Alice Evans's essay resists this categorization, but we think it exemplifies the rich institutional and political economy analysis that economists can undertake when they no longer act as public ...cheerleaders for every form of globalization. ...that a post-Trump Republican party is less in thrall to its free-market factions, it is unsurprising that conservatives want an economics that allows nonpecuniary values of tradition, authority, and security to be articulated as social goals to be traded off against economic performance. Trading off EPA regulations against blue collar worker employment is an acceptable position (as the recent Trump Council of Economic Advisors report kind of does), but selectively ignoring the evidence on, for example, infant mortality effects of pollution or costs of climate change is not (as the report also does). The elevation of human capital, tastes, and biological comparative advantage in 1960s economics, for example, made it a fertile garden for all of Albert Hirschman's Rhetoric of Reaction, with an endless stream of arguments for why attempts to improve the lot of the poorest (or non-white people or women) are doomed to fail or backfire.
The Starving State Stiglitz, Joseph E; Tucker, Todd N; Zucman, Gabriel
Foreign affairs (New York, N.Y.),
01/2020, Volume:
99, Issue:
1
Magazine Article
For millennia, markets have not flourished without the help of the state. Without regulations and government support, the nineteenth-century English cloth-makers and Portuguese winemakers whom the ...economist David Ricardo made famous in his theory of comparative advantage would have never attained the scale necessary to drive international trade. Most economists rightly emphasize the role of the state in providing public goods and correcting market failures, but they often neglect the history of how markets came into being in the first place. The invisible hand of the market depended on the heavier hand of the state.The state requires something simple to perform its multiple roles: revenue. It takes money to build roads and ports, to provide education for the young and health care for the sick, to finance the basic research that is the wellspring of all progress, and to staff the bureaucracies that keep societies and economies in motion. No successful market can survive without the underpinnings of a strong, functioning state.That simple truth is being forgotten today. In the United States, total tax revenues paid to all levels of government shrank by close to four percent of national income over the last two decades, from about 32 percent in 1999 to approximately 28 percent today, a decline unique in modern history among wealthy nations. The direct consequences of this shift are clear: crumbling infrastructure, a slowing pace of innovation, a diminishing rate of growth, booming inequality, shorter life expectancy, and a sense of despair among large parts of the population. These consequences add up to something much larger: a threat to the sustainability of democracy and the global market economy.
The Starving State Stiglitz, Joseph E.; Tucker, Todd N.; Zucman, Gabriel
Foreign affairs (New York, N.Y.),
01/2020, Volume:
99, Issue:
1
Magazine Article
Presence of anti-human leukocyte antigen donor-specific antibodies (DSAs) is associated with poor outcome after lung transplantation. Currently, DSAs are detected using the Luminex technique, which ...may be overly sensitive. The new C1q assay allows for the exclusive detection of complement (C1q)-binding antibodies, involved in antibody-mediated rejection. We investigated whether early detection of complement-binding DSAs is associated with chronic lung allograft dysfunction (CLAD) and survival.From 2009 to 2012, lung transplant recipients from three transplantation centres were screened for the presence of DSA and their complement-binding capacity during the 6-12 months post-transplantation in a stable condition.The analysis included 168 patients. The 3-year rates of freedom from CLAD and graft survival were lower for patients with complement-binding DSAs (33.6% and 53.7%, respectively), as compared with patients with non-complement-binding DSAs (61.9% and 77.4%, respectively) and patients without DSA (70% and 84.9%, respectively) (p<0.001 and p=0.001, respectively). Detection of complement-binding DSA was associated with a risk of graft loss that was nearly tripled after adjustment for clinical, functional, histological and immunological factors (hazard ratio 2.98, 95% CI 1.33-6.66; p=0.008).Assessment of the C1q-binding capacity of DSA appears to be useful in identifying stable lung transplant recipients at high risk of lung allograft loss.
Identifying individuals at higher risk of developing hepatocellular carcinoma (HCC) is pivotal to improve the performance of surveillance strategies. Herein, we aimed to evaluate the ability of ...single nucleotide polymorphisms (SNPs) to refine HCC risk stratification.
Six SNPs in PNPLA3, TM6SF2, HSD17B13, APOE, and MBOAT7 affecting lipid turnover and one variant involved in the Wnt–β-catenin pathway (WNT3A-WNT9A rs708113) were assessed in patients with alcohol-related and/or HCV-cured cirrhosis included in HCC surveillance programmes (prospective CirVir and CIRRAL cohorts). Their prognostic value for HCC occurrence was assessed using Fine-Gray models combined into a 7-SNP genetic risk score (GRS). The predictive ability of two clinical scores (a routine non-genetic model determined by multivariate analysis and the external aMAP score) with/without the GRS was evaluated by C-indices. The standardised net benefit was derived from decision curves.
Among 1,145 patients, 86 (7.5%) developed HCC after 43.7 months. PNPLA3 and WNT3A-WNT9A variants were independently associated with HCC occurrence. The GRS stratified the population into three groups with progressively increased 5-year HCC incidence (Group 1 n = 627, 5.4%, Group 2 n = 276, 10.7%, and Group 3 n = 242, 15.3%; p <0.001). The multivariate model identified age, male sex, diabetes, platelet count, gamma-glutamyltransferase levels, albuminemia and the GRS as independent risk factors. The clinical model performance for 5-year HCC prediction was similar to that of the aMAP score (C-Index 0.769). The addition of the GRS to both scores modestly improved their performance (C-Indices of 0.786 and 0.783, respectively). This finding was confirmed by decision curve analyses showing only fair clinical net benefit.
Patients with cirrhosis can be stratified into HCC risk classes by variants affecting lipid turnover and the Wnt–β-catenin pathway. The incorporation of this genetic information modestly improves the performance of clinical scores.
The identification of patients at higher risk of developing liver cancer is pivotal to improve the performance of surveillance. Risk assessment can be achieved by combining several clinical and biological parameters used in routine practice. The addition of patients’ genetic characteristics can modestly improve this prediction and will ultimately pave the way for precision medicine in patients eligible for HCC surveillance, allowing physicians to trigger personalised screening strategies.
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•HCC risk stratification will ultimately enable refinement of surveillance strategies in patients with cirrhosis.•Universal scoring systems based on routine parameters may currently be applied regardless of the cause of liver disease.•Seven genetic variants can be combined into a genetic risk score for HCC in patients in surveillance programs.•The addition of this genetic information to clinical scoring systems modestly improves their performance for risk stratification.
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