"To Save Lives Without Limitation"

At the recent World Transplant Congress 2006. pediatric nephrologist Richard N. Fine, MD, the outgoing president of the American Society of Transplantation, called on his medical colleagues "to challenge prior prohibitions and enhance approaches that have heretofore been taboo to the transplant professional."

Both the Talmud and Koran extol us to save lives without limitations. At present, transplant professionals are not enthralled with solicitation of a donor for individual specific recipients. Such solicitation, whether on the Internet or billboards or by utilization of the media is an anathema to the transplant professional. The primary reason that such methodologies are offensive is because they circumvent "equity". The playing field is not level because individuals with means or brashness have a potential distinct advantage. However, no one is actually harmed by such events and everyone potentially benefits because the waiting list shrinks as more individuals receive the gift of life.

It is time that we cease to be pious about "equity" in the acquisition of solid organs for transplantation? Equity is in the eyes of the beholder: Is it equitable that a child with AIDS living in the United States is provided drugs that can sustain life whereas a similar child born in Africa or parts of Asia will die because the world economies do not deem provision of such drugs a priority; Is it equitable that children in many areas of the world go to bed hungry every night yet the silos in the Midwest of the United States are overflowing and the harvest is stockpiled in the open fields; Is it equitable that a child born in Ethiopia or Sierra Leone has a life expectancy of fewer than 33 years whereas one born in the U.S. can expect to live an average of 78?

It is time that we enhance all approaches to increase the availability of solid organs without the prejudice of the taboos of the past. We should not arbitrarily dismiss such extraordinary solicitations but should strive to incorporate any legitimate methodology that results in a "life" being saved.

Since 1984, it has been a felony in the United States to pay for an organ for transplantation. Why is paying for a body part so repugnant? I believe the major impetus for such prohibition is fear. Fear that impoverished individuals will be exploited and/or coerced to donate part of their body. Fear that unscrupulous individuals will monopolize the donation efforts for financial gain. Fear that potential donors will not be appropriately evaluated and that follow-up care will not be provided thereby jeopardizing their health.

Parenthetically, in the United States there is no statute that mandates lifelong follow-up and medical care for live donors and no registry that categorizes the long-term potential adverse consequences of solid organ donation.

Is it wrong for an individual, who because of the fate of circumstances is impoverished and relegated to a life of poverty and who wishes to utilize part of his/her body for the benefit of another and in return will be provided with financial compensation that could obliterate a life of destitution for the individual and his/her family? If we can put a man on the moon we can surely devise a system that guarantees the short and long-term safety of potential donors, guarantees that the financial reward is not subverted and assures that availability is not limited to the wealthy. I realize that there are substantive risks to financially incentizing organ donation. In addition to potential exploitation and coercion of potential donors and manipulation of the process by unscrupulous individuals, a deleterious impact on altruistic donation could result.

I realize that this approach is iconoclastic; however, our current efforts have fallen far short of providing an adequate number of solid organs. If we, as Transplant Professionals, do not seize the opportunity of exerting a leadership role in expanding potential sources of organs we risk that less dedicated and committed individuals will potentially control the process. I also realize that the recent IOM report on organ donation was unenthusiastic about the concept of incentivization.

Therefore, I challenge the Transplant Community to reassess attitudes that potentially limit availability of organs for transplantation and suggest pursuing the following:

(1) SLIDE 11: Support the Collaborative to ensure that an increasing number of centers are involved in this innovative approach to increasing availability of deceased donor solid organs. Lobby the Federal Government to increase rather than decrease funding for the Department of Transplantation to enhance this effective effort.

(2) SLIDE 12: Partner with alternative approaches to solicit organ donation --Internet, billboards, media--to assure that potential donors receive optimal information and counseling and that the maximal number of potential recipients have access to these approaches.

(3) SLIDE 13: Re-evaluate the prohibition of financial incentives for both live and deceased donor organ donation. Initiate serious discussions to develop a system that assures optimal surveillance of the entire process and prevents exploitation and coercion of both donor and recipient.

(4) SLIDE 14: Actively advocate for a long-term live-donor registry and pursue the assurance that all live donors receive lifetime insurance coverage for any medical issue linked to the donation of a solid organ.

I've put the full text of Dr. Fine's speech online here.

Posted by Virginia Postrel on August 03, 2006 • Comments

Kidney Blogging Cont'd

Dick Cass, president of the Baltimore Ravens, donated a kidney to a friend from law school. The WaPost's Les Carpenter reports with remarkable matter-of-factness, reflecting Cass's own attitude:

"Maybe I'm intellectualizing this too much. But it's not a great risk," he said late last week as he sat in his office at the team's headquarters. "When you can do this for someone, it makes you feel good. It's really easy. It sounds silly, I know, to say that, but it's not that big a deal."

As a kidney donor, I agree completely. A kidney donation is a big deal to the recipient, but public perceptions drastically exaggerate what's involved for the donor. That not only discourages volunteers. It also warps public policy. As I noted in my AEI talk (large PDF of the PowerPoint here), many bioethicists have promulgated a faulty and patronizing series of assumptions, which shape organ-donation policy:

1) Normal people won't give up an organ except under coercion.
2) Anything that encourages a decision to donate is by definition coercion.
3) To avoid coercion, living donors should be discouraged.

I hope Cass's example inspires other donors, and that his attitude spreads.

Posted by Virginia Postrel on August 03, 2006 • Comments

Signs of Our Times

My new Atlantic column looks at the persistent appeal of neon signs. Despite civic campaigns against them--most recently in Madrid--neon signs remain beloved features of the urban landscape and increasingly valuable collector items. This old motel sign recently sold for $21,275 at auction. As neon signs have become less common on the roadside, they've become more and more treasured as artwork and memorabilia. The question now is whether, as LEDs replace neon in many commercial applications, there will be enough demand for glass bending craftsmanship to keep those skills alive.

The free link to the article is only good for a couple of days. The permanent link, which requires a (bargain price!) Atlantic subscription, is here.

Posted by Virginia Postrel on August 02, 2006 • Comments

Upcoming Appearances

I've updated my speaking schedule for the next couple of months to include open-to-the-public appearances in Columbia, SC, Boston, and Washington.

Posted by Virginia Postrel on July 31, 2006 • Comments

"Every Place Is the Same"--and That's Good

The LAT's John O'Dell reports that Nissan workers are staying in droves as the company moves operations to Nashville. O'Dell's report naturally highlights the downsides of California life--including hugely expensive housing--but it also spotlights the advantage of the much-decried "homogenization of America."

Whatever workers' reasons for going, Nissan's 42% employee retention rate sends a message to businesses in California: The Golden State's charms aren't what they used to be....

"There is a bit of that attitude, especially at the state level, that California is just so great that no one would ever want to leave — that its natural features, creative services and the quality of its higher education system are so good they're enough to get the job done," said Greg Whitney, vice president of business development for the Los Angeles County Economic Development Corp.

Nissan's experience argues against that conceit, he said. Typically, a company moving its headquarters 2,000 miles, especially from a major urban center to a smaller, more rural region, is fortunate to hang on to 25% to 30% of its workforce.

These days, though, California's schools are no longer among the nation's best, its infrastructure is deteriorating from a lack of funds for upkeep, and an ever-increasing population is crowding its cities and jamming its highways.

Companies usually decide to move for one reason — to save money — whereas employees have individual, often complex reasons, Whitney said.

"But the world is becoming more homogenized," he said, "and the fact that Starbucks are everywhere helps make moving a lot easier these days." ...

California employees who chose to make the move are relocating to an area that has an international airport and 19 colleges, including Vanderbilt University. It is within 700 miles of 60% of the U.S. population and is closer to Nissan operations in Canada and Mexico than is the Gardena site. ...

For single mother Johnston and her three daughters, ages 11 to 17, the move was a chance to start a new life in vastly improved surroundings.

In Torrance, her family was squeezed into a 1,064-square-foot home she rented from her mother, who has moved to Tennessee as well.

In Franklin, the family was able to trade up to a 4,000-square-foot, two-story, all-brick home with five bedrooms, four bathrooms and a quarter-acre lot. Instead of power lines and neighbors' fences, the views are of tree-covered hillsides.

And at $449,000, Johnston said, the house cost $217,000 less than what her mom received for selling the Torrance place. ...

What made the case for Hedrick, the product manager, was turning off Interstate 65 and onto the Cool Springs offramp "and realizing that you could really be anywhere USA."

"There's a great, big regional shopping mall, and most of the stores and restaurants are the same ones we see in California," he said. "Yet a few miles away you're in downtown and there's lots of local color too."

Hedrick said several visits during the winter also helped him and life partner Kevin Rogers make the decision to move to Franklin--as it turns out, to the same development as Johnston--from the Fairfax Avenue area of Los Angeles.

"We're giving up dim sum and first-run independent films, 24-hour grocery stores. There'll be no more morning coffee at the Newsroom with Robert Downey Jr. sitting at the next table, and we'll miss sunset walks along the strand in Manhattan Beach," Hedrick said.

"But we're going to a place with spectacular scenery, rivers that don't have concrete banks, much more affordable housing, a lot less traffic and pretty close proximity to a lot of major cities, like Atlanta and Chicago, that are just a few hours away by car or an hour by plane."

As I wrote in chapter two of The Future and Its Enemies:

Urban intellectuals, accustomed to an environment full of boutiques and family-owned ethnic restaurants, frequently and reflexively denounce the spread of chain restaurants and stores. While the chains may seem trivial in and of themselves, in much public discussion they have come to represent the evils of commercial evolution and, by implication, of dynamism in general. "America's the most boring country to tour already because everywhere looks like everywhere else," says New York Times columnist Thomas Friedman on the PBS Charlie Rose Show. "And what's sad to me, Charlie, is that the world is starting to look that way, you know, in the big cities now and even outside them, you know, with the Pizza Hut and the McDonald's and the Burger King on every corner." "

But for the people in less-developed areas, whether in the developing nations today or most of America until recently, the coming of chains has increased rather than decreased both the variety and quality of restaurant food. "When I was growing up" in 1950s Little Rock, recalls the economist Michael Cox, "whenever we went out to eat, we'd eat at a place called Franke's Cafeteria. You'd get your tray, go down the line, and get your food. It wasn't much different from the food at home, and there was certainly no atmosphere. But Mom didn't have to cook." A progression of burger joints, then steakhouses, then fried chicken and pizza, then Chinese food gradually increased the choices. "If you look in the [Dallas] phone book," marvels Cox, "in 1970 there wasn't even any pizza delivery.: It is this sense of history--of what actually existed before the "homogeneous" chains arrived--that is missing from the snide stasist dismissal of what the political scientist Benjamin Barber calls "McWorld."

When big cities no longer have a monopoly on amenities and niche retailing, whether because of chains or the Internet, they have to worry about quality of life issues they've previously ignored. Los Angeles discourages new housing and road construction, while the rest of the Sunbelt generally encourages both. People will move. The weather is great in L.A., but Nashville and Dallas aren't Buffalo.

Posted by Virginia Postrel on July 31, 2006 • Comments

RSS Bleg

The RSS link from my blog has disappeared, perhaps in the reformatting to accommodate the PJ Media ads, and I can't figure out how to get it back--or whether, in fact, a better version is available. Can someone recommend the best way of adding RSS to a Movable Type-based blog? Thanks.

UPDATE: Problem solved. Thanks to readers Nathan Bowers and Yaron Davidson for the help. The RSS feed is here.

Posted by Virginia Postrel on July 31, 2006 • Comments

Selection Bias

In a challenge to John Fund, Mickey Kaus suggests that anyone who doesn't want to punish current illegal immigrants by banning them from becoming legal is simply catering to Latino voters. Not so. Mickey hasn't spent nearly enough (if any) time thinking about business or labor markets, not to mention where immigrants past, present, and future will come from. What he proposes--a large-scale bracero program that excludes current illegals--is better than no legal attempt to let supply and demand adjust, particularly across the southern border. But his idea deliberately selects for less Americanized, and far less well-trained workers. That's certainly not good for, say, the construction business. And it's not good for the country. Ad hominems and anti-immigrant snarkiness may make for good blogging, and very good politics. But they don't make for sensible policy.

Posted by Virginia Postrel on July 31, 2006 • Comments

Bigger and Healthier

Gina Kolata, who demonstrates again and again that the strengths of the NYT lie in its outstanding individual talents not its corporate brand, has a must-read article on long-term improvements in Americans' health and physiques. (Via Tyler Cowen.)

Another trend, unmentioned by Kolata and her sources because it's a bit off the main one, is that medicine can now effectively treat chronic problems like migraines that were once not even worth mentioning to the doctor. Of course, effective treatments also lead us to acknowledge--or complain about--diseases that were once ignored or considered just part of getting older. The frequent complaints about "stress" and the "medicalization of life" are thus signs of progress.

Posted by Virginia Postrel on July 31, 2006 • Comments

Substance and Style

WWD.com reports that the WSJ is creating a fashion and design bureau and promising daily coverage under a specific logo. The paper seems to see the move as an ad-sales play designed to cater to female readers as consumers, however, rather than an important supplement to its business coverage for both men and women.

In response to questioning from WWD, Journal publisher L. Gordon Crovitz issued a statement Monday afternoon, calling female Journal readers "the most affluent and most influential, style-setting women, and we're delighted now to be able to serve them even better with our expanded coverage." He added that the Journal readership purchases "more women's fashion items than do all the readers of the women's magazines — combined."

But maybe that's just the WWD spin. Still, I have to wonder about the feasibilty of selling ads that appeal to, at best, half the newspaper's audience--especially since even a well-produced newspaper like the Journal is not a good a medium for luxurious, full-color ads as a glossy magazine. There's a good economic reason that fashion advertisers put their ads in magazines where a) all the readers are potential buyers b) those readers are thinking about fashion when they're reading c) the periodical looks and feels good.

Posted by Virginia Postrel on July 25, 2006 • Comments

No Such Thing as a Free Museum

Hardly a day goes by when the NYT does not run an article on the Metropolitan Museum's new "recommended" $20 admission policy. The typical attitude seems to be that pricey museum tickets are an abomination. (Never mind that if you join the museum, as frequent visitors tend to do, admission is free.) Economics columnist David Leonhardt, by contrast, provides a bracingly clear-eyed assessment:

So before denouncing the Met's new policy, it's worth considering what the alternatives are. There is no such thing, after all, as a free museum. No matter what the price on the ticket reads, somebody is paying to buy, preserve, protect and display all those van Goghs and Giacomettis. One option is for taxpayers to pick up the bill, in the form of government subsidies. New York City already covers about 13 percent of the Met's $180 million in annual operating expenses, and it — or the state or federal government — could theoretically pay the rest as well.

This plan, however, seems about as wise as it is likely to happen. If those of us who visit the Met aren't willing to pay for its operation, why should people who don't visit it be asked to pay? Schools, hospitals and roads, all of which could use the money, certainly seem like they should have first claim on the population's collected earnings....

Those who don't feel comfortable with it can simply pay the old one, or whatever they would like. There will surely be some well-to-do freeloaders, visitors who pay $1 when they could easily pay $20, but if there were too many of them, the Met's policy never would have survived this long.

"It's an imperfect system," said Judith Chevalier, a Yale economist who studies pricing, "but I'm not exactly sure what a better one is."

The easiest way to see the virtues of variable prices is sometimes to think about what would happen in their absence. Last week the nearby Neue Galerie said it would charge $50, up from the usual $15, to patrons who wanted to view five Klimt paintings on Wednesdays, a day the gallery is usually closed. A few days later, it abandoned the plan in the face of a public outcry.

So think about what happens now. People who would have paid the $50 and gone on a Wednesday will instead go on other, more crowded days, causing everyone to have less space to enjoy the Klimts. The museum, meanwhile, will bring in less money. Precisely nobody benefits from the cancellation of the $50 tickets.

The last time I was in New York, I witnessed one disadvantage of the "recommended" price policy--not at the Met but at the Museum of the City of New York, which has a "suggested" admission price of $9. A couple of Polish tourists, following a guidebook in their native tongue, were trying to convince the ticket seller that the museum didn't charge. She wouldn't budge and kept pointing to the $9 sign. They kept pointing to their guidebook. The language barrier made communication impossible, but I suspect that nobody has let the ticket seller in on the idea that you can pay what you want. In fact, you can't.

Posted by Virginia Postrel on July 23, 2006 • Comments