Showing posts with label repugnance. Show all posts
Showing posts with label repugnance. Show all posts

Saturday, March 15, 2025

Danny Kahneman's final decision

Danny Kahneman spent his life thinking about how humans make decisions.  His final decision was to travel to Switzerland to avail himself of the medical aid in dying laws there. (A number of American states permit medical aid in dying, but only for those who have been diagnosed as very near death.)  Danny chose to depart on his own schedule.

 The WSJ has the story:

The Last Decision by the World’s Leading Thinker on Decisions
Shortly before Daniel Kahneman died last March, he emailed friends a message: He was choosing to end his own life in Switzerland. Some are still struggling with his choice
.  By Jason Zweig, March 14, 2025 

"In mid-March 2024, Daniel Kahneman flew from New York to Paris with his partner, Barbara Tversky, to unite with his daughter and her family. They spent days walking around the city, going to museums and the ballet, and savoring soufflés and chocolate mousse. Around March 22, Kahneman, who had turned 90 that month, also started emailing a personal message to several dozen of the people he was closest to.

“On March 26, Kahneman left his family and flew to Switzerland. His email explained why:

“This is a goodbye letter I am sending friends to tell them that I am on my way to Switzerland, where my life will end on March 27.”

###########

I wasn't among the recipients of Danny's email, but I am not surprised.  Here is my blog post from a year ago, noting his passing:

Wednesday, March 27, 2024 Danny Kahneman (1934-2024)

"His death was confirmed by his stepdaughter Deborah Treisman, the fiction editor for the New Yorker. She did not say where or how he died."



Thursday, March 13, 2025

Colombia proposes coca leaf legalization

 The Guardian has the story:

Colombia urges UN to remove coca leaf from harmful substances list
Foreign minister says legalisation of main ingredient of cocaine the only way to stop drug trafficking and violence
  Agence France-Press in Vienna
 
"Colombia, whose president, Gustavo Petro, is a vocal critic of the US-led war on drugs, has urged the UN to remove coca – the main ingredient in cocaine – from a list of harmful substances.

Used not only for cocaine, the coca leaf is also chewed as a stimulant in countries such as Colombia, Peru, Bolivia and Ecuador, or brewed into a tea thought to combat altitude sickness.

"Colombian foreign minister Laura Sarabia, in an address to the UN’s commission on narcotic drugs in Vienna, insisted on Monday that the leaf “is itself not harmful to health”.

"Removing it from a 1961 UN list of harmful narcotics, where it sits alongside cocaine and heroin, would allow it to be used to “its full potential in industrial applications such as fertilisers and beverages,” she said.

"She argued that legalisation was the only way to stop drug traffickers monopolising the plant – forcing rural communities to grow it for them, and razing forests for its cultivation.
...
Colombia is the world’s main producer of cocaine – much of its production in the hands of drug cartels and violent guerrilla groups.

In 2023, the South American country set a new record last year for coca leaf cultivation and cocaine production, which rose 53% from 1,738 tonnes (1,915 US tons) to 2,600 tonnes, according to the UN.

The United States is the biggest cocaine consumer.

...

“If you want peace, you have to dismantle the business (of drug trafficking),” he said during a government meeting. “It could easily be dismantled if they legalise cocaine in the world. It would be sold like wine.”

"Sarabia on Monday insisted that changing the approach from a punitive one towards a more humanitarian one did not imply “normalising or coexisting with drug trafficking”.

Wednesday, March 12, 2025

Nicotine underlip: Zyn, snu to manage (and start) nicotine addiction

Move over vapes: more ways to access nicotine without starting a fire: (I understand these are quite popular among our MBA students...)

  The New Yorker has the story:

Zyn and the New Nicotine Gold Rush. White snus pouches were designed to help Swedish women quit cigarettes. They’ve become a staple for American dudes. By Carrie Battan  March 10, 2025 

"In November, 2024, Sweden was declared “smoke-free” because its adult smoking rate had dipped below five per cent. As smoking has declined, so have related illnesses, such as emphysema; Sweden has one of the lowest rates of lung cancer in the E.U. This shift is broadly described in academic papers as “the Swedish Experience.”

"And yet the Swedes have an immense appetite for nicotine, the addictive chemical found in tobacco. About a third of Swedish people consume nicotine, and they mostly get their fix from snus—small, gossamer pouches that look like dollhouse pillows, which users nestle in their gums. Snus pouches deliver nicotine to the bloodstream through sensitive oral membranes; Swedes refer to the resulting buzz as the nicokick.

...

"Scandinavians have a proud history of snus usage. During the mid-seventeenth century, ground-up sniffing tobacco became popular in the French royal court and made its way to Sweden. Later, working-class Swedes started adding liquid to the powder and placing it against their gums, as a claylike paste. The preportioned pouches that are common today were introduced in the nineteen-seventies, as more people turned to snus in order to stop smoking. In the early nineteen-nineties, when Sweden held a referendum on whether to join the E.U., which had a bloc-wide snus ban, voters adorned their cars with bumper stickers that read, “E.U.? Not without my snus.” Ultimately, Sweden was granted an exemption from the ban in exchange for stricter warning labels.

...

"Until recently, the word “snus” referred solely to a pungent product made of tobacco leaves. But, over the past decade, the earthy brown substance has been joined by white snus, a new product with a characteristically Swedish design elegance. White snus, which consists of pure nicotine mixed with filling agents, has little natural odor and does not stain the teeth the way that the traditional kind can. It was developed by Swedish scientists to appeal to women, a constituency that hadn’t historically taken to brown snus. The creators also had ambitions to eventually reach Americans.

...

"In 2019, after five years of selling in select shops, mostly in the Southwest and Pacific Northwest, Swedish Match took Zyn national. Three years later, sales of nicotine pouches had increased by six hundred and forty-one per cent, and Philip Morris acquired the company for sixteen billion dollars. By this point, Zyn was a mainstay for a growing variety of users: purple-state early adopters, hockey and baseball players, Wall Street guys, medical students, truck drivers, and anyone who could use a quick jolt.

...

"Nicotine can have cardiovascular effects, including heightened blood pressure, heart rate, and cholesterol. Some pouch users complain of mouth lesions from long-term use. Yet more figures in addiction research are acknowledging the importance of smokeless tobacco products in the fight against cigarettes. In a recent interview, Ann McNeill, a pioneering scholar of tobacco addiction, said she’d started to see the benefit of adopting a harm-reduction approach—getting people to trade one dangerous habit for another, significantly less dangerous one. 

...

"Today’s nicotine entrepreneurs cite Juul as both an inspiration and a cautionary tale; the product’s appeal was so broad that teen-agers flocked to it. When the 2024 National Youth Tobacco Survey was published, Coogan and others in the industry were relieved: the rate of underage pouch usage had remained relatively low, at 1.8 per cent. Because of the Juul debacle, Zyn flavors in the U.S. are restricted to mint, coffee, cinnamon, and citrus varieties. "

Monday, March 3, 2025

Tesla Owners Beware of Vandalism (email)

 There is some debate in the business literature about what effect taking a public position on controversial social and political issues has on consumer-facing businesses.  Here's a suggestion that there may be reaction not just affecting sales of Teslas and the company's stock price, but to privately owned Teslas. (I used to live in Brookline, MA, and am still on some town email lists there, and this came in a mass email.)

"To all my Brookline neighbors who own Teslas,

"There is a person, or group of people, who have been going around Brookline defacing Teslas.  The sticker in the attached picture was stuck to my car this afternoon.  It’s large and I can’t get it off (if anyone knows how to do this without damaging the car, please let me know.)  The Brookline Police told me that they have received many reports of this.  If you have a Tesla, please turn on Sentry Mode (now!) so if something like this happens to you, there will be video evidence.  I had previously set my car to disable this feature when at home, as it prevents the car from sleeping, and uses a lot of energy. I will now have it enabled 24/7.  If your car has been vandalized, please report it to the police so there is a record of the crime
." 

 


 
I'm reminded of reports at one time that animal rights activists/terrorists sometimes attacked people wearing fur coats by spraying the coats with paint. (See e.g. the retrospective story Cutting cruelty out of fashion.)

 

Wednesday, February 26, 2025

Abortion bans have increased both births and infant mortality (JAMA)

 Not unexpectedly:

US Abortion Bans and Infant Mortality, by Alison Gemmill, PhD1; Alexander M. Franks, PhD2; Selena Anjur-Dietrich, PhD1; et alAmy Ozinsky, BS1; David Arbou r, PhD3; Elizabeth A. Stuart, PhD4; Eli Ben-Michael, PhD5; Avi Feller, PhD6; Suzanne O. Bell, PhD1  JAMA. Published online February 13, 2025. doi:10.1001/jama.2024.28517


"Findings  This analysis of US national vital statistics data from 2012 through 2023 found higher than expected infant mortality in states after adoption of abortion bans (observed vs expected, 6.26 vs 5.93 per 1000 live births; relative increase, 5.60%). Estimated increases were relatively larger among infants who were Black, had congenital anomalies, or were born in southern states.

Meaning  Abortion bans were associated with increases in infant mortality. These increases were larger for populations that already experienced higher than average rates of infant mortality." 

########

There's also an accompanying editorial:

Abortion May Be Controversial—Supporting Children and Families Need Not Be  by Alyssa Bilinski  JAMA. Published online February 13, 2025. doi:10.1001/jama.2025.0854
 

"In this issue of JAMA, 2 articles characterize the impact of recent state abortion restrictions.1,2 Applying observational causal inference methods, the authors estimate a 1.7% increase in birth rates from abortion restrictions in affected states (corresponding to about 22 000 excess births) and a 6% increase in infant mortality (about 500 excess deaths) from 2021 to 2023.1,2 Excess births occurred disproportionately among racially and ethnically minoritized, low-income, and unmarried individuals.1 Among births linked to abortion bans, infant mortality rates were about 4 times higher than rates in the general population.2 The authors note that this likely resulted both as a consequence of abortion bans requiring pregnant individuals to carry fetuses with lethal abnormalities to term and from excess births occurring disproportionately among individuals at high risk for complications. "

Sunday, February 16, 2025

Kidneys, compensation, and altruistic activists

 Here's a well written story about kidney donation, and  some of the very interesting people involved in the debate over compensating donors.  It's written by the talented science writer Carrie Arnold, in  Noema magazine (which she described to me as "a pub that has a philosophical bent published by the Berggruen Foundation," when I was among the many people she interviewed for the story). 

 It starts by introducing us to non-directed donors like Elaine Perlman and her son Abie Rohrig (he donated first and she followed). Elaine is now a leader in promoting organ donation and compensation of donors, not least through the End Kidney Deaths Act.   We also meet the indefatigable Frank McCormick, an economist at the forefront of understanding the finances of transplantation (and how much money it saves society and the healthcare system compared to dialysis).

 Here's the story:

How Much Is Your Kidney Worth? To address the deadly organ shortage, some are proposing compensating living kidney donors, creating an ethical dilemma.  By Carrie Arnold , in Noema, February 13, 2025

Ms. Arnold gives me the last word. The very last line of the story concerns the End Kidney Deaths Act:

This is a proposal that just says donors are really generous,” Roth said, “maybe we can be generous to them in return.

Saturday, February 15, 2025

Politics, Physician Senators, and the Hippocratic Oath (regarding the confirmation of RFK Jr. as HHS secretary)

 Here's an opinion piece from MedpageToday

Physician Senators, What Have You Done?— They have betrayed the Hippocratic Oath in voting to confirm RFK Jr.   by Joseph V. Sakran, MD, MPH, MPA, and Samuel Okum, February 14, 2025 

"When Senator Bill Cassidy, MD (R-La.) -- a physician, longtime advocate for healthcare policy, and potential swing vote on the Finance Committee -- voted to advance Robert F. Kennedy Jr. as secretary of HHS, he didn't just make a political choice. He made a choice that undermines science, public health, and the very Hippocratic Oath he once swore to uphold.

"While Cassidy claims to have taken this decision "very seriously," he must know it is wrong. As a legislator, he understands that the HHS secretary oversees critical health institutions like the CDC, FDA, and CMS. As a doctor, he has firsthand knowledge of how these agencies impact patient care, from ensuring access to safe medications to shaping life-saving public health policies. Entrusting this role to Kennedy -- a man with no qualifications beyond his fame as a purveyor of medical disinformation -- isn't just reckless. It endangers us all. 

...

"Through his organization, Children's Health Defense, Kennedy has falsely linked vaccines to autismopens in a new tab or window, opposed COVID-19 safety measuresopens in a new tab or window, and promoted debunked medical treatmentsopens in a new tab or window. In 2021, the Center for Countering Digital Hate identified him as one of the "Disinformation Dozenopens in a new tab or window" -- a small group responsible for nearly two-thirds of anti-vaccine content circulating online. All of this suggests this promotion of falsehoods has eroded public trust in vaccines, contributing to preventable disease outbreaks and declining immunization ratesopens in a new tab or window.

"The consequences of his rhetoric have been deadly. In 2019, Kennedy traveled to Samoa to support an investigationopens in a new tab or window into routine childhood vaccinations. His visit coincided with a devastating measles outbreak that infected thousands and killed dozens of unvaccinated children. When confronted by the country's prime minister, Kennedy expressed no remorse. Instead, he baselessly suggested that the measles, mumps, and rubella (MMR) vaccineopens in a new tab or window itself may have been responsible for the deaths.

...

"

We believe Cassidy prioritized political expediency over medical integrity. He arguably chose to align himself with President Donald Trump and conspiracy rather than the national interest and public health.

Meanwhile, Cassidy set the stage for his physician colleagues -- Republican senators Roger Marshall, MD (Kan.), John Barrasso, MD (Wyo.), and Rand Paul, MD (Ky.) -- to follow suit. They have all betrayed their oath as doctors."


Wednesday, February 5, 2025

States' fights over abortions: New York moves to shield doctors from prosecution in states with abortion bans

 Not all politics is Federal, even in these unprecedented times.

The NYT has the story:

N.Y. Moves to Shield Doctors Who Send Abortion Pills to States With Bans.   Gov. Kathy Hochul signed a bill meant to protect medical practitioners in New York who prescribe and send abortion pills out of state.  By Benjamin Oreskes

"Gov. Kathy Hochul of New York signed a bill on Monday intended to give the state’s health care providers an extra layer of protection to shield them from prosecution in states that ban abortion.

"The newly signed law comes days after a New York doctor was indicted in Louisiana for prescribing and sending abortion pills to someone in the state. The charges represented an escalation in the fractious battle between mostly Republican-led states that ban abortion and Democratic-led states seeking to protect or expand abortion access.

"The law, which takes effect immediately, will allow health-care practitioners to avoid putting their names on prescriptions for medications used in abortions, and instead use the names of their medical practices.

"Ms. Hochul, a Democrat, said the goal was to better conceal the identity of providers in hopes of protecting them from criminal, civil or other legal action that anti-abortion states try to take against them.

...

"The legislation signed on Monday augments the state’s telemedicine abortion shield law, under which New York authorities are barred from cooperating with a prosecution or other action taken by another state against a New York abortion provider.

"New York is one of eight states to have adopted such laws. Sending the pills across state lines has become a key way to provide abortion access to women in states with bans.

"Since the Supreme Court overturned the national right to abortion in 2022, a dozen states have enacted near-total abortion bans, and others have imposed strict limits on when during a pregnancy an abortion is allowed.

"In the Louisiana case, Dr. Margaret Carpenter of New Paltz, N.Y., was charged last week, along with her medical practice, for “criminal abortion by means of abortion-inducing drugs.”

Sunday, February 2, 2025

Challenge trials are becoming more accepted

Challenge trials, also called human infection trials, are clinical trials in which e.g. a vaccine is tested on participants who have volunteered to be infected with the disease the vaccine is meant to prevent. It's been a source of controversy.  But maybe open letters have some effect after all?  

The NYT has the story:

Would You Get Sick in the Name of Science?  Since the pandemic, drug trials that purposely make people vomit, shiver and ache have become a research area of growing interest. All that’s needed: brave volunteers. By Brent Crane

"challenge trials have become an area of enthusiasm since the Covid-19 pandemic. Funding for trials has poured in. Countries including India, Canada and Australia are beginning to develop the capacity for conducting them. Some researchers have found it easier to recruit volunteers, who are willing to shiver, sweat, puke and ache all in the name of helping others (and earning a little cash).

...

" Researchers have found that challenge trials can be used to observe not just immune responses but also transmission and infection. And by the standards of disease research, they are nimble; the whole process can take as little as a few months. This is in contrast to the years it often takes to run a traditional trial requiring thousands of research subjects to naturally become infected with a disease.

...

" In April 2020, 35 U.S. congressional members wrote a letter calling on regulators to permit challenge trials for Covid-19 vaccines. Three months later, 177 prominent scientists, including 15 Nobel laureates, joined their call. But opponents argued that the risks of infecting volunteers with a poorly understood virus were too great. The National Institutes of Health, Food and Drug Administration and Centers for Disease Control and Prevention all refused to allow them. At least one trial, in the Netherlands, was scuttled because of the perceived risk.

"And yet, instead of torpedoing the field, the pandemic “revitalized” it, said Dr. Christopher Chiu, an immunologist at Imperial College London. In 2021, after months of deliberation, the world’s first Covid-19 challenge trial began at Imperial College London — one of two that took place between 2021 and 2022 for Covid-19 — and interest grew from there.

"In 2020, while locked down in his Brooklyn apartment, a former corporate lawyer named Joshua Morrison stumbled upon an early draft of the Journal of Infectious Diseases article arguing for Covid challenge trials. That March, Mr. Morrison and two others founded an advocacy group in Washington, D.C., as a place to organize potential volunteers for Covid-19 challenge trials. As a nod to the speed of challenge trials, they called it 1Day Sooner. Within months, the organization had tens of thousands of sign-ups.

"1Day Sooner went on to promote challenge trials for maladies including norovirus, hepatitis-C and shigella, a bacteria that can cause dysentery."

  ########H

Here are all my posts on challenge trials




Wednesday, January 29, 2025

Anti trans leads to anti transplant in Indiana Senate

 In Indiana, the Daily Journal reports on a debate that has at least temporarily stalled a bill meant to protect organ donors' access to insurance.

Living organ donor bill sparks emotional discussion in the Senate
By TheStatehouseFile.com -January 27, 2025 

"During Thursday afternoon’s Senate hearing, 10 bills were brought up for their final vote before moving to the House of Representatives. While nine of the bills passed without discussion, one of the bills, SB 111, which would, among other provisions, protect organ donors from being denied coverage by insurance companies, sparked debate

...

"Sen. Andrea Hunley, D-Indianapolis, who authored the bill with Sen. Scott Baldwin, R-Noblesville, and Sen. Kyle Walker, R-Lawrence, began the discussion by describing the necessity of protecting Hoosier organ donors. She was then questioned by Sen. Liz Brown, R-Fort Wayne.

“My concern is that if a trans woman wanted a uterine transplant, that would be covered under the bill,” said Brown.

"Brown, who mentioned her concern about uterine transplants repeatedly during the discussion, was also concerned about possible raises in insurance rates for Hoosiers."


HT: Martha Gershun

#######

The uterus is just a muscle, so some transplant surgeons  I've talked to think such a transplant could be done.  The pregnancy would start with IVF, and the delivery would be by C-section…

 

Monday, January 27, 2025

Derek Humphry, Pivotal Figure in Right-to-Die Movement, (1930-2025)

 Here's the NYT obit:

Derek Humphry, Pivotal Figure in Right-to-Die Movement, Dies at 94
His own experience assisting his terminally ill wife in ending her life set him on a path to founding the Hemlock Society and writing a best-selling guide. 
By Michael S. Rosenwald, NYT,  Jan. 24, 2025

"Derek Humphry, a British-born journalist whose experience helping his terminally ill wife end her life led him to become a crusading pioneer in the right-to-die movement and to publish “Final Exit,” a best-selling guide to suicide, died on Jan. 2 in Eugene, Ore. He was 94.

His death, at a hospice facility, was announced by his family

...

"In August 1980, he and his [second] wife rented the Los Angeles Press Club to announce the establishment of the Hemlock Society, which they ran out of the garage of their home in Santa Monica.

"The organization grew quickly. In 1981, it issued “Let Me Die Before I Wake,” a guide to medicines and dosages for inducing “peaceful self-deliverance.” The group also lobbied state legislatures to enact laws making assisted suicide legal. In 1990, the Hemlock Society moved to Eugene. By then it had more than 30,000 members, but the right-to-die conversation hadn’t yet reached most dinner tables in America. 

"That changed spectacularly in 1991, after Mr. Humphry published “Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying.” The book was a 192-page step-by-step guide that, in addition to explaining suicide methods, provided Miss Manners-like tips for exiting gracefully.

...

"“Final Exit” quickly shot to No. 1 in the hardcover advice category of The New York Times’s best-seller list.

“That is an indication of how large the issue of euthanasia looms in our society now,” the bioethicist Dr. Arthur Caplan told The Times in 1991. “It is frightening and disturbing, and that kind of sales figure is a shot across the bow. It is the loudest statement of protest of how medicine is dealing with terminal illness and dying.”

"Reactions to “Final Exit” were generally divided along ideological lines. Conservatives blasted it.

“What can one say about this new ‘book’? In one word: evil,” the University of Chicago bioethicist Leon R. Kass wrote in Commentary magazine, calling Mr. Humphry “the Lord High Executioner.”  

...

"But progressives embraced the book, even as public health experts expressed concern that the methods it laid out could be used by depressed people who weren’t terminally ill. "

Saturday, January 25, 2025

Informed consent and compensation for clinical trial participants (Ambuehl, Ockenfels and Stewart in REStat)

 Here's the latest in a series of papers that suggests that participants who are attracted to e.g. clinical trials by the pay may be those who have the most trouble evaluating the costs and risks. So high pay should be paired with robust procedures for informed consent.

Ambuehl, Sandro, Axel Ockenfels, and Colin Stewart. "Who opts in? Composition effects and disappointment from participation payments." Review of Economics and Statistics 107, no. 1 (2025): 78-94.

Abstract: "Participation payments are used in many transactions about which people know little but can learn more: incentives for medical trial participation, signing bonuses for job applicants, or price rebates on consumer durables. Who opts into the transaction when given such incentives? We theoretically and experimentally identify a composition effect whereby incentives disproportionately increase participation among those for whom learning is harder. Moreover, these individuals use less information to decide whether to participate, which makes disappointment more likely. The learning-based composition effect is stronger in settings in which information acquisition is more difficult. 


"we contribute to the burgeoning literature on the moral constraints on markets (Kahneman et al., 1986; Roth, 2007; Ambuehl et al., 2015; Ambuehl, 2022; Elias et al., 2019). Around the world, the principles of informed consent are fundamental to regulations concerning human research participation, as well as to transactions such as human egg donation, organ donation, and gestational surrogacy (DHEW 1978, The Belmont Report, 1978; Faden & Beauchamp, 1986). According to these principles, the decision to participate in a transaction is ethically sound if it is made not only voluntarily but also in light of all relevant information, properly comprehended.3 Our results show that payments for participation can be in conflict with participants’ understanding about the consequences of participation. They further show that the severity of this conflict grows with respect to both the amount of the payment and the difficulty of acquiring and processing information about the consequences of the transaction."

#######

Earlier:

Wednesday, September 4, 2024 Incentives matter for getting participation in clinical trials by low income households

 

Sunday, March 10, 2024 Does high pay equal "undue inducement"? An experiment by Sandro Ambuehl



 

 


Friday, January 24, 2025

New marriage laws, in Thailand and Iraq (allowing same sex marriage, and child marriage, respectively)

 Same-sex couples can now marry in Thailand, and children as young as nine can now be married in Iraq.

Thailand Celebrates New Same-Sex Marriage Law With Mass Wedding  Hundreds of people began registering their marriages at a mall in Bangkok, as Thailand became one of the few places in Asia to legalize same-sex unions.   By Richard C. Paddock and Muktita Suhartono

“Today we feel secure and safe and happy,” said Ploynaplus Chirasukon, 33, who wed her partner, Kwanporn Kongpetch, 32, in the event’s first marriage. “We are happy that we have played a part in the equal marriage law reaching this point.”

Other weddings were planned around the country, and organizers say they expect more than 1,000 same-sex couples to marry on the first day." 

#######

Here's the Guardian on Iraq:

‘The end of women and children’s rights’: outrage as Iraqi law allows child marriage. The Iraqi parliament has passed a ‘terrifying’ law permitting children as young as nine to marry by Maria Talal and Hala Abdulla

"Iraqi MPs and women’s rights groups have reacted with horror to the Iraqi parliament passing a law permitting children as young as nine years old to marry, with activists saying it will “legalise child rape”.

"Under the new law, which was agreed yesterday, religious authorities have been given the power to decide on family affairs, including marriage, divorce and the care of children. It abolishes a previous ban on the marriage of children under the age of 18 in place since the 1950s.

“We have reached the end of women’s rights and the end of children’s rights in Iraq,” said the lawyer Mohammed Juma, one of the most prominent opponents of the law."


Tuesday, January 21, 2025

The debate over compensating organ donors is heating up

  It's a new year, and maybe there will be progress in increasing organ donation.  Here's a video in which Elaine Perlman explains the End Kidney Deaths Act, which might be debated by Congress this year, and would be an attempt to increase living donation by allowing some compensation (in the form of tax credits) for kidney donation.  And there are  a slew of articles in medical journals (of which I sample two) saying that the first and most important rule of organ transplantation is that donors should not be compensated (and that the same goes for other SoHOs (Substances of Human Origin) such as blood plasma. 

 

"Passing the End Kidney Deaths Act isn’t just an ethical decision—it’s a practical solution to one of the most pressing public health challenges in America.
100,000 Americans are counting on us to get the End Kidney Deaths Act to the finish line. The choice is clear and 2025 is our year. Let’s contact Congress now to pass the End Kidney Deaths Act and ensure a future where no one dies while waiting for a kidney. Because saving lives is not only ethical—it’s our responsibility."

#########

And here are two articles reaffirming their opposition:

Promoting Equitable and Affordable Patient Access to Safe and Effective Innovations in Donation and Transplantation of Substances of Human Origin and Derived Therapies
Cuende, Natividad MD, MPH, PhD1; Tullius, Stefan G. MD, PhD2; Izeta, Ander PhD3; Plattner, Verena PhD4; Börgel, MSc, Martin5; Ciccocioppo, Rachele MD6; Correa-Rocha, Rafael PhD7; Koh, Mickey B. C. MD, PhD8,9; De Angelis, Vincenzo MD10; Gondolesi, Gabriel E. MD, MAAC11; ten Ham, Renske PhD, PharmD12; Porte, Robert J. MD, PhD13; Hernández-Maraver, Dolores MD, PhD14; Hawthorne, Wayne J. MD, PhD15; Sureda, Anna MD, PhD16; Orlando, Giuseppe MD, PhD17; Haraldsson, Börje MD, PhD18; Ascher, Nancy L. MD, PhD19; Dominguez-Gil, Beatriz MD, PhD14; Oniscu, Gabriel C. MBChB, MD20
Author Information

Transplantation 109(1):p 36-47, January 2025. | DOI: 10.1097/TP.0000000000005169


 Note which ethical principle is at the top of the list.

###########

And this report speaks of global kidney exchange, but not for the poor...

 Expanding Opportunities for Living Donation: Recommendations From the 2023 Santander Summit to Ensure Donor Protections, Informed Decision Making, and Equitable Access, by
Lentine, Krista L. MD, PhD1; Waterman, Amy D. PhD2; Cooper, Matthew MD3; Nagral, Sanjay MS, FACS4; Gardiner, Dale MD5; Spiro, Michael MBBS6; Rela, Mohamed MS, FRCS, DSc7; Danovitch, Gabriel MD8; Watson, Christopher J. E. MD9; Thomson, David MD10; Van Assche, Kristof PhD11; Torres, Martín MD, MS12; Domínguez-Gil, Beatriz MD, PhD13; Delmonico, Francis L. MD14;  On behalf of the Donation Workgroup Collaborators*
Transplantation 109(1):p 22-35, January 2025. | DOI: 10.1097/TP.0000000000005124

 

"International KPE is acceptable if the donor-recipient pairs belong to a similar sociodemographic reality and are properly covered and protected by healthcare systems. GKE that exploits financial inequalities between pairs (or countries) must be prohibited."