The markets for organ transplants

As a general rule around here we think markets work. We’re also entirely cool with the idea that sometimes restrictions must be placed upon markets to make them work better. There are, for example, those varied problems with externalities, things not accounted for in market prices. We’re even happy with the idea that we should have a market in market restrictions. How else are we to find out what actually works if we don’t go try it?

We do though insist that we then learn our lessons from those market outcomes. Something that isn’t being done with organ transplants. The government here has nationalised our corpses - moved from an opt-in process for the use of cadaver organs for transplant to an opt-out. Instead of us registering that we would like to help those in need after our death it is now assumed that unless we have distinctly stated otherwise our bits and pieces may be so used.

This doesn’t actually work:

Abstract:
Studies comparing opt-out and opt-in approaches to organ donation have generally suggested higher donation and transplantation rates in countries with an opt-out strategy. We compared organ donation and transplantation rates between countries with opt-out versus opt-in systems to investigate possible differences in the contemporary era. Data were analysed for 35 countries registered with the Organisation for Economic Co-operation and Development (17 countries classified as opt-out, 18 classified as opt-in) and obtained organ donation and transplantation rates for 2016 from the Global Observatory for Donation and Transplantation. Compared to opt-in countries, opt-out countries had fewer living donors per million population (4.8 versus 15.7, respectively) with no significant difference in deceased donors (20.3 versus 15.4, respectively). Overall, no significant difference was observed in rates of kidney (35.2 versus 42.3 respectively), non-renal (28.7 versus 20.9, respectively), or total solid organ transplantation (63.6 versus 61.7, respectively).

It’s worth noting that this is being reported by Al Roth - reported, not the original paper - whose Nobel was for the design of markets and matching systems at least in part concerning organ transplants.

Which brings us to our view - probably not supported by Roth - concerning organ donation. Nice though it would be to think that they are enough it turns out that charity and empathy aren’t. This accords with the Welsh experience recently, where the move to opt-out didn’t move the dial on that rate of organ transplant. We’ve done the experiment, seen the outcome, and variations on uncompensated donation don’t solve the problem. Thus, if we want to solve the problem we need to move to a system of compensated donation.

As we’ve said many times over the years. Closely managed compensation of live donors of those organs which can be gained from live donors does in fact work in the one place it is generally allowed - Iran. Market experimentation in its true sense, using different arrangements to see what works, has shown us the answer. If we want to solve the problem this is therefore what we should be doing.

From killing to conserving

On July 3rd, 1844, the last surviving pair of Great Auks were killed on Eldey, off the coast of Iceland, making the species extinct. The bird was flightless, and clumsy on land, but an efficient swimmer, living off fish and crustaceans. There were once millions of them, but it has been an important food source for humans, from the Neanderthals 100,000 years ago, until its demise in the 19th Century. The birds were hunted for their meat, eggs, and their down feathers that were used in pillows.

The Great Auk is only one among many species whose extinction has been linked to humans and their hominid predecessors. The arrival of humans in places that had no previous human inhabitants has often, if not always, precipitated a mass extinction. The megafauna of the late Pleistocene or Holocene became extinct partly because of changes in the Earth's climate, but significantly because they were easy prey to skilled, tool-using, early human hunters. Victims include charismatic animals and birds, including the woolly mammoth, quagga, dodo, moa, glyptodon and countless others less well known.

The development of agriculture and animal husbandry caused extinctions through habitat changes, and early industrialization and population increase created a demand for easily processed animal products. Whales were hunted to near extinction for their oil, used in margarine and soap, and in the lamps that lit homes and streets. Ironically, they were saved by the development of petroleum products led by John D Rockefeller, someone not otherwise noted as a conservationist.

As humanity's wealth has increased, however, so has it diminished the need to exploit animals to extinction. Now that technology has given us alternatives, we can practise and afford conservation. Indeed, technology is enabling us to save species that would probably be gone without it. Artificial insemination and IVF is being used to breed endangered species like the giant panda. Cloning is being used to save others.

Even more exotic techniques are under development. Genetically modified crops are being developed to grow in salty and arid conditions, reducing the need to destroy rainforest habitats to plant food crops. Cultured "lab-grown" meats will greatly reduce the need for pastures, again allowing us to leave wild habitats alone, and even to rewild large areas of current farmland. Research is being done to develop lab-grown ivory, produced in quantity from a few cells. When it floods the market, it will make poaching uneconomic by lowering the price of ivory to a fraction of what it currently fetches.

And slightly further down the road is the prospect of restoring species already lost by recreating them from their DNA. The Great Auk is a likely early candidate, given the quantities of DNA we have from it. The technique will be to replace the nucleus in the egg of a similar bird with Great Auk DNA, so it will be a Great Auk chick that is hatched. A similar project is under way to restore the woolly mammoth by altering an elephant's embryo and having it gestate a mammoth. Almost certainly this can be done with other currently extinct species.

Further still down that road will be recreating lost species, not from their DNA, but by manipulating the genes not turned on in their descendants. This raises the prospect of recreating dinosaurs from their surviving avian relatives.

Humanity, having wiped out species throughout its past, now for the first time in its history has the resources and the beginnings of the expertise to make amends for some of what its predecessors did. It won't be achieved by us all becoming vegans or living more simply. It will be done by putting our wealth and our technology toward making that goal a reality.

Boris' idea has merit even if the plan needs work

We are indeed believers in us all enjoying less government than we currently suffer under. Thus this idea of Boris’ has merit, even if the detailed plan of action needs some work:

Boris Johnson is considering proposals to shrink the size of the Cabinet after key backers urged him to slim down the Government if he becomes prime minister.

Mr Johnson has already voiced a desire to merge the Department for International Development and the Foreign Office, but supporters are encouraging him to go further by reviewing the future of seven or more other departments to save billions of pounds.

The departments for Justice, Business, Culture, International Trade, Work and Pensions, Transport, and Brexit could all be abolished or merged with other departments under plans being championed by members of Mr Johnson’s team.

Shuffling who does the paperwork doesn’t change what nor the amount of what government does. Therefore refining the bureaucracy doesn’t alleviate the taxpayer burden of government. What is needed is to stop government actually doing something.

To take an absurd and not to be taken seriously example, saving the cost of the embassy in Ulan Bator requires closing the embassy in Ulan Bator. Not shuffling responsibility of it either to or from, even between, the aid and foreign departments.

Thus, close down things, not change how they are administered. We would, of course, be delighted to help in identifying those things which central government should no longer do. We’d perhaps start with the departments of education, trade, agriculture and rural affairs and we can all note that the Brexit department will soon enough be redundant.

Time to revive one of our older ideas. Through those mists of time we can’t quite recall whether the offer was a Viscountcy or an Earldom but a serious and significant hereditary title at least. For each and every Cabinet Minister who agreed that, upon taking office, their job was to close down their department. The title being granted only once they’d succeeded of course, made certain there was no possibility of a second such title ever arising. After all, why not, gongs are cheap, the benefits would be large….

How the eyes of Nostradamus saw the future

Nostradamus, who died on July 2nd, 1566, was an apothecary and a physician before he turned his attention to predicting the future. From 1550 he wrote at least one Almanac a year, containing between them nearly 6.500 prophecies. He is remembered today mostly for “The Prophecies” (1555), which is cast as a series of French quatrains (verses) that claim to predict how world events will unfold.

The reception was mixed, in that some thought him a servant of Satan, while others hailed his divine insights. Catherine de' Medici, wife of King Henry II of France, was an admirer, and bestowed royal favour upon him. Many of his prophecies are lifted from other authors, including classical texts, in an age when plagiarism was not regarded as abnormal, or even unethical. His language is so obscure, couched in ambiguous terms, that to modern eyes it reads more like the astrology columns in newspapers than it resembles serious futurology.

While popular culture thrives upon his alleged foretelling of major events subsequent to his own life, academics have revealed that most of the copies and translations of his works are spurious, altered after the fact to make them seem better and clearer than they were. At a scientific level he is not thought to have had any prophetic powers.

His prophecies mostly dealt with natural or human disasters such as earthquakes and outbreaks of plague, or of wars and conquests. He is alleged to have predicted the Great Fire of London, the French Revolution, Napoleon, Adolf Hitler, and Donald Trump, plus both world wars, and the atom bombs on Hiroshima and Nagasaki.

Usually people look at the events of their own time, and interpret Nostradamus in ways that make it seem he predicted them. Thus he is credited with foretelling the moon landing in 1969, the Space Shuttle Challenger disaster in 1986, the death of Diana, Princess of Wales in 1997, and the September 11 attacks on the World Trade Center in 2001. He didn’t.

None of his quatrains has been interpreted to predict a specific event before it occurred, except than in ambiguous terms that could equally apply to any number of other events. To gain a genuine reputation, the prophet or futurologist has to be more specific.

My own method of predicting future progress is largely based on looking to what people want to achieve, and estimating if people are prepared to commit the resources and the effort. Because, like Julian Simon, I think human creativity is the ultimate limitless resource, I think humanity will usually achieve the things it wants badly enough.

In “Britain and the World in 2050,” I list specific achievements I think likely to be accomplished, many of them much sooner than that. It is a world of cheap energy, abundant water and food, many diseases conquered, pilotless aerial taxis, and with enviable opportunities and choices. Of course, the media went to town on the mammoths, dodos and dinosaurs, as I knew they would.   

Why not just make drugs legal?

This is indeed an advance and it’ll cut overdose deaths:

Addicts will be able to get their illegal class A drugs tested for purity and quality without fear of prosecution under plans for city centre labs licensed by the Home Office.

The Loop, a non-profit group that already tests drugs at festivals, plans a network of up to five centres in cities from Bristol to Manchester where users hand in a dose-size samples of drugs like heroin and cocaine.

The test results are given back after they undergo a 20-minute consultation by The Loop’s volunteer health care professionals who assess their drug and medical histories and current use and provide health or medical advice.

The major cause of overdoses being that uncertainty of what the dose is. So, yes, an advance, this will cut the number of deaths. And with the possibility of fentanyl entering the supply, as it has done in the US - the reason for it not having done so as yet being ascribed to the generally higher purity of heroin in the UK supply chain - this could become more important.

But if we’re going to do this why not just go the whole hog? Make drugs legal. Properly legal, with known producers each responsible for their own brand. And thus desirous of making sure that dosages are clean, known and what they say upon the tin. For it is true that known dosages of clean heroin cause few deaths. Someone on regular doses of pharmaceutically pure heroin functions pretty normally for decades. It’s the uncertainty of dosage as a result of the illegality that leads to the deaths.

That is, if we’ve already accepted the argument that wraps should be checked for dose and safety why not move to the system we know does this best? Manufacturers taking legal responsibility for their own products?

The most dangerous financial phrase of all - this time is different

The Observer tells us that the water companies in England really must be taken back into public ownership. Because only the public, through that ownership, can provide the socially optimal level of capital to produce the desired outcomes in terms of water quality, environmental protection and so on.

The claim is to fail to understand why they were privatised in the first place, to insist that this time, no really, it will all be different.

Now that Europe is sweltering in record-breaking heat, a second front is opening up against the water companies. And this centres on the investment needed, not just to replace leaking pipes but to support efforts to tackle the climate emergency.

Even in Britain, water is becoming a scarce resource. In the torrential storms that have become increasingly prevalent, the water runs off the land, into rivers, rages through town centres and out to sea. Parts of the country need more reservoirs, which means giving over land near cities that might otherwise be farmed, left fallow for wildlife or used for some form of development. Where aquifers are running dry due to overextraction, public bodies need to decide on the priorities, juggling the competing demands of farmers, local businesses and households.

We’ll accept the basic contention, just for the sake of argument. The water system needs more capital devoted to it in order to deal with our new world.

The fund managers who dominate ownership of the UK’s water companies have no interest in collaborating to develop a water system fit for a dry future.

That bit being arguable of course. Argue we shall, using this same industry as our example. So, why were the water companies privatised in the first place? Because vast capital investment was needed in such systems. And public ownership, state ownership, meant that such money was not forthcoming.

The theory being used by The Observer is that government will produce the socially optimal amount of investment in whatever. Not just that it is theoretically possible that the wise and omniscient planner could, but that the political process will. And yet investment in the water systems soared after privatisation - that was the reason it was done, the public finances, the political process, wouldn’t do it.

So, why is it that this time will be different? Last time around political control produced less investment that capitalist profit seeking. Why, in this time of greater investment need, won’t it play out the same way again?

The example given to us:

Dŵr Cymru (Welsh Water) is a not-for-profit business that is busily repaying debts from its previous life as a profit generator while also improving the network. It is not the only model for change, but it’s a good start.

In the privatisation process England got for profit water companies, Wales a communally owned not for profit, Scotland a state owned for profit, NI remained with local councils supplying the water. A decade after the process OfWat checked upon progress, measuring price (lower is good), water quality (higher is better) and environmental protection (more is good). In terms of who improved the most it ran England, Wales, Scotland, NI.

That is, capitalist water companies worked by the very measures the Observer is using today. Why will this time be different? Even, why revert to the system we abandoned because it doesn’t work by these very same measurements?

The costs of German Economic Union

On July 1st, 1990, the former Soviet-controlled East Germany, liberated in 1989, was merged into the economy of West Germany as part of the reunification process. People gathered in their thousands outside banks at the stroke of midnight to cash in their low value Ostmarks for the hard currency Deutsche Marks.

The exchange rate was 1:1, whereas the real (black market) rate had been between 7 and 11 Ostmarks to each Deutsche Mark. The average sum exchanged was 4,000 marks per person. Of the 25 billion Deutsche Marks sent over ahead of the transfer, some 3.4 billion were handed out on the first day.

The changeover was applied to pensions, wages and savings as well, giving East Germans what was, for them, unprecedented spending power. They flooded to the West to buy Western goods of far higher quality than those they left unsold in the shops of the East. Many Eastern businesses closed, unable to compete once borders were opened. Factories ceased production, and unemployment soared. A government agency, the Treuhand, was established to oversee privatization of the East’s state industries.

Estimates for the cost of fiscal unification to Germany’s social system are put at about €1.5 billion, but there were dislocation and upheaval costs throughout the German economy, costs that reverberated for years to come.

The decision to unify was a political one that was opposed by some Western powers who feared that a unified Germany would unbalance the EU with its huge population and economic strength. The careful balance between a France and a Germany, previously roughly equal in size, would be upset. A larger Germany would demand greater voting power, and could be expected to dominate the EU economy.

The decision to offer an exchange rate of 1:1 was also a political decision. It was controversial in West Germany because it was far out of accord with economic reality. Chancellor Helmut Kohl wanted the full co-operation of the East in the reunification process, however, and knew that a 1 for 1 offer would secure that. Some critics described it as a bribe. Kohl knew it would cause major dislocation, but took the long-term view that when things settled down, Germany would still be united. The subsequent outturn proved him correct.

The parallel today might be with Brexit. East and West Germany had been separate for four-and-a-half decades, and a change in that relationship had to face upheaval as they adjusted to the new status. The UK has been a member of the EU for a similar period of time, and there have to be adjustments on both sides as that relationship is changed. There will be temporary dislocation and upheaval as the UK adjusts to the new reality, just as there was with German reunification. But at the end of it, the UK will still be outside the EU, just as Germany remained united. It will settle into a new role as an independent player on the world stage, and will most likely prosper accordingly.

Venezuela Campaign — Chavista terror follows a familiar path of violence as a political weapon

Aside from bribery, fear and terror are the means by which the Chavista regime keeps itself in power.  As the regime weakens and has fewer resources at its command it is becoming more reliant on terror as a means of enforcing obedience.  Terror methods include imprisoning or killing dissenters and their families. Of course, the regime doesn’t need to kill all of its opponents, only enough of them to frighten others into acquiescence. 

Targeted violence is used against individuals and indiscriminate violence against protestors. Earlier this year, during peaceful civilian protests to support the entry of international humanitarian aid, 107 people were arbitrarily arrested, (a significant number of which were subsequently reported as “disappeared”), 7 people were killed, 58 were wounded by gunfire and a large number injured by other means, including rubber pellets, tear gas canisters, marbles & knives.

Extrajudicial killings are deployed to an increasing extent. The National Police’s Special Actions Force (FAES) is mainly responsible for these.  Such killings often target poor areas that oppose the regime. Amnesty International has documented six extrajudicial executions of young men linked to the protests in February this year. The FAES often turn up to the apartment of their intended victims and then shoot them in the head. 

On January 24th in Carora, (Lara state) two young men were executed after being linked to a viral audio announcing protests in the city. At around 3pm more than 20 heavily armed, hooded members of the FAES burst into the home of Luis Enrique Ramos Suárez, dragged him out in front of 10 family members, and shot him dead. His friend Eduardo Luis Ramos, also implicated in the audio, was killed when he tried to go and see where the FAES has taken his friend’s body. He was executed in a nearby alley. 

Terror is often directed at opposition politicians. Councillor Fernando Alban was arrested on returning from New York before being taken to State Police Headquarters where he died, supposedly after jumping out of a 10th floor window. This is unlikely to say the least, as Alban was a devout Catholic in a secure building. 

Opponents of the regime are often imprisoned. As of June 13, the respected human rights organisation Foro Penal counted 773 political prisoners, as well as another 8,613 subject to unfair criminal procedures. Opposition political leaders are usually jailed on trumped-up charges. At 2am on March 21 this year, Venezuelan secret police broke into the house of Roberto Marrero, Juan Guaido’s Chief of Staff, claimed that they found two rifles and a grenade, and arrested him for making “treasonous” social media posts calling for the delivery of international humanitarian aid. National Assembly deputies are meant to have parliamentary immunity against such charges, but this has not prevent the regime from arresting many more, including National Assembly Vice-President Edgar Zambrano, who was charged with treason on May 8th .

Some opposition figures, such as National Assembly Deputy Gilber Caro and Ferrominera union leader Rubén González, have been put before military tribunals, which according to Amnesty International, “undermines the rule of law in the country, violating the Venezuelan Constitution and international laws.”

Major Luz Mariela Santafé Acevedo, the military judge allocated to rule on the case of Gilber Caro, denounced the “planting of false evidence” and defected to Colombia because she “no longer wanted to continue making decisions against due process, effective judicial protection, the right to defence and, above all, the violation of human rights.” 

Those arrested are often held in clandestine detention centres, some run by pro-regime militias. On April 5, human rights NGO PROVEA announced the discovery of several such centres, including three allegedly run by colectivos, police, state security forces, and intelligence agencies, where the regime extra-legally detains and abuse Venezuelan citizens. Torture, often directed by Cuban agents, is frequently deployed on prisoners, particularly on those with military backgrounds.

In September 2018 Argentina, Chile, Colombia, Peru, Paraguay and Canada formally asked the International Criminal Court to investigate the regime for crimes against humanity. The request is backed up by a 500 page submission from the Organisation of American States (OAS) which, along with instances of torture, rape, imprisonment, and other forms of persecution, cites at least 6,385 murders and extrajudicial killings. 

Vicious brutality is a hallmark of the Chavista regime. Without the use of terror, it would have collapsed long ago.  We must hope that those responsible will be held to account and Venezuelans will soon be liberated from the Chavistas’ reign of terror.

More information on the Venezuela Campaign can be found on their website. 

When Hong Kong was ceded to China

The UK’s 99-year lease of the Hong Kong New Territories expired on June 30th, 1997. It would have been impractical, if not impossible, to separate them from Hong Kong Island, ceded to Britain in 1842, and the Kowloon Peninsula, ceded in 1860, so all of them were ceded to China at the time of the Handover, as it was called.

The Sino-British Joint Declaration established the principle of “One country, two systems,” declaring that mainland China’s socialist system would not be applied to Hong Kong, which would be allowed to continue its capitalist system and its way of life for at least 50 years. The democratic Hong Kong Assembly was, however, replaced by a new body in which only a minority of the seats are elected locally.

Nervousness about what the Communist authorities might do, once they were in control, led to a mass wave of emigration from Hong Kong lasting over five years. Popular destinations included the UK, Singapore, Canada, Australia and the US. Vancouver was an especially popular destination. One million people left between the start of the transfer negotiations in 1984 and their conclusion in 1997. This was reckoned to have constituted a serious drain of talent and resources from Hong Kong’s economy.

Hong Kong prospered under economic freedom. Despite having no natural resources, it went from being a subsistence economy to a global economic superpower in a single generation. The one resource it had was the native talent of its people, unleashed by light taxation and regulation, plus free trade. China, whose own economy is increasingly capitalist, does not want to disrupt this wealth-creating economy on its doorstep. Yet it remains determined to monopolize political power in the hands of the Communist Party, meaning it has a delicate balancing act.

It has already provoked street protests by young people when it is heavy-handed in restricting the freedoms Hong Kongers have hitherto enjoyed. The recent protests about accused offenders having to face extradition to trials in mainland China is only the latest concern. Companies will be reluctant to do business in Hong Kong if their executives face extradition to kangaroo courts in China under the thumb of the Communist Party and required to follow its orders. Hong Kong is under the rule of law; mainland China is not. The Chinese have wisely backed down for now.

One thing causes China to tread more delicately than it might otherwise. It is Taiwan, regarded by the PRC as part of China, but which has operated as an independent and successful country for decades. It enjoys democracy and economic freedom. It is watching how China treats Hong Kong, and will never agree to integration into China if Hong Kong loses its free way of life and its free economy.

When the facts change we change our minds. And you Mr. Health Secretary?

We all recall that there’s recently been a listeria outbreak in the National Health Service. This then being the trigger for the Health Secretary, Matt Hancock, to argue that NHS catering should be brought back in house. For the outbreak was traced to an external supplier of sandwiches. As we noted, this sounds more like an excuse than a reaction:

Listeria’s an excellent excuse to bring National Health Service catering in house, it’s just not a good reason to do so. But that seems to be the way Matt Hancock is taking matters.

Why can’t sandwiches be made in an NHS kitchen, after all?

Except the facts have changed:

A sandwich company has gone into liquidation just days after it was cleared of being the source of an outbreak of listeria which killed five hospital patients.

The Good Food Chain announced it was to cease trading with the loss of 125 jobs because the impact of the contamination crisis had severely affected business.

The company, based in Stone, Staffordshire, had ceased production at the start of June shortly after the outbreak was discovered.

Earlier this week, the Food Standards Agency (FSA) confirmed the Good Food Chain was not the source of the outbreak.

The strain of listeria was identified in meat produced by North Country Cooked Meats, which supplied produce to Good Food Chain’s sandwiches.

The interesting thing is to watch what happens next. Does the argument change to all meats must now be cooked in house? The NHS must make ham? Or are we going to remain with the idea that the NHS must be making the sandwiches, the thing which didn’t cause the listeria outbreak?

The answer will tell us two things. Firstly, whether politicians do indeed do what we do, what Keynes said all should, change minds when facts change. The other being, of course, whether this use of listeria to argue for in house NHS catering was a reason or an excuse.