The ethics and practice of blood donation

We’ve one of those lovely Guardian discussions over the morality of commercial practices. You can guess the tone just from the headline:

Blood money: is it wrong to pay donors?

And we of course observe the comments section filling up with outraged screams that of course it’s morally wrong.

Which isn’t actually the point that should be under discussion. What we’d really like to know is whether paid blood donation is efficient. And the answer there is that no, it’s not really. When offered a choice those who purchase blood place a higher price on blood that has been donated rather than that which has come from paid donors. Such pricing is because donations do tend to be og higher quality. So, if we could fulfill our requirements for blood and blood products purely from donations we would, by preference, do so.

But we can’t so fill our preferences. So, for blood products specifically in the UK, we purchase from paid donors in other countries. Shrug. It’s either that or simply don’t offer the treatment and it’s hardly moral to deny treatment because of some squeamishness that cash was involved in the process.

The important of this observation isn’t confined just to blood of course. We tend to think that kidney transplants are better than he slow death which is dialysis. But many do die simply because there aren’t enough kidneys available for transplant. And this would be true even if ever potentially usable organ was stripped from corpses, the wishes of their now deceased former owner be damned. To fill this gap we must therefore ask for live donations (much the same being true of liver and lung transplants, heart such cannot of course be carried out from a live donor). But there’s a rather limited supply of people willing to live donate a kidney.

When, as we do from time to time, we suggest that the obvious answer is simply to pay donors, as they do in Iran, we’re told that paying for kidneys would simply be immoral. As with those shouting about blood. Shrug: this means that people will die because of some squeamishness over cash having been involved.

Oh yes, most moral that outcome is.

A plain pack of lies

BBC News tells us that: “A law introducing plain cigarette packaging in England and Wales could come into force in 2016 after ministers said MPs would be asked to vote on the plan before May’s general election.”

We really are seeing the thin end of the wedge here as yet another misjudged interference in the free market looks set to take place. The confusion that people like Public Health Minister Jane Ellison harbour is that they only seem to think of smoking in terms of bodily damage. Yes, if you only want to think about smoking in terms of the effects of physical degeneration on body parts, then cigarettes are a terrible thing, and plain packaging can be argued for on those (albeit flimsy) grounds. But only a fool would do that. Jane Ellison is presumably aware that many people still smoke even though they have full knowledge of how bad cigarettes are for them. With this knowledge she ought to have a clue that there is a reason people smoke in spite of knowledge of its degenerative effects – they enjoy doing it. Clearly people who voluntarily hand over money to buy and smoke cigarettes have accounted for cigarettes being bad for your health, but have still concluded that the positive effects of smoking outweigh those negatives. Ben Southwood’s blog on smoking is particularly appropriate here.

Contrary to the ‘plain packaging’ lobby’s misapprehension, it is trivially obvious, that smoking is only entirely bad for you if you forget all the reasons that it is good for you. The trouble with going down this road is that if you consider only the costs, then just about everything is bad for you. Take drinking water. By only counting the costs you’d find drinking water is a pretty disagreeable action – it brings about increased urination, it causes time lost in the toilet, it engenders increased chlorine levels in your stomach, and it causes gradual damage to your detrusor muscle in the bladder. Drinking water – one of the most innocuous activities we can undertake – has risks and it has costs, but no one thinks it’s bad for you in net terms. Quite the contrary, in places where water is scarce we do all we can to make it plentiful.

Governments interfere too much by focusing only on costs and ignoring benefits. It’s unsurprising that people like Jane Ellison want to trespass into other people’s free choices so much – she’s only aspiring to do what the state does on a frequent basis.  This is the simple and straightforward reason why I’m a libertarian, and why I hold the view that a small government is best. People know how to run their lives better than any government. That’s not a blanket truism, but it’s true for the vast majority of people, and it’s true in the majority of ways that relate to how we live our lives by making cost-benefit analyses and exercise our freedom of choice. Politicians are quick to interfere or ban things that have costs, which often involves failing to appreciate that humans can decide for themselves whether those costs are worth paying.

Because it is impossible for the state to know how much every individual values health, exercise, weight training, smoking, alcohol, and so forth, it is impossible for the government to know better than its citizens what is good for them. A good government would understand this, and seek to minimise its involvement in our lives to enhance our welfare and liberty, as the quality of welfare and the benefits of liberty are synchronised to enable people to voluntarily undertake the activities they prefer.

There are some people we must prevent from working in public service

Try this on for size:

Having spent years attempting to fix broken projects and teams within the NHS and local government, and also in the private sector, what I have learned is this: a public service and a business are inherently different beasts and asking one to behave as the other is like asking a fish to ride a bicycle.

The clue is in the name: the primary aim of a public service is to provide a service to the public – to protect crucial social utilities from the instabilities of capitalism and to avoid negative social impacts.

Public services are democratic. If a service fails to deliver our needs, we can hold those responsible to account at the ballot box. Important matters such as wages, pensions and working conditions are the result of negotiation, and subject to internal and popular support.

No, no, don’t agree or disagree a yet, add this from the same piece:

Businesses are hierarchical, not democratic, and wages, terms and conditions are set by the executive and subject to the market. This can be mitigated to some degree by collective bargaining through unions, but the private sector has historically delivered lower wages and poorer working conditions for its employees.

And piece the two together. A public service really, really, is only there to provide that service. Yet it also pays its workers better than a private business. Therefore, the inescapable conclusion must be that a public service is more inefficient than a private business. Because, of whatever available resources there are to provide said service more of them are lavished upon the workers rather than the service provision.

Kerry-anne Mendoza is a former ­management consultant in banking, local government and the NHS, who left her job to join the Occupy protest.

Probably a good idea eh, as we almost certainly don’t want her running a public service, do we?

Farage, ‘improper’ English and his inimical proposal

Attacking people who “cannot speak English properly” with suggestions of unemployment is just the tip of the iceberg of inimical and inhumane anti-foreign and anti-immigrant policies that threaten to lead Britain into socioeconomic retrogression. Farage also claims that “middle management” would be his target in making cuts in the NHS and, though this aspect is justified and welcome, the fact that it’s accompanied by the aforementioned divisive rhetoric reveals the discriminatory sentiment and true roots of his policy suggestions.

Of course, this proposal would only affect the NHS but the danger is that when such sentiments are formally empowered in elections, it will inevitably lead to similar regulations being extended to other spheres and, therefore, also inhibit the private sector’s ability to recruit talented individuals. The Entrepreneurs Network released a report showing how we are already failing international graduate students and, therefore, British businesses: “Although nearly half, 42%, of international students intend to start up their own business following graduation, only 33% of these students, or 14% of the total, want to do so in the UK” – current immigration policy is already unfavourable toward beneficial, legal migration.

Mukand (2012) found that “the globalization of labour could dwarf those from foreign aid or even the liberalization of trade and capital flows. For example, a decision by developed countries to liberalize immigration restrictions by a mere 3% could result in an estimated output gain of more than $150 billion”; simply put, the proposed policy road UKIP is signalling with its anti-immigrant, anti-multicultural and xenophobic rhetoric is poor Economics that will, undoubtedly, make Britain poorer.

The attraction for many Europeans to come here, instead of elsewhere, is to learn English; the best way to learn a foreign language is to speak it and live where it is spoken. A major reason why India has been particularly successful in exporting services is the workforce’s inherent, multilingual capabilities. The only way Britain will be able to compete effectively, develop and exporting more is to have more multilingual people and this will inevitably require native speakers of foreign languages. A hostile environment toward bilingual and multilingual peoples will exacerbate the pre-existing shortage in both the private and public sector (the military, for example, is facing a particularly acute shortage). Furthermore, if people are discouraged from coming to Britain in the first place, it will significantly diminish our cultural capital.

Finally, don’t make the mistake of thinking that the upcoming UK elections are only really relevant for Britain. Just because our economy and our armed forces make up a far smaller proportion of world output and military strength than they did previously does not change the fact that this election’s outcome will have profound, global implications. The whole world is watching closely, as was the case with Scotland’s independence referendum.

Though both Britain and the USA are doing comparatively well (growth, unemployment and all that), Britain has the added attraction of having a welfare state that Europeans (amongst others) love and, therefore, this means that many look here. The increase in migration (both perceived and actual) reflects Britain having fared better (probably also contributed to it having done better) and, thus, people the world over look to British public policy; hence, as the voting public, we have essentially been called upon to be global leaders and good leaders lead by example.

Farage has carefully exploited anti-foreigner rhetoric and UKIP is our (albeit more civilised and less extremist) version of the extremist parties that have gained popularity during these hard times. When we vote anti-foreign, it will encourage those who look to us to reciprocate. Subsequently, trade restrictions and currency wars will intensify alongside a myriad of other protectionist policies and international hostilities (all of which happened in the run-up to WWII).  We need to think carefully about the examples we set and the rhetoric we reward and, what’s equally as important, the rhetoric we keep quiet about.

The joys of food rationing, the perils of obesity

Yes, we’ve again got someone telling us how lovely it was that the government decided what we could all eat:

Yet by most measures, food rationing was a good thing. The startling truth about this 75th anniversary of national privation is, that, as Driver insists, “for three prime reasons – scientific knowledge, efficient administration, and a newly discovered national sense of equity – Britain as a whole was more healthily fed during the 1940s than ever before (or since, some might add).” He published these prophetic words in 1983, when our current national obesity plague was just puppy fat. There is universal agreement that Britain was better nourished after the imposition of rationing than before it; last year we discovered that obesity is responsible for more than 12,000 cases of cancer every year.

What joy that the prodnoses should salivate over us all being told what to ingest, eh? Except, except, no one ever quite manages to grasp the point made by Chris Snowdon:

I have picked 1948 as a reference point here because it falls in a period covered by a British Medical Journal study that I briefly mentioned in The Fat Lie. Published in 1953, the study looked at calorie intake and weight changes amongst the British population during the years of rationing. It shows not only how much people were eating, but how much they needed to eat.

Comparison of the relation between the food-consumption levels and the body weight changes recorded in this paper and the calorie value of total supplies of food moving into civilian consumption (Ministry of Food, 1949, 1951a) shows that during 1944, when the calorie value of the total food supply was just over 3,000 per head per day, adult men and women gained weight; that during 1945, when the calorie value was over 2,900, weight was roughly constant; that during 1946 and the early part of 1947, when the calorie level fell below 2,900 and dissatisfaction over the food supply was voiced publicly, adults lost weight. In 1948, when the calorie level had again risen above 2,900, the trend of 1946 and 1947 was reversed.

The authors concluded that the government of the day’s advice that an average British adult should consume 2,800 calories a day was ‘probably too low’. They suggested that 2,900 calories a day was closer to what was needed to maintain a healthy weight. This was based on empirical data that showed that people tended to lose weight if they consumed less than that.

By contrast, today the government advises the average Briton to consume 2,250 calories a day to maintain a healthy weight. A diet that would be considered as the bare minimum, or even below the minimum, in the 1940s would be enough to make most modern Britons gain weight.

On average we all consume very much fewer calories than we did when rationing was in place. Thus it’s not an increase in calorie consumption that is causing the rise in obesity. It just simply isn’t. Indeed, if we all returned to that wartime diet we’d all gain substantial amounts of weight.

The entire thrust of bien pensant opinion (and not for the first time) is thus simply wrong. We might well consume too many calories for our current lifestyles but we don’t consume more than we used to.