Un article assez tripé sur le cours du rein... et qui va droit à la question clef : faut-il légaliser la vente d'organes et le débitage du pauvre en pièces détachées ? Vous prendrez la noix, la bavette ou la gite-gite ? Saddam casse tous les prix...

For Sale, Used Kidneys : Buyer Beware

Michael Finkel © The New York Times Magazine Thursday, May 31, 2001 http://www.iht.com/articles/21515.htm

After four years on dialysis, with no sign that he was nearing the top of the transplant waiting list, Moshe Tati decided to buy a kidney. Shortly before he made his decision, he had suffered a heart attack. It was minor but it reduced his suitability for transplant surgery and dropped his standing on the organ-waiting list.

Mr. Tati was 43 years old, he was dying and not one of his family members was a suitable match for a kidney donation. So he called a broker.

Mr. Tati lives in Israel, which happens to be one of the more active nations in the international organ-trafficking market. The market, which is completely illegal, is so complex and well-organized that a single transaction often crosses three continents : a broker from Los Angeles, say, matches an Italian with kidney failure to a seller in Jordan, for surgery in Turkey.

Though hearts and livers and lungs are occasionally sold, the business deals almost exclusively in kidneys. There are two reasons for this. First, kidneys are, by far, the organ in greatest demand - there are currently 48,963 patients on the U.S. kidney waiting list, and fewer than a tenth as many on the heart list. Second, the kidney is the only major organ that can be wholly removed from a living person while leaving the donor essentially unharmed, with the second kidney picking up all the work.

In other words, with kidneys there are people who want to buy and people who want to sell.

But the sale of human organs, whether from a living person or a cadaver, is against the law in virtually every country (Iran is perhaps the only exception) and has been condemned by all of the world's medical associations. Yet, in Israel and a handful of other nations, including India, Turkey, China, Russia and Iraq, organ sales are conducted with only a scant nod toward secrecy. Paying for an organ has become so routine in Israel that there have been instances in which a patient has elected not to accept the offer of a kidney donation from a well-matched relative. "Why risk harm to a family member ?" one patient remarked. Instead, these patients have decided that purchasing a kidney from someone they have never met - in almost all cases someone who is impoverished and living in a foreign land - is a far more acceptable option. American dialysis patients have been significantly less eager than Israelis to enter the kidney market. Most Americans, it seems, harbor a deep reluctance to engage in such medical procedures, even though they are being done overseas. "I can get you a kidney immediately," said the broker whom Mr. Tati called. "All I need is the money." Then he quoted a price : $145,000, cash in advance. This would cover everything, the broker said - all hospital fees, the payment to the seller, accommodations for accompanying family members and a chartered, round-trip flight to the country where the surgery would take place. The trip would last about five days, he said, and the destination would be kept secret until they left. The broker promised that one of the top transplant surgeons in Israel would be flying with them to perform the operation. The broker instructed Mr. Tati to undergo blood and tissue exams so that a match with a kidney seller could be arranged. "I can guarantee you a living donor," the broker said, "a young, strong man. This won't be a cadaver organ." Desire for a living donor is another reason why dialysis patients often prefer to purchase a kidney and circumvent national programs, where legally transplanted organs are almost always from cadavers. The median survival length of a kidney transplanted from a cadaver is about 11 years ; from a living donor, it is more than 20 years. It was only after he was aboard a chartered plane at Ben-Gurion International Airport that Mr. Tati and three other kidney patients learned they would be going to Turkey. The surgery to remove the seller's kidney, Mr. Tati says, was performed by a Turkish team ; the transplant surgery was completed by an Israeli physician and nurses who had flown with them. As Mr. Tati awoke from his transplant surgery, the Israeli doctor was at his bedside, grinning. "He told me, 'Congratulations, everything's great,'" Mr. Tati said. " He said I had already urinated. The first time in four years ! He said it was a complete success. But I did not feel good. I felt pain from my neck to my stomach. Then I blacked out." Mr. Tati had suffered a second heart attack, this time a major one. His entire body was swollen. He was flown back to Israel and rushed to a hospital. Toxins were detected in his blood.

(à suivre : http://www.iht.com/articles/21515.htm)

Après les joies du libéralisme, la série : "vendez votre sang, c'est le Parti qui le veut" et ses épisodes plus macabres :

http://www.iht.com/articles/21510.htm

China's Dark Secret : AIDS and Corruption in a Poor Province

Elisabeth Rosenthal New York Times Service Thursday, May 31, 2001

DONGHU, China The most striking things about people from this village are that their threadbare clothes seem way too big and that nearly all of them share a hollow, desperate look in their eyes.

Stooped and shuffling, frail before their time, farmers who should be in their peak productive years are unable to tend their wheat fields or to care for their children. In this picturesque central Chinese village of 4,500, every family is touched by gruesome maladies : fevers, chronic diarrhea, mouth sores, unbearable headaches, weight loss, racking coughs, boils that do not heal. Dozens of relatively young people have died here in each of the last two years. In December, 14 people in their 30s and 40s died.

The culprit that has devastated not just the health but the very soul of this impoverished place is something that officials here in Henan Province have generally insisted is not a problem : It is HIV, the virus that causes AIDS.

While hints of this secret epidemic first seeped out from remote areas of China's countryside last year, the depth of the tragedy and its staggering toll on villages like Donghu are only now emerging, as desperate, dying farmers have started to speak out.

(suite : http://www.iht.com/articles/21510.htm)

Pour se détendre, une vieille thèse : que fait la droite si la gauche a su si bien imiter sa politique ?

http://www.iht.com/articles/21430.htm

Now Comes (Yawn) a Big Conservative Victory in Britain

Niall Ferguson The New York Times Thursday, May 31, 2001

OXFORD, England The imminent landslide victory for conservatism in the British general election should come as no surprise to anyone. Yes, you heard right : I said conservatism. Not, please note, the victory of the Conservatives. They will do abysmally - almost as badly, pessimistic Tories fear, as the Canadian Conservatives did when they were wiped out in 1993.

Yet even if their seats are reduced to just double figures in the House of Commons, they and their supporters will be able to console themselves with the thought that conservatism, albeit in the form of the Labour Party, has won at the British polls once again.

The Italians have a word for it : trasformismo. "Transformation" was a characteristic feature of politics in Italy of the 1880s, and what it meant was a blurring of ideological differences. As critics noted then, "the government of the left is the same as the government of the right." That neatly sums up what has happened in Britain in the course of the past decade.

The party of the left has shifted so far to the right politically that it has come close to making the Conservative Party an irrelevance. The smaller Liberal Party now finds itself in the unprecedented position of being to the left of Labour. This is why the current election campaign strikes most Britons as so excruciatingly, agonizingly boring. Apart from a blissful eruption when the deputy prime minister, John Prescott, rediscovered his proletarian roots and thumped a protester who had thrown an egg at him, this election has been the most tedious in living memory. William Hague, the leader of the Conservatives, has struggled and failed to present himself as a credible alternative to Tony Blair. In footballing terms, there is already talk of bringing on a substitute. But the Conservatives' lamentable standing in the polls has more profound causes than Mr. Hague's charisma deficit. His party has been made to look superfluous.

At the last election there was some doubt in voters' minds. They could see that Labour had stolen the Tories' clothes on a range of policies. But was there, as Conservative posters implied, still a demonic socialist purpose lurking behind Mr. Blair's friendly face ? Now, four years on, we know the truth. There wasn't.

The essence of the new trasformismo - and it's happening all over Europe - is that the old socialist parties have accepted not only the principle that the free market is superior to state planning or ownership, but also its practical implications.

(suite : http://www.iht.com/articles/21430.htm)

LA glasnost arriverait-elle à la recherche sur le cancer ?

http://www.iht.com/articles/21447.htm

Stoking a Fire Over Research

Alexis Jetter Ndw York Times Service Thursday, May 31, 2001

Muckraking Newsletter Keeps Its Eye on Cancer's Power Elite NEW YORK There's the war on cancer, and there's the war over cancer - the high-stakes competition over money, medicine and policy. And no one has a better time stirring the pot than Paul Goldberg, a writer, who with his wife, Kirsten Boyd Goldberg, produces The Cancer Letter, a newsletter in Washington that keeps a muckraker's eye on cancer's power elite.

Mr. Goldberg, 41, a Russian émigré with a quirky sense of humor and a thirst for the jugular, has spent 10 years challenging phony cures, celebrity doctors and power-hungry bureaucrats. He has been called a Bolshevik and an irritant. But everybody who is anybody in cancer reads his stories.

"Within the cancer world, The Cancer Letter is both respected and feared," said Susan Love, a surgeon and author. "There's lots of money for research, but is it supporting the best research or my buddy's research or research in the district of some congressman ? That's what Paul does : He shines a light where it needs to be shined."

Fran Visco, president of the National Breast Cancer Coalition, an advocacy group for patients, adds : "Paul is one of the few things in the world of cancer that's fun. He doesn't take himself, or any of us, too seriously."

But the weekly newsletter's several thousand readers, who include leading cancer researchers, activists and policy makers, take it very seriously. The letter gave early voice to the patient activist movement, helped force out an unpopular Clinton administration health official, exposed a society doctor whose treatments may have cost lives and recently revealed - much to the embarrassment of the American Cancer Society - that it had unwittingly hired two public relations firms with ties to the tobacco industry.

Even those who have felt the publication's sting give it credit for energizing the sometimes stodgy cancer community.

Mr. Goldberg is enjoying the attention. "Through the First Amendment, we're licensed to be kvetches, and we love that role," he said amiably. "We're not worried about making friends or enemies."

Ms. Goldberg, 37, the publisher and editor in chief, adds : "Scientists fight about ideas and dollars, and they fight passionately. It wouldn't be good journalism to gloss over those fights." A former education writer, she took over as publisher when her father, who founded the newsletter in 1973, retired 11 years ago.

Two years ago, the American Journalism Review dubbed the Goldbergs - the newsletter's only full-time staff members - "small but mighty watchdogs" for exposing a loophole in federally approved clinical trials that allowed a controversial cancer drug to be used on thousands of patients without accurate information about its safety or effectiveness. That investigation won an award for Watchdog Journalism from the Washington chapter of the Society of Professional Journalists. No other newsletter had ever won the prize.

But some critics say success has spoiled the publication, and they contend Mr. Goldberg has overstepped the boundaries of ethical journalism. At issue are his articles criticizing the American Cancer Society and its brainchild, the National Dialogue on Cancer. The dialogue, whose co-chairman is George Bush, the former president, is a consortium of 160 public and private groups working on cancer prevention and treatment. ITS leaders have expressed hopes that the dialogue will help cancer groups collaborate on outreach programs and speak in a more unified voice.

(suite : http://www.iht.com/articles/21447.htm)

max
medecin.ch