The latest argument for paid kidney donation

Apparently people receiving kidney transplants sometimes have to put up with pretty much any old dog end:

Almost 300 patients have been given kidneys previously turned down by other hospitals, with the majority not having been informed.

One in 11 kidneys transplanted from dead donors recently were used after at least three other units rejected them, official figures showed.

Doctors said a shortage of donors meant there was a need to use lower-quality “second-hand organs”. Critically ill patients are being forced to choose whether to hold out for a better organ that might never come.

Recipients were, however, not told that the organs had been turned down elsewhere. Patient leaders are calling for improvements to be made to enable patients to make informed choices. Patients are told what is wrong with the organs, but surgeons said it was irrelevant how many others had rejected them.

Kidneys have been offered on a “fast track” scheme after they had been rejected by five hospitals if the donor was brain dead, or three if the donor died after cardiac arrest since 2012.

This is not, to put it mildly, optimal. However, it is a useful illustration of the basic point about kidney transplantation. Which is that, very simply, not enough people die healthy enough to provide the kidneys needed for those who will die without a transplant. This is true whether we use an opt in system, an opt out one, even if we nationalised the cadavers of everyone in the country. We have to supplement that cadaveric supply with live donations.

At which point we’ll make our now ritual point. There’s only one country in the world with no shortage of kidneys for transplant. There’s also only one country that allows direct compensation of live donors (under quite strict government and ethical control, of course). Iran is the only place that manages both. given that this does in fact work, does save lives, it’s really something we ought to be doing ourselves. And, given that a transplant is vastly cheaper over time than continued dialysis it would save the NHS substantial sums if we did just bung a live donor £25k or so.

There really are some things that are just too important not to have markets in them.

This is not the right time for another pay claim by NHS unions

On Monday, NHS unions plan stoppages ‘short of strike action’. It may not feel like it if your hospital treatment has been cancelled or you are lying in a ward with fewer nurses to look after you.

The stoppages come after strikes back in October failed to move the government to raise its pay offer for NHS staff. A pay review body recommended a 1% increase for all NHS staff, but the government argues that this is unaffordable and unfair. After all, the 3% ‘increment’ rise puts more money into the hands of higher-paid NHS workers than lower-paid ones.And some 55% of NHS staff already get an annual 3% rise: so the government is saying that any extra cash for wages should go to the workers who do not get this. So it is proposing a 1% rise for the others, but not an extra 1% on top of the existing 3% increments.

Extending the 1% rise to all NHS workers, says the government, will cost around £300 million. Some 75% of hospitals’ budgets is staff costs, so the extra cost that the union proposals would impose on them would mean cutbacks in staff – some 4,000 nurses lost this year, and another 10,000 next year. That could leave hospitals unsafe, risking another Mid-Staffordshire disaster.

Many members of the public would say that NHS staff should count themselves lucky. Average pay in the UK grew just 0.1% last year, and many businesses are hanging on by the skin of their teeth. But NHS pay has been rising since 2012. More than 5,000 nurses were recruited last year, and more midwives too. Public sector pay is generally higher than private sector pay for the same job, even before you count the more secure and higher public sector pensions. Lower paid workers, including those in the NHS, have been helped by the rise in the tax threshold to £10,000. Moreover, the £133 billion NHS budget – some 18% of public spending or over £2,000 per man, woman and child – is ring-fenced, so there is no chance of it falling – unlike the fortunes of most high-street businesses.

And if you want to know how bad things can really get, look at Portugal, which slashed its health budget 17%. Our public finances are not quite in that much of a mess, but things are still tight. The UK has economic growth of 3% but it is still fragile, and there are lots of things that could still spell disaster – a potential crisis in the eurozone, ebola, tension with Russia, you name it. The British government is 1.45trillion in debt, and adding to that debt by another £100 billion a year, despite creaming off 40% of the national income in taxes.

This just is not the right time for another pay claim. And certainly not for another Winter of Discontent (with images of ambulance crews dropping ‘non-emergency’ cases off in the snow to find their way home). The mind shivers. It is clear the government cannot budge, so why don’t we all go back to work and try to get Britain out of this mess?

The Annals of Bad Research; public health edition

A quite delightful misinterpretation of a piece of public health research over at Salon:

States with lower HPV vaccination rates have higher cervical cancer rates
Science confirms what we probably could have guessed

Well, no actually, Science would tell us that HPV vaccination rates would have no effect whatsoever on current rates of cervical cancer.

A new study presented at a conference for the American Association for Cancer Research found that states with the lowest rates of human papillomavirus (HPV) vaccination have the highest rates of cervical cancer and deaths from the disease. This is not surprising.

Well, actually, yes it is.

Low rates of HPV vaccination in Southern states have troubled medical professionals for some time.

Ah, yes, all those religious (and possibly even Republican!) Southerners not vaccinating their daughters.

What the paper itself actually says is that those places which have more preventive medicine have more preventive medicine. Vaccines are preventive medicine: as are things like Pap smears which can find potential cancers that can be treated before they become cancers.

But there’s absolutely no causal connection at all between high vaccination rates and the subsequent lower cervical cancer rates. As science would tell us.

For cervical cancer takes 10-20 years to develop. And Gardasil, the first HPV vaccine, has only been on the market since 2006. To a reasonable approximation exactly no cases, yet, of cervical cancer have been prevented by the vaccine. It’s also true that the likely age group to present with the cancer is women between 35 and 55. Absolutely none of whom will have had the vaccine as it is not offered to those who have already become sexually active (again, to a realistic level the number of those in that age group who were virgins in 2006 is going to be zero or darn close).

The vaccine itself is a wonderful idea and we thoroughly support everyone who will benefit from it getting it (and that includes men too, on the grounds that the tango does take two). However, let’s not make up stories about it all. An 8 year old vaccine for a disease that takes 10-20 years to present will have had, as yet, absolutely no effect on the numbers presenting with that disease.

Some might think this not important but come along now, we’ve got it on good authority that comment is free but facts are sacred.

Why not let rich people fund drug development directly?

That is, why not let ill rich people fund directly the research into a treatment that might cure them? That’s the premise of this fascinating plutocratic proposal. That piece is very long, very detailed and walks you through almost all aspects of what is being offered.

The essential idea is that, especially with cancers, there’s a lot of weird ones that affect very few people. But there’s quite a lot of rich people about and there’s enough of them that, statistically, at least a few, a handful, of such rich people will get each and every one of those weird cancers.

This helps us to solve a certain problem that we’ve got with funding research into disease cures. We should, obviously, as a society be working on the low hanging fruit. A cure for something that kills 20,000 out of 100,000 people is worth a very great deal more in terms of human utility than a cure for something that kills 5 out of 100,000 people is. Tax funding of such research should therefore, again obviously, be concentrated on trying to find the cures for those widely suffered from diseases, not the weird and rare ones.

However, when we move from societal benefit to private benefit the numbers rather change. Someone suffering from one of those weird cancers is very interested indeed in a cure for that weird cancer. And some of those very interested people will be rich enough to fund the next step in the research. The step being talked about here is the movement of a likely looking treatment out of the lab and into Phase I clinical trials.

Those Phase I trials are where the first 10 or 50 people get given the treatment to see what it actually does to human beings. And there’s a number of problems at this point. Neither tax money nor standard pharma investment cash is going to be very interested. One on the grounds that societal benefit will be greater with efforts made elsewhere, the other on the grounds that the final market simply isn’t large enough to make it worthwhile. But of course rich people dying of the weird cancer face a different calculus.

The proposal is, at its simplest, just to allow said rich and ill people to pay for the Phase I trials (or some portion of them) in return for a guaranteed place on that very trial. They get this treatment that may cure them, 9 to 49 people get that same treatment without having had to pay anything and we all get the benefit of the advance in human knowledge.

Predictably this will cause howls of outrage in certain quarters. But we think that it’s a fascinating idea: at the very least it’s something that should be widely discussed and also in detail. No one is claiming that this is a perfect and final plan. Only that it’s a very interesting one.

If we can harness the desire of rich people not to die to our goal of treating non-rich people dying of the same diseases then why the heck not?

Isn’t this an interesting little finding about drugs?

Isn’t this an interesting little assertion from one of the government’s own reports?

Decriminalising drugs would have little effect on the number of people abusing illegal substances, a highly controversial Home Office report has said.

The report – which sources said had caused “panic” within the Home Office – said: “There are indications that decriminalisation can reduce the burden on criminal justice systems.

“It is not clear that decriminalisation has an impact on levels of drug use.

“The disparity in drug use trends and criminal justice statistics between countries with similar approaches, and the lack of any clear correlation between the ‘toughness’ of an approach and levels of drug use demonstrates the complexity of the issue.”

The point being, and this can be readily verified by anyone with even the most modest experience of social life in Britain, that all those who want to consume drugs are currently easily able to find the drugs they wish to consume. Meaning that the illegality isn’t particularly affecting the availability of supply. Thus decriminalisation seems like a good idea as it’s not going to lead to half the population toking itself into a stupor.

However, that decriminalisation isn’t enough as we’ve mentioned around here before. For the major danger of drugs comes not from they themselves, but from the fact that purity and concentration are, given that they are illegal products, entirely unknown to the user. Overdosing is thus depressingly commonplace, as are all sorts of diseases and illnesses from the admixtures. Thus we need to be thinking very seriously about legalisation: not just decriminalisation of small amounts for personal use but the legalisation of supply and production. For that is how we would get brands, reliant upon their quality and consistency, and also get a transparent supply network that can be checked for quality.

It’s not just the criminality of taking drugs that is causing our current problems, it’s the illegality of supply as well.