Dynamist Blog

Fresh Flowers, Fresh Fruit

Since I'm in exile from the LA jacarandas (though the Dallas crepe myrtles are lovely), I appreciate the photos on Grace Peng's blog. Grace also sends this addendum to my Times column on container shipping:

In addition to container shipping, advances in polymers also fueled the increase in container shipping of produce. In the ~late eighties, a polymer was created that allowed the cheap (in energy and $) separation of nitrogen and oxygen. Produce would be shipped in nitrogen-filled containers that did not require refrigeration.

As a working scientist, I always like to point out the ways in which science research leads to far-reaching consequences.

Massages Everywhere

My first Atlantic column is out in the new July/August issue and available--but only for the next couple of days--here. Here's the opening:

When you step off a plane in Indianapolis, one of the first things you see—right next to the directions to baggage claim and ground transport—is a sign advertising massages, from the fifteen-minute "Fast Track" for $18 to the half-hour "Extended Stay" for $33. Travelers can find similar services at airports in Providence, Anchorage, Cedar Rapids, and Baltimore. The Seattle-based Massage Bar has expanded from Sea-Tac to airports serving Nashville, Newark, and Washington, D.C.

And you don't have to go to the airport. Car washes in Dallas and Austin offer chair massages while you wait. Tired shoppers can get them at the Fashion Show mall on the Vegas Strip, at Whole Foods Markets, and at many large bookstores. Massage breaks are regular features at business conventions and sporting events.

Once a specialized therapy for injured athletes, an indulgence for the idle rich, or a cover for prostitution, massage has become a legitimate and seemingly ubiquitous enterprise. Between August 2004 and July 2005, about 47 million American adults got at least one massage, up 2 million from the previous year, according to the American Massage Therapy Association's annual consumer survey.

david.jpg One of the most important factors in the spread of massages was the invention of the portable massage chair. I tracked down the inventor David Palmer, shown here. Here, from the article, is how he got started:

In 1982, he was running a San Francisco massage school and worried that not enough graduates were finding jobs. If massage was so great, why didn't more people want it?

The answer was pretty obvious: everything about the experience scared off potential clients. "If you want to make sure massage didn't make it into the mainstream," Palmer says, "make it as expensive, inconvenient, and scary as possible. Force people to go into a private room behind closed doors, take off all their clothes with a stranger, lie down on a table, get slathered with oil for an hour, and pay $70, $80, $90 for the privilege."

Massage needed a form that was cheap, quick, convenient, and fully clothed. Palmer developed an acupressure-based routine, or kata, that took just fifteen minutes and was done while the client sat on a drummer's stool. [Like the one Palmer is sittig on in the photo above--vp.] Although a chair massage might cost more per minute than a table massage, the price for the experience was much lower. The next step was to create a special chair to support the client's head, arms, and legs.

assemble.jpg The first massage chairs were made of wooden pieces that fit into a wooden carrying case and were assembled, often with some fanfare, onsite, as Palmer is demonstrating in the photo. The case and chair weighed 27 pounds, so it's not surprising that they were eventually replaced by lightweight, collapsible models.

My columns will be available to magazine subscribers in the archive on The Atlantic's great website. The Atlantic online archive is incredible, stretching back to the 19th century, and it alone is worth the price of a subscription.

I'm Not Making This Up

The Dallas Morning News reports that the Secret Service has busted a Dallas-area tract house--not a suburban ranch but a religious ministry printing evangelical materials. The suspected crime: counterfeiting. The evidence: fake $1,000,000 bills (a denomination that doesn't exist). The DMN's Donna Fielder describes them:

The fake bills are the same size as U.S. currency. They have the distinctive peach and green coloring of new $20 bills and appear to carry the Department of the Treasury and U.S. Federal Reserve seals. But the Treasury seal reads, "Thou shalt not steal."

The back of the bill also looks like the $20 bill, but around the edges are admonitions against looking at a woman with lust and other sins, and repentance is urged.

According to federal Web sites, the largest bill printed is a $100,000 bill, but it circulates only among Federal Reserve banks. Grover Cleveland's picture, which appears on the $1 million religious tracts, actually appears on the $1,000 bill.

Nobody has been arrested, but the counterfeiting cops did seize the group's inventory and may issue a formal "cease and desist" order later this week.

Organ Donation Incentives, Cont'd

In response to a post and comments at Marginal Revolution, I wrote the following, which I'm cross posting here:

The objections to incentives fail to adequately consider a) the range of incentives that might be considered or b) the way organ markets, if such things existed, would in fact operate within a system of insurance (including federal programs) and transplant centers. Incentives, for instance, might include tax advantages of interest primarily to the wealthy. One, proposed by my economist husband, would be a one-year exemption from federal income tax. That would result in organs going from the rich to the poor.

If there were a fully open market, organ acquisition would become just another cost of the transplant, like immunosuppressant drugs or transplant surgeons' fees, to be covered through the normal channels. The problem is when you don't make payment an above-board part of the medical system. That's when you get the many problems we currently observe in black markets, ranging from inadequate care and contract/financial protections for those who sell organs to the availability of organs only to those who are willing to break the law and have the means to travel abroad.

I don't believe that permitting payments, whether for organs outright, through tax incentives, or simply to make up for lost wages (which isn't illegal but doesn't happen today in large part because people think it's illegal), would make unpaid donations disappear. Blood donations coexist with blood banks that pay for blood. Volunteer fire fighters work alongside professionals. I would have donated a kidney without compensation even if it were legal. But I am a relatively affluent person who can afford to take such risks, and miss a certain amount of income, without compensation.

Expecting people to take risks and give up something of value without compensation strikes me as far more blatant exploitation than paying them. I don't expect soldiers or police officers to work for free, and I don't think we should base our entire organ donation system on the idea that everyone but the donor should get paid. Like all price controls, that creates a shortage--in this case, a deadly one.

While giving up a kidney has risks, it is no more risky and far less emotionally fraught than being a surrogate mother, something many women receive both money and personal gratifications from doing. I suspect that if, like the people who use surrogates (or egg donors), kidney patients were affluent professionals with political clout, markets in kidneys would also be legal. Unfortunately, the typical kidney patient tends to be a relatively low-income wage earner without the time, education, or social capital it takes to get policies changed.

As for the idea [from an earlier commmenter] that "Most people view the body/life/health as a sacred matter much like religion is," I certainly agree. When people hear that you are going to donate a kidney, they tend to be repulsed, though after the fact they dole out lots of praise. But we don't need everyone to think it's OK to give or sell kidneys. A tiny minority will do. The rest of the world can simply tolerate their odd behavior.

When I write about "organ donors," I am referring to live donors, primarily of kidneys, but many of the same arguments would apply to incentives for families considering donation of a deceased loved one's organs.

The issue of lost wages is a significant one, especially since kidney patients and their friends and families are disproportionately likely to be of lower socioeconomic status. In many cases, people who might be willing to serve as living donors simply cannot take the chance of financial ruin posed by losing a few weeks of pay (and that's assuming their understanding bosses would give them leave).

Addressing this problem does not require changing federal law--or any government policy. It can be done on a local level by voluntary donations. A philanthropic fund at a major transplant center like Washington Hospital Center, where our surgeries took place, could be established to cover documented lost wages of living donors, presumably with some income cap. Churches could do something similar for members who serve as living donors, presumably for relatives or other church members. This would be particularly valuable in the African-American community; black Americans make up about a third of the people who need kidney transplants.

The National Kidney Foundation's Baleful Effects, Cont'd

Reader Chaim Katz writes:

You may not know this, but in 2004 the state legislature of South Carolina passed a bill authorizing tax credits for [cadaver] organ donors. (The $1000 credit was to have been redeemed by the family.)

The Governor of the state, Mark Sanford, vetoed the bill. His veto message is here.

I found this veto ironic, tragic, and mysterious given that Sanford is ostensibly one of the most libertarian governors in the country. This isn't just my opinion--The State newspaper uses the 'L word' regularly to describe Sanford.

As examples of Sanford's libertarians bona fides, you might note that he was self-limited U.S. Congressman; as Governor he proposed statewide universal school choice (through tax credits); and he has vetoed such measures as increased fines for failure to use child safety seats and an unconstitutional ban on protesting within 1000 yards of a funeral.

Yet given a solution that could possibly save thousands of lives while coercing no one--and costing zero political capital--Sanford punted. My mind boggles.

Sanford may be correct that a state tax credit would violate federal law--a test case would be needed--but there is no reason to deem it immoral, except that the National Kidney Foundation says so. Sanford cites the NKF's opposition in his veto message, on the false assumption that they speak for the interest of people with kidney disease. I'm not sure how big a difference a tax credit would make, but it is worth a try, especially since the very existence of the credit could encourage more people to sign organ donor cards.

Credit Check

For those who want a better credit card deal, Postrel family friend (and Dynamist weblog advertiser) "Mycroft" has some suggestions, especially for gas guzzlers like him. And if you're sick and tired of getting 50 million credit card solicitations in the mail, you can now opt out at this site run by the major credit bureaus.

The National Kidney Foundation vs. Open Debate and Increasing Kidney Donations

The National Kidney Foundation is behaving reprehensibly, especially given its mandate. When I first got interested in organ donations, I naively thought that the foundation would be in the business of doing everything possible to encourage kidney donations. I was terribly wrong. The group vehemently, and successfully, opposed a bill that would have allowed tests of incentives for organ donors. (CEO John Davis brags here, scroll to second item.)

So determined is the NKF that kidney donors should never, ever, in any way be compensated for their organs--no matter how many kidney patients current policy kills--that the organization is now trying to stamp out public discussion of the idea. When they heard that AEI is planning a conference on the subject for June 12, they wrote a letter to AEI president Chris DeMuth suggesting that the conference shouldn't be held. The letter from NKF chief Davis (PDF available here) opens:

The officers and staff of the National Kidney Foundation (NKF) were surprised to learn that AEI has scheduled a forum entitled "Buy or Die: Market Mechanisms to Reduce the National Organ Shortage" that will be held on June 12, 2006. We agree that there should be open discussion of all reasonable approaches to increase organ donation, and that the shortage of organs for transplantation deserves greater attention by policy makers. Nevertheless, we believe that the concept of financial incentives has been adequately debated for 15 years, begining with the National Kidney Foundation's 1991 workshop on "Controversies in Organ Donation," and culminating in the definitive Institute of Medicine (IOM) report that was issued late in April 2006. We don't see how an AEI forum would contribute substantively to debate on this issue. [Emphasis added.]

In other words, "We'd like to maintain our monopoly on the policy debate, so please shut up."

Keep in mind by way of context that there are 66,000 Americans on the waiting list for kidneys and that if every single person in the country agreed to be a post-mortem kidney donor, that would only double the supply of cadaver kidneys to about 13,000 a year, since a relatively few causes of death allow for organ transplants.

For more background on the policy debate, see previous posts here, here, and here. Marginal Revolution blogger and GMU economist Alex Tabarok takes a detailed look at incentives here.

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