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Please note that this is BBC copyright and maynot be reproduced or copied for any other
purpose.
RADIO 4
CURRENT AFFAIRS
ANALYSISREPUGNANT MARKETS
TRANSCRIPT OF A RECORDED DOCUMENTARY
Presenter: Tim HarfordProducer: Richard Vadon
Editor: Nicola Meyrick
BBCWhite City
201 Wood LaneLondon
W12 7TS
020 8752 7279
Broadcast Date: 12.07.07 2030-2100Repeat Date: 15.07.07 2130-2200CD Number:
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Duration: 2741Taking part in order of appearance:
Virginia Postrel
Writer
Al RothProfessor of Economics, Harvard University
Dr Lee RayfieldBishop of Swindon
Dr Tom ShakespeareResearch Fellow in Policy, Ethics and Life Sciences,
University of Newcastle
Prof Robin HansonEconomist, George Mason University
Prof Naomi PfefferSociologist & Historian, London MetropolitanUniversity
Prof Andrew OswaldEconomist Warwick University
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HARFORD: Last month, 20-year old David Lomas
donated over half his liver to save the life of his father, Stephen. Many
others donate a kidney to friends or relatives. Its an inspiring sacrifice.
Yet there arent enough donors to go around and 400 people die each
year in the UK while on the waiting list for an organ transplant. So what
about a bit of basic economics here: if we want more live organ donors,
shouldnt we pay people for their trouble?
To many, the very idea is offensive. And that raises an important
question. Why do some markets disgust or outrage us? Why can I buy
a loaf of bread but not your kidney? Why do we let people get jobs as
coal miners or shop assistants but protest if they want to work as
prostitutes or human cannonballs? And if I can bet on the Grand
National, why cant I call a bookmaker and bet on something a bit more
important?
BOOKMAKER PHONECALL
EMPLOYEE: How can I help you?
HARFORD: Yeah, I wanted to place a bet that I,
Tim Harford, was going to die in the next year. Could you give
me odds on that?
EMPLOYEE: Right.
HARFORD: Can I take a bet on my own death?
EMPLOYEE: Erm, Im not too sure. Just hold the
line a moment please. Thank you. (Music)
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HARFORD: Should we let our feelings of repugnance
get in the way of the market?
LADBROKES PHONECALL
EMPLOYEE: Hello, Mr Harford?
HARFORD: Hello.
EMPLOYEE: Hello, sorry to keep you waiting
there. Okay. No, basically we dont bet on deaths because its
a negative bet, you see.
HARFORD: Theres a lesson in that. If you want to
take a bet with a stranger that youre going to die, dont call a
bookmaker call a life insurance company. Virginia Postrel, an
American writer, reminds us that our notions of what should be bought
and sold have changed over time.
POSTREL: When you think about it, life
insurance is a really ghoulish thing. I mean you have
insurance thats going to pay your relatives if you die. Thats
kind of disgusting. And it was considered disgusting until
fairly late in history, until the early 20th century. There was a
big shift where life insurance went from being considered
immoral, ghoulish, to being considered something that a
responsible person should buy.
ROTH: There are things whose repugnance
has changed over time - so, for instance, it used to be
repugnant to charge interest for loans in much of Christendom.
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It used to notbe so repugnant to sell slaves, but it now is. So I
think actually its a little hard to predict on first principles
which things will be repugnant and which not because theyre
different in different times and places.
HARFORD: That was Al Roth, a professor of
economics from Harvard who has been designing markets for many
years for example, to help allocate school places. Professor Roth has
recently been asking the question, why do we find some markets
repugnant? Are our notions of what is acceptable just arbitrary?
ROTH: As economists we have to
understand that there are repugnant transactions and we have
to work hard to understand how repugnance works in the
world, but I dont think theres going to be a simple principle.
One thing that sometimes adds repugnance to some kinds of
transactions is adding money. Its against the law in Britain
and the US to buy a kidney, but its not against the law to give
away a kidney - right? Lots of kidney transplants these daysare from live donors. Its a wonderful thing - you know the gift
of life. So sometimes something that isnt repugnant in itself -
a transaction - becomes repugnant when money is added.
HARFORD: But why is it that money turns a beautiful
act into an ugly one? Dr Lee Rayfield has a PhD in transplantation
immunology and is a member of both the British and International
Transplantation Societies; he is also the Bishop of Swindon.
RAYFIELD: Although Christians hold a very high
value, an enormous value of the human body and its
immensely precious because we believe that God himself came
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as a human being, there are those occasions when it is right to
give your body for others. When were talking about offering a
transplant, a vital organ like a kidney, that is a gift which is
meant to enrich and bless the life of another person for no
reward for the person who is doing it save the act of giving.
As soon as you introduce a transaction into giving a kidney,
you have changed the whole basis of whats going on. The
kidney itself has become a commodity and its very difficult
then to sort of look at the altruistic sacrificial side of
something as separate from the whole event.
HARFORD: Its not enough to object to a trade in
kidneys on the grounds that it commodifies the human body.
Commodity is just another word for something that is bought and
sold merely a re-description in more pejorative language. But the
thrust of the Bishops argument is clear and widely held: some things,
such as a kidney or sex, are meant to be given in the context of a
loving relationship. A cash transaction corrupts that relationship. But
that is not the only reason to object to repugnant transactions. Dr Tom
Shakespeare is a research fellow in policy, ethics and life sciences at
the University of Newcastle.
SHAKESPEARE: Many people are concerned that
once we start having a trade in body parts, whether its
kidneys or sperm or eggs or anything else, arguably this is
leading to exploitation of poor people, people who have less
choices, particularly people in non-Western countries.
HARFORD: This question of exploitation is a tricky
one, though. If somebody is in a vulnerable enough position to sell
their kidney, their body, or their dignity, that vulnerability doesnt go
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away just because the trade is banned. Just ask Manuel Wackenheim
a self-proclaimed professional human missile and a person of
restricted growth. To be blunt, Mr Wackenheim was a dwarf whose
career consisted of being hurled around for public entertainment. A
French municipal government banned him from plying his trade and Mr
Wackenheim pursued the case through the courts. Harvard economist
Al Roth takes up the story.
ROTH: He finally went to the UN
Commission on Human Rights and argued that France was
depriving him of his right to employment. And the French
dwarf has a very moving statement in his part of the case
record. He says you know France says that this is a violation of
human dignity, but there arent any jobs for dwarves in France
and the essence of human dignity is having a job and this is my
job. And I remember when I read that, I thought you know the
little guy wins. You know this is a great argument. But in fact
he didntwin. The UN found in favour of France and basically
they argued that its such a repugnant thing for him to sell theright to throw him that human dignity is compromised; that
you and I become less human every time he makes this
transaction.
HARFORD: In other words, they werent that
worried about the dwarfs dignity. They were worried about
everybody elses dignity?
ROTH: I think so. I mean this was what I
thought was a pure case of repugnance. You know it didnt
involve these complicated questions about kidneys or
prostitution. This seemed like a pure case of repugnance. The
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UN collectively said yuck, you know you know he shouldnt
be allowed to do that.
HARFORD: Medical ethicist Tom Shakespeare has a
more personal perspective on the case: hes a person of restricted
growth himself. Dr Shakespeare certainly sees the repugnance, but
thats not his only objection.
SHAKESPEARE: I think one thing we have to ask is
what if we remove the word dwarf from the phrase dwarf
throwing and put in Jew or gay or indeed any other
minority? Immediately we feel very, very uncomfortable about
such a situation. This is using a human being as a missile. Its
by definition objectifying. I think there are Its not as if
there arent other ways for this person or these people to
make money. And I think that if they consent to this, it has
harms not just to themselves because people with restrictedgrowth have got spinal and joint problems, but also potential
harms to other people, other restricted growth people both in
terms of being demeaning and offending peoples self esteem,
but also making people more vulnerable to violence. So if
somebodys watched dwarf throwing in a pub or wherever its
performed and then sees me walking down the street and
theyve had one drink too many, maybe theyd think it would
be fun to throw me into a bush or across the road. So I think
that I would draw the line at dwarf throwing .
HARFORD: Now this is an argument that even an
economist like me can understand.
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HANSON: I guess the best way I could
reconstruct that repugnance is as an externality, so the
standard economic lingo for something that affects somebody
else whos not part of the transaction.
HARFORD: Professor Robin Hanson is an economist
at George Mason University.
HANSON: If this dwarf makes a deal with the
bar to let him be tossed around, he benefits by the cash they
pay him, the bar benefits by more customers and the
customers have fun, but there could be third parties who are
hurt like other dwarves. So if other dwarves think this
demeans them and puts them down and makes them you know
less respected by their peers, then they may be upset that he
lets himself be tossed around.
HARFORD: That suggests to me that theres
almost a stronger economic argument against dwarf tossingthan there is against say trading organs.
HANSON: Sure. Theres not really that many
other parties who could claim to be hurt by trading organs.
HARFORD: But trading organs is illegal and
tossing dwarves in many countries is still legal.
HANSON: Thats right.
HARFORD: So weve got it the wrong way
round?
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HANSON: I would think so.
HARFORD: But its not a question of either/or here.
We could ban all of these distasteful activities, or we could allow all of
them. Dwarf tossing is appalling. Selling kidneys might seem
disgusting. Why should we allow any of these repugnant markets to
exist?
The answer is that markets can do a lot of good. If you think about our
historical prohibitions on lending money or writing life insurance, you
realise they blinded us to opportunities to make life better much
better, in fact. Life insurance is a wonderful product, providing financial
support to the bereaved and peace of mind to the rest of us. And its
no exaggeration to say that one of the essential features of the
healthy, wealthy countries of North America, Europe and the pacific
rim is a banking system that works.
Of course, its hard to claim that the wealth of western civilisation is
based on a liberal attitude to dwarf tossing. But perhaps the wealth of
the professional human missile Manuel Wackenheim is.
Whenever two people decide to get together and trade, there has to be
a presumption that they know what theyre doing and will only be
harmed by banning that trade. Thats not to say that anything goes
just that before we let our disgust get the better of us, we should be
sure that we know what problem we think were solving.
Professor Robin Hanson has personal experience of being on the wrong
end of a rush to judgement.
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HANSON: So on Monday morning two senators
you know denounced the project and the very next morning
the Secretary of Defence announced the project was cancelled.
There was basically no sort of consultation with us who were
running the project. This was perceived as crossing a very
simple moral boundary. Its not about the details, its not
about the consequences; its just about theres a line and you
dont cross it.
HARFORD: The project that was so hastily cancelled
was a proposal from the Pentagons research arm, on which Robin
Hanson was an advisor.
His idea was to improve intelligence analysis of the middle east by
offering analysts from the CIA, the Pentagon and the State Department
an opportunity to reveal what they really thought. How? By inviting
them to bet anonymously on political events. In presidential elections,
people now pay as much attention to the betting market as to the
polls. Economists have discovered that if you want to predict the
chance of something happening, the betting odds give you a very good
idea. But just how far were Hanson and his colleagues planning to go?
The headlines said they were taking bets on coups, assassinations and
terrorist attacks.
HANSON: We were not planning to bet on the
details of individual terrorist attacks. We had on our sample
web page that went up a faint background screen and that
showed various sort of things that might have been in the real
market. And in one of those small corners was a miscellaneous
section because we werent sure we could cover everything
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with our standard set of questions and some sample
miscellaneous questions included Arafat assassination and
North Korea missile strike. And unfortunately those were the
basis for the claim that we were setting up a market on
terrorist attacks.
HARFORD: So the controversy was based on
something fairly flimsy, but I mean in principle would you be
opposed to taking a bet that a foreign leader might be
assassinated?
HANSON: Not on the kind of markets we were
going to set up because you could make only a few tens of
dollars on our markets, so its not like somebodys going to go
assassinate Arafat in order to win twenty dollars in our market.
HARFORD: But still some people might think
that the idea is disgusting.
HANSON: Well and they might, but you know
we do all sorts of disgusting things in intelligence. Thats the
nature of intelligence.
HARFORD: So youre not saying that this is
something we should be proud of. Simply that it might
actually work, it might deliver results?
HANSON: Right. If youre willing to do other
sorts of intelligence, if youre willing to have spies or look into
distasteful things that might happen, this is another way you
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should do that, you should consider doing that.
HARFORD: Could this futures market have worked?
Perhaps. Imagine that US government agents and analysts had been
able to take anonymous bets about the number of American soldiers
killed in Iraq, month by month my example, not Robin Hansons. You
see both how disturbing the idea is but also how useful it might if the
betting market actually produced a warning of trouble ahead.
Yet what struck me about my conversation with Robin Hanson was that
he judged the idea only on its results: would it work? Could it be
abused? My impression was that what really mattered was not whether
it was disturbing or offensive, but whether it would lead to better
decision making. Not everyone thinks that results should be the
benchmark for judging a market.
In the end, the idea of using futures markets to analyse political risk
was sunk by bad publicity. And some repugnant markets thrive by
avoiding such publicity whenever possible for example, the trade in
human tissue such as bones, skin and blood, often from dead bodies,
occasionally from living ones. Professor Naomi Pfeffer, a sociologist and
historian at London Metropolitan University, has been studying the
little-known trade for years.
PFEFFER: Mrs Bloggs might agree to her head
of femur being used by the hospital when she has her hip
replacement operation and then unbeknown to her itll be
handed over to one of the big commercial organisations which
are processing bone and that company will then process it.
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And theyve got catalogues you know showing the different
size bones and you can buy it in powder form or pellet form or
whatever. And theyre doing that for money. Now the point at
which it becomes a market, I mean thats arguable.
HARFORD: But the market is concealed from
ordinary people?
PFEFFER: Yes.
HARFORD: The person who actually donates the
bone or other tissue never receives a penny?
PFEFFER: No. And also the people in whom
that tissue will be implanted often dont realise its happening.
HARFORD: So is our disgust counterproductive, by
driving these markets underground?
PFEFFER: I dont think it drives thingsunderground. It is underground because we are disgusted by
it and its very difficult for us to think about it. I mean Ive
given up eating meat working in this area. Im constantly in a
state of being disgusted and it seems to me to be a very
fundamental feeling about it.
HARFORD: Our disgust might be inevitable, but its
not at all clear that it helps us make better decisions. We go to
extraordinary lengths to avoid facing up to the fact that the human
body is enormously valuable. Professor Pfeffers research suggests that
a corpse is worth about 110,000, or $220,000 more than many
people in poor countries earn in a lifetime.
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HARFORD: So youre worth more dead than you
are alive?
PFEFFER: Oh yes, much more.
HARFORD: Just break it down for me. How can
a body be worth $220,000?
PFEFFER: Well probably the most valuable
body part is the bone and there is a huge industry processing
bones for dentists, for cosmetic surgeons, and also for very
serious conditions. The next biggest is probably skin. Skin is
ostensibly collected for use in very major burns. Its used as a
dressing. When someones had a you know horrible burn, they
dress the burn with cadaver skin. But - and this was thereason for a huge scandal in the States - they also process it
for cosmetic surgery, so that women who have their lips puffed
up and men who want penis enlargements, its often carried
out with some product thats been made out of cadaver skin.
HARFORD: So I might think that my loved ones
body parts after they die are going to some wonderful
therapeutic cause, but in fact theyre being used in penis
enlargements?
PFEFFER: Yes.
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HARFORD: And that might upset quite a few
people.
PFEFFER: It certainly did in the States when it
came out. I must say that in this country the blood service,
which is the major source of cadaver skin, it does not sell it for
cosmetic purposes.
KIDNEY ADVERTISEMENT
(Music) Providing immediate transplants, both cadaver and
live, in countries concerned with providing safe and legal
procedures is our primary goal. The cost for a kidney or
pancreas is 140,000 US dollars. The cost for a heart, lung or
liver is 290,000 US dollars. These costs include travel and all
hospital fees. There are no additional costs.
HARFORD: The text of our little advertisement comes
from a genuine website, based in California, selling organs for
transplant overseas. And frankly, it all sounds disgusting. Yet
distasteful or not, there is a serious problem to be solved. Four
hundred people die each year on the UK waiting list for an organ, and
about 3,500 die waiting for a kidney in the US. Writer Virginia Postrel
has been campaigning for a change in the law.
POSTREL: In the US there are 70,000 plus
people waiting for kidney donations. And there are not nearly
enough cadaver organs, deceased donors to provide for all
those people, so that increasingly people turn to live donors -
primarily family members, sometimes friends. But not
everybody has family members, not everybody has healthy
family members or compatible family members, so there is a
question of how do you find somebody if your loved ones are
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not an option. I believe that as part of the same way that the
transplant surgeon gets paid and the nurses get paid and the
drugs get paid for and all these things get paid for that the
donors should also be paid for the valuable and essentialthing
that theyre providing, which is the kidney.
HARFORD: If you pay people for kidneys, you could
certainly solve the kidney shortage. But wouldnt the offer lead to the
exploitation of the poor and the desperate?
POSTREL: If youre really concerned that the
donors would be poor, we can rig a system where only rich
people would have the incentive to donate. We could have a
one year tax exemption where you pay no income taxes for the
year in which you donate an organ - so this is the special you
know zillionaire kidney transaction where all the rich people,
you know they have this big monetary incentive to donate a
kidney and then they brag about it to their friends. If your
primary objection is the egalitarian objection, then I would saylets start with something where payment is biased toward the
rich, only rich people can make money selling their kidneys.
HARFORD: But would that really resolve Bishop
Rayfields concerns about exploiting the vulnerable?
RAYFIELD: If somebody is really looking to make
money out of it, I think it muddies the whole thing so much
that it does take us back into the kind of issues that Im
thinking of. And I have a feeling that the selling of organs and
the proposed kind of markets that people are wanting to put in
place for this again are problematic for human dignity and
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dehumanised society.
HARFORD: Fundamentally, the disagreement here is
about whether we are worried about the process and the motive
behind it, or about the results. Virginia Postrel and Robin Hanson
believe that the motive behind a market is far less important than the
results. The positive results are obvious and they believe the negative
consequences can be addressed. The NHS could pay a regulated
minimum price for kidneys; donors could be vetted for informed
consent; we could even insist that donors were British. But for Bishop
Rayfield, the results are secondary to the dehumanising process and
the mercenary motive.
Some economists are trying to satisfy the desire both for results and
for a purer motive. Professor Andrew Oswald of Warwick University is
one of them.
OSWALD: Ive suggested that people could begiven a tiny tax break, a break on their tax forms if they
agreed to donate their kidneys if they were tragically killed.
And I think of that as stimulating a kind of gift between me
and the state; and, second, I think that this box on a tax form
would be useful in alerting people to the tremendous shortage
of kidneys and alerting them to the importance of this
problem.
HARFORD: This is interesting. You are
simultaneously trying to create a sort of price for volunteering
to maybe be a kidney donor, and at the same time youre
talking about gifts. How do you reconcile the two?
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OSWALD: Im trying to find a middle ground in-
between the hard hearted market and the pure altruistic case
where there are no incentives. I think we could exploit that
ground. I know its an unfamiliar thing to do in Western
society, but somehow have partly a gift and partly a purer
incentive.
HARFORD: Youre an economist. Why do you
describe the market transaction as hard hearted?
OSWALD: Because there are some areas of life
where I think even economists like me understand that its
going to be hard to run, and perhaps even undesirable to run a
pure market. Some people have suggested that we could have
a market with prices for kidneys and other parts of the body
even. And perhaps in fifty years time or a hundred years time
something like that will operate.
HARFORD: That might just work, although there are
a couple of objections. One is that it leaves patients waiting around for
others to die from a head injury. Another is that organs from dead
donors dont work as well as organs from live ones. You might say that
this is both repugnant and inefficient. But Professor Oswalds incentive
scheme isnt the only way to soften the edge of a market transaction.
Al Roth, the Harvard economist who matches students with school
places, realised that there was an opportunity to do a different kind of
match with kidneys.
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ROTH: Not everyone who is healthy enough
to give a kidney can give it to the person they want to because
if you wanted to give me a kidney, say, I might have a blood
type that doesnt allow me to take a kidney from someone of
your blood type, or there can be other kinds of immunological
barriers. So theres about a 50% chance that you - not
knowing anything about you - that you could take my kidney,
but theres only about a 30% chance that my wife could take
my kidney because were parents and in the course of
childbirth her immune system may have been exposed to and
developed antibodies to some of the proteins that our children
have that come from me. And if thats the case, then her
immune system would be ready to attack my kidney, so I might
wantto give her a kidney but I cant. And you might want to
give someone a kidney, but you cant. But what kidney
exchange is is I could give a kidney to your patient and you
could give a kidney to my patient. So no money changes
hands.
HARFORD: Professor Roth and his colleagues both
surgeons and economists have already made 22 transplants possible
in New England using their kidney exchange program. The NHS
division, UK Transplant, is making plans for a similar exchange in the
UK. But isnt this a sort of sleight-of-hand, a market based on barter
rather than cash?
For people such as Bishop Rayfield, the essential difference between a
market and a kidney exchange is that the exchange preserves an
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altruistic motive.
But is it really true that the gift relationship is better than a
straightforward commercial transaction? Sometimes gifts can produce
far more onerous obligations than price-tags. And loving relationships
are rarely as simple as they seem. Virginia Postrel thinks we make far
too much fuss about what is, after all, only a spare kidney.
POSTREL: People get to think oh how heroic it
is, these people donating their kidneys! Isnt that wonderful?
I get a happy glow from it! And they want to keep it as a
heroic, uncompensated act because it makes them feel good.
Never mind that you know tens of thousands of people are
dying for your right to feel good about other peoples heroic
acts.
HARFORD: Belittling the heroism of kidney donors
sounds cynical. But perhaps Virginia Postrel isnt the cynic she seems
to be.
HARFORD: Now you did give a kidney to
someone you didnt know terribly well. Are you crazy? Why
did you do it?
POSTREL: (Laughs) Well I do think that, yeah,
a lot of my interest in this issue came out of my own
experience of donating a kidney to a friend - not a close friend,
but someone that I did like a lot who had no family. And she
was somebody who was only going to get a living donation
from you know someone like me. She didnt ask. I heard
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about it from a mutual friend that she needed one. And my
experience with that was that the reaction is completely
disproportionate to the actual risks involved. People do act
like youre completelynuts.
HARFORD: You dont feel in a way that youve
almost delivered the perfect counterpoint to your own
argument? I mean if your friend had offered you money, would
you have been more likely to do it or less likely?
POSTREL: Well knowing my particular friend,
she would have really liked to do an arms length transaction
with a stranger where she paid somebody she didnt know
because there can be a great deal of emotional entanglement
when there is a gift. It happens to be that Im not the kind of
person to think that she owes me anything, but especially in
families there are all kinds of psychodramas that go on with
requiring this to be a gift. Its not some kind of horrible
exploitation. Its a perfectly normal, safe procedure and weshould allow people to be compensated for it.
HARFORD: This argument is really whether we care
more about motives, or more about results. Either way, there seems to
be a strong case for banning the human missile, Mr Wackenheim, from
plying his trade. The negative repercussions especially on other
people of restricted growth are all too obvious. But as Robin Hanson
pointed out, its hard to see who else is hurt when money changes
hands for an organ. Perhaps Mr Wackenheim should be able to make
some money by selling a kidney instead; it might still make us queasy,
but rather than providing a tacky night out, he could save somebodys
life.