted organs was most often an incarcerated prisoner. China took a major step to condemn this practice publicly in 2015. However, because there is no law or regulation that prohibits this unethical practice, there has been ongoing concern that this practice may be continuing. Notwithstanding such a reality, there have been regulations that are citable and may be reflective of the changing experience of organ donation and transplantation in China that are consistent with the World Health Organization (WHO) Guiding Principles.

...

"WHAT CONTINUES TO BE OBJECTIONABLE

"The Chinese Red Cross is prominent in the organ donation process and a center of support for deceased donor families designated by the Red Cross as humanitarian aid to donor families.7 However, such humanitarian aid, although not limited to China, should not be misinterpreted to be an effort because it includes payment to elicit consent for donation. The Sun Yat-sen publication suggests that the Red Cross policies follow WHO guidelines while recognizing specific aspects of Chinese culture without elaboration as to the cultural details. A payment to donor families for funeral expenses or other monetary incentives should be recognized as a form of commercialization and would not comply with WHO guidelines."

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Some background may help put this objection in perspective. Doctors Delmonico and Ascher are prominent signatories of a declaration that payments to families of organ donors are crimes against humanity (as are payments to living donors, and both are declared comparable to transplanting organs from executed prisoners, and to be organ trafficking. See my 2017 post.)

So, they raise the question of whether saving many lives by increasing deceased donation in China will be justified if it involves paying funeral expenses of donors.  

My guess is that Chinese health authorities, thinking of the many lives to be saved, will think that this act of generosity to families of deceased donors will indeed be justified, taking account of (see above) "national conditions and the social reality in China aiming to build an ethical and effective scientific organ donation and transplantation system." 

Many people in China and elsewhere might even think that little if any justification is needed for generosity, particularly generosity to families of deceased donors, that is to families who are themselves generous.

Kidney Paired Donation in Developing Countries: a Global Perspective

 Vivek Kute and his colleagues argue that one of the lessons from the developing world is that kidney exchange can save many lives, but may need to be organized differently in some ways than in the developed world.

Kidney Paired Donation in Developing Countries: a Global Perspective by Vivek B. Kute, Vidya A. Fleetwood, Sanshriti Chauhan, Hari Shankar Meshram, Yasar Caliskan, Chintalapati Varma, Halil Yazıcı, Özgür Akın Oto & Krista L. Lentine, Current Transplantation Reports (2023)  (here's a link that may provide better access]

Abstract

...

"Despite the advantages of KPD programs, they remain rare among developing nations, and the programs that exist have many differences with those of in developed countries. There is a paucity of literature and lack of published data on KPD from most of the developing nations. Expanding KPD programs may require the adoption of features and innovations of successful KPD programs. Cooperation with national and international societies should be encouraged to ensure endorsement and sharing of best practices.

Summary

KPD is in the initial stages or has not yet started in the majority of the emerging nations. But the logistics and strategies required to implement KPD in developing nations differ from other parts of the world. By learning from the KPD experience in developing countries and adapting to their unique needs, it should be possible to expand access to KPD to allow more transplants to happen for patients in need worldwide."

...

" Despite the advantages of KPD programs, they remain rare in the developing world, and the programs that exist have many differences with those of developed countries. Program structure is one of these differences: multi-center, regional, and national KPD programs (Swiss, Australia, Canada, Dutch, UK, USA) are more common in the developed than the developing world, whereas single center programs are more common

...

"kidney exchanges frequently take weeks to months to obtain legal permission in India despite the fact that only closely-related family members (i.e., parents, spouse, siblings, children, and grandparents) are allowed to donate a kidney [47].

...

"Protecting the privacy of a donor, including maintaining anonymity when requested, is common practice among developed countries but uncommon in developing nations. Anonymous allocation during KPD is a standard practice in the Netherlands, Sweden, and other parts of Europe, but this is not the case in countries such as India, Korea, and Romania [14, 48, 49]. In areas where anonymity is not maintained, the intended donor/recipient pair must meet and share medical information once a potential exchange is identified, but before formal allocation of pairs occurs. The original donor/ recipient pair may refuse the proposed exchange option for any reason and continue to be on the waitlist. In India, nonanonymous KPD allocation is standard practice and has the goal of increasing trust and transparency between the transplant team and the administrative team [14, 49]. Countries differ in philosophical approaches to optimizing trust and transparency, and objective data on most effective practices would benefit the global community."

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Tomorrow I hope to have a few words to say about the equally unique situation in China.

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Update:

Tuesday, September 19, 2023

Organ transplantation in China: in transition--and controversy about paying funeral costs