Sunday, May 27, 2018

Ireland votes to repeal a constitutional ban on abortion

A vote in Ireland strikes down a consitutional ban on abortion, and will likely lead to legal abortions in at least some cases, and a reduction in black market and overseas abortions.

The NY Times has the story:
Ireland Votes to End Abortion Ban in Rebuke to Catholic Church

"DUBLIN — Ireland voted decisively to repeal one of the world’s more restrictive abortion bans, sweeping aside generations of conservative patriarchy and dealing the latest in a series of stinging rebukes to the Roman Catholic Church.

"The surprising landslide cemented the nation’s liberal shift at a time when right-wing populism is on the rise in Europe and the Trump administration is imposing curbs on abortion rights in the United States. In the past three years alone, Ireland has installed a gay man as prime minister and has voted in another referendum to allow same-sex marriage.
...
"The vote repeals the Eighth Amendment of the Constitution — a 1983 measure that conferred equal rights on the fetus and the mother and banned abortion under almost all circumstances. Before the referendum, the government had pledged to pass legislation by the end of the year to allow unrestricted terminations up to 12 weeks if the amendment was set aside.

"The outcome signaled the end of an era in which thousands of women each year had been forced either to travel abroad or to buy pills illegally online to terminate their pregnancies, risking a 14-year jail sentence.
...
"It was the latest, and harshest, in a string of rejections of the church’s authority in recent years.

"The church lost much of its credibility in the wake of scandals involving pedophile priests and thousands of unwed mothers who were placed into servitude in so-called Magdalene laundries or mental asylums as recently as the mid-1990s.
...
"Abortion supporters had campaigned heavily on so-called hard cases faced by women, such as rape or fetal abnormalities. The referendum result showed that many Irish voters agreed that women in those circumstances should be allowed a choice.

That shift in attitude was driven in part by prominent cases, such as the 2012 death of Savita Halappanavar, who had asked for a termination of her pregnancy but later died of complications from a septic miscarriage. Ms. Halappanavar’s face was printed on placards supporting abortion, and on Saturday morning people placed flowers in front of a mural of her face in Dublin.

“People started realizing that compassion didn’t fit just one side,” Ms. Reidy said.

Saturday, May 26, 2018

Update on the Orthopaedic Sports Medicine Fellowship Match

From the Orthopaedic Journal of Sports Medicine:
Outcomes in the Orthopaedic Sports Medicine Fellowship Match, 2010-2017
by Mary K. Mulcahey, MD*, Meghan K. Hayes, BS, Christopher M. Smith, MD, Matthew J. Kraeutler, MD, Jeffrey D. Trojan, BA, Eric C. McCarty, MD

"Together with an increase in the number of applicants for orthopaedic fellowships, the process of applying to fellowship programs has evolved over the past several years. Currently, the majority of orthopaedic fellowship programs utilize a centralized, formal matching process.2 Sports medicine fellowship programs utilized the National Resident Matching Program until 2005.2 After the discontinuation of the formal matching process, residents were often asked to commit to a position during their third year of residency, before receiving adequate exposure to all subspecialties, or they were forced to accept or reject an offer before they could compare programs.
...
"A recent study assessed the match process and the Accreditation Council for Graduate Medical Education (ACGME) status of fellowships in the 9 orthopaedic subspecialties (adult reconstructive orthopaedics, foot and ankle orthopaedics, hand surgery, musculoskeletal oncology, orthopaedic sports medicine, orthopaedic surgery of the spine, orthopaedic trauma, pediatric orthopaedics, and shoulder and elbow surgery).3 This study discovered that 25% of available orthopaedic fellowship positions are devoted to sports medicine.3,12 Sports medicine is also the most popular orthopaedic subspecialty among current AAOS members, with the percentage of members who completed a sports medicine fellowship rising from 27% in 2004 to 49% in 2010.16 Additionally, orthopaedic sports medicine was found to have the highest proportion of ACGME-accredited fellowship programs, with 93.1% of programs and 97.3% of positions receiving accreditation.
...
:A 2014 study by Daniels et al3 investigated orthopaedic subspecialty fellowships in terms of the match process, characteristics, and ACGME accreditation. Fellowships were assessed by searching subspecialty society webpages and individual program websites. This study found that among the 9 orthopaedic subspecialty fellowships, there were collectively more positions offered than there were graduating orthopaedic residents.3 In 2013, there were 792 allopathic and osteopathic resident graduates and 897 total fellowship positions.3 The current study demonstrates that the opposite trend exists for applicants to sports medicine fellowships. In each year, excluding 2014, there were more sports medicine fellowship applicants than positions available."
***********
See my previous posts on orthopaedics, most of which are about the fellowship match.

Friday, May 25, 2018

Some adult supervision of the law clerk hiring process


Kagan Says She'll 'Take Into Account' Whether Judges Follow New Clerk Hiring Plan

"U.S. Supreme Court Justice Elena Kagan recently threw her support behind the new law clerk hiring plan by saying she will “take into account” in her own hiring whether judges and law schools comply with the new process
...
"Kagan’s message for her own chambers is likely to be heard coast to coast. In her nearly eight years on the high court, Kagan has hired clerks largely from the D.C. Circuit but also from the Fourth, Sixth and Ninth circuits and from judges across the ideological spectrum.

A former Harvard Law School dean and professor, Kagan is in a position to understand the effect on students of the former hiring process in which first-year students faced pressure to make clerkship commitments and law professors make recommendations “on less and less information,” Morrison said."
***********
see my earlier post

Tuesday, March 6, 2018



HT: Kim Krawiec

Thursday, May 24, 2018

Gambling and Sports

A class of repugnant transactions (gambling, subject to many legal restrictions designed to limit its availability) and  protected transactions (sports events, subject to many regulations designed to protect their integrity) have come a bit closer together through a recent Supreme Court decision about a complicated law.

Here's the news story from Inside Higher Ed:
Gambling on Sports Legal
The Supreme Court has opened the way for states to legalize betting on athletics, a defeat for the National Collegiate Athletic Association and professional leagues.

"The U.S. Supreme Court on Monday struck down a law that had forbidden gambling on college and professional sports outside Nevada."

The link above goes to the Supreme Court decision.
But what makes the law that they struck down complicated is that it didn't make sports betting a crime, rather it forbade States from allowing it.

Here's some legal commentary on the decision from a law firm involved in the case:
https://www.gibsondunn.com/supreme-court-strikes-down-federal-limits-on-sports-gambling/

"The Supreme Court held 7-2 that a federal law prohibiting States from authorizing sports betting violates the Tenth Amendment because it impermissibly commandeers state legislatures.

"Background: A federal law – the Professional and Amateur Sports Protection Act of 1992 (PASPA) – prohibits States from authorizing or licensing sports gambling.  In 2014, the New Jersey legislature repealed existing prohibitions on sports gambling at casinos and racetracks.  The NCAA and the four major professional sports leagues sued the State, arguing that the decision to allow sports gambling violated PASPA.

"Issue: Whether PASPA’s federal prohibition on state authorization of sports gambling violates the Tenth Amendment because it commandeers state legislatures.

"Court’s Holding: Yes.  PASPA unconstitutionally commandeers state legislatures by dictating the content of state law regarding sports gambling (i.e., preventing States from legalizing sports gambling).

“A more direct affront to state sovereignty is not easy to imagine.”

***********
Here's the Volokh conspiracy on possible broader implications of this decision

Broader Implications of the Supreme Court's Sports Gambling Decision
Commentators are right to suggest that Murphy v. NCAA will help sanctuary cities, but wrong to claim it is like to undermine federal laws restricting state taxes.

Wednesday, May 23, 2018

Still bleeding for Canada

Here's a paper on the ongoing debate in Canada about whether it should be legal to pay plasma donors.

Moral NIMBY-ism? Understanding Societal Support for Monetary Compensation to Plasma Donors in Canada
by
Nicola Lacetera, Mario Macis
NBER Working Paper No. 24572 May 2018

Abstract: "The growing demand for plasma, especially for the manufacture of therapeutic products, prompts discussions on the merits of different procurement systems. We conducted a randomized survey experiment with a representative sample of 826 Canadian residents to assess attitudes toward legalizing payments to plasma donors, a practice that is illegal in several Canadian provinces. We found no evidence of widespread societal opposition to payments to plasma donors. On the contrary, over 70% of respondents reported that they would support compensation. Our Canadian respondents were more in favor of paying plasma donors elsewhere than in Canada, but the differences were small, suggesting a weak role for moral “NIMBY-ism” or relativism. Moral concerns were the respondents’ main reason for opposing payments, together with concerns for the safety of plasma from compensated donors, although most of the plasma in Canada does come from paid U.S. donors. Among those in favor of legalizing payments to donors, the main rationale was to guarantee a higher domestic supply. Finally, roughly half of those who declared to be against payments reported that they would reconsider their position if domestic supply plus imports did not cover domestic demand. Most Canadians, therefore, seem to espouse a consequentialist view on issues related to the procurement of plasma.

Tuesday, May 22, 2018

Forbes Health Forum in Mexico City, May 23

I'm travelling to Mexico today, to speak about kidney exchange at a health forum sponsored by Forbes, and to meet with colleagues at Pro-Renal, the new kidney exchange program there.

Here's a brief news story:
Alvin E. Roth, el Nobel de Economía que ha salvado miles de vidas
No es médico, pero el doctor Roth ha ayudado a miles de personas a recibir un trasplante de riñón, lo que le valió un Nobel en 2012.

And here's the conference program:

FORO FORBES SALUD
May 23,
HACIENDA DE LOS MORALES, CDMX

Agenda (via Google translate)
08:30 HRS. WELCOME
MANAGING TEAM OF FORBES MEDIA LATAM


08:40 HRS. FORBES HEALTH FORUM RECOGNITION
ALFREDO QUIÑONES-HINOJOSA , "DOCTOR Q", MD, FAANS, FACS. WILLIAM J. AND CHARLES H. MAYO PROFESSOR | CHAIR, NEUROLOGIC SURGERY

Dr. Alfredo Quiñones is an example to follow. His history as a migrant in the United States is a reflection of tenacity, dedication, inspiration. He is currently one of the most recognized doctors in the United States for his contributions to neurosurgery. And it's Mexican.


09:00 HRS. INAUGURAL DISCOURSE
TBD

An economic-financial diagnosis of the sector and the challenges it faces such as increased investment in health services.


09:30 HRS. CONFERENCE.
"THE ECONOMY CURES THE HUMANS"

ALVIN E. ROTH , NOBEL PRIZE OF ECONOMY 2012

The work of Dr. Roth has allowed the realization of more than 4 thousand kidney transplants in the United States. This economist developed a "Algorithm of Compatibility" based on technology, big data and the economy applied to health that is solving two of the main public health problems in the world: chronic renal failure and incompatibility between couples of donors and recipients of transplants.


10:00 HRS. RECESS | EXPO | NETWORKING OPPORTUNITY 


10:30 HRS. PANEL. 1
"HEALTHY SOCIETY = HEALTHY ECONOMY"

Investing in health can mean big business, but above all the best practice to build a better future. The principle is basic: if we have healthy Mexicans, companies and the public sector would register a better performance and, consequently, economic activity would register better numbers. How to face costs, have the necessary infrastructure, treat chronic degenerative diseases and maintain a decent level of quality of life?

DR. DAVID KERSHENOBICH STALNIKOWITZ , DIRECTOR GENERAL OF THE NATIONAL INSTITUTE OF MEDICAL SCIENCES AND NUTRITION SALVADOR ZUBIRÁN
ÁNGELES DE GYVES , CEO OF THE CORPORATE HEALTH AND WELFARE COUNCIL


11:00 HRS. PANEL. 2
"THE DIGITAL WORLD IN HEALTH"

The patient has changed and that forces companies in the sector to adapt to the new circumstances. The digital revolution is largely responsible for this transformation. How to understand the new consumption habits? How to transmit the information to customers? This table will be aimed at understanding and applying the best techniques to know the voice of the e-patient.

JENNIFER BARBA , FOUNDER AND CEO OF FRAME CONSULTING
ALEJANDRO PAOLINI , MANAGING DIRECTOR OF SIEMENS HEALTHINEERS MESOAMÉRICA AND MEXICO
HÉCTOR VALLE MESTO , EXECUTIVE PRESIDENT OF THE MEXICAN FOUNDATION FOR HEALTH, AC
JORGE RUIZ ESCAMILLA


11:30 HRS. PANEL. 3
"HACKING HEALTH"

New forms emerge as a muscle for efficient use and maximization of resources, patient management and electronic records. Along with this, home care, mobile applications and regulatory challenges begin to be promoted. Also, the best practices of IT companies. This space will serve to know the best strategies that allow the Health Sector to capitalize on the new trends.

MARTHA GONZÁLEZ , DIRECTOR OF IBM WATSON & amp; CLOUD PLATFORM
JAVIER CORDERO , PRESIDENT OF ORACLE MEXICO
FERNANDO OLIVEROS , CEO OF MEDTRONIC
GABRIEL LOOR MD., FACC , SURGICAL DIRECTOR, LUNG TRANSPLANT PROGRAM BAYLOR AT ST. LUKE'S MEDICAL CENTER
MODERATOR : ARMANDO SANDERS , CO-FOUNDER OF GENO +


12:00 HRS. PANEL. 4
"HEALTH AS A BUSINESS AND INVESTMENT"

Health is a good investment. The Mexican Pharmaceutical Industry as a contributor to the productive capacity of the country. Multinational and Mexican companies will share their success stories and strategies to adapt to market conditions.

RODRIGO PUGA , CEO OF PFIZER MEXICO
ANA LONGORIA , CEO OF NOVARTIS MEXICO
RAFAEL GUAL , DIRECTOR GENERAL OF CANIFARMA
VLADIMIRO DE LA MORA , PRESIDENT OF GE MEXICO
MODERATOR : JUANA RAMÍREZ , FOUNDER AND PRESIDENT OF SOHIN


12:30 HRS. CONFERENCE.
"EXPONENTIAL HEALTH", ACCORDING TO SINGULARITY UNIVERSITY

RAYMOND MCCAULEY , CHAIR OF THE BIOTECH TRACK OF SINGULARITY UNIVERSITY


13:00 HRS. TIME FOR FOOD


14:30 HRS. PANEL. 5
"THE NEW FINANCING"

Pharmaeconomics, changing the health dialogue. Going from asking for "budget" and "demonstrating that health brings productivity". This space has a clear objective: to understand public finances and the impact it has on the country's fiscal balance. What are the new financing models? Topics such as investment in infrastructure, private equity and health financing models will be put on the table.

PATRICK DEVLYN , PRESIDENT OF THE CCE HEALTH COMMISSION
PABLO ESCANDÓN , PRESIDENT AND DIRECTOR GENERAL OF GRUPO NADRO
FRÈDÈRIC GARCÍA , PRESIDENT OF THE EXECUTIVE BOARD OF GLOBAL COMPANIES (CEEG)
FÁTIMA MASSE , CONSULTANT IN URBAN URBAN DEVELOPMENT
ANTONIO CHEMOR RUIZ , NATIONAL COMMISSIONER OF SOCIAL PROTECTION IN HEALTH / PEOPLE'S INSURANCE
MODERATOR : GUSTAVO CANTÚ , CEO OF SEGUROS MONTERREY NEW YORK LIFE


15:00 HRS. PANEL. 6
"THE END OF THE TRADITIONAL DISTRIBUTION"

New disruptive models of distribution and access to primary health care. The customer service in the last chain of the process in the distribution of the drug is being transformed.

MAX LEONARDO , ATTORNEY GENERAL OF PHARMACIES OF SAVINGS
RICARDO MARTÍ , DIRECTOR OF WALMART FARMACIAS


15:30 HRS. CONFERENCE.
"BENEFITS OF AEROSPACE MEDICINE ON EARTH"

EMMANUEL URQUIETA, MD, MS , SENIOR RESEARCH PORTFOLIO MANAGER OF THE TRANSLATIONAL RESEARCH INSTITUTE FOR SPACE HEALTH


16:00 HRS. HEALTH VIEWED BY THE NEXT SEXENIUM

The political times are already here and, under this environment, this table will convene the links of the candidates to the Presidency of the Republic to share with the audience the great tasks that would be carried out in the next six years.

JORGE ALCOCER VARELA , REPRESENTATIVE OF ANDRÉS MANUEL LÓPEZ OBRADOR, PRESIDENTIAL CANDIDATE FOR THE COALITION TOGETHER WE WILL HISTORY


16:30 HRS. CLOSING
***********

And here's an article in the Mexican edition of Forbes describing some of the health problems faced in Mexico:

La biotecnología puede ser una cura para muchos males en México
México está enfermo: Cada año unas 100 mil personas mueren a causa de diabetes, 80 mil por infartos y 80 mil por tumores, sin embargo, la tecnología podría estar cerca de cambiar las reglas del juego. Este tema y otros se tocarán en el Foro Forbes de Salud.

Google translate:
"Biotechnology can be a cure for many ills in Mexico
Mexico is sick: Every year about 100 thousand people die from diabetes, 80 thousand from heart attacks and 80 thousand from tumors, however, technology could be close to changing the rules of the game. This theme and others will be played at the Forbes Health Forum."

Monday, May 21, 2018

Safe injection sites in New York City? Learning from Canada...

The NY Times has two recent stories, one perhaps a reaction to the other.  First this:
De Blasio Moves to Bring Safe Injection Sites to New York City

"Mayor Bill de Blasio is championing a plan that would make New York City a pioneer in creating supervised injection sites for illegal drug users, part of a novel but contentious strategy to combat the epidemic of fatal overdoses caused by the use of heroin and other opioids.
"Safe injection sites have been considered successful in cities in Canadaand Europe, but do not yet exist in the United States. Leaders in San Francisco, Philadelphia and Seattle have declared their intention to create supervised sites, although none have yet done so because of daunting obstacles. Among them: The sites would seem to violate federal law.
"The endorsement of the strategy by New York, the largest city in the country, which last year saw 1,441 overdose deaths, may give the movement behind it impetus.
"For the sites to open, New York City must still clear some significant hurdles. At minimum, the plan calls for the support of several district attorneys, and, more critically, the State Department of Health, which answers to Gov. Andrew M. Cuomo. The city sent a letter on Thursday to the state, asserting its intention to open four injection centers.

 ...
"The most serious obstacle to the safe injection sites may be the federal government. A section of federal law known as the crack house statute makes it illegal to own, rent or operate a location for the purpose of unlawfully using a controlled substance.
The enforcement of the statute in the case of safe injection sites, however, would be up to the discretion of federal authorities. While it is unclear how the Trump Justice Department will respond to the city’s proposal, the attorney general, Jeff Sessions, has taken a hard line on drug policy.
“We don’t believe a president who has routinely voiced concern about the national opioid epidemic will use finite federal law enforcement resources to prevent New York City from saving lives,” Eric F. Phillips, the mayor’s press secretary, said in a written statement.
Advocates for the sites point out that needle exchanges were considered illegal when they began, and they are now commonplace; in 2015, for example, when Mike Pence was governor of Indiana, he put aside his moral opposition to needle exchanges and allowed a program to stem the flood of H.I.V. cases."
************
And, today, this:
Opioid Crisis Compels New York to Look North for Answers
Supervised injection sites for heroin users have prevented overdose deaths in Canada. But is New York City ready for the scenes that come with them?

"As Mayor Bill de Blasio has come out in support of supervised injection centers in New York, his stance has been shaped by Canada’s lead.
The country has been a pioneer; its first supervised injection facility, where heroin can be used under supervision, opened in Vancouver in 2003. A decade of political and legal wrangling followed, culminating with the Canadian Supreme Court ruling in favor of the approach in 2011."