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Background Invasive fungal diseases (IFD) have been described in patients (pts) with severe coronavirus disease 2019 (COVID), albeit with geographic variability in rates. Methods We performed a retrospective study to determine rates of & risk factors for IFD occurring within 30 days (d) of COVID diagnosis (dx) in adults requiring critical care for severe COVID between 5/11/20 & 2/7/21. Mortality was assessed at 90 d following COVID dx and at 84 d after IFD dx, if applicable. ECMM/ISHAM criteria were used for COVID-associated pulmonary aspergillosis (CAPA) and EORTC/MSGERC criteria were used for other IFD and treatment response. Results 218 pts were included; median age was 62 (19 – 91) & 63% were men. Underlying conditions included solid organ transplant (Tx) (16; 7%), allogenic stem cell Tx (3; 1%), malignancy (21; 10%), & exposure to either high-dose steroids (HDS) (11; 5%) or T- or B-cell suppressants (29; 13%) within 90 d prior to COVID dx. 209 (96%) pts had respiratory failure & 127 (58%) required mechanical ventilation. 15 (7%) required extracorporeal membrane oxygenation. COVID treatment consisted of corticosteroids in 205 (96%) & tocilizumab in 10 (5%). 12 (6%) pts developed IFD. 6 pts had CAPA (2 probable, 4 possible); 50% were men, median age 64.5 (48 – 83). Mean time to CAPA dx from COVID dx was 17 d (± 14d). All pts had received corticosteroids for COVID but only 1 pt received > 30d of HDS by the time of IFD dx. Mortality at 84 d from CAPA dx was 67%. 5 (2%) pts had central venous catheter associated candidemia; 80% were men & median age 61 (55 – 77). Mean time from COVID to candidemia dx was 29 d (±12 d). All pts with Candida infection had received steroids for COVID. Mortality at 84 d from candidemia dx was 60%. A 35-year-old man with prolonged exposure to HDS had Paecilomyces pneumonia; he was alive at 84 d after IFD dx. No cases of mucormycosis were identified. All-cause mortality in the entire cohort was 38% at 90 d after COVID dx. Mortality among pts who developed IFD was 58% at the same time point. Conclusion Rates of IFD in pts with severe COVID were low and most pts with IFD after COVID had CAPA or catheter-associated candidemia. All but one pt with CAPA had no risk factors for IFD. In pts with severe COVID, mortality was higher among pts who developed IFD than those who did not. Disclosures Marisa H. Miceli, MD, Astellas: Advisor/Consultant|F2G: Grant/Research Support|Miravista: Advisor/Consultant|PSI: Advisor/Consultant|Scynaxis: Advisor/Consultant|Scynaxis: Grant/Research Support.

We conducted a retrospective review of the infectious complications and outcomes over a 2-year follow-up period of adult patients who received a second allogeneic hematopoietic cell transplant (2nd allo-HCT) during a five-year period at two cancer centers in Michigan. Sixty patients, of whom 44 (73%) had acute leukemia or myelodysplastic syndrome, were studied. The majority (n = 37,62%) received a 2nd allo-HCT because of relapsed leukemia. Infection episodes after the 2nd allo-HCT totaled 112. Bacteria were identified in 76 episodes, the majority of which occurred pre-engraftment. The most common infecting organisms were Enterococcus species and Clostridioides difficile. Viral infections, predominantly cytomegalovirus, accounted for 59 infection episodes and occurred mostly in pre-engraftment and early post-engraftment periods. There were 16 proven/probable fungal infections, of which 9 were invasive aspergillosis or candidiasis. Mortality was 45% (n = 27) at one year and 65% (n = 39) at 2 years after transplant, and 16 deaths (41%) were due to infection. Of those 16 infection deaths, 8 were bacterial, 4 fungal, 2 both bacterial and fungal, and 2 viral. Failure to engraft neutrophils or platelets was significantly associated with decreased survival, p 0.0001 and p 0.001, respectively. Infections are common after a 2nd allo-HCT and are associated with a high mortality rate.

For most of US history, the federal government let states conduct congressional elections with only minimal interference. This changed with Congress’s passage of the Voting Rights Act (1964) and the Supreme Court’s one-man-one-vote (“OMOV”) decision in Carr (1965). Yet even then the Supreme Court stopped short of overruling gerrymandered congressional districts. Fifteen years ago, Justice Kennedy acknowledged that workable approaches still did not exist, but challenged litigants to do better. The Supreme Court’s devastating opinion in Rucho v. Common Cause (2019) marks the end of this experiment. The question remains whether some fresh departure can satisfy the Court’s objections. This paper investigates the leading candidates. The most conservative possibility is to tighten traditional visual criteria like “contiguity” and “compactness” to make them binding. We present detailed numerical arguments showing that such rules would have to be so stringent as to deprive legislators of practically all discretion in drawing lines. This, however, would split communities at random. We argue that this (a) violates OMOV just as a deliberate gerrymander would, and (b) disrupts grassroots networks that voters rely on to educate themselves, making votes less valuable to those who cast them. It follows that OMOV is always improved by replacing random districting with determinate rules that track communities. Our second candidate implements this strategy. Remarkably, recent social science research shows (a) that education and social pressure across voters play an important role in shaping community opinion, and (b) that the probability of such interactions between voters can be reliably estimated from an inverse square law. We describe a new open source software program that uses these insights to track community and test it against county-level population data from Texas. We show that the resulting maps are visually similar to those produced by legislatures; are fully determinate; efficiently balance OMOV constraints against respect for community; and are robust against manipulation. The chief downside is that some districts are discontinuous, although this is rare and could be mitigated even further. In the meantime, our algorithm provides a valuable safe harbor for States hoping to avoid future court challenges, an attractive model for reform legislation, and a transparent benchmark for exposing gerrymanders to public scrutiny.

Industry has organized increasingly effective self-governance initiatives since the 1980s. Almost all of these are based on the economic leverage of large retailers and manufacturers over their worldwide supply chains. This article documents commonalities in six of the best-studied examples—coffee, dolphin-safe tuna, fisheries, lumber, food processing, and artificial DNA—and offers straightforward economic and political theories to explain them. The theories teach that oligopoly competition can strongly constrain private power so that firms are answerable to a shadow electorate of consumers. Furthermore, rational firms often benefit from ceding significant power to suppliers and NGOs. These results extend traditional arguments that free markets constrain private power and suggest an explicit framework for deciding when private politics are legitimate.1

The genius of the Framers lay in identifying and systematically planning for the known pathologies of democratic government. That said, most of their evidence was limited to Greek and Roman history. This gave little warning of the disastrous polarization that would destabilize European mass democracies over the next two centuries. This paper asks how the Framers might have extended their design had they understood these dangers. The paper starts by noting that the well-known “median voter theorem,” which holds that successful American political parties must position themselves near the center, depends on very special assumptions about how public opinion is actually distributed. This implies that American politics can and probably will behave very differently as polarization increases. This paper presents a typology of possible polarizations, and argues from both theory and history that each is associated with its own unique political style. Significantly, only some of these styles favor consensus politics. Others are confrontational, with extremists deliberately sabotaging government to coerce opponents. Recent government shutdowns are an extreme expression of these tactics. One peculiarity of coercive politics is that it depends at least as much on political passion (“intensity”) as raw vote totals. Asking whether such politics are democratically legitimate necessarily forces us beyond the familiar language of one-man-one-vote (“OMOV”) theories that count all votes equally. This philosophical question also has a practical side. After all, no real government can go on passing laws that increase public anger forever. The paper develops a simple baseline model of intensity-weighted voting and asks how familiar American rules like supermajorities, presidential vetoes, and filibusters have modified OMOV to avoid oppressive outcomes in the past. In doing so, the paper relies heavily on European historical precedents and ask how these might change in American circumstances. The paper concludes by arguing that coercive politics, while sometimes pathological, is an essential tool for measuring and accommodating voter intensity. It follows that reform should aim less to suppress coercive methods than to make them less costly. Suitably reformed versions of government shutdowns, supermajorities, sunset legislation, regular order, and stiffened rule of law incentives offer the fastest path to restoring cooperative politics.

Scientists have long recognized two distinct forms of human thought. “Type 1” reasoning is unconscious, intuitive, and specializes in finding complex patterns. It is typically associated with the aesthetic emotion that John Keats called “beauty.” “Type 2” reasoning is conscious, articulable, and deductive. Scholars usually assume that legal reasoning is entirely Type 2. However, critics from Holmes to Posner have protested that unconscious and intuitive judgments are at least comparably important. This article takes the conjecture seriously by asking what science can add to our understanding of how lawyers and judges interpret legal texts. This is a good time to take stock. Recent advances in cognitive psychology, brain imaging, and neural network theory have already pushed many humanities scholars to rethink postmodern interpretations that privilege politics and culture over texts. This article argues that a parallel shift is overdue in law and that Type 1 reasoning, which specializes in pattern recognition, provides a natural explanation for how judges choose among competing legal theories. Finally, and most surprisingly, the article documents cognitive psychology evidence showing that Type 1 judgments show significant universality, i.e. that humans who study subjects for long periods often make similar choices without regard to the societies they were born into. This solves a long-standing difficulty in jurisprudence, which often struggles to explain why one legal interpretation should be more convincing than another. The rest of the article analyzes how Type 1 thinking enters into legal reasoning and outcomes. It begins by reviewing 19th Century theories that claimed a leading role for intuitive reasoning in public policy. It then updates these theories to accommodate the relatively weak statistical correlations that psychologists have documented, arguing that modern court systems amplify these signals in approximately determinate ways. It also explains why advocates should rationally prefer formalist judges to pragmatic ones. Crucially, the existence of universality implies a measure of agreement across all lawyers regardless of personal bias or politics. This common ground gives judges a reliably neutral basis for deciding cases.

This book presents eleven classic papers by the late Professor Suzanne Scotchmer with introductions by leading economists and legal scholars. The book introduces Scotchmer's life and work; analyzes her pioneering contributions to the economics of patents and innovation incentives with a special focus on the modern theory of cumulative innovation' and describes her pioneering work on law and economics, evolutionary game theory, and general equilibrium/club theory. The book also provides a self-contained introduction for students who want to learn more about the various fields Professor Scotchmer worked in, with a particular focus on patent incentives and cumulative innovation.

Classical proofs for the efficiency of markets do not apply to innovation. Since the 1960s, economists have worked to construct a theoretical framework for deciding when patent incentives do and do not make society better off. This chapter reviews the literature’s main findings and asks how well the legal system implements them. It begins by reviewing how patents balance the benefits of faster innovation against the burden of monopoly. It then shows how these arguments change in more complicated models where patents must also coordinate effort across multiple independent inventors. It also asks how faithfully current patent doctrines implement economists’ insights in practice. It explores how our patents framework is extended to other bodies of law, including copyright, trademark, and competitions policy. Finally, it concludes with proposals for aligning current IP law more closely with theory.

Screening mammography can detect early breast cancers and reduce subsequent cancer mortality. However, there is a lack of consensus as to when to discontinue screening. The absence of clear-cut guidelines on when not to screen means that many patients with advanced malignancies continue screening despite unclear benefit. We performed a retrospective cohort study of female patients diagnosed with a non-breast malignancy to explore the incidence and effects of screening mammography. Female patients diagnosed with a non-breast malignancy stage II or higher between 2007 and 2012 were identified through the Vermont Cancer Registry and cross-referenced with mammography screening logs from January 1, 2007 to September 30, 2014. Additional data were collected through chart review, in May 2016. Twenty-six percent of women (398/1501) with a stage II or greater cancer (other than breast) diagnosed between 2007 and 2012 had a screening mammogram within the first 5 years of their diagnosis. Of these 398 women, 193 (48.5%) were alive without cancer, 132 (33.2%) had died, and 73 (18.3%) were alive with cancer at the time of chart review. Of those who died, 84 (63.6%) had a stage III or IV cancer. Eighteen (4.5%) had a breast biopsy following a screening mammogram suspicious for cancer, resulting in 13 (3.3%) benign diagnoses and 5 (1.3%) breast cancer diagnoses. No patient died of breast cancer. Except for highly curable cancers, female patients diagnosed with an advanced non-breast malignancy experienced mortality that outweighs a breast cancer mortality benefit from screening mammography as estimated from prior studies.

The usual assumption that copyright rewards creativity is a fiction. In practice, most authors earn very little compared to their publishers. This article asks what services, if any, publishers supply to justify these payments. We argue that the only reasonable candidate is search, i.e. finding worthwhile titles among the million or so books written each year. For most of the 20th Century, there was just one search technology: Human judgment. This led to a complex ecosystem of editors, bookstore owners, reviewers and other middlemen. The difference in the 21st Century is the emergence of a second technology – “Big Data” – that could make traditional methods obsolete. But in that case what new institutions will implement it? Depending on how Big Data evolves, we can anticipate three futures. In the first, the technology never advances much beyond its existing capabilities so that current institutions continue in something like their present form. We argue that is already an improvement over mid-20th Century publishing. At the same time, the advent of e-readers allows new forms of price discrimination that could significantly improve economic efficiency. Judges should reform the Second Circuit’s Apple decision to make this happen. More powerful “Big Data” technologies will force deeper changes. These will almost certainly start with massive vertical integration. Our second future analyzes the case where today’s dominant on-line retailers continue expanding up- and downstream. Despite obvious concerns, we argue that clearing away costly middlemen will almost certainly improve social welfare on net. We also consider an alternate future in which today’s dominant publishers preempt retailers by creating an open search platform. Taking search outside traditional proprietary models can radically improve consumer welfare, but only if legislators are prepared to make correspondingly large adjustments to copyright law. Finally, we ask which of our three futures is most likely. We argue that Big Data algorithms are inherently voracious, so that the future belongs to whichever institutions collect the biggest and most useful datasets. We identify the conditions under which proprietary solutions can outperform open source and vice versa. The article concludes by asking what judges and policymakers should do to create a level playing field so that the most efficient institutions really do emerge if and when technology makes them possible.

A decade ago, many biologists and legal scholars thought that open source (OS) methods would revolutionize drug discovery. These predictions were clearly disappointed. Not surprisingly, some scholars now take the opposite view that OS methods and drug discovery are inherently incompatible. This article argues for balance. Economists have observed that OS methods offer both advantages and disadvantages compared with conventional institutions. This article reviews what economists have learned regarding the strengths and weaknesses of OS methods and identifies specific drug-discovery tasks where OS methods are likely to work especially well. Successful OS collaborations should carefully focus on segments of the drug-discovery pipeline where the advantages of OS methods are particularly relevant and existing commercial methods are known to work badly. The article concludes by offering detailed suggestions for how existing OS software models can be modified and extended to conduct effective drug discovery.

Advanced technologies for making chemical, biological, and nuclear weapons can be purchased from hundreds of companies around the world. But negotiating treaties to regulate this trade would take y...

Network effects play a central role in industries such as software and electronics. So far, however, their role in shaping biotechnology innovation has largely been overlooked. Since network effects can make markets vulnerable to monopoly, it is important to know whether and to what extent they operate in biology. We address this issue by a multimethod study of academic and commercial stem cell research. We present statistics showing that researchers focus on a tiny fraction of available lines; that network effects provide the best explanation of this phenomenon; and that these effects are primarily driven by reduced user costs due to learning spillovers. We conclude with a model of network effects in biology research and development. Surprisingly, some winner-take-all outcomes are transient, so that antitrust intervention may not be necessary.

Voluntary standards in the synthetic biology industry point a way forward to controlling many emerging and potentially dangerous technologies, even as they become easier to acquire than ever before and traditional government controls and treaties become less effective.

For almost a decade, synthetic biologists have bet their future on the idea that new organisms can be designed by combining short snippets of DNA—so‐called standard biological parts—into complex genetic blueprints in the same manner that LINUX modules are now combined to make software. Scientists and their governments are further betting on this vision to create a multi‐billion dollar industry; and they seem to be right. Consider, for example, the apparent success of the industry's leading company, Amyris (Emeryville, CA, USA). Four years ago, The Bill & Melinda Gates Foundation supported the company with US$50 million to design a new organism that can secrete the precursor of the anti‐malarial compound artemisin. Amyris will reportedly achieve this goal on time and under budget, yet this is only the beginning. Although Amyris agreed to do the work at cost, it gained something much more valuable than profit: experience. Having assembled 30 or more parts into a working organism, the company's next project will proceed at a faster pace and cost less money. It has already decided to chase the biggest market of the twenty‐first century: biofuels. Amyris claims that its organisms will be turning sugar cane into diesel by 2010, into jet fuel by 2011 and into gasoline by 2013. Technologically, then, the idea of assembling standard biological parts into increasingly complex DNA blueprints has worked beautifully. But the standard parts strategy is about more than technology. It also has powerful economic implications. Twenty years ago, the need for standardized software gave us the Microsoft monopoly. Will something similar happen in synthetic biology, or can the community push the analogy in a more hopeful direction; for example, by launching a LINUX‐like initiative for standard DNA parts? > Technologically, then, the idea of assembling standard biological parts into increasingly complex DNA blueprints has worked …

Legal scholars usually analyze copyright as an incentive and sometime obstacle to creation. This encourages us to see publishers as middlemen who siphon off rents that would be better spent on authors. By comparison, recent social science research emphasizes that word-of-mouth markets are highly imperfect. This means that many deserving titles will never find readers unless some publisher takes the trouble to market them. But this second view is deeply subversive. After all, the need for publishers – and reward – does not end when a book is published. At least in principle, copyright should last forever. The trouble with this argument is that it assumes what ought to be proven. How much effort do publishers really invest in finding forgotten titles? And does vigorous marketing attract more readers than high copyright prices deter? This article looks for answers in the history of 20th Century print publishers and today’s Print-on-Demand and eBook markets. We argue that, far from promoting dissemination, copyright frequently operates to suppress works that would otherwise erode the price of new titles. This pathology has gotten dramatically worse in the Age of eBooks. Meanwhile, public domain publishers are facing their own crisis. Mid-20th Century books had large up-front costs. This deterred copyists. By comparison, digital technologies make it easy for copyists to enter the market. This has suppressed profits to the point where many public domain publishers spend little or nothing on forgotten titles.The article concludes by reviewing possible reforms. Partial solutions include clarifying antitrust law so that firms have more freedom to implement price discrimination; modifying copyright so that consumers can re-sell used eBooks; letting on-line markets limit the number of publishers allowed to post redundant public domain titles on their sites; and strengthening non-commercial institutions for finding, curating, and delivering quality titles to readers.

According to proponents of ‘the tragedy of the Anticommons’ hypothesis, resources with fragmented ownership are often under-exploited. This paper describes how approximately 100 academic biologists tried to trade their data for corporate support of a worldwide Depository for human mutations data. Although the group obtained a $ 2.3 million offer, it became deadlocked in trying to respond. Analysis of this failure suggests that Anticommons effects exist in biotechnology. Deadlock occurred because most members could not afford the information costs needed to reach a decision. Project advocates tried to reduce the Anticommons effects by making information easier to obtain. Opponents added to the information burden of members by making assertions that could not easily be checked.

For the first time in history, worldwide neglected disease budgets may be large enough to deliver a new drug every few years. That said, sponsors will only succeed if they extract maximum value from every dollar spent. This paper reviews possible cost-containment strategies and provides an evidence-based framework for choosing between them. Current proposals can be categorized as "end-to-end" proposals which require the sponsor to set a single reward for companies that complete the entire drug discovery process or "pay-as-you-go" schemes in which sponsors offer repeated rewards as drug candidates progress through the pipeline. A generic weakness of end-to-end proposals is that rewards are likely to be 20-30% higher than they would be in an equivalent pay-as-you-go programme. However, the benefits of pay-as-you-go programmes may be lost if commercial pharmaceutical companies are substantially better at choosing successful programmes than are their non-profit counterparts. The efficiency of pay-as-you-go methods depends on sponsors' willingness to withdraw funding from failed drug discovery programmes.

Patents differ from other forms of intellectual property in that independent invention is not a defence to infringement. We argue that the patent rule is inferior in any industry where the cost of independently inventing a product is not too much less than (no less than half) the inventor’s cost. First, the threat of entry by independent invention would induce patent holders to license the technology, lowering the market price. Second, a defence of independent invention would reduce the wasteful duplication of R&D effort that occurs in patent races. In either case, the threat of independent invention creates a mechanism that limits patentholders’ profits to levels commensurate with their costs of R&D.

For the past twenty years, large corporations have routinely developed and enforced industry-wide standards to address problems that are only distantly related to earning a profit. This includes writing detailed private regulations for environmental protection, national security, working conditions, and other topics formerly reserved to governments. At the same time, the US Supreme Court has said that the Sherman Act forbids any “extra-governmental agency” that “provides extra-judicial tribunals for the determination and punishment of violations.” This seems to ban enforceable rules. Despite this, many US policymakers continue to argue that private standards are efficient and desirable. Many corporations are sympathetic but fear legal liability and are reluctant to participate unless and until the law is clarified. This article asks how existing law can be reformed to arrive at principled rules for deciding when private standards violate the Sherman Act. We begin with an historical account of recent private initiatives to regulate food processing, fisheries, forestry, and coffee production. We argue that these private rules are often just as effective – and burdensome – as government regulation. We then generalize from this evidence to explain when and how large corporations are able to impose their preferences through industry-wide standards. We also describe the politics that determines how large corporations use their power. We argue that the need to earn positive profit and defend market share frequently encourages – and sometimes forces – large companies to choose standards that please consumers. In these cases, consumers act as a shadow electorate that constrains private power in much the same way that real voters constrain elected officials. Finally, our examples show that big corporations often decide to share power with smaller rivals, suppliers, NGOs, and other stakeholders. We argue that these delegations are genuine and make private standards more accountable. The article concludes by asking how current law can be reformed. We argue that the Sherman Act serves two goals. The first is economic efficiency. We argue that private standards advance this goal by addressing problems (“externalities”) that lack well-defined market prices. We argue that private bodies should be allowed to address such problems in the first instance knowing that government may later step in to change or supplement policy. The second goal is to protect democracy from private power. We argue that this danger is minimal so long as (a) market structure encourages corporations to make choices that please consumers and other shadow electorates, (b) the standard setting body represents a wide range of affected stakeholders, or (c) industry selects the prevailing standard from multiple competing proposals. Significantly, all of these tests can be determined from objective evidence without obscure metaphysical inquiries into when private power becomes “illegitimate” or “poses a threat” to democratic politics.

Copyright theorists often ask how incentives can be designed to create better books, movies, and art. But this is not the whole story. As the Roman satirist Martial pointed out two thousand years ago, markets routinely ignore good and even excellent works. The insight reminds us that incentives to find content are just as necessary as incentives to make it. Recent social science research explains why markets fail and how timely interventions can save deserving titles from oblivion. This article reviews society’s long struggle to fix the vagaries of search since the invention of literature. We build on this history to suggest policies for the emerging world of online media. Homeric literature was produced and disseminated through direct interactions between audiences and authors. Though appealing in many ways, the process was agonizingly slow. By the 1st Century AD commercial publishers had moved to the modern model of charging readers above-cost prices to pay for search and marketing. Crucially, the new model was only sustainable so long as firms could suppress copying. We argue that Roman and early modern publishers developed remarkably successful self-help strategies to do this. However, their methods did little to suppress copying after the first edition. This seemingly modest defect made publishers profoundly risk averse. Ancient best-seller lists were invariably dominated by authors who had been dead for centuries. Publishers’ self-help systems collapsed under a wave of piracy in the mid-17th Century. This led to the first modern copyright statutes. Crucially, the new laws extended protection beyond the first edition. This encouraged modern business models in which publishers gamble on a dozen titles for each that succeeds. The ensuing proliferation of titles helped fuel the Enlightenment. It also promoted a rich new ecosystem of search institutions including libraries, newspaper critics, and editors. The Digital Age has changed everything. As copyright fades, the old institutions for finding titles are drying up. We explore several possible responses. First, society can shore up current publishing models by expanding copyright and technical protections. We argue that these methods cannot save book search but might be adequate for music and movies. Second, search engines could pay for editors. We argue that an on-line Digital Bookstore can suppress copyists long enough to fund reasonable search efforts. Finally, society can return to the Homeric pattern of harvesting advice directly from audiences. We explore various commercial and open source institutions for organizing the work.

Open source methods offer a powerful and attractive model for organizing synthetic biology research. At the same time, the differences between biology and software are very deep. For this reason, attempts to design ‘open parts collaborations’ by naive analogy to LINUX and other existing software institutions are likely to fail. Conversely, successful designs must be grounded in a careful understanding of (a) how current institutions manage the various social challenges of producing software, and (b) the extent to which synthetic biology research raises new and distinct challenges. I discuss these issues under four headings (appropriability, cartel effects, stability, and agency problems) and explain how existing open source institutions can be extended to accommodate synthetic biology research. I also identify particularly simple test cases where organizers can experiment with these ideas. These modest projects provide useful ‘stepping stones’ to demonstrating a full-scale parts collaboration.

The growing importance of shared networks, shared platforms and shared standards leads to a renewed discussion of the essential facilities doctrine of antitrust. This is an area where European law and American law have diverged. In Trinko (2007), the U.S. Supreme Court came close to abolishing it. At the same time, it was reinvigorated by the European Commission, which asserted it successfully in E.C. v. Microsoft, and then, facing criticism, clarified the doctrine in a Guidance document. We harmonize the main cases around the doctrine’s original but often forgotten purpose namely, harvesting economic synergies through sharing. We argue that, absent such a doctrine, these synergies could be lost as firms either avoid sharing to avoid antitrust liability, or create sharing arrangements that undermine competition. We show how and why the original purpose of the doctrine has become entangled with other antitrust issues, in particular, leveraging. We systematize the sharing rules that have been imposed or allowed, with an emphasis on how to harvest synergies while mitigating any harm to competition.