Thursday, February 4, 2010

The fertility biz: too many hazardous twins?

The NY Times reports on the complicated incentives in the fertility business that often lead to the birth of twins, despite the increased hazard that attend low birthweight babies: The Gift of Life, and Its Price .

"...leaders of the fertility industry and government health officials say that twins are a risk that should be avoided in fertility treatments. But they also acknowledge that they have had difficulty curtailing the trend.
Many fertility doctors routinely ignore their industry’s own guidelines, which encourage the use of single embryos during the in-vitro fertilization procedure, according to interviews and industry data. Some doctors say that powerful financial incentives hold sway in a competitive marketplace. Placing extra embryos in a woman’s womb increases the chances that one will take. The resulting babies and word of mouth can be the best way of luring new business." (emphasis added)
"Doctors are also often under pressure from patients eager for children, who have incentives to gamble as well. Frequently, they have come to IVF as a last resort after years of other treatments, are paying out of pocket, and are anxious to be successful on the first try. And many do not fully understand the risks. "

A subsequent report, Grievous Choice on Risky Path to Parenthood, indicates that more multiple births result from intrauterine insemination than from in vitro fertilization, but that

"While less effective than IVF, intrauterine insemination is used at least twice as frequently because it is less invasive, cheaper and more likely to be covered by insurance, interviews and data show."

The story goes on to suggest that IU may not in fact even be cheaper, when subsequent care for compromised low-birthweight babies is taken into account.

Earlier, the Times invited several commentators to discuss the issue: Eight Is Enough
"A woman in Southern California has given birth to eight babies, the world’s second live-born set of octuplets. With advances in fertility treatment, multiple births are becoming more common, but how many are too many? What are the costs of delivering and caring for premature babies? And what about the emotional costs? We asked several experts to give us their thoughts.
Jeffrey Ecker, perinatologist
Felice J. Freyer, medical writer at The Providence Journal
Mark I. Evans, a doctor who specializes in reproductive genetic services
Ellie Tesher, the author of “The Dionnes” "

Wednesday, February 3, 2010

A famous experiment in game theory

In an earlier post I wrote about Nagel's guessing/beauty contest game: a famous experiment in game theory .

Who knew how famous. Here's the cartoon version.

One way to think about the game is as a model of a certain kind of unraveling.

Law clerks at the Supreme Court

Some guest Volokh Conspirators have an interesting post on the history of law clerks at the Supreme Court: Disenclerking the Supreme Court.

"During this period [1940's], some Justices seem to have forged closer bonds with their clerks than with their colleagues on the Court. A Frankfurter comment is noteworthy in this regard: “They are, as it were, my junior partners—junior only in years. In the realm of the mind there is no hierarchy. I take them fully into my confidence so that the relation is free and easy.” Law clerks made perfect colleagues, it seems, or at least better colleagues than the other Justices.
In the 1960s, Associate Justices still had only two clerks each, but a rising flood of petitions and appeals soon led most Justices to hire a third. In 1972, Justice Powell requested an additional clerk, pleading his own lack of background in criminal and constitutional law. Soon, they were all entitled to have four clerks.
The importance of the clerks over the past few decades is highlighted by J. Harvie Wilkinson’s comment that “Justice Powell often said that the selection of his clerks was among the most important decisions he made during a term.” It is nowadays taken for granted that clerks play a large role in the opinion-writing process. One Justice reportedly told a clerk who asked for elaborate guidance in drafting an opinion, “If I had wanted someone to write down my thoughts, I would have hired a scrivener.”


They cite their sources: "...we rely heavily on Todd C. Peppers, Courtiers of the Marble Palace: The Rise and Influence of the Supreme Court Clerks (2006), and Artemus Ward & David Weiden, Sorcerers’ Apprentices: 100 Years of Law Clerks at the Unite States Supreme Court (2006)."


Here are some papers on the market for law clerks, which is one of the best places to observe exploding offers.

In this recession year, there are unusually many applicants for appellate clerkships, and the ABA Journal reports Deluged with Clerkship Apps, Some Federal Judges Don’t Look at All of Them
" Although the Online System for Clerkship Application and Review allows judges to sort applications by characteristics such as law school and law journal experience, a number of judges prefer to look only at applications from individuals who come recommended by others they know or review mailed applications only..."
"Slightly more than 400,000 applications were made for 1,244 clerkships, according to the Administrative Office of the U.S. Courts. However, many applicants submitted dozens of applications."

Tuesday, February 2, 2010

Kant on compensation for organ donors

The Jerusalem Post has a column making the case for compensation of organ donors: Recompense for organ donors.

It begins with the following interesting paragraph:
"No one can be sure exactly how long there have been organ transplants, or their ethical ramifications, but they were already mentioned in Kant’s Lectures on Ethics two centuries ago. He gave the specific example of selling teeth. Kant was against them; he felt they violated his “practical imperative” to treat others as an end and not merely as a means to an end. An organ, in Kant’s view, was part of a human being, and so selling one (and, presumably, giving one) to someone else would turn a person into a means only.
Kant may have been against them, but today we are for them. Organ donations today save people’s lives, not only their bites, and massive efforts are invested to encourage people to make donations."

To my surprise when I looked at Kant's lectures, he was actually thinking of live donation, since he considers the case "if someone were to sell his sound teeth as a replacement for the decayed dentition of somebody else." This is followed immediately by his judgements on the improperness of suicide, or selling oneself into slavery. So, I'm left uncertain about how Kant would feel regarding the contemporary debate about compensation for live kidney donation.

Monday, February 1, 2010

Finance as portrayed in Victorian novels

I think of my work on repugnance, and on protected transactions, as part of a broader project of understanding how the workings of the economy are viewed by non-economists, in ways that may have economic consequences. Some popular views are very longlasting, while some, as politicians know, are subject to change, particularly when the economy goes from boom to bust.

One way to gain some intuition about this might be to study how various kinds of markets and transactions are portrayed in literature. The 2009 book Guilty Money: The City of London in Victorian and Edwardian Culture, 1815-1914 by the financial historian Ranald Michie takes a timely look back at how financial markets were imagined in an earlier century.

He looks at how finance is portrayed in novels, writing "Given the steady production of novels over this period, they also provide a means of continually monitoring changing cultural values. In contrast, other evidence of contemporary culture lacks either the continuity or depth necessary to observe trends over time. Cartoons do provide useful snapshots, such as during the Railway Mania, while there was a brief flurry of paintings with a City theme in the late 1870s, but finance only rarely lends itself to visual display..."

In the Winter 2009 issue of the Business History Review, Andrew Popp writes of the book
"The portrayals are rarely flattering: the City is a place of speculation, gambling, fraud, and deceit; financiers are not to be trusted and are often Jewish, foreign, or both; morals are currupted; true religion is impossible; old England is another, better world; the aristocracy are degraded fools; and all widowers, spinsters, and retired clergymen are innocent dupes."
...
"At the end, the mystery remains of how global financial success could coexist so happily with a fiercely antifinancial culture."

All this seems very timely. Yesterday the Times of London reported from Davos on French President Sarkozy's speech about bankers under the headline Davos: Fear and loathing in the Alps
"Sarkozy railed against the evils of unbridled capitalism and reserved special opprobrium for bankers. “To earn such enormous sums and not to bear responsibility is immoral,” he said. There was a stony silence, broken by a clutch of people who had the courage to clap.
“I thank those two members of the audience for their support,” Sarkozy said with a grin, getting a big laugh. "

Sunday, January 31, 2010

A LEAP forward at Harvard

Here is an email announcement I received today from my colleague Raj Chetty:

I am writing to introduce the Lab for Economic Applications and Policy
(LEAP) at Harvard. The mission of LEAP is facilitate policy-relevant applied research, with the ultimate aim of injecting scientific evidence into policy debates.

LEAP has three components. First, we fund faculty and student research, such as pilot field experiments or empirical studies that could not be easily or quickly funded through the NSF or other grant agencies. The LEAP executive committee (Larry Katz, Guido Imbens, Brigitte Madrian, and myself) will review applications on a rolling basis and authorize funding within 4-6 weeks. The application form is available at our temporary website:
http://economics.harvard.edu/leap. Please spread the word about these new funding opportunities among your graduate students.

Second, we run a visitor program that brings in two leading researchers every semester to visit the department and teach short topics courses related to their research. This year’s visitors are Jon Skinner, Stephen Coate, Doug Staiger, and Richard Blundell.

Finally, we have a cluster of offices on the 2nd floor of Littauer that includes a lounge to facilitate interaction among faculty and students.
This space includes visitor offices as well as a rotating office used by junior faculty at HKS and HBS. We plan to hold a small inaugural reception in the lounge at 3:15 on Wed Feb. 10 before the labor/pf seminar, and invite you to join us then to learn more about LEAP.

We look forward to working with you at LEAP!

Raj Chetty
Guido Imbens
Larry Katz
Brigitte Madrian

Where repugnant transactions motivate 'honor crimes'

No More Honor Killings writes Melik Kaylan in Forbes (1/29/10), in a column suggesting the practice may date to pre-Islamic Arab culture.

Jordan Times: No legal exemption for 'honour crimes': "Currently, some defendants who murder their female relatives in the name of family honour could get a minimum of six months in prison if the court decides to invoke Article 98 of the Penal Code, which stipulates a minimum of three months and a maximum of two years in prison for a murder that is committed in a fit of fury caused by an unlawful act on the part of the victim."...
"According to Momen Hadidi, head of the National Institute of Forensic Medicine, most female victims of honour crimes are found to be virgins during the autopsy. He noted that the "killers based their judgements of the victims on mere suspicions that they had improper relationships"." (In Jordan, see also a film: Crimes of Honour. )

Rights groups decry Gaza 'honor killing' "Honor killings usually target female victims of rape, women suspected of engaging in premarital sex, and women accused of adultery. They are murdered by relatives because the violation of a woman's chastity is viewed as an affront to the family's honor -- on the woman's part. In a statement, Al Mezan said honor killings were murder and "cannot be lawfully justified... the leniency with which the authority treats the perpetrators of such crimes, who usually allege that they were acting to preserve the honor of the family, has contributed to the noticeable increase in honor killings." " (see also Commodifying Honor in Female Sexuality: Honor Killings in Palestine

Al Jazeera reports on Social exclusion in southern Yemen in a video interview of girls and women living under protection.

Chechnya: “Honor killings” defended by President Kadyrov

In England (December 2009): Honour crime up by 40% due to rising fundamentalism

'Honor killings' in USA raise concerns (Nov. 2009)"Muslim immigrant men have been accused of six "honor killings" in the United States in the past two years, prompting concerns that the Muslim community and police need to do more to stop such crimes.
"There is broad support and acceptance of this idea in Islam, and we're going to see it more and more in the United States," says Robert Spencer, who has trained FBI and military authorities on Islam and founded Jihad Watch, which monitors radical Islam.
Honor killings are generally defined as murders of women by relatives who claim the victim brought shame to the family. Thousands of such killings have occurred in Muslim countries such as Egypt, Jordan, Pakistan and Palestinian territories, according to the World Health Organization.
Some clerics and even lawmakers in these countries have said families have the right to commit honor killings as a way of maintaining values, according to an analysis by Yotam Feldner in the journal Middle East Quarterly."

Update: this widely reported story came out the week following the above post: Turkish girl, 16, buried alive for talking to boys: Death reopens debate over 'honour' killings in Turkey, which account for half of all the country's murders

Corporate funding of research

Joshua Gans writes (following a John Tierny column) about a new category of transaction in danger of being regarded as repugnant, corporate funding of academic research: Disclosure versus prohibition

Saturday, January 30, 2010

College football and the BCS as a political football

The WSJ reports today: U.S. May Examine College Footbal Bowl System
"Sen. Orrin Hatch (R.-Utah) said he received a letter from the Justice Department, in which it "outlined the inequities" of the BCS system and said that it is considering whether to investigate the BCS under the antitrust laws. The letter also said that the administration is exploring other options to address college football's postseason, including encouraging the NCAA to take control and asking the Federal Trade Commission to examine the BCS's legality under consumer-proteciton laws.
Shortly after he was elected in November 2008, Barack Obama said he would "throw my weight around a little bit" regarding college football's lack of playoff system. Currently, the BCS stages a national title game between the two teams that finish atop a compilation of polls, while other arguably deserving teams often get excluded. Mr. Hatch, whose home-state Utah Utes were left out following the 2008 season despite a perfect record, has been advocating for changes, too, writing a letter to the president in October asking for an antitrust investigation."

The article goes on to quote the BCS director as saying we've seen this before: ""There is much less to this letter than meets the eye," Mr. Hancock said. "The White House knows that with all the serious issues facing the country, the last thing they should do is increase the deficit by spending money to investigate how the college football playoffs are played. With all due respect to Sen. Hatch, he is overstating the importance of the letter he received from the Office of Legislative Affairs." "

Here are my previous posts on the BCS and the serious business of college football.

iPhone app for finding broken parking meters

Application identifies broken meters so that drivers can park at them without paying.

The app, called NYC Broken Meters, "allows users to locate the closest broken parking meter along with detailed directions on how to get to it. This is no trivial issue. According to city ordinances, it is legal to park next to a broken meter for one hour without paying, making this application a vital one in city where parking prices can reach $500 or more a month. "

misc kidney exchange news stories, videos

VIDEO: Woman Part Of Kidney Exchange Benefiting 10 People - Video ...Twenty people in four states will have surgeries, giving 10 people a chance at a better life.

Washington, D.C News - feedmap.netChris Conte, 49, a single dad who lives near Frederick, and his cousin, Pam Hull, have always been close Last week, that relationship got even closer when they took part in a large-scale kidney exchange at Georgetown University Hospital

Health Watch: DC Kidney Exchange - TopixA record-setting kidney exchange took place at Georgetown University Hospital. The exchange got many people off dialysis.

Four Days, Two Hospitals, 14 Surgeries, story in Georgetown University Hospital newsletter.
Here's a video of part of the Georgetown news conference with the patients.

Kidney exchange program helps save two lives in Kentucky - WAVE 3 ...Dec 17, 2009 ... WAVE 3 TV Louisville, KY

Three-Way Kidney Exchange Worked NBC San DiegoDec 17, 2009 ... Three lives were saved in a medical first for San Diego County.

YouTube - Rare Kidney Exchange, interview with donors and patients in a short non-directed donor chain.

YouTube - Alliance for Paired Donation: A chain of altruism, a video presentation about Rees' now famous first non-simultaneous chain (not a gripping video, just magazine pictures, but it gives an idea of the span in time and space...).

Friday, January 29, 2010

Moving towards kidney exchange on a national scale in the U.S.

There are lots of good reasons to move towards kidney exchange on a national scale (the main ones being the benefits of a thick market). One approach is to try to organize kidney exchange nationally, and I continue to have some hope for that, although organizing a national program involves the difficulty of creating a top-down logistical structure, as well as a Byzantine political struggle.

Another approach is to have the existing regional exchanges merge and grow until they have national reach. This approach presents logistical problems of its own. The two big regional exchanges with which I've been most intimately involved, the New England Program for Kidney Exchange (NEPKE) and the Alliance for Paired Donation haven't yet managed to work well together, although each has expanded its reach and worked well with hospitals outside of their original regions.


One vision of how things might develop in the intermediate term can be gleaned from the Paired Exchange Program at the University of Minnesota Medical Center, led by the eminent Dr. Arthur Matas. A recent post on their blog discusses the three exchange networks in which they take part:


"At the University of Minnesota Transplant Center we are participating in three exchange lists:
North Central Donor Exchange Cooperative which is based in the upper midwest. There are 9 transplant centers in this consortium. The website is http://www.ncdec.org/.
Alliance for Paired Donation (APD) is based at University of Toledo, Ohio. It started in 2007. Currently there are 69 transplant centers from across the country that are registering pairs for matching in this database. This exchange has been using non-directed donors to optimize the number of transplant possibilities. A non-directed donor is someone who wants to donate a kidney to anyone who needs it. A non-directed donor's involvement can allow a long chain of transplants to occur, spread out over a period of months. For example, a non-directed donor gives a kidney to a recipient in the database. That recipient's "mismatched" donor then agrees to give a kidney to someone else, as soon as a match becomes available. In this way, several donations can take place in a chain over time. There has been a successful chain of as many as 10 transplants. You can learn more about paired exchange at http://www.paireddonation.org/.
National Kidney Registry is based in New York. There are 30 transplant centers from across the U.S that are registered with this network. They have done 61 transplants to date. Their website is http://www.kidneyregistry.org/. "


Of course, one of the logistical problems that participation in multiple networks poses is that, unless the timing of their operations is coordinated, networks may essentially compete for particular patient-donor pairs, with more than one network planning surgeries involving a particular pair.

Thursday, January 28, 2010

Dogs and cats becoming repugnant as food in China?

The Guardian reports Chinese legal experts call for ban on eating cats and dogs.

"Chinese legal experts are proposing a ban on eating dogs and cats in a contentious move to end a culinary tradition dating back thousands of years."
...
"In ancient times, dog meat was considered a medicinal tonic. Today, it is commonly available throughout the country, but particularly in the north where dog stew is popular for its supposed warming qualities.
In recent years, however, such traditions are increasingly criticised by an affluent, pet-loving, urban middle class. Online petitions against dog and cat consumption have attracted tens of thousands of signatures. "

..."Online critics said it was hypocritical to protect only dogs and cats, and that the government should focus on human welfare before protecting animals.
"This is absurd. Why only dogs and cats? How about pigs, cows and sheep," wrote a poster going by the name Mummy on the Xhinua news agency website."

HT: Dean Jens

Surrogacy

The NY Times has a forum on The Baby Market:

"The Times recently published an article on the ethical and legal issues surrounding the use of surrogates in reproduction, which become even more complicated when the parents are essentially contractors who find egg donors, sperm donors and pregnancy surrogates to carry the baby.
As surrogacy becomes more common, should contracts for babies be subject to the strict vetting applied to adoption? Is there a public interest in regulating the process and deciding who can obtain a baby through surrogacy? Or is this a reproductive right that should be left to the private realm?
Diane B. Kunz, Center for Adoption Policy
Arthur Caplan, bioethicist, University of Pennsylvania
Charles P. Kindregan Jr., professor of family law
Rebecca Dresser, law professor, Washington University "

Wednesday, January 27, 2010

The Australian paired Kidney eXchange (AKX) goes live

"The Australian paired Kidney eXchange Program (AKX) is a nationwide live kidney donor exchange program which will become operational in January 2010 and operate under the auspices of the Australian Organ and Tissue Authority"

Tuesday, January 26, 2010

School choice in SF moves forward

Yesterday Muriel Niederle and Clayton Featherstone were among the presenters to the San Francisco Board of Education, speaking about possible designs for a new school choice system there. It seems that they are well on the way to a good outcome.

One of the Board members, Rachel Norton, has a blog on which she posted before and after accounts of the meeting:
Tonight’s student assignment meeting should be interesting!
Recap: Closing in on a student assignment policy

Here is a video of the whole meeting (but you can navigate a bit so you don't have to watch the full 3 hours: Muriel's testimony, from her slide presentation through answering of questions from the board is from 1:09 to 2:09 on the video).

For the technically inclined, papers about our prior work on school choice systems in NYC and Boston are here.

It has been mentioned in the SF discussions that our team of market designers has worked on a number of problems aside from school choice, so here are background links on some of them for SF readers who are interested:
National Resident Matching Program and related medical labor markets
Gastroenterologists, Orthopaedic surgeons
Kidney Exchange
AEA market for new economists

Closing NY City High Schools

The NY Times has a story by Sharon Otterman on closing "persistently lowest performing" high schools. These are often the large, unscreened schools that serve, or try to serve, the hardest to educate students.

"Since 2002, the city has closed or is in the process of closing 91 schools, replacing them with smaller schools and charter schools, often several in the same building, with new leadership and teachers. This year, the city has proposed phasing out 20 schools, the most in any year. It is also the first year in which the city is required to hold public hearings at each school proposed for closing, as a result of a change in the mayoral control law that resulted from complaints about an insufficient role for parents. "

"The city’s Education Department says that on the whole, the closings have been a success. The small high schools created in the shells of old large high schools have average graduation rates of 75 percent, 15 percent higher than in the city as a whole and far greater than those of the schools they replaced."

"A study last year by the Center for New York City Affairs at the New School backed the chancellor’s argument that students at the smaller schools — which are organized around themes like science or community service — fare better. But the study also found evidence of a domino effect at the large high schools.
Because the new schools, at first, accepted relatively few special education and non-English-speaking students, those students began enrolling in greater numbers in the remaining large high schools. Overall enrollment increased at many large high schools, and attendance fell. “While a few schools were successful in absorbing such students, most were not,” the report said. "

"The Columbus student body is in constant flux. Because the school has unscreened admissions, it takes children expelled from charter schools, released from juvenile detention, and others on a near-daily basis: last year, 359 of its 1,400 students arrived between October and June. Even after the city proposed the school’s closing in December, it received 27 more students. ...
"The city does not dispute that Columbus has been dealt a tough hand, but it argues that other high schools with a similar population — 26 percent are classified as special education and 18 percent are not fluent in English — have had better results. Columbus was also included on New York State’s list of “persistently lowest performing” schools last week, which requires the city to produce a plan either for closing or for staff changes and reorganization of the school."

Update: January 27. City Panel Approves Closing of 19 Schools

Spring 2010 courses in Market Design in Boston/Cambridge

Susan Athey at Harvard and Tayfun Sonmez at Boston College will both be teaching market design courses this semester, and Peter Coles and Benjamin Edelman will be teaching an MBA class at HBS called Managing Networked Businesses, that has a substantial focus on entrepreneurial market design.

Susan Athey: Economics 2056b. Topics in Market Design Catalog Number: 0402 Half course (spring term). Tu., Th., 1–2:30. EXAM GROUP: 15, 16Studies topics in market design, focusing on auctions, auction-based marketplaces and platform markets. Covers methods and results from theory, empirical work, econometrics and experiments, highlighting practical issues in real-world design.

Tayfun Sonmez: EC 802 Advanced Microeconomic Theory (Spring: 3)In recent years, auction theory and matching theory have found applications in many interesting real-life problems from a market/mechanism design perspective. Topics of this course include the theory of matching markets, multi-object auctions, school choice and kidney exchange.

Monday, January 25, 2010

Pay to play at Russian universities

The Chronicle of Higher Education reports on an anti-corruption campaign at Kazan State University: A Russian University Gets Creative Against Corruption (gated, unfortunately, but the excerpts below give you the idea).

"Too many students and professors have a "pay to play" mentality, reformers say, in which grades and test scores are bought and sold.
Anticorruption videos are shown daily. Students participate in classroom discussions about the problem. Kazan State's rector, Myakzyum Salakhov, has installed video cameras in every hallway and classroom, so that the security department can watch students and professors in every corner of the university to catch any bribes as they are made."
...
"Across Russia, bribery and influence-peddling are rife within academe. Critics cite a combination of factors: Poor salaries lead some professors to pocket bribes in order to make ends meet. Students and their families feel they must pay administrators to get into good universities, if only because everyone else seems to be doing it. And local government officials turn a blind eye, sometimes because they, too, are corrupt."
...
"Students and administrators alike say that bribery is rampant on the campus, and that it includes everyone from students to department chairs.
"Corruption is just a routine we have to deal with," says Alsu Bariyeva, a student activist and journalism major who joined the campaign after a professor in the physical-culture department suggested that she pay him to get credit for her work that semester. She paid.
Several students said they once saw a list of prices posted in the hallway of the law department. The cost of a good grade on various exams ranged from $50 to $200. Students from other departments report similar scenarios.
Many people on the campus identify the arrest last March of the head of the general-mathematics department as a turning point. Police, tipped off by students and parents, charged in and arrested Maryan Matveichuk, 61, as he was pocketing thousands of rubles from a student for a good mark on a summer exam.
The police investigation concluded that in at least six instances Mr. Matveichuk, a respected professor, had accepted bribes of 4,000 to 6,000 rubbles, or about $135 to $200, from students in other departments for good grades on their math exams and courses.
Last September a court in Kazan found the math professor guilty of accepting a total of 29,500 rubles, or $1,000, in bribes, issued a suspended sentence of three years in prison, and stripped him of his teaching credential.
Mr. Matveichuk's arrest inspired Mr. Salakhov, the rector, to form an anticorruption committee, including administrators and students."

Sunday, January 24, 2010

Sex for the disabled and healthcare

The London Times asks: Is sex for the disabled the last taboo?
"The sexual feelings of disabled people have long been ignored. Now the medical profession is debating the issue"

The issue is not sex, so much as sex workers as a part of health care, and the role that the health care system should play, particularly for the most severely disabled patients who may need logistical support from health care workers .

The report is in connection with a conference called " “Disability: sex, relationships and pleasure”, which is being hosted by the Royal Society of Medicine in Central London. It aims to educate carers about the sexual needs of patients and to introduce disabled people to available support networks. It is backed by the Sexual Health and Disability Alliance (SHADA) and the Tender Loving Care Trust (TLC), which help to put disabled people in touch with appropriate sexual and therapeutic services, and offer confidential support and advice on sexual matters.
Tuppy Owens, the founder of the TLC, campaigns for the sexual needs of disabled people to be recognised by care workers. “Sex is right at the bottom of the list when it comes to their care requirements,” she says. “But they have a right to enjoy all elements of life just like everyone else. It is also important that they have access to sex workers because they don’t have the same opportunities as the average person to explore their bodies."
...
"The Sexual Offences Act allows care workers to help disabled patients to book sex workers over the telephone, provided they do not become involved in the negotiation of fees. But there have been many reported cases of authorities stepping in to stop the practice.
“The problem is that many health professionals think it is illegal,” says Owens. “The TLC has had calls from carers who say that they have even considered giving in their notice out of frustration that they are unable to help patients seeking a sexual service that could make them happier.”
Many high-profile names have backed the TLC’s cause, including Lord Faulkner of Worcester, Baroness Miller of Chilthorne Domer and the philosopher and author A. C. Grayling, but no one has gone so far as to suggest that sex workers should be paid for by the NHS. "