Human Nature: Science, Technology, and Life.

The Two-Child Policy

Oops!

Remember that Chinese policy of restricting most couples to one child? Apparently, the bean counters in Shanghai (actually, they're human-being counters) have changed their minds. According to Reuters:

Shanghai is urging eligible couples to have two children as worries about the looming liability of an aging population outweighs concerns about over-stretched resources, a city official said on Friday. The policy marks the first time in decades Chinese officials have actively encouraged procreation. ... More children would help relieve the heavy pressure from aging people, said Zhang Meixin, a spokesman for the Shanghai Municipal Population and Family Planning Commission ...

The U.S.-based Center for Strategic and International Studies warned in April that by 2050 China ... will have just 1.6 working-age adults to support every person aged 60 and above, compared with 7.7 in 1975. ... China's underfunded state pension system and shrinking family size has removed a traditional layer of support for elders, leaving society ill-prepared to cope with an aging population.

You don't say.

This is the main problem with central family planning (if you don't count the tyranny). Centralized systems are more farsighted but less sensitive and adaptive than decentralized systems. Look at abortion rates in nontotalitarian countries: They go up or down in conjunction with economic indicators. Each woman decides how big a family she can afford and whether now is a good time to have a baby. Sure, there are outliers and mistakes. But overall, the crowd of procreators acts prudently. And when circumstances change, family size adjusts accordingly.

Centralized systems interfere with this natural dynamic. They make it harder to change course. And they never seem to learn that the problem is centralization itself.

So good luck, Shanghai being counters. May your generational ledgers even out, despite you.

Abortion and Economics

Lots of talk yesterday about President Obama's commencement address at Notre Dame. The main topic was "common ground" on abortion. I'll post some thoughts on that later today or tomorrow. But one thing is worth pointing out now: It's a bit odd to see abortion being treated by activists and the press as an issue separate from the economy. In real life, women who get pregnant think hard about their financial circumstances. They try to figure out whether they can afford to raise a child. That's what is happening right now in Singapore, according to Agence France Presse:

Despite a national campaign to boost the birthrate, Singapore has one of Asia's most liberal abortion policies and the global financial crisis could be prompting more women to terminate pregnancies. A Ministry of Health spokeswoman said there were 12,222 abortions in the city-state last year, compared to 11,933 in 2007. No official figures are available for 2009. Gynaecologist Saifuddin Sidek said his private practice had recorded a 20 percent rise in abortion patients so far this year compared with the same period last year. "A lot of them are because of the current economic climate," he said.

The same logic applies to the United States. If you look at the chart on Page 9 of last year's report by the Alan Guttmacher Institute, "Trends in the Characteristics of Women Obtaining Abortions, 1974 to 2004," you'll see that the "abortion ratio per 100 pregnancies" rose from 1974 to the early 1980s and then steadily fell, except for the first couple of years of the 1990s and 2000s. That roughly correlates with economic indicators. The better the economy, the more likely women are to go through with their pregnancies.

At Notre Dame, Obama talked about adoption, pregnancy prevention, and other things the government can facilitate to lower the abortion rate. Good for him. But don't be surprised if abortion trends during his presidency end up having little to do with his abortion policies and a great deal to do with his management of the economy.

Selling Organs in the Recession

Will the global recession push more people to sell their organs? Apparently, the answer is yes.

Here's the question as I posed it two months ago:

You don't normally think of selling your body's parts or products. But bad times can make you think hard. One reason you might not have thought of selling something from your body is that the idea felt unnatural or somehow made you uncomfortable. But for $5,000, with bills to pay and no other income prospects, you decide you can get over those feelings. ... The next question is whether money can persuade you to donate not just a body product, but a body part.

And here's an initial answer, courtesy of Agence France Presse:

The economic crisis has forced dozens of "desperate" people in Spain to put their organs up for sale on the Internet, a consumers association said Tuesday. The association, FACUA, told Spanish authorities it has detected "31 announcements of organ sales" on 13 Internet sites by Spaniards and Latin American immigrants. "These are offers of kidneys, lungs and bone marrow, by persons who say they are going through economic difficulties and asking for sums ranging from 15,000 to one million euros (19,000 to 1.3 million dollars)," FACUA said.

The trend is all too logical: As the recession takes away the external assets of more and more people, they'll be forced to sell what's left.

Surrogacy and the State

Is the global market in womb rentals out of control? Does it need regulation?

I wondered about that three weeks ago when I saw this Reuters story: "Poverty Makes Surrogates of Indian Women in Gujarat." The $4,000 to $8,000 paid to successful surrogates in India is "a huge sum of money in a country where many live on less than $2 a day," Rina Chandran reported. But compared with U.S. rates, it's cheap. That's why foreigners have begun

to flock to [Nayna] Patel's clinic, drawn by the lower costs, relaxed attitude toward surrogates and lack of legislation. A draft bill on surrogacy is pending before parliament, and meanwhile, hundreds of clinics have mushroomed across the country, with critics saying touts promoting this "reproductive tourism" care little for the health or rights of the surrogates. ... Patel has a list of nearly 200 [would-be surrogates] and is seeing more women walk in everyday because they are feeling the pinch of the slowdown.

And yet, Chandran noted, Patel "draws the line at gay couples."

Cheap reproductive labor for wealthy foreigners, but no gay parents allowed? For the usual incoherent combination of lefty reasons—not enough private discrimination in working conditions, too much private discrimination in family values—I felt the urge to support regulation of the industry.

Then, yesterday, Reuters published another investigation of overseas surrogacy conditions, this time in China. "With China's rising affluence, increasing numbers of infertile couples have been seeking surrogate mothers," James Pomfret reported. "Surrogacy agencies have been recruiting girls, often from poor villages, to have babies on behalf of prospective parents."

Should the government do something about this? Actually, authorities are already on the case:

In the southern Chinese city of Guangzhou, three young surrogate first-time mothers were discovered by authorities hiding in a communal flat. Soon afterwards, district family planning and security officers broke into the flat, bundled them into a van and drove them to a district hospital where they were manhandled into a maternity ward, the mothers recounted to Reuters. "I was crying 'I don't want to do this'," said a young woman called Xiao Hong, who was pregnant with four-month-old twins. "But they still dragged me in and injected my belly with a needle," the 20-year-old told Reuters. ... Another of the surrogates, who said she'd come from a village in Sichuan province, recounted how officers made her take pills then surgically removed her three-month-old fetus while she was unconscious.

This isn't the kind of policing liberals have in mind when they call for tighter regulation of the fertility industry. But the tricky thing about official intervention is that once the state gets its foot in the door, you don't necessarily get to dictate what it can and can't do.

Every time the global market in human body parts and rentals looks ugly enough to regulate, I'm reminded how much uglier things can get when the government steps in.

Creativity and Body Parts

Drawn by payments of up to $10,000, an increasing number of women are offering to sell their eggs at U.S. fertility clinics as a way to make money amid the financial crisis. ... The Center for Egg Options in Illinois has seen a 40 percent increase in egg donor inquiries since the start of 2008. New York City's Northeast Assisted Fertility Group said interest had doubled and the Colorado Center for Reproductive Medicine said it had received 10 percent more inquiries.

One clinic's egg donation manager explains that the bad economy "encourages women to find creative ways to make money." It's an interesting use of the word creative. In this case, two kinds of creativity seem to be involved. One is the invention of egg donation in the first place. Selling eggs was impossible until doctors learned how to extract, preserve, fertilize, and transfer them for successful implantation. These breakthroughs made eggs transferrable and commercially valuable.

The second kind of creativity goes hand in hand with the first. You don't normally think of selling your body's parts or products. But bad times can make you think hard. One reason you might not have thought of selling something from your body is that the idea felt unnatural or somehow made you uncomfortable. But for $5,000, with bills to pay and no other income prospects, you decide you can get over those feelings.

Economics clearly drives the donation market. Two years ago, Reuters notes, a study found that the average payment to an egg donor in the United States was $4,216. But the average sperm donor in New York City gets only $60 per deposit. And sperm banks, unlike egg donation programs, are reporting no recent increase in donations. The money's not good enough.

The next question is whether money can persuade you to donate not just a body product, but a body part. In principle, half the world's kidneys are expendable. People are already buying and selling them on the global market, regardless of laws. Some reformers are proposing to replace this black market with a regulated system of incentives ranging from $15,000 to $40,000. If $5,000 is enough to make people think creatively about donating their eggs, $15,000 might well be enough to do the same for kidneys.

Seven Ways To Sell Your Body

As economies around the world continue to shrink, how many people will start thinking about selling their bodies?

Two years ago, the global market in human flesh looked like a humanitarian issue. It was a problem for those poor people in developing countries, not for us. But global capitalism doesn't care what color your skin is, as long as you've got some to sell and you need the cash. And, increasingly, people need the cash.

The idea starts with superficial rentals. Last month, according to the New York Times,

FeelUnique.com, an online beauty products store, paid 10 men and women to apply temporary tattoos with the company's Web address on their eyelids and then wink at strangers. Chosen randomly from more than 6,000 who applied online, participants were paid 100 pounds (about $149) to wink at people 1,000 times, or 10 pence a wink, an allusion to pay-per-view Web advertising.

Harmless, right? So let's move around to the back of the head. Thirty people have hired themselves out to Air New Zealand as "cranial billboards," the Times reports. "For shaving their noggins and displaying the ad copy for two weeks in November, they received either a round-trip ticket to New Zealand (worth about $1,200) or $777 in cash."

A bit tacky, but who are we to judge? They need the money. And if people are willing to wear temporary tattoos for pay, why not permanent ones?

Since 2005, Dunlop Tires has hired tattoo artists to work at its booth at the annual Specialty Equipment Market Association show in Las Vegas, geared to motorists who modify cars. Volunteers who agree to be permanently tattooed—either with Dunlop's logo or its trademarked tire tread—while onlookers gawk receive a set of tires worth $500 to $1,000, said Jim Davis, a Dunlop spokesman. About 200 people have been tattooed so far.

If it's OK to sell permanent advertising on your skin, it's hard to see why we outlaw temporary prostitution, especially in view of current financial pressures:

Signs of the economic free fall have cropped up in many of Nevada's 25 or so legal brothels. The Mustang Ranch, for example, has a steady stream of customers, but the number of women vying for work has soared.

Should women who resort to this line of work in other states continue to be arrested? Do you have some other employment opportunity to offer them?

And if extra cash to women who need it is a good thing, what about the increasing use of undeveloped countries as testing grounds for drugs not yet approved in the West? According to an article in the New England Journal Medicine, "Pharmaceutical and device companies can realize substantial cost savings by conducting trials in developing countries, so they are increasingly moving phase 2 and phase 3 trials to places such as India and South America." In these countries,

There may be a relative lack of understanding of both the investigational nature of therapeutic products and the use of placebo groups. In some places, financial compensation for research participation may exceed participants' annual wages, and participation in a clinical trial may provide the only access to care for persons with the condition under study. Standards of health care in developing countries may also allow ethically problematic study designs or trials that would not be allowed in wealthier countries. In one study, only 56% of the 670 researchers surveyed in developing countries reported that their research had been reviewed by a local institutional review board or health ministry. In another study, 90% of published clinical trials conducted in China in 2004 did not report ethical review of the protocol and only 18% adequately discussed informed consent.

So, the standards overseas are lower, and the people recruited to test the drugs have fewer choices. But isn't that how capitalism works? Aren't these people getting value in exchange for supplying their bodies at lower cost? As Ezekiel Emanuel, chairman of bioethics at the National Institutes of Health Clinical Center, puts it: "More places outside the United States are participating in research—is that a bad thing?"

And what about the sale of human eggs, sperm, and surrogacy? Driven by the recession, women are lining up to sell their eggs and rent out their wombs. It's fully legal. Do you want to stop them or their clients? Do you think you can?

If it's OK to sell your eggs and skin—and to rent out your body for pregnancy or drug testing—why not let people sell expendable organs? Thanks to the progress and spread of transplant technology, every healthy person with two good kidneys or a splittable liver now has a fungible asset. Earlier this month, for instance, the Asahi Shimbun reported:

Amid the serious shortage of available organs in Japan, a nonprofit organization admitted to helping 17 Japanese receive transplants in China even after Beijing banned such operations for foreigners in 2007. A deputy chief of the NPO [said] the group paid doctors in China, in addition to treatment costs, for the kidney and liver transplants there. ... Cases have already emerged of Japanese traveling to Southeast Asia for new organs.

I'm not saying all of these practices are acceptable or unacceptable. Some are more worrisome than others. But they're all happening, and they're all being driven by money. And as the recession takes away the external assets of more and more people, we're going to face increasingly difficult questions about letting them sell what's left.

Eggonomics

Looking for some extra income to make ends meet during the recession? Try selling eggs. Not chicken eggs. Your eggs.

Melinda Beck has the story in today's Wall Street Journal:

Here's another sign of the tough economic times: Some clinics are reporting a surge in the number of women applying to donate eggs or serve as surrogate mothers for infertile couples.
"Whenever the employment rate is down, we get more calls," says Robin von Halle, president of Alternative Reproductive Resources, an agency in Chicago where inquiries from would-be egg donors are up 30% in recent weeks—to about 60 calls a day. "We're even getting men offering up their wives. It's pretty scary." James Liu, a reproductive endocrinologist at University Hospitals, Case Medical Center, in Cleveland, says there is no waiting now for egg donors since his roster has swelled from the usual 4 to 17. Andrew Vorzimer, an attorney who represents prospective parents in Los Angeles, says the usual six-month wait for a surrogate in California has vanished as well. "Many of these women have college loans to pay off or they want to help buy a house or provide for their own kids' education," says Mr. Vorzimer, who is also CEO of Egg Donation Inc., a recruiting agency.

So the good news is, you have an exploitable asset in your ovaries. The bad news is, you have to compete with all the other young women—and apparently their husbands—who have realized the same thing. Did I mention the daily hormone shots? The prohibition on intercourse? The needle extraction?

Still, it's a better deal than lots of people in the developing world are getting. They're selling kidneys; you're only selling eggs. And you can make a lot more money than they can. Beck lays out the numbers:

The going rate for a surrogate is about $25,000. Egg donors generally receive $3,000 to $8,000. But a few agencies advertise that they'll pay much more for specific characteristics. One ad running in campus newspapers promises $25,000 for a donor who is "100% Jewish with ... High SAT Scores... Attractive, at Healthy Body Weight and Free of Genetic Diseases." ... "Now that we have more donors, it's become a buyer's market," Ms. von Halle says. "Some people are looking for a 6-foot Swedish volleyball player with 39 ACTs, and they'll take their time." ... Darlene Pinkerton, executive director of A Perfect Match in San Diego, which offers up to $50,000 for egg donors with high SATs ... [has] seen a doubling of inquiries recently. The American Society for Reproductive Medicine considers compensation above $10,000 to be inappropriate; Ms. Pinkerton argues that the offer brings in donors who might not otherwise be interested.

In other words, the egg market is working like any other market. A Perfect Match is offering big bucks for exactly the same reason the ASRM opposes this practice—because money can persuade people to do things they otherwise wouldn't do. Actually, the 50 grand supplies only half the persuasion. The other half comes from the recession. You need money; you're running out of options; here's a way to get it.

But ordinary eggs won't get you the 50 grand. For that, you'll need the SAT scores, and the face, and maybe a bit more height. You'll need to be tested for the wrong genes—and maybe for the right ones, now that we can project athletic potential from specific variants.

Do you find this scrutiny degrading? Does the whole tiered pricing system offend you? Then go look in the mirror. Catering to buyers' tastes is part of selling. I know it's a lousy economy out there. But if you don't want others treating your eggs as a commodity, don't treat them that way yourself.

Hospitals vs. Factories

Last week I promised to start using this blog to highlight and explain the day's top stories. Unfortunately, scanning wires, papers, magazines, journals, and Web sites for the best stories (make sure to bookmark the Human Nature home page so you'll get the list every day) has taken so much time that I haven't been able to make good on my promise. Sorting out how long these tasks take, and which of them I should spend my time on, will take at least a few weeks. Anyway, I've cleared some time this afternoon to talk about today's stories, so let's get to it.

One item worth noting is today's Wall Street Journal article [subscription required] on hospitals replacing factories. Reporter Conor Dougherty lays out the data:

Demand for health care tends to stay strong during recessions. Cash-strapped consumers are more likely to cut back on new appliances or cars than emergency-room visits. Indeed, while the number of manufacturing jobs nationwide fell by 48,000 in March and by 310,000 over the past 12 months, health-care employment rose by 23,000 last month and is up 363,000 jobs on the year ... Growth in health care is fueling local economies across the country, as medical facilities replace factories. In Duluth, Minn., 20% of the jobs are in health care, compared with 14% a decade ago. In the Canton, Ohio, area, which lost the maker of Hoover vacuum cleaners and dozens of other manufacturers, the health-care industry is expanding rapidly. A similar story is unfolding in Anderson, Ind., once a major producer of cars and car parts.

I haven't researched this topic enough to analyze all the factors. But one theme is already intriguing: An economy based on constructing and repairing objects is giving way to an economy based on repairing and maintaining the human body. Faced with recession, consumers are deciding that widgets are expendable, but people aren't.

Actually, that's not quite right. We haven't decided that the health of ­all people is so important. The manufacturing that used to happen here is migrating to the developing world. Likewise, its replacement by hospitals is happening here, not there. Yes, American and European medicine are often being outsourced to poorer countries. But the patients benefiting from this overseas treatment are still American and European. Just ask all those transplant tourists.

My bet is that the trends reflected in this article will dominate the economy of the next century. The biotechnology of human health will increasingly become the technology most highly valued by the measure that counts most: economic demand. To put it in moral terms: The most valued objects of maintenance and repair will be subjects.

That's the good news. The bad news is that because the mechanism behind this process is economic, and because wealth is unevenly distributed, billions of people will benefit little or not at all. Dougherty shows us, through interviews and stories, how easily supply and demand can shuffle workers not only from manufacturing to health care, but vice versa when nursing wages don't add up. That's why, in much of the world, the economy will continue to value objects more than subjects, no matter what morality says.