Life or Death

A recent New York Times report documented a shockingly inefficient system that decides who lives or dies waiting for a kidney transplant. While no one questions a need to avoid the cost of marginally successful surgery, the facts seem to call for a total reevaluation of the system when nearly 4,800 people died last year waiting for a kidney and over 2600 donated kidneys were discarded.

One disturbing report detailed the tragic death of a healthy 36-year-old. His liver and one kidney were transplanted into waiting patients. His other kidney -just as healthy- was ultimately offered to more than 10,000 potential matches with no takers. It ended up discarded - disgraceful.

The systems for allocating livers, hearts and lungs have been revised to take into account the urgency of need and the life expectancy of the recipient, factors that are disregarded in the case of kidneys. Efforts to update these and other outdated rules take years to change. Meanwhile, perfectly good kidneys are being tossed in the garbage and people are dying. How dumb is that?

One might question the ethics of the medical centers that turn down marginally viable kidneys for patients in need. But it’s not that simple. One kidney center was censured because they had an 88% success record. In order to keep from being decertified they cut back the number of kidney transplants done and raised their success rate to 96%. The doctor in charge of the program mused which would you choose 88 successful transplants out of 100, or 59 out of 60? The choice of the 29 people who might have been saved is crystal clear. 

According to the Times story, “A computer simulation suggests that a redesigned system could add 10,000 years of life from one year of transplants.” Currently an outdated computer matching program makes the process inefficient. Add to that government oversight, the overreliance by doctors on inconclusive tests and even federal laws against age discrimination. Medical rationing that arguably gives all candidates a fair shot at a transplant but does not save as many lives as it might. 

We can all agree that dumping organs that might give life to those in need is not what we should be doing. We should all agree that the reported 14,484 kidneys recovered last year is pitiful; especially in light of the 93,413 folks waiting for one recently (2012.09.19). It’s disgraceful that all last year something less than 7,500 people remembered to make sure that should something fatal befall them, their organs could help others live. Who could possibly not want that to happen? 

There is no easy way to estimate the potential number of organs that could be recovered. But consider that the latest available annual highway death toll in 2010 totaled 32,885 individuals, a number that could vastly increase the number of organs recovered. Then add in other accidental deaths, and deaths from a wide variety of causes and it becomes apparent that we are ignoring an opportunity to give the gift of life, perhaps to several people. Shame on us!

Beyond Disgusting

We had to know that decades of sexual abuse cover-ups in our churches were not the only cases of adults taking advantage of trusting youngsters. Then the disaster at Penn State University came to light; an all-powerful football program covered up the horrific actions of one of its leaders. Where young people gather, predators are sure to lurk, in churches, in sports programs, these youngsters are easy prey.

And now a series in the Los Angeles Times exposes decades of abuse and cover-ups in the Boy Scouts (BSA); cover-ups by the BSA and some in the media with leadership roles in the movement. It’s not surprising that the Scouts have made every effort to hide sexual assaults by Scout leaders on the boys in their program. Leaning on a Congressional Charter, the organization has a history of arrogant independence, haughtily refusing to be accountable to any outside entity.

Meanwhile they have been paying out millions to victims who brought lawsuits against the Scouts as a result of abuse. The Times has obtained some 1,600 pages of documents made public by these lawsuits. There is no way to know how many cases are still hidden away in the BSA files. They have spent millions in the courts fighting attempts to open this cesspool to public view.  

Over the years the BSA has published many rules and regulations, but like the elegant Code of Ethics proudly displayed by Enron prior to its fall, the BSA rules in most cases were not worth the paper they were printed on. They repeatedly ignored reports of abuse and allowed the abusers to continue to work with boys.

The Times story included these disturbing instances among many others: “In at least 50 cases, the Boy Scouts expelled suspected abusers, only to discover later that they had reentered the program and were accused of molesting again.”

“One scoutmaster was expelled in 1970 for sexually assaulting a 14-year-old boy in Indiana. After being convicted of the crime, he went on to join two troops in Illinois between 1971 and 1988. He later admitted to molesting more than 100 boys, was convicted of the sexual assault of a Scout in 1989 and was sentenced to 100 years in prison, according to his file and court records.”

“In 1991, a Scout leader convicted of abusing a boy in Minnesota returned to his old troop — right after getting out of jail.”

These disturbing reports go on page after page. While the BSA appears to have toughened up its standards and rules, there is no reason to believe that they are any more willing to open themselves up to reputation damaging revelations than they have been in the past. 

We understand the thinking behind this behavior, the belief that all the good the BSA, the Church, the Sports program, etc., etc., does, justifies “protecting it.” How about protecting the victims for a change?

Rule Or Ruin?

Many technical advances present two faces. For instance, we have an unrealistic view of life in the “Horse & Buggy” age. In the motor vehicle age we see death and injury rates and imagine that things were better in earlier times. They were not by any measure; horses are difficult to control at best and the drivers then were no more responsible than they are now. The key to reducing the downside of motor vehicles has been to make cars, trucks and big boy’s toys safer through technical improvements. The rules of the road -among other things- have to improve as well.

A new book, Automate This: How Algorithms Came to Rule Our World, came out last week. Former tech journalist Christopher Steiner delves into the rise in the use of this digital tool as well as its impact on our society. In a Fast Company interview, he says he initially planned to just cover the use of algorithms on Wall Street. But from that starting point his research took him out further and further into our lives like the concentric waves when a rock splashes in a lake. Algorithms make Google search work. They drive customer service programs, they are everywhere.

Many of us know that algorithms underlie the high-speed traders who dominate our stock markets these days. They carry out most of the billions of trades the markets see every day. The upside is that the cost of trading has been going down with this volume. One downside is that some high-volume traders use this tool to shadow trades being exercised by pension funds and other wealth management entities. They can race ahead of these traders scooping up their target stocks and selling them to the funds at a higher price seconds later. The effect is to drive up the cost of the securities in your 401(k) or Grandma’s pension plan.  

Worse, they have contributed to the market’s abandonment of its only benefit to society, as a source of capital for business. In fact the markets have veered from the view of arguably the most talented investor in the world, Warren Buffett, who famously said, "The best time to sell a stock is never." Businesses are obsessed with daily prices and struggle to meet the quarterly expectations of the market instead of the long-term goals that could make them hugely more profitable.

There is a simple solution for this problem. Tax capital gains based on the length of time an investment is held. Just for fun let’s say if you hold an investment for twenty years or more, there would be no tax liability. Ten to twenty years, 5%, five to ten years 10%, two to five years 15%, one to two years 25%, one month to a year 50%, one week to a month 75%, less than a week 95%. Better than pirating value from Grandma’s pension, better for investors, better for business and their employees, better for America. Ethically there is no basis for the gambling hall culture on Wall Street; high speed trading is one gaming table we don’t need.