Core Values by John Blundell
It is described by some as “the new cannibalism”. It is macabre. It can seem alarming. It can also seem offensive.
There are corners to this new trade that I would not wish to be associated with in any way. Yet there is another perspective. It is a wonderful and benign fact that, after our death, our corneas or kidneys can bring sight or health to those still living. A loving father or brother donating a liver is admired as volunteering an act of affection and generosity. All these topics are accelerating as medical expertise advances and the understanding of tissue compatibility becomes more refined. Organ donation feels different when the giver and the recipient are strangers – and will never meet.
The huge leap that we know now is on the horizon is the adoption of the near miraculous stem cells to create new organs from the patients themselves.
My suspicion is that President Bush’s veto – the only one he has enacted in his presidency – of any Federal funding for future stem cell research will prove to be both a bonus as well as an emblem of stupidity. It is only US government-funded laboratories that will desist from this new corner of science. Bush cannot deter private researchers. Nor can the US government, mighty entity that it is, censor development in the UK or in any other nation.
I see the silly gesture of banning scientific efforts out of some atavistic fear of religious sensibilities as offering a huge commercial opportunity for British business. This is not to deny there are ethical dilemmas to be resolved. We are all on a learning curve which may take us in unimagined directions.
When Edward Jenner started injecting against smallpox in the 18th century he was regarded as evil or deranged. Yet his innovation reduced misery for millions and opened other doors for medicine. It is not easy to think of any major medical advance that has not encountered horror from divines or inertia from that highly conservative force – the medics themselves.
A market in human tissues seems to be a near perfect cameo of text book economics. If vendors are to agree with buyers they need to agree a price. Prices tend to be set by intermediaries – or market makers – who can filter for quality, type, health and accessibility, propinquity. They have expertise and knowledge which allows values to be created … they in turn are subjective and fluid in terms of supply and demand.
Argue this of cocoa beans or planks of wood or ingots of steel and few dissent. Argue it for human organs, or stem cell cultured “new” organs, and you risk offending deep prejudices about the sanctity of the body and the integrity of those trying to operate this still very experimental market.
At one end of the spectrum is the donation of blood. I have not detected anybody arguing that this should be suppressed. You do encounter heated arguments opposed to those with rare blood types being paid a premium. I do not dismiss the altruistic notion that gifting blood leaves you with a small glow of civic virtue – in exchange for the modest compensation of a cup of tea and a bourbon biscuit. Register though that this increasingly sophisticated blood market has to be paid for. The blood has to be analysed, assessed, stored and transported. The donor is only a tiny part of the trade.
This is a more important point than is widely understood. The medical professions have a deep hostility to market pricing. Professor Milton Friedman has written discerningly about how clinicians prefer over-regulation and over-training. They profit from creating illusory shortages in medical expertise. It keeps the price protected. So, we have barrages of hostility about the liaison between buyers and sellers of tissues but almost no discussion of how the medical staff are content to preserve a market without price information. A market without price is not a market. It is a bureaucracy.
It is grotesque that a poor Indian farmer may donate a kidney to pay for his daughter’s dowry. When organ donation is a badge of despair or deep poverty or ignorance I do not applaud it. Yet if one of my sons was in a traffic accident and needed a kidney or bone marrow I hope I would not evade an opportunity to assist a loved one.
Stem cell advances change the debate. The donor is also the recipient. I am told that millions with type 1 diabetes could soon benefit from the generation of new pancreatic cells. How President Bush can regard this as an evil to be blocked eludes me.
I can pretend no expertise in these niches of science. What I do assert is that when I observe efforts to suppress a market errors are being applied. They are familiar fallacies long exploded by economics. Markets work. They coordinate diverse needs. I also assert they will be futile to prohibit. Blundell’s Law applies: “All political interventions achieve the opposite of their nominal intentions.” President Bush’s efforts to delay or impede stem cell research will simply displace it to the UK or other jurisdictions. If diabetic Americans cannot profit in the US from the new therapies emerging then they will travel to where they can obtain relief.
Science always evolves in patterns no experts can forecast. I read about the doubts that stem cell research may not be a breakthrough as great as the antibiotic revolution. I cannot judge it. What I do know is that science is exactly and precisely like a market. It is a body of conjectures and refutations. Good ideas and good practices survive.
There will be fraudsters in the undergrowth. Some quasi-medical articles talk of near eternal life with a new organ being added when one fails. This is to equate us with cars to be re-engineered with spare parts. The analogy is not apt. Anyone offering medical eternal life strikes me as bogus as those divines who offer life-after-death if we make offerings to them now.
We are all familiar with the stories of Burke and Hare, the 18th century bodysnatchers who robbed graves for the surgeon’s dissection tables. They developed a pricing system with a “fresh healthy body” securing 14 guineas. A decayed one was worth less than five guineas. These grim entrepreneurs also priced the risk of apprehension by the Edinburgh constabulary. Burke mis-assessed the dangers. He was hanged. Dr Knox, the surgeon buying the bodies, was not prosecuted.
Here is the core of the argument perhaps. If we volunteer our bodies for research or individual organs to unknown third parties why should the state stop us? Markets work their harmonies by voluntary action. It is a different matter if the NHS nationalises our tissues without our consent. The exchange in human tissues has leapt from a local and very chancy market. It is now international and ever more complex but it is starved of price information. A lively market in organs, no pun intended, is really only adverse news for one profession – the undertakers.
John Blundell is director general of the Institute of Economic Affairs.