Magic mushrooms have a role in hospice care

 Pain experienced while dying may be partly spiritual.

 National Geographic has the story: 

These drugs could be a game changer for end-of-life care
Certain psychoactive substances can improve the mental health of terminally ill cancer patients—but few patients can currently access them.  By Meryl Davids Landau

 "Several years ago in Vancouver Island, Canada, a 32-year-old mother with advanced metastatic cancer was so wracked with pain and a fear of dying she constantly wept in bed. Through a targeted Canadian government program, the woman accessed psilocybin, the main psychedelic ingredient in magic mushrooms. The day after taking a dose of the drug she was pain-free, able to joke with family members and reconnect with old friends before she died the following week.

...
"The drugs can help with “the existential component of pain that is tied in with spiritual and psychological experiences,” something conventional medicine has few tools to address, says Masuda, a physician with SATA Centre for Conscious Living, who has since facilitated dozens of psychedelic sessions for similar patients.

"Some 400 terminal patients in Canada have legally accessed psilocybin in the past five years via its special programs, and several countries already allow for similar uses. Due to federal drug laws, terminally ill people in the U.S. cannot currently take psilocybin outside of a handful of clinical trials.

"But this may finally change, as government agencies are evaluating whether to allow its use for end-of-life care—thanks to pressure from physicians and years of research. Many palliative care doctors in the U.S. say the change can’t come soon enough." 

Trump Administration Removes Pride Flag From Stonewall National Monument (but the Stonewall Inn is still in private hands)

 When a national monument is designated around a private business in a liberal state, the ability of the President to alter its message is  at least partially circumscribed.

Trump Administration Removes Pride Flag From Stonewall National Monument  The enduring symbol of LGBTQ+ liberation has been taken down from the historic site.
By James Factora and Quispe López  February 10, 2026 

 

 

 "Manhattan borough president Brad Hoylman-Sigal told the New York Times that the directive to remove the Pride flag came from the Trump administration. The monument itself was designated in 2016 to honor the origin of Pride in the United States, and was also the first U.S. national monument dedicated to LGTBTQ+ rights.

"But like the 1969 rebellion that cemented Stonewall into history books, queer and trans people are not taking it without a fight. While the park and monument across from the original Stonewall Inn is now a federal park, the business itself is private property.

“Bad news for the Trump Administration: these colors don’t run,” Human Rights Campaign Press Secretary Brandon Wolf said in a statement. “The Stonewall Inn & Visitor’s Center is still privately owned, their flags are still flying high, and that community is just as queer as it was yesterday. While their policy agenda throws the country into chaos, the Trump administration is obsessed with trying to suffocate the joy and pride that Americans have for their communities.”

##########

N.Y.C. Officials Reinstate Pride Flag at Stonewall After Federal Removal   By Liam Stack and Olivia BensimonUpdated Feb. 13, 2026, 2:40 a.m. ET

"A group of New York elected officials gathered on Thursday to replace the Pride flag that was removed from the Stonewall National Monument after a directive from the Trump administration, mounting a defiant response to the government’s assault on diversity initiatives at a federal site honoring the L.G.B.T.Q. rights movement.

"The plan to re-raise the flag in the center of the small park outside the historic Stonewall Inn in Greenwich Village had been widely publicized on social media, and hundreds of spectators cheered as its rainbow colors made their way back up the flagpole under a cloudy winter sky."

Are some applications of AI repugnant?

Here's a new HBS working paper on repugnance of A.I.

 Performance or Principle: Resistance to Artificial Intelligence in the U.S. Labor Market
By: Simon Friis and James W. Riley

Abstract
From genetically modified foods to autonomous vehicles, society often resists otherwise beneficial technologies. Resistance can arise from performance-based concerns, which fade as technology improves, or from principle-based objections, which persist regardless of capability. Using a large-scale U.S. survey quota-matched to census demographics and assessing 940 occupations (N = 23,570 occupation ratings), we disentangle these sources in the context of artificial intelligence (AI). Despite cultural anxiety about artificial intelligence displacing human workers, we find that Americans show surprising willingness to cede most occupations to machines. Given current AI capabilities, the public already supports automating 30% of occupations. When AI is described as outperforming humans at lower cost, support for automation nearly doubles to 58% of occupations. Yet a narrow subset (12%)—including caregiving, therapy, and spiritual leadership—remains categorically off-limits because such automation is seen as morally repugnant. This shift reveals that for most occupations, resistance to AI is rooted in performance concerns that fade as AI capabilities improve, rather than principled objections about what work must remain human. Occupations facing public resistance to the use of AI tend to provide higher wages and disproportionately employ White and female workers. Thus, public resistance to AI risks reinforcing economic and racial inequality even as it partially mitigates gender inequality. These findings clarify the “moral economy of work,” in which society shields certain roles not due to technical limits but to enduring beliefs about dignity, care, and meaning. By distinguishing performance- from principle-based objections, we provide a framework for anticipating and navigating resistance to technology adoption across domains. 

 

 

When AI use is morally repugnant

Researchers used a moral repugnance scale (1-7) to measure public resistance to automation across 940 occupations. They found widespread support for AI in some roles but others remain categorically off-limits, regardless of AI’s capabilities.

Occupation	Repugnance score
Clergy	5.91
Childcare workers	5.86
Marriage and family therapists	5.64
Administrative law judges, adjudicators, and hearing officers	5.62
Athletes and sports competitors	5.52
Biostatisticians	2.54
Switchboard operators, including answering service	2.52
Transportation planners	2.38
Search marketing strategists	2.31
File clerks	2.17

 

Moral Economics: back-cover blurbs

 I now know what blurbs will likely be on the back cover of Moral Economics when it comes out in May. They are by Peter Singer, Abhijit Banerjee & Esther Duflo, Claudia Goldin, and Paul Milgrom & Bob Wilson, all people whose work I admire more than I can say.

    “Alvin Roth received the Nobel Prize for work in economics that has saved thousands of lives. In Moral Economics, Roth applies his open-minded, evidence-based thinking to controversial issues at the intersection of markets and morals, where his way of thinking could save even more lives.”
    Peter Singer, author of Ethics in the Real World

    “A surprising large part of economics is about things money can't buy, for many good and bad and complicated reasons. This wonderful book by the leading scholar in that area of economics is something else that just money could never buy. It's a labor of love, a testament from a lifetime of thought and research.”
    Abhijit V. Banerjee and Esther Duflo, Nobel laureates and authors of Poor Economics

    “With clarity and compassion, Al Roth explores the transactions society cannot escape—surrogacy, the purchase of body parts, the sale of sex, and a host of ‘repugnant’ relationships. What should be regulated? What should be banned? What are the limits of using price in the marketplace? Be prepared to think in new ways and gain from the insights of a great market designer.”
    Claudia Goldin, Nobel laureate and author of Career and Family

    “From the right to sell a kidney to the cost of a surrogate birth, our sense of ‘right and wrong’ shapes the economy more than we realize. Nobel laureate Alvin Roth—the world's leading ‘philosopher-economist’—unpacks the hidden moral codes that govern our most intimate transactions. This is a clear-eyed guide to understanding where the market ends, where morality begins, and how we can design a world that honors both.”
    Paul Milgrom and Robert Wilson, Nobel laureates, Stanford University
 

Tobacco banned in Indian state of Odisha

 Here's the story from the Times of India, Govt notifies ban on all chewable tobacco, nicotine products | Bhubaneswar News - The Times of India.  It remains to be seen how enforceable a statewide ban will be. (Local bans on something as addictive as nicotine are likely to face black markets sourced from neighboring jurisdictions without a ban.)

 

  

 

Repugnance: two overviews (one by humans, one by Ai)

Here are two overviews of repugnance, one by economists in a forthcoming book chapter, and one from xAi via its large language model, in Grokipedia.

First, here's the human report, by three veteran scholars of repugnant transactions and controversial markets:

 The Morality of Market Exchanges: Between Societal Values and Tradeoffs   by Julio J. Elias, Nicola Lacetera & Mario Macis
NBER Working Paper 34647 DOI 10.3386/w34647  January 2026

"Certain behaviors in markets are unambiguously unethical. In other cases, however, voluntary exchanges that can create gains from trade remain contested on moral grounds, because of what is traded or of the price at which the exchange occurs. This chapter offers a framework to analyze these contested markets and provides examples of two general instances. First, we examine “repugnant” transactions involving the human body—such as compensated organ donation and gestational surrogacy—where concerns about dignity, exploitation, and inequality conflict with welfare gains from expanding supply. Second, we study price gouging in emergencies, where demands for a “just price” clash with the incentive and allocation roles of price adjustments under scarcity. Across both cases, we synthesize evidence on societal attitudes and highlight how support for policy options depends on perceived trade-offs between autonomy, fairness and efficiency, and on institutional features that can separate compensation from allocation."
 

And here's the first sentence of a long overview of repugnance at Grokipedia, an Ai generated encyclopedia launched in October 2025:

Repugnancy costs
"Repugnancy costs denote the multifaceted disutilities—including reputational harm, social sanctions, moral distress, and enforcement expenses—that emerge when voluntary transactions clash with dominant cultural or ethical norms, effectively rationing or prohibiting markets even among consenting parties. "

What to read in 2026: FT recommends Moral Economics (plus blurbs by Milgrom, Wilson and Goldin:)

 The Financial Times looks into its crystal ball to suggest what books to read in the coming year, organized by the month in which they are scheduled to appear.  I'm happy to see my book among them. (And the first two blurbs are now online as well:)

What to read in 2026 

May 

    Moral Economics: What Controversial Transactions Reveal About How Markets Work by Alvin Roth (Basic Books)
Today’s fiercest moral battles are reframed as questions of market design, rather than absolute rights and wrongs. From reproductive medicine to drug policy and organ donation, Nobel Prize winner Roth shows how societies can calibrate what is permitted, restricted or banned without abandoning ethical concern.
 

The subtitle (subtly different from the U.S. version) reveals that they are thinking of the U.K. Version of my book. 

 

 

"Review
"From the right to sell a kidney to the cost of a surrogate birth, our sense of "right and wrong" shapes the economy more than we realize. Nobel laureate Alvin Roth - the world's leading "philosopher-economist" -unpacks the hidden moral codes that govern our most intimate transactions. This is a clear-eyed guide to understanding where the market ends, where morality begins, and how we can design a world that honors both -- Paul Milgrom and Robert Wilson, Nobel laureates, Stanford University

"With clarity and compassion, Al Roth explores the transactions society cannot escape - surrogacy, the purchase of body parts, the sale of sex, and a host of "repugnant" relationships. What should be regulated? What should be banned? What are the limits of using price in the marketplace? Be prepared to think in new ways and gain from the insights of a great market designer -- Claudia Goldin, Nobel laureate and author of CAREER AND FAMILY  "

Commercial plasma collection in the US: the Jaworski report for 2025

 Peter Jaworski, a tireless student of blood donation around the world, has published a report on the plasma industry.  It's full of interesting facts, a few of which are highlighted below.

America’s Plasma Contribution to the World: 2025
Launching the Georgetown Blood and Plasma Research Group and the annual state of the U.S. plasma industry report  by Peter Jaworski 

"I am proud to announce the official launch of the Georgetown Blood and Plasma Research Group. Housed at Georgetown University, this initiative will serve as a dedicated academic hub for research on the ethics and economics of global supply chains for not only blood plasma, but blood, bone marrow, and other medically-useful substances of human origin. Our goal is to provide data-driven insights, foster serious philosophical discussion, and be a home for interdisciplinary research.
 

"This 2025 Annual Report is the first contribution to that mission. 

...

"As of December 31, there are 1,247 plasma collection centers in the United States (including four centers in Puerto Rico).

"To put this into perspective: The U.S. is now home to more plasma centers than community colleges (just over 1,000) or Kohl’s department stores (around 1,175). There are almost as many plasma collection centers as Denny’s restaurants (around 1,300). 

...

"we can look at the economics of independent plasma companies. Their business is to sell plasma to fractionators, not to make medicine from the plasma.

"The current selling price of a liter of plasma is around $190, give or take $10.

• Donors receive between 30-40% of that revenue, or around $70 (an average donation is 850 - 880 mL, requiring more than one donation to equal a liter).
• The center spends a majority of the remaining revenue on costs like employees, supplies (“softgoods”), testing, and facility overhead.
• The plasma center will pocket around 8-12%, or around $15 in profit. 

...

"The U.S. plasma industry does more than save American lives, it provides the material for life-saving therapies for patients around the world.

"The 62.5 million liters collected in the U.S. in 2025 represents around 68% of global plasma collections for the manufacture of medicines. About 52% of those collections will end up in medicines to treat American patients, while the remaining 48% will end up treating patients in the rest of the world."

Prenups: formerly repugnant, now online

 The New Yorker writes about prenuptial agreements that can be written online, and not just for the wealthy.

Why Millennials Love Prenups
Long the province of the ultra-wealthy, prenuptial agreements are being embraced by young people—including many who don’t have all that much to divvy up.
By Jennifer Wilson

"The past few years have seen the rise of new apps such as HelloPrenup, Wenup, and Neptune that fast-track the process; the latter has couples discuss their finances with an A.I. chatbot before being matched, by algorithm, with a lawyer.

...

"There had been limited cases since the eighteenth century in which prenuptial contracts were recognized in the U.S., but these typically pertained to the handling of a spouse’s assets after death. The idea of a contract made in anticipation of divorce was considered morally repugnant. In an oft-cited case from 1940, a Michigan judge refused to uphold a prenup, emphasizing that marriage was “not merely a private contract between the parties.” You could not personalize it any more than you could traffic laws."
 

Medical aid in dying to become available in New York State

 Here's the announcements from the New York State Governor's office:

Governor Hochul Reaches Agreement With State Legislature to Pass Medical Aid in Dying Act in New York  

"Governor Hochul today announced an agreement with the Legislature to make medical aid in dying available to terminally ill New Yorkers with less than six months to live. This comes after careful reflection and deliberation with the bill’s sponsors, advocacy organizations, and most importantly, everyday New Yorkers who shared personal experiences with the Governor. The bill, with the agreed-upon amendments, will be passed and signed in January, and the law will go into effect six months later.

“New York has long been a beacon of freedom, and now it is time we extend that freedom to terminally ill New Yorkers who want the right to die comfortably and on their own terms,” said Governor Hochul. “My mother died of ALS, and I am all too familiar with the pain of seeing someone you love suffer and being powerless to stop it. Although this was an incredibly difficult decision, I ultimately determined that with the additional guardrails agreed upon with the legislature, this bill would allow New Yorkers to suffer less–to shorten not their lives, but their deaths.”
 

"The bill, as passed by the Legislature, had a number of protections in place to ensure that no patient was coerced into utilizing medical aid in dying and no doctor or religiously affiliated health facility was forced to offer medical aid in dying. With today’s agreement, the Governor announces a number of additional guardrails that the Legislature has agreed to enact aimed at ensuring the integrity of the patient’s decision and the preparedness of medical institutions to appropriately administer medical aid in dying. Today’s agreement memorializes a shared path forward on this bill, with additional key guardrails, including:

    A mandatory waiting period of 5 days between when a prescription is written and filled.
    An oral request by the patient for medical aid in dying must be recorded by video or audio.
    A mandatory mental health evaluation of the patient seeking medical aid in dying by a psychologist or psychiatrist.
    A prohibition against anyone who may benefit financially from the death of a patient from being eligible to serve as a witness to the oral request or an interpreter for the patient.
    Limiting the availability of medical aid in dying to New York residents.
    Requiring that the initial evaluation of a patient by a physician be in person.
    Allowing religiously-oriented home hospice providers to opt out of offering medical aid in dying.
    Ensuring that a violation of the law is defined as professional misconduct under the Education Law.
    Extending the effective date of the bill to six months after signing to allow the Department of Health to put into place regulations required to implement the law while also ensuring that health care facilities can properly prepare and train staff for compliance."

 

The market for used underwear, in the journal Genre, sexualité & société

 The study of repugnant transactions and controversial markets can lead to some strange markets.

 In the latest issue of the journal Genre, sexualité & société (after right clicking to translate to English) :

Product qualification in a contested market: The case of the used underwear market
by Ludine Cayla and Julien Gradoz
https://doi-org.stanford.idm.oclc.org/10.4000/154ww 

Abstract: This article focuses on the used underwear market, defined as the market for underwear that has been worn by one or more individuals and sold unwashed, meaning it contains deliberately left secretions and fluids. It distinguishes websites where the nature of the product sold must be concealed (such as resale websites for secondhand items) due to the prohibition of the transactions, and websites where the product can be openly discussed (such as websites specializing in the sale of sexual items). This distinction allows for the study of the issue of product qualification and disqualification in a contested market, which has been hardly explored. More broadly, this article helps identify the main characteristics of an overlooked market that, until now, has only been the subject of sensationalist analyses. 

"this is a "contested market," that is, a market in which some people would like to carry out transactions, but third parties oppose them on the basis of moral considerations. This opposition can then translate into constraints placed on the organization of the market (Roth, 2007), such as its prohibition (e.g., organs), the prohibition of advertising (cigarettes), difficulties in obtaining a bank loan (pornography), the imposition of punitive taxes (sodas), or even the stigmatization of participants in the transactions. Contested markets have been the subject of a substantial body of literature over the past decade (e.g., Steiner and Trespeuch, 2014; Bertrand et al ., 2020; Bertrand and Panitch, 2024; Gradoz and Dekker, 2025), and this article proposes to analyze the used underwear market based on this literature, moving beyond the sensationalism that has prevailed until now. This literature has focused in particular on the justifications used by third parties to challenge the existence of certain markets, or on the strategies implemented by participants in transactions to cope with the constraints resulting from this challenge." 

The national politics of deceased organ donation

 The U.S. transplant system is relatively open to foreign patients, and the NYT reports with some concern the number of foreign citizens receiving scarce organs from deceased donors, sometimes paying full list price to the hospitals involved.  One question I have that I haven't seen addressed in discussions of this type is how many foreign citizens who happen to die while visiting the US become deceased organ donors?

Here's the NYT:

Hospitals Cater to ‘Transplant Tourists’ as U.S. Patients Wait for Organs
International patients can bring a hospital as much as $2 million for a transplant. In recent years, they have typically gotten organs faster than U.S. patients. By Brian M. Rosenthal and Mark Hansen

  "In the past dozen years, more than 1,400 patients from abroad received a transplant in the United States after traveling specifically for the procedure. That was a small fraction of all U.S. transplants, and most transplant centers did not operate on international patients at all.

"But The Times found that a handful of hospitals are increasingly catering to overseas patients, who make up an ever-larger share of their organ recipients: 11 percent for hearts and lungs at the University of Chicago; 20 percent for lungs at Montefiore Medical Center in the Bronx; 16 percent for lungs at UC San Diego Health; 10 percent for intestines at MedStar Georgetown University Hospital in Washington; and 8 percent for livers at Memorial Hermann-Texas Medical Center in Houston.

"In many countries, this would be illegal. World leaders agreed in 2008 to fight so-called transplant tourism, and most nations do not provide organs to overseas patients. Yet the United States has long allowed it. The policy has drawn criticism in the past, such as when organs went to Saudi royals and a Japanese crime boss. 

...

"Dr. Mark Fox, a former chair of the transplant system’s ethics committee, said the findings were troubling, especially because overseas patients do not contribute to America’s pool of donated organs. “The unfortunate reality is that we don’t have enough organs,” he said. “When people jet in, get an organ and jet home, it’s a problem. It’s not fair.” 

 ##########

I'm reminded of this 2018 article which expressed a similar concern :

Delmonico, F. L., Gunderson, S., Iyer, K. R., Danovitch, G. M., Pruett, T. L., Reyes, J. D., & Ascher, N. L. (2018). Deceased donor organ transplantation performed in the United States for noncitizens and nonresidents. Transplantation, 102(7), 1124-1131. 

Abstract: "Since 2012, the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) has required transplant centers to record the citizenship residency status of patients undergoing transplantation in the United States. This policy replaced the 5% threshold of the non–US citizen/nonresidents (NC/NR) undergoing organ transplantation that could result in an audit of transplant center activity. Since April 1, 2015, the country of residence for the NC/NR on the waitlist has also been recorded. We analyzed the frequency of NC/NR deceased donor organ transplants and waitlist registrations at all US transplant centers by data provided by UNOS for that purpose to the UNOS Ad Hoc International Relations Committee. During the period of 2013 to 2016, 1176 deceased donor transplants (of all organs) were performed in non–US citizen/non–US resident (NC/NR) candidates (0.54% of the total number of transplants). We focused on high-volume NC/NR transplant centers that performed more than 5% of the deceased donor kidney or liver transplants in NC/NR or whose waitlist registrants exceeded 5% NC/NR. This report was prepared to fulfill the transparency policy of UNOS to assure a public trust in the distribution of organs. When viewed with a public awareness of deceased donor organ shortages, it suggests the need for a more comprehensive understanding of current NC/NR activity in the United States. Patterns of organ specific NC/NR registrations and transplantations at high-volume centers should prompt a review of transplant center practices to determine whether the deceased donor and center resources may be compromised for their US patients." 

They note that " a noncitizen/nonresident could be a foreign student or businessperson traveling to the United States, whereas an undocumented individual living in the United States would also be a noncitizen/resident." 

Abortions in the U.S. since state bans have been enacted

 It's hard to effectively ban something that is legal in neighboring jurisdictions.

The NYT has the story:

A Small Illinois City at the Center of a Seismic Shift in Abortion Access. 
Carbondale, Ill., a liberal enclave within driving distance of 10 states with abortion bans, has become a hub for the procedure. Last year there were nearly 11,000 abortions in this city of 21,000.   By Elizabeth Williamson

"Abortion is legal in Illinois, but the state is surrounded by others that have largely banned the procedure in the three years since the Supreme Court overturned Roe v. Wade. As a result, Illinois now leads the nation in out-of-state abortion patients. Carbondale, a college town in Illinois’s southern tip within driving distance of 10 states with abortion bans, has become a major abortion hub.

"Last year three clinics in this city of 21,000 provided close to 11,000 abortions, almost all for women from other states. The numbers, provided by the clinics, account for nearly a third of all out-of-state abortions in Illinois. 

,,,

"The clinics have already drawn protests as well as intervention efforts from Coalition Life, a St. Louis-based anti-abortion group that stations “sidewalk counselors” outside Carbondale’s clinics.

...

"In states without total bans, there were 1,038,100 clinician-provided abortions in 2024, according to the Guttmacher Institute, a research organization that supports abortion rights. The number includes 155,000 abortions for patients who had crossed state lines. Overall, the number of abortions in the country has slightly increased since the Dobbs decision, largely because of medication abortions."

 

Ludwig Amadeus Minelli (5 December 1932 – 29 November 2025), leader of Dignitas assisted suicide organization

 The Washington Post has the story

Ludwig Minelli, founder of leading assisted suicide group, ends his life at 92.  Dignitas, which Mr. Minelli founded, has helped thousands of people to die, some from countries where assisted suicide is illegal.  By Maham Javaid

 "Ludwig Minelli, who became a leader of the death-with-dignity movement as the founder of Dignitas, a Swiss organization with more than 10,000 members that provides and advocates for access to assisted suicide, died Saturday, ending his life through the process he helped promote. He was 92 and would have celebrated his 93rd birthday on Friday.

...

"Mr. Minelli, a lawyer specializing in human rights, was the general secretary of Dignitas, which since 1998 has helped thousands of people from around the world, including from countries where assisted suicide is illegal, to die. 

...

"Mr. Minelli and his group claimed responsibility for major milestones in the field of assisted death. In 2011 the European Court of Human Rights confirmed the right and freedom of a competent individual to decide on the manner and the time of their own end of life. In 2022, the German Federal Constitutional Court declared a law that made providing professional assistance in suicide impossible in Germany was unconstitutional. The same year, Austria also revoked a blanket prohibition on assisted suicide.

"In recent years, Australia, Canada and New Zealand have shifted their stance on assisted dying.

"Dignitas has participated in nearly 4,200 accompanied suicides since Mr. Minelli founded the group in 1998, the group reported in 2024. More than a third of those people lived in Germany, and there were over 600 people each from France and Britain. The group says it has more than 10,000 members. "

#########

Here is the statement/obituary from Dignitas: Passing of a pioneer and warrior 

Are transplants too scarce, or not scarce enough? A surprising debate about India

 India, now the most populous country in the world, does the third highest number of kidney transplants in the world (although their rate of transplantation per million population is quite low).  So transplants are nevertheless very scarce in India compared to the need, which is the situation worldwide.

Earlier this year, however, a paper by three veteran (non-Indian) transplant professionals who have headed large organizations expressed repugnance for the volume of transplants in India, and the fact that it depends mostly on living donor transplantation (LDT), suggesting it can be viewed as "both alarming and reprehensible."  Their paper's title makes it clear how they view it. 

Domínguez-Gil, Beatriz, Francis L. Delmonico, and Jeremy R. Chapman. "Organ transplantation in India: NOT for the common good." Transplantation 109, no. 2, February, 2025: 240-242. 

"The field of organ transplantation has evolved very differently across the world under the influence of different national healthcare financing systems. Healthcare is, in most countries, financed by taxation and thus through governmental budgets, in combination with private funds, mostly through contributory health insurance systems (eg, Australia, Canada, Europe, New Zealand, South America, and the United States). But across much of Asia, tertiary healthcare services, such as transplantation, are almost entirely dependent on the private finances of individuals. The impressive growth in Indian organ transplantation has been accomplished in for-profit hospitals, which have expanded Indian transplantation into 807 facilities, mostly associated with the major corporate hospital chains.6 Organ transplantation, in a part of the world where one-fifth of all people live, is thus largely not for the common good, but a treatment available for those with ample monetary resources." 

########## 

 This was followed by a firm rebuttal by distinguished Indian transplant professionals.  Their title makes their view equally clear:

Rela, Mohamed, Ashwin Rammohan, Vivek Kute, Manish R. Balwani, and Arpita Ray Chaudhury. "Organ Transplantation in India: INDEED, for the Common Good!." Transplantation 109, no. 6 (2025): e340-e342. 

 "We were deeply concerned by the article “Organ Transplantation in India: NOT for the Common Good” by Domínguez-Gil et al,  which we felt provided an unfairly critical view of the current state of organ transplantation in India. We aim to provide a point-by-point rebuttal based on actual figures and ground-reality rather than tabloid-press articles as cited by the authors.
 

"It is true that in the past 5 y, there has been an extraordinary growth in the number of transplantations in India (more than those achieved over several decades by European countries). While it is natural to be wary of this astronomical increase in transplant numbers, the authors’ assumption that this growth is likely nefarious reflects an outdated western mindset, rather than a true understanding of over 2 decades of massively coordinated effort by the Government of India, transplant professionals and all other stakeholders in the country. 

...

" The development of LDT has been presented with a negative connotation. This shows a scant understanding of the geo-socio-political idiosyncrasies prevalent in the Asian region, and unlike the west, its conventional dependence on LDT.

 ...

"The authors have further confused LDT and deceased donor transplantation with regards to foreigners having access to organs in India. The authors’ accusation of deceased donor organs being preferentially allocated to foreigner is presumptuous at best. The current organ allocation system under the aegis of the Government of India and state-wise organ transplant governing bodies is a very transparent process—and is reserved for Indian nationals.

...

" Transplant tourism being equated with organ commerce is erroneous, the authors’ fail to understand that many poor countries find India a more financially viable destination to get a transplant than countries in the west. Even affordable Governments in the middle east are moving to the east for transplantation, where the ministries have a direct tie-up with transplant units. 

"While it should be conceded that transplantation in India may not be available to all, true social upliftment necessitates broader initiatives beyond just immediate transplant availability: that of addressing poverty. Nonetheless, access to transplants for the underprivileged has greatly improved over the past decade. There are several public sector hospitals in the country that routinely provide transplantation services. In 2023, in the state of Tamil Nadu, 35.1% of all deceased donor renal transplants were performed for free in public sector hospitals (Table 1). 5 While traditionally, the private pay-from-pocket healthcare has been only for those with the resources, the central and several state governments (Tamil Nadu, Andhra Pradesh, Gujarat, etc) sponsor an all-inclusive healthcare state insurance for the poor, which includes transplantation at any approved private hospital in the state; which includes LDT.

####### 

I'm on my way to a conference in Cairo that is motivated in part by concern that healthcare in low and middle income countries has been impeded by some of the international healthcare organizations' lack of understanding or empathy for their situations. 

Funeral expense reimbursement to enhance organ donation and transplantation , by Chan and Sweat

 It's legal to pay funeral expenses for whole-body donors (for research) but not for organ donors for transplantation.  Here's a call to change that:

Chan, A., Sweat, K. Funeral expense reimbursement as a strategy to enhance organ donation and transplantation access. npj Health Syst. 2, 39 (2025). https://doi.org/10.1038/s44401-025-00046-z 

Abstract: We propose amending the National Organ Transplant Act to permit reimbursement of funeral expenses for deceased organ donors, analogous to current practices for whole-body donors. This ethically consistent policy could increase organ donation rates by 9–35%, saving 105,000–419,000 life-years and generating $200–800 million annually in Medicare savings—without commodifying human organs, compromising altruism, or undermining established ethical standards governing organ donation. 

Yuck! and the long journey to a book title

 

As I mentioned in yesterday's post, I'm working on the galleys of my forthcoming book, Moral Economics. This has reminded me of the long journey to a book title.

 

For one thing, the British title isn't exactly  the same as the American title--they have different subtitles. British readers will have to open the book to discover that prostitution and organ sales are among the topics covered, while American readers can see this on the cover.

 

  

My original, working title was "Controversial Markets and Repugnant  Transactions," based in part on my 2007 article  "Repugnance as a Constraint on Markets".  But I soon realized that when non-economists heard me mention that a transaction was repugnant, they thought I meant that I didn't like it and that they shouldn't either, when what I did mean was merely that some people object to it, often on moral grounds.

So for a while my working title became "Controversial Markets and Morally Contested Transactions." 

That's descriptive, but clunky.  So I didn't resist too much when my publisher suggested "Moral Economics," although I worried that was too cryptic, so a sub-title would be needed.

And all of this is stored in a folder with the title "Yuck" that I opened on my hard drive when I first started to think about writing a book on repugnant transactions. 

New book! Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work--forthcoming!

 

 I have a forthcoming book, (at long last) and it now even has a cover. (Note the halo:)  I'm reading the galleys right now...

 

Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work    forthcoming – May 12, 2026

also available to preorder at other fine bookstores. (I'll be happy to autograph pre-orders that are mailed to me, btw...)

 

"A Nobel Prize–⁠winning economist shows us why we have to deal in trade-offs when we can’t agree on what’s right and what’s wrong

"Some of the most intractable controversies in our divided society are, at bottom, about what actions and transactions should be banned. Should women and couples be able to purchase contraception, access in vitro fertilization, and end pregnancy by obtaining an abortion? Should people be able to buy marijuana? What about fentanyl? Can someone be paid to donate blood plasma, or a kidney?

"Disagreements are fierce because arguments on both sides are often made in uncompromising moral or religious terms. But in Moral Economics, Nobel Prize–winning economist Alvin E. Roth asserts that we can make progress on these and other difficult topics if we view them as markets—tools to help decide who gets what—and understand how those markets can be fine-tuned to be more functional. Markets don’t have to allow everything or ban everything. Prudent market design can find a balance between preserving people’s rights to pursue their own interests and protecting the most vulnerable from harm.

"Combining Roth’s unparalleled expertise as market design pioneer with his incisive, witty accounts of complicated issues, Moral Economics offers a powerful and innovative new framework for resolving today’s hardest controversies. "

 

Do we need to worry that surrogacy will be banned in the US? (by the UN??)

  Stat News has a call to prevent surrogacy from being banned, following a recent UN resolution to do just that.

How to keep commercial surrogacy from getting banned
An unlikely alliance working to end surrogacy is gaining power    By Arthur L. Caplan  Oct. 20, 2025
Caplan is head of the Division of Medical Ethics at the NYU Grossman School of Medicine. 

 

Caplan calls for more regulation, which might be a fine idea.  But I don't share his concern that the UN call to ban surrogacy will lead to it being banned in the US. Surrogacy in one form or another has been legalized in every US state (or maybe all but one.)   This is one of those times where it's good that the UN is toothless. 

 

HT: Martha Gershun 

In-game sports betting is something different

 The NYT has the story:

The Seductive, and Risky, Power of Live Sports Betting
In-game betting is predicted to grow to more than $14 billion by the end of the decade. It’s a huge part of the sports gambling industry. Public health officials worry that it could be increasing the risks for gamblers.  By Jenny Vrentas 

"These bets — known as in-game or live betting — have become ubiquitous and are one of the fastest growing areas of the sports gambling industry in the United States. They range from wagers on the result of a game while it is underway to what are known as microbets on events that are resolved quickly, sometimes in a matter of seconds, like the speed of a baseball pitch. Others are on outcomes of random events — will the halftime point total be an odd or even number, for instance. Once you are on the FanDuel or DraftKings mobile apps, there are scrolls and scrolls of bets, worldwide, day or night.

"For betting companies, or sportsbooks, the popularity of live betting is driving rapid revenue growth. Bets during games accounted for more than half the money wagered on FanDuel and DraftKings in recent quarters 

...

"With artificial intelligence being used to automate and accelerate the creation of more betting markets, in-game betting is expected to continue its rapid growth. Revenues from in-game bets could triple by the end of this decade, to more than $14 billion, according to a report released last October by the investment bank Citizens. That is an amount on par with the total revenue generated by the U.S. sports betting industry last year.

...

"Some professional sports leagues now allow ads for sports betting companies to be integrated into the live action of a game broadcast — as opposed to just during a commercial break. Michael Kay, the Yankees play-by-play announcer, or the N.B.A. commentators Charles Barkley and Kenny Smith will offer odds or set up predictions and direct viewers to a sportsbook that sponsors the broadcast and takes the bets. The N.B.A. and Major League Baseball permit up to two of these integrations per game.

"Streaming, too, has enabled new ways for fans to bet while they watch. Last year, the N.B.A. debuted an optional overlay on its livestreaming platform that displays in-game betting odds. Users can tap to click through to a prefilled bet slip in the DraftKings or FanDuel apps. The N.F.L. has gone a step further, allowing its games to be streamed inside sportsbook apps (and still count toward the Nielsen audience ratings).

"The professional sports leagues also benefit from live-betting revenue through their financial stakes in data providers, like Sportradar and Genius Sports. Those data companies sell the real-time data from games that facilitates live bets to sportsbooks, and they get a portion of the sportsbooks’ gambling revenues. The data companies have said that the percentage they take from in-game bets is higher than from pregame bets. (Chris Dougan, a spokesman for Genius Sports, said its partnership with the N.F.L. enabled legal and fair betting on N.F.L. games."