Desperately Selling a Kidney

It was a strange experience reading Sally Satel’s essay, Desperately Seeking a Kidney in last Sunday’s New York Times. The writer, a resident scholar at the conservative think tank, American Enterprise Institute, needed a kidney transplant. She offers her personal narrative, and then some proposals for inducing the poor to sell their bodies in a free market.

Ms. Satel begins with her experience as a woman suddenly faced with a life-threatening illness…

Three days a week, for four debilitating hours at a time, I would be tethered to a blood-cleansing machine. Even simple things like traveling to see friends or to give talks would be limited. This would very likely continue for at least five years until my name crawled to the top of the national list of people waiting for kidneys from the newly deceased. On average, 12 names, the death toll from the ever-growing organ shortage, would be scratched off the list each day.

She is a psychiatrist, working in a methadone clinic, and she knew from her medical training what dialysis involves. She dreaded it so much that she chose not to wait on the transplant list, opting instead to search for a live donor. She writes honestly and unsparingly of her failed negotiations with two friends, then with a man she met online. Finally she received an offer from an acquaintance, Virginia Postrel, a fellow conservative writer, and the transplant was successful.

While Ms. Satel calls the gift she received, ‘altruism’  she has a different definition when applied to people outside her circle.

We must be bold and experiment with offering prospective donors other incentives for giving, not necessarily payment but material reward of some kind– perhaps something as simple as offering donors lifelong Medicare coverage. Or maybe Congress should grant waivers so that states can implement their own creative ways of giving something to donors: tax credits, tuition vouchers or a contribution to a giver’s retirement account.

This is the kinder, gentler version. She is not ignorant of how desperate things can get for the poor in this world…

I flirted with the idea of becoming a ‘transplant tourist’  in Turkey or the Philippines, where I could buy a kidney. Or going to China, where I would have to face the frightful knowledge that my kidney would probably come from an executed prisoner. Grim choices, but I was afraid I could die on dialysis if I didn’t do something to save myself.

In all of this long essay Ms. Satel never wonders what would have happened if she were poor and uninsured. She seems to live in a bubble where the only problem is a lack of donated organs. And she downplays, almost callously, the risk to the donor.

The operation is done by laparoscope, leaving only a modest three-inch scar. She would have been out of the hospital after two or three nights. Most important, the chance of death is tiny–2 in every 10,000 transplants– and the long-term health risks are generally negligible.

This kind of reasoning explains a lot about why conservatives can be persuaded that whatever works for them is just peachy. There is a reason nature gave us two kidneys, a woman with chronic renal failure should be able to figure that out. If you lose one, as did my aunt, to a tumor, or my friend, to a motorcycle accident, you have a spare. And I’m not so casual about the long-term health risks — we haven’t been doing these transplants for all that long. Not to mention the risk of post-surgical infection as antibiotic resistant germs increase. Myself, I would gladly take this risk for love, but god grant I never have to for money.

But back to the kinder, gentler. The mother who sells a kidney so her son can go to college ( no pressure, Sonny), or the eighteen year old who needs cash and feels invincible. Or the man who needs insurance and can’t get accepted on an affordable plan. David Holcberg, of the Ayn Rand Institute puts it a little more frankly. This was printed on the Journal’s editorial page —

A person may reasonably decide, after considering all the relevant facts (including the pain, risk and inconvenience of surgery), that selling an organ is actually in his own best interest. A father, for example, may decide that one of his kidneys is worth selling to pay for the best medical treatment available for his child…

Opponents of a free market in organs argue as well that it would benefit only those who could afford to pay–not necessarily those in most desperate need. This objection should also be rejected. Need does not give anyone the right to damage the lives of other people, by prohibiting a seller from getting the best price for his organ, or a buyer from purchasing an organ to further his life. Those who can afford to buy organs would benefit at no one’s expense but their own. Those unable to pay would still be able to rely on charity, as they do today. And a free market would enhance the ability of charitable organizations to procure organs for them.

Just think, all those deadbeats sitting in the waiting room at Hasbro with their sick kids, they could be persuaded to put out if they want ‘the best medical treatment for their sick child’.

But don’t consider giving free medical care to needy children, or scholarships to hardworking poor students. That would be immoral.

We are really on the edge of a class disparity that is not only about money but blood. We already pay lip service to ‘serving our country’ while dangling cash and scholarships in front of the kids at Central and Hope High. The recruiters know where to go.

No matter how well written, and no matter how much natural sympathy one feels for anyone who goes through a dangerous illness, Sally Satel’s essay is horrible. In countries where desperate people sell their kidneys, you can be sure there will be many who die prematurely when their remaining kidney gives out, and there will be no help for them. I wonder where in the Libertarian scheme of things you put the person who sold a kidney, and now needs one. Do you chalk it up to ‘bad choices’ ? We will be going down a very dark road if we give up the principle of taking care of our own, rich or poor, and instead let the rich use the poor for spare parts.

For another, less temperate, take on this, check out Daily Kos. And yes, I’ve signed a donor card, but they’re not getting them until I’m dead.

19 thoughts on “Desperately Selling a Kidney

  1. The amazing narrative of Ms Satel and the “transplant” world brings into focus the new ethical and moral challenges that the world of medical progress has brought us. The new dilemmas of life and death decisions that so many of us must confront highlight the gap between potential and fact that so often results from new innovations and discoveries before there are mechanisms to deal with them. Transplant science and technology has advanced to levels of possibility hardly thought likely only a few years ago and continue to march forward with still new accompishments. Unfortunately social and religious mechanisms needed for acceptance of the possibilities have not kept pace. I think wmore effort should be made educating us all about the good that can result from donation but also the process of making that happen. Apart from that donation card or signature on a driving permit, most of us never come in contact with the process in any meaningful way. Only when someone near to us needs a transplant, or we ourselves are told we need a new heart, lungs, kidney, bone marrow, liver or anything else, does the process make that ultimate connection. The rapidly growing industry of organ harvesting from Third World populations, or even the sale of body parts voluntarily (what does that mean?) or by government action (how frightening), is most disturbing. Given the ever increasing pace of medical advancement, and the lethargy of the evolution of societal coping mechanisms, the issues will get worse not better.

  2. Nancy, excellent piece of writing.

    However, I vehemently disagree with this part:

    “…We are really on the edge of a class disparity that is not only about money but blood…”

    We are not on the “edge” of class disparity. We plunged over that cliff decades ago. The wealthy have been waging unabashed, unashamed, and unremittant class warfare on the vast majority for a long, long time.

    Look at the conservative approach to the military: use ’em as cannon fodder, as long as it’s Someone Else’s Kid.

    Heck, while we’re at it, why don’t the poor just sell their children? We could bring back slavery. That would make it so much easier to get reliable help. Or, with a hat tip to Dr Swift, we could introduce a new culinary delight at all the most exclusive restaurants….

    Let’s call it “enfant au vin.”

  3. Horrifying. Simply horrifying. When did we humans grow so far apart?

    I recently edited an article on two women who met through, which hooks up those needing organs with those who might like to donate. Our story concerned a potential [lesbian] donor who had heard about the site on NPR and thought, Hey, that’s something I could afford to do that would make a positive difference in someone’s life. But she said she then spent about eight months on the site reading the stories of those seeking organs and got really turned off by the endless “Looking for my angel” and “God bless you” set.

    Then one day she was paging through stories and found a woman who mentioned not wanting to abandon her female life partner and their children. Not only did the donor figure she had something already in common with this woman, she thought the recipient might have an extra hurdle to overcome with conservative Christians or otherwise narrow-minded folk. The two women began corresponding, such that by the time they met in person several months later they were already friends. They turned out to be a match and the transplant was successful.

    My favorite part of the story is that the woman needing a kidney had hesitated at first about being “out” in her profile, but her partner and the gay father of their children both said, Hey, might as well be up front about it, lest she find a donor only to be rejected in the end because she’s gay. And that ended up being the reason she found her match. Take that, angel seekers!

    Hey, humanity can be inspiring when it isn’t utterly corrupted by money.

  4. Teresa, it’s interesting that Sally Satel worried that a potential donor might be put off if they read her political essays on such websites as national review. as i read her essay i could feel her struggling with the contradictions of her ideology of total self-sufficiency, and the crisis that made her dependant on the help of others.
    i worked with a nurse who donated a kidney to her husband, and although he eventually died she bought him some good time.
    i loved your story. there are some things that people will do for lovingkindness, even for a stranger. that is the amazing grace of being human.

  5. Nancy, as usual, you rock!

    Satel is an Open Ally of Dr. Laura and proudly so; The NY Times frequentlty trots her out for their “Science Times” pieces.

    I will read her piece soon, however…Please visit my revived blog and comment freely, thanks.

    Happy Solstice to All.

  6. I’d like to correct a couple of points that the post has distorted.

    1) The risk of having one kidney rather than two is not especially high–barring a severe trauma or kidney cancer (two fairly unusual events) all forms of kidney disease affect both kidneys simultaneously. That’s why you need a transplant. Having two doesn’t do much for your health. (I was worried about this issue as well until I checked the data.)

    As for long-term health consequences, the very first kidney donor ever is still alive. Follow-up studies on large donor populations have shown no systematic health problems. The level of routine (i.e. medical rather than investigational) follow-up for live kidney donors could be better, however; right now, they kind of kiss you goodbye once you’re done.

    2) While anti-market sentiment that precludes poor people from benefitting through the sale of their own kidneys strikes me as mean-spirited, I know that this kind of paternalism perceive it as enlightened. As a compromise, there are many forms of compensation that could be introduced that would avoid any possibilty of “exploiting” the poor.

    a) Virginia Postrel (Sally Satel’s donor) has suggested that medical students could have their tuitions (often loans) forgiven if they donated a kidney. Since this is a population of young, healthy, and well-informed folks whose expected future income exceeds the average income of recipients (who tend to skew poor), their donations would be medically appropriate, non-impulsive, and rich-to-poor. It would also give them an early, if mild, taste of what the system will look like to their patients–probably an educational experience.

    b) I have suggested giving an income tax credit or holiday for the calendar year in which someone donates a kidney. I like to call this the “We just had our IPO! Time to donate a kidney!” plan. Since only people with large tax liability would find this attractive, it would also induce richer people to give their kidneys to poorer people. (It would probably be necessary to put some sort of cap on the size of the benefit an individual could receive, or else a kidney that might go for $30,000 on the market could net the donor millions. Note that the social value of the donation is much greater than $30,000 because of the consumer surplus of the recipient, the vast savings in getting the patient off dialysis, and shortening the list for a cadaver organ–we just don’t want to give all that benefit to the donor.)

    c) Other forms of in-kind compensation could be arranged that would not appear “coercive” to the sensibility displayed on this blog. For example, guaranteed private hospital rooms or other medical amenities, vouchers for future assisted living expenses, etc., could be offered. Such incentives seem unlikely to attract the desperate or impulsive.

    3. You can’t have it both ways. If donating a kidney is really so dangerous and terrible, then it seems like a bad idea to have most live donations come from family members, who are at risk of emotional blackmail of various kinds. (Note that 95% of donors surveyed are very happy to have done the deed when asked about it years later, so this concern is largely hypothetical.)Payments to strangers are less likely to induce ill-thought-out donations.

    4. Lots of people who need kidney transplants (disproportionately poor and black, for those of you who care about that) are suffering and dying every day, even though a safe and effective first-line treatment is available–live donation of kidneys. This treatment is infinitely better for the patient and significantly cheaper for the taxpayer than the alternative, dialysis. Yet the number of people suffering from kidney disease and dying from kidney disease before they can get an organ is large, and is projected to grow substantially as the population gets older and more diabetic over time. Sentimental complaints about the repugnance of paying for organs cannot have much weight when balanced against the thousands of unnecessary deaths and the vast suffering cause by our current policy.

  7. your blog is great. tell me more about the dr. laura connection. didn’t dr.laura have some embarrassment with her son?

  8. Dear SRP,
    thank you for writing. If you read my post again you will see that I don’t say anywhere that donating a kidney is dangerous and terrible, although Sally Patel mentions the trade in parts of the world where prisoners and destitute people are used for spare parts.
    I don’t buy into there being such a low risk to donating that everyone should cash in their extra before the next tax return. Also the operation is not risk-free for the recipient.
    I don’t anticipate any persuasion that will draw hordes of the rich and comfortable to check in for surgery to give their body parts to the poor and ill. Call me cynical, but watching how the rich hang onto their money makes me doubt they’ll give away other things.
    Most important, this whole argument turns on the fact that the basic preventative health care that we have the knowledge and means to provide is denied to millions of Americans just because they can’t afford it. And the compensations you are talking about would have to be covered by government programs. So that people who need money will donate kidneys. To the insured.
    Why not start universal health care coverage right now? That would do a lot to remedy the fact that the poor are suffering from kidney disease. The poor suffer from a lot of preventable diseases. We are all paying for that in more ways than we want to admit.
    Finally, I want to say that I admire Virginia Postrel’s unselfish gift of life to Sally Satel, and also the grace and dignity with which she did it. Have you signed your donor card, SRP?

  9. 1) Of course donating a kidney isn’t risk free. Neither is being a firefighter, but we let people do that for money. It happens that the risks of kidney donation are mostly the risks of general anaesthesia, which apply even to cosmetic surgery (and you have to pay for that!). I hope you would not want to ban cosmetic surgery on similar paternalistic grounds.

    I don’t see why it matters that the operation has risks for the recipient. Those risks are dwarfed by the expected losses in life span and normal functioning occasioned by time on dialysis.

    2) Your dislike of financially successful people is leading you into self-contradiction. If they are as greedy as you say, then they will jump at the chance to save hundreds of thousands dollars on their taxes in return for a relatively innocuous medical procedure. (If you really want to place a negative stereotype on the rich, they can even brag afterward about their charitable good deed.)

    3) You ignore the medical-student loan-forgiveness idea, which would target a donor base that is cash-strapped now but expects to have money later. Given that this group would find it relatively easy to assess the risks of the surgery and is disproportionately young and healthy, it seems like a good group to go after.

    4) The government (Medicare) is already paying for everybody’s hideously expensive kidney dialysis. Any plan that paid reasonable amounts to kidney donors out of Medicare funds would reduce overall spending on health care and relieve the taxpayers of some of their burden. This is a rare, clear-cut opportunity to reduce spending and simultaneous increase health and longevity.

    Universal health care is a red herring–people are not suffering on dialysis because of insurance problems (Medicare covers them) but because of a kidney shortage. Things would be no better under the insurance systems used in Canada, Britain, France, Japan, Germany, etc. So even if your fondest wish for socialized medicine were realized, the problems identified by Sally Satel would be unchanged. And if we were to incentivize the poor, the best way to do it would be with cash, in my opinion–the suggestion to give health coverage instead is a misguided attempt to buy off folks such as yourself, who go crazy at the idea of organs for cash.

    5)Donor cards apply to cadaveric organs, not live donations. Unless you die in a pretty unusual way (fatal brain truama from a motorcycle accident is one of the best) your kidneys are not usable. Even if every person who died in one of those special ways signed a donor card, we would have a large and growing gap between the number of people awaiting transplant and the supply of kidneys.

    As for live donation, Virginia and I have decided that one per couple is enough for now. If a family member or friend were in a jam, though, I wouldn’t rule it out.

  10. Please send my regards to Virginia Postrel, and I want to say again that I admire what she did and how she did it. Also, I agree that there are many people doing just fine with one kidney and there’s every reason to believe that she will too. I hope that she and Sally Satel enjoy good health and long lives.

    I am going to run your suggestion that medical students will jump at the chance to sell their kidneys by some of the doctors and nurses I know. It will be an unscientific survey, but it should be interesting.

    I meet people every day who are suffering from preventable or curable diseases, but are getting no or inadequate care because they can’t afford primary care. Like you say, the poor suffer from kidney disease, often as a direct result of untreated diabetes or exposure to pollutants. Our system of accepting people into the emergency room, sending them a huge bill, and not investing in prevention is not only inhumane, it’s wasteful. I would love to see us begin to construct a system that rewards doctors for keeping people healthy. It would cost more in the short term and pay us back in the long term.

    I’m guessing that you have health insurance. Do you feel that this is the heavy hand of paternalism?

    Finally, some of my best friends are rich. Good for them. Some of my best friends are poor. A good number of the people I work with in the less well-paying areas of health care have no insurance themselves. It makes it very hard to save and strive to get ahead when you know that a minor accident or illness could wipe out all your savings. Some of the people in this situation are the young, and small business owners, and people a few years from medicare. Seeing this every day I am convinced that basic health insurance for all is something we should provide as an affluent and civilized society.

  11. spr: I agree with some of what you say. It is paternalistic to prohibit the voluntary sale of organs.

    However, you are right, but only up to a point.

    First, there was no animosity towards the well-to-do. Ninjanurse said that financially comfortable people aren’t likely to sign up, and I agree. The problem comes with the level of compensation. Set it too high, and the system doesn’t work because it’s too expensive. Set it too low, and you decrease the pool of people willing to “donate for money.”

    When you talk about halving the cost of med school: how much is that, exactly? $100k? (my apologies, but I’m not up on current med school tuition). Can you be sure that the system can support $100k kidneys, in addition to the other attendent costs?

    If the compensation is lower than that, the incentive diminishes, especially for more affluent “donors.” Which leads us back to lower income people selling their organs.

    Which brings us to the other problem. You also fall into the trap that all free-marketers do by assuming that the buyer and the seller have equal amounts of knowledge and power, and this is simply not true when dealing with less educated or less affluent people.

    And as an example of asymetric information, I need only point out the current sub-prime financial mess. Some very sophisticated people paid a lot of money for CDOs and SIVs that weren’t worth nearly as much as they thought. If the CEO of Morgan Stanley can get taken to the cleaners, then what chance is there that someone with a HS diploma can deal on equal terms?

    And if there aren’t equal terms, then you set the table for exploitation.

    And let’s face it: there are fewer affluent people than lower income people. So the pool is smaller to start with. So, what percentage of the affluent can you entice with $50k? 10%? But if you can entice 10% of the lowest income quintile, then you’ve enticed a lot of people.

    In other words, your plan is based on that rarest of individuals: the “rational economic agent” that neo-classical economists are fond of discussing. The problem is, this person is a myth. In our society, nothing is more fraught with emotional baggage than money. Nothing is harder to be rational about. What is the single biggest cause of marital disputes? Money.

    I don’t mean to be disparaging. It’s just that I’m really tired of the whole “free markets will solve everything” diatribe. They won’t. They can’t. They don’t, and they never have. They just introduce a different set of problems. And the problems free markets introduce are the sort that the well-off can handle easily, leaving the rest of the world to twist in the wind.

    Your plan sounds wonderful in theory. And that’s where it will work: in theory. In the real world, the people who will be selling kidneys are those at the bottom of the income scale. That’s not class-animus; it’s simply an observation based on experience.

  12. srp, please avoid the straw-men. No one is saying that markets don’t work. I’m saying that they aren’t magic, in the way you seem to view them.

    The market did not prevent predatory lending practices. In fact, the market sought out sub-standard lenders and gave them loans that were unlikely to be paid off. Why? Because the loan originator sold the mortgage and had no reason to care whether the borrower could pay. That is the sort of distortion that free markets create.

    And you would have us beleive that selling a kidney is a less complex transaction than taking out a mortgage? That is your implication.

    With profit to be made, people will try to game the system. If trying to prevent such abuse is, as you sneeringly call it, ‘paternalistic,’ then by all means, let’s be paternalistic. The term is, I believe, ‘regulation.’ Or don’t you believe in medical regulation?

    The point wasn’t that selling kidneys is more complex than CDOs. It’s that if ‘sophisticated’ ivestors can be taken to the cleaners, then some level of ‘paternalism’ is necessary to protect individuals who aren’t quite so ‘sophisticated.’

    Which brings us to asymetrical information. For a free market to work per the theory, both sides of the transaction have to have approximately equal amounts of knowledge. To assume that both sides of a kidney sale will have anything approaching equal levels of knowledge, except in rare instances, is theoretical to the point of fantasy.

    OK, let’s split the difference and call it $25k per kidney. And yet, you’re going to offer half of med-school tuition in exchange? So, for the run-of-the-mill donor, it’s $25k. But, for a future member of the financial elite, we’ll fork over tuition reimbursement which could run $100k or more?

    What’s wrong with this picture? Sounds like the game is already rigged in favor of those who have–or will have–more money, because you want to pay them 4 times market rate. How is that a free market?

    Look, I’m not saying that you’re completely wrong, or that the market cannot be made to work to solve this problem. I’m saying your proposal, as it stands, is simplistic, to the point of naive. The devil is in the details. You need something much more structured, including a lot of regulation, to make this work, and to prevent the exploitation of the less-sophisitcated parties in this proposed exchange. $25k will probably not entice someone who is financially comfortable. So who’s left?

  13. SRP, i checked into the sociologist you cited, Kieran Healy, and his paper about donated vs paid blood donations and i am not sure it backs up what you are saying. his paper runs thirty pages and i was reading it off the screen, but it doesn’t seem to me to say that donated blood is far more likely to be HIV+ because it is donated.
    Before HIV threw everyone into a panic there was a known risk of Hepatitis B to health care workers from needlesticks, and there was another kind called ‘transfusion related Hepatitis’, that we now know as a retrovirus called Hepatitis C. Today health care workers and much of the public is immunized against Hep B, there is no vaccine for Hep C.
    I really don’t mind at all that the Government has a role in monitoring the safety of the blood supply, and prescription drugs and practicing doctors. Not perfect, but there are some areas where you don’t want it to be ‘buyer beware’.
    I noticed that Kieran Healy has published papers and a book about the benefits of paid organ donors. Another opinion comes from the World Health Organization–
    “Types of blood donation
    The safest blood is donated by the safest blood donors. The prevalence of HIV, hepatitis viruses and other blood-borne infections is lowest among voluntary unpaid blood donors who give blood purely for altruistic reasons. Higher infection rates are found among family or family replacement donors who give blood only when it is required by a member of the patient’s family or community. Worldwide, the highest rate of infection is found among donors who give blood for money or other form of payment. Adequate stocks of safe blood can only be assured by regular donation by voluntary unpaid blood donors.”

  14. Klaus: I’m not sure we disagree that much. (I do think you exaggerate the theoretical and empirical informational requirements for functioning markets. But that’s a big topic and I’m not interested in thread-jacking.) The asymmetric information issue is nearly irrelevant for live kidney donors in any case because the recipient is informed just as much as the donor about the risks. It couldn’t be much more symmetric. Nor is the transaction particularly complex. So we don’t need to go there.

    I agree with you that it would be better to just pay people straight cash for kidneys. That would allow average Joe and Jane to benefit from the exchange. The proposals for med students, etc. are introduced purely as second-best or third-best alternatives to overcome various political and ideological objections. I am most worried about the potential recipients, who are the ones needlessly suffering and dying every hour of every day, so if there is some inter-donor inequity but we can get people to accept payment for kidneys, I’m willing to accept the second or third best solution.

    ninjanurse: My understanding is that Healy’s point (in his book) about HIV in the blood supply is historical. When HIV was new, collectors of plasma for hemophiliacs who relied on voluntary donations were very concerned about not asking too many questions or turning away their donors, many of whom were gay. Paid collectors were more worried about market acceptance of their product and tried harder to screen their donors. At the time, unfortunately, there was no HIV test so they tried to use hepatitis as a proxy, which wasn’t correlated enough to protect a population receiving such a large number of transfusions. The point is about incentives, not results.

    In general, the WHO point of view about blood supplies is contested by many people who have studied the question. With modern testing of blood and questioning of donors, it is not clear that the limiting factor on blood quality is the quality of the donor pool as much as it is the willingness to rigorously apply the tests and disqualify high-risk donors. (I believe that the cost of blood is going up, but suspect that has to do with the application of these more rigorous screening practices.)

    There is nothing wrong with government oversight of the blood supply, provided that they don’t create unnecessary shortages; to date, I have not heard of any problems in that regard. You can’t say that about the rabidly anti-market kidney policy with which we have been saddled. If we could get kidney policy to the level of rationality of current blood policy, I’d celebrate.

  15. OK, SRP. I hope I was plain enough that I could see your point, because I can, and I suspect you’re right that we’re not that far apart.

    Sometimes I get wrapped a little too tight, and the issue of economic fairness is very near and dear to my heart.

    So, we’ll need to work on the details.

    And, universal health care would be a great start.

  16. I have to pass this along. The 1/7/08 issue of the New Yorker has an article on professional “guinea pigs;” people who make a near-career out of volunteering for Phase I clinical trials. They are given room, board, ameninties, and a fairly generous chunk of cash to test new drugs for adverse side affects. The people who do this tend to be people with time: the unemployed and students.

    But: Miami/Dade County just shut down a former Holiday Inn that was doing trials on undocumented immigrants, paying them bargain basement fees. The place was shut down largely because the physical building had become so run-down.

    In the 1990s, pharma Co Lily ran a similar operation in Indianapolis that catered to the homeless. Word of this got around, to the point that homeless were traveling from all parts of the country to avail themselves.

    Part of the problem is oversight: or lack thereof. There are for-profit Institutional Review Boards (IRBs) that will approve conditions of such testing. Of course, one wonders if the payment of the fee might not prejudice the IRB’s willingness to police the trial.

    Nah. Couldn’t happen. The “invisible hand” will prevent such abuses.

    Except that’s exactly what happened with Arthur Anderson and their “oversight” of Enron’s financial dealings.

    My point is that, when enough money is involved, the system will become corrupted. After all, if you aren’t cheating, you aren’t really trying. The solution is rigorous oversight–by the gov’t. The problem becomes one of funding. If the appropriate board doesn’t have the funding, it doesn’t have the personnel to provide proper oversight. Then you get ‘for-profit’ proxies, and the fun really begins.

  17. wow. klaus, this is really in depth and troubling. in the mid ’90’s i worked in clinical trials of AIDS drugs as a study nurse at a hospital. It was just before the more effective anti-retrovirals started to come onto the market. the desperation of the study subjects, all of whom were hoping to be the first in line to get a cure, was heartbreaking. i didn’t last long in that job,for many reasons, but one stressor was that even though everything was done according to the rules, there were times when the best interest of the individual patient conflicted with the need to get data. the power disparity between someone facing a disease and the health care providers, is huge.
    i had heard that drug trials are being outsourced to poorer countries, but not that trials were being conducted on poor people here.
    this is not only immoral, it’s lousy science. the best study subjects are people who are well-informed and organized enough to keep appts. and not tempted to give false information for any reason.

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