14 Comments

Robin Hanson can tell you the answer - health is sacred and must not be defiled with money.

It's irrational and kills people, but there it is.

Expand full comment

The slippery slope argument says, wottabout organ sales? To which I say, why not? Aha but if there is a legal market in pre-owned organs? Bad guys like Putin and Xi will farm slaves for their organs. I doubt it. Urban legend says that there is a black market in kidneys and suchlike. If there is, despite strong financial incentive it is very small, not like the trade in aborted fetuses. Legalizing it would bring the price down to sub-billionaire levels and reputable surgeons wouldn't be afraid to touch it.

From that we move on to blood donors. In some enlightened countries, donors are paid. When I was working in the Australian outback, when I donated in Alice Springs they offered me a choice of a soda or a beer. Guess which one I took. Thereafter every time my mates on the mine had a few days off and went to the Alice to razzle, their first stop was the blood clinic.

It's not only medicine. The overdeveloped ethical sense that has now matured into Wokeism has also sentenced the rhino to species extinction. Legalize rhino horn trade and in ten years I won't be able to step out my door (I live in Africa) without bumping into a rhino.

Expand full comment

Good article. No doubt paternalists will argue the poor who will take up these experiments will do so against their self-interest and thus should be banned from doing so. That, and, the poor will be "forced" alone to participate in these schemes. Both objections fail to hold water.

Expand full comment

When far more terrible contagions than COVID come around we might all realize Bryan is correct.

Expand full comment
Apr 19, 2023·edited Apr 19, 2023

Because of your link to bioethicists and how they don't know what they're talking about, I now know that Iron Maiden was quoting the Prisoner in the song Back in the Village. It only took me about 40 years to learn that. (the quote being "Questions are a burden, and answers a prison for oneself".

Expand full comment

Like abortion, there is probably some ideal space where:

1) It's legal

2) Regulated

3) Taboo and low status

That is a very hard nut to crack. People who engage in an activity because it's legal don't want to be stigmatized, but it's the stigmatization that keeps it from slippery sloping into things one would object to. Too much stigmatization and you can't do it legally or nobody wants to try.

During COVID I think the real objection was that too many people who too much to gain during COVID, and there was no figure willing to cut through the bullshit. We spent more money on COVID then we spent defeating the Axis at Midway and Stalingrad, Human Challenge Trials would have spoiled all that (and maybe elected Trump).

Expand full comment

If you haven't already, Bryan, you may want to read Scoot Alexander's book review regarding IRBs. Maddening stuff.

https://astralcodexten.substack.com/p/book-review-from-oversight-to-overkill

Expand full comment

I've seen some people put in their IRB forms that respondents wouldn't be paid "too much" - otherwise, they, especially if they're poorer, may feel compelled to take part in the research. Then their participation wouldn't be strictly voluntary. Allegedly this helps them pass ethics review.

If something were actually dangerous, I could imagine that a low payment would be viewed as unethical, as it doesn't compensate for the risks. On the other hand, paying someone between $8,000 - $20,000 may be seen as so much that people, especially poor people, would feel compelled to take part.

Expand full comment

But fear not! In 1901, medical researchers figured out how yellow fever spreads. The answer, in case you haven’t heard, is mosquitos. Vaccines didn’t come until the 1930s, but many countries managed to practically eliminate yellow fever simply by eliminating the insects that carry the disease. The critical question really was simply “How does yellow fever spread?”

Not quite true. As detailed in the wonderful book "Eradication" by Nancy Stepan, mosquito control efforts were very successful (particularly Brazil) but as soon as you stopped them yellow fever came back and in some places they just didn't seem to work (there is a lot of diversity in species of mosquitoes). Vaccines turned out to be a much more successful approach than mosquito control and really turned things around for YF

Expand full comment